Chapter 40: Nursing Care of the Child With an Alteration in Gas Exchange/Respiratory Disorder - ML6

A client asks the nurse why a healthy newborn would be at risk for hypoxemia. How should the nurse reply?

"A newborn only has half of the number of alveoli developed, placing the newborn at risk."

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful?

"Exposure to second- or third-hand smoke increases the risk for developing RSV."

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?

"Has your infant been around any crowds?"

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 this hospital worker take a picture of your lungs."

The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse?

"I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms."

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 do chores such as sweeping the floor."

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 sister and her family love animals, and when we go to their house my daughter always has 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."

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.

(1) assess airway (2) administer IV methylprednisolone

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.

What is the most common debilitating disease of childhood among those of European descent?

Cystic fibrosis

Upon providing discharge instructions home after a tonsillectomy and adenoidectomy, which is most important?

Note any frequent swallowing.

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

The nurse is caring for a child who has been admitted with a possible diagnosis of tuberculosis. Which laboratory/diagnostic tools would most likely be used to help diagnose this child?

Purified protein derivative test

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

Which electrolyte does the client with cystic fibrosis need in abundance?

Sodium

What is a definitive test for cystic fibrosis?

Sweat chloride

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 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 tripod position.

A 2-year-old toddler is seen for acute laryngotracheobronchitis. What observation would lead the nurse to suspect airway occlusion?

The respiratory rate is gradually increasing.

A 6-year-old child was diagnosed as having streptococcal pharyngitis. At the follow-up visit, the nurse will assess the child for which potential complication?

development of rheumatic fever

A child has been admitted to the pediatric unit with pneumonia. The nurse is preparing to administer the prescribed medication to the child to help reduce the viscosity of the child's secretions. Which medication would the nurse most likely give?

guaifenesin

If there is a foreign body in the larynx, how will the client present?

with stridor

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.

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.

A worried mother calls the nurse and tells her that her son has developed a horrible croup cough and is having trouble breathing. What would be the best intervention for the nurse to recommend to the mother?

Run a hot shower to fill the bathroom with steam and have the boy stay there.

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 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.

Which clinical manifestation of acute nasopharyngitis is more of a concern for the infant than the older child?

Nasal congestion

A child presents to the health clinic with a temperature of 101.8°F (38.8°C), dysphagia, headache, and a sore, erythematous throat. Which collaborative intervention will the nurse complete first?

Obtain a throat culture.

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan?

Obtain testing for respiratory syncytial virus.

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease?

Open capsule and sprinkle on food.

Which nursing diagnosis would best apply to a child with allergic rhinitis?

Pain related to sinus edema and headache

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?

Pancreatic enzymes

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.

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's airway will remain clear and free of mucus.

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 triggers in the environment

The nurse caring for the child with asthma weighs the child daily. What is the most important reason for doing a daily weight on this child?

To determine fluid losses

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 nurse is collecting data on a child with a diagnosis of tonsillitis. Which clinical manifestation would likely have been noted in the child with this diagnosis?

erythema of the pharynx

A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as:

funnel.

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, what would the nurse expect to be used to deliver the highest concentration of oxygen to the child?

nonrebreather (face) mask

The nurse is teaching a child and their parents how best to manage the child's asthma. Which piece of equipment will be most helpful in determining the status of this child's airway?

peak flow meter

What is a complication of cystic fibrosis?

pneumothorax

What is a symptom of allergic rhinitis (hay fever)?

sinus pain

The nurse is assessing an infant who has been admitted with acute bronchiolitis. Which probable cause should the nurse suspect?

viral infection

The nurse is doing discharge teaching for a child who has had a tonsillectomy. The nurse tells the client and family that the child should have plenty of fluids. In addition, the nurse would explain to the child's caregiver that the child may:

vomit dark, old blood, but the caregiver should call the clinic if the child has bleeding between the fifth and seventh days postoperatively.

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?

Apply oxygen via a facemask.

The nurse is doing an in-service training with nurses working with families who may be in situations that create high-risk health situations for their children. The nurse explains that children of caregivers with which situation should be tested annually for tuberculosis?

a caregiver whose family is homeless

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

The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the order in which the nurse should administer these medications as the child's condition worsens.

(1) Albuterol as needed (2) Low-dose inhaled corticosteroid (3) Medium-dose inhaled corticosteroid (4) Medium-dose inhaled corticosteroid and salmeterol

The child has been admitted to the hospital with a possible diagnosis of pneumonia. Which finding(s) is consistent with this diagnosis? Select all that apply.

(1) The child's chest x-ray indicates the presence of perihilar infiltrates. (2) The child's white blood cell count is elevated. (3) The child's respiratory rate is rapid. (4) The child is producing yellow purulent sputum.

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?

Metered-dose inhaler

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first?

"Have him use his short-acting bronchodilator right away."

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress?

2-year-old child with epiglottitis

The nurse working at the child community clinic must administer the influenza vaccine to the high-risk children first. Which child would she choose first?

23-month-old client who had heart surgery as an infant for a defect

An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. What is the course of treatment that the nurse would expect in this situation?

Antipyretic, analgesic, and antibiotic

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete?

Arterial blood gas (ABG)

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis?

Assisting with racemic epinephrine nebulizer therapy

Pancreatic enzymes are part of the treatment in cystic fibrosis. When should the nurse administer the enzymes?

Before meals and snacks with milk

The nurse is caring for an infant whose oxygen saturation levels frequently drop below 90%. Which data is most important to relate to the health care provider?

Blood gases

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?

Continue to assess for bleeding.

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.

Which acute respiratory condition is the most common in early childhood?

croup