A nurse is caring for a 4-year-old child suspected of having epiglottitis.
The child presents with a muffled voice and is leaning forward with outstretched arms.
Which statement regarding epiglottitis is accurate?
"Epiglottitis is most commonly caused by viral infections.”..
"Epiglottitis primarily affects adolescents and adults.”..
"The child may adopt a tripod position to maximize airway patency.”..
"Epiglottitis typically results in a loud, high-pitched cry.”..
The Correct Answer is C
Choice A rationale:
Epiglottitis is most commonly caused by bacterial infections, specifically Haemophilus influenzae type b (Hib) bacteria.
This bacterium can cause inflammation and swelling of the epiglottis, leading to airway obstruction.
Viral infections are not the primary cause of epiglottitis in children.
Choice B rationale:
Epiglottitis primarily affects children, not adolescents and adults.
The peak incidence occurs in children between the ages of 2 and 6 years.
Choice C rationale:
The child adopting a tripod position, leaning forward with outstretched arms, is a classic sign of epiglottitis.
This position helps maximize airway patency and ease breathing.
It is a protective mechanism that children instinctively assume to maintain their airway.
Choice D rationale:
Epiglottitis does not typically result in a loud, high-pitched cry.
The child with epiglottitis is usually quiet and prefers to sit still in a tripod position to maintain airway patency.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The nurse should monitor for signs of adrenal insufficiency and hyperglycemia as potential side effects of corticosteroid therapy.
Corticosteroids can suppress the adrenal glands, leading to adrenal insufficiency, which can manifest as weakness, fatigue, low blood pressure, and abdominal pain.
Hyperglycemia (elevated blood sugar levels) is a common side effect of corticosteroids and can worsen diabetes or predispose non-diabetic individuals to high blood sugar levels.
Choice B rationale:
Decreased oxygen saturation levels are not a common side effect of corticosteroid therapy.
Corticosteroids help reduce airway inflammation, which can actually improve oxygenation in conditions like epiglottitis by reducing airway obstruction and respiratory distress.
Choice C rationale:
Allergic reactions to corticosteroids are possible, but they are relatively rare.
Symptoms of an allergic reaction can include rash, itching, swelling, severe dizziness, or difficulty breathing.
While allergic reactions are a concern with any medication, they are not the primary side effect that nurses should monitor for when administering corticosteroids.
Choice D rationale:
Increased sensitivity to antibiotics is not a known side effect of corticosteroid therapy.
Corticosteroids work by suppressing the immune response and reducing inflammation, but they do not affect the body's sensitivity to antibiotics.
Antibiotic effectiveness is determined by factors such as the specific antibiotic used, the type of bacteria causing the infection, and antibiotic resistance patterns.
Correct Answer is B
Explanation
Choice A rationale:
The importance of oral medications to relieve symptoms is relevant, but it doesn't specifically prevent epiglottitis.
Preventive measures like vaccination are more crucial in avoiding the condition.
Choice B rationale:
Educating the child and their family about the signs and symptoms of epiglottitis is essential for early recognition and prompt medical intervention.
Understanding the symptoms can lead to quicker medical attention, which is vital in managing epiglottitis effectively.
Choice C rationale:
Avoiding complete immunization against Hib is not a recommended practice.
Hib vaccination significantly reduces the risk of epiglottitis caused by Hib bacteria.
Encouraging complete immunization is a key preventive measure against the disease.
Choice D rationale:
Using nebulized medications for treatment might be a part of the management plan if the child already has epiglottitis, but it's not a preventive measure.
Prevention focuses on vaccination and awareness of symptoms, making choice D less relevant in the context of prevention.
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