E3: Respiratory
A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action? a. Notify the health care provider. b. Continue to assess for bleeding. c. Give the child a red flavored ice pop. d. Position the child in a Trendelenburg position.
ANS: B Some secretions, particularly dried blood from surgery, are common after a tonsillectomy. Inspect all secretions and vomitus for evidence of fresh bleeding (some blood-tinged mucus is expected). Dark brown (old) blood is usually present in the emesis, as well as in the nose and between the teeth. Small amounts of dark brown blood should be further monitored. A redflavored ice pop should not be given and the Trendelenburg position is not recommended.
The nurse is caring for a newborn with suspected congenital diaphragmatic hernia. What of the following findings would the nurse expect to observe? (Select all that apply.) a. Loud, harsh murmur b. Scaphoid abdomen c. Poor peripheral pulses d. Mediastinal shift e. Inguinal swelling f. Moderate respiratory distress
ANS: B, D, F Clinical manifestations of a congenital diaphragmatic hernia include a scaphoid abdomen, a mediastinal shift, and moderate to severe respiratory distress. The infant would not have a harsh, loud murmur or poor peripheral pulses. Inguinal swelling is indicative of an inguinal hernia.
A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? A. Asthma B. Pneumonia C. Bronchiolitis D. Foreign body in trachea
A. Asthma
What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (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
Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections? A. They are safer. B. They are less expensive. C. Respiratory secretions are dried by steam vaporizers. D. A more comfortable environment is produced.
A. They are safer
A child with asthma is having pulmonary function tests. Which of the following explains the purpose of the peak expiratory flow rate? A. To assess severity of asthma B. To determine cause of asthma C. To identify "triggers" of asthma D. To confirm diagnosis of asthma
A. To asses severity of asthma
When caring for a child after a tonsillectomy, the nurse should do which of the following? A. Watch for continuous swallowing. B. Encourage gargling to reduce discomfort. C. Apply warm compresses to the throat. D. Position the child on the back for sleeping.
A. Watch for continuous swallowing
The leading cause of chronic illness in children is: A. asthma. B. pertussis. C. tuberculosis. D. cystic fibrosis.
A. asthma
A 1-year-old child has acute otitis media (AOM) and is being treated with oral antibiotics. What should the nurse include in the discharge teaching to the infants parents? a. A follow-up visit should be done after all medicine has been given. b. After an episode of acute otitis media, hearing loss usually occurs. c. Tylenol should not be given because it may mask symptoms. d. The infant will probably need a myringotomy procedure and tubes.
ANS: A Children with AOM should be seen after antibiotic therapy is complete to evaluate the effectiveness of the treatment and to identify potential complications, such as effusion or hearing impairment. Hearing loss does not usually occur with acute otitis media. Tylenol should be given for pain, and the infant will not necessarily need a myringotomy procedure.
A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infants vital signs are T, 101.6 F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason? a. Tachypnea b. Paroxysmal cough c. Irritability d. Fever
ANS: A Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for fluids by mouth to be contraindicated.
A tonsillectomy or adenoidectomy is contraindicated in what conditions? (Select all that apply.) a. Cleft palate b. Seizure disorders c. Blood dyscrasias d. Sickle cell disease e. Acute infection at the time of surgery
ANS: A, C, E Contraindications to either tonsillectomy or adenoidectomy are (1) cleft palate because both tonsils help minimize escape of air during speech, (2) acute infections at the time of surgery because the locally inflamed tissues increase the risk of bleeding, and (3) uncontrolled systemic diseases or blood dyscrasias. Tonsillectomy or adenoidectomy is not contraindicated in sickle cell disease or seizure disorders.
The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate which of the following? A. Sore throat B. Inspiratory stridor C. Complete obstruction D. Respiratory tract infection
C. Complete obstruction
An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires the following isolation: A. reverse isolation. B. airborne isolation. C. Contact Precautions. D. Standard Precautions.
C. Contact Precautions
Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39o C (102.2o F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner would instruct the parents to use: A. decongestants to ease stuffy nose. B. antihistamines to help the child sleep. C. aspirin for pain and fever management. D. benzocaine ear drops for topical pain relief.
D. benzocaine ear drops for topical pain relief.
A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, My tummy hurts. The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the childs pain? a. Ice chips b. Tylenol PO c. Tylenol PR d. Popsicle
c. Tylenol PR The throat is very sore after a tonsillectomy. Most children experience moderate pain after a tonsillectomy and need pain medication at regular intervals for at least the first 24 hours. Analgesics may need to be given rectally or intravenously to avoid the oral route.
A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)? a. Less than 18 mEq/L b. 18 to 40 mEq/L c. 40 to 60 mEq/L d. Greater than 60 mEq/L
d. Greater than 60 mEq/L
A family requires home care teaching with regard to preventative measures to use at home to avoid an asthmatic episode. What strategy should the nurse teach? a. Use a humidifier in the childs room. b. Launder bedding daily in cold water. c. Replace wood flooring with carpet. d. Use an indoor air purifier with HEPA filter
ANS: D Allergen control includes use of an indoor air purifier with HEPA filter. Humidity should be kept low, bedding laundered in hot water once a week, and carpet replaced with wood floors.
A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect: A. allergies. B. acute pharyngitis. C. foreign body in nose. D. acute nasopharyngitis.
C. foreign body in the nose
The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: A. has a cough. B. becomes fussy. C. shows signs of an earache. D. has a fever higher than 37.5° C (99° F).
C. shows signs of an earache
A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with which? a. Racemic epinephrine and corticosteroids b. Nebulizer treatments and oxygen c. Antibiotics and albuterol d. Chest physiotherapy and humidity
A. Racemic epinephrine and corticosteroids Nebulized epinephrine (racemic epinephrine) is now used in children with LTB that is not alleviated with cool mist. The beta-adrenergic effects cause mucosal vasoconstriction and subsequent decreased subglottic edema. The use of corticosteroids is beneficial because the antiinflammatory effects decrease subglottic edema. Nebulizer treatments are not effective even though oxygen may be required. Antibiotics are not used because it is a viral infection. Chest physiotherapy would not be instituted.
An infant's parents ask the nurse about preventing otitis media (OM). Which of the following should be recommended? A. Avoid tobacco smoke. B. Use nasal decongestant. C. Avoid children with OM. D. Bottle- or breast-feed in supine position.
A. Avoid tobacco smoke.
Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which of the following? A. Do not use for more than 3 days. B. Keep drops to use again for nasal congestion. C. Administer drops after feedings and at bedtime. D. Give two drops every 5 minutes until nasal congestion subsides.
A. Do not use for more than 3 days
The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic, since these symptoms are suggestive of which of the following? A. Pneumothorax B. Bronchodilation C. Carbon dioxide retention D. Increased viscosity of sputum
A. Pneumothorax
. A 5-year-old child is admitted with bacterial pneumonia. What signs and symptoms should the nurse expect to assess with this disease process? a. Fever, cough, and chest pain b. Stridor, wheezing, and ear infection c. Nasal discharge, headache, and cough d. Pharyngitis, intermittent fever, and eye infection
ANS: A Children with bacterial pneumonia usually appear ill. Symptoms include fever, malaise, rapid and shallow respirations, cough, and chest pain. Ear infection, nasal discharge, and eye infection are not symptoms of bacterial pneumonia.
The nurse is preparing to admit a 3-year-old child with acute spasmodic laryngitis. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.) a. High fever b. Croupy cough c. Tendency to recur d. Purulent secretions e. Occurs sudden, often at night
ANS: B, C, E Clinical features of acute spasmodic laryngitis include a croupy cough, a tendency to recur, and occurring sudden, often at night. High fever is a feature of acute epiglottitis and purulent secretions are seen with acute tracheitis.
A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal? a. Encourage increased fluid intake. b. Recommend increased use of a budesonide (Pulmicort) inhaler. c. Administer an antitussive to suppress coughing. d. Encourage the child to blow a pinwheel every 6 hours while awake
ANS: D Play techniques that can be used for younger children to extend their expiratory time and increase expiratory pressure include blowing cotton balls or a ping-pong ball on a table, blowing a pinwheel, blowing bubbles, or preventing a tissue from falling by blowing it against the wall. Increased fluids, increased use of a Pulmicort inhaler, or suppressing a cough will not increase expiratory effectiven
It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent: A. otitis media. B. diabetes insipidus (DI). C. nephrotic syndrome. D. acute rheumatic fever.
D. acute rheumatic fever
A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup? a. A bath in tepid water can help resolve this type of croup. b. Tylenol can help to relieve the cough and stridor. c. A cool mist vaporizer at the bedside can help prevent this type of croup. d. Antibiotics need to be given to reduce the inflammation.
c. A cool mist vaporizer at the bedside can help prevent this type of croup.
. An infant with a congenital heart defect is to receive a dose of palivizumab (Synagis). What is the purpose of this? a. Prevent RSV infection. b. Prevent secondary bacterial infection. c. Decrease toxicity of antiviral agents. d. Make isolation of infant with RSV uneccessary
ANS: A The only product available in the United States for prevention of RSV is palivizumab, a humanized mouse monoclonal antibody, which is given once every 30 days (15 mg/kg) between November and March. It is given to high-risk infants, which includes an infant with a congenital heart defect.
A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. This medication should be administered: A. after chest physiotherapy (CPT). B. Before chest physiotherapy (CPT) C. after receiving 100% oxygen. D. before receiving 100% oxygen.
B. Before chest physiotherapy (CPT) Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.
Which of the following is the most important consideration in managing tuberculosis (TB) in children? A. Skin testing B. Chemotherapy C. Adequate rest D. Adequate hydration
B. Chemotherapy Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and isoniazid and rifampin given two or three times a week by direct observation therapy for the remaining 4 months. Chemotherapy is the most important intervention for TB
The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily which of the following? A. Mothers of hospitalized toddlers often experience guilt. B. The mother's presence will reduce anxiety and ease child's respiratory efforts. C. Separation from mother is a major developmental threat at this age. D. The mother can provide constant observations of the child's respiratory efforts
B. The mother's presence will reduce anxiety and ease child's respiratory efforts.
Which of the following statements is the most descriptive of asthma? A. It is inherited. B. There is heightened airway reactivity. C. There is decreased resistance in the airway. D. The single cause of asthma is an allergic hypersensitivity.
B. There is heightened airway reactivity.
A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). This drug: A. is given subcutaneously. B. may cause voice alterations. C. may cause mucus to thicken. D. is not indicated for children younger than age 12 years.
B. may cause voice alterations.
One of the goals for children with asthma is to maintain the child's normal functioning. To accomplish this, one of the principles of treatment is to: A. limit participation in sports. B. reduce underlying inflammation. C. minimize use of pharmacologic agents. D. have yearly evaluations by health care provider.
B. reduce underlying inflammation
Chronic otitis media with effusion (OME) differs from acute otitis media (AOM) because it is usually characterized by which of the following? A. Severe pain in the ear B. Anorexia and vomiting C. A feeling of fullness in the ear D. Fever as high as 40° C (104° F)
C. A feeling of fullness in the ear
A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action? a. Throat culture b. Nasal pharynx washing c. Administration of corticosteroids d. Emergency intubation
ANS: D Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation. Nasotracheal intubation or tracheostomy is usually considered for a child with epiglottitis with severe respiratory distress. The throat should not be inspected because airway obstruction can occur, and steroids would not be done first when the child is in severe respiratory distress.
. A child is diagnosed with active pulmonary tuberculosis. What medications does the nurse anticipate to be prescribed for the first 2 months? (Select all that apply.) a. Isoniazid (INH) b. Cefuroxime (Ceftin) c. Rifampin (Rifadin) d. Pyrazinamide (PZA) e. Ethambutol (Myambutol)
ANS: A, C, D, E For the child with clinically active pulmonary and extrapulmonary TB, the goal is to achieve sterilization of the tuberculous lesion. The American Academy of Pediatrics (2012) recommends a 6-month regimen consisting of INH, rifampin, ethambutol, and PZA given daily or twice weekly for the first 2 months followed by INH and rifampin given two or three times a week by DOT for the remaining 4 months (Mycobacterium tuberculosis). Cefuroxime is not part of the regimen.
The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The childs SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? a. Withhold feedings. b. Notify the health care provider. c. Put the infant in an infant seat. d. Keep the infant in the plastic hood.
ANS: B The American Academy of Pediatrics practice parameter (2006) recommends the use of supplemental oxygen if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat would not increase the saturation reading. The infant should be kept in the hood, but because the saturation reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen concentration.
A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurses action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what? a. Adequate b. Adequate but should be taken between meals c. Needs to be increased to increase the number of bowel movements per day d. Needs to be increased to decrease the number of bowel movements per day
ANS: D The amount of enzyme is adjusted to achieve normal growth and a decrease in the number of stools to one or two per day
The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. Which of the following statements by the parent would indicate a correct understanding of the teaching? A. "I can use an ice collar on my child for pain control along with analgesics." B. "My child should clear the throat frequently to clear the secretions." C. "I should allow my child be as active as tolerated." D. "My child should gargle and brush teeth at least three times per day."
A. "I can use an ice collar on my child for pain control along with analgesics."
An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. Instructions to the parent should include which of the following? A. Administer all of the prescribed medication. B. Continue medication until all symptoms subside. C. Immediately stop giving medication if hearing loss develops. D. Stop giving medication and come to the clinic if fever is still present in 24 hours.
A. Administer all of the prescribed medication.
An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? A. Administration of antibiotics B. Frequent complete assessment of the infant C. Round-the-clock administration of antitussive agents D. Strict monitoring of intake and output to avoid congestive heart failure
A. Administration of antibiotics
The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. Which of the following is essential in this child's care? A. Monitor pulse oximetry. B. Monitor arterial blood gases. C. Administer oxygen if respiratory distress develops. D. Administer oxygen if child's lips become bright, cherry-red in color.
B. Monitor ABG/s
The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? A. Force fluids. B. Monitor pulse oximetry. C. Institute seizure precautions. D. Encourage high-protein diet.
B. Monitor pulse oximetry.
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which of the following? A. Admit to the hospital and observe for impending epiglottitis. B. Provide fluids that the child likes and use comfort measures. C. Control fever with acetaminophen and call if cough gets worse tonight. D. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.
B. Provide fluids that the child likes and use comfort measures.
What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include? a. Rhinorrhea, wheezing, and fever b. Tachypnea, cyanosis, and apnea c. Retractions, fever, and listlessness d. Poor breath sounds and air hunger
ANS: A Symptoms such as rhinorrhea and a low-grade fever often appear first. OM and conjunctivitis may also be present. In time, a cough may develop. Wheezing is an initial sign as well. Progression of illness brings on the symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger, and apnea
What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild respiratory tract infection? (Select all that apply.) a. Cool mist b. Warm mist c. Steam vaporizer d. Keep child in a flat, quiet position e. Run a shower of hot water to produce steam
ANS: A, B, C, E Warm or cool mist is a common therapeutic measure for symptomatic relief of respiratory discomfort. The moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement. A time-honored method of producing steam is the shower. Running a shower of hot water into the empty bathtub or open shower stall with the bathroom door closed produces a quick source of steam. Keeping a child in this environment for 10 to 15 minutes may help ease respiratory efforts. A small child can sit on the lap of a parent or other adult. The child should be quiet but upright, not flat. The use of steam vaporizers in the home is often discouraged because of the hazards related to their use and limited evidence to support their efficacy
The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.) a. A child with asthma b. A child with diabetes c. A child with hemophilia A d. A child with cancer receiving chemotherapy e. A child with gastroesophageal reflux disease
ANS: A, B, D The live attenuated influenza vaccine (LAIV) is an acceptable alternative to the IM vaccine (IIV) for ages 2 to 49 years. It is a live vaccine administered via nasal spray. Several groups are excluded from receiving it, including children with a chronic heart or lung disease (asthma or reactive airways disease), diabetes, or kidney failure; children who are immunocompromised or receiving immunosuppressants; children younger than 5 years of age with a history of recurrent wheezing; children receiving aspirin; patients who are pregnant; children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components; or children with a history of Guillain-Barr Syndrome after a previous dose. A child with hemophilia A or gastroesophageal reflux disease would not be immunocompromised so they can receive the LAIV
A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what? a. 80% of a personal best, and the routine treatment plan can be followed. b. 50% to 79% of a personal best and needs an increase in the usual therapy. c. 50 % of a personal best and needs immediate emergency bronchodilators. d. Less than 50% of a personal best and needs immediate hospitalization.
ANS: B The interpretation of a peak expiratory flow rate that is yellow (50%79% of personal best) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone
A child is in the hospital for cystic fibrosis. What health care providers prescription should the nurse clarify before implementing? a. Dornase alfa (Pulmozyme) nebulizer treatment bid b. Pancreatic enzymes every 6 hours c. Vitamin A, D, E, and K supplements daily d. Proventil (albuterol) nebulizer treatments tid
ANS: B The principal treatment for pancreatic insufficiency that occurs in cystic fibrosis is replacement of pancreatic enzymes, which are administered with meals and snacks to ensure that digestive enzymes are mixed with food in the duodenum. The enzymes should not be given every 6 hours, so this should be clarified before implementing this prescription. Dornase alfa (Pulmozyme) is given by nebulizer to decrease the viscosity of secretions, vitamin supplements are given daily, and Proventil nebulizer treatments are given to open the bronchi for easier expectoration.
The nurse is preparing to admit a 7-year-old child with acute laryngotracheobronchitis (LTB). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Dysphagia b. Brassy cough c. Low-grade fever d. Toxic appearance e. Slowly progressive
ANS: B, C, E Clinical manifestations of LTB include a brassy cough, low-grade fever, and slow progression. Dysphagia and a toxic appearance are characteristics of acute epiglottitis
In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? a. Fats and proteins must be greatly curtailed. b. Most fruits and vegetables are not well tolerated. c. Diet should be high in calories, proteins, and unrestricted fats. d. Diet should be low fat but high in calories and proteins
ANS: C Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat
A child has a streptococcal throat infection and is being treated with antibiotics. What should the nurse teach the parents to prevent infection of others? a. The child can return to school immediately. b. The organism cannot be transmitted through contact. c. The child can return to school after taking antibiotics for 24 hours. d. The organism can only be transmitted if someone uses a personal item of the sick child
ANS: C Children with streptococcal infection are noninfectious to others 24 hours after initiation of antibiotic therapy. It is generally recommended that children not return to school or daycare until they have been taking antibiotics for a full 24-hour period. The organism is spread by close contact with affected personsdirect projection of large droplets or physical transfer of respiratory secretions containing the organism.
A term infant is delivered, and before delivery, the medical team was notified that a congenital diaphragmatic hernia (CDH) was diagnosed on ultrasonography. What should be done immediately at birth if respiratory distress is noted? a. Give oxygen. b. Suction the infant. c. Intubate the infant. d. Ventilate the infant with a bag and mask.
ANS: C Many infants with a CDH require immediate respiratory assistance, which includes endotracheal intubation and GI decompression with a double-lumen catheter to prevent further respiratory compromise. At birth, bag and mask ventilation is contraindicated to prevent air from entering the stomach and especially the intestines, further compromising pulmonary function. Oxygen and suctioning may be used for mild respiratory distress.
The nurse is interpreting a tuberculin skin test. If the nurse finds a result of an induration 5mm or larger, in which child should the nurse document this finding as positive? (Select all that apply.) a. A child with diabetes mellitus b. A child younger than 4 years of age c. A child receiving immunosuppressive therapy d. A child with a human immunodeficiency virus (HIV) infection e. A child living in close contact with a known contagious case of tuberculosis
ANS: C, D, E
The nurse is preparing to admit a 7-year-old child with pulmonary edema. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Fever b. Bradycardia c. Diaphoresis d. Pink frothy sputum e. Respiratory crackles
ANS: C, D, E Clinical manifestations of pulmonary edema include diaphoresis, pink frothy sputum, and respiratory crackles. Fever or bradycardia are not manifestations of pulmonary edema.
A 6-year-old child is in the hospital for status asthmaticus. Nursing care during this acute period includes which prescribed interventions? a. Prednisolone (Pediapred) PO every day, IV fluids, cromolyn (Intal) inhaler bid b. Salmeterol (Serevent) PO bid, vital signs every 4 hours, spot check pulse oximetry c. Triamcinolone (Azmacort) inhaler bid, continuous pulse oximetry, vital signs once a shift d. Methylprednisolone (Solumedrol) IV every 12 hours, continuous pulse oximetry, albuterol nebulizer treatments every 4 hours and prn
ANS: D The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring. A systemic corticosteroid (oral, IV, or IM) may also be given to decrease the effects of inflammation. Inhaled aerosolized short-acting 2- agonists are recommended for all patients. Therefore, Solumedrol per IV, continuous pulse oximetry, and albuterol nebulizer treatments are the expected prescribed treatments.
What medication is contraindicated in children post tonsillectomy and adenoidectomy? a. Codeine b. Ondansetron (Zofran) b. Amoxil (amoxicillin) c. Acetaminophen (Tylenol)
ANS; A Codeine is contraindicated in pediatric patients after tonsillectomy and adenoidectomy. In 2012, the Food and Drug Administration issued a Drug Safety Communication that codeine use in certain children after tonsillectomy or adenoidectomy may lead to rare but life-threatening adverse events or death. Zofran, amoxicillin, and Tylenol are not contraindicated after tonsillectomy and adenoidectomy.
Which of the following diagnostic tests for allergies involves the injection of specific allergens? A. Phadiatop B. Skin testing C. Radioallergosorbent tests (RAST) D. Blood examination for total immunoglobulin E (IgE)
C. Radioallergosorbent tests (RAST)
Inhaled corticosteroids are currently the recommended first-line therapy for children with asthma over the age of 5 years. Children who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? A. Cough B. Osteoporosis C. Slowed growth D. Cushing syndrome
C. Slowerd growth
The nurse is preparing a staff education program about pediatric asthma. Which of the following concepts should the nurse include when discussing the asthma severity classification system? Select all that apply. A. Children with mild persistent asthma have nighttime symptoms less than two times a month. B. Children with moderate persistent asthma use a short-acting β-agonist more than two times per week. C. Children with severe persistent asthma have a peak expiratory flow (PFE) of 60% to 80% of predicted value. D. Children with mild persistent asthma have symptoms more than two times per week. E. Children with moderate persistent asthma have some limitations with normal activity. F. Children with severe persistent asthma have frequent nighttime symptoms.
D. Children with mild persistent asthma have symptoms more than two times per week. E. Children with moderate persistent asthma have some limitations with normal activity. F. Children with severe persistent asthma have frequent nighttime symptoms.
Which of the following statements best represents infectious mononucleosis? A. Herpes simplex type 2 is principal cause. B. A complete blood count shows a characteristic leukopenia. C. A short course of ampicillin is used when pharyngitis is present. D. Clinical symptoms and blood tests are both needed to establish the diagnosis.
D. Clinical symptoms and blood tests are both needed to establish the diagnosis.
Cystic fibrosis (CF) may affect single or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following? A. Hyperactivity of sweat glands B. Hypoactivity of autonomic nervous system C. Atrophic changes in mucosal wall of intestines D. Mechanical obstruction caused by increased viscosity of mucous gland secretions
D. Mechanical obstruction caused by increased viscosity of mucous gland secretions
A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should do which of the following? A. Make her lie down and rest quietly. B. Examine her oral pharynx and report to the physician. C. Auscultate her lungs and prepare for placement in a mist tent. D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation
D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation
Pancreatic enzymes are administered to the child with cystic fibrosis. Nursing considerations should include which of the following? A. Give pancreatic enzymes between meals if at all possible. B. Do not administer pancreatic enzymes if child is receiving antibiotics. C. Decrease dose of pancreatic enzymes if child is having frequent, bulky stools. D. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at beginning of meal.
D. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at beginning of meal.
Which of the following tests aids in the diagnosis of cystic fibrosis (CF)? a. Sweat test, stool for fat, chest x-ray films b. Sweat test, bronchoscopy, duodenal fluid analysis c. Sweat test, stool for trypsin, biopsy of intestinal mucosa d. Stool for fat, gastric contents for hydrochloride, chest x-ray films
a. Sweat test, stool for fat, chest x-ray films
Which of the following drugs 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
