The nurse is caring for a toddler with acute laryngotracheobronchitis. Which action aids in bronchodilation to improve breathing for this child?

Teaching the child to take long, slow breaths

Assisting with racemic epinephrine nebulizer therapy

Administering an oral analgesic

Administering a corticosteroid

Answer and Explanation

The Correct Answer is B

A. Teaching the child to take long, slow breaths:

While teaching slow breathing techniques can be helpful in managing anxiety and promoting a sense of calm, it may not directly address the underlying airway inflammation and bronchodilation needed in acute laryngotracheobronchitis.

B. Assisting with racemic epinephrine nebulizer therapy:

Racemic epinephrine is a medication that contains epinephrine, a bronchodilator. Nebulizer therapy with racemic epinephrine helps reduce airway inflammation, allowing for bronchodilation and improved breathing. This is a common intervention for managing acute respiratory distress in conditions like croup.

C. Administering an oral analgesic:

Oral analgesics, such as pain medications, can provide relief from discomfort or pain, but they do not directly address the bronchodilation needed for conditions like acute laryngotracheobronchitis.

D. Administering a corticosteroid:

Corticosteroids have anti-inflammatory properties and can help reduce swelling and inflammation in the airways. By doing so, they contribute to bronchodilation and improved breathing in conditions like croup. Corticosteroids are often used as part of the treatment plan for acute laryngotracheobronchitis.

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Correct Answer is D

Explanation

A. The child has the beginning signs of tooth eruption:

Teething usually begins around 4-7 months of age, so the beginning signs of tooth eruption (teething) are typical at six months.

B. The child is able to track and follow objects:

By six months, most infants can track and follow objects with their eyes, which is a normal developmental milestone for this age.

C. The child’s anterior fontanel is open:

The anterior fontanelle, the soft spot at the top of the baby's head, remains open until around 18-24 months of age, so its presence at six months is expected and considered normal.

D. The child’s posterior fontanel is open.

By six months of age, the posterior fontanelle, the soft spot located at the back of the baby's head, typically closes or is significantly smaller than it was at birth. The posterior fontanelle usually closes between 2 to 4 months of age in most infants. If it remains noticeably open by six months, it might warrant further evaluation as it could be indicative of a developmental or medical issue.

A. “Bring the child to the emergency room immediately.” B. “Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief.” C. “Take the child into the steam-filled room for an additional 15 minutes. If there is no relief, bring the child to the emergency room.” D. “Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there’s no relief in an hour.”

Correct Answer is A

Explanation

A. “Bring the child to the emergency room immediately.”

This is the most appropriate recommendation given the symptoms described, including the barking cough, elevated temperature, and blueness around the mouth. These signs may indicate respiratory distress, and immediate medical attention is needed.

B. “Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief.”

Taking a child out into the cold is not a recommended intervention for respiratory distress. This action may exacerbate the child's breathing difficulties. The symptoms described require urgent evaluation in a healthcare setting.

C. “Take the child into the steam-filled room for an additional 15 minutes. If there is no relief, bring the child to the emergency room.”

While steam may provide temporary relief for mild respiratory symptoms, the presence of blueness around the mouth suggests a more severe condition. Delaying care by waiting for an additional 15 minutes may not be appropriate in this situation.

D. “Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there’s no relief in an hour.”

Using a cool mist humidifier may be helpful for mild respiratory symptoms, but the severity of the symptoms described, especially blueness around the mouth, indicates a need for immediate medical attention. Waiting for an hour could lead to worsening of the child's condition.

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