A 4-year-old client presents to the emergency department with drooling, agitation, and inability to cough. The nurse should recognize these findings are associated with which diagnosis?
Bronchiolitis
Asthma
Nasopharyngitis
Bacterial epiglottitis
The Correct Answer is D
A. Bronchiolitis usually presents with wheezing and difficulty breathing, not drooling or inability to cough.
B. Asthma typically presents with wheezing, shortness of breath, and coughing, but not with drooling or an inability to cough.
C. Nasopharyngitis, or the common cold, usually causes symptoms like runny nose, cough, and sore throat, but not drooling or agitation.
D. Bacterial epiglottitis is a life-threatening condition characterized by drooling, agitation, inability to cough, and potential airway obstruction. The child often appears anxious and sits leaning forward in a "tripod" position.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Projectile vomiting is a classic sign of pyloric stenosis, where the thickened pylorus muscle obstructs the passage of food from the stomach to the small intestine, causing forceful vomiting.
B. Large amounts of bilious emesis would suggest an obstruction beyond the pylorus, which is not characteristic of pyloric stenosis.
C. Watery diarrhea is not associated with pyloric stenosis, which typically causes dehydration and constipation.
D. Steatorrhea, or fatty stools, is not a feature of pyloric stenosis but rather is associated with malabsorption syndromes.
Correct Answer is D
Explanation
A. While monitoring blood pressure is important, a blood pressure of 98/62 mm Hg may not immediately warrant notification unless there are signs of hypotension or other symptoms. The focus should be on careful management of fluid and electrolytes.
B. In cases of acute renal failure, potassium levels can become elevated due to impaired renal function. Therefore, IV fluids should typically be low in potassium to prevent hyperkalemia.
C. In acute renal failure, a diet high in protein and sodium is not recommended. Instead, dietary restrictions are usually advised to manage waste products and fluid balance.
D. Administering IV fluids slowly helps to prevent fluid overload, which is crucial in managing renal failure and maintaining hemodynamic stability.
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