Peds - Respiratory

D Instruct the adolescent that fluticasone/salmeterol is a combination of long acting beta agonist and corticosteroid medications, and to use it for maintenance control of asthma.

A nurse is teaching an adolescent about the appropriate use of his asthma medication. Which of the following medications should the nurse instruct the client to use as needed before exercise? A. Fluticasone/salmeterol B. Montelukast C. Prednisone D. Albuterol

C -- The throat is very sore after a tonsillectomy. Most children experience moderate pain after a tonsillectomy and need pain medication at regular intervals for at least the first 24 hours. Analgesics may need to be given rectally or intravenously to avoid the oral route.

A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, "My tummy hurts." The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the child's pain? a. ice chips b. tylenol PO c. tylenol PR d. popsicle

C -- Acute spasmodic laryngitis (spasmodic croup, "midnight croup," or "twilight croup") is distinct from laryngitis and LTB and characterized by paroxysmal attacks of laryngeal obstruction that occur chiefly at night. The child goes to bed well or with some mild respiratory symptoms but awakens suddenly with characteristic barking; a metallic cough; hoarseness; noisy inspirations; and restlessness. However, there is no fever, and the episode subsides in a few hours. Children with spasmodic croup are managed at home. Cool mist is recommended for the child's room. A tepid water bath will not help, but steam provided by hot water may relieve the laryngeal spasm. The child will not need Tylenol, and antibiotics are not given for this type of croup.

A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup? a. a bath in tepid water can help resolve this type of croup b. tylenol can help to relieve the cough and stridor c. a cool mist vaporizer at the bedside can help prevent this type of croup d. antibiotics need to be given to reduce the inflammation

D -- Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation. Nasotracheal intubation or tracheostomy is usually considered for a child with epiglottitis with severe respiratory distress. The throat should not be inspected because airway obstruction can occur, and steroids would not be done first when the child is in severe respiratory distress.

A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action? a. throat culture b. nasal pharynx washing c. administration of corticosteroids d. emergency intubation

D -- This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.

A 4-year-old girl is brought to the emergency department. She has a "frog-like" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner? a. Make her lie down and rest quietly. b. Examine her oral pharynx and report to the physician. c. Auscultate her lungs and prepare for placement in a mist tent. d. Notify the physician immediately and be prepared to assist with tracheostomy or intubation.

B -- Some secretions, particularly dried blood from surgery, are common after a tonsillectomy. Inspect all secretions and vomitus for evidence of fresh bleeding (some blood-tinged mucus is expected). Dark brown (old) blood is usually present in the emesis, as well as in the nose and between the teeth. Small amounts of dark brown blood should be further monitored. A red-flavored ice pop should not be given and the Trendelenburg position is not recommended.

A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action? a. Notify the HCP. b. Continue to assess for bleeding. c. Give the child a red flavored ice pop. d. Position the child in a Trendelenburg position.

A Children who have cystic fibrosis excrete an excessive amount of sodium and chloride in their sweat. children who have cystic fibrosis are expected to have decreased blood levels of fat soluble vitamins Children who have cystic fibrosis are expected to have large, bulky, greasy, foul smelling stool

A nurse is reviewing the diagnostic findings for preschool age child who is suspected of having cystic fibrosis. Which of the following findings should the nurse identify as an indication of cystic fibrosis? A. sweat chloride Content 85 mEq/L B. Increased blood levels of fat soluble vitamins C. 72 hour stool analysis sample indicating hard packed stools D. Chest x-ray negative for atelectasis

A, C

A nurse is teaching a child who has asthma how to use a peak flow meter. Which of the following information should the nurse include in the teaching? Select all that apply. A. Zero the meter before each use B. Record the average of the attempts C. Perform three attempts D. Deliver a long slow breath into the meter E. Sit in a chair with feet on the ground

D Amantindine can shorten the length of the illness. Rimantadine is administered orally two times per day for 7 days. Zanamivir is approved for children over 5. Oseltamivir decreases flu manifestations in client who have findings for less than 48 hrs.

A nurse is teaching a group of guardians about influenza. Which of the following information should the nurse include in the teaching? A. Amantadine will prevent the illness. B. Rimantadine is administered intramuscularly. C. Zanamivir can be given to children 1 year and older. D. Oseltamivir should be given within 48 hours of onset of manifestations.

A, B, C

A nurse is teaching an adolescent to self administer a corticosteroid medication using a metered dose inhaler. Which of the following instructions should the nurse include? Select all that apply. A. Shake the device prior to use B. Rinse and expectorate after administration C. Inhale slowly with medication administration D. Exhale quickly after medication administer ion. E. Wait 30 seconds between puffs.

D -- Play techniques that can be used for younger children to extend their expiratory time and increase expiratory pressure include blowing cotton balls or a ping-pong ball on a table, blowing a pinwheel, blowing bubbles, or preventing a tissue from falling by blowing it against the wall. Increased fluids, increased use of a Pulmicort inhaler, or suppressing a cough will not increase expiratory effectiveness.

A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal? a. encourage increased fluid intake b. recommend increased use of a budesonide inhaler c. administer an antitussive to suppress coughing d. encourage the child to blow a pinwheel every 6 hrs while awake

C -- The irritation of a foreign body in the nose produces local mucosal swelling with foul-smelling nasal discharge, local obstruction with sneezing, and mild discomfort. Allergies would produce clear bilateral nasal discharge. Nasal discharge is usually not associated with pharyngitis. Acute nasopharyngitis would have bilateral mucous discharge.

A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect what condition? a. allergies b. acute pharyngitis c. foreign body in the nose d. acute nasopharyngitis

A -- Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of OM; antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside.

An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. What instructions should be given to the parent? a. Administer all of the prescribed medication. b. Continue medication until all symptoms subside. c. Immediately stop giving medication if hearing loss develops d. stop giving medication and come to clinic if fever is still present in 24 hrs

A -- The only product available in the United States for prevention of RSV is palivizumab, a humanized mouse monoclonal antibody, which is given once every 30 days (15 mg/kg) between November and March. It is given to high-risk infants, which includes an infant with a congenital heart defect.

An infant with a congenital heart defect is to receive a dose of palivizumab (Synagis). What is the purpose of this? a. prevent RSV infection b. prevent secondary bacterial infection c. decrease toxicity of antiviral agents d. make isolation of infant with RSV unnecessary

C -- RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? a. reverse isolation b. airborne isolation c. contact precautions d. standard precautions

A -- Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be fed in a semivertical position to prevent OM.

An infant's parents ask the nurse about preventing otitis media (OM). What information should be provided? a. avoid tobacco smoke b. use nasal decongestants c. avoid children with OM d. bottle or breastfeed in a supine position

C -- OME is characterized by a feeling of fullness in the ear or other nonspecific complaints. OME does not cause severe pain. This may be a sign of AOM. Vomiting, anorexia, and fever are associated with AOM.

Chronic otitis media with effusion (OME) differs from acute otitis media (AOM) because it is usually characterized by which signs or symptoms? a. severe pain in the ear b. anorexia and vomiting c. a feeling of fullness in the ear d. fever as high as 104 F

D -- Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition? a. otitis media b. diabetes insipidus c. nephrotic syndrome d. acute rheumatic fever

B -- In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37° C is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if the child develops noisy respirations or drooling.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention? a. Admit to the hospital and observe for impending epiglottitis. b. Provide fluids that the child likes and use comfort measures. c. Control fever with acetaminophen and call if cough gets worse tonight. d. Try OTC cough medicine and come to the clinic tomorrow if no improvement.

B -- The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt and that separation from mother is a major developmental threat for toddlers, but the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. What is the primary rationale for this action? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease the child's respiratory efforts. c. Separation from the mother is a major developmental threat at this age. d. The mother can provider constant observations of the child's respiratory efforts.

C -- If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Sore throat and pain on swallowing are early signs of epiglottitis. Stridor is aggravated when a child with epiglottitis is supine. Epiglottitis is caused by Haemophilus influenzae in the respiratory tract.

The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition? a. sore throat b. inspiratory stridor c. complete obstruction d. respiratory tract infection

B -- The American Academy of Pediatrics practice parameter (2006) recommends the use of supplemental oxygen if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat would not increase the saturation reading. The infant should be kept in the hood, but because the saturation reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen concentration.

The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child's SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take? a. withhold feedings b. notify the HCP c. put the infant in an infant seat d. keep the infant in the plastic hood

A -- Pain control after a tonsillectomy can be achieved with application of an ice collar and administration of analgesics. The child should avoid clearing the throat or coughing and does not need to gargle and brush teeth a certain number of times per day and should avoid vigorous gargling and toothbrushing. Also, the child's activity should be limited to decrease the potential for bleeding, at least for the first few days.

The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching? a. "I can use an ice collar on my child for pain control along with analgesics." b. "My child should clear the throat frequently to clear the secretions." c. "I should allow my child to be as active as tolerated." d. "My child should gargle and brush teeth at least 3x per day."

B, C, E Clinical manifestations of LTB include a brassy cough, low-grade fever, and slow progression. Dysphagia and a toxic appearance are characteristics of acute epiglottitis.

The nurse is preparing to admit a 7-year-old child with acute laryngotracheobronchitis (LTB). What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. dysphagia b. brassy cough c. low-grade fever d. toxic appearance e. slowly progressive

B, C, D, E

The nurses is caring for a child who is receiving a broncodilator medication by nebulized aerosoltherapy. Which of the following action should the nurse take? Select all that apply. A. Instruct the child that the treatment will last 30 minutes B. Obtain vital signs prior to the procedure C. Tell the child to take slow deep breaths D. Determine if the child should use a mask E. Attach the device to an air source

A -- Usually the signs of pneumothorax are nonspecific. Tachypnea, tachycardia, dyspnea, pallor, and cyanosis are significant signs and symptoms and are indicative of respiratory distress caused by pneumothorax. If the bronchial tubes were dilated, the child would have decreased work of breathing and would most likely be asymptomatic. Carbon dioxide retention is a result of the chronic alveolar hypoventilation in CF. Hypoxia replaces carbon dioxide as the drive for respiration progresses. Increased viscosity would result in more difficulty clearing secretions.

The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these signs and symptoms are suggestive of what condition? a. pneumothorax b. bronchodilation c. carbon dioxide retention d. increased viscosity of sputum

C -- If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant. Cough can be a sign of nasopharyngitis. Irritability is common in an infant with a viral illness. Fever is common in viral illnesses.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition? a. has a cough b. becomes fussy c. shows signs of an earache d. has a fever higher than 99 F

D -- Short-acting β2-agonists are the first treatment in an acute asthma exacerbation. Ephedrine and aminophylline are not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations.

What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. ephedrine b. theophylline c. aminophylline d. short-acting B2-agonists

A -- The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are later manifestations of CF.

What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)? a. meconium ileus b. history of poor intestinal absorption c. foul-smelling, frothy, greasy stools d. recurrent pneumonia and lung infections

D -- The characteristics of the disease—malaise, sore throat, lymphadenopathy, central nervous system manifestations, and skin lesions—are similar to presenting signs and symptoms in other diseases. Hematologic analysis (heterophile antibody and monospot) can help confirm the diagnosis. However, not all young children develop the expected laboratory findings. Herpes-like Epstein-Barr virus is the principal cause. Usually, an increase in lymphocytes is observed. Penicillin, not ampicillin, is indicated. Ampicillin is linked with a discrete macular eruption in infectious mononucleosis.

What statement best represents infectious mononucleosis? a. Herpes simplex type 2 is the principle cause. b. A complete blood count shows a characteristic leukopenia c. a short course of ampicillin is used when pharyngitis is present d. clinical s/s and blood tests are both needed to establish the diagnosis

B -- In asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. Atopy, or development of an immunoglobulin E (IgE)-mediated response, is inherited but is not the only cause of asthma. Asthma is characterized by increased resistance in the airway. Asthma has multiple causes, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors.

What statement is the most descriptive of asthma? a. It is inherited. b. There is heightened airway reactivity. c. There is decreased resistance in the airway. d. The single cause of asthma is an allergic hypersensitivity.

A -- A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Bronchoscopy, duodenal fluid analysis, stool tests for trypsin, and intestinal biopsy are not helpful in diagnosing CF. Gastric contents normally contain hydrochloride; it is not diagnostic.

What tests aid in the diagnosis of cystic fibrosis (CF)? a. sweat test, stool for fat, chest radiography b. sweat test, bronchoscopy, duodenal fluid analysis c. sweat test, stool for trypsin, biopsy of intestinal mucosa d. stool for fat, gastric contents for hydrochloride, radiography

A -- Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretions.

When caring for a child after a tonsillectomy, what intervention should the nurse do? a. Watch for continuous swallowing. b. Encourage gargling to reduce discomfort. c. Apply warm compresses to the throat. d. Position the child on the back for sleeping.

A -- Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both cool-mist vaporizers and steam vaporizers may promote a more comfortable environment, but cool-mist vaporizers have decreased risk for burns and growth of organisms.

Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried by steam vaporizers. d. A more comfortable environment is produced

A, B, D, F

A nurse is assessing a child who had epiglottitis. Which of the following findings should the nurse expect? Select all that apply. A. Hoarseness and difficulty speaking B. Difficulty swallowing C. Low grade fever D. Drooling E. Dry, barking cough F. Stridor

A -- Children with AOM should be seen after antibiotic therapy is complete to evaluate the effectiveness of the treatment and to identify potential complications, such as effusion or hearing impairment. Hearing loss does not usually occur with acute otitis media. Tylenol should be given for pain, and the infant will not necessarily need a myringotomy procedure.

A 1-year-old child has acute otitis media (AOM) and is being treated with oral antibiotics. What should the nurse include in the discharge teaching to the infant's parents? a. A follow-up visit should be done after all medicine has been given. b. After an episode oof AOM, hearing loss usually occurs. c. Tylenol should not be given because it may mask symptoms. d. The infant will probably need a myringotomy procedure and tubes.

B Blowing the nose causes pressure and could increase the risk of bleeding. Analgesics should be administered on a scheduled basis to provide pain relief. Citrus juices can cause discomfort and should be avoided postoperatively. The client should be positioned on the abdomen or side lying following a tonsillectomy.

A nurse is caring for a child and the postoperative. Following a tonsillectomy. Which of the actions should the nurse take? A. Encourage the child to blow her nose gently. B. Administer analgesics on a schedule. C. Offer orange juice. D. Position the child supine.

D -- Normally sweat chloride content is less than 40 mEq/L, with a mean of 18 mEq/L. A chloride concentration greater than 60 mEq/L is diagnostic of CF; in infants younger than 3 months, a sweat chloride concentration greater than 40 mEq/L is highly suggestive of CF.

A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)? a. less than 18 mEq/L b. 18-40 mEq/L c. 40-60 mEq/L d. greater than 60 mEq/L

B -- The interpretation of a peak expiratory flow rate that is yellow (50%-79% of personal best) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be increased. Call the practitioner if the child stays in this zone.

A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what? a. 80% of a personal best, and the routine treatment plan can be followed. b. 50% to 79% of a personal best and needs an increase in the usual therapy. c. 50 % of a personal best and needs immediate emergency bronchodilators. d. Less than 50% of a personal best and needs immediate hospitalization.

C -- The growth of children on long-term inhaled steroids should be assessed frequently to evaluate systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

Children who are taking long-term inhaled steroids should be assessed frequently for what potential complication? a. cough b. osteoporosis c. slowed growth d. Cushing syndrome

C -- Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the impaired intestinal absorption).

In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind? a. Fats and proteins must be greatly curtailed. b. Most fruits and vegetables are not well tolerated. c. Diet should be high in calories, proteins, and unrestricted fats. d. Diet should be low fat but high in calories and proteins.

D -- Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Enzymes should be given just before meals and snacks. Pancreatic enzymes are not a contraindication for antibiotics. The dose of enzymes should be increased if child is having frequent, bulky stools.

Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care? a. Give pancreatic enzymes between meals if at all possible. b. Do not administer pancreatic enzymes if the child is receiving antibiotics. c. Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food at the beginning of a meal

A, B, D The live attenuated influenza vaccine (LAIV) is an acceptable alternative to the IM vaccine (IIV) for ages 2 to 49 years. It is a live vaccine administered via nasal spray. Several groups are excluded from receiving it, including children with a chronic heart or lung disease (asthma or reactive airways disease), diabetes, or kidney failure; children who are immunocompromised or receiving immunosuppressants; children younger than 5 years of age with a history of recurrent wheezing; children receiving aspirin; patients who are pregnant; children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components; or children with a history of Guillain-Barré Syndrome after a previous dose. A child with hemophilia A or gastroesophageal reflux disease would not be immunocompromised so they can receive the LAIV.

The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.) a. a child with asthma b. a child with diabetes c. a child with hemophilia A d. a child with cancer receiving chemotherapy e. a child with GERD

A -- Asthma is the most common chronic disease of childhood, the primary cause of school absences, and the third leading cause of hospitalization in children younger than the age of 15 years. Pertussis is not a chronic illness. Tuberculosis is not a significant factor in childhood chronic illness. Cystic fibrosis is the most common lethal genetic illness among white children.

What condition is the leading cause of chronic illness in children? a. asthma b. pertussis c. tuberculosis d. cystic fibrosis

A -- Symptoms such as rhinorrhea and a low-grade fever often appear first. OM and conjunctivitis may also be present. In time, a cough may develop. Wheezing is an initial sign as well. Progression of illness brings on the symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger, and apnea.

What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include? a. rhinorrhea, wheezing, and fever b. tachypnea, cyanosis, and apnea c. retractions, fever, and listlessness d. poor breath sounds and air hunger

A -- Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for fluids by mouth to be contraindicated.

A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant's vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason? a. tachypnea b. paroxysmal cough c. irritibility d. fever

D -- The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring. A systemic corticosteroid (oral, IV, or IM) may also be given to decrease the effects of inflammation. Inhaled aerosolized short-acting β2-agonists are recommended for all patients. Therefore, Solumedrol per IV, continuous pulse oximetry, and albuterol nebulizer treatments are the expected prescribed treatments. Oral medications would not be used during the acute stage of status asthmaticus. Vital signs once a shift and spot pulse oximetry checks would not be often enough.

A 6-year-old child is in the hospital for status asthmaticus. Nursing care during this acute period includes which prescribed interventions? a. Prednisolone (Pediapred) PO every day, IV fluids, cromolyn (Intal) inhaler bid b. Salmeterol (Serevent) PO bid, vital signs every 4 hours, spot check pulse oximetry c. Triamcinolone (Azmacort) inhaler bid, continuous pulse oximetry, vital signs once a shift d. Methylprednisolone (Solumedrol) IV every 12 hours, continuous pulse oximetry, albuterol nebulizer treatments every 4 hours and prn

A -- Asthma may have these chronic signs and symptoms. Pneumonia appears with an acute onset, fever, and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the trachea occurs with acute respiratory distress or failure and maybe stridor.

A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests what condition? a. asthma b. pneumonia c. bronchiolitis d. foreign body in trachea

C -- Children with streptococcal infection are noninfectious to others 24 hours after initiation of antibiotic therapy. It is generally recommended that children not return to school or daycare until they have been taking antibiotics for a full 24-hour period. The organism is spread by close contact with affected persons—direct projection of large droplets or physical transfer of respiratory secretions containing the organism.

A child has a streptococcal throat infection and is being treated with antibiotics. What should the nurse teach the parents to prevent infection of others? a. The child can return to school immediately. b. The organism cannot be transmitted through contact. c. The child can return to school after taking antibiotics for 24 hours. d. The organism can only be transmitted if someone uses a personal item of the sick child.

A -- Nebulized epinephrine (racemic epinephrine) is now used in children with LTB that is not alleviated with cool mist. The beta-adrenergic effects cause mucosal vasoconstriction and subsequent decreased subglottic edema. The use of corticosteroids is beneficial because the anti-inflammatory effects decrease subglottic edema. Nebulizer treatments are not effective even though oxygen may be required. Antibiotics are not used because it is a viral infection. Chest physiotherapy would not be instituted.

A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with which? a. racemic epinephrine and corticosteroids b. nebuliizer treatments and oxygen c. antibiotics and albuterol d. CPT and humidity

A -- Peak expiratory flow rate monitoring is used to monitor the child's current pulmonary function. It can be used to manage exacerbations and for daily long-term management. The cause of asthma is known. Asthma is caused by a complex interaction among inflammatory cells, mediators, and the cells and tissues present in the airways. The triggers of asthma are determined through history taking and immunologic and other testing. The diagnosis of asthma is made through clinical manifestations, history, physical examination, and laboratory testing.

A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate? a. to assess severity of asthma b. to determine cause of asthma c. to identify triggers of asthma d. to confirm diagnosis of asthma

B -- Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. after CPT b. before CPT c. after receiving 100% oxygen d. before receiving 100% oxygen

B -- One of the only adverse effects of DNase is voice alterations and laryngitis. DNase is given in an aerosolized form, decreases the viscosity of mucus, and is safe for children younger than 12 years.

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). What statement about DNase is true? a. given subcutaneously b. may cause voice alterations c. may cause mucus to thicken d. not indicated for children younger than 12

C

A nurse caring for a child who is receiving oxygen therapy and is on a continuous oxygen saturation monitor that is reading 89%. Which of the following actions should the nurse take first? A. Increase the oxygen flow rate B. Encourage the child to take deep breaths C. Ensure proper or placement of the sensory probe D. Place the child in the Fowler's position.

C - Nonproductive cough is a manifestation of a respiratory infection. Hypoventilation is a manifestation of oxygen toxicity. Nasal stuffiness is a manifestation of a respiratory infection.

A nurse in the emergency department is assessing a newly admitted infant. Which of the following findings is an early indication of hypoxemia? A. Nonproductive cough B. Hypoventilation C. Tachypnea D. Nasal stuffiness

C, D RSV causes bronchiolitis. Corticosteroids are not indicated. Cheat percussion and postural drainage are not indicated. Antibiotics not indicated. Humidified oxygen provides moisture to the airway and is an action the nurse should take. Suctioning will assist the client to clear secretions.

A nurse is acting for a child who has bronchiolitis. Which of the following actions should the nurse take? Select all that apply. A. Administer oral prednisone. B. Initiate chest percussion and postural drainage C. Administer humidified oxygen. D. Suction the nasopharynx as needed. E. Administer oral penicillin.

A, C, D, E Children have cystic fibrosis have pulmonary infections. Administering antibiotics in expected part of the plan of care. Children who have cystic fibrosis have constipation and are expected to have a laxative or stool softener as part of the plan of care. Loperamide is an anti-diarrheal. Children who have cystic fibrosis have difficulty absorbing fat. Supplementation of the fat soluble vitamins is an expected part of the plan of care. Children who have cystic fibrosis have a mucous plugs. Administering a bronchodilator is an expected part of the plan of care Children who have cystic fibrosis have a mucous plugs. Administering dornase alpha, which decreases the viscosity of the mucus, is an expected part of the plan of care

A nurse is admitting a child who has cystic fibrosis. Which of the following medication should the nurse expect to include in the plan of care? Select all that apply. A. Tobramycin B. Loperamide C. Fat-soluble vitamins D. Albuterol E. Dornase Alfa

B, C, E

A nurse is assessing a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status? Select all that apply. A. Oxygen saturation 95% B. Wheezing C. Retraction of sternal muscles D. Warm extremities E. Nasal flaring

D

A nurse is caring for a child who is receiving oxygen. Which of the following findings indicates oxygen toxicity? A. Increased blood pressure B. Hyperventilation C. Decreased PaCO2 D. Unconsciousness

C

A nurse is caring for a client who is in the postoperative period following a tonsillectomy. Which of the following is a clinical finding of postoperative bleeding? A. Hgb 11.6 and Hct 37% B. Inflamed and reddened throat C. Frequent swallowing and clearing of the throat D. Blood-tinged mucus

A, B, C, D

A nurse is discussing risk factors for asthma with a group of newly licensed nurses. Which of the following conditions should the nurse include in the teaching? Select all that apply. A. Family hx of asthma B. Family hx of allergies C. Exposure to smoke D. Low birth weight E. Being underweight

A, B, C

A nurse is performing an admission assessment for a child who has cystic fibrosis. Which of the following findings should the nurse expect? Select all that apply. A. Wheezing B. Clubbing of fingers and toes C. Barrel-shaped chest D. Thin, watery mucus E. Rapid growth spurts

B, C, E

A nurse is planning care for a child who has asthma. Which of the following intervention should the nurse include in the plan of care? Select all that apply. A. Perform chest percussion. B. Place the child in a upright position. C. Monitor oxygen saturation. D. Administer bronchodilators. E. Administer dornase Alfa daily.

B

A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? A. Provide a low-calorie, low protein diet B. Administer pancreatic enzymes with meals and snacks C. Implement a fluid restriction during times of infection D. Restrict physical activity

D -- The mucous glands produce a thick mucoprotein that accumulates and results in dilation. Small passages in organs such as the pancreas and bronchioles become obstructed as secretions form concretions in the glands and ducts. The exocrine glands, not sweat glands, are dysfunctional. Although abnormalities in the autonomic nervous system are present, it is not hypoactive. Intestinal involvement in CF results from the thick intestinal secretions, which can lead to blockage and rectal prolapse.

Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF? a. hyperactivity of sweat glands b. hypoactivity of autonomic nervous system c. atrophic changes in mucosal wall of intestines d. mechanical obstruction caused by increased viscosity of mucous gland secretions

A -- Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness and not used for other children because they may become contaminated with bacteria. Drops administered before feedings are more helpful. Two drops are administered to cause vasoconstriction in the anterior mucous membranes. An additional two drops are instilled 5 to 10 minutes later for the posterior mucous membranes. No further doses should be given.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which information? A. Do not use for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops after feedings and at bedtime. d. Give two drops every 5 mins until nasal congestion subsides.

B -- Children with asthma are often excluded from exercise. This practice interferes with peer interaction and physical health. Most children with asthma can participate provided their asthma is under control. Inflammation is the underlying cause of the symptoms of asthma. By decreasing inflammation and reducing the symptomatic airway narrowing, health care providers can minimize exacerbations. Pharmacologic agents are used to prevent and control asthma symptoms, reduce the frequency and severity of asthma exacerbations, and reverse airflow obstruction. It is recommended that children with asthma be evaluated every 6 months.

One of the goals for children with asthma is to maintain the child's normal functioning. What principle of treatment helps to accomplish this goal? a. Limit participation in sports. b. Reduce underlying inflammation. c. Minimize use of pharmacologic agents. d. Have yearly evaluation by a HCP.

D -- Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39° C (102.2° F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication? a. decongestants to ease stuffy nose b. antihistamines to help the child sleep c. aspirin for fever and pain management d. benzocaine ear drops for topical pain relief