NCLEX STYLE Questions for Exam 2

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a spacer. Correct nebulizer. peak expiratory flow meter. trial of chest physiotherapy.

The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism to administer medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.

13. The nurse is assessing a child with croup( acute epiglottitis). Examining the child's throat by using a tongue depressor might precipitate which of the following? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

ANS: B 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.

7. It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days.

ANS: C After children have taken antibiotics for 24 hours, they are no longer contagious to other children.

8. A child is diagnosed with influenza, probably type A disease. Management includes which of the following? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride to reduce symptoms d. Antibiotics to prevent bacterial infection

ANS: C Amantadine may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C.

38. Which of the following drugs is considered the most useful in treating cardiac arrest? a. Bretylium b. Lidocaine hydrochloride c. Epinephrine hydrochloride d. Naloxone (Narcan)

ANS: C Epinephrine works on alpha and beta receptors in the heart and is the most useful drug in cardiac arrest.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it A. liquefies secretions. B. improves oxygenation. C. promotes ventilation. D. soothes inflamed mucous membrane

humidified inspired air soothes the membranes inflamed by the infection and dry air. the size of the droplets in humidified air is too large to liquify secretions. no additional oxygen is provided with humidified air. the humidity has o effect on ventilation

6. The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: a. becomes fussy. b. has a cough. c. has a fever over 99° F. d. shows signs of an earache.

ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and should be referred to a practitioner for evaluation.

26. β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? a. Liquefy secretions b. Dilate the bronchioles c. Reduce inflammation of the lungs d. Reduce infection

ANS: B These medications work to dilate the bronchioles in acute exacerbations.

29. Which statement expresses accurately the genetic implications of cystic fibrosis (CF)? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected.

ANS: A CF is an autosomal recessive gene inherited from both parents.

36. In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

ANS: A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption.

18. Which of the following is the most important consideration in managing TB in children? a. Skin testing b. Chemotherapy c. Adequate nutrition d. Adequate hydration

ANS: B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months.

14. Which of the following types of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Epiglottitis is always a medical emergency needing antibiotics and airway support for treatmen

The parent of a child with cystic fibrosis 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 symptoms are suggestive of pneumothorax. Correct bronchodilation. carbon dioxide retention. increased viscosity of sputum.

The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the described symptoms. Carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially due to a pneumothorax.

1. The nurse enters a room and finds a 6-year-old child who is unconscious. After calling for help and before being able to use an automatic external defibrillator, what steps should the nurse take? Place in correct order. a. Place on a hard surface. b. Administer 30 chest compressions with two breaths. c. Feel carotid pulse while maintaining head tilt with the other hand. d. Use the head tilt-chin lift maneuver and check for breathing. e. Place heel of one hand on lower half of sternum with other hand on top. f. Give two rescue breaths.

a, d, f, c, e, b

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

Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam.

40. The Heimlich maneuver is recommended for airway obstruction in children older than: a. 1 year. b. 4 years. c. 8 years. d. 12 years.

ANS: A The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. Younger than 1 year, back blows and chest thrusts are administered.

37. Cardiopulmonary resuscitation (CPR) is begun on a toddler. Which of the following pulses is usually palpated because it is the most central and accessible? a. Radial b. Carotid c. Femoral d. Brachial

ANS: B In a toddler, the carotid pulse is palpated.

20. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? a. Force fluids. b. Monitor pulse oximetry. c. Institute seizure precautions. d. Encourage high-protein diet.

ANS: B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS.

34. A child with CF is receiving recombinant human deoxyribonuclease (rhDNase). This drug: a. may cause mucus to thicken. b. may cause voice alterations. c. is given subcutaneously. d. is not indicated for children younger than 12 years.

ANS: B One of the only adverse effects of DNase is voice alterations and laryngitis.

30. What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: 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.

Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? C, D A, E, K A, D, E, K Correct C, folic acid

A, D, E, and K are the fat-soluble vitamins, which need to be supplemented in higher doses for the child with cystic fibrosis. C and folic acid are not fat-soluble vitamins. D also needs to be supplemented in children with cystic fibrosis.

31. Which of the following tests aid in the diagnosis of CF? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF.

24. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

ANS: A Asthma may have these chronic symptoms.

16. A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which of the following? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A Bronchitis is characterized by these symptoms and occurs in children older than 6 years.

33. A child with CF receives aerosolized bronchodilator medication. This medication should be administered: a. before chest physiotherapy (CPT). b. after CPT. c. before receiving 100% oxygen. d. after receiving 100% oxygen

ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier.

12. An infant's parents ask the nurse about preventing OM. Which of the following should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses.

23. Which of the following statements is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

ANS: A In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function.

39. Effective CPR on a 5-year-old child should include which of the following? a. One breath to every five chest compressions b. Two breaths to every 15 chest compressions c. Reassessment of child after 50 cycles of compression and ventilation d. Reassessment of child every 10 minutes that CPR continues

ANS: A One breath to five chest compressions is the standard for infants.

3. The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which of the following actions should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

ANS: A, C, D Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure.

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

ANS: B The family's presence will decrease the child's distress.

22. Asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites.

ANS: B Viral illnesses cause inflammation that causes increased airway reactivity in asthma.

27. A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend which of the following? a. Soccer b. Running c. Swimming d. Basketball

ANS: C Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming.

5. It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

ANS: C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs.

32. CF is suspected in a toddler. Which of the following tests is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF.

35. Pancreatic enzymes are administered to the child with CF. Nursing considerations should include which of the following? a. Do not administer pancreatic enzymes if child is receiving antibiotics. b. Decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. Administer pancreatic enzymes between meals if at all possible. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole.

10. Which of the following statements is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

ANS: D Historically AOM has been treated with a range of antibiotics. However, new research shows that antibiotics do not improve outcomes in children with uncomplicated AOM.

9. Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by which of the following? a. Fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear

ANS: D OME is characterized by feeling of fullness in ear or other nonspecific complaints.

28. Which of the following drugs 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 â2 agonists

ANS: D Short-acting β2 agonists are the first treatment in an acute asthma exacerbation.

2. The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which of the following interventions should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

ANS: D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended.

A school-age child has undergone a tonsillectomy and is being cared for postoperatively in the hospital setting. The nurse assigned to the patient is developing a plan of care with regard to nutrition and hydration. What factors should be included in the postoperative plan of care for this patient? (Select all that apply.) Medicate for pain around the clock to ensure that the patient will be able to eat and maintain hydration. Incorrect Restrict food and oral fluids initially making sure that the patient is fully alert and there is no evidence of bleeding. Correct Avoid giving fluids that are color tinged red or brown. Correct Provide milk to help maintain nutritional balance. Provide pudding to facilitate swallowing. Incorrect

Although the patient should receive appropriate analgesics to maintain comfort, medicating the patient around the clock typically is not indicated. Restricting food and oral fluids until fully awake with no evidence of bleeding is prudent proactive. Withholding fluids that are color tinged red or brown is also recommended as it will be hard to distinguish potential bleeding if there is emesis. Providing milk or pudding is not advised as it milk products can lead to clearing of throat as a result of coating effect and therefore may pose an irritation leading to potential bleeding.

The school nurse is called to the cafeteria because a child "has eaten something he is allergic to." The child is in severe respiratory distress. The first action by the nurse is to determine what the child has eaten. administer diphenhydramine (Benadryl) PO stat. Incorrect move the child to the nurse's office or hallway. have someone call for an ambulance and paramedic rescue squad or 9-1-1. Correct

Because the child is in severe respiratory distress, the nurse should have someone call for a rescue squad or 9-1-1. Because severe respiratory distress is occurring, treatment of the response is indicated. What the child has eaten can be determined later. Diphenhydramine by mouth will not be effective for this type of emergency allergic reaction. The child should not be moved, unless the child is currently in a place that puts him or her at greater hazard.

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37º C (98.6º F). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. Correct trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement. bringing the child to the hospital to be admitted and to be observed for impending epiglottitis.

Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptom, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever.

D. ACute Rheumatic Fever. Children with group A β-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome.

The nurse is interviewing the parents of a 4-month-old infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in the crib with a blanket over the head, lying face down in bloody fluid from the nose and mouth. The parents indicate no problems when the infant was placed in the crib asleep. Which of the following causes of death does the nurse suspect? a.Suffocation b. Child abuse c. Infantile apnea d. Sudden infant death syndrome (SIDS)

Death is consistent with the appearance of SIDS. The infant is usually found in a disheveled bed; with blankets over the head; huddled into a corner and clutching the sheets; with frothy, blood-tinged fluid in the mouth and nose; and lying face down. The diaper is also usually full of stool, indicating a cataclysmic type of death. Although the child was found under the blanket, the other findings are consistent with SIDS. The findings as reported are consistent with SIDS, not child abuse. The history and physical findings are consistent with SIDS, not infantile apnea.

7. The most appropriate nursing intervention for a child following a tonsillectomy is to a. watch for continuous swallowing. b. encourage gargling to reduce discomfort. c. position the child on the back for sleeping. d. apply warm compresses to the throat

Frequent swallowing is the most obvious early sign of bleeding from the operative site in a child who has had a tonsillectomy. Gargling should be avoided after a tonsillectomy because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, decreasing the pain. Heat or warmth would increase the risk of bleeding.

What clinical manifestation would the nurse expect when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? a. Barrel chest b. Wheezing c. Thermal instability d.Nasal flaring and retractions

Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not with acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.

An immediate intervention to teach parents for when an infant chokes on a piece of food would be to have infant lie quietly while a call is placed for emergency help. position infant in a head-down, face-down position and administer five quick back slaps. Correct administer mouth-to-mouth resuscitation. give some water by a cup to relieve the obstruction.

Positioning the infant head and face down while administering five quick blows between the shoulder blades is the correct initial sequence of actions for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

One of the goals for children with asthma is to prevent respiratory tract infection because infections lessen effectiveness of medications. encourage exercise-induced asthma. increase sensitivity to allergens. can trigger an episode or aggravate asthmatic stat

Respiratory tract infections can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity, not a respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.

A 4-year-old child is brought to the emergency department. The child has a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. The priority action by the nurse is to examine the child's oropharynx and report the assessment to the health care provider. make the child lie down and rest quietly. auscultate the child's lungs and make preparations for placement in a mist tent. notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.

Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may cause total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? Confirms the diagnosis of asthma Determines the cause of asthma Identifies the "triggers" of asthma Assesses the severity of asthma Correct

The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.

The most appropriate time to perform bronchial postural drainage is A. immediately before all aerosol therapy. B before meals and at bedtime. Correct C. immediately on arising and at bedtime. D. 30 minutes after meals and at bedtime

The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food intake, thereby increasing the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways, facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be done three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include (Select all that apply.) lung function. Correct associated allergies. Incorrect frequency of symptoms. Correct frequency and severity of exacerbations. Correct

The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.

A parent with a toddler who has a respiratory infection wants to use the traditional method of topical vapor rub. Which statement by the parent indicates that additional teaching is needed with regard to administration of this treatment? The parent states that he will wash his hands before applying the medication. The parent will read the product label before administering the medication. The parent will inform the pediatrician that the medication is being used. Application of the medication will be given orally to avoid potential sneezing. Correct

Topical vapor rubs should never be given orally or applied beneath the nose. All of the other options indicate appropriate action on the part of the parent in terms of medical asepsis, obtaining information by reading label and notifying the health care provider that a medication is being used in the current treatment plan.

Treatment methods used for status asthmaticus focus on supportive oxygen therapy to maintain saturation at 90%. Incorrect resolving acid-base disturbances that have led to alkalosis. restoring hydration. Correct decreasing airway compliance.

Treatment methods for status asthmaticus are aimed at improving ventilation, decreasing airway resistance, relieving bronchospasm, correcting dehydration and acidosis, decreasing anxiety and treating any underlying concurrent infection. Oxygen saturation should be maintained at greater than 90%, typical acid-base disturbances result in acidosis, not alkalosis.

4. Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which of the following? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion.

5. What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

Preventing dehydration by small frequent feedings is an important intervention in the febrile child

1. An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? (Select all that apply.) a. Cluster care to conserve energy b. Round-the-clock administration of antitussive agents c. Strict intake and output to avoid congestive heart failure d. Administration of antibiotics

ANS: A, D Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential.

21. The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which of the following is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red.

ANS: B Arterial blood gases are the best way to monitor carbon monoxide poisoning.

11. An 18-month-old child is seen in the clinic with AOM. Trimethoprim- sulfamethoxazole (Bactrim) is prescribed. Which of the following statements made by the parent indicates a correct understanding of the instructions? a. "I should administer all of the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria.

Apnea of infancy has been diagnosed in an infant scheduled for discharge with home monitoring. Part of the infant's discharge teaching plan should include? Cardiopulmonary resuscitation (CPR) Correct Administration of intravenous (IV) fluids Foreign airway obstruction removal using the Heimlich maneuver Advice that the infant not be left with caretakers other than the parents

CPR is essential for all parents and caregivers to know, especially when an infant has a history of apnea of infancy that is being monitored at home. Most likely, the child will not be receiving home IV therapy as part of the discharge care. The Heimlich maneuver is used to intervene when a child or an adult is experiencing a choking episode. It would not be necessary for the parents to learn the maneuver at this time. (Back slaps and chest thrusts are used on the responsive infant for choking.) The parents should arrange for other caregivers to help when possible. There is no reason that the infant cannot be left with capable and trained individuals. Anyone caring for the infant will need to be taught to use equipment and how to perform CPR.

17. Skin testing for tuberculosis (TB) (the Mantoux test) is recommended: a. every year for all children older than 2 years. b. every year for all children older than 10 years. c. every 2 years for all children starting at age 1 year. d. periodically for children who reside in high-prevalence regions.

Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years.

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? Atrophic changes in the mucosal wall of the intestines Hypoactivity of the autonomic nervous system Hyperactivity of the apocrine glands Mechanical obstruction caused by increased viscosity of exocrine gland secretions Correct

Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.

In reviewing potential susceptibility to respiratory infections for children, which statement is based on supportive physiological evidence? Newborns are more likely to develop respiratory infections in the neonatal period due to changes from intrauterine to external environment. Incorrect With advancing age, immunity decreases leading to greater chances of developing respiratory infections. There is an increase in infection rate between 3 to 6 months due to loss of protective effects of maternal antibodies. Correct Viral respiratory infections increase dramatically by 5 years of age.

Newborns have immune protection that lasts from 3 to 6 months due to maternal antibody transfer and are therefore less likely to develop a respiratory infection. Development of respiratory infection is not related to transitioning from intrauterine to external environments. With advancing age, immunity increases rather than decreases. Viral respiratory infections occur less frequently by 5 years of age.

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to prevent respiratory syncytial virus (RSV) infection. Correct make isolation of the infant with RSV unnecessary. prevent secondary bacterial infection. decrease toxicity of antiviral agents.

Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents.

A 5-year-old child is brought the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) Vital signs Correct Throat culture Medical history Correct Assessment of breath sounds Correct Emergency airway equipment readily available Correct

Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

A child is standing playing with toys and suddenly collapses. Attempts to engage the child in conversation are met with no response. Skin color indicates cyanosis. A preliminary assessment of the environment presents no specific issues. Based on this information, you would suspect that the child is?

A child who is in severe respiratory distress as a result of foreign body aspiration will not be able to speak, become cyanotic and collapse. This would be considered a medical emergency. Playing with a toy may potentially lead to aspiration if the toy parts are smaller than the child's airway. Within that age group, it is likely that the child may place items in his/her mouth. There is nothing to suggest seizure activity, allergic reaction or traumatic injury.

19. The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which of the following? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak

ANS: D The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child.