A nurse in an emergency department is caring for an adult client who reports periodic episodes of wheezing and shortness of breath.

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Choice A rationale

Viral pharyngitis is characterized by inflammation of the pharyngeal structures without the presence of bacterial pathogens. Therefore, a throat culture would typically be negative for group A beta-hemolytic streptococci. While the white blood cell count of 16,000/mm is elevated above the normal range of 5,000 to 10,000/mm, this leukocytosis can occur in viral infections due to the systemic inflammatory response. A negative culture helps differentiate viral causes from bacterial strep throat.

Choice B rationale

Severe hyperemia of the pharyngeal mucosa is a common physical finding in viral pharyngitis. The viral invasion causes local vasodilation and increased blood flow to the tissues, resulting in a bright red, swollen, and inflamed appearance of the throat. This inflammation triggers the pain and scratchy sensation the client feels. The nurse should expect to see generalized redness of the posterior pharynx and possibly the tonsils, reflecting the acute infectious process.

Choice C rationale

Petechiae on the chest and abdomen are not standard findings for viral pharyngitis or asthma. Such findings might suggest a systemic coagulation disorder, meningococcemia, or a severe bacterial infection rather than a localized viral upper respiratory infection. In pharyngitis, petechiae are sometimes noted on the soft palate in cases of infectious mononucleosis or certain bacterial infections, but generalized truncal petechiae would be an unexpected and concerning finding requiring a different diagnostic focus.

Choice D rationale

Elevated serum glucose levels are not a direct manifestation of viral pharyngitis. While stress from an infection or the use of systemic corticosteroids for asthma can cause a transient rise in blood glucose, it is not a primary finding expected from the pharyngeal inflammation itself. Normal fasting serum glucose is 70 to 99 mg/dL. The nurse focuses more on respiratory and localized inflammatory signs rather than metabolic changes unless the client has comorbid poorly managed diabetes.

Choice A rationale

A pulmonary function test is specifically designed to quantify the volume and flow of air during inhalation and exhalation. This includes measuring the forced expiratory volume in one second and the forced vital capacity. These values help determine if there is an obstructive pattern, typical of emphysema, or a restrictive pattern. Explaining it in terms of air movement is the most accurate and understandable way to describe the mechanical assessment of lung function to a patient.

Choice B rationale

Oxygen saturation is measured using pulse oximetry, which is a non-invasive method using light waves, or through an arterial blood gas analysis. While oxygen levels are important in respiratory care, they are not the primary measurement of a pulmonary function test. A PFT focuses on volumes and capacities of the lungs rather than the percentage of hemoglobin saturated with oxygen. Confusing these two could lead the patient to misunderstand the purpose of the more complex breathing maneuvers required.

Choice C rationale

Measuring the balance of oxygen, carbon dioxide, and pH is the purpose of an arterial blood gas test, not a pulmonary function test. An ABG provides information about gas exchange at the alveolar-capillary level and the body's acid-base status. Normal pH ranges from 7.35 to 7.45. While these values are crucial for patients with emphysema who may retain carbon dioxide, a PFT is a different diagnostic tool that assesses the physical mechanics and airflow limits of the lungs.

Choice D rationale

The movement of oxygen and carbon dioxide between the lungs and the blood refers to diffusion capacity, which can be part of a comprehensive PFT but is not the general definition. This specific process is often measured by the DLCO test. However, the most fundamental description of a PFT for a patient involves the general movement of air. Emphysema specifically involves the destruction of alveoli, which reduces the surface area for this exchange and causes air trapping.