Editing Pediatric Nursing – RN Practice Questions (section)

==Question 12==
A 6-year-old brought in for an asthma exacerbation initially had loud expiratory wheezes throughout all lung fields. After 20 minutes the nurse notes that the chest is now quiet on auscultation, the child is sitting forward, and the respiratory rate has increased with marked retractions. What does this change indicate?
# The bronchodilator has been effective and the child is improving.
# Airflow has become so limited that the child is in severe obstruction and impending respiratory failure.
# The child has developed a pneumothorax on the left side only.
# The child is anxious and is hyperventilating.

'''Answer:''' 2. Airflow has become so limited that the child is in severe obstruction and impending respiratory failure.

''Rationale:'' Wheezing requires turbulent airflow to generate sound. Loss of wheezing in a child whose work of breathing is increasing means too little air is moving to make noise, a "silent chest," and is an emergency requiring immediate escalation. Option 1 is the classic trap: improvement would be accompanied by decreased work of breathing and decreased respiratory rate, not increased retractions. Option 3 would produce unilateral, not global, changes. Option 4 dismisses objective distress.