Peds Chapter40-Nursing Care of the Child With an Alteration in Gas Exchange/ Respiratory Disorder

1. The nurse is assessing a 7-year-old boy with pharyngitis. The nurse would least likely expect to assess which of the following? A) Working hard to breathe B) Difficulty swallowing C) Rash on the abdomen D) Sore throat and headache

A) Working hard to breathe Disorders of the nose and throat do not result in increased work of breathing, so that would not be observed by the nurse. Difficulty swallowing, sore throat, and headache are consistent with pharyngitis, as is the rash, which would be fine, red, and sandpaper-like (called scarlatiniform).

8. The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which of the following drugs would the nurse identify as an adjunct to a b2-adrenergic agonist for treatment of bronchospasm? A) Ipratropium B) Montelukast C) Cromolyn D) Theophylline

A) Ipratropium Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a b2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation.

Which is the most appropriate treatment for epistaxis? a. With the child lying down and breathing through the mouth, apply pressure to the bridge of the nose. b. With the child lying down and breathing through the mouth, pinch the lower third of the nose closed. c. With the child sitting up and leaning forward, apply pressure to the bridge of the nose. D. With the child sitting up and leaning forward, pinch the lower third of the nose closed.

D. The child must not lie down, to prevent risk of aspiration. Nosebleeds most often occur in the lower third of the nose, so pinching should occur there.

11. A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? A) Simple mask B) Venturi mask C) Nasal cannula D) Oxygen hood

A) Simple mask A simple mask would be used to deliver a flow rate of 8 liters per minute. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 liters per minute. An oxygen hoodrequires a liter flow of 10 to 15 liters per minute.

17. A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? A) IgA B) IgE C) IgG D) IgM

B) IgE The immunoglobulin involved in the immune response associated with allergic rhinitis is IgE. IgA, IgG, and IgM are not involved in this response.

14. A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? A) "She really doesn't need the vaccine until she reaches 1 year of age." B) "She will probably receive it the next time she is to get her routine shots." C) "Since your daughter is older than 6 months, she should get the vaccine every year." D) "The vaccine has many side effects, so she wouldn't get it until she's ready to go to school."

C) "Since your daughter is older than 6 months, she should get the vaccine every year." The current recommendations are for all children older than 6 months of age to be immunized yearly against influenza

23. The nurse is preparing to provide tracheostomy care to an infant. After gathering the necessary equipment, which of the following would the nurse do next? A) Position the infant supine with a towel roll under the neck B) Cut the new tracheostomy ties to the appropriate length C) Cut the tracheostomy ties from around the tracheostomy tube D) Cleanse around the site of the tracheostomy with the prescribed solution

A) Position the infant supine with a towel roll under the neck After gathering the necessary equipment, the nurse would position the infant supine with a blanket or towel roll to extend the neck. Then the nurse would open all the packaging and cut the new tracheostomy ties to the appropriate length. This would be followed by cleaning the site with the appropriate solution and then rinsing it. After placing the precut sterile gauze under the tracheostomy tube, the nurse would cut the ties and remove them from the tube while an assistant holds the tube in place.

9. The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which of the following? A) Suctioning a tracheostomy tube B) Administering drugs with a nebulizer C) Providing tracheostomy care D) Suctioning with a bulb syringe

A) Suctioning a tracheostomy tube Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen.

Which of these factors contributes to infants' and children's increased risk for upper airway obstruction as compared with adults? a. Underdeveloped cricoid cartilage and narrow nasal passages b. Small tonsils and narrow nasal passages c. Cylinder-shaped larynx and underdeveloped sinuses d. Underdeveloped cricoid cartilage and smaller tongue

A. - Infants and children have smaller nasal passages than adults, thus making obstruction with mucus more common. - The funnel shape of the larynx due to underdevelopment of the cricoid cartilage places children less than 10 years of age at increased risk of airway obstruction in the event of edema or mucus production.

18. A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A) Salmeterol B) Albuterol C) Ipratropium D) Cromolyn

B) Albuterol Albuterol is a short-acting b2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting b2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to b2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cellstabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

12. A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which of the following? A) Children's demand for oxygen is lower than that of adults. B) Children develop hypoxemia more rapidly than adults do. C) An increase in oxygen saturation leads to a much larger decrease in pO2. D) Children's bronchi are wider in diameter than those of an adult.

B) Children develop hypoxemia more rapidly than adults do. Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.

20. A nursing instructor is preparing a class on chronic lung disease. Which of the following would the instructor include when describing this disorder? A) It is a result of cystic fibrosis. B) It is seen most commonly in premature infants. C) It typically affects females more often than males. D) It is characterized by bradypnea.

B) It is seen most commonly in premature infants. Chronic lung disease, formerly known as bronchopulmonary dysplasia, is often diagnosed in infants who have experienced respiratory distress syndrome, most commonly seen in premature infants. Male gender is a risk factor for development. Tachypnea and increased work of breathing are characteristic of chronic lung disease.

19. The nurse is preparing to perform a physical examination of a child with asthma. Which of the following techniques would the nurse be least likely to perform? A) Inspection B) Palpation C) Percussion D) Auscultation

B) Palpation When examining the child with asthma, the nurse would inspect, auscultate, and percuss. Palpation would not be used.

3. The nurse is examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which of the following as most helpful in determining the extent of the child's hypoxia? A) Pulmonary function test B) Pulse oximetry C) Peak expiratory flow D) Chest radiograph

B) Pulse oximetry Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest radiographs can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size.

7. The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, which of the following would be least appropriate for the nurse to perform? A) Providing 100% oxygen B) Visualizing the throat C) Having the child sit forward D) Auscultating for lung sounds

B) Visualizing the throat The child is exhibiting signs and symptoms of epiglottitis, which can be life-threatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.

16. A child with a pneumothorax has a chest tube attached to a water seal system. When assessing the child, the nurse notices that the chest tube has become disconnected from the drainage system. Which of the following would the nurse do first? A) Notify the physician B) Apply an occlusive dressing C) Clamp the chest tube D) Perform a respiratory assessment

C) Clamp the chest tube If a chest tube becomes disconnected from the water seal drainage system, the nurse would first clamp the chest tube to prevent air from entering the child's chest cavity. Then the nurse would perform a respiratory assessment and notify the physician. An occlusive dressing would be applied first if the chest tube became dislodged from the child's chest.

22. When performing the physical examination of a child with cystic fibrosis , which of the following would the nurse expect to assess? A) Dullness over the lung fields B) Increased diaphragmatic excursion C) Decreased tactile fremitus D) Hyperresonance over the liver

C) Decreased tactile fremitus Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lung fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged.

4. A rapid strep test has confirmed that a 5-year-old girl has a group A Streptococcus infection. When teaching the parents about measures to implement, which of the following would be the least immediate concern? A) Using a cool mist humidifier B) Encouraging the child to drink liquids C) Discarding the child's toothbrush D) Administering antibiotic therapy

C) Discarding the child's toothbrush The least immediate concern would be to discard the child's toothbrush so that she does not reinfect herself. Usually this is accomplished after 24 hours of antibiotic therapy. Immediate care measures would include using a cool mist humidifier in the child's room and encouraging her to drink liquids or eat ice chips. In addition, antibiotic therapy would be initiated immediately and continue until the entire prescription is complete.

5. A nurse is administering 100% oxygen to a child with a pneumothorax based on the understanding that this treatment is used primarily for which reason? A) Improve gas exchange B) Bypass the obstruction C) Hasten air reabsorption D) Prevent hypoxemia

C) Hasten air reabsorption Administration of 100% oxygen is used to treat pneumothorax primarily because it hastens the reabsorption of air. Generally this is used only for a few hours. Although the oxygen also improves gas exchange and prevents hypoxemia, these are not the reasons for its use in this situation. There is no obstruction with a pneumothorax.

15. A nurse is preparing a teaching program for a parenting group about preventing foreign body aspiration. Which of the following would the nurse include? A) Avoid giving popcorn to children younger than the age of 2 years. B) Withhold peanuts from children until they are at least 5 years of age. C) If an object fits through a standard toilet paper roll, the child can aspirate it. D) Keep pennies and dimes out of the child's reach; quarters do not pose a problem.

C) If an object fits through a standard toilet paper roll, the child can aspirate it. Items smaller than 1.25 inches can be aspirated easily. A simple way for parents to estimate the safe size of a small item or toy piece is to gauge its size against a standard toilet paper roll, which is generally about 1.5 inches in diameter. If it fits through the roll, it can be aspirated. Popcorn and peanuts should not be given to children until they are at least 3 years old. All coins should be kept out of the reach of children.

2. The nurse hears wheezing when auscultating a 4-year-old. Which of the following conditions would the nurse most likely rule out based on the assessment findings? A) Bronchiolitis B) Asthma C) Influenza D) Cystic fibrosis

C) Influenza Wheezing typically is not associated with influenza. Wheezing is caused by an obstruction of the bronchioles that may be caused by bronchiolitis, asthma, cystic fibrosis, or chronic lung disease. In addition, if the bronchiolitis is due to influenza, wheezing may be heard.

A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention? a. Attempt to calm the infant by placing him in his mother's lap and offering him a bottle. b. Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest x-ray. c. Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure. d. Bring the emergency equipment to the room and begin bag-valve-mask ventilation.

C. Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation. Children who experience respiratory distress often deteriorate very quickly, and the nurse must be prepared in the event of respiratory failure or arrest.

13. The nurse is providing care to several children who have been brought to the clinic by the parents for complaints of cold-like symptoms. The nurse would most likely suspect sinusitis in which child? A) A 2-year-old with thin watery nasal discharge B) A 3-year-old with sneezing and coughing C) A 5-year-old with nasal congestion and sore throat D) A 7-year-old with halitosis and thick, yellow nasal discharge

D) A 7-year-old with halitosis and thick, yellow nasal discharge The frontal sinuses, those most commonly associated with sinus infection, develop by age 6 to 8 years. Therefore, the 7-year-old would most likely experience sinusitis. In addition, this child also exhibits halitosis and a thick, yellow nasal discharge, other findings associated with sinusitis. Thin watery discharge in a 2-year-old is more likely to indicate allergic rhinitis. A 3-year-old with coughing and sneezing or a 5-year-old with nasal congestion and sore throat suggests the common cold

24. A child is brought to the emergency department by his parents because he suddenly developed a barking cough. Further assessment leads the nurse to suspect that the child is experiencing croup. Which of the following would the nurse have most likely assessed? A) High fever B) Dysphagia C) Toxic appearance D) Inspiratory stridor

D) Inspiratory stridor A child with croup typically develops a bark-like cough often at night. This may be accompanied by inspiratory stridor and suprasternal retractions. Temperature may be normal or slightly elevated. A high fever, dysphagia, and toxic appearance are associated with epiglottitis

A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention? a. Airway maintenance and 100% oxygen by mask b. 100% oxygen and pulse oximetry monitoring c. Airway maintenance and continued reassessment d. 100% oxygen and provision of comfort

A. Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation.

6. Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? A) Fever B) Oxygen saturation level of 96% C) Tachypnea with retractions D) Pale skin color

C) Tachypnea with retractions Pneumonia is usually a self-limiting disease. Children with bacterial pneumonia can be successfully managed at home if the work of breathing is not severe and oxygen saturation is within normal limits. Hospitalization would most likely be required for the child with tachypnea, significant retractions, poor oral intake, or lethargy for the administration of supplemental oxygen, intravenous hydration, and antibiotics. Fever, although common in children with pneumonia, would not necessitate hospitalization. An oxygen saturation level of 96% would be within normal limits. Pallor (pale skin color) occurs as a result of peripheral vasoconstriction in an effort to conserve oxygen for vital functions; this finding also would not necessitate hospitalization.

21. A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which of the following would the nurse instruct the parents to administer orally? A) Recombinant human DNase B) Bronchodilators C) Anti-inflammatory agents D) Pancreatic enzymes

D) Pancreatic enzymes Most people with CF need to take pancreatic enzyme capsules before every meal and snack so their bodies can digest the nutrients. Meals and snacks include breast milk, formula, milk and nutritional supplements. People with CF should take enzymes with any food, unless it is pure sugar (such as a clear Popsicle, hard candy or fruit juice).

10. The nurse is examining a 5-year-old boy. Which of the following signs or symptoms is a reliable first indication of respiratory illness in children? A) Slow, irregular breathing B) A bluish tinge to the lips C) Increasing lethargy D) Rapid, shallow breathing

D) Rapid, shallow breathing Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.

The nurse is caring for a child with cystic fibrosis who receives pancreatic enzymes. Which statement by the child's mother indicates an understanding of how to administer the supplemental enzymes? a. "I will stop the enzymes if my child is receiving antibiotics." b. "I will decrease the dose by half if my child is having frequent, bulky stools." c. "Between meals is the best time for me to give the enzymes." d. "The enzymes should be given at the beginning of each meal and snack."

D. The enzymes are necessary for appropriate digestion and absorption of food and nutrients. They must be given each time the child eats, usually in smaller doses for snacks than for meals.