A nurse is caring for a client who has dysphagia. Which of the following actions should the nurse take?

Choice A reason: A pleural friction rub is associated with conditions that cause pleural inflammation, such as pleuritis or pneumonia, rather than Chronic Obstructive Pulmonary Disease (COPD). While patients with COPD may experience other abnormal lung sounds like wheezing or crackles, pleural friction rubs are not typically a feature of COPD.

Choice B reason: Peripheral edema is a common finding in clients with advanced COPD, particularly in those who develop right-sided heart failure (also known as cor pulmonale). The prolonged hypoxia and pulmonary hypertension that often accompany COPD can put additional strain on the right side of the heart, leading to fluid retention and swelling in the extremities. This is a typical finding in later stages of COPD.

Choice C reason: Spoon nails (koilonychia) are typically associated with iron deficiency anemia or other conditions affecting the circulatory system. Although COPD is a chronic respiratory condition that can impact oxygenation, spoon nails are not commonly associated with COPD. This condition is more commonly seen in anemia or other nutritional deficiencies.

Choice D reason:

Hyperresonance on percussion is a typical finding in COPD, especially in those with emphysema, where air trapping occurs. This is due to the destruction of lung tissue and the over-inflation of alveoli, which creates a more resonant sound when the chest is percussed. This finding indicates the presence of hyperinflated lungs, a hallmark of emphysema and a common component of COPD.

Choice A reason: Urine osmolality of 200 mOsm/kg is lower than expected in dehydration. Dehydration typically results in higher osmolality due to the concentration of urine.

Choice B reason: Cloudy urine can be a sign of infection or other conditions, but it is not a specific indicator of dehydration.

Choice C reason: Dark-colored urine is a common finding in dehydration as the body conserves water, leading to
more concentrated urine.

Choice D reason: A urine specific gravity of 1.015 is within the normal range. In dehydration, we would expect a higher specific gravity, indicating more concentrated urine.