Peds. Chapter 20. Respiratory
The mother of a 6-month-old infant who was recently admitted for a "whooping" cough, rhinorrhea, and fever, reports that she has two other children age 3 and 5 at home. Which action should do the nurse take?
Advise to consult these children with a HCP
The nurse is caring for a child recently admitted to the hospital with upper respiratory infection and "whooping" cough. Which prescription would the nurse question?
Ambulating in the hall (should be on droplet precautions)
While inspecting the thorax of a 3-year-old child, the nurse notes an increased respiratory rate and retractions while the child is supine on the examining table. Which action can the nurse perform next to obtain an accurate respiratory assessment?
Reposition child upright
The nurse is teaching the parents of a 3—month-old how to administer oral nystatin suspension to their infant. Which statement made by the parents indicate they need further instruction?
"I will be sure to discontinue the medication as soon as the white spots clear up."
The nurse is seeing a 5-year-old patient in the emergency department for a week-long history of a cold with an associated cough. What might be an associated ophthalmic finding in this patient with a week-long history of cough?
A subconjunctival hemorrhage
A 2-year-old female presents with stridor, restlessness, and a hoarse cry. The nurse reviews the health care provider's prescription. Which medication would the nurse question?
Ampicillin intravenous (croup is viral)
The nurse is receiving an admission report for a child with a head injury who is has papilledema, decreased consciousness, and retinal hemorrhage. The child is otherwise stable. What interventions should the nurse prepare to initiate?
Implement seizure precautions
Which component of the respiratory system contracts and flattens to cause inspiration?
Diaphragm
What are the best initial actions and assessments for a child who presents with a head injury?
Immobilize the neck, assess the airway and breathing of the client, perform a Glasgow coma scale to determine consciousness, and monitor for S/S of increased intracranial pressure
How does the upper airway prevent bacterial infections?
Adenoids filter lymph fluid
How is pilocarpine iontophoresis (sweat test) used to diagnose cystic fibrosis?
Chloride levels in sweat are measured
The nurse is providing care to a 1-week-old infant admitted with apnea. Which provider's order would the nurse question?
Remove monitor for breastfeeding
A 9-month-old infant is brought to the hospital by the parents because the infant is "breathing fast." Assessment reveals retractions, wheezing, rhinorrhea, and oxygen saturation is 89%. Which question would help the nurse determine the next intervention?
" how many wet diapers has the infant had today?" bronchiolitis causing dehydration
The nurse is caring for a 2-year-old with hyphema (collection of blood inside the anterior chamber of the eye). The parents want to know how someone could have hurt the child. How should the nurse respond?
"A hyphema does not necessarily mean that the child was purposefully injured."
The nurse is providing education to the parents of a child at risk for tuberculosis. The parents wish to forego testing because they report the child is healthy. Which response by the nurse is appropriate?
"Children with tuberculosis may not have symptoms."
A 16-year-old patient presents to the emergency department with a bag containing one of his teeth. The patient admits he was in a fight the week before which resulted in an avulsed tooth that he kept in his room since the injury. Which statement by the nurse explains the possible consequence of this patient's situation?
"Irreversible damage usually occurs as soon at 60 minutes after losing a tooth. You may see the emergency department care provider, but we will not be able to replace your tooth."
The parents of a 4-year-old with pharyngitis are caring for their child at home. They are not sure their child is receiving enough fluids and call their health care provider's office. What can the nurse ask to determine if the child is receiving enough fluids?
"Is the child urinating a normal amount?"
The nurse is obtaining a history for a child with a language disorder. Which statements help the nurse to differentiate receptive language disorders from expressive language disorders?
"My child does not follow my simple directions even though she is old enough to do so." , My child always listens to what I say but gets really frustrated when she needs to tell me something.", My child can show me what he wants and uses hand signals to get his point across, and he is a great listener.
A child with a respiratory tract infection is having bouts of vomiting and refuses oral fluids. What advice should the nurse give to the family to promote hydration? "Give thick fruit juice to provide high calorie intake." "Force the child to drink fluids to maintain hydration level." "Offer the child's favorite beverages to promote hydration." "Give oral fluids at fixed intervals even if the child is sleeping."
"Offer the child's favorite beverages to promote hydration." The nurse should advise the family to maintain an optimum level of hydration in the child. The child can be offered his or her favorite beverages. Though the beverage may not have any nutritional content, it will help in the child's hydration. High calorie or thick fruit juices may not be palatable and easy to digest, because the child is vomiting. The child should not be forced to drink fluids. It is likely that the child may develop more aversion to take food or fluids. In addition, forcing fluids may result in vomiting. The child should not be awakened to take fluids because this may have the same result as forcing the child to take fluids.
A child has Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) from a head injury. The parents are questioning why the child is on a fluid restriction. What is the nurse's best response?
"The child cannot take in too many fluids or this can lead to swelling of the brain."
The nurse is giving discharge instructions to a caregiver and child about care after a concussion. The caregiver questions why the child cannot return to playing basketball the following day since the child is well enough to go home. How should the nurse respond?
"Your child can be monitored at home, but a second concussion before this concussion has healed could cause brain injury or even death."
The nurse is screening a child for tuberculosis. Which child is at risk for developing tuberculosis?
A 13-year-old malnourished Latino female who lives in an urban area. This child is at risk for tuberculosis because malnutrition, Latino race, adolescence, and living in an urban area are all risk factors for tuberculosis.
Which anatomic parts are included in the lower airway? Larynx Alveoli Bronchi Pharynx Bronchioles
Alveoli, bronchi, and bronchioles Anatomic parts are included in the lower airway include alveoli, bronchi, and bronchioles. The larynx and pharynx are part of the upper airway.
The nurse is assessing a 2-year-old child and notes wheezing, nasal congestion, retractions, and abdominal breathing. Which assessment finding is consistent with an expected (normal) physiologic difference of the pediatric respiratory system?
Abdominal breathing
A 6-year-old child has experienced a viral illness for the past week and presents with rapid onset of fever and ear pain overnight. Why do these symptoms indicate acute otitis media (AOM) rather than otitis media with effusion (OME)?
Acute otitis media presents with rapid onset and signs and symptoms of infection.
A 9-month-old infant has a "whooping" cough after having a runny nose, low-grade fever, and mild cough. Which action should the nurse consider doing next?
Administer antibiotics as prescribed
The nurse is assessing an infant with bronchopulmonary dysplasia (BPD) admitted yesterday and notes the following: retractions, difficulty feeding with 24 kcal formula, restlessness, and weight increase of 60 grams from admission. Which is the most important action for the nurse to take?
Administer furosemide Because this infant with BPD has signs of fluid volume overload impacting the respiratory status, the most important nursing action is to administer a diuretic, such as furosemide.
A 6-year-old child presents with anxiety, stridor, and becomes agitated when asked questions. The parents report the child had a high fever. Which action by the nurse is a priority?
Administer humidified oxygen
The nurse is caring for a 2-month-old infant who presents with fever, breathing difficulties, wheezing, persistent cough, and difficulty feeding. Which health instructions by the nurse are appropriate to provide the parents?
Allow rest periods during the day, offer the child's liquids frequently, and use a humidifier in the child's room
A 3-year-old female presents with a persistent cough, rhonchi and poor oral intake. The nurse reviews the health care provider's prescription. Which prescription would the nurse question?
Antibiotics
The nurse is caring for a child with a left lower lobe infiltrate. Labs are obtained and the nurse receives the following results: WBC 16,000, Hgb 12.5, Platelet count 180,000, urine specific gravity 1.035, BUN 22. Which provider's prescription would the nurse anticipate in this patient?
Antibiotics, acetaminophen, and IV fluids
A 3-year-old male presents with drooling, retractions, and oxygen saturation of 88% on room air. The parents report the child became sick over the past few hours and cries quietly when disturbed. Which action by the nurse is priority?
Anticipate emergency support
What is the primary rationale for the nurse administering antiemetic medication to a child recovering from eye surgery?
Antiemetics decrease the likelihood of vomiting and vomiting can increase intraocular pressure.
A 14-year-old child who was admitted due to fever, night sweats, mild cough, and weight loss, with a positive Mantoux test, is being prepared for discharge. Which actions should the nurse consider doing next?
Assess familys financial status (meds expensive) and coordinate care with health department
Which describes the nursing assessment and interventions needed for a child who has developed ARDS?
Assess pulse oximetry, counting respiratory rate, measuring intake and output, and monitoring arterial blood gases
Which nursing intervention is a priority for the infant who suddenly begins gagging, coughing, and wheezing?
Assess resp status
The nurse is caring for a newborn delivered at 30-weeks gestation. Order the nursing interventions based on pediatric differences in the respiratory system by priority with the highest priority being placed first.
Assess respiratory status, suction the nose, provide oxygen, and administer surfactant
A nurse's assessment of a mechanically ventilated patient includes which basic ongoing assessments? Assessing skin color Assessing capillary refill Assure displacement of tube Assessing level of consciousness Observing chest rise and fall for symmetry
Assess skin color, capillary refill, LOC, and observing chest rise and fall for symmetry Basic ongoing nursing assessments include assessing skin color, capillary refill, level of consciousness, and chest rise and fall for symmetry. Displacement of the tube will cause sudden deterioration of an intubated patient.
The nurse is preparing a 7-year-old for a tonsillectomy. Just before going to surgery, the child states, "I was hoping my tooth would fall out before I went to sleep so the tooth fairy would come while I am in the hospital." What is the nurse's priority action?
Assess the child for any loose teeth prior to surgery.
A mother with asthma is concerned her 7-year-old child will develop asthma. Which explanation by the nurse is most appropriate?
Asthma can be passed down from a parent
Which response by the nurse is appropriate for an adolescent with history of asthma as a child who tells the nurse he does not have asthma now?
Asthma severity usually decreases as the airway grows
Which explains the next best step in assessing and managing a child who aspirated a marble and has a partial obstruction of the larynx?
Auscultating the lungs while the child speaks will allow the nurse to assess the lungs and check the child for aphonia. This assessment will allow the nurse to address any worsening obstruction that requires immediate intervention.
A 4-week-old infant presents to the clinic for a routine health assessment. The nurse notices that the infant stops breathing for 12 seconds. Which known physiological difference in the pediatric respiratory system would explain this infant's breathing pattern?
Brief periods of apnea are normal
The parents of a young child with sinusitis want to know what they can do to help their child be more comfortable. What should the nurse recommend?
Bring child into the mist of a hot shower, use acetaminophen for pain and fever, used a bedside humidifier, apply warm moist compress
The nurse is providing care to a child admitted with status asthmaticus. Which provider's order would the nurse question?
Budesonide every 20 minutes
One of the goals for children with asthma is to prevent respiratory tract infection because infections do what? Increase sensitivity to allergens Lessen effectiveness of medications Encourage exercise-induced asthma Can trigger an episode or aggravate an asthmatic state
Can trigger an episode or aggravate an asthmatic state A respiratory tract infection can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection, not the medications, affects the asthma. Exercise-induced asthma is caused by vigorous activity, not a respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.
The nurse notes that a 1-day-old newborn is cyanotic. After stimulating the newborn, he begins breathing again. Which is the most important action for the nurse to take?
Check blood glucose level
The nurse is trying to determine if a child's eye disorder has progressed from strabismus to amblyopia. Which key findings on clinical presentation help to differentiate amblyopia from strabismus?
Child frequently squints and reports a headache, Child's eyes appear misaligned with an unequal red reflex, Parents report child often runs into things that should be easily seen
Which clinical manifestations help the nurse to differentiate between a contusion and a concussion type of head injury?
Child has some difficulty speaking that comes and goes, site of petechial hemorrhage is away from the site of direct impact, and child as a headache and indicates that the head hurts with palpation.
When providing teaching to the family of a child recently diagnosed with a respiratory illness, which component of differences in the pediatric respiratory system would the nurse emphasize?
Children have increased resistance to air flow during respiratory illnesses.
How does the respiratory system facilitate movement of mucous?
Cilia move mucous to the pharynx
Which helps keep mucus flowing, and sweep microorganisms and other foreign agents away from the lungs to be coughed or swallowed? Epiglottis Ciliary action Mucus blanket Lymphoid tissues
Ciliary action Ciliary action helps keep mucus flowing, and sweeps microorganisms and other foreign agents away from the lungs to be coughed or swallowed. The epiglottis protects the respiratory tract from invading material, preventing material from being aspirated into the lower respiratory tract. The mucus blanket secretes sticky mucus, to which airborne organisms adhere. Lymphoid tissues help localize and contain invading organisms so they can be destroyed by the body's humoral defense mechanisms.
What assessment finding is most expected with a stable patient with cystic fibrosis? Clubbing Clear chest x-ray Cheyne Stokes breathing Supraclavicular retractions
Clubbing Clubbing is an expected finding with a teen with cystic fibrosis due to the chronic nature of cystic fibrosis. A clear x-ray is not seen due to increased mucus related to cystic fibrosis. Cheyne Stokes breathing is most often associated with impending death. Supraclavicular retractions are associated with severe airway obstruction.
Which test result would the nurse use to assess the likelihood of worsening respiratory distress in a child with asthma?
Continuous pulse oximetry
3-year-old male presents with persistent coughing and a temperature of 101.8F. The parents report the child became sick over the past few days. The child is now resting. Which action by the nurse is a priority?
Count respirations
What is the primary rationale for the nurse encouraging parents to quickly soothe a child who is recovering from eye surgery?
Crying can increase intraocular pressure and damage the eye.
The nurse is administering the DTaP vaccine to a 4-month-old infant. The parents question the nurse about the importance of this vaccination. Which response by the nurse is appropriate?
DTaP can prevent pertussis and associated complications
Which physiologic differences can cause increased oxygen usage in a 2-year-old child when compared to an adult?
Decreased lung surface, increased metabolic and respiratory rate
A child who is hospitalized with cystic fibrosis often refuses to let the nurse perform some nursing interventions. What is the most effective method by which the nurse can continue the care management without interruption? Develop a daily schedule of events with the child. Perform the interventions even if the child resists. Avoid waking up the child to perform any activities. Use a little force to make the child allow the activities.
Develop a daily schedule of events with the child. There are several therapies, tests, and medication regimens to be followed in a child with cystic fibrosis. If the child resists some interventions, the nurse should develop a daily schedule of events with the child. This gives the child some control. The exclusion of any intervention from the daily regimen can worsen the child's condition; therefore, the nurse should develop a way to do all the required activities even though the child resists. However, as much as possible, the interventions should be performed with the child's consent and cooperation. The activities should be performed on time. Therefore, if it is required, the child should be woken up to perform the activity. The nurse should have a frank discussion with the child. The child should not be forced to cooperate, or the child may become more resistant to any interventions being performed.
The nurse is providing education to the parents of a 6-month-old infant diagnosed with bacterial pneumonia, who is now being discharged home from the emergency department. Which education by the nurse is appropriate?
Education on offering the infant a bottle frequently, educating on administering acetaminophen for a fever, and providing instruction and emphasizing the importance of finishing the antibiotic prescribed
A 5-year-old child who was admitted for chills, fever, breathing difficulties, and chest pain, begins coughing and is restless. Which action by the nurse is a priority?
Elevate HOB
Which patient scenario reflects the appropriate nurse-patient interaction for communicating effectively with a child with hearing loss?
Eliminate background noise, look directly into child's face, speak clearly and slightly slower than usual, and have the child's complete attention before beginning to speak
Which statement appropriately describes the primary role of the alveoli?
Exchange of oxygen for carbon dioxide takes place in the alveoli
Which explanation will best assist a parent in prevention of passive smoke exposure for an infant?
Exposure to cigs can cause illness
An 8-year-old patient presents with a low-grade fever, nasal congestion with purulent nasal discharge, cough (which usually increases when the child is lying down), and headache. Which areas of the head and face should the nurse assess in this patient?
Eyes, throat, sinuses, and mucous membranes
A 13-month-old female is brought to the hospital because the parents suspect spasmodic croup. What information would help the nurse determine appropriate interventions for this child?
Family history, onset of symptoms, presence of mucous, and when coughing occurs
Which symptoms should the nurse discuss when educating a newly diagnosed child about the signs of an asthma exacerbation?
Fatigue, wheezing, chest tightness, and dry cough at night
A child is brought to the emergency room for severe wheezing and shortness of breath. The mother reports using a fluticasone inhaler three times on the way to the hospital. Which nursing intervention is a priority?
Give albuterol
An infant has been diagnosed with bronchopulmonary dysplasia (BPD) and presents with low potassium levels. Which is the most important action for the nurse to take?
Give potassium bolus as ordered
The nurse is teaching the parents of a newborn about massaging a blocked lacrimal duct. What information should the nurse include?
Hands should be washed and place the index finger over lacrimal duct and milk the duct in an upward motion
The parents of an 8-year-old with conjunctivitis want to know how to keep their other four children from contracting the infection. What should the nurse emphasize when providing education?
Handwashing and not sharing of anything that comes into contact with the infected eye.
The nurse is caring for a 7-year-old child due to strident cough and irritability. Upon exam, the nurse finds the child's epiglottis to be edematous and cherry red, with vital signs readings of T = 100.9 oF, HR 100, RR 24, BP 100/70, O2 sat 95% on room air. Which action should the nurse take?
IV amoxicillin
A patient is severely dehydrated. The nurse is aware to monitor for which associated electrolyte imbalance? Increased iron Increased calcium Increased potassium Decreased blood urea nitrogen
Increased potassium The nurse is aware to monitor for increased potassium electrolyte imbalance with dehydration. One of the disturbances that complicate both fluid losses and acid-base imbalance is an alteration of potassium levels. During dehydration, fluid moves out of the ICF compartment into the ECF compartment in an attempt to balance the fluid losses. In doing so, potassium also moves out, creating a total body potassium depletion. Because renal function is drastically reduced in dehydration, normal excretion of potassium does not take place. This causes elevated serum levels that can produce all the signs and symptoms of hyperkalemia. Decreased calcium is associated with various types of dehydration. Iron and blood urea nitrogen are not electrolyte imbalances.
Which manifestations would be expected in a patient diagnosed with asthma?
Increased residual volume indicating inflammation, diminished expiratory flow indicating bronchospasms, decreased vital capacity caused by thickened secretions in the airway
The parents of a 1-year-old bring their child into the primary care clinic for evaluation. The child has not been sleeping, is irritable, and has a fever. The nurse notes that the child is pulling at the left ear and sees purulent drainage from the left ear. The symptoms have been present for four days. The nurse anticipates what treatment?
Initiation of oral amoxicillin to treat the ear infection
What care must the nurse take when performing the tuberculin skin test for a child? Use 10 tuberculin units of purified protein derivative (PPD). Administer medication intramuscularly in the upper arm. Use a 14-gauge needle and a 1-mL syringe for the procedure. Inject in such a way that a visible wheal appears on the skin.
Inject in such a way that a visible wheal appears on the skin. The nurse injects the PPD so that a visible wheal appears on the skin. A wheal 6 to 10 mm in diameter should form between the layers of the skin when the solution is injected properly. If the wheal is not formed, the procedure is repeated. A 27-gauge needle and a 1-mL syringe are used to administer 5 tuberculin units of PPD. It is generally injected intradermally in the volar or dorsal aspect of the forearm.
A 6-month-old is sleeping in the parent's arms. The mother reports the infant has been "breathing fast," coughing repeatedly, and crying more often than usual. Which component of the respiratory assessment should the nurse perform first?
Inspection
The nurse is caring for a 7-year-old child who presents with enlarged tonsils, abdominal breathing, respiratory rate 34, and irregular breathing pattern. Which assessment finding is most concerning?
Irregular breathing pattern
A child's glow stick cracked and the contents sprayed into the child's eye. What is the appropriate action the nurse should take?
Irrigate the eye
A nurse monitors a patient in metabolic acidosis for what expected compensation? Stridor Crackles Kussmaul breathing Cheyne Stokes breathing
Kussmaul breathing When a patient has metabolic acidosis, hyperventilation (such as in Kussmaul breathing) is an expected compensation. Stridor indicates partial or complete airway obstruction. Crackles indicate excess fluid in the lungs and Cheyne Stokes breathing is an indication that death is near.
Which anatomic parts are included in the upper airway? Larynx Alveoli Bronchi Pharynx Upper part of the trachea
Larynx, pharynx, and upper part of the trachea Anatomic parts are included in the lower airway include alveoli and bronchi. The larynx, pharynx, and the upper part of the trachea are part of the upper airway.
The nurse is assessing a 12-year-old child with history of asthma and notes the following: clear breath sounds, cough, and restlessness. The child states, "I know I am not having an asthma attack because I am not wheezing, but I feel so tired." Which response by the nurse is most appropriate?
Let me place this pulse oximeter on your finger
Which diagnostic tests would the nurse expect to be ordered for a 10-year-old child with fever, night sweats, and cough with occasional blood for more than 3 weeks?
Mantoux test, sputum culture, and chest radiography
]A nurse is performing a follow-up respiratory assessment for a 7-year-old child who had pneumonia of the right middle lobe. Which anatomical landmark should the nurse use to assist in auscultation of the right upper lobe?
Midclavicular line (right middle lobe is best heard anteriorly)
The nurse is assessing a patient with a 3-year history of asthma. Which associated findings can the nurse expect to see?
Nasal polyps, inflammation and redness around the nose, and discomfort and pressure around the eyes
A 4-year-old child is brought to the emergency department. The child exhibits a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. What is the priority action by the nurse? Make the child lie down and rest quietly. Auscultate the child's lungs and make preparations for placement in a mist tent. Examine the child's oropharynx and report the assessment to the health care provider. Notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.
Notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation. Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may result in total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.
The nurse is caring for child diagnosed with croup, who is now being discharged. The parents are concerned and question the nurse about what to do when they get home. Which response by the nurse is most appropriate?
Observe for signs of respiratory distress.
A 2-year-old child is brought to the hospital for persistent coughing, weight loss, and appearing malnourished. While gathering history, the mother reports the child has a positive Mantoux test "a few months ago." Which action should the nurse take?
Obtain a medication history (make sure they completed the meds)
A 2-year-old child presents to ER due to chills, fever, chest pain on left side, productive cough, and difficulty breathing. The health care provider prescribes therapies for the child. Which prescription should the nurse question?
Oral antihistamines
A 1-year-old female presents with restlessness, rhinorrhea, retractions, and poor feeding. The nurse reviews the health care provider's prescription. Which treatment would the nurse question?
Palivizumab IM (used for prevention)
Why might a patient who tests positive for Bordetella Pertussis also present with an unusually low blood pressure?
Pertussis is a gram negative bacteria that can release endotoxins and cause symptoms of shock, including low blood pressure.
Bordatella pertussusis have pili that surround their thin cell wall. Why is this significant for understanding the pathophysiology of the disease?
Pili are rigid projections help the bacteria survive and adhere to the mucosa of the respiratory tract
A nurse is caring for a 6-year-old who needs continuous pulse oximetry monitoring. What nursing intervention should the nurse undertake? Secure the sensor tightly. Secure the sensor to the great toe. Remove the child's purple nail polish. Place a snugly fitting sock over the child's foot.
Remove the child's purple nail polish. Purple or other dark-color nail polish can cause inaccurate SaO2 measurements. Hence, the nurse should remove the child's purple nail polish. The sensor should not be secured too tightly, because its pressure can cause skin necrosis. The sensor is secured to the great toe in infants, but in a 6-year-old, it can be secured to the index finger. A snugly fitting sock is placed over the foot when used on infants to help anchor the device. In older children, taping the wire to the back of the hand keeps the device in place.
Which statement by the child diagnosed with asthma indicates successful long-term management?
The child's statement that levalbuterol, a rescue inhaler, has not been needed in months indicates successful long-term management of asthma, because successful management is marked by decreased need for rescue inhalers.
A 4-year-old boy needs to use a metered-dose inhaler for asthma. He cannot coordinate his breathing to use it effectively. What should the nurse suggest that he use? Spacer Nebulizer Peak expiratory flow meter Trial of chest physiotherapy
Spacer The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a device for administering medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters are used to measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.
Which technique by the nurse is appropriate while conducting respiratory assessment on a 2-year-old child?
Stand at the side of the child to palpate the chest
The nurse is caring for a child who presents with tachypnea, cyanosis, and periods of apnea. ABG results show pH 7.32, CO2 35, HCO3 18, paO2 78. The nurse also notes diminished breath sounds bilaterally. Labs are obtained. Which action should the nurse take?
Start oxygen inhalation
A mother brings her 3-week-old infant in to be examined. The child has nasal congestion and difficulty with breathing. Which action should the nurse do next?
Suction the nose
A 9-day-old infant presents with inflammation of the conjunctiva and associated itching and burning of the eye. Why might systemic antibiotics need to be considered in the care of this patient?
The 9-day-old might have a Chlamydial eye infection.
A child with cleft palate presents with a fever and is pulling at the ear. What does the nurse suspect might be the cause of these symptoms?
The child may have ear pain associated with an acute otitis media.
A 6-month-old infant presents with retractions and a sunken anterior fontanel. The nurse obtains the following vital signs: temperature 102.3o F, HR 148, RR 62, and oxygen saturation 89% on room air. Order the nursing interventions based on priority, with the highest priority being placed first.
The infant presents with signs of bronchiolitis and dehydration. The first action is to reposition the infant to maximize airflow and ensure the airway is open; then, apply oxygen for the low oxygen saturation of 89%, where IV access is needed to rehydrate the infant; finally, apply the cardio/resp monitor to continue monitoring vital signs.
The nurse is assessing a newborn with edema on the skull. The nurse needs to educate the parents on the condition that the child has. What assessments can the nurse make to determine what education to provide to the parents?
The nurse identifies the onset of the edema, noting if it was present at birth or if it occurred later.The nurse palpates the edema to see if it crosses the suture line
A parent and child come into the emergency department. The parent hands the nurse a tooth that the child lost after slipping and hitting his face on playground equipment approximately 10 minutes ago. What is the best action for the nurse to take?
The nurse should keep the tooth moist and alert a primary health care provider.
The nurse notices edema on the head of the newborn. What initial action should the nurse take?
The nurse should palpate the head closely to see if the edema crosses the suture lines.
Which rationale should the nurse provide to a child who reports an increase in wheezing and coughing at bedtime?
This can be caused from extra mucous in lungs
Two days after a child was discharged post tympanostomy tube placement, the parents call the nurse reporting a small amount of red drainage from the ear. Which is the nurse's best action?
This is a normal finding. Continue to monitor for heavy bleeding.
A child with asthma, who has been intubated and confined in ICU, is prescribed to undergo arterial blood gas (ABG) testing due to which reasons?
To determine acide-base balance and to measure the level of carbon dioxide.
A premature infant is about to be discharged home. The neonatologist orders palivizumab before discharge. What is the purpose of this medication? To prevent secondary bacterial infection To decrease toxicity of antiviral agents To prevent respiratory syncytial virus (RSV) infection To make isolation of the infant with RSV unnecessary
To prevent respiratory syncytial virus (RSV) infection Palivizumab (Synagis) is a monoclonal antibody specific for respiratory syncytial virus (RSV). The antibody is specific to RSV, not bacterial infection. Palivizumab will have no effect on the toxicity of antiviral agents. The reason for using this drug is to prevent RSV; it will therefore not affect the need to isolate the child if RSV infection develops.
Why should ibuprofen be given with food or milk? To reduce dehydration To suppress the bad taste To prevent stomach upset To enhance the drug action
To prevent stomach upset Ibuprofen irritates the stomach, so it is always advisable to take the drug with food or milk. Food or milk reduces dehydration. This action is irrespective of the action of the drug. However, when food or milk is given along with the drug, it protects the stomach from irritation. Food or milk is not given to suppress the bad taste, but to avoid side effects of the drug. The drug action does not depend on taking food or milk.
The nurse is caring for a 5-year-old child with hearing loss and speech difficulties. What should the nurse do to successfully communicate with the child?
Use a board that has pictures when communicating with the child.
A child with asthma is undergoing pulmonary function tests. What is the purpose of the peak expiratory flow rate test? Used to assess the severity of asthma Used to determine the cause of asthma Used to identify the triggers of asthma Used to confirm the diagnosis of asthma
Used to assess the severity of asthma The peak expiratory flow rate (PEFR) test is a measure of the maximal amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.
A 9-month-old male infant is diagnosed with pneumonia. The parents are confused about the diagnosis because the infant had RSV a few weeks ago. Which response by the nurse is appropriate to help the parents understand the etiology of pneumonia?
Viruses can cause pneumonia in children. Viruses like RSV, cause 80-85% of pneumonia
What is the most appropriate nursing intervention for a child after tonsillectomy? Watching for continuous swallowing Applying warm compresses to the throat Encouraging gargling to reduce discomfort Positioning the child on the back for sleeping
Watching for continuous swallowing Frequent swallowing is the most obvious early sign of bleeding from the surgical site in a child who has undergone tonsillectomy. Gargling should be avoided after a tonsillectomy because of the potential for trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, easing the pain. Heat or warmth would increase the risk of bleeding.
Which arterial blood gas result is indicative of metabolic alkalosis? pH ↓, PCO 2 normal, HCO 3 ↓ pH ↑, PCO 2 normal, HCO 3 ↑ pH ↓, PCO 2 ↑, HCO 3 normal pH ↑, PCO 2 ↓, HCO 3 normal
pH ↑, PCO 2 normal, HCO 3 ↑
