Ch. 26 Pediatric Quiz

A (Nausea and vomiting)

Clinical manifestations of influenza usually include all of the following EXCEPT: A. Nausea and vomiting B. Fever and chills C. Sore throat and dry mucous membranes D. photophobia and myalgia

C (Somnolence)

A child is developing respiratory failure. What are the assessment findings to indicate the signs of hypoxia are becoming severe? A. Tachypnea B. Tachycardia C. Somnolence D. Restlessness

D (All of the above)

A congenital diaphragmatic hernia is suspected when the newborn has which of the following? A. Acute respiratory distress B. Scaphoid abdomen C. Signs of shock D. All of the above

Spot test (Monospot)

A slide test of high specificity for the diagnosis of infectious mononucleosis.

Epstein-Barr

A virus; the principal cause of infectious mononucleosis.

B (A child with classic signs of strep throat and rapid antigen testing that was negative.)

According to the American Academy of Pediatrics, a throat culture for streptococcus is recommended in: A. All children with classic signs of strep throat B. A child with classic signs of strep throat and rapid antigen testing that was negative. C. A child with classic signs of strep throat and rapid antigen testing that was positive. D. None of the above, as a throat culture for streptococcus is not recommended in children.

Pharyngeal tonsils

Adenoids; located above the palatine tonsils on the posterior wall of the nasopharynx.

Adenoids

Also known as pharyngeal tonsils.

A (Frequent swallowing.)

An early indication of hemorrhage in a child who has had a tonsillectomy is: A. Frequent swallowing. B. Decreasing blood pressure. C. Restlessness. D. Bradycardia.

A (Bulging tympanic membranes)

An otoscopic examination in a child with OM would reveal: A. Bulging tympanic membrane. B. A light reflex. C. Orange tympanic membrane. D. Mobile tympanic membrane.

Heterophil antibody test

Determines the extent to which the patient's serum will agglutinate sheep red blood cells; used to diagnose infectious mononucleosis (titer of 1:160 required for diagnosis); rapid, sensitive, inexpensive, and easy to perform.

C (Heterophil agglutination test is positive.)

Diagnosis of infectious mononucleosis is established when the: A. Red blood cell count is depressed B. Leukocyte count is depressed C. Heterophil agglutination test is positive D. Heterophil agglutination is negative

Palatine tonsils

Faucial tonsils; located on either side of the oropharynx, behind and below the pillars of the fauces; usually visible during oral examination; removed during tonsillectomy.

Tubal tonsils

Found near the posterior nasopharyngeal opening of the eustachian tubes; not a part of the Waldeyer tonsillar ring.

C (Brief illness that leaves the child at risk for serious sequelae)

Group A B-Hemolytic streptococci infection is usually a: A. Serious infection of the upper airway. B. Common cause of pharyngitis in children over the age of 15 years. C. Brief illness that leaves the child at risk for serious sequelae. D. Disease of the heart, lungs, joints, and central nervous system.

Strep throat

Group A B-hemolytic streptococcus (GABHS) infection of the upper airway.

A (Antipyretics)

Home management for children with nasopharyngitis may include: A. Antipyretics B. Antihistamines C. Expectorants D. Cough suppressants

D (Administration of water-soluble vitamins)

Identify which of the following therapies is NOT usually included in the care of the child or adolescent with cystic fibrosis. A. Administration of pancreatic enzymes B. Airway clearance therapy C. Administration of fat-soluble vitamins D. Administration of water-soluble vitamins

C (Splenomegaly)

In about half of all cases of infectious mononucleosis, there will be: A. Skin rash B. Otitis media C. Splenomegaly D. Failure to thrive

D (Enlarged cervical lymph nodes)

In addition to acute pain, the clinical manifestations of otitis media include: A. Purulent discharge in the external auditory canal B. Clear discharge in the external auditory canal C. Enlarged axillary lymph nodes D. Enlarged cervical lymph nodes

C (Immunization status of the infant)

In an 8-month-old infant admitted with pertussis, the nurse should assess the: A. Living conditions of the infant B. Labor and delivery history of the mother C. Immunization status of the infant D. Alcohol and drug intake of the infant

A (Have intubation equipment available)

In the child who is suspected of having epiglottitis, the nurse should: A. Have intubation equipment available. B. Prepare to immunize the child for H. influenzae C. Obtain a throat culture. D. Do all of the above.

A (Enzyme-linked immunosorbent assay test on nasal secretions)

In the infant who is admitted with possible RSV, the nurse would expect the laboratory to perform: A. Enzyme-linked immunosorbent assay test on nasal secretions. B. A viral culture of the stool. C. A bacterial culture of nasal secretions. D. An anaerobic culture of the blood.

D (Observed for subtle signs of hemorrhage.)

In the postoperative period following a tonsillectomy, the child should be: A. Placed in Trendelenburg position. B. Encouraged to cough and deep breathe. C. Suctioned vigorously to clear the airway. D. Observed for subtle signs of hemorrhage.

B (Apnea)

Infants under the age of 6 months who are diagnosed with pertussis are more likely to present with: A. Severe cough B. Apnea C. Tachypnea D. Sore throat

B (Self-limiting disease)

Infectious mononucleosis is usually a: A. Disease complicated by pneumonitis and anemia B. Self-limiting disease C. Disabling disease D. Difficult and prolonged disease

Prevent and control symptoms; reduce frequency and severity of exacerbations; reverse airflow obstruction

List the three primary goals of pharmacologic therapy for asthma.

Increased RR makes it difficult to take in fluids/nurse; Fever increases total body fluid turnover; Nasal secretions block passageways making it difficult to breathe, making it difficult to drink/nurse

List three reasons infants and small children can become easily dehydrated when they have an upper respiratory tract infection.

Lingual tonsils

Located at the base of the tongue.

Antigenic shift

Major changes in viruses that occur at intervals of usually 5 to 10 years.

Antigenic drift

Minor variations in viruses that occur almost annually.

1 to 2

Most antiviral influenza medications must be administered within __________________ days of the onset of symptoms to be effective.

C (Can be cared for at home.)

Most children with croup: A. Require hospitalization. B. Will need to be intubated. C. Can be cared for at home. D. Are over 6 years old.

B (Amoxicillin)

Of the following antibiotics, the one that would most likely be prescribed for uncomplicated otitis media would be: A. Tetracycline. B. Amoxicillin. C. Gentamicin. D. Methicillin.

D (Acute epiglottitis)

Of the following croup syndromes, the one that is potentially life threatening is: A. Spasmodic croup. B. Laryngotracheobronchitis. C. Acute spasmodic laryngitis. D. Acute epiglottitis.

C (Flavored ice pops.)

Of the following foods, the most appropriate to offer first to an alert child in the postoperative period following a tonsillectomy would be: A. Ice cream. B. Red gelatin. C. Flavored ice pops. D. Flavored yogurt.

C (Tonsillitis)

Offensive mouth odor, persistent dry cough, and a voice with a muffled nasal quality are commonly the result of: A. Pneumonia B. Otitis externa C. Tonsillitis D. Otitis media

Acute glomerulonephritis

One of the more serious sequelae of strep throat; an acute kidney infection.

Acute rheumatic fever

One of the more serious sequelae of strep throat; an inflammatory disease of the heart, joints, and central nervous system.

C (Orally or intravenously at regular intervals.)

Pain medication for the child in the postoperative period following a tonsillectomy should be administered: A. Rectally at regular intervals. B. Orally only as requested. C. Orally or intravenously at regular intervals. D. Rectally or intravenously as needed.

D (Tympanostomy tubes)

Recurrent otitis media with effusion after a total of 4 to 6 months of bilateral effusion with bilateral hearing deficit would most likely be managed therapeutically by: A. Tonsillectomy. B. Steroids. C. Polyvalent pneumococcal polysaccharide vaccine. D. Tympanostomy tubes.

Adenoidectomy

Removal of the adenoids; recommended for those children in whom hypertrophied adenoids obstruct nasal breathing.

Tonsillectomy

Removal of the palatine tonsils; indicated for massive hypertrophy that results in difficulty breathing and eating.

B (Acute epiglottitis)

Since the advent of immunization for H. influenza type B, there has been a decrease in the incidence of: A. Laryngotracheobronchitis. B. Acute epiglottitis. C. Bacterial tracheitis. D. Bronchiolitis.

A (Endotracheal suctioning every 2 hours)

Strategies to prevent ventilator-associated pneumonia in infants and children include all of the following EXCEPT: A. Endotracheal suctioning every 2 hours. B. Elevation of the head of the bed (30-35 degrees). C. Oral care every 4 hours. D. Closed suctioning system.

D (Adolescents)

The age-group with the highest asthma mortality risk includes: A. Infants and toddlers. B. Preschoolers. C. School age. D. Adolescents.

B (To avoid contact with infected persons)

The best technique to use to prevent spread of nasopharyngitis is: A. Antibiotic administration B. To avoid contact with infected persons C. Mist vaporization D. To ensure adequate fluid intake

B (Tuberculin skin test)

The best test to screen for tuberculosis in a child is the: A. Chest x-ray. B. Tuberculin skin test. C. Sputum culture. D. Multipuncture tests (MPT), such as the tine test.

A (Lie in a relatively horizontal plane)

The infant is predisposed to developing otitis media because the eustachian tubes: A. Lie in a relatively horizontal plane B. Have a limited amount of lymphoid tissue C. Are long and narrow D. Are underdeveloped

B (Viruses)

The largest percentage of respiratory tract infections in children is caused by: A. Pneumococci B. Viruses C. Streptococci D. Haemophilus influenzae

Waldeyer tonsillar ring

The mass of lymphoid tissue that encircles the nasal and oral pharynx.

B (Meconium ileus)

The most common early manifestation of cystic fibrosis is: A. Meconium aspiration. B. Meconium ileus. C. Growth failure. D. Chronic cough.

C (Maternal antibodies have disappeared, and the infant's own antibody production is immature.)

The most likely reason that the respiratory tract infection rate increases drastically in the age range from 3 to 6 months is that the: A. Infant's exposure to pathogens is greatly increased during this time. B. Viral agents that are mild in older children are severe in infants. C. Maternal antibodies have disappeared, and the infant's own antibody production is immature. D. Diameter of the airways is smaller in the infant than in the older child.

D (Try inserting a smaller tube.)

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What would be the nurse's next action? A. Notify the surgeon. B. Perform oral intubation. C. Try inserting a larger tube. D. Try inserting a smaller tube.

D (Cover the skin with a shirt or gown before percussing.)

The nurse is teaching a mother how to perform chest physiotherapy and postural drainage on her 3-year-old child, who has cystic fibrosis. What would the nurse include in the instructions for performing percussion? A. Strike the chest wall with a flat-hand position. B. Percuss before and after positioning for postural drainage. C. Percuss over the entire trunk anteriorly and posteriorly. D. Cover the skin with a shirt or gown before percussing.

C (Drooling, agitation, and absence of cough)

The nurse should suspect epiglottitis if the child has: A. Cough, sore throat, and agitation. B. Cough, drooling, and retractions. C. Drooling, agitation, and absence of cough. D. Hoarseness, retractions, and absence of cough.

B (Yearly immunization with influenza vaccine)

The prevention of influenza in children 6 months to 18 years of age is primarily based on: A. Administration of antiviral medications B. Yearly immunization with influenza vaccine C. Strict avoidance of infected persons D. Yearly administration of Haemophilus influenzae type B vaccine

A (Vigilant assessment, cool mist, racemic epinephrine, and corticosteroids)

The primary therapeutic regimen for croup usually includes: A. Vigilant assessment, cool mist, racemic epinephrine, and corticosteroids. B. Vigilant assessment, cool mist, racemic epinephrine, and antibiotics. C. Intubation, cool mist, racemic epinephrine, and corticosteroids. D. Intubation, nebulized epinephrine, and antibiotics

A, B, D (Isoniazid (INH); Rifampin; Ethambutol)

The recommended treatment for the child who has clinically active tuberculosis includes a 6-month regimen of (SELECT ALL THAT APPLY): A. Isoniazid (INH). B. Rifampin. C. Pyrazinamide (PZA). D. Ethambutol. E. Rocephin.

B (Oral or intramuscular antibiotic administration.)

The standard effective treatment for GABHS is: A. Intravenous antibiotic administration. B. Oral or intramuscular antibiotic administration. C. Nebulized racemic epinephrine. D. Warm saline gargles.

C (Codeine)

There is evidence that ___________ may not be metabolized effectively in some small children after tonsillectomy or adenoidectomy, possibly causing life-threatening adverse events or death. A. Acetaminophen B. Morphine C. Codeine D. Oxycodone

A, C (Acetaminophen or ibuprofen (as age permits); benzocaine ear drops)

To help alleviate the discomfort and fever of acute otitis media, the parents are advised to administer (SELECT ALL THAT APPLY): A. Acetaminophen or ibuprofen (as age permits). B. Antihistamines (as age permits). C. Benzocaine ear drops. D. Decongestants (as age permits).

A (Oximetry)

What blood oxygenation tests is the photometric measurement of oxygen saturation? A. Oximetry B. Capnography C. Arterial puncture D. Transcutaneous oxygen and carbon dioxide monitoring

A (Infants rely almost entirely on diaphragmatic-abdominal breathing.)

What helps nurses understand how the respiratory tract in children is different from the respiratory tract in adults? A. Infants rely almost entirely on diaphragmatic-abdominal breathing. B. Smooth muscle development in the airways increases until about age 12 years. C. The configuration of the chest at birth is not as round as it becomes by adulthood. D. With age there is a decrease in both number of alveoli and branching of terminal bronchioles.

C (Compliance)

What is a measure of chest wall and lung distensibility? A. Resistance B. Ventilation C. Compliance D. Alveolar surface tension

D (Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades.)

What is a primary intervention when an infant chokes on a piece of food? A. Administer mouth-to-mouth resuscitation. B. Open the infant's mouth and perform a blind finger sweep. C. Have the infant lie quietly while a call is placed for emergency help. D. Position the infant in a head-down, prone position and administer five quick blows between the shoulder blades.

C (Ensure uninterrupted delivery of the appropriate oxygen concentration.)

What is included in nursing considerations related to the administration of oxygen in an infant? A. Discontinue during feedings so child can be held. B. Assess infant to determine how much oxygen should be given. C. Ensure uninterrupted delivery of the appropriate oxygen concentration. D. Direct oxygen flow so that it blows directly into the infant's face in a hood.

C (A lateral neck soft tissue radiograph)

Which of the following diagnostic adjuncts is often used to diagnose acute epiglottitis? A. A 2-view chest radiograph (anterior and lateral views) B. Throat inspection with tongue blade C. A lateral neck soft tissue radiograph D. Laryngoscopy with mild sedation

A (Live attenuated influenza vaccine)

Which of the following influenza vaccines were discontinued due to concerns about its effectiveness? A. Live attenuated influenza vaccine B. Inactivated influenza vaccine C. Intradermal influenza vaccine

D (Gastroesophageal reflux)

Which of the following is NOT usually a cause of ARDS/ALI in children? A. Smoke inhalation B. Submersion injury C. Sepsis D. Gastroesophageal reflux

B (Palivizumab)

Which of the following is administered prophylactically to infants at high risk for the development of RSV? A. Ribavirin B. Palivizumab C. Pneumococcal vaccine D. Penicillin G

C (Dry the ear canal after swimming with a cotton swab)

Which of the following techniques would be CONTRAINDICATED for the nurse to recommend to parents to prevent recurrent otitis media? A. Place a combination of vinegar and alcohol in each ear after swimming B. Limit swimming to less than an hour C. Dry the ear canal after swimming with a cotton swab D. Use a hair dryer on low heat at 18 to 24 inches for 30 seconds several times a day