Which assessment finding would the nurse expect in a client with a 10-year history of emphysema admitted for acute respiratory distress?

• A. Chest pain on inspiration
• B. Prolonged expiration with use of accessory muscles
• C. Signs and symptoms of respiratory alkalosis
• D. Decreased respiratory rate

Answer: (B)

Air trapping from emphysema makes exhaling difficult, so the body relies on accessory muscles to help force air out and the expiratory phase becomes prolonged. In acute respiratory distress, this manifests as increased work of breathing with visible use of the neck and chest muscles and a noticeably long, extended expiration as air is forced out slowly. The other patterns don’t fit COPD exacerbations: chest pain on inspiration is more typical of pleurisy or pulmonary embolism; respiratory alkalosis would imply blowing off CO2 from rapid breathing (not the usual CO2-retaining pattern of chronic emphysema); and a decreased respiratory rate would not align with the heightened drive to breathe seen in acute distress.