A nurse is caring for a client who has developed cor pulmonale secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following manifestations is caused by corpulmonale?

Barrel chest

Clubbing of the fingers

Destruction of the alveoli

Peripheral edema

Answer and Explanation

The Correct Answer is D

A.   Barrel chest is a physical finding commonly associated with COPD due to hyperinflation of the lungs. It results from chronic air trapping and enlargement of the chest. While barrel chest is not directly caused by cor pulmonale, it is a characteristic feature of advanced COPD.
B.   Clubbing of the fingers is not directly caused by cor pulmonale. It is typically associated with chronic hypoxia, which can occur in advanced lung diseases like COPD. Clubbing involves changes in the shape and texture of the nails and fingertips due to chronic lack of oxygen in the blood.
C.   Destruction of the alveoli is a hallmark of emphysema, which is a type of COPD. Emphysema leads to loss of lung tissue elasticity and surface area, contributing to chronic airflow limitation. While emphysema is a risk factor for developing cor pulmonale, destruction of alveoli itself does not directly cause cor pulmonale.
D.   Peripheral edema is a manifestation caused by cor pulmonale. When the right side of the heart fails (cor pulmonale), it leads to increased pressure in the pulmonary circulation, which can eventually cause fluid to leak out into the tissues, resulting in peripheral edema. This is a consequence of the right heart's inability to effectively pump blood forward due to pulmonary hypertension and subsequent right ventricular failure.

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Correct Answer is C

Explanation

A. The soles of the feet are not typically assessed for cyanosis because they are not a reliable indicator of central cyanosis. Cyanosis is best evaluated in areas where mucous membranes are visible.
B. Similar to the soles of the feet, the palms of the hands are not a reliable indicator of central cyanosis. Cyanosis is not typically visible on the palms unless there are severe systemic circulation issues.
C. The oral mucosa (inside the mouth) is a reliable area to assess for central cyanosis. The nurse can inspect the lips, tongue, and buccal mucosa for a bluish discoloration, which indicates decreased arterial oxygen saturation.
D. The nail beds are also a reliable indicator of central cyanosis. The nurse can assess the color of the nail beds and look for bluish discoloration, which can be more apparent in darker-skinned individuals compared to the lips and oral mucosa.

A. Petechiae on the oral mucosa. B. Hemoglobin of 14 g/dL. C. Bleeding of the gums after oral care. D. Pain and swelling in one leg.

Correct Answer is D

Explanation

A. Petechiae are tiny, pinpoint, red or purple spots on the skin or mucous membranes, caused by bleeding under the skin. While petechiae can indicate bleeding, they are not specific to HIT and can occur due to various reasons, including low platelet count or coagulation disorders. They do not necessarily indicate thrombotic complications associated with HIT.
B. This hemoglobin level is within the normal range for adults and does not directly correlate with HIT. However, it is important to monitor hemoglobin levels in patients with HIT due to the risk of bleeding and thrombosis.
C. Bleeding gums can occur due to various reasons, including gum disease or thrombocytopenia (low platelet count). In HIT, the concern is not just bleeding but also the paradoxical risk of thrombosis despite low platelet counts. Bleeding from mucosal surfaces can indicate underlying thrombocytopenia but does not specifically highlight the thrombotic risk of HIT.
D. This symptom is concerning for deep vein thrombosis (DVT), which is a thrombotic complication associated with HIT. HIT predisposes patients to thrombosis due to the formation of antibodies against

platelet factor 4/heparin complexes, leading to platelet activation and clot formation. DVT is a serious complication that requires immediate intervention to prevent pulmonary embolism (PE).

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A nurse is caring for a client who has developed cor pulmonale secondary to an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following manifestations is caused by corpulmonale?

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