A 3-month-old with bronchiolitis is brought to the clinic experiencing irritability and poor oral intake. Which finding should alert the practical nurse (PN) that the child is in acute respiratory distress?
Flaring of the nares.
Resting respiratory rate of 35 breaths/minute.
Bilateral bronchial breath sounds.
Diaphragmatic respirations.
The Correct Answer is A
Flaring of the nares, or widening of the nostrils, is a sign of respiratory distress in infants. It indicates that the child is working harder to breathe. This finding should alert the practical nurse (PN) that the child with bronchiolitis is in acute respiratory distress.
A resting respiratory rate of 35 breaths/minute (B) is within the normal range for a 3-month-old infant. Bilateral bronchial breath sounds (C) and diaphragmatic respirations (D) are not specific signs of acute respiratory distress in infants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Albuminuria, or the presence of albumin in the urine, is an early sign of relapse in a toddler with minimal change nephrotic syndrome (MCNS) who has been treated with corticosteroids. MCNS is a kidney disorder that can cause the body to excrete too much protein in the urine, leading to albuminuria. The practical nurse should recognize this finding as an early sign of relapse and take appropriate action to manage the child's condition.
The other answers are incorrect because they are not directly related to the early signs of relapse in a toddler with minimal change nephrotic syndrome (MCNS) who has been treated with corticosteroids.
- Increased thirst is not a known early sign of relapse in MCNS.
- Tachypnea, or rapid breathing, is not a known early sign of relapse in MCNS.
- A rounded face can be a side effect of corticosteroid treatment, but it is not an early sign of relapse in MCNS.
Correct Answer is D
Explanation
Encouraging the client to initiate daily rituals, such as practicing relaxation techniques, engaging in physical exercise, and spending time with friends and family, can be an effective way to diminish anxiety. These activities can provide a sense of structure and routine that can help to manage stress and anxiety. Options A and C are not recommended because alcohol and caffeine can worsen sleeplessness and anxiety. Option B can be counterproductive and increase the client's anxiety level. Therefore, Option D is the best option to assist this client in diminishing his anxiety.
Therefore, options A, B, and C are not answers because they are not the best action to assist this client in diminishing his anxiety.
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