# A 12-year-old child with cystic fibrosis is admitted to the pediatric unit with increased respiratory distress and thick, tenacious secretions. The child's oxygen saturation is 88% on room air, and chest physiotherapy has been ordered. Which nursing intervention should be the priority?

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## 문제

A 12-year-old child with cystic fibrosis is admitted to the pediatric unit with increased respiratory distress and thick, tenacious secretions. The child's oxygen saturation is 88% on room air, and chest physiotherapy has been ordered. Which nursing intervention should be the priority?

## 보기

1. Administer bronchodilators before chest physiotherapy **✔ 정답**
2. Increase fluid intake to 3000 mL per day
3. Position the child in high Fowler's position continuously
4. Schedule chest physiotherapy sessions every 4 hours

**정답: 1**

## 해설

Administering bronchodilators before chest physiotherapy is the priority to dilate airways and mobilize thick secretions in cystic fibrosis, optimizing therapy effectiveness. Other options are supportive but do not address immediate airway clearance needs.

## 심화 해설

Understanding the Priority in Cystic Fibrosis Airway Clearance

The correct answer is to administer bronchodilators before chest physiotherapy. In a child with cystic fibrosis (CF) presenting with increased respiratory distress, thick secretions, and an oxygen saturation of 88% on room air, the priority nursing intervention is to optimize the airway for secretion mobilization. The underlying pathophysiology involves chronic, irreversible dilation of the bronchi, a condition known as bronchiectasis, which is a hallmark of advanced CF lung disease [1]. This structural damage impairs mucociliary clearance, leading to the accumulation of thick, tenacious secretions that obstruct airflow and cause ventilation-perfusion mismatch, directly contributing to the child's hypoxemia.

Administering a bronchodilator first is a critical, evidence-based step that directly impacts the efficacy of the subsequent therapy. Bronchodilators work by relaxing the smooth muscles surrounding the bronchioles, which helps to reverse any bronchospasm component that often accompanies the chronic inflammation and irritation from retained secretions. By opening the airways, the bronchodilator facilitates deeper penetration of air distal to the mucus plugs and makes it physically easier to mobilize secretions during the chest physiotherapy session that follows. Performing chest physiotherapy on constricted, inflamed airways is not only less effective but can also increase the work of breathing and exacerbate respiratory distress. This sequence of bronchodilator administration followed by airway clearance techniques is a cornerstone of managing obstructive and suppurative lung diseases like CF and non-CF bronchiectasis [1].

Analysis of Other Options

While the other options are important components of the overall care plan for a child with CF, they do not represent the immediate priority action before a scheduled airway clearance session.

*   Increasing fluid intake to 3000 mL per day is a systemic intervention aimed at hydrating secretions over time, making them less viscous. While adequate hydration is essential for long-term management, it does not provide the immediate airway dilation needed to make the upcoming chest physiotherapy session safe and effective. This is a supportive, not a priority, intervention in this acute moment.

*   Positioning the child in high Fowler's position continuously is a supportive measure to ease the work of breathing by using gravity to lower the diaphragm and allow for maximal chest expansion. However, it is a passive intervention for oxygenation and does not actively address the core problem of mobilizing the thick, obstructive secretions. The child needs active secretion clearance, not just a positioning strategy.

*   Scheduling chest physiotherapy sessions every 4 hours is a standard frequency for airway clearance, but the timing is secondary to the preparation for each individual session. The immediate priority is to ensure the session that is about to occur is as effective and safe as possible, which is achieved by pre-treatment with a bronchodilator. The scheduling frequency can be adjusted based on the child's response, but the therapeutic sequence within each session is the critical factor.References (research sources)

- [1]Management of Adult Bronchiectasis: Consensus-Based Guidelines of the German Respiratory Society.GuidelineRingshausen FC, Baumann I, de Roux A, Dettmer S, Diel R, Eichinger M, Ewig S, Flick H, Hanitsch LG, Hillmann T, Koczulla R, Köhler M, Koitschev A, Kugler C, Nüsslein T, Ott SR, Pink I, Pletz M, Rohde G, Sedlacek L, Slevogt H, Sommerwerck U, Sutharsan S, von Weihe S, Welte T, Wilken M, Mertsch P, Rademacher J. (2026) · DOI: 10.1159/000551643

## 임상 시나리오

CF Airway Clearance: Pre-Treatment PriorityOptimizing the airway before secretion mobilization
For a CF patient with thick secretions and hypoxemia, the priority is to administer a bronchodilator 15-30 minutes before chest physiotherapy. This reverses bronchospasm and opens airways, allowing deeper air penetration and more effective secretion clearance.

Perform chest physiotherapy only after bronchodilation. Percussion and postural drainage on constricted airways are less effective and can increase the work of breathing.

CautionNever perform chest physiotherapy on a patient with untreated bronchospasm. Ensure the bronchodilator has taken effect to prevent exacerbating respiratory distress during the procedure.

## 핵심 개념

- **Cystic Fibrosis** — Cystic fibrosis. An autosomal recessive genetic disorder caused by mutations in the CFTR gene, affecting exocrine glands (such as sweat and mucous glands) and leading to the production of thick, sticky mucus. This primarily causes serious problems in the respiratory and digestive systems.
- **Bronchodilator** — Bronchodilator. A medication that relaxes the smooth muscles of the bronchi to widen the airways. It is used to relieve breathing difficulties and promote secretion clearance in conditions such as cystic fibrosis, asthma, and COPD. (e.g., albuterol, salbutamol).
- **Chest Physiotherapy** — Chest physiotherapy. A series of physical techniques, including percussion, vibration, and postural drainage, that help loosen and clear bronchial secretions from the airways. It is a core component of routine respiratory care for patients with cystic fibrosis.
- **Tenacious Secretions** — Thick and sticky secretions. A pathophysiological feature of cystic fibrosis that interferes with normal ciliary movement and obstructs the airways, increasing the risk of infection and respiratory failure.
- **High Fowler's Position** — High Fowler's position. This is a position where the patient's upper body is elevated to about 60-90 degrees. It helps ease breathing difficulties by facilitating diaphragm movement and promoting lung expansion.

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