Which symptom would warrant immediate reevaluation in a child with a concussion?

Choice A rationale

Epiglottitis is a rapidly progressive, life-threatening bacterial infection causing severe swelling of the epiglottis, potentially leading to acute, complete upper airway obstruction. The most critical initial nursing action is to minimize distress and be immediately prepared for definitive airway management (intubation or tracheostomy) by the appropriate team, as the airway can close suddenly.

Choice B rationale

Racemic epinephrine is an α-adrenergic agonist used to cause vasoconstriction and reduce subglottic edema, primarily indicated for croup. Epiglottitis involves supraglottic swelling, and while it may theoretically reduce edema, the primary risk is mechanical obstruction, making preparation for airway management the priority.

Choice C rationale

While prompt intravenous antibiotic administration is essential to treat the causative bacterium, usually Haemophilus influenzae type b, this action is secondary to securing a patent airway. A patient can die from asphyxiation much faster than from bacteremia, thus airway security must be addressed first.

Choice D rationale

Attempting to obtain a throat culture in a child with suspected epiglottitis is contraindicated. Any manipulation of the posterior pharynx or epiglottis, such as using a tongue blade or swab, can trigger laryngospasm and cause immediate, complete airway obstruction, which is a catastrophic complication.

Choice A rationale

Weight gain of 1 kg suggests fluid retention, which is contrary to the expected diuretic effect of furosemide. Furosemide, a loop diuretic, acts by inhibiting the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle, increasing water and electrolyte excretion. A decrease in body weight due to diuresis is the primary indicator of effectiveness in reducing fluid overload associated with CHF.

Choice B rationale

Decreased urine output indicates a diminished response to the diuretic, suggesting ineffectiveness or potential complications like dehydration or pre-renal injury. Effective diuresis should significantly increase the urine output, facilitating the removal of excess interstitial and intravascular fluid volume to alleviate the symptoms of pulmonary and systemic congestion in CHF. Normal urine output for children is typically 1 to 2 mL/kg/hr.

Choice C rationale

Increased crackles, also known as rales, are adventitious lung sounds that signify the presence of fluid in the alveoli and small airways, characteristic of pulmonary edema in CHF. Furosemide aims to decrease this fluid, improving oxygenation and reducing the audible crackles, making an increase an indicator of worsening condition or ineffective treatment.

Choice D rationale

Decreased respiratory rate often accompanies improved oxygenation and reduced work of breathing, secondary to the resolution of pulmonary congestion and edema. Furosemide's action reduces the fluid burden on the lungs, lowering the hydrostatic pressure and facilitating gas exchange, which in turn reduces the tachypnea and respiratory distress common in pediatric CHF.