The 10 year-old is being treated for asthma. Before administering the drug, the nurse should check the?

DHS Staff Nurse - 2018 (Shift-2nd)

Child Health Nursing (Pediatrics)

Hard

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The question asks for the key assessment before giving an asthma drug to a 10-year-old.
Asthma rescue medications are typically beta-agonist bronchodilators (e.g., albuterol).
While these drugs act on beta-2 receptors in the lungs to ease breathing, they also stimulate beta-1 receptors in the heart.
This stimulation of beta-1 receptors commonly causes tachycardia (an increased heart rate).
Therefore, checking the pulse is the most critical pre-administration assessment to establish a baseline and ensure the patient is not already dangerously tachycardic.

Option A: Bronchodilators do not have a direct, immediate effect on urinary output. This assessment is relevant for monitoring hydration status or renal function, not for the specific side effects of this drug class.
Option B: While blood pressure can be affected by beta-agonists (either increasing or decreasing), the most common and predictable cardiovascular side effect is tachycardia. Therefore, pulse is the more direct and crucial parameter to monitor.
Option D: Temperature is not affected by bronchodilator medication. An elevated temperature would indicate a possible infection, which might be the trigger for the asthma attack, but it is not a parameter for monitoring the drug's side effects.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Pre-administration nursing assessment for bronchodilator therapy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A baseline pulse rate is crucial. If a child's pulse is already significantly high (e.g., over 140 bpm for a 10-year-old), the nurse must withhold the medication and notify the healthcare provider before proceeding.
Patient education is key. Nurses should teach patients and families to monitor for feelings of a 'racing heart' or palpitations and report them.
What if? If the child is in severe respiratory distress (e.g., using accessory muscles, low oxygen saturation), the life-saving bronchodilator should be administered even with tachycardia. However, the nurse must immediately inform the provider and prepare for continuous cardiac monitoring, as the hypoxia itself can cause a high heart rate.

How to Approach the Question

First, identify the core of the question: It asks for the most important pre-administration check for an asthma drug in a child.
Recall the main class of rescue medications for asthma, which are bronchodilators (e.g., albuterol, salbutamol).
Remember the mechanism and primary side effects of these drugs. They are beta-agonists.
Connect the most common side effect to the necessary nursing assessment. Beta-agonists are known to cause tachycardia (increased heart rate).
Based on this, conclude that the most critical vital sign to check before giving the drug is the pulse to get a baseline.
Quickly evaluate the other options to confirm your choice. Blood pressure, temperature, and urine output are not as directly and immediately impacted by the drug's primary side effect profile.

Concept Tested & Keywords

Concept Tested: Pre-administration nursing assessment for bronchodilator therapy.
Stem keywords: 10 year-old, asthma, administering the drug, nurse should check
Lead-in keywords: should check
Clinical cues: Patient is a 10-year-old child, which requires consideration of age-specific normal vital sign ranges.
Clinical cues: The condition is asthma, indicating a bronchodilator is the likely drug class.

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E6 Pharmacology Nursing Lilley 11e Part 1 p. 320-322

E6 Pharmacology Nursing Lilley 11e Part 2 p. 284-286