A parent brings her child to the pediatrician’s office because of difficulty breathing and a “barking” cough. These signs are associated with which of the following conditions?
Cystic fibrosis
Asthma
Epiglottitis
Croup
The Correct Answer is D
Croup (laryngotracheobronchitis) is a viral infection (commonly caused by the parainfluenza virus) that leads to inflammation and narrowing of the larynx and trachea, resulting in upper airway obstruction.
It typically affects children between 6 months and 3 years old. Symptoms are often worse at night and may follow an upper respiratory infection.
Rationale for correct answer:
4. The hallmark signs, barking cough and difficulty breathing, are classic indicators of croup. The cough results from laryngeal swelling, and inspiratory stridor occurs due to narrowing of the upper airway. Treatment typically includes humidified air, corticosteroids (e.g., dexamethasone), and, in moderate to severe cases, nebulized epinephrine to reduce airway edema.
Rationale for incorrect answers:
1. Cystic fibrosis is a genetic disorder causing thick mucus secretions affecting the lungs and pancreas. It presents with chronic cough, recurrent infections, and malabsorption, not a barking cough or acute airway obstruction.
2. Asthma causes wheezing, shortness of breath, and chest tightness due to lower airway bronchoconstriction, not a barking cough or stridor.
3. Epiglottitis presents with drooling, dysphagia, high fever, tripod positioning, and absence of cough not a barking cough. It’s a medical emergency due to risk of complete airway obstruction.
Take home points
- Barking cough and stridor are hallmark signs of croup which is viral and usually mild to moderate.
- Drooling, no cough, and high fever are symptoms of epiglottitis a bacterial emergency.
- Wheezing and chest tightness are typical of asthma.
- Chronic productive cough and malabsorption are symptoms of cystic fibrosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Croupis a common respiratory illness in toddlers characterized by a barking cough, often caused by viral inflammation leading to airway narrowing. Discharge teaching focuses on home management and recognizing signs of worsening illness.
Rationale for correct answers:
1. Cool mist helps soothe inflamed airwaysand can reduce airway irritation, making breathing easier. It is a safe, non-invasive home therapy to help alleviate symptoms.
3. Stridor at restindicates significantairway obstructionand respiratory distress that requires urgent medical evaluation to prevent respiratory failure.
4. Adequate hydration thins mucus secretions, prevents dehydration, and supports overall recovery.
Rationale for incorrect answers:
2. Over-the-counter cough syrups are not recommended for young children due to limited efficacy and potential side effects.
5. Aspirinis contraindicated in children because of the risk of Reye’s syndrome, a serious and potentially fatal condition.
Take home points
- Use cool-mist humidifiers and maintain hydration to support symptom relief in croup.
- Recognize signs of respiratory distress such as stridor at rest and seek emergency care promptly.
- Avoid cough syrups and aspirin in young children.
Correct Answer is A
Explanation
Infants and young children have anatomical and physiological differences in their upper airways compared to adults that increase their risk for airway obstruction. These differences include a smaller and more flexible airway structure and narrower passages, which make them more vulnerable to swelling and obstruction.
Rationale for correct answer:
1. Underdeveloped cricoid cartilage and narrow nasal passagescontribute significantly to the increased risk of upper airway obstruction in infants and children. The cricoid cartilageis the narrowest part of a child’s airway and is less rigid than in adults, making it more prone to collapse or swelling. Narrow nasal passagescan become easily blocked by secretions or inflammation, further compromising airflow.
Rationale for incorrect answers:
2. Tonsils in children tend to be relatively large, not small, and can contribute to obstruction. The nasal passages are narrow, but this option misses the critical role of cricoid cartilage development.
3. The child’s larynx is funnel-shaped, not cylindrical, with the narrowest point at the cricoid cartilage. While sinuses develop over time, their underdevelopment doesn’t directly increase risk of upper airway obstruction.
4. Children actually have proportionally larger tonguesrelative to their oral cavity, which can contribute to obstruction, so “smaller tongue” is inaccurate.
Take home points
- Infants and children have a funnel-shaped, narrower airway with a less rigid cricoid cartilage, making them more susceptible to airway obstruction.
- Narrow nasal passages add to the risk by limiting airflow, especially during inflammation.
- Understanding these anatomical differences is critical when assessing respiratory distress in pediatric patients.
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