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 D

Explanation

D. Warm compresses or heat therapy are not recommended for the initial management of a sprained ankle, especially within the first 24 hours. Heat can increase blood flow and exacerbate swelling and inflammation, which may worsen pain and delay healing.

A. Applying ice packs in this manner helps reduce inflammation and swelling, which are common after a sprain. Alternating ice application with periods of rest allows for effective cooling without causing tissue damage.

B. Wrapping the ankle in an Ace bandage can provide compression and support, which may help reduce swelling and stabilize the joint during the healing process. However, it's important not to wrap the bandage too tightly, as this can impair circulation.

C. Elevating the leg when sitting helps reduce swelling by promoting venous return and preventing fluid accumulation in the injured area. Keeping the ankle elevated above the level of the heart whenever possible is recommended for optimal swelling reduction.

A. Observation for increasing intracranial pressure B. Isolation precautions C. Turn lights on to brighten the room D. Preparation for lumbar puncture E. Apply seizure precautions

Correct Answer is ["A","B","D","E"]

Explanation

A. Observation for increasing intracranial pressure is a critical intervention in the care of a child with infectious meningitis. Meningitis can lead to inflammation of the meninges, which may result in increased pressure within the skull.

B. Isolation precautions may be necessary depending on the causative organism and mode of transmission of the infectious meningitis. Bacterial meningitis, for example, may require droplet precautions to prevent the spread of infection to others.

D. Lumbar puncture (also known as a spinal tap) is a diagnostic procedure often performed to collect cerebrospinal fluid (CSF) for analysis in cases of suspected meningitis. It is an essential intervention in the diagnostic workup of infectious meningitis as it helps identify the causative organism and guide appropriate treatment.

C. Seizure precautions are important for children with infectious meningitis, as meningitis can increase the risk of seizures due to inflammation and irritation of the brain.

C. Bright lights can exacerbate symptoms such as headache and photophobia (sensitivity to light) in patients with meningitis, especially during the acute phase of illness. Therefore, it is not advisable to turn lights on to brighten the room for a child with infectious meningitis.

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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

The nurse is providing instructions about how to treat a sprained ankle. What statement by the mother does the nurse recognize as indicative of a need for additional teaching?

Correct Answer is D

Explanation

What intervention(s) would the nurse caring for a child with infectious meningitis include? (Select all that apply.)

Correct Answer is ["A","B","D","E"]

Explanation

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