The nurse is caring for a client with a diagnosis of emphysema of five years. Which of the following findings should the nurse expect to see during the morning assessment? (Select all that apply)

Barrel chest

Edema

Productive cough

Dyspnea

Clubbed fingers

Answer and Explanation

Correct Answer : A,D,E

Choice A reason: Barrel chest develops in emphysema from chronic air trapping, overexpanding lungs and flattening the diaphragm, altering thoracic shape over years.

Choice B reason: Edema relates to right heart failure from cor pulmonale, a late emphysema complication, not a direct or universal finding after five years.

Choice C reason: Productive cough is typical in chronic bronchitis, not emphysema, which features alveolar destruction and minimal mucus, leading to dry cough instead.

Choice D reason: Dyspnea in emphysema results from alveolar loss reducing oxygen exchange, forcing compensatory rapid breathing, a core symptom even after five years.

Choice E reason: Clubbed fingers occur in chronic hypoxia from emphysema, as poor oxygenation over years triggers nail bed angiogenesis, a common late finding.

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Correct Answer is D

Explanation

Choice A reason: Increasing oxygen to 3 L/min may help but risks CO2 retention in COPD without assessing respiratory rate, depth, and saturation first, making it premature.

Choice B reason: Coughing clears secretions, but without assessing respiratory status, it’s unclear if secretions are the issue or if the client can effectively cough, so it’s not priority.

Choice C reason: Calling emergency services assumes severity without data like oxygen saturation or distress level, delaying care by skipping initial assessment in this stable setting.

Choice D reason: Assessing respiratory status (rate, oxygen saturation, lung sounds) identifies the cause of difficulty, guiding interventions like oxygen adjustment or escalation, per ABC priority.

A. Maintain oxygen saturations greater than or equal to 92% B. Administer ibuprofen C. Administer enteric-coated acetaminophen D. Obtain an EKG

Correct Answer is D

Explanation

Choice A reason: Maintaining oxygen saturation helps symptoms but doesn’t diagnose the cause (e.g., MI), delaying critical evaluation of atypical pain and dyspnea.

Choice B reason: Ibuprofen relieves pain but risks bleeding in potential MI, not addressing cardiac etiology of jaw, back pain, and shortness of breath urgently.

Choice C reason: Acetaminophen eases pain but doesn’t assess or treat potential cardiac ischemia, missing the diagnostic priority for these MI-like symptoms.

Choice D reason: An EKG identifies cardiac ischemia (e.g., MI) in atypical pain (jaw, back), dyspnea, and nausea, guiding urgent treatment, the priority action here.

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The nurse is caring for a client with a diagnosis of emphysema of five years. Which of the following findings should the nurse expect to see during the morning assessment? (Select all that apply)

Nursing Test Bank

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