NCLEX Question of the Day – Sunday, June 28, 2026

Today’s question targets priority-setting in pediatric care. This matters because children can worsen fast, and subtle changes often show up before a full crisis. A nurse who spots the most urgent finding early can prevent respiratory failure, dehydration, or shock.

Clinical Scenario

A nurse in a pediatric urgent care clinic is caring for a 3-year-old child who was brought in by a parent for fever, poor appetite, and a harsh cough that started last night. The child weighs 14 kg, has a history of mild eczema, and is up to date on routine vaccines. On assessment, the nurse notes a temperature of 38.7 C, heart rate 138/min, respiratory rate 34/min, and oxygen saturation 94% on room air. The child is sitting upright on the parent’s lap, appears anxious, has audible inspiratory stridor at rest, and is drooling. The parent says, “He does not want to lie down, and he cries when I try to get him to drink.”

The Question

Which action should the nurse take first?

Answer Choices

1. A. Use a tongue depressor to inspect the back of the throat for redness and swelling
2. B. Place the child in a supine position and obtain a full set of repeat vital signs
3. C. Keep the child calm, maintain an upright position, and notify the provider for urgent airway evaluation
4. D. Offer oral fluids and a flavored ice pop to improve hydration and reduce throat discomfort

Correct Answer

C. Keep the child calm, maintain an upright position, and notify the provider for urgent airway evaluation

Detailed Rationale

This child has signs of possible epiglottitis or another severe upper airway emergency. The key clues are stridor at rest, drooling, refusal to lie down, anxious appearance, and sitting upright. Those findings point to threatened airway patency, not a simple sore throat.

The nurse’s first priority is airway. In children, upper airway swelling can narrow the airway quickly because the airway is already small. Even a modest amount of swelling can cause major obstruction. That is why the safest first action is to avoid upsetting the child, keep the child upright, and get urgent help.

What the nurse should assess right away:

• Work of breathing: retractions, nasal flaring, stridor at rest, ability to vocalize or cry
• Mental status: irritability, fatigue, decreased responsiveness
• Color and oxygenation: pallor, cyanosis, pulse oximetry trend
• Airway protection signs: drooling, difficulty swallowing, tripod positioning

What the nurse should do:

• Keep the child with the parent if that helps reduce fear
• Maintain the position of comfort, usually upright
• Limit handling and avoid procedures that may trigger crying
• Call the provider or rapid response process used in the setting for urgent airway assessment
• Prepare for possible advanced airway management and supplemental oxygen if tolerated

What the nurse should monitor:

• Increasing stridor or suddenly quieter breath sounds, which can mean less airflow
• Retractions or rising respiratory effort
• Changes in oxygen saturation
• Lethargy, which can be a late and dangerous sign

The reason this choice is best is that it protects the airway while reducing the chance of sudden obstruction. In a child with suspected severe upper airway inflammation, agitation can make swelling and airflow problems worse. A calm approach is not just comforting. It is a safety intervention.

Why the Other Options Are Wrong

A. Use a tongue depressor to inspect the back of the throat for redness and swelling

This is unsafe. Direct throat inspection in a child with suspected epiglottitis can trigger laryngospasm or complete airway obstruction. The nurse should not put anything in the child’s mouth unless an airway specialist is ready and the environment is controlled.

B. Place the child in a supine position and obtain a full set of repeat vital signs

This can make breathing worse. The child is already showing that lying flat is not tolerated. Forcing a supine position may increase distress and airway compromise. Repeat vital signs matter, but not before protecting the airway and preserving the child’s position of comfort.

D. Offer oral fluids and a flavored ice pop to improve hydration and reduce throat discomfort

This is not the priority and may be dangerous. The child is drooling and has trouble swallowing, so oral intake raises the risk of aspiration and more distress. Hydration can be addressed later, once the airway is stable.

Key Takeaways

• In pediatrics, stridor at rest plus drooling is an airway red flag.
• A child who refuses to lie down may be trying to protect the airway.
• Do not inspect the throat with a tongue blade if severe upper airway swelling is suspected.
• Keeping the child calm is a clinical intervention, not just a comfort measure.
• Airway comes before hydration, throat exam, or nonessential reassessment.

• On-shift mini-checklist:
• Look first: work of breathing, position, drooling, color, level of distress.
• Do not separate the child from the parent unless necessary.
• Keep the child upright and avoid upsetting procedures.
• Call for urgent airway evaluation early.
• Prepare equipment and monitor for rapid decline.

Quick Practice Extension

1. A 2-year-old with a barking cough and mild stridor only when crying is calm in the parent’s arms. Which assessment finding would make the nurse suspect the condition is getting worse?

2. A child with upper airway swelling becomes suddenly less restless and the stridor becomes softer. Why might that be more concerning than improvement?

Category for today: Pediatrics

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