143 Module 2 - Upper Respiratory Tract Disorders (PRACTICE QUESTIONS)

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has: A. epiglottitis. B. asthma. C. cystic fibrosis. D. tuberculosis (TB).

A. The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.

A client has had a nasogastric tube in place for 6 days due to the development of paralytic ileus after surgery. In light of the prolonged presence of the nasogastric tube, the nurse should prioritize assessments related to which complication? A. Sinus infections B. Esophageal strictures C. Pharyngitis D. Laryngitis

ANS: A Rationale: Clients with nasotracheal and nasogastric tubes in place are at risk for development of sinus infections. Thus, accurate assessment of clients with these tubes is critical. Use of a nasogastric tube is not associated with the development of esophageal strictures, pharyngitis, or laryngitis.

A client visiting the clinic is diagnosed with acute sinusitis. To promote sinus drainage, the nurse should instruct the client to perform which action? A. Apply a cold pack to the affected area. B. Apply heat to the forehead. C. Perform postural drainage. D. Increase fluid intake.

ANS: C Rationale: Management of acute laryngitis includes resting the voice, avoiding irritants (including smoking), resting, and inhaling cool, not warm, steam or an aerosol. Fluid intake should be increased, not limited. Warm washcloths on the throat will not help relieve the symptoms of acute laryngitis.

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has: A. cystic fibrosis. B. epiglottitis. C. asthma. D. tuberculosis (TB).

B. The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.

After a tonsillectomy, a client is being prepared for discharge. The nurse should instruct the client to report which sign or symptom immediately? A. Difficulty talking B. Throat pain C. Difficulty swallowing D. Bleeding

D. The nurse should instruct the client to report bleeding immediately. Delayed bleeding may occur when the healing membrane separates from the underlying tissue — usually 7 to 10 days postoperatively. Difficulty swallowing and throat pain are expected after a tonsillectomy and typically are present even before the client is discharged. Sudden difficulty talking wouldn't occur after discharge if the client could talk normally at the time of discharge, because swelling doesn't take that long to develop.

A nursing student is discussing a client with viral pharyngitis with the preceptor at the walk-in clinic. What should the preceptor tell the student about nursing care for clients with viral pharyngitis? A. Teaching focuses on safe and effective use of antibiotics. B. The client should be preliminarily screened for surgery. C. Symptom management is the main focus of medical and nursing care. D. The focus of care is resting the voice to prevent chronic hoarseness.

ANS: C Rationale: Nursing care for clients with viral pharyngitis focuses on symptomatic management. Antibiotics are not prescribed for viral etiologies. Surgery is not indicated in the treatment of viral pharyngitis. Chronic hoarseness is not a common sequela of viral pharyngitis, so teaching ways to prevent it would be of no use in this instance.

A mother calls the clinic asking for a prescription for amoxicillin for her 2-year-old child, who has what the nurse suspects to be viral rhinitis. What should the nurse explain to this mother? A. "I will relay your request promptly to the doctor, but I suspect that the doctor won't get back to you if it's a cold." B. "I'll certainly inform the doctor, but if it is a cold, antibiotics won't be used because they do not affect the virus." C. "I'll phone in the prescription for you since it can be

ANS: B Rationale: Antimicrobial agents (antibiotics) should not be used because they do not affect the virus or reduce the incidence of bacterial complications. In addition, their inappropriate use has been implicated in development of organisms resistant to therapy. It would be inappropriate to tell the client that the health care provider will not respond to the request.

A client is being treated for bacterial pharyngitis. Which of the following should the nurse recommend when promoting the client's nutrition during treatment? A. A 1.5 L/day fluid restriction B. A high-potassium, low-sodium diet C. A liquid or soft diet D. A high-protein diet

ANS: C Rationale: A liquid or soft diet is provided during the acute stage of the disease, depending on the client's appetite and the degree of discomfort that occurs with swallowing. The client is encouraged to drink as much fluid as possible (at least 2 to 3 L/day). There is no need for increased potassium or protein intake.

It is cold season, and the school nurse has been asked to provide an educational event for the parent teacher organization of the local elementary school. Which information should the nurse include in education about the treatment of pharyngitis? A. Pharyngitis is more common in children whose immunizations are not up to date. B. There are no effective, evidence-based treatments for pharyngitis. C. Use of warm saline gargles or throat irrigations can relieve symptoms. D. Heat may increase the sp

ANS: C Rationale: Depending on the severity of the pharyngitis and the degree of pain, warm saline gargles or throat irrigations are used. Applying heat to the throat would reduce, not increase, spasms in the pharyngeal muscles. There is no evidence that pharyngitis is more common in children whose immunizations are not up to date. Warm saline gargles and throat irrigations are evidence-based treatments for pharyngitis.

The nurse has been caring for a client who has been prescribed an antibiotic for pharyngitis and has been instructed to take the antibiotic for 10 days. On day 4, the client is feeling better and plans to stop taking the medication. What information should the nurse provide to this client? A. Keep the remaining tablets for an infection at a later time. B. Discontinue the medications if the fever is gone. C. Dispose of the remaining medication in a biohazard receptacle. D. Finish the full course

ANS: D Rationale: The nurse informs the client about the need to take the full course of any prescribed antibiotic. Antibiotics should be taken for the entire prescribed course to eliminate the microorganisms. A client should never be instructed to keep leftover antibiotics for use at a later time. Even if the fever or other symptoms are gone, the medications should be continued. Antibiotics do not need to be disposed of in a biohazard receptacle, though they should be discarded appropriately.

The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which disorder? A. Epiglottitis B. Laryngotracheobronchitis C. Spasmodic laryngitis D. Tonsillitis

A. The child with epiglottitis may have had a mild upper respiratory infection before the development of a sore throat, and then became anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. The child with acute laryngotracheobronchitis develops hoarseness and a barking cough with a fever, cyanosis, heart failure; acute respiratory embarrassment can also result.

A nurse has pharyngitis and will be providing self care at home. It is most important for the nurse to A. Seek medical help if he experiences inability to swallow B. Stay in bed when experiencing a fever C. Place an ice collar on the throat to relieve soreness D. Properly dispose of used tissues

A. The client should seek medical assistance if swallowing is impaired to prevent aspiration. Following Maslow's hierarchy of needs, airway clearance is the highest priority.

A 2-year-old child has had a common cold for 4 days. The caregiver calls the nurse in the emergency department at 2 a.m. on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; the child seems blue around the mouth. The nurse would appropriately recommend what action to the caregiver? A. "Bundle the child up and take the child out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief." B. "Brin

B. Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104° F (40° C) to 105° F (40.6° C). As the disease progresses, marked laryngeal edema occurs and the child's breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory distress can result. The child needs to be treated immediately. Humidified air is helpful in reducing laryngospasm; humidifiers may be used in the child's bedroom to provide high humidity. Cool humidifiers are recommended, but vaporizers also may be used. Taking the child into the bathroom and opening the hot water taps with the door closed is a quick method for providing moist air, if the water runs hot enough. Sometimes the spasm is relieved by exposure to cold air: for instance, when the child is taken out into the night to go to the emergency department or to

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress? A. 11-month-old infant with nasopharyngitis B. 2-year-old child with epiglottitis C. 16-year-old adolescent with asthma D. 3-year-old child with croup

B. Epiglottitis is a medical emergency due to the swelling of the epiglottis covering the larynx. This client needs frequent assessment for respiratory distress, especially since young children have smaller, more compliant airways. The 3-year-old child has more developed respiratory passages than a 2-year-old child, and although croup may cause respiratory distress, the likelihood of airway obstruction is lower when compared to epiglottitis. The 11-month-old infant has a common cold, typically from a virus. The 16-year-old adolescent with asthma has fully developed respiratory airways, which are less likely to be obstructed.

A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother? A. Have the boy drink a full glass of water to clear out the mucus. B. Run a hot shower to fill the bathroom with steam and have the boy stay there. C. Administer an analgesic to the boy. D. Administer cough syrup to the boy.

B. One emergency method of relieving croup symptoms is for a parent to run the shower or hot water tap in a bathroom until the room fills with steam, then keep the child in this warm, moist environment as this relaxes the airway tissues and widens the bronchi lumens. If this does not relieve symptoms, parents should bring the child to an emergency department for further evaluation and care. Caution parents not to give cough syrup routinely to children as many produce little effect and the risk of overdose, incorrect dosing, and adverse events is greater than the benefit of the syrup. An analgesic might help alleviate pain due to inflammation and irritation of the throat from coughing, but it is not the priority intervention in this case. Drinking would likely be painful for this child and would not provide lasting benefit.