Which assessment finding in a client with emphysema indicates advanced disease?
Flattened diaphragm on chest x-ray
Increased breath sounds
Clear lung fields and dry cough
Bradycardia and constricted pupils
The Correct Answer is A
Rationale:
A. In emphysema, destruction of alveolar walls and loss of elastic recoil lead to air trapping and hyperinflation of the lungs. Over time, this causes the diaphragm to flatten as the lungs expand, which is a classic radiographic sign of advanced emphysema. This finding correlates with reduced ventilatory efficiency, increased work of breathing, and progressive respiratory compromise.
B. In emphysema, breath sounds are often decreased due to the destruction of alveoli and hyperinflation of the lungs. Loud or increased breath sounds are more typical in conditions such as bronchospasm or pulmonary edema with turbulent airflow.
C. While early emphysema may present with minimal auscultatory findings and a mild cough, advanced disease is associated with hyperinflated lungs, decreased breath sounds, and sometimes wheezing. Clear lung fields alone do not indicate severe or advanced disease.
D. Bradycardia and constricted pupils are incorrect. These findings are unrelated to emphysema. Bradycardia and miosis may suggest medication effects (e.g., opioids) or neurologic conditions, not pulmonary pathology.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Hypertension is incorrect. While high blood pressure is a common cardiovascular condition, it is not a direct complication of deep vein thrombosis (DVT). DVT involves clot formation in the deep veins, primarily of the lower extremities, rather than elevated arterial pressure.
B. Pulmonary embolism is correct. A major and potentially life-threatening complication of DVT is pulmonary embolism (PE). If a thrombus (blood clot) from a deep vein dislodges, it can travel through the venous system to the pulmonary arteries, obstructing blood flow to the lungs. This can cause sudden shortness of breath, chest pain, hypoxia, and even death if not promptly recognized and treated.
C. Urinary tract infection is incorrect. UTIs are infections of the urinary system and are not caused by DVT. While immobility related to DVT may increase UTI risk indirectly, it is not a direct complication.
D. Peptic ulcer disease is incorrect. Peptic ulcers involve erosions in the gastric or duodenal mucosa, typically due to Helicobacter pylori infection or NSAID use. They are unrelated to the pathophysiology of DVT.
Correct Answer is A
Explanation
Rationale:
A. It promotes water reabsorption in distal tubules is correct. Antidiuretic hormone (ADH), also called vasopressin, is secreted by the posterior pituitary in response to increased plasma osmolality or decreased blood volume. ADH acts primarily on the distal convoluted tubules and collecting ducts of the kidney, increasing their permeability to water by inserting aquaporin-2 channels into the tubular membranes. This allows water to move from the tubular lumen back into the bloodstream, concentrating the urine and expanding blood volume, thereby helping maintain blood pressure and plasma osmolality.
B. It enhances sodium retention in the loop of Henle is incorrect. Sodium reabsorption is primarily regulated by aldosterone, not ADH. While water follows sodium osmotic gradients, ADH’s effect on water reabsorption is independent of direct sodium regulation.
C. It decreases renal artery blood flow is incorrect. ADH does have vasoconstrictive properties via V1 receptors in high concentrations, but its primary role in normal physiology is water reabsorption, not reducing renal perfusion. Decreased renal blood flow is not the mechanism by which ADH increases blood volume.
D. It stimulates the adrenal cortex to release aldosterone is incorrect. Aldosterone secretion is primarily regulated by the renin-angiotensin-aldosterone system and plasma potassium levels, not by ADH. ADH increases blood volume directly through water retention, not indirectly via aldosterone release.
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