A nurse is assessing a client who has preeclampsia with severe features and is receiving intravenous magnesium sulfate. The nurse notes a respiratory rate of 8/min with absent deep tendon reflexes.
Which of the following actions is the nurse's priority?

Choice A rationale

Local funeral home morgues would be quickly overwhelmed and inadequate for mass casualties resulting from a nuclear detonation. The sheer volume of bodies would exceed their capacity, and they may lack the specialized facilities required for handling contaminated remains, posing significant public health and safety risks. Normal morgue capacity is designed for typical mortality rates.

Choice B rationale

Refrigerated trucks provide a temporary, scalable solution for storing a large number of bodies, helping to prevent decomposition and the spread of pathogens in a mass casualty event. This method allows for organized collection and identification processes to be established while awaiting more permanent arrangements, crucial in disaster response. Proper refrigeration maintains body integrity.

Choice C rationale

Hospital morgues, like local funeral home morgues, have limited capacity and are primarily designed for routine patient deaths. In a large-scale disaster, they would be rapidly overfilled, compromising their ability to manage current hospital fatalities and posing logistical challenges for body management and identification. Normal hospital morgues are equipped for standard operations.

Choice D rationale

Mass graves are a last resort in extreme mass casualty events when conventional methods of body disposal are overwhelmed or impractical due to scale, contamination, or resource limitations. While a somber decision, they can be a necessary measure to manage large numbers of deceased individuals safely and efficiently, preventing widespread public health crises. Proper procedures minimize environmental impact.

The nurse should recognize that the child is most likely experiencing A. Spasmodic croup as evidenced by their A. Parent’s reports.

Rationale for correct answers:
Spasmodic croup typically presents in toddlers aged 1–3 years with sudden onset of a barking, seal-like cough, often at night, without fever or signs of systemic illness. This condition is usually triggered by allergens or minor viral infections and lacks daytime respiratory distress. The child’s physical exam shows no wheezing or abnormal lung sounds, and the temperature is within normal limits (37.3°C), suggesting a non-infectious etiology like spasmodic croup rather than viral or bacterial illness.
Parent’s reports of hoarse, barking nighttime cough, normal daytime behavior, and absence of fever or appetite change are hallmark subjective cues for spasmodic croup. Objective findings during the visit are normal, so clinical suspicion relies heavily on the history provided.

Rationale for incorrect Response 1 Options:
Respiratory syncytial virus (RSV) typically presents with cough, nasal congestion, wheezing, and often respiratory distress or fever, none of which are present.
Epiglottitis presents with sudden onset of high fever, drooling, muffled voice, and severe respiratory distress, often requiring emergency airway management—not consistent with this child’s stable, playful presentation.
Acute laryngitis in toddlers is rare and typically presents with hoarseness but not the classic barking cough, and it usually follows viral upper respiratory symptoms.

Rationale for incorrect Response 2 Options:
Lung sounds are clear, so they don't support a diagnosis involving significant airway inflammation or obstruction.
Immunization history helps with disease prevention but doesn't assist in diagnosing the acute condition.
Laboratory results are normal except for mildly elevated eosinophils (780/mm³), suggesting atopy or eczema but not a direct link to the cough pattern.

Take-home points:

• Spasmodic croup is often triggered by allergies or viral irritants and is characterized by nighttime barking cough in toddlers.
• It should be differentiated from viral croup, RSV, and epiglottitis based on onset, symptoms, and physical findings.
• Clinical history from caregivers is crucial when physical signs are minimal or absent during examination.
• Absence of fever, normal labs, and clear lungs support non-infectious causes like spasmodic croup in an otherwise healthy child.