The practical nurse (PN) reviews client data.

Select the 3 possible conditions that could have the symptom of clubbed nails for this client.

Rationale:

A. Anemia: Anemia is a condition characterized by a decreased number of red blood cells or hemoglobin, often identified through pallor, fatigue, or laboratory values. Tenting of the skin is not a clinical sign of anemia and does not provide information about red blood cell status.

B. Edema: Edema involves excess fluid in the interstitial space, often causing swelling and pitting in dependent areas such as the ankles or sacrum. Tenting, which reflects delayed skin recoil, indicates fluid deficit rather than fluid excess, so it is inconsistent with edema.

C. Dehydration: Skin tenting occurs when the skin loses elasticity due to fluid loss, a hallmark sign of dehydration. The delayed return of the skin to its normal position demonstrates reduced turgor, which reflects inadequate hydration and is especially relevant in older adults or clients with acute fluid deficits.

D. Normal aging: While aging naturally decreases skin elasticity, mild tenting may be observed in older adults without dehydration. However, pronounced tenting in the back of the hand usually indicates an abnormal fluid deficit rather than solely age-related changes, distinguishing dehydration from normal aging.

Rationale:

A. Note sputum characteristics: Documenting the color, consistency, and amount of sputum provides valuable information about potential respiratory infection or inflammation. However, it is not the immediate priority because it does not directly indicate the client’s current physiological stability.

B. Monitor white blood cell count: An elevated WBC count can suggest infection, but laboratory results may not be immediately available. This information supports assessment but does not provide real-time data about the client’s acute status.

C. Measure vital signs: Vital signs offer immediate and objective data on the client’s respiratory and cardiovascular status, including heart rate, respiratory rate, oxygen saturation, and temperature. Given a productive cough, monitoring for fever, tachypnea, or hypoxia is critical to identify acute deterioration and guide prompt intervention.

D. Assess for dependent edema: Checking for edema can indicate fluid overload or cardiac compromise, but in the context of a productive cough, respiratory status takes priority over circulatory findings. Edema assessment is important but not the first action in this scenario.