The nurse in the emergency department is caring for a child who appears extremely ill with a high fever, unable to control their oral secretions. with voice hoarseness and inspiratory stridor and inspiratory sternal retractions while breathing. The nurse suspects epiglottitis. Which would the nurse do next?
Contact the assigned emergency room physician to evaluate the need for an advanced airway
Administer intravenous corticosteroids
Obtain a throat culture
inspect the throat to obtain further data to support the diagnosis
The Correct Answer is A
A. Contact the assigned emergency room physician to evaluate the need for an advanced airway
Explanation:
Epiglottitis is a medical emergency that can rapidly progress to airway obstruction. The classic signs and symptoms include a high fever, difficulty swallowing, voice hoarseness, inspiratory stridor, and sternal retractions. Immediate intervention may be necessary to secure the airway. Therefore, contacting the emergency room physician to evaluate the need for an advanced airway (such as intubation) is a priority.
B. Administer intravenous corticosteroids
Explanation: While corticosteroids may be used in the management of epiglottitis to reduce airway inflammation, securing the airway is the priority in the acute phase. Corticosteroids would typically be administered after securing the airway.
C. Obtain a throat culture
Explanation: Obtaining a throat culture is not the immediate priority in the case of suspected epiglottitis. Prompt intervention to secure the airway takes precedence over diagnostic tests.
D. Inspect the throat to obtain further data to support the diagnosis
Explanation: Direct visualization of the throat (inspection) may exacerbate the airway obstruction and is not recommended in the acute management of suspected epiglottitis. The priority is to secure the airway while minimizing agitation and discomfort for the child. Diagnostic procedures, such as obtaining a throat culture, can be considered after the airway is stabilized.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Rye toast
Explanation: Rye contains gluten, so it is not appropriate for individuals with celiac disease. Rye, like wheat and barley, should be avoided.
B. Rice
Explanation:
Celiac disease is a condition characterized by an immune reaction to gluten, a protein found in wheat, barley, and rye. Therefore, individuals with celiac disease need to avoid gluten-containing foods. Rice is naturally gluten-free, making it a suitable and safe option for individuals with celiac disease.
C. Wheat bread
Explanation: Wheat contains gluten, and products made from wheat, including wheat bread, should be strictly avoided by individuals with celiac disease.
D. Oatmeal
Explanation: Oats themselves are gluten-free, but they are often contaminated with gluten during processing. Some individuals with celiac disease can tolerate pure, uncontaminated oats, while others may need to avoid oats altogether. It is important to choose certified gluten-free oats if including them in the diet.
Correct Answer is ["C","D","E"]
Explanation
A. Set the water heater at 65.6° C (150° F):
The recommended temperature for a water heater is around 49°C (120°F) to prevent burns. Setting it at 65.6°C (150°F) can lead to scald injuries.
B. Install accordion style gates: Accordion-style gates are not recommended because they can pose a strangulation risk. The safer option is to use gates with vertical or horizontal slats that are spaced closer together.
C. Fit the mattress so that it is snug against the sides of the crib: A snug-fitting mattress prevents gaps where the baby could get trapped or injured.
D. Tie plastic bags in knots before discarding them:
This prevents accidental suffocation or choking hazards that can occur if an infant gets hold of a plastic bag.
E. Serve food in small, non-circular pieces:Serving food in small, non-circular pieces reduces the risk of choking. Infants should be given age-appropriate foods to minimize the risk of choking, and cutting food into small, easy-to-manage pieces is recommended.
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