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 ["A","B","C","E"]
Explanation
Choice A rationale
Photophobia, or an extreme sensitivity to light, is a common symptom in meningitis, resulting from the meningeal irritation and inflammation caused by the bacterial infection. The meninges, the protective layers covering the brain and spinal cord, contain pain-sensitive fibers. When inflammation reaches the optic nerve pathways or specific cranial nerves, light perception becomes a painful stimulus.
Choice B rationale
A petechial or purpuric rash is a critical and potentially ominous finding, especially in meningococcemia (caused by Neisseria meningitidis). The rash is caused by endothelial damage and vasculitis as the bacteria and inflammatory mediators enter the bloodstream, leading to small, non-blanching hemorrhages beneath the skin due to capillary leakage and microthrombi formation.
Choice C rationale
Nuchal rigidity (stiffness of the neck), a classic sign, is caused by inflammation of the meninges surrounding the cervical spinal cord. Attempting to flex the neck stretches the irritated meninges, eliciting pain and muscle spasm. This rigidity is often assessed using maneuvers like Brudzinski's or Kernig's signs, indicating meningeal irritation.
Choice D rationale
A high-pitched cry is more commonly associated with increased intracranial pressure (ICP), which can be a complication of severe meningitis, particularly in infants due to hydrocephalus or cerebral edema. While a sign of neurological distress, it is a less direct or specific initial symptom compared to the direct signs of meningeal irritation or systemic infection.
Choice E rationale
Seizures are a frequent complication, particularly in infants and young children with bacterial meningitis. They result from the direct inflammatory irritation of the cerebral cortex by the infectious process, cerebral edema, or vascular changes (e.g., thrombosis, infarcts) associated with severe intracranial infection, causing abnormal electrical activity.
Correct Answer is D
Explanation
Choice A rationale
Periorbital edema (swelling around the eyes) is a common sign of nephrotic syndrome or other systemic fluid overload states, such as congestive heart failure. While heart failure can be a complication of severe infective endocarditis (IE), periorbital edema is a non-specific finding and not a primary, classic physical finding of the infection itself.
Choice B rationale
Bounding pulses in the lower extremities are most characteristic of a condition causing a wide pulse pressure, such as a large patent ductus arteriosus (PDA) or aortic regurgitation. While aortic valve damage can occur in IE, the bounding pulse is not a hallmark finding directly resulting from the infectious process.
Choice C rationale
A high-pitched cry is a non-specific sign of neurological distress or pain in an infant. While systemic infection and potential septic emboli from infective endocarditis could affect the central nervous system, this symptom is not a primary or expected clinical manifestation of the localized heart valve infection.
Choice D rationale
Splinter hemorrhages are small, linear, dark-red streaks that appear under the nails. They are a classic peripheral sign of infective endocarditis caused by microemboli (tiny fragments of the infected vegetation) lodging in the distal capillaries of the nail bed, making this a highly indicative finding.
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