A nurse is caring for a 3-year-old child.
For each of the flowing findings, click to specify if the finding is consistent with acute laryngotracheobronchitis or pneumonia. Each finding may support more than one disease process
Irritability
Cough findings at 0800
Stridor
Temperature
The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A,B"}}
Both acute laryngotracheobronchitis (croup) and pneumonia can cause irritability in a child due to discomfort from respiratory symptoms and fever.
The presence of a barking, non-productive cough at 0800 is consistent with acute laryngotracheobronchitis (croup), as it is a characteristic symptom. Pneumonia can also present with cough, but it is typically productive and associated with other respiratory symptoms such as dyspnea and crackles.
Stridor, an inspiratory wheezing sound, is a hallmark symptom of acute laryngotracheobronchitis (croup) due to inflammation and narrowing of the upper airway. It is not typically associated with pneumonia.
Fever can occur in both acute laryngotracheobronchitis (croup) and pneumonia. In this case, the tympanic temperatures of 38.1°C and 38.2°C are consistent with both conditions. However, pneumonia may present with higher fevers compared to croup.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Examining the child for skin irritation at the cast edges is important to prevent complications but may not be the priority compared to monitoring for signs of impaired circulation or compartment syndrome.
B. Restricting the child's strenuous activities for 3 days is important for preventing damage to the cast, but it is not as urgent as monitoring for potential complications.
C. Monitoring for pallor or swelling in the child's affected hand is the priority to assess for impaired circulation or compartment syndrome, which are potential complications of cast application.
D. Using a hair dryer on a cool setting to relieve itching is a helpful tip but is not as urgent as monitoring for signs of impaired circulation.
Correct Answer is D
Explanation
A. Offering sips of water 4 hours following surgery may be too early and could increase the risk of aspiration in the immediate postoperative period.
B. Ambulation 12 hours following surgery may not be appropriate depending on the extent of the surgery and the patient's condition. It's important to follow physician orders regarding activity and mobilization.
C. Maintaining the head of the bed at a 30° angle may help prevent respiratory complications but is not specific to scoliosis repair with spinal instrumentation.
D. Logrolling the adolescent every 2 hours helps to prevent complications such as pressure ulcers and maintains proper alignment of the spine postoperatively.
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