What classic sign would the nurse, auscultating the breath sounds of a child hospitalized for an acute asthma attack, expect to find?
Fine crackles.
Coarse rhonchi.
Expiratory wheezing.
Decreased breath sounds at lung bases.
The Correct Answer is C
Choice A rationale
Fine crackles are typically associated with fluid in the small airways or alveoli, as seen in conditions like pneumonia or heart failure, rather than the bronchoconstriction characteristic of asthma. During an acute asthma attack, the primary issue is narrowing of the bronchioles, leading to different adventitious sounds.
Choice B rationale
Coarse rhonchi are often indicative of secretions in larger airways, which can be cleared by coughing. While some mucus production can occur in asthma, coarse rhonchi are not the classic or primary auscultatory finding during an acute asthma attack, where airway smooth muscle constriction is the dominant pathology.
Choice C rationale
Expiratory wheezing is the hallmark auscultatory finding in an acute asthma attack. It is produced by the turbulent flow of air through narrowed lower airways, particularly during exhalation, as the bronchial smooth muscles constrict, and the airways become obstructed due to inflammation and mucus plugging.
Choice D rationale
Decreased breath sounds at the lung bases can indicate poor air entry into those areas, often due to atelectasis, pleural effusion, or severe airway obstruction. While severe asthma can lead to diminished breath sounds if airflow is severely compromised, expiratory wheezing is the more specific and classic initial finding during an acute exacerbation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The sweat chloride test is the gold standard for diagnosing cystic fibrosis. It measures the concentration of chloride in sweat, which is significantly elevated (normal range is generally less than $40 \text{ mmol/L}$, while values greater than or equal to $60 \text{ mmol/L}$ are diagnostic) in individuals with cystic fibrosis due to a defect in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, impairing chloride reabsorption.
Choice B rationale
A sputum culture identifies specific microorganisms present in the respiratory tract and their antibiotic sensitivities, which is useful for guiding treatment of respiratory infections in cystic fibrosis, but it does not confirm the underlying genetic defect characteristic of the disease. It is a diagnostic tool for secondary complications.
Choice C rationale
A stool fat content analysis assesses malabsorption, which is a common finding in cystic fibrosis due to pancreatic insufficiency. While indicative of pancreatic involvement, it does not definitively confirm the diagnosis, as other conditions can also cause fat malabsorption. The normal range for 24-hour fecal fat excretion is less than $7 \text{ g}$ in adults on a $100 \text{ g/day}$ fat diet.
Choice D rationale
Pulmonary function tests evaluate lung volumes, capacities, and flow rates. These tests are essential for assessing the severity and progression of lung disease in cystic fibrosis patients, but they do not establish the initial diagnosis. They provide information on the functional impact of the disease on the respiratory system.
Correct Answer is A
Explanation
Choice A rationale
Room temperature water is optimal for hydration in asthmatic children because it is less likely to trigger bronchospasm. Cold fluids can irritate the sensitive airways and cause constriction of the smooth muscles surrounding the bronchioles, exacerbating respiratory symptoms in individuals with reactive airways like asthmatics.
Choice B rationale
Carbonated beverages are generally not recommended for asthmatic children. The carbonation can cause bloating and discomfort, potentially leading to increased pressure on the diaphragm and exacerbating breathing difficulties. Additionally, the sugars and artificial ingredients in some carbonated drinks may not be ideal for overall health.
Choice C rationale
Iced fruit juice, similar to other cold beverages, can induce bronchospasm in susceptible individuals with asthma. The cold temperature can trigger airway hyperreactivity, leading to narrowing of the airways and worsening of asthmatic symptoms. Therefore, it is best to avoid very cold drinks.
Choice D rationale
Cold milk, like other cold beverages, can potentially trigger bronchoconstriction in asthmatic children due as it can irritate sensitive airways. Furthermore, some individuals with asthma may have co-existing milk allergies or sensitivities that can exacerbate respiratory symptoms, making it a less optimal choice.
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