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 D
Explanation
Choice A reason: Herpes simplex is a viral infection that causes painful blisters or ulcers in the mouth or on the lips. It does not cause a white, milky plaque that does not come off with rubbing.
Choice B reason: Dermatitis is a skin inflammation that causes redness, itching, and scaling. It does not affect the mouth or cause a white, milky plaque that does not come off with rubbing.
Choice C reason: Squamous cell carcinoma is a type of skin cancer that develops from the squamous cells that line the mouth and other parts of the body. It causes a hard, irregular, or ulcerated growth that may bleed or become infected. It does not cause a white, milky plaque that does not come off with rubbing.
Choice D reason: Candidiasis, also known as oral thrush, is a fungal infection that causes a white, milky plaque that coats the tongue, cheeks, and roof of the mouth. It can be scraped off, but may leave a red, sore, or bleeding surface. It is more common in people who have a weakened immune system, such as those who take antibiotics, immunosuppressants, or corticosteroids. It can also be triggered by smoking, dry mouth, or poor oral hygiene.
Correct Answer is A
Explanation
Choice A reason: Meningitis is a possible condition, as it is an inflammation of the membranes that cover the brain and spinal cord. It can be caused by various microorganisms, such as bacteria, viruses, or fungi. The infant has many signs and symptoms of meningitis, such as fever, irritability, lethargy, bulging fontanel, and clear cerebrospinal fluid from the lumbar puncture.

Choice B reason: Hydrocephalus is not a likely condition, as it is an accumulation of cerebrospinal fluid in the brain, which causes increased intracranial pressure and enlargement of the head. The infant has a bulging fontanel, which can indicate increased intracranial pressure, but not necessarily hydrocephalus. The infant does not have other signs of hydrocephalus, such as a rapidly increasing head circumference, prominent scalp veins, or sunset eyes.
Choice C reason: Intracranial hemorrhage is not a probable condition, as it is a bleeding within the skull, which can result from trauma, vascular malformation, or coagulation disorder. The infant has retinal hemorrhages, which can indicate intracranial hemorrhage, but not necessarily. The infant does not have other signs of intracranial hemorrhage, such as seizures, vomiting, or altered mental status.
Choice D reason: Sepsis is not a definite condition, as it is a systemic inflammatory response to an infection, which can cause organ dysfunction and shock. The infant has a fever, which can indicate sepsis, but not necessarily. The infant does not have other signs of sepsis, such as tachycardia, tachypnea, hypotension, or poor perfusion.
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