A nurse is collecting data from a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status?
(Select All that Apply.)

Warm extremities

Wheezing

Nasal flaring

Retraction of sternal muscles

Oxygen saturation 95%

Answer and Explanation

Correct Answer : B,C,D

B. Wheezing is a common symptom of asthma exacerbation and can indicate airway obstruction. Wheezing may worsen during an asthma attack, suggesting deterioration in respiratory status.

C. Nasal flaring is a sign of increased respiratory effort and can occur during respiratory distress. In a child with asthma, nasal flaring may indicate worsening airway obstruction and increased work of breathing, suggesting deterioration in respiratory status.

D. Retraction of sternal muscles, also known as intercostal retractions, occurs when the muscles between the ribs are drawn inward during inspiration, indicating increased effort to breathe. Intercostal retractions are a sign of respiratory distress and can occur in children with asthma during exacerbations, particularly when airway obstruction is severe.

A. Warm extremities are not typically indicative of deterioration in respiratory status in a child with asthma. In fact, warm extremities may suggest adequate peripheral perfusion.

E. An oxygen saturation of 95% is within the normal range for most children and may not necessarily indicate deterioration in respiratory status. However, oxygen saturation should be interpreted in conjunction with other clinical signs and symptoms.

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Correct Answer is ["A","D"]

Explanation

A. Corticosteroids help reduce airway inflammation during an asthma exacerbation, which can help improve breathing and reduce symptoms.

D. Bronchodilator medications, such as albuterol, help relax the muscles around the airways, making it easier to breathe during an asthma exacerbation. They are typically used as rescue medications to provide immediate relief of asthma symptoms.

B. Placing the client in a supine position (lying flat on their back) is not recommended during an asthma exacerbation. This position can make breathing more difficult for someone experiencing respiratory distress.

C. Vigorous physical activity can exacerbate asthma symptoms and trigger an asthma attack. During an asthma exacerbation, it's important to encourage the client to rest and avoid strenuous activities that could worsen their breathing difficulties.

E. Cold compresses are not recommended for asthma exacerbations. Warm, moist air may help loosen mucus and ease breathing, but cold compresses could potentially exacerbate symptoms or discomfort.

A. "If the baby turns blue, I will immediately put the baby upright in an infant seat." B. "If the baby turns blue, I will lay him down on a firm surface with his head lower than the rest of his body." C. "If the baby turns blue, I will put the baby in supine position with his head elevated." D. "If the baby turns blue, I will hold him against my shoulder with his knees bent up toward his chest."

Correct Answer is D

Explanation

This position, often referred to as the "knee-to-chest" position, is recommended during a cyanotic spell in infants with tetralogy of Fallot because it can help increase venous return to the heart and improve oxygenation. It's important for caregivers to understand this positioning as part of the management for hypercyanotic spells in children with this condition.

A. Placing the baby upright in an infant seat may help improve blood flow and oxygenation, but it's not the recommended position for managing cyanosis in a baby with tetralogy of Fallot.

B. Placing the baby with the head lower than the rest of the body could potentially worsen cyanosis by increasing right-to-left shunting of blood and decreasing pulmonary blood flow.

C. Placing the baby in a supine position with the head elevated worsens pulmonary blood flow by increasing systemic vascular resistance. This position can help worsen cyanosis by promoting better oxygenation.

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A nurse is collecting data from a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? (Select All that Apply.)

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Naxlex Comprehensive Predictor Exams

Which interventions should be implemented for a pediatric client experiencing an asthma exacerbation? (SELECT ALL THAT APPLY)

Correct Answer is ["A","D"]

Explanation

The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly becomes cyanotic. Which statement by the father leads the nurse to determine he understood the instructions?

Correct Answer is D

Explanation

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A nurse is collecting data from a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status?
(Select All that Apply.)