A nurse assesses a client who presents to the provider's office to evaluate multiple nevi. Which finding should the nurse identify to the provider as possible sign of malignancy?

A) Unilateral upper extremity weakness:
Guillain-Barré Syndrome (GBS) typically presents with bilateral weakness, not unilateral. The weakness in GBS typically begins symmetrically in the lower extremities and ascends upward toward the upper body, including the arms, face, and respiratory muscles. Therefore, unilateral weakness is not characteristic of GBS, and its presence should prompt further investigation into other possible causes.

B) Bilateral ascending weakness:
One of the hallmark signs of Guillain-Barré Syndrome is ascending weakness, which means that the weakness usually starts in the lower extremities (legs) and progresses upwards to the upper extremities, face, and potentially the respiratory muscles. This bilateral ascending paralysis is a classic feature of GBS and occurs due to the immune system attacking the myelin sheath of peripheral nerves. The nurse should be vigilant for signs of progressive weakness, as GBS can quickly lead to respiratory failure and requires prompt intervention.

C) Mask-like facial expressions:
Mask-like facial expressions are more commonly associated with Parkinson's disease, not Guillain-Barré Syndrome. Parkinson’s disease is characterized by a reduction in facial expressiveness due to the loss of dopaminergic neurons, leading to a fixed, unblinking, or "masked" appearance. While facial involvement can occur in GBS as the weakness ascends, it is not typically described as a "mask-like" expression.

D) Pill rolling actions made by the client's fingers:
Pill-rolling is a characteristic tremor often associated with Parkinson's disease and involves the repetitive motion of the fingers, as if rolling a pill. It is a resting tremor seen in Parkinson's disease and not in Guillain-Barré Syndrome. GBS primarily presents as weakness and loss of motor function, rather than tremors or other involuntary movements.

A) Administering oxygen via nasal cannula at 2 L/min:
Oxygen therapy may be necessary for clients with COPD, but in this case, the primary concern is thick, tenacious bronchial secretions that the client cannot clear. Administering oxygen may be appropriate if the client has low oxygen saturation, but it does not directly address the difficulty in expectorating sputum. The focus should be on hydration and mobilization of secretions, rather than oxygen administration alone.

B) Helping the client select a low-salt diet:
While a low-salt diet is important for clients with conditions like hypertension or heart failure, it is not directly relevant to the issue of tenacious bronchial secretions in COPD. The priority in this scenario is to improve the client’s ability to clear the thick mucus, which is more effectively addressed by hydration rather than dietary changes.

C) Maintaining a semi-Fowler's position as often as possible:
Positioning the client in a semi-Fowler's position can help improve lung expansion and facilitate breathing. It can also reduce the work of breathing and increase comfort. However, while this is a helpful positioning strategy, it is not the most direct intervention to address the client’s difficulty with expectoration. The client’s difficulty with mucus clearance is best addressed with hydration to thin the secretions.

D) Encouraging the client to drink 2 to 3 L of water daily:
Hydration is one of the most important interventions for clients with COPD who have tenacious bronchial secretions. Adequate fluid intake helps to thin mucus, making it easier to cough up and clear from the airways. This intervention directly addresses the client’s complaint of not being able to bring up mucus, making it the most appropriate action to take.