A nurse is preparing to obtain a sputum specimen for a client.
Which of the following actions should the nurse plan to take?

Choice A rationale

Bradycardia is not a typical assessment finding for a client with emphysema. Instead, these clients often experience tachycardia as a compensatory mechanism for chronic hypoxia. The heart rate increases to pump oxygenated blood more quickly to the tissues in response to decreased gas exchange efficiency in the alveoli. Therefore, a slow heart rate would be unexpected unless the client has a coexisting cardiac conduction disorder or is taking certain medications like beta-blockers.

Choice B rationale

Dyspnea, or shortness of breath, is a hallmark symptom of emphysema due to the destruction of alveolar walls and the loss of elastic recoil in the lungs. This leads to air trapping and hyperinflation, making it difficult for the client to exhale fully and inhale fresh air. As the disease progresses, dyspnea occurs even at rest because the physiological dead space increases, significantly reducing the surface area available for effective gas exchange and oxygenation.

Choice C rationale

Deep respirations are generally not found in emphysema; rather, clients tend to have rapid, shallow breathing patterns. Because of the hyperinflation of the lungs and the flattened diaphragm, the chest cannot expand and contract effectively for deep breaths. Clients often use accessory muscles to assist with breathing and may adopt a tripod position to help move air. The inefficiency of the respiratory pump in emphysema prevents the client from achieving significant tidal volumes.

Choice D rationale

A barrel chest is a classic clinical sign of emphysema resulting from chronic air trapping in the alveoli. Over time, the lungs stay hyperinflated, which increases the anteroposterior diameter of the thorax relative to the lateral diameter. This anatomical change reflects the permanent overdistension of the air spaces distal to the terminal bronchioles. It is a physical manifestation of the long-term struggle to exhale against obstructed airways and lost lung elasticity.

Choice E rationale

Clubbing of the fingers is a clinical sign characterized by the bulbous enlargement of the distal phalanges and a loss of the normal angle at the nail bed. It is often associated with chronic hypoxemia, which occurs in advanced emphysema. The exact mechanism involves increased capillary growth and fibroblast activity in the fingertips in response to low systemic oxygen levels. Its presence indicates long-standing respiratory insufficiency and significant impairment in pulmonary gas exchange.

Choice A rationale

Respiratory alkalosis is not expected in a client with stable COPD and emphysema. Instead, these clients are prone to respiratory acidosis due to chronic carbon dioxide retention. As alveolar walls are destroyed, the lungs lose their elastic recoil, leading to air trapping and impaired gas exchange. This results in an elevated partial pressure of carbon dioxide and a lower pH. Normal arterial pH is 7.35 to 7.45, and a PCO2 above 45 mmHg indicates CO2 retention.

Choice B rationale

An increased anteroposterior diameter of the chest, often called a barrel chest, is a classic finding in emphysema. This structural change occurs because of chronic air trapping in the overdistended alveoli. The rib cage stays partially expanded all the time, making the chest appear rounded. The nurse expects to see this because the loss of lung elasticity prevents the lungs from fully deflating, forcing the thoracic cavity to adapt to the permanently increased volume of residual air.

Choice C rationale

An oxygen saturation level of 96 percent is generally considered normal for a healthy individual but is often higher than what is seen in a client with significant COPD. Clients with emphysema typically have lower baseline saturations, often ranging from 88 percent to 92 percent. Their drive to breathe may become dependent on low oxygen levels rather than high carbon dioxide levels. Expecting a high normal saturation would be unrealistic for someone presenting with shortness of breath and emphysema.

Choice D rationale

Petechiae, which are small red or purple spots caused by minor hemorrhage into the skin, are not a manifestation of COPD or emphysema. Petechiae are more commonly associated with platelet disorders, certain infections, or trauma. In the context of respiratory assessment, a nurse would be more likely to look for cyanosis, which is a bluish discoloration of the skin or mucous membranes indicating poor oxygenation, rather than petechiae, which have no direct scientific link to alveolar destruction.