Difficulty: Medium
Average Score: 89%
Simulated
Passage / Scenario
The nurse employed in an emergency department is monitoring a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the neck extended.How would the nurse interpret this finding?
Correct answer
B
Rationale
The nurse would interpret the finding as an airway obstruction because it is a critical condition requiring immediate intervention to ensure proper oxygenation. Extreme fatigue, pain, and dehydration may be important but do not directly affect the airway patency. Identifying and addressing an airway obstruction is crucial to prevent respiratory distress and potential respiratory failure. The other choices are not the priority in this scenario.