What should be the nurse’s first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea?

Immediate IV placement.

Immediate respiratory treatment.

Thorough physical assessment.

Lateral neck radiographs.

Answer and Explanation

The Correct Answer is B

These findings, high fever, dysphagia, drooling, tachycardia, and tachypnea, are classic signs of acute epiglottitis, a life-threatening airway emergency. The inflamed epiglottis can rapidly obstruct the airway, leading to respiratory arrest if not managed immediately.

Rationale for correct answer:

2. The priority is airway maintenance which takes precedence over all other actions. The nurse should ensure the airway remains open and support the child in an upright position, avoiding any agitation or procedures that might worsen obstruction. Notify the provider and prepare emergency airway equipment (intubation or tracheostomy tray) immediately. Oxygen may be given by blow-by, but no invasive airway procedures (like suctioning or tongue inspection) should be attempted until the airway is secured by an experienced provider.

Rationale for incorrect answers:

1. Starting an IV requires restraint and may agitate the child, causing airway spasm and obstruction. IV access should only be obtained after the airway is secured.

3. Attempting a detailed assessment, especially of the throat, is dangerous, even minor throat manipulation can trigger complete airway obstruction. The assessment should be brief, observational, and noninvasive until airway stability is ensured.

4. Although lateral neck radiographs can confirm the diagnosis (showing the thumbprint sign), it should only be done after airway stabilization and in a controlled setting (e.g., radiology or OR) with emergency equipment available.

Take home points

Airway management is the top priority in suspected epiglottitis.
Do not attempt throat examination or IV insertion before securing the airway.
Prepare for emergency intubation or tracheostomy. Ensure skilled personnel and equipment are available.
Administer oxygen cautiously and notify the provider immediately for airway intervention.

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Correct Answer is B

Explanation

Epiglottitisis a life-threatening bacterial infection—most commonly due to Haemophilus influenzae type B (Hib), that causes inflammation and swelling of the epiglottis, leading to airway obstruction. Typical presentation includes sudden onset of high fever, drooling, severe sore throat, dysphagia, muffled voice, stridor, tripod positioning, absence of cough, anxiety and restlessness due to respiratory distress.

Rationale for correct answer:

2. A 6-year-old who has high fever, no spontaneous cough, and frog-like croaking: These are classic signs of acute epiglottitis and signal imminent airway obstruction. The absence of a cough differentiates it from croup, and the frog-like croak indicates severe upper airway involvement. The child is in extreme danger of airway closure and requires immediate airway management and emergency medical treatment, often including intubation or tracheostomy and IV antibiotics.

Rationale for incorrect answers:

1. A 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions: This presentation is typical of mild viral croup (laryngotracheobronchitis). The child is stable and can usually be managed with humidified air or nebulized epinephrine, not an emergency.

3. A 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough: Although the child has distress, the presence of a barky cough indicates croup, not epiglottitis. Treatment includes corticosteroids and nebulized epinephrine, but it’s not as emergent as airway obstruction from epiglottitis.

4. A 13-year-old who has a high fever, stridor, and purulent secretions: This presentation suggests bacterial tracheitis, a serious but slower-progressing condition than epiglottitis. Requires IV antibiotics and airway monitoring, but it does not progress to complete airway obstruction as rapidly as epiglottitis.

Take home points

Epiglottitis is an emergency. Look for high fever, drooling, no cough, muffled or croaking voice.
Never attempt to examine the throat since this may trigger complete airway obstruction.
Immediate airway stabilization and IV antibiotics are priorities.
Rapid recognition and intervention are life-saving in epiglottitis.

A. Cystic fibrosis B. Asthma C. Epiglottitis D. Croup

Correct Answer is D

Explanation

Acute laryngotracheobronchitis (croup)is a viral upper airway infectioncausing inflammation of the larynx, trachea, and bronchi. It typically affects toddlers (6 months–3 years) and presents with barking cough, stridor, respiratory distress, and agitation or anxiety due to difficulty breathing

Rationale for correct answer:

4. The barking cough is the classic hallmark of croupand helps differentiate it from other pediatric respiratory conditions. Respiratory distress is typically mild to moderate, and management includes humidified air, corticosteroids, and nebulized epinephrine if severe.

Rationale for incorrect answers:

1. Cystic fibrosisis a chronic genetic disorder affecting lungs and pancreas, presenting with persistent cough, thick mucus, and recurrent infections, not an acute barking cough.

2. Asthmais characterized by wheezing, chest tightness, and shortness of breath due to lower airway obstruction; does not cause a barking cough.

3. Epiglottitisis a bacterial emergency causing drooling, dysphagia, high fever, and absence of cough. Airway obstruction is rapid, and the child usually sits upright in tripod position, not displaying a barking cough.

Take home points

Barking cough and stridor are symptoms of croup.
Drooling, dysphagia, and high fever suggest epiglottitis an emergency.
Persistent productive cough with poor growth may indicate cystic fibrosis.
Recognizing these hallmark features helps prioritize interventions and ensure airway safety.

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What should be the nurse’s first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which child is in the greatest need of emergency medical treatment?

Correct Answer is B

Explanation

A child with difficulty breathing and a “barking cough’ is displaying signs associated with which condition?

Correct Answer is D

Explanation

While examining a child with acute epiglottitis, a nurse should have which item available?

The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse’ s best response?

During the recovery stages of croup, a nurse should explain which intervention to parents?

A 4-year-old female child presents to the emergency department with a sore throat, difficulty swallowing, and a suspected diagnosis of acute epiglottitis. Which information should be included in the initial assessment of the child? Select all that apply

A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse’s best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?

Which sign in a 3-year-old child with acute epiglottitis indicates that the client’s respiratory distress is increasing?

What should be the nurse’s first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea?

Which instruction should a nurse give the parents of a 2-year-old child who wakes in the night with a barking cough?