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 C
Explanation
Choice A rationale
The primary nurse, while having a close relationship with the client and family, is not typically the first professional to address organ donation. Their role involves providing direct medical care and support, and discussing organ donation could introduce a conflict of interest or compromise the therapeutic relationship during a sensitive time.
Choice B rationale
The social worker provides psychosocial support and resource navigation. While they may be involved in discussions about end-of-life care, initiating the organ donation conversation is a specialized role requiring specific training and adherence to legal and ethical guidelines, which typically falls outside their initial scope.
Choice C rationale
The organ procurement coordinator is specifically trained and legally authorized to discuss organ donation with families. They possess the necessary knowledge about the donation process, ethical considerations, and legal requirements, ensuring the conversation is handled sensitively and accurately, minimizing distress for the family.
Choice D rationale
The attending physician’s primary responsibility is the medical care of the patient. Introducing the topic of organ donation could potentially be perceived as abandoning care or create a conflict of interest. While they may support the coordinator, direct initiation by the physician is generally avoided to maintain trust and focus on patient care.
Correct Answer is ["C"]
Explanation
Choice A rationale: A heart rate of 75/min in a 7-year-old child falls within the normal pediatric range of 70 to 110 beats per minute. Heart rate variability can be influenced by activity, anxiety, or health status. Since this child is alert and cooperative with no signs of distress, this heart rate is physiologically appropriate and does not indicate an urgent cardiovascular problem requiring immediate follow-up.
Choice B rationale: A pulse oximetry reading of 98% on room air is considered within normal limits for a child. Normal oxygen saturation ranges from 95% to 100% in healthy individuals, indicating adequate oxygenation and effective pulmonary gas exchange. Since the child shows no respiratory distress and oxygen saturation is stable, no immediate intervention is necessary based on this value.
Choice C rationale: A blood pressure of 148/88 mm Hg in a 7-year-old is significantly elevated. Pediatric hypertension is defined as systolic or diastolic BP at or above the 95th percentile for age, sex, and height. For this age and height, normal systolic BP is approximately 90–112 mm Hg, and diastolic is 55–75 mm Hg. This reading suggests stage 2 hypertension, requiring urgent evaluation to prevent end-organ damage.
Choice D rationale: Height of 154.9 cm (61 inches) at age 7 is above average but not concerning by itself. Growth charts indicate the 95th percentile for 7-year-old boys is around 128 cm (50 inches). This height is unusually tall, likely indicating early growth spurt or familial tall stature but does not require immediate clinical follow-up unless accompanied by other symptoms.
Choice E rationale: Weight of 44.5 kg (98 lb) at age 7 is significantly above the typical weight range, with the 95th percentile approximately 34 kg. This child is likely obese, which predisposes to hypertension and metabolic complications. However, obesity alone is not an immediate threat requiring urgent follow-up, but it warrants lifestyle counseling and monitoring.
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