Which symptoms are most consistent for a school-age patient who presents with mild to moderate asthma?
Cyanosis.
Chest tightness.
A cough that is always productive.
Wheezing.
Prolonged expiration.
Correct Answer : B,D,E
Choice A rationale
Cyanosis, a bluish discoloration of the skin and mucous membranes, indicates significant hypoxemia (low oxygen saturation) and is a sign of severe, life-threatening asthma exacerbation, not a mild to moderate presentation. In mild to moderate asthma, the body can usually compensate to maintain adequate tissue oxygenation despite airway constriction and inflammation.
Choice B rationale
Chest tightness is a subjective but common symptom in asthma, resulting from the bronchoconstriction and smooth muscle spasm that narrow the airways. The sensation is often described as a band around the chest, reflecting the increased work of breathing and the mechanical effort required to move air through the restricted bronchial passages.
Choice C rationale
An asthma cough is typically non-productive (dry) or, if secretions are present, it is often a mucoid, tenacious sputum. A consistently productive cough suggests other underlying conditions, such as infection (e.g., pneumonia) or bronchiectasis, rather than being the hallmark of a primary, mild-to-moderate asthma flare.
Choice D rationale
Wheezing, a high-pitched whistling sound, is the classic objective sign of asthma, caused by the vibration of air attempting to move rapidly through the severely narrowed, obstructed small airways (bronchioles) during respiration. It is often most prominent on expiration but can be present on inspiration during a significant episode.
Choice E rationale
Prolonged expiration occurs because the narrowed, inflamed airways obstruct the outflow of air, leading to air trapping and a higher residual volume. The patient must forcefully and slowly push air out against the resistance, making the expiratory phase last significantly longer than the inspiratory phase, a key sign of obstructive lung disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D"]
Explanation
Choice A rationale
Decreased urine output (oliguria, typically <1 mL/kg/hour in a child) is a sign of poor renal perfusion due to reduced cardiac output and is characteristic of later, decompensated shock. In early, compensated septic shock, systemic vascular resistance (SVR) is often reduced (warm shock), and the compensatory mechanisms may still maintain adequate renal blood flow and normal urine output.
Choice B rationale
Cool extremities result from intense peripheral vasoconstriction as a compensatory mechanism to shunt blood to vital organs. This is characteristic of hypovolemic or cold septic shock (high SVR). However, in the more common early warm septic shock in children, peripheral vasodilation (low SVR) leads to flushed, warm extremities, not cool ones.
Choice C rationale
Normal blood pressure (BP) (systolic BP within the normal range, which varies by age, e.g., >90 mmHg in a school-aged child) is the hallmark of compensated shock. Compensatory mechanisms, primarily tachycardia and mild vasoconstriction, are successfully maintaining cardiac output and thus adequate mean arterial pressure, despite underlying circulatory dysfunction.
Choice D rationale
Tachycardia (elevated heart rate, normal range varies by age, e.g., >130 bpm in a toddler) is one of the earliest and most reliable signs of all forms of shock in children. It represents a critical cardiovascular compensatory mechanism to increase cardiac output (Cardiac Output = Stroke Volume×Heart Rate) in response to systemic vasodilation and early hypovolemia characteristic of sepsis.
Correct Answer is D
Explanation
Choice A rationale
Stroke (either ischemic or hemorrhagic) is a less common cause of isolated subdural hematoma (SDH) in infants compared to trauma. While some hemorrhagic strokes can cause SDH, a stroke generally involves a disruption of blood flow within the brain parenchyma, distinct from the tearing of bridging veins that causes a typical subdural bleed.
Choice B rationale
Sports injury is an improbable cause of SDH in infants, as they are not involved in contact sports. Sports-related head trauma is a frequent cause of SDH in older children and adolescents, but the mechanism is irrelevant to the unique vulnerabilities of the infant skull and brain.
Choice C rationale
Motor vehicle accidents (MVA) can certainly cause SDH in infants due to significant impact, but they are not the most common cause. Non-accidental trauma (abusive head trauma) is statistically the leading cause of SDH in this age group, followed by the relatively less forceful trauma of a difficult delivery.
Choice D rationale
Birth trauma, specifically the forces exerted during delivery, especially difficult or assisted ones, can lead to the stretching and tearing of the delicate bridging veins that cross the subdural space, resulting in a SDH. The infant's brain is pliable, and the skull bones are mobile, making this mechanism a common cause of SDH in the neonatal period.
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