A nurse is admitting a child who has acute epiglottitis.
Which of the following actions should the nurse take?
Check oxygen saturation every 4 hr.
Obtain a throat culture.
Assist the child into supine position.
Initiate droplet isolation precautions.
The Correct Answer is D
Choice A rationale:
Checking oxygen saturation every 4 hours is a monitoring parameter for patients with respiratory issues but is not the priority in a child with acute epiglottitis. Airway management and infection control are more critical in this situation.
Choice B rationale:
Obtaining a throat culture is important to confirm the diagnosis of epiglottitis. However, initiating isolation precautions and ensuring the child's airway is secure take precedence in the immediate care of a child with acute epiglottitis.
Choice C rationale:
Assisting the child into a supine position is contraindicated in acute epiglottitis. This position can further compromise the airway by obstructing it. The child should be allowed to sit in a position of comfort, usually sitting upright and leaning slightly forward.
Choice D rationale:
Initiating droplet isolation precautions is crucial when dealing with a suspected or confirmed case of epiglottitis. Epiglottitis is highly contagious and is transmitted via respiratory droplets. Isolation precautions help prevent the spread of the infection to others.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Placing the child on a clear liquid diet for 24 hours following the arterial cardiac catheterization procedure is not necessary. The procedure does not typically require dietary restrictions. However, the healthcare provider may provide specific pre-procedure dietary instructions if needed, but it's not a standard practice.
Choice B rationale:
Instructing the child that they will be on bed rest for 2 days after the procedure is not accurate. While the child may need to rest after the procedure, the duration of bed rest is typically much shorter than 2 days. It's important to provide accurate information to the child to reduce anxiety and promote understanding.
Choice C rationale:
Explaining to the child that they will need to keep their leg straight for 8 hours following the procedure is important and accurate information. Arterial cardiac catheterization often involves the insertion of a catheter through an artery in the leg, and keeping the leg straight helps prevent complications at the insertion site. This information is essential for the child to follow post-procedure instructions correctly.
Choice D rationale:
Telling the child that their dressing will be removed 12 hours after the procedure is not accurate. Dressing removal timing may vary depending on the healthcare provider's protocol, but it's not typically done immediately after the procedure. Providing inaccurate information may lead to confusion and anxiety for the child.
Correct Answer is D
Explanation
Choice A rationale:
Heart rate is important to monitor but is not specific to the management of cystic fibrosis or the prescribed treatments mentioned in the exhibit. Monitoring heart rate is essential in various clinical situations, but it is not the focus here.
Choice B rationale:
WBC count, or white blood cell count, is a marker of infection or inflammation in the body. While it can be useful in assessing the overall health of a patient, it is not specific to cystic fibrosis or the prescribed treatments mentioned in the exhibit.
Choice C rationale:
HbA1c, or glycated hemoglobin, is a marker used in diabetes management to assess long-term blood sugar control. It is not relevant to cystic fibrosis or the medications prescribed in this case.
Choice D rationale:
Oxygen saturation is a crucial parameter to monitor in a child with cystic fibrosis, especially considering the respiratory complications associated with this condition. Low oxygen saturation levels can indicate respiratory distress, which needs prompt medical attention. Reporting any abnormal oxygen saturation values to the provider ensures timely intervention and appropriate management of the child's respiratory status.
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