A nurse administers albuterol as ordered to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

Choice A reason: Bradycardia is not typical in emphysema, where chronic hypoxia and hypercapnia cause tachycardia as the heart compensates for reduced oxygenation. Emphysema’s impact on lung function does not slow heart rate, making this an unexpected finding in this client with chronic respiratory disease.

Choice B reason: Barrel chest is a classic emphysema finding, resulting from chronic air trapping and lung hyperinflation. Over time, the chest wall expands, increasing the anteroposterior diameter, as alveoli lose elasticity, leading to persistent lung hyperinflation, a hallmark of advanced chronic obstructive pulmonary disease.

Choice C reason: Clubbing of the fingers occurs in emphysema due to chronic hypoxia, stimulating vascular changes in the nail beds. This leads to bulbous fingertip enlargement, reflecting long-term oxygen deprivation, a common finding in advanced COPD as the body adapts to chronic respiratory insufficiency.

Choice D reason: Cachectic appearance is common in emphysema due to increased metabolic demand from labored breathing and systemic inflammation. Muscle wasting and weight loss occur as the body prioritizes energy for respiratory effort, making cachexia a frequent finding in advanced emphysema, reflecting chronic disease burden.

Choice E reason: Weight gain is not typical in emphysema, where cachexia is common due to high metabolic demand and inflammation. Weight gain may occur in conditions like heart failure but is not a hallmark of emphysema, making this an unexpected finding in this client.

Choice A reason: Increased respiratory rate suggests persistent respiratory distress or ineffective airway clearance in pneumonia, as the body compensates for hypoxia or hypercapnia. This indicates ongoing secretions or inflammation, not a therapeutic response, making it an incorrect indicator compared to clear lung sounds.

Choice B reason: Clear lung sounds indicate effective airway clearance in pneumonia, as treatments like antibiotics and chest physiotherapy reduce secretions and inflammation, allowing normal air movement. This reflects resolved airway obstruction and improved gas exchange, making it the best indicator of a therapeutic response to treatment.

Choice C reason: Brisk capillary refill reflects adequate peripheral perfusion but is unrelated to airway clearance in pneumonia. It does not indicate resolution of secretions or improved lung function, making it an irrelevant marker for evaluating treatment response compared to clear lung sounds, which directly assess airway patency.

Choice D reason: Decreased pleuritic pain suggests reduced pleural inflammation but does not confirm airway clearance. Pain reduction may occur without clearing secretions, the primary issue in pneumonia. Clear lung sounds better indicate successful treatment by demonstrating unobstructed airways and improved respiratory function.