The nurse is completing an assessment of a 42-year-old female with suspected Graves' disease.
The nurse would assess the client for:

Condition: Spasmodic croup
2 actions: Administer a single dose of oral dexamethasone; Position the child upright and provide humidified air
2 parameters: Respiratory rate and oxygen saturation; Stridor and work of breathing

Rationale for correct condition
Spasmodic croup presents in toddlers with sudden onset of nighttime barking cough without fever. It is often associated with atopy, such as eczema. The child is playful and afebrile with no daytime distress. Lungs are clear with normal oxygen saturation (98%) and respiratory rate (28/min; normal 20–40/min for toddlers). No infectious signs are present, supporting a diagnosis of spasmodic croup.

Rationale for correct actions
Oral dexamethasone reduces airway inflammation in croup and decreases symptom duration through corticosteroid-mediated cytokine inhibition. A single dose is effective in mild-to-moderate cases, reducing subglottic edema.
Positioning the child upright and using humidified air improves airflow by decreasing upper airway narrowing and soothing inflamed mucosa. It is a first-line supportive measure to alleviate nocturnal symptoms.

Rationale for correct parameters
Monitoring respiratory rate and oxygen saturation assesses oxygenation and ventilation status. Tachypnea or desaturation may signal worsening airway obstruction.
Stridor and work of breathing are key signs of upper airway compromise. Increased inspiratory effort or stridor at rest requires escalation of care.

Rationale for incorrect conditions
Respiratory syncytial virus causes wheezing, fever, and lower respiratory symptoms, which are absent here.
Epiglottitis presents with high fever, drooling, and toxic appearance, not seen in this playful child.
Acute laryngitis lacks the barking cough and is uncommon in toddlers.

Rationale for incorrect actions
Preparing for intubation is reserved for airway obstruction, which is not present.
Broad-spectrum antibiotics are ineffective in non-bacterial etiologies like croup.
Ribavirin targets RSV, which this child does not have.

Rationale for incorrect parameters
Swallowing ability and drooling assess epiglottitis, not croup.
Fever and WBC count are normal and nonspecific.
Wheezing and lung sounds assess lower airway disease, not upper airway croup.

Take-home points:

• Spasmodic croup causes nighttime barking cough without fever in toddlers.
• Differentiate from RSV (wheezing), epiglottitis (drooling), and laryngitis (hoarseness).
• Steroids and humidified air reduce symptoms in mild croup.
• Key assessments include stridor and respiratory status, not fever or wheezing.

Choice A rationale

Hypertension is a major modifiable risk factor for the progression of polycystic kidney disease (PKD) to end-stage renal disease (ESRD). Uncontrolled blood pressure exacerbates glomerular damage and accelerates the decline in renal function. Effective blood pressure control, often targeting specific parameters, significantly reduces the strain on kidneys, preserving nephron function and delaying ESRD.

Choice B rationale

While blood glucose control is crucial for clients with diabetes to prevent diabetic nephropathy, it is not the primary or most important intervention for slowing the progression of polycystic kidney disease (PKD). PKD is an inherited disorder characterized by cyst formation, and its progression is mainly driven by factors like hypertension.

Choice C rationale

Fluid restriction is generally not a primary intervention for slowing the progression of polycystic kidney disease (PKD). In fact, maintaining adequate hydration is often encouraged to prevent dehydration and reduce the risk of kidney stone formation, which can be a complication in PKD. Fluid management is individualized based on kidney function.

Choice D rationale

Pain management is important for comfort in clients with polycystic kidney disease (PKD) dueating to cyst enlargement or complications. However, managing pain does not directly slow the progression of the underlying disease process to end-stage renal disease (ESRD). The primary focus for slowing progression is on managing factors that directly impact renal function.