A nurse is caring for a toddler who has acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings indicates that the treatment has been effective?
Improved hydration
Decreased temperature
Decreased stridor
Barking cough
The Correct Answer is C
Choice A reason: Improved hydration is not a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Hydration status should be monitored for any child with a respiratory infection, but it does not reflect the severity of the airway inflammation.
Choice B reason: Decreased temperature is not a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Fever may or may not be present in this condition, and it does not correlate with the degree of airway obstruction.
Choice C reason: Decreased stridor is a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Stridor is a high-pitched sound caused by turbulent airflow through a narrowed upper airway. It indicates a significant obstruction that can compromise breathing. A reduction in stridor means that the airway inflammation has subsided and the child can breathe more easily.
Choice D reason: Barking cough is not a specific indicator of the effectiveness of the treatment for acute laryngotracheobronchitis. Barking cough is a characteristic symptom of this condition, caused by the swelling of the vocal cords. It may persist for several days after the acute episode, even when the child is improving.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: A respiratory rate of 24 breaths/min is within the normal range for a 3-year-old child. It does not indicate the degree of hydration or dehydration of the child.
Choice B reason: A heart rate of 130/min is above the normal range for a 3-year-old child, which is 80 to 120/min. It may indicate dehydration, fever, pain, or anxiety. It does not indicate the effectiveness of oral rehydration therapy.
Choice C reason: A urine specific gravity of 1.015 is within the normal range for a child, which is 1.005 to 1.030. It indicates that the child's urine is adequately concentrated and that the child is well hydrated. It is a reliable indicator of the effectiveness of oral rehydration therapy.
Choice D reason: A capillary refill of greater than 3 seconds is abnormal and indicates poor peripheral perfusion. It may be a sign of dehydration, shock, or hypothermia. It does not indicate the effectiveness of oral rehydration therapy.
Correct Answer is A
Explanation
Choice A reason: Headache is a sign of oxygen toxicity, which is a condition that occurs when the client receives too much oxygen for a prolonged period of time. Oxygen toxicity can damage the lungs and other organs, and cause symptoms such as confusion, seizures, and respiratory failure. The nurse should instruct the client to report headache and adjust the oxygen flow rate accordingly.
Choice B reason: Dry mouth is not a sign of oxygen toxicity, but it could be a side effect of some medications or a result of dehydration. The nurse should instruct the client to drink plenty of fluids and use a humidifier or a nasal saline spray to moisten the mucous membranes.
Choice C reason: Increased appetite is not a sign of oxygen toxicity, but it could be a positive outcome of oxygen therapy, as it indicates improved oxygenation and metabolism. The nurse should encourage the client to eat a balanced diet and monitor their weight and nutritional status.
Choice D reason: Nausea is not a sign of oxygen toxicity, but it could be a side effect of some medications or a symptom of another condition, such as gastroesophageal reflux disease (GERD) or peptic ulcer disease (PUD). The nurse should instruct the client to take their medications as prescribed and avoid foods that trigger nausea, such as spicy, fatty, or acidic foods.
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