The nurse assessing a client for symptoms of chronic obstructive pulmonary disease (COPD) realizes that the earliest manifestation to occur in the course of the disease is:

Question

1. Clubbing of the fingers.
2. Cyanotic nail beds.
3. Dysrhythmias.
4. Cough in the morning producing clear sputum.

Answer 1

4. Cough in the morning producing clear sputum

Rationale:
The earliest presenting symptom of COPD is a morning cough with clear sputum unless the client develops an infection, in which case the sputum would become yellow or green in color. With the progression of COPD the body compensates by producing extra red blood cells. These extra blood cells clog the small blood vessels of the fingers leading to the development of cyanotic nail beds and clubbing of the fingertips. Enlargement and thickening of the right ventricle of the heart often results in dysrhythmias.