A client's 24-hour urine for creatinine clearance reveals the client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m². What stage of chronic kidney disease is the client in?

Stage 4

Stage 3

Stage 2

Stage 1

Answer and Explanation

The Correct Answer is B

Choice A reason: Stage 4 chronic kidney disease is characterized by a GFR of 15-29 mL/min/1.73 m², indicating severe kidney dysfunction. The kidneys have limited ability to filter waste, leading to accumulation of toxins, fluid overload, and electrolyte imbalances such as hyperkalemia or metabolic acidosis. A GFR of 43 mL/min/1.73 m² is higher, reflecting moderate rather than severe impairment, making Stage 4 incorrect.

Choice B reason: Stage 3 chronic kidney disease is defined by a GFR of 30-59 mL/min/1.73 m², subdivided into Stage 3A (45-59) and Stage 3B (30-44). A GFR of 43 falls within Stage 3B, indicating moderate kidney damage. This stage involves reduced filtration capacity, potentially causing symptoms like edema, hypertension, or early uremia due to impaired waste excretion and fluid balance regulation.

Choice C reason: Stage 2 chronic kidney disease corresponds to a GFR of 60-89 mL/min/1.73 m², indicating mild kidney dysfunction. Patients may be asymptomatic, but structural kidney damage may be present, detectable via proteinuria or imaging. A GFR of 43 is lower, indicating more significant impairment with increased risk of complications like anemia or bone disease, ruling out Stage 2.

Choice D reason: Stage 1 chronic kidney disease is defined by a GFR ≥90 mL/min/1.73 m² with evidence of kidney damage, such as proteinuria or abnormal imaging. Kidney function is nearly normal, and symptoms are typically absent. A GFR of 43 indicates moderate to severe kidney damage, far below the normal range, making Stage 1 an incorrect classification for this client.

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Correct Answer is B

Explanation

Choice A reason: Atelectasis is the collapse of alveoli, causing reduced lung volume and hypoxemia, often due to obstruction or compression. It does not cause paradoxical chest movement (inward during inspiration, outward during expiration). The symptoms and physical findings described are more consistent with mechanical chest wall instability, not alveolar collapse.

Choice B reason: Flail chest occurs when multiple rib fractures create a free-floating segment of the chest wall, causing paradoxical movement: inward motion during inspiration and outward during expiration. This impairs ventilation, leading to dyspnea and pain, as described. It is a critical injury requiring stabilization and possibly mechanical ventilation to restore effective breathing.

Choice C reason: Hemothorax involves blood accumulation in the pleural space, causing lung compression and dyspnea. It does not produce paradoxical chest movement, as the chest wall remains intact. The symptoms of dyspnea and pain may occur, but the specific physical finding of paradoxical motion points to flail chest, not hemothorax.

Choice D reason: Pneumothorax is air in the pleural space, causing lung collapse and dyspnea. It may cause reduced chest movement on the affected side but not paradoxical movement, which requires chest wall instability. The described inward inspiration and outward expiration are characteristic of flail chest, not pneumothorax, despite similar symptoms like pain.

A. PaCO2 greater than 50 mm Hg B. Bradycardia C. PaO2 less than 60 mm Hg D. Peripheral edema

Correct Answer is C

Explanation

Choice A reason: PaCO2 greater than 50 mm Hg indicates hypercapnia, characteristic of hypercapnic respiratory failure due to hypoventilation, as seen in COPD or neuromuscular disorders. Hypoxemic respiratory failure is defined by low oxygen levels (PaO2 <60 mm Hg) with normal or low PaCO2, making hypercapnia less relevant.

Choice B reason: Bradycardia is not a primary feature of hypoxemic respiratory failure. Hypoxemia typically causes tachycardia as a compensatory response to low oxygen delivery. Bradycardia may occur in severe, late-stage hypoxia but is not the most indicative finding compared to PaO2, which directly measures oxygenation status.

Choice C reason: Hypoxemic respiratory failure is defined by a PaO2 less than 60 mm Hg, indicating severe impairment in oxygen transfer due to conditions like ARDS or pulmonary edema. This low arterial oxygen level, despite adequate ventilation, is the hallmark finding, requiring urgent intervention to restore tissue oxygenation.

Choice D reason: Peripheral edema suggests fluid overload, often seen in heart failure, which may contribute to pulmonary edema and hypoxemia. However, it is not a direct indicator of hypoxemic respiratory failure. PaO2 <60 mm Hg specifically defines the condition, as it reflects the primary issue of inadequate oxygenation.

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A client's 24-hour urine for creatinine clearance reveals the client has a glomerular filtration rate (GFR) of 43 mL/min/1.73 m². What stage of chronic kidney disease is the client in?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

Which clinical finding is most indicative of hypoxemic respiratory failure?

Correct Answer is C

Explanation

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