Editing Pediatric Nursing – RN Practice Questions (section)

==Question 1==
A 3-year-old is brought to the emergency department with a temperature of 39.4 degrees Celsius, drooling, a muffled voice, and no cough. The child is sitting upright, leaning forward with the chin thrust out, and appears anxious. Which action should the nurse take '''first'''?
# Obtain a throat culture to identify the causative organism.
# Place the child in a supine position and start an intravenous line.
# Keep the child upright in the parent's lap and notify the provider immediately while emergency airway equipment is brought to the bedside.
# Depress the tongue with a blade to visualize the posterior pharynx.

'''Answer:''' 3. Keep the child upright in the parent's lap and notify the provider immediately while emergency airway equipment is brought to the bedside.

''Rationale:'' The four Ds (drooling, dysphagia, dysphonia, distress), tripod positioning, absent cough, and high fever describe epiglottitis, an airway emergency. Keeping the child calm and upright preserves the airway, and skilled airway personnel and equipment must be assembled before anything else. Options 1 and 4 are contraindicated because manipulating the oropharynx can trigger laryngospasm and complete obstruction. Option 2 is wrong on both counts: supine positioning worsens obstruction, and the distress of an intravenous stick may precipitate airway collapse before airway support is available.