A nurse is collecting data on an older adult client. Which of the following findings should indicate to the nurse that the client has a bladder infection?
Changed mental status
WBC count 9,000/mm³
Diminished reflexes
Temperature 37.3°C (99.1°F)
The Correct Answer is A
Choice A reason: Changed mental status, such as confusion, agitation, or delirium, can be a sign of a bladder infection in older adults, as they may not have the typical symptoms of dysuria, frequency, or urgency.
Choice B reason: WBC count 9,000/mm³ is within the normal range of 4,500 to 11,000/mm³ and does not indicate an infection.
Choice C reason: Diminished reflexes are not related to a bladder infection and may be due to aging, neurological disorders, or medication side effects.
Choice D reason: Temperature 37.3°C (99.1°F) is slightly elevated but not indicative of a bladder infection. Older adults may have lower baseline temperatures and may not develop fever in response to an infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Having a bologna sandwich is not a good choice for a client who has hypertension, as bologna is a processed meat that contains high amounts of sodium and saturated fat, which can raise blood pressure and cholesterol levels.
Choice B reason: Seasoning food with vinegar is a good choice for a client who has hypertension, as vinegar is a low-sodium condiment that can add flavor and acidity to food without increasing blood pressure.
Choice C reason: Seasoning food with ketchup is not a good choice for a client who has hypertension, as ketchup is a high-sodium condiment that can increase blood pressure and fluid retention.
Choice D reason: Having canned soup is not a good choice for a client who has hypertension, as canned soup is a high-sodium food that can increase blood pressure and fluid retention. The client should choose low-sodium or homemade soup instead.
Correct Answer is B
Explanation
Choice A: This is incorrect. The nurse should don clean gloves before removing the dressing, and then change to sterile gloves before applying the new dressing.
Choice B: This is correct. The nurse should offer the client pain medication before the procedure, as changing a dressing for a stage III pressure ulcer can be very painful.
Choice C: This is incorrect. The nurse should prepare the sterile dressing supplies just before the dressing change, not 30 min before, to prevent contamination.
Choice D: This is incorrect. The nurse should not disinfect the wound bed with alcohol, as this can damage the healthy tissue and delay healing. The nurse should use a saline solution or an antiseptic solution as prescribed.
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