Elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.

Option B: Fever and chills are classic signs of pneumonia that may appear later in the elderly. The inflammatory response results in a proliferation of neutrophils. This can damage lung tissue, leading to fibrosis and pulmonary edema, which also impairs lung expansion.
Option C: Hemoptysis is a late sign of pneumonia. Bleeding in the lungs may originate from bronchial arteries, pulmonary arteries, bronchial capillaries, and alveolar capillaries. Dyspnea may occur early, especially among the elderly. Swelling and mucus can make it harder to move air through the airways, making it harder to breathe. This leads to shortness of breath, difficulty of breathing, and feeling more tired than normal.
Option D: Cough and pleuritic chest pain are the common symptoms of pneumonia. The air sacs may fill with fluid or pus, causing cough with phlegm or ous, fever, chills, and difficulty breathing.

Typical signs and symptoms are chills, fever, night sweats, and hemoptysis.

Option A: Chest pain may be present from coughing but isn’t usual. Pleurisy is a condition where there is inflammation or irritation of the lining of the lungs and chest. There is a sharp pain felt when breathing, coughing, or sneezing.
Option C: Clients with TB typically have low-grade fevers, not higher than 102°F (38.9°C). Fever typically develops in the late afternoon or evening in 68% of the cases, and this typical fever is significantly more common in patients less 60 years of age.
Option D: Nausea, headache, and photophobia aren’t usual TB symptoms. Typical symptoms include a cough that lasts for more than 3 weeks, loss of appetite and unintentional weight loss, fever, chills, and night sweats.

Based on the client’s history and symptoms, acute asthma is the most likely diagnosis.

Option B: Bronchial pneumonia most often exhibits a productive cough. It is the type of pneumonia that affects the bronchi in the lungs. This condition commonly results from a bacterial infection, but viral and fungal infections can also cause it.
Option C: COPD commonly occurs in middle-aged people, mostly over the age of 40. Chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
Option D: Emphysema is most common in men between the ages of 50 and 70. It is a lung condition that causes shortness of breath. The air sacs in the lungs are damaged. Over time, the inner walls of the air sacs weaken and rupture-creating larger air spaces instead of many small ones.

Narcotics can cause respiratory arrest if given in large quantities.

Option A: The client’s respiratory system is most likely being suppressed, so an acute asthma attack would be unlikely. In an asthma attack, the airways become swollen and inflamed. The muscles around the airways contract and the airways produce extra mucus, causing the breathing (bronchial) tubes to narrow.
Option C: A seizure is not likely to occur in the situation. Seizures are mostly caused by paroxysmal discharges from groups of neurons, which arise as a result of excessive excitation or loss of inhibition.
Option D: The client’s respiratory rate is too low and she might be going into a respiratory arrest. Respiratory depression happens when the lungs fail to exchange carbon dioxide and oxygen efficiently. This dysfunction leads to a buildup of carbon dioxide in the body, which can result in health complications.

Reduction in vital capacity is a normal physiologic change including decreased elastic recoil of the lungs, fewer functional capillaries in the alveoli, and an increase in residual volume.

Option A: Elastic recoil in the lungs of the elderly are decreased. There is homogenous degeneration of the elastic fibers around the alveolar duct starting around 0 years of age resulting in enlargement of air spaces.
Option B: There are fewer functional capillaries in the alveoli as one ages. The alveoli can lose their shape and become baggy.
Option C: Decreases in the measures of lung function such as the vital capacity occurs as part of the age-related changes.