NORCET 2 - 2021 (shif…: If a patient's tongue and epiglottis protrude inside the mouth, what finding would be seen in the patient?

NORCET 2 - 2021 (shift-1)

Medical & Surgical Nursing

Medium

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

Stridor is a high-pitched, predominantly inspiratory sound.
It is caused by turbulent airflow through a partially obstructed upper airway (larynx or trachea).
Protrusion of the tongue and epiglottis creates such an obstruction, making stridor the expected finding.
Stridor is considered a medical emergency as it indicates significant airway compromise.

Option A: Rhonchi are low-pitched, coarse sounds originating from secretions in the larger, lower airways (bronchi), not from a structural obstruction in the upper airway.
Option C: Wheezing is a high-pitched, musical sound caused by narrowing of the smaller, lower airways (bronchioles), typically heard on expiration.
Option D: A gurgling sound is produced by air moving through liquid (e.g., saliva, vomit, blood) in the oropharynx or upper airway. It is not the characteristic sound of air passing a solid or structural obstruction.

Clinical Relevance

Nursing practice connection: Use the key finding related to Assessment of adventitious breath sounds and their correlation with airway obstruction to guide bedside assessment, documentation, and the next nursing action.
Recognizing stridor is a critical nursing skill because it signals a life-threatening upper airway obstruction that requires immediate intervention.
The nurse's first actions upon hearing stridor are to assess the patient's airway, breathing, and circulation (ABCs), apply oxygen, and prepare for emergency airway management.
What if? If the patient was an infant with stridor that worsens when crying but is otherwise feeding well, the cause is more likely laryngomalacia (floppy larynx), which is often benign and self-resolving, unlike the acute obstruction described in the question.

How to Approach the Question

First, analyze the clinical scenario presented in the question stem: a patient's tongue and epiglottis are protruding, which points to a physical blockage in the upper airway.
Next, consider the pathophysiology. A partial blockage in the upper airway will cause air to flow turbulently as the person inspires, creating a specific sound.
Evaluate each option based on its known cause and location of origin.
Eliminate Rhonchi and Wheezing, as these are sounds generated in the lower airways.
Differentiate between Stridor and Gurgle. Gurgling is from fluid, whereas the question describes a structural obstruction. Stridor is the classic sound of a structural upper airway narrowing.
Select Stridor as the correct answer because it directly matches the pathophysiology of the described condition.

Concept Tested & Keywords

Concept Tested: Assessment of adventitious breath sounds and their correlation with airway obstruction.
Stem keywords: tongue, epiglottis, protrude, finding
Lead-in keywords: what finding
Clinical cues: Protrusion of tongue and epiglottis signifies a potential upper airway obstruction.

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 397-399

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 299-301, 359-361