The nurse provides care for a client diagnosed with bronchitis. Which statement is most significant during the assessment of a client diagnosed with chronic bronchitis?
"I was short of breath when I walked around the block yesterday."
"I have a loose sounding cough every day when I get up in the morning."
"My respiratory secretions are greenish-yellow colored today."
"My feet are swollen and painful at the end of the afternoon."
The Correct Answer is B
Choice A reason: "I was short of breath when I walked around the block yesterday." is not the most significant statement because it is a common symptom of chronic bronchitis, but it does not indicate the severity or the progression of the condition. Shortness of breath is caused by the inflammation and narrowing of the airways, which reduce the airflow and oxygen delivery to the lungs.
Choice B reason: "I have a loose sounding cough every day when I get up in the morning." is the most significant statement because it indicates the presence of excessive mucus production, which is a hallmark of chronic bronchitis. Mucus traps bacteria and other irritants, which can lead to infections and further inflammation of the airways. A chronic cough is defined as a cough that lasts for at least three months in two consecutive years.
Choice C reason: "My respiratory secretions are greenish-yellow colored today." is not the most significant statement because it is a sign of a possible infection, but it does not necessarily indicate chronic bronchitis. Greenish-yellow colored sputum can be caused by various respiratory conditions, such as pneumonia, tuberculosis, or cystic fibrosis.
Choice D reason: "My feet are swollen and painful at the end of the afternoon." is not the most significant statement because it is a sign of a possible complication of chronic bronchitis, but it does not directly relate to the condition. Swollen and painful feet can be caused by right-sided heart failure, which can result from chronic bronchitis. Chronic bronchitis can increase the pressure in the pulmonary arteries, which can strain the right ventricle and cause it to fail. This can lead to fluid retention and edema in the lower extremities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Glomerulonephritis is an inflammation of the glomeruli, the filtering units of the kidneys. It can cause damage to the renal tissue and lead to intrinsic acute kidney injury, not prerenal acute kidney injury.
Choice B reason: Fluid volume deficit is a condition in which the body loses more fluid than it takes in. It can cause hypovolemia, which reduces the blood flow to the kidneys and impairs their function. This is the most common cause of prerenal acute kidney injury, which is a result of decreased perfusion to the kidneys.
Choice C reason: Neurogenic bladder is a dysfunction of the bladder caused by a nerve problem. It can affect the ability to store or empty urine. It can cause urinary retention, which increases the pressure in the urinary tract and damages the kidneys. This is a type of postrenal acute kidney injury, which is a result of obstruction to the urine outflow.
Choice D reason: Renal calculus is a solid mass formed from crystals in the urine. It can block the ureter, the tube that carries urine from the kidney to the bladder. It can cause hydronephrosis, which is a swelling of the kidney due to accumulation of urine. This is another type of postrenal acute kidney injury.
Correct Answer is B
Explanation
Choice A reason: Hyperplasia is not the best term because it is a condition where the number of cells in a tissue or organ increases, which can be caused by various factors, such as hormones, inflammation, or stress. Hyperplasia does not involve the change of cell type, but the increase of cell number.
Choice B reason: Metaplasia is the best term because it is a condition where the type of cells in a tissue or organ changes, usually in response to chronic irritation or injury. Metaplasia involves the replacement of one type of cell with another type of cell that is more resistant to the harmful stimulus, but less specialized in function. Metaplasia can occur in the bronchi, which are the airways that branch from the trachea to the lungs, and are normally lined with ciliated columnar cells, which are cells that have hair-like projections that help to move mucus and foreign particles out of the respiratory tract. Metaplasia can replace the ciliated columnar cells with stratified squamous epithelial cells, which are cells that have multiple layers and a flat shape, and are more durable, but less effective in clearing the airways.
Choice C reason: Neoplasia is not the best term because it is a condition where the growth of cells in a tissue or organ is abnormal and uncontrolled, which can result in the formation of tumors, which are masses of abnormal cells that can be benign or malignant. Neoplasia does not involve the change of cell type, but the abnormal proliferation of cells.
Choice D reason: Dysplasia is not the best term because it is a condition where the shape, size, and organization of cells in a tissue or organ are abnormal, which can be caused by various factors, such as chronic inflammation, infection, or precancerous changes. Dysplasia does not involve the change of cell type, but the alteration of cell morphology and arrangement.
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