The nurse employed in an emergency department is instructed to monitor a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. The nurse interprets this observation as indicating which finding?
Extreme fatigue
An airway obstruction
The presence of dehydration
The presence of pain
The Correct Answer is B
B. Leaning forward with the chin thrust out, often described as the "sniffing position," is a classic sign of airway obstruction, particularly in cases of epiglottitis. This positioning helps to maximize airway patency by opening the airway and reducing the risk of further obstruction.
A. Leaning forward with the chin thrust out is not typically associated with extreme fatigue. Instead, it is a specific positioning often seen in individuals with epiglottitis to help alleviate airway obstruction and facilitate breathing.
C. Leaning forward with the chin thrust out is not indicative of dehydration. Dehydration may present with other signs and symptoms such as dry mucous membranes, decreased urine output, sunken fontanelle (in infants), and poor skin turgor.
D. Pain may be present in a child with epiglottitis but leaning forward with the chin thrust out is not primarily indicative of pain. This positioning is primarily a compensatory mechanism to alleviate airway obstruction rather than a response to pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Amblyopia occurs when one eye has weaker vision than the other due to abnormal visual development early in life. Patching the good eye helps to encourage the brain to rely more on the weaker eye, stimulating its visual development. This treatment aims to improve vision in the affected eye and restore visual acuity.
B. Patching the affected eye is not a common treatment for amblyopia. In fact, patching the affected eye would further decrease visual input to that eye and could potentially exacerbate the condition. The goal of treatment for amblyopia is to strengthen the weaker eye by encouraging its use, rather than resting it.
C. Corticosteroids are not typically used to treat amblyopia unless there is a specific underlying condition causing inflammation of the optic nerve. Amblyopia is primarily a developmental issue rather than an inflammatory condition, so corticosteroids would not be the first-line treatment for this condition.
D. This is not a common treatment for amblyopia. In fact, the goal of treatment for amblyopia is to improve vision in the affected eye, not to intentionally blur the vision in the good eye. Glasses prescribed for amblyopia typically aim to correct refractive errors (such as nearsightedness, farsightedness, or astigmatism) and provide clear vision to both eyes, which can help support visual development in the weaker eye.
Correct Answer is D
Explanation
D. An oxygen saturation level of 85% is significantly below the normal range and indicates hypoxemia (low blood oxygen levels). This finding is concerning, especially in a child with cystic fibrosis, which can lead to respiratory complications such as airway obstruction, infection, or mucus plugging.
A. A blood glucose level of 140 mg/dL is within the normal range for children, so this finding would not typically require immediate reporting to the provider.
B. A serum sodium level of 156 mEq/L is significantly elevated and above the normal range. However, hypoxia is the priority.
C. A red blood cell (RBC) count of 3.2 million/µL falls within the normal range for children, so this finding would not typically require immediate reporting to the provider.
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