A nurse is auscultating the breath sounds of a client who has chronic obstructive pulmonary disease.
When the client exhales, the nurse hears continuous high-pitched whistling sound.
The nurse should document this as?

Choice A rationale

Deep vein thrombosis (DVT) involves a blood clot in a deep vein, usually in the legs. Symptoms include swelling, pain, and redness, but not typically cold legs or hair loss, making it unlikely in this scenario.

Choice B rationale

Venous insufficiency occurs when veins struggle to send blood back to the heart, leading to varicose veins, swelling, and skin changes. While it can cause leg discomfort, it does not typically result in cold legs or hair loss.

Choice C rationale

Varicosities are enlarged, twisted veins caused by increased pressure. They can cause pain and swelling but not cold legs or hair loss, making them an unlikely cause of the described symptoms.

Choice D rationale

Arterial insufficiency, caused by poor blood flow due to narrowed arteries, results in symptoms such as cold legs, hair loss, pain, and weakened pulses. The description of cold legs and hair loss fits arterial insufficiency, making it the most likely diagnosis.

Choice A rationale

Vitiligo is a condition caused by the destruction or malfunction of melanocytes, the cells responsible for producing melanin pigment. This leads to the development of white patches on the skin, as melanin is absent in these areas. Vitiligo is an autoimmune condition and can affect any part of the body, including the skin, hair, and mucous membranes.

Choice B rationale

Excess apocrine glands in the feet are not related to vitiligo. Apocrine glands are sweat glands found primarily in the underarm and genital areas and are responsible for the secretion of a thick, odorless fluid. Their overactivity does not result in the white patches seen in vitiligo.

Choice C rationale

Impetigo is a bacterial skin infection characterized by red sores, blisters, and crusting. It is not related to vitiligo and does not cause depigmentation. Impetigo is treated with antibiotics, whereas vitiligo requires different management strategies to address the loss of pigment.

Choice D rationale

Vitiligo is not caused by an excess of melanin pigment. Rather, it is the result of melanin loss or the absence of melanocytes in certain areas of the skin, leading to the characteristic white patches.