Which sign should alert a nurse that an 18-month-old child with croup is experiencing increased respiratory distress?
A barking cough
Intercostal retractions
Clubbing of the fingers
Increased anterior-posterior chest diameter
The Correct Answer is B
Croup (laryngotracheobronchitis) is a viral infection commonly caused by the parainfluenza virus that causes inflammation and narrowing of the larynx, trachea, and bronchi, leading to upper airway obstruction. Typical signs include barking cough, inspiratory stridor, and hoarseness.
Rationale for correct answer:
2. Intercostal retractions indicate increased work of breathing and use of accessory muscles due to airway narrowing or obstruction. This is a sign of worsening respiratory distress in a child with croup and warrants immediate evaluation and possible medical intervention such as nebulized epinephrine or corticosteroids. Retractions occur because the child’s compliant chest wall is pulled inward during inspiration as airway resistance increases.
Rationale for incorrect answers:
1. The barking, seal-like cough is a typical feature of croup, but by itself does not indicate worsening distress. It is a baseline symptom, not a progression sign.
3. Clubbing of the fingers indicates chronic hypoxemia from long-term respiratory disease such as cystic fibrosis, or congenital heart disease. It does not develop acutely in croup.
4. Increased anterior-posterior chest diameter occurs with chronic obstructive conditions such as asthma or cystic fibrosis due to air trapping over time, not with acute viral croup.
Take home points
- Retractions, nasal flaring, stridor at rest, and restlessness signal increasing respiratory distress in children with croup.
- Prompt recognition and intervention are essential to prevent airway compromise.
- Mild croup: barking cough, stridor only with activity.
- Severe croup: stridor at rest, marked retractions, agitation, possible cyanosis, requires emergency treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Croup(laryngotracheobronchitis)is a viral respiratory infection, most often caused by the parainfluenza virus. It is highly contagiousand spreads through respiratory dropletsand direct contactwith contaminated surfaces.
Rationale for correct answer:
1. Hand hygieneis the most effective infection-control measure for preventing the spread of viral respiratory illnesses such as croup. Viruses are easily transmitted through touching contaminated hands, toys, or surfaces, and frequent hand washing with soap and water minimizes transmission. Hand hygiene should be performed before and after contact with the child or their environment.
Rationale for incorrect answers:
2. Isolationis not routinely required for croup unless another specific infection (like RSV or influenza) is suspected or confirmed. Standard precautionswith hand hygiene and droplet precautions if coughing/sneezing are usually sufficient.
3. Whileteaching children to use tissues ishelpful for older children, an 18-month-old or young child may not effectively use tissues or practice good respiratory hygiene. Teaching tissues alone is not adequate to prevent transmission.
4. Keeping siblings in the same room increases the risk of cross-infection, as croup is contagious. Siblings, especially those who are young or immunocompromised, should be kept apart during the illness.
Take home points
- Hand washing is the single most effective way to prevent the spread of respiratory infections like croup.
- Standard precautions should be followed by avoiding close contact, cleaning toys/surfaces, and encouraging covering the mouth when coughing.
- Droplet precautions may be added in healthcare settings if the child is coughing or sneezing.
- Good hygiene practices protect both family members and healthcare providers from infection.
Correct Answer is C
Explanation
A nighttime cough in a young child without fever often indicates mild upper respiratory irritation or postnasal drip. Non-pharmacologic comfort measures can help reduce coughing and promote better sleep without unnecessary medication.
Rationale for correct answer:
3. Raising the head of the baby’s crib can help reduce coughingby promoting drainage of nasal secretions and reducing postnasal drip that irritates the throat. This simple intervention is safe, non-invasive, and can improve the child’s comfort and sleep quality.
Rationale for incorrect answers:
1. Steam vaporizersplaced too close can cause burns or be a safety hazard. Cold mist humidifiers used properly can help, but the placement should be safe and not directly next to the child’s face or crib.
2. Nonprescription cough and cold medicinesare not recommended for children under 2 years due to lack of efficacy and potential serious side effects. The FDA advises against their use in infants and toddlers.
4. Antibioticsare not appropriate without signs of bacterial infection such as fever or purulent symptoms. Most coughs in toddlers are viral and self-limiting.
Take home points
- For mild nighttime cough without fever in toddlers, non-pharmacologic measures like elevating the head of the crib can improve comfort.
- Avoid over-the-counter cough and cold medicines in children under 2 due to safety concerns.
- Antibiotics should not be prescribed unless bacterial infection is clearly suspected.
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