A 2-year-old child presents to the emergency department with a barking cough, stridor, and a hoarse voice that worsens at night. The child is afebrile but appears anxious and has labored breathing. The nurse suspects croup as the diagnosis. Which of the following interventions should the nurse prioritize to manage the child's symptoms and prevent further respiratory distress?
Administer a dose of oral antibiotics to treat the infection
Place the child in a supine position to facilitate airflow to the lungs
Encourage the child to lie down to conserve energy
Provide a cool mist humidifier or take the child outside into cool night air
The Correct Answer is D
A. Croup is usually viral in origin (most commonly parainfluenza virus), so antibiotics are not indicated unless there is evidence of a secondary bacterial infection. Routine antibiotic administration does not improve viral croup and can contribute to antibiotic resistance.
B. Placing the child in a supine position may worsen airway obstruction and increase respiratory effort. Children with croup often assume an upright or sitting position to maximize airway patency and ease breathing.
C. Encouraging the child to lie down to conserve energy is not appropriate. Lying down can exacerbate airway obstruction in croup, increase stridor, and worsen respiratory distress.
D. Providing a cool mist humidifier or taking the child outside into cool night air helps reduce airway inflammation and swelling in the upper airway. Cool air can soothe the larynx, decrease stridor, and ease the barking cough. These noninvasive measures are first-line interventions to manage mild to moderate croup and prevent progression to severe respiratory distress. Supporting the child in an upright, calm position while monitoring oxygenation and respiratory effort is also essential.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
A. Hemolysis occurs due to microvascular endothelial damage, which leads to fragmentation and destruction of red blood cells. Laboratory evidence includes elevated lactate dehydrogenase (LDH >600 U/L), elevated indirect bilirubin, and decreased haptoglobin. This contributes to fatigue, malaise, and jaundice in severe cases.
B. Elevated liver enzymes indicate hepatocellular injury caused by microvascular damage. Laboratory evidence includes AST >70 U/L and mildly to moderately elevated ALT. This liver damage correlates with right upper quadrant or epigastric pain and may also lead to nausea and vomiting.
C. Although often present, severe hypertension is not required for diagnosis. Some women with HELLP may have only mild or normal blood pressure, so elevated blood pressure alone cannot confirm the syndrome.
D. Hyperglycemia is unrelated; blood glucose levels are usually normal in HELLP syndrome. Elevated glucose may suggest another metabolic disorder such as gestational diabetes.
E. Low platelets occur due to platelet aggregation and consumption in the damaged microvasculature. Laboratory evidence includes platelet counts <100,000/mm³. This increases the risk for bleeding, bruising, and complications during delivery.
Correct Answer is C
Explanation
A. While cold compresses can reduce local pain and inflammation, they do not address the systemic risk of tetanus. Given the child’s symptoms (stiff jaw, muscle spasms, difficulty swallowing) 10 days after stepping on a rusty nail, tetanus is suspected, and simply treating the wound locally is insufficient.
B. Muscle stiffness and spasms in tetanus are caused by neurotoxin effects on the nervous system, not inactivity. Ambulation does not prevent the progression of tetanus and could increase the risk of falls or injury.
C. The child’s clinical presentation is consistent with tetanus, which is a medical emergency. The priority intervention is to neutralize the toxin and provide active and passive immunization. The tetanus booster stimulates active immunity, while tetanus immune globulin (TIG) provides immediate passive immunity to neutralize circulating toxin. This intervention is life-saving and takes priority over local wound care or antibiotics.
D. Antibiotics like metronidazole or penicillin are used to reduce bacterial load, but they do not neutralize circulating tetanus toxin and are secondary to immediate immunotherapy. Delaying TIG while focusing only on antibiotics could be fatal.
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