As a mandatory reporter of elder abuse, which of these statements must be present before a nurse notifies the authorities?

Choice A reason: Clubbing, characterized by bulbous nail bed enlargement, is associated with chronic hypoxemia from conditions like asthma or COPD. It results from long-term low oxygen levels, making it the expected finding in this patient with chronic respiratory issues.

Choice B reason: Onychomycosis is a fungal nail infection unrelated to hypoxemia or asthma. Clubbing is directly linked to chronic oxygen deficiency, so this is not the expected nail condition in this patient’s context.

Choice C reason: Spooning (koilonychia) is associated with iron deficiency anemia, not hypoxemia or asthma. Clubbing is the nail abnormality seen in chronic respiratory conditions, so this is incorrect for the patient’s condition.

Choice D reason: Paronychia is an infection around the nail, typically from trauma or bacteria, not hypoxemia. Clubbing is the hallmark nail change in chronic asthma with low oxygen, so this is not the expected finding.

Choice A reason: Simultaneously palpating both carotid arteries is dangerous, risking reduced cerebral blood flow, especially in cardiovascular patients. Using the bell to listen for bruits is safer, so this is incorrect.

Choice B reason: Deep breaths are for lung auscultation, not carotid, where patients hold breath to reduce noise. The bell detects low-pitched bruits, so instructing deep breaths is incorrect for carotid assessment.

Choice C reason: Compressing the carotid artery risks reducing blood flow or dislodging plaques, which is unsafe. Listening with the bell for bruits is the standard method, so this is incorrect.

Choice D reason: Listening with the bell of the stethoscope detects low-frequency bruits, indicating carotid artery narrowing, which is critical in cardiovascular disease. This is the correct technique for safe assessment.