A Medical-Surgical nurse is performing an assessment on a client with a history of chronic obstructive pulmonary disease. Which of the following findings will the nurse most likely observe?
Unequal chest expansion.
Atrophied neck and trapezius muscle.
Increased tactile fremitus.
An anterior-to-posterior chest diameter ratio of 1:1.
The Correct Answer is A
Choice A rationale:
Unequal chest expansion is the correct choice. In a patient with chronic obstructive pulmonary disease (COPD), the airways are often narrowed and obstructed, leading to difficulty in moving air in and out of the lungs. This can result in unequal chest expansion during breathing, where one side of the chest expands less than the other. This finding is commonly observed in patients with COPD due to the imbalance in lung function between different areas of the lungs.
Choice B rationale:
Atrophied neck and trapezius muscle is not a typical finding in COPD. Muscle atrophy can occur in conditions of prolonged disuse or immobility, but it is not a characteristic manifestation of COPD itself.
Choice C rationale:
Increased tactile fremitus refers to increased vibrations felt on the chest wall during speech. This finding is more commonly associated with conditions that cause lung consolidation, such as pneumonia. In COPD, there is often air trapping and hyperinflation of the lungs, which would not lead to increased tactile fremitus.
Choice D rationale:
An anterior-to-posterior chest diameter ratio of 1:1 is not a typical finding in a healthy individual, let alone in a patient with COPD. In COPD, there is often an increase in the anterior-to-posterior chest diameter ratio, giving the chest a barrel-like appearance. This is due to the trapped air and hyperinflation of the lungs, which is characteristic of the disease.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Drowsiness is not a typical finding associated with hypoxia. Hypoxia often leads to increased alertness and anxiety as the body tries to compensate for the lack of oxygen. Drowsiness might be seen in severe cases of hypoxia, but it's not a consistent finding.
Choice B rationale:
Jaundice is not directly related to hypoxia. Jaundice is usually caused by elevated bilirubin levels due to liver dysfunction or other underlying issues. It is not a primary manifestation of hypoxia.
Choice C rationale:
Flushed pink cheeks can be an indicator of increased blood flow to the skin, which might occur as the body tries to compensate for hypoxia. However, this finding is not as consistent or specific as tachycardia in cases of hypoxia.
Choice D rationale:
Tachycardia, or an abnormally rapid heart rate, is a common physiological response to hypoxia. The body attempts to deliver more oxygen to tissues by increasing the heart rate. This compensatory mechanism helps maintain tissue perfusion in the face of reduced oxygen levels.
Correct Answer is B
Explanation
Choice A rationale:
Autonomy refers to a patient's right to make their own decisions about their medical care. While autonomy is an important ethical principle, it is not directly related to the situation described. The nurse providing oxygen therapy to the patient without the patient's consent is not an example of respecting autonomy.
Choice B rationale:
Beneficence is the correct choice. Beneficence is the ethical principle of doing what is best for the patient's well-being. In this situation, providing oxygen therapy to a patient experiencing difficulty in breathing aligns with the principle of beneficence. Oxygen therapy aims to improve the patient's oxygenation and alleviate respiratory distress.
Choice C rationale:
Veracity refers to truthfulness and honesty in communication. While honesty is important, it is not the primary ethical principle at play in this situation. Providing oxygen therapy to improve the patient's condition is more aligned with beneficence.
Choice D rationale:
Fidelity refers to the duty to be faithful and keep promises. While fidelity is important in maintaining trust between healthcare providers and patients, it is not the primary principle relevant here. The priority is to address the patient's immediate health needs through appropriate interventions like oxygen therapy.
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