Exhibits

Rationale for Correct Choices:

• Place on Oxygen: The client’s oxygen saturation dropped to 85% on room air, indicating hypoxemia. Supplemental oxygen is required immediately to maintain levels above 93% and prevent worsening respiratory failure. This is consistent with the provider’s orders and emergent asthma care protocols.

• Administer Albuterol:  Albuterol is a rapid-acting beta-2 agonist bronchodilator that relieves airway constriction in acute asthma. It directly addresses the wheezing, chest tightness, and severe shortness of breath. Frequent nebulized doses are recommended in status asthmaticus.

• Status Asthmaticus: This is a severe, life-threatening asthma exacerbation unresponsive to initial bronchodilator therapy. The client’s confusion, tachypnea, hypoxemia, and inability to speak in full sentences are classic signs. Without prompt treatment, it can progress to respiratory arrest.

• Pulse Oximetry : Continuous pulse oximetry helps track oxygenation and the effectiveness of interventions. Given the hypoxemia, frequent monitoring is essential to prevent respiratory arrest.

• Respirations Respiratory rate and pattern reflect both asthma severity and the client’s progression toward respiratory fatigue. Worsening asthma can cause sudden respiratory rate drops as exhaustion sets in.

Rationale for Incorrect Choices:

• Suction Airway: There is no evidence of excessive secretions or mucus plugging; the main issue is bronchospasm and airway narrowing, not obstruction from secretions.

• Administer a Diuretic: Diuretics treat fluid overload (e.g., pulmonary edema), which is not present here. This client’s symptoms stem from asthma, not heart failure or volume excess.

• Obtain Sputum Culture: This is done if infection is suspected; the client denies fever and shows no purulent sputum production. This is an acute asthma exacerbation, not pneumonia.

• Anaphylactic Reaction: While both involve airway compromise, there are no signs of urticaria, hypotension, or sudden onset after allergen exposure. This client’s symptoms developed over 2–3 days.

• Pulmonary Edema: Pulmonary edema causes crackles, frothy sputum, and fluid overload symptoms, none of which are present. This client’s lung sounds are wheezy, not wet.

• RSV: RSV is a viral respiratory infection more common in infants and young children; the presentation and history point to asthma, not viral bronchiolitis.

• Troponin: Troponin measures cardiac injury, which is not suspected here. The client’s tachycardia is secondary to respiratory distress, not myocardial infarction.

• Urine Output: While urine output is important in some critical conditions, it is not the primary priority in acute asthma management.

• Temperature: There is no indication of infection or hyperthermia; temperature monitoring is routine but not a key focus in this acute situation.