Chapter 32: Eye, Ear, Throat, and Respiratory Problems

After a tonsillectomy, the child begins to vomit bright red blood. Which is the initial nursing action? 1. Turn the child to the side. 2. Notify the registered nurse (RN). 3. Administer the prescribed antiemetic. 4. Maintain NPO (nothing by mouth) status.

1 Rationale: After a tonsillectomy, if bleeding occurs, the child is turned to the side and the RN or PHCP is notified. An NPO status would be maintained, and an antiemetic may be prescribed; however, the initial nursing action would be to turn the child to the side. Test-Taking Strategy: Note the strategic word, initial. Although all of the options may be appropriate to maintain physiological integrity, the initial action is to turn the child to the side.

The nurse reinforces instructions to the mother of a child who has been hospitalized with croup. Which statement made by the mother would indicate the need for further teaching? 1. "I will give my child cough syrup if a cough develops." 2. "During an attack, I will take my child to a cool location." 3. "I can give acetaminophen if my child develops a fever." 4. "I will be sure that my child drinks at least three to four glasses of fluids every day."

1 Rationale: Cough syrups should not be given unless specifically prescribed because they may dry and thicken secretions. During a croup attack, the child can be taken to a cool basement or garage. Acetaminophen is used if a fever develops. Adequate hydration of 500 to 1000 mL of fluids daily is important for thinning secretions. Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Knowledge of the pathophysiology related to croup will assist you with eliminating options 3 and 4 first. Recalling that taking the child to a cool location during an attack is appropriate will direct you to the correct option from the remaining options.

The nurse has provided instructions to the mother of an infant with viral pneumonia. Which statement by the mother would indicate the need for further teaching? 1. "I understand I will need to have my baby on antibiotics for this pneumonia." 2. "I will need to give a cough suppressant before meals if his cough gets too bad." 3. "I will be careful and allow my baby to sleep, so he can conserve energy and fight this infection." 4. "I understand that my baby has viral pneumonia and I need to monitor his temperature because of the risk for febrile seizures."

1 Rationale: The child with viral pneumonia will not be prescribed antibiotics; it is bacterial pneumonia that requires antibiotics for treatment. It is important to monitor the infant for fever spikes because of the risk for febrile seizures. Use of a cough suppressant may be prescribed before rest times and meals if the cough is disturbing and unproductive. Promoting bed rest to conserve energy, encouraging fluid intake and the administration of antipyretics for fever, and bronchodilators are typical interventions for pneumonia. Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Knowledge of pneumonia will assist you with eliminating options 2 and 4 as these are correct interventions. Recalling that bacterial pneumonia requires antibiotics will direct you to the correct option.

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by the respiratory syncytial virus (RSV). Which interventions would be included in the plan of care? Select all that apply. 1. Place the infant in a private room. 2. Place the infant in a room near the nurses' station. 3. Ensure that the infant's head is in a flexed position. 4. Wear a mask at all times when in contact with the infant. 5. Place the child in a tent that delivers warm, humidified air. 6. Position the infant side-lying, with the head lower than the chest.

1, 2, 4 Rationale: The hospitalized infant with RSV needs to be isolated in a private room. The infant needs to be placed in a room near the nurses' station for close observation of respiratory status. The infant would 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 to decrease pressure on the diaphragm. Cool, humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea. Contact, droplet, and standard precautions are necessary to reduce the nosocomial transmission of RSV. Test-Taking Strategy: Focus on the subject, care of the child with RSV. Recalling the mode of transmission of RSV will assist you with determining that the infant needs to be placed in a private room and that droplet, contact, and standard precautions need to be maintained. Recalling the reasons to maintain a patent airway (edema and the accumulation of mucus obstruct the bronchioles) will assist you with determining that the infant needs to be observed closely, that the infant's head needs to be elevated, and that the infant would receive cool, humidified oxygen.

Isoniazid is prescribed for a 2-year-old child with a positive tuberculin skin test. The mother of the child asks the nurse how long the child will need to take the medication. Which time frame is the appropriate response to the mother? 1. 4 months 2. 9 months 3. 12 months 4. 18 months

2 Rationale: Isoniazid is given to prevent TB infection from progressing to active disease. A chest x-ray film is obtained before the initiation of preventive therapy. In infants and children, the recommended duration of isoniazid therapy is 9 months. For children with human immunodeficiency virus infection, a minimum of 12 months is recommended. Test-Taking Strategy: Focus on the subject, treatment for TB. Knowledge regarding treatment with isoniazid in a 2-year-old child is required to answer this question. Remember that in infants and children, the recommended duration of isoniazid therapy is 9 months.

The nurse is instructing a mother of a 1-year-old child with strabismus about the treatment options. Which statement by the mother would indicate the need for further teaching? 1. "My child will outgrow this by the time he is 2 years old and be able to see just fine." 2. "I will have my child wear an eye patch over the good eye to help strengthen the weak eye." 3. "If this eye patch does not work I know that we will have to do surgery to correct my child's crossed eyes." 4. "There are a few causes of this condition and they tell me my child has crossed eyes because of a muscle imbalance."

2 Rationale: Isoniazid is given to prevent TB infection from progressing to active disease. A chest x-ray film is obtained before the initiation of preventive therapy. In infants and children, the recommended duration of isoniazid therapy is 9 months. For children with human immunodeficiency virus infection, a minimum of 12 months is recommended. Test-Taking Strategy: Focus on the subject, treatment for TB. Knowledge regarding treatment with isoniazid in a 2-year-old child is required to answer this question. Remember that in infants and children, the recommended duration of isoniazid therapy is 9 months.

The nurse reinforces instructions to the mother of a child with croup about the measures to take if an acute spasmodic episode occurs. Which statement by the mother indicates the need for further teaching? 1. "I will take my child out into the humid night air." 2. "I will place a steam vaporizer in my child's bedroom." 3. "I will place a cool-mist humidifier in my child's bedroom." 4. "I will place my child in a closed bathroom and allow my child to inhale steam from the running water."

2 Rationale: Steam from warm running water in a closed bathroom and cool mist from a bedside humidifier are effective for reducing mucosal edema. Cool-mist humidifiers are recommended compared with steam vaporizers, which present a danger of scalding burns. Taking the child out into the humid night air may also relieve mucosal swelling. Remember, however, that a cold mist may precipitate bronchospasm. Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and the need to select the incorrect statement. Recall the goals of reducing mucosal edema and providing a safe environment. Note the word steam in option 2. Option 2 would provide an unsafe environment for the child.

The nursing instructor asks a nursing student about sudden infant death syndrome (SIDS). Which statement by the student indicates further teaching is needed? 1. "Some of the interventions that are used to prevent SIDS include having infants sleep in the supine position." 2. "The incidence of SIDS has been found to be higher in breast-fed infants and infants that use a pacifier." 3. "Infants exposed to cigarette smoking during pregnancy and after birth are considered at risk for SIDS." 4. "SIDS refers to sudden infant death syndrome that can occur in healthy infants under 1 year of age, and no exact cause is known."

2 Rationale: The incidence of SIDS has been found to be lower in breast-fed infants and infants who sleep with a pacifier. Options 1, 3 and 4 are correct statements about SIDS. Test-Taking Strategy: Note the strategic words , further teaching is needed. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Knowledge of SIDS will assist you in eliminating options 3 and 4. Recalling prevention and interventions for SIDS will direct you to the correct option.

The nurse is working in the emergency department and is caring for a child who has been diagnosed with epiglottitis. Which is an indication that the child may be experiencing airway obstruction? 1. Retractions and coughing 2. Nasal flaring and bradycardia 3. Tripod positioning and dyspnea 4. A low-grade fever and complaints of a sore throat

3 Rationale: Clinical manifestations that are suggestive of airway obstruction include tripod positioning (leaning forward supported by the hands and arms with the chin thrust out and the mouth open), nasal flaring, tachycardia, retractions, and dyspnea. Epiglottitis is the bacterial form of croup with symptoms of a high fever, sore throat, and an absence of spontaneous cough. Test-Taking Strategy: Focus on the subject, signs/symptoms of airway obstruction. Eliminate option 2 first because tachycardia rather than bradycardia will occur in a child who is experiencing respiratory distress. Eliminate option 4 next, knowing that a high fever occurs with epiglottitis. From the remaining options, recall that tripod positioning and dyspnea are present in airway obstruction and no spontaneous cough is evident.

The nurse assists to prepare a teaching plan regarding the administration of eardrops for the parents of a 2-year-old child with otitis media. Which would be included in the plan? 1. Wear gloves when administering the eardrops. 2. Pull the ear up and back before instilling the eardrops. 3. Pull the earlobe down and back before instilling the eardrops. 4. Hold the child in a sitting position when administering the eardrops.

3 Rationale: When administering eardrops to a child who is younger than 3 years old, the ear needs to be pulled down and back. For children who are older than 3 years old, the ear is pulled up and back. Gloves do not need to be worn by the parents, but hand washing needs to be performed before and after the procedure. The child needs to be in a side-lying position with the affected ear facing upward to facilitate the flow of medication down the ear canal by gravity. Test-Taking Strategy: Focus on the subject, administering eardrops to a 2-year-old child. Visualizing this procedure will assist you with eliminating options 1 and 4 first. From the remaining options, recalling the anatomy of the 2-year-old's ear canal will direct you to the correct option.

The nurse is instructing the mother of a child with cystic fibrosis (CF) about the appropriate dietary measures. Which meal best illustrates the most appropriate diet for a client with CF? 1. Veggie salad and a caramel apple 2. Strawberry jelly sandwich and pretzels 3. Plate of nachos and cheese and a cupcake 4. Chicken tenders and a baked potato with butter

4 Rationale: Children with CF are managed with 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. Chicken tenders and a baked potato with butter provide a high-calorie and high-protein meal that includes fat. Test-Taking Strategy: Focus on the subject, dietary measures for a child with CF. Note the strategic words, best and most appropriate. Eliminate options 1, 2, and 3 because they are not high in protein or calories. From the remaining options, recalling the appropriate diet for the child with CF will direct you to the correct option.

The nurse has provided instructions to the mother of a child who has been diagnosed with bacterial conjunctivitis. Which statement by the mother would indicate the need for further teaching? 1. "I need to wash my hands frequently." 2. "I need to clean the eye, as prescribed." 3. "I need to give the eye drops, as prescribed." 4. "I need to use hot compresses to relieve the eye irritation."

4 Rationale: Parents are to be instructed to use cool compresses to lessen eye irritation and wear dark glasses for photophobia. Options 1, 2, and 3 are correct measures. Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Recall that instructions to the parents include infection control measures, use of cool compresses, administration of eye drops, and to avoid rubbing the eye. Also, noting the word hot in option 4 will direct you to this option.

The nurse is assigned to care for a child after a myringotomy with the insertion of tympanostomy tubes. The nurse notes a small amount of reddish drainage from the child's ear after the surgery. On the basis of this finding, which action would the nurse take? 1. Document the findings. 2. Notify the RN immediately. 3. Change the ear tubes so that they do not become blocked. 4. Check the ear drainage for the presence of cerebrospinal fluid.

1 Rationale: After a myringotomy with the insertion of tympanostomy tubes, the child is monitored for ear drainage. A small amount of reddish drainage is normal during the first few days after surgery. However, any heavy bleeding or bleeding that occurs after 3 days needs to be reported. The nurse would document the findings. Options 2, 3, and 4 are not necessary. Test-Taking Strategy: Note the subject, a small amount of reddish drainage. Considering both the anatomical location of the surgery and the subject of the question will direct you to the correct option.