The nurse employed in an emergency department is monitoring a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the neck extended. How would the nurse interpret this finding? -
Extreme fatigue
An airway obstruction
Presence of pain
Presence of dehydration
The Correct Answer is B
A. Extreme fatigue is not indicated by this positioning.
B. The child’s forward-leaning position with neck extension is a classic sign of epiglottitis, where the child is attempting to open the airway and facilitate breathing in response to obstruction.
C. Pain may be present, but the positioning is primarily related to an attempt to alleviate airway obstruction.
D. Dehydration would not typically cause this specific positioning.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Croup is a viral infection that typically presents with a barking cough and stridor, rather than difficulty swallowing and excessive drooling.
B. Epiglottitis is a life-threatening condition characterized by sudden onset of fever, drooling, difficulty swallowing, and difficulty speaking (dysphonia). It is a medical emergency and often caused by Haemophilus influenzae type B.
C. Bronchiolitis is usually caused by respiratory syncytial virus (RSV) and presents with wheezing, cough, and respiratory distress but not typically with drooling or difficulty swallowing.
D. Laryngotracheobronchitis (another name for croup) also presents with a barking cough and stridor but does not cause difficulty swallowing or drooling.
Correct Answer is B
Explanation
A. Extreme fatigue is not indicated by this positioning.
B. The child’s forward-leaning position with neck extension is a classic sign of epiglottitis, where the child is attempting to open the airway and facilitate breathing in response to obstruction.
C. Pain may be present, but the positioning is primarily related to an attempt to alleviate airway obstruction.
D. Dehydration would not typically cause this specific positioning.
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