Peds 2 review

A 10-year-old child with recently diagnosed asthma is receiving information about the use of a peak expiratory flow meter (PEFM). The nurse knows that the child understands how to use the PEFM when she makes which statement? 1"I have to blow out as fast and hard into the machine as I can." 2"I can stand or sit to use the flow meter. I just can't lie down." 3"I have to take three readings and record the average on the flow sheet." 4"I'll use the meter whenever I can throughout the day—it doesn't really matter when."

1 A PEFM is used to measure the amount of air being exhaled. To adequately measure this, the client must blow out fast and hard. The client should use the PEFM while in a standing position to permit better expansion of the lungs. The highest of three readings, not the average, is recorded. The readings should be obtained close to the same time each day to ensure consistency.

What will a nurse teach the parents of a toddler with newly diagnosed cystic fibrosis about the administration of vitamins A, D, E, and K? 1Offer them in a water-miscible form. 2Give them during meals and snack times. 3The dosage is based on the child's height and weight. 4Present them to the child with fruit juice rather than milk.

1 Because children with cystic fibrosis do not absorb fat-soluble vitamins effectively, they should be given in a water-miscible form. These vitamins may be given with other vitamins once a day; pancreatic enzymes are administered with meals and snacks. The nurse does not have to base the dosage of these vitamins on the child's height and weight. There is no reason to select juice over milk when administering these vitamins.

A 5-year-old child with a ventricular septal defect (VSD) is scheduled for cardiac catheterization. The parents ask the nurse why this test is being done. While formulating a reply, what does the nurse recall is the function of the test? 1Identifies the specific location of the defect 2Confirms the presence of a pansystolic murmur 3Reveals the degree of cardiomegaly that is present 4Establishes the presence of ventricular hypertrophy

1 Cardiac catheterization visualizes the exact location of the ventricular septal defect; also it measures pulmonary pressures. A murmur can be heard with a stethoscope placed at the left lower sternal border. Cardiomegaly and ventricular hypertrophy are both demonstrated on electrocardiography and echocardiography.

The parents of a child with spasmodic croup ask why their child is receiving humidified oxygen. What effect of humidified oxygen should the nurse include in the explanation? 1It helps prevent drying of membranes. 2It provides a mode of giving inhalant drugs. 3It increases the surface tension of the respiratory tract. 4It provides an environment free of pathogenic organisms

1 Cool mist helps reduce inflammation and edema of the upper respiratory tract. Inhalant drugs are administered with the use of a nebulizer. The mist has no effect on surface tension in the respiratory tract. Eliminating pathogenic organisms is not the purpose of humidified oxygen.

A 3-year-old boy in respiratory distress is treated in the emergency department. A diagnosis of acute spasmodic laryngitis (spasmodic croup) is made. At the time of discharge, the mother asks how to handle another attack at home. What should the nurse recommend? 1Placing him near a cool-mist humidifier 2Bringing him to the emergency department 3Giving him an over-the-counter cough syrup 4Offering him warm tea sweetened with honey

1 During a spasmodic croup attack, cool humidified air to decrease inflammation is a fast home remedy. An attempt should be made to interrupt the attack at home first rather than going to the emergency department. Cough syrup is ineffective because it does not relieve laryngeal spasm. Tea with honey is an ineffective remedy for a spasmodic croup attack, and the tea may present a risk of aspiration.

A 5-month-old infant is admitted with a diagnosis of respiratory syncytial virus (RSV) infection. The infant's condition suddenly deteriorates, and a dose of epinephrine is prescribed to relieve bronchospasm. For what side effect of the medication should the nurse assess the infant? 1Tachycardia 2Hypotension 3Respiratory arrest 4Central nervous system depression

1 Epinephrine stimulates beta- and alpha-receptors; its actions include increasing heart rate and blood pressure and inducing bronchodilation. Increased blood pressure, not hypotension, is a potential side effect. Epinephrine relieves respiratory problems; it does not cause respiratory arrest. Epinephrine stimulates, not depresses, the central nervous system.

An infant with tetralogy of Fallot becomes cyanotic and dyspneic after a crying episode. In what position should the nurse place the infant to relieve the cyanosis and dyspnea? 1Knee-chest 2Orthopneic 3Lateral Sims 4Semi-Fowler

1 Flexing the hips and knees decreases venous return to the heart from the legs. When venous return to the heart is decreased, the cardiac workload is decreased. Although the orthopneic position reduces pressure of the abdominal organs on the diaphragm, it does not put enough pressure on the femoral veins and vena cava to sufficiently reduce venous return to the heart. The lateral Sims position does not reduce venous return to the heart. It does not put enough pressure on the femoral veins and vena cava to sufficiently reduce venous return to the heart. Although the semi-Fowler position reduces pressure of the abdominal organs on the diaphragm, it does not put enough pressure on the femoral veins and vena cava to sufficiently reduce venous return to the heart.

A nurse is caring for a preschooler in the immediate postoperative period after a tonsillectomy. What should the nurse encourage the parents to offer the child? 1Ginger ale 2Orange juice 3Hot chocolate 4Cherry popsicle

1 Ginger ale is a clear liquid and is soothing to the traumatized oropharyngeal membranes. Ginger ale also helps decrease nausea. Orange juice is acidic and is irritating to the oropharyngeal membranes. Hot or warm liquids should be avoided in the immediate postoperative period to help prevent bleeding. Also, hot or warm fluids may irritate the child's throat, which is already inflamed. Red fluids should not be offered because those fluids may be confused with bloody fluids.

An infant with bronchiolitis caused by respiratory syncytial virus (RSV) is admitted to the pediatric unit. What does the nurse expect the prescribed treatment to include? 1Humidified cool air and adequate hydration 2Postural drainage and oxygen by hood 3Bronchodilators and cough suppressants 4Corticosteroids and broad-spectrum antibiotics

1 Humidified cool air and hydration are essential to facilitating improvement in the child's physical status. Postural drainage is not effective with this disorder; oxygen is used only if the infant has severe dyspnea and hypoxia. Bronchodilators are not used, because the bronchial tree is not in spasm; cough suppressants are ineffective. Corticosteroids are ineffective; antibiotics are also ineffective, because the causative agent is viral.

A 3-year-old child with the diagnosis of tetralogy of Fallot is brought to the United States by a charitable organization for cardiac surgery. What should the nurse expect when conducting an admission assessment of the child? 1Clubbing of fingers 2Increased temperature 3Slow, irregular respirations 4Subcutaneous hemorrhages

1 Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips. A fever is not expected unless the child has an infection or is dehydrated; the data do not indicate this. The child's respiratory rate will be increased, not decreased. The child's problems are related to decreased oxygenation, not to a clotting deficiency.

A child undergoes tonsillectomy and adenoidectomy for numerous recurrent respiratory tract infections. After the surgery, what should the nurse teach the parents to do? 1Offer crushed ice chips. 2Encourage the intake of ice cream. 3Keep the child in the supine position. 4Gargle with a diluted mouthwash solution

1 Ice chips are soothing and promote vasoconstriction. Cool water, flavored ice pop, or diluted fruit juice may be given but fluids with a red or brown color should be avoided to distinguish fresh or old blood in emesis from the ingested liquid. Milk and milk products coat the mouth, causing the child to clear the throat, which may precipitate bleeding. The supine position promotes edema and does not allow oral secretions to drain from the mouth. The head of the bed should be elevated and the child should be positioned on the side. Mouthwash solution is too caustic; a warm, saltwater solution is preferred.

A 15-year-old adolescent is admitted to the hospital with a diagnosis of status asthmaticus. An intravenous infusion of methylprednisolone is initiated. What adverse effect requires the nurse to intervene immediately? 1Polyuria 2Tinnitus 3Drowsiness 4Hypotension

1 Intravenous administration of a steroid can cause a rapid increase in the blood glucose level. One early sign of hyperglycemia is increased urine output. Blood glucose should be checked frequently and insulin administered as needed. Tinnitus is associated with some antibiotics and with aspirin, not steroids. Drowsiness is associated with sedatives, not steroids. Hypertension, not hypotension, is associated with steroid administration.

A nurse is obtaining the health history of a 7-month-old who has had repeated episodes of otitis media. What question is most important for the nurse to include in the interview with the mother? 1Please describe your child's feeding pattern." 2Tell me how often your child has had ear infections." 3What medicine do you give your child for the ear infections?" 4"Do any of your children other than your baby have this problem?"

1 It is important to determine the infant's feeding pattern, because drinking formula from a bottle while in a recumbent position may lead to pooling of fluid in the pharyngeal cavity, which hinders eustachian tube drainage. Although knowing the frequency of ear infections is important, the factor that precipitated the otitis media is more significant. Although it is important to determine what medication has been given for otitis media, it is more important to determine the cause of this infection. Asking about the other family members is irrelevant, because otitis media is an inflammatory response, not a hereditary disease.

A 20-year-old woman is known to be heterozygous for the cystic fibrosis (CF) gene. Her husband's genotype is unknown at present, and the couple is expecting their first child. What should the nurse tell the couple about the probability of their baby having CF? 1 25% or less 2 50% or more 3 Extremely common 4 Unknown at this time

1 Males with CF are usually sterile; therefore the father likely does not have CF; however, he could be a carrier. If both parents are heterozygous carriers, the chance of having a child with CF is 25%. When one parent is a heterozygous carrier and the other has two unaffected genes, the chance of having a child who has CF is 0%, but the chance of having a child who is a carrier is 50%. If both parents are heterozygous carriers or if one parent is a heterozygous carrier and one parent has two unaffected genes, the chance of having a child that is a carrier, not a child that is affected, is 50%. Stating that it is extremely rare is an inaccurate conclusion when the father's genotype is unknown. In light of the data provided, the mother is a heterozygous carrier and the father is either a heterozygous carrier or has two unaffected genes. Under these circumstances it is safe to conclude that the chance that their baby will have CF is 25% or less.

A nurse in the pediatric clinic is testing a 4-year-old child with recurrent otitis media for signs of hearing loss. The child's parent asks what can be done if there is a hearing loss. The nurse responds that the most common treatment is what? 1Myringotomy 2Adenoidectomy 3Neomycin ear drops 4Systemic steroid therapy

1 Myringotomy is surgical incision of the eardrum to permit drainage of infected middle ear fluid and thus improve hearing. Removal of the adenoids will not relieve the pressure from inflamed ears. Antibiotics are administered systemically, not locally, if needed. Systemic antibiotics, not steroids, are prescribed; a myringotomy is performed if antibiotics are ineffective.

A nurse is caring for a 4-year-old child with just-diagnosed cystic fibrosis. The child has been passing loose, bulky, foul-smelling stools and is in the third percentile for weight. What is the best explanation of the growth failure? 1Impaired digestion and absorption because of the lack of pancreatic enzymes 2Dyspnea and shortness of breath, which cause anorexia and disinterest in food 3Increased bowel motility and diarrhea, which lead to inadequate absorption of nutrients 4Pulmonary obstruction, which causes an oxygen deficit and inadequate tissue nourishment

1 Obstruction of the pancreatic duct and the absence of enzymes (e.g., trypsin, amylase, and lipase) to aid fat digestion and absorption lead to wasting of tissues and failure to thrive. Currently it is recommended that children with cystic fibrosis consume 150% to 200% of the calories recommended for their body weight. Despite dyspnea and shortness of breath, when feeling well these children have voracious appetites; the difficulty involves poor digestion and malabsorption of fats and fat-soluble vitamins. Increased bowel motility and diarrhea are not associated with cystic fibrosis. The pulmonary disease process leads to localized respiratory dysfunction, not to retarded physical growth.

A child is being treated with oral ampicillin for otitis media. What should be included in the discharge instructions that the nurse provides to the parents of the client? 1Complete the entire course of antibiotic therapy. 2Herbal fever remedies are highly discouraged. 3Administer the medication with meals. 4Stop the antibiotic therapy when the child no longer has a fever.

1 Once antibiotic therapy is initiated, the antibiotics start to destroy specific bacterial infections that the healthcare provider is trying to treat. Antibiotic therapy takes a specific dose and number of days to completely eliminate the bacteria. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria have a chance to grow again, become resistant to antibiotic treatment, and multiply. The nurse should not discourage use of herbal fever remedies; however, the herbal treatment should be reviewed to see if it is contraindicated. Ampicillin should be taken 1 to 2 hours after meals. Antibiotic therapy should be completed as prescribed.

A nurse is reviewing discharge instructions with the parent of an infant with cystic fibrosis. What statement indicates that the parent knows how to administer the pancreatic enzyme replacement? 1"We should give the medication with feedings." 2"We should put crushed enteric-coated pills in the formula." 3"We need to give the medication every 6 hours, even during the night." 4"We should feed the granules from the capsule in applesauce every morning."

1 Pancreatic enzyme replacement is given just before or with every meal to aid digestion. Breaking up and dissolving the medication will hasten its degradation by gastric secretions and interfere with its efficiency. The medication must be given just before or with every meal, not every 6 hours or every morning, to aid digestion.

The parents of a 12-year-old boy with cystic fibrosis (CF) ask the nurse why he needs a glucose tolerance test. What information should the nurse consider before replying? 1Pancreatic scarring predisposes the child to diabetes. 2The thickened mucus blocks the insulin-secreting glands. 3The test reveals the degree to which the child adheres to the diet. 4Adjustments of the dosage of pancreatic enzymes are based on the results of the test.

1 Pancreatic scarring affects the ability of the islets of Langerhans to produce insulin; about half of all children with CF have altered glucose tolerance. The endocrine glands, which produce insulin, are ductless and are not affected by the thickened mucus in the ducts. However, the general scarring throughout the pancreas does affect the insulin-producing glands. The glucose tolerance test is a measure of the body's ability to produce and metabolize carbohydrates, not a measure of the child's adherence to the diet. The dosage of pancreatic enzymes is based on food consumption, not the blood glucose level.

When will a nurse plan to administer pancrelipase to a child with cystic fibrosis? 1With meals and snacks 2In the morning and at bedtime 3On awakening and every 3 hours while the child is awake 4After each bowel movement and after postural drainage is performed

1 Pancrelipase must be taken with food and snacks because it is essential for the digestion of nutrients. The enzyme is ineffective when taken without food; it is contraindicated at any other time.

The nursing student is learning about submersion injuries. Which component of sea water does the nurse know to be responsible for making it hypertonic compared to body fluids? 1Salt 2Mud 3Algae 4Chlorine

1 Salt makes sea water hypertonic compared to body fluids. Mud, algae, and chlorine are present in abundance in freshwater, which is hypotonic.

What intervention is included in the nursing care plan for a 4-month-old infant with tetralogy of Fallot and heart failure? 1Providing small, frequent feedings 2Positioning the child flat on the back 3Encouraging nutritional fluids often 4Measuring the head circumference daily

1 Small, frequent feedings with adequate rest periods in between may improve the infant's intake at each feeding; infants with tetralogy of Fallot become extremely fatigued while suckling. Positioning the child with the head elevated, not flat on the back, facilitates respiration; an infant cardiac seat, similar to a car seat, helps maintain the child in the semi-Fowler position. As a means of reducing the cardiac workload, excessive fluids usually are not offered, and fluids may even be restricted. The head circumference is not an important assessment for infants with congenital heart disease; daily head measurements should be taken for infants with hydrocephaly.

The parents of a 3-year-old child who has recurrent attacks of acute spasmodic laryngitis (spasmodic croup) ask the nurse why this happens to their child. What is the best rationale for the nurse to convey why this is a disorder of young children? 1They have small airways. 2They are mouth breathers. 3They have immature immune systems. 4They are prone to upper respiratory infections

1 Swelling and edema in airways with small diameters lead to the signs and symptoms of croup. Mouth breathing is not the cause of croup. An immature immune system is too general an explanation; it depends on the specific resistance of the individual child. A tendency to contract upper respiratory infections does not explain why only small children get croup.

A 4-year-old child is found to have mucocutaneous lymph node syndrome (Kawasaki disease). The child is admitted to the pediatric unit, where the nurse performs an initial assessment. What clinical finding supports the diagnosis? 1Strawberry tongue 2Copious discharge from the eyes 3Insidious onset of low-grade fever 4Maculopapular rash on the extremities

1 The characteristic "strawberry tongue" is a result of sloughing of the normal coating of the tongue that leaves the papillae exposed. There is bilateral congestion of the ocular conjunctiva without an exudate. The fever associated with Kawasaki disease is high and is abrupt in onset; it is unresponsive to antibiotics and antipyretics. A maculopapular rash on the extremities does not occur; peripheral edema and erythema occur with desquamation of the palms and soles.

An 8-year-old boy with asthma is being taught breathing exercises. The nurse uses several techniques in a play situation, and the child performs a repeat demonstration for the nurse. Which technique indicates that the child needs further teaching? 1Moving a cotton ball when inhaling 2Singing songs containing long phrases 3Puffing through a straw to move small items 4Blowing through a plastic pipe to make soap bubbles

1 The goal for teaching a child with asthma breathing exercises is to lengthen expiratory time and expiratory pressure. This activity focuses on inhalation, not exhalation. Singing songs with long phrases forces the child to exhale until each phrase is completed. Activities such as puffing through a straw or blowing through a pipe encourage exhalation.

An infant with tetralogy of Fallot begins to cry frantically and exhibits worsening cyanosis and dyspnea. In which position should the nurse place the child? 1Knee-chest 2Orthopneic 3Lateral Sims 4Semi-Fowler

1 The knee-chest position decreases circulation to and from the extremities, thereby improving circulation to the heart and lungs and increasing oxygenation. The knee-chest position has the same effect as the squatting that is seen in the older child with tetralogy of Fallot. Blood circulating in the heart and lungs has a lower oxygen content when the child is in the orthopneic position than it does with the child in the knee-chest position. Blood circulating in the heart and lungs has a lower oxygen content when a person is in the semi-Fowler position or lateral Sims position.

A client is admitted to the emergency department with allergic rhinitis and asthma. The laboratory report shows histamines and prostaglandins. Which type of hypersensitivity reaction may have occurred? 1Type I 2Type II 3Type III 4Type IV

1 Type I hypersensitivity reactions (immediate hypersensitivity reactions) involve the immunoglobulin E (IgE)-mediated release of histamines and other mediators from mast cells and basophils. Allergic rhinitis and asthma may occur when mediators such as histamine and prostaglandins are involved as mediators of injury. Type II hypersensitivity reaction is cytotoxic mediated; it occurs in transfusion reactions. Type III reactions are immune complex-mediated hypersensitivity reactions such as rheumatoid arthritis. Type IV hypersensitivity reactions are delayed hypersensitivity reactions; an example is contact dermatitis.

After multiple upper respiratory infections, a school-aged child undergoes a tonsillectomy and adenoidectomy. Two weeks after surgery the nurse assesses the child's condition. On what should the nurse focus? Select all that apply. 1 Taste 2 Smell 3 Hearing 4 Breathing 5 Facial symmetry

1,2,3,4 Edematous adenoids interfere with nasal breathing, which affects the sense of taste. Enlarged adenoids usually cause mouth breathing, which affects the sense of smell. Because hearing usually is affected by repeated oropharyngeal infections, this is an important postoperative assessment. Breathing is an important postoperative assessment because one goal of a tonsillectomy and adenoidectomy is to convert mouth breathing to nasal breathing. Facial symmetry is not affected by these procedures.

The nurse is caring for victims who have suffered submersion injuries due to near-drowning in freshwater. How does the nurse correctly understand the order of events that take place in the body of a victim of freshwater submersion based on his or her knowledge of the pathophysiology of submersion injury? 1.Water is aspirated. 2.Water rapidly leaks to capillary bed and circulation. 3.Acute respiratory distress syndrome develops. 4.Destruction of surfactant and alveolar-capillary membrane occurs. 5.Noncardiogenic pulmonary edema occurs.

1,2,4,5,3 The osmotic gradient caused by aspirated freshwater leads to fluid imbalances in the body of a submersion victim. Hypotonic freshwater is rapidly absorbed into the circulatory system through the alveoli. Freshwater is often contaminated with chlorine, mud, or algae. This causes the breakdown of lung surfactant and alveolar-capillary membrane. The resulting fluid seepage causes noncardiogenic pulmonary edema, which leads to the development of acute respiratory distress syndrome.

The nurse is reviewing the problems that may occur after frequent episodes of otitis media in infants. What complications may be precipitated by this infection? Select all that apply. 1 Mastoiditis 2 Heart failure 3 Hearing loss 4 Gastroenteritis 5 Bacterial meningitis

1,3,5 Mastoiditis is an inflammation of the mastoid gland; it may occur as a complication of otitis media because of the mastoid gland's proximity to the ear. Hearing loss is a common complication of otitis media; the child should be assessed frequently for this problem. The closeness of the infant's structures results in infections of surrounding organs; meningitis is a complication of otitis media. Heart failure and gastroenteritis are not complications of otitis media.

What is the correct order of events that take place in a client with saltwater submersion injury? 1.Fluid is drawn from the vascular space into the alveoli. 2.Pulmonary pressure keeps increasing. 3.Alveolar ventilation is impaired. 4.Blood is shunted to the lungs. 5.Hypoxia occurs.

1,3,5,4,2 Hypertonic saltwater draws fluid from the vascular space into the alveoli, which impairs alveolar ventilation and causes hypoxia. The body attempts to compensate for hypoxia by shunting blood to the lungs, which results in increased pulmonary pressures and deteriorating respiratory status. More and more blood is shunted through the alveoli. However, the blood is not adequately oxygenated, and hypoxemia worsens. This can result in cerebral injury, edema, and brain death.

A 4-year-old child is to be treated with intravenous immunoglobulin (IVIG) for Kawasaki disease. Before administration of the IVIG, what action(s) will the nurse take? Select all that apply. 1 Start an intravenous (IV) line. 2 Obtain a cardiac monitor. 3 Ensure nothing-by-mouth status. 4 Check for allergies to antibiotics. 5 Have the parents sign permission for blood product administration.

1,5 IVIG is administered intravenously, so an IV line would be required. Because IVIG is a blood product, the parents will need to sign the appropriate permission form. A cardiac monitor is not required. The child does not need to be on nothing-by-mouth status. Common side effects include headache and kidney issues. Shortness of breath and back pain may be reported. IVIG is not an antibiotic. The parents should be asked about reactions to previously administered blood products.

The nurse is assessing clients who have sustained submersion injuries. Which are most likely to be the nurse's assessment findings? Select all that apply. 1 Ronchi 2 Areflexia 3 Hypertension 4 Fixed, dilated pupils 5 Cough with pink-frothy sputum

1,5 Ronchi and cough with pink-frothy sputum are common pulmonary assessment findings in submersion victims. The absence of reflexes is associated with hypothermia, not necessarily submersion. Hypotension, not hypertension, is a common assessment finding associated with submersion injuries. Fixed, dilated pupils are associated with victims of hypothermia.

The parent of a 9-year-old child who has undergone tonsillectomy is receiving discharge instructions. Which statement indicates to the nurse that the parent needs further teaching? 1"I won't let her use a straw to drink." 2Cherry milkshakes will ease the pain." 3"I shouldn't let her gargle for at least 10 days." 4"She'll be able to play with friends in 1 week."

2 "She'll be able to play with friends in 1 week." A serious posttonsillectomy complication is hemorrhage; red liquids are contraindicated because they may mask bleeding. Drinking from a straw produces suction, which may traumatize the surgical site and cause bleeding. Likewise, gargling is traumatic to the surgical site and may precipitate bleeding. Hemorrhage may occur as long as 10 days after surgery; regular activity may be resumed after 1 week if there are no complications.

A 30-month-old toddler is brought to the emergency department in acute respiratory distress, and a diagnosis of laryngotracheobronchitis (viral croup) is made. What is the most important equipment for the nurse to have available when the child is admitted to the pediatric unit? 1Intravenous set 2Tracheotomy set 3Nasal cannula for oxygen 4Crib with padded side rails

2 A patent airway is the priority. A tracheotomy set should be kept immediately available in case of complete obstruction of the airway. An intravenous setup may be needed later if the child does not respond to treatment. Humidified mist, not oxygen, is the treatment of choice unless the child does not respond to the treatment. Padded side rails are appropriate for seizures, which are not associated with croup.

A nurse is reviewing the prescriptions for a 2-year-old child who has been admitted to the pediatric unit with acute laryngotracheobronchitis (croup). What is the rationale for the prescription to administer oxygen by way of a nasal cannula? 1Congeals mucous secretions and relieves dyspnea 2Decreases the effort required for breathing and permits rest 3Triggers the cough reflex and facilitates expectoration of mucus 4Liquefies mucous secretions and makes them easier to expectorate

2 Administering oxygen by way of nasal cannula limits the energy required for breathing; this allows the child to conserve energy that can be used for fluid and nutrient intake. Congealed mucus will obstruct air passageways and increase respiratory distress. Oxygen administration does not trigger the cough reflex. Oxygen administration through a nasal cannula will have a drying effect.

An 8-year-old child with a history of asthma is brought to the emergency department because of respiratory distress. The nurse immediately places the child in a bed with the head of the bed elevated and administers oxygen by means of a face mask. The healthcare provider performs a physical assessment, writes prescriptions, and admits the child to the pediatric unit. Which instruction should the nurse carry out first? 1Teach incentive spirometer use. 2Administer the nebulizer treatment. 3Obtain a blood specimen for a complete blood count. 4Notify the respiratory therapist to perform chest physiotherapy.

2 Albuterol (Proventil) relaxes smooth muscles in the respiratory tract, resulting in bronchodilation. The priority is to facilitate respiration, and this intervention follows the ABCs of emergency care—airway, breathing, and circulation. The use of an incentive spirometer may be taught after the acute episode of respiratory distress has been resolved. It will take time to obtain the device and teach the child about its use, and it should be used after the airway has been opened. Obtaining a blood specimen is not the priority. The results will not influence the priority intervention. Notifying the respiratory therapist is not the priority. Chest physical therapy is performed after the airway has been opened.

Electrocardiography (ECG) is scheduled for an infant who has tetralogy of Fallot. The mother asks the nurse what type of test this is and why it is done. What is the best response by the nurse? 1"It's a type of x-ray that shows us the size of the baby's heart." 2"Electrical activity in the baby's heart is recorded, then printed on graph paper." 3"It's an ultrasound procedure that produces images of the structures in the baby's heart." 4"Contrast material is injected into the baby's vein to visualize the flow of blood through the heart."

2 An ECG not only records electrical impulses in the heart but can also reveal atrial and ventricular hypertrophy. The x-ray procedure that shows the size of a baby's heart is a chest x-ray. The ultrasound procedure that would be used to produce images of the structures in a baby's heart is the echocardiogram. The intravenous injection of contrast material to visualize the flow of blood through the heart is an angiogram.

A nurse is caring for a child with a diagnosis of cystic fibrosis. Which schedule of chest physiotherapy (CPT) is best? 1Three times a day, before meals 2Three times a day, halfway between meals 3Two times a day, on awakening and at bedtime 4Two times a day, after breakfast and after dinner

2 CPT is performed several hours after meals to avoid regurgitation and several hours before meals so unpleasant odors and tastes do not affect the appetite. CPT should be done more frequently than two times a day. CPT performed after a meal may result in vomiting.

A toddler is found to have coarctation of the aorta. What does the nurse expect to identify when taking the child's vital signs? 1Irregular heartbeat 2Weak femoral pulse 3Thready radial pulses 4Increased temperature

2 Coarctation of the aorta is a narrowing of the aorta, usually in the thoracic segment, resulting in decreased blood flow below the constriction and increased blood volume above it. The femoral pulses are weak or absent. An irregular heartbeat and increased temperature are not related to coarctation of the aorta. The radial pulses are bounding in coarctation of the aorta.

A nurse is teaching the parents of an 8-year-old child who is taking a high dose of oral prednisone for asthma. What critical information about prednisone will be included? 1It protects against infection. 2It should be stopped gradually. 3An early growth spurt may occur. 4A moon-shaped face will develop

2 Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The drug usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect.

What clinical manifestation of tetralogy of Fallot should the nurse expect when caring for an infant with this diagnosis? 1Slow respiration 2Clubbing of fingers 3Decreased red cell counts 4Subcutaneous hemorrhages

2 Hypoxia leads to poor peripheral oxygenation of tissues; clubbing develops over time as a result of tissue hypertrophy and additional capillary development in the fingers. Respiration is generally rapid to compensate for oxygen deprivation. Affected children have polycythemia. Subcutaneous hemorrhages do not occur in children with tetralogy of Fallot.

A neonate diagnosed with congestive heart failure has been prescribed furosemide. What changes to the dosage or time intervals between doses should be made? 1The time between doses should be shortened. 2The time between doses should be lengthened. 3The dosage should be doubled. 4The dosage should be cut in half.

2 In neonates, the half-life of furosemide is increased. To avoid toxicity of the drug, the nurse should lengthen the time interval between the doses. If the time interval is shortened or the dosage is doubled, the level of drug circulating in the blood will be increased leading to toxic effects of the drug. Halving the dose is not an appropriate solution.

After performing an otoscopic examination on a client who reports a decrease in hearing acuity, the primary healthcare provider diagnoses the condition as otitis media. Which assessment finding supports the diagnosis? 1Nodules on the pinna 2Redness of the eardrum 3Lesions in the external canal 4Excessive soft cerumen in the external canal

2 Many conditions are associated with a decrease in hearing acuity. One such condition is otitis media. This condition is diagnosed by redness of the eardrum observed during the otoscopic examination. Nodules on the pinna may be an indication of rheumatoid arthritis, chronic gout, or basal or squamous cell carcinoma. Lesions in the external canal may cause a decrease in hearing acuity but not the manifestation of otitis media. Excessive soft cerumen in the external canal impacts the hearing acuity but not the manifestation of otitis media.

A 2-year-old toddler has hearing loss caused by recurrent otitis media. What treatment does the nurse anticipate that the practitioner will recommend? 1Ear drops 2Myringotomy 3Mastoidectomy 4Steroid therapy

2 Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Ear drops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

A 3-month-old infant has been hospitalized with respiratory syncytial virus (RSV). What is the priority intervention? 1Administering an antiviral agent 2Clustering care to conserve energy 3Offering oral fluids to promote hydration 4Providing an antitussive agent whenever necessary

2 Often the infant will have a decreased pulmonary reserve, and the clustering of care is essential to provide for periods of rest. Antiviral therapy is controversial for this age group and is not given unless complications ensue. Intravenous fluids are given during the acute phase to prevent dehydration. Antitussive agents are not used; nasal secretions are aspirated with the use of a bulb syringe whenever necessary.

A healthcare provider prescribes inhaled corticosteroids for a 6-year-old child with asthma. The nurse concludes that the mother understands the teaching about the side effects of this medication when the mother makes which statement? 1"I'll watch for frequent urination." 2"I'll check for white patches in the mouth." 3"I'll be alert for short episodes of not breathing." 4"I'll monitor for an increased blood glucose level.

2 Oral candidiasis is a potential side effect of inhaled steroids because of steroids' antiinflammatory effect; the child should be taught to rinse the mouth after each inhalation. Frequent urination is not a side effect of steroid therapy. Apneic episodes are not a side effect of steroid therapy. Hyperglycemia is not a side effect of inhaled steroid therapy; it may occur when steroids are administered for a systemic effect.

While teaching a parents' group about acute otitis media, the nurse includes the fact that among infants and children acute otitis media is an infection commonly caused by what? 1A virus 2Bacteria 3A fungus 4Rickettsia

2 Otitis media, one of the most prevalent illnesses in toddlers, is caused by a bacterial infection. The causative agent is not a fungus, virus, or rickettsial organism.

The nurse is providing care to an infant who is diagnosed with cystic fibrosis (CF). Which parental statement indicates the need for further education related to the potential for poor growth? 1"My child's diagnosis causes delayed bone growth." 2My child will have a poor appetite, which will lead to poor growth." 3My child will have increased oxygen demands, which will lead to poor growth." 4"My child will have a decreased ability to absorb nutrients, which will cause poor growth."

2 Pediatric clients who are diagnosed with CF experience poor growth despite a healthy appetite and diet; therefore, the parental statement indicates that the infant's poor appetite will lead to poor growth indicates the need for further education. Pediatric clients diagnosed with CF experience poor growth due to delayed bone growth, increased oxygen demands, and a decreased ability to absorb nutrients.

A nurse is admitting a 2-year-old toddler with a tentative diagnosis of cystic fibrosis to the pediatric unit. Pilocarpine is used as part of the diagnostic process. The nurse knows that the pilocarpine will stimulate which process? 1Secretion of mucus 2Activity of sweat glands 3Excretion of pancreatic enzymes 4Release of bile from the gallbladder

2 Pilocarpine is a cholinergic that is applied to the skin to stimulate sweat production; the sweat is then tested to confirm the diagnosis of cystic fibrosis. Pilocarpine does not stimulate the secretion of mucus, the excretion of pancreatic enzymes, or the release of bile from the gallbladder.

A 6-month-old infant is brought to the emergency department in severe respiratory distress. A diagnosis of respiratory syncytial virus (RSV) infection is made, and the infant is admitted to the pediatric unit. What should be included in the nursing plan of care? 1Place in a warm, dry environment. 2Maintain standard and contact precautions. 3Administer prescribed antibiotic immediately. 4Allow parents and siblings to room in with the infant

2 RSV is highly contagious. The infant should be isolated or placed with other infants with RSV. Standard and contact precautions are instituted to limit the spread of pathogens to others. The infant should receive cool, humidified oxygen by nasal cannula or mask or in a croup tent. Because RSV is extremely contagious, the number of visitors should be limited. Uninfected children should not be allowed near the infant, and as few personnel as possible should care for the infant. Antibiotics are not effective against RSV, and their use is contraindicated.

A nurse is caring for a school-aged child with cystic fibrosis who has been admitted to the pediatric unit with pneumonia. What potential consequence of repeated infections should the nurse consider when caring for this child? 1Increased irritability 2Development of diabetes 3Impaired academic ability 4Depression of bone marrow

2 Repeated infections in children with cystic fibrosis, over time, contribute to the development of insulin resistance and the development of type 1 diabetes. Increased irritability, changes in academic ability, and bone marrow depression are not related to chronic infections.

A complete blood count is prescribed for a 5-month-old infant with tetralogy of Fallot. What does the nurse expect to see when reviewing the laboratory results? 1Anemia 2Polycythemia 3Agranulocytosis 4Thrombocytopenia

2 The body responds to the chronic hypoxia caused by the heart defect by increasing the production of red blood cells (RBCs) in an attempt to increase the oxygen-carrying capacity of the blood. The RBC count will be increased because the body increases erythrocyte production in an attempt to make more cells available to carry oxygen. Agranulocytosis does not result from hypoxia; it occurs when the white blood cell count decreases to a very low level and neutropenia becomes pronounced. Leukopenia occurs when the white blood cells become low and is not associated with tetralogy of Fallot.

A toddler with a history of enlarged lymph nodes, prolonged fever that is unresponsive to antibiotics, erythema of the extremities, and a rash is admitted to the pediatric unit with a diagnosis of Kawasaki disease. What does the nurse suspect was essential in confirming this diagnosis? 1An increased antistreptolysin O (ASO) titer 2A combination of signs 3A low-grade temperature 4An increased sedimentation rate

2 The diagnosis is based on the presence of five of six specific signs: fever, trunk rash, enlarged cervical lymph nodes, bilateral congestion of the conjunctiva, edema, and redness of the extremities. Increased ASO titer is associated with streptococcal infection. Pronounced fever is a sign of Kawasaki disease. Increased sedimentation rate is not specific to Kawasaki disease; the sedimentation rate increases in the presence of inflammation.

The parents of an 18-month-old toddler are anxious to know why their child has experienced several episodes of acute otitis media. What should the nurse explain to the parents about why toddlers are prone to middle ear infections? 1Immunologic differences between adults and young children 2Structural differences between eustachian tubes of younger and older children 3Functional differences between eustachian tubes of younger and older children 4Circumference differences between middle ear cavity size of adults and young children

2 The eustachian tube in young children is shorter and wider, allowing a reflux of nasopharyngeal secretions. Immunologic differences are not a factor in the development of otitis media. There is no difference in the function of the eustachian tube among age groups. The size of the middle ear does not play a role in the occurrence of otitis media in young children.

A 3½-year-old boy from Central America who has tetralogy of Fallot attends the pediatric cardiac clinic for a diagnostic workup before corrective surgery is scheduled. The nurse's assessment of the child's motor ability demonstrates that he is just beginning to walk unsupported. When comparing this child with other 3½-year-old children, what does the nurse determine about the child? 1Has started to walk at the appropriate age 2Should have started to walk about 2 years earlier 3Demonstrates an insignificant delay in starting to walk 4Probably walked by holding on at 24 to 30 months of age

2 The expected age for walking is between 12 and 15 months. Just beginning to walk at 3½ years represents a developmental delay; it is explained by the limitations imposed by the cardiac defect. This is a significant delay; surgical correction of the cardiac defect should allow the child to catch up in physical development. Guessing when the child started "cruising" (walking while holding on) is not relevant in this developmental assessment.

A nurse is caring for an infant with tetralogy of Fallot. What clinical finding should the nurse expect when assessing this child? 1Slow respirations 2Clubbing of the fingers 3Subcutaneous hemorrhages 4Decreased red blood cell count

2 The mixing of oxygenated and deoxygenated blood results in tissue hypoxia; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips. The respirations are rapid, not slow. The child's problems are related to decreased oxygenation, not to a clotting defect. The body attempts to compensate for the hypoxemia associated with tetralogy of Fallot by increased erythropoiesis.

A nurse teaches a 5-year-old child with cystic fibrosis how to use an inhaler. What is the most appropriate way to evaluate the child's understanding of the technique? 1Asking questions about using the inhaler 2Having the child demonstrate inhaler use 3Explaining how the inhaler will be used at home 4Having the child tell the nurse about the technique that was learned

2 The nurse can best evaluate teaching by asking the learner for a return demonstration. Behavior, rather than words, more easily shows what has been learned. A child may be too young to know whether he or she has any questions. A demonstration, rather than an explanation, can be evaluated more readily. Telling the nurse about the technique that was learned is difficult for a 5-year-old child; the ability to articulate a concept is not that advanced; nor is the vocabulary.

A 4-year-old child is admitted to the pediatric unit for a tonsillectomy. During preoperative planning a nurse reviews the child's laboratory report. Which lab value is of most significance in this situation? 1Potassium level 2Coagulation studies 3Red blood cell (RBC) count 4Erythrocyte sedimentation rate (ESR)

2 Tonsillectomy may result in hemorrhage because of the vascularity of the oropharynx; clotting function must be adequate. The potassium level, RBC count, and ESR are not significant in this type of surgery if the child is otherwise healthy.

After many episodes of otitis media a 3-year-old child is to undergo myringotomy and have tubes implanted surgically. What should the nurse include in the discharge preparation for this family? 1Keep the child at home for 1 week. 2Insert earplugs during the child's bath. 3Apply an ointment to the ear canal daily. 4Use cotton swabs to clean the inner ears.

2 Water in the ears after myringotomy may be a source of infection. There is no reason that the child cannot be around other children, because there is no infectious process. Applying an ointment to the ear canal daily will clog the ear canal and serves no purpose. Cotton swabs may be used occasionally in the outer ear, but should not be inserted into the ear.

While caring for a client with asthma, the nurse auscultates a bilateral high-pitched, continuous whistling sound in the anterior lung fields. What finding does the nurse document in the medical record? 1Crackles 2Wheezes 3Rhonchus 4Pleural friction rub

2 Wheezing, an adventitious breath sound, is a high-pitched continuous whistling that does not clear with coughing. Crackles are popping, discontinuous sounds caused by air moving into previously deflated airways. Rhonchus is a lower-pitched, coarse, continuous snoring sound that arises from the large airways. Pleural friction rub is a loud, rough, grating sound produced by inflammation of the pleural lining.

A toddler with cystic fibrosis has been hospitalized with bacterial pneumonia. The nurse determines that the child has no known allergies. What does the nurse conclude is the reason that the healthcare provider selected a specific antibiotic? 1Tolerance of the child 2Sensitivity of the bacteria 3Selectivity of the bacteria 4Preference of the healthcare provider

2 When the causative organism is isolated, it is tested for antimicrobial susceptibility (sensitivity) to various antimicrobial agents. When a microorganism is sensitive to a medication, the medication is capable of destroying the microorganism. The tolerance of the child of the particular antibiotic is unknown because up to this time the child has not exhibited any allergies. Bacteria are not selective. Although the healthcare provider may have a preference for a particular antibiotic, it first must be determined whether the bacteria are sensitive to it.

Which questions will allow the nurse to assess a preschool-age child diagnosed with asthma for delayed peer relationships? Select all that apply. 1 "Can your child independently dress each day?" 2 "Does your child use 'baby-like' terms when talking?" 3 "Does your child play with the other children in the playroom?" 4 "Has your child ever thought that the asthma is a punishment?" 5 "Does your child become anxious before respiratory treatments?".

2,3 Peer relationships begin to form during the preschool stage of development. This task can be affected by the diagnosis of a chronic illness, such as asthma. The nurse should assess the child for socialization with peers and overprotection by the family by asking if the child uses "baby-like" terms when talking and about interactions with other children in the playroom. Information obtained from these questions will allow the nurse to plan care that enhances the child's ability to socialize with other children. Mastery of self-care skills may also be affected; therefore, the nurse would ask the parent if the child is able to independently dress each day. Preschool-age children learn through preoperational thought which includes magical thinking; therefore, the nurse should assess information related to the child believing the diagnosis is a punishment. The child's body image may also be impacted; therefore, the nurse should assess for anxiety prior to respiratory treatments. However, assessment of these last three aspects addresses other concerns than peer relationships

An infant is admitted to the pediatric unit with bronchiolitis caused by respiratory syncytial virus (RSV). What interventions are appropriate nursing care for the infant? Select all that apply. 1 Limiting fluid intake 2 Instilling saline nose drops 3 Maintaining contact precautions 4 Suctioning mucus with a bulb syringe 5 Administering warm humidified oxygen

2,3,4 Saline nose drops help clear the nasal passage, which improves breathing and aids the intake of fluids. RSV is contagious; infants with RSV should be isolated from other children, and the number of people visiting or caring for the infant should be limited. Infants with RSV produce copious amounts of mucus, which hinders breathing and feeding; suctioning before meals and at naptime and bedtime provides relief. Fluid intake should be increased; adequate hydration is essential to counter fluid loss. These infants have difficulty nursing and often vomit their feedings. If measures such as suctioning before feeding and instilling saline nose drops are ineffective, intravenous fluid replacement is instituted. The humidified oxygen should be cool. It relieves the dyspnea and hypoxia that is prevalent in infants with RSV.

The nurse is caring for rescued flood victims in the emergency department. Which drugs are used to treat cerebral edema or decrease free water in clients with submersion injuries? Select all that apply. 1 Atropine (AtroPen) 2 Furosemide (Lasix) 3 Phencyclidine (PCP) 4 Mannitol (Osmitrol) 5 Chlorpromazine (Thorazine)

2,4 Furosemide (Lasix) or Mannitol (Osmitrol) is used to treat cerebral edema or decrease free water in clients with submersion injuries. Atropine (AtroPen) is used as an antidote for nerve agent poisoning. Phencyclidine (PCP) is a street drug that is considered to be a risk factor for heat-related emergencies. Intravenous chlorpromazine (Thorazine) is the drug of choice to control shivering in victims of heatstroke.

Which medications does the nurse expect to be prescribed for a preschooler with newly diagnosed cystic fibrosis? Select all that apply. 1 Steroids 2 Antibiotics 3 Antihistamines 4 Pancreatic enzymes 5 Fat-soluble vitamins

2,4,5 Antibiotics are prescribed to treat recurrent respiratory tract infections. Thick secretions obstruct the pancreatic ducts, and essential pancreatic enzymes are blocked from reaching the duodenum; therefore pancreatic enzymes are administered with meals to aid digestion. Fat-soluble vitamins are necessary because of the decreased absorption of fat. Steroids are not indicated in the treatment of cystic fibrosis. Antihistamines are not used because of their drying effect on the already tenacious mucus.

A nurse is reviewing the laboratory values of a school-aged child with rheumatic heart disease. Which finding does the nurse conclude is related to this condition? 1Negative C-reactive protein 2Increased reticulocyte count 3Positive antistreptolysin titer 4Low erythrocyte sedimentation rate

3 A positive antistreptolysin titer is expected with rheumatic fever because of a previous streptococcal infection. A positive, not a negative, C-reactive protein reading is expected with rheumatic heart disease. A positive C-reactive protein reading is indicative of an inflammatory process. An increased reticulocyte count is unexpected. An increased reticulocyte count is usually related to anemia, which stimulates the bone marrow to produce so many red blood cells that more immature blood cells (reticulocytes) enter the circulation. The erythrocyte sedimentation rate is increased, not decreased, with rheumatic heart disease, indicating the presence of an inflammatory process.

After a 5-year-old child's tonsillectomy, the nurse notes that the child swallows frequently. What should the nurse conclude about the child's behavior? 1This is a sign of respiratory distress. 2The child is experiencing throat pain. 3The child is bleeding from the surgical site. 4This is a reaction from the general anesthesia

3 A trickle of blood from the surgical site will cause the child to swallow frequently; usually this is the first sign of hemorrhage. If the child were experiencing respiratory distress the clinical manifestations would include dyspnea, tachycardia, and changes in behavior or skin color. The child with a sore throat tries not to swallow. Frequent swallowing is not a usual response on awakening from general anesthesia.

A nurse is caring for a 10-year-old child with cystic fibrosis who is taking a pancreatic enzyme replacement. Which effect of the medication will the nurse look for that may indicate the enzyme is inadequate? 1Generalized edema 2Acute nephrolithiasis 3Abdominal cramping 4Sudden gain in weigh

3 Abdominal cramping and distention are associated with inadequate pancreatic enzyme replacement because foods are accumulating in the gut and are not being digested. If pancreatic enzyme replacement is inadequate, the child will experience a weight loss (not a gain) because of decreased digestion and absorption. Generalized edema and acute nephrolithiasis (kidney stones) do not indicate pancreatic enzyme status.

A nurse administers albuterol to a child with asthma. For what common side effect will the nurse monitor the child? 1Flushing 2Dyspnea 3Tachycardia 4Hypotension

3 Albuterol produces sympathetic nervous system side effects such as tachycardia and hypertension. Pallor, not flushing, is a common side effect. Dyspnea is not a common side effect; this medication is given to decrease respiratory difficulty. Hypertension, not hypotension, is a common side effect.

After a tonsillectomy, which finding alerts the nurse to suspect the initial stage of hemorrhage? 1Noisy snoring 2Asking for water 3Frequent swallowing 4Gradual onset of pallor

3 Blood seeping from the surgical site drains into the oral cavity, causing the child to swallow. Snoring is to be expected after a tonsillectomy because of edema. A child who has been on nothing-by-mouth for an extended time and is not able to swallow fluids easily will probably ask for fluids. Gradual onset of pallor may be a later sign of hemorrhage.

A toddler is admitted to the emergency department with a diagnosis of acute spasmodic laryngitis. After the spasms subside, the child is ready to be discharged. What should the nurse teach the parents to do at home to help prevent another croup episode? 1Perform postural drainage. 2Discourage before-bedtime snacks. 3Use a cool mist vaporizer in the child's room. 4Demonstrate to the child how to expel air after inspiration

3 Cool mist provides humidification. Postural drainage would likely increase the child's anxiety. There is no relationship between eating and the onset of spasmodic croup. It is useless to give instruction while the child is fighting to breathe.

A nurse manager is providing a class on cystic fibrosis for the pediatric staff nurses. Physiologic adaptations to cystic fibrosis are a result of which problem? 1Dysfunction of sweat glands 2Inactivity of respiratory tract cilia 3Pathology of mucus-secreting glands 4Overproduction of endocrine gland activity

3 Cystic fibrosis is a genetic disorder affecting all mucus-secreting (exocrine) glands. A sweat gland abnormality is not involved in cystic fibrosis; children with cystic fibrosis lose excessive amounts of sodium through perspiration caused by exocrine gland dysfunction. Cilia action may be influenced by the thickened secretions, but the cilia are not affected by cystic fibrosis. Exocrine, not endocrine, glands are involved in cystic fibrosis.

A nurse is reviewing the laboratory report of an infant with tetralogy of Fallot that indicates an increased red blood cell (RBC) count. What does the nurse identify as the cause of the polycythemia? 1Low blood pressure 2Diminished iron level 3Tissue oxygen needs 4Hypertrophic cardiac muscle

3 Decreased tissue oxygenation stimulates erythropoiesis, resulting in excessive production of RBCs. Low blood pressure and hypertrophic cardiac muscle are not direct causes of polycythemia. Diminished iron level may or may not affect the production of RBCs.

A 5-month-old child undergoes heart surgery to repair the defects associated with tetralogy of Fallot. Prevention of what behavior is a priority for the nurse after the surgery? 1Crying 2Coughing 3Straining at stool 4Unnecessary movement

3 Forceful evacuation involves taking a deep breath, holding it, and straining (Valsalva maneuver). This increases intrathoracic pressure, which puts excessive strain on the heart sutures. Crying is not a problem after cardiac surgery; it may, in fact, help prevent respiratory complications. Coughing and deep breathing are essential for the prevention of postoperative respiratory complications. Activity is gradually increased.

A nurse is providing preoperative teaching to the parents of a toddler who is to undergo myringotomy. The nurse explains that the type of infection most common in children that are prone to otitis media is what? 1Viral 2Fungal 3Bacterial 4Rickettsial

3 Haemophilus influenzae and Streptococcus pneumoniae, both bacteria, are the most frequent causes of otitis media. If an ear infection develops, the parents should contact their healthcare provider immediately so an antibiotic may be prescribed. Otitis media is not caused by viral, fungal, or rickettsial organisms.

A nurse is planning the discharge of a 9-year-old child who has undergone tonsillectomy. The nurse informs the parents that their child may have a mouth odor, slight ear pain, and a low-grade fever for a few days. In addition to the prescribed analgesic, what should the nurse recommend to ease their child's pain? 1Warm saline gargles 2Heating pad to the neck 3Light-colored ice pops 4Peppermint candy for sucking.

3 Ice pops or ice chips provide a cool liquid that may be soothing to the oropharynx. Red, orange, or brown liquids are contraindicated because they mask bleeding. Gargling is contraindicated because it may traumatize the surgical site, resulting in bleeding; also, warm fluids promote capillary dilation, which may cause bleeding. A heating pad produces vasodilation, which may increase pain and promote bleeding. Hard candies can traumatize the surgical site and cause bleeding

A school-aged child with Kawasaki disease is in pain caused by the desquamating rash. What does the primary nurse identify as the best short-term goal for this child? 1The rash will diminish after lotion is applied. 2Analgesics will be administered as prescribed. 3Pain will be maintained at a level of 3 on a 0-to-10 scale. 4Diversional activities will help distract the child from the discomfort.

3 Maintaining pain at a level below 3 on a 0-to-10 scale is client centered, specific, and measurable and has a time frame ("maintained" implies "at all times"). Diminution of the rash after lotion is applied is not a specific or measurable goal. Administration of an analgesic as prescribed is a nursing goal, not a client-centered goal. Diversional activities represent a combination of an intervention and a potential outcome; the outcome is not specific or measurable and does not have a proposed time frame.

A nurse is caring for an infant who has undergone myringotomy because of recurrent otitis media. What does the nurse expect to note when assessing this child? 1Difficulty voiding 2Excessive tearing 3Drainage into the external auditory canal 4Symptoms of central nervous system irritation

3 Myringotomy is an incision made in the tympanic membrane of the ear that relieves pressure and prevents spontaneous rupture of the eardrum by allowing fluid to escape from the middle ear into the external auditory canal. Tearing, dysuria, and central nervous system irritation are not expected after myringotomy.

A 12-year-old child with cystic fibrosis is to receive four pancrelipase capsules five times a day. The nurse explains that the medication should be taken with meals and snacks to accomplish which goal? 1Enhance oxygenation 2Limit excretion of fats 3Facilitate nutrient utilization 4Prevent iron-deficiency anemia

3 Pancreatic enzyme replacement is needed because children with cystic fibrosis cannot manufacture pancreatic enzymes that promote the digestion of food. This results in large amounts of fat in the stool, which can cause bloating and abdominal cramping. Increased oxygenation is not the effect of pancrelipase; pancrelipase contains enzymes to break down fats, proteins, and carbohydrates. Pancrelipase promotes the body's ability to metabolize and absorb fat rather than limit its excretion. The purpose of pancrelipase is not the prevention of anemia.

Which disorder would the nurse state is related to the tonsils? 1Rhinitis 2Sinusitis 3Pharyngitis 4Pneumonia

3 Pharyngitis, or sore throat, is a common inflammation of the pharyngeal mucous membranes that often occurs with rhinitis and sinusitis. Rhinitis is an inflammation of the nasal mucosa. It is a common problem of the nose and often involves the sinuses. Sinusitis is an inflammation of the mucous membranes or of one or more of the sinuses and is usually associated with rhinitis. Rhinitis and sinusitis are disorders related to the nose and sinuses. Pneumonia is excess fluid in the lungs resulting from an inflammatory process.

An 8-year-old child undergoes tonsillectomy. What is the priority action in the immediate postoperative period? 1Assisting with coughing and deep breathing 2Encouraging frequent intake of cool liquids 3Ensuring airway patency by placing the child in a side-lying position 4Promoting consciousness by encouraging caregivers to interact with the child

3 Positioning the child on the side permits flow of secretions from the mouth that could block the child's airway. Although deep breathing is encouraged, airway patency is the priority. Excessive coughing could actually trigger bleeding. The child will be on nothing-by-mouth status during the immediate postoperative period, and it is more important to maintain an open airway. Although significant caregivers are encouraged to remain with the child, there is no reason to keep the child awake.

A client with cystic fibrosis asks why the percussion procedure is being performed. The nurse explains that the primary purpose of percussion is to do what? 1Relieve bronchial spasms 2Increase depth of respirations 3Loosen pulmonary secretions 4Expel carbon dioxide from the lungs

3 Postural drainage and percussion also known as chest physical therapy (CPT), is a way to help clients with cystic fibrosis (CF) breathe with less difficulty and stay healthy. This intervention uses gravity and clapping the chest to loosen the thick, sticky mucus in the lungs so it can be removed by coughing. Percussion does not relieve bronchial spasms. Once pulmonary secretions are loosened by percussion and the client has a clearer airway, the depth of respirations may increase and facilitate removal of carbon dioxide from the lungs.

A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. What is the priority nursing intervention? 1Having the child rest as much as possible 2Checking the child's eosinophil count daily 3Preventing exposure of the child to infection 4Offering nothing by mouth to the child except oral medications

3 Prednisone reduces the child's resistance to certain infectious processes and, as an antiinflammatory drug, masks infection. The child will self-limit activity depending on respiratory status. The eosinophil count is often consistently increased in children with asthma. The child will need adequate hydration to help loosen and expel mucus.

A 2-year-old child who is hospitalized for repair of tetralogy of Fallot is seen squatting in the playroom. In response to this behavior, what should the nurse do? 1Administer oxygen through a mask. 2Call the respiratory therapist for a nebulizer treatment. 3Continue to observe the child if there are no other signs of distress. 4Notify the healthcare provide that the child's condition is deteriorating.

3 Squatting is a physiologic adaptation for children with tetralogy of Fallot. By squatting, the child decreases the amount of arterial blood that is flowing to the extremities, which in turn decreases venous return to the heart and reduces preload. Oxygen is not indicated. The child has a heart, not a respiratory, problem, so a nebulizer treatment is not indicated. The child's condition has not deteriorated; squatting is a physiologic adaptation.

The parents of an infant with tetralogy of Fallot ask a nurse about the problems involved with this disorder. When answering, what must the nurse consider? 1Overriding aorta, aortic stenosis, patent ductus arteriosus, and mitral insufficiency are the components of this defect. 2Tricuspid atresia, ventricular septal defect, atrioventricular canal, and coarctation of the aorta are the components of this defect. 3The disorder consists of right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta. 4The disorder consists of right ventricular hypertrophy, atrial septal defect, patent ductus arteriosus, and mitral insufficiency.

3 Tetralogy of Fallot consists of right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and an overriding aorta.

A nurse is preparing a 10-year-old child for a tonsillectomy and adenoidectomy to be performed later in the day. What information should the nurse share with the child? 1How the surgical procedure will be performed 2The type of surgical equipment that will be used 3What the child will experience before and after the procedure 4The changes in the child's nose and throat during the procedure

3 The explanation should be based on the sensations the child will experience. Discussing how the procedure is performed, the type of equipment that is used, or the changes in the child's anatomy during the procedure shortly before surgery may increase the child's anxiety.

A 3-month-old infant with tetralogy of Fallot is admitted for a diagnostic workup in preparation for corrective surgery. The morning after cardiac catheterization the infant suddenly becomes cyanotic and begins breathing rapidly. In what position should the nurse immediately place the infant? 1Supine 2Lateral 3Knee-chest 4Semi-Fowler

3 The infant is experiencing a hypercyanotic ("tet" spell) episode caused by a sudden decrease in pulmonary blood flow and an increase in right-to-left shunting. It usually occurs after increased activity. The knee-chest position decreases venous return from the legs, which increases systemic vascular resistance, thereby increasing pulmonary blood flow. The supine and lateral positions increase venous return, which exacerbates the problem. Although the semi-Fowler position is recommended for infants with cardiac disease, it is not adequate for an infant experiencing a tet spell.

The first responders rescue and bring submersion victims of a natural disaster to the emergency department. Which is an appropriate intervention for treating clients with submersion injuries? 1Refrain from inserting urinary catheter 2Immediately provide intubation and mechanical ventilation 3Stabilize or immobilize cervical spine in all near-drowning victims 4Immediately apply heating devices to keep the client's body temperature elevated

3 The nurse should assume cervical spine injury in all near-drowning victims and stabilize or immobilize the victim's cervical spine. The nurse should insert a gastric tube and urinary catheter as an initial intervention for a submersion victim. The nurse should anticipate the need for intubation and mechanical ventilation if the airway is compromised, such as if the gag reflex is absent; intubation and mechanical ventilation need not be provided immediately to all clients if not required. While the client should be warmed if needed, the nurse needs to monitor the client's temperature and maintain normothermia.

A nurse is caring for several school-aged children with cystic fibrosis. Why does the nurse anticipate that these children will probably be small and underdeveloped for their age? 1There is muscle atrophy from lack of motor activity. 2There is decreased secretion of pituitary growth hormone. 3These children digest little food because pancreatic enzymes are blocked. 4These children have anorexia with minimal amounts of nutritional intake.

3 The production of tenacious mucus in the pancreatic ducts prevents the flow of digestive enzymes into the intestines. Therefore fats, proteins, and, to a lesser extent, carbohydrates cannot be digested and absorbed. Muscle atrophy from a lack of motor activity is not a problem associated with cystic fibrosis. Cystic fibrosis does not influence secretion of the growth hormone. Anorexia is not a usual problem in children with cystic fibrosis; usually they are ravenously hungry.

Several hours after admission of a child to the pediatric unit with laryngotracheobronchitis (viral croup), the nurse determines that tachypnea and tachycardia, accompanied by intercostal and substernal retractions and increased restlessness, have developed. What is the priority nursing action? 1Suctioning secretions from the trachea 2Dislodging mucus by striking the back 3Reporting the respiratory status to the practitioner 4Increasing the concentration of oxygen being delivered

3 These are signs of increasing hypoxia; intubation may be necessary to maintain an open airway. The signs are not indicative of increased secretions; suctioning could precipitate sudden laryngospasm. Striking the back is ineffective against laryngeal spasms. The inflammation is preventing the oxygen from reaching the lungs; increasing the amount of oxygen will not be effective until the inflammation is reduced.

A 4-month-old infant is admitted to the pediatric unit with a diagnosis of congestive heart failure. Which nursing assessment would most accurately demonstrate improvement in the infant's condition? 1Decreased tremors 2Increased hours of sleep 3Weight loss during next 2 days 4More rapid heart rate within 2 days

3 Weight loss indicates fluid loss. Water retention is a classic sign of congestive heart failure. Tremors are not typical in infants with heart disease. Tremors are related to central nervous system irritability. If the infant's condition improved, energy would increase and sleeping needs would decrease. Tachycardia is a sign of congestive heart failure. The purpose of the cardiotonic is to slow the heart rate.

The nurse instructed a client with asthma about the use of a peak flow meter at home. The client assesses the peak expiratory flow by using the peak flow meter. Which action performed by the client would be appropriate when the reading is in the yellow zone? 1Perform the peak expiratory flow again immediately 2Increase the prescribed drug therapy 3Use a prescribed reliever drug therapy 4Reassess the asthma plan and change the controller medication

3 Yellow is a range between 50% and 80% of personal best. When the reading is in this range, the client is recommended to use the prescribed reliever drug. After a few minutes of the intake of a prescribed reliever drug, the peak expiratory flow should be determined again to know the effect of the reliever medication. Prescribed drug therapy should not be increased without consulting the primary healthcare advisor. Reassessing the asthma plan and changing the controller medication would be required when there are frequents reading in the yellow zone.

An emergency tracheotomy is performed on a toddler in acute respiratory distress from laryngotracheobronchitis (viral croup). What early signs of respiratory distress indicate that it is necessary for the nurse to suction the tracheotomy? Select all that apply. 1 Stridor 2 Cyanosis 3 Restlessness 4 Increased pulse rate 5 Substernal retractions

3,4 Restlessness and increased pulse rate are early signs of hypoxia; suctioning is required to keep the airway patent. Stridor, cyanosis, and substernal retractions are late signs of hypoxia; suctioning should be performed before substernal retractions occur.

A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what? 1Sinusitis 2Recurrent tonsillitis 3An inflamed mastoid process 4An obstructed eustachian tube

4 A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.

A 1-month-old infant with a ventricular septal defect (VSD) is examined in the cardiology clinic. What sign related to this disorder does the nurse expect to find when assessing this infant? 1Bradycardia at rest 2Activity-related cyanosis 3Bounding peripheral pulses 4Murmur at the left sternal border

4 A murmur at the left sternal border is the most characteristic finding in infants and children with a VSD. A left-to-right shunt is caused by the flow of blood from the higher pressure left ventricle to the lower pressure right ventricle. Children with VSDs generally have tachycardia and are often acyanotic. A bounding peripheral pulse is not a common finding in children with a VSD.

A school-aged child admitted to the hospital with a diagnosis of status asthmaticus appears to be improving. What is the most objective way for the nurse to evaluate the child's response to therapy? 1Auscultating breath sounds 2Monitoring the respiratory pattern 3Assessing the lips for decreased cyanosis 4Evaluating the child's peak expiratory flow rate

4 A peak expiratory flow meter (PEFM) is used to obtain the peak expiratory flow rate (PEFR). The PEFM provides an objective measure of the maximal flow of air that can be forcefully exhaled in 1 second. The PEFM individualizes data for the child because after a personal best value is established, this baseline can be compared with current values to determine progress or lack of progress regarding the child's respiratory status. Although breath sounds may be auscultated, the child's respiratory pattern may be monitored, and the color of the lips may be assessed, none is as objective a measure as a PEFR result.

The parents of a 4-month-old infant with a diagnosis of acute otitis media and fever ask the nurse about the use of antibiotics to treat this condition. What is the best response by the nurse? 1"Antiinflammatory medications are recommended for this condition." 2"Typically antiviral medications are given to treat acute otitis media." 3"Current practice is to wait 72 hours to see whether the condition resolves." 4"Antibiotics are recommended for infants younger than 6 months with acute otitis media."

4 All cases of acute otitis media (AOM) in infants younger than 6 months should be treated with antibiotics because of their immature immune systems and the potential for infection with bacteria. Current literature indicates that waiting up to 72 hours for spontaneous resolution is safe and appropriate management of AOM in healthy infants older than 6 months and children. However, the watchful waiting approach is not recommended for children younger than 2 years of age who have persistent acute symptoms of fever and severe ear pain. Antiviral or antiinflammatory medications would not be recommended in an acute case of otitis media.

Which type of allergic skin condition in a client is associated with immunological irregularity, asthma, and allergic rhinitis? 1Urticaria 2Psoriasis 3Acne vulgaris 4Atopic dermatitis

4 Atopic dermatitis is an allergic skin condition that is a genetically influenced, chronic, relapsing disease. It is associated with immunologic irregularity involving inflammatory mediators associated with allergic rhinitis and asthma. Urticaria is an allergic skin condition that results in a local increase in permeability of capillaries, causing erythema and edema in the upper dermis. Psoriasis is an autoimmune chronic dermatitis but not an allergic skin condition. Acne vulgaris is an inflammatory disorder of sebaceous glands.

A 3-month-old infant is admitted to the pediatric unit with a diagnosis of tetralogy of Fallot. The nurse's assessment reveals that the infant's weight has declined from the 25th percentile to the 5th. The nurse concludes that what is the most likely reason for this inadequate weight gain? 1Cyanosis resulting in cerebral changes 2Decreased arterial oxygen level resulting in polycythemia 3Pulmonary hypertension resulting in recurrent respiratory infections 4Inadequate oxygen perfusion leading to activity intolerance, resulting in diminished energy to nurse

4 Because of quick fatigue it is difficult for the infant to consume sufficient calories for adequate weight gain. Increased caloric intake is needed to meet the infant's nutritional needs. Although cyanosis is present, it may not lead to cerebral changes. Cyanosis is not directly related to inadequate weight gain. Although decreased Po2 does lead to polycythemia, it does not affect the infant's ability to gain adequate weight. Although there is pulmonary hypertension, it is not directly related to inadequate weight gain or respiratory infections.

After a discussion with the primary healthcare provider, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. How should the nurse respond? 1The diameter of the aorta is enlarged. 2The wall between the right and left ventricles is open. 3It is a narrowing of the entrance to the pulmonary artery. 4It is a connection between the pulmonary artery and the aorta.

4 Before birth, oxygenated fetal blood is shunted directly into the systemic circulation by way of the ductus arteriosus, a connection between the pulmonary artery and the aorta. After birth, the increased oxygen tension causes a functional closure of the ductus arteriosus. Occasionally, particularly in preterm infants, this vessel remains open, a condition known as patent ductus arteriosus. Enlargement of the diameter of the aorta is not the problem in patent ductus arteriosus. A defective wall between the right and left ventricles is a description of ventricular septal defect. A narrowing of the entrance to the pulmonary artery is a description of pulmonic stenosis.

The nurse is caring for a 6-year-old child admitted from the emergency department after an acute asthma attack. The child has a new prescription for fluticasone. What instructions must the family be given about this drug before the child's discharge? 1Fluticasone needs to be taken with food or milk. 2Fluticasone is primarily used to treat acute asthma attacks. 3The child should suck on hard candy to help relieve dry mouth. 4Watch for white patches in the mouth and report them to the primary healthcare provider

4 Fluticasone is a steroid commonly administered by way of inhalation for long-term control of asthma symptoms. Oral thrush is a side effect that manifests as white patches. Fluticasone is administered via inhalation so food or milk is not needed prior to administration. Dry mouth is not a side effect of fluticasone.

A 5-year-old child is admitted to the pediatric intensive care unit with a diagnosis of acute asthma. A blood sample is obtained to measure the child's arterial blood gases. What finding does the nurse expect? 1High oxygen level 2Increased alkalinity 3Decreased bicarbonate 4Increased carbon dioxide level

4 Gas exchange is limited because of narrowing and swelling of the bronchi; the carbon dioxide level increases. The oxygen level will be decreased, not increased. The pH will decrease; the child is in respiratory acidosis, not alkalosis. The bicarbonate level will be increased to compensate for acidosis.

What physiologic alteration does the nurse expect when assessing a 6-month-old infant with bronchiolitis (respiratory syncytial virus [RSV])? 1Decreased heart rate 2Intercostal retractions 3Increased breath sounds 4Prolonged expiratory phase

4 Infectious and mechanical changes narrow the bronchial passages and make it difficult for air to leave the lungs. As a result of increased respiratory effort and decreased oxygen exchange, tachycardia may develop. Intercostal retractions are unlikely because of overinflation of the chest with air and shallow, rapid breathing. Breath sounds may be diminished because of swelling of the bronchiolar mucosa and filling of the lumina with mucus and exudate.

The nurse is planning care for a preschooler with Kawasaki disease. Which intervention should the nurse plan to implement? 1Restricting fluids, especially fruit juices 2Ensuring bright lighting in the room during assessments 3Administering penicillin G benzathine (Bicillin) as prescribed 4Administering intravenous immune globulin (IVIG) as prescribed

4 Kawasaki disease is treated with high-dose IVIG in combination with aspirin to lower the risk of coronary artery abnormalities. Nursing care is focused on adequate hydration, so fluids should not be restricted and fruit juices are not contraindicated. A clinical manifestation of bilateral nonpurulent conjunctivitis occurs with Kawasaki disease, so the nurse should avoid bright overhead lights. Kawasaki disease is an acute febrile exanthematous illness of children with a generalized vasculitis of unknown origin. It is not an infectious disease, so antibiotics (penicillin) are not administered.

The parents of a school-aged child with cystic fibrosis tell the nurse that they have changed to natural pancreatic enzymes because of money issues. What is an appropriate response by the nurse? 1You don't need to give the enzymes now that your child is in school." 2Natural enzymes don't have any side effects and can be taken without regard to meals." 3If you are using generic enzymes, you will need to give twice as many to achieve the required effect." 4Natural enzymes are not as effective as the brand-name product. This is something you need to discuss with your healthcare provider."

4 Natural pancreatic enzymes are not considered adequate in children with cystic fibrosis because of the bioavailability of the enzymes. Pancreatic enzyme supplementation is a lifelong treatment for cystic fibrosis. All medications have side effects, and pancreatic enzymes should be taken with meals. Giving twice as many natural enzymes does not constitute accurate dosing.

What should the nursing care of an 8-month-old infant with tetralogy of Fallot include? 1Restriction of fluid intake to conserve energy 2Provision of iron-fortified formula to prevent anemia 3Administration of coagulants to control bleeding tendencies 4Prevention of increased respiratory effort to promote oxygenation

4 Preventing respiratory distress minimizes the workload of the heart; this is accomplished with such interventions as positioning, maintaining diet restrictions, administering medications, and promoting conservation of energy. Restriction of fluid intake will promote hemoconcentration; if oral fluids are limited to conserve energy, intravenous fluids may be indicated. Additional iron intake will aggravate the polycythemia that results from hypoxia caused by reduced pulmonary blood flow. Administration of coagulants along with hemoconcentration is conducive to thrombus formation.

The nurse is caring for a child with spasmodic croup. The nurse knows that which symptom requires immediate nursing intervention? 1Irritability 2Hoarseness 3Barking cough 4Rapid respiration

4 Rapid respiration may be a sign of impending airway obstruction. Unless irritability is accompanied by severe restlessness, symptomatic care should be given. Unless accompanied by signs of respiratory embarrassment, hoarseness needs no immediate intervention. A barking cough may sound ominous, but it is not a sign of respiratory compromise, as is rapid respiration.

A nurse is teaching parents about treating their infant's recurrent attacks of spasmodic croup at home. What is the desired effect of the actions that the nurse teaches the parents? 1Dilation of the bronchi 2Reduction of the fever 3Depression of the cough 4Interruption of the spasm

4 Spasms must be interrupted, or hypoxia will occur. Fever and cough are not life threatening and are not the priority. Dilation of the bronchi is not the goal.

The parents of an infant with tetralogy of Fallot ask the nurse to explain what is wrong with their baby's heart. Before explaining the problem in a way that they will understand, the nurse remembers that tetralogy of Fallot includes what features? 1Tricuspid atresia, ventricular septal defect, atrioventricular canal, and coarctation of the aorta 2Overriding of the aorta, aortic stenosis, patent ductus arteriosus, and mitral valve insufficiency 3Atrial septal defect, right ventricular hypertrophy, patent ductus, and mitral valve insufficiency 4Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding of the aorta.

4 The four structural defects associated with tetralogy of Fallot are right ventricular hypertrophy, ventricular septal defect, pulmonary stenosis, and overriding of the aorta

A nursing student compares the pathophysiology of submersion injury in victims of freshwater drowning and victims of saltwater drowning. Which statement made by the nursing student indicates effective learning? 1"Freshwater is hypertonic while saltwater is hypotonic." 2"Both types of water are drawn from the vascular space into the alveoli." 3"Destruction of surfactant and alveolar-capillary membrane occurs only in case of saltwater aspiration." 4"The osmotic gradient caused by the aspirated fluid causes fluid imbalances in case of submersion in both types of water."

4 There is a difference in tonicity of both saltwater and freshwater with that of normal body fluids. When either saltwater or freshwater is aspirated by the submerged victim, the osmotic gradient caused by the aspirated fluid causes fluid imbalances in the body. Freshwater is hypotonic and saltwater is hypertonic. Only hypertonic saltwater draws fluid from the vascular space into the alveoli. Destruction of surfactant and alveolar-capillary membrane occurs in case of both saltwater and freshwater aspiration.

The parent of a 10-month-old infant with otitis media tells the nurse in the pediatric clinic that this is the baby's third episode in 3 months. The infant is tugging at the ear but is not acutely ill. What factor should the nurse consider before responding? 1Analgesics are contraindicated. 2Oral antibiotics will be prescribed. 3The labyrinth and cochlea are inflamed. 4The eustachian tube is short and horizontal.

4 This anatomical difference in young children permits easier migration of microorganisms from the oral cavity into the middle ear, predisposing them to otitis media. Analgesics such as acetaminophen or ibuprofen are recommended to relieve discomfort. Studies have shown that antibiotics are not effective in children younger than 2 years if the child is not severely ill. Antibiotic therapy is necessary when the infant has a fever or is in severe pain. The labyrinth and cochlea are part of the inner ear and are not affected by otitis media.

A preterm infant is started on digoxin and furosemide for persistent patent ductus arteriosus. Which nursing assessment provides the best indication of the effectiveness of the furosemide? 1Pedal Edema =reduced. 2Digoxin toxicity is prevented. 3Fontanels appear depressed. 4Urine output exceeds fluid intake.

4 Urine output exceeding fluid intake is the expected outcome. Output exceeding intake indicates that furosemide is causing diuresis. Although it is important to determine whether pedal edema is reduced, this could be influenced by other factors. Furosemide can cause hypokalemia, which may precipitate digoxin toxicity; it is not given to prevent digoxin toxicity. Depressed fontanels are not the desired outcome; this finding indicates dehydration, which may occur with excessive diuresis.

B

In the diagram, which letter identifies the patent ductus arteriosus?