A nurse is caring for a 3-year-old child.
For each of the following findings, click to specify if the finding is consistent with acute laryngotracheobronchitis or pneumonia. Each finding may support more than one disease process.
Temperature
Cough findings at 0800
Irritability
Stridor
The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A"},"C":{"answers":"A,B"},"D":{"answers":"A"}}
Temperature: Acute laryngotracheobronchitis: ☑️ Pneumonia: ☑️
Both acute laryngotracheobronchitis and pneumonia can present with fever. While croup typically presents with a low-grade fever, pneumonia can also present with fever, though it can sometimes be higher.
Cough findings at 0800: Acute laryngotracheobronchitis: ☑️ Pneumonia: ☐
A "barking" non-productive cough is a classic symptom of acute laryngotracheobronchitis (croup). Pneumonia usually presents with a productive cough rather than a barking one, although it can sometimes be non-productive in children.
Irritability: Acute laryngotracheobronchitis: ☑️ Pneumonia: ☑️
Irritability can be seen in both conditions as a result of discomfort, fever, and difficulty breathing. It is a nonspecific symptom that can occur in many illnesses, including respiratory infections like croup and pneumonia.
Stridor: Acute laryngotracheobronchitis: ☑️ Pneumonia: ☐
Stridor, particularly inspiratory stridor, is a hallmark of acute laryngotracheobronchitis (croup), which involves inflammation of the upper airway causing a characteristic sound during breathing. Stridor is not typically associated with pneumonia, which usually affects the lower respiratory tract and may present with wheezing or crackles instead.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Encourage maintaining bilateral elbow restraints: This is not typically used for cleft palate repair. Elbow restraints might be used for other procedures.
B. Apply antibiotic ointment to the suture line for 3 days postoperatively: Applying antibiotic ointment to the suture line helps prevent infection and promotes healing. It’s essential to follow the postoperative care instructions to ensure the best outcomes for the infant.
C. Encourage use of straws when drinking fluids: Using straws can create negative pressure in the oral cavity, which may put stress on the suture line and compromise wound healing. The suction force generated during straw use can potentially disrupt the surgical site.
D. Avoid disturbing any crusts that form on the suture line: This is generally good advice to promote healing and prevent infection.
Correct Answer is A
Explanation
A. Provide for periods of rest. Correct. Children with heart failure have reduced exercise tolerance and fatigue easily. Regular periods of rest help prevent overexertion and cardiac strain.
B. Increase the child's oxygen flow rate until the child no longer has cyanosis. This can be dangerous. Oxygen therapy should be used as prescribed by a healthcare provider, as excessive oxygen can lead to oxygen toxicity or other complications, especially in children with heart conditions.
C. Withhold digoxin if the child's pulse is greater than 100/min. Digoxin is typically withheld if the heart rate is too low (bradycardia), not high. The nurse should follow specific parameters set by the healthcare provider, but a pulse greater than 100/min is not a standard reason to withhold digoxin.
D. Weigh the child once each month. In children with heart failure, daily weights are important to monitor fluid status and detect worsening heart failure. Monthly weighing is not frequent enough.
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