Questions: A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). Which finding would be most concerning? Oxygen saturation of 90% on room air Increased anterior-posterior chest diameter Use of accessory muscles during breathing Productive cough with clear sputum

The most concerning finding would be the use of accessory muscles during breathing.

Explanation for each option:

1. Oxygen saturation of 90% on room air: While this is lower than normal (typically 95-100% in healthy individuals), it is not uncommon for patients with COPD to have lower oxygen saturation levels. This finding is concerning but not the most critical.

2. Increased anterior-posterior chest diameter: This is a common physical change in patients with COPD, often referred to as "barrel chest." It indicates chronic lung hyperinflation but is not immediately life-threatening.

3. Use of accessory muscles during breathing: This is the most concerning finding. It indicates that the patient is working harder to breathe and may be experiencing respiratory distress or impending respiratory failure. This requires immediate medical attention.

4. Productive cough with clear sputum: A productive cough is a common symptom in COPD patients. Clear sputum is less concerning than sputum that is yellow, green, or bloody, which could indicate an infection or other complications.

Summary: The use of accessory muscles during breathing is the most concerning finding as it suggests the patient is in respiratory distress and may need urgent medical intervention.