A nurse in a clinic is collecting data from a client. The client reports that they do not believe in receiving immunizations. Which of the following questions should the nurse ask the client?

A) Request an x-ray of the neck: In cases of suspected epiglottitis, a lateral neck x-ray can help confirm the diagnosis by showing the classic "thumbprint sign," which indicates swelling of the epiglottis. This is a critical diagnostic step, but it should only be performed in a controlled setting where the child’s airway can be monitored closely. The priority is to avoid any procedures that may cause irritation or further compromise the airway.

B) Monitor urine for protein: Monitoring urine for protein is not relevant to the management of epiglottitis. This condition is related to inflammation and obstruction of the upper airway, and the focus should be on respiratory management rather than renal function.

C) Obtain a nasopharyngeal swab: While obtaining a nasopharyngeal swab can help identify the organism causing an infection (often bacterial), it is not the immediate priority in a child with suspected epiglottitis. The child’s airway is the most critical concern, and diagnostic interventions that could potentially cause further distress or obstruction (such as swabbing) should be avoided until airway management is stable.

D) Administer fluconazole: Fluconazole is an antifungal medication, and its use is not appropriate for epiglottitis. Epiglottitis is most often caused by a bacterial infection, particularly Haemophilus influenzae type b (Hib), which requires antibiotic therapy, not antifungals.

Correct answers: C

Rationale:

A. Staff members using a class A fire extinguisher for an electrical fire is incorrect and dangerous. Class A extinguishers are for ordinary combustibles like paper and wood. Electrical fires require class C extinguishers to prevent the conduction of electricity.

B. Reviewing the locations of fire extinguishers every 2 to 3 years is insufficient for an effective safety plan. Regular fire safety drills and location reviews should occur at least annually. Frequent reinforcement ensures rapid response during a real fire emergency.

C. An evacuation order when fire extinguishers are ineffective indicates an effective safety plan and sound clinical judgment. The priority in the RACE acronym is to rescue and then evacuate if the fire is not contained. This protects life when suppression fails.

D. Fire alarms having the same sound as other alarms is a failure in safety design. Distinctive auditory signals are required to prevent confusion during an emergency. Unique alarms ensure that staff and patients immediately identify the specific nature of the threat.