A nurse is collecting data from a client who is experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect?

Choice A rationale Concave curving of the fingernail beds, also known as koilonychia or spooning of the nails, is typically associated with iron deficiency anemia rather than chronic obstructive pulmonary disease. In chronic respiratory conditions characterized by long term hypoxia, the nurse would instead expect to find clubbing. Clubbing involves the straightening of the nail angle and a bulbous swelling of the fingertips due to connective tissue proliferation from chronic low oxygen levels in the systemic circulation. Choice B rationale A PaO2 of 99 mm Hg is within the normal reference range of 80 to 100 mm Hg and represents excellent oxygenation of the arterial blood. In a client experiencing an acute exacerbation of chronic obstructive pulmonary disease, the nurse should expect hypoxemia. This occurs because of air trapping, alveolar hypoventilation, and a ventilation perfusion mismatch. Therefore, a PaO2 significantly lower than 80 mm Hg would be a much more common finding during an acute respiratory crisis. Choice C rationale A decreased anterior-posterior chest diameter is not expected in this condition. Patients with chronic obstructive pulmonary disease typically develop an increased diameter, commonly referred to as a barrel chest. This structural change results from chronic air trapping and hyperinflation of the lungs. The rib cage remains partially expanded at all times because the lungs lose their elastic recoil. A decreased diameter is not consistent with the pathophysiology of long term obstructive airway disease or hyperinflation. Choice D rationale A PaCO2 of 48 mm Hg is elevated above the normal reference range of 35 to 45 mm Hg, indicating respiratory acidosis and hypercapnia. This is a classic finding in chronic obstructive pulmonary disease exacerbations. As the airways become more obstructed and the lungs lose elasticity, the client cannot effectively exhale carbon dioxide. This results in the retention of CO2 in the blood. Hypercapnia is a hallmark of advanced or acute respiratory failure in these specific patients.