Ch 40- Respiratory

The 18-month-old client has had recurrent respiratory infections. The mother expresses concern that this child is having more complications from respiratory infections than her older children had. The nurse's best response would be:

"Air passages are small in toddlers, and when inflamed they become smaller because of edema and are occluded with mucus."

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful?

"Exposure to second- or third-hand smoke increases the risk for developing RSV."

The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching?

"Give your child high-calorie foods and snacks." "Feed your child foods that are high in protein." "Give pancreatic enzymes with meals."

A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?

"Has your infant been around any crowds?"

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first?

"Have him use his short-acting bronchodilator right away."

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed?

"It is okay for our child to do chores such as sweeping the floor."

A nurse is teaching the parents of a 3-year-old child diagnosed with cystic fibrosis about pancreatic enzyme replacement therapy. The nurse determines that additional teaching is needed based on which statement?

"It's okay to add the medicine to hot foods."

The nurse is working with a group of caregivers of small children discussing various disorders seen in children. One of the caregivers makes the statement that her children always seem to have a common cold. After discussing this condition, the caregivers make the following statements. Which statement indicates the most accurate understanding of a complication related to the common cold?

"Next time he has a cold, I will watch closely to see if my 1-year-old pulls at his ears."

The nurse has assessed four clients. Which assessment finding warrants immediate action?

1-week old newborn with nasal congestion

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress?

2-year-old child with epiglottitis

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete?

ABG

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first?

Administer the bronchodilator via a nebulizer.

What is the most common debilitating disease of childhood among those of European descent?

Cystic Fibrosis

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?

Encourage everyone in the family to use good handwashing techniques.

An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition?

Encourage high-calorie, high-protein snacks.

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?

Epiglottitis

The nurse is caring for a newborn in the birth room and notes the infant is pink when crying but becomes cyanotic at rest. Which collaborative intervention will the nurse perform next?

Insert a soft catheter tube into the nares.

Which clinical manifestation of acute nasopharyngitis is more of a concern for the infant than the older child?

Nasal congestion

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important?

Note any frequent swallowing.

A child presents to the health clinic with a temperature of 101.8°F (38.8°C), dysphagia, headache, and a sore, erythematous throat. Which collaborative intervention will the nurse complete first?

Obtain a throat culture.

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan?

Obtain testing for respiratory syncytial virus.

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease?

Open capsule and sprinkle on food.

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

Pancreatic enzymes

The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child?

Providing fluids by straw

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child?

Pulmonary functions test

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child?

Respiratory stridor

Which electrolyte does the client with cystic fibrosis need in abundance?

Sodium

The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method?

Sprinkled onto the food

The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child?

Sweat sodium chloride test

The nurse is caring for a newly admitted 3-year-old child who has been diagnosed with tuberculosis. When reviewing the child's records which finding(s) is consistent with this disease? Select all that apply.

The child has been experiencing night sweats. The child and the family were homeless for a period of time in the past 3 months. The child has had recent weight loss.

A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care?

The infant's airway will remain clear and free of mucus.

The NICU nurse is caring for a preterm neonate with respiratory distress syndrome on mechanical ventilation. Which assessment data would alert the nurse that a pneumothorax might have developed? Select all that apply.

The neonate's respiratory rate is 68. Neonate is exhibiting nasal flaring and grunting. The neonate's chest is asymmetrical with decreased breath sounds on one side.

The nurse makes the statement that if an older child inhales a foreign body, the inhaled object is more likely to be drawn into the right bronchus rather than the left. What is the basis for this statement?

The right bronchus is shorter and wider than the left.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status?

The triggers in the environment

The nurse is caring for a 3-year-old child after a tonsilectomy. Which finding concerns the nurse? Select all that apply.

Throat clearing every 10 minutes and before speaking Change in pulse rate from 88 to 110 beats per minute Respiratory rate change from 26 to 34 breaths per minute

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 bronchodilator and mast cell stabilizers.

The nurse is bottle feeding an infant diagnosed with pneumonia. An important action for the nurse to take is clearing the infant's nose, and then the nurse should feed the infant using:

a nipple that is small enough so that the baby doesn't choke, but not so small that they have to work too hard to eat.

A child has been prescribed a nasal cannula for oxygen delivery. What should the nurse do before applying the cannula?

assess patency of the nares

The nurse is caring for a child who has just arrived to the emergency department. The child is pale and has labored breathing. The nurse is inspecting the child while placing the child on oxygen, obtaining a pulse oximeter reading, and raising the head of the bed. Which assessment finding best reflects that the child's respiratory status is due to a chronic condition?

clubbing of the fingertips

A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child?

elevate the head of the bed

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:

epiglottitis

A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which medication will the nurse instruct the parents to administer orally?

pancreatic enzyme

The nurse has received the morning report on a group of pediatric clients. For which pediatric client should the nurse prioritize care?

school-age child with dysphagia, drooling, and a hoarse voice

A child is brought to the emergency department late one evening and is diagnosed with croup. The child was noted to have a shrill, harsh respiratory sound when breathing in. This symptom is referred to as:

stridor

In teaching home care to parents of a child with cystic fibrosis, the nurse will emphasize:

techniques to clear the airway.

If there is a foreign body in the larynx, how will the client present?

with stridor