Question 28

Choice A reason: Chest tube discomfort can significantly limit deep breathing and ambulation, increasing atelectasis risk. Administering pain medication reduces discomfort, enabling the patient to perform deep breathing exercises and ambulate, which promote lung expansion and prevent complications like pneumonia. Pain control directly enhances compliance with these critical activities.

Choice B reason: Educating the patient about lung expansion’s importance may improve understanding but does not address the physical barrier of pain. Pain limits the ability to perform deep breathing and ambulation, making education alone insufficient. Pain management is needed first to enable compliance with these respiratory and mobility interventions.

Choice C reason: Arranging rest periods supports patient recovery but does not directly address pain, the primary barrier to deep breathing and ambulation. While rest is important, it does not facilitate the active participation required for lung expansion or mobility, which are critical to prevent respiratory complications in chest tube patients.

Choice D reason: Teaching incentive spirometer use promotes lung expansion but is ineffective if pain prevents deep breathing. The chest tube’s discomfort limits the patient’s ability to use the device effectively. Pain management must precede teaching to ensure the patient can perform the necessary respiratory exercises without discomfort hindering compliance.

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.