Chapter 18: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder - ML6

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?

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

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed?

"It is okay for our child to do chores such as sweeping the floor."

A 4-year-old child has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. The parents are extremely distraught over the child's condition and the fact that the child has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of the parents?

Allow the parents to remain with the child as much as possible.

An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. What is the course of treatment that the nurse would expect in this situation?

Antipyretic, analgesic, and antibiotic

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis?

Assisting with racemic epinephrine nebulizer therapy

The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent and immediate intervention?

Compliance with therapy is diminished.

The nurse is preparing a presentation for a local community parent group about measures to prevent the common cold. What would the nurse stress as a vital prevention measure?

Frequent handwashing

A 7-year-old child is being discharged home after a tonsillectomy where the child will be cared for by the parents. Which information will the nurse include in the discharge teaching for the parents regarding pain control? Select all that apply.

Give the full dose of pain medication prescribed. Make sure the child gets the recommended amount of fluids.

In caring for the child with asthma, the nurse recognizes that which nursing diagnosis would be the highest priority in this child's plan of care?

Ineffective airway clearance related to the diagnosis

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease?

Open capsule and sprinkle on food.

Which nursing diagnosis would best apply to a child with allergic rhinitis?

Pain related to sinus edema and headache

The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet?

Pancreatic enzymes

A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother?

Run a hot shower to fill the bathroom with steam and have the boy stay there.

The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method?

Sprinkled onto the food

The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child?

Sweat sodium chloride test

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 attends day care.

The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment?

The child is in tripod position.

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider?

The child was eating peanuts yesterday.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status?

The triggers in the environment

The nurse hears wheezing when auscultating a 4-year-old. Which condition would the nurse most likely rule out based on the assessment findings?

Upper respiratory infection

The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with:

a bronchodilator and mast cell stabilizers.

The nurse is obtaining the history from the parents of an infant who suffered an episode of apnea. If the apnea was an acute life-threatening event, what would the nurse expect the parents to report? Select all that apply.

altered muscle tone coughing change in color bradycardia

How is wheezing in children best heard?

as the child exhales

Which acute respiratory condition is the most common in early childhood?

croup

The nurse is collecting data on a child with a diagnosis of tonsillitis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

erythema of the pharynx

What is a symptom of bacterial pharyngitis?

fever

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?

guaifenesin

The nurse is considering risk factors for influenza in a group of preschool children. Which factors are considered to place children at an increased risk? Select all that apply.

heart failure diabetes renal disease history of asthma

After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify what as a common allergen for asthma?

shellfish

What is a symptom of allergic rhinitis (hay fever)?

sinus pain

The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority?

suctioning secretions from the airway

The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client?

tachycardia

The nurse is assessing an infant who has been admitted with acute bronchiolitis. Which probable cause should the nurse suspect?

viral infection

If there is a foreign body in the larynx, how will the client present?

with stridor

What is the most common debilitating disease of childhood among those of European descent?

Cystic fibrosis

A female nurse of childbearing ages caring for a 2-year-old child diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to:

monitor the child regularly for signs of cyanosis.

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first?

"Have him use his short-acting bronchodilator right away."

The health care provider prescribes fluorescent antibody testing for a child. Which statement by the nurse demonstrates an accurate understanding of this diagnostic test?

"I need to obtain nasopharyngeal secretions and place in a sterile specimen cup." Explanation:

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 give the enzymes before each meal or snack."

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 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."

The nurse working at the child community clinic must administer the influenza vaccine to the high-risk children first. Which child would she choose first?

23-month-old client who had heart surgery as an infant for a defect

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:

epiglottitis.

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, O2 saturation 95% on room air. Which action will the nurse take first?

Administer the bronchodilator via a nebulizer.

The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the order in which the nurse should administer these medications as the child's condition worsens.

Albuterol as needed Low-dose inhaled corticosteroid Medium-dose inhaled corticosteroid Medium-dose inhaled corticosteroid and salmeterol

The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention?

Continue to assess for bleeding.

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 child has been admitted to the hospital with a possible diagnosis of pneumonia. Which finding(s) is consistent with this diagnosis? Select all that apply.

The child's chest x-ray indicates the presence of perihilar infiltrates. The child's white blood cell count is elevated. The child's respiratory rate is rapid. The child is producing yellow purulent sputum.

The nurse is teaching home care to the parents of a 4-year-old client diagnosed with asthma. The nurse knows additional teaching is needed if the parents make which statement?

"We will not enroll our child in preschool this year."

A 4-year-old with bronchiolitis has been admitted to the hospital with respiratory compromise. The father asks the nurse why the physician won't prescribe an antibiotic, "My child just keeps getting worse." What is the best response by the nurse?

"Bronchiolitis is almost always caused by the respiratory syncytial virus (RSV). Unfortunately, antibiotics don't work on viruses."

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?

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

A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?

"Has your infant been around any crowds?"

The nurse notes a 3-year-old child is restless, has a respiratory rate of 55 breaths/minute, and has an oxygen saturation of 90%. Which action will the nurse take first?

Apply oxygen via a facemask.

A 4-year-old child is brought to the emergency department experiencing severe respiratory distress. The health care provider has diagnosed epiglottitis. What nursing intervention(s) should the nurse include in this child's plan of care? Select all that apply.

Keep the child quiet. Administer prescribed nebulizer treatments. Have intubation equipment readily available.

In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason?

Relief of acute symptoms

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child?

Respiratory stridor

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family?

The child will maintain a clear airway. The child will have adequate fluid intake.

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's airway will remain clear and free of mucus.

A 2-year-old toddler is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion?

The respiratory rate is gradually increasing.

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method?

Using a nebulizer

A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as:

funnel.

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, what would the nurse expect to be used to deliver the highest concentration of oxygen to the child?

nonrebreather (face) mask

What is a complication of cystic fibrosis?

pneumothorax

The young child has been diagnosed with group A streptococcal pharyngitis. The physician orders amoxicillin 45 mg/kg in three equally divided doses. The child weighs 23 lb (10.45 kg). Calculate how many milligrams the child will receive with each dose of amoxicillin. Record your answer using a whole number.

157

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver?

"Pollen is a cause of these symptoms. Allergy medicine may help your child."

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete?

Arterial blood gas (ABG)

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma?

"I'm going to have this hospital worker take a picture of your lungs."

The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse?

"I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms."

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress?

2-year-old child with epiglottitis

During a class for caregivers of children with asthma, a caregiver asks the nurse the following question when medications are being discussed. "They told me about a plastic device my child can hold in his a hand which will give him a premeasured and exact amount of his corticosteroid." The nurse recognizes that the caregiver is most likely referring to which device?

Metered-dose inhaler

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be:

chronic lack of oxygen.

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child?

Pulmonary functions test

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?

Encourage everyone in the family to use good handwashing techniques.