Pediatrics: Throat/Respiratory
The nurse is instructing the mother of a child with cystic fibrosis (CF) about the appropriate dietary measures. Which meal best illustrates the most appropriate diet for a client with cystic fibrosis (CF)?
✅Chicken tenders and a baked potato with butter 📑Rationale: Children with CF are managed with a high-calorie, high-protein diet. Pancreatic enzyme replacement therapy is undertaken, and fat-soluble vitamin supplements are administered. Fats are not restricted unless steatorrhea cannot be controlled by increased levels of pancreatic enzymes. Chicken tenders and a baked potato with butter provide a high-calorie and high-protein meal that includes fat.
A hospitalized 2-year-old child with croup is receiving corticosteroid therapy. The mother asks the nurse why the primary health care provider did not prescribe antibiotics. The nurse makes which response to the mother?
"Antibiotics are not indicated unless a bacterial infection is present." Rationale: Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. In addition, the question does not include any supporting data to indicate that the child may be allergic to antibiotics.
A nursing instructor asks a nursing student about the use of bacillus Calmette-Guerin vaccine (BCG). Which response made by the nursing student is correct?
"BCG is administered to asymptomatic human immunodeficiency virus (HIV)-infected children who are at increased risk for developing TB." Rationale: The BCG vaccine is used mainly for children with a negative chest x-ray and skin test results who have had repeated exposures to TB and for asymptomatic HIV-infected children who are at increased risk for developing TB.
The nurse is reinforcing instructions to the mother of an 8-year-old child who had a tonsillectomy. The mother tells the nurse that the child loves tacos and asks when the child can safely eat one. The nurse should make which response to the mother?
"In 3 weeks" Rationale: Rough, scratchy foods or spicy foods are to be avoided for 3 weeks. Citrus juices, which irritate the throat, need to be avoided for 10 days. Red liquids are avoided because they will give the appearance of blood if the child vomits. A full-liquid diet is allowed on the second postoperative day, and soft foods are allowed as the child tolerates them.
Following a tonsillectomy, which of the primary health care provider's prescriptions should the nurse question?
Allow ice cream when awake. Rationale: Clear, cool liquids are encouraged. Milk and milk products are avoided initially because they coat the throat, which causes the child to clear the throat, increasing the risk of bleeding. Monitoring Vital Signs and Monitoring for bleeding are important nursing interventions following any type of surgery.
The nurse is preparing for the administration of ribavirin to a child with respiratory syncytial virus. Which supplies will the nurse obtain for the administration of this medication?
A pair of goggles. Rationale: Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. The medication is administered via hood, face mask, or oxygen tent, not by the IM or IV route. A mask may be worn. Hand washing is to be performed before and after any child contact. A gown is not necessary.
A mother of a child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child has discomfort on the right side and that the acetaminophen is not very effective. Which is the best suggestion by the nurse?
Encourage the child to lie on the right side. Rationale: Splinting of the affected side by lying on that side may decrease discomfort. It is inappropriate to advise the mother to increase the dose or frequency of the acetaminophen. Lying on the left side will not be helpful in alleviating discomfort.
The nurse is developing goals for a school-age child with a knowledge deficit related to the use of inhalers and peak flow meters. The nurse identifies which goal as appropriate for this child?
Expresses feelings of mastery and competence with breathing devices. Rationale: School-age children strive for mastery and competence to achieve the developmental task of industry and accomplishment.
A child has epistaxis. The nurse understands that which treatment is appropriate for epistaxis?
Have the child sit up and lean forward. Rationale: Correct treatment for epistaxis (a nosebleed) involves having a client sit up and lean forward. Continuous pressure should be applied to the nose for at least 10 minutes.
A child with a diagnosis of pertussis (whooping cough) is being admitted to the pediatric unit. As soon as the child arrives in the unit, which action should the nurse do first?
Place the child on a pulse oximeter. Rationale: To adequately determine whether the child is getting enough oxygen, the child is placed on a pulse oximeter. The pulse oximeter will then provide ongoing information on the child's oxygen level. The child is also immediately placed on a cardiorespiratory monitor to provide early identification of periods of apnea and bradycardia. The nurse would then gather data including taking the child's temperature and weight and asking the parents about the child.
The nurse teaches a child with cystic fibrosis how to perform the "huff" maneuver. Which instructions should the nurse tell the child?
Take a deep breath and then exhale rapidly, whispering the word huff. Rationale: The "huff" maneuver (forced expiratory technique) is used to mobilize secretions. This technique reduces the likelihood of bronchial collapse. The child is taught to cough with an open glottis by taking a deep breath, then exhaling rapidly, whispering the word huff.
A child is scheduled for a tonsillectomy. Which should present the highest risk of aspiration during surgery?
The presence of loose teeth. Rationale: In the preoperative period, the child should be observed for the presence of loose teeth to decrease the risk of aspiration during surgery. Bleeding during surgery will be controlled via packing and suction as needed.
The nurse is planning education for the parent whose child has recently been prescribed cromolyn sodium as a part of the treatment plan for asthma. Which information should the nurse reinforce in the teaching? Select all that apply.
This medication is inhaled using a Spinhaler. This medication is not to be used as a rescue inhaler. This medication should be inhaled slowly to ensure the medication reaches the lower airways. Rationale: Cromolyn sodium (NSAID) Used for Prevention of Asthma. The medication is inhaled slowly using a Spinhaler to ensure the medication reaches the lower airway. Cromolyn sodium should be used before exercise, not after exercise, to prevent exercise-induced asthma because this medication is not a rescue inhaler. Bronchodilators include Albuterol and Terbutaline.
The nurse is observing a nursing student preparing to suction a pediatric client through a tracheostomy. The nurse intervenes if the student verbalizes which intention?
To apply continuous suction when inserting the catheter. Rationale: The nurse would not use continuous suction on the catheter during insertion because this could cause tissue trauma; suction is applied only when withdrawing the catheter. limiting insertion and suctioning time to 5 seconds, reoxygenating the child between suction catheter passes, and using a twisting motion on the catheter when withdrawing the catheter are all correct interventions regarding this procedure.
The nurse is caring for a hospitalized infant with a diagnosis of bronchiolitis. The nurse places the infant in which position?
With the head and chest at a 30-degree angle, with the neck slightly extended. Rationale: The nurse should position the infant with the head and the chest at a 30- to 40-degree angle with the neck slightly extended to maintain an open airway and to decrease pressure on the diaphragm.
The nurse reinforces instructions to the mother of a child who has been hospitalized with croup. Which statement made by the mother would indicate the need for further teaching?
✅ "I will give my child cough syrup if a cough develops." 📑Rationale: Cough syrups and cold medicines are not to be given because they may dry and thicken secretions. During a croup attack, the child can be taken to a cool basement or garage. Acetaminophen is used if a fever develops. Adequate hydration of 500 mL to 1000 mL of fluids daily is important for thinning secretions.
The nurse reinforces instructions to the mother of a child with croup about the measures to take if an acute spasmodic episode occurs. Which statement by the mother indicates the need for further teaching?
✅ "I will place a steam vaporizer in my child's bedroom." 📑Rationale: Steam from warm running water in a closed bathroom and cool mist from a bedside humidifier are effective for reducing mucosal edema. Cool-mist humidifiers are recommended compared with steam vaporizers, which present a danger of scalding burns. Taking the child out into the humid night air may also relieve mucosal swelling. Remember, however, that a cold mist may precipitate bronchospasm.
The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by the respiratory syncytial virus (RSV). Which interventions should be included in the plan of care? Select all that apply.
✅ Place the infant in a private room. ✅ Place the infant in a room near the nurses' station. 📑Rationale: The infant with RSV should be isolated in a private room or in a room with another child with RSV. The infant should be placed in a room near the nurses' station for close observation. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and to decrease pressure on the diaphragm. Cool, humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea. Contact precautions (wearing gloves and a gown) reduce the nosocomial transmission of RSV.
The nurse has provided instructions to the mother of an infant with viral pneumonia. Which statement by the mother would indicate the need for further teaching?
✅"I understand I will need to have my baby on antibiotics for this pneumonia." 📑Rationale: The child with viral pneumonia will not be prescribed antibiotics, it is bacterial pneumonia that requires antibiotics for treatment. It is important to monitor the infant for fever spikes because of the risk for febrile seizures. Use of a cough suppressant may be prescribed before rest times and meals if the cough is disturbing and unproductive. Promoting bed rest to conserve energy, encouraging fluid intake and the administration of antipyretics for fever, and bronchodilators are typical interventions for pneumonia.
A child with croup is placed in a cool-mist tent. The mother asks if the child may have her security blanket inside the tent. Which is the most appropriate response by the nurse
"The child may have the security blanket inside the tent." Rationale: Familiar objects provide a sense of security for children in the strange hospital environment. The child is allowed to have a favorite toy or blanket while in the mist tent.
A nurse discussing options with a mother of a child with cystic fibrosis (CF) asks if she understands the education. Which statement by the mother indicates a need for further teaching?
"I can give my child whatever foods he likes to eat, since he gets enzymes anyway." A diet of high-protein, high-calorie, moderate-fat is prescribed. Option 4 is incorrect. Cystic fibrosis is a genetic disease in which excess mucous production occurs because of exocrine gland dysfunction. The lungs, intestine, sinuses, reproductive tract, sweat glands, and pancreas are all affected. Treatment includes gene therapy, bronchodilators, expectorants, oral pancreatic enzymes, double doses of fat-soluble vitamins and mucolytics. Lung transplant is an option for these clients.
The nurse is reinforcing home care instructions to the mother of a child diagnosed with pneumonia. Which statement by the mother indicates the need for further teaching?
"I can use a warm mist humidifier to keep the secretions loose." Rationale: A cool mist humidifier rather than a warm mist should be used for the child with pneumonia. In addition, vaporizers that produce steam pose a danger of burns. Appropriate home care instructions regarding care of the child with pneumonia would be: Administering acetaminophen (Tylenol) for fever. Giving the child warm liquids to loosen secretions. Administer antibiotics until the prescribed amount is completed.
A child with croup is being discharged from the hospital. The nurse reinforces home care instructions to the mother and advises the mother to bring the child to the emergency department if the child develops which symptom?
Stridor. Rationale: The mother should be instructed to bring the child to the emergency department if the child develops stridor at rest, cyanosis, severe agitation or fatigue, moderate to severe retractions, or is unable to take oral fluids.
A child with croup is placed in a cool-mist tent. The mother becomes concerned because the child is frightened, consistently crying, and tries to climb out of the tent. Which is the appropriate nursing action?
Let the mother hold the child and direct a cool mist over the child's face. Rationale: Crying aggravates laryngospasm and increases hypoxia, which may cause airway obstruction. If the use of a tent or hood is causing distress, treatment may be more effective if the child is held by the parent and a cool mist is directed toward the child's face. A mild sedative would not be administered to the child. Telling the mother the child must stay in the tent or placing a toy inside the tent will not alleviate the child's fear.
After a tonsillectomy, the child begins to vomit bright red blood. Which is the initial nursing action?
✅ Turn the child to the side. 📑Rationale: After a tonsillectomy, if bleeding occurs, the child is turned to the side and the RN or PHCP is notified. An NPO status would be maintained, and an antiemetic may be prescribed; however, the initial nursing action would be to turn the child to the side.
The nurse is working in the emergency department and is caring for a child who has been diagnosed with epiglottitis. Which is an indication that the child may be experiencing airway obstruction?
✅ Tripod positioning and dyspnea. 📑Rationale: Clinical manifestations that are suggestive of airway obstruction include tripod positioning (leaning forward supported by the hands and arms with the chin thrust out and the mouth open), nasal flaring, tachycardia, retractions, and dyspnea. Epiglottitis is the bacterial form of croup with symptoms of a high fever, sore throat, and an absence of spontaneous cough.
A child is scheduled for a tonsillectomy in the day-stay surgical unit. On the day following surgery, the mother calls the surgical unit and expresses concern because the child has a very bad mouth odor. The nurse should make which response to the mother?
"Bad mouth odor is normal and may be relieved by drinking more liquids." Rationale: Bad mouth odor is normal following tonsillectomy and may be relieved by drinking more liquids. Additionally, mouthwash gargles will irritate the throat.
The nurse caring for an infant with bronchiolitis is monitoring for signs of dehydration. The nurse monitors which method as reliable for determining fluid loss?
BODY WEIGHT. Rationale: Body weight is the most reliable method of measurement of body fluid loss or gain. One kilogram of weight change represents 1 L of fluid loss or gain.
The nurse is caring for a 2-year-old child diagnosed with croup. The nurse collects data on the child, knowing that which are characteristics of this illness? Select all that apply.
The cough is harsh and metallic. Inspiratory stridor may be present. Symptoms usually worsen at night and are better during the day. It is usually preceded by several days of upper respiratory infection symptoms. Rationale: Croup often begins at night and may be preceded by several days of upper respiratory infection symptoms. It is characterized by a sudden onset of a harsh, metallic cough; sore throat; and inspiratory stridor. Symptoms usually worsen at night and are better in the day.
The nursing instructor asks a nursing student about sudden infant death syndrome (SIDS). Which statement by the student indicates further teaching is needed?
✅"The incidence of SIDS has been found to be higher in breastfed infants and infants that use a pacifier." 📑 Rationale: The incidence of SIDS has been found to be lower in breastfed infants and infants who sleep with a pacifier. Some of the interventions that are used to prevent SIDS include having infants sleep in the supine position. Infants exposed to cigarette smoking during pregnancy and after birth are considered at risk for SIDS. SIDS refers to (sudden infant death syndrome) that can occur in healthy infants under 1 year of age, and no exact cause is known.
The nurse is reinforcing instructions to the mother of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the mother?
"The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination." Rationale: It is essential that children with cystic fibrosis be adequately protected from communicable diseases by immunization. It is recommended that in addition to the basic series of immunizations, children with cystic fibrosis also should receive yearly influenza vaccines.
A mother of a child with cystic fibrosis asks the nurse when the postural drainage should be performed. The mother states that the child eats meals at 8:00 am, 12 noon, and at 6:00 pm. What times should the nurse tell the mother to perform postural drainage?
10:00 am, 2:00 pm, and 8:00 pm. Rationale: Respiratory treatments should be performed at least 1 hour before meals or 2 hours after meals to prevent vomiting. In some children with cystic fibrosis, treatments are prescribed every 2 hours, particularly if infection is present. It is also important to perform these treatments before bedtime to clear airways and facilitate rest.
A mother of a child with cystic fibrosis asks the clinic nurse about the disease. How should the nurse respond to the mother about the disease?
Cystic fibrosis is a chronic multisystem disorder affecting the exocrine glands. Rationale: Cystic fibrosis is a chronic multisystem disorder affecting the exocrine glands. The mucus produced by these glands (particularly those of the bronchioles, small intestine, and the pancreatic and bile ducts) is abnormally thick, causing obstruction of the small passageways of these organs. It is transmitted as an autosomal recessive trait.
The nurse employed in an emergency department is instructed to monitor a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. The nurse interprets this observation as indicating which finding?
An airway obstruction. Rationale: Signs and symptoms suggestive of airway obstruction include tripod positioning (leaning forward supported by arms, chin thrust out, mouth open), nasal flaring, tachycardia, a high fever, and sore throat.
The emergency department nurse is gathering initial data on a child suspected of epiglottitis. Which is the nurse's highest priority?
Check for a patent airway. Explanation: When epiglottitis is suspected, the priorities are to maintain a patent airway and to next obtain an x-ray to confirm the diagnosis. If epiglottitis is present, the child is taken promptly to the operating room for tracheal intubation.
After a tonsillectomy, a child is brought to the pediatric unit. The nurse places the child in which appropriate position?
Prone. Rationale: The child should be placed in a prone or side-lying position after tonsillectomy to facilitate drainage.
The nurse is providing instructions to a child with cystic fibrosis regarding how to perform the "huff" maneuver. The child asks the nurse about the purpose of this type of breathing. Which nursing response is appropriate?
"This type of breathing is used to mobilize secretions so that they can be easily coughed out." Rationale: The "huff" maneuver (forced expiratory technique) is used to mobilize secretions. This technique reduces the likelihood of bronchial collapse. The child is taught to cough with an open glottis by taking a deep breath, then exhaling rapidly whispering the word, "huff."
A 10-year-old child with asthma is treated for acute exacerbation. Which finding would indicate that the condition is worsening?
Decreased wheezing. Explanation: Decreased wheezing in a child who is not improving clinically may be interpreted incorrectly as a positive sign, when in fact it may signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing may actually signal that the child's condition is improving. Warm, dry skin indicates an improvement in the condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats per minute.
A nursing student is asked to discuss sudden infant death syndrome (SIDS) at the clinical conference being held at the end of the clinical day. The student plans to include which information in the discussion during the conference?
SIDS usually occurs during sleep and is more common in premature infants. Rationale: SIDS usually occurs during sleep. It most frequently occurs between the second and fourth months of life. It is more common in boys, low-birth-weight infants, and premature infants.
The nurse checks the vital signs of an infant with a respiratory infection and notes that the respiratory rate is 50 breaths per minute. Which action is appropriate?
Document the findings. Rationale: The normal respiratory rate in an infant is 30 to 60 breaths per minute. The nurse would document the findings.
The nurse is assisting in developing a plan of care for a child who will be returning from the operating room following a tonsillectomy. The nurse plans to place the child in which position on return from the operating room?
Side-lying. Rationale: The child should be placed in a prone or side-lying position following tonsillectomy to facilitate drainage.
A 3-year-old child has returned to his room following a tonsillectomy. Which finding needs immediate notification of the registered nurse?
Nasal flaring and rib retractions. Rationale: Nasal flaring and rib retractions are signs of respiratory distress, a major concern following a tonsillectomy. These signs require immediate notification. The vital signs are normal for a 3-year-old child. Drooling slightly blood-tinged saliva and refusal to take sips of liquids are common after a tonsillectomy.
A child with a tracheal obstruction is brought to the emergency department by emergency medical services. The child aspirated a grape, and the foreign body was removed by direct laryngoscopy. Following the procedure, which information does the nurse plan to give to the parents of the child?
The child will need to be hospitalized for observation. Rationale: Removal of foreign bodies from the respiratory tract may need to be performed by direct laryngoscopy or bronchoscopy. After the procedure, the child should remain hospitalized for observation for laryngeal edema and respiratory distress. Cool mist is provided, and antibiotic therapy is prescribed if appropriate.
An 8-year-old boy is being treated with percussion treatments for cystic fibrosis. Which indicates that the treatment is effective?
The child has a productive cough of thick sputum. Rationale: Percussion treatments are intended to produce sputum. Thick sputum is characteristic of cystic fibrosis. Being afebrile is not necessarily reflective of the effectiveness of percussion treatments. Although a high sodium content in the skin is a sign associated with cystic fibrosis, percussion treatments will not help this characteristic. The percussion treatments will not help bowel movements.
The nurse is monitoring a child following a tonsillectomy. Which finding would indicate that the child is bleeding?
RESTLESSNESS. Rationale: Frequent swallowing, restlessness, a fast and thready pulse, and vomiting bright red blood are signs of bleeding. An elevated BP is not an indication of bleeding. Complaint of discomfort is an expected finding following a tonsillectomy.
The nurse is caring for a child who returned from tonsillectomy surgery 30 minutes ago and enters the room for routine monitoring to see the child repeatedly and rapidly swallowing. Using the SBAR (Situation, Background, Assessment, Recommendation) technique, which statements and/or questions should the nurse include in the conversation with the primary health care provider? Select all that apply.
"Could you please come assess the child as soon as possible?" "I am concerned that the child is bleeding from the surgical sites." "Two minutes ago, I entered the child's room for routine monitoring and observed that she was swallowing repeatedly and rapidly." "Hello, this is Maria on the third floor. I am the nurse caring for Ella Smith, the 6-year-old child in room 342 who returned 30 minutes ago from a tonsillectomy." Rationale: Repeatedly swallowing following a tonsillectomy can be an early sign of bleeding. It is vital that the nurse call the provider immediately and give the provider enough information to understand the possible emergency situation at hand without extra details. For example, the nurse should say to the provider, "Hello, this is Maria on the third floor. I am the nurse caring for Ella Smith, the 6-year-old child in room 342 who returned 30 minutes ago from a tonsillectomy." These two sentences convey the situation and the background. The nurse follows with her assessment: "Two minutes ago, I entered the child's room for routine monitoring and observed that she was swallowing repeatedly and rapidly." The nurse would complete the SBAR conversation with her recommendations by saying, "I am concerned the child is bleeding from the surgical sites," and, "Could you please come assess the child as soon as possible?" At this time, it is most important that the provider immediately assess the child for bleeding. The child is expected to have pain in her throat because she just returned from surgery. If the child is bleeding from the surgical site, leaving the hospital is not recommended but does not need to be relayed to the provider at this time.
A mother arrives at the clinic with her child. The mother tells the nurse that the child has had a fever and a cough for the past 2 days, and this morning the child began to wheeze. Viral pneumonia is diagnosed. Which component of the treatment plan should the nurse anticipate?
Supportive treatment. Rationale: With viral pneumonia, treatment is supportive. More severely ill children may be hospitalized and given oxygen, chest physiotherapy, and IV fluids. Antibiotics are not given. Bacterial pneumonia, however, is treated with antibiotic therapy.
A nursing student is preparing a clinical conference, and the topic of the discussion is caring for the child with cystic fibrosis (CF). The student prepares a handout for the group and lists which on the handout? Select all that apply.
It is transmitted as an autosomal recessive trait. It is a disease that causes mucous formation to be abnormally thick. It is a chronic multisystem disorder affecting the exocrine glands. Rationale: CF is a chronic multi-system disorder affecting the exocrine glands. The mucus produced by these glands (particularly those of the bronchioles, small intestine, and pancreatic and bile ducts) is abnormally thick, causing obstruction of the small passageways of these organs. It is transmitted as an autosomal recessive trait and can affect both males and females.
A mother arrives at the emergency department with her child and a diagnosis of epiglottitis is documented. Which of the primary health care provider's prescription should the nurse question?
Obtain a throat culture. Rationale: The throat of a child with suspected epiglottitis should not be examined or cultured because any stimulation with a tongue depressor or culture swab could cause laryngospasm and complete airway obstruction. Humidified oxygen and antipyretics are components of the treatment. Axillary rather than oral temperatures should be taken.
The nurse is reviewing the laboratory results of a child scheduled for tonsillectomy. Which laboratory value would be significant to review?
Platelet Count. Rationale: Before the surgical procedure, the child is assessed for signs of active infection and for redness and exudate of the throat. Because the tonsillar area is so vascular, postoperative bleeding is a concern. The prothrombin (PT), partial thromboplastin time (PTT), platelet count, hemoglobin and hematocrit (H&H), white blood cell (WBC) count, and urinalysis are performed preoperatively. The platelet count result would identify a potential for bleeding. The BUN and creatinine would not determine the potential for bleeding but rather evaluate renal function.
