A nurse is preparing a teaching plan for the parent of a school-age child who has asthma. Which of the following manifestations should the nurse include as an indication of an exacerbation of asthma?

Choice A rationale A green zone reading on a peak expiratory flow meter indicates that the child's asthma is well-controlled and symptoms are absent or minimal. This measurement, typically 80% to 100% of the child's personal best, reflects good airflow through the airways and is not a sign of an asthma exacerbation. The purpose of this device is to monitor pulmonary function and detect early changes. Choice B rationale Rhinitis is an inflammation of the nasal mucous membranes, commonly caused by allergic reactions or viral infections. While allergies can be a trigger for asthma, rhinitis itself is not a primary manifestation of an acute asthma exacerbation. An asthma attack is characterized by bronchospasm, airway inflammation, and increased mucus production, leading to respiratory distress, not just nasal symptoms. Choice C rationale An axillary temperature of 37.2° C (99° F) is within the normal temperature range for a school-age child. A fever is generally defined as a temperature above 38° C (100.4° F), and while infections can trigger asthma, this specific temperature does not indicate a fever or an acute exacerbation of asthma. A normal temperature range is 36.5° C to 37.5° Choice D rationale A hacking nonproductive cough is a classic manifestation of an asthma exacerbation. The cough is a physiological response to the inflammation, bronchoconstriction, and increased mucus production in the airways. The cough is nonproductive because the bronchospasm makes it difficult to clear the thickened mucus, which further contributes to the child's respiratory distress.