Chapter 20: Alterations in Respiratory Function

Which nursing diagnosis is most appropriate for an infant with acute bronchiolitis due to respiratory syncytial virus (RSV)? 1. Activity Intolerance 2. Decreased Cardiac Output 3. Pain, Acute 4. Tissue Perfusion, Ineffective (peripheral)

Answer: 1 Activity intolerance is a problem because of the imbalance between oxygen supply and demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory-disease process.

Following parental teaching, the nurse is evaluating the parents' understanding of environmental control for their child's asthma management. Which statement by the parents indicates appropriate understanding of the teaching? 1. "We will replace the carpet in our child's bedroom with tile." 2. "We're glad the dog can continue to sleep in our child's room." 3. "We'll be sure to use the fireplace often to keep the house warm in the winter." 4. "We'll keep the plants in our child's room dusted."

Answer: 1 Explanation: 1. Control of dust in the child's bedroom is an important aspect of environmental control for asthma management. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

A nurse delegates the task of neonatal vital-sign assessment to a nurse technician. Which instruction will the nurse give to the technician prior to assign care? 1. Report any neonate using abdominal muscles to breathe. 2. Report any neonate with apnea for 10 seconds. 3. Count respirations for 15 seconds and multiply by 4 to get the rate for 1 minute. 4. Report any neonate with a breathing pause that lasts 20 seconds or longer.

Answer: 4 Explanation: 1. The abnormal assessment finding for vital signs that the nurse should instruct a nurse technician to report is any breathing pause by a neonate lasting longer than 20 seconds. This can indicate apnea and could lead to an apparent life-threatening event (ALTE). A breathing pause of 10 seconds or less is called periodic breathing and is a normal pattern for a neonate. Respirations should be counted for 1 minute, not 15 seconds. It is normal for neonates to use abdominal muscles for breathing.

A nurse is assessing a neonate. Which assessment finding indicates that the neonate's respiratory status is worsening? 1. Acrocyanosis 2. Arterial CO2 of 40 3. Periorbital edema 4. Grunting respirations with nasal flaring

Answer: 4 Grunting respirations with nasal flaring indicates respiratory status is becoming worse. Acrocyanosis (cyanosis of the extremities) is a normal finding in a neonate. CO2 of 40 is within a normal range. Periorbital edema does not necessarily mean deterioration in respiratory status.

4. The mother of a 20-month-old child tells the nurse that the child has a barking cough at night. The child's temperature is 37° C (98.6° F). Based on the nurse's knowledge of upper respiratory infections, this is a symptom of croup. The nurse should recommend to: A. control the fever with acetaminophen and call if the cough gets worse tonight. B. try a cool-mist vaporizer at night and watch for signs of difficulty breathing. C. try over-the-counter cough medicine and come to the clinic tomorrow if there is no improvement. D. admit to the hospital and observe for impending epiglottitis.

B. try a cool-mist vaporizer at night and watch for signs of difficulty breathing. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief.

A nurse is planning care for a child who has asthma Which of the following interventions should the nurse include in the plan of care? Select all that apply a. perform chest percussion b. place the child in an upright position c. monitor oxygen saturation d. administer bronchodilators e. administer dornase alfa daily

b. place the child in an upright position c. monitor oxygen saturation d. administer bronchodilators

A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase) (dornase alfa). Which is an adverse effect of this medication? a.Mucus thickens b.Voice alters c.Tachycardia d.Jitteriness

b.Voice alters **One of the only adverse effects of DNase is voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years. β2 agonists can cause tachycardia and jitteriness.

Bronchiolitis is a. Bacterial infection of lungs b. Bacterial infection of respiratory tract c. Acute viral infection of respiratory tract d. Inflammation of lungs

c. Acute viral infection of respiratory tract

A nurse in an emergency department is caring for a toddler who is in acute respiratory distress. Which of the following findings should alert the nurse to the possibility of epiglottitis? a. Lethargy b. Spontaneous coughing c. Drooling d. Hoarseness

c. Drooling

Nurse working in ER caring for child who has been diagnosed w/epiglottitis. Indications that child may be experiencing airway obstruction include which of following?

The child thrusts the chin forward and opens the mouth.R: Clinical manifestations that are suggestive of airway obstruction include tripod positioning (leaning forward supported by the hands and arms w/chin trhust out and mouth open), nasal flaring, tachcardia, a high fever, and a sore throat.

Home management for nasopharyngitis includes: Select all that apply a. Antipyretics b. bulb suctioning as indicated c. Hot baths d. Normal Saline (NS) nasal drops e. Naintaining adequate fluid intake & comfort measures

a. Antipyretics b. bulb suctioning as indicated d. Normal Saline (NS) nasal drops e. Naintaining adequate fluid intake & comfort measures

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

a. Asthma

A nurse is providing teaching to a school-age child who has a new diagnosis of asthma. Which of the following statements should the nurse include in the teaching? a. Avoid triggers that cause an attack. b. Use the peak expiratory flow meter once a week. c. You should stop playing basketball, but you can swim instead. d. Take cromolyn sodium at the first sig of breathing difficulty.

a. Avoid triggers that cause an attack.

Cystic fibrosis affects: Select all that apply a. Bile ducts b. Heart c. Small intestine d. Bronchi e. Pancreatic ducts

a. Bile ducts c. Small intestine d. Bronchi e. Pancreatic ducts

Which of the following statements are true regarding the pediatric respiratory system? Select all that apply a. Fewer alveoli until age 12 b.Respiratory muscles are weaker, there is smaller vital capacity, thus less reserve c. Immune system immature (less lymphoid tissue) d. Toddlers are obligatory nose breathers

a, b, and c. **INFANTS are obligatory nose breathers (less than 4-6 months) NOT toddlers.

You have just completed assessments on the following infants. Which infant's findings are most suggestive of bronchiolitis? a. 1 month old with RR of 70, AP- 180 with expiratory wheezes b. 11 month old with RR of 40, Ap- 144, with a mild expiratory stridor c. 5 month old with RR of 77, AP- 182, with a prolonged inspiratory phase d. 9-month old with RR 48, Ap-136, with an inspiratory wheeze

a. 1 month old with RR of 70, AP- 180 with expiratory wheezes

Which of the following statements are true regarding Cystic fibrosis? a. There is an increased viscosity of mucous gland secretions b. Mucous glands produce thick mucoproteins obstructing small passages in selected organs such as pancreas & bronchioles c. Earliest manifestation of CF may be a meconium ileus in newborn d. Those affected are at a decreased risk for respiratory infections

a. There is an increased viscosity of mucous gland secretions b. Mucous glands produce thick mucoproteins obstructing small passages in selected organs such as pancreas & bronchioles c. Earliest manifestation of CF may be a meconium ileus in newborn

A nurse is discussing risk factors for asthma with a group of newly licensed nurses. Which of the following conditions should the nurse include in the teaching? Select all that apply a. family history of asthma b. family history of allergies c. exposure to smoke d. low birth weight e. being underweight

a. family history of asthma b. family history of allergies c. exposure to smoke d. low birth weight

A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? a. Maintaining strict bedrest. b. Avoiding contact with family members. c. Instilling saline nose drops and bulb suctioning. d. Keeping the head of the bed flat.

c. Instilling saline nose drops and bulb suctioning. **Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gentle suctioning with a bulb syringe are often recommended

The healthcare provider is planning care for a child with a diagnosis of bronchiolitis. Which of the following interventions should be included in the child's plan of care? a. Performing chest physiotherapy b.Drawing blood for blood cultures c. Administering a cough suppressant d. Promoting hydration and nutrition

d. Promoting hydration and nutrition **care of a child who has bronchiolitis involves supportive measures. A cough can help mobilize mucus and should not be suppressed. Bronchiolitis is caused by a viral infection so blood cultures are not routinely done. Hydration and nutrition are two important supportive measures implemented when caring for a child with bronchiolitis. Hydration helps loosen secretions and supports physiological function; nutrition supports immune function. Chest physiotherapy is not helpful in this situation and may cause the child undue distress.

Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a.Ephedrine b.Theophylline c.Aminophylline d.Short-acting β2 agonists

d.Short-acting β2 agonists (Albuterol, levalbuterol)

A late sign of dehydration in infants and children is

hypotension

The childhood vaccine ____________________ has dramatically reduced the incidence of epiglottitis

influenzae type B (HIB) vaccineThe nurse should encourage parents of young children to have their children immunized against H. influenzae to decrease the risk for contracting epiglottitis

What sign is indicative of respiratory distress in infants? a. Nasal flaring b. Respiratory rate of 55 breaths/min c. Irregular respiratory pattern d. Abdominal breathing

a. Nasal flaring ** Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. It also allows more air to enter as the nares flare.

Cystic fibrosis may lead to a decrease or absence of pancreatic enzymes which can cause: Select all that apply a. Poor growth (May be present as failure to thrive in infant) b. Increase in mucus c. Islet of Langerhan cells to be affected d. Type 1 DM to develop

a. Poor growth (May be present as failure to thrive in infant) c. Islet of Langerhan cells to be affected d. Type 1 DM to develop

A nurse is performing an admission assessment for a child who has cystic fibrosis. Which of the following findings should the nurse expect? Select all that apply a. wheezing b. clubbing of fingers and toes c. barrel shaped chest d. thin, watery mucus e. rapid growth spurts

a. wheezing b. clubbing of fingers and toes c. barrel shaped chest

A nurse is teaching a child who has asthma how to use a peak flow meter. Which of the following information should the nurse include in the teaching? Select all that apply a. zero the meter before each use b. record the average of the attempts c. perform three attempts d. deliver a long, slow breath into the meter e. sit in a chair with feet on the floor

a. zero the meter before each use c. perform three attempts

Nurse instructing mother of child w/Cystic Fibrosis about appropriate dietary measures. Which type of diet w/be included in instructions

A high-calorie, high-protein diet. R: Children w/CF are managed w/a high-calorie, high-protein diet. Pancreatic enzyme replacement therapy is undertaken, and fat-soluble vitamin supplements are administered. Fats are not restricted unless steatorrhea cannot be controlled by increased levels of pancreatic enzymes.

Bronchiolitis is associated with a a. Barky cough b. Low grade fever c. Drooling d. Hyperactivity

b. Low grade fever

Infants that are at greatest risk for RSV are: Select all that apply a. C-section birth b. Premature c. Those with cardiac diseases d. Those with chronic lung diseases e. Immunodeficient

b. Premature c. Those with cardiac diseases d. Those with chronic lung diseases e. Immunodeficient

A child is admitted to the hospital with the diagnosis of laryngotracheobronchitis (LTB). Which nursing intervention is the priority for this child? 1. Administer nebulized epinephrine and oral or IM dexamethasone. 2. Administer antibiotics and assist with possible intubation. 3. Swab the throat for a throat culture. 4. Obtain a sputum specimen.

Answer: 1 Nebulized epinephrine and dexamethasone are given for LTB. Antibiotic administration and possible intubation are associated with epiglottitis. Throat cultures are not obtained for LTB because it is viral and swabbing the throat could cause complete obstruction to occur. Sputum specimens will not assist in the diagnosis of LTB.

A newborn is suspected of having cystic fibrosis. As the child is being prepared for transfer to a pediatric hospital, the mother asks the nurse which symptoms made the practitioner suspect cystic fibrosis. Which response by the nurse is the most appropriate? 1. Steatorrheic stools 2. Constipation 3. Meconium ileus 4. Rectal prolapse

Answer: 3 Newborns with cystic fibrosis may present in the first 48 hours with meconium ileus. Steatorrhea, constipation, and rectal prolapse may be signs of cystic fibrosis seen in an older infant or child.

The practitioner changes the medications for the child with asthma to salmeterol (Serevent). The mother asks the nurse what this drug will do. The nurse explains that salmeterol (Serevent) is used to treat asthma because the drug produces which characteristic? 1. Decreases inflammation 2. Decreases mucous production 3. Controls allergic rhinitis 4. Dilates the bronchioles

Answer: 4 Explanation: 1. Salmeterol (Serevent) is a long-acting beta2-agonist that acts by bronchodilating. Steroids are anti-inflammatory, anticholinergics decrease mucous production, and antihistamines control allergic rhinitis.

Cystic fibrosis may affect single or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: A. mechanical obstruction caused by increased viscosity of mucous gland secretions. B. atrophic changes in mucosal wall of intestines. C. hypoactivity of the autonomic nervous system. D. hyperactivity of sweat glands.

A. mechanical obstruction caused by increased viscosity of mucous gland secretions. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.

5. An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to: A. prevent RSV infection. B. prevent secondary bacterial infection. C. decrease toxicity of antiviral agents. D. make isolation of infant with RSV unnecessary.

A. prevent RSV infection.

A child is showing signs of acute respiratory distress. Which position will the nurse place this child? 1. Upright 2. Side-lying 3. Flat 4. In semi-Fowler's

Answer: 1 Explanation: 1. Upright is correct because it allows for optimal chest expansion. Side-lying, flat, and semi-Fowler's (head up slightly) do not allow for as optimal chest expansion as the upright position.

What information should the nurse teach workers at a daycare center about RSV? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent handwashing can decrease the spread of the virus.

d. Frequent handwashing can decrease the spread of the virus. **A RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces.

With bronchiolitis, the infection will cause the child's work of breathing to increase due to compensatory mechanisms kicking in. These compensatory mechanisms include: Select all that apply a. Increase oxygenation b. Breathing faster c. Use of accessory muscles to breathe d. Apnea

a. Increase oxygenation b. Breathing faster c. Use of accessory muscles to breathe

A nurse is providing dietary teaching to a parent of a child who has cystic fibrosis. Which of the following dietary recommendations should the nurse make? a. Increase the child's protein intake. b. Decrease the child's calorie intake. c. Increase the child's fiber intake. d. Decrease the child's salt intake.

a. Increase the child's protein intake.

For a patient diagnosed with RSV, it is best to: Select all that apply a. Maintain good hand-washing b. Place on contact precautions c. Keep dedicated equipment in patient's room d. Keep patient in supine position

a. Maintain good hand-washing b. Place on contact precautions c. Keep dedicated equipment in patient's room

What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

a. Meconium ileus

Interventions used for RSV include: Select all that apply a. Monitor respiratory status b. Humidified oxygen c. Maintain adequate hydration d. Keep child upright and HOB elevated e. Encourage crying to get rid of secretions

a. Monitor respiratory status b. Humidified oxygen c. Maintain adequate hydration d. Keep child upright and HOB elevated ** Do not want crying- crying aggravates laryngospasm and increases hypoxia; rest decreases metabolic need for oxygen

Preventative medications used for Asthma include: Select all that apply a. Montelukast b. Mast Cell stabilizer (Cromolyn) c. Albuterol d. Long-acting beta-agonists (solmeterol) (servent)

a. Montelukast b. Mast Cell stabilizer (Cromolyn) d. Long-acting beta-agonists (solmeterol (servent) **Albuterol is short-acting beta agonist and is used as a rescue med during acute exacerbations

A 6-month-old infant who was seen in the Emergency Department with wheezing and coughing is admitted to the pediatric unit with a diagnosis of bronchiolitis. During the admission assessment, which of these will alert the healthcare provider the infant's condition is worsening? a. Decreased inspiratory breath sounds b. Respiratory rate of 38 breaths/min c. Irritability and crying d. Dysphasia and loss of appetite

a. Decreased inspiratory breath sounds Decreased breath sounds may indicate impending respiratory failure because less air is moving into the lungs.

Drooling is an indication that secretions cannot be swallowed because the oropharynx is obstructed; a common clinical finding in a. Epiglottitis b. Asthma c. Bronchiolitis d. Pneumonia

a. Epiglottitis

Aerosol therapy for managing cystic fibrosis includes: Select all that apply a. Hypertonic saline (6-7%) b. Ibuprofen c. DNase (dornase alfa) (Pulmozyme) d. Bronchodilators d. Bronchodilators

a. Hypertonic saline (6-7%) c. DNase (dornase alfa) (Pulmozyme) d. Bronchodilators

A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for? a.Immediate IV placement. b. Respiratory treatment of racemic epinephrine. c. A tracheostomy set at the bedside. d. Informing the child's parents about a tonsillectomy.

b. Respiratory treatment of racemic epinephrine. **The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.

The most frequent cause of serious respiratory tract infections in infants & young children is a. Asthma b. Pneumonia c. Respiratory Syncytial Virus (RSV) d. Tonsillitis

c. Respiratory Syncytial Virus (RSV)

Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

d. Give cool, humidified oxygen. Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea. ** A The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. B The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary bacterial infection. C Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration.

Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C and calcium b. Vitamin B6 and B12 c. Magnesium d. Vitamins A, D, E, and K

d. Vitamins A, D, E, and K **Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore supplements are necessary.

A nurse is teaching an adolescent about the appropriate use of his asthma medications. Which of the following medications should the nurse instruct the client to use as needed before exercise? a. fluticasone/ salmeterol b. montelukast c. prednisone d. albuterol

d. albuterol

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a.not administer pancreatic enzymes if child is receiving antibiotics. b.decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c.administer pancreatic enzymes between meals if at all possible. d.pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

d.pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

An infant who is dehydrated will exhibit which of the following findings? Select all that apply. a. Sunken anterior fontanelle b. Tachycardia c.Irritability d. Tetany e. Reduced urine output

a. sunken anterior fontanelle b. Tachycardia c. Irritability e. Reduced urine output

A nurse is reviewing the diagnostic findings for a preschool age child who is suspected of having cystic fibrosis. Which of the following findings should the nurse identify as an indication of cystic fibrosis? a. sweat chloride content 85 mEq/L b. increased serum levels of fat soluble vitamins c. 72 hr stool analysis sample indicating hard, packed stools d. chest x-ray negative for atelectasis

a. sweat chloride content 85 mEq/L

A nurse is admitting a child who has cystic fibrosis. Which of the following medications should the nurse anticipate including in the plan of care? Select all that apply a. tobramycin b. loperamide c. fat soluble vitamins d. albuterol e. dornase alfa

a. tobramycin c. fat soluble vitamins d. albuterol e. dornase alfa

The parents of an infant with a history of nasal congestion, mild cough, and a temperature of 100.4 , point, 4 F (38C) call the clinic to ask what treatments are recommended for their child. Which of the following should be included in the teaching plan? Select all that apply. a. "Give your child a baby aspirin every 4 to 6 hours." b. "Make sure your child gets plenty of fluids." c. "You may use some saline nose drops and a bulb syringe to help clear the nose." d. "Our office will call in a prescription antibiotic for your to pick up." e. "Pick up a children's cough suppressant at the drug store." f. "Be sure to keep your child away from secondhand smoke."

b. "Make sure your child gets plenty of fluids." c. "You may use some saline nose drops and a bulb syringe to help clear the nose." f. "Be sure to keep your child away from secondhand smoke."

A nurse is obtaining an infant's vital signs. The heart rate is 180/ min, and the temperature is 40C (104F). The father asks why the baby's heart is beating so fast. Which of the following is an appropriate response by the nurse? a. "This is within the expected range for your baby." b. "The fever is causing an increase in your baby's heart rate." c. "As your baby begins to fall asleep, the heart rate will decrease. d. "Your baby's heart is beating fast in an attempt to cool down the body"

b. "The fever is causing an increase in your baby's heart rate." ** The expected range for the temperature of an infant from birth to 1 year is 36.5° C (97.7° F) to 37.2° C (98.9° F). This infant has a fever. The infant's heart rate will increase as a result of the fever. The expected range for heart rate in an infant 3 months to 2 years old is 80-150/min while awake and 70-120/min while asleep. If the infant is active or has a fever, the heart rate may be as high as 220/min.**

Steven is a four-year-old brought to clinic by his mother. He has a sore throat, difficulty swallowing & is drooling. His temperature is 39 (102.2). His voice is muffled and you note inspiratory stridor. He appears ill, is agitated and assumes a position of sitting & leaning forward supported by arms with chin thrust out (tripod position/obstruction). This is indicative of? a. Laryngitis b. Asthma c. Epiglottitis d. Spasmodic croup

c. Epiglottitis

The nurse educator is teaching a group of nursing students how to perform a respiratory assessment for a newborn in the newborn intensive care unit (NICU) diagnosed with respiratory distress syndrome (RDS). Which normal characteristics of the newborn's respiratory system increase the risk for obstruction? Select all that apply. 1. Shorter and narrower airway 2. Higher trachea 3. Bronchial branching at different angles 4. Inadequate smooth muscle bundles 5. Diaphragmatic breather

Answer: 1, 2, 3 Explanation: 1. Normal characteristics of the pediatric respiratory system that increase the risk for obstruction include a shorter and narrower airway, a higher trachea, and a different angle for bronchial branching. Inadequate smooth muscle bundles and being diaphragmatic breathers are characteristics that do not increase the risk of obstruction.

The nurse is teaching the parents of a newly diagnosed cystic fibrosis patient how to administer the pancreatic enzymes. How often will the nurse teach the parents to administer the enzymes? 1. Two times per day 2. With meals and snacks 3. Every 6 hours around the clock 4. Four times per day

Answer: 2 Explanation: 1. Pancreatic enzymes are administered with meals and large snacks. A scheduled time would not be appropriate because the enzymes are used to assist in digestion of nutrients.

A child is admitted to the hospital with pneumonia. The child's oximetry reading is 88 percent upon admission to the pediatric floor. Which is the priority nursing intervention for this child? 1. Obtain a blood sample to send to the lab for electrolyte analysis. 2. Begin oxygen per nasal cannula. 3. Medicate for pain. 4. Begin administration of intravenous fluids.

Answer: 2 Explanation: 1. Pulse oximetry reading should be 92 or greater. Oxygen by nasal cannula should be started initially. Medicating for pain, administering IV fluids, and sending lab specimens can be done once the child's oxygenation status has been addressed.

The nurse is providing care to an infant in the emergency department. Upon assessment, the infant is noted to have to be experiencing tachypnea, wheezing, retractions, and nasal flaring. The infant is irritability and the parents state the infant has had poor fluid intake for two days. Pulse ox reading is currently at 85 percent on room air. The infant's blood gas is pending. Which diagnosis does the nurse anticipate for this infant? 1. Bronchitis 2. Bronchiolitis 3. Pneumonia 4. Active pulmonary tuberculosis

Answer: 2 Explanation: 1. The nurse anticipates the infant will be diagnosed with bronchiolitis. Symptoms of bronchiolitis include mild respiratory symptoms that progress to tachypnea, wheezing, retractions, nasal flaring, irritability, poor fluid intake, hypoxia, cyanosis, and decreased mental status. Symptoms of bronchitis include a dry hacking cough, increases in severity at night, painful chest and ribs. Symptoms of pneumonia include initial rhinitis and cough, followed by fever, crackles, wheezes, dyspnea, tachypnea, restlessness, diminished breath sounds. Symptoms of active pulmonary tuberculosis include persistent cough, decreased appetite, weight loss or failure to gain weight, low-grade fever, night sweats, chills, enlarged lymph nodes.

The nurse is teaching a group of mothers of infants about the benefits of immunization. Which immunization will the nurse teach to the mothers that can assist in preventing the life-threatening disease epiglottitis? 1. Measles, mumps, and rubella (MMR) 2. Haemophilus influenzae type B (HIB) 3. Hepatitis B 4. Polio

Answer: 2 The Haemophilus influenzae type B (HIB) immunization can assist in prevention of epiglottitis. Hepatitis B, measles, mumps, rubella, and the polio virus are not causative agents for epiglottitis.

A child is prescribed rifampicin for treatment of tuberculosis. For which length of time will the nurse tell the parents that this child must remain on the medication? 1. 2 months 2. 4 months 3. 6 months 4. 8 months

Answer: 3 Explanation: 1. Active and latent TB are treated with isoniazid, rifampicin, pyrazinamide, and ethambutol. Therapy for active TB usually involves a 6-month regimen consisting of isoniazid, rifampicin, pyrazinamide, and ethambutol for the first 2 months and isoniazid and rifampicin for the remaining 4 months. Therefore, the child will remain on rifampicin for a total of 6 months.

Parents of a child admitted with respiratory distress are concerned because the child won't lie down and wants to sit in a chair leaning forward. Which response by the nurse is the most appropriate? 1. "This helps the child feel in control of his situation." 2. "The child needs to be encouraged to lie flat in bed." 3. "This position helps keep the airway open." 4. "This confirms the child has asthma."

Answer: 3 Explanation: 1. Leaning forward helps keep the airway open. The child is not in control just because he is leaning forward. Lying flat in bed will increase the respiratory distress. This position does not confirm asthma.

The nurse is providing care to an infant who is diagnosed with bronchiolitis. Which breath sounds indicate the infant is experiencing respiratory distress? Select all that apply. 1. Tachypnea 2. Wheezing 3. Grunting 4. Retractions 5. Eupnea

Answer: 1, 2, 3 Explanation: 1. Wheezing and grunting are adventitious respiratory sounds that indicate respiratory distress in the neonate. Tachypnea is the term used to indicate a respiratory rate of greater than 60 breaths per minute in an infant. While this does indicate respiratory distress, tachypnea is not a type of breath sound. Retractions, or the use of accessory muscles, are indicative of respiratory distress in the neonate, but this is not a type of breath sound. Eupnea is the medical term for "normal breathing."

A 2-month-old child is admitted to the pediatric unit with a diagnosis of bronchiolitis. The child is lethargic and dehydrated. Which of the following should the healthcare provider monitor to assess hydration status? Select all that apply. a. Urine output b. Fontanels c. Emesis d. Skin turgor e. Digital clubbing f. Heart Rate

a. Urine output b. Fontanels c. Emesis d. Skin turgor f. Heart Rate In addition to monitoring fluid entering the body, the healthcare provider will want to measure fluid exiting the body. When intracellular and extracellular fluid is balanced, the child's skin will be elastic and mobile. Fontanels should feel flat and firm. If the baby is dehydrated, the fontanel will be soft and sunken below the margins of the skull.

A school nurse is planning care for a school-age child recently diagnosed with asthma. Which items will the school nurse include in the plan of care at the school? Select all that apply. 1. Maintain a log of quick-relief medication administration. 2. Call the parents if quick-relief medications work appropriately. 3. Assess for symptoms of exercise-induced bronchospasm. 4. Coordinate education of the child's teachers. 5. Conduct a support group for all children with asthma.

Answer: 1, 3, 4, 5 Explanation: 1. Appropriate interventions for the school nurse to include in the plan of care include: keeping a log of the quick-relief medications administered; assessing the child for exercise-induced bronchospasms and reporting, if needed; coordinating education of the child's teachers; and conducting a support group for all children in the school with asthma. The nurse would only call the parents if the quick-relief mediation was not effective in treating the child's symptoms.

The recommendation for diagnosis and treatment of bronchiolitis includes: Select all that apply a. diagnose and assess disease severity by conducting a thorough medical history of the child and detailed physical examination b. Order x ray, laboratory tests c. Antibiotics, steroids, or bronchodilators d. close monitoring of the child's hydration, oxygen level e. close monitoring of the child's ability to drink and retain fluids.

a. diagnose and assess disease severity by conducting a thorough medical history of the child and detailed physical examination d. close monitoring of the child's hydration, oxygen level e. close monitoring of the child's ability to drink and retain fluids.

A 1-year-old child has had a cough and a runny nose for the past 3 days. The parents call the clinic to ask if their child should be brought to the clinic. Which of these questions will the healthcare provider ask to determine the severity of the child's illness? Select all that apply. a. "How fast is your baby breathing?" b. "Are your baby's eyes red or swollen?" c. "Do you see skin sucking in around the chest when your baby breathes?" d. " Is your baby more sleepy than usual?" e. "Do you know how to take your baby's temperature?"

a. "How fast is your baby breathing?" c. "Do you see skin sucking in around the chest when your baby breathes?" d. " Is your baby more sleepy than usual?" **Infants and young children can become easily fatigued with respiratory infections because increased oxygen consumption per unit of body weight and structural differences make them less able to tolerate increased work of breathing.

A 10-month-old infant who was seen in the Emergency Department for respiratory distress is admitted to the pediatric unit with a diagnosis of bronchiolitis. Which of these, if assessed in the infant, alerts the healthcare provider the bronchiolitis is worsening? a. Head bobbing b. Inspiratory stridor c. Drooling d. Pleuritic chest pain

a. Head bobbing **Head bobbing may be seen in when work of breathing is increased in an infant who is using accessory muscles of inspiration to breathe. Because infants have large heads in relation to the rest of their bodies and their neck muscles are not strong enough to keep the head stable, the head will move up and down with respirations.

A nurse is teaching the mother of a 5-year-old child with cystic fibrosis about pancreatic enzymes. The nurse should understand that further teaching is necessary when the mom states? a. I will give my son the enzymes between meals. b. The enzymes probably wont cause many adverse effects. c. the enzymes help him digest fat d.I will put the enzyme crystals in his applesauce

a. I will give my son the enzymes between meals

The healthcare provider is giving discharge instructions to the parents of an infant with a history of prematurity and low birth weight. Which of these instructions should be included to help prevent respiratory syncytial virus (RSV) infection? Select all that apply. a. Practice good hand hygiene b. Continue breastfeeding c. Avoid contact with sick individuals d. Avoid contact with pets e. Obtain palivizumab immunoglobulin f. Use a humidifier in the baby's room

a. Practice good hand hygiene b. Continue breastfeeding c. Avoid contact with sick individuals e. Obtain palivizumab immunoglobulin

A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first action in this situation? a. Prepare intubation equipment and call the physician. b. Examine the child's oropharynx and call the physician. c. Obtain a throat culture for respiratory syncytial virus (RSV). d. Obtain vital signs and listen to breath sounds.

a. Prepare intubation equipment and call the physician. **This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures.

Symptoms of respiratory dysfunction include: Select all that apply a. Restlessness (air hunger) b. Increased RR, diminished breath sounds c. Grunting/ stridor (noisy breathing) d. Use of accessory muscles e. Absence of nasal flaring

a. Restlessness (air hunger) b. Increased RR, diminished breath sounds c. Grunting/ stridor (noisy breathing) d. Use of accessory muscles (retraction) **Would expect to see nasal flaring in respiratory dysfunction. **

An 8-month-old infant is admitted to the pediatric unit with a respiratory syncytial virus (RSV) infection and bronchiolitis. During the admission assessment, which of these signs should the healthcare provider recognize as an early sign of respiratory distress? a. Tachycardia b. Anxiety c. Nasal flaring d. Intercostal retractions

a. Tachycardia **Early signs of respiratory distress are an attempt to increase oxygenated blood flow to the periphery. Later signs of respiratory failure involve processes that expend energy and increase oxygen demand. Tachycardia is an early sign of impending respiratory distress as the infant attempts to compensate for an oxygen deficit. Anxiety, grunting, and retractions are signs of persisting hypoxemia.

A nurse is assessing a 6-month-old infant who was recently admitted with acute vomiting and diarrhea. Which of the following findings indicates that the infant has moderate dehydration? a. Tachypnea b. Bradycardia c. Bulging anterior fontanel d. Polyuria

a. Tachypnea

Children with bronchiolitis can become easily dehydrated due to. Select all that apply. a. Tachypnea b. Fever c. Vomiting d. Diarrhea

a. Tachypnea b. Fever

A nurse is assessing a child who has epiglottitis. Which of the following findings should the nurse expect? Select all that apply a. hoarseness and difficulty speaking b. difficulty swallowing c. low grade fever d. drooling e. dry, barking cough f. stridor

a. hoarseness and difficulty speaking b. difficulty swallowing d. drooling f. stridor

The healthcare provider is preparing an educational seminar about bronchiolitis. Which of these should be included in the teaching?Select all that apply. a. A definitive diagnosis is usually made by obtaining a sputum sample. b. Airway narrowing and mucus plugging can cause atelectasis in the lungs. c. Bronchiolitis is an infection affecting the mucosa of the nasal passages and pharynx. d. Most cases of bronchiolitis in the northern hemisphere occur November through April. e. Supplemental oxygen is the primary treatment for children hospitalized with bronchiolitis. f. Bronchiolitis most commonly affects children under 2 years of age.

b. Airway narrowing and mucus plugging can cause atelectasis in the lungs. d. Most cases of bronchiolitis in the northern hemisphere occur November through April. e. Supplemental oxygen is the primary treatment for children hospitalized with bronchiolitis. f. Bronchiolitis most commonly affects children under 2 years of age.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

b. Epiglottitis **Epiglottitis is always a medical emergency that requires antibiotics and airways upport for treatment.

What is the best preventative intervention for RSV? a. Immunization b. Hand-washing c. Antibiotics d. Breast feeding

b. Hand-washing

Young children are more susceptible to respiratory illness due to: Select all that apply a. Having more smooth muscle b. Having less tissue and cartilage in trachea and bronchi c. Shorter & narrow airway structures contribute to rapid & widespread transmission of organisms d. Having more alveoli

b. Having less tissue and cartilage in trachea and bronchi c. Shorter & narrow airway structures contribute to rapid & widespread transmission of organisms **young children have less smooth muscle, not more. Have less alveoli**

Which of the following should the nurse recognize as an early sign of dehydration in a 9-month-old infant? a. Heart rate of 66 b. Heart rate of 170 c. Blood pressure of 118/63 d. Blood pressure of 62/44

b. Heart rate of 170

A clinician is developing the plan of care for a patient with a history of asthma. Which of the following is the priority problem for this patient during an acute exacerbation? a. Risk for ineffective airway clearance b. Ineffective breathing pattern c. Activity intolerance d. Altered coping

b. Ineffective breathing pattern

A nurse in an emergency department is assessing an infant who is dehydrated. Which of the following findings should the nurse expect? a. Slow, bounding pulse b. Irritability c. Decreased temperature d. Tetany

b. Irritability

A nurse is admitting a toddler who has Respiratory syncytial virus (RSDV). Which of the following actions should the nurse take? a. Initiate airborne precautions. b. Keep thermometer in the toddler's room. c. Allow the toddler to play in the common room. d. Place the toddler in a room that has negative air pressure.

b. Keep thermometer in the toddler's room. ** This is contact precautions. So nurse should keep and use dedicated equipment such as BP monitor, stethoscope, and thermometer in the room**

The mother of an infant who has had a series of hospitalizations related to bronchiolitis asks the healthcare provider why her infant seems to be prone to respiratory infections. Which of these provide the most accurate information about the respiratory systems of infants and young children? a. Infants and young children have more rigid chest walls which increases the work of breathing. b. Respiratory airways of infants and young children are more narrow so they are easily obstructed. c. The metabolic rate and oxygen consumption of infants and young children are slower than older children. d. Decreased surfactant in infants and young children makes it harder for them to keep their airways open.

b. Respiratory airways of infants and young children are more narrow so they are easily obstructed.

Which of the following statements are true regarding infants with RSV? Select all that apply a. Requires immediate antibiotic treatment b. Transmission is by direct contact. c. Use contact precautions. d. Good hand-washing is key to prevent spread of disease. e. Presents with tachypnea and expiratory wheezing.

b. Transmission is by direct contact. c. Use contact precautions. d. Good hand-washing is key to prevent spread of disease. e. Presents with tachypnea and expiratory wheezing.

A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? a. provide a low calorie, low protein diet b. administer pancreatic enzymes with meals and snacks c. implement a fluid restriction during times of infection d. restrict physical activity

b. administer pancreatic enzymes with meals and snacks ** (within 30 minutes before a meal or snack, and capsules can be swallowed whole or taken apart & sprinkled in soft foods)**

A nurse is assessing a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? Select all that apply a. oxygen saturation 95% b. wheezing c. retraction of sternal muscles d. warm extremities e. nasal flaring

b. wheezing c. retraction of sternal muscles e. nasal flaring

High level of fecal fat, sweat chloride test result of >60 mEq/L and frequent respiratory infections occur with a. Asthma b. Bronchiolitis c. Cystic Fibrosis d. Pneumonia

c. Cystic Fibrosis

While caring for an infant with a diagnosis of bronchiolitis, the healthcare provider notices audible grunting sounds during the infant's respirations. How should the healthcare provider interpret the grunting in relation to the infant's respiratory status? a. Oxygen consumption is decreased with grunting which helps resolve hypoxemia. b. During grunting lung volume increases as more air moves through the conducting airways. c. Grunting increases end expiratory pressure and promotes gas exchange. d. During grunting the diameter of the bronchi and bronchioles is increased.

c. Grunting increases end expiratory pressure and promotes gas exchange. **Grunting is a compensatory mechanism to improve oxygenation. Grunting involves exhalation against a partially closed glottis, causing a grunting sound. Grunting increases positive pressure in the lungs, preventing the collapse of small airways and alveoli, thereby promoting gas exchange.

A 9-month-old infant with a history of fever and nasal congestion is admitted with a diagnosis of bronchiolitis. During the admission assessment, which of these assessment findings should the healthcare provider expect? a. A barky, seal-like cough b. A pruritic rash on the chest c. Restlessness or lethargy d. A high fever and chills

c. Restlessness or lethargy **Restlessness or lethargy indicate hypoxemia or impending respiratory failure.

A nurse in an emergency department is assessing a school-age child who is experiencing an acute asthma exacerbation. Which of the following findings is a priority for the nurse to report to the provider? a. Excessively prolonged expiration b. Increased production of frothy sputum c. Sudden decrease in wheezing d. Increased diaphoresis

c. Sudden decrease in wheezing **sudden decrease in wheezing can be an indication that the child is experiencing decreased air movement and should be reported to the provider**

A nurse is caring for a child who is experiencing respiratory distress. Which of the following findings are early manifestations of respiratory distress? Select all that apply. a. Bradypnea b. Peripheral cyanosis c. Tachycardia d. Diaphoresis e. Restlessness

c. Tachycardia d. Diaphoresis e. Restlessness

A nurse is caring for a child who has bronchiolitis. Which of the following actions should the nurse take? select all that apply a. administer oral prednisone b. initiate chest percussion and postural drainage c. administer humidified oxygen d. suction the nasopharynx as needed e. administer oral penicillin

c. administer humidified oxygen d. suction the nasopharynx as needed

The healthcare provider is reviewing the medical record of an infant admitted with a diagnosis of respiratory distress related to bronchiolitis. Which of the following will the healthcare provider expect to find in the infant's history? a. atopic dermatitis b. neonatal jaundice c. unrepaired congenital heart defect d. C-section birth

c. unrepaired congenital heart defect *Infants who have an unrepaired congenital heart defect often have diminished pulmonary reserve and are more prone to hospitalization during respiratory illnesses such as bronchiolitis.

A 2-year-old has just been diagnosed with cystic fibrosis (CF). The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? a. "You can expect your child to develop a barrel-shaped chest." b. "You can expect your child to develop a chronic productive cough." c. "You can expect your child to develop bronchiectasis." d. "You can expect your child to develop wheezing respirations."

d. "You can expect your child to develop wheezing respirations."

A nurse in an emergency department is caring for a child experiencing an acute asthma attack. Which of the following medications should the nurse expect to administer first? a. Fluticasone b. Budesonide c. Montelukast d. Albuterol

d. Albuterol **Albuterol is considered a "rescue" medication due to its rapid onset of action.