Ch. 40 Prep U

A client asks the nurse why a healthy newborn would be at risk for hypoxemia. How should the nurse reply? "A newborn only has half of the number of alveoli developed, placing the newborn at risk." "A newborn would be at risk, because the newborn has smaller lung volumes." "The shape of the chest and the smaller airway structures place the newborn at higher risk." "The newborn does not take in as much oxygen with each breath, placing the newborn more at risk."

"A newborn only has half of the number of alveoli developed, placing the newborn at risk." Explanation: Alveoli begin developing in the fetus at 24 weeks' gestation. In a healthy newborn born at term, there are approximately 150 million alveoli present. The number of alveoli duplicate until the adult number of 300 million are present somewhere between 3 and 8 years of age. The smaller numbers of alveoli place the newborn at a higher risk for hypoxemia and carbon dioxide retention, because this is where gas exchange occurs. This is also more pronounced if the newborn is premature. Newborns consume twice as much oxygen (6 to 8 L) as adults (3 to 4 L). This is due to higher metabolic and resting respiratory rates. The shape of the chest and smaller airways contribute to adequate oxygenation for the size of the newborn. They do not place the newborn at high risk for hypoxemia. Newborns do have smaller lung volumes, but these volumes are adequate for size and grow as the newborn grows.

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful? "Early initiation of antibiotics can lessen the severity of the infection." "Infants are less affected by RSV than older children." "RSV season occurs primarily April through September." "Exposure to second- or thirdhand smoke increases the risk for developing RSV."

"Exposure to second- or thirdhand smoke increases the risk for developing RSV."

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication? "I should stop the enzymes if my child is taking antibiotics." "I should give the enzymes before each meal or snack." "Between meals is the best time to give the enzymes." "I should reduce the dose if she has large, malodorous stools."

"I should give the enzymes before each meal or snack."

The nurse is teaching an in-service program to a group of nurses on the topic of children diagnosed with sickle cell anemia. The nurses in the group make the following statements. Which statement is most accurate regarding sickle cell anemia? "If the trait is inherited from both parents the child will have the disease." "The trait or the disease is seen in one generation and skips the next generation." "Males are much more likely to have the disease than females." "The disease is most often seen in individuals of Asian decent."

"If the trait is inherited from both parents the child will have the disease."

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with iron-deficiency anemia. One of the caregivers tells the group, "I give my child ferrous sulfate." Which statement made by the caregivers is correct regarding giving ferrous sulfate? "When I give my son ferrous sulfate I know he also needs potassium supplements." "I always give the ferrous sulfate with meals." "We watch closely for any diarrhea since that usually happens when he takes ferrous sulfate." "My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

"My husband gives our daughter orange juice when she takes her ferrous sulfate, so she gets Vitamin C."

The nurse is working with a group of caregivers of children diagnosed with asthma. Which statement made by a caregiver is most accurate regarding the triggers that may cause an asthma attack? "My neighbor told me that asthma attacks are caused by hot weather." "One person told me that asthma is caused by using antibiotics for infection." "My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." "I always thought that a lack of exercise caused my child's asthma."

"My sister and her family love animals, and when we go to their house my daughter always has an asthma attack."

The caregiver of a child with sickle cell disease asks the nurse how much fluid her child should have each day after the child goes home. In response to the caregiver's question, the nurse would explain that for the child with sickle cell disease, it is best that the child have: 300 to 800 ml of fluid per day. 1,000 to 1,200 ml of fluid per day. 1,500 to 2,000 ml of fluid per day. 2,500 to 3,200 ml of fluid per day.

1,500 to 2,000 ml of fluid per day.

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia? A 7-month-old infant who has started table food A 15-year-old adolescent who has heavy menstrual periods A 3-month-old infant who is totally breastfed An 8-year-old child who carries lunch to school

A 15-year-old adolescent who has heavy menstrual periods

A parent with a child who has cystic fibrosis asks the nurse how to determine if the child is receiving an adequate amount of pancreatic enzymes. How should the nurse respond? Select all that apply. A. "The dose is adequate when your child is only having 1 to 2 stools per day." B. "The dose is adequate when your child's weight is improving." C. "The dose prescribed is based on your child's pancreatic laboratory values so it should be correct." D. "When your child starts to eat more quantity of food you will need to adjust the amount of enzyme pills." E. "You will need to give your child less enzyme pills when high-fat foods are eaten."

A. "The dose is adequate when your child is only having 1 to 2 stools per day." B. "The dose is adequate when your child's weight is improving." D. "When your child starts to eat more quantity of food you will need to adjust the amount of enzyme pills."

A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child? A. Elevate the head of the bed B. Administer oxygen C. Notify the health care provider D. Obtain oxygen saturation levels

A. Elevate the head of the bed

An infant with a high respiratory rate is NPO and is receiving IV fluids. What assessment(s) will the nurse make to assure this infant is hydrated? Select all that apply. A. Measure skin turgor B. Palpate anterior fontanel C. Determine urine output D. Review electrolyte laboratory results E. Assess the lung sounds

A. Measure skin turgor B. Palpate anterior fontanel C. Determine urine output

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2saturation 95% on room air. Which action will the nurse take first? Administer the bronchodilator via a nebulizer. Give the antibiotic as prescribed. Apply oxygen at 2 liters via a nasal cannula. Apply a cardiac monitor to the child.

Administer the bronchodilator via a nebulizer. Explanation: The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.

Which diagnostic test is the most useful when a child has respiratory distress? Venous blood gas EEG Complete blood count Arterial blood gas

Arterial blood gas

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding? A. Children's demand for oxygen is lower than that of adults. B. Children develop hypoxemia more rapidly than adults do. C. An increase in oxygen saturation leads to a much larger decrease in pO2. D. Children's bronchi are wider in diameter than those of an adult.

B. Children develop hypoxemia more rapidly than adults do. Children develop hypoxemia more rapidly than adults do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease in pO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction.

A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? A. "She really doesn't need the vaccine until she reaches 1 year of age." B. "She will probably receive it the next time she is to get her routine shots." C. "Since your daughter is older than 6 months, she should get the vaccine every year." D. "The vaccine has many side effects, so she wouldn't get it until she's ready to go to school."

C. "Since your daughter is older than 6 months, she should get the vaccine every year."

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important? Stress regular fluid consumption Allow child an age-appropriate, quiet plan Provide acetaminophen for pain Note any frequent swallowing

Note any frequent swallowing

Which electrolyte does the client with cystic fibrosis need in abundance? Potassium Chlorine Sodium Magnesium

Sodium

If there is a foreign body in the larynx, how will the client present? Quietly Speaks clearly Edematous Stridor

Stridor

What is a definitive test for cystic fibrosis? Blood culture Sweat chloride CBC Blood gas

Sweat chloride

A 5-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious. These may be early signs of respiratory distress in a child if accompanied by: Retractions Clubbing of fingers Cyanosis Tachypnea

Tachypnea

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia? The child is a triplet. The child was a postmaturity date infant. The child has diabetes. The child attends day care.

The child attends day care. Explanation: Attending day care is a known risk factor for pneumonia. Being a triplet is a factor for bronchiolitis. Prematurity rather than postmaturity is a risk factor for pneumonia. Diabetes is a risk factor for influenza.

x A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care? The infant will attain oxygen saturation of 90% on room air. The infant's airway will remain clear and free of mucus. The infant's breathing will be less labored. The infant will have decreased nasal stuffiness.

The infant's airway will remain clear and free of mucus. Explanation: Keeping the infant's airway clear is the top priority. An O2 saturation of 90% on room air is minimally acceptable. It is important that the infant's breathing be less labored and that there is decreased nasal stuffiness, but having the airway clear and free of mucus is most important.

The nurse makes the statement that if an older child inhales a foreign body, the inhaled object is more likely to be drawn into the right bronchus rather than the left. What is the basis for this statement? The left bronchus is more vertical than the right. The right bronchus is shorter and wider than the left. The left bronchus is shorter and wider than the right. Both bronchi are the same size, but the left is more vertical than the right.

The right bronchus is shorter and wider than the left.

The nurse caring for the child with asthma weighs the child. What is the most important reason for doing a daily weight on this child? To determine medication dosages To monitor adequate nutrition To determine fluid losses To determine accurate medication effectiveness.

To monitor adequate nutrition Explanation: During an acute asthma attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting. Theophylline administration also has a diuretic effect, which compounds the problem. Weigh the child daily to help determine fluid losses. The child's weight is used to determine medication dosages, to ensure that the child is appropriately gaining weight and growing, and that the intake is adequate. However, the most important reason for a daily weight is to determine fluid loss.

A 6 year old child was diagnosed as having streptococcal pharyngitis. At the follow-up visit, the nurse will assess for which potential complication? development of rheumatic fever swollen lymph nodes that obstruct the air way nephrosis of the kidney infection that may cause a tooth abcess

development of rheumatic fever

What is the nursing management for epiglottis?

do not visulaize throat do not lead unattended do not place supine provide 100% O2 in least invasive manner Trach may be necessary

what are some warning signs indication problems of sensory development?

does not respond to loud noises does not focus on a near object does not make sounds or babble by 4 months does not turn head to locate sound at 4 months Infant crosses eyes most of time at 6 months

The nurse is providing care for a 13-year-old child diagnosed with iron-deficiency anemia. The client's current hemoglobin level is 11 g/dL (110 g/L). Which intervention will the nurse anticipate including in the client's care? providing a high dose of intravenous immunoglobulin weekly giving ferrous sulfate with orange juice between meals packed red blood cell transfusions increasing the daily intake of fresh fruits and vegetables

giving ferrous sulfate with orange juice between meals

A child has been admitted to the pediatric unit with pneumonia. The nurse is preparing to administer the prescribed medication to the child to help reduce the viscosity of the child's secretions. Which medication would the nurse most likely give? dextromethorphan ipratropium guafenesin albuterol

guafenesin

What can be done to make the health assessment easier for a toddler?

incooperate play allow toddler to sit on mom's lap

What is bronchiolitis?

inflammation of the bronchioles, caused usually by RSV, leads to hyperinflation, atelectasis, impaired gas exchange

What is epiglotitis?

inflammation/swelling of the epiglottis

How might a toddler interpret a health exam or procedure?

invasive fears body invasion, multilation

A 10-year-old girl with an intestinal virus has been vomiting and has become dehydrated. She says she is mildly thirsty, her skin turgor is poor, and her skin is dry and cool. Her serum sodium level is normal. The nurse recognizes that she has which type of dehydration? Acidotic hypotonic isotonic hypertonic

isotonic

What is tx for bronchiolitis?

o2 suctioning hydration bronchodilator

What kind of breathers are babies?

obligate nose/belly breathers

What often occurs with tonsillitis?

pharyngitis

What necessitates a tonsilectomy?

recurrent strptococcal tonsilitis, kissing tonsils

What are the complications of pharyngitis?

rheumatic fever acute glomerulonephritis

What bacteria usually causes epiglottisis?

hib

When should a child start getting the flu shot?

6 months

A nurse is conducting a class to a group of parents on sickle cell anemia. Which statement by a parent indicates teaching has been effective? "The sickle shape of red blood cells decreases oxygen to tissues." "Sickle cell anemia is common in people of Asian descent." "This is a hereditary disease that is transmitted by one affected gene." "Fluid restriction is necessary to control sickle cell anemia."

"The sickle shape of red blood cells decreases oxygen to tissues."

What is the nursing care for a tonsilectomy?

- promote airway clearance - side lying/prone maintaining fluid volume - discourage coughing - encourage fluids - avoid citrus, brown, red food - ice collar - analgestics

What age range is an infant?

0-12 months

In what time span does the weight double in a child?

0-6 months

When do fontanels close?

18 months

The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions? Select all that apply. Admin analgesics Maintain fluid intake Admin oxygen Admin platelets Promote exercise and activity

Admin analgesics Maintain fluid intake Admin oxygen

The nurse is teaching the parents about medications for their 9-year-old boy who has a respiratory disorder. The nurse would be alert for an increased need for medications if the child was exposed to second-hand smoke and has which condition? Common cold Pneumonia Asthma Allergic rhinitis

Asthma

A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A. Salmeterol B. Albuterol C. Ipratropium D. Cromolyn

B. Albuterol

The nurse is preparing to perform a physical examination of a child with asthma. Which technique would the nurse be least likely to perform? A. Inspection B. Palpation C. Percussion D. Auscultation

B. Palpation

The nurse is performing a respiratory assessment on a child. The nurse includes five steps in her assessing technique: observation, inspection, palpation, and percussion. Which step was left out of her techniques? Touch Playing with the child Feeding the child Listening to the lung sounds

Listening to the lung sounds

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan? Obtain testing for respiratory syncytial virus. Obtain vital signs to determine an infection. Draw a blood count to see if the client is septic. Screen for the "allergic salute."

Obtain testing for respiratory syncytial virus.

What is the number one treatment for hypoxemia? Fluids Breathing treatment Oxygen Antibiotics

Oxygen

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis? Slightly yellow sclera Enlarged mandibular growth Increased growth of long bones Depigmented areas on the abdomen

Slightly yellow sclera

What should a baby be doing at 9 months?

Hold themselves to stand Cruising Can hold bottle/cup Can say mom/dada Able to wave bye Separation anxiety

What should a baby be doing at 2 months?

Cooing Social smile Head held up Baby recognizing parents

When the nurse is reinforcing teaching with the caregiver of a 3-year-old child being discharged following a tonsillectomy, the caregiver states to the nurse, "I understand why there might be bleeding in the first 24 hours, but I do not understand why there might be bleeding in 1 week or so." What is the most appropriate explanation for the nurse to give this caregiver? "We do not usually do this surgery until the child is older, so postoperative bleeding is a possible complication because of the child's age." "Bleeding can occur at this time because the clots dissolve and new tissue is not yet present." "By next week the child will be eating regular foods again, and the salt content may cause bleeding." "The child will have forgotten about the surgery by that time and might start coughing, and the pressure of coughing can cause bleeding."

"Bleeding can occur at this time because the clots dissolve and new tissue is not yet present."

The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirementsfor the child. What should be included in this teaching? A. "Give your child high-calorie foods and snacks." B. "Feed your child foods that are high in protein." C. "Administer fat soluble vitamins." D. "Give panreatic enzymes with meals." E. "Give your child foods high in fat."

A. "Give your child high-calorie foods and snacks." B. "Feed your child foods that are high in protein. C. "Administer fat soluble vitamins." D. "Give panreatic enzymes with meals."

The nurse is obtaining a health history of a child suspected of tuberculosis. What question would the nurse ask first about the child's cough? A. "How long has your child had a cough?" B. "Does your child cough only at night?" C. "Does your child cough up anything when coughing?" D. "Has your child been around anyone who is coughing?"

A. "How long has your child had a cough?" Tuberculosis is a highly contagious disease. Most children contract it from an infected immediate household member. When taking the health history, the nurse should ask about symptoms such as malaise, weight loss, anorexia, chest tightness and a cough. The child's cough from tuberculosis is described as progressing slowly over several weeks and months rather than having an acute onset. Asking about the production from the cough is a way to determine if hemoptysis has occurred. Asking about being around anyone coughing is a way to determine if the child has been exposed to anyone with tuberculosis. Coughing only at night could be related to other respiratory disorders such as asthma.

A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do before applying the cannula? A. Assess patency of the nares B. Test the oxygen saturation C. Add humidification to the delivery device D. Assess the lung sounds

A. Assess patency of the nares

What would ABG's show in those with RSV?

Co2 retention hypoxemia

A child is diagnosed with sickle cell anemia. Which test will the nurse expect the primary health care provider to prescribe for this client? Hemoglobin Leukocyte Thrombocyte Metabolic screen

Hemoglobin

What statement is the most accurate regarding the structure and function of the newborn's respiratory system? Most infants are nasal breathers rather than mouth breathers. The diameter of the child's trachea is the same as that of adults. Infants and young children have smaller tongues in proportion to their mouths. The diameter of the child's trachea is the same as that of adults.

Most infants are nasal breathers rather than mouth breathers.

For a toddler, what medication delivery system will the nurse choose to relieve bronchospasm of asthma? Sub Q injection Oral liquid Dry powder inhaler Nebulizer

Nebulizer

When assessing a child for the probable cause of acute bronchiolitis, the nurse focuses on which factor? Environmental allergies Viral infections Bacterial infections Prenatal complications

Viral infections

The nurse is caring for a child admitted with asthma. Which clinical manifestations would likely have been noted in the child with this diagnosis? Wheezing Elevated temperature Clubbed fingers Circumoral cyanosis

Wheezing

A young child is prescribed pancreatic enzymes as part of the treatment plan for cystic fibrosis. The child has difficulty swallowing medications. After teaching the parents of a young child with cystic fibrosis about how to administer pancreatic enzymes, the parents demonstrate understanding by stating: We need to dissolve the capsule in water." "We can open the capsule and sprinkle it on his cereal." "We can puncture the capsule and pour the liquid on our child's tongue." "We should crush the capsule to make it smaller pieces."

"We can open the capsule and sprinkle it on his cereal."

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which statement best indicates an understanding of the management and treatment for this diagnosis? "We have taken the carpet out of our house and let my mom take our dog." "He knows how and even when he needs to use his peak flow meter." "Even the babysitter helps us keep up the diary with her symptoms." "The medications she takes are all in one place, ready for her to take at any time."

"We have taken the carpet out of our house and let my mom take our dog." Explanation: Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.

When performing the physical examination of a child with cystic fibrosis, what would the nurse expect to assess? A. Dullness over the lung fields B. Increased diaphragmatic excursion C. Decreased tactile fremitus D. Hyperresonance over the liver

C. Decreased tactile fremitus

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching? Suggest the child participate in sports activities without restriction. Remind parents that the child should avoid immunizations to prevent the introduction of bacteria into the body. Ensure a consistent and daily intake of adequate fluids to prevent dehydration. Treat upper respiratory infections with over-the-counter medication.

Ensure a consistent and daily intake of adequate fluids to prevent dehydration.

The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which disorder? Epiglottitis Spasmodic laryngitis Tonsillitis Laryngotracheobronchitis

Epiglottitis

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? Use guided imagery and therapeutic touch Administer meperidine as ordered Initiate pain assessment with standardized pain scale Administer an NSAID as ordered

Initiate pain assessment with standardized pain scale

Is pharyngitis caused by a virus or a bacteria?

can be caused by either or

What children are at greater risk for a severe influenza infection?

chronic heart/lung diabetes chronic renal disease immune deficiency cancer recieving chemo