A nurse is assisting with the care of a preschooler who has epiglottitis. Which of the following actions should the nurse take?

Request an x-ray of the neck.

Monitor urine for protein.

Obtain a nasopharyngeal swab

Administer fluconazole.

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is ["B","C","F","G","H"]

Explanation

B. Stool results: A positive hemoccult test indicates gastrointestinal bleeding, likely due to a peptic ulcer. Immediate follow-up is needed to assess for ongoing blood loss and the potential for hemorrhagic complications.

C. Heart rate: The tachycardia (118/min) suggests a compensatory response to hypovolemia from gastrointestinal bleeding. This requires prompt intervention to prevent hemodynamic instability.

F. Blood pressure: Hypotension (90/50 mm Hg) is concerning for volume depletion due to chronic or active gastrointestinal bleeding. This requires immediate follow-up to prevent shock.

G. Hemoglobin and hematocrit: A hemoglobin of 9.1 g/dL and hematocrit of 27% indicate anemia, likely due to gastrointestinal blood loss. Further evaluation and potential blood transfusion may be required.

H. Current medications: Ibuprofen use is a major risk factor for peptic ulcer disease and gastrointestinal bleeding. Immediate follow-up is needed to discontinue NSAIDs and initiate appropriate ulcer management.

Incorrect:

A. Respiratory rate: A rate of 18/min is within the normal range and does not require urgent follow-up.

D. Temperature: A temperature of 37.5°C (99.5°F) is slightly elevated but not clinically significant for immediate intervention.

E. WBC count: The WBC count is within the normal range, making it less of an immediate concern.

A. Regresses to an earlier developmental level B. Alienates himself from his peers C. Believes that his brother's death will be reversible D. Believes his bad behavior is causing his brother's death

Correct Answer is D

Explanation

A) Regresses to an earlier developmental level:
While it is possible for a child to show some regression in behavior when faced with a stressful situation such as a sibling’s illness, school-age children are typically able to understand more complex concepts. Regression to an earlier developmental stage is more common in younger children (preschool-age) rather than school-age children, who are more likely to express their emotions in other ways.

B) Alienates himself from his peers:
While the child may experience feelings of isolation or withdrawal due to the stress of a sibling’s terminal illness, alienation from peers is not the most typical or immediate response for a school-age child. It is more common for children of this age to seek comfort and support from peers, though they may struggle with how to discuss their feelings.

C) Believes that his brother's death will be reversible:
At a school-age level, children generally begin to understand the permanence of death. While younger children may have magical thinking that could lead them to believe the death of a loved one could be reversible, this is not the expected response for a school-age child. By this age, children typically comprehend that death is final, although they may struggle with the emotional aspect of it.

D) Believes his bad behavior is causing his brother's death:
This response is the most typical for a school-age child. At this stage, children often have a sense of responsibility for events around them and may develop feelings of guilt or magical thinking, where they believe their actions or behavior contributed to the illness or death of a loved one. This belief is part of the normal coping process but needs to be addressed in counseling or with support from caregivers to help the child understand the situation and alleviate any misplaced guilt.

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A nurse is assisting with the care of a preschooler who has epiglottitis. Which of the following actions should the nurse take?

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