The nurse provides care for a client admitted one hour ago with the diagnosis of salicylate toxicity. The client has an arterial pH of 7.32. Which finding does the nurse expect to observe?

Choice A reason: Facial muscle atrophy is not the expected finding because it is a condition where the facial muscles lose their mass and strength, which can be caused by various factors, such as aging, nerve damage, or muscular dystrophy. Facial muscle atrophy is not a common manifestation of myxedema, which is a severe form of hypothyroidism, which is a condition where the thyroid gland does not produce enough thyroid hormones, which regulate the metabolism and growth of the body.

Choice B reason: Facial and periorbital edema is the expected finding because it is a characteristic manifestation of myxedema, which is caused by the accumulation of mucopolysaccharides, which are complex carbohydrates that are normally found in the connective tissues. Mucopolysaccharides can attract water and cause swelling of the tissues, especially in the face and around the eyes. Facial and periorbital edema can also cause the facial features to appear coarse and puffy, and the eyelids to droop.

Choice C reason: Facial muscle twitching is not the expected finding because it is a condition where the facial muscles contract involuntarily, which can be caused by various factors, such as stress, fatigue, or caffeine. Facial muscle twitching is not a common manifestation of myxedema, which can cause the facial muscles to become weak and slow, and the facial expressions to become dull and flat.

Choice D reason: Unilateral ptosis is not the expected finding because it is a condition where one eyelid droops lower than the other, which can be caused by various factors, such as nerve damage, stroke, or tumor. Unilateral ptosis is not a common manifestation of myxedema, which can cause bilateral ptosis, which is the drooping of both eyelids, due to the edema and weakness of the eyelid muscles.

Choice A reason: "I was short of breath when I walked around the block yesterday." is not the most significant statement because it is a common symptom of chronic bronchitis, but it does not indicate the severity or the progression of the condition. Shortness of breath is caused by the inflammation and narrowing of the airways, which reduce the airflow and oxygen delivery to the lungs.

Choice B reason: "I have a loose sounding cough every day when I get up in the morning." is the most significant statement because it indicates the presence of excessive mucus production, which is a hallmark of chronic bronchitis. Mucus traps bacteria and other irritants, which can lead to infections and further inflammation of the airways. A chronic cough is defined as a cough that lasts for at least three months in two consecutive years.

Choice C reason: "My respiratory secretions are greenish-yellow colored today." is not the most significant statement because it is a sign of a possible infection, but it does not necessarily indicate chronic bronchitis. Greenish-yellow colored sputum can be caused by various respiratory conditions, such as pneumonia, tuberculosis, or cystic fibrosis.

Choice D reason: "My feet are swollen and painful at the end of the afternoon." is not the most significant statement because it is a sign of a possible complication of chronic bronchitis, but it does not directly relate to the condition. Swollen and painful feet can be caused by right-sided heart failure, which can result from chronic bronchitis. Chronic bronchitis can increase the pressure in the pulmonary arteries, which can strain the right ventricle and cause it to fail. This can lead to fluid retention and edema in the lower extremities.