A patient will be receiving oral theophylline (Theo-Dur), 600 mg/day, in three divided doses.

Identify how many milligrams the patient will receive per dose.

Choice A rationale

Swimming is often recommended for asthmatic children because the warm, humid air around a swimming pool helps to keep airways moist, reducing the likelihood of exercise-induced bronchoconstriction. The horizontal body position also facilitates easier breathing and lessens the impact of gravity on respiratory effort.

Choice B rationale

Gymnastics involves short bursts of intense activity and often takes place in indoor environments where air quality might be variable or allergens present. The sudden, high-intensity exertion without sustained rhythmic breathing can trigger exercise-induced asthma, making it less ideal for asthmatic children due to fluctuating energy demands.

Choice C rationale

Baseball involves intermittent activity with periods of rest, allowing for recovery between bursts of exertion. This stop-and-go nature, combined with playing outdoors in potentially open air, generally makes it a suitable sport for children with asthma as it reduces the continuous strenuous effort that can trigger bronchospasm.

Choice D rationale

Cross-country skiing, especially in cold, dry air, is a significant trigger for exercise-induced bronchoconstriction in asthmatic individuals. The combination of intense, sustained exertion and breathing cold, dry air rapidly irritates and constricts the airways, making it a high-risk activity for asthmatic children.

Choice E rationale

Distance running involves prolonged, continuous, and often high-intensity aerobic activity, which can lead to significant increases in minute ventilation. This sustained exertion, especially in varying environmental conditions, is a common and potent trigger for exercise-induced asthma, making it a challenging sport for many asthmatic children.

Choice A rationale

A 30-pack-year smoking history indicates significant cumulative exposure to respiratory irritants, predisposing the client to COPD development. However, this historical factor does not indicate acute respiratory distress requiring immediate intervention. While a strong risk factor, it doesn't present as an emergent physiological alteration demanding first assessment in this scenario. Current physiological stability takes precedence over historical risk.

Choice B rationale

A client in a tripod position utilizing accessory muscles to breathe indicates significant respiratory distress and increased work of breathing. This compensatory mechanism suggests impending respiratory failure or severe hypoxemia. This is an acute, life-threatening physiological manifestation demanding immediate nursing assessment and intervention to prevent respiratory arrest and optimize oxygenation.

Choice C rationale

Dependent edema and clubbed fingers are chronic manifestations of long-standing respiratory and/or cardiovascular compromise, often seen in advanced COPD or cor pulmonale. While indicative of significant disease progression, they do not represent an acute, life-threatening emergency demanding immediate assessment over active respiratory distress. These are chronic adaptations, not acute decompensation.

Choice D rationale

A chronic cough with thick, tenacious secretions is a common symptom in COPD, indicating impaired mucociliary clearance and chronic inflammation. While these symptoms can exacerbate acute respiratory issues, they do not inherently suggest the acute, life-threatening respiratory distress seen in a client using accessory muscles, thus not requiring the absolute first assessment.