The nurse employed in an emergency department is instructed to monitor a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. The nurse interprets this observation as indicating which finding?

Extreme fatigue

An airway obstruction

The presence of dehydration

The presence of pain

Answer and Explanation

The Correct Answer is B

B. Leaning forward with the chin thrust out, often described as the "sniffing position," is a classic sign of airway obstruction, particularly in cases of epiglottitis. This positioning helps to maximize airway patency by opening the airway and reducing the risk of further obstruction.

A. Leaning forward with the chin thrust out is not typically associated with extreme fatigue. Instead, it is a specific positioning often seen in individuals with epiglottitis to help alleviate airway obstruction and facilitate breathing.

C. Leaning forward with the chin thrust out is not indicative of dehydration. Dehydration may present with other signs and symptoms such as dry mucous membranes, decreased urine output, sunken fontanelle (in infants), and poor skin turgor.

D. Pain may be present in a child with epiglottitis but leaning forward with the chin thrust out is not primarily indicative of pain. This positioning is primarily a compensatory mechanism to alleviate airway obstruction rather than a response to pain.

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Correct Answer is A

Explanation

A. Prompt initiation of appropriate antibiotics is essential to prevent the spread of infection, alleviate symptoms, and promote healing.

B. Surgical debridement of necrotic tissue is often necessary for treating acute osteomyelitis, especially if there is extensive tissue damage or the formation of abscesses. Surgical intervention aims to remove infected and dead tissue, reduce bacterial load, and promote wound healing.

C. Antipyretic therapy, such as acetaminophen or ibuprofen, may be administered to reduce fever and alleviate associated symptoms in clients with acute osteomyelitis. While fever management is important for comfort and overall well-being, it may not be the immediate priority unless the fever is high or causing significant distress.

D. Adequate nutrition and hydration support immune function, tissue repair, and overall recovery. However, while important for long-term management, optimizing nutrition and hydration may not be the immediate priority unless the client is severely malnourished or dehydrated.

A. Use a hair dryer on a hot setting to dry the cast. B. Discourage the client from ambulating. C. Keep the client's leg in a dependent position. D. Perform a neurovascular check of the lower extremities.

Correct Answer is D

Explanation

D. This is the correct action to take. A neurovascular check involves assessing the circulation, sensation, and movement in the affected limb. This check helps monitor for complications such as impaired circulation, nerve damage, or compartment syndrome, which can occur after the application of a plaster cast. Regular neurovascular checks are essential for early detection of any issues and appropriate intervention if necessary.

A. Using a hair dryer on a hot setting can cause burns to the skin under the cast. It can also cause the cast material to heat up and potentially cause discomfort or injury to the patient.

B. It's essential to follow the healthcare provider's instructions regarding weight-bearing restrictions, but completely discouraging ambulation can lead to complications such as muscle atrophy, decreased circulation, and increased risk of blood clots.

C. Keeping the client's leg in a dependent position means positioning it lower than the heart. This can increase swelling and exacerbate pain, potentially leading to complications such as compartment syndrome.

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The nurse employed in an emergency department is instructed to monitor a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. The nurse interprets this observation as indicating which finding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with the care of a newly-admitted client who has acute osteomyelitis. Which of the following interventions is the priority for the nurse to implement?

Correct Answer is A

Explanation

A nurse is caring for an adolescent following the application of a plaster cast for a fractured right tibia. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

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