Read the client scenario and answer question.

COPD patient's chart - Nurse's Note (0800) 84-year-old male client with a chronic obstructive pulmonary disease (emphysema) history is admitted to the inpatient Med surge unit provider today. Upon admission, the client reports unusual increased shortness of breath and fatigue. The client is on 1 liter of oxygen via a nasal cannula; 02 saturation is 93%. The client's respiratory rate is 30 bpm with accessory muscle use, heart rate is 125 bpm, and blood pressure is 127/89 mmHg. The client has a barrel chest and extremities. On call provided paged, pending call back.

Identify listed assessment findings as expected or findings that need to be reported to the provider. Select only one answer per finding.

Barrel chest

Increased fatigue

Respiratory rate 40bpm

Thin appearance

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A"}}

Assessment findings	Expected Findings	Findings to be reported to provider
Barrel chest	✔️
Increased fatigue		✔️
Respiratory rate 40bpm		✔️
Thin appearance	✔️

Barrel chest: Expected Finding

Increased fatigue: Finding to be reported to the provider

Respiratory rate 40 bpm: Finding to be reported to the provider

Thin appearance: Expected Finding

Rationales:

Barrel chest – Expected Finding:

A barrel chest is a common physical finding in clients with chronic obstructive pulmonary disease (COPD), especially emphysema. It results from hyperinflation of the lungs over time, altering the shape of the chest wall.

Increased fatigue – Finding to be reported to the provider:

While COPD clients often experience fatigue, a sudden or unusual increase in fatigue may indicate worsening respiratory function or exacerbation of the disease. This finding requires further assessment and possible intervention to prevent complications.

Respiratory rate 40 bpm – Finding to be reported to the provider:

A respiratory rate of 40 bpm indicates significant tachypnea and respiratory distress. This finding, coupled with accessory muscle use, suggests the client may be experiencing an acute exacerbation of COPD or impending respiratory failure, which requires immediate provider notification.

Thin appearance – Expected Finding:

Clients with COPD often have a thin or cachectic appearance due to increased energy expenditure for breathing and reduced caloric intake. This is a typical finding in advanced COPD and does not require urgent reporting unless accompanied by other concerning symptoms.

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Correct Answer is B

Explanation

A. 250 mg:

This represents the amount of levodopa in the tablet, not carbidopa. Sinemet contains two active ingredients: carbidopa (25 mg) and levodopa (250 mg), as shown on the label.

B. 25 mg:

This is the correct answer, as the label indicates that each tablet contains 25 mg of carbidopa. Carbidopa is combined with levodopa to improve its effectiveness and reduce side effects like nausea.

C. 5 mg:

This is not accurate; the label clearly states that the carbidopa dose is 25 mg per tablet.

D. 200 mg:

This does not correspond to the dose of carbidopa or levodopa in this medication. The label specifies 25 mg of carbidopa and 250 mg of levodopa.

A. Sodium 136 mEq/L B. Potassium 4.5 mEq/L C. Calcium 10 mg/dL D. Potassium 2.9 mEq/L

Correct Answer is D

Explanation

A) Sodium 136 mEq/L:
A sodium level of 136 mEq/L is within the normal reference range of 135–145 mEq/L. While clients with heart failure may experience fluid shifts and altered sodium levels, this result does not immediately require reporting to the provider. Sodium at this level is considered normal.

B) Potassium 4.5 mEq/L:
A potassium level of 4.5 mEq/L is within the normal range of 3.5–5.0 mEq/L, making it a safe and appropriate level. There is no immediate concern regarding potassium levels here, so no action is required. This value does not need to be reported to the provider.

C) Calcium 10 mg/dL:
The normal range for calcium is generally between 8.5–10.5 mg/dL. A calcium level of 10 mg/dL is within this normal range, so this finding does not require further action. No reporting is necessary to the provider.

D) Potassium 2.9 mEq/L:
A potassium level of 2.9 mEq/L is below the normal range (3.5–5.0 mEq/L) and is considered hypokalemia. Furosemide is a loop diuretic that can cause potassium depletion by increasing renal excretion of potassium. This is a serious concern because hypokalemia can lead to dangerous cardiac arrhythmias, muscle weakness, and other complications. The nurse should immediately report this low potassium level to the provider so that potassium supplementation or adjustments in diuretic therapy can be made.

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How many milligrams of carbidopa is this patient taking per dose/tablet?

Correct Answer is B

Explanation

A nurse is reviewing the serum laboratory findings for a client who has heart failure and is prescribed furosemide. Which of the following findings should the nurse report to the provider?

Correct Answer is D

Explanation

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