A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse’s best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?

“Children this age rarely get epiglottitis; you should not blame yourself.”

“It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen.”

“Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son’s symptoms.”

“Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly.”

Answer and Explanation

The Correct Answer is D

Epiglottitis is a life-threatening bacterial infection (commonly caused by Haemophilus influenzae type B) that causes rapid inflammation and swelling of the epiglottis, leading to airway obstruction. The illness progresses suddenly and severely, often within hours, and requires immediate airway management and IV antibiotic therapy.

Rationale for correct answer:

4. “Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly.” This response provides emotional support and reassurance to the parent. It helps alleviate guilt by explaining that the condition worsens very rapidly, often within hours, and that early recognition is difficult. The nurse is showing empathy, validating the parent’s feelings while maintaining focus on the child’s urgent care needs.

Rationale for incorrect answers:

1. “Children this age rarely get epiglottitis; you should not blame yourself.” While reassuring, this statement is inaccurate. Epiglottitis most commonly affects children ages 2 to 6 years. It also minimizes the parent’s emotions rather than addressing them therapeutically.

2. “It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen.” This is non-therapeutic and blaming, implying that the parent’s delay contributed to the severity of the illness. It increases guilt instead of offering comfort.

3. “Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son’s symptoms.” This is factually incorrect since epiglottitis progresses rapidly, not slowly. Such misinformation may increase the parent’s distress.

Take home points

Epiglottitis is a medical emergency that can progress from mild sore throat to severe airway obstruction within hours.
The nurse’s role includes both clinical vigilance and emotional support for the family.
Therapeutic communication focuses on reassurance, empathy, and education without assigning blame.
Early recognition and prompt airway management are critical for survival.

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Correct Answer is C

Explanation

Epiglottitisis a life-threatening bacterial infection(commonly caused by Haemophilus influenzae type B) that leads to inflammation and swelling of the epiglottis, potentially causing complete airway obstruction. It most often affects children aged 2–6 years and presents with sudden onset of high fever, drooling, dysphagia, muffled voice, and tripod positioning.

Rationale for correct answer:

3. A lateral neck x-raycan confirm the diagnosis by revealing the classic “thumbprint sign”, which represents an enlarged, swollen epiglottis protruding into the airway. This imaging study helps differentiate epiglottitis from croup, which shows a “steeple sign” (subglottic narrowing). Importantly, the x-ray should only be performed after the airway is stabilized and under controlled conditions with emergency equipment and personnel available.

Rationale for incorrect answers:

1. Blood testsuch as CBC or cultures may show infection but are nonspecific and not diagnostic. They are typically performed after the airway is secure.

2. Swabbing or inspecting the throatare contraindicated since it can trigger laryngospasmand complete airway obstructiondue to tissue irritation.

4. Although signs and symptoms such as drooling, tripod position, muffled voice, or stridor are strongly suggestive, a definitive diagnosis requires visualization or imaging. They should be safely done through a lateral neck x-ray or direct laryngoscopy in a controlled setting.

Take home points

Lateral neck x-ray showing the “thumbprint sign” confirms epiglottitis.
Never use a tongue blade or obtain a throat swab since both can precipitate complete obstruction.
Ensure emergency airway equipment is available before any diagnostic procedure.
Immediate I.V. antibiotics and airway management are key to treatment.

A. A 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. B. A 6-year-old who has high fever, no spontaneous cough, and frog-like croaking. C. A 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough. D. A 13-year-old who has a high fever, stridor, and purulent secretions.

Correct Answer is B

Explanation

Epiglottitisis a life-threatening bacterial infection—most commonly due to Haemophilus influenzae type B (Hib), that causes inflammation and swelling of the epiglottis, leading to airway obstruction. Typical presentation includes sudden onset of high fever, drooling, severe sore throat, dysphagia, muffled voice, stridor, tripod positioning, absence of cough, anxiety and restlessness due to respiratory distress.

Rationale for correct answer:

2. A 6-year-old who has high fever, no spontaneous cough, and frog-like croaking: These are classic signs of acute epiglottitis and signal imminent airway obstruction. The absence of a cough differentiates it from croup, and the frog-like croak indicates severe upper airway involvement. The child is in extreme danger of airway closure and requires immediate airway management and emergency medical treatment, often including intubation or tracheostomy and IV antibiotics.

Rationale for incorrect answers:

1. A 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions: This presentation is typical of mild viral croup (laryngotracheobronchitis). The child is stable and can usually be managed with humidified air or nebulized epinephrine, not an emergency.

3. A 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough: Although the child has distress, the presence of a barky cough indicates croup, not epiglottitis. Treatment includes corticosteroids and nebulized epinephrine, but it’s not as emergent as airway obstruction from epiglottitis.

4. A 13-year-old who has a high fever, stridor, and purulent secretions: This presentation suggests bacterial tracheitis, a serious but slower-progressing condition than epiglottitis. Requires IV antibiotics and airway monitoring, but it does not progress to complete airway obstruction as rapidly as epiglottitis.

Take home points

Epiglottitis is an emergency. Look for high fever, drooling, no cough, muffled or croaking voice.
Never attempt to examine the throat since this may trigger complete airway obstruction.
Immediate airway stabilization and IV antibiotics are priorities.
Rapid recognition and intervention are life-saving in epiglottitis.

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A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse’s best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which is diagnostic for epiglottitis?

Correct Answer is C

Explanation

Which child is in the greatest need of emergency medical treatment?

Correct Answer is B

Explanation

Which is the nurse’s best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be?

While examining a child with acute epiglottitis, a nurse should have which item available?

Which sign in a 3-year-old child with acute epiglottitis indicates that the client’s respiratory distress is increasing?

A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse’s best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?

During the recovery stages of croup, a nurse should explain which intervention to parents?

Which assessment is of greatest concern in a 15-month-old?

Which nursing concern should be a priority for the nurse when working with the family of a toddler being treated for acute laryngotracheobronchitis?

A 5-year-old is brought to the ED with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for?