A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client would the nurse assess first?

Choice A rationale

Alpha-1 antitrypsin (AAT) deficiency is an autosomal co-dominant genetic disorder, not strictly recessive. While individuals with two deficient alleles (PiZZ) are at highest risk, heterozygous carriers (PiMZ) also have an increased risk for developing COPD, particularly with environmental exposures like smoking. Therefore, stating children will be at high risk is an oversimplification and potentially inaccurate regarding the genetic transmission pattern.

Choice B rationale

While genetic counseling is an appropriate recommendation for individuals with AAT deficiency to understand inheritance patterns and reproductive risks, it is not the most immediate and direct response regarding the client's personal health implications. The client's question focuses on what the diagnosis means for *them*, not their offspring initially.

Choice C rationale

AAT deficiency significantly increases the risk for developing emphysema, a form of COPD, especially when compounded by environmental factors such as smoking. AAT normally protects lung tissue from elastase, and its deficiency leads to unchecked protease activity and subsequent lung destruction. This response directly addresses the client's personal health risk and a major modifiable factor.

Choice D rationale

This statement is inaccurate. AAT deficiency is not a recessive gene in a simple Mendelian sense where only homozygous recessive individuals are affected. It's an autosomal co-dominant condition where both alleles contribute to AAT levels, and even heterozygous carriers (PiMZ) can have lower AAT levels and increased risk for COPD, especially with smoking. Thus, it certainly impacts health.

Choice A rationale

Tachypnea, or rapid breathing, significantly increases insensible fluid loss through the respiratory tract. Each exhalation carries water vapor, and with increased respiratory rate and depth, the total volume of water lost through respiration can be substantial, leading to dehydration despite oral fluid intake. This explains the physiological mechanism of fluid imbalance related to respiratory effort.

Choice B rationale

While pneumonia can be associated with dehydration due to fever, decreased oral intake, and increased metabolic demands, stating that "everyone with pneumonia is dehydrated" is an overgeneralization and not scientifically accurate. The degree of dehydration varies among individuals based on their specific physiological response and hydration status.

Choice C rationale

While intravenous fluids are often used to administer antibiotics, the client specifically asked about dehydration despite drinking water. This response avoids directly addressing the client's concern and the physiological reason for their dehydration, missing an opportunity for client education regarding their condition.

Choice D rationale

This response is a therapeutic communication technique, but in this specific scenario, the client is directly asking for a scientific explanation of their dehydration. Responding with another question shifts the burden of explanation back to the client and does not provide the requested physiological information, which is critical for their understanding and adherence. .