A 2-year-old boy is brought to the emergency department with a barking cough, hoarseness, and inspiratory stridor.
His parents report that he has been sick for 2 days and that his symptoms have been getting worse.
The boy's vital signs are as follows: temperature 102°F (38.9°C), heart rate 120 beats/minute, respiratory rate 28 breaths/minute, and oxygen saturation 95% on room air.
Physical examination reveals a well-developed, well-nourished boy in moderate respiratory distress.
He is using accessory muscles of respiration and has intercostal retractions.
His lungs are clear to auscultation.
Which of the following statements by the nurse is most appropriate?

"Your son has croup.

"Your son has epiglottitis.

"Your son has asthma.

"Your son has pneumonia.

Answer and Explanation

The Correct Answer is A

The correct answer is choice A, “Your son has croup.”

Choice A rationale:

The symptoms described, including a barking cough, hoarseness, and inspiratory stridor, are classic signs of croup. Croup is a common respiratory condition in young children that leads to swelling of the larynx and trachea, causing the characteristic cough and stridor.

Choice B rationale:

While epiglottitis can present with respiratory distress, it is more commonly associated with high fever, severe sore throat, drooling, and difficulty swallowing, rather than a barking cough and stridor.

Choice C rationale:

Asthma typically presents with wheezing and difficulty exhaling, not the barking cough and inspiratory stridor seen in croup. Additionally, asthma is often associated with a history of allergies or atopic conditions, which are not mentioned in the scenario.

Choice D rationale:

Pneumonia usually presents with fever, cough producing phlegm, and crackles or wheezes on lung auscultation. The clear lungs on auscultation and the absence of productive cough make pneumonia less likely in this case.

In summary, the presentation of a barking cough, hoarseness, and inspiratory stridor in a young child who is in moderate respiratory distress with a recent onset of symptoms is most indicative of croup. This is supported by the age of the child and the clinical findings, which align with the typical presentation of croup.

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Correct Answer is ["A","D"]

Explanation

Choice A rationale:

Croup is indeed a common viral infection of the upper respiratory tract that causes inflammation of the larynx.

This statement is accurate and important for the parent to understand the nature of the illness.

Choice B rationale:

Croup is most common in children under the age of 5, not just under the age of 3.

However, this statement is not entirely accurate, as older children can also be affected by croup.

It is essential to provide correct information to the parent.

Choice C rationale:

The symptoms of croup often worsen at night due to the natural narrowing of the airways during sleep, making breathing more difficult.

Therefore, this statement is correct and relevant to include in the teaching.

Choice D rationale:

The classic croup cough is indeed described as a barking cough, which results from the inflammation of the larynx and trachea.

This description helps the parent recognize a distinctive symptom of croup.

Including this information in the teaching is appropriate.

Choice E rationale:

Croup is primarily managed with supportive care, such as humidified air and nebulized medications.

Over-the-counter cough syrup and expectorants are not typically recommended for treating croup in children.

This statement is incorrect and should not be included in the teaching.

A. Administer antibiotics. B. Provide cool mist humidification. C. Administer bronchodilators. D. Administer corticosteroids. E. Encourage the child to cough loudly.

Correct Answer is ["B","C","D"]

Explanation

Nursing interventions for a child with croup include providing cool mist humidification, administering bronchodilators, and administering corticosteroids.

Choice A rationale:

Administering antibiotics is not a standard intervention for croup unless there is a secondary bacterial infection present.

Croup is typically caused by viral infections, so antiviral medications might be considered if the cause is identified as a specific virus.

However, antibiotics do not directly address the symptoms of croup.

Choice B rationale:

Providing cool mist humidification is appropriate for a child with croup.

Cool mist helps soothe the inflamed airways and can alleviate respiratory distress by reducing airway edema.

Moist air can make breathing easier for the child.

Choice C rationale:

Administering bronchodilators can be beneficial in the treatment of croup, especially if there is evidence of bronchoconstriction.

Bronchodilators help dilate the airways, making breathing easier for the child.

This intervention can be particularly useful if the child is experiencing wheezing in addition to stridor.

Choice D rationale:

Administering corticosteroids, such as dexamethasone, is a common and evidence-based intervention for croup.

Corticosteroids reduce airway inflammation and edema, leading to symptom improvement.

A single dose of oral corticosteroids is often sufficient to manage croup symptoms effectively.

Choice E rationale:

Encouraging the child to cough loudly is not a recommended intervention for croup.

Coughing forcefully may exacerbate airway irritation and inflammation, worsening the child's symptoms.

Instead, interventions should focus on reducing airway edema and providing respiratory support.

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Naxlex Comprehensive Predictor Exams

A nurse is teaching a parent about the signs and symptoms of croup.Which of the following statements should the nurse include in the teaching?Select all that apply.

Correct Answer is ["A","D"]

Explanation

A nurse is caring for a child with croup and needs to implement nursing interventions.What interventions are appropriate for a child with croup? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

Select all that apply.Which of the following are nursing interventions for a child with croup?

A nurse is educating a parent about the prevention of croup.Which of the following statements should the nurse include in the teaching?

A nurse is caring for a child with croup in the hospital.The child is receiving humidified air and nebulized racemic epinephrine.The nurse monitors the child's respiratory status closely.Which of the following findings would indicate to the nurse that the child's condition is worsening?

A nurse is performing a nursing assessment of a child with croup.What should the nurse assess to determine the severity of respiratory distress?

A nurse is assessing a 2-year-old child with croup.The child's mother states that the child has had a barking cough for 2 days, which is worse at night.The child also has a fever and is hoarse.Which of the following statements by the nurse is most appropriate?

A nurse is educating parents of a child with croup about the signs and symptoms.Which clinical manifestations should the nurse include in the teaching? Select all that apply.

A nurse is caring for a child with croup.The child's respiratory status is worsening, and they are becoming increasingly agitated.What action should the nurse take?