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Muscle weakness is often associated with hypokalemia, which can be an electrolyte imbalance found in metabolic alkalosis due to increased renal potassium excretion; however, it is a symptom of the disorder and electrolyte shift, not a primary physiological compensatory mechanism utilized by the body to return the blood pH (normal range 7.35 to 7.45) toward a normal range.

Frequent crying is a behavioral response, often observed in children under stress or discomfort, but it does not represent a direct physiological compensatory mechanism for metabolic alkalosis. Crying involves changes in breathing patterns, but it is not a sustained, controlled physiological process like hypoventilation designed to restore acid-base balance toward a neutral pH.

Crackles, also known as rales, are abnormal respiratory sounds indicating fluid in the small airways or alveoli, often associated with conditions like pulmonary edema or heart failure, and they are not a compensatory mechanism for metabolic alkalosis. The primary respiratory compensation is a deliberate decrease in the ventilation rate to retain CO2.

While administering oxygen is a necessary supportive measure for a client experiencing hypoxemia during status asthmaticus, the immediate life-threatening problem is the severe airway obstruction, which must be addressed first to open the airways and allow the oxygen to reach the alveoli. The SABA (Choice A) addresses the root problem of bronchospasm most rapidly and effectively.

Administering a long-acting B2 agonist (LABA) is not appropriate for the acute management of status asthmaticus. LABAs, such as salmeterol, have a slow onset of action and are designed for long-term control and maintenance therapy of asthma, not for the immediate relief of a severe, acute exacerbation requiring rapid bronchodilation.

Administering intravenous corticosteroids (e.g., methylprednisolone) is a crucial intervention to reduce airway inflammation in status asthmaticus, but their therapeutic effects require several hours to become fully evident. Therefore, they are secondary to the immediate life-saving bronchodilation provided by the inhaled short-acting B2 agonist (Choice A).
 

Developing a chart and checklist is a structured technique that might be more engaging for an older, school-age child who can understand and appreciate the goal-setting and reward structure, but it is typically too abstract and lacks the imaginative component required to effectively engage a preschooler (ages three to five).

Leaving a favorite drink at the bedside relies on the preschooler's intrinsic thirst mechanism and independent decision to drink, which is an unreliable strategy for ensuring adequate intake in a potentially ill or distracted young child. Preschoolers often require active encouragement and play to maintain consistent fluid intake.

Promising a reward for compliance, while sometimes effective, can lead to a power struggle and may not foster a positive association with the necessary health behavior. The focus should be on making the activity itself fun and appealing through developmentally appropriate means, such as engaging imaginative play.

A report of chest tightness is a common and serious symptom of asthma exacerbation, indicating bronchoconstriction and airway narrowing. However, it is a subjective report and is not as immediately indicative of impending respiratory failure as a significant, objective physical finding like absent breath sounds (Choice D).

An expiratory wheeze heard at the lung base indicates narrowed airways due to bronchospasm, but the presence of any breath sounds, even abnormal ones, indicates air movement is still occurring. This finding is serious but is less critical than the loss of audible breath sounds, which signals a dire emergency.

A heart rate of 112 beats per minute (tachycardia) is a common physiological response to hypoxemia, stress, or the use of B2 agonist medications (e.g., albuterol). While it warrants monitoring, it is a compensatory sign and does not represent the immediate, life-threatening crisis that a lack of air movement does.

Planning a home visit is an inappropriate initial action because it delays the mandated reporting required by law when a health professional suspects child abuse or neglect. The nurse’s primary legal and ethical obligation is to ensure the child’s safety by reporting the immediate danger of sexual abuse to the proper authorities, such as Child Protective Services (CPS), before any further contact occurs. Delaying reporting can put the child at continued and immediate risk of harm.

While involving the principal might be a step in the school protocol for addressing safety issues, arranging a meeting with the parents and principal before reporting is a significant failure of the legal mandate to report suspected child abuse immediately. The child's statement constitutes reasonable suspicion of sexual abuse, which requires direct reporting to CPS. Discussing the allegations with the parents first could potentially increase the child's risk or compromise the necessary investigation.

Advising the child to re-report the abuse to the parents is inadequate and unsafe, as the child has already reported to the parents who subsequently dismissed the concern and mandated the visit. This action places the responsibility for protection back on the child and the unresponsive parents. The nurse has a professional and legal duty to bypass the non-protective parents and report the alleged abuse directly to the appropriate governmental protective agency (CPS) immediately.

Intravenous antibiotics are indicated only if a bacterial secondary infection is suspected, which is not the primary mechanism of bronchodilation in croup (laryngotracheobronchitis), which is typically viral. Hydration is supportive but does not directly cause bronchodilation. Croup causes subglottic inflammation and edema, and antibiotics will not reduce this swelling or open the narrowed airway, thus making this intervention ineffective for immediate bronchodilation.

Administering an oral analgesic, such as ibuprofen or acetaminophen, may help with fever or discomfort but has no direct pharmacologic effect on bronchodilation or the inflammation causing the airway narrowing in croup. Bronchodilation requires medications that act on the smooth muscle or mucosal inflammation of the airway, which analgesics do not do, rendering this an ineffective treatment for the primary respiratory distress.

Nasopharyngeal suctioning may clear upper airway secretions, which is helpful in infants but does not address the main obstruction, which is subglottic laryngeal edema located below the vocal cords. Antipyretics only reduce fever. These interventions do not effectively reduce the inflammation and edema in the subglottic region that causes the stridor and airway obstruction, making them ineffective for achieving true bronchodilation. .

Reducing tissue oxygen demands is not the most immediate or highest-priority concern in this scenario. While the client may be slightly anemic due to excessive milk intake impairing iron absorption, the primary issue is chronic constipation and excessive caloric intake from whole milk, which necessitates dietary changes before focusing on oxygen demands. Hemoglobin levels typically need to be assessed to determine the severity of any anemia before this is a primary focus.

Developing a safety plan, such as discussing injury prevention, is a standard component of well-child visits for a 15-month-old due to increased mobility and curiosity. However, the client's current physiological issues, specifically severe constipation and high-calorie intake from milk, pose a more urgent risk to health and development, making dietary intervention the priority.

Promoting increased physical activity is a crucial health recommendation for an overweight child and is appropriate for this age group. Nevertheless, the client is already described as active, and the immediate, painful issue of severe constipation and the underlying dietary imbalance must be addressed first, as the diet is the root cause of the current discomfort and potential nutrient deficiency.

Discussing toilet training methods is inappropriate for a 15-month-old, as most children lack the physiological and psychological readiness until 18 to 24 months, which is beyond this client's current developmental stage. The current focus should be on resolving the client's ongoing severe constipation through dietary changes and increasing fiber intake.

Respiratory acidosis is caused by hypoventilation, leading to retention of carbon dioxide (CO_2), which then combines with water to form carbonic acid. Diarrhea does not directly impair respiratory function; in fact, the body compensates for metabolic acidosis by increasing ventilation (Kussmaul breathing) to blow off CO_2.

Metabolic alkalosis is characterized by an excessive loss of acid or an excessive retention of base, resulting in an elevated blood pH and an elevated serum bicarbonate level. This is commonly seen with prolonged vomiting (loss of gastric HCl) or diuretic use, which is the opposite of the fluid and electrolyte loss pattern seen with diarrhea.

Respiratory alkalosis is caused by hyperventilation, leading to an excessive loss of carbon dioxide (CO_2), resulting in a decrease in the partial pressure of CO_2 (PaCO_2 normal 35 to 45 mmHg) and an elevated blood pH. While the child may hyperventilate as a compensatory mechanism, this is not the primary physiological imbalance caused by diarrhea itself.

While cognitive development is important, cerebral palsy (CP) is fundamentally a disorder of movement and posture. The primary educational focus must be on managing the motor impairments, spasticity, and associated musculoskeletal issues like contractures, which directly impact the child's daily function and quality of life, making motor skill preservation the priority.

Maintaining immobility of the limbs with splints is incorrect and detrimental. Splints and orthotics are used in CP to prevent contractures and support proper alignment, but they must be combined with active and passive range-of-motion exercises to maintain joint flexibility and muscle length, not to immobilize the limbs entirely, which would worsen contractures.

Swallowing and feeding difficulties are common in CP due to poor muscle control. While special formulas or modified food textures may be needed to ensure adequate nutrition and prevent aspiration, the primary intervention is often postural changes and specific feeding techniques, not just offering a special formula, and the major physical priority is muscle and joint management. .