A nurse is caring for a 58-year-old male client in an outpatient clinic.

Select the 3 possible conditions that could have the clinical manifestations of clubbed nails for this client.

Pneumonia

Lung cancer

Chronic obstructive pulmonary disease (COPD)

Chronic bronchitis

Flu

Answer and Explanation

Correct Answer : B,C,D

Choice A rationale: Pneumonia is an acute infection of the lung parenchyma, often causing fever, cough, and infiltrates on chest imaging. Clubbing usually develops over weeks to months, associated with chronic hypoxia or inflammation, which is uncommon in acute pneumonia. Therefore, clubbing is not typically a manifestation of pneumonia. The nail changes require persistent hypoxemia or chronic pulmonary pathology, which acute pneumonia generally does not produce.

Choice B rationale: Lung cancer can cause digital clubbing due to tumor-induced secretion of growth factors such as vascular endothelial growth factor (VEGF), which promote vascular hyperplasia and connective tissue proliferation in the nail beds. Hypoxia and chronic inflammation from tumors also contribute. Clubbing often accompanies lung malignancies and serves as a paraneoplastic sign. This fits with the client’s history of smoking and respiratory symptoms.

Choice C rationale: Chronic obstructive pulmonary disease (COPD) causes chronic hypoxemia due to airflow limitation and impaired gas exchange. Sustained low oxygen levels stimulate vasodilation and fibroblast proliferation in nail beds, causing clubbing. The long-term smoking history and recurrent infections support COPD as an underlying cause. Clubbing incidence in COPD varies but is associated with more severe disease and hypoxemia.

Choice D rationale: Chronic bronchitis, a subtype of COPD, involves chronic airway inflammation and mucus hypersecretion, leading to airflow obstruction and hypoxemia. Persistent hypoxia induces vascular and connective tissue changes in the digits, resulting in clubbed nails. The client’s history of recurrent respiratory infections and smoking is consistent with chronic bronchitis as a cause of clubbing.

Choice E rationale: Influenza (flu) is an acute viral respiratory infection causing fever, cough, and malaise but does not cause chronic hypoxia or persistent inflammation required for clubbing development. Nail changes develop over prolonged periods, making influenza an unlikely cause. Clubbing is not a known complication of acute viral infections like flu.

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Correct Answer is B

Explanation

Choice A rationale

Faint whistling over both lung bases, also known as wheezing, indicates narrowed airways due to bronchoconstriction, inflammation, or secretions. This is an abnormal adventitious breath sound, often associated with conditions like asthma, bronchitis, or chronic obstructive pulmonary disease, and is not considered a normal finding during chest auscultation.

Choice B rationale

Blowing, hollow sounds heard above the sternum are characteristic of tracheal or bronchial breath sounds. These sounds are normal when auscultated directly over the trachea or main bronchi because of the rapid airflow through these larger airways. They are louder and higher-pitched than vesicular sounds and are considered a normal finding in this specific anatomical location.

Choice C rationale

Breath sounds over the right lung fields are typically similar in intensity to the left, assuming symmetrical lung expansion and clear airways. If the right breath sounds are distinctly louder than the left, it could indicate an abnormality such as consolidation in the right lung, a pleural effusion on the left, or other pathological conditions affecting sound transmission, making it an abnormal finding.

Choice D rationale

Slight crackling throughout lung fields, commonly referred to as crackles or rales, indicates the presence of fluid or secretions in the alveoli or small airways. These are adventitious sounds, often associated with conditions such as pneumonia, heart failure, or pulmonary fibrosis, and are not a normal finding during respiratory auscultation in healthy individuals.

A. Need for a walker to aid in ambulation. B. Increased risk for falling. C. Likely onset of Parkinson's disease. D. Expected results for an older adult.

Correct Answer is B

Explanation

Choice A rationale

A balance score of 12 and a gait score of 8, with a total score of 20 on the Tinetti assessment, indicates significant impairment. A total score below 26 suggests an increased risk of falls. While a walker may be a suitable intervention, the results primarily indicate a *risk* for falling, not the specific need for a walker directly from the score.

Choice B rationale

The Tinetti Performance Oriented Mobility Assessment (POMA) is a widely used tool to assess gait and balance in older adults and determine fall risk. A total score of 20 (balance 12 + gait 8) is below the threshold of 26, which is commonly associated with an increased risk of falling. Scores below 19 indicate a high risk, and 19-24 indicate a moderate risk. Therefore, 20 clearly shows increased risk.

Choice C rationale

While Parkinson's disease can manifest with impaired gait and balance, the Tinetti scores alone are not diagnostic for Parkinson's disease. The assessment identifies functional deficits in mobility that contribute to fall risk, but it does not differentiate between underlying neurological conditions. Other specific neurological examinations are required for such a diagnosis.

Choice D rationale

Expected results for an older adult without significant mobility issues would typically be a higher score on the Tinetti assessment, often above 26, indicating minimal to no fall risk. A score of 20 demonstrates clear deficits in both balance and gait, which are not considered typical or expected age-related changes; rather, they signify impaired mobility.

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A nurse is caring for a 58-year-old male client in an outpatient clinic. Select the 3 possible conditions that could have the clinical manifestations of clubbed nails for this client.

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Which assessment finding, obtained during chest auscultation, should the nurse consider a normal finding?

Correct Answer is B

Explanation

A nurse performs a Tinetti assessment on an older adult client and calculates a balance score of 12 and a gait score of 8. Which do these results indicate?

Correct Answer is B

Explanation

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A nurse is caring for a 58-year-old male client in an outpatient clinic.

Select the 3 possible conditions that could have the clinical manifestations of clubbed nails for this client.