Pediatric Respiratory Disorders

The nurse is providing care for an infant with an inner ear infection. The nurse is aware that the condition has occurred multiple times in a 3-month period. Which comment by the parent indicates to the nurse that specific teaching is needed regarding the incidences of infection? 1. "I now put her to bed with a bottle." 2. "I clean her ears with cotton swabs." 3. "She likes her ears submerged while bathing." 4. "Her older brother brings colds home from school."

ANS 1 This is correct. Eustachian tubes are shorter and more horizontal in children than adults and are more prone for migration of substances in the mouth to the inner ear, causing an inner ear infection. The migration of milk is enhanced by putting an infant to bed with a bottle. The nurse will present teaching on this topic. The nurse will reinforce that cotton swabs should not be placed in a child's ear. However, the practice is less likely to be the cause of an inner infection. Some infants do not mind having their ears submerged when in a bath. This practice alone is not likely to be the cause of an inner infection. An infant may be susceptible to an upper respiratory infection from an older sibling who attends school. However, the scenario does not present other symptoms of a cold, such as a stuffy nose.

The nurse on a pediatric acute care unit is providing care for an infant who is 11 months of age. The infant is diagnosed with a lower respiratory infection that produces large amounts of thick secretions the infant cannot cough up. When planning to suction the infant, which factor is important to remember? 1. The parents are likely to become angry about the procedure. 2. The infant will respond negatively to a temporary loss of breath. 3. The nurse should apologize after the procedure for stress related to the procedure. 4. The nurse should have assistance to immobilize the infant during the procedure.

ANS 2 During the suctioning, the nurse will hold the infant tightly and the infant will temporarily experience a loss of breath. During the suctioning, the nurse will hold the infant tightly and the infant will temporarily experience a loss of breath. Providing emotional support and verbal explanation of the procedure to both child and parent is crucial for establishing a good rapport; however, the explanation and support needs to occur before the procedure. The nurse should be able to manage an infant during the process of suctioning. Additional assistance may cause additional stress and should only be acquired if necessary.

A 6-year-old patient is being assessed by the pediatrician for breathing difficulties. The pediatrician expresses a need for diagnostic tests to identify or rule out asthma. Which tests does the nurse anticipate ordering? 1. Throat culture 2. Pulmonary function tests 3. Electrocardiogram 4. Peak flow meter

ANS 2 This is correct. Pulmonary function tests measure the volumes of inhalation and exhalation, normal and forced. The test evaluates the effectiveness of the lungs. Electrocardiograms record the electrical activity of the heart, not the function of the lungs. Peak flow meters are portable, handheld devices that measure the ability to push air out of the lungs. It is not diagnostic but is used for monitoring therapy. The parameters range from below "personal best" to the personal best level measured when in optimal health. The need for interventions is based on color zones.

The pediatric nurse is preparing a teaching plan for new mothers with small infants. Which is a key point for the nurse to include in the teaching plan? 1. Infants are obligatory mouth breathers for the first month. 2. All sinuses are formed and aerating within 2 months of birth. 3. Infants are abdominal breathers until they are 12 months old. 4. Infant airways get blocked more easily than those in older children.

ANS 4 Newborn airways are approximately 4 mm in diameter compared with 20 mm for the average adult's airway. Inflammation 1 mm in circumference would decrease a child's airway diameter 50% but only 20% for an adult. Newborns are obligatory nose breathers until 4 weeks of age, which is the reason newborns with upper respiratory infections have difficulty with feeding from the breast or bottle. Only ethmoid and maxillary sinuses are present at birth and are not aerated until 4 months. Sphenoid and frontal sinuses develop later in childhood and continue to mature into adolescence. The infant's intercostal muscles are not fully developed, and pronounced abdominal wall movement with respiration is normal until 6 years of age.

The nurse is providing care for a school-age patient who received a head injury while playing sports. Which initial assessment finding causes the nurse greatest concern? 1. Confusion and disorientation 2. Headache with periods of nausea 3. Immediate loss of consciousness 4. Changes in breathing and heart rates

ANS 4 Normal breathing is involuntary; the central nervous system controls rate and volume of respiration. Adjustments are made in respiration rate, heart rate, and cardiac output to maintain adequate gas exchange. The finding will alert the nurse to either hypoxia in the brain or injury to the part of the brain that controls respiratory function. The scenario does not specify an increase or decrease in the rates. Confusion and disorientation are common manifestations of a head injury. This finding does not cause the greatest concern for the nurse. Headache and periods of nausea are not uncommon after a head injury. While initially this finding does not cause the nurse greatest concern, frequent reassessment is necessary to identify manifestations of increasing intracranial pressure. Immediate loss of consciousness at the time of a head injury is not uncommon. However, the nurse will continue to monitor for manifestations of increasing intracranial pressure.

The nurse in a pediatric clinic is performing assessments on multiple infants. Which infant does the nurse recognize as being at greatest risk for a respiratory disorder? 1. The infant born at 36 weeks who exhibited respiratory problems at birth 2. The infant who was born at term and recently adopted from another country 3. The infant who sleeps all night, exhibits eczema, and has a family history of asthma 4. The infant with recurrent sore throats and both pets and smokers in the house

ANS 4 The infant with recurrent sore throats and exposure to environmental irritants such as pets and smokers in the household is at greatest risk for developing a respiratory disorder. This patient is recognized by the nurse as having three risk factors Without additional manifestations or information, the premature infant who exhibited respiratory problems at birth is not the patient with the greatest risk for respiratory disorders. The only risk factor is gestational age. The infant who was recently adopted from another country is at risk for respiratory problems because of unknown environmental, physiologic, and/or genetic influences. The only risk factor is being born in another country. The infant with eczema and a family history of asthma has two risks for the development of a respiratory disorder. Sleeping all night is not a risk factor.

The nurse in an acute care pediatric facility is preparing to assume care of multiple patients at the change of shift. Which patient will the nurse plan to assess first? 1. The toddler who exhibits clubbing of the fingertips 2. The preschooler with pneumonia who has poor skin turgor 3. The infant who can sleep only with the head of the bed elevated 4. The infant who prefers a tripod position instead of lying down

ANS 4 When an infant prefers to sit in a tripod position, exhibits a jaw thrust, or is insistent on sitting upright, the indications are relevant to air hunger and oxygen deficiency. This is the patient the nurse will assess first. A toddler may exhibit clubbing of the fingertips if diagnosed with chronic hypoxia from a chronic respiratory disorder. The manifestation occurs over a period of time and does not alone indicate a need for being assessed first. The preschooler with pneumonia and poor skin turgor may be dehydrated from mouth breathing, tachypnea, fever, and/or anorexia. Without additional symptoms, this is not the patient the nurse will assess first. The infant who can sleep only with the head of the bed elevated is not presently in distress. This patient does not need to be assessed first.

The nurse is interviewing an adolescent patient 17 years of age who was diagnosed with cystic fibrosis (CF) as an infant. The patient shares feelings of frustration about needing to always live with parents. Which information provided by the nurse is likely to be most important to the patient? 1. How chest physiotherapy (CPT) can be performed independently 2. The availability of home meal delivery to those needing a therapeutic diet 3. Organizations that will provide transportation for persons with chronic illness 4. A list of social organizations available for young persons who have special needs

ANS: 1 Chest physiotherapy is necessary three to four times daily for the patient with CF. The nurse can inform the patient about equipment and techniques. Some suggestions will include handheld massager and an oscillating vest. The nurse will use a multidisciplinary approach to promote independence for the patient. The patient will benefit from teaching about how to independently meet dietary needs and does not necessarily need home-delivered meals. Persons with CF are not excluded from driving. The patient is likely to have a social circle of friends. Referring the patient to organizations that are designed for persons with special needs is not necessary/appropriate.

37. An 8-year-old boy with a long history with cystic fibrosis has been admitted for malnutrition. The doctor has ordered labs for the child. The nurse clarifies which doctors order before proceeding? 1. Obtain a stool sample for Clostridium difficile 2. Metabolic panel for hydration status 3. Serum albumin level to measure the nutritional status 4. Provide chest physiotherapy before bedtime

ANS: 1 Feedback 1. A stool sample should be used for the absence of trypsin. 2. Malnutrition may be caused by metabolic issues. 3. Serum albumin levels will help indicate nutritional status and are appropriate for this patient. 4. Chest physiotherapy is needed at bedtime to rid as many secretions as possible prior to lower activity levels.

8. A 5-year-old child has been admitted for complications related to asthma. When the nurse auscultates the childs lungs, she would anticipate hearing: 1. Wheezes because the bronchioles have been restricted. 2. Rhonchi because of thick secretions from the flare-up. 3. Crackles because there is fluid in the alveoli. 4. All of the above may be heard.

ANS: 1 Feedback 1. Asthma constricts the airway and alveoli in children, causing wheezing to be heard when in auscultation. 2. Rhonchi usually will clear with a cough. A child with an asthma exacerbation will not stop the sound after coughing. 3. Asthma causes the narrowing of airways. Crackles occur only when fluid is present. 4. The airway and alveoli constriction causes wheezing.

32. A neonate has been diagnosed with respiratory distress syndrome. The nurse notes the neonate is retracting and is hypoxic. The best intervention at this time would be: 1. Providing oxygen support via a mask. 2. Providing oxygen support via nasal cannula. 3. Attempt to reposition the neonate. 4. Check the temperature of the neonate so that the child does not experience cold stress.

ANS: 1 Feedback 1. Oxygen delivered by mask is the highest percentage of oxygen to be delivered other than intubation. 2. The neonate does not receive as high of a rate of oxygen saturation with a nasal cannula. 3. Repositioning may open the airway more, but the retracting occurs because of deterioration, thus requiring oxygen support. 4. Cold stress can cause respiratory issues, but is short term once the neonate is warm.

60. A newborn, premature twin exhibits respiratory distress with retractions, nasal flaring, cyanosis, grunting, and fine, scattered rales. What nursing interventions would you expect the physician to order? 1. Place an NG tube for feeds, monitor respiratory status on ventilator, record I& Os, start an IV, and send electrolyte panel to the laboratory and monitor temperatures 2. Cardio- respiratory monitoring, frequent suctioning on ventilator, and monitoring blood glucose level hourly 3. Placing infant in semi-fowlers position on affected side with head of the bed elevated, oxygen via nasal cannula, keeping NPO, and preparing parents for surgery 4. Giving surfactant intravenously within the first 12 hours of life and repeating every 12 hours for three days.

ANS: 1 Feedback 1. Place an NG tube for feeds, monitor respiratory status on ventilator, record I& Os, start an IV, and send electrolyte panel to the lab and monitor temperatures 2. A ventilator is not needed at this time. Blood glucose should be monitored because it can cause an increase in respiratory distress. 3. Surgery is not indicated at this time. 4. The statement does not indicate the level of prematurity for the infant. Surfactant is not needed at this particular time.

3. When a child exhibits difficulty breathing, the best positioning would be: 1. Having the head of the bed at 45 degrees. 2. Placing the child in a 90 degree angle on the parents lap. 3. Placing the child in a side lying position. 4. Having the child sit in a chair.

ANS: 1 Feedback 1. Positioning the head of the bed slightly elevated will take weight off of the diaphragm and allow for full chest expansion. 2. Placing the child at a 90 degree angle will put too much pressure on the diaphragm, thus causing the shortness of breath to continue. 3. A side lying position does not help to support the diaphragm or aid in relieving the shortness of breath. 4. Sitting in a chair will place more stress on the accessory muscles, thus the child will continue to have shortness of breath.

22. Following a tonsillectomy, a nurse should provide the patient with: 1. Ice chips, no pillow, and no straw for drinking. 2. Ice chips and orange juice. 3. A sippy cup and pudding. 4. A pillow, red Gatorade, and a straw.

ANS: 1 Feedback 1. The patient should lie flat to help clotting occur, ice chips will provide hydration, and no straw should be given because this can cause the clots to break and increase bleeding. 2. Orange juice should not be used because the pulp may lodge into the surgical site. 3. A sippy cup can cause clots to break because of the sucking motion and pudding is too thick to swallow at this point. 4. A patient should lie flat to help with clotting, Gatorade should not be used because you cannot assess for blood because of the color, and a straw will cause the clots to break and increase bleeding.

43. The nurse is assessing a child that was in a motor vehicle accident, which occurred two hours ago. The childs chest is not rising on the right and lacks lung sounds. The X-ray confirmed a hemothorax. The nurse should anticipate the order for: 1. A chest tube and pnuemovac. 2. IV fluids. 3. Placing a nasogastric tube. 4. None of the above would be appropriate for the situation.

ANS: 1 Feedback 1. The pnuemovac will aid in the creation of a sterile container to help decompress the hemothorax. 2. IV fluids may be ordered eventually, but they are not a priority at this time. Airway security is the priority. 3. A nasogastric tube will not influence the hemothorax. 4. The nurse should anticipate the use of the pneumovac to help decompress the hemothorax.

54. An infant born an hour ago exhibits coughing and drooling, cyanosis, abdominal distention, and moderate retractions and grunting. Based on these symptoms, what would be the most likely diagnosis? 1. Tracheoesophageal fistula 2. Laryngomalacia 3. Respiratory distress syndrome 4. Bronchopulmonary dysplasia

ANS: 1 Feedback 1. Tracheoesophageal fistula is the most likely diagnosis. 2. Laryngomalacia would cause more grunting. 3. The child may initially present similar respiratory distress, but the drooling indicates that more is involved. 4. Bronchopulmonary dysplasia occurs after long-term ventilator support, not soon after birth.

16. A mother calls the triage nurse because her 8-year-old son is having trouble keeping his balance, but has otherwise appeared healthy for the past few days. The nurse should advise the mother to: 1. Make a doctors appointment because the child could have issues with his inner ear. 2. Take the child immediately to the ER because this is a neurological emergency. 3. Ask the child if he has consumed any drugs or alcohol in the last few days. 4. Call back in a few days with an update.

ANS: 1 Feedback 1. Unknown etiologies of unsteady balance are a sign of inner ear infections. 2. Since the mother feels the child is healthy and does not exhibit any other neurological symptoms, a doctors appointment is advisable. 3. A child would be exhibiting more symptoms than unsteady balance if he was taking a substance. 4. The concern should be addressed and an appointment made to find the cause of the unsteady balance.

56. It is May, and a mother brings in her 3-year-old son, who has had a harsh whooping cough, runny nose, and watery eyes for the past five days. What would be the most appropriate question to ask the mother? 1. Are the childs immunizations up-to-date, including his Tdap vaccine? 2. Did the child receive his Hib vaccine? 3. Have you taken the child outside in the rain? If so, what happened? 4. When was the last time your child was ill?

ANS: 1 Feedback 1. Up-to-date immunizations will include the Tdap vaccine. If the child has had the vaccine the occurrence/severity of the illness is less. 2. Hib does not include the Whooping Cough vaccine. The question would not be appropriate at this time. 3. Weather does not influence the vaccines. 4. Past illnesses is not the focus of the current assessment and is not appropriate at this time.

The nurse in the newborn unit of a pediatric hospital is providing care for a neonate born at 34 weeks' gestation. The nurse is aware that the immediate risk to the neonate is which condition? 1. A lack of a phospholipid in the alveoli 2. Inability to maintain body temperature 3. Delay in closure of cardiac foramen 4. A decrease in renal function

ANS: 1 This is correct. The nurse's immediate concern is related to respiratory function. A premature neonate is likely to have a low level of surfactant, which is a phospholipid in the alveoli that keeps alveoli pliable, preventing them from collapsing completely at the end of each expiration. phospholipid in the alveoli that keeps alveoli pliable, preventing them from collapsing completely at the end of each expiration. Neonates at any level of maturity can have delays in the closure of cardiac foramen. The immediate risk for a premature neonate is the ability to provide adequate oxygenation. A decrease in renal function in a premature neonate can be related to poor oxygenation because of compromised respiratory function.

The nurse is conducting a class for parents of children with asthma. After covering the topic of asthma triggers, the nurse asks for feedback on the information. Which statements indicate the parents understand actions to reduce asthma triggers? Select all that apply. 1. "I think that we will need to stop using the fireplace." 2. "We will be rethinking the possibility of a family pet." 3. "Now may be the time for relocating to a warmer climate." 4. "No more going outside without a mask from now on." 5. "Reorganizing our schedules will definitely reduce stress."

ANS: 1, 2, 5 This is correct. Smoke from any source is a commonly recognized trigger for asthma; understanding the need to stop using the fireplace is indicative of an appropriate action. This is correct. Pet dander is a commonly recognized trigger for asthma; voicing the need to reconsider getting a family pet is indicative of an appropriate action. This is correct. Stress is a commonly recognized trigger for asthma; reorganizing schedules may be an effective way to reduce stress. This is incorrect. Cold air is commonly recognized as a trigger for asthma; however, moving to a warmer climate is not necessary. The patient needs to place a scarf over the mouth and nose before being exposed to cold air. This is incorrect. Viral infections are commonly recognized as a trigger for asthma; however, wearing a mask whenever going outside the home is not a necessary action. Staying away from people who are ill, good hand hygiene, and promoting overall good health is important. Masks may be considered during flu season.

The nurse is providing teaching to the parent of a toddler 2 years of age diagnosed with otitis media. The toddler presented with a fever of 100.9°F (38.3°C) and does not indicate symptoms related to pain. Which information does the nurse give the parent when the physician orders 48 to 72 hours of supportive care? Select all that apply. 1. Provide age-appropriate analgesics as needed. 2. Administer all of the prescribed antibiotic. 3. Support hydration with fluid increases. 4. Monitor temperature and report increases. 5. Apply topical steroid preparations as instructed.

ANS: 1, 3, 4 The nurse will instruct the parent to administer age-appropriate analgesics as needed. This supportive care is recommended if a child older than 23 months is not in severe discomfort and fever is lower than 102.2°F. Observation for 48 to 72 hours is an important option. The nurse will instruct the parent to avoid dehydration in the child by frequently offering fluids. The nurse will instruct the parent to monitor the child's temperature and report increases, especially if it is 102.2°F or higher. This is incorrect. Antibiotics will not be prescribed immediately and then will be prescribed conservatively. Supportive care is cost-effective and decreases overuse of antibiotics that lead to resistant strains of pathogens. Topical antibiotics, an acidifying agent, and steroid preparation are prescribed for otitis externa.

74. Parents are attending a pre-baby class and receiving information on SIDS. Identify important information the nurse should provide during the course. Select all that apply. 1. A firm mattress 2. A bendy bumper around the entire bed 3. A pillow 4. Tight-fitting sheets 5. A well-ventilated room

ANS: 1, 4, 5 Feedback 1. A firm mattress keeps the baby from sinking into the bedding, thus preventing suffocation. 2. Bendy bumpers can create pockets for the infants face to become stuck, thus creating a suffocation risk. 3. A pillow is too bulky and can cause an infant to become stuck, thus creating a suffocation risk. 4. Tight-fitting sheets decrease the chance for suffocation because there is little room for the infants head to get stuck. 5. A well-ventilated room creates air movement and a good exchange of oxygen and carbon dioxide.

47. The mother of a 3 year old complains to the nurse after the physician leaves the room, saying, My baby is sick with a fever, bad cough, runny nose, and flushed cheeks. He didnt give me any medicine to make him better! What is the nurses best response? 1. It is okay to give your child over-the-counter medicine. Just make sure you get a cold and fever medication. 2. The doctor stated that he believes this to be a virus, so antibiotics will not relieve the symptoms. 3. The best way to treat your child is to give him plenty of fluids, bedrest, and coloring books. 4. The doctor believes this to be a viral illness, so you can use over-the-counter cold medications as long as they say pediatric on the label.

ANS: 2 1. You should not use cold medicine in children under the age of 5. 2. The doctor stated that he believes this to be a virus, so antibiotics will not relieve the symptoms. 3. Fluids, bedrest, and limiting contacts would help the management of current symptoms. This does not address the mothers concern of not receiving medication. 4. You should not use cold medicine in children under the age of 5.

The parents of three children aged 4, 6, and 9 years are preparing to travel abroad as missionaries. The children are in good health and up to date for immunizations; however, the parents are concerned about the high level of TB in the area to which they are assigned. Which recommendation does the nurse make for the protection of the children? 1. Protect the children with good nutrition. 2. Have the children receive the BCG vaccine. 3. Arrange for monthly TB testing for the family. 4. Start the children on preventive medication.

ANS: 2 Before traveling abroad, the children should get a BCG vaccine, which is a live attenuated strain of Mycobacterium bovis. The vaccine is not widely used in the United States because there is less risk for infection in the United States. It provides incomplete protection, and other precautions are warranted. The BCG vaccine does provide better protection for children than adults. Good nutrition and providing overall good health to prevent infections is beneficial for the entire family regardless of their location. The diagnosis of TB in children is challenging, because symptoms are nonspecific and vary and are dependent on the age of the child. Children 5 to 10 years of age may not have clinical symptoms, but an x-ray will confirm if TB symptoms exist. Laboratory tests are less likely to be positive in children, and diagnosis is often made without laboratory confirmation. The children can be protected with nutrition, hand hygiene, avoidance of persons identified with TB, and the BCG vaccine. Preventive medications can have undesirable side effects.

55. A 12 year old comes in with her mother and has the following symptoms: a 40.0 C fever, chills, coughing, and chest pains. Her mother states that she just finished Amoxicillin for strep throat and her chest x-ray shows consolidation. Based on these findings, what would be possible nursing interventions to manage this patient? 1. Monitor oxygenation status and results of sputum culture, CBC, PTT, and sweat chloride test from the laboratory 2. Monitor respiratory, oxygenation, and hydration status and give antibiotics as ordered 3. Monitor respiratory and oxygenation status and give pneumococcal vaccine injection as ordered 4. Monitor oxygenation and hydration status and inform mother that antibiotics would be ineffective for her daughter

ANS: 2 Feedback 1. A PTT and sweat chloride test are not needed at this time because this is the initial incidence of respiratory issues. 2. Although RSV causes 80%85% of all pneumonia in children, the nurse suspects bacterial pneumonia due to the recent strep infection. This is why antibiotics are expected to be ordered. 3. A pneumococcal vaccine should be given prior to the illness. 4. Although RSV causes 80%85% of all pneumonia in children, the nurse suspects bacterial pneumonia due to the recent strep infection. Antibiotics can be effective in this situation.

15. A mother has brought her 18-month-old boy into the pediatric clinic because of irritability, high fever, and has been tugging at his ear for the last 24 hours. The nurse would anticipate which of the following orders? 1. Place the child NPO and attempt to get a head CT. 2. Administering antibiotics for otitis media and acetaminophen for pain and fever control. 3. No orders, as this is a common childhood ailment that requires no interventions. 4. Admitting the child to the hospital to control the high fever.

ANS: 2 Feedback 1. A child with a high fever is normally irritable and this would not be an indication for a head CT as a first priority. 2. The tugging at the ear can be an indication of a child having otitis media. Acetaminophen can help control the ear pain and fever in order to help decrease irritability. 3. Due to the high fever and irritability, the child is demonstrating pain. An intervention is needed. 4. Not enough information is provided to indicate the fever level. Normally this can be controlled at home with acetaminophen.

41. A newborn is experiencing apneic episodes. The nurse should do which of the following when an episode occurs? 1. Give the newborn CPR 2. Stimulate the newborn by rubbing its back 3. Reposition the newborn 4. Hold the newborn

ANS: 2 Feedback 1. An assessment to see if the newborn has a heart rate is needed. 2. Stimulating the newborn may help his/her breathing. 3. Repositioning the newborn is important and should occur after breathing stimulation is provided. 4. Holding the newborn will not stimulate him/her to breathe.

42. A former 24-week, premature infant is now adjusted in age to be one year of age. The baby has a known history of bronchopulmonary dysplasia. The parents of the child are asking if their baby will catch up in height and weight to her peers by the time she is 2 years old. The best reply from the nurse would be: 1. Normally, premature infants will be the same height and weight as their peers by their second birthday. 2. The bronchopulmonary dysplasia requires your childs lungs to work harder to breath. This causes the body to have a higher metabolism, so she may remain on the small side for several years. 3. You baby is now healthy and will continue to grow at her own rate. 4. Your baby will remain small for most of her life due to the bronchopulmonary dysplasia.

ANS: 2 Feedback 1. Children with bronchopulmonary dysplasia require high nutritional demands to the body. The growth of children with this diagnosis tends to be slower than their peers. 2. Children with this diagnosis tend to be smaller than their peers for a longer period of time. 3. This is a true statement, but does not address why the child is not growing at the same rate. 4. The childs body can grow and may be the same as peers later in life.

30. The best way to prevent pertussis in children is with: 1. Good hand hygiene. 2. Keeping immunizations up-to-date. 3. Isolation precautions. 4. All of the above are correct.

ANS: 2 Feedback 1. Hand hygiene is important but the pertussis virus is usually airborne. 2. Immunizations help to build immunity to the disease. 3. Isolation precautions are needed after a child has the illness. 4. Immunizations to help build immunity to the disease is the priority.

44. The purpose of administering surfactant to a preterm neonate is: 1. Because the preterm neonates lungs do not produce it. 2. To prevent the alveoli from collapsing. 3. To help the diaphragm function. 4. Because a preterm neonate needs more surfactant than an older child.

ANS: 2 Feedback 1. Preterm neonates do have some surfactant in the lungs, but not enough to keep the alveoli open for a long period of time. 2. Surfactant is the lubricant in the lungs that allows all for alveoli to remain moist and prevents them from collapsing. 3. The diaphragm is outside of the lung tissue and does not receive surfactant. 4. A preterm neonates needs do not differ from those of an older child.

27. A 2 year old has been placed in contact isolation because of a diagnosis of Respiratory Syncytial Virus (RSV). The father questions why the staff is wearing masks and gowns every time someone comes into the room. The best response would be: 1. The equipment is needed to protect myself and others from your childs illness. 2. Since bronchiolitis is highly contagious for other children, it is important for the staff to wear the equipment to prevent spreading it to others. 3. Every child that comes in with a respiratory illness is required to be in isolation. 4. The equipment is needed to protect your child from acquiring an illness from the staff.

ANS: 2 Feedback 1. The equipment is protecting the health-care worker from transmitting the virus to other patients. 2. Prevention of the spread of the disease is the primary reason for the equipment. 3. Not all respiratory illnesses require isolation. 4. The equipment is protecting the health-care worker from transmitting the virus to other patients.

20. Amantadine hydrochloride has been prescribed for a patient. The nurse knows this medication is used for: 1. Sinusitis. 2. Influenza. 3. Upper respiratory tract infections. 4. Asthma.

ANS: 2 Feedback 1. The medication is not prescribed for sinusitis. 2. The medication helps reduce the symptoms and spread of the influenza virus. 3. Upper respiratory tract infections do not benefit from the use of the medication. 4. Asthma exacerbations do not benefit from the use of this medication.

5. A nurse is attempting to assess the skin color of a child with dark skin. The nurse knows the best place to assess the childs skin color is: 1. The nailbeds. 2. Inside the mouth in the cheek area. 3. The eyes. 4. On the chest.

ANS: 2 Feedback 1. The nailbeds should be used to assess capillary refill. 2. A pen light can be used to examine the inside of a childs mouth in the cheek area for color. 3. The eyes can indicate jaundice, but not any other type of color changes. 4. Capillary refill can be assessed on the chest since the oral mucous membranes are more accurate.

11. A childs ABG results are: pH: 7.14 pCO2: 24.6 HCO3: 8.0 The nurse interprets these results as: 1. Normal ABG. 2. Partially Compensated Metabolic Acidosis. 3. Uncompensated Metabolic Acidosis. 4. Uncompensated Respiratory Acidosis.

ANS: 2 Feedback 1. The pH is acidotic, the CO2 is alkalotic, and the HCO3 is acidotic. Because the pH and the HCO3 are acidotic, it causes the Metabolic Acidosis. Compensation occurs because the pH and the CO2 go in the opposite direction, and the pH is not in the normal range to cause the partial. 2. The pH is acidotic, the CO2 is alkalotic, and the HCO3 is acidotic. Because the pH and the HCO3 are acidotic, it causes the Metabolic Acidosis. Compensation occurs because the pH and the CO2 go in the opposite direction, and the pH is not in the normal range to cause the partial. 3. Compensation occurs because the pH and the CO2 go in the opposite direction, and the pH is not in the normal range to cause the partial. 4. Because the pH and the HCO3 are acidotic, it causes the Metabolic Acidosis.

23. A newborn is lying in his crib in the hospital nursery. The nurse picks up the newborn to prepare for a feeding and notes frothy oral secretions around the newborns mouth. The nurse should: 1. Wipe the newborns mouth and give the feeding. 2. Clean the newborns mouth and notify the doctor of the findings. 3. Feed the newborn. 4. Take the baby to the mother to feed.

ANS: 2 Feedback 1. The wiping the mouth for an assessment is needed, but the newborn should not be fed because the secretions are an indication of lack of secretion drainage. 2. These actions should occur because the child is at risk for tracheal esophageal atresia. 3. The newborn should not be fed because the secretions are an indication of lack of secretion drainage and increases the chance for aspiration. 4. The newborn should not be fed because the secretions are an indication of lack of secretion drainage and increase the chance for aspiration.

53. A 15 month old admitted with croup is sleeping in a cool mist tent. The nurse checks on him and notices that he is retracting and tachypneic. What is the first thing she should do? 1. Increase the oxygen flow to the tent 2. Check the childs pulse oximetry 3. Check the childs temperature 4. Notify the physician

ANS: 2 Feedback 1. This is not the first intervention. A pulse oximetry should be assessed to identify the need for oxygen. 2. The first intervention should be to check the childs pulse oximetry. 3. Fever can cause tachypnea. This is not the first action needed. 4. Notifying the physician is not the first action needed.

The pediatric nurse is reviewing anatomy and physiology in order to have a better understanding of the pediatric respiratory system. The nurse is aware that fluid in the chest cavity can be normal. Which application of this knowledge is correct? 1. Pleural fluid is abundant at birth and decreases over the lifetime. 2. Only enough fluid is present to promote painless movement. 3. Fluid will accumulate in the plural cavity from immobility. 4. Infections such as pneumonia cause fluid in the plural cavity.

ANS: 2 This is correct. There are two pleural membranes: one around the lungs and one covering the inside of the pleural cavity. The two pleural membranes are normally separated by only enough fluid to lubricate the surfaces for painless movement. Fluid is not abundant in the plural cavity at birth; fluid is in the lungs at birth. It is suctioned in order to promote normal respirations. Normal fluid in the pleural cavity does not decrease over the lifetime. Fluid can accumulate in the lungs as a result of immobility. Pneumonia is an infection that causes fluid to build up in the lungs.

The nurse is caring for a newborn diagnosed with esophageal atresia and tracheoesophageal fistula. Which information does the nurse provide to the parents? Select all that apply. 1. Prenatal conditions that contribute to the problem 2. The manifestation supporting the diagnosis 3. Diagnostic tests performed since the birth 4. Methods of treating the condition 5. Actions for promoting recovery

ANS: 2, 3, 4, 5 This is correct. The parents need to know the manifestations that support the diagnosis. The newborn is likely to experience respiratory distress within minutes, days, or weeks of birth; excessive oral secretions; cyanosis; coughing spells; abdominal distention; and upper airway instability. This is correct. The nurse will inform the parents that x-rays, tracheoscopy, echocardiography, and ultrasound was performed after the birth and with the onset of manifestations. This is correct. The nurse will inform the parents that the newborn will require surgery for the repair of the defect. After the physician acquires an informed consent, the nurse will ask about questions and concerns. This is correct. Parent teaching aimed at recovery of the newborn will include information about preventing aspiration, feeding, positioning, and the importance of adherence to frequent follow-up appointments. Parent teaching aimed at recovery of the newborn will include information about preventing aspiration, feeding, positioning, and the importance of adherence to frequent follow-up appointments. This is incorrect. Even if known, the nurse will not present information about any prenatal conditions that contributed to the newborn's condition. The physician may need to discuss the topic after the initial treatment is performed.

The nurse is providing postoperative teaching to the parents of a preschool child after a tonsillectomy. For which events does the nurse prompt the parents to contact the physician? Select all that apply. 1. The child keeps an emesis basin close by. 2. The child is frequently swallowing without food or fluids. 3. Bright red blood is noticed in the child's mouth. 4. The child is asking for ice chips and popsicles. 5. The child refuses pain pills because it hurts to swallow.

ANS: 2, 3, 5 This is correct. Frequent swallowing without the presence of food or fluid is an indication of bleeding; the parents are instructed to call the physician if this occurs. This is correct. Bright red blood in the child's nose or mouth is indicative of bleeding, and the physician needs to be called. This is correct. If the child refuses to take pain pills because it hurts to swallow, the doctor needs to be contacted. It is likely the prescription can be changed to a liquid.. It is not unusual for a child to experience nausea from drainage after a tonsillectomy. There is no need to contact the physician unless the nausea is severe and there is a risk for vomiting This is incorrect. The child's willingness to eat ice chips and popsicles will sooth the throat, help to stop bleeding, and promote hydration.

46. The mother of an 18 month old states that she is concerned due to the fact that her child has been diagnosed with otitis media three times in the last year. Which answer would be appropriate to alleviate the mothers concerns? 1. A childs airway is short and narrow. As the child grows, the airway will grow, and the number of alveoli will increase. 2. A childs tonsils are larger than an adults and block emptying of the Eustachian tubes. As the child grows, the tubes get longer even though tonsils dont change. 3. A childs Eustachian tubes are shorter and more horizontal, allowing nasopharyngeal secretions to enter. As the child grows, the incidence of OM will decrease. 4. A childs larynx is more flexible than an adults and easily stimulated to spasm. As he grows, he will be less sensitive to laryngospasms and pooling of secretions.

ANS: 3 1. Although choice 1 is correct, it does not address the ears and recurrent infection. 2. A childs tonsils are not larger than an adults. They do not block the emptying of the Eustachian tubes. 3. A childs Eustachian tubes are shorter and more horizontal, allowing nasopharyngeal secretions to enter. As the child grows, the incidence of OM will decrease. 4. A childs larynx is not more flexible than an adults

12. A child has the following results for an ABG: pH: 7.42 pCO2: 43.9 HCO3: 26.8 The nurse interprets these results to be: 1. Compensated Respiratory Acidosis. 2. Compensated Respiratory Alkalosis. 3. Normal ABG. 4. Compensated Metabolic Acidosis.

ANS: 3 Feedback 1. All results are within normal range and are not causing acidosis or compensation. 2. All results are within normal range and are not causing alkalosis or compensation. 3. All results are within normal ranges, thus this is a normal ABG finding. 4. All results are within normal range and are not causing compensation or acidosis.

52. What is the most accurate statement regarding Palivizumab? 1. It is a humanized monoclonal antibody given as an IM injection before the start of HPV season. 2. It is recommended for premature infants with 29-35 weeks gestation, children with congenital heart defects, and the elderly. 3. It is costly and is given usually between October to May in a series of five injections. 4. Before administering, you need to evaluate results of complete blood count and electrolyte panel from the laboratory.

ANS: 3 Feedback 1. Given prior to RSV season 2. Not given to the elderly 3. It is given prophylactically before the start of RSV season. The nurse needs to evaluate platelets and coagulants before administering. 4. The nurse needs to evaluate platelets and coagulants before administering.

36. Children with cystic fibrosis should be frequently checked for: 1. Hypernatremia. 2. Hypocalcemia. 3. Hyponatremia. 4. Hypercalcemia.

ANS: 3 Feedback 1. High sodium is not an issue in children with cystic fibrosis. 2. Low calcium levels are not an issue for children with cystic fibrosis. 3. The lack of sodium is noted in children with this diagnosis. 4. High calcium levels are not common in children with cystic fibrosis.

The nurse is doing discharge teaching with the parents of a child with new diagnosis of CF. What is the most important concept for parents of CF patients to remember? 1. Hospitalizations can be avoided with consistent chest physiotherapy. 2. There are multiple support groups in the community available to help them cope when the symptoms increase as the child grows older. 3. It affects multiple body systems over a lifetime, which requires vigilant respiratory care and individualized dietary modifications. 4. All symptoms of cystic fibrosis can be managed by diet modifications and increasing the fluids and salt intake of the child.

ANS: 3 Feedback 1. Multiple adaptations to the lifestyle will be needed to maintain a healthy body and avoid hospitalizations. 2. Support groups and summer camps should be implemented right away to learn how to adapt to the illness emotionally. 3. It affects multiple body systems over a lifetime, which requires vigilant respiratory care and individualized dietary modifications. 4. Some individuals will be more ill than others and need different modifications to their diet.

4. A father is concerned that his newborn baby girl is cold because her hands are blue. The nurse explains to the father that: 1. This is a sign of respiratory distress, and the baby needs to return to the nursery. 2. Most newborns have trouble regulating their body temperature. 3. This is acrocyanosis and should go away within 48 hours after her birth. 4. This is bruising the baby received during the birth process.

ANS: 3 Feedback 1. Respiratory distress would be noted if the newborn had circumoral cyanosis. 2. Healthy newborns are able to regulate their body temperature soon after birth if dressed for the environment. 3. The newborn is exhibiting acrocyanosis. It is not a sign of coldness. 4. Bruising usually does not occur on the hands.

51. A mother brought her 8 year old into the emergency room because although she was fine when she woke up this morning, she now has a fever of 39.8 C, cannot speak, is drooling, and is tachypneic and stridorous. Her pulse oximetry reading is 90 percent on a rebreather mask. What would be the next appropriate nursing action? 1. Suction her mouth, then conduct throat and blood cultures as well as a test for gram positive bacteria. 2. Prepare the child and mother for an MRI scan to evaluate for a thumb sign. 3. Monitor respiratory status closely, prepare for intubation, and keep the child calm to avoid crying. 4. Suction her mouth, monitor respiratory status closely, and give a Palivizumab injection.

ANS: 3 Feedback 1. Suctioning can cause more traumas to the area. 2. The thumb sign will not occur in this condition. 3. The nurse would monitor and be prepared for possible rapid decline in respiratory status and try to keep the child from crying. 4. Suctioning the mouth can cause more damage, and the injection should not be given at this time.

2. When a nurse enters the room of a child with chronic lung disease, she notes that the child is sitting in a tripod position. Identify the reason for this positioning by the child. 1. The child feels more comfortable playing in this position. 2. The child is attempting to have a bowel movement. 3. The child is having trouble breathing, and the position is comfortable 4. The child is in a resting position after walking in the hallway.

ANS: 3 Feedback 1. The child may feel comfortable in this position, but it is not the primary reason for the positioning. 2. A child will squat on their haunches when having a bowel movement. 3. The tripod position enables the diaphragm to fully expand and attempt to get as much oxygen into the body as possible. 4. A child who is resting will sit or lie down on the bed.

28. A nurse is assessing a 3-month-old child with RSV. The nurse identifies the following: HR of 140; RR of 32; Oxygen saturation is 89% on room air; inspiratory and expiratory wheezing of the upper lungs; temperature of 38.1 degrees Celsius; large amounts of thin secretions. Identify the priority at this time. 1. Administering acetaminophen to reduce the fever 2. Providing oxygen for the low saturation 3. Suctioning the nares and oropharnyx to remove the secretions 4. Providing a quiet environment

ANS: 3 Feedback 1. The fever is low grade and not a priority at this time. 2. 89 percent oxygen saturation on room air needs to have a further assessment to see why the child is low in saturations. 3. Suctioning helps remove all the secretions and opens the airway with the possibility of increasing oxygen saturations. 4. A quiet environment will help the child rest, but is not a priority at this time.

49. A father brings his 6-month-old infant into the clinic with a four day history of nighttime, seal-like cough. The infant is afebrile, tachycardic, and tachypneic with a pulse oximetry reading of 98 percent. What interventions would you expect the physician to order for this child? 1. Cool mist tent with supplemental oxygen, racemic epinephrine, and corticosteroids 2. Beta adrenergics aerosolized, cool mist tent, and periodic testing of blood glucose levels 3. Close monitoring of respiratory status, cool mist tent, beta adrenergics, and corticosteroids 4. Close monitoring of respiratory status, supplemental oxygen with simple mask, and racemic epinephrine

ANS: 3 Feedback 1. The infants pulse oximetry is 98 percent and does not need supplemental oxygen. 2. Beta adrenergic meds do not increase blood glucose levels. 3. These interventions are appropriate for croup-like symptoms. 4. The infants pulse oximetry is 98 percent and does not need supplemental oxygen.

25. A mother calls the pediatric triage nurse to report that her son has a barky cough, and it started about midnight. The nurse should instruct the mother to: 1. Take the child to the emergency room right away. 2. Sleep with the child in an upright position. 3. Take the child into a room with a cool mist humidifier or go outside and see if the barky cough subsides. 4. All of the above would be appropriate responses for the mother.

ANS: 3 Feedback 1. The mother should attempt to relieve the symptoms at home prior to coming to the emergency room. 2. The child will more than likely not sleep. 3. A cool mist humidifier or going outside can help reduce the inflammation of the trachea and larynx area. 4. Only using the cool mist humidifier or taking this child into the cool night is effective treatment.

17. Treatment for otitis externa (OE) is usually: 1. No treatment because it resolves on its own. 2. Antibiotic therapy. 3. Corticosteroid therapy. 4. Applying a warm pack to the area for comfort

ANS: 3 Feedback 1. Treatment is recommended because long-term or frequent infections can cause hearing loss. 2. The concern is the fluid and inflammation. Antibiotics will not help remove the fluid and inflammation. 3. Corticosteroids will help reduce the inflammation and fluid in the ear. 4. The warm pack can be a comfort measure, but the fluid and inflammation need to be addressed.

3. The nurse is providing care for an infant who is 2 months old. Which assessment finding will cause the nurse to suspect an upper respiratory infection? 1. A raspy cry and occasional cough 2. Adventitious lung sounds bilaterally 3. A stuffy nose and reddened eardrums 4. A fever, lethargy, and skin pallor

ANS: 3 The upper respiratory tract is a passageway that includes the nasopharynx and oropharynx and is connected to the ears by the eustachian tubes. Because of the stuffy nose and reddened eardrums, the nurse suspects an upper respiratory infection. The lungs are part of the lower respiratory system due to the presence of the terminal bronchioles, which end in sacs called alveoli. This finding is indicative of a lower respiratory infection. A raspy cry results from inflammation of the larynx; however, an occasional cough is more indicative of trachea irritation. The manifestations do not necessarily indicate an upper respiratory infection because structures of both the upper and lower respiratory tract are involved. Fever, lethargy, and pallor can be seen in either an upper or lower respiratory infection.

68. An infant is tachypneic, retracting, and tachycardic with a temp of 39.0 C and a pulse oximetry of 92 percent. You place the infant on 1L nasal cannula oxygen and raise the head of the bed. What intervention would the nurse expect the physician to order next? 1. MRI 2. CT 3. Bronchoscopy 4. Chest x-ray

ANS: 4 Feedback 1. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies. 2. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies. 3. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies. 4. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies.

What is the major contributing factor for the development of BPD? 1. Immature lungs have a decreased number of alveoli for gas exchange 2. Premature birth with decreased number of functional alveoli, leading to lung injury 3. Chronic respiratory infections, leading to pulmonary hypertension and lung scarring 4. Ventilator assistance with high oxygen flow rate at birth, causing inflammation and scarring in lungs

ANS: 4 Feedback 1. BPD occurs because of the increased resistance and amount of damaged alveoli, decreasing the amount of oxygen exchange. 2. Scarring occurs on the alveoli that are present. The preemie baby has the same amount of alveoli, but less surface area to ventilate. 3. Neonates do not commonly have respiratory infections to cause an increased risk for BPD. 4. Ventilator assistance with high oxygen flow rate at birth, causing inflammation and scarring in lungs

18. Important discharge teaching for a 4-year-old boy who had a tympanostomy procedure done would include: 1. The tubes usually fall out spontaneously within a year. 2. Draining of purulent fluid after two days, then return for a follow-up. 3. Placing waterproof ear plugs in the ears when swimming. 4. All of the above should be included in the discharge teaching.

ANS: 4 Feedback 1. Because of the rapid growth of children, the tubes usually last approximately one year. 2. Purulent fluid is a sign of infection. 3. Preventing water from entering the tubes will help decrease the chance of infection. 4. Because of the rapid growth of children, the tubes usually last approximately one year. Purulent fluid is a sign of infection. Preventing water from entering the tubes will help decrease the chance for infection.

63. Which statement is most accurate regarding chest physiotherapy (CP)? 1. CP includes postural drainage, chest percussion, vibration, and daily chest x-rays. 2. CP is used to mechanically loosen secretions to prevent or manage atelectasis and gastritis. 3. CP should only be performed in the absence of respiratory distress. 4. CP is contraindicated when chest rib fractures, lung contusions, or hemothorax are present.

ANS: 4 Feedback 1. CP does not require daily X-rays. 2. CP is not used for gastritis. 3. CP should only be done with patients with an increase in respiratory secretions. 4. Chest physiotherapy is contraindicated when rib fractures, lung contusions, or hemothorax are present because further damage can occur.

26. When assessing a child with epiglotitus, the nurse should assess for all of the following except: 1. Drooling. 2. Dysphonia. 3. Stridor. 4. Crackles in the upper lungs.

ANS: 4 Feedback 1. Drooling can indicate swelling of the epiglottitis because the secretions are not able to go to the stomach. 2. Dysphonia can occur because of the swelling. 3. Stridor is common because of the swelling of the epiglottitis. 4. Crackles are heard in lower respiratory illnesses, not the upper respiratory illnesses in children.

64. A 6 year old who exhibits a moist, productive cough has a history of bronchitis several times every year and eating everything in sight. She appears thin for her age and has a sweat chloride test that is 67 mEQ/L. Her mother states, I just want to get this eating disorder treated so my baby can have a normal life. What is the nurses best response? 1. We will consult the dietician for a behavior management and eating plan, focusing on appropriate portion size. 2. We will need to do another sweat chloride test next week. Have your child take supplemental water-soluble vitamins, such as A, D, K and iron. 3. You should incorporate tofu and mayonnaise in your meal preparation to promote feeling full for a longer period of time. 4. Cystic fibrosis can cause an increase in appetite because of the lack of nutrients and calories absorbed. This affects children across the life span.

ANS: 4 Feedback 1. Food choices that contain the needed vitamins and minerals should be discussed. 2. The child already has the diagnosis and another test will not indicate which vitamins to give. 3. This diet will not easily be digested by a person with CF. The menu should be reconsidered. 4. Increased appetite is a physiologic response to decreased fat-soluble nutrients and calories absorbed in the CF digestive track. This requires fat-soluble (A,D, E, K) vitamins and pancreatic enzyme supplements.

61. A newborn has a scaphoid-shaped abdomen, irregular chest wall movements, and decreased breath sounds on the left side of chest. What other symptoms would you expect to find? 1. Central cyanosis and pink nailbeds with brisk capillary refill 2. Protruding abdomen and fullness with palpation 3. Increased breath sounds over trachea, tachypnea, and stidor 4. Tachypnea, nasal flaring, and retractions

ANS: 4 Feedback 1. Nailbeds will be cyanotic and exhibit slow capillary refill. 2. The abdomen will be full and stiff because of excessive air. 3. Grunting may be present, and there will be decreased breath sounds. 4. Tachypnea, nasal flaring, and retractions are the correct symptoms.

67. If a nurse suspects that a 2-month-old infants death was related to SIDS, what statement made by the mother reflects an accurate understanding of SIDS? 1. I knew that I should not have given our baby the antibiotics for the ear infection. 2. Being a twin with low birth weight, he didnt have a chance. 3. I should not have fed him that eight-ounce bottle before laying him down. 4. I am having a hard time not knowing what happened. I had just checked on him 20 minutes earlier in the crib, and he was sleeping on his back.

ANS: 4 Feedback 1. SIDS is a diagnosis of exclusion. Antibiotics are not known to cause SIDS. 2. A lower birth weight child is at more risk, but is not the only reason SIDS can occur. 3. The amount of feeding does not influence the occurrence of SIDS. 4. SIDS is a diagnosis of exclusion. It is difficult to know what exactly causes the death in SIDS cases.

21. A child is scheduled to have a tonsillectomy in two hours. The nurses assessment should include: 1. A question to see if the child snores or has difficulty breathing at times. 2. Assessing for halitosis. 3. The size of the tonsils. 4. All of the above

ANS: 4 Feedback 1. Snoring and difficulty breathing are an indication of obstruction of the tonsils. 2. Halitosis is common in children with enlarged tonsils because of the bacterial content. 3. Tonsil size should be documented because removal of the entire tissue will need to occur during surgery. 4. Snoring and difficulty breathing are an indication of obstruction of the tonsils. Halitosis is common in children with enlarged tonsils because of the bacterial content. Tonsil size should be documented because removal of the entire tissue will need to occur during surgery.

58. Which statement regarding the pathophysiology of TB is accurate? 1. The settling of the bacillus in the alveoli triggers the clotting response. 2. Macrophages form hard tubercules around bacilli that always remain dormant in the lungs. 3. TB can affect the lungs, spinal cord, bone formation and the brain. 4. Tubercles in the lungs can remain dormant or progress to active tuberculosis, but are not as prevalent in children.

ANS: 4 Feedback 1. The clotting response is not triggered by the bacillus. 2. The tubercules are rare in children. 3. TB affects the lungs only. 4. Tubercles in the lungs can remain dormant or progress to active tuberculosis, but are not as prevalent in children.

38. Teaching a child with a chronic respiratory illness to forcefully exhale can be done by: 1. Pretending to blow candles out. 2. Blowing bubbles. 3. Pretending to blow out a flashlight. 4. All of the above are techniques for teaching a child to forcefully exhale.

ANS: 4 Feedback 1. This requires a large volume for inhalation and expiration, thus being an effective treatment. 2. This requires pursed-lip breathing and helps force air, thus being an effective treatment. 3. This requires a large volume for inhalation and expiration, thus being effective treatment. 4. Pretending to blow out candles or a flashlight require a large volume for inhalation and expiration, thus being effective treatment. Blowing bubbles requires pursed-lip breathing and helps force air, thus being an effective treatment.

A toddler who is 2 years old is playing in the playroom at the hospital and suddenly begins to choke and cough. The nurse attending the toddler places the child in which position to dislodge a possibly inhaled object? 1. Head down and on the left side 2. Head down and on the right side 3. Head horizontal to the floor and supine 4. Head in a neutral position and prone

ANS 2 In children, the bifurcation of the right and left bronchi occurs higher in the airway, and the right bronchus enters the lung at a steeper angle than does the bronchi of an adult. Placing the child head down and on the right side will help to dislodge the object. The right bronchus is more likely to be blocked because of its steep angle into the lungs; turning the child to the left will impede the removal of the object. The object needs to move up and out of the bronchus; it cannot do that lying flat or horizontal. Lying prone and in a neutral position will not enable the object to be coughed up and out.

A child has the following ABG results: pH: 7.38 pCO2: 52.6 HCO3: 32.5 The nurse interprets these results as: 1. Compensated Respiratory Acidosis. 2. Uncompensated Respiratory Alkalosis. 3. Compensated Respiratory Alkalosis. 4. Uncompensated Respiratory Acidosis.

ANS: 1 Feedback 1. The pH is on the low end, creating a more acidotic state along with the CO2 in an acidotic state, thus indicating the respiratory acidosis. The HCO3 is alkalotic, creating compensation. 2. The pH and the CO2 are acidotic and the HCO3 is alkalotic, creating compensation. 3. The pH and CO2 are in acidotic states, not alkalotic states. 4. Compensation has occurred because of the HCO3 being alkalotic.

48. A 6 year old had a tonsillectomy today. When the nurse goes into the room to give him his antibiotics, she finds him irritable, coughing, nauseated, and swallowing repeatedly. What is the next action the nurse should take? 1. Assess for signs of frank red blood in the mouth and nose and get a complete set of vital signs. 2. Ask the child for a pain score and if he would like a popsicle with his pain medicine. 3. Suction mouth vigorously to avoid aspiration of blood, and then hang antibiotic. 4. Take a complete set of vital signs and divert the childs attention to the cartoon on TV.

ANS: 1 Feedback 1. This intervention assesses for bleeding. 2. An assessment for blood needs to occur because the child continues to swallow. 3. Suctioning can cause clots to loosen and increases bleeding. It should be avoided. 4. Vital signs are needed and a focused assessment needs to be completed in order to identify complications.

71. Signs that a child is exhibiting respiratory distress include: (Select all that apply.) 1. Nasal flaring. 2. Synchronized rise and fall of the abdomen and the chest. 3. A capillary refill of less than three seconds. 4. Grunting. 5. Intercostal retractions.

ANS: 1, 4, 5 Feedback 1. Nasal flaring indicates that the child is struggling with breathing. 2. Synchronized rise and fall is a normal breathing pattern of a child. 3. A capillary refill of less than 3 seconds is normal for a child. 4. Grunting indicates that the child has to exhale harder than normal, thus indicating respiratory distress. 5. Intercostal retractions indicate that the child needs to use accessory muscles, creating respiratory distress.

45. The mother of a child with cystic fibrosis calls the triage nurse and asks which type of antihistamine would be the most beneficial for her sons head cold. The nurse should: 1. Recommend Benadryl for her son. 2. Discourage the use of antihistamines because the drug can dry out the mucous and make it harder to expel. 3. Encourage the mother to give the child a dose of the antihistamine every four hours. 3. Recommend any over-the-counter antihistamine that states it is a pediatric formula.

ANS: 2 Feedback 1. Benadryl will dry out the mucous membranes and cause further problems for the child. 2. Discouragement of antihistamine usage is important because the medication can dry out the mucous membranes too much for a child with cystic fibrosis. 3. Antihistamine medication can dry out the mucous membranes too much for a child with cystic fibrosis, creating further problems. 4. Antihistamine medication can dry out the mucous membranes too much for a child with cystic fibrosis and create further problems.

62. Cystic fibrosis is best categorized as: 1. An autosomal recessive disease with deletion of Chromosome 17 that affects the lungs and finances of the parents. 2. An autosomal recessive disorder of the exocrine glands marked by increased mucus and sodium chloride production and decreased pancreatic enzyme production. 3. An autosomal recessive disorder that affects the respiratory, cardiac, and digestive systems. 4. An autosomal recessive disorder that is marked by the increased mucus destruction and decreased pancreatic enzyme production.

ANS: 2 Feedback 1. Cystic fibrosis is an autosomal recessive disorder of exocrine glands and is not seen on chromosome 17. 2. Cystic fibrosis is an autosomal recessive disorder of exocrine glands marked by increased mucus and sodium chloride production and decreased pancreatic enzyme production. 3. Cystic fibrosis is an autosomal recessive disorder that impacts the respiratory and GI tract, not the heart. 4. Cystic fibrosis is an autosomal recessive disorder of the exocrine glands marked by increased mucus and sodium chloride production and decreased pancreatic enzyme production.

The nurse in a pediatric clinic is assessing an infant who is 3 months old during a well-baby visit. Which assessment finding will be of greatest concern to the nurse? 1. The infant mouth breathes when crying. 2. The infant's eardrums are pink in color. 3. The infant exhibits 15-second periods of apnea. 4. The infant's respiratory rate is fast and irregular.

ANS 3 This is correct. Periods of apnea (the absence of respiration) that last up to 15 seconds are typical of newborns; however, at 3 months of age this patient is considered an infant. The finding is not expected and causes the nurse concern. Newborns are obligatory nose breathers until 4 weeks of age. It is not unexpected or of concern for a 3-month-old infant to take mouth breaths when crying. The nurse will perform further assessment to determine if the infant is exhibiting signs of a mild ear infection. This finding is of concern, but periods of apnea are of greatest concern. A child's metabolic rate is higher than that of an adult's, creating a higher oxygen demand. An infant's respiratory rate is expected to be faster, with an irregular pattern.

31. A school nurse has been made aware that an eighth grader has latent tuberculosis (TB). Education for the teaching staff should include: 1. A document with the signs and symptoms of illness for a person with TB. 2. Do not allow the child into the classroom when he coughs. Send him to the nurses office to prevent the spread of the illness. 3. Provide universal precautions with the child. 4. The child does not need any interventions at this time because the TB is dormant.

ANS: 1 Feedback 1. A signs and symptoms document will help increase the awareness of the disease and can also help identify those who are infected early. 2. The spread of the disease cannot occur just because of coughing. 3. Universal precautions should be used with every student, not just the ill children. 4. Interventions will help prevent the illness from spreading.

7. When performing an assessment on an 8-year-old boy who is hospitalized for pneumonia, the nurse would anticipate what type of lung sounds? 1. Crackles 2. Stridor 3. Normal 4. Wheezes

ANS: 1 Feedback 1. Fluid is built up in the lungs because of the infection, causing crackles to be heard. 2. Stridor is common in children with larynx issues, not pneumonia. 3. When fluid builds up in the lungs, it will cause the lungs sounds to be abnormal with a diagnosis of pneumonia. 4. A child will have wheezes if the airway is constricted, not full of fluid.

35. Clubbing of the nailbeds in the fingers would be a clinical finding on which patient? 1. A child with cystic fibrosis 2. A child with croup 3. A child with respiratory distress syndrome 4. A child with RSV

ANS: 1 Feedback 1. Long-term hypoxia causes clubbing of the nailbeds because of the lack of oxygen. 2. Croup is a short-term respiratory issue, which does not causing clubbing. 3. Respiratory distress syndrome is short lived and does not cause clubbing. 4. RSV is short lived and does not cause clubbing.

73. A nurse is giving discharge instructions to parents taking a newborn home with apneic episodes. The newborn has an apnea monitor for home. The instructions should include: (Select all that apply.) 1. How to clean the monitor pieces. 2. Allowing the monitor to be off when the parents are sitting with the newborn in an awake state. 3. Never take the monitor off. 4. Take the monitor off when bathing the baby. 5. Reset the alarm limits if the monitor is ringing frequently.

ANS: 1, 2, 4 Feedback 1. Keeping the pieces clean will aid in decreasing the chances for infection and help maintain a working monitor. 2. The newborn can be off the monitor while awake, and being supervised helps decrease skin breakdown. 3. The monitor should be taken off for periods while the newborn is awake and supervised. 4. Since the monitor is electric, it should not become wet at any time. 5. The alarm limits are prescribed by a provider and should not be reset.

13. A 10-month-old boy is being given a sweat test because: 1. The child has had several high fevers. 2. The test is assessing for cystic fibrosis. 3. The test is assessing for respiratory failure. 4. The child does not demonstrate thermoregulation.

ANS: 2 Feedback 1. A child with a high fever does not require a sweat test. Sweating can be a normal occurrence during fevers. 2. The sweat test is a common test for cystic fibrosis diagnostics. 3. The sweat test will not give an indication as to respiratory failure. 4. The sweat test does not deal with the thermal regulation of a child.

1. An 8-year-old child with a history of cystic fibrosis has a chest that is larger than normal. This type of feature on a child is known as: 1. A concaved chest. 2. A barrel chest. 3. An asymmetrical chest. 4. All of the above are correct.

ANS: 2 Feedback 1. The chest does not bow inward in a child with cystic fibrosis. 2. A barrel chest is common in a child with cystic fibrosis because of the air trapping that occurs within the lungs. 3. The chest is symmetrical in appearance with cystic fibrosis. 4. Not all of the options are correct.

39. A diet for a child with cystic fibrosis should include: 1. Foods with high protein and high fat content. 2. Foods with low fat and high protein content. 3. A daily dose of fat-soluble vitamin supplements. 4. A daily dose of water-soluble vitamin supplements.

ANS: 3 Feedback 1. A diet with a high fat content can cause digestion issues because of the lack of enzymes. 2. A diet with low protein is needed for the child to aid in health. 3. The fat-soluble vitamins are needed because the child is not able to digest fat easily. 4. A child with cystic fibrosis should be able to receive the needed water-soluble vitamins in a regular diet.

33. When assessing a newborn with a known diaphragmatic hernia, the nurse would anticipate hearing bowel sounds: 1. In the upper abdomen. 2. In the lower abdomen. 3. To not exist. 4. In the chest.

ANS: 4 Feedback 1. Normal bowel sounds can be heard in the upper abdomen. 2. Normal bowel sounds can be heard in the lower abdomen. 3. Bowel sounds do exist, just in a different area of the body. 4. Because of the lack of diaphragm, the gastrointestinal tract is shifted into the chest cavity.

24. A newborn has had a repair of a trancheoesophageal fistula one hour ago. When the newborn is taken to the neonatal intensive care unit, the nurse should: 1. Monitor the oxygen saturations of the newborn. 2. Assess for respiratory distress. 3. Provide oral suctioning as needed. 4. All of the above should be done for the newborn.

ANS: 4 Feedback 1. Oxygen saturations will indicate the respiratory status of the newborn. 2. Assessment for respiratory distress is needed because the surgery requires some trauma to the trachea. 3. Suctioning is needed so the secretions do not cause blockage in the airway. 4. Oxygen saturations will indicate the respiratory status of the newborn. Assessment for respiratory distress is needed because the surgery requires some trauma to the trachea. Suctioning is needed so the secretions do not cause blockage in the airway.

6. A child with respiratory distress can experience dehydration because: 1. The child is not drinking enough fluids. 2. The body requires an increased amount of fluids when sick. 3. The child is retaining water in the kidneys since the body is using all the oxygen in the lungs. 4. Mouth breathing occurs when in distress, so the child is losing hydration.

ANS: 4 Feedback 1. Respiratory distress causes dehydration issues. 2. Fluids are required to keep mucous membranes and secretions moist, but are not the reason for dehydration. 3. Water is not retained in the kidneys with respiratory difficulties. 4. Children are known to be mouth breathers during respiratory distress situations, thus increasing their risk for dehydration due to the lack of moist mucous membranes

40. A nurse is attempting to educate a 10-year-old girl in the use of a peak flow meter. Identify the best way to explain the test to the child. 1. The purpose of the test is to see how hard you breathe. 2. The purpose of the test is for you to monitor what is normal and abnormal for you. Then your parents can help with your medication on days when you are not measuring in your normal ranges. 3: We are measuring how well you can blow birthday candles out. 4. The meter will help monitor when you are healthy and when you are becoming ill.

ANS: 4 Feedback 1. The description is not accurate, and a 10 year old is able to comprehend the reason for use of a peak flow meter. 2. The description of normal and abnormal can cause concern for the child. It is important to explain that the peak flow meter is a measurement of health. 3. This description can be used for a younger child. A 10 year old is able to comprehend the use of the peak flow meter. 4. The peak flow meter is a monitor used to indicate when the child is breathing easily and when illness may be starting.

50. An 8 month old was admitted to the hospital last night with cold symptoms and respiratory distress. She is on a simple mask with a flow rate of 10 L and on a cardiorespiratory monitor. The nurse goes into the infants room to find her tachypneic, retracting, and slightly cyanotic with a pulse oximetry of 90%. What would be the oxygen delivery system that may help the infant? 1. A venturi mask with an oxygen flow of 1 liter per minute. 2. A nasal cannula with an oxygen flow of 4 liters per minute. 3. An oxygen tent with an oxygen flow rate of 10 liters per minute. 4. A partial rebreather mask with an oxygen flow rate of 8 liters per minute.

ANS: 4 Feedback 1. The pressure is not adequate to oxygenate the infant. 2. A nasal cannula does not deliver enough pure oxygen to raise the oxygen saturation of the infant. 3. The oxygen tent will not allow for enough pressure for the infant to raise the oxygen saturation. 4. A partial rebreather mask with an oxygen flow rate of 8 liters per minute will raise the oxygen saturation of the infant.

57. You suspect a 14 year old with persistent cough, anorexia, low-grade fever, and night sweats has tuberculosis. What is the most accurate statement about the treatment of this patient? 1. A nurse needs to collect serial sputum cultures in the a.m. and do serial AFB tests. 2. Latent TB would be treated with antituberculin medication combinations in higher doses for nine months. 3. Anti-tubercular medications given in higher doses in combination for six months are only effective after BCG vaccine is given. 4. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months.

ANS: 4 Feedback 1. The time of day does not influence when the sample should be taken. 2. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months. 3. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months. 4. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months.

19. An outbreak of influenza has occurred at the middle school. The school nurse is preparing to send home information about influenza. Her flyer should include all of the following except: 1. The virus is contagious one to two days prior to the appearance of symptoms. 2. Do not send your child to school if he/she has the chills or a erythematous rash. 3. Hydration is important. 4. If your child vomits, take them to the emergency room immediately

ANS: 4 Feedback 1. The virus is most contagious one to two days prior to the appearance of symptoms. 2. Chills and a erythematous rash indicate fever and can cause the spread of the virus. 3. Hydration will help keep mucous membranes moist to remove secretions. 4. Vomiting may occur and is not a medical emergency.

The nurse in a pediatric clinic is assessing a toddler brought in by a parent who states, "I have noticed some increasing incidents of coughing and wheezing over the last few weeks." Auscultation by the nurse reveals some adventitious breath sounds in the upper right lobe. Which questions does the nurse ask the parent? Select all that apply. 1. "Have you noticed any missing small toys?" 2. "How often is the child allowed to self-feed?" 3. "Is there an older child who gives this child food?" 4. "Can you recall a specific time of gagging or cyanosis?" 5. "Have you noticed any foreign objects in the child's stool?"

20. ANS: 1, 3, 4 1. This is correct. The nurse needs to ascertain if and what type of foreign object the toddler may have aspirated. This is an appropriate question if it is suspected that the child aspirated a foreign object. 3. This is correct. The nurse is appropriate in asking if there is another child who may have given the toddler food that could be aspirated. The parent may not be aware but needs to consider the possibility. Of greatest concern is peanuts, tree nuts, hard candies, etc. 4. This is correct. At the time, if the parent noticed the toddler gagging or appearing cyanotic, the nurse may have a better timeline, and the parent's memory may be jogged about a cause. 2. This is incorrect. Asking how often the child is allowed to self-feed is not an important question if the nurse suspects aspiration of a foreign object. 5. This is incorrect. Questioning the parent about noticing a foreign object in the toddler's stool is not applicable to the possibility of aspirating a foreign body. Swallowing an object may cause passage in the stool.

34. A nurse is repositioning an infant with a known diaphragmatic hernia. The nurse should place the infant in which position? 1. With the head of bed elevated 20 degrees 2. Supine 3. Prone 4. In a semi-fowlers position

ANS: 4 Feedback 1. This position does not take enough pressure off of the respiratory muscles. 2. Supine can cause the collapsing of the chest cavity and increase difficulty breathing. 3. Prone can cause too much pressure on the respiratory muscles and not allow for expansion. 4. Semi-fowlers will allow for pressure to be taken off of the diaphragm and decrease difficulty breathing.

14. Otitis media is a common infection children have when an upper respiratory illness is present because: 1. The Eustachian tubes are short and immature. 2. The immune system is extremely compromised and more susceptible to infections. 3. Bottle feeding increases the risk in babies. 4. All of the above are correct.

1. Eustachian tubes are short and do not provide adequate draining for mucous during an upper respiratory infection in children. 2. Immunity and susceptibility to infections cause the primary illness. Otitis media is a secondary illness. 3. A child that is positioned correctly during bottle feedings is not at an increased risk for otitis media. 4. Eustachian tubes are short and do not provide adequate draining for mucous during an upper respiratory infection in children, causing only one answer to be correct.

Parents bring a toddler who is 2-1/2 years old to the hospital because of observed difficulty with breathing. In addition, they share that at bedtime the toddler has a barky cough. The toddler is diagnosed with laryngotracheobronchitis, commonly referred to as croup. Which assessment finding does the nurse expect related to the diagnosis? 1. Fever accompanied by a congested cough 2. Inspiratory stridor heard in the upper airway 3. Elevated temperature and diaphoresis 4. Snoring sounds throughout respirations

ANS 2 Inspiratory stridor, hoarseness, and air hunger are attributed to croup. Although fever accompanies croup, the cough is not congested but dry and barky. Although an elevated temperature may accompany croup, diaphoresis or sweating does not. Snoring (rhonchi) is low-pitched sounds heard throughout the respiration as air passes through thick secretions. Snoring does not occur with croup.

75. A nurse is discussing the process in which tuberculosis can infect a child. Place the following in the correct order. __ Sputum specimen is obtained __ Tubercles are dormant __ Bacillus triggers the immune response __ Bacilli spread to the lymphatic system __ Macrophages form tubercles around bacilli

ANS: 5, 4, 1, 3, 2

70. The most accurate physiologic reason for respiratory distress in respiratory distress syndrome (RDS) is: 1. Altered surface tension causes fluid and protein leak, preventing atelectasis and ground glass appearance on CXR. 2. Infants with RDS are premature and incidence of RDS increases with increased gestational age. 3. Infants with RDS have a decreased number of alveoli, increased surface tension, and decreased AP diameter, limiting lung development. 4. Infants with RDS have altered surface tension, which produces hyaline membrane, atelectasis, and hypoventilation.

NS: 4 Feedback 1. The hypoventilation occurring in RDS causes an increased risk. 2. RDS can occur in any gestational age neonate. 3. The neonates have damage to the alveoli, not a decreased number. 4. Infants with RDS have altered surface tension, which produces, hyaline membrane, atelectasis and hypoventilation.

9. When assessing a 12-year-old girl with the diagnosis of pneumonia, the nurse performs percussion. The lower left lobe is noted to have a dull sound. What should the nurse do next? 1. Call the doctor with the assessment. 2. Check the orders and start chest physiotherapy. 3. Palpate the chest to check for tactile fremitus. 4. Place the child on oxygen

ANS: 4 Feedback 1. The doctor will need to be called after oxygen is applied because the first priority is to maintain oxygen saturation in order to prevent further respiratory distress. 2. The child needs immediate intervention. 3. Tactile fremitus will be increased due to the pneumonia. 4. The assessment indicates that the child has a lower lobe that is not expanding and needs oxygen supplementation in order to maintain saturation levels.

69. The parents of a 3 year old from India state that the child has been losing weight and coughing for a year. Additionally, the childs grandmother was diagnosed with TB. Which of the following is the most accurate statement regarding this situation? 1. Tubercules are more prevalent in children than adults, and all family members should be tested for TB. 2. Prevalence is high in developing countries, and only 20 percent of complete treatment because the length, intensity, and cost of treatment. 3. A blood culture is the definitive diagnosis for TB after a negative skin test. 4. Diagnosing TB in children is difficult because it varies with the changes in the seasons, and the symptoms can be vague.

68. An infant is tachypneic, retracting, and tachycardic with a temp of 39.0 C and a pulse oximetry of 92 percent. You place the infant on 1L nasal cannula oxygen and raise the head of the bed. What intervention would the nurse expect the physician to order next? 1. MRI 2. CT 3. Bronchoscopy 4. Chest x-ray

2. The father of a 13-year-old boy with sinusitis calls the triage nurse at the pediatric clinic to ask what he can do to rest. The nurse should advise the father to: (Select all that apply.) 1. Place a cold compress on the infected sinus areas. 2. Have the child blow his nose with one nostril closed off at a time. 3. Use a warm mist humidifier in his bedroom. 4. Use saline drops to help clear the nasal passage. 5. Use a bulb syringe to remove secretions.

ANS: 2, 4, 5 Feedback 1. Cold compresses will not encourage drainage. 2. Attempting to blow a nose with one nostril closed at a time helps provide pressure to remove the secretions. 3. A cool mist humidifier should be used to help reduce the chance of steam burns. 4. Saline drops can keep the airways moist and help remove secretions. 5. The child is too old for bulb syringe suction. Blowing the nose is just as effective.

29. A common cause of viral pneumonia in children is: 1. The influenza virus. 2. Streptococcus. 3. Fungus. 4. Beta-hemolytic streptococcus pneumoni.

ANS: 1 Feedback 1. Influenza is a common cause for viral pneumonia in children as a secondary infection. 2. Streptococcus is a bacterium, not a virus. 3. Fungus is not a virus. 4. Beta-hemolytic strep is bacterial, not viral.

59. The nurse is doing discharge teaching with the mother of a 10 year old, who has been newly diagnosed with TB. Which statement is not accurate regarding the spread of TB? 1. The patient should take anti-tubercular medicine for two weeks before being exposed to any non-infected people. 2. Everyone should wash their hands or use sanitizer after exposure to respiratory secretions. 3. It is transmitted through inhaled droplets from a close contact that is infected. 4. About 460,000 new cases of multi-drug sensitive TB are reported every year because of incomplete treatment regimes.

ANS: 4 Feedback 1. The medication will be needed for this length of time before being exposed to others. 2. Washing of hands should occur with every patient. 3. Close contact with those who have the disease increases the risk. 4. This statement is not accurate.