The nurse offers a variety of fluids to a 5-year-old asthmatic child to compensate for the fluid loss through dyspnea.
Which fluids are most appropriate?

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.

Choice A rationale

Cystic fibrosis is an autosomal recessive genetic disorder. This means that for a child to express the disease phenotype, they must inherit two copies of the defective gene, one from each parent. If only one parent carries the CF gene, the child would be a carrier but would not manifest the disease.

Choice B rationale

For an autosomal recessive disorder like cystic fibrosis, both parents must be heterozygous carriers of the defective gene. Each parent contributes one copy of the recessive allele, resulting in a 25% chance with each pregnancy that the child will inherit two copies of the defective gene and develop cystic fibrosis.

Choice C rationale

Multifactorial inheritance involves the interaction of multiple genes and environmental factors, leading to a phenotypic expression. While some complex diseases have multifactorial inheritance, cystic fibrosis has a well-defined monogenic autosomal recessive inheritance pattern, meaning it is primarily determined by mutations in a single gene, the CFTR gene.

Choice D rationale

While genetic mutations are the underlying cause of cystic fibrosis, the phrasing "probably a genetic mutation" is too vague and does not accurately explain the inheritance pattern. The mutation must be present on both alleles of the CFTR gene, inherited from carrier parents, to cause the disease.