Upon assessment, the nurse noted a temperature of 102.1, respirations of 30 breaths per minute, oxygen saturation of 90% on room air, decreased expansion and dullness over the right lung, and crackles heard on the right lower lobe. Which condition should the nurse suspect?

A. Thoracic muscle tenderness is not directly associated with intercostal retraction. Muscle tenderness may occur due to overuse or strain but does not cause the retraction of the intercostal spaces. It is more related to musculoskeletal issues rather than respiratory conditions.
B. Barrel chest refers to an increased anterior-posterior chest diameter, often seen in chronic obstructive pulmonary disease (COPD) and emphysema. While barrel chest can indicate chronic lung conditions that might cause respiratory distress, it does not directly cause intercostal retraction.
C. Pectus excavatum, or "funnel chest," is a congenital deformity where the sternum is depressed inward, giving the chest a sunken appearance. However, pectus excavatum itself does not directly cause retractions but can be associated with increased respiratory effort.
D. Atelectasis refers to the collapse of part or all of a lung, leading to decreased lung volume. This condition often results in increased respiratory effort and can be associated with intercostal retractions as the body struggles to expand the collapsed lung areas and improve ventilation.
E. Obstruction of the airways, such as from a foreign body, mucus plug, or severe bronchoconstriction, can lead to increased respiratory effort as the client tries to overcome the obstruction. This increased effort often results in visible signs of respiratory distress, including intercostal retraction.

A. Palpable lymph nodes are assessed through palpation, not inspection. The nurse would use their hands to feel for lymph nodes in areas such as the axilla (armpit) and supraclavicular regions. This is a tactile examination and therefore not documented as part of the inspection.
B. Symmetry refers to the visual observation of whether the breasts are equal in size and shape. During the inspection phase, the nurse notes whether the breasts appear symmetrical or if there are any visible asymmetries.
C. Breast sensitivity is typically assessed through palpation or the client’s report of symptoms rather than through inspection alone. Sensitivity involves asking the client about their experience of pain or discomfort in the breasts, which cannot be observed visually.
D. Tenderness is assessed through palpation, where the nurse would gently press on the breast tissue to determine if the client experiences pain. Tenderness is not a visual finding and therefore is not documented during the inspection phase.