A nurse is assessing a client who has a long history of untreated HIV infection. The client presents with multiple painless, purplish skin lesions on the lower extremities and oral mucosa. Based on this finding, which of the following conditions should the nurse suspect?

A. Symmetrical chest expansion: In a tension pneumothorax, chest expansion is usually asymmetrical because air trapped in the pleural space prevents full lung expansion on the affected side. Symmetrical movement would not be expected in this condition.

B. Tracheal deviation away from the affected side: This is a hallmark sign of tension pneumothorax. As intrapleural pressure increases, the mediastinum shifts, pushing the trachea and other structures toward the unaffected side, which is a medical emergency requiring immediate intervention.

C. Increased breath sounds on the affected side: Breath sounds are typically absent or markedly diminished over the affected lung due to lung collapse. Increased breath sounds would not occur in the presence of trapped air compressing the lung.

D. Hyperresonance to percussion on the affected side: Hyperresonance can occur with a simple pneumothorax due to excess air in the pleural cavity. However, while present, it is not as specific or critical as tracheal deviation, which directly indicates a tension pneumothorax.

A. Administration of oxygen is contraindicated in clients who are using bronchodilators: Oxygen therapy is not contraindicated with bronchodilators. In fact, bronchodilators and oxygen are commonly used together to relieve airway obstruction and improve gas exchange in COPD.

B. High oxygen concentrations will cause coughing and dyspnea: While oxygen therapy can sometimes dry airways or cause minor irritation, coughing and dyspnea are not direct effects of high oxygen concentration. Dyspnea in COPD is due to impaired gas exchange and airflow limitation.

C. Increased oxygen use will cause the client to become dependent on the oxygen: Oxygen therapy does not create physical dependence. Clients with COPD may require long-term oxygen due to disease progression, but this is related to their chronic hypoxemia rather than dependency.

D. High oxygen concentration may inhibit the hypoxic stimulus to breathe: Clients with COPD often rely on hypoxemia as their primary drive to breathe, since chronic CO₂ retention blunts the normal hypercapnic drive. Administering high oxygen concentrations can suppress this hypoxic drive, leading to hypoventilation and CO₂ narcosis.