Nokea
A 4-year-old girl is brought to the emergency department. She has a froglike croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner?
- A. Make her lie down and rest quietly.
- B. Examine her oral pharynx and report to the physician.
- C. Auscultate her lungs and prepare for placement in a mist tent.
- D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
Correct Answer: D
Rationale: The symptoms suggest epiglottitis, a medical emergency requiring immediate physician notification and preparation for airway support like tracheostomy or intubation. Lying down worsens breathing, examining the throat risks obstruction, and mist tents are ineffective for epiglottitis.
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The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37 C (98.6 F). The nurse suspects mild croup and should recommend which intervention?
- A. Admit to the hospital and observe for impending epiglottitis.
- B. Provide fluids that the child likes and use comfort measures.
- C. Control fever with acetaminophen and call if cough gets worse tonight.
- D. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.
Correct Answer: B
Rationale: For mild croup, providing hydration with preferred fluids and comfort measures minimizes distress. Hospital admission is unnecessary without epiglottitis signs, the temperature is normal, and over-the-counter cough medicine is not recommended; parents should return if noisy breathing or drooling occurs.
The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition?
- A. Has a cough
- B. Becomes fussy
- C. Shows signs of an earache
- D. Has a fever higher than 37.5 C (99 F)
Correct Answer: C
Rationale: Signs of an earache in an infant with nasopharyngitis may indicate complications like otitis media or secondary bacterial infection, requiring medical evaluation. Cough and fussiness are common with viral illnesses, and a fever of 37.5 C is normal and not concerning.
An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation?
- A. Reverse isolation
- B. Airborne isolation
- C. Contact Precautions
- D. Standard Precautions
Correct Answer: C
Rationale: RSV requires Contact Precautions, including gloves and gowns, to prevent droplet transmission, in addition to Standard Precautions. Reverse isolation protects immunocompromised patients, airborne isolation is for diseases like measles, and Standard Precautions alone are insufficient.
The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this childs care?
- A. Monitor pulse oximetry.
- B. Monitor arterial blood gases.
- C. Administer oxygen if respiratory distress develops.
- D. Administer oxygen if childs lips become bright, cherry-red in color.
Correct Answer: B
Rationale: Monitoring arterial blood gases is essential for CO poisoning, as pulse oximetry is unreliable due to normal PaO2 levels. High-flow oxygen should be administered immediately, not only if distress or cherry-red lips (a late sign) appear, to displace CO from hemoglobin.
The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the childs throat using a tongue depressor might precipitate what condition?
- A. Sore throat
- B. Inspiratory stridor
- C. Complete obstruction
- D. Respiratory tract infection
Correct Answer: C
Rationale: Examining the throat of a child with suspected epiglottitis risks complete airway obstruction due to irritation of an inflamed epiglottis. Sore throat is already present, stridor worsens with positioning, and the infection is pre-existing, not caused by examination.