Walkthrough Q3: Reduction of Risk Potential – NCLEX-PN®

00:01 The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease.

00:06 Which physical exam finding is of most concern? Okay. Hang out in that stem.

00:12 You know the drill. So, who am I? I'm the nurse and I'm taking care of a client.

00:17 What's unique about this client? Well, they have a diagnosis of chronic obstructive pulmonary disease.

00:25 Now, that last sentence, the one that really focuses you.

00:28 Which physical exam finding is of most concern? Okay. Why did I do that? Well, because I want you to really see that word most concern. I only have four options.

00:41 That means the correct answer is the one that's of most concern of these four.

00:49 You don't get to rewrite the question. You don't get to argue.

00:52 The NCLEX elves that write these questions want to see, of these four options, can you recognize which one is the most concerning? Okay. So, let's go. I put it in my own - in my own words.

01:05 Which exam finding is most concerning for a client with chronic obstructive pulmonary disease? That is the topic of the question. Number one, hyperresonance on percussion of the lung fields.

01:19 Okay. In a COPD patient, is this concerning? No. Actually, it's kind of normal because hyperresonance happens when in COPD, there's a lot of damage that's done to the lung tissue.

01:34 And so, this can be a normal, more of an expected finding with COPD.

01:40 So, I don't think this is going to be the most concerning, but I don't know till I work through all of these.

01:46 So, for now, I'm going to compare number one to number two because that's the key to prioritizing, compare what you have and see which one is the worst. I always tell students, "Think of this as a card game." These are the four cards that you're dealt. You have to work with what you have.

02:03 So, now, let's look at number two. Clubbing of the client's fingers.

02:08 So, this is a COPD patient, chronic obstructive pulmonary disease. They have clubbing of their fingers.

02:14 Well, patients' fingers club because they've been low oxygen in their bloodstream over a long period of time.

02:23 Am I more worried about hyperresonance or clubbing? Well, I think I'm going to go with number one because that seems to have more to do with the respiratory status, so, I'm going to cross-off number two.

02:35 Now, I'm going to compare number three. Barrel-chested appearance with pursed lip breathing.

02:41 Okay. Barrel-chested means you normally are supposed to be, like, wider this way than you are this way, right? But barrel-chested people, it looks like they're wearing a barrel because of the damage that's done to their lung tissues, it pushes everything out.

02:54 And what about the pursed-lip breathing? Are they in - are they in respiratory distress? Well, probably not necessarily because we know that that is when they exhale, they do this.

03:03 That's pursed-lipped breathing. They're putting extra intentional effort into emptying their lungs with air because that's really tough. For COPD patients, air gets trapped in there.

03:20 So, is that most concerning? Well, it's more concerning than number one because not everyone with COPD sits around going all the time.

03:31 So, now, I can get rid of number one because number three is a little bit bigger deal.

03:37 Number four, dullness to percussion in the left lower lung. Now, that's really specific.

03:43 Dullness to percussion in the left lower lung. Is that normal with COPD? No. Hyperresonance is normal. Dullness to percussion means, "Hey, something else is going on." Either the lung has collapsed or it's really full and thick of stuff or something's going on that we need to follow-up.

04:04 Number four is the most concerning physical assessment of these three.

04:11 So, go back, check your answer one more time, make sure it lines up with that final sentence.

04:16 I'm confident that it is and there you go.

04:19 You're done with this prioritization or most concerning physical assessment question.