The nurse is reviewing collected data.
Which finding is consistent with acute laryngotracheobronchitis or pneumonia?

Stridor.

Type of cough.

Fever.

Irritability.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Stridor is a high-pitched sound often caused by airway obstruction or inflammation. It is a hallmark of acute laryngotracheobronchitis. The narrowed airways produce turbulent airflow, leading to this characteristic noise during inspiration.

Choice B rationale

The cough type, while clinically relevant, lacks specificity. It does not help differentiate between laryngotracheobronchitis and pneumonia since both conditions may present with cough.

Choice C rationale

Fever commonly accompanies infection but does not distinguish laryngotracheobronchitis from pneumonia. Both conditions are often associated with elevated body temperature due to immune response.

Choice D rationale

Irritability may occur due to hypoxia or fever in various respiratory conditions. However, it is nonspecific and does not directly confirm laryngotracheobronchitis or pneumonia.

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

Explanation

Choice A rationale

A nasopharyngeal specimen is crucial for confirming RSV infection. This test detects viral antigens or RNA through assays like immunofluorescence or polymerase chain reaction. Such diagnostic accuracy guides treatment decisions and minimizes misdiagnosis.

Choice B rationale

Sterile suctioning clears nasal secretions, improving airway patency and oxygenation. This intervention is especially necessary before feeding to prevent aspiration, which can exacerbate respiratory distress. Suctioning supports effective feeding by maintaining a clear nasal passage.

Choice C rationale

Nebulized albuterol sulfate is primarily indicated for bronchospasm related to conditions like asthma. While RSV can cause wheezing, bronchodilators are not typically effective for viral-induced airway inflammation and are not a standard treatment for RSV.

Choice D rationale

Administering oxygen to maintain SaO2 above 90% is essential for managing hypoxemia in RSV cases. Oxygen therapy ensures adequate tissue oxygenation, preventing complications like respiratory failure. This is a cornerstone of supportive care for RSV.

Choice E rationale

Chest percussion and drainage are not standard RSV treatments. This intervention targets mucus mobilization in chronic or bacterial respiratory conditions. RSV management focuses on supportive measures like suctioning and hydration rather than percussion.

A. Administer the vaccine into the dorsogluteal muscle. B. Massage the injection site for 15 seconds after administration. C. Ensure the guardian signed an informed consent form for the immunization. D. Aspirate for the presence of blood return prior to administering the vaccine.

Correct Answer is C

Explanation

Choice A rationale

The dorsogluteal muscle is not recommended for vaccine administration in toddlers due to its proximity to the sciatic nerve and potential for injury. The anterolateral thigh is the preferred site due to the presence of thicker muscle layers in younger children.

Choice B rationale

Massaging the injection site is not necessary and may lead to irritation or increased discomfort. Vaccine administration guidelines emphasize minimizing trauma to the site rather than stimulating the area post-injection.

Choice C rationale

Obtaining informed consent is essential before administering any vaccine. This step ensures legal and ethical compliance, allowing guardians to understand the risks and benefits associated with the immunization.

Choice D rationale

Aspiration is no longer recommended in vaccine administration according to updated guidelines. Aspiration increases injection time and patient discomfort without evidence of enhancing safety.

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The nurse is reviewing collected data.Which finding is consistent with acute laryngotracheobronchitis or pneumonia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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

Explanation

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Correct Answer is C

Explanation

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The nurse is reviewing collected data.
Which finding is consistent with acute laryngotracheobronchitis or pneumonia?