A nurse is reinforcing teaching with a newly licensed nurse about physiological changes in the digestive system that occur with aging. The nurse should include that older adults might experience which of the following physiological changes?

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: While it is important to save the specimen in a clean container, this is not a preparatory action for
obtaining the specimen.

Choice B reason: Rinsing the client's mouth before collecting the specimen is the correct answer because it helps to remove food particles and bacteria that could contaminate the sample.

Choice C reason: Collecting a sputum specimen after a meal is not recommended as it may be contaminated by food particles.

Choice D reason: The time of day is less important than the preparation of the client; however, early morning is usually preferred for collecting a sputum specimen as it tends to be more concentrated after a night's rest.