PEDIATRIC NURSING-CH 18 PREPU

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When preparing the room for an infant with bronchiolitis, which equipment is most important?

?? Oxygen tubing and facemask A metered dose inhaler IV antibiotics A tracheostomy set

A mother calls the advance practice pediatric nurse practitioner about her 7-year-old daughter's dental hygiene. The daughter has had three cavities. She does not know what to do and asks the nurse for guidance. How should the nurse respond?

"Are you able to supervise her brushing?" -The number one dental problem in middle childhood is tooth decay. Until age 7, the child may need assistance brushing her teeth. Children tend to concentrate on the front teeth, because they can see them easily and "forget" the teeth in the back. Parental oversight is needed to be sure those overlooked are brushed carefully.

The nurse is performing a well-child assessment on a 2-week-old infant. The nurse asks why her baby only breathes out of his nose and does not seem to mouth breathe. What information can the nurse provide to the mother?

"Babies are nose breathers for about the first 4 weeks of life." -Newborns are obligatory nose breathers until at least 4 weeks of age. The young infant cannot automatically open his or her mouth to breathe if the nose is obstructed. The nares must be patent for breathing to be successful while feeding. Newborns breathe through their mouths only while crying. pg594

The mother of a 7-year-old girl is asking the nurse's advice about getting her daughter a 2-wheel bike. Which response by the nurse is most important?

"Be sure to get the proper size bike."

The mother of a 6-year-old is asking the nurse how to handle the child's lying and fabricated stories when confronted with questionable actions. Which response would be most appropriate by the nurse?

"Children this age sometimes can't distinguish between fantasy and reality."

The nurse is presenting information about school-aged children at a community event. Which statement should the nurse prioritize for further teaching and providing more information?

"Food is so expensive, we always make our children eat everything on their plates."

A 4 week old is diagnosed with bronchiolitis. The parent states, "I do not know how the baby got this!" The nurse is most correct to ask which question?

"Has the baby been around any crowds?"

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

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication? a) "I should give the enzymes before each meal or snack." b) "Between meals is the best time to give the enzymes." c) "I should reduce the dose if she has large, malodorous stools." d) "I should stop the enzymes if my child is taking antibiotics."

"I should give the enzymes before each meal or snack." Correct Explanation: The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.

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?

"I'm going to have this hospital worker take a picture of your lungs."

The mother of a child with asthma tells the nurse that she occasionally gives her child her steroid medicine she takes for her rheumatoid arthritis when the child has a "flare up" of asthma, "It's easier than going to the hospital or doctor every time a flare up happens." What is the best response by the nurse?

"I'm sure it must be difficult to cope with the flare ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms.

The nurse is taking a health history for a 12-year-old boy who is seriously overweight. Which general question would the nurse direct to the child's parents?

"Is there a family history of hypertension, heart disease, or diabetes?""

A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse?

"It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?"

The parents of a 10-year-old tell the clinic nurse that they are concerned because they noticed that their child has gained about 10 pounds over the past 2 years. What is the best response by the nurse?

"Normal growth and development for this age results in an average weight gain of 7 pounds per year." Children of school-age grow an average of 2.5 inches (6 to 7 centimeters) per year and gain an average of 7 pounds per year; therefore, the 10 pounds over 2 years is normal and it is important for the parents to know this, regardless if they are not overweight. Simply comparing them to other children seen in the clinic doesn't mean it is a normal expectation. While activity is important, the nurse must first address the parent's concern. Page 154

The nurse is caring for a 6-year-old boy. During the course of a routine wellness examination, the mother proudly reports that the child eats whatever the mother puts on his plate. The nurse wants to emphasize the importance of allowing the child to make some of his own choices regarding the types of foods he eats. How should the nurse communicate this to the mother

"Now is the time to let him choose some of his meals."

During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be?

"Play helps children to develop cognitively, socially, physically, and emotionally."

The parents of an 8-year-old girl with a slow-to-warm temperament are concerned about their daughter's reaction when she visits the dentist for the first time after having a cavity filled at the last visit. How should the nurse respond?

"Remind her in simple terms what will happen in the dentist's office."

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) "Even the babysitter helps us keep up the diary with her symptoms." c) "The medications she takes are all in one place, ready for her to take at any time." d) "He knows how and even when he needs to use his peak flow meter."

"We have taken the carpet out of our house and let my mom take our dog." Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.

The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which statement best indicates an understanding of the management and treatment for this diagnosis?

"We have taken the carpet out of our house and let my mom take our dog." Correct Explanation: Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.

A parent brings a 6-year-old to the clinic and informs the nurse that the child is tired all the time even though the child sleeps 7 to 8 hours each night. What is the best response by the nurse?

"Your child should be getting 11 to 12 hours of sleep per night with some quiet time after school."

The parents of a 7-year-old girl report concerns about her seemingly low self-esteem. The parents question how self-esteem is developed in a young girl. Which response by the nurse is best?

"Your daughter's self-esteem is influenced by feedback from people they view as authorities at this age."

Drag and Drop question - Click and drag the following steps to place them in the correct order. Question: The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the following in order of occurrence as the child's condition worsens. The nurse administers albuterol as needed. The nurse administers a medium-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid and salmeterol. The nurse administers a low-dose inhaled corticosteroid.

1. The nurse administers albuterol as needed. 2. The nurse administers a low-dose inhaled corticosteroid. 3. The nurse administers a medium-dose inhaled corticosteroid. 4. The nurse administers a medium-dose inhaled corticosteroid and salmeterol. Explanation: The first step is to administer a short acting beta 2-agonist as needed. The second step is to administer a low-dose inhaled corticosteroid. The third step is to administer a medium-dose inhaled corticosteroid. The fourth step is to administer a medium-dose inhaled corticosteroid and a long-acting beta 2-agonist.

The young child has been diagnosed with group A streptococcal pharyngitis. The physician orders amoxicillin 45 mg/kg in three equally divided doses. The child weighs 23 lb (10.45 kg). Calculate how many milligrams the child will receive with each dose of amoxicillin. Record your answer using a whole number.

157

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. The young child has been diagnosed with group A streptococcal pharyngitis. The physician orders amoxicillin 45 mg/kg in three equally divided doses. The child weighs 23 pounds. Calculate how many milligrams the child will receive with each dose of amoxicillin (round to the nearest whole milligram).

157 Explanation: 23 pounds x 1 kg/2.2 pounds = 10.4545 kg 10.4545 kg x 45 g/kg = 470.455 mg 470.455 mg/3 = 156.82 Rounded to 157 mg per dose

The nurse working at the child community clinic must administer the influenza vaccine to the high-risk kids first. Which child would she choose? a) 21-month-old Chris who has a cold b) 12-month-old Sally who is very healthy c) 23-month-old Ava who had heart surgery as an infant for a defect d) 22-month-old Jared who has a wound from touching a hot pan at home

23-month-old Ava who had heart surgery as an infant for a defect Explanation: Children who are considered high risk and could benefit from the influenza vaccine are: immunocompromised; have a chronic pulmonary disease; have had a congenital abnormality, chronic renal or metabolic diseases, sickle-cell disease, HIV, and any type of neurological disorder (seizures). The other choices would be considered normal and the child is not at high risk.

The nurse working at the child community clinic must administer the influenza vaccine to the high-risk kids first. Which child would she choose? a) 12-month-old Sally who is very healthy b) 22-month-old Jared who has a wound from touching a hot pan at home c) 21-month-old Chris who has a cold d) 23-month-old Ava who had heart surgery as an infant for a defect

23-month-old Ava who had heart surgery as an infant for a defect Correct Explanation: Children who are considered high risk and could benefit from the influenza vaccine are: immunocompromised; have a chronic pulmonary disease; have had a congenital abnormality, chronic renal or metabolic diseases, sickle-cell disease, HIV, and any type of neurological disorder (seizures). The other choices would be considered normal and the child is not at high risk.

The young child is wearing a nasal cannula. The oxygen is set at 3 L/minute. Calculate the percentage of oxygen the child is receiving?

33 percent Explanation: Room air is 21%. Each 1 liter of oxygen flow is equal to an additional 4% of oxygen. The child is receiving 3 liters of oxygen. 21% (room air) + 3(4%) = 33% of oxygen.

The nurse is doing an in-service training with nurses working with families who may be in situations that create high-risk health situations for their children. The nurse explains that children of caregivers with which of the following situations should be tested annually for tuberculosis?

A caregiver whose family is homeless

A 4-year-old girl has acute nasopharyngitis (a common cold). Which of the following measures would you want to teach her parents? a) Healthy children rarely have more than one cold per year. b) Typically the child will pull her ear when a cold is present. c) A cough that accompanies a cold should rarely be suppressed. d) An antibiotic is prescribed for children under 5 years of age.

A cough that accompanies a cold should rarely be suppressed. Correct Explanation: Coughing can be therapeutic because it raises respiratory secretions and prevents them from becoming infected.

The nurse at an elementary school is explaining the concept of industry versus inferiority to a group of nursing students. What is part of this stage of Erikson's theory?

A sense of competence, mastery, and worth

Which of the following nursing diagnoses would be most appropriate for a child with pneumonia during the acute phase of illness? a) Activity intolerance related to poor oxygen-carbon dioxide exchange b) Altered urinary elimination related to hypervolemic state c) Pain related to swelling of abdominal lymph nodes d) Excess fluid volume related to excessive mucus production

Activity intolerance related to poor oxygen-carbon dioxide exchange Explanation: Children with pneumonia generally feel exhausted during their illness and the immediate period following.

Which of the following nursing diagnoses would be most appropriate for a child with pneumonia during the acute phase of illness? a) Pain related to swelling of abdominal lymph nodes b) Excess fluid volume related to excessive mucus production c) Activity intolerance related to poor oxygen-carbon dioxide exchange d) Altered urinary elimination related to hypervolemic state

Activity intolerance related to poor oxygen-carbon dioxide exchange Correct Explanation: Children with pneumonia generally feel exhausted during their illness and the immediate period following.

A 4-year-old girl has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. Her parents are extremely distraught over her condition and the fact she has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of these parents? a) Encourage the parents to return home and get some rest. b) Avoid telling the parents unnecessary facts regarding her prognosis. c) Allow the parents to remain with the child as much as possible. d) Tell the parents that their child is receiving the best care possible.

Allow the parents to remain with the child as much as possible. Pneumonia is a frightening disease for parents because before the age of antibiotics, it was fatal to children. Encouraging them to visit and offer support can increase self-esteem and decrease anxiety.

Which medication is a respiratory stimulant?

Aminophylline

Which medication is a bronchodilator? a) Furosemide b) Prednisolone c) Spironolactone d) Aminophylline

Aminophylline Explanation: Aminophylline is a bronchodilator that opens the airway of the lungs. It relaxes the smooth muscles around the airways.

Which medication is a bronchodilator? a) Prednisolone b) Spironolactone c) Aminophylline d) Furosemide

Aminophylline Correct Explanation: Aminophylline is a bronchodilator that opens the airway of the lungs. It relaxes the smooth muscles around the airways.

While treating a minor playground injury for an 8-year-old girl, the school nurse discovers that the injury was the result of bullying. What should be the nurse's first action?

Assess the situation with the help of the school staff and parents.

Which of the following measures would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? a) Urging the child to continue to take oral fluids b) Administering an oral analgesic c) Teaching the child to take long, slow breaths d) Assisting with racemic epinephrine nebulizer therapy

Assisting with racemic epinephrine nebulizer therapy Explanation: A bronchodilator increases the lumen of airways.

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis

Assisting with racemic epinephrine nebulizer therapy Correct Explanation: A bronchodilator increases the lumen of airways.

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

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

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

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

The nurse is caring for a child whose oxygen saturation levels frequently drop below 90%. Which data is most important to relate to the health care provider?

Blood Gases

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) Vital signs c) Blood gases d) Diet

Blood gases Explanation: Infants may respond to low blood oxygen levels with increased respirations followed by a period of apnea. Conditions such as bronchopulmonary dysplasia, pneumonia, and bronchiolitis can put infants at risk. Nursing care should focus on blood oxygen levels. The other choices are basic nursing assessments.

Certain respiratory diseases in children result in hypoxia in a child. What should nurses focus on in the nursing care of these children? a) Blood gases b) Diet c) Urine output d) Vital signs

While observing a group of 9-year-old children at school, the nurse is concerned that one of the children is not cognitively developing according the Piaget's stage of concrete-operational thought processes. With which activity is the nurse concerned?

Does not understand the phrase "slow as molasses" when used by the teacher

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be which of the following? a) Decreased respiratory capacity b) Chronic lack of oxygen c) Impaired digestive activity d) High sodium chloride concentration in the sweat

Chronic lack of oxygen Explanation: In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.

The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent intervention?

Compliance with therapy is diminished.

The school-age child develops the ability to recognize that if a block of clay is in a round ball and then is flattened, the shape changes but not the amount of clay. This child has developed an understanding of:

Conservation Correct Explanation: The skill of conservation is the ability to recognize that a change in shape does not necessarily mean a change in amount or mass.

Which acute respiratory condition is the most common in early childhood? a) Asthma b) Croup c) Broncholitis d) Pneumonia

Croup Explanation: Croup is the most common acute respiratory condition in early childhood (6 months to 6 years). The cardinal sign is a "barking cough." Croup is an upper airway obstruction caused by some type of inflammation.

Which of the following child's history puts them at increased risk for asthma-related death? a) A child who has never been hospitalized b) Current use of corticosteroids c) No history of psychosocial or psychiatric disease d) Compliance with an asthma treatment plan

Current use of corticosteroids Explanation: Current use of corticosteroids is a risk factor for an asthma-related death. Prior hospitalization, a history of psychosocial issues, and noncompliance with an asthma treatment plan also put children at risk for an asthma-related death.

Which of the following child's history puts them at increased risk for asthma-related death? a) A child who has never been hospitalized b) Compliance with an asthma treatment plan c) No history of psychosocial or psychiatric disease d) Current use of corticosteroids

Current use of corticosteroids Correct Explanation: Current use of corticosteroids is a risk factor for an asthma-related death. Prior hospitalization, a history of psychosocial issues, and noncompliance with an asthma treatment plan also put children at risk for an asthma-related death.

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

Cystic fibrosis

Which of the following childhood diseases used to be fatal and now needs a holistic approach to care? a) Cystic fibrosis b) BPD c) Asthma d) Pneumonia

Cystic fibrosis Explanation: Cystic fibrosis is a highly complex disease that is autosomal and genetic in origin, in which a mucus layer covers and blocks ducts of major organs. Survival rate has greatly improved and life expectancy has risen to 37 years after many new advances.

Which of the following childhood diseases used to be fatal and now needs a holistic approach to care? a) Cystic fibrosis b) Pneumonia c) BPD d) Asthma

Cystic fibrosis Correct Explanation: Cystic fibrosis is a highly complex disease that is autosomal and genetic in origin, in which a mucus layer covers and blocks ducts of major organs. Survival rate has greatly improved and life expectancy has risen to 37 years after many new advances.

Pneumonia is a disorder involving infection and inflammation of the fine bronchioles and bronchi. a) False b) True

False Explanation: Pneumonia is a disorder involving infection and inflammation of the alveoli. Bronchitis is inflammation and infection of the fine bronchioles and bronchi.

A nurse is applying a nasal cannula with prongs to a 10-year-old boy. Which of the following should the nurse be careful to observe for in this client? a) Development of necrosis on the nasal septum b) Development of hypoxia in the child c) The device slipping and obscuring his view d) The child being scalded by the device

Development of necrosis on the nasal septum Explanation: Most children do not like nasal prongs or catheters because they are intrusive. Assess their nostrils carefully when using these as the pressure of prongs can cause areas of necrosis, particularly on the nasal septum. Masks, rather than cannulas, tend to slip and obstruct the client's view. Vaporizers, not cannulas, can cause a serious scald burn if children accidentally pull a vaporizer over on themselves. Development of hypoxia while receiving oxygen therapy is highly improbable.

A nurse is applying a nasal cannula with prongs to a 10-year-old boy. Which of the following should the nurse be careful to observe for in this client? a) Development of necrosis on the nasal septum b) The device slipping and obscuring his view c) The child being scalded by the device d) Development of hypoxia in the child

The nurse is teaching parents of an 11-year-old girl how to deal with the issues relating to peer pressure to use tobacco and alcohol. Which suggestion provides the best course of action for the parents

Discuss tobacco and alcohol use with the child.

The school nurse is meeting with a 10-year-boy who is concerned about his weight. He reports he doesn't eat much candy but loves fruit, pasta, potatoes, and bread. Which suggestion should the nurse prioritize to help him maintain a healthy weight?

Encourage activities that will increase his physical activity.

The nurse is doing teaching with the caregivers of a child with cystic fibrosis. Of the following, which is most important for the nurse to teach this family? a) Be sure the patient exercises daily. b) Encourage everyone in the family to use good handwashing. c) Watch for signs that the family unit is stressed. d) Avoid overprotecting the child.

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

The nurse is doing teaching with the caregivers of a child with cystic fibrosis. Of the following, which is most important for the nurse to teach this family? a) Watch for signs that the family unit is stressed. b) Encourage everyone in the family to use good handwashing. c) Avoid overprotecting the child. d) Be sure the patient exercises daily.

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

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) Tonsillitis c) Laryngotracheobronchitis d) Epiglottitis

Epiglottitis The child with epiglottitis may have had a mild upper respiratory infection before the development of a sore throat, and then became anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. The child with acute laryngotracheobronchitis develops hoarseness and a barking cough with a fever, cyanosis, heart failure and acute respiratory embarrassment can result.

The nurse is collecting data on a child with a diagnosis of tonsillitis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

Erythema of the pharynx The child with tonsillitis may have a fever of 101°F (38.4°C) or more, a sore throat, often with dysphagia (difficulty swallowing), hypertrophied tonsils, and erythema of the pharynx. The child with spasmodic laryngitis has a bark-like cough, and hoarseness, and inability to make audible voice sounds.

Which of the following is a symptom of bacterial pharyngitis? a) Fever as high as 104 °F b) WBC in normal range c) Symptoms have a gradual onset d) Rhinitis

Fever as high as 104 °F Correct Explanation: A fever of up to 104 °F is a symptom of bacterial pharyngitis; others symptoms are an elevated white blood count (WBC), abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes.

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

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

A 2-year-old boy is seen for acute laryngotracheobronchitis. Which of the following observations would lead you to suspect that airway occlusion is occurring? a) He states he is tired and wants to sleep. b) His nasal discharge is increasing. c) His respiratory rate is gradually increasing. d) His cough is becoming harsher.

His respiratory rate is gradually increasing. Explanation: An increasing respiratory rate is a major sign of airway occlusion (breathing faster because less air is received with each breath).

A 2-year-old boy is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion?

His respiratory rate is gradually increasing. Explanation: An increasing respiratory rate is a major sign of airway occlusion (breathing faster because less air is received with each breath).

A child is at risk for infection related to a respiratory disorder. What would the nurse educate the family on to prevent infection? a) Hygiene, hand washing b) Which friends can come and play c) The type of medication needed d) The amount of exercise the patient needs

Hygiene, hand washing Explanation: The nurse should evaluate the child and family understanding of techniques to prevent infection (hand washing, hygiene, rest, nutrition, and avoiding sick people). The other choices are important in the care of the patient but are not the number-one way to prevent the spread of infection.

A child with a suspected airway obstruction is brought to the emergency room. He produces a harsh, strident sound on inspiration (stridor). Where is the obstruction likely to be located, based on this information?

In the larynx

Which of the following is a side effect of bronchodilator medications? a) Increased heart rate b) Hypoactivity c) Muscle cramps d) Smooth tone

Increased heart rate Explanation: Side effects of bronchodilators include an increased heart rate, shakiness or tremors, and hyperactivity.

Which of the following is a side effect of bronchodilator medications? a) Muscle cramps b) Increased heart rate c) Hypoactivity d) Smooth tone

Increased heart rate Correct Explanation: Side effects of bronchodilators include an increased heart rate, shakiness or tremors, and hyperactivity.

What measure at home could help a child with an upper respiratory infection breathe more easily? a) Increasing room humidity b) Playing "rapid breathing" games c) Limiting fluid intake d) Enforcing strict bed rest

Increasing room humidity Explanation: A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise.

What measure at home could help a child with an upper respiratory infection breathe more easily?

Increasing room humidity -A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise. pg613

An 8-year-old boy who says he wants to be a doctor when he grows up pleads with the nurse to let him put on his own band-aid after receiving an injection. The nurse agrees and watches as the boy very carefully lines the band-aid up with the mark left by the injection and applies it to his skin. Then he asks, "Did I do it right?" and waits eagerly for the nurse's feedback. The nurse recognizes in this situation the boy's attempt to master the primary developmental step of school age. What is that step?

Industry

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

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

What statement is the most accurate regarding the structure and function of the newborn's respiratory system?

Most infants are nasal breathers rather than mouth breathers.

The nurse is administering medications to a child with cystic fibrosis. Which of the following methods would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? a) Open capsule and sprinkle on food b) Pour in medication cup and have child drink c) Shake inhaler and hold close to mouth d) Draw up in syringe and administer subcutaneously

Open capsule and sprinkle on food Pancreatic enzymes come in capsules that can be swallowed or opened and sprinkled on the child's food.

What is the number-one treatment for hypoxemia? a) Breathing treatment b) Antibiotics c) Fluids d) Oxygen

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

A 6-month-old infant who was born premature is being seen for a follow-up examination. The child is to receive an intramuscular injection monthly through the winter and spring season. Which of the following would the nurse expect to be ordered? a) Nedocromil b) Zanamivir c) Amantadine d) Palivizumab

Palivizumab Explanation: Palivizumab is a monoclonal antibody used for prevention of serious lower respiratory syncytial virus (RSV) disease. RSV bronchiolitis occurs most often in infants and toddlers, with a peak incidence around 6 months of age. Infants born prematurely are more at risk. The peak occurrence of bronchiolitis is in the winter and spring. Nedocromil decreases the frequency and intensity of allergic reactions. Amantadine is used to treat and prevent influenza A. Zanamivir is used to treat and prevent influenza A.

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

Pancreas and liver Explanation: The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.

A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, which parts of the body (besides the lungs) are most affected by this disease?

Pancreas and liver -The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs. pg635

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 will teach the caregiver that which of the following likely needs adjustment in the child's diet? The amount of a) Iodized salt b) Calories from protein c) Pancreatic enzymes d) Saturated fat

Pancreatic enzymes Explanation: Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.

The nurse is caring for a 6-month-old infant who has chronic apneic episodes. Which intervention should the nurse place in the plan of care

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

Which of the following is a complication of cystic fibrosis? a) Kidney disease b) Crohn disease c) Pneumothorax d) UTI

Pneumothorax Explanation: A pneumothorax is a complication of cystic fibrosis. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age.

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

Which test in a child with cystic fibrosis would help monitor airway function?

Pulmonary function

Which test in a CF patient would help monitor airway function? a) Pulmonary function b) Peak flow measurement c) Bronchoprovocation d) Pulse oximetry

Pulmonary function Explanation: The pulmonary function tests help measure airway function, lung volumes, and gas exchange. Bronchoprovocation provokes bronchospasms to determine airway constriction. Peak flow measurement measures lung velocity. Pulse oximetry monitors blood level oxygen saturation.

The nurse is caring for a child who has been admitted with a diagnosis of asthma. Which of the following laboratory/diagnostic tools would likely have been used for this child? a) Sweat sodium choloride test b) Pulmonary functions test c) Blood culture and sensitivity d) Purified protein derivative test

Pulmonary functions test Explanation: Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection.

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 -Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. pg 602

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

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

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

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

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

The nurse is talking with a school-aged child about her interests. In which interest do most school-aged children place the most focus?

School

The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do?

Seat the child leaning forward and pinch the anterior portion of the nose closed. -The child should sit up and lean forward. Apply continuous pressure to the anterior portion of the nose by pinching it closed. The bleeding usually stops within 10 to 15 minutes. Ice or a cold cloth on the bridge of the nose may help, but pressure will stop the bleeding. Lying down or tipping the head back may allow aspiration of the blood and should be avoided. pg 620

After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify which of the following as a common allergen for asthma? a) Dust mites b) Shellfish c) Pet dander d) Indoor molds

Shellfish Explanation: Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds are a common asthma trigger. Pet dander is a common asthma trigger. Dust mites are a common asthma trigger.

During an assessment, a child exhibits an audible high-pitched inspiratory noise. The nurse documents this as which of the following? a) Rales b) Stridor c) Tympany d) Wheeze

Stridor Explanation: Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. A wheeze is a high-pitched sound heard on auscultation, usually on expiration. It is due to obstruction in the lower trachea or bronchioles. Rales are crackling sounds heard on auscultation when the alveoli become fluid filled. Tympany is a sound heard with percussion over an air-filled area.

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 which of the following? a) Stridor b) Barking cough c) Hoarseness d) Wheezing

Stridor Correct Explanation: In the child with croup syndrome, inspiratory stridor (shrill, harsh respiratory sound) is often noted.

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

Sweat chloride Explanation: The definitive test in diagnosing CF is the sweat chloride test. This test is performed by stimulating a small patch of sweat glands on the inner aspect of the forearm. There must be two positive tests and clinical symptoms to confirm the diagnosis. The other choices are routine diagnostic tests.

The nurse is 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 choloride test Correct Explanation: Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

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

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

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

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

Marcy is 4 years old with CF. The nurse is trying to pick a method to teach Marcy a good way to exercise her lungs. Which would be the developmentally correct strategy to help Marcy? a) Teach Marcy to jump rope. b) Teach Marcy to hop on one foot. c) Teach Marcy to ride a bike. d) Teach Marcy to blow bubbles.

Teach Marcy to blow bubbles. Correct Explanation: A helpful exercise for Marcy would be to blow bubbles, a horn, or a pinwheel. This would help her exercise her lung capacity and is age appropriate for early childhood. The other exercises are all normal activities for school-aged children.

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia?

The child attends day care.

An 11-year-old child is preparing to see the dentist to have his teeth cleaned. Which finding would considered most appropriate for this age?

The child has 28 permanent teeth.

The nurse has taken a health history and performed a physical exam for a 12-year-old boy. Which finding is the most likely?

The child has a leaner body mass than a girl at this age.

The nurse is assessing the psychosocial development of a 10-year-old child. What observations would lead the nurse to determine that the child is not achieving the developmental task of Erikson's industry versus inferiority? Select all that apply.

The child tries out for various teams at school but does not make any of them The child is an average soccer player and the parents enforce 1 to 2 hours of practice per day

You see a 3-year-old boy in an ambulatory setting for localized wheezing on auscultation. Which statement by his mother would be most important to report? a) The child was eating peanuts yesterday. b) She gives the child hard candy as an afternoon treat. c) She likes the child to play by himself for 15 minutes every afternoon. d) The child has two cousins who have many allergies.

The child was eating peanuts yesterday. Explanation: Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration.

The nurse sees a 3-year-old boy in an ambulatory setting for localized wheezing on auscultation. Which statement by his mother would be most important to report?

The child was eating peanuts yesterday. Correct Explanation: Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, all of these goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family?

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

The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the following in order of occurrence as the child's condition worsens. The nurse administers albuterol as needed. The nurse administers a low-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid and salmeterol.

The nurse administers albuterol as needed. The nurse administers a low-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid and salmeterol. Explanation: The first step is to administer a short acting beta 2-agonist as needed. The second step is to administer a low-dose inhaled corticosteroid. The third step is to administer a medium-dose inhaled corticosteroid. The fourth step is to administer a medium-dose inhaled corticosteroid and a long-acting beta 2-agonist.

The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? a) The child's diet b) The triggers for the environment c) The child's weight d) The child's hospital history

The triggers for the environment Explanation: When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.

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 diet c) The child's hospital history d) The child's weight

The triggers for the environment Correct Explanation: When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.

A mother tells you her 6-year-old has been biting his fingernails since he began first grade. After analyzing the cause of this as increased stress, the advice the nurse would give the mother regarding this problem would be to:

allow some time every day for the child to talk about new experiences.

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 monitor the child's growth pattern b) To determine fluid losses c) To determine medication dosages d) To ensure that the child's food intake is adequate

To determine fluid losses Explanation: During an acute attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting. Theophylline administration also has a diuretic effect, which compounds the problem. Weigh the child daily to help determine fluid losses. The child's weight is used to determine medication dosages, to ensure that the child is appropriately gaining weight and growing, and that the intake is adequate. However, the most important reason for a daily weight is to determine fluid loss.

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

True

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

True

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method?

Using a nebulizer -Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis. pg630

The nurse is caring for a 10-year-old girl with allergic rhinitis. Which intervention helps prevent secondary bacterial infection?

Using normal saline nasal washes

A 6-year-old child is diagnosed as having streptococcal pharyngitis. When planning care, you should be aware that the chief danger of such an infection is that a) lymph nodes will swell and obstruct the airway. b) the infection may spread and cause a tooth abscess. c) four out of five children develop nephrosis afterward. d) a small proportion of children develop rheumatic fever.

a small proportion of children develop rheumatic fever. Explanation: Certain strains of streptococci can cause a hypersensitivity reaction that results in either rheumatic fever or glomerulonephritis.

A 6-year-old child is diagnosed as having streptococcal pharyngitis. When planning care, you should be aware that the chief danger of such an infection is that a) four out of five children develop nephrosis afterward. b) the infection may spread and cause a tooth abscess. c) lymph nodes will swell and obstruct the airway. d) a small proportion of children develop rheumatic fever.

a small proportion of children develop rheumatic fever. Correct Explanation: Certain strains of streptococci can cause a hypersensitivity reaction that results in either rheumatic fever or glomerulonephritis.

Pneumonia is a disorder involving infection and inflammation of the fine bronchioles and bronchi. a) False b) True

a) False Explanation: Pneumonia is a disorder involving infection and inflammation of the alveoli. Bronchitis is inflammation and infection of the fine bronchioles and bronchi.

After tonsillectomy surgery, the preferred position of a child until fully awake is on the a) side with the head elevated. b) side with continuous oxygen by cannula at 30%. c) back with warm compresses applied to the throat. d) abdomen with a pillow under the chest.

abdomen with a pillow under the chest. Explanation: Lowering the child's head slightly and placing the child on the stomach allows mouth and throat secretions to flow out, avoiding possible aspiration and allowing for better assessment of bleeding from the surgery site.

The nurse is assisting a child to the bed after being returned from a tonsillectomy. In which way would the nurse place the child until fully awake?

Children have less lung elasticity in the alveoli. Which response would the nurse give a mom who wants to know what risks this poses to her child? a) "They are at risk for diabetes." b) "They are at risk for pulmonary edema." c) "They are at risk for liver cancer." d) "They are at risk for kidney disease."

b) "They are at risk for pulmonary edema." Explanation: The alveoli have less elastic tissue in children. This puts them at risk for pulmonary edema, as well as pneumothorax and pneumomediastinum. The minimum elastic recoil can cause pulmonary collapse. The other choices are not directly related to the pulmonary system.

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

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

The nurse is reinforcing teaching with the parents of a 2-year-old who has cystic fibrosis regarding medications. The nurse suggest that pancreatic enzymes may be given by which method? a) Through a gastrostomy tube b) Sprinkled onto the food c) Directly into the vein d) Using a nebulizer

b) Sprinkled onto the food Explanation: Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose).

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:

be at risk for respiratory distress.

A child is at risk for infection related to a respiratory disorder. What would the nurse educate the family on to prevent infection? a) The type of medication needed b) Which friends can come and play c) Hygiene, hand washing d) The amount of exercise the patient needs

c) Hygiene, hand washing Explanation: The nurse should evaluate the child and family understanding of techniques to prevent infection (hand washing, hygiene, rest, nutrition, and avoiding sick people). The other choices are important in the care of the patient but are not the number-one way to prevent the spread of infection.

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

Which diagnostic test is the most useful when a child has respiratory distress? a) Complete blood count b) EEG c) Venous blood gas d) Arterial blood gas

d) Arterial blood gas Explanation: The most useful diagnostic test in respiratory distress is an arterial blood gas. Knowing normal blood gas values for children is very important for evaluation.

When caring for hospitalized school-aged children, it is important to:

consistently reinforce their worth. Correct Explanation: Helping children experience satisfaction in projects they complete helps them gain a sense of industry.

The physician orders fluorescent antibody testing for a child with suspected respiratory syncytial virus infection. The nurse would obtain the specimen for testing from which of the following? a) Sweat b) Sputum c) Arterial blood d) Nasopharyngeal secretions

d) Nasopharyngeal secretions Explanation: A nasopharyngeal specimen is obtained for fluorescent antibody testing. Arterial blood gases require a specimen of arterial blood. A sputum specimen is used for a sputum culture. Collection of sweat on filter paper after stimulation is used for a sweat chloride test to diagnose cystic fibrosis.

A school-aged child develops a nosebleed (epistaxis). Which of the following would you do? a) Elevate the head of the bed slightly and apply pressure to the forehead. b) Keep the child flat and apply pressure to the bridge of the nose. c) Turn the child's head to the side and press on the nasal ridge. d) Sit the child upright and apply pressure to the sides of the nose.

d) Sit the child upright and apply pressure to the sides of the nose. Explanation: Keeping a child upright reduces pressure on cerebral vessels and aids coagulation at the site of a broken vessel.

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

epiglottitis -The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. pg 614

The developmental task of the school-aged period, according to Erikson, is gaining a sense of:

industry versus inferiority.

A school-aged child develops school phobia. When counseling her mother, the nurse would advise her that the accepted action is to:

make her child attend school every day.

A nurse is caring for a hospitalized 7-year-old whose family members have been unable to visit for 2 days. The nurse is preparing a diversional activity for the child. Which activity would best be suited for a child in this age group?

paint by numbers

During a well-child check at the ambulatory clinic, the mother of a 10-year-old boy reports concerns about her son's frequent discussions about death and dying. Based upon knowledge of this age group, the nurse understands that:

preoccupation with death and dying is common in the school-aged child.

A 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:

tachypnea.

The nurse is obtaining the history from the parents of an infant who suffered an acute life-threatening event. Which of the following would the nurse expect the parents to report? Select all that apply. a) Apnea b) Respiratory distress c) Coughing d) Wheezing e) Change in color

• Apnea • Change in color • Coughing Explanation: An acute life-threatening event is characterized by some combination of apnea, color change, muscle tone alteration, coughing, or gagging. Respiratory distress or wheezing would not be present.

Choice Multiple question - Select all answer choices that apply. A child who has had a tracheostomy is admitted to the hospital for abdominal surgery. When assessing the child's tracheostomy, which of the following would the nurse identify as a normal finding? Select all that apply. a) Clear, clean tracheostomy tube b) Small amount of clear drainage from stoma c) Two fingers slide under tracheostomy ties d) Tube free of secretions e) Stoma pale pink

• Clear, clean tracheostomy tube • Tube free of secretions • Stoma pale pink Explanation: A tracheostomy tube should be clean and free from secretions and the stoma should appear pink and without bleeding or drainage. The tracheostomy ties should fit securely, allowing one finger to slide beneath the ties.

Which of the following is a symptom of allergic rhinitis? a) Sinus pain b) Purulent secretions c) Laryngitis d) Fever

Sinus pain Correct Explanation: The following are the symptoms that occur with allergic rhinitis: sinus pain, family history of atopy, and conjunctival pruritis.

A school-aged child develops a nosebleed (epistaxis). Which action should the nurse take

Sit the child upright and apply pressure to the sides of the nose.

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?

Smaller number of alveoli

The caregivers of a 2-year-old who has had a common cold for 4 days calls the nurse in the Emergency Department at 2 AM on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; she seems blue around her mouth. The nurse would most appropriately recommend which of the following to the caregiver? a) "Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief." b) "Turn on all of the hot water taps in the bathroom and close the door. Take the child into the steam filled room for 15 minutes. If there is no relief, bring the child to the emergency room." c) "Bring the child to the emergency room immediately." d) "Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there's no relief in an hour."

"Bring the child to the emergency room immediately." Correct Explanation: Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104 to 105 degrees Fahrenheit. As the disease progresses, marked laryngeal edema occurs and the child's breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory embarrassment can result. The child needs to be treated immediately. Humidified air is helpful in reducing laryngospasm; humidifiers may be used in the child's bedroom to provide high humidity. Cool humidifiers are recommended, but vaporizers also may be used. Taking the child into the bathroom and opening the hot water taps with the door closed is a quick method for providing moist air, if the water runs hot enough. Sometimes the spasm is relieved by exposure to cold air: for instance, when the child is taken out into the night to go to the emergency department or to see the physician.

A 4-year-old with bronchiolitis has been admitted to the hospital with respiratory compromise. The father asks the nurse why the physician won't prescribe an antibiotic, "My child just keeps getting worse." What is the best response by the nurse?

"Bronchiolitis is almost always caused by the respiratory syncytial virus (RSV). Unfortunately, antibiotics don't work on viruses."

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice?

"As parents, you need to be good role models."

When the nurse is reinforcing teaching with the caregiver of a 3-year-old child being discharged following a tonsillectomy, the caregiver states to the nurse, "I understand why there might be bleeding in the first 24 hours, but I don't understand why there might be bleeding in a week or so." The most appropriate explanation for the nurse to give this caregiver is which of the following. a) "We don't usually do this surgery until the child is older, so postoperative bleeding is a possible complication because of your child's age." b) "By next week your child will be eating regular foods again and some rough food hitting the tissue would be likely to cause bleeding." c) "Your child will have forgotten about the surgery by that time and might start coughing and the pressure of coughing can cause bleeding." d) "Bleeding can occur at this time because the clots dissolve and new tissue isn't yet present."

"Bleeding can occur at this time because the clots dissolve and new tissue isn't yet present." Explanation: Hemorrhage is the most common complication of a tonsillectomy. Bleeding is most often a concern within the first 24 hours after surgery and the fifth to seventh postoperative day. Bleeding can occur when the clots dissolve between the fifth and seventh postoperative days if new tissue is not yet present.

The caregivers of a 2-year-old who has had a common cold for 4 days calls the nurse in the Emergency Department at 2 AM on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; she seems blue around her mouth. The nurse would most appropriately recommend which of the following to the caregiver? a) "Turn on all of the hot water taps in the bathroom and close the door. Take the child into the steam filled room for 15 minutes. If there is no relief, bring the child to the emergency room." b) "Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief." c) "Bring the child to the emergency room immediately." d) "Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there's no relief in an hour."

"Bring the child to the emergency room immediately." Explanation: Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104 to 105 degrees Fahrenheit. As the disease progresses, marked laryngeal edema occurs and the child's breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory embarrassment can result. The child needs to be treated immediately. Humidified air is helpful in reducing laryngospasm; humidifiers may be used in the child's bedroom to provide high humidity. Cool humidifiers are recommended, but vaporizers also may be used. Taking the child into the bathroom and opening the hot water taps with the door closed is a quick method for providing moist air, if the water runs hot enough. Sometimes the spasm is relieved by exposure to cold air: for instance, when the child is taken out into the night to go to the emergency department or to see the physician.

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. Which of the following would the nurse instruct the mother to do first? a) "Continue to watch his PEFR readings and call back if they go below 40%." b) "You need to take him to the emergency department right away." c) "Have him use his short-acting bronchodilator right away." d) "Have him use his low-dose steroid inhaler now and again in 15 minutes."

"Have him use his short-acting bronchodilator right away." Correct Explanation: The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.

During a routine wellness examination, the nurse is trying to determine how well a 5-year-old boy communicates and comprehends instructions. What is the best specific trigger question to determine the preschooler's linguistic and cognitive progress?

"How well does your son communicate or follow instructions?"

The school nurse asks a group of school-age children about pedestrian safety. Which comments by the children should the nurse address with either the child or parents of the child? Select all that apply.

"I am 6 years old and I walk my younger brother to the park that is 5 blocks from our house." My friends and I like to walk on the side of the road because our sidewalk is very uneven." "I think it is funny to hide behind my dad's car before he leaves for work and scare him."

The nurse is teaching a group of caregivers of school-age children about the importance of setting a consistent bedtime for the school-age child. Which statement made by a caregiver indicates an understanding of the sleep patterns and needs of the school-age child?

"My child sleeps between 11 and 12 hours a night." Correct Explanation: The school-age child needs 10 to 12 hours of sleep each night. Staying up late after taking an after-school nap, not knowing when the child is tired, and sleeping more than a teenager when compared with a school-age child refer to sleep behaviors and needs of children of younger and older ages.

The nurse is working with a group of caregivers of children diagnosed with asthma. Which of the following statements made by the caregivers is most accurate regarding the triggers that may cause an asthmatic attack? a) "One person told me that asthma is caused by using antibiotics for infection." b) "My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." c) "My neighbor told me that asthma attacks are caused by hot weather." d) "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." Correct Explanation: Asthma may be a response to certain foods, or may be triggered by exercise or exposure to cold weather. Irritants such as wood-burning stoves, cigarette smoke, dust, pet dander, and foods such as chocolate, milk, eggs, nuts, and grains may also aggravate the condition. Additionally, infections such as bronchitis and upper respiratory infection can provoke asthma attacks. Using antibiotics to treat infections does not cause an asthmatic attack.

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

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

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

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

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

The parents of a 9-year-old child voice concern that their daughter seems to be gaining weight rapidly. The nurse reviews the medical record and notes the child has increased his weight by 6 or 7 pounds (2.7 to 3.2 kg) per year for the past 2 years. What response by the nurse is indicated?

"Weight gains of about 7 pounds per year are normal for children in this age range."

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) Decreased activity and increased fluids c) A bronchodilator and mast cell stabilizers d) Corticosteroids and leukotriene inhibitors

A bronchodilator and mast cell stabilizers Explanation: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.

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) A bronchodilator and mast cell stabilizers b) Corticosteroids and leukotriene inhibitors c) Decreased activity and increased fluids d) Removal of allergens in the home and school

The caregiver of a 6-week-old boy calls the nurse, concerned about her child. The child has been vomiting, has diarrhea, and is sneezing. The child's temperature is normal. The nurse suspects that the cause of the symptoms is which of the following? a) A pollen-based allergy b) Cystic fibrosis c) A common cold d) Pneumonia

A common cold Explanation: The child with a common cold sneezes and becomes irritable and restless. The congested nasal passages can interfere with nursing, increasing the infant's irritability. Because an older child can mouth breathe, nasal congestion in him or her is not as great a concern as it is in the infant. The child might have vomiting or diarrhea, which might be caused by mucous drainage into the digestive system. Younger infants usually are afebrile. The child with an allergy will not likely have vomiting and diarrhea. The infant with pneumonia will most likely have an elevated temperature. The child with cystic fibrosis will have a hard, nonproductive chronic cough, a barrel chest, and clubbing of fingers. The abdomen be comes distended, and body muscles become flabby.

The caregiver of a 6-week-old boy calls the nurse concerned about her child. The child has been vomiting, has diarrhea, and is sneezing. The child's temperature is normal. The nurse suspects that the cause of the symptoms is:

A common cold Correct Explanation: The child with a common cold sneezes and becomes irritable and restless. The congested nasal passages can interfere with nursing, increasing the infant's irritability. Because an older child can mouth breathe, nasal congestion in him or her is not as great a concern as it is in the infant. The child might have vomiting or diarrhea, which might be caused by mucous drainage into the digestive system. Younger infants usually are afebrile. The child with an allergy will not likely have vomiting and diarrhea. The infant with pneumonia will most likely have an elevated temperature. The child with cystic fibrosis will have a hard, nonproductive chronic cough, a barrel chest, and clubbing of fingers. The abdomen be comes distended, and body muscles become flabby.

A 4-year-old girl has acute nasopharyngitis (a common cold). Which of the following measures would you want to teach her parents? a) A cough that accompanies a cold should rarely be suppressed. b) Typically the child will pull her ear when a cold is present. c) An antibiotic is prescribed for children under 5 years of age. d) Healthy children rarely have more than one cold per year.

A cough that accompanies a cold should rarely be suppressed. Explanation: Coughing can be therapeutic because it raises respiratory secretions and prevents them from becoming infected.

A 4-year-old girl has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. Her parents are extremely distraught over her condition and the fact she has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of these parents? a) Avoid telling the parents unnecessary facts regarding her prognosis. b) Tell the parents that their child is receiving the best care possible. c) Allow the parents to remain with the child as much as possible. d) Encourage the parents to return home and get some rest.

Allow the parents to remain with the child as much as possible. Correct Explanation: Pneumonia is a frightening disease for parents because before the age of antibiotics, it was fatal to children. Encouraging them to visit and offer support can increase self-esteem and decrease anxiety.

Question: The nurse is working with the parents of a child with cystic fibrosis, teaching them how to perform chest physiotherapy. The nurse would instruct the parents to percuss the segments of the lungs for 1 to 2 minutes each. The parents demonstrate the proper technique by demonstrating percussion of the lower lobes. Place these segments in the order in which the parents would percuss them.

Anterior basal segments Posterior basal segments Lateral basal segments Superior segments Explanation: When percussing the lower lobes, the anterior basal segments would be done first, followed by the posterior basal segment, lateral basal segments, and finally superior segments.

An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. Which of the following is the course of treatment that the nurse most expects in this situation? a) Tonsillectomy b) Antipyretic, analgesic, and antibiotic c) Adenoidectomy d) Antipyretic and analgesic

Antipyretic, analgesic, and antibiotic Correct Explanation: These symptoms are consistent with bacterial tonsillitis. Therapy for bacterial tonsillitis includes an antipyretic for fever, an analgesic for pain, and a full 7 to 10-day course of an antibiotic such as penicillin or amoxicillin. If the cause is viral, no therapy other than comfort or fever reduction strategies is necessary. Tonsillectomy is removal of the palatine tonsils. Adenoidectomy is removal of the pharyngeal tonsils. In the past, tonsillectomy was recommended for children after an episode of tonsillitis. This is no longer recommended as tonsillar tissue is an important component of the immune system.

An 11-year-old boy is significantly above the 100% percentile for height. The boy tells the school nurse that his parents expect so much out of him when he is playing basketball for the school team that he is thinking of quitting. What action should the nurse take?

Arrange a conference with the parents, son, and nurse to discuss the child's concerns.

The nurse is teaching the parents about medications for their 9-year-old boy who has a respiratory disorder. The nurse would be alert for an increased need for medications if the child was exposed to second-hand smoke and has which condition?

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

A 7-year-old child has been scheduled for a tonsillectomy. Which of the following would be most important to assess prior to surgery? a) Specific gravity of urine b) Pulse and respiratory rate c) Bleeding and clotting time d) Blood pressure both lying down and sitting up

Bleeding and clotting time Explanation: Because removal of tonsils leaves a large denuded area, not a simple suture line, hemorrhage following surgery can occur.

A 7-year-old child has been scheduled for a tonsillectomy. Which of the following would be most important to assess prior to surgery? a) Bleeding and clotting time b) Blood pressure both lying down and sitting up c) Specific gravity of urine d) Pulse and respiratory rate

Bleeding and clotting time Correct Explanation: Because removal of tonsils leaves a large denuded area, not a simple suture line, hemorrhage following surgery can occur.

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be which of the following? a) Impaired digestive activity b) Chronic lack of oxygen c) Decreased respiratory capacity d) High sodium chloride concentration in the sweat

Chronic lack of oxygen Correct Explanation: In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.

You notice that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. Which of the following would be the best intervention? a) Continue to assess for bleeding. b) Suction the back of the throat. c) Encourage the child to cough. d) Notify the physician immediately.

Continue to assess for bleeding. Explanation: Children will have a small amount of blood mixed with saliva following a tonsillectomy. Suctioning or coughing could irritate the surgical site and cause hemorrhage.

The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention?

Continue to assess for bleeding. Correct Explanation: Children will have a small amount of blood mixed with saliva following a tonsillectomy. Suctioning or coughing could irritate the surgical site and cause hemorrhage.

The father of a 12-year-old girl reports his daughter does not have high self-esteem. He asks for suggestions to increase her feels of self-worth. What activities would be appropriate for the nurse to suggest? Select all that apply.

Encourage the child to join a club at school. Recommend she begin to participate in after-school activities. Recommend the child investigate opportunities for volunteering at local charities.

The nurse is planning care for a child with a pneumothorax. The nurse adds the nursing diagnosis, "Risk for injury related to potential dislodgement of chest tube" to the care plan. When writing the care plan, what should the nurse be sure to include as interventions?

Ensure a pair of hemostats are at the bedside Monitor pulse oximetry readings Assess lungs as directed by the physician or as the client's condition warrants Maintain chest tube bottle in an upright position and below the level of the chest

An 8-year-old boy's foster mother is concerned about three recent cavities found in his permanent teeth and reports the child eats a nutritional diet, doesn't eat junk food, and the town water supply is fluoridated. Which suggestion should the nurse prioritize to this mother in regard to the child's dental health?

Ensure that the child brushes his teeth after each meal and snacks.

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting up and leaning forward in a tripod position to breath. The nurse further notes that the child's mouth is open and the tongue is out. The signs the nurse noted indicate the child likely has which of the following? a) Cystic fibrosis b) Epiglottitis c) Asthma d) Tuberculosis

Epiglottitis Explanation: The child with epiglottitis is very anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.

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

Epiglottitis -Epiglottitis is acute inflammation of the epiglottis that most often affects children ages 2 to 7 years. The child may have been well or may have had a mild upper respiratory infection before the development of a sore throat (difficulty swallowing) and a high fever of 102.2℉ to 104℉ (39℃ to 40℃). The child is very anxious and prefers to breathe by to sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary. pg 614

Epiglottitis Correct Explanation: The child with epiglottitis is very anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.

Epiglottitis Correct Explanation: The child with epiglottitis may have had a mild upper respiratory infection before the development of a sore throat, and then became anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. The child with acute laryngotracheobronchitis develops hoarseness and a barking cough with a fever, cyanosis, heart failure and acute respiratory embarrassment can result.

Which of the following is a symptom of bacterial pharyngitis? a) Fever as high as 104 °F b) Symptoms have a gradual onset c) Rhinitis d) WBC in normal range

Fever as high as 104 °F Explanation: A fever of up to 104 °F is a symptom of bacterial pharyngitis; others symptoms are an elevated white blood count (WBC), abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes.

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

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

A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as which of the following? a) Cylindrical b) Oval c) Spherical d) Funnel

Funnel Explanation: In infants and children (younger than the age of 10 years), the cricoid cartilage is underdeveloped, resulting in laryngeal narrowing and a funnel-shaped larynx. In teenagers and adults, the larynx is cylindrical and fairly uniform in width.

Funnel Correct Explanation: In infants and children (younger than the age of 10 years), the cricoid cartilage is underdeveloped, resulting in laryngeal narrowing and a funnel-shaped larynx. In teenagers and adults, the larynx is cylindrical and fairly uniform in width.

A child who is experiencing an exacerbation of asthma is brought to the emergency department by his parents. When reviewing the child's laboratory and diagnostic test results, which is consistent with the diagnosis?

Hyperinflation of lungs on chest radiograph

Shellfish Correct Explanation: Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds are a common asthma trigger. Pet dander is a common asthma trigger. Dust mites are a common asthma trigger.

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) Risk for infection related to anatomic structures of involved body system c) Risk for fluid volume excess related to medications d) Ineffective airway clearance related to the diagnosis

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

What is a symptom of allergic rhinitis?

Sinus Pain

The nurse is caring for a 2-year-old diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to do which of the following? a) Check for hyperthermia related to enclosure in the tent b) Avoid contact with the mist if the nurse is a sexually active female of childbearing age c) Monitor the child regularly for signs of cyanosis d) Use contact transmission precautions

Monitor the child regularly for signs of cyanosis Explanation: In some treatment of bacterial pneumonia a croupette or mist tent is used. Children have become cyanotic in mist tents, with subsequent arrest, due to their lack of visibility while in the tent; the child must be constantly observed. Ribavirin (Virazole), an antiviral drug that may be used to treat certain children with RSV, is administered as an inhalant by hood, mask, or tent; it has a high risk for teratogenicity (causing damage to a fetus) so care must be taken when the drug is administered. In treating a patient with bacterial pneumonia, the patient may need to be placed on infection control precautions according to the policy of the health care facility, and the nurse should look for hyperthermia related to the infection process.

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

Most infants are nasal breathers rather than mouth breathers Explanation: The infant is a nasal breather and it is essential to keep the nasal passages clear to enable the infant to breath and to eat. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. Dur ing the first 5 years infants and young children have larger tongues in proportion to their mouths.

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

Most infants are nasal breathers rather than mouth breathers Explanation: The infant is a nasal breath er and it is essential to keep the nasal passages clear to enable the infant to breath and to eat. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. Dur ing the first 5 years infants and young children have larger tongues in proportion to their mouths.

The physician orders fluorescent antibody testing for a child with suspected respiratory syncytial virus infection. The nurse would obtain the specimen for testing from which of the following? a) Nasopharyngeal secretions b) Arterial blood c) Sputum d) Sweat

Nasopharyngeal secretions Explanation: A nasopharyngeal specimen is obtained for fluorescent antibody testing. Arterial blood gases require a specimen of arterial blood. A sputum specimen is used for a sputum culture. Collection of sweat on filter paper after stimulation is used for a sweat chloride test to diagnose cystic fibrosis.

Which of the following is a symptom of allergic rhinitis? a) Laryngitis b) Purulent secretions c) Sinus pain d) Fever

Sinus pain Explanation: The following are the symptoms that occur with allergic rhinitis: sinus pain, family history of atopy, and conjunctival pruritis.

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

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

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

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

The nursing instructor is leading a discussion on school-aged children. The instructor determines the session is successful when the students correctly choose which factor as being a priority for the school-aged child?

Needs 10 to 12 hours of sleep per night

Which of the following age of children have a trachea 4 cm long? a) Newborn b) School-aged child c) Teenager d) Toddler

Newborn Explanation: Pediatric airways are much smaller in diameter and shorter in length than in adults. A newborn trachea is 4 cm long, a toddler's is 7 cm long, and a teenager's is 12 cm long.

Which of the following age of children have a trachea 4 cm long? a) Newborn b) Toddler c) Teenager d) School-aged child

Newborn Correct Explanation: Pediatric airways are much smaller in diameter and shorter in length than in adults. A newborn trachea is 4 cm long, a toddler's is 7 cm long, and a teenager's is 12 cm long.

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, which of the following would the nurse expect to be used to deliver the highest concentration of oxygen to the child? a) Nonrebreathing mask b) Oxygen hood c) Venturi mask d) Partial rebreathing mask

Nonrebreathing mask A nonrebreathing mask provides 95% oxygen concentration. An oxygen hood provides up to 80% to 90% oxygen concentration. This delivery method is used only for infants. A partial rebreathing mask provides 50% to 60% oxygen concentration. A Venturi mask provides 24% to 50% oxygen concentration.

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, what would the nurse expect to be used to deliver the highest concentration of oxygen to the child?

Nonrebreathing mask -A nonrebreathing mask provides 95% oxygen concentration. An oxygen hood provides up to 80% to 90% oxygen concentration. This delivery method is used only for infants. A partial rebreathing mask provides 50% to 60% oxygen concentration. A Venturi mask provides 24% to 50% oxygen concentration. pg 606

The nurse is administering medications to a child with cystic fibrosis. Which of the following methods would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? a) Shake inhaler and hold close to mouth b) Draw up in syringe and administer subcutaneously c) Pour in medication cup and have child drink d) Open capsule and sprinkle on food

Open capsule and sprinkle on food Correct Explanation: Pancreatic enzymes come in capsules that can be swallowed or opened and sprinkled on the child's food.

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

Pancreas and liver Explanation: The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.

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

Providing fluids by straw Explanation: Providing fluids by straw may cause trauma to the surgical site and should be avoided. Applying an ice collar, if ordered, helps relieve pain. Placing the child on his side, until he is fully awake, facilitates safe drainage of secretions. The child should be discouraged from coughing, clearing his throat, and blowing his nose to avoid trauma to the surgical site.

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?

A nurse is caring for a hospitalized 10-year-old. What would be an appropriate activity for this child to meet the developmental tasks of this age group?

Participating in a craft project

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

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

Which of the following is a complication of cystic fibrosis? a) Pneumothorax b) UTI c) Crohn disease d) Kidney disease

Pneumothorax Correct Explanation: A pneumothorax is a complication of cystic fibrosis. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age.

The nurse is caring for an 11-year-old boy with pneumonia who is exhibiting an increased work of breathing. Which would the nurse identify as the priority for this child?

Positioning the child in a comfortable position

What would the appropriate nursing intervention be for a child with an ineffective breathing pattern? a) Provide oxygen as needed to maintain oxygen saturation above 93%. b) Place child in a supine position in bed. c) Only give medications if condition worsens. d) Have everyone leave child's room so it isn't crowded.

Provide oxygen as needed to maintain oxygen saturation above 93%. Explanation: Provide oxygen to increase oxygen saturation. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The other choices do not promote an open airway, decrease anxiety, or give reassurance; medications will not decrease inflammation.

What would the appropriate nursing intervention be for a child with an ineffective breathing pattern? a) Only give medications if condition worsens. b) Have everyone leave child's room so it isn't crowded. c) Place child in a supine position in bed. d) Provide oxygen as needed to maintain oxygen saturation above 93%.

Provide oxygen as needed to maintain oxygen saturation above 93%. Correct Explanation: Provide oxygen to increase oxygen saturation. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The other choices do not promote an open airway, decrease anxiety, or give reassurance; medications will not decrease inflammation.

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

Providing fluids by straw Correct Explanation: Providing fluids by straw may cause trauma to the surgical site and should be avoided. Applying an ice collar, if ordered, helps relieve pain. Placing the child on his side, until he is fully awake, facilitates safe drainage of secretions. The child should be discouraged from coughing, clearing his throat, and blowing his nose to avoid trauma to the surgical site.

The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which of the following laboratory/diagnostic tools would likely be used to help determine the diagnosis of this child? a) Pulmonary functions test b) Sweat sodium choloride test c) Blood culture and sensitivity d) Purified protein derivative test

Purified protein derivative test Explanation: Purified protein derivative tests are used to detect TB. Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother?

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

The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do? a) With the child lying on his back, apply pressure to the bridge of the nose. b) Seat the child with his head tipped back and apply ice or a cold cloth to the nose. c) With the child lying on his back, pinch the anterior portion of the nose closed. d) Seat the child leaning forward and pinch the anterior portion of the nose closed.

Seat the child leaning forward and pinch the anterior portion of the nose closed. Explanation: The child should sit up and lean forward. Apply continuous pressure to the anterior portion of the nose by pinching it closed. The bleeding usually stops within 10 to 15 minutes. Ice or a cold cloth on the bridge of the nose may help, but pressure will stop the bleeding. Lying down or tipping the head back may allow aspiration of the blood and should be avoided.

The school nurse is reviewing the chart of a 12-year-old student who has had excessive absences due respiratory infections. What is the best action by the nurse?

Speak with the parents about the unusual increased number of respiratory infections

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 Correct Explanation: Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose).

Stridor Explanation: In the child with croup syndrome, inspiratory stridor (shrill, harsh respiratory sound) is often noted.

The nurse identifies a nursing diagnosis of ineffective airway clearance related to inflammation and copious thick secretions. Which of the following would be the priority? a) Monitoring oxygen saturation by pulse oximeter b) Administering oxygen as ordered c) Administering analgesics as ordered d) Suctioning secretions from the airway

Suctioning secretions from the airway Correct Explanation: The priority intervention is suctioning secretions to provide a patent airway. Administering oxygen as ordered, monitoring oxygen saturation by pulse oximeter, and administering analgesics as ordered would be secondary interventions.

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

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) Pulmonary functions test b) Sweat sodium choloride test c) Purified protein derivative test d) Blood culture and sensitivity

Sweat sodium choloride test Explanation: Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.

When caring for children with respiratory issues in relationship to the anatomy and physiology of the child's respiratory system, it is important to recognize which of the following? a) As soon as the child is born, respiratory passages needed during fetal life close. b) The newborn uses the thoracic muscles to breathe and as they grow begin using the abdominal muscles to breathe. c) The diameter of the child's trachea is about the size of the child's little finger. d) Full development of the lungs and respiratory organs involved does not occur until the child is an adolescent.

The diameter of the child's trachea is about the size of the child's little finger. Explanation: The diameter of the infant's and child's trachea is about the size of the child's little finger. This small diameter makes it extremely important to be aware that something can easily lodge in this small passageway and obstruct the child's airway.

The nurse caring for the child with asthma weighs the child daily. What is the most important reason for doing a daily weight on this child?

To determine fluid losses Correct Explanation: During an acute attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting. Theophylline administration also has a diuretic effect, which compounds the problem. Weigh the child daily to help determine fluid losses. The child's weight is used to determine medication dosages, to ensure that the child is appropriately gaining weight and growing, and that the intake is adequate. However, the most important reason for a daily weight is to determine fluid loss.

The most common cause of acute bronchiolitis is which of the following? a) Bacterial infection b) Prenatal complications c) Viral infection d) Hereditary factors

Viral infection Explanation: Acute bronchiolitis is caused by a viral infection. Hereditary and prenatal complications do not relate to this disorder and the respiratory syncytial virus which causes the infection is not bacterial.

The most common cause of acute bronchiolitis is which of the following? a) Viral infection b) Bacterial infection c) Hereditary factors d) Prenatal complications

The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the patient and family that the child should have plenty of fluids. In addition, the nurse would explain to the child's caregiver that the child may a) Vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days post operatively b) Have severe throat pain for up to 2 weeks post operatively; this is not a concern c) Have a painful earache around the third day post operatively, but the earache will be gone by the fourth day d) Be given ice cream and milk the first postoperative day because these foods make swallowing easier

Vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days post operatively Explanation: Bleeding is most often a concern within the first 24 hours following surgery and between the fifth to seventh days postoperatively. Bright, red-flecked emesis or oozing indicates fresh bleeding. If at any time following the surgery there is bright red bleeding, frequent swallowing, or restlessness, the care provider should be notified. A mild earache may be expected around the third day. Encourage fluid intake but avoid irritating liquids such as orange juice. Be aware that milk and ice cream products tend to cling to the surgical site and make swallowing more difficult; thus they are poor choices despite the old tradition of offering ice cream after a tonsillectomy.

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

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

The nurse is caring for a child admitted with asthma. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Wheezing b) Clubbed fingers c) Circumoral cyanosis d) Elevated temperature

Wheezing Explanation: Symptoms of asthma include dry hacking cough, wheezing (the sound of expired air being pushed through obstructed bronchioles), and difficulty breathing. Elevated temperature is not usually seen. Circumoral cyanosis is seen with a diagnosis of pneumonia, and clubbing of the fingers is seen in cystic fibrosis.

The nurse is caring for a child admitted with asthma. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Clubbed fingers b) Elevated temperature c) Circumoral cyanosis d) Wheezing

Wheezing Correct Explanation: Symptoms of asthma include dry hacking cough, wheezing (the sound of expired air being pushed through obstructed bronchioles), and difficulty breathing. Elevated temperature is not usually seen. Circumoral cyanosis is seen with a diagnosis of pneumonia, and clubbing of the fingers is seen in cystic fibrosis.

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

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

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

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

With stridor Correct Explanation: If a foreign body is in the larynx, the patient presents with a cough, stridor, trouble with phonation, and maybe severe respiratory distress.

Wheezing in children is best heard a) as the child cries. b) without a stethoscope. c) as the child exhales. d) with the child supine.

as the child exhales. Explanation: Wheezing is an expiratory sound from difficulty pushing air through a narrowed airway.

Wheezing in children is best heard:

as the child exhales. -Wheezing is an expiratory sound from difficulty pushing air through a narrowed airway. pg601

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. Which of the following would the nurse instruct the mother to do first? a) "Continue to watch his PEFR readings and call back if they go below 40%." b) "Have him use his short-acting bronchodilator right away." c) "You need to take him to the emergency department right away." d) "Have him use his low-dose steroid inhaler now and again in 15 minutes."

b) "Have him use his short-acting bronchodilator right away." Explanation: The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.

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 degrees Fahrenheit. 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) Spasmodic laryngitis b) Epiglottitis c) Acute laryngotracheobronchitis d) Mild asthma

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

A child with a suspected airway obstruction is undergoing arterial blood gas analysis. Which of the following would suggest an airway obstruction? (Select all that apply.) a) SaO2 at 95% b) Low pH c) Increased PCO2 d) Decreased PO2

b) Low pH c) Increased PCO2 d) Decreased PO2 Explanation: When children cannot evacuate accumulated CO2 because of an obstruction or hypoventilation, the partial pressure of CO2 (PCO2) in the arterial blood rises and the concentration of carbonic acid (formed when carbon dioxide dissolves in H2O in plasma) also rises. This leads to acidosis (a decrease in serum pH or an increase in acidity). In case of airway obstruction, the partial pressure of oxygen (PO2) would be decreased. Oxygen saturation at 95% is normal.

Which test in a CF patient would help monitor airway function? a) Peak flow measurement b) Pulmonary function c) Bronchoprovocation d) Pulse oximetry

b) Pulmonary function Explanation: The pulmonary function tests help measure airway function, lung volumes, and gas exchange. Bronchoprovocation provokes bronchospasms to determine airway constriction. Peak flow measurement measures lung velocity. Pulse oximetry monitors blood level oxygen saturation.

The nurse is caring for an 11-year-old boy with pneumonia who is exhibiting an increased work of breathing. Which of the following would the nurse identify as the priority for this child? a) Providing supplemental oxygen as ordered b) Administering intravenous fluids as ordered c) Positioning the child in a comfortable position d) Administering analgesics as ordered

c) Positioning the child in a comfortable position Explanation: Positioning the child in a comfortable position helps to open the airway and provide more room for lung expansion, resulting in more effective breathing patterns while supplemental oxygen and intravenous fluids are administered. Administering intravenous fluids would be appropriate once the child is positioned in a comfortable position. Oxygen would be administered after the child is positioned comfortably. Analgesics may be ordered and administered if the child is experiencing pain from coughing.

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