Which of the following assessment findings would be expected in a client with chronic hypoxemia due to chronic obstructive pulmonary disease (COPD)?

Scattered rhonchi and crackles with an elevated WBC count

Clubbing of the fingers and polycythemia

Copious amounts of rust-colored sputum with cyanosis

Distended neck veins and dependent edema

Answer and Explanation

The Correct Answer is B

A. Scattered rhonchi and crackles with an elevated WBC count: These findings suggest an acute respiratory infection or pneumonia, not chronic hypoxemia. Elevated WBC count points to infection rather than a long-term adaptation to COPD.

B. Clubbing of the fingers and polycythemia: These are expected in chronic hypoxemia. Clubbing results from prolonged low oxygen levels, while polycythemia develops as the body compensates by producing more red blood cells to increase oxygen-carrying capacity.

C. Copious amounts of rust-colored sputum with cyanosis: Rust-colored sputum is typically associated with bacterial pneumonia, particularly pneumococcal infection, not chronic hypoxemia. Cyanosis may occur, but the sputum description makes this finding less appropriate.

D. Distended neck veins and dependent edema: These findings are consistent with cor pulmonale or right-sided heart failure, a complication of COPD, but they are not the expected baseline findings of chronic hypoxemia itself.

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Correct Answer is A

Explanation

A. Speaking in short phrases or sentences: This indicates severe dyspnea and increased work of breathing, suggesting the client may not be able to maintain adequate ventilation and oxygenation. It is a sign of respiratory distress and requires immediate intervention.

B. Distant heart sounds: While this may be present in COPD due to hyperinflation of the lungs, it is not immediately life-threatening and does not require urgent action compared to severe dyspnea.

C. Diminished lung sounds: This is common in COPD due to air trapping and hyperinflation but does not always indicate acute deterioration unless accompanied by other distress signs.

D. Pursed-lip breathing: This is actually a beneficial compensatory mechanism that helps keep airways open longer to improve carbon dioxide elimination and is not a sign of acute danger.

A. Non-adherence to medications B. Non-attendance of treatment programs C. Lack of social activities D. Substance use to self medicate

Correct Answer is A

Explanation

A. Non-adherence to medications: Antipsychotic medications are essential for symptom control, and missing doses or discontinuing treatment often leads to exacerbation of psychotic symptoms and the need for hospitalization.

B. Non-attendance of treatment programs: While skipping therapy or support groups can negatively affect progress, it is not the main cause of relapse. Medication adherence remains the most critical component in preventing symptom recurrence and maintaining stability.

C. Lack of social activities: Social isolation can worsen negative symptoms and impact overall quality of life, but it does not directly cause acute relapse requiring hospitalization. The client may remain stable on medications even with limited social interactions.

D. Substance use to self medicate: Substance use can complicate treatment and increase relapse risk, but it is not the primary factor. Even clients without substance use issues frequently relapse if they stop taking prescribed antipsychotics.

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Which of the following assessment findings would be expected in a client with chronic hypoxemia due to chronic obstructive pulmonary disease (COPD)?

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