Which of the following are expected clinical manifestations of viral croup?
Stridor.
Barking cough.
Hoarseness.
Tripod positioning.
Drooling.
Correct Answer : A,B,C
Choice A rationale
Stridor is a high-pitched, inspiratory sound resulting from turbulent airflow through a partially obstructed upper airway, specifically the larynx or trachea. In viral croup (laryngotracheobronchitis), inflammation and edema of the subglottic region cause this characteristic narrowing, making stridor a key expected clinical manifestation, especially when the child is agitated or crying.
Choice B rationale
The barking or "seal-like" cough is the hallmark symptom of viral croup, primarily caused by the inflammation and edema localized to the larynx and vocal cords. The narrowed, swollen subglottic area below the vocal cords creates the distinctive resonant sound as air rushes past the restricted space during exhalation, often worsening at night.
Choice C rationale
Hoarseness is a direct result of the inflammatory process affecting the vocal cords within the larynx. The edema and irritation cause the vocal cords to vibrate abnormally, altering the voice's pitch and quality, leading to the rough or husky sound that is commonly observed in children with viral croup.
Choice D rationale
Tripod positioning (sitting upright, leaning forward, with the neck extended) is a compensatory posture typically associated with severe respiratory distress from epiglottitis or a foreign body, indicating imminent airway collapse, but is generally not an expected early finding in the milder upper airway obstruction of viral croup.
Choice E rationale
Drooling results from the inability to swallow secretions due to severe pain and swelling of the epiglottis, making it a cardinal sign of epiglottitis, a bacterial infection. In contrast, viral croup typically involves inflammation lower down in the subglottic area, so drooling is not an expected clinical feature.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The sweat chloride test is the gold standard diagnostic test for cystic fibrosis (CF). CF is caused by a mutation in the CFTR gene, which impairs chloride ion transport across epithelial cells. This defect leads to abnormally high chloride concentration in sweat, typically >60 mEq/L in children, which provides biochemical confirmation of the disease.
Choice B rationale
Pulmonary function tests (PFTs) measure lung volumes and airflow, typically revealing an obstructive pattern in CF due to chronic infection and inflammation. While they monitor disease progression and severity, PFTs are not diagnostic for the underlying genetic disorder that defines cystic fibrosis.
Choice C rationale
A Chest X-ray (CXR) may show characteristic findings of chronic lung disease in CF, such as bronchiectasis, hyperinflation, or atelectasis, reflecting the disease's pulmonary complications. However, the CXR is an imaging tool for assessing lung structure, not a diagnostic test for the systemic genetic condition itself.
Choice D rationale
Sputum cultures are used to identify the specific bacterial pathogens, such as Pseudomonas aeruginosa or Staphylococcus aureus, colonizing the airways of CF patients. While essential for guiding antibiotic therapy, a sputum culture only detects secondary infection and does not confirm the diagnosis of cystic fibrosis.
Correct Answer is ["A","C","E"]
Explanation
Choice A rationale
Hypercyanotic spells, or "tet spells," result from a sudden decrease in pulmonary blood flow and increased right-to-left shunting, leading to profound hypoxemia. Administering oxygen helps by slightly increasing arterial oxygen tension, which acts as a mild pulmonary vasodilator, potentially reducing pulmonary vascular resistance and improving oxygen delivery to tissues. This aims to counteract the immediate hypoxemia.
Choice C rationale
Morphine administration is appropriate because of its central nervous system depressant effects. It helps to calm the infant, decreasing systemic oxygen demands and reducing the hyperpnea (rapid, deep breathing) that often accompanies the spell. Furthermore, morphine mildly vasodilates, which increases systemic vascular resistance, decreasing the right-to-left shunt flow.
Choice E rationale
Placing the infant in the knee-chest position significantly increases systemic vascular resistance (SVR) by compressing the major arteries in the lower extremities. The increased SVR reduces the pressure gradient driving the right-to-left shunt through the ventricular septal defect, thereby increasing pulmonary blood flow and improving oxygen saturation during the hypercyanotic event.
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