AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 3-year-old child presents with a sudden onset of high fever (103.5°F), sore throat, dysphagia, and inspiratory stridor. The child is drooling, appears anxious, and is sitting in a 'tripod' position. The parents report the child's immunizations are not up to date. Which of the following actions should the FNP prioritize?
- ASecure the airway and prepare for intubation.
- BAdminister oral antibiotics immediately.
- CPerform a rapid strep test and throat culture.
- DVisualize the pharynx with a tongue depressor.
Show answer & explanationAnswer & explanation
Correct answer: A. Secure the airway and prepare for intubation.
The symptoms of sudden high fever, sore throat, dysphagia, drooling, inspiratory stridor, and tripod positioning in an unvaccinated child are highly indicative of acute epiglottitis, a life-threatening airway emergency. The priority is to secure the airway and prepare for intubation, usually in a controlled environment like an operating room, to prevent complete airway obstruction.
Why the other options are wrong
- B. Administering oral antibiotics is not the immediate priority; airway management comes first.
- C. Performing a rapid strep test or throat culture can irritate the epiglottis and precipitate acute airway obstruction.
- D. Visualizing the pharynx with a tongue depressor is contraindicated in suspected epiglottitis due to the risk of precipitating laryngeal spasm and complete airway obstruction.
Acute Epiglottitis Management
Acute epiglottitis is a medical emergency characterized by inflammation and swelling of the epiglottis, leading to rapid airway obstruction. Airway management is the top priority.
- Classic presentation: sudden high fever, dysphagia, drooling, stridor, tripod position.
- High risk in unimmunized children (H. influenzae type b).
- Contraindicated: direct visualization of throat (tongue depressor) due to risk of laryngospasm.
- Priority: secure airway (intubation) in a controlled setting.
Memory trick: Tripod, drool, and stridor so high, secure that airway, or the child may die!