The client tells the nurse that clear fluid is seeping out of a blister on the arm. The nurse describes this type of fluid as which of the following?

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.

Rationale:

A. In end-stage renal disease (ESRD), the kidneys lose the ability to produce sufficient erythropoietin (EPO), a hormone that stimulates the bone marrow to produce red blood cells. Without adequate EPO, erythropoiesis is impaired, leading to a reduced number of circulating red blood cells and anemia. This anemia is typically normocytic and normochromic, meaning the red blood cells are of normal size and color but decreased in number.

B. ESRD does not reduce red blood cell destruction. In fact, uremic toxins in ESRD may actually shorten the lifespan of red blood cells, contributing further to anemia rather than preventing it.

C. Increased erythropoietin production is incorrect. In ESRD, erythropoietin production is diminished, not increased. The lack of EPO is the primary reason for decreased red blood cell production in these patients.

D. Elevated hemoglobin levels is incorrect. Hemoglobin levels are typically decreased in ESRD due to the reduced erythropoiesis and shortened red blood cell lifespan. Elevated hemoglobin is not a feature of anemia associated with kidney disease.