PEDS Exam 1 Practice Questions
A child with asthma states, "I want to play some sports like my friends. What can i do?" The nurse responds to the child based on the understanding of which information? A. Physical activities are inappropriate for children with asthma B. Children with asthma must be excluded from team sports C. Vigorous physical exercise frequently precipitates an asthmatic episode D. Most children with asthma can participate in sports if the asthma is controlled
D Physical activities are beneficial to asthmatic children, physically and psychosocially. Most children with asthma can engage in school and sports activities that are geared to the child's condition and within the limits imposed by the disease. The coach and other team members need to be aware of the child's condition and know what to do in case an attack occurs. Those children who have exercise-induced asthma usually use a short-acting bronchodilator before exercising.
Which outcome criterion would the nurse develop for a child with cystic fibrosis who has ineffective airway clearance realted to increased pulmonary secretions and inability to expectorate? A. Respiratory rate and rhythm within expected range B. Absence of chills and fever C. Ability to engage in age related activities D. Abiliity to tolerate usual diet without vomiting
A After treatment, the client outcome would be that respiratory status would be within normal limits, as evidenced by a respiratory rate and rhythm within expected range. Absence of chills and fever, although related to an underlying problem causing the respiratory problem (Ex: the infection), goes not specifically rate to the respiratory problem of ineffective airway clearance. The child's ability to engage in age-related activities may provide some evidence of improved respiratory status. However, this outcome criterion is more directly related to activity intolerance. Although the child's ability to tolerate his or her usual diet may indirectly relate to respiratory function, this outcome is more specifically related to an imbalanced nutrition that may or may not be related to the child's respiratory status
When developing a teaching plan for the parent of an asthmatic child concerning measures to reduce allergic triggers, which suggestion should the nurse include? A. Have the child bring his or her own pillow when sleeping away from home B. If using bunk beds, have the child sleep on the bottom C. Use a scented room deodorizer to keep the room fresh D. Vacuum the carpet once or twice a week
A Down pillows and exposure to the dust mites are common allergic triggers. The family can reduce exposure to bedding related allergens during travel or sleepovers by having the child bringing a pillow from home. Typically, the child with asthma should sleep in the top bunk bed to minimize the risk of exposure to dust mites. The risk of exposure to dust mites increases when the child sleeps in the bottom bunk bed because dust mites fall from the top bed, settling in the bottom bed. Scented sprays should be avoided because they may trigger an asthmatic episode. Ideally, carpeting should be avoided in the home id the child has asthma. However, if it is present, carpeting in the child's room should be vacuumed often, possibly daily, to remove dust mites and dust particles.
A child with cystic fibrosis is receiving gentamicin. Which nursing action is most important? A. Monitoring intake and output B. Obtaining daily weights C. Monitoring the client for indications of constipation D. Obtaining stool samples to test for occult blood
A Monitoring intake and output is the most important nursing action when administering an aminoglycoside, such as gentamicin, because a decrease in output is an early sign of renal damage. Daily weight monitoring is not indicated when the client is receiving an aminoglycoside. Constipation and bleeding are not adverse effects of aminoglycosides
The nurse assessment of a 6 month old infant brought to the outpatient clinic reveals a respiratory rate of 52 breaths/min, retractions, and wheezing. The mother states that her infant was doing fine until yesterday. Which action would be most aappropriate? A. Administer a nebulizer treatment B. Send the infant for a chest radiograph C. Refer the infant to the ER D. Provide teaching about cold care to the mother
C Based on the assessment findings of increased respiratory rate, retractions, and wheezing, this infant needs further evaluation, which could be obtained in an emergency department. Without a definitive diagnosis, administering a nebulizer treatment would be outside the nurse's scope of practice unless there was a prescription for such a treatment. Sending the infant for a radiograph may not be in the nurse's scope of practice. The findings need to be reported to an HCP who can then determine whether or not a chest radiograph is warranted. The infant is exhibiting signs and symptoms of respiratory distress and is too ill to send out with just instructions on cold care for the mother
A 12 year old with asthma wants to exercise. Which activity should the nurse suggest to improve breathing? A. Soccer B. Swimming C. Track D. Gymnastics
B Swimming is appropriate for this child because it requires controlled breathing, assists in maintaining cardiac health, enhances skeletal muscle strength, and promotes ventiltaion and perfusion. Stop-and-start activities, such as soccer, track, and gymnastics, commonly trigger symptoms in asthmatic clients.
A child has viral pharyngitis. What should the nurse advise the parents to do? Select all that apply. A. Use a cool mist vaporizer B. Offer a soft-to-liquid diet C. Administer amoxicillin D. Administer acetaminophen E. Place the child on secretion precautions
A, B, D Viral pharyngitis is treated with symptomatic, supportive therapy. Treatment includes use of a cool mist vaporizer, feeding a soft or liquid diet, and administration of acetaminophen for comfort. Viral infections don't respond to antibiotic administration. The child does not need to be on secretion precautions because viral pharyngitis is not contagious.
In preparation for discharge, the nurse teaches the mother of an infant diagnosed with bronchiolitis about the condition and its treatment. Which statement by the mother indicates successful teaching? A. "I need to be sure to take my child's temperature every day." B. "I hope i do not get a cold from my child." C. "Next time my child gets a cold i need to listen to the chest." D. "I need to wash my hands more often."
D Hand washing is the best way to prevent respiratory illnesses and spread of disease. Bronchiolitis, a viral infection primarily affecting the bronchioles, causes swelling and mucus accumulation of the lumina and subsequent hyperinflation of the lung with air trapping. It is transmitted primarily by direct contact with respiratory secretions as a result of eye-to-hand or nose-to-hand contact or from contaminated fomites. Therefore, hand washing minimizes the risk for transmission. Taking the child's temperature is not appropriate in most cases. As long as the child is getting better, taking the temperature will not be helpful. The mother's statement that she hopes she does not get a cold from her child does not indicate understanding of what to do after discharge. For most parents, listening to the child's chest would not be helpful because the parents would not know what they were listening for. Rather, watching for an increased respiratory rate, fever, or evidence of poor eating or
Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease? A. An abnormality in the body's mucus-secreting glands B. Formation of fibrous cysts in various body organs C. Failure of the pancreatic ducts to develop properly D. Reaction to the formation of antibodies against streptococcus
A CF is characterized by a dysfunction in the body's mucus producing exocrine glands. The mucus secretions are thick and sticky rather than thin and slippery. The mucus obstructs the bronchi, bronchioles, and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine, resulting in poor digestion and poor absorption of various food nutrients. Fibrous cysts don't form in various organs. Cystic fibrosis is an autosomal recessive inherited disorder and does not involve any reaction to the formation of antibodies against streptococcus.
A school age client with cystic fibrosis aasks the nurse what sports she can become involved in as she becomes older. What is the best information for the nurse to provide about sports and cystic fibrosis? A. "the best sport is one that you will enjoy and do regularly" B. Swimming is the best exercise for anyone with cystic fibrosis" C. "You should avoid contact sports where you might experience a blow to the chest" D. "Indoor sports have lower risks of infection than outdoor sports"
A Responses to physical activity among children with cystic fibrosis vary greatly; therefore, plans of care must be individualized. Selecting a sport that the child likes and will do regularly is most important because children with CF who exercise regularly have better health and quality of life. Many children with CF tolerate and enjoy swimming, but some children don't. There are no universal recommendations that children with CF should not engage in contact sports. There is evidence to suggest that clients who exercise outdoors are at greater risk of infection compared to those who exercise indoors.
The parent of a 16 month old child calls the cliic because the child has a low grade fever, cold symptoms, and a hoarse cough. What should the nurse suggest that the parent do? A. Offer extra fluids frequently B. Bring the child to the clinic immediately C. Count the child's respiratory rate D. Use a hot air vaporizer
A The toddler is exhibiting sold symptoms. A hoarse cough may be prat of the upper respiratory tract infection. The best suggestion is to have the father offer the child additional fluids at frequent intervals to help keep secretions loose and membranes moist. There is no evidence presented to suggest that the child needs to be brought to the clinic immediately. Although having the father count the child's respiratory rate may provide some additional information, it may lead the father to suspect that something is seriously wrong, possibly leading to undue anxiety. A hot air vaporizer is not recommended. However, a cool mist vaporizer would cause vasoconstriction of the respiratory passages, making it easier for the child to breathe and loosening secretions
Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply. A. Coughing B. Respiratory rate of 35 breaths/min C. Heart rate of 95 beats/min D. Restlessness E. Malaise F. Diaphoresis
A, B, D, F Coughing, especially at night and in the absence of an infection, is a common symptom of asthma. Early signs of respiratory distress include restlessness, tachypnea, tachycardia, and diaphoresis. Other signs also include hypertension, nasal flaring, grunting, wheezing, and intercostal retractions. A heart rate of 95 bpm is normal for a toddler. Malaise typically does not indicate respiratory distress
A teaching care plan to prevent the transmission of respiratory syncytial virus (RSV) should include what information? Select all that apply. A. The virus can be spread by direct contact B. The virus can be spread by indirect contact C. Palivizumab is recommended to prevent RSV for all toddlers in day care D. The Virus is typically contagious for 3 weeks E. Older children seldom spread RSV F. Frequent hand washing helps reduce the spread of RSV
A, B, F RSV can be spread through direct contact such as kissing the face of an infected person, and it can be spread through indirect contact by touching surfaces covered with infected secretions. Hand washing is one of the best ways to reduce the risk of disease transmission. Palivizumab can prevent severe RSV infections but is only recommended for the most at risk infants and children. RSV is typically contagious for 3-8 days. RSV frequently manifests in older children as cold-like symptoms. Infected school-age children frequently spread the virus to other family members.
An infant is being treated at home for bronchiolitis. What should the nurse teach the parent about home care? Select all that apply. A. Offering small amounts of fluids frequently B. Allowing the infant to sleep prone C. Calling the clinic if the infant vomits D. Writing down how much the infant drinks E. Performing chest physiotherapy every 4 hours F. Watching for difficulty breathing
A, F An infant with bronchiolitis will have increased respirations and will tire more quickly, so it is best and easiest for the infant to take fluids more often in smaller amounts. The parents also would be instructed to watch for signs of increased difficulty breathing, which signal possible complications. Healthy infants and even those with bronchiolitis should sleep in the supine position. Calling the clinic for an episode of vomiting would not be necessary. However, the parents would be instructed to call if the infant cannot keep down any fluids for a period of more than 4 hours. Parents would not need to record how much the infant drinks. Chest physiotherapy is not indicated because it does not help and further irritates the infant.
When developing the plan of care for a child with cystic fibrosis who is scheduled to receive postural drainage, the nurse should anticipate performing postural drainage at which times? A. After meals B. Before meals C. After rest periods D. Before inhalation treatments
B Postural drainage, which aids in mobilizing the thick, tenacious secretions commonly associated with CF, is usually performed before meals to avoid the possibility of vomiting or regurgitating food. Although he child with CF needs frequent rest periods, this is not an important factor in scheduling postural drainage. However, the nurse would not want to interrupt the child's rest period to perform the treatment. Inhalation treatments are usually given before postural drainage to help loosen secretions.
A child with cystic fibrosis doesn't like taking a pancreatic enzyme supplement with meals and snacks. The parent doesn't like to force the child to take the supplement. What is the most important reason for the child to take the pancreatic enzyme supplement with meals and snacks? A. The child will become dehydrated if the supplement is not taken with meals and snacks B. The child needs these pancreatic enzymes to help the digestive system absorb fats, carbs, and proteins C. The child needs the
B The child must take the pancreatic enzyme supplement with meals and snacks to help absorb nutrients so he can grow and develop normally. In cystic fibrosis, the normally liquid mucus is tenacious and blocks three digestive enzymes from entering the duodenum and digesting essential nutrients. Without the supplemental pancreatic enzyme, the child will have voluminous, foul, fatty stools due to the undigested nutrients and may experience developmental delays due to malnutrition. Dehydration is not a problem related to cystic fibrosis. The pancreatic enzymes have no effect on the viscosity of the tenacious mucus. Diarrhea is not caused by failing to take the pancreatic enzyme supplement.
What toy should the nurse include as part of a recreational therapy plan of care for a 3 year old child hospitalized with pneumonia and cystic fibrosis? A. 100 piece jigsaaw puzzle B. Child's favorite doll C. Fuzzy stuffed animal D. Scissors, paper, and paste
B The child's favorite doll would be a good choice of toys. The doll provides support and is familiar to the child. Although a 3 year old may enjoy puzzles, a 100 piece puzzle is too complicated for an ill 3 year old child. In view of the child's lung pathology, a fuzzy stuffed animal would not be advised because of its potential as a reservoir for dust and bacteria, possibly predisposing the child to additional respiratory problems. Scissors, paper, and paste are not appropriate for a 3 year old unless the child is supervised closely.
A 21 month old child admitted with the diagnosis of croup now has a respiratory rate of 48 breaths/min, a heart rate of 120 bpm, and a temperature of 100.8F rectally. The nurse is having difficulty calming the child. What should the nurse do next? A. Administer acetaminophen B. Notify HCP immediately C. Allow the toddler to continue to cry D. Offer clear fluids every few minutes
B The nurse may be having difficulty calming the child because the child is experiencing increasing respiratory distress. The normal respiratory rate for 21 month old is 25-20 breaths/min. The child's respiratory rate is 48 breaths/min. Therefore, the HCP needs to be notified immediately. Typically, acetaminophen is not given to a child unless the temperature is 101 F or higher. Letting the toddler cry is inappropriate with croup because crying increases respiratory distress. Offering fluids every few minutes to a toddler experiencing increasing respiratory distress would do little, if anything, to calm the child. Also, the child would have difficulty coordinating breathing and swallowing, possibly increasing the risk of aspiration.
A child, who uses an inhaled bronchodilator only when needed for asthma, has a best peak expiratory flow rate of 270 L/min. The child's current peak flow reading is 180 L/min. How does the nurse interpret this reading? A. The child's asthma is under god control, so the routine treatment plan should continue B. The child needs to use short-acting, inhaled beta 2 agonist medication C. This is a medical emergency requiring a trip to the emergnecy department for treatment D. The child needs to use i
B The peak flow of 180 L/min is in the yellow zone, or 50% to 80% of the child's personal best. This means that the child's asthma is not well controlled, thereby necessitating the use of a short-acting beta 2 agonist medication to relieve the bronchospasm. A peak flow reading >80% of the child's personal best (in this case, 220 L/min or better) would indicate that the child's asthma is in the green zone or under good control. A peak flow reading in the red zone, or <50% of the child's personal best (135 L/min or less), would require notification of the HCP or a trip to the ER. Cromolyn sodium is not used for short-term treatment of acute bronchospasm. It is used as part of aa long-term therapy regimen to help desensitize mast cells and thereby help to prevent symptoms
The nurse assesses the results of a gentamicin trough blood level for an adolescent with cystic fibrosis who has had been treated with gentamicin several times over the last year. The drug level is high. What is the nurse's primary concern? A. The child may develop liver dysfunction B. The child may suffer hearing loss C. The medication may have been administered incorrectly D. The child may need to hvae a different antibiotic
B When given for an extended period of time, aminoglycoside antibiotics can cause permanent hearing loss. The high trough level may indicate that the childhasa decreased kidney function and is not clearing the drug out of their system efficiently. While hepatotoxicity has been shown in isolated reports, changes in liver function resolve rapidly once gentamicin is stopped. While errors in medication administration can cause abnormal lab results, the child's clinical history and frequency of gentamicin use support an elevated blood level. The lab result indicates that the dose of gentamicin may need to be decreased.
A 7 year old child with a hsitory of asthma controlled without medications is referred to the school nurse by the teacher because of persistent coughing. What should the nurse do first? A. Obtain the child's heart rate B. Give the child a PRN nebulizer treatment C. Call a parent to obtain more information D. Have a parent come and pick up the child
C Because persistent coughing may indicate an asthma attack and a 7 year old child would be able to provide only minimal history information, it would be important to obtain information from the parent. Although determining the child's heart rate is an important part of the assessment, it would be done after the history is obtained. More information needs to be obtained before giving the child a nebulizer treatment. Although it may be necessary for the parent to come and pick up the child, a thorough assessment including history information should be obtained first.
An adolescent with cystic fibrosis has been hospitalized several times. On the latest admission, the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which initial nursing actions are most important? A. Placing the client on bed rest and obtaining a prescription for a blood gas analysis B. Implementing a high-calorie, high-protein, low-fat, vitamin-enriched diet and pancreatic granules C. Applying an oximeter and initiating respiratory therapy D. Inserting an IV li
C Clients with CF commonly die from respiratory problems. The mucus in the lungs is tenacious and difficult to expel, leading to lung infections and interference with oxygen and carbon dioxide exchange. The client will likely need supplemental oxygen and respiratory treatments to maintain adequate gas exchange, as identified by the oximeter reading. The child will be on bed rest due to respiratory distress. However, although blood gases will probably be prescribed, the oximeter readings will be used to determine oxygen deficit and are, therefore, more of a priority. A diet high in calories, proteins, and vitamins with pancreatic granules added to all foods ingested will increase nutrient absorption and help the malnutrition; however, this intervention is not priority at this time. Inserting an IV to administer antibiotics is important and can be done after ensuring adequate respiratory function.
A parent brings a 3 month old infant to the clinic, reporting that the infant has a cold, is having trouble breathing, and "just does not seem to be acting right." Which action should the nurse take first? A. Chest the infant's heart rate B. Weigh the infant C. Assess the infant's oxygen saturation D. Obtain more information from the parent
C In an infant with these symptoms, the first action by the nurse would be to obtain an oxygen saturation reading to determine how well the infant is oxygenating. Because the parent probably can provide no other information, checking the heart rate would be the second action done by the nurse. Then the nurse would obtain the infant's weight.
An 11 year old is admitted for treatment of an asthma attack. Which finding indicates immediate intervention is needed? A. Thin, copious mucous secretions B. Productive cough C. Intercostal retractions D. Respiratory rate of 20 breaths/min
C Intercostal retractions indicate aan increase in respiratory effort, which is a sign of respiratory distress. During an asthma attack, secretions are thick, the cough is tight, and respiration is difficult (and shortness of breath may occur). If mucous secretions are copious but thin, the client ca expectorate them, which indicates an improvement in the condition. If the cough is productive, it means the bronchospasm and the inflammation have been resolved to the extent that the mucus can be expectorated. A respiratory rate of 20 breaths/min would be considered normal and no intervention would be needed
After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease? A. "We try to keep him happy at all costs; otherwise, he has an asthma attack." B. "We keep our child away from other children to help cut down on infections." C. "Although our child's disease is serious, we try not to let it be the focus of our family." D. "I'm afraid that when my child ge
C Positive adjustment to a chronic condition requires placing the child's illness in its proper perspective. Children with asthma need to be treated as normally as possible within the scope of the limitations imposed by the illness. They also need to learn how to manage exacerbations and then resume as normal a life as possible. Trying to keep the child happy at all costs is inappropriate and can lead to the child's never learning how to accept responsibility for behavior and get along with others. Although minimizing the child's risk for exposure to infections is important, the child needs to be with his or her peers to ensure appropriate growth and development. Children with a chronic illness need to be involved in their care so that they can learn to manage it. Some parents tend to overprotect their child with a chronic illness. This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent, to rebel against the overprotectiveness a
An adolescent with chest pain goes to the nurse. The nurse determines that the teenager has a history of asthma but has had no problems for years. What should the nurse do next? A. Call the adolescent's parent B. Have the adolescent lie down for 30 minutes C. Obtain a peak flow reading D. Have the teen take 2 puffs of a short-acting bronchodilator
C Problems of chest pain in children and adolescents are rarely cardiac. With history of asthma, the most likely cause of the chest pain is related to the asthma. Therefore, the nurse should check the adolescent's peak flow reading to evaluate the status of the airflow. Calling the adolescent's parent would be appropriate, but this would be done after the nurse obtains the peak flow reading and additional assessment date. Having the adolescent lie down may be an option, but more data need to be collected to help establish a possible cause. Because the adolescent has not experienced any asthma problems for a long time, it would be inappropriate for the nurse to administer a short-acting bronchodilator at this time
When preparing the teaching plan for the mother of a child with asthma, what information should the nurse include as a sign to alert the mother that her child is having an asthma attack? A. Secretion of thin, copious mucus B. Tight, productive cough C. Wheezing on expiration D. Temperature of 99.4 F
C The child who is experiencing an asthma attack typically demonstrates wheezing on expiration initially. This results from air moving through narrowed airways secondary to bronchoconstriction. The child's expiratory phase is normally longer than the inspiratory phase. Expiration is passive as the diaphragm relaxes. During an asthma attack, secretions are thick ans are not usually expelled until the bronchioles are more relaxed. At the beginning of an asthma attack, the cough will be tight but not productive. Fever is not always present unless there is an infection that may have triggered the attack
