A nurse is planning care for a child who has epiglottitis. Which of the following actions should the nurse plan to take?
Obtain a throat culture.
Visualize the epiglottis using a tongue depressor.
Provide moist air to reduce the inflammation of the epiglottis
Initiate airborne precautions.
The Correct Answer is C
A. Obtain a throat culture.
This option is not appropriate as a primary nursing action in the acute management of epiglottitis. While obtaining a throat culture may be necessary for diagnostic purposes, it is not a priority in the immediate care of a child with suspected epiglottitis. The focus should be on ensuring airway patency and providing emergency treatment.
B. Visualize the epiglottis using a tongue depressor.
This option is contraindicated in the acute management of epiglottitis. Direct visualization of the epiglottis using a tongue depressor or other instruments can provoke spasm of the epiglottis and worsen airway obstruction. Attempting to visualize the epiglottis should be avoided until the child's airway has been secured in a controlled environment, such as in the operating room under anesthesia.
C. Provide moist air to reduce the inflammation of the epiglottis.
This option is appropriate. Providing moist air, such as humidified oxygen or a cool mist, can help soothe the inflamed tissues of the epiglottis and upper airway. Moist air may help alleviate discomfort and reduce inflammation, although it will not directly address the risk of airway obstruction. It is often used as supportive therapy in conjunction with other interventions.
D. Initiate airborne precautions.
This option is not necessary for the care of a child with epiglottitis. Epiglottitis is not typically transmitted through airborne droplets. The priority in the management of epiglottitis is ensuring a patent airway and providing appropriate treatment to reduce inflammation and prevent complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Onlooker play:
Onlooker play is when a child observes others playing without actively participating themselves. This type of play typically involves watching others engage in activities or play without joining in. It does not directly involve role-playing or hands-on activities to prepare a child for surgery.
B. Therapeutic play:
This is the correct answer. Therapeutic play involves using play activities to help children express their feelings, fears, and concerns about medical procedures or hospitalization. It often includes role-playing and hands-on activities such as practicing medical procedures on dolls or stuffed animals. Therapeutic play helps children become familiar with medical equipment and procedures in a non-threatening environment, reducing anxiety and promoting coping skills.
C. Cooperative play:
Cooperative play involves children playing together, interacting, and collaborating in shared activities. While cooperative play can be beneficial for social development, it does not necessarily involve role-playing or hands-on activities specific to preparing a child for surgery.
D. Play therapy:
Play therapy is a form of psychotherapy that uses play to communicate with and help children express their thoughts and emotions. While play therapy can be therapeutic for children dealing with various issues, including medical procedures, it is typically facilitated by a trained therapist rather than being directly utilized to prepare a child for surgery through role-playing or hands-on activities.
Correct Answer is D
Explanation
A. Instruct the client to cough. Coughing is generally encouraged after chest physiotherapy to help expel loosened secretions, but it is not the first action. The bronchodilator should be administered first to maximize the effectiveness of the chest physiotherapy.
B. Perform vibration while the client exhales slowly through the nose. Vibration is a component of chest physiotherapy used to help loosen secretions during exhalation, but it is performed after the bronchodilator is administered and once the client is positioned properly.
C. Percuss the upper posterior chest.Percussion helps to mobilize secretions but is typically done after the bronchodilator has been administered to allow for more effective airway clearance.
D. Administer albuterol by nebulizer.Administering albuterol first dilates the airways, making it easier to mobilize and clear secretions during percussion, vibration, and postural drainage.
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