A nurse is caring for a toddler who has acute laryngotracheobronchitis and has been placed in a cool mist tent. Which of the following findings should indicate to the nurse that the treatment is effective?
Barking cough
Decreased stridor
Decreased temperature
Improved hydration
The Correct Answer is B
Choice A reason: Barking cough is not a finding that indicates the effectiveness of the treatment. Barking cough is a sign of inflammation of the larynx and trachea, which causes a hoarse and harsh sound. It is a common symptom of acute laryngotracheobronchitis, also known as croup.
Choice B reason: Decreased stridor is a finding that indicates the effectiveness of the treatment. Stridor is a high-pitched, wheezing sound that occurs when the airway is narrowed or obstructed. It is a sign of respiratory distress and hypoxia. The cool mist tent helps to humidify and soothe the airway, reducing the swelling and inflammation.
Choice C reason: Decreased temperature is not a finding that indicates the effectiveness of the treatment. Decreased temperature could be a sign of hypothermia or sepsis, which are serious complications that require immediate attention. The normal temperature range for a toddler is 36.5°C to 37.5°C (97.7°F to 99.5°F).
Choice D reason: Improved hydration is not a finding that indicates the effectiveness of the treatment. Improved hydration is a sign of adequate fluid intake and output, which are important for maintaining electrolyte balance and preventing dehydration. However, hydration status does not directly affect the airway inflammation or obstruction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The child has a normal potassium level, as it is within the reference range of 3.5 to 5 mEq/L. Potassium is an electrolyte that helps regulate the fluid balance, nerve impulses, and muscle contractions in the body.
Choice B reason: The child has a low hemoglobin level, as it is below the reference range of 10 to 15.5 g/dL. Hemoglobin is a protein in the red blood cells that carries oxygen to the tissues. Sickle cell anemia is a genetic disorder that causes the red blood cells to have an abnormal shape and become rigid, sticky, and prone to clumping. This can lead to hemolysis, anemia, and reduced oxygen delivery.
Choice C reason: The child has a normal platelet level, as it is within the reference range of 150,000 to 450,000 mm^3^. Platelets are blood cells that help with clotting and prevent bleeding. Sickle cell anemia can cause thrombocytopenia, a low platelet count, due to increased destruction or sequestration of platelets in the spleen.
Choice D reason: The child has a normal blood glucose level, as it is within the reference range of 70 to 110 mg/dL. Blood glucose is the main source of energy for the cells in the body. Sickle cell anemia can cause hypoglycemia, a low blood glucose level, due to impaired glucose metabolism, increased glucose utilization, or decreased glucose production.
Correct Answer is A
Explanation
Choice A reason: This is the best option to prevent the toddler from touching or injuring the surgical site. The nurse should apply soft padded restraints and check the circulation and skin integrity of the wrists frequently.
Choice B reason: Offering fluids through a straw is not recommended for a toddler who has had a cleft palate repair, as it can cause suction and pressure in the mouth that can disrupt the sutures. The nurse should offer fluids with a cup or a spoon.
Choice C reason: Implementing a soft diet is not appropriate for a toddler who has had a cleft palate repair, as it can cause irritation and infection in the mouth. The nurse should provide clear liquids for the first 24 hr and then advance to full liquids as tolerated.
Choice D reason: Administering opioids for pain is not the first choice for a toddler who has had a cleft palate repair, as it can cause respiratory depression and constipation. The nurse should use nonpharmacological methods such as distraction, comfort, and reassurance first, and then administer acetaminophen or ibuprofen as prescribed.
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