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Offering liquids to a child with airway obstruction and respiratory distress risks aspiration and worsened airway compromise. The child may be unable to swallow safely.

 Inspecting the throat with a flashlight and tongue blade can trigger gagging or laryngospasm, leading to sudden airway obstruction and respiratory arrest in a child with suspected epiglottitis or similar airway obstruction. Throat inspection should only be performed by experienced providers in a controlled environment with airway equipment ready.

While vital signs and lung auscultation are important, the immediate priority is securing airway and emergency care. Assessment should not delay urgent intervention.

 Steam vaporizers placed too close can cause burns or be a safety hazard. Cold mist humidifiers used properly can help, but the placement should be safe and not directly next to the child’s face or crib.

Nonprescription cough and cold medicines are not recommended for children under 2 years due to lack of efficacy and potential serious side effects. The FDA advises against their use in infants and toddlers.

Antibiotics are not appropriate without signs of bacterial infection such as fever or purulent symptoms. Most coughs in toddlers are viral and self-limiting.

Antibiotics are not appropriate without signs of bacterial infection such as fever or purulent symptoms. Most coughs in toddlers are viral and self-limiting.

 Tonsils in children tend to be relatively large, not small, and can contribute to obstruction. The nasal passages are narrow, but this option misses the critical role of cricoid cartilage development.

The child’s larynx is funnel-shaped, not cylindrical, with the narrowest point at the cricoid cartilage. While sinuses develop over time, their underdevelopment doesn’t directly increase risk of upper airway obstruction.

Children actually have proportionally larger tongues relative to their oral cavity, which can contribute to obstruction, so “smaller tongue” is inaccurate.

Cystic fibrosis is a genetic disorder causing thick mucus secretions affecting the lungs and pancreas. It presents with chronic cough, recurrent infections, and malabsorption, not a barking cough or acute airway obstruction.

Asthma causes wheezing, shortness of breath, and chest tightness due to lower airway bronchoconstriction, not a barking cough or stridor.

Epiglottitis presents with drooling, dysphagia, high fever, tripod positioning, and absence of cough not a barking cough. It’s a medical emergency due to risk of complete airway obstruction.

Giving oral fluids during acute respiratory distress increases the risk of aspiration. Oral intake should be avoided until the child’s breathing improves and the airway is stable.

 Warm, dry air can worsen airway inflammation and dry out secretions, making symptoms worse. The goal is cool, moist air, not warm air.

Although warm mist was once recommended, cool mist is now preferred because it is safer and equally effective. Warm mist can sometimes increase swelling in the inflamed airway and poses a burn risk.

The barking, seal-like cough is a typical feature of croup, but by itself does not indicate worsening distress. It is a baseline symptom, not a progression sign.

Clubbing of the fingers indicates chronic hypoxemia from long-term respiratory disease such as cystic fibrosis, or congenital heart disease. It does not develop acutely in croup.

Increased anterior-posterior chest diameter occurs with chronic obstructive conditions such as asthma or cystic fibrosis due to air trapping over time, not with acute viral croup.

 Isolation is not routinely required for croup unless another specific infection (like RSV or influenza) is suspected or confirmed. Standard precautions with hand hygiene and droplet precautions if coughing/sneezing are usually sufficient.

While teaching children to use tissues is helpful for older children, an 18-month-old or young child may not effectively use tissues or practice good respiratory hygiene. Teaching tissues alone is not adequate to prevent transmission.

Keeping siblings in the same room increases the risk of cross-infection, as croup is contagious. Siblings, especially those who are young or immunocompromised, should be kept apart during the illness.

During playtime: The child may be active and uncooperative, making treatment less effective and potentially stressful.

After the child eats: Treatment immediately after meals may increase risk of vomiting or aspiration.

After the parents leave: Young children need parental reassurance during respiratory treatment. Administering nebulizers in the parent’s absence can increase anxiety and worsen symptoms.

“The cough indicates a severe allergic reaction that is causing the airways to constrict rapidly.” While allergic reactions can cause airway constriction, the croup cough is not due to an allergic process but an inflammatory viral infection.

 “The cough is a reflex to clear mucus and other secretions from the lungs in children with a respiratory illness.” The cough in croup is primarily due to upper airway narrowing, not just mucus clearance from the lungs.

“The child is making this sound due to anxiety and distress about their condition.” Anxiety may worsen respiratory symptoms but is not the cause of the characteristic barking cough.