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A nurse is caring for a pre-school age child who has epiglottitis and presents with a high fever, drooling, and a muffled voice. Which of the following actions should the nurse take?

A.

Use a tongue depressor to observe the epiglottis.

B.

Initiate airborne precautions.

C.

Monitor oxygen saturation.

D.

Obtain a throat culture.

Answer and Explanation

The Correct Answer is C

A. Using a tongue depressor can provoke spasm of the epiglottis and lead to airway obstruction; therefore, this action is contraindicated in a child with epiglottitis.  

 

B. Airborne precautions are not necessary for epiglottitis; droplet precautions are more appropriate due to the risk of transmission.  

 

C. Monitoring oxygen saturation is critical in this situation to assess the child's respiratory status and ensure adequate oxygenation, making it the most appropriate action.  

 

D. Obtaining a throat culture may not be safe or practical in this scenario, as it can provoke further distress and complications; immediate assessment and stabilization are prioritized.  


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View Related questions

Correct Answer is C

Explanation

A. Montelukast is a leukotriene receptor antagonist used for long-term management and prevention of asthma symptoms, not for acute relief.

B. Budesonide is an inhaled corticosteroid used for long-term control of asthma but does not provide immediate relief during an acute attack.

C. Albuterol is a short-acting beta-agonist (SABA) that provides rapid bronchodilation and is the first-line medication for relieving acute asthma symptoms.

D. Fluticasone is also an inhaled corticosteroid intended for long-term management, which does not address the immediate needs of an acute asthma attack.

Correct Answer is B

Explanation

A. Enforcing strict bed rest without any physical activity can lead to feelings of isolation and boredom, which may negatively affect the child's well-being and engagement.

B. Allowing the child to decorate their hospital room with personal items fosters a sense of ownership and comfort, helping to promote emotional well-being and engagement during hospitalization.

C. Limiting visits can increase feelings of loneliness and anxiety in the child, which is not conducive to their emotional health; maintaining social connections is important for well-being.

D. Using medical terms may confuse the child and does not support their understanding or engagement; explanations should be age-appropriate and easily understood.

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