A nurse is assisting with the care of a preschooler who has epiglottitis. Which of the following actions should the nurse take?

Request an x-ray of the neck.

Monitor urine for protein.

Obtain a nasopharyngeal swab

Administer fluconazole.

Answer and Explanation

The Correct Answer is A

A) Request an x-ray of the neck: In cases of suspected epiglottitis, a lateral neck x-ray can help confirm the diagnosis by showing the classic "thumbprint sign," which indicates swelling of the epiglottis. This is a critical diagnostic step, but it should only be performed in a controlled setting where the child’s airway can be monitored closely. The priority is to avoid any procedures that may cause irritation or further compromise the airway.

B) Monitor urine for protein: Monitoring urine for protein is not relevant to the management of epiglottitis. This condition is related to inflammation and obstruction of the upper airway, and the focus should be on respiratory management rather than renal function.

C) Obtain a nasopharyngeal swab: While obtaining a nasopharyngeal swab can help identify the organism causing an infection (often bacterial), it is not the immediate priority in a child with suspected epiglottitis. The child’s airway is the most critical concern, and diagnostic interventions that could potentially cause further distress or obstruction (such as swabbing) should be avoided until airway management is stable.

D) Administer fluconazole: Fluconazole is an antifungal medication, and its use is not appropriate for epiglottitis. Epiglottitis is most often caused by a bacterial infection, particularly Haemophilus influenzae type b (Hib), which requires antibiotic therapy, not antifungals.

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Correct Answer is D

Explanation

A) Cimetidine: Cimetidine is an H2 receptor antagonist used to treat gastrointestinal issues like heartburn or ulcers. It does not have a known significant interaction with enoxaparin. Therefore, it is generally considered safe to use with enoxaparin, but it may require monitoring for other potential drug interactions, such as those with warfarin, not enoxaparin specifically.

B) Docusate: Docusate is a stool softener commonly used to prevent constipation. It does not interact with enoxaparin and is safe for use with the medication. It helps relieve constipation without increasing bleeding risks, which is a concern with certain other medications.

C) Calcium supplement: Calcium supplements are generally safe to use with enoxaparin. There is no significant interaction between calcium and enoxaparin, and calcium is often recommended for clients to maintain bone health, especially in those who are at risk of osteoporosis. Therefore, calcium supplements do not pose a risk when taken with enoxaparin.

D) Naproxen: Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that increases the risk of bleeding. NSAIDs, including naproxen, inhibit platelet aggregation, which can potentiate the anticoagulant effects of enoxaparin and increase the risk of bleeding. Therefore, naproxen should be avoided in clients taking enoxaparin.

A. Check the client's pulse rate B. Administer oxygen to the client. C. Establish a patent airway for the client. D. Place a pulse oximeter on the client's finger.

Correct Answer is C

Explanation

A) Check the client's pulse rate: While it is important to assess vital signs, the priority in this scenario is ensuring that the client’s airway is open and that they can breathe adequately. A pulse rate check can be performed after addressing the immediate respiratory needs.

B) Administer oxygen to the client: Administering oxygen is important for clients who are cyanotic and showing signs of respiratory distress. However, oxygen will not be effective if the airway is obstructed. The first priority is to ensure that the airway is open and clear, as this is the most immediate need for breathing.

C) Establish a patent airway for the client: The most immediate priority is to ensure that the client has a patent airway. Cyanosis and a decreased respiratory rate with shallow respirations indicate that the client is likely unable to get enough oxygen, possibly due to an obstruction or inadequate airway. Once the airway is secured, other interventions such as administering oxygen can follow.

D) Place a pulse oximeter on the client's finger: While measuring oxygen saturation is important, the priority action is to ensure that the client’s airway is open first. If the client is cyanotic and showing signs of respiratory distress, the nurse must address the airway immediately before assessing the pulse oximeter reading, as it may not provide accurate data without a patent airway.

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