Exemplar 15.E Respiratory Syncytial Virus/Bronchiolitis (RSV/B)
Which population should the nurse assigned to care for pediatric clients recognize as having the highest risk of hospitalization due to RSV? A) Alaskan Native infants B) African American infants C) Native American infants D) Asian American infants
A RSV is a major cause of hospitalization among Alaskan Native infants and is responsible for one-third of hospitalizations of children younger than 3 years in Alaska. The rate of hospitalization is three to five times higher for Alaskan Native infants than for other infants.
The clinic nurse is educating a group of new moms on the risk factors and prevention of respiratory syncytial virus (RSV). What should the nurse stress as the best way to prevent RSV? A) Hand washing B) Monitoring temperature C) Administering antibiotics D) Limiting fluid intake
A The best way to prevent RSV is through good hand hygiene and infection-control measures. Monitoring temperature would not prevent infection but would be appropriate for monitoring infection. Administering antibiotics is usually ordered by the physician when a bacterial infection is suspected, not a viral infection. There is no indication of the need to limit fluids, which could potentially produce other complications.
The nurse working in the emergency department (ED) is assessing an infant client. Which findings does the nurse anticipate in a child diagnosed with respiratory syncytial virus (RSV)? Select all that apply. A) Rhinorrhea B) Irritability C) Grunting D) Bradypnea E) Tachypnea
A, B, C, E A) The early signs of RSV include rhinorrhea (drainage of mucus from the nose), cough, irritability, and a low-grade fever for 1-3 days. Other clinical manifestations include, but are not limited to, tachypnea (not bradypnea), wheezing, and grunting. B) The early signs of RSV include rhinorrhea (drainage of mucus from the nose), cough, irritability, and a low-grade fever for 1-3 days. Other clinical manifestations include, but are not limited to, tachypnea (not bradypnea), wheezing, and grunting. C) The early signs of RSV include rhinorrhea (drainage of mucus from the nose), cough, irritability, and a low-grade fever for 1-3 days. Other clinical manifestations include, but are not limited to, tachypnea (not bradypnea), wheezing, and grunting. E) The early signs of RSV include rhinorrhea (drainage of mucus from the nose), cough, irritability, and a low-grade fever for 1-3 days. Other clinical manifestations include, but are not limited to, tachypnea (not bradypnea), wheezing, and grunting.
Which prevention strategies would be the most beneficial for the nurse to discuss with the parents of a child who has had repeated admissions for respiratory syncytial virus (RSV) bronchiolitis? Select all that apply. A) Do not smoke, and avoid all secondhand smoke around the child. B) Practice frequent hand washing. C) Encourage physical activity and play. D) Consider alternatives to sending the child to daycare. E) Ensure an adequate nutritional intake.
A, B, D A) Exposure to cigarette smoke and attending daycare are both risk factors for RSV/bronchiolitis. The nurse should discuss with the parents smoking cessation and alternative methods of childcare. Practicing frequent hand washing is a primary prevention method for RSV, so this should be practiced by the parents. Nutritional intake and physical activity are good for maintaining general health, but they are not specific for preventing RSV/bronchiolitis. B) Exposure to cigarette smoke and attending daycare are both risk factors for RSV/bronchiolitis. The nurse should discuss with the parents smoking cessation and alternative methods of childcare. Practicing frequent hand washing is a primary prevention method for RSV, so this should be practiced by the parents. Nutritional intake and physical activity are good for maintaining general health, but they are not specific for preventing RSV/bronchiolitis. D) Exposure to cigarette smoke and attending daycare are both risk factors for RSV/bronchiolitis. The nurse should discuss with the parents smoking cessation and alternative methods of childcare. Practicing frequent hand washing is a primary prevention method for RSV, so this should be practiced by the parents. Nutritional intake and physical activity are good for maintaining general health, but they are not specific for preventing RSV/bronchiolitis.
The nurse is developing a plan of care for a toddler diagnosed with respiratory syncytial virus (RSV). Which intervention is inappropriate for this client? A) Offer small, frequent meals. B) Encourage to ambulate frequently. C) Encourage oral intake. D) Monitor intake and output.
B It would not be appropriate to encourage frequent ambulation. Nursing interventions should be introduced in an effort to reduce fatigue, such as allowing rest periods. All other interventions are appropriate for this client.
The mother of a 5-month-old baby, who attends daycare, is concerned because the child has developed a runny nose, cough, and low-grade fever over the last few days. These symptoms are consistent with which condition? A) Meningitis B) Respiratory syncytial virus (RSV) bronchiolitis C) Bronchitis D) The common cold
B The typical clinical presentation of respiratory syncytial virus (RSV) bronchiolitis in otherwise healthy children begins 3-5 days after exposure to the virus. The early signs of a mild infection include rhinorrhea or a runny nose, cough, irritability, and a low-grade fever for 1-3 days. A fever is not associated with the common cold. A runny nose and cough are not symptoms associated with meningitis. Bronchitis has a distinctive cough and may or may not be associated with a fever.
The nurse is planning care for a child with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should the nurse include in the child's plan of care to address the nursing diagnosis Impaired Gas Exchange? Select all that apply. A) Weigh daily. B) Monitor vital signs and pulse oximetry. C) Administer oxygen as prescribed. D) Weigh diapers. E) Provide frequent rest periods.
B, C B) Interventions appropriate for the client with the nursing diagnosis of Impaired Gas Exchange due to RSV bronchiolitis include monitoring vital signs, pulse oximetry, and breathing pattern, and administering oxygen. Daily weight would be appropriate for the nursing diagnosis of Impaired Nutrition: Less than Body Requirements. Weighing diapers would be appropriate for the nursing diagnosis of Fluid Volume Deficit. Providing frequent rest periods would be appropriate for the nursing diagnosis of Activity Intolerance. C) Interventions appropriate for the client with the nursing diagnosis of Impaired Gas Exchange due to RSV bronchiolitis include monitoring vital signs, pulse oximetry, and breathing pattern, and administering oxygen. Daily weight would be appropriate for the nursing diagnosis of Impaired Nutrition: Less than Body Requirements. Weighing diapers would be appropriate for the nursing diagnosis of Fluid Volume Deficit. Providing frequent rest periods would be appropriate for the nursing diagnosis of Activity Intolerance.
The nurse assesses fatigue in an infant with acute bronchiolitis due to respiratory syncytial virus (RSV). Which nursing diagnosis would be most appropriate for the infant? A) Acute Pain B) Ineffective Tissue Perfusion C) Activity Intolerance D) Decreased Cardiac Output
C Activity intolerance is a problem because of the imbalance between oxygen supply and demand. Increased levels of fatigue may indicate the disease is more severe. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually associated with acute bronchiolitis. Tissue perfusion is not affected by this respiratory disease process.
The nurse is providing care to a client diagnosed with respiratory syncytial virus (RSV) bronchiolitis. Which assessment finding indicates that treatment has been effective? A) Client ingesting small amounts of clear fluids when encouraged B) Client resting in bed with limited interest in play or activities C) Client respiratory rate within normal limits for age D) Client coughing copious amounts of green sputum and requires occasional suctioning
C Evidence that care is effective would include normal rate, rhythm, and quality of the breathing patterns for the client's age. The client who is resting in bed with limited interest in play or activities is not demonstrating an improvement in respiratory status. The client who is ingesting small amounts of fluids might still be experiencing thickened secretions. If the client is coughing copious amounts of green sputum and requiring occasional suctioning, the interventions have not been effective, as the child still needs assistance with clearing the airway.
The nurse observes a toddler, admitted with possible respiratory syncytial virus (RSV) bronchiolitis, grunting with expiration. Which action by the nurse is appropriate? A) Assist the child to clear the nasal passages. B) Limit fluids. C) Suction the airway to relieve the obstruction. D) Lay the child on his back.
C Grunting is seen with partial airway obstruction caused by increased secretions and edema. The nurse should suction the airway to relieve the obstruction. Laying the child on his back will not improve the child's ability to breathe. Fluids should be increased to thin secretions. Assisting the child to clear the nasal passages would be applicable if the child were experiencing rhinorrhea.
An infant with respiratory syncytial virus (RSV) bronchiolitis is prescribed intubation to maintain an adequate airway. Who will the nurse collaborate with to maintain the endotracheal tube and ventilation? A) An advanced practice nurse B) The primary healthcare provider C) A respiratory therapist D) A play therapist
C Infants who need endotracheal intubation will be closely cared for by the respiratory therapist. The advanced practice nurse, primary healthcare provider, and play therapist are not responsible for maintaining the client's endotracheal tube and ventilation.
Which is the most appropriate outcome for the nurse to select for a 78-year-old resident of a long-term care facility with regard to preventing RSV? A) The client's airways will remain clear of secretions. B) The client's fluid intake will meet daily requirements of 2000 mL per day. C) The client will demonstrate knowledge of proper hand washing techniques. D) The client will meet daily nutritional needs as provided by a nutritionist.
C RSV is spread by direct contact with contaminated surfaces or an infected individual, so use of proper hand washing techniques can help prevent infection in susceptible individuals. Both adequate fluid intake and meeting daily nutritional needs will be beneficial for the client, but they are not specifically related to preventing infection. An outcome related to airways remaining clear of secretions is more appropriate for an individual who already has RSV.
The primary cells involved in infection by respiratory syncytial virus (RSV) are the A) smooth muscle cells in the bronchi and bronchioles. B) granular pneumonocytes in the alveoli. C) squamous epithelial cells of the bronchioles and alveoli. D) macrophages and monocytes of the bronchioles and alveoli.
C Respiratory syncytial virus infects the squamous epithelial cells of the bronchioles and alveoli. It does not infect smooth muscle cells, granular pneumonocytes (the surfactant-secreting cells), or the macrophages and monocytes.
The mother of an 8-month-old baby who has developed respiratory syncytial virus (RSV)/bronchiolitis wants to know which factors contribute to the risk of contracting RSV. Which response by the nurse is appropriate? A) "There is a higher risk in children who are being breastfed." B) "There is no way to avoid the illness." C) "There is a higher risk in children who are exposed to secondary cigarette smoke." D) "It is seen more frequently in children who do not attend daycare."
C The risk of infection with RSV is higher for infants and toddlers who are not breastfed, live in homes with secondary cigarette exposure, attend daycare, live in crowded conditions, or are socioeconomically disadvantaged. RSV can be avoided by limiting these risk factors.
The nurse is providing care to a 7-month-old child hospitalized with RSV/bronchiolitis. The nurse can expect to provide client teaching to the parents about which medication? A) Corticosteroids B) Nebulized epinephrine C) Antibiotics D) Nebulized hypertonic saline
D Nebulized hypertonic saline is used to promote mucociliary clearance in hospitalized clients with RSV/bronchiolitis. Nebulized epinephrine and corticosteroids are no longer recommended for clients with RSV/bronchiolitis. Because RSV is a virus, antibiotics should not be used.
The nurse is assessing an adult client with respiratory syncytial virus (RSV). Which symptom will the nurse expect to assess that is not seen in infants with RSV? A) Rhinorrhea B) Cough C) Apnea D) Headache
D Rhinorrhea (runny nose) and cough are symptoms that are common to both infants and adults with RSV. Apnea is more commonly seen in infants, not in adults. However, a headache must be reported by the client, which infants are unable to do. Therefore, headaches are more commonly assessed in adults with RSV and not infants.
