A client with chronic bronchitis reports increased coughing in the morning. What is the most likely cause?

Supine positioning overnight

Circadian rhythm of respiratory drive

Increased mucous production overnight

Hyperactive gag reflex

Answer and Explanation

The Correct Answer is C

Rationale:

A. Supine positioning overnight is incorrect. While lying flat can contribute to some fluid accumulation in the lungs or exacerbate gastroesophageal reflux, it is not the primary reason for the increased morning cough in chronic bronchitis.

B. Circadian rhythm of respiratory drive is incorrect. Although respiratory drive can fluctuate slightly throughout the day, these variations do not account for the pronounced morning cough seen in chronic bronchitis patients.

C. In chronic bronchitis, the airways are inflamed and hypersecretory, leading to the accumulation of thick mucus in the bronchi during periods of inactivity, such as during sleep. When the client wakes, the body naturally attempts to clear the accumulated secretions through coughing, which is why the cough is often more pronounced in the morning. This is a classic symptom of chronic bronchitis, reflecting the disease’s pathophysiology of chronic airway inflammation and excessive mucus production.

D. Hyperactive gag reflex is incorrect. A hyperactive gag reflex may contribute to cough in some situations, but it is not the primary cause of the morning cough in chronic bronchitis. The cough in this context is related to mucus clearance, not upper airway reflexes.

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Correct Answer is B

Explanation

Rationale:

A. Hypothalamus and pituitary are involved in autonomic and endocrine regulation, such as temperature control, hormone secretion, and homeostasis. While the hypothalamus can influence respiratory rate indirectly through stress or temperature changes, it does not serve as the primary control center for breathing.

B. Medulla and pons are the primary control centers for respiration. The medulla oblongata contains the dorsal respiratory group (DRG), which initiates inspiration by sending impulses to the diaphragm and external intercostal muscles, and the ventral respiratory group (VRG), which regulates forced inspiration and expiration. The pons contains the pontine respiratory group, including the apneustic and pneumotaxic centers, which fine-tune the rate and depth of breathing, coordinating smooth transitions between inhalation and exhalation. These centers respond to chemical signals (like CO₂, O₂, and pH levels) detected by central and peripheral chemoreceptors, making the medulla and pons essential for maintaining automatic, rhythmic breathing.

C. Frontal cortex and occipital lobe are parts of the cerebral cortex responsible for voluntary movements, cognitive functions, and visual processing, respectively. While the frontal cortex can exert voluntary control over breathing (e.g., holding one’s breath), it is not the primary center responsible for automatic respiratory regulation.

D. Cerebellum and corpus callosum are involved in motor coordination, balance, and interhemispheric communication. They do not control the basic rhythmic pattern of respiration or respond directly to blood gas changes.

A. Inhalation Injury B. Contractures C. Hypovolemic Shock D. Hearing Loss E. Increased Muscle Mass F. Infection

Correct Answer is ["A","B","C","F"]

Explanation

Rationale:

A. Inhalation injury is a serious complication of severe burns, especially those involving the face, neck, or upper torso, or occurring in a fire with smoke or toxic fumes. Thermal or chemical injury to the respiratory tract can cause airway edema, bronchospasm, and impaired gas exchange, which can be life-threatening if not promptly managed.

B. Contractures can develop during the healing process of deep partial-thickness or full-thickness burns. Scar tissue and skin grafts can limit joint mobility, leading to permanent deformities if proper positioning, physical therapy, and splinting are not implemented.

C. Hypovolemic shock is a common early complication of severe burns. Extensive burn injuries cause massive fluid loss through damaged skin and increased capillary permeability, leading to decreased circulating blood volume, hypotension, and organ hypoperfusion. Immediate fluid resuscitation is critical to prevent shock and organ failure.

D. Hearing loss is not a recognized complication of burn injuries. Burns typically do not affect the auditory system unless there is a direct traumatic injury to the ears, which is rare.

E. Increased muscle mass is incorrect. Severe burns are associated with catabolism, muscle wasting, and negative nitrogen balance due to hypermetabolic stress, not increased muscle mass.

F. Infection is a major risk in burn patients because the skin barrier is destroyed, providing a portal for bacteria, fungi, and viruses. Burn wounds are highly susceptible to local infections and sepsis, which is a leading cause of morbidity and mortality in severe burn injuries.

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A client with chronic bronchitis reports increased coughing in the morning. What is the most likely cause?

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Naxlex Comprehensive Predictor Exams

Where is the primary control center for breathing located?

Correct Answer is B

Explanation

Select the complications that can arise from a severe burn injury. Select All That Apply

Correct Answer is ["A","B","C","F"]

Explanation

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