A nurse is caring for an 18-month-old toddler who has been hospitalized for 10 days.
After the toddler’s mother leaves the room, the nurse observes the toddler sitting quietly in the corner of the crib, sucking her thumb.
When the nurse approaches the crib, the toddler turns away from the nurse.
The nurse should understand that these behaviors indicate which of the following developmental reactions?

Choice A rationale:

Oxygen saturation of 88% on room air is significantly below the normal range (95-100%) and indicates hypoxemia. This finding should be reported to the provider as it may require supplemental oxygen or other interventions.

Choice B rationale:

A heart rate of 128/min is elevated for a school-age child and may indicate increased work of breathing, fever, or other underlying issues. This finding should be reported to the provider for further evaluation.

Choice C rationale:

While the child reporting chest discomfort as 4 on a scale of 0 to 10 is important, it is not as critical as the other findings. The provider should be aware of the discomfort, but it may not require immediate intervention.

Choice D rationale:

An elevated WBC count of 15,000/mm³ indicates an infection, which is consistent with the diagnosis of bilateral pneumonia. While this is important information, it is expected in the context of the current diagnosis and may not require immediate reporting.

Choice E rationale:

Passing three large, frothy, foul-smelling stools is significant in a child with cystic fibrosis as it may indicate malabsorption or other gastrointestinal issues. This finding should be reported to the provider for further evaluation and potential adjustment of the treatment plan.

The correct answers are Choices A, C, and E.

Choice A rationale

Daytime symptoms occurring more than twice a week is an expected finding in mild persistent asthma. This indicates that the asthma is not well-controlled and requires regular use of a controller medication.

Choice B rationale

Nighttime symptoms occurring approximately twice a month is more characteristic of intermittent asthma, not mild persistent asthma.

Choice C rationale

Minor limitations with normal activity are expected in mild persistent asthma. This indicates that the asthma is affecting the child’s daily activities to some extent.

Choice D rationale

Symptoms that are continuous throughout the day are indicative of severe persistent asthma, not mild persistent asthma.

Choice E rationale

A peak expiratory flow (PEF) greater than or equal to 80% of the predicted value is an expected finding in mild persistent asthma. This indicates that the child’s lung function is relatively well-preserved. .