A caregiver calls the pediatrician’s office and reports to the nurse that her 4-year-old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6°F (39.2°C). The caregiver has tried to get the child to nap but the child gets panicky, sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which condition?

Epiglottitis

Mild asthma

Spasmodic laryngitis

Acute laryngotracheobronchitis

Answer and Explanation

The Correct Answer is A

A. Epiglottitis:

Epiglottitis is an inflammation of the epiglottis, which can result in rapid onset of symptoms such as severe sore throat, high fever, and difficulty breathing. The characteristic position described, with the child preferring to sit up, lean forward, and keep the mouth open, is known as the "tripod position." This is a protective mechanism to maintain a patent airway.

B. Mild asthma:

Asthma is a chronic respiratory condition characterized by recurrent episodes of wheezing, coughing, and shortness of breath. However, the scenario does not describe typical asthma symptoms, and the child's preference for sitting up and leaning forward is more indicative of an airway obstruction.

C. Spasmodic laryngitis:

Spasmodic laryngitis is characterized by sudden episodes of severe respiratory distress, a barking cough, and sometimes stridor. It often occurs at night and is usually not associated with high fever. The child's behavior in the scenario, particularly the preference for sitting up and leaning forward, is not a common feature of spasmodic laryngitis.

D. Acute laryngotracheobronchitis:

Acute laryngotracheobronchitis, or croup, typically presents with a barking cough, stridor, and respiratory distress. It does not usually cause the preference for sitting up and leaning forward as described in the scenario. Croup is more commonly associated with a distinctive cough sound.

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Correct Answer is B

Explanation

A. Teaching the child to take long, slow breaths:

While teaching slow breathing techniques can be helpful in managing anxiety and promoting a sense of calm, it may not directly address the underlying airway inflammation and bronchodilation needed in acute laryngotracheobronchitis.

B. Assisting with racemic epinephrine nebulizer therapy:

Racemic epinephrine is a medication that contains epinephrine, a bronchodilator. Nebulizer therapy with racemic epinephrine helps reduce airway inflammation, allowing for bronchodilation and improved breathing. This is a common intervention for managing acute respiratory distress in conditions like croup.

C. Administering an oral analgesic:

Oral analgesics, such as pain medications, can provide relief from discomfort or pain, but they do not directly address the bronchodilation needed for conditions like acute laryngotracheobronchitis.

D. Administering a corticosteroid:

Corticosteroids have anti-inflammatory properties and can help reduce swelling and inflammation in the airways. By doing so, they contribute to bronchodilation and improved breathing in conditions like croup. Corticosteroids are often used as part of the treatment plan for acute laryngotracheobronchitis.

A. The mother opens the capsule and some medication spills on the fingers. B. The child takes a dose before having an afternoon snack. C. The child chews an enteric form of the medication. D. The father tells the child that diarrhea is expected with this medication.

Correct Answer is B

Explanation

A. The mother opens the capsule and some medication spills on the fingers:

Pancreatic enzymes are usually taken intact, and their contents are meant to be sprinkled on soft food, not opened and spilled. This observation suggests a misunderstanding of the proper administration.

B. The child takes a dose before having an afternoon snack.

In cystic fibrosis, pancreatic enzyme replacement therapy is commonly used to help digest and absorb nutrients. The enzymes are typically taken with meals and snacks to aid in the digestion of food.

C. The child chews an enteric form of the medication:

Pancreatic enzymes are usually enteric-coated to protect them from stomach acid, and they are not meant to be chewed. Chewing can reduce their effectiveness. This observation indicates a need for clarification on administration.

D. The father tells the child that diarrhea is expected with this medication:

While gastrointestinal side effects can occur with pancreatic enzyme use, persistent diarrhea may indicate a dosage issue or other problems. It's important to address this with the healthcare provider. The statement suggests a potential misunderstanding or need for clarification.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a toddler with acute laryngotracheobronchitis. Which action aids in bronchodilation to improve breathing for this child?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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