The nurse is assessing the elderly client's respiratory system. Upon auscultation, rales are detected bilaterally in both lower lobes. Scattered rales are heard in the upper lung fields. These adventitious sounds do not clear with a cough
The nurse percusses the client's lung fields and determines the presence of dull sounds. The nurse would correctly suspect which of the following? 1. Emphysema
2. Pulmonary edema
3. End-stage chronic obstructive pulmonary disease
4. Pulmonary fibrosis
2
Rationale 1: Emphysema produces diminished breath sounds.
Rationale 2: Rales that extend upward and do not clear with cough suggest pulmonary edema. Dullness indicates fluid accumulation from pulmonary edema.
Rationale 3: The absence of breath sounds, harsh rhonchi, or bronchovesicular breath sounds in the periphery are indicative of advanced chronic lung disease.
Rationale 4: Coarse, loud rales may be signs of pulmonary fibrosis and are usually found in clients with longstanding lung disease.
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