Advanced Health Assessment Practice Exam

What does clubbing of the fingernails typically indicate in a client with a history of heavy smoking?

1. Dehydration

2. Chronic hypoxia

3. Lung cancer

4. Congestive heart failure

The correct answer is: Chronic hypoxia

Clubbing of the fingernails is often associated with chronic hypoxia, which can result from longstanding respiratory conditions or oxygen deprivation in the tissues. In a client with a history of heavy smoking, clubbing can signal the presence of underlying lung disease. Chronic hypoxia leads to changes in the nail bed and surrounding tissues, resulting in the characteristic rounded, bulbous appearance of the nails. In smokers, conditions that commonly lead to chronic hypoxia include chronic obstructive pulmonary disease (COPD) and interstitial lung disease, both of which can adversely affect oxygen exchange in the lungs. As the body struggles to obtain adequate oxygen, it stimulates changes that manifest as clubbing, making it a significant clinical sign indicating chronic respiratory issues. While lung cancer may also be a consideration in heavy smokers, it is less directly associated with the phenomenon of clubbing compared to chronic hypoxia, which is a broader condition that encompasses various lung-related diseases common among smokers. Dehydration and congestive heart failure can have their own effects but are not typically linked to clubbing in the same definitive way as chronic hypoxia.