A nurse is collecting data from a client who reports feeling stress. Which of the following should the nurse identify as an external stressor?

A) Decreased platelets: A decrease in platelet count (thrombocytopenia) is often associated with conditions such as bleeding disorders, bone marrow problems, or certain infections, but it is not a direct indicator of infection. While infections can cause a drop in platelets, this is not a specific or primary indicator of infection.

B) Decreased hemoglobin: A decrease in hemoglobin is typically indicative of anemia, which can result from a variety of causes, including nutritional deficiencies, chronic disease, or blood loss. While anemia can be associated with some infections, it is not a specific indicator of infection.

C) Increased erythrocyte sedimentation rate (ESR): An increased ESR is a nonspecific indicator of inflammation in the body and can be associated with infections, autoimmune diseases, and other inflammatory conditions. It is commonly elevated during infections, as the body responds to the inflammatory process. Therefore, an elevated ESR is a useful laboratory finding when suspecting an infection.

D) Increased iron level: Increased iron levels are typically associated with conditions such as hemochromatosis or iron overload, not with infections. During infections, iron levels can actually decrease due to the body's response to restrict iron availability to pathogens.

A) Occasional small clots in the urine:
Occasional small clots can be expected after a transurethral resection of the prostate (TURP) due to the surgical trauma to the prostate and surrounding tissues. However, any change in the nature or frequency of clots, or if they become larger, should be reported, but small clots are not immediately concerning in the early postoperative period.

B) Urine output of 300 mL over 8 hr:
This urine output is within a reasonable range. While urine output may be initially monitored closely after TURP, a volume of 300 mL over 8 hours does not constitute a concerning finding. It may be less than expected, but it is not an emergency. The nurse should continue to monitor urine output, but this is not immediately concerning unless the client has a significantly reduced or absent output.

C) Dark red urine:
Dark red urine is a concerning finding as it may indicate excessive bleeding or hemorrhage, especially within the first 24 hours after TURP. While some initial hematuria (blood in the urine) is common, the urine should not remain dark red or worsen. This could indicate active bleeding or a clot obstructing the urinary flow, which requires immediate intervention and reporting to the healthcare provider to prevent complications.

D) Frequent urge to urinate:
A frequent urge to urinate is not an unusual finding following TURP, as the bladder may be irritated due to the catheter or residual inflammation from the surgery. While it is a discomforting symptom, it is typically not an immediate concern and often resolves as the healing process progresses. However, persistent or painful urination may require further evaluation.