PrepU Chapter 40 Respiratory Disorder

A young child is prescribed pancreatic enzymes as part of his treatment plan for cystic fibrosis. The child has difficulty swallowing medications. After teaching the parents of a young child with cystic fibrosis about how to administer pancreatic enzymes, the parents demonstrate understanding by stating: a) "We can open the capsule and sprinkle it on his cereal." b) "We can puncture the capsule and pour the liquid on his tongue." c) "We need to dissolve the capsule in water." d) "We should crush the capsule to make it smaller."

a) "We can open the capsule and sprinkle it on his cereal." If the child has difficulty swallowing the pancreatic enzyme capsules, the parents can open the capsule and sprinkle the contents onto the child's cereal or applesauce. Dissolving the capsule in water or crushing it would be appropriate. The capsule does not contain liquid so there would not be any liquid to pour on the child's tongue.

The nurse is teaching the parents of a 9-year-old boy with a respiratory disorder about medications. The nurse would be alert for an increased need for medications if the child was exposed to second-hand smoke and has which condition? a) Asthma b) Pneumonia c) Common cold d) Allergic rhinitis

a) Asthma In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, exposure to second-hand smoke increases the need for medications in children with asthma and increases the frequency of asthma exacerbations. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with a cold. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with pneumonia. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with allergic rhinitis.

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

a) Before meals and snacks with milk Enzymes should be administered before all meals and snacks to help in normal absorption of nutrients from the food. The other choices do not promote absorption of foods or are not taken with food.

A caregiver calls the pediatrician's office and reports to the nurse that her 4-year-old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6° F (39.2° C). The caregiver has tried to get the child to nap but the child gets panicky, immediately sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which condition? a) Epiglottitis b) Acute laryngotracheobronchitis c) Mild asthma d) Spasmodic laryngitis

a) Epiglottitis Epiglottitis is acute inflammation of the epiglottis that most often affects children ages 2 to 7 years. The child may have been well or may have had a mild upper respiratory infection before the development of a sore throat (difficulty swallowing) and a high fever of 102.2 to 104 degrees Fahrenheit. The child is very anxious and prefers to breathe by to sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.

A child with a suspected airway obstruction is brought to the emergency room. He produces a harsh, strident sound on inspiration (stridor). Where is the obstruction likely to be located, based on this information? a) In the larynx b) Bronchioles c) Pharynx d) Lower trachea

a) In the larynx The vibrations produced as air is forced past obstructions such as mucus in the nose or pharynx, the noise produced is a snoring sound (rhonchi). If the obstruction is at the base of the tongue or in the larynx, a harsher, strident sound on inspiration (stridor) occurs. If an obstruction is in the lower trachea or bronchioles, an expiratory whistle sound (wheezing) occurs.

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

a) 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.

What is the No. 1 treatment for hypoxemia? a) Oxygen b) Breathing treatment c) Fluids d) Antibiotics

a) Oxygen Oxygen is the most indicated treatment and is needed to increase low PaO2 levels in the blood. Oxygen can be delivered by mask, nasal cannula, oxygen hood, oxygen tent, or mechanical ventilation.

The nurse is caring for a 6-month-old infant who has chronic apneic episodes. Which intervention should the nurse institute? a) Place on a cardiopulmonary monitor and do frequent assessments. b) Sit infant up in the infant seat to keep airway open. c) Place infant in a crib so he can rest and get stronger. d) Help infant's mother do his morning bath.

a) Place on a cardiopulmonary monitor and do frequent assessments. The optimal treatments for kids with chronic apnea are hospitalization, frequent monitoring and observation, and parent education. The nurse should continuously monitor the infant on a cardiopulmonary monitor; frequently assess color, breathing patterns, and effort; and assess tone. The other choices do not include constant monitoring and assessments, which are crucial in treatment.

An 8-year-old boy is suffering from allergic rhinitis. The nurse should advise his mother to avoid which allergen? a) Pollen b) Peanuts c) Penicillin d) Soap

a) Pollen The allergens that usually cause allergic rhinitis are pollens or molds rather than foods or drugs. Soap is not associated with allergic rhinitis.

The nurse enters the room of Molly who has pneumonia. Molly has a low oxygen level and is working hard to breathe. The nurse raises the head of the bed and has Molly tilt her head back. What is the next appropriate action of the nurse? a) Provide oxygen therapy to Molly. b) Give Molly a drink of water. c) Tell her mother she is fine and to go get some lunch. d) Take Molly's temperature.

a) Provide oxygen therapy to Molly. Oxygen is the indicated treatment for hypoxia. Patency and opening of the airway is also important. The oxygen saturation level should be above 93%. The other choices will not increase Molly's blood oxygen level or decrease her work of breathing.

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

a) 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.

A worried mother calls the nurse and tells her that her son has developed a horrible croupy cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother? a) Run a hot shower to fill the bathroom with steam and have the boy stay there. b) Administer an analgesic to the boy. c) Administer cough syrup to the boy. d) Have the boy drink a full glass of water to clear out the mucus.

a) Run a hot shower to fill the bathroom with steam and have the boy stay there. One emergency method of relieving croup symptoms is for a parent to run the shower or hot water tap in a bathroom until the room fills with steam, then keep the child in this warm, moist environment as this relaxes the airway tissues and widens the bronchi lumens. If this does not relieve symptoms, parents should bring the child to an emergency department for further evaluation and care. Caution parents not to give cough syrup routinely to children as many produce little effect and the risk of overdose, incorrect dosing, and adverse events is greater than the benefit of the syrup. An analgesic might help alleviate pain due to inflammation and irritation of the throat from coughing, but it is not the priority intervention in this case. Drinking would likely be painful for this child and would not provide lasting benefit.

Newborns who are born more than 24 hours after rupture of the amniotic membranes are particularly prone to developing pneumonia in their first few days of life. a) True b) False

a) True

The nurse is admitting a child who is experiencing an asthma attack. Which clinical manifestation would likely be noted in this child? a) Wheezing b) Circumoral cyanosis c) Chest retractions d) Hoarseness

a) Wheezing The onset of an attack can be very abrupt or can progress over several days, as evidenced by a dry hacking cough, wheezing (the sound of expired air being pushed through obstructed bronchioles), and difficulty breathing.

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

a) With stridor If a foreign body is in the larynx, the client presents with a cough, stridor, trouble with phonation, and maybe severe respiratory distress.

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 breath. The signs the nurse noted indicate the child likely has: a) epiglottitis. b) cystic fibrosis. c) tuberculosis. d) asthma.

a) 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 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? a) Laryngotracheobronchitis b) Epiglottitis c) Tonsillitis d) Spasmodic laryngitis

b) 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 and acute respiratory embarrassment can result.

The nurse is preparing a presentation for a local community parent group about measures to prevent the common cold. What would the nurse stress as a vital prevention measure? a) Antibiotic use for household members with colds b) Frequent hand washing c) Avoiding second-hand smoke d) Minimizing exposure to crowds, especially during the spring

b) Frequent hand washing Frequent hand washing helps to decrease the spread of viruses that cause the common cold. The common cold is caused by viruses, so antibiotics would be of no assistance in preventing them. Although avoiding second-hand smoke is a preventive measure, it is not the most important measure. Crowds should be avoided, especially during the winter when the colds occur more frequently.

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

b) 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.

In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason? a) Management of chronic pain b) Relief of acute symptoms c) To stabilize the cell membranes d) Prevention of mild symptoms

b) Relief of acute symptoms Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Brochodilators are not effective for pain.

A Mantoux skin test is used to screen for tuberculosis. a) False b) True

b) True Diagnosis of tuberculosis is confirmed with a positive Mantoux test, positive gastric washings for acid-fast bacillus, interferon-gamma release assay (IGRA), and/or a chest radiograph consistent with tuberculosis.

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method? a) Sprinkled onto the food b) Using a nebulizer c) Directly into the vein d) Through a gastrostomy tube

b) Using a nebulizer 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). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis.

The nurse is working with a child diagnosed with tonsillitis. Which of the following is accurate related to this diagnosis? a) A 10-day course of antivirals are usually given to treat the infection. b) Blood cultures are drawn to determine the causative organism. c) A complication seen in long-term or chronic conditions is partial deafness. d) A warm-mist vaporizer is used as a comfort measure to relieve symptoms.

c) A complication seen in long-term or chronic conditions is partial deafness. If the tissue itself becomes a site of acute or chronic infection, it may become hypertrophied and can interfere with breathing, may cause partial deafness, or may become a source of infection in itself.

The nurse is teaching the caregivers of a child with cystic fibrosis. What is it most important for the nurse to teach this family? a) Watch for signs that the family unit is stressed. b) Avoid overprotecting the child. c) Encourage everyone in the family to use good hand-washing techniques. d) Be sure the child exercises daily.

c) Encourage everyone in the family to use good hand-washing techniques. The child with cystic fibrosis has low resistance especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good hand-washing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.

A caregiver calls the pediatrician's office and reports to the nurse that her 4-year-old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6° F (39.2° C). The caregiver has tried to get the child to nap but the child gets panicky, immediately sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which condition? a) Acute laryngotracheobronchitis b) Spasmodic laryngitis c) Epiglottitis d) Mild asthma

c) Epiglottitis Epiglottitis is acute inflammation of the epiglottis that most often affects children ages 2 to 7 years. The child may have been well or may have had a mild upper respiratory infection before the development of a sore throat (difficulty swallowing) and a high fever of 102.2 to 104 degrees Fahrenheit. The child is very anxious and prefers to breathe by to sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.

What is a symptom of bacterial pharyngitis? a) Rhinitis b) Symptoms have a gradual onset c) Fever d) WBC in normal range

c) Fever Fever is a symptom of bacterial pharyngitis; other symptoms are an elevated white blood count (WBC), abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes.

child with a severe lower respiratory tract infection has been prescribed an antibiotic and a bronchodilator. The nurse recognizes that which treatment would be best for delivering the medication directly into the respiratory tract, as well as providing moisture to promote removal of mucus? a) Flutter device b) Vaporizer c) Nebulizer d) Percussion

c) Nebulizer Nebulizers are mechanical devices that provide a stream of moistened air directly into the respiratory tract. Nebulizers also serve as an important means for the delivery of respiratory tract medications. Drugs such as antibiotics or bronchodilators can be combined with the nebulized mist and sprayed into the lungs. Vaporizers humidify the air by emitting a stream of air moistened by fine droplets of water into the air, providing either a cool or a warm mist to the entire room. A mucus-clearing device (a Flutter device), which looks like a small plastic pipe, has a stainless-steel ball inside that moves when the child breathes out, causing vibrations in the lungs, which help loosen mucus so that it can be moved up the airway and expectorated. Percussion involves striking a cupped or curved palm against the chest to determine the consistency of tissue beneath the surface area.

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

c) Pancreatic enzymes Pancreatic enzymes are administered orally to promote adequate digestion and absorption of nutrients. Recombinant human DNase, bronchodilators, and anti-inflammatory agents are typically administered by inhalation.

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

c) 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.

The nurse is examining a 4-year-old who is injured and crying. What might the nurse document about the child's breathing? a) Respirations are regular b) Respirations are slow and shallow c) Tachypnea d) Tachycardia

c) Tachypnea Tachypnea (rapid breathing or panting) may be observed in a child with fear, anxiety, or stress. Slow, shallow, or regular respirations are normal. Tachycardia is an increased heart rate.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, all of these goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? a) The child and family will improve knowledge and understanding of home care. b) The child will have decreased fatigue. c) The child will have adequate fluid intake. d) The child will maintain a clear airway. e) The child and family will have decreased anxiety.

c) The child will have adequate fluid intake. d) The child will maintain a clear airway. The initial major goals for the child include maintaining a clear airway and an adequate fluid intake and relieving fatigue and anxiety. The family's goals include learning how to manage the child's life with asthma. The airway and fluid intake are the highest priorities.

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? a) The child's diet b) The child's weight c) The triggers in the environment d) The child's hospital history

c) 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.

To help meet the nutritional needs of a child with pneumonia, you would a) encourage reducing fluid intake. b) suggest feeding by enteral tube feedings. c) offer small, frequent feedings. d) encourage intake of three large meals daily.

c) offer small, frequent feedings. Children with pneumonia need a high fluid intake to keep respiratory secretions moist. Eating small meals frequently prevents tiring them and putting pressure on the lungs from a distended stomach.

What is the most common debilitating disease of childhood among those of European descent? a) BPD b) Asthma c) Pneumonia d) Cystic fibrosis

d) 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 median age for survival being the late 30s.

A child who is experiencing an exacerbation of his asthma is brought to the emergency department by his parents. When reviewing the child's laboratory and diagnostic test results, which would the nurse expect to find? a) Low arterial blood carbon dioxide level b) Decreased pulmonary function tests c) Increased peak expiratory flow rate d) Hyperinflation on chest radiograph

d) Hyperinflation on chest radiograph The chest radiograph usually reveals hyperinflation. Peak expiratory flow rate usually is decreased during an exacerbation. With arterial blood gases, carbon dioxide retention is usually noted. Although pulmonary function tests are useful in determining the degree of disease, they are not useful during an attack.

In caring for the child with asthma, the nurse recognizes that which nursing diagnosis would be the highest priority in this child's plan of care? a) Risk for infection related to anatomic structures of involved body system b) Delayed growth and development related to physical restrictions. c) Risk for fluid volume excess related to medications d) Ineffective airway clearance related to the diagnosis

d) Ineffective airway clearance related to the diagnosis The highest priority for the child with asthma is to keep the airway clear because of the bronchospasms and increased pulmonary secretions the child may have. The child is more likely to have deficient fluid volume related to tachypnea and diaphoresis. Infections can occur, but they are less of a concern than the airway clearance. Growth and development issues can occur because the child may have to limit activities, but these issues are not the priority.

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. What would the nurse have most likely assessed? a) Toxic appearance b) High fever c) Dysphagia 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.

During a class for caregivers of children with asthma, a caregiver asks the nurse the following question when medications are being discussed. "They told me about a plastic device my child can hold in his a hand which will give him a premeasured and exact amount of his corticosteroid." The nurse recognizes that the caregiver is most likely referring to which device? a) Medication cup b) Needleless syringe c) Nebulizer d) Metered-dose inhaler

d) Metered-dose inhaler In the treatment of asthma corticosteroids are most often delivered by metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). The medication cup and needleless syringe may deliver PO medications, but most often corticosteroids are not given PO in the treatment of asthma, and those would not be premeasured and an exact dosage like a metered-dose inhaler would be. Corticosteroids are not administered by nebulizer.

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? a) With the child lying on his back, apply pressure to the bridge of the nose. b) Seat the child with his head tipped back and apply ice or a cold cloth to the nose. c) With the child lying on his back, pinch the anterior portion of the nose closed. d) Seat the child leaning forward and pinch the anterior portion of the nose closed.

d) 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.

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

d) 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 listening to breath sounds through auscultation. She hears a low-pitched, soft sound. Which type of breath sound is the nurse hearing? a) Rhonchi b) Adventitious c) Bronchovesicular d) Vesicular

d) Vesicular Vesicular breath sounds are soft, low-pitched sounds heard more during inspiration than expiration and over the entire lung field. The other choices are breath sounds that modulate to high-pitched sounds including harsh, loud sounds.

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

d) 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.