Ch. 40 Ricci

What is a complication of cystic fibrosis? A. pneumothorax B. urinary tract infection C. kidney disease D. Crohn disease

A. pneumothorax Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age. Crohn disease is a gastrointestinal disorder that is not associated with cystic fibrosis. Urinary tract infection and kidney disease are also not associated with CF. Most of the problems and complications associated with CF relate to the respiratory system, the gastrointestinal system, and infectious disorders.

Which acute respiratory condition is the most common in early childhood? A. pneumonia B. croup C. asthma D. bronchiolitis

B. croup Croup is the most common acute respiratory condition in early childhood (3 months to 3 years). The cardinal sign is a "barking cough." Croup is an upper airway obstruction caused by some type of inflammation. Asthma may be caused by some allergen trigger and causes bronchoconstriction and inflammation of the lower airways. Pneumonia and bronchiolitis are infectious disorders caused by bacteria or viruses; they affect lower airways.

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? A. Open capsule and sprinkle on food. B. Shake inhaler and hold close to mouth. C. Draw up in syringe and administer subcutaneously. D. Pour in medication cup and have the child drink.

A. Open capsule and sprinkle on food. Pancreatic enzymes should be administered at all meals and snacks to promote adequate digestion and absorption of nutrients. They are supplied in capsule form. For the infant and young child, they can be opened and sprinkled on foods such cereal, pudding, or applesauce. They also can be swallowed whole. They are not supplied in liquid form, so the child could not take them in a medication cup. They are not supplied for injection or inhalation, only oral use.

In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason? A. Relief of acute symptoms B. Management of chronic pain C. To stabilize the cell membranes D. Prevention of mild symptoms

A. Relief of acute symptoms Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Bronchodilators are not effective for pain.

How is wheezing in children best heard? A. with the child supine B. as the child exhales C. as the child cries D. without a stethoscope

B. as the child exhales Wheezing occurs from obstruction in the lower trachea and bronchioles. It is an expiratory sound from difficulty pushing air through a narrowed airway. When there is obstruction of the bronchioles—as with such disease processes as asthma and cystic fibrosis—wheezing will not clear with coughing. A stethoscope is necessary to auscultate lung sounds and hear wheezing. If a child is wheezing it can be heard with the child in any position. Crying makes the lung sounds harder to hear.

An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition? A. Provide high caloric meals to the client's liking. B. Delay pancreatic enzymes until food enters the small intestine. C. Encourage high calorie, high protein snacks. D. Limit sodium to a 2 gram sodium restricted diet

C. Encourage high calorie, high protein snacks. The best nursing intervention is a high calorie, high protein snack. Calories can be obtained from non-nutritious foods. It is not only that the client needs calories for energy, but nutrition needs to be present. Pancreatic enzymes aid in digestion so they need to be available for foods; thus they are given prior to ingestion. Sodium is encouraged due to the high sodium loss.

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child? A. Purified protein derivative test B. Sweat sodium chloride test C. Blood culture and sensitivity D. Pulmonary functions test

D. Pulmonary functions test Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection.

The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method? A. Directly into the vein B. Through a gastrostomy tube C. Using a nebulizer D. Sprinkled onto the food

D. Sprinkled onto the food Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler [MDI], which is a hand-held plastic device that delivers a premeasured dose.

The nurse is planning care for a 6-year-old returning from a tonsillectomy and adenoidectomy. Which nursing intervention is most helpful in meeting the client goal of ingestion of 75 cc of fluid each hour? A. Offer to make a milkshake B. Obtain a cherry popsicle C. Offer pain medication as scheduled D. Distract the client with a board game

C. Offer pain medication as scheduled One barrier to the child drinking fluids is that the client is in pain. Offering pain medication as scheduled helps to control pain. Cherry popsicles are not allowed as the coloring could be misinterpreted as blood. Distraction is good, and playing can provide motivation to drink, but not if it is painful. Milkshakes are no longer offered postoperatively as milk products cling to the surgical site.

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be: A. impaired digestive activity. B. high sodium chloride concentration in the sweat. C. chronic lack of oxygen. D. decreased respiratory capacity.

C. chronic lack of oxygen. In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.

The nurse is teaching a child and their parents how best to manage the child's asthma. Which piece of equipment will be most helpful in determining the status of this child's airway? A. nebulizer B. inhaler C. peak flow meter D. incentive spirometer

C. peak flow meter The peak flow meter provides the most reliable early sign of an asthma episode. Most episodes begin gradually, and a drop in peak flow can alert the child and parents to begin medications before symptoms actually are noticeable. A nebulizer and inhaler treat symptoms. An incentive spirometer is used for lung expansion, especially after surgery.

The nurse is caring for an 11-year-old child with pneumonia who is exhibiting an increased work of breathing. Which intervention is the priority? A. providing supplemental oxygen as prescribed B. administering analgesics as prescribed C. positioning the child in Fowler position D. administering intravenous fluids as prescribed

C. positioning the child in Fowler position Positioning the child in Fowler position helps to open the airway and provide more room for lung expansion, resulting in more effective breathing patterns while supplemental oxygen and intravenous fluids are administered. Administering intravenous fluids and administering oxygen are appropriate actions after the child is placed in a comfortable position. Analgesics may be prescribed and administered if the child is experiencing pain from coughing.

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? A. Urging the child to continue to take oral fluids B. Administering an oral analgesic C. Teaching the child to take long, slow breaths D. Assisting with racemic epinephrine nebulizer therapy

D. Assisting with racemic epinephrine nebulizer therapy Croup is a viral infection that causes inflammation and edema of the larynx, trachea, and bronchi. One form of treatment is the use of nebulized racemic epinephrine. Racemic epinephrine is an alpha adrenergic agent. It works on the mucosal vasoconstriction to reduce the edema. This increases the lumen of airways, allowing for better intake of air. A child in respiratory distress is unable to take slow, deep breaths. The child should not be offered fluids because this is an aspiration risk and analgesics will not reduce swelling.

Which nursing suggestion is the most helpful when discussing frequent allergic rhinitis (hay fever) attacks with a 12-year-old client and parent? A. Avoid offending allergen if at all possible. B. Take an antihistamine before known allergen exposure. C. Offer homeopathic suggestions on decreasing symptoms. D. Consider identification of allergen and hyposensitization.

D. Consider identification of allergen and hyposensitization. The most helpful discussion with a client who is experiencing frequent allergic rhinitis (hay fever) attacks is identification of the allergen and then possible hyposensitization. Many individuals have allergy symptoms even when taking allergy relief medications and utilizing homeopathic remedies. Some allergies such as those to outdoor grass and pollens are difficult to avoid.

The nurse is assessing the site of a client's Mantoux skin test. The client is HIV positive. The nurse notes the induration to be 10 mm. Which action will the nurse take next? A. Determine if the client has been exposed to tuberculosis. B. Place the client on droplet precaution. C. Document the finding in the client's medical record D. Schedule the client for a chest x-ray.

D. Schedule the client for a chest x-ray. Diagnosis of tuberculosis (TB) is confirmed with a positive Mantoux test. An induration of 5 mm is considered positive for clients with HIV. If a client's Mantoux test is positive, the client is next scheduled for a chest x-ray to look for lung changes related to TB, or for a sputum smear test. These tests are done to determine if a client has latent or active TB, which will then determine the course of action for the client. The nurse will document the results; however, documentation is not priority. There is no need to ask about exposure since the test results indicate exposure. The client with active TB will be placed on airborne precautions.

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia? A. The child is a triplet. B. The child was a postmaturity date infant. C. The child has diabetes. D. The child attends day care.

D. The child attends day care. Attending day care is a known risk factor for pneumonia. Being a triplet is a factor for bronchiolitis. Prematurity rather than postmaturity is a risk factor for pneumonia. Diabetes is a risk factor for influenza.

The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment? A. The child is pale and has vomited. B. The child has pale, elevated patches on the skin. C. The child is irritable and tachycardiac. D. The child is in tripod position.

D. The child is in tripod position. Inflammation and swelling of the epiglottis and surrounding structures are common in children ages 2 to 7 years. The child will attempt to improve his/her airway by sitting forward and extending the neck forward with the jaw up, in a "sniffing position" (tripod position). Being pale, vomiting, and having elevated patches on the skin are not associated with epiglottis. Stridor, tachycardia, and the rapid onset are classical signs of epiglottitis.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? A. The child will maintain a clear airway. B. The child will have adequate fluid intake. C. The child and family will connect with families living with the same diagnosis. D. The child and family will improve knowledge and understanding of varied pharmacologic options. E. The child will maintain adequate pain control.

A. The child will maintain a clear airway. B. The child will have adequate fluid intake. Treatment and management of asthma centers around avoiding triggers and controlling inflammatory episodes. Keeping the airway open is always the priority (ABCs). The next physiologic need is adequate fluid intake. These are priorities over psychosocial considerations such as connecting with other families. Pain is not normally an issue. The family does not need to understand every available pharmacologic option. They need to understand the action plan for their child.

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. epiglottitis. 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.

What is a symptom of bacterial pharyngitis? A. fever B. rhinitis C. symptoms have gradual onset D. white blood cell (WBC) count in normal range

A. fever Bacterial pharyngitis is most often caused by group A streptococcus. Fever is a symptom of bacterial pharyngitis. Other symptoms are an elevated WBC count, abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes. It must be treated with an antibiotic. Penicillin is the drug of choice. Symptoms of rhinitis, a normal WBC count, and slow onset are indicative of viral pharyngitis.

A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as: A. funnel. B. cylindrical. C. oval. D. spherical.

A. funnel. In infants and children (younger than the age of 10 years), the cricoid cartilage is underdeveloped, resulting in laryngeal narrowing and a funnel-shaped larynx. In teenagers and adults, the larynx is cylindrical and fairly uniform in width.

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful? A. "RSV season occurs primarily April through September." B. "Exposure to second- or third-hand smoke increases the risk for developing RSV." C. "Infants are less affected by RSV than older children." D. "Early initiation of antibiotics can lessen the severity of the infection."

B. "Exposure to second- or third-hand smoke increases the risk for developing RSV." An infant exposed to second- or third-hand smoke is at risk for developing respiratory syncytial virus (RSV). RSV season runs from September through April. Current treatment recommendations for RSV do not include antibiotics. Infants are susceptible to RSV much more than older children.

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete? A. Arterial blood gas (ABG) B. Complete blood count (CBC) C. Electroencephalogram (EEG) D. Pulmonary function test

A. Arterial blood gas (ABG) The most useful diagnostic test in respiratory distress is an ABG. Knowing normal blood gas values for children is very important for evaluation and proper treatment. A CBC is a blood test used to test for disorders including anemia, infection, and leukemia. An EEG is a test used to find problems related to electrical activity of the brain. A pulmonary function test is performed to evaluate the respiratory system. Based on the findings, the child is experiencing respiratory distress and has an elevated temperature. Airway and breathing are priority over an elevated temperature. The child's blood pressure is within normal range for this age.

The nurse is mentoring a new graduate who is completing a respiratory assessment on a client with suspected epiglottitis. Which action by the new graduate would require clarification? A. Assessment of the nasopharynx B. Humidified air C. Continuous pulse oximetry D. Parenteral antibiotic administration

A. Assessment of the nasopharynx Assessment of the nasopharynx, especially with a tongue blade, is contraindicated as it may initiate a gag reflex and complete obstruction may occur. The mentoring nurse would advise the nursing student to listen to the quality of the client's respiration to document status. Humidified air, continuous pulse oximetry and parenteral antibiotic administration are treatment options for the client with suspected epiglottitis.

Which nursing diagnosis would best apply to a child with allergic rhinitis? A. Pain related to sinus edema and headache B. Ineffective tissue perfusion related to frequent nosebleeds C. Disturbed self-esteem related to inherited tendency for illness D. Risk for infection related to blocked eustachian tubes

A. Pain related to sinus edema and headache Many children with allergic rhinitis develop sinus headaches from edema of the upper airway. In younger children the maxillary and ethmoid sinuses are involved. In children aged 10 years and older the frontal sinuses are also involved. The pain comes from mucosal swelling, decreased ciliary movement and a thickened nasal discharge. Nosebleeds are not common with either allergic rhinitis or sinusitis nor are either of these inherited. The eustachian tubes would cause symptoms of otitis, not of the nasal passage.

The nurse is caring for a child with thickened pulmonary secretions. Which action(s) would the nurse use to assist the child breathe with less effort? Select all that apply. A. Perform chest physiotherapy B. Avoid humidification of oxygen if oxygen is in use C. Encourage oral fluids D. Assess pulse oximetry every 12 hours E. Observe for cyanosis and labored breathing every 12 hours

A. Perform chest physiotherapy C. Encourage oral fluids

The nurse enters the room of a client who has pneumonia. The client has a low oxygen level and is working hard to breathe. The nurse raises the head of the bed and has the client tilt her head back. What is the next appropriate action by the nurse? A. Provide oxygen therapy to the client. B. Give the client a drink of water. C. Take the client's temperature. D. Tell her mother she is fine and to go get some lunch.

A. Provide oxygen therapy to the client. Oxygen is the indicated treatment for hypoxia. Patency and opening of the airway is also important. The oxygen saturation level should be above 93%. The other choices will not increase the client's blood oxygen level or decrease her work of breathing.

The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child? A. Providing fluids by straw B. Applying an ice collar C. Placing the child on his side D. Discouraging the child from coughing

A. Providing fluids by straw Providing fluids by straw may cause trauma to the surgical site and should be avoided. Applying an ice collar, if ordered, helps relieve pain. Placing the child on his side, until he is fully awake, facilitates safe drainage of secretions. The child should be discouraged from coughing, clearing his throat, and blowing his nose to avoid trauma to the surgical site.

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child? A. Respiratory stridor B. Wheezing in the bases C. Rales in the middle lobe D. Rhonchi throughout the lung

A. Respiratory stridor Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe. A wheeze is a high-pitched sound heard on auscultation, usually on expiration. It is due to obstruction in the lower trachea or bronchioles. Rales are crackling sounds heard on auscultation when the alveoli become fluid filled. Rhonchi is a snoring sound heard throughout the lung field when inflammation occurs.

The nurse is trying to pick a method to teach a 4-year-old with cystic fibrosis a good way to exercise her lungs. Which would be the developmentally correct strategy to help this client? A. Teach the client to blow bubbles. B. Teach the client to hop on one foot. C. Teach the client to jump rope. D. Teach the client to ride a bike.

A. Teach the client to blow bubbles. A helpful exercise for the client would be to blow bubbles, a horn, or a pinwheel. This would help her exercise her lung capacity and is age-appropriate for early childhood. The other exercises are all normal activities for school-aged children.

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? A. "We will keep an albuterol inhaler with our child at all times." B. "It is okay for our child to do chores such as sweeping the floor." C. "We will both enroll in smoking cessation classes." D. "Our family dog will need to go live with a grandparent."

B. "It is okay for our child to do chores such as sweeping the floor." Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement. An inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.

A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care? A. The infant will attain oxygen saturation of 90% on room air. B. The infant's airway will remain clear and free of mucus. C. The infant's breathing will be less labored. D. The infant will have decreased nasal stuffiness.

B. The infant's airway will remain clear and free of mucus. Keeping the infant's airway clear is the top priority. An O2 saturation of 90% on room air is minimally acceptable. It is important that the infant's breathing be less labored and that there is decreased nasal stuffiness, but having the airway clear and free of mucus is most important.

The nurse is doing an in-service training with nurses working with families who may be in situations that create high-risk health situations for their children. The nurse explains that children of caregivers with which situation should be tested annually for tuberculosis? A. a caregiver who has been serving in the military in the Middle East B. a caregiver whose family is homeless C. a caregiver who immigrated from Africa before her child was born D. a caregiver with a diagnosis of HIV

B. a caregiver whose family is homeless Tuberculosis screening is recommended annually for children in high-risk situations or communities, including the following: a family in which there is an active case of TB; Native American children; and children who recently immigrated from Central or South America, the Caribbean, Africa, Asia, or the Middle East. Other high-risk children are those infected with HIV, those who are homeless or live in overcrowded conditions, and those immunosuppressed from any cause.

The young child is wearing a nasal cannula. The oxygen is set at 3 L/minute. Calculate the percentage of oxygen the child is receiving. Record your answer using a whole number.

33 Room air is 21%. Each 1 liter of oxygen flow is equal to an additional 4% of oxygen. The child is receiving 3 liters of oxygen. 21% (room air) + 3(4%) = 33% of oxygen.

The nurse is providing discharge teaching to the parents of a child who had a tonsillectomy. Which statement(s) by the parents indicate learning has occurred? Select all that apply. A. "Fluids are very important. Our child loves popsicles so we will get a variety of flavors, except cherry and strawberry." B. "We can use an ice collar on the throat as long as we do not leave it on too long at a time." C. "Milkshakes should be drunk with straws so that not too much is swallowed at a time." D. "Warm soup should be easy to swallow and will help with controlling the pain." E. "If our child starts swallowing a lot, we may need to call the health care provider."

A. "Fluids are very important. Our child loves popsicles so we will get a variety of flavors, except cherry and strawberry." B. "We can use an ice collar on the throat as long as we do not leave it on too long at a time." E. "If our child starts swallowing a lot, we may need to call the health care provider." Excessive swallowing is an indication of bleeding and should be reported to the health care provider. Fluids are very important, but red fluids should be avoided as they can be mistaken for blood. Ice collars can be used for pain and to decrease bleeding, but they should not be left on the throat for extended periods. Hot or warm liquids and the use of straws would cause bleeding to occur and should be avoided.

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first? A. "Have him use his short-acting bronchodilator right away." B. "You need to take him to the emergency department right away." C. "Continue to watch his PEFR readings and call back if they go below 40%." D. "Have him use his low-dose steroid inhaler now and again in 15 minutes."

A. "Have him use his short-acting bronchodilator right away." The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.

Which education will the nurse provide to parents of a 1-month-old infant recently diagnosed with congenital laryngomalacia? Select all that apply. A. "Most children improve as the cartilage becomes stronger." B. "Return to the clinic if your infant doesn't improve in 1 week." C. "Your infant may need to take frequent breaks when feeding." D. "Seek medical care if you notice signs of a respiratory illness." E. "This disorder will require life-long treatment and medical care."

A. "Most children improve as the cartilage becomes stronger." C. "Your infant may need to take frequent breaks when feeding." D. "Seek medical care if you notice signs of a respiratory illness." Congenital laryngomalacia results when an infant's laryngeal structure is weaker and more flexible than normal. There is no treatment for congenital laryngomalacia, besides slow feedings and frequent rest periods. For this reason, parents would not need to bring the infant back if there was no improvement within 1 week. Most children will outgrow this disorder around 1 year of age as the cartilage of the larynx becomes stronger. Parents should be advised to seek medical care at the first signs of an upper respiratory illness because the infant could develop a more severe laryngeal collapse.

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver? A. "Pollen is a cause of these symptoms. Allergy medicine may help your child." B. "Penicillin is the treatment of choice. Be sure your child takes the entire prescribed amount." C. "Your child needs to avoid peanuts until further testing is completed." D. "When bathing, your child needs to use a mild soap, free of dye and fragrance."

A. "Pollen is a cause of these symptoms. Allergy medicine may help your child." The allergens that usually cause allergic rhinitis (hay fever) are pollens or molds rather than foods or drugs. Over-the-counter or prescription allergy medications may help provide relief for these clients when taken. Peanuts and soap are not associated with allergic rhinitis. Antibiotics are used to treat bacterial infections, not allergic responses in clients.

The nurse has assessed four clients. Which assessment finding warrants immediate action? A. 1-week old newborn with nasal congestion B. 4-year-old child with enlarged tonsillar and adenoidal tissue C. 6-year-old child who is consistently mouth breathing D. 10-year-old child with extreme sinus pressure and headache

A. 1-week old newborn with nasal congestion Until 4 weeks of age, newborns are obligatory nose breathers and breathe only through their mouths when they are crying. The newborn cannot automatically open the mouth to breathe if the nose is obstructed; therefore, a newborn with nasal congestion needs immediate action. Also, the newborn and young infant have very small nasal passages, so when excess mucus is present, airway obstruction is more likely. Mouth breathing may occur when a large amount of nasal congestion is present. Although this finding is abnormal and warrants follow up, in a 6-year-old child this finding does not warrant immediate action. Through early school-age, children tend to have enlarged tonsillar and adenoidal tissue even in the absence of illness; therefore, this finding is normal in a 4-year-old child and does not warrant immediate follow up. The frontal sinuses and the sphenoid sinuses develop by age 6 to 8 years; therefore a 10-year-old child may develop a sinus infection. Although these symptoms warrant follow up, immediate action is not necessary.

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? A. Administer the bronchodilator via a nebulizer. B. Give the antibiotic as prescribed. C.. Apply oxygen at 2 liters via a nasal cannula. D. Apply a cardiac monitor to the child.

A. Administer the bronchodilator via a nebulizer. The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.

The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the order in which the nurse should administer these medications as the child's condition worsens. A. Albuterol as needed B. Medium-dose inhaled corticosteroid and salmeterol C. Medium-dose inhaled corticosteroid D. Low-dose inhaled corticosteroid

A. Albuterol as needed D. Low-dose inhaled corticosteroid B. Medium-dose inhaled corticosteroid C. Medium-dose inhaled corticosteroid and salmeterol

Which family member would be restricted from the room of an infant receiving ribavirin? A. Any pregnant female B. Any sibling under 18 years of age C. Anyone who is immunocompromised D. Anyone over the age of 65

A. Any pregnant female Ribavirin is classified as a category X drug, signaling a high risk for teratogenicity. The medication is administered by mist which may escape into the room. No pregnant female should be admitted in the room. The other family members may be present.

The nurse is caring for an infant whose oxygen saturation levels frequently drop below 90%. Which data is most important to relate to the health care provider? A. Blood gases B. Vital signs C. Respiratory depth and pattern D. Breath sounds

A. Blood gases Infants may respond to low blood oxygen levels with increased respirations followed by a period of apnea. Conditions such as bronchopulmonary dysplasia (chronic lung disease), pneumonia, and bronchiolitis can put infants at risk. The health care provider needs to be kept updated on blood oxygen levels. Vital signs, respiratory depth, and pattern, and breath sounds are basic nursing assessments that provide helpful data on the respiratory system, but these data are not as important as the laboratory results.

The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent and immediate intervention? A. Compliance with therapy is diminished. B. The family becomes overvigilant. C. The child feels fearful and isolated. D. Siblings are jealous and worried.

A. Compliance with therapy is diminished. Until the family adjusts to the demands of the disease, they can become overwhelmed and exhausted, leading to noncompliance, resulting in worsening of symptoms. Typical challenges to the family are becoming overvigilant, the child feeling fearful and isolated, and the siblings being jealous or worried, but these are not a priority over the noncompliance.

What is the most common debilitating disease of childhood among those of European descent? A. Cystic fibrosis B. Asthma C. Pneumonia D. BPD

A. Cystic fibrosis Cystic fibrosis is the most common debilitating disease of childhood among those of European descent. Medical advances in recent years have greatly increased the length and quality of life for affected children, with median age for survival being the late 30s.

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family? A. Encourage everyone in the family to use good handwashing techniques. B. Watch out for signs that family members are overly stressed. C. Be sure the child exercises daily. D. Avoid overprotecting the child.

A. Encourage everyone in the family to use good handwashing techniques. The child with cystic fibrosis has low resistance, especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good handwashing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.

The nurse is carefully assessing the infant diagnosed with bacterial pneumonia whose respiratory status is declining. Which nursing findings are reported immediately to the charge nurse and health care provider? Select all that apply. A. Flaring of the nostrils B. Circumoral cyanosis C. Respiratory rate of 44 breaths/min D. Temperature 104°F (40°C) E. Intercostal retractions

A. Flaring of the nostrils B. Circumoral cyanosis D. Temperature 104°F (40°C) E. Intercostal retractions Assessment findings which need to be reported immediately (as they indicate a declining respiratory status) include flaring of the nostrils, circumoral cyanosis and intercostal retractions. A temperature of 104°F (40°C) is also reported. A respiratory rate of 44 breaths/min is within normal limits for an infant.

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, what would the nurse expect to be used to deliver the highest concentration of oxygen to the child? A. nonrebreather (face) mask B. oxygen hood C. partial rebreather mask D. Venturi mask

A. nonrebreather (face) mask A nonrebreather (face) mask provides 95% oxygen concentration. An oxygen hood provides up to 80% to 90% oxygen concentration. This delivery method is used only for infants. A partial rebreather mask provides 50% to 60% oxygen concentration. A Venturi mask provides 24% to 50% oxygen concentration.

After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify what as a common allergen for asthma? A. shellfish B. indoor molds C. pet dander D. dust mites

A. shellfish Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds, pet dander, and dust mites are common asthma triggers.

The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client? A. tachycardia B. hypoactivity C. bronchial muscle relaxation D. increased appetite

A. tachycardia Adverse reactions of albuterol, a bronchodilator, include tachycardia, nervousness, tremors, hyperactivity, malaise, palpitations, increased appetite, hypokalemia, and muscle cramps. The expected action of albuterol is to relax bronchial, uterine, and vascular smooth muscle by stimulating beta-2 receptors. While tachycardia and increased appetite are both adverse reactions, tachycardia happens abruptly following the first dose and can be alarming for clients. It is a priority for the nurse to provide education on this over a slower, less concerning change.

A nurse is demonstrating to parents how to use normal saline nose drops and how to suction nasal secretions from the nose of an infant. The nurse positions the infant correctly and then performs the procedure. Place the steps below in the order that the nurse would complete them. Use all options. A. Release the pressure on the bulb syringe. B. Instill several drops of saline into one of the infant's nostrils. C. Compress the sides of the bulb syringe completely. D. Remove the syringe from the nose and empty the contents. E. Place the rubber tip of the bulb syringe into the nose.

B. Instill several drops of saline into one of the infant's nostrils. C. Compress the sides of the bulb syringe completely. E. Place the rubber tip of the bulb syringe into the nose. A. Release the pressure on the bulb syringe. D. Remove the syringe from the nose and empty the contents. When using a bulb syringe with saline nose drops to suction secretions, after correctly positioning the infant, the nurse would do the following: instill several drops of saline solution in one of the infant's nostrils; compress the sides of the bulb syringe completely; place the rubber tip in the infant's nose; release pressure on the bulb; and then remove the syringe and squeeze bulb over tissue or the sink to empty it of secretions.

What statement is the most accurate regarding the structure and function of the newborn's respiratory system? A. The diameter of the child's trachea is the same as that of adults. B. Most infants are nasal breathers rather than mouth breathers. C. The respiratory tract in the child is fully developed by age 2. D. Infants and young children have smaller tongues in proportion to their mouths.

B. Most infants are nasal breathers rather than mouth breathers. Newborns are obligatory nose breathers until at least 4 weeks of age. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. During the first 5 years of life, infants and young children have larger tongues in proportion to their mouths.

A 6-month-old infant who was born premature is being seen for a follow-up examination. The child is to receive an intramuscular injection monthly through the winter and spring season. Which drug would the nurse expect to be ordered? A. Nedocromil B. Palivizumab C. Amantadine D. fZanamivir

B. Palivizumab Palivizumab is a monoclonal antibody used for prevention of serious lower respiratory syncytial virus (RSV) disease. RSV bronchiolitis occurs most often in infants and toddlers, with a peak incidence around 6 months of age. Infants born prematurely are more at risk. The peak occurrence of bronchiolitis is in the winter and spring. Nedocromil decreases the frequency and intensity of allergic reactions. Amantadine is used to treat and prevent influenza A. Zanamivir is used to treat and prevent influenza A.

The nurse is caring for a child with a history of asthma who presents to the emergency department with wheezing, tachypnea, and dyspnea. What will the nurse do first? A. Ask what may have triggered the attack. B. Place the child in a high-Fowler position. C. Assess the child's pulse oximetry reading. D. Apply oxygen via nasal cannula at 2 liters.

B. Place the child in a high-Fowler position. The nurse will first elevate the head of the bed to improve the child's ability to breathe. Elevating the head of the bed allows the diaphragm to expand, consequently maximizing ventilation and oxygenation. After elevating the head of the bed, the nurse will assess the pulse oximetry and apply oxygen if needed. After stabilizing the child, the nurse can ask what may have triggered the asthma attack.

A hospitalized toddler being treated for pneumonia requires supplemental oxygen. The respiratory rate is 44 breaths/min and the oxygen saturation is 90% on room air. Which oxygen delivery device would be best for this toddler? A. simple face mask B. nasal cannula C. partial rebreather D. nonrebreather

B. nasal cannula The best form of oxygen delivery for this toddler is a nasal cannula. The nasal cannula is the most comfortable and the most likely to stay in place. The nasal cannula provides up to 44% more oxygen delivery than room air. Oxygen can be delivered up to 4 liters via nasal cannula. The child can eat or talk with the nasal cannula in place. The oxygen should be humidified. The simple face mask can provide 35% to 60% of oxygen via a flow rate of 6 to 10 liters. It is used when there is increasing respiratory difficulty. Children have difficulty keeping it in place. A nonrebreather (face) mask is used for serious respiratory problems. It can deliver 95% oxygen via 10 to 12 liters flow. A partial rebreather mask is also needed when an increased amount of oxygen delivery is needed. This mask can provide 50% to 60% oxygen set at 10 to 12 liters flow.

The nurse is caring for a 3-year-old girl who is cyanotic and breathing rapidly. Which intervention is best to relieve these symptoms? A. suction B. oxygen administration C. saline lavage D. saline gargles

B. oxygen administration Oxygen administration is indicated for the treatment of hypoxemia. Suctioning removes excess secretions from the airway caused by colds or flu. Saline lavage loosens mucus that may be blocking the airway so that it may be suctioned out. Saline gargles are indicated for relieving throat pain as with pharyngitis or tonsillitis.

The nurse is caring for a 10-year-old girl with allergic rhinitis. Which intervention helps prevent secondary bacterial infection? A. educating parents about oral antihistamines B. using normal saline nasal washes C. discussing anti-inflammatory nasal sprays D. teaching parents how to avoid allergens

B. using normal saline nasal washes Using nasal washes to improve air flow will help prevent secondary bacterial infection by preventing the mucus from becoming thick and immobile. Teaching parents how to avoid allergens such as tobacco smoke, dust mites, and molds helps prevent recurrence of allergic rhinitis. Discussing anti-inflammatory nasal sprays and teaching parents about using oral antihistamines would help in prevention and treatment of the disorder.

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

C. 2-year-old child with epiglottitis 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.

The nurse working at the child community clinic must administer the influenza vaccine to the high-risk children first. Which child would she choose first? A. 12-month-old client who is very healthy B. 21-month-old client who has a cold C. 23-month-old client who had heart surgery as an infant for a defect D. 22-month-old client who has a wound from touching a hot pan at home

C. 23-month-old client who had heart surgery as an infant for a defect Children who are considered high risk and could benefit from the influenza vaccine are: immunocompromised have a chronic pulmonary disease have had a congenital abnormality chronic renal or metabolic disease sickle-cell disease HIV any type of neurological disorder (seizures) The other choices would be considered normal and the child is not at high risk.

The nurse is caring for a 6-month-old infant who has chronic apneic episodes. Which intervention should the nurse place in the plan of care? A. Sit the infant upright in the infant seat to keep the airway open. B. Teach the infant's parents how to perform infant cardiopulmonary resuscitation (CPR). C. Place on a cardiopulmonary monitor and do frequent assessments. D. Recommend surgical removal of tonsils and adenoids.

C. Place on a cardiopulmonary monitor and do frequent assessments. The optimal treatments for infants, toddlers, and children with chronic apnea are hospitalization, frequent monitoring and observation, and parent education. The nurse should continuously monitor the infant on a cardiopulmonary monitor, frequently assess skin color, breathing patterns and effort of breathing, and assess for poor pharyngeal or laryngeal tone. The other actions do not include constant monitoring and assessments, which are crucial in treatment. The nurse is aware of apnea when the monitor alarms. Placing the child in an upright position will not stop the apneic episode. Teaching the parents about infant CPR is not a recommended activity for this case scenario. Although tonsillectomy and adenoidectomy are considered as a form of treatment for obstructive sleep apnea, recommending to parents these procedures is beyond the scope of practice of a nurse.

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method? A. Directly into the vein B. Through a gastrostomy tube C. Using a nebulizer D. Sprinkled onto the food

C. Using a nebulizer Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis.

Which medication is a respiratory stimulant? A. furosemide B. prednisolone C. aminophylline D. spironolactone

C. aminophylline Aminophylline is a respiratory stimulant and bronchodilator that opens the airway of the lungs. It relaxes the smooth muscles around the airways. Prednisolone is a glucocorticoid. Furosemide is a loop diuretic. Spironolactone is a aldosterone antagonist diuretic.

The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the client and family that the child should have plenty of fluids. In addition, the nurse would explain to the child's caregiver that the child may: A. be given ice cream and milk the first postoperative day because these foods make swallowing easier. B. have a painful earache around the third day postoperatively, but the earache will be gone by the fourth day. C. vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days postoperatively. D. have severe throat pain for up to 2 weeks postoperatively; this is not a concern.

C. vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days postoperatively. Bleeding is most often a concern within the first 24 hours following surgery and between the fifth to seventh days postoperatively. Bright, red-flecked emesis or oozing indicates fresh bleeding. If at any time following the surgery there is bright red bleeding, frequent swallowing, or restlessness, the care provider should be notified. A mild earache may be expected around the third day. Encourage fluid intake but avoid irritating liquids such as orange juice. Be aware that milk and ice cream products tend to cling to the surgical site and make swallowing more difficult; thus they are poor choices despite the old tradition of offering ice cream after a tonsillectomy.

The health care provider prescribes fluorescent antibody testing for a child. Which statement by the nurse demonstrates an accurate understanding of this diagnostic test? A. "I will need a respiratory therapist to perform this test." B. "I need the child to cough and spit a specimen into the sterile specimen cup." C. "I will apply a probe to the child's finger for this test." D. "I need to obtain nasopharyngeal secretions and place in a sterile specimen cup."

D. "I need to obtain nasopharyngeal secretions and place in a sterile specimen cup." A nasopharyngeal specimen is obtained for fluorescent antibody testing. To obtain a nasopharyngeal specimen, the nurse will instill 1 to 3 ml of sterile normal saline into one nostril, aspirate the contents using a small sterile bulb syringe, place the contents in sterile container, and immediately send them to the laboratory. Collecting a nasopharyngeal specimen is within the nursing scope of practice. There is no need for a respiratory therapist to perform this test. A sputum specimen is used for a sputum culture and must be true sputum, not mucus from the mouth or nose. The child can deep breathe, cough, and spit the sputum into the specimen container. Probes are attached to the child's finger to attain pulse oximetry or oxygen saturation.

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider? A. The child received the pneumococcal vaccine series within his or her first year. B. The child has two cousins who have many allergies. C. The parent has supervised the child in the same room for the past 24 hours. D. The child was eating peanuts yesterday.

D. The child was eating peanuts yesterday. Aspiration can cause airway mucosal inflammation. When aspiration from a small object occurs, the child may cough and gasp for a few seconds to a few minutes. Following that, the child may not be symptomatic for a day or longer. The aspiration of a foreign body may mimic an asthma attack, but an asthma attack would have generalized wheezing. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration. Allergic situations cause early symptoms such as rash development and are generally not genetic or inherited in nature. The US Centers for Disease Control and Prevention recommends children receive pneumococcal vaccine series before 2 years of age, usually at 2, 4, and 6 months.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? A. The child's weight B. The child's diet C. The child's hospital history D. The triggers in the environment

D. The triggers in the environment When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.

The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with: A. decreased activity and increased fluids. B. corticosteroids and leukotriene inhibitors. C. removal of allergens in the home and school. D. a bronchodilator and mast cell stabilizers.

D. a bronchodilator and mast cell stabilizers. Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.

The nurse is assessing an infant who has been admitted with acute bronchiolitis. Which probable cause should the nurse suspect? A. bacterial infection B. environmental allergy C. prenatal complication D. viral infection

D. viral infection Acute bronchiolitis is most commonly caused by a viral, not bacterial, infection. Neither allergies nor prenatal complications contribute to the development of this disorder.

A 9-year-old female child was brought to the emergency department after experiencing wheezing and shortness of breath while playing soccer. The parents administered two puffs of albuterol metered dose inhaler (MDI) with little effect, and 911 was notified. Paramedics applied oxygen 2 liters by nasal cannula for oxygen saturation of 90% on room air, and administered an albuterol nebulizer treatment. Audible wheezing was heard, and a 20-gauge intravenous (IV) catheter was inserted. Vital signs upon arrival at the emergency room: temperature, 98.8°F (37.1°C); heart rate, 125 beats/min; blood pressure, 88/50 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 92% on simple face mask. Child appears anxious. The emergency room nurse should first _______ then __________.

assess airway administer intravenous (IV) methylprednisolone The nurse should assess the child's airway first. Assessment should always be prioritized using the ABCs (airway, breathing, and circulation).Intravenous (IV) methylprednisolone should be administered promptly to decrease inflammation in the lungs, which will improve air flow. Circulation would be assessed after airway and breathing.Level of consciousness is simultaneously checked with ABCs (airway, breathing, and circulation), but the nurse must first perform a focused respiratory assessment and implement interventions promptly to prevent respiratory arrest.Metered-dose inhalers would not be used in status asthmaticus. Aerosol nebulizer treatments would be administered.Because the child is in severe respiratory distress, the nurse would not perform peak flow meter instruction at this time.