A nurse is assessing the carotid arteries of a client diagnosed with cardiovascular disease. What action should be performed next by the nurse when assessing the carotid arteries in this client?

A) When the client is obese:
While obesity can affect the overall ease of breathing due to increased fat tissue around the chest and abdomen, it is not a direct cause of unequal chest expansion. Obesity can limit the depth of breath and potentially make it harder for the chest to expand fully, but it would not typically cause asymmetry in the movement of the chest on one side. Unequal chest expansion is more likely to occur due to underlying respiratory or structural issues.

B) When part of the lung is obstructed or collapsed:
This is the most accurate reason for unequal chest expansion. If part of the lung is obstructed (such as with a mucous plug or foreign body) or collapsed (as in the case of pneumothorax or atelectasis), it prevents that area of the lung from fully expanding during inspiration. As a result, the affected side of the chest will expand less than the opposite side. This can be a critical finding and warrants immediate further investigation to determine the cause and ensure appropriate treatment.

C) When accessory muscles are used to facilitate respiratory effort:
While the use of accessory muscles (e.g., the sternocleidomastoid, scalene, and intercostal muscles) often occurs during labored breathing, it does not specifically result in unequal chest expansion. Accessory muscle use typically occurs in conditions like severe asthma, chronic obstructive pulmonary disease (COPD), or respiratory distress, where there is an increased effort to breathe, but it doesn't cause asymmetry in the chest's movement. Unequal chest expansion is usually related to a localized problem in the lung or pleura, not the general use of muscles.

D) When bulging of the intercostal spaces is present:
Bulging of the intercostal spaces may suggest increased pressure in the pleural space, such as in the case of a pleural effusion or severe respiratory distress. However, while bulging intercostal spaces can be a sign of a respiratory condition, it is not typically associated with unequal chest expansion. Instead, bulging could indicate that the lung or chest wall is under stress or that there is fluid accumulation, which would lead to other physical findings like decreased breath sounds or dullness to percussion, but it does not directly cause unequal expansion. Unequal expansion is more likely to occur when part of the lung is obstructed or collapsed

A) Client's oral temperature is 38.4°C (101.2°F):
This is objective data, as it is a measurable, observable finding obtained through direct assessment (in this case, using a thermometer). Objective data are facts or measurements that can be verified or observed by the healthcare provider.

B) Client reports the rash on their back is itchy:
This is subjective data, as it is based on the client's personal experience and report. The feeling of itchiness cannot be directly measured or observed by the nurse; it is something the client experiences and describes. Subjective data include symptoms, sensations, or feelings reported by the client.

C) Client reports nausea following administration of pain medication:
This is subjective data. Nausea is a symptom that the client reports experiencing, which cannot be objectively measured or directly observed by the nurse. It is based on the client's perception and report, making it subjective.

D) Client has a vesicular rash on their upper back:
This is objective data. The rash is something the nurse can observe and describe. Objective data include observable facts, such as physical exam findings, lab results, or diagnostic test results.

E) Client reports dull, aching pain in lower right calf:
This is subjective data, as pain is a sensation that the client experiences and describes. The intensity, location, and type of pain (dull, aching) are subjective experiences that only the client can report.