A nurse is assessing a child with suspected epiglottitis.
Which clinical manifestation should the nurse prioritize when evaluating the severity of the condition?
"I can't swallow, and my throat hurts.”..
"I feel anxious and restless.”..
"I'm making a high-pitched sound when I breathe.”..
"My skin and lips look bluish.”..
The Correct Answer is D
Choice A rationale:
Difficulty swallowing and throat pain are common symptoms of epiglottitis, but they do not necessarily indicate the severity of the condition.
Choice B rationale:
Feeling anxious and restless may be a sign of distress, but it does not specifically indicate the severity of epiglottitis.
Choice C rationale:
Making a high-pitched sound when breathing (called stridor) is a serious symptom indicating airway obstruction.
While this is concerning, it is not the most critical manifestation in evaluating the severity of epiglottitis.
Choice D rationale:
Cyanosis, characterized by a bluish discoloration of the skin and lips, indicates severe lack of oxygen and is a critical sign in assessing the severity of epiglottitis.
Cyanosis suggests inadequate oxygenation and is indicative of impending respiratory failure, requiring immediate medical intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Administering antibiotics intravenously is important in treating the infection, but it doesn't directly address maintaining a patent airway.
The priority in epiglottitis is to ensure an open airway to prevent respiratory distress.
Choice B rationale:
Providing humidified air or cool mist therapy helps moisten the airway, making it easier for the child to breathe.
This intervention can provide immediate relief and aid in maintaining a patent airway, which is crucial in epiglottitis.
Choice C rationale:
Administering corticosteroids intravenously can help reduce inflammation, but it might not be the primary intervention to maintain a patent airway.
Humidified air therapy directly addresses airway moisture, which is essential in epiglottitis management.
Choice D rationale:
Administering analgesics and antipyretics can address pain and fever associated with epiglottitis but does not directly contribute to maintaining a patent airway.
While these medications can improve the child's comfort, they are not the priority in this situation.
Correct Answer is ["A","C"]
Explanation
Choice A rationale:
Haemophilus influenzae type b (Hib) infection is a significant risk factor for epiglottitis in children.
Hib vaccination has significantly reduced the incidence of epiglottitis caused by this bacterium.
Choice B rationale:
Trauma to the throat or neck is not a common risk factor for epiglottitis.
The primary cause is bacterial infection, especially by Hib bacteria.
Choice C rationale:
Thermal injury from hot liquids can lead to thermal epiglottitis, a rare condition caused by the inhalation of hot steam or liquid, resulting in inflammation and swelling of the epiglottis.
Choice D rationale:
Seasonal factors are not a direct risk factor for epiglottitis.
The condition is primarily caused by bacterial infections and is not significantly influenced by seasonal changes.
Choice E rationale:
Mycoplasma pneumoniae infection is not a common cause of epiglottitis.
Bacterial infections, especially Hib, are the primary culprits in pediatric cases of epiglottitis.
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