The nurse examines a patient who has asthma and chronic hypoxemia. The nurse would expect to find which condition of the nails?

Choice A reason: Normal pupil findings include equal size (2–5 mm) and brisk reaction to light bilaterally. A fully dilated, nonreactive right pupil with a reactive left pupil indicates a neurological abnormality, not a normal finding, as it suggests significant brain dysfunction.

Choice B reason: Rechecking findings is prudent, but the described pupil changes—unilateral dilation and nonreactivity—are classic signs of a serious condition. Delaying action by only rechecking could miss critical intervention timing, as these findings strongly indicate a neurological emergency.

Choice C reason: A unilaterally dilated, nonreactive pupil with a normal contralateral pupil suggests increased intracranial pressure, often from a hematoma or swelling compressing the oculomotor nerve (Cranial Nerve III). This causes pupil dilation and loss of light reflex, requiring urgent intervention.

Choice D reason: Brainstem injury typically causes bilateral pupil changes, such as fixed, pinpoint, or dilated pupils, due to damage to brainstem nuclei. The unilateral findings here are more indicative of focal pressure (e.g., hematoma) than diffuse brainstem injury, making this less likely.

Choice A reason: Alcohol can interact with medications, altering their metabolism via liver enzymes (e.g., CYP450), and exacerbate conditions like liver disease or hypertension. This information is critical for safe treatment planning, making it the primary reason for inquiry.

Choice B reason: Assessing patient reliability is not the purpose of asking about alcohol use. This question focuses on clinical implications, not trustworthiness, as alcohol’s effects on health and medications are the priority, making this an incorrect rationale.

Choice C reason: Alcohol use is relevant even without an obvious drinking problem, as even moderate consumption can affect medication efficacy or disease progression. Dismissing this question unless a problem is evident overlooks potential risks, making this incorrect.

Choice D reason: Teaching all patients to avoid alcohol is not universally necessary, as moderate use may be safe for some. The inquiry aims to identify specific risks, like drug interactions, not to enforce blanket abstinence, making this an incorrect reason.