Chapter 40: Respiratory Dysfunction (Perry)

Abdominal thrusts (the Heimlich maneuver) are recommended for airway obstruction in children older than: a.1 year. c.8 years. b.4 years. d.12 years.

ANS: A The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. In children younger than 1 year, back blows and chest thrusts are administered.

Instructions for decongestant nose drops should include what recommendations? a.Avoiding use for more than 3 days. b.Keeping drops to use again for nasal congestion. c.Administering drops until nasal congestion subsides. d.Administering drops after feedings and at bedtime.

ANS: A Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. Before chest physiotherapy (CPT) b. After CPT c. Before receiving 100% oxygen d. After receiving 100% oxygen

ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier. Aerosolized bronchodilator medications are not helpful when used after CPT. Oxygen administration is necessary only in acute episodes with caution because of chronic carbon dioxide retention.

A nurse is charting that a hospitalized child has labored breathing. Which medical term describes labored breathing? a. Dyspnea b. Tachypnea c. Hypopnea d. Orthopnea

ANS: A Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in upright position.

A school-age child has had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of: a.Bronchitis. c.Viral-induced asthma. b.Bronchiolitis. d.Acute spasmodic laryngitis.

ANS: A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

Which statement expresses accurately the genetic implications of cystic fibrosis (CF)? a.If it is present in a child, both parents are carriers of this defective gene. b.It is inherited as an autosomal dominant trait. c.It is a genetic defect found primarily in non-Caucasian population groups. d.There is a 50% chance that siblings of an affected child also will be affected.

ANS: A CF is an autosomal recessive gene inherited from both parents and is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance that a sibling will be infected but a 50% chance a sibling will be a carrier.

In providing nourishment for a child with cystic fibrosis (CF), what diet consideration should be stressed to both the child and caregivers a.Diet should be high in carbohydrates and protein. b.Diet should be high in easily digested carbohydrates and fats. c.Most fruits and vegetables are not well tolerated. d.Fats and proteins must be greatly curtailed.

ANS: A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests which respiratory condition? a.Asthma. c.Bronchiolitis. b.Pneumonia. d.Foreign body in the trachea.

ANS: A Children with asthma usually have these chronic symptoms. Pneumonia appears with an acute onset and fever and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea will manifest with acute respiratory distress or failure and maybe stridor.

An infant's parents ask the nurse about preventing otitis media (OM). What should the nurse recommend? a.Avoid tobacco smoke. b.Use nasal decongestant. c.Avoid children with OM. d.Bottle-feed or breastfeed in supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory infection symptoms. Children should be fed in an upright position to prevent OM.

What are the earliest recognizable clinical manifestation of cystic fibrosis (CF)? a.Meconium ileus. b.History of poor intestinal absorption. c.Foul-smelling, frothy, greasy stools. d.Recurrent pneumonia and lung infections.

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF.

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

ANS: A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma.

An 18-month-old child is seen in the clinic is diagnosed with acute otitis media (AOM). Oral amoxicillin is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

ANS: A An 18-month-old child is seen in the clinic is diagnosed with acute otitis media (AOM). Oral amoxicillin is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? "I should administer all the prescribed medication." "I should continue medication until the symptoms subside." "I will immediately stop giving medication if I notice a change in hearing." "I will stop giving medication if fever is still present in 24 hours."

What nursing intervention should be included in the plan of care for a young child diagnosed with pneumonia? a. Monitor for abdominal pain b. Encourage the child to lie on the unaffected side c. Administer analgesicsd. d. Place the child in the Trendelenburg position

ANS: A The pain of pneumonia may be referred to the abdomen in young children. Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. Analgesics are not indicated. Children should be placed in a semierect position or position of comfort.

Which information should the nurse teach families about reducing exposure to pollens and dust? (Select all that apply.) a. Replace wall-to-wall carpeting with wood and tile floors b. Use an air conditioner c. Put dust-proof covers on pillows and mattresses d. Keep humidity in the house above 60% e. Keep pets outside

ANS: A, B, C Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander, but will not affect exposure to pollen and dust.

The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this child's care? a.Monitor pulse oximetry. b.Monitor arterial blood gases. c.Administer oxygen if respiratory distress develops. d.Administer oxygen if child's lips become bright, cherry red.

ANS: B Arterial blood gases and COHb levels are the best way to monitor CO poisoning. PaO2 monitored with pulse oximetry may be normal in the case of CO poisoning. Oxygen at 100% should be given as quickly as possible, not only if respiratory distress or other symptoms develop.

Which statement best describes why children have fewer respiratory tract infections as they grow older? a.The amount of lymphoid tissue decreases. b.Repeated exposure to organisms causes increased immunity. c.Viral organisms are less prevalent in the population. d.Secondary infections rarely occur after viral illnesses.

ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and groups A and B streptococcal infections.

Which type of croup is always considered a medical emergency? a.Laryngitis c.Spasmodic croup b.Epiglottitis d.Laryngotracheobronchitis (LTB)

ANS: B Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory infection symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing intervention should be included in the plan of care? a.Force fluids. c.Institute seizure precautions. b.Monitor pulse oximetry. d.Encourage a high-protein diet.

ANS: B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that: a.Mothers of hospitalized toddlers often experience guilt. b.The mother's presence will reduce anxiety and ease the child's respiratory efforts. c.Separation from the mother is a major developmental threat at this age. d.The mother can provide constant observations of the child's respiratory efforts.

ANS: B The family's presence will decrease the child's distress. The mother may experience guilt, but this is not the best answer. Although separation from the mother is a developmental threat for toddlers, the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant cardiorespiratory monitoring and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

b-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack for what resulting action? a.Liquefy secretions c.Reduce inflammation of the lungs b.Dilate the bronchioles d.Reduce infection

ANS: B These medications work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (rhDNase). What information should be included in the medication education provided the child and family? a.May cause mucus to thicken. b.May cause voice alterations. c.Is given subcutaneously. d.Is not indicated for children younger than 12 years.

ANS: B Two of the only adverse effects of rhDNase are voice alterations and laryngitis. rhDNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years of age.

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

ANS: B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by Haemophilus influenzae in the respiratory tract.

What distinguishing manifestation of spasmodic croup should parents be taught to identify? a. Wheezing is heard audibly b. It has a harsh, barky cough c. It is bacterial in nature d. The child has a high fever

ANS: B Spasmodic croup is viral in origin, is usually preceded by several days of symptoms of upper respiratory tract infection, and often begins at night. It is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness. Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. A high fever is not usually present.

When it is generally recommended that a child being treated for acute streptococcal pharyngitis can return to school? a.When the sore throat is better. c.After taking antibiotics for 24 hours. b.If no complications develop. d.After taking antibiotics for 3 days.

ANS: C After children have taken antibiotics for 24 hours, even if the sore throat persists, they are no longer contagious to other children. Complications may take days to weeks to develop.

An 8-year-old child is diagnosed with influenza, probably type A disease. What intervention should be included in the plan of care? a.Clear liquid diet for hydration. b.Aspirin to control fever. c.Amantadine hydrochloride to reduce symptoms. d.Antibiotics to prevent bacterial infection.

ANS: C Amantadine hydrochloride may reduce symptoms related to influenza type A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye's syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

A parent whose two school-age children diagnosed with exercise-induced bronchospasm (EIB) asks the nurse in what sports, if any, they can participate. The nurse should recommend which sport? a.Soccer. c.Swimming. b.Running. d.Basketball.

ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer, running, and basketball. Prophylaxis with medications may be necessary.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently to monitor. for what increased risk? a.Cough. c.Slowed growth. b.Osteoporosis. d.Cushing's syndrome.

ANS: C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing's syndrome is caused by long-term systemic steroids.

Which intervention for treating croup at home should be taught to parents? a. Have a decongestant available to give the child when an attack occurs. b. Have the child sleep in a dry room. c. Take the child outside if air is cool and moist. d. Give the child an antibiotic at bedtime.

ANS: C Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms. Decongestants are inappropriate for croup, which affects the middle airway level. A dry environment may contribute to symptoms. Croup is caused by a virus. Antibiotic treatment is not indicated.

The nurse is caring for a 10-month-old infant diagnosed with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care? (Select all that apply.) a. Administer antibiotics b. Administer cough syrup c. Encourage infant to drink 8 ounces of formula every 4 hours d. Institute cluster care to encourage adequate rest e. Place on noninvasive oxygen monitoring

ANS: C, D, E Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended.

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a.Bronchoscopy c.Urine creatinine b.Serum calcium d.Sweat chloride test

ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Although bronchoscopy is helpful for identifying bacterial infection in children with CF, it is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

Pancreatic enzymes are administered to the child with cystic fibrosis. What information should be included in patient education concerning the administration of these enzymes? a.Do not administer pancreatic enzymes if the child is receiving antibiotics. b.Decrease dose of pancreatic enzymes if the child is having frequent, bulky stools. c.Administer pancreatic enzymes between meals if at all possible. d.Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit or swallowed whole at the beginning of a meal, not between meals. Pancreatic enzymes are not contraindicated with antibiotics. The dose of enzymes should be increased if the child is having frequent, bulky stools.

When should the parent of an infant with nasopharyngitis be instructed to notify the health care professional? a.Becomes fussy. c.Has a fever over 99° F. b.Has a cough. d.Shows signs of an earache.

ANS: D If an infant with nasopharyngitis has a fever over 101° F, there is early evidence of respiratory complications. Irritability and a slight fever are common in an infant with a viral illness. Cough can be a sign of nasopharyngitis.

A nurse providing care to a child diagnosed with chronic otitis media with effusion (OME) will assess for which signs/symptom? a.Fever as high as 40° C (104° F). c.Nausea and vomiting. b.Severe pain in the ear. d.A feeling of fullness in the ear.

ANS: D OME is characterized by an immobile or orange-discolored tympanic membrane and nonspecific complaints and does not cause severe pain. Fever and severe pain may be signs of AOM. Nausea and vomiting are associated with otitis media.

When caring for an infant with an upper respiratory tract infection and elevated temperature, an appropriate nursing intervention is to: a.Give tepid water baths to reduce fever. b.Encourage food intake to maintain caloric needs. c.Have child wear heavy clothing to prevent chilling. d.Give small amounts of favorite fluids frequently to prevent dehydration.

ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C and calcium b. Vitamins B6 and B12 c. Magnesium d. Vitamins A, D, E, and K

ANS: D Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore, supplements are necessary. Vitamin C and calcium are not fat soluble. Vitamins B6 and B12 are not fat-soluble vitamins. Magnesium is a mineral, not a vitamin.

Which information should the nurse stress to workers at a day care center about respiratory syncytial virus (RSV)? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent hand washing can decrease the spread of the virus.

ANS: D Meticulous hand washing can decrease the spread of organisms. RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour and on cribs and other nonporous surfaces for up to 6 hours.

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a. "We will only prop the bottle during the daytime feedings." b. "Breastfeeding will be discontinued after 4 months of age." c. "We will place the child flat right after feedings." d. "We will be sure to keep immunizations up to date."

ANS: D Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a. They have a widened, shorter airway. b. There is a defect in their sucking ability. c. The gag reflex increases mucus production. d. Mucus and edema obstruct small airways.

ANS: D The airway in infants and young children is narrower, not wider, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not produce mucus.