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 A
Explanation
Rationale:
A. Raised, solid lesion less than 1 cm in diameter is correct. A papule is a small, elevated, solid lesion of the skin that is typically less than 1 centimeter in diameter. Papules can result from a variety of dermatologic conditions, including inflammatory responses, infections, or benign growths, and they are distinct from vesicles or pustules because they do not contain fluid or pus.
B. Non-inflammatory lesion with darkened color due to oxidation is incorrect. This description corresponds to a comedo, such as a blackhead, which is a type of acne lesion formed by oxidized sebum in clogged hair follicles. While comedones are common in acne, they are not considered papules because they are not solid raised lesions caused by cellular proliferation or inflammation.
C. Inflamed bump on the skin that can be tender to the touch is incorrect. While some papules may become inflamed and tender, the defining characteristic of a papule is its size and solid, raised nature, not necessarily inflammation. Inflammatory bumps that are tender and red may be better classified as pustules or nodules depending on their content and size.
D. Large, firm lesion containing purulent material is incorrect. This description defines a pustule or abscess, which contains pus composed of white blood cells, bacteria, and cellular debris. Papules do not contain fluid or pus, making this option inconsistent with the definition of a papule.
Correct Answer is A
Explanation
Rationale:
A. Dark, cloudy urine and facial edema are hallmark features of post-streptococcal glomerulonephritis (PSGN). PSGN is an immune-mediated disorder that develops after infection with nephritogenic strains of Streptococcus pyogenes, typically following a throat or skin infection. Immune complexes deposit in the glomeruli, leading to inflammation and damage to the filtration barrier. This results in hematuria, causing dark or tea-colored urine, and proteinuria, which contributes to fluid retention. Sodium and water retention lead to edema, often first noticeable in the periorbital area, and hypertension may also develop due to volume expansion.
B. Elevated serum calcium is not associated with PSGN. Calcium levels in the blood are primarily regulated by parathyroid hormone, vitamin D, and renal excretion of calcium. PSGN primarily affects glomerular filtration and fluid balance, not calcium metabolism. Any abnormalities in calcium would likely be incidental or due to other conditions, not a direct consequence of post-streptococcal glomerulonephritis.
C. Sudden onset of severe flank pain is more typical of renal calculi (kidney stones) or acute pyelonephritis. Kidney stones can obstruct urine flow, causing sharp, colicky flank pain radiating to the groin. Pyelonephritis, an infection of the renal pelvis, may cause flank pain accompanied by fever and urinary symptoms. PSGN, however, does not usually produce acute pain; its manifestations are primarily related to glomerular inflammation and fluid retention rather than obstruction or infection.
D. Excessive concentrated urine output and low blood pressure is inconsistent with PSGN. In PSGN, the glomerular injury reduces filtration, often causing oliguria (reduced urine output). Retained sodium and water contribute to fluid overload and hypertension rather than hypotension. Excessively concentrated urine is more characteristic of conditions with high antidiuretic hormone activity or dehydration, not post-infectious glomerulonephritis.
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