A health care provider is preparing to examine the throat of a child diagnosed with acute epiglottitis. A priority nursing responsibility would be to:
have a tracheotomy set at the bedside.
restrain the child's arms.
immobilize the child's head.
have oxygen available.
The Correct Answer is A
A. have a tracheotomy set at the bedside. Acute epiglottitis is a medical emergency due to the risk of sudden airway obstruction. Manipulating the throat may trigger complete airway blockage. Emergency airway equipment must be available.
B. restrain the child's arms. Restraint can worsen anxiety and possibly exacerbate airway obstruction.
C. immobilize the child's head. This is not a priority and may interfere with breathing efforts.
D. have oxygen available. While oxygen is important, having emergency airway support (e.g., tracheotomy) is the priority in case of airway collapse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Platelet count of 25,000/mm³: Normal platelet count is 150,000–400,000/mm³. A count of 25,000 indicates severe thrombocytopenia, which can cause spontaneous bleeding, petechiae, and bruising.
B. Leukocyte count of 14,000/mm³: This is mildly elevated and may indicate infection or inflammation but does not explain bleeding symptoms.
C. Hemoglobin level of 8 g/dL: Indicates anemia, which may cause fatigue or pallor, not bleeding or bruising.
D. Hematocrit level of 36%: This is within the normal range for a child and does not correlate with bleeding manifestations.
Correct Answer is B
Explanation
A. An 18-month-old crying after cleft palate repair: Crying increases tension on sutures but is not immediately life-threatening.
B. An 8-year-old who is swallowing frequently after tonsillectomy: Frequent swallowing is an early sign of bleeding, a potentially life-threatening complication after tonsillectomy. Requires immediate attention.
C. A 15-year-old with IV pain at the insertion site: This may indicate infiltration or phlebitis but is not an immediate emergency.
D. A 12-year-old refusing to ambulate post-appendectomy: Ambulation is important to prevent complications, but refusal does not signal an urgent clinical issue.
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