The nurse provides care for a client diagnosed with pulmonary emphysema. The nurse observes the following: respiratory rate 20 breaths/minute, use of intercostal muscles, and decreased mental alertness. Which is the best explanation for these observations?

Bronchial constriction after inhalation of an irritant

Damage to the mucociliary lining of the segmental bronchi

Infiltration of bacteria and inflammatory exudates into the alveoli

Enlargement of the alveoli with destruction of the alveolar walls

Answer and Explanation

The Correct Answer is D

Choice A reason: Bronchial constriction after inhalation of an irritant is a possible trigger for an asthma attack, not emphysema. It causes wheezing, coughing, and dyspnea, but it does not affect the alveolar structure or function.

Choice B reason: Damage to the mucociliary lining of the segmental bronchi is a consequence of chronic bronchitis, not emphysema. It impairs the clearance of mucus and pathogens from the airways, leading to recurrent infections and inflammation.

Choice C reason: Infiltration of bacteria and inflammatory exudates into the alveoli is a sign of pneumonia, not emphysema. It causes fever, chills, productive cough, and chest pain, but it does not cause permanent damage to the alveoli.

Choice D reason: Enlargement of the alveoli with destruction of the alveolar walls is the hallmark of emphysema. It reduces the surface area for gas exchange, increases the dead space, and decreases the elastic recoil of the lungs. It causes tachypnea, use of accessory muscles, and hypoxia, which can lead to decreased mental alertness.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A reason: Lymph structures were removed and fluid cannot move out of the area easily is the correct explanation because a radical mastectomy involves the removal of the breast, the underlying chest muscles, and the lymph nodes in the axilla. The lymph nodes are part of the lymphatic system, which is responsible for draining excess fluid from the tissues and returning it to the bloodstream. When the lymph nodes are removed, the fluid cannot be drained properly and accumulates in the affected arm and hand, causing edema.

Choice B reason: There is still too much swelling in the area of the surgery and fluid is accumulating is not the correct explanation because it does not address the underlying cause of the edema. Swelling is a normal response to surgery, but it usually subsides within a few days or weeks. The edema caused by lymph node removal is chronic and persistent, and it does not improve with time.

Choice C reason: The veins were removed from the axilla during surgery and there is poor circulation now is not the correct explanation because it is not true. The veins are not removed during a radical mastectomy, only the lymph nodes are. The veins are part of the circulatory system, which carries blood throughout the body. The blood flow to the arm and hand is not affected by the surgery, unless there is a complication such as a blood clot or an infection.

Choice D reason: You will need to wear a compression bandage to help fluids move from the area is not the correct explanation because it is a treatment, not a cause. A compression bandage is a type of elastic bandage that applies pressure to the arm and hand, which helps to reduce the swelling and prevent further fluid accumulation. However, it does not address the root cause of the edema, which is the removal of the lymph nodes.

A. Glomerulonephritis B. Fluid volume deficit C. Neurogenic bladder D. Renal calculus

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.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse provides care for a client diagnosed with pulmonary emphysema. The nurse observes the following: respiratory rate 20 breaths/minute, use of intercostal muscles, and decreased mental alertness. Which is the best explanation for these observations?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client develops edema of the left arm and hand following a left radical mastectomy. The nurse explains the cause of the edema. Which explanation is correct?

Correct Answer is A

Explanation

Which risk factor is significant for the development of prerenal acute kidney injury?

Correct Answer is B

Explanation

The nurse provides care for a client diagnosed with non-Hodgkin lymphoma. Which observation does the nurse expect to find during assessment of the client?

The nurse cares for a client recently diagnosed with infectious mononucleosis. Which explanation best describes the microorganism that causes this disease?

The nurse cares for a client who has had a left-sided intracerebral hemorrhage. The client is unable to detect light and pain touch on the right arm. Which explanation best describes these observations?

The nurse provides care for a client diagnosed with pulmonary emphysema. The nurse observes the following: respiratory rate 20 breaths/minute, use of intercostal muscles, and decreased mental alertness. Which is the best explanation for these observations?

Which inflammatory mediators cause the clinical manifestations of asthma?

The client has a diagnosis of systolic heart failure. Which statement does the nurse anticipate during the assessment?

A client diagnosed with type 1 diabetes mellitus has experienced the Somogyi effect. Which explanation best describes this phenomenon?

The nurse provides care for a patient with an 8-year history of Parkinson's disease. The patient has difficulty getting out of chairs, makes tremulous movements, and mumbles words. What is the best explanation for these clinical manifestations?