A nurse is reinforcing teaching with a client who has kidney stones. Which of the following instructions should the nurse include?

Choice A reason: A pleural friction rub is associated with conditions that cause pleural inflammation, such as pleuritis or pneumonia, rather than Chronic Obstructive Pulmonary Disease (COPD). While patients with COPD may experience other abnormal lung sounds like wheezing or crackles, pleural friction rubs are not typically a feature of COPD.

Choice B reason: Peripheral edema is a common finding in clients with advanced COPD, particularly in those who develop right-sided heart failure (also known as cor pulmonale). The prolonged hypoxia and pulmonary hypertension that often accompany COPD can put additional strain on the right side of the heart, leading to fluid retention and swelling in the extremities. This is a typical finding in later stages of COPD.

Choice C reason: Spoon nails (koilonychia) are typically associated with iron deficiency anemia or other conditions affecting the circulatory system. Although COPD is a chronic respiratory condition that can impact oxygenation, spoon nails are not commonly associated with COPD. This condition is more commonly seen in anemia or other nutritional deficiencies.

Choice D reason:

Hyperresonance on percussion is a typical finding in COPD, especially in those with emphysema, where air trapping occurs. This is due to the destruction of lung tissue and the over-inflation of alveoli, which creates a more resonant sound when the chest is percussed. This finding indicates the presence of hyperinflated lungs, a hallmark of emphysema and a common component of COPD.

Choice A reason: An upper GI series is a series of X-rays used to examine the esophagus, stomach, and small intestine, not the rectum or colon.

Choice B reason: A colonoscopy is the most appropriate test for screening for rectal cancer as it allows for the

examination of the entire colon and rectum and can also facilitate the removal of polyps.

Choice C reason: ERCP is primarily used to diagnose and treat conditions in the liver, gallbladder, bile ducts, and pancreas, not the rectum.

Choice D reason: An upper GI endoscopy, or esophagogastroduodenoscopy (EGD), is used to examine the lining of the upper part of the gastrointestinal tract, which includes the esophagus, stomach, and duodenum, not the rectum.