NCLEX Question of the Day – Saturday, July 18, 2026

Today’s NCLEX question targets priority setting in pediatric respiratory care. This skill matters because children can worsen quickly when breathing problems start to progress. A nurse who notices the right early signs can act before a child becomes critically unstable.

Clinical Scenario

A 3-year-old child is brought to the pediatric urgent care clinic in late evening by a parent. The child has had a runny nose and low-grade fever for 2 days. Over the last 6 hours, the parent reports a barky cough, trouble sleeping, and noisy breathing that is worse when the child cries. The child weighs 14 kg and has no history of asthma or heart disease. Immunizations are up to date.

On assessment, the nurse notes the child is sitting upright on the parent’s lap and appears anxious. Vital signs are: temperature 38.1 C, heart rate 132/min, respiratory rate 34/min, blood pressure 96/58 mm Hg, and oxygen saturation 93% on room air. Inspiratory stridor is heard at rest. Mild suprasternal retractions are present. The child is able to swallow and is crying with a hoarse voice.

The Question

Which action should the nurse take first?

Answer Choices

1. Place the child in a supine position for a full throat assessment with a tongue blade
2. Prepare the child for immediate chest physiotherapy to loosen airway secretions
3. Keep the child calm and administer humidified oxygen while notifying the provider
4. Offer oral fluids to reduce throat dryness and reassess in 30 minutes

Correct Answer

C. Keep the child calm and administer humidified oxygen while notifying the provider

Detailed Rationale

This child’s presentation is most consistent with croup, also called laryngotracheobronchitis. The key clues are the barky cough, hoarse voice, inspiratory stridor, recent upper respiratory symptoms, and symptoms that worsen with agitation. The priority is airway support.

The most important assessment detail is stridor at rest. That finding suggests more significant upper airway narrowing than stridor that happens only when the child is active or crying. The mild suprasternal retractions and oxygen saturation of 93% also show increased work of breathing. Even though the child is still alert and able to swallow, the airway is not stable enough for delayed action.

The nurse should first reduce oxygen demand and prevent worsening airway obstruction. In young children with upper airway swelling, crying and distress can make obstruction worse. That is why keeping the child calm is not just comforting. It is a direct airway intervention. Allowing the child to stay with the parent, avoiding unnecessary handling, and using a gentle approach all help lower the work of breathing.

Humidified oxygen is appropriate because the oxygen saturation is below normal and the child shows respiratory distress. Oxygen does not fix the swelling itself, but it supports gas exchange while the team moves to the next steps. Notifying the provider promptly is also correct because children with stridor at rest may need medication such as corticosteroids or nebulized epinephrine depending on severity.

After this first action, the nurse should continue focused monitoring. That includes respiratory rate, depth, retractions, nasal flaring, stridor frequency, oxygen saturation, skin color, level of alertness, and ability to take fluids. The nurse should also watch for signs of worsening obstruction such as fatigue, decreasing breath sounds, cyanosis, or reduced responsiveness. A child who becomes quieter is not always improving. In respiratory illness, a sudden drop in noise can mean less air is moving.

On shift, the practical sequence is simple: recognize upper airway distress, avoid agitation, support oxygenation, and escalate care early.

Why the Other Options Are Wrong

A. Place the child in a supine position for a full throat assessment with a tongue blade

This is unsafe. Forcing a distressed child with upper airway symptoms to lie flat can worsen breathing. Using a tongue blade can also increase agitation. In some airway conditions, such as epiglottitis, aggressive throat examination can trigger sudden obstruction. Even though this case fits croup better than epiglottitis, the nurse should not start with a stressful airway exam.

B. Prepare the child for immediate chest physiotherapy to loosen airway secretions

Chest physiotherapy is not the priority here and is not a standard first-line response for croup. The main problem is upper airway swelling, not lower airway mucus retention. Percussion and handling would likely upset the child and increase oxygen demand, which could make stridor worse.

D. Offer oral fluids to reduce throat dryness and reassess in 30 minutes

Fluids can be helpful later if the child is stable and able to drink safely, but they do not address the current priority: airway compromise. Reassessing in 30 minutes without intervening would delay care in a child who already has stridor at rest and retractions. Waiting is not appropriate when breathing effort is increased.

Key Takeaways

• Stridor at rest is a red flag for more serious upper airway narrowing.
• In pediatric airway problems, keeping the child calm is a clinical intervention, not just emotional support.
• Do not do procedures that increase crying or distress unless absolutely necessary.
• Support oxygenation early and notify the provider when respiratory distress is present.
• Watch trends: retractions, saturation, mental status, and air movement matter more than one isolated sign.

• What you’d do on shift: keep the child upright with the parent, minimize handling, apply humidified oxygen, reassess breathing often, and prepare for ordered medications if symptoms continue or worsen.

Quick Practice Extension

1. If this child becomes drowsy and the stridor suddenly becomes faint, what would that change in assessment suggest?

2. After the provider prescribes a corticosteroid for croup, which response would show the treatment is working over the next few hours?

Download