A nurse in a provider's office is caring for a child who has a history of asthma. Which of the following findings should the nurse report to the provider?
Respiratory rate of 24 breaths/min
Wheezes in the lower lobes
Oxygen saturation of 95%
Peak expiratory flow rate of 80% of personal best
The Correct Answer is B
Choice A reason: A respiratory rate of 24 breaths/min is within the normal range for a child, depending on their age. It does not indicate respiratory distress or asthma exacerbation.
Choice B reason: Wheezes in the lower lobes are a sign of airway obstruction and inflammation due to asthma. They indicate that the child may need additional medication or intervention to relieve their symptoms. The nurse should report this finding to the provider.
Choice C reason: An oxygen saturation of 95% is within the normal range for a child. It does not indicate hypoxia or impaired gas exchange due to asthma.
Choice D reason: A peak expiratory flow rate of 80% of personal best is considered a green zone result, meaning that the child's asthma is well controlled. It does not indicate a need for change in the child's asthma action plan.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Assess the rest of the child's body for a rash.
The child's red marks across the cheeks are characteristic of fifth disease (also known as erythema infectiosum). Fifth disease is caused by parvovirus B19 and typically presents with a bright red rash on the cheeks, often referred to as "slapped cheek" appearance. The rash may eventually spread to other areas of the body, including the arms, trunk, thighs, and buttocks. It is usually mild and self-limiting.
Choice B reason: This option is not appropriate for a rash caused by fifth disease. There is no indication of child abuse or neglect.
Choice C reason: The rash is due to a viral infection and not related to trauma or injury. Questioning the parents is unnecessary.
Choice D reason: While assessing the child's temperature is important in general nursing care, it is not specifically related to the red marks on the cheeks in this case.
Correct Answer is A
Explanation
Choice A reason: The posterior fontanel, which is the soft spot at the back of the infant's head, normally closes by 2 to 4 months of age. Therefore, the nurse should expect to find a closed posterior fontanel in a 6-month-old infant.
Choice B reason: Lateral incisors, which are the teeth on either side of the central incisors, normally erupt between 7 and 10 months of age. Therefore, the nurse should not expect to find lateral incisors in a 6-month-old infant.
Choice C reason: Sitting steadily without support is a developmental milestone that is usually achieved between 6 and 9 months of age. Therefore, the nurse may or may not expect to find this skill in a 6-month-old infant, depending on the individual variation.
Choice D reason: Using thumb and index fingers in a pincer grasp is a fine motor skill that is usually developed between 9 and 12 months of age. Therefore, the nurse should not expect to find this skill in a 6-month-old infant.
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