Chapter 11: Respiratory Disorders

35. Clubbing of the nailbeds in the fingers would be a clinical finding on which patient? 1. A child with cystic fibrosis 2. A child with croup 3. A child with respiratory distress syndrome 4. A child with RSV

1 (1. Long-term hypoxia causes clubbing of the nailbeds because of the lack of oxygen. 2. Croup is a short-term respiratory issue, which does not causing clubbing. 3. Respiratory distress syndrome is short lived and does not cause clubbing. 4. RSV is short lived and does not cause clubbing.)

31. A school nurse has been made aware that an eighth grader has latent tuberculosis (TB). Education for the teaching staff should include: 1. A document with the signs and symptoms of illness for a person with TB. 2. Do not allow the child into the classroom when he coughs. Send him to the nurse's office to prevent the spread of the illness. 3. Provide universal precautions with the child. 4. The child does not need any interventions at this time because the TB is dormant.

1 (1. A signs and symptoms document will help increase the awareness of the disease and can also help identify those who are infected early. 2. The spread of the disease cannot occur just because of coughing. 3. Universal precautions should be used with every student, not just the ill children. 4. Interventions will help prevent the illness from spreading.)

37. An 8-year-old boy with a long history with cystic fibrosis has been admitted for malnutrition. The doctor has ordered labs for the child. The nurse clarifies which doctor's order before proceeding? 1. Obtain a stool sample for Clostridium difficile 2. Metabolic panel for hydration status 3. Serum albumin level to measure the nutritional status 4. Provide chest physiotherapy before bedtime

1 (1. A stool sample should be used for the absence of trypsin. 2. Malnutrition may be caused by metabolic issues. 3. Serum albumin levels will help indicate nutritional status and are appropriate for this patient. 4. Chest physiotherapy is needed at bedtime to rid as many secretions as possible prior to lower activity levels.)

8. A 5-year-old child has been admitted for complications related to asthma. When the nurse auscultates the child's lungs, she would anticipate hearing: 1. Wheezes because the bronchioles have been restricted. 2. Rhonchi because of thick secretions from the flare-up. 3. Crackles because there is fluid in the alveoli. 4. All of the above may be heard.

1 (1. Asthma constricts the airway and alveoli in children, causing wheezing to be heard when in auscultation. 2. Rhonchi usually will clear with a cough. A child with an asthma exacerbation will not stop the sound after coughing. 3. Asthma causes the narrowing of airways. Crackles occur only when fluid is present. 4. The airway and alveoli constriction causes wheezing.)

14. Otitis media is a common infection children have when an upper respiratory illness is present because: 1. The Eustachian tubes are short and immature. 2. The immune system is extremely compromised and more susceptible to infections. 3. Bottle feeding increases the risk in babies. 4. All of the above are correct.

1 (1. Eustachian tubes are short and do not provide adequate draining for mucous during an upper respiratory infection in children. 2. Immunity and susceptibility to infections cause the primary illness. Otitis media is a secondary illness. 3. A child that is positioned correctly during bottle feedings is not at an increased risk for otitis media. 4. Eustachian tubes are short and do not provide adequate draining for mucous during an upper respiratory infection in children, causing only one answer to be correct.)

7. When performing an assessment on an 8-year-old boy who is hospitalized for pneumonia, the nurse would anticipate what type of lung sounds? 1. Crackles 2. Stridor 3. Normal 4. Wheezes

1 (1. Fluid is built up in the lungs because of the infection, causing crackles to be heard. 2. Stridor is common in children with larynx issues, not pneumonia. 3. When fluid builds up in the lungs, it will cause the lung's sounds to be abnormal with a diagnosis of pneumonia. 4. A child will have wheezes if the airway is constricted, not full of fluid.)

29. A common cause of viral pneumonia in children is: 1. The influenza virus. 2. Streptococcus. 3. Fungus. 4. Beta-hemolytic streptococcus pneumoni.

1 (1. Influenza is a common cause for viral pneumonia in children as a secondary infection. 2. Streptococcus is a bacterium, not a virus. 3. Fungus is not a virus. 4. Beta-hemolytic strep is bacterial, not viral.)

32. A neonate has been diagnosed with respiratory distress syndrome. The nurse notes the neonate is retracting and is hypoxic. The best intervention at this time would be: 1. Providing oxygen support via a mask. 2. Providing oxygen support via nasal cannula. 3. Attempt to reposition the neonate. 4. Check the temperature of the neonate so that the child does not experience cold stress.

1 (1. Oxygen delivered by mask is the highest percentage of oxygen to be delivered other than intubation. 2. The neonate does not receive as high of a rate of oxygen saturation with a nasal cannula. 3. Repositioning may open the airway more, but the retracting occurs because of deterioration, thus requiring oxygen support. 4. Cold stress can cause respiratory issues, but is short term once the neonate is warm.)

60. A newborn, premature twin exhibits respiratory distress with retractions, nasal flaring, cyanosis, grunting, and fine, scattered rales. What nursing interventions would you expect the physician to order? 1. Place an NG tube for feeds, monitor respiratory status on ventilator, record I& O's, start an IV, and send electrolyte panel to the laboratory and monitor temperatures 2. Cardio- respiratory monitoring, frequent suctioning on ventilator, and monitoring blood glucose level hourly 3. Placing infant in semi-fowler's position on affected side with head of the bed elevated, oxygen via nasal cannula, keeping NPO, and preparing parents for surgery 4. Giving surfactant intravenously within the first 12 hours of life and repeating every 12 hours for three days.

1 (1. Place an NG tube for feeds, monitor respiratory status on ventilator, record I& O's, start an IV, and send electrolyte panel to the lab and monitor temperatures 2. A ventilator is not needed at this time. Blood glucose should be monitored because it can cause an increase in respiratory distress. 3. Surgery is not indicated at this time. 4. The statement does not indicate the level of prematurity for the infant. Surfactant is not needed at this particular time.)

3. When a child exhibits difficulty breathing, the best positioning would be: 1. Having the head of the bed at 45 degrees. 2. Placing the child in a 90 degree angle on the parent's lap. 3. Placing the child in a side lying position. 4. Having the child sit in a chair.

1 (1. Positioning the head of the bed slightly elevated will take weight off of the diaphragm and allow for full chest expansion. 2. Placing the child at a 90 degree angle will put too much pressure on the diaphragm, thus causing the shortness of breath to continue. 3. A side lying position does not help to support the diaphragm or aid in relieving the shortness of breath. 4. Sitting in a chair will place more stress on the accessory muscles, thus the child will continue to have shortness of breath.)

10. A child has the following ABG results: pH: 7.38 pCO2: 52.6 HCO3: 32.5 The nurse interprets these results as: 1. Compensated Respiratory Acidosis. 2. Uncompensated Respiratory Alkalosis. 3. Compensated Respiratory Alkalosis. 4. Uncompensated Respiratory Acidosis.

1 (1. The pH is on the low end, creating a more acidotic state along with the CO2 in an acidotic state, thus indicating the respiratory acidosis. The HCO3 is alkalotic, creating compensation. 2. The pH and the CO2 are acidotic and the HCO3 is alkalotic, creating compensation. 3. The pH and CO2 are in acidotic states, not alkalotic states. 4. Compensation has occurred because of the HCO3 being alkalotic.)

22. Following a tonsillectomy, a nurse should provide the patient with: 1. Ice chips, no pillow, and no straw for drinking. 2. Ice chips and orange juice. 3. A sippy cup and pudding. 4. A pillow, red Gatorade, and a straw.

1 (1. The patient should lie flat to help clotting occur, ice chips will provide hydration, and no straw should be given because this can cause the clots to break and increase bleeding. 2. Orange juice should not be used because the pulp may lodge into the surgical site. 3. A sippy cup can cause clots to break because of the sucking motion and pudding is too thick to swallow at this point. 4. A patient should lie flat to help with clotting, Gatorade should not be used because you cannot assess for blood because of the color, and a straw will cause the clots to break and increase bleeding.)

43. The nurse is assessing a child that was in a motor vehicle accident, which occurred two hours ago. The child's chest is not rising on the right and lacks lung sounds. The X-ray confirmed a hemothorax. The nurse should anticipate the order for: 1. A chest tube and pnuemovac. 2. IV fluids. 3. Placing a nasogastric tube. 4. None of the above would be appropriate for the situation.

1 (1. The pnuemovac will aid in the creation of a sterile container to help decompress the hemothorax. 2. IV fluids may be ordered eventually, but they are not a priority at this time. Airway security is the priority. 3. A nasogastric tube will not influence the hemothorax. 4. The nurse should anticipate the use of the pneumovac to help decompress the hemothorax.)

48. A 6 year old had a tonsillectomy today. When the nurse goes into the room to give him his antibiotics, she finds him irritable, coughing, nauseated, and swallowing repeatedly. What is the next action the nurse should take? 1. Assess for signs of frank red blood in the mouth and nose and get a complete set of vital signs. 2. Ask the child for a pain score and if he would like a popsicle with his pain medicine. 3. Suction mouth vigorously to avoid aspiration of blood, and then hang antibiotic. 4. Take a complete set of vital signs and divert the child's attention to the cartoon on TV.

1 (1. This intervention assesses for bleeding. 2. An assessment for blood needs to occur because the child continues to swallow. 3. Suctioning can cause clots to loosen and increases bleeding. It should be avoided. 4. Vital signs are needed and a focused assessment needs to be completed in order to identify complications.)

54. An infant born an hour ago exhibits coughing and drooling, cyanosis, abdominal distention, and moderate retractions and grunting. Based on these symptoms, what would be the most likely diagnosis? 1. Tracheoesophageal fistula 2. Laryngomalacia 3. Respiratory distress syndrome 4. Bronchopulmonary dysplasia

1 (1. Tracheoesophageal fistula is the most likely diagnosis. 2. Laryngomalacia would cause more grunting. 3. The child may initially present similar respiratory distress, but the drooling indicates that more is involved. 4. Bronchopulmonary dysplasia occurs after long-term ventilator support, not soon after birth.)

13. A 10-month-old boy is being given a sweat test because: 1. The child has had several high fevers. 2. The test is assessing for cystic fibrosis. 3. The test is assessing for respiratory failure. 4. The child does not demonstrate thermoregulation.

2 (1. A child with a high fever does not require a sweat test. Sweating can be a normal occurrence during fevers. 2. The sweat test is a common test for cystic fibrosis diagnostics. 3. The sweat test will not give an indication as to respiratory failure. 4. The sweat test does not deal with the thermal regulation of a child.)

16. A mother calls the triage nurse because her 8-year-old son is having trouble keeping his balance, but has otherwise appeared healthy for the past few days. The nurse should advise the mother to: 1. Make a doctor's appointment because the child could have issues with his inner ear. 2. Take the child immediately to the ER because this is a neurological emergency. 3. Ask the child if he has consumed any drugs or alcohol in the last few days. 4. Call back in a few days with an update.

1 (1. Unknown etiologies of unsteady balance are a sign of inner ear infections. 2. Since the mother feels the child is healthy and does not exhibit any other neurological symptoms, a doctor's appointment is advisable. 3. A child would be exhibiting more symptoms than unsteady balance if he was taking a substance. 4. The concern should be addressed and an appointment made to find the cause of the unsteady balance.)

56. It is May, and a mother brings in her 3-year-old son, who has had a harsh whooping cough, runny nose, and watery eyes for the past five days. What would be the most appropriate question to ask the mother? 1. Are the child's immunizations up-to-date, including his Tdap vaccine? 2. Did the child receive his Hib vaccine? 3. Have you taken the child outside in the rain? If so, what happened? 4. When was the last time your child was ill?

1 (1. Up-to-date immunizations will include the Tdap vaccine. If the child has had the vaccine the occurrence/severity of the illness is less. 2. Hib does not include the Whooping Cough vaccine. The question would not be appropriate at this time. 3. Weather does not influence the vaccines. 4. Past illnesses is not the focus of the current assessment and is not appropriate at this time.)

73. A nurse is giving discharge instructions to parents taking a newborn home with apneic episodes. The newborn has an apnea monitor for home. The instructions should include: (Select all that apply.) 1. How to clean the monitor pieces. 2. Allowing the monitor to be off when the parents are sitting with the newborn in an awake state. 3. Never take the monitor off. 4. Take the monitor off when bathing the baby. 5. Reset the alarm limits if the monitor is ringing frequently.

1, 2, 4 (1. Keeping the pieces clean will aid in decreasing the chances for infection and help maintain a working monitor. 2. The newborn can be off the monitor while awake, and being supervised helps decrease skin breakdown. 3. The monitor should be taken off for periods while the newborn is awake and supervised. 4. Since the monitor is electric, it should not become wet at any time. 5. The alarm limits are prescribed by a provider and should not be reset.)

74. Parents are attending a pre-baby class and receiving information on SIDS. Identify important information the nurse should provide during the course. Select all that apply. 1. A firm mattress 2. A bendy bumper around the entire bed 3. A pillow 4. Tight-fitting sheets 5. A well-ventilated room

1, 4, 5 (1. A firm mattress keeps the baby from sinking into the bedding, thus preventing suffocation. 2. Bendy bumpers can create pockets for the infant's face to become stuck, thus creating a suffocation risk. 3. A pillow is too bulky and can cause an infant to become stuck, thus creating a suffocation risk. 4. Tight-fitting sheets decrease the chance for suffocation because there is little room for the infant's head to get stuck. A well-ventilated room creates air movement and a good exchange of oxygen and carbon dioxide.)

71. Signs that a child is exhibiting respiratory distress include: (Select all that apply.) 1. Nasal flaring. 2. Synchronized rise and fall of the abdomen and the chest. 3. A capillary refill of less than three seconds. 4. Grunting. 5. Intercostal retractions.

1, 4, 5 (1. Nasal flaring indicates that the child is struggling with breathing. 2. Synchronized rise and fall is a normal breathing pattern of a child. 3. A capillary refill of less than 3 seconds is normal for a child. 4. Grunting indicates that the child has to exhale harder than normal, thus indicating respiratory distress. 5. Intercostal retractions indicate that the child needs to use accessory muscles, creating respiratory distress.)

21. A child is scheduled to have a tonsillectomy in two hours. The nurse's assessment should include: 1. A question to see if the child snores or has difficulty breathing at times. 2. Assessing for halitosis. 3. The size of the tonsils. 4. All of the above

1. Snoring and difficulty breathing are an indication of obstruction of the tonsils. 2. Halitosis is common in children with enlarged tonsils because of the bacterial content. 3. Tonsil size should be documented because removal of the entire tissue will need to occur during surgery. 4. Snoring and difficulty breathing are an indication of obstruction of the tonsils. Halitosis is common in children with enlarged tonsils because of the bacterial content. Tonsil size should be documented because removal of the entire tissue will need to occur during surgery.

55. A 12 year old comes in with her mother and has the following symptoms: a 40.0 C fever, chills, coughing, and chest pains. Her mother states that she just finished Amoxicillin for strep throat and her chest x-ray shows consolidation. Based on these findings, what would be possible nursing interventions to manage this patient? 1. Monitor oxygenation status and results of sputum culture, CBC, PTT, and sweat chloride test from the laboratory 2. Monitor respiratory, oxygenation, and hydration status and give antibiotics as ordered 3. Monitor respiratory and oxygenation status and give pneumococcal vaccine injection as ordered 4. Monitor oxygenation and hydration status and inform mother that antibiotics would be ineffective for her daughter

2 (1. A PTT and sweat chloride test are not needed at this time because this is the initial incidence of respiratory issues. 2. Although RSV causes 80%85% of all pneumonia in children, the nurse suspects bacterial pneumonia due to the recent strep infection. This is why antibiotics are expected to be ordered. 3. A pneumococcal vaccine should be given prior to the illness. 4. Although RSV causes 80%85% of all pneumonia in children, the nurse suspects bacterial pneumonia due to the recent strep infection. Antibiotics can be effective in this situation.)

15. A mother has brought her 18-month-old boy into the pediatric clinic because of irritability, high fever, and has been tugging at his ear for the last 24 hours. The nurse would anticipate which of the following orders? 1. Place the child NPO and attempt to get a head CT. 2. Administering antibiotics for otitis media and acetaminophen for pain and fever control. 3. No orders, as this is a common childhood ailment that requires no interventions. 4. Admitting the child to the hospital to control the high fever.

2 (1. A child with a high fever is normally irritable and this would not be an indication for a head CT as a first priority. 2. The tugging at the ear can be an indication of a child having otitis media. Acetaminophen can help control the ear pain and fever in order to help decrease irritability. 3. Due to the high fever and irritability, the child is demonstrating pain. An intervention is needed. 4. Not enough information is provided to indicate the fever level. Normally this can be controlled at home with acetaminophen.)

41. A newborn is experiencing apneic episodes. The nurse should do which of the following when an episode occurs? 1. Give the newborn CPR 2. Stimulate the newborn by rubbing its back 3. Reposition the newborn 4. Hold the newborn

2 (1. An assessment to see if the newborn has a heart rate is needed. 2. Stimulating the newborn may help his/her breathing. 3. Repositioning the newborn is important and should occur after breathing stimulation is provided. 4. Holding the newborn will not stimulate him/her to breathe.)

45. The mother of a child with cystic fibrosis calls the triage nurse and asks which type of antihistamine would be the most beneficial for her son's head cold. The nurse should: 1. Recommend Benadryl for her son. 2. Discourage the use of antihistamines because the drug can dry out the mucous and make it harder to expel. 3. Encourage the mother to give the child a dose of the antihistamine every four hours. 4. Recommend any over-the-counter antihistamine that states it is a pediatric formula.

2 (1. Benadryl will dry out the mucous membranes and cause further problems for the child. 2. Discouragement of antihistamine usage is important because the medication can dry out the mucous membranes too much for a child with cystic fibrosis. 3. Antihistamine medication can dry out the mucous membranes too much for a child with cystic fibrosis, creating further problems. 4. Antihistamine medication can dry out the mucous membranes too much for a child with cystic fibrosis and create further problems.)

42. A former 24-week, premature infant is now adjusted in age to be one year of age. The baby has a known history of bronchopulmonary dysplasia. The parents of the child are asking if their baby will catch up in height and weight to her peers by the time she is 2 years old. The best reply from the nurse would be: 1. "Normally, premature infants will be the same height and weight as their peers by their second birthday." 2. "The bronchopulmonary dysplasia requires your child's lungs to work harder to breath. This causes the body to have a higher metabolism, so she may remain on the small side for several years." 3. "You baby is now healthy and will continue to grow at her own rate." 4. "Your baby will remain small for most of her life due to the bronchopulmonary dysplasia."

2 (1. Children with bronchopulmonary dysplasia require high nutritional demands to the body. The growth of children with this diagnosis tends to be slower than their peers. 2. Children with this diagnosis tend to be smaller than their peers for a longer period of time. 3. This is a true statement, but does not address why the child is not growing at the same rate. 4. The child's body can grow and may be the same as peers later in life.)

62. Cystic fibrosis is best categorized as: 1. An autosomal recessive disease with deletion of Chromosome 17 that affects the lungs and finances of the parents. 2. An autosomal recessive disorder of the exocrine glands marked by increased mucus and sodium chloride production and decreased pancreatic enzyme production. 3. An autosomal recessive disorder that affects the respiratory, cardiac, and digestive systems. 4. An autosomal recessive disorder that is marked by the increased mucus destruction and decreased pancreatic enzyme production.

2 (1. Cystic fibrosis is an autosomal recessive disorder of exocrine glands and is not seen on chromosome 17. 2. Cystic fibrosis is an autosomal recessive disorder of exocrine glands marked by increased mucus and sodium chloride production and decreased pancreatic enzyme production. 3. Cystic fibrosis is an autosomal recessive disorder that impacts the respiratory and GI tract, not the heart. 4. Cystic fibrosis is an autosomal recessive disorder of the exocrine glands marked by increased mucus and sodium chloride production and decreased pancreatic enzyme production.)

30. The best way to prevent pertussis in children is with: 1. Good hand hygiene. 2. Keeping immunizations up-to-date. 3. Isolation precautions. 4. All of the above are correct.

2 (1. Hand hygiene is important but the pertussis virus is usually airborne. 2. Immunizations help to build immunity to the disease. 3. Isolation precautions are needed after a child has the illness. 4. Immunizations to help build immunity to the disease is the priority.)

44. The purpose of administering surfactant to a preterm neonate is: 1. Because the preterm neonates lungs do not produce it. 2. To prevent the alveoli from collapsing. 3. To help the diaphragm function. 4. Because a preterm neonate needs more surfactant than an older child.

2 (1. Preterm neonates do have some surfactant in the lungs, but not enough to keep the alveoli open for a long period of time. 2. Surfactant is the lubricant in the lungs that allows all for alveoli to remain moist and prevents them from collapsing. 3. The diaphragm is outside of the lung tissue and does not receive surfactant. 4. A preterm neonate's needs do not differ from those of an older child.)

69. The parents of a 3 year old from India state that the child has been losing weight and coughing for a year. Additionally, the child's grandmother was diagnosed with TB. Which of the following is the most accurate statement regarding this situation? 1. Tubercules are more prevalent in children than adults, and all family members should be tested for TB. 2. Prevalence is high in developing countries, and only 20 percent of complete treatment because the length, intensity, and cost of treatment. 3. A blood culture is the definitive diagnosis for TB after a negative skin test. 4. Diagnosing TB in children is difficult because it varies with the changes in the seasons, and the symptoms can be vague.

2 (1. TB is more prevalent in adults than children. 2. Prevalence is high in developing countries, and only 20 percent of complete treatment because the length, intensity, and cost of treatment. 3. The Mantoux test gives an indication as to whether TB is present in the person's body. 4. TB presents the same no matter the season in both children and adults.)

1. An 8-year-old child with a history of cystic fibrosis has a chest that is larger than normal. This type of feature on a child is known as: 1. A concaved chest. 2. A barrel chest. 3. An asymmetrical chest. 4. All of the above are correct.

2 (1. The chest does not bow inward in a child with cystic fibrosis. 2. A barrel chest is common in a child with cystic fibrosis because of the air trapping that occurs within the lungs. 3. The chest is symmetrical in appearance with cystic fibrosis. 4. Not all of the options are correct.)

27. A 2 year old has been placed in contact isolation because of a diagnosis of Respiratory Syncytial Virus (RSV). The father questions why the staff is wearing masks and gowns every time someone comes into the room. The best response would be: 1. "The equipment is needed to protect myself and others from your child's illness." 2. "Since bronchiolitis is highly contagious for other children, it is important for the staff to wear the equipment to prevent spreading it to others." 3. "Every child that comes in with a respiratory illness is required to be in isolation." 4. "The equipment is needed to protect your child from acquiring an illness from the staff."

2 (1. The equipment is protecting the health-care worker from transmitting the virus to other patients. 2. Prevention of the spread of the disease is the primary reason for the equipment. 3. Not all respiratory illnesses require isolation. 4. The equipment is protecting the health-care worker from transmitting the virus to other patients.)

20. Amantadine hydrochloride has been prescribed for a patient. The nurse knows this medication is used for: 1. Sinusitis. 2. Influenza. 3. Upper respiratory tract infections. 4. Asthma.

2 (1. The medication is not prescribed for sinusitis. 2. The medication helps reduce the symptoms and spread of the influenza virus. 3. Upper respiratory tract infections do not benefit from the use of the medication. 4. Asthma exacerbations do not benefit from the use of this medication.)

5. A nurse is attempting to assess the skin color of a child with dark skin. The nurse knows the best place to assess the child's skin color is: 1. The nailbeds. 2. Inside the mouth in the cheek area. 3. The eyes. 4. On the chest.

2 (1. The nailbeds should be used to assess capillary refill. 2. A pen light can be used to examine the inside of a child's mouth in the cheek area for color. 3. The eyes can indicate jaundice, but not any other type of color changes. 4. Capillary refill can be assessed on the chest since the oral mucous membranes are more accurate.)

11. A child's ABG results are: pH: 7.14 pCO2: 24.6 HCO3: 8.0 The nurse interprets these results as: 1. Normal ABG. 2. Partially Compensated Metabolic Acidosis. 3. Uncompensated Metabolic Acidosis. 4. Uncompensated Respiratory Acidosis.

2 (1. The pH is acidotic, the CO2 is alkalotic, and the HCO3 is acidotic. Because the pH and the HCO3 are acidotic, it causes the Metabolic Acidosis. Compensation occurs because the pH and the CO2 go in the opposite direction, and the pH is not in the normal range to cause the partial. 2. The pH is acidotic, the CO2 is alkalotic, and the HCO3 is acidotic. Because the pH and the HCO3 are acidotic, it causes the Metabolic Acidosis. Compensation occurs because the pH and the CO2 go in the opposite direction, and the pH is not in the normal range to cause the partial. 3. Compensation occurs because the pH and the CO2 go in the opposite direction, and the pH is not in the normal range to cause the partial. 4. Because the pH and the HCO3 are acidotic, it causes the Metabolic Acidosis.)

23. A newborn is lying in his crib in the hospital nursery. The nurse picks up the newborn to prepare for a feeding and notes frothy oral secretions around the newborn's mouth. The nurse should: 1. Wipe the newborn's mouth and give the feeding. 2. Clean the newborn's mouth and notify the doctor of the findings. 3. Feed the newborn. 4. Take the baby to the mother to feed.

2 (1. The wiping the mouth for an assessment is needed, but the newborn should not be fed because the secretions are an indication of lack of secretion drainage. 2. These actions should occur because the child is at risk for tracheal esophageal atresia. 3. The newborn should not be fed because the secretions are an indication of lack of secretion drainage and increases the chance for aspiration. 4. The newborn should not be fed because the secretions are an indication of lack of secretion drainage and increase the chance for aspiration.)

53. A 15 month old admitted with croup is sleeping in a cool mist tent. The nurse checks on him and notices that he is retracting and tachypneic. What is the first thing she should do? 1. Increase the oxygen flow to the tent 2. Check the child's pulse oximetry 3. Check the child's temperature 4. Notify the physician

2 (1. This is not the first intervention. A pulse oximetry should be assessed to identify the need for oxygen. 2. The first intervention should be to check the child's pulse oximetry. 3. Fever can cause tachypnea. This is not the first action needed. 4. Notifying the physician is not the first action needed.)

47. The mother of a 3 year old complains to the nurse after the physician leaves the room, saying, "My baby is sick with a fever, bad cough, runny nose, and flushed cheeks. He didn't give me any medicine to make him better!" What is the nurse's best response? 1. "It is okay to give your child over-the-counter medicine. Just make sure you get a cold and fever medication." 2. "The doctor stated that he believes this to be a virus, so antibiotics will not relieve the symptoms." 3. "The best way to treat your child is to give him plenty of fluids, bedrest, and coloring books." 4. "The doctor believes this to be a viral illness, so you can use over-the-counter cold medications as long as they say 'pediatric' on the label."

2 (1. You should not use cold medicine in children under the age of 5. 2. "The doctor stated that he believes this to be a virus, so antibiotics will not relieve the symptoms." 3. Fluids, bedrest, and limiting contacts would help the management of current symptoms. This does not address the mother's concern of not receiving medication. 4. You should not use cold medicine in children under the age of 5.)

72. The father of a 13-year-old boy with sinusitis calls the triage nurse at the pediatric clinic to ask what he can do to rest. The nurse should advise the father to: (Select all that apply.) 1. Place a cold compress on the infected sinus areas. 2. Have the child blow his nose with one nostril closed off at a time. 3. Use a warm mist humidifier in his bedroom. 4. Use saline drops to help clear the nasal passage. 5. Use a bulb syringe to remove secretions.

2, 4, 5 (1. Cold compresses will not encourage drainage. 2. Attempting to blow a nose with one nostril closed at a time helps provide pressure to remove the secretions. 3. A cool mist humidifier should be used to help reduce the chance of steam burns. 4. Saline drops can keep the airways moist and help remove secretions. 5. The child is too old for bulb syringe suction. Blowing the nose is just as effective.)

39. A diet for a child with cystic fibrosis should include: 1. Foods with high protein and high fat content. 2. Foods with low fat and high protein content. 3. A daily dose of fat-soluble vitamin supplements. 4. A daily dose of water-soluble vitamin supplements

3 (1. A diet with a high fat content can cause digestion issues because of the lack of enzymes. 2. A diet with low protein is needed for the child to aid in health. 3. The fat-soluble vitamins are needed because the child is not able to digest fat easily. 4. A child with cystic fibrosis should be able to receive the needed water-soluble vitamins in a regular diet.)

12. A child has the following results for an ABG: pH: 7.42 pCO2: 43.9 HCO3: 26.8 The nurse interprets these results to be: 1. Compensated Respiratory Acidosis. 2. Compensated Respiratory Alkalosis. 3. Normal ABG. 4. Compensated Metabolic Acidosis.

3 (1. All results are within normal range and are not causing acidosis or compensation. 2. All results are within normal range and are not causing alkalosis or compensation. 3. All results are within normal ranges, thus this is a normal ABG finding. 4. All results are within normal range and are not causing compensation or acidosis.)

46. The mother of an 18 month old states that she is concerned due to the fact that her child has been diagnosed with otitis media three times in the last year. Which answer would be appropriate to alleviate the mother's concerns? 1. A child's airway is short and narrow. As the child grows, the airway will grow, and the number of alveoli will increase. 2. A child's tonsils are larger than an adult's and block emptying of the Eustachian tubes. As the child grows, the tubes get longer even though tonsils don't change. 3. A child's Eustachian tubes are shorter and more horizontal, allowing nasopharyngeal secretions to enter. As the child grows, the incidence of OM will decrease. 4. A child's larynx is more flexible than an adult's and easily stimulated to spasm. As he grows, he will be less sensitive to laryngospasms and pooling of secretions.

3 (1. Although choice 1 is correct, it does not address the ears and recurrent infection. 2. A child's tonsils are not larger than an adult's. They do not block the emptying of the Eustachian tubes. 3. A child's Eustachian tubes are shorter and more horizontal, allowing nasopharyngeal secretions to enter. As the child grows, the incidence of OM will decrease. 4. A child's larynx is not more flexible than an adult's.)

52. What is the most accurate statement regarding Palivizumab? 1. It is a humanized monoclonal antibody given as an IM injection before the start of HPV season. 2. It is recommended for premature infants with 29-35 week's gestation, children with congenital heart defects, and the elderly. 3. It is costly and is given usually between October to May in a series of five injections. 4. Before administering, you need to evaluate results of complete blood count and electrolyte panel from the laboratory.

3 (1. Given prior to RSV season 2. Not given to the elderly 3. It is given prophylactically before the start of RSV season. The nurse needs to evaluate platelets and coagulants before administering. 4. The nurse needs to evaluate platelets and coagulants before administering.)

36. Children with cystic fibrosis should be frequently checked for: 1. Hypernatremia. 2. Hypocalcemia. 3. Hyponatremia. 4. Hypercalcemia.

3 (1. High sodium is not an issue in children with cystic fibrosis. 2. Low calcium levels are not an issue for children with cystic fibrosis. 3. The lack of sodium is noted in children with this diagnosis. 4. High calcium levels are not common in children with cystic fibrosis.)

65. The nurse is doing discharge teaching with the parents of a child with new diagnosis of CF. What is the most important concept for parents of CF patients to remember? 1. Hospitalizations can be avoided with consistent chest physiotherapy. 2. There are multiple support groups in the community available to help them cope when the symptoms increase as the child grows older. 3. It affects multiple body systems over a lifetime, which requires vigilant respiratory care and individualized dietary modifications. 4. All symptoms of cystic fibrosis can be managed by diet modifications and increasing the fluids and salt intake of the child.

3 (1. Multiple adaptations to the lifestyle will be needed to maintain a healthy body and avoid hospitalizations. 2. Support groups and summer camps should be implemented right away to learn how to adapt to the illness emotionally. 3. It affects multiple body systems over a lifetime, which requires vigilant respiratory care and individualized dietary modifications. 4. Some individuals will be more ill than others and need different modifications to their diet.)

4. A father is concerned that his newborn baby girl is cold because her hands are blue. The nurse explains to the father that: 1. This is a sign of respiratory distress, and the baby needs to return to the nursery. 2. Most newborns have trouble regulating their body temperature. 3. This is acrocyanosis and should go away within 48 hours after her birth. 4. This is bruising the baby received during the birth process.

3 (1. Respiratory distress would be noted if the newborn had circumoral cyanosis. 2. Healthy newborns are able to regulate their body temperature soon after birth if dressed for the environment. 3. The newborn is exhibiting acrocyanosis. It is not a sign of coldness. 4. Bruising usually does not occur on the hands.)

51. A mother brought her 8 year old into the emergency room because although she was fine when she woke up this morning, she now has a fever of 39.8 C, cannot speak, is drooling, and is tachypneic and stridorous. Her pulse oximetry reading is 90 percent on a rebreather mask. What would be the next appropriate nursing action? 1. Suction her mouth, then conduct throat and blood cultures as well as a test for gram positive bacteria. 2. Prepare the child and mother for an MRI scan to evaluate for a "thumb sign." 3. Monitor respiratory status closely, prepare for intubation, and keep the child calm to avoid crying. 4. Suction her mouth, monitor respiratory status closely, and give a Palivizumab injection.

3 (1. Suctioning can cause more traumas to the area. 2. The "thumb sign" will not occur in this condition. 3. The nurse would monitor and be prepared for possible rapid decline in respiratory status and try to keep the child from crying. 4. Suctioning the mouth can cause more damage, and the injection should not be given at this time.)

2. When a nurse enters the room of a child with chronic lung disease, she notes that the child is sitting in a tripod position. Identify the reason for this positioning by the child. 1. The child feels more comfortable playing in this position. 2. The child is attempting to have a bowel movement. 3. The child is having trouble breathing, and the position is comfortable 4. The child is in a resting position after walking in the hallway.

3 (1. The child may feel comfortable in this position, but it is not the primary reason for the positioning. 2. A child will squat on their haunches when having a bowel movement. 3. The tripod position enables the diaphragm to fully expand and attempt to get as much oxygen into the body as possible. 4. A child who is resting will sit or lie down on the bed.)

28. A nurse is assessing a 3-month-old child with RSV. The nurse identifies the following: HR of 140; RR of 32; Oxygen saturation is 89% on room air; inspiratory and expiratory wheezing of the upper lungs; temperature of 38.1 degrees Celsius; large amounts of thin secretions. Identify the priority at this time. 1. Administering acetaminophen to reduce the fever 2. Providing oxygen for the low saturation 3. Suctioning the nares and oropharnyx to remove the secretions 4. Providing a quiet environment

3 (1. The fever is low grade and not a priority at this time. 2. 89 percent oxygen saturation on room air needs to have a further assessment to see why the child is low in saturations. 3. Suctioning helps remove all the secretions and opens the airway with the possibility of increasing oxygen saturations. 4. A quiet environment will help the child rest, but is not a priority at this time.)

49. A father brings his 6-month-old infant into the clinic with a four day history of nighttime, seal-like cough. The infant is afebrile, tachycardic, and tachypneic with a pulse oximetry reading of 98 percent. What interventions would you expect the physician to order for this child? 1. Cool mist tent with supplemental oxygen, racemic epinephrine, and corticosteroids 2. Beta adrenergics aerosolized, cool mist tent, and periodic testing of blood glucose levels 3. Close monitoring of respiratory status, cool mist tent, beta adrenergics, and corticosteroids 4. Close monitoring of respiratory status, supplemental oxygen with simple mask, and racemic epinephrine

3 (1. The infant's pulse oximetry is 98 percent and does not need supplemental oxygen. 2. Beta adrenergic meds do not increase blood glucose levels. 3. These interventions are appropriate for croup-like symptoms. 4. The infant's pulse oximetry is 98 percent and does not need supplemental oxygen.)

25. A mother calls the pediatric triage nurse to report that her son has a barky cough, and it started about midnight. The nurse should instruct the mother to: 1. Take the child to the emergency room right away. 2. Sleep with the child in an upright position. 3. Take the child into a room with a cool mist humidifier or go outside and see if the barky cough subsides. 4. All of the above would be appropriate responses for the mother.

3 (1. The mother should attempt to relieve the symptoms at home prior to coming to the emergency room. 2. The child will more than likely not sleep. 3. A cool mist humidifier or going outside can help reduce the inflammation of the trachea and larynx area. 4. Only using the cool mist humidifier or taking this child into the cool night is effective treatment.)

17. Treatment for otitis externa (OE) is usually: 1. No treatment because it resolves on its own. 2. Antibiotic therapy. 3. Corticosteroid therapy. 4. Applying a warm pack to the area for comfort.

3 (1. Treatment is recommended because long-term or frequent infections can cause hearing loss. 2. The concern is the fluid and inflammation. Antibiotics will not help remove the fluid and inflammation. 3. Corticosteroids will help reduce the inflammation and fluid in the ear. 4. The warm pack can be a comfort measure, but the fluid and inflammation need to be addressed.)

68. An infant is tachypneic, retracting, and tachycardic with a temp of 39.0 C and a pulse oximetry of 92 percent. You place the infant on 1L nasal cannula oxygen and raise the head of the bed. What intervention would the nurse expect the physician to order next? 1. MRI 2. CT 3. Bronchoscopy 4. Chest x-ray

4 (1. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies. 2. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies. 3. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies. 4. A chest x-ray is the least invasive and can visualize the lung fields. The other answers require sedation, making the infant NPO prior to studies.)

66. What is the major contributing factor for the development of BPD? 1. Immature lungs have a decreased number of alveoli for gas exchange 2. Premature birth with decreased number of functional alveoli, leading to lung injury 3. Chronic respiratory infections, leading to pulmonary hypertension and lung scarring 4. Ventilator assistance with high oxygen flow rate at birth, causing inflammation and scarring in lungs

4 (1. BPD occurs because of the increased resistance and amount of damaged alveoli, decreasing the amount of oxygen exchange. 2. Scarring occurs on the alveoli that are present. The preemie baby has the same amount of alveoli, but less surface area to ventilate. 3. Neonates do not commonly have respiratory infections to cause an increased risk for BPD. 4. Ventilator assistance with high oxygen flow rate at birth, causing inflammation and scarring in lungs)

18. Important discharge teaching for a 4-year-old boy who had a tympanostomy procedure done would include: 1. The tubes usually fall out spontaneously within a year. 2. Draining of purulent fluid after two days, then return for a follow-up. 3. Placing waterproof ear plugs in the ears when swimming. 4. All of the above should be included in the discharge teaching.

4 (1. Because of the rapid growth of children, the tubes usually last approximately one year. 2. Purulent fluid is a sign of infection. 3. Preventing water from entering the tubes will help decrease the chance of infection. 4. Because of the rapid growth of children, the tubes usually last approximately one year. Purulent fluid is a sign of infection. Preventing water from entering the tubes will help decrease the chance for infection.)

63. Which statement is most accurate regarding chest physiotherapy (CP)? 1. CP includes postural drainage, chest percussion, vibration, and daily chest x-rays. 2. CP is used to mechanically loosen secretions to prevent or manage atelectasis and gastritis. 3. CP should only be performed in the absence of respiratory distress. 4. CP is contraindicated when chest rib fractures, lung contusions, or hemothorax are present.

4 (1. CP does not require daily X-rays. 2. CP is not used for gastritis. 3. CP should only be done with patients with an increase in respiratory secretions. 4. Chest physiotherapy is contraindicated when rib fractures, lung contusions, or hemothorax are present because further damage can occur.)

26. When assessing a child with epiglotitus, the nurse should assess for all of the following except: 1. Drooling. 2. Dysphonia. 3. Stridor. 4. Crackles in the upper lungs.

4 (1. Drooling can indicate swelling of the epiglottitis because the secretions are not able to go to the stomach. 2. Dysphonia can occur because of the swelling. 3. Stridor is common because of the swelling of the epiglottitis. 4. Crackles are heard in lower respiratory illnesses, not the upper respiratory illnesses in children.)

64. A 6 year old who exhibits a moist, productive cough has a history of bronchitis several times every year and "eating everything in sight." She appears thin for her age and has a sweat chloride test that is 67 mEQ/L. Her mother states, "I just want to get this eating disorder treated so my baby can have a normal life." What is the nurse's best response? 1. "We will consult the dietician for a behavior management and eating plan, focusing on appropriate portion size." 2. "We will need to do another sweat chloride test next week. Have your child take supplemental water-soluble vitamins, such as A, D, K and iron." 3. "You should incorporate tofu and mayonnaise in your meal preparation to promote feeling full for a longer period of time." 4. "Cystic fibrosis can cause an increase in appetite because of the lack of nutrients and calories absorbed. This affects children across the life span."

4 (1. Food choices that contain the needed vitamins and minerals should be discussed. 2. The child already has the diagnosis and another test will not indicate which vitamins to give. 3. This diet will not easily be digested by a person with CF. The menu should be reconsidered. 4. Increased appetite is a physiologic response to decreased fat-soluble nutrients and calories absorbed in the CF digestive track. This requires fat-soluble (A,D, E, K) vitamins and pancreatic enzyme supplements.)

61. A newborn has a scaphoid-shaped abdomen, irregular chest wall movements, and decreased breath sounds on the left side of chest. What other symptoms would you expect to find? 1. Central cyanosis and pink nailbeds with brisk capillary refill 2. Protruding abdomen and fullness with palpation 3. Increased breath sounds over trachea, tachypnea, and stidor 4. Tachypnea, nasal flaring, and retractions

4 (1. Nailbeds will be cyanotic and exhibit slow capillary refill. 2. The abdomen will be full and stiff because of excessive air. 3. Grunting may be present, and there will be decreased breath sounds. 4. Tachypnea, nasal flaring, and retractions are the correct symptoms.)

33. When assessing a newborn with a known diaphragmatic hernia, the nurse would anticipate hearing bowel sounds: 1. In the upper abdomen. 2. In the lower abdomen. 3. To not exist. 4. In the chest.

4 (1. Normal bowel sounds can be heard in the upper abdomen. 2. Normal bowel sounds can be heard in the lower abdomen. 3. Bowel sounds do exist, just in a different area of the body. 4. Because of the lack of diaphragm, the gastrointestinal tract is shifted into the chest cavity.)

24. A newborn has had a repair of a trancheoesophageal fistula one hour ago. When the newborn is taken to the neonatal intensive care unit, the nurse should: 1. Monitor the oxygen saturations of the newborn. 2. Assess for respiratory distress. 3. Provide oral suctioning as needed. 4. All of the above should be done for the newborn.

4 (1. Oxygen saturations will indicate the respiratory status of the newborn. 2. Assessment for respiratory distress is needed because the surgery requires some trauma to the trachea. 3. Suctioning is needed so the secretions do not cause blockage in the airway. 4. Oxygen saturations will indicate the respiratory status of the newborn. Assessment for respiratory distress is needed because the surgery requires some trauma to the trachea. Suctioning is needed so the secretions do not cause blockage in the airway.)

6. A child with respiratory distress can experience dehydration because: 1. The child is not drinking enough fluids. 2. The body requires an increased amount of fluids when sick. 3. The child is retaining water in the kidneys since the body is using all the oxygen in the lungs. 4. Mouth breathing occurs when in distress, so the child is losing hydration.

4 (1. Respiratory distress causes dehydration issues. 2. Fluids are required to keep mucous membranes and secretions moist, but are not the reason for dehydration. 3. Water is not retained in the kidneys with respiratory difficulties. 4. Children are known to be mouth breathers during respiratory distress situations, thus increasing their risk for dehydration due to the lack of moist mucous membranes.)

67. If a nurse suspects that a 2-month-old infant's death was related to SIDS, what statement made by the mother reflects an accurate understanding of SIDS? 1. "I knew that I should not have given our baby the antibiotics for the ear infection." 2. "Being a twin with low birth weight, he didn't have a chance." 3. "I should not have fed him that eight-ounce bottle before laying him down." 4. "I am having a hard time not knowing what happened. I had just checked on him 20 minutes earlier in the crib, and he was sleeping on his back."

4 (1. SIDS is a diagnosis of exclusion. Antibiotics are not known to cause SIDS. 2. A lower birth weight child is at more risk, but is not the only reason SIDS can occur. 3. The amount of feeding does not influence the occurrence of SIDS. 4. SIDS is a diagnosis of exclusion. It is difficult to know what exactly causes the death in SIDS cases.)

58. Which statement regarding the pathophysiology of TB is accurate? 1. The settling of the bacillus in the alveoli triggers the clotting response. 2. Macrophages form hard tubercules around bacilli that always remain dormant in the lungs. 3. TB can affect the lungs, spinal cord, bone formation and the brain. 4. Tubercles in the lungs can remain dormant or progress to active tuberculosis, but are not as prevalent in children.

4 (1. The clotting response is not triggered by the bacillus. 2. The tubercules are rare in children. 3. TB affects the lungs only. 4. Tubercles in the lungs can remain dormant or progress to active tuberculosis, but are not as prevalent in children.)

40. A nurse is attempting to educate a 10-year-old girl in the use of a peak flow meter. Identify the best way to explain the test to the child. 1. "The purpose of the test is to see how hard you breathe." 2. "The purpose of the test is for you to monitor what is normal and abnormal for you. Then your parents can help with your medication on days when you are not measuring in your normal ranges." 3: "We are measuring how well you can blow birthday candles out." 4. "The meter will help monitor when you are healthy and when you are becoming ill."

4 (1. The description is not accurate, and a 10 year old is able to comprehend the reason for use of a peak flow meter. 2. The description of normal and abnormal can cause concern for the child. It is important to explain that the peak flow meter is a measurement of health. 3. This description can be used for a younger child. A 10 year old is able to comprehend the use of the peak flow meter. 4. The peak flow meter is a monitor used to indicate when the child is breathing easily and when illness may be starting.)

9. When assessing a 12-year-old girl with the diagnosis of pneumonia, the nurse performs percussion. The lower left lobe is noted to have a dull sound. What should the nurse do next? 1. Call the doctor with the assessment. 2. Check the orders and start chest physiotherapy. 3. Palpate the chest to check for tactile fremitus. 4. Place the child on oxygen.

4 (1. The doctor will need to be called after oxygen is applied because the first priority is to maintain oxygen saturation in order to prevent further respiratory distress. 2. The child needs immediate intervention. 3. Tactile fremitus will be increased due to the pneumonia. 4. The assessment indicates that the child has a lower lobe that is not expanding and needs oxygen supplementation in order to maintain saturation levels.)

70. The most accurate physiologic reason for respiratory distress in respiratory distress syndrome (RDS) is: 1. Altered surface tension causes fluid and protein leak, preventing atelectasis and ground glass appearance on CXR. 2. Infants with RDS are premature and incidence of RDS increases with increased gestational age. 3. Infants with RDS have a decreased number of alveoli, increased surface tension, and decreased AP diameter, limiting lung development. 4. Infants with RDS have altered surface tension, which produces hyaline membrane, atelectasis, and hypoventilation.

4 (1. The hypoventilation occurring in RDS causes an increased risk. 2. RDS can occur in any gestational age neonate. 3. The neonates have damage to the alveoli, not a decreased number. 4. Infants with RDS have altered surface tension, which produces, hyaline membrane, atelectasis and hypoventilation.)

59. The nurse is doing discharge teaching with the mother of a 10 year old, who has been newly diagnosed with TB. Which statement is not accurate regarding the spread of TB? 1. The patient should take anti-tubercular medicine for two weeks before being exposed to any non-infected people. 2. Everyone should wash their hands or use sanitizer after exposure to respiratory secretions. 3. It is transmitted through inhaled droplets from a close contact that is infected. 4. About 460,000 new cases of multi-drug sensitive TB are reported every year because of incomplete treatment regimes

4 (1. The medication will be needed for this length of time before being exposed to others. 2. Washing of hands should occur with every patient. 3. Close contact with those who have the disease increases the risk. 4. This statement is not accurate.)

50. An 8 month old was admitted to the hospital last night with cold symptoms and respiratory distress. She is on a simple mask with a flow rate of 10 L and on a cardiorespiratory monitor. The nurse goes into the infant's room to find her tachypneic, retracting, and slightly cyanotic with a pulse oximetry of 90%. What would be the oxygen delivery system that may help the infant? 1. A venturi mask with an oxygen flow of 1 liter per minute. 2. A nasal cannula with an oxygen flow of 4 liters per minute. 3. An oxygen tent with an oxygen flow rate of 10 liters per minute. 4. A partial rebreather mask with an oxygen flow rate of 8 liters per minute.

4 (1. The pressure is not adequate to oxygenate the infant. 2. A nasal cannula does not deliver enough pure oxygen to raise the oxygen saturation of the infant. 3. The oxygen tent will not allow for enough pressure for the infant to raise the oxygen saturation. 4. A partial rebreather mask with an oxygen flow rate of 8 liters per minute will raise the oxygen saturation of the infant.)

57. You suspect a 14 year old with persistent cough, anorexia, low-grade fever, and night sweats has tuberculosis. What is the most accurate statement about the treatment of this patient? 1. A nurse needs to collect serial sputum cultures in the a.m. and do serial AFB tests. 2. Latent TB would be treated with antituberculin medication combinations in higher doses for nine months. 3. Anti-tubercular medications given in higher doses in combination for six months are only effective after BCG vaccine is given. 4. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months.

4 (1. The time of day does not influence when the sample should be taken. 2. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months. 3. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months. 4. Active TB is treated with combinations of rifampicin, isoniazid, ethambutol, and streptomycin in higher doses for six months.)

19. An outbreak of influenza has occurred at the middle school. The school nurse is preparing to send home information about influenza. Her flyer should include all of the following except: 1. The virus is contagious one to two days prior to the appearance of symptoms. 2. Do not send your child to school if he/she has the chills or a erythematous rash. 3. Hydration is important. 4. If your child vomits, take them to the emergency room immediately.

4 (1. The virus is most contagious one to two days prior to the appearance of symptoms. 2. Chills and a erythematous rash indicate fever and can cause the spread of the virus. 3. Hydration will help keep mucous membranes moist to remove secretions. 4. Vomiting may occur and is not a medical emergency.)

34. A nurse is repositioning an infant with a known diaphragmatic hernia. The nurse should place the infant in which position? 1. With the head of bed elevated 20 degrees 2. Supine 3. Prone 4. In a semi-fowlers position

4 (1. This position does not take enough pressure off of the respiratory muscles. 2. Supine can cause the collapsing of the chest cavity and increase difficulty breathing. 3. Prone can cause too much pressure on the respiratory muscles and not allow for expansion. 4. Semi-fowlers will allow for pressure to be taken off of the diaphragm and decrease difficulty breathing.)

38. Teaching a child with a chronic respiratory illness to forcefully exhale can be done by: 1. Pretending to blow candles out. 2. Blowing bubbles. 3. Pretending to blow out a flashlight. 4. All of the above are techniques for teaching a child to forcefully exhale.

4 (1. This requires a large volume for inhalation and expiration, thus being an effective treatment. 2. This requires pursed-lip breathing and helps force air, thus being an effective treatment. 3. This requires a large volume for inhalation and expiration, thus being effective treatment. 4. Pretending to blow out candles or a flashlight require a large volume for inhalation and expiration, thus being effective treatment. Blowing bubbles requires pursed-lip breathing and helps force air, thus being an effective treatment.)

75. A nurse is discussing the process in which tuberculosis can infect a child. Place the following in the correct order. _1_ Sputum specimen is obtained _2_ Tubercles are dormant _3_ Bacillus triggers the immune response _4_ Bacilli spread to the lymphatic system _5_ Macrophages form tubercles around bacilli

5, 4, 1, 3, 2