PEDS PrepU Resp
The nurse is performing a well-child assessment on a 2-week-old male infant. The mother 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 breathe from both their nose and mouth around 2 or 3 weeks of age." "Breathing from the nose only will be noted in newborns for about the first 6 weeks of life." "Your baby is breathing normally for his age." "Babies are nose breathers for about the first 4 weeks of life."
"Babies are nose breathers for about the first 4 weeks of life." Explanation: 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.
A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond? "Do you have allergies in the family?" "Do any family members have history of asthma?" "Do you have air conditioning in your house?" "Has your infant been around any crowds?"
"Has your infant been around any crowds?" Explanation: Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.
Which device is indicated for a patient with sleep apnea? Non-rebreather mask CPAP BiPAP Ventilator
CPAP Rationale:A CPAP device is indicated for patients with sleep apnea. This holds the airway open and can help significantly with obstructive sleep apnea.
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? Suction the back of the throat. Encourage the child to cough. Continue to assess for bleeding. Notify the health care 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.
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 device? Medication cup Metered-dose inhaler Nebulizer Needleless syringe
Metered-dose inhaler 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.
Which nursing intervention is indicated when a patient is on a non-rebreather mask? Monitor vital signs q 4 hours. Allow the patient to leave the unit unsupervised. Encourage the patient to ambulate. Monitor a continuous pulse oximetry level.
Monitor a continuous pulse oximetry level. Rationale:It is good practice to have continuous pulse oximetry on patients on non-rebreather masks. Vital signs every 4 hours is too infrequent, they should not leave the unit unsupervised, and they should not be ambulating if they require high oxygen support.
What statement is the most accurate regarding the structure and function of the newborn's respiratory system? The diameter of the child's trachea is the same as that of adults. Most infants are nasal breathers rather than mouth breathers. The respiratory tract in the child is fully developed by age 2. Infants and young children have smaller tongues in proportion to their mouths.
Most infants are nasal breathers rather than mouth breathers. Explanation: Newborns are obligatory nose breathers until at least 4 weeks of age. 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. During the first 5 years of life, infants and young children have larger tongues in proportion to their mouths.
Which nursing diagnosis would best apply to a child with allergic rhinitis? Pain related to sinus edema and headache Ineffective tissue perfusion related to frequent nosebleeds Disturbed self-esteem related to inherited tendency for illness Risk for infection related to blocked eustachian tubes
Pain related to sinus edema and headache Explanation: Many children with allergic rhinitis develop sinus headaches from edema of the upper airway. In younger children the maxillary and ethmoid sinuses are involved. In children aged 10 years and older the frontal sinuses are also involved. The pain comes from mucosal swelling, decreased ciliary movement and a thickened nasal discharge. Nosebleeds are not common with either allergic rhinitis or sinusitis nor are either of these inherited. The eustachian tubes would cause symptoms of otitis, not of the nasal passage.
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? Iodized salt Saturated fat Pancreatic enzymes Calories from protein
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 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child? Providing fluids by straw Applying an ice collar Placing the child on his side Discouraging the child from coughing
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.
In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason? Relief of acute symptoms Management of chronic pain To stabilize the cell membranes Prevention of mild symptoms
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. Bronchodilators 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 Wheezing in the bases Rales in the middle lobe Rhonchi throughout the lung
Respiratory stridor Explanation: Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe. 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. Rhonchi is a snoring sound heard throughout the lung field when inflammation occurs.
A patient breathes through their mouth. It is determined that they need oxygen at a 2 L/min. Which is the best oxygen delivery system for this patient? Nasal cannula High-flow nasal cannula Simple face mask Non-rebreather mask
Simple face mask Rationale:A simple facemask will deliver a low-flow oxygen level that will assist with mouth breathing. A nasal cannula will not be as beneficial to this patient, and a high-flow nasal cannula and a non-rebreather mask are not indicated.
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? Directly into the vein Through a gastrostomy tube Using a nebulizer Sprinkled onto the food
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.
What is a definitive test for cystic fibrosis? Complete blood count Blood gas Blood culture Sweat chloride
Sweat chloride Explanation: The definitive test in diagnosing cystic fibrosis 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? Purified protein derivative test Sweat sodium chloride test Blood culture and sensitivity Pulmonary functions test
Sweat sodium chloride test Explanation: Sweat sodium chloride 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 anti-infective 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 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 is a triplet. The child was a postmaturity date infant. The child has diabetes. The child attends day care.
The child attends day care. Explanation: Attending day care is a known risk factor for pneumonia. Being a triplet is a factor for bronchiolitis. Prematurity rather than postmaturity is a risk factor for pneumonia. Diabetes is a risk factor for influenza.
The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment? The child is pale and has vomited. The child has pale, elevated patches on the skin. The child is irritable and tachycardiac. The child is in tripod position.
The child is in tripod position. Explanation: Inflammation and swelling of the epiglottis and surrounding structures are common in children ages 2 to 7 years. The child will attempt to improve his/her airway by sitting forward and extending the neck forward with the jaw up, in a "sniffing position" (tripod position). Being pale, vomiting, and having elevated patches on the skin are not associated with epiglottis. Stridor, tachycardia, and the rapid onset are classical signs of epiglottitis.
A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care? The infant will attain oxygen saturation of 90% on room air. The infant's airway will remain clear and free of mucus. The infant's breathing will be less labored. The infant will have decreased nasal stuffiness.
The infant's airway will remain clear and free of mucus. Explanation: Keeping the infant's airway clear is the top priority. An O2 saturation of 90% on room air is minimally acceptable. It is important that the infant's breathing be less labored and that there is decreased nasal stuffiness, but having the airway clear and free of mucus is most important.
The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? The child's weight The child's diet The child's hospital history The triggers in the environment
The triggers in 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 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? Directly into the vein Through a gastrostomy tube Using a nebulizer Sprinkled onto the food
Using a nebulizer Explanation: 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.
What is a symptom of bacterial pharyngitis? fever rhinitis symptoms have gradual onset white blood cell (WBC) count in normal range
fever Explanation: Bacterial pharyngitis is most often caused by group A streptococcus. Fever is a symptom of bacterial pharyngitis. Other symptoms are an elevated WBC count, abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes. It must be treated with an antibiotic. Penicillin is the drug of choice. Symptoms of rhinitis, a normal WBC count, and slow onset are indicative of viral pharyngitis.
The nurse is considering risk factors for influenza in a group of preschool children. Which factors are considered to place children at an increased risk? Select all that apply. heart failure diabetes obesity renal disease history of asthma
heart failure diabetes renal disease history of asthma Explanation: Influenza viral infection (known commonly as the "flu") occurs primarily during the winter. It is spread through inhalation of droplets or contact with fine-particle aerosols. Children with chronic heart or lung conditions, diabetes, chronic renal disease, or immune deficiency are at higher risk for more severe influenza infection compared to other children.
What is a complication of cystic fibrosis? pneumothorax urinary tract infection kidney disease Crohn disease
pneumothorax Explanation: Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age. Crohn disease is a gastrointestinal disorder that is not associated with cystic fibrosis. Urinary tract infection and kidney disease are also not associated with CF. Most of the problems and complications associated with CF relate to the respiratory system, the gastrointestinal system, and infectious disorders.
The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? suctioning secretions from the airway administering oxygen as ordered monitoring oxygen saturation by pulse oximeter administering analgesics as ordered
suctioning secretions from the airway 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.
The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client? tachycardia hypoactivity bronchial muscle relaxation increased appetite
tachycardia Explanation: Adverse reactions of albuterol, a bronchodilator, include tachycardia, nervousness, tremors, hyperactivity, malaise, palpitations, increased appetite, hypokalemia, and muscle cramps. The expected action of albuterol is to relax bronchial, uterine, and vascular smooth muscle by stimulating beta-2 receptors. While tachycardia and increased appetite are both adverse reactions, tachycardia happens abruptly following the first dose and can be alarming for clients. It is a priority for the nurse to provide education on this over a slower, less concerning change.
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 the respiratory therapist get some of the mucus from your lungs." "I'm going to have this hospital worker take a picture of your lungs." "We're going to go take a look at your lungs to see if there are any sores on them." "I'm going to hold your hand while the phlebotomist gets blood from your arm."
"I'm going to have this hospital worker take a picture of your lungs." Explanation: The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.
The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? "We will keep an albuterol inhaler with our child at all times." "It is okay for our child to do chores such as sweeping the floor." "We will both enroll in smoking cessation classes." "Our family dog will need to go live with a grandparent."
"It is okay for our child to do chores such as sweeping the floor." Explanation: Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement. An inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.
The nurse is working with a group of caregivers of children diagnosed with asthma. Which statement made by a caregiver is most accurate regarding the triggers that may cause an asthma attack? "My neighbor told me that asthma attacks are caused by hot weather." "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." "One person told me that asthma is caused by using antibiotics for infection."
"My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." 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 asthma attack.
A young child is prescribed pancreatic enzymes as part of the 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: "We can open the capsule and sprinkle it on his cereal." "We need to dissolve the capsule in water." "We should crush the capsule to make it smaller pieces." "We can puncture the capsule and pour the liquid on our child's tongue."
"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.
The nurse has assessed four clients. Which assessment finding warrants immediate action? 4-year-old child with enlarged tonsillar and adenoidal tissue 10-year-old child with extreme sinus pressure and headache 1-week old newborn with nasal congestion 6-year-old child who is consistently mouth breathing
1-week old newborn with nasal congestion Explanation: Until 4 weeks of age, newborns are obligatory nose breathers and breathe only through their mouths when they are crying. The newborn cannot automatically open the mouth to breathe if the nose is obstructed; therefore, a newborn with nasal congestion needs immediate action. Also, the newborn and young infant have very small nasal passages, so when excess mucus is present, airway obstruction is more likely. Mouth breathing may occur when a large amount of nasal congestion is present. Although this finding is abnormal and warrants follow up, in a 6-year-old child this finding does not warrant immediate action. Through early school-age, children tend to have enlarged tonsillar and adenoidal tissue even in the absence of illness; therefore, this finding is normal in a 4-year-old child and does not warrant immediate follow up. The frontal sinuses and the sphenoid sinuses develop by age 6 to 8 years; therefore a 10-year-old child may develop a sinus infection. Although these symptoms warrant follow up, immediate action is not necessary.
A 9-year-old female child was brought to the emergency department after experiencing wheezing and shortness of breath while playing soccer. The parents administered two puffs of albuterol metered dose inhaler (MDI) with little effect, and 911 was notified. Paramedics applied oxygen 2 liters by nasal cannula for oxygen saturation of 90% on room air, and administered an albuterol nebulizer treatment. Audible wheezing was heard, and a 20-gauge intravenous (IV) catheter was inserted. Vital signs upon arrival at the emergency room: temperature, 98.8°F (37.1°C); heart rate, 125 beats/min; blood pressure, 88/50 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 92% on simple face mask. Child appears anxious. The emergency room nurse should first _____ then __________. 1. assess airway, assess circulation, assess LOC 2. admin albuterol MDI, instruct client to use a peak flow meter, admin IV methylprednisolone
1. assess airway 2. administer intravenous (IV) methylprednisolone Explanation: The nurse should assess the child's airway first. Assessment should always be prioritized using the ABCs (airway, breathing, and circulation).Intravenous (IV) methylprednisolone should be administered promptly to decrease inflammation in the lungs, which will improve air flow. Circulation would be assessed after airway and breathing.Level of consciousness is simultaneously checked with ABCs (airway, breathing, and circulation), but the nurse must first perform a focused respiratory assessment and implement interventions promptly to prevent respiratory arrest.Metered-dose inhalers would not be used in status asthmaticus. Aerosol nebulizer treatments would be administered.Because the child is in severe respiratory distress, the nurse would not perform peak flow meter instruction at this time.
The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress? 3-year-old child with croup 11-month-old infant with nasopharyngitis 2-year-old child with epiglottitis 16-year-old adolescent with asthma
2-year-old child with epiglottitis Explanation: Epiglottitis is a medical emergency due to the swelling of the epiglottis covering the larynx. This client needs frequent assessment for respiratory distress, especially since young children have smaller, more compliant airways. The 3-year-old child has more developed respiratory passages than a 2-year-old child, and although croup may cause respiratory distress, the likelihood of airway obstruction is lower when compared to epiglottitis. The 11-month-old infant has a common cold, typically from a virus. The 16-year-old adolescent with asthma has fully developed respiratory airways, which are less likely to be obstructed.
What is the amount of oxygen in room air? 5% 21% 72% 100%
21% Rationale:Room air contains 21% oxygen
A patient is receiving oxygen via nasal cannula. What is the lowest number in L/min a nurse should apply humidification to the oxygen delivery? 2 4 6 8
4 Rationale:the nurse should apply humidification at 4 L/min to make up for the amount of forced air entering the nasal passage, helping to moisten it.
A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? Administer the bronchodilator via a nebulizer. Give the antibiotic as prescribed. Apply oxygen at 2 liters via a nasal cannula. Apply a cardiac monitor to the child.
Administer the bronchodilator via a nebulizer. Explanation: The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.
A 4-year-old child has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. The parents are extremely distraught over the child's condition and the fact that the child 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 the parents? Allow the parents to remain with the child as much as possible. Encourage the parents to return home and get some rest. Tell the parents that their child is receiving the best care possible. Avoid telling the parents unnecessary facts regarding the child's prognosis.
Allow the parents to remain with the child as much as possible. Explanation: Pneumonia may be caused by many reasons: bacteria, viruses, fungus, and aspiration. If the child has mild symptoms (no respiratory distress) he or she may be treated at home. Hospitalization is required if the child has oxygen requirements, shows signs of respiratory distress, has poor oral intake, and has lethargy. Oxygen supplementation, IV fluids, and antibiotics will be necessary. It is very frightening for the parents to see their child so ill, and it is very frightening for the child to be so sick and be in a strange environment. The parents should be allowed to remain with their child at all times and their concerns should be addressed. The nurse should explain that not eating is part of the illness, but the child is being hydrated with IV fluids and will start eating as the illness improves. Telling the parents the child is receiving the best care possible does not address their concern of not eating. Parents should be educated on all aspects of the child's condition and prognosis.
The nurse notes a 3-year-old child is restless, has a respiratory rate of 55 breaths/minute, and has an oxygen saturation of 90%. Which action will the nurse take first? Notify the primary health care provider. Consult respiratory therapy. Apply oxygen via a facemask. Request a breathing treatment.
Apply oxygen via a facemask. Explanation: Oxygen is the most indicated treatment and is needed to increase low partial pressure of oxygen (PaO2) levels in the blood. The child is showing signs of hypoxemia and needs oxygen. The nurse will notify the health care provider after administering oxygen. Respiratory therapy and breathing treatments may be needed based on the child's response to oxygen.
Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? Urging the child to continue to take oral fluids Administering an oral analgesic Teaching the child to take long, slow breaths Assisting with racemic epinephrine nebulizer therapy
Assisting with racemic epinephrine nebulizer therapy Explanation: Croup is a viral infection that causes inflammation and edema of the larynx, trachea, and bronchi. One form of treatment is the use of nebulized racemic epinephrine. Racemic epinephrine is an alpha adrenergic agent. It works on the mucosal vasoconstriction to reduce the edema. This increases the lumen of airways, allowing for better intake of air. A child in respiratory distress is unable to take slow, deep breaths. The child should not be offered fluids because this is an aspiration risk and analgesics will not reduce swelling.
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 Common cold Pneumonia Allergic rhinitis (hay fever)
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 (hay fever).
The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent and immediate intervention? Compliance with therapy is diminished. The family becomes overvigilant. The child feels fearful and isolated. Siblings are jealous and worried.
Compliance with therapy is diminished. Explanation: Until the family adjusts to the demands of the disease, they can become overwhelmed and exhausted, leading to noncompliance, resulting in worsening of symptoms. Typical challenges to the family are becoming overvigilant, the child feeling fearful and isolated, and the siblings being jealous or worried, but these are not a priority over the noncompliance.
What is the most common debilitating disease of childhood among those of European descent? Cystic fibrosis Asthma Pneumonia BPD
Cystic fibrosis Explanation: Cystic fibrosis is the most common debilitating disease of childhood among those of European descent. Medical advances in recent years have greatly increased the length and quality of life for affected children, with median age for survival being the late 30s.
The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which disorder? Spasmodic laryngitis Tonsillitis Laryngotracheobronchitis Epiglottitis
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; acute respiratory embarrassment can also result.
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: decreased activity and increased fluids. corticosteroids and leukotriene inhibitors. removal of allergens in the home and school. a bronchodilator and mast cell stabilizers.
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 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: report ear pain. experience nuchal rigidity. have unilateral breath sounds upon auscultation. be at risk for respiratory distress.
be at risk for respiratory distress. Explanation: If the airway becomes completely occluded due to epiglottitis, respiratory distress may lead to respiratory arrest and death. Aseptic meningitis is a complication of infectious mononucleosis, resulting in nuchal rigidity; acute otitis media resulting in ear pain is a complication of influenza; and children with pneumonia are at risk for pneumothorax.
A nurse is assessing a 3-month-old infant during a pediatric clinic visit. The nurse believes the infant is demonstrating mild manifestations of respiratory distress. Which clinical manifestation(s) leads the nurse to suspect this distress? Select all that apply. bradycardia acrocyanosis decreased intake nasal congestion fussiness
decreased intake nasal congestion fussiness Explanation: Mild signs of respiratory distress in an infant include fussiness, nasal congestion, and no interest in feeding. Moderate distress presents with nasal flaring, grunting, retractions, mild tachypnea and mild tachycardia. Signs of severe respiratory distress included cyanosis, diaphoresis, dehydration, severe tachypnea and severe tachycardia, as well as exhaustion from respiration effort.
