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Complete blood count (CBC) may detect infection or eosinophilia, but it does not evaluate acute respiratory status.

Blood urea nitrogen (BUN) reflects kidney function, unrelated to asthma exacerbation.

Partial thromboplastin time (PTT) measures clotting time, not respiratory function.

Knowing the last time the child ate is relevant if intubation or sedation might be required (aspiration risk), but not the most urgent information in status asthmaticus.

Knowing whether the child has been exposed to any of the usual asthma triggers is useful for long-term prevention and management, but not immediately life-saving during the acute crisis.

Asking when the child was last admitted to the hospital for asthma provides background history of severity but does not influence urgent management in the current emergency.

“I should always use a spacer when administering the albuterol inhaler.” Spacers help children coordinate inhalation and maximize delivery of medication to the lungs, reducing deposition in the mouth/throat.

“I should be sure that my child is in an upright position when administering the inhaler.” Upright positioning optimizes lung expansion and medication delivery to the lower airways.

“I should always shake the inhaler before administering a dose.” Shaking ensures the medication is properly mixed for accurate dosing.

Prednisone is a corticosteroid used for longer-term control of inflammation in moderate to severe exacerbations but does not provide immediate relief. It can take several hours to days to be effective.

Montelukast (Singulair) is a leukotriene receptor antagonist used for long-term asthma control and prevention, not for acute symptom relief.

Fluticasone (Flovent) is an inhaled corticosteroid for daily maintenance therapy to reduce airway inflammation. It does not work quickly enough to treat acute attacks.

A 12-month-old, mild cry, pale, diminished breath sounds, SpO₂ 93%: This is concerning but not the most urgent. Diminished breath sounds are worrisome, but SpO₂ is still slightly higher (93%), and the child still has some cry showing air movement.

A 5-year-old, complete sentences, pink, wheezing bilaterally, SpO₂ 93%: This child is stable compared to the others. The ability to speak in complete sentences and normal color indicate adequate air exchange. Wheezing is expected but not immediately life-threatening.

A 16-year-old, short sentences, wheezing, sitting upright, SpO₂ 93%: These symptoms indicate moderate distress, but the child is compensating by sitting upright and still moving air with SpO₂ 93%. Not as critical as the quiet 9-year-old with worsening hypoxemia.

Using an incentive spirometer requires a level of cooperation and understanding not expected in a 3-year-old. It is more appropriate for older children and adults.

Breathing into a paper bag is not used in asthma; it is sometimes used for hyperventilation due to anxiety. In asthma, this could worsen hypoxemia by limiting oxygen intake.

Taking several deep breaths without a focus on prolonged exhalation does not specifically target the problem of air trapping in asthma.

“Use a humidifier in your child’s room.” Humidifiers can actually promote mold growth and dust mites, which are common asthma triggers. A dehumidifier may be more appropriate in damp environments.

“Have your carpet cleaned chemically once a month.” Carpet cleaning chemicals may irritate airways. Instead, minimizing carpet use and vacuuming with a HEPA filter vacuum is better for asthma management.

“Wash household pets weekly.” While washing pets may temporarily reduce dander, it does not eliminate exposure. The best approach is to keep pets out of the child’s bedroom and limit close contact if pet dander is a known trigger.

Several attacks per month indicate moderate persistent asthma, not status asthmaticus.

Less than six attacks per year indicate mild intermittent asthma, not status asthmaticus.

While partial nonresponse may occur in severe asthma, status asthmaticus is defined by complete or nearly complete lack of response and constant symptoms, making option 4 more precise.

Educate the child to avoid triggers: Education is important for long-term asthma management, but it does not address the acute respiratory distress the child is experiencing.

Transport the child to the emergency department: Transport may be necessary if severe symptoms persist or worsen, but initial assessment is required to determine the severity and urgency.

Notify the child’s parents of his condition: Parental notification is important, but the child’s respiratory status takes priority. Immediate assessment ensures timely intervention.

The MDI must be shaken to mix the medication and propellant before each dose.

The recommended wait time between puffs of the same bronchodilator is usually about 1 minute, not 10 seconds, to allow the first dose to take effect.

The canister is pressed once per puff, not continuously for 30 seconds. Holding it down for an extended time is not necessary and can waste medication.