The nurse is caring for a client who has been diagnosed with renal calculi. Which pathophysiologic change occurs as renal calculi move through the urinary tract?

Choice A reason: Intermittent claudication in PAD results from arterial occlusion, reducing blood flow to muscles during activity, causing ischemic pain. Atherosclerotic plaques narrow arteries, limiting oxygen delivery, leading to pain relieved by rest. This is the core pathophysiology, aligning with evidence-based explanations for PAD’s hallmark symptom in client education.

Choice B reason: Muscle atrophy may occur in advanced PAD due to chronic ischemia, but it is not the primary cause of claudication. Claudication is acute ischemic pain during activity from arterial occlusion. Atrophy is a long-term consequence, making this incorrect for explaining the immediate pathophysiology of claudication.

Choice C reason: Reduced blood flow when legs are elevated may worsen PAD symptoms but is not the primary cause of claudication. Claudication occurs during activity due to arterial occlusion limiting oxygen delivery. Elevation affects chronic symptoms, not the acute ischemic pain central to claudication’s pathophysiology.

Choice D reason: Reddened color in dependent feet (rubor) indicates advanced PAD but does not cause claudication. Claudication is ischemic pain from arterial occlusion during activity, not a positional color change. This choice misrepresents the pathophysiology, as rubor is a sign, not the mechanism of claudication pain.

Choice A reason: Acute lymphoblastic leukemia (ALL) is an aggressive malignancy of lymphoid cells, often achieving complete remission with intensive chemotherapy, especially in children. Suppression without remission is not typical, as ALL responds well to treatment, targeting rapidly dividing blast cells. CLL, a slower-progressing disease, better fits the description of suppression without complete cure.

Choice B reason: Chronic lymphocytic leukemia (CLL) is a low-grade malignancy of mature B-lymphocytes, often managed with chemotherapy to suppress disease progression rather than achieve complete remission. CLL’s indolent nature means it can be controlled, but residual disease persists due to slow cell turnover, aligning with the question’s description of suppression.

Choice C reason: Acute myelogenous leukemia (AML) is an aggressive malignancy of myeloid cells, requiring intensive chemotherapy or stem cell transplant for potential remission. Suppression without remission is less common, as AML treatment aims for complete response. CLL’s chronic nature makes it more likely to result in disease control rather than cure.

Choice D reason: Hairy-cell leukemia is a rare, indolent B-cell malignancy highly responsive to purine analogs, often achieving long-term remission or near-cure. Suppression without remission is not characteristic, as treatment typically yields durable responses. CLL’s partial response to chemotherapy better matches the scenario of ongoing disease suppression.