Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder

When the nurse is reinforcing teaching with the caregiver of a 3-year-old child being discharged following a tonsillectomy, the caregiver states to the nurse, "I understand why there might be bleeding in the first 24 hours, but I do not understand why there might be bleeding in 1 week or so." What is the most appropriate explanation for the nurse to give this caregiver? "Bleeding can occur at this time because the clots dissolve and new tissue is not yet present." "We do not usually do this surgery until the child is older, so postoperative bleeding is a possible complication because of the child's age." "By next week the child will be eating regular foods again, and the salt content may cause bleeding." "The child will have forgotten about the surgery by that time and might start coughing, and the pressure of coughing can cause bleeding."

"Bleeding can occur at this time because the clots dissolve and new tissue is not yet present."

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which statement best indicates an understanding of the management and treatment for this diagnosis? "We have taken the carpet out of our house and let my mom take our dog." "He knows how and even when he needs to use his peak flow meter." "Even the babysitter helps us keep up the diary with her symptoms." "The medications she takes are all in one place, ready for her to take at any time."

"We have taken the carpet out of our house and let my mom take our dog." Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.

A 4-year-old with bronchiolitis has been admitted to the hospital with respiratory compromise. The father asks the nurse why the physician won't prescribe an antibiotic, "My child just keeps getting worse." What is the best response by the nurse? "Bronchiolitis is almost always caused by the respiratory syncytial virus (RSV). Unfortunately, antibiotics don't work on viruses." "You have a very good physician who I trust completely. I'm sure everything possible is being done for your child." "Oftentimes it is more beneficial to treat the symptoms of bronchiolitis rather than try to kill the bacteria with an antibiotic." "Your physician probably doesn't want to take a chance of your child building up an immunity to the antibiotic in case the condition worsens and more antibiotics are needed."

"Bronchiolitis is almost always caused by the respiratory syncytial virus (RSV). Unfortunately, antibiotics don't work on viruses." Bronchiolitis is an acute inflammatory process of the bronchioles and small bronchi. Nearly always caused by a viral pathogen, respiratory syncytial virus (RSV) accounts for the majority of cases of bronchiolitis; therefore, antibiotic therapy is not warranted.

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? "Have him use his short-acting bronchodilator right away." "You need to take him to the emergency department right away." "Continue to watch his PEFR readings and call back if they go below 40%." "Have him use his low-dose steroid inhaler now and again in 15 minutes."

"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.

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma? "I'm going to have the respiratory therapist get some of the mucus from your lungs." "I'm going to have this hospital worker take a picture of your lungs." "We're going to go take a look at your lungs to see if there are any sores on them." "I'm going to hold your hand while the phlebotomist gets blood from your arm."

"I'm going to have the respiratory therapist get some of the mucus from your lungs." The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma. "I'm going to have the respiratory therapist get some of the mucus from your lungs." "I'm going to have this hospital worker take a picture of your lungs." "We're going to go take a look at your lungs to see if there are any sores on them." "I'm going to hold your hand while the phlebotomist gets blood from your arm."

"I'm going to have this hospital worker take a picture of your lungs." The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse? "I understand that appointments can be annoying but steroid use can cause your child to have high blood sugar, peptic ulcers, slowed growth rate, and various other problems." "An adult should never give a child their medication. The doses may be very different." "As long as you only occasionally give your child the medication it shouldn't be a problem." "I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms."

"I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms." Showing empathy for the parent is important when explaining the possibility of the steroid's side effects and the importance of the physician monitoring the child's asthma. Just listing all of the side effects of the steroid is not therapeutic communication and doesn't address the need for the child to be seen by the physician. Scolding the parent by telling her that she should never give her child her medication does not encourage good rapport. Giving the child the mother's medication even "occasionally" is not advisable.

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

"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.

The nurse is teaching home care to the parents of a 4-year-old client diagnosed with asthma. The nurse knows additional teaching is needed if the parents make which statement? "We will not enroll our child in preschool this year." "It is important for us to know what triggers an attack." "We feel confident we can administer medication with a nebulizer." "Emergency instructions and phone numbers are posted in our home."

"We will not enroll our child in preschool this year." Enrolling in preschool is fine for children with asthma. There is the risk for increased exposure to illness; however, asthma should not limit the child from living a normal, active life. Should the child enroll, the nurse can assist in meeting the asthma education needs of the preschool staff through counseling the parents and providing access to accurate asthma education materials. The parents should know what triggers an asthma attack in their child, have emergency information and numbers posted in the home for emergency situations, and should know how to use a nebulizer as needed.

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

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.

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? Administer the bronchodilator via a nebulizer. Give the antibiotic as prescribed. Apply oxygen at 2 liters via a nasal cannula. Apply a cardiac monitor to the child.

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.

A 4-year-old child has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. The parents are extremely distraught over the child's condition and the fact that the child has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of the parents? Allow the parents to remain with the child as much as possible. Encourage the parents to return home and get some rest. Tell the parents that their child is receiving the best care possible. Avoid telling the parents unnecessary facts regarding the child's prognosis.

Allow the parents to remain with the child as much as possible.

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? Humidified air Continuous pulse oximetry Parenteral antibiotic administration Assessment of the nasopharynx

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

Assisting with racemic epinephrine nebulizer therapy Explanation: 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.

Pancreatic enzymes are part of the treatment in cystic fibrosis. When should the nurse administer the enzymes? Once a day Three times a day with water Before meals and snacks with milk At night after dinner

Before meals and snacks with milk

The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention? Suction the back of the throat. Encourage the child to cough. Continue to assess for bleeding. Notify the health care immediately.

Continue to assess for bleeding. Children will have a small amount of blood mixed with saliva following a tonsillectomy. Suctioning or coughing could irritate the surgical site and cause hemorrhage.

The health care provider has prescribed beclomethasone for long term control of asthma. The nurse is most correct to advise the client that beclomethasone is a: mast cell stabilizer. xanthine derivative. Corticosteroid leukotriene inhibitor.

Corticosteroid Beclomethasone is a corticosteroid prescribed for long-term asthma control. Mast cell stabilizers help to decrease bronchospasm and mucous membrane inflammation. A xanthine derivative such as theophylline is a time-released bronchodilator. Leukotriene inhibitors help with bronchodilation and decrease airway edema.

What is the most common debilitating disease of childhood among those of European descent? Cystic fibrosis Asthma Pneumonia BPD

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 the median age for survival being the late 30s.

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

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

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: Epiglottitis. Asthma Cystic fibrosis. Tuberculosis (TB).

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? Fever Rhinitis Symptoms have gradual onset White blood cell (WBC) count in normal range

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.

The nurse is correct in identifying which group of symptoms as present with acute laryngotracheobronchitis. Wheezing and a moist cough Fever and labored respirations Crackles in lung fields with cyanosis Hypoxia with shallow respirations

Fever and labored respirations Acute laryngotracheobronchitis presents with hoarseness and a barking cough with fever reaching 104°F to 105°F (40°C to 40.6°C) As the disease progresses, marked laryngeal edema occurs with dyspnea, a rapid pulse and cyanosis. Stridor is heard in the lung fields.

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: Funnel Cylindrical Oval Spherical

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.

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

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.

Which clinical manifestation of acute nasopharyngitis is more of a concern for the infant than the older child? Fever Vomiting Nasal congestion Diarrhea

Nasal congestion The infant has smaller airways, making it more difficult to breathe when nasal congestion occurs. The older child can tolerate the congestion better than the infant with smaller airways. Depending upon the age of the child, younger infants are afebrile. Vomiting and diarrhea can occur at any age as the mucus from the nasal drainage enters the gastrointestinal tract.

At which age do children have a trachea 4 mm in width? Newborn Toddler Teenager School-age children

Newborn Pediatric airways are much smaller in diameter and shorter in length than in adults. A newborn trachea is 4 mm wide compared to an adult of 20 mm. Because the trachea is so narrow even small amounts of mucus or edema can cause significant resistance to airflow. The trachea continues to grow and develop as the child grows so the toddler, school-age child, and adolescent would all have a trachea width larger than 4 mm.

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important? Provide acetaminophen for pain. Note any frequent swallowing. Allow the child an age-appropriate, quiet plan. Stress regular fluid consumption.

Note any frequent swallowing. A complication of a tonsillectomy and adenoidectomy is bleeding. If the child is bleeding he or she must be brought to the emergency room immediately. To determine if a child is bleeding, the parents must assess for frequent swallowing. All of the other discharge instructions are appropriate, but noting any frequent swallowing is the priority.

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan? Obtain testing for respiratory syncytial virus. Screen for the "allergic salute." Obtain vital signs to determine an infection. Draw a blood count to see if the client is septic.

Obtain testing for respiratory syncytial virus. The symptoms presented are of acute nasopharyngitis. Many times this is viral in nature and can be common in the very young from respiratory syncytial virus (RSV). RSV is tested by obtaining nasal secretions and sending to the lab. A 6-week-old may rub his/her face but is too young for the "allergic salute," which is done to relieve itching and open nasal pathways. Vital signs can be helpful to note the beginning of an infectious process.

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

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.

A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, which parts of the body (besides the lungs) are most affected by this disease? Brain and spinal cord Pancreas and liver Heart and blood vessels Kidney and bladder

Pancreas and liver The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.

The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet? Iodized salt Saturated fat Pancreatic enzymes Calories from protein

Pancreatic enzymes Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.

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

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? Respiratory stridor Wheezing in the bases Rales in the middle lobe Rhonchi throughout the lung

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.

A female nurse of childbearing ages caring for a 2-year-old child diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to: monitor the child regularly for signs of cyanosis. avoid contact with the mist. use contact transmission precautions. check for hyperthermia related to enclosure in the tent.

monitor the child regularly for signs of cyanosis.

The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do? Seat the child leaning forward and pinch the anterior portion of the nose closed. Seat the child with his head tipped back and apply ice or a cold cloth to the nose. With the child lying on his back, pinch the anterior portion of the nose closed. With the child lying on his back, apply pressure to the bridge of the nose.

Seat the child leaning forward and pinch the anterior portion of the nose closed. The child should sit up and lean forward. Apply continuous pressure to the anterior portion of the nose by pinching it closed. The bleeding usually stops within 10 to 15 minutes. Ice or a cold cloth on the bridge of the nose may help, but pressure will stop the bleeding. Lying down or tipping the head back may allow aspiration of the blood and should be avoided.

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? Shellfish indoor molds pet dander dust mites

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.

Which electrolyte does the client with cystic fibrosis need in abundance? Potassium Sodium Chlorine Magnesium

Sodium Explanation: Dietary intake of sodium is encouraged due to increased sodium losses. Clients are especially encouraged to eat salty pretzels, potato chips, etc. during hot weather or when sodium losses are anticipated.

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? Directly into the vein Through a gastrostomy tube Using a nebulizer Sprinkled onto the food

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 preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate? Standard precautions Airborne precautions Droplet precautions Contact precautions

Standard precautions Airborne precautions should be initiated for any client with suspected tuberculosis. Clients with suspected TB are placed away from other hospitalized clients in a single-occupancy room. Airborne precautions are implemented over droplet precautions as the bacilli can remain in the air and inhaled by others. Standard and contact precautions do not involve protecting the respiratory system.

What is a definitive test for cystic fibrosis? Complete blood count Blood gas Blood culture Sweat chloride

Sweat chloride The definitive test in diagnosing cystic fibrosis is the sweat chloride test. This test is performed by stimulating a small patch of sweat glands on the inner aspect of the forearm. There must be two positive tests and clinical symptoms to confirm the diagnosis. The other choices are routine diagnostic tests.

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? Tachycardia Hypoactivity Bronchial muscle relaxation Increased appetite

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 5-year-old girl who was already admitted to the hospital for an unrelated condition suddenly becomes irritable, restless and anxious. These may be early signs of respiratory distress in a child if accompanied by: Tachypnea Retractions Cyanosis Clubbing of fingers

Tachypnea Restlessness, irritability, and anxiety result from difficulty in securing adequate oxygen. These might be very early signs of respiratory distress, especially if accompanied by tachypnea (an increased respiratory rate). Retractions can be a sign of airway obstruction but occur more commonly in newborns and infants than in older children. Cyanosis (a blue tinge to the skin) indicates hypoxia, which may be a sign of airway obstruction but would not be the first. Children with chronic respiratory illnesses often develop clubbing of the fingers, a change in the angle between the fingernail and nailbed because of increased capillary growth in the fingertips. Clubbing would not occur in an acute airway obstruction, as is indicated in the scenario above.

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? The child is pale and has vomited. The child has pale, elevated patches on the skin. The child is irritable and tachycardiac. The child is in tripod position.

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.

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? The infant will attain oxygen saturation of 90% on room air. The infant's airway will remain clear and free of mucus. The infant's breathing will be less labored. The infant will have decreased nasal stuffiness.

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.

A 2-year-old toddler is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion? The toddler states being tired and wanting to sleep. The respiratory rate is gradually increasing. The cough is becoming harsher. The nasal discharge is increasing.

The respiratory rate is gradually increasing. Acute laryngotracheobronchitis is also know as croup. It produces edema of the larynx, trachea, and bronchi. An increasing respiratory rate, retractions, and nasal flaring are signs of major respiratory distress and occlusion. The toddler is breathing faster because less air is received with each breath. Nasal discharge is generally not seen with croup. The cough of croup is due to the inflammation in the larynx and trachea and it is a barking cough (sounds like a seal). A 2-year-old toddler will become tired and fall asleep or be irritable and unable to fall asleep. This age group is unable to verbalize being tired and wanting to sleep.

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? The child's weight The child's diet The child's hospital history The triggers in the environment

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 nurse caring for the child with asthma weighs the child daily. What is the most important reason for doing a daily weight on this child? To determine medication dosages To monitor the child's growth pattern To ensure that the child's food intake is adequate To determine fluid losses

To determine fluid losses During an acute asthma attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting. Theophylline administration also has a diuretic effect, which compounds the problem. Weigh the child daily to help determine fluid losses. The child's weight is used to determine medication dosages, to ensure that the child is appropriately gaining weight and growing, and that the intake is adequate. However, the most important reason for a daily weight is to determine fluid loss.

If there is a foreign body in the larynx, how will the client present? Edematous Speaks clearly Quietly With stridor

With stridor A foreign body can be either solid or liquid and it can lodge in the upper or lower airways. If a child has symptoms of cough, wheezing and/or stridor, it is an indication the foreign body is obstructing the upper airway. The child with a foreign body obstruction is anxious, has difficulty talking, and may be drooling. Edema of the airways may have occurred but generalized edema is not present.

The nurse has administered an intradermal injection of 0.1 ml of purified protein derivative. During which time frame will the nurse evaluate the site for reactions? Within 15 minutes Not before 24 hours Within 48 to 72 hours After 1 week

Within 48 to 72 hours Clients who have had a tuberculin skin test will need to return to the facility to have the site evaluated for a reaction within 48 to 72 hours. Redness, swelling, induration, and itching are signs of a positive reaction.

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: decreased activity and increased fluids. corticosteroids and leukotriene inhibitors. removal of allergens in the home and school. a bronchodilator and mast cell stabilizers.

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.

How is wheezing in children best heard? with the child supine as the child exhales as the child cries without a stethoscope

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.

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: impaired digestive activity high sodium chloride concentration in the sweat. chronic lack of oxygen. decreased respiratory capacity.

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.

When preparing the room for an infant with bronchiolitis, which equipment is most important? a tracheostomy set a metered dose inhaler IV antibiotics oxygen tubing and facemask

oxygen tubing and facemask Bronchiolitis is an acute inflammatory process in the bronchioles and small bronchi. The treatment is supportive oxygen therapy, suctioning, and hydration. Rarely is a tracheostomy set needed for care. An infant is not able to use a metered dose inhaler but nebulized bronchodilators may occasionally be needed. Bronchiolitis is most commonly associated with the respiratory syncytial virus (RSV), thus antibiotics would not be warranted in the treatment plan.

What is a symptom of allergic rhinitis (hay fever)? purulent secretions difficulty breathing Laryngitis sinus pain

sinus pain Rhinosinusitis is a bacterial infection of the paranasal sinuses. It can be an acute disorder or children may develop it as a chronic condition. The child will exhibit a cough, fever, halitosis (especially in preschoolers and older children), facial pain, eyelid edema, irritability, and poor appetite. Pharyngitis would occur if there was a throat infection, not a sinus infection. The drainage from the infected sinuses will generally be thick but it is not purulent. Respiratory difficulty is not seen because only the sinuses are involved.