A nurse is caring for an 18-month-old client in a pediatric clinic for a well-child visit and assessment of new symptoms.
Complete the following sentence by using the lists of options. The nurse should recognize that the child is most likely experiencing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
The nurse should recognize that the child is most likely experiencing A. Spasmodic croup as evidenced by their A. Parent’s reports.
Rationale for correct answers:
Spasmodic croup typically presents in toddlers aged 1–3 years with sudden onset of a barking, seal-like cough, often at night, without fever or signs of systemic illness. This condition is usually triggered by allergens or minor viral infections and lacks daytime respiratory distress. The child’s physical exam shows no wheezing or abnormal lung sounds, and the temperature is within normal limits (37.3°C), suggesting a non-infectious etiology like spasmodic croup rather than viral or bacterial illness.
Parent’s reports of hoarse, barking nighttime cough, normal daytime behavior, and absence of fever or appetite change are hallmark subjective cues for spasmodic croup. Objective findings during the visit are normal, so clinical suspicion relies heavily on the history provided.
Rationale for incorrect Response 1 Options:
Respiratory syncytial virus (RSV) typically presents with cough, nasal congestion, wheezing, and often respiratory distress or fever, none of which are present.
Epiglottitis presents with sudden onset of high fever, drooling, muffled voice, and severe respiratory distress, often requiring emergency airway management—not consistent with this child’s stable, playful presentation.
Acute laryngitis in toddlers is rare and typically presents with hoarseness but not the classic barking cough, and it usually follows viral upper respiratory symptoms.
Rationale for incorrect Response 2 Options:
Lung sounds are clear, so they don't support a diagnosis involving significant airway inflammation or obstruction.
Immunization history helps with disease prevention but doesn't assist in diagnosing the acute condition.
Laboratory results are normal except for mildly elevated eosinophils (780/mm³), suggesting atopy or eczema but not a direct link to the cough pattern.
Take-home points:
- Spasmodic croup is often triggered by allergies or viral irritants and is characterized by nighttime barking cough in toddlers.
- It should be differentiated from viral croup, RSV, and epiglottitis based on onset, symptoms, and physical findings.
- Clinical history from caregivers is crucial when physical signs are minimal or absent during examination.
- Absence of fever, normal labs, and clear lungs support non-infectious causes like spasmodic croup in an otherwise healthy child.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","F"]
Explanation
Choice A rationale
Frequent enemas are sometimes used in the management of Hirschsprung's disease, but their primary purpose is to empty the bowel of accumulated stool, not to stimulate bowel movements. The disease is characterized by an absence of ganglion cells, which prevents normal peristalsis, making stimulation ineffective.
Choice B rationale
Avoiding medications that can cause constipation is crucial for children with Hirschsprung's disease. Since their colon lacks the necessary ganglion cells for normal peristalsis, any further slowing of bowel transit due to medication can exacerbate fecal impaction and increase the risk of enterocolitis.
Choice C rationale
Maintaining a high-fiber diet is generally contraindicated in Hirschsprung's disease. High-fiber diets increase stool bulk, which can worsen constipation and impaction in a colon that is unable to propel stool effectively due to the absence of ganglion cells in the affected segment.
Choice D rationale
There is no specific evidence or recommendation for strict adherence to a low-protein diet in the management of Hirschsprung's disease. Dietary interventions primarily focus on managing constipation and preventing enterocolitis, rather than protein restriction, which can impact growth and development.
Choice E rationale
Daily laxative use is generally not recommended as a primary long-term management strategy for Hirschsprung's disease. While laxatives might provide temporary relief, they do not address the underlying physiological defect and can lead to dependency or electrolyte imbalances. Surgical correction is the definitive treatment.
Choice F rationale
Surgical intervention is the definitive treatment for Hirschsprung's disease. This involves removing the aganglionic segment of the bowel, allowing for normal peristalsis to be restored. Without surgery, the child will continue to experience severe constipation, impaction, and potential life-threatening complications like enterocolitis.
Choice G rationale
While complications like enterocolitis in Hirschsprung's disease may necessitate emergency department visits, the goal of management is to minimize these occurrences through appropriate medical and surgical interventions. Frequent visits for routine bowel management indicate suboptimal long-term care, not a planned approach.
Correct Answer is B
Explanation
Choice A rationale
Episiotomy involves an incision in the perineum to enlarge the vaginal opening. While it can facilitate delivery, it does not directly address the mechanical obstruction caused by the shoulder impacting against the maternal symphysis pubis, which is the hallmark of shoulder dystocia.
Choice B rationale
The McRoberts maneuver is most commonly used first to relieve shoulder dystocia. It involves hyperflexing the maternal hips onto the abdomen, which flattens the sacrum, rotates the symphysis pubis cephalad, and often allows the impacted anterior shoulder to clear underneath the symphysis pubis, facilitating delivery.
Choice C rationale
The Zavanelli maneuver involves pushing the fetal head back into the birth canal and performing a Cesarean section. This is a highly invasive and often last-resort maneuver, employed only after less invasive methods like McRoberts and suprapubic pressure have failed due to its significant risks.
Choice D rationale
Fundal pressure involves applying downward pressure on the top of the uterus. This maneuver is contraindicated in shoulder dystocia because it can worsen the impaction of the fetal shoulder against the maternal symphysis pubis, potentially leading to more severe injury to the fetus or mother.
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