PrepU Chapter 20 --> Respiratory Disorders
The parents of a 10-year-old boy with cystic fibrosis restrict him from camping, sleepovers with friends, and school field trips. They time his respiratory treatments and log his diet, choosing most foods for him. They have him seen medically between scheduled appointments and call their physician frequently with concerns. The nurse considers these behaviors indicative of:
Vulnerable child syndrome
If there is a foreign body in the larynx, how will the client present?
With Stridor
The nurse has been caring for an 8-year-old girl with asthma. Her parents are compliant with her treatment regimen, and the girl has experienced no exacerbation of her symptoms in over 12 months. When the nurse inquires about her participation in sports or other extracurricular activities, the girl says that she can't participate because she is sick with asthma. Which response by the nurse would be most appropriate?
Your activity is not limited; what types of things would you like to do?
The nurse is bottle feeding an infant diagnosed with pneumonia. An important action for the nurse to take is clearing the infant's nose, and then the nurse should feed the infant using:
A nipple that is small enough so that the baby doesn't choke, but not so small that they have to work too hard to eat.
The 18-month-old client has had recurrent respiratory infections. The mother expresses concern that this child is having more complications from respiratory infections than her older children had. The nurse's best response would be:
Air passages are small in toddlers, and when inflamed they become smaller because of edema and are occluded with mucus.
The nurse is preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate?
Airborne Precautions
How is wheezing in children best heard?
As the child exhales
Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis?
Assisting with Racemic Epinephrine Nebulizer Therapy
The nurse is making a follow-up visit to the home of a family with a baby newly diagnosed with Cystic Fibrosis. Which outcome indicates that the parents are adjusting to the child's care needs?
Baby has gained weight
The nurse is caring for a 5-year-old girl who shows signs and symptoms of epiglottitis. The nurse recognizes a common complication of the disorder is for the child to:
Be at risk for respiratory distress
A 4-year-old with bronchiolitis has been admitted to the hospital with respiratory compromise. The father asks the nurse why the physician won't prescribe an antibiotic, "My child just keeps getting worse." What is the best response by the nurse?
Bronchiolitis is almost always caused by the Respiratory Syncytial Virus (RSV). Unfortunately, antibiotics don't work on viruses
A mother brings her 4-year-old son to the emergency department because the child has swallowed a marble. The nurse assesses the child and notes wheezing that is localized to one side of the chest. The nurse determines that the obstruction is at which location?
Bronchus
The nurse is caring for a 7-year-old client with pneumonia. Several minutes after beginning an infusion of an IV dose of Gentamicin, the nurse observes the client having labored breathing and scratching at red areas on her arms. The nurse turns off the infusion immediately. Which of the following actions should the nurse take next?
Document the symptoms of the adverse reaction and notify the pharmacist and prescribing physician
The nurse is correct to identify which group of symptoms as present with acute laryngotracheobronchitis?
Fever and Labored Respirations
Infectious mononucleosis ("mono") is caused by which of the following?
Epstein-Barr Virus
A nurse is teaching a parent how to use a bulb syringe to suction the infant who is recovering from bronchiolitis. What is the best way for the nurse to evaluate the parent's learning?
Observe the parent using the bulb syringe to suction the infant
A nurse is educating the parents of a toddler diagnosed with spasmodic laryngitis. Which statement made by the parents indicates that the teaching was effective?
Our Child's symptoms will likely resolve with minimal intervention
A child is exhibiting signs and symptoms of hypoxemia. Which of the following would the nurse expect to administer?
Oxygen
A pediatric client is having difficulty breathing. Which nursing intervention is appropriate for this client?
Provide oxygen as needed to maintain oxygen saturation above 93%
The nurse is concerned that a school-age child is developing pneumonia. What did the nurse most likely assess in this client? Select all that apply.
- Rales - Elevated Temperature - Productive, Harsh Cough
The nurse is performing a routine assessment on a 3-year-old child. Which finding(s) prompts the nurse to perform an in-depth assessment of the child's respiratory status? Select all that apply.
- Restlessness - Tachycardia - Tachypnea - Diaphoresis
The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family?
Encourage everyone in the family to use good handwashing techniques
An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition?
Encourage high calorie, high protein snacks
A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, which parts of the body (besides the lungs) are most affected by this disease?
Pancreas and Liver
A parent of an 8-year-old with asthma tells the nurse, "I allow him to play soccer at school as long as he has his inhaler. He has been instructed when and how to use his inhaler." What type of caregiver response is this parent exhibiting?
Gradual Acceptance
Which of the following would be most important to determine when assessing a child who is suspected of having tuberculosis?
History of exposure
What statement is the most accurate regarding the structure and function of the newborn's respiratory system?
Most infants are nasal breathers rather than mouth breathers
For a toddler, what medication delivery system will the nurse choose to relieve the bronchospasm that occurs with asthma?
Nebulizer
The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child?
Pulmonary functions test
The nurse is completing a respiratory assessment hourly. Which assessment finding is of most concern?
Quiet chest on auscultation
A child diagnosed with tuberculosis is receiving drug therapy. The nurse instructs the parents that the child's urine and secretions may turn orange because which of the following was prescribed?
Rifampin
Angie is 14 months old and has bronchopulmonary dysplasia (BPD). What type of side effects would the nurse assess for when giving Angie bronchodilators?
Shakiness and Tremors
A child is brought to the emergency department late one evening and is diagnosed with croup. The child was noted to have a shrill, harsh respiratory sound when breathing in. This symptom is referred to as:
Stridor
The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which intervention?
Suctioning a Tracheostomy tube
The nurse is assessing a 6-month-old child with suspected cystic fibrosis. What test will the nurse anticipate as most likely for the child?
Sweat Chloride Test
The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child?
Sweat sodium chloride test
The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia?
The child attends day care
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 in the tripod position
The nurse makes the statement that if an older child inhales a foreign body, the inhaled object is more likely to be drawn into the right bronchus rather than the left. What is the basis for this statement?
The right bronchus is shorter and wider than the left
The nurse is taking a respiratory HX 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 triggers in the environment
The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method?
Using a Nebulizer
The health care provider has prescribed beclomethasone for long term control of asthma. The nurse is most correct to advise the client that beclomethasone is a:
Corticosteroid
The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:
Epiglottitis
The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with:
A bronchodilator and mast cell stabilizers
A 6-year-old child is seen in the clinic for a sick visit. The parent states the child has had a cold for 4 days but today the child seems worse. The nurse has completed an initial assessment with the findings in the chart note shown above. Based on this information, the nurse should expect a diagnosis of which disorder?
Laryngotracheobronchitis (LTB)
Which of the following in the child's history puts them at increased risk for asthma-related death?
Current use of Corticosteroids
A caregiver calls the pediatrician's office and reports to the nurse that her 4-year-old, who was fine the previous day, complained of a sore throat early in the morning and now has a temperature of 102.6°F (39.2°C). The caregiver has tried to get the child to nap but the child gets panicky, immediately sits back up, and leans forward with her mouth open and tongue out when the caregiver encourages her to lie down. The nurse suspects the child has which condition?
Epiglottitis
The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect?
Increased HR and Restlessness
The nurse is reviewing the chart of a client that reads: "3-year-old client with history of an upper respiratory infection that slowly increased in severity over approximately 1 week. Today, the client exhibits a brassy cough, dyspnea, and irritability. Heart rate 110 beats/min, respiratory rate 45 breaths/min, blood pressure 92/56 mm Hg, oral temperature 100.9°F (38.3°C)." To which croup syndrome should the nurse attribute these findings?
Laryngotracheobronchitis (LTB)
The caregivers of a child who was diagnosed with cystic fibrosis 5 mon 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?
Pancreatic Enzymes
Which electrolyte does the client with cystic fibrosis need in abundance?
Sodium
The nurse has assessed four clients. Which assessment finding warrants immediate action?
1 week-old newborn with nasal congestion
The nurse is assisting in an emergency situation at a store. The child appears pale, has small quick respirations, exhibits stridor and is sitting in a tripod position. What action will the nurse take first?
Instruct someone to call 911 for emergency assistance
The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider?
The child was eating peanuts yesterday
The nurse is caring for a 5 year-old client and notes RR of 45 b/min, BP 100/70 mmHg, HR 115, Temp 101ºF, and O2 sat of 86%. Which diagnostic test is priority for the nurse to complete?
Arterial Blood Gas (ABG)
The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be:
Chronic Lack of Oxygen
The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed?
It is okay for our child to to chores with as sweeping the floor
The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method?
Sprinkled onto the food
The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be:
Chronic lack of oxygen
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 ER nurse should first .... ASSESS AIRWAY & then ADMINISTER IV METHLPREDNISONE
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?
Epiglottitis
A child is hospitalized with pneumonia. The nurse assesses an increase in the work of breathing and in the respiratory rate. What intervention should the nurse do first to help this child?
Elevate the HOB
