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Multiple Choice
Based on the client's respiratory assessment, which finding most likely indicates impaired gas exchange?
A
Warm, dry skin
B
Clear breath sounds bilaterally
C
Cyanosis of the lips and fingertips
D
Respiratory rate of 16 breaths per minute
Verified step by step guidance
1
Step 1: Understand the concept of gas exchange. Gas exchange refers to the process by which oxygen is absorbed into the bloodstream from the lungs and carbon dioxide is expelled. Impaired gas exchange can result in insufficient oxygen delivery to tissues and accumulation of carbon dioxide.
Step 2: Evaluate the provided findings. Warm, dry skin and clear breath sounds bilaterally are normal findings and do not indicate impaired gas exchange. A respiratory rate of 16 breaths per minute is within the normal range for adults (12-20 breaths per minute).
Step 3: Focus on cyanosis as a key indicator. Cyanosis refers to a bluish discoloration of the skin, lips, or fingertips due to inadequate oxygenation of the blood. This is a hallmark sign of impaired gas exchange, as it suggests hypoxemia (low oxygen levels in the blood).
Step 4: Relate cyanosis to the underlying physiology. Cyanosis occurs when hemoglobin in the blood is not sufficiently oxygenated, often due to issues such as lung disease, airway obstruction, or circulatory problems that impair oxygen delivery.
Step 5: Conclude that cyanosis of the lips and fingertips is the most likely finding indicating impaired gas exchange, as it directly reflects insufficient oxygenation of the blood.