Respiratory MAIN
The nurse is working with a group of caregivers of children diagnosed with asthma. Which statement made by a caregiver is most accurate regarding the triggers that may cause an asthma attack? My neighbor told me that asthma attacks are caused by hot weather." "I always thought that a lack of exercise caused my child's asthma." "My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." "One person told me that asthma is caused by using antibiotics for infection."
"My sister and her family love animals, and when we go to their house my daughter always has an asthma attack."
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which of the following statements best indicates an understanding of the management and treatment for this diagnosis? a) "We have taken the carpet out of our house and let my mom take our dog." b) "The medications she takes are all in one place, ready for her to take at any time." c) "He knows how and even when he needs to use his peak flow meter." d) "Even the babysitter helps us keep up the diary with her symptoms."
"We have taken the carpet out of our house and let my mom take our dog."
A child with a suspected airway obstruction is undergoing arterial blood gas analysis. Which of the following would suggest an airway obstruction? (Select all that apply.) a) Decreased PO2 b) Increased PCO2 c) SaO2 at 95% d) Low pH
• Increased PCO2 • Decreased PO2 • Low pH
15-year-old Stephen has an upper respiratory infection for which he is to be given Keflex 1.5 grams in 50 ml of a 5% Dextrose solution. According to the pharmacy, this preparation should be administered in 30 minutes. You would set your IV pump at __________mL/hour. 120mL/hr 110mL/hr 100mL/hr 115mL/hr
100mL/hr
The nurse receives report on the client care area. Which client should the nurse see FIRST? An 18-month-old boy with bronchiolitis caused by Respiratory syncytial virus (RSV) who requires oral suctioning every two to three hours. A 16-year-old boy in balanced suspension traction for a left fractured femur appears pale. The client reports severe muscle spasms in the left leg. A 4-month-old infant with a sweat chloride test result of 30 mEq/L and an axillary temperature of 99.0 F. A 13-year-old boy with a tracheostomy is turning restlessly in bed. Vital signs are blood pressure 110/64, pulse 114, and respirations 28.
A 13-year-old boy with a tracheostomy is turning restlessly in bed. Vital signs are blood pressure 110/64, pulse 114, and respirations 28. normal BP is 110-135/65-85 pulse 55-85 12-18 This boys BP is low HR is high and resp is high. These are signs of sepsis. What are some red flag findings in sepsis? Fever, tachycardia, tachypnea, abnormal pulse, abnormal cap refill, hypotension, abnormal mental status
A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent whose child is diagnosed with epiglottitis and in severe distress and in need of intubation? A) epiglottitis is rapidly progressive and you could not have predicted that the symptoms would worsen so quickly B) it is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen C) epiglottitis is slowly progressive, so early interventions may have decreased the extent of your son's symptoms D) we are also never certain if symptoms are serious
A) epiglottitis is rapidly progressive and you could not have predicted that the symptoms would worsen so quickly Airway inflammation Increased pulse Restlessness Retractions Anxiety increased Inspiratory strider Drooling
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. Airway maintenance and 100% oxygen by mask . Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation.
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. Underdeveloped cricoid cartilage and narrow nasal passages.
12. A hospitalized child with minimal change nephrotic syndrome is receiving high doses of prednisone. Which is an appropriate nursing goal related to this? a. Prevent infection. b. Stimulate appetite. c. Detect evidence of edema. d. Ensure compliance with prophylactic antibiotic therapy.
ANS: AHigh-dose steroid therapy has an immunosuppressant effect. These children are particularly vulnerable to upper respiratory tract infections. A priority nursing goal is to minimize the risk of infection by protecting the child from contact with infectious individuals. Appetite is increased with prednisone therapy. The amount of edema should be monitored as part of the disease process, not necessarily related to the administration of prednisone. Antibiotics would not be used as prophylaxis.
4. The nurse is aware that rapid respirations are a possible cause of dehydration because they: a. prevent the child from drinking. b. increase circulation, thus increasing urine production. c. cause evaporation of fluid on the mucous membranes. d. often lead to vomiting.
ANS: CRapid respirations cause increased insensible fluid loss.
Certain respiratory diseases in children result in hypoxia in a child. What should nurses focus on in the nursing care of these children? a) Urine output b) Diet c) Blood gases d) Vital signs
Blood gases
A group of nursing students are reviewing info about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding when they identify which finding? A) children's demand for oxygen is lower than that of adults B) children develops 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 develops hypoxemia more rapidly than adults do
which statement by the parents of a 7 yo with asthma indicates comprehension of medication use for control of the illness? A) the meds are complex and require extensive teaching B) a spacer used on an inhaler helps trap the med so it is inhaled more readily C) if a spacer is used, a whistling sound indicates that the med is being inhaled correctly D) dry powder inhalers are better than metered dose inhalers for use in competitive sports
B) a spacer used on an inhaler helps trap the med so it is inhaled more readily
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? a. "I'm going to have the respiratory therapist get some of the mucus from your lungs." b. "I'm going to have this hospital worker take a picture of your lungs." c. "We're going to go take a look at your lungs to see if there are any sores on them." d. "I'm going to hold your hand while the phlebotomist gets blood from your arm."
Answer: b 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 knows that respiratory disorders in children are sometimes attributed to anatomical and physiologic differences from adults. Which statement is accurate? a. Adults have twice as many alveoli as newborns. b. The tongue is proportionately smaller in infants than in adults. c. Infants consume twice as much oxygen as adults. d. Hypoxemia occurs later in children than adults.
Answer: c Infants consume twice as much oxygen (6 to 8 L) as adults (3 to 4 L). This is due to higher metabolic and resting respiratory rates. Term infants are born with about 50 million alveoli, which is only 17% of the adult number of around 300 million. The tongue of the infant, relative to the oropharynx is larger than adults. Infants and children will develop hypoxemia more rapidly than adults when in respiratory distress.
The nurse is caring for a 5-year-old girl who shows signs and symptoms of epiglottitis. The nurse recognizes a common complication of the disorder is for the child to: a. report ear pain. b. experience nuchal rigidity. c. have unilateral breath sounds upon auscultation. d. be at risk for respiratory distress.
Answer: d If the airway becomes completely occluded due to epiglottitis, respiratory distress may lead to respiratory arrest and death. Aseptic meningitis is a complication of infectious mononucleosis, resulting in nuchal rigidity; acute otitis media resulting in ear pain is a complication of influenza; and children with pneumonia are at risk for pneumothorax.
an 11 yo is admitted to the hospital for treatment of an asthma attack. Which s/s indicate an immediate intervention is needed? A) green nasal drainage B) frequent productive coughing C) intercostal retractions D) RR of 20 breaths/min and O2 sat of 95%
C) intercostal retractions
which assessment would be consistent with a diagnosis of asthma? A) cyanosis on any exertion B) productive mucous when coughing C) primarily expiratory wheezes, possibly some on inspiration also D) intermittent rales and rhonchi
C) primarily expiratory wheezes, possibly some on inspiration also
bacterial pneumonia is suspected in a 4 yo boy with fever, HA, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? A) frequent congested coughing B) oxygen saturation level of 96% C) tachypnea with retractions D) pale skin color
C) tachypnea with retractions
What are some signs and symptoms of Cystic Fibrosis: (select all that apply) Clubbing of fingers and toes Barrel-shaped chest Hard, packed stools A history of meconium ileus at birth
Clubbing of fingers and toes Barrel-shaped chest A history of meconium ileus at birth Meconium is the first stool (bowel movement) that a newborn has. This stool is very thick and sticky. Meconium ileus is a bowel obstruction that occurs when the meconium in your child's intestine is even thicker and stickier than normal meconium, creating a blockage in a part of the small intestine called the ileum.
A child experiencing an acute asthma attack presents to the ED. Which is the first med the nurse expects to administer to the child? A) IV Terbutaline (Brethine) B) Fluticasone propionate/Salmeterol (advair, Flovent) via a powder inhaler C) prednisone (Deltasone) by mouth or IV D) Albuterol (Proventil, Proair) via nebulizer
D) Albuterol (Proventil, Proair) via nebulizer
a 12 yo is being treated for acute respiratory distress. Which assessment finding would be indicative for applying the nursing diagnosis ineffective breathing pattern? A) oxygen saturation of 96% at rest B) heart rate of 100 bpm and temp of 99.8 C) bicarb level of 38 D) RR of 60-70 breaths per min
D) RR of 60-70 breaths per min normals breaths is 14-22
the nurse is instructing a child with cystic fibrosis regarding the use of pancreatic capsules. Which of the following instructions should the nurse give to the patient? A) the same # of capsules is taken with all meals B) capsules are taken 30 min after meals to digest meals C) dose not open capsules and sprinkle on food D) capsules are taken with all meals and snacks
D) capsules are taken with all meals and snacks
Pancreatic enzymes are administered to the child with cystic fibrosis. Which considerations should the nurse use when conducting teaching with parents? A) do not administer pancreatic enzymes if the child is receiving ABX B) decrease dose of pancreatic enzymes if the child is having frequently frothy, foamy, bulky stools C) administer pancreatic enzymes between meals with a full glass of water D) pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of the meal
D) pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of the meal 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.
A 9-month-old baby who is wheezing and coughing is admitted to the pediatric unit with Respiratory syncytial virus (RSV). Which of these indicate the infant's condition is worsening? Respiratory rate of 38 breaths/min Decreased inspiratory breath sounds, retractions in 3 areas Crying Dysphasia and loss of appetite
Decreased inspiratory breath sounds, retractions in 3 areas resp for 9 months is 25-40
The adolescent patient in the emergency department is given a nebulizer breathing treatment of epinephrine to treat a severe asthma attack. Because this medication is a beta-adrenergic agonist, what response to the medication will the nurse tell the patient to expect? Bronchodilation and decreased heart rate Increased heart rate and respiratory rate Increased ease of breathing and increased heart rate Decreased inflammation and increased heart rate
Increased ease of breathing and increased heart rate
A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? (Select all that apply) Monitor blood sugar Implement fluid restrictions during times of infection. Administer pancreatic enzymes at bedtime for more effective intestinal absorption. Provide a high-calorie, high-protein diet. Supplement with fat-soluble vitamins
Monitor blood sugar Provide a high-calorie, high-protein diet. Supplement with fat-soluble vitamins
What is the number-one treatment for hypoxemia? a) Fluids b) Oxygen c) Breathing treatment d) Antibiotics
Oxygen Hypoxemia is a below-normal level of oxygen in your blood, specifically in the arteries. Hypoxemia is a sign of a problem related to breathing or circulation, and may result in various symptoms, such as shortness of breath
The nurse understands that which occurring soon after birth can indicate cystic fibrosis? a. Hypoglycemia b. Murmur c. Meconium ileus d. Muscle weakness
c. Meconium ileus
2-year-old Juanita has been diagnosed with bronchiolitis. Which of the following interventions should be included in her plan of care? Performing chest physiotherapy (CPT) Drawing blood for blood cultures Administering a cough suppressant and bronchodilators Promoting hydration, and supportive therapy including suctioning and possible o2 and pressure support
Promoting hydration, and supportive therapy including suctioning and possible o2 and pressure support
What would the appropriate nursing intervention be for a child with an ineffective breathing pattern? a) Have everyone leave child's room so it isn't crowded. b) Provide oxygen as needed to maintain oxygen saturation above 93%. c) Place child in a supine position in bed. d) Only give medications if condition worsens.
Provide oxygen as needed to maintain oxygen saturation above 93%.
Janey is a 5-year-old who is brought into the emergency department with suspected epiglottitis. The priority intervention for this child is to: Take vital signs Secure the child's airway Visualize the child's throat with a tongue depressor Obtain throat cultures
Secure the child's airway
What drug is usually given first in the emergency treatment of acute, severe asthma episode in a young child?
Short-acting beta-2 agonists
The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which of the following laboratory/diagnostic tools would likely be used to help determine the diagnosis of this child? a) Sweat sodium choloride test b) Pulmonary functions test c) Purified protein derivative test d) Blood culture and sensitivity
Sweat sodium choloride test
An 8-month-old infant is admitted to the pediatric unit with a respiratory syncytial virus (RSV) infection and bronchiolitis. During the admission assessment, which of these signs should the healthcare provider recognize as an early sign of respiratory distress?
Tachycardia
The nurse cares for a child diagnosed with pneumococcal pneumonia. The child receives oxygen per nasal cannula at 4 L/min. If the oxygen therapy is effective, what will the nurse expect to observe? The child is able to expectorate secretions from the lower airways. The nurse notes a decrease in crackles in the bases of the child's lungs. The nurse notes the child is more alert and less agitated or restless. The child's blood pressure is 114/72 while supine and 98/68 after moving to a sitting position.
The nurse notes the child is more alert and less agitated or restless.
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 triggers for the environment b) The child's weight c) The child's diet d) The child's hospital history
The triggers for the environment
A child with acetaminophen (Tylenol) poisoning has been admitted to the emergency department. What antidote does the nurse anticipate being prescribed? a. Deferoxamine (Desferal) b. Carnitine (Carnitor) c. N-acetylcysteine (Mucomyst) d. Fomepizole (Antizol) c. N-acetylcysteine (Mucomyst)
c. N-acetylcysteine (Mucomyst) common for children to OD on tynneoln it also afecst their liver
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 of the following conditions? a) Epiglottitis b) Mild asthma c) Acute laryngotracheobronchitis d) Spasmodic laryngitis
a) Epiglottitis Airway inflammation Increased pulse Restlessness Retractions Anxiety increased Inspiratory strider Drooling AIRRAID
What type of treatment would be given for bronchiolitis? a) Oxygen therapy b) Antibiotics c) Bronchodilators d) Corticosteriods
a) Oxygen therapy
GOOD 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) Take Molly's temperature. c) Give Molly a drink of water. d) Tell her mother she is fine and to go get some lunch.
a) Provide oxygen therapy to Molly.
The nurse is providing care to a 2-year-old girl who is experiencing hypoxemia related to a respiratory infection. The nurse understands that which anatomic characteristic accounts for the higher risk of hypoxemia in children? a) Smaller number of alveoli b) Narrow trachea and bronchi c) Diaphragmatic breathing d) Compliant chest walls
a) Smaller number of alveoli
The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent intervention? a. Compliance with therapy has diminished b. The family becomes over-vigilant c. The child feels fearful and isolated d. Siblings are jealous and worried
a. Compliance with therapy has diminished
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 of the following disorders? a) Spasmodic laryngitis b) Epiglottitis c) Laryngotracheobronchitis d) Tonsillitis
b) Epiglottitis AIRRAID Airway inflammation Increased pulse Restlessness Retractions Anxiety increased Inspiratory strider Drooling
In caring for the child with asthma, the nurse recognizes that which of the following nursing diagnoses would be the highest priority in this child's plan of care? a) Delayed growth and development related to physical restrictions. b) Ineffective airway clearance related to the diagnosis c) Risk for infection related to anatomic structures of involved body system d) Risk for fluid volume excess related to medications
b) Ineffective airway clearance related to the diagnosis
The most common cause of acute bronchiolitis is which of the following? a) Hereditary factors b) Viral infection c) Bacterial infection d) Prenatal complications
b) Viral infection RSA IS MOST COMMON CAUSE OF bronchiolitis
GOOD EXPLINATION The nurse is caring for a 3-year-old girl who is cyanotic and breathing rapidly. Which intervention is BEST to relieve these symptoms? a. Suction b. Oxygen administration c. Saline lavage d. Saline gargles
b. Oxygen administration Oxygen administration is indicated for the treatment of hypoxemia. Suctioning removes excess secretions from the airway caused by colds or flu. Saline lavage loosens mucus that may be blocking the airway so that it may be suctioned out. Saline gargles are indicated for relieving throat pain as with pharyngitis or tonsillitis.
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) Removal of allergens in the home and school b) Corticosteroids and leukotriene inhibitors c) A bronchodilator and mast cell stabilizers d) Decreased activity and increased fluids
c) A bronchodilator and mast cell stabilizers
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) Common cold b) Pneumonia c) Asthma a) Allergic rhinitis
c) Asthma
The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? a) Administering analgesics as ordered b) Monitoring oxygen saturation by pulse oximeter c) Suctioning secretions from the airway d) Administering oxygen as ordered
c) Suctioning secretions from the airway
The nurse is assessing several children. Which child is MOST at risk for dysphagia? a. 7-month-old with erythematous rash b. 8-year-old with fever and fatigue c. 5-year-old with epiglottitis d. 2-month-ol with toxic appearance
c. 5-year-old with epiglottitis Dysphagia is difficulty swallowing The 5-year old with epiglottitis has a sore, swollen throat placing the child at risk for dysphagia (difficulty swallowing). Erythematous rash and mild toxic appearance are typical of influenza. Fever and fatigue are symptoms of a common cold. Influenza and the common cold may cause sore throats but would not be the highest risk for dysphagia.
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 radiograph. 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.
GOOD Which diagnostic test is the most useful when a child has respiratory distress? a) Venous blood gas b) Complete blood count c) EEG d) Arterial blood gas
d) Arterial blood gas
The nurse caring for the child with asthma weighs the child daily. Which of the following is the most important reason for doing a daily weight on this child? a) To ensure that the child's food intake is adequate b) To monitor the child's growth pattern c) To determine medication dosages d) To determine fluid losses
d) To determine fluid losses
A mother calls the clinic because her 2-year-old daughter has a rectal temperature of 37.8°C (100°F). She wonders how high a fever should be before she should give medications to reduce it. What is the best response by the nurse? a. "All fevers should be treated to prevent seizures." b. "Antipyretics should be used with any rise in temperature. They can help change the course of the infection." c. "Give your child aspirin when her fever is above 38°C (100.4°F)." d. "In a normal healthy child, if your child is not uncomfortable, fevers less than 39°C (102.2°F) do not require medication."
d. Health care providers need to remember and to educate parents that fever is a protective mechanism the body uses to fight infection. Evidence exists that elevated body temperatures enhance various components of the immune response. Studies have shown that the use of antipyretics may actually prolong illness. Concern also exists that reducing fever may hide signs of serious bacterial illness. Aspirin should never be administered to children to reduce fever due to the risk of Reye syndrome.
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 a) clubbing of fingers b) tachypnea. c) cyanosis. d) retractions.
tachypnea
A 5-year-old child is brought to the clinic by his father because the child developed a high fever over the past 2 to 3 hours. The nurse suspects epiglottitis based on which signs and symptoms? Select all that apply. a) Difficulty speaking b) Frightened appearance c) Sitting with neck extended d) Cough e) Drooling
• Difficulty speaking• Drooling• Sitting with neck extended• Frightened appearance
