Peds EAQs
The parents of a 4-year-old child call the health center and report that their child has a fever of 102.6° F (39.2° C), is complaining of a sore throat, and will not lie down, preferring to sit up and lean forward. The child is drooling and looks ill and agitated. In light of this information, what guidance should the nurse provide the family? The child needs to be seen immediately by a healthcare provider. The parents should provide cool mist and continue to give fluids to the child. The child should receive ibuprofen in an appropriate dose to decrease the fever. The parents should call back in several hours and update the health center on the child's condition.
a This child is presenting with signs and symptoms of epiglottitis, which is a medical emergency. Cool mist is effective in reducing inflammation of croup, but usually it is not effective in epiglottitis; the child will not be able to drink any fluids because of the enlarged epiglottis. A nonsteroidal antiinflammatory drug such as ibuprofen will help reduce fever, but the child will have difficulty swallowing, which may cause the epiglottis to spasm and close off the airway. Waiting to call is unsafe.
A nurse is reviewing the prescriptions for a 2-year-old child who has been admitted to the pediatric unit with acute laryngotracheobronchitis (croup). What is the rationale for the prescription to administer oxygen by way of a nasal cannula? a. Congeals mucous secretions and relieves dyspnea b. Decreases the effort required for breathing and permits rest c. Triggers the cough reflex and facilitates expectoration of mucus d. Liquefies mucous secretions and makes them easier to expectorate
b Administering oxygen by way of nasal cannula limits the energy required for breathing; this allows the child to conserve energy that can be used for fluid and nutrient intake. Congealed mucus will obstruct air passageways and increase respiratory distress. Oxygen administration does not trigger the cough reflex. Oxygen administration through a nasal cannula will have a drying effect.
A child with a history of asthma is brought to the emergency department experiencing an acute exacerbation of asthma. Which nursing assessment findings support this conclusion? a. Fever b. Stridor c. Wheezing d. Tachycardia e. Hypotension
c, d Bronchial constriction with mucus production causes wheezing. With the decrease in arterial oxygenation associated with asthma, the heart rate will increase. An increased temperature is characteristic of sepsis, not asthma. Stridor is due to foreign body obstruction, not asthma. Hypertension, not hypotension, may occur with asthma.
A nurse is providing discharge teaching for the parents of a 6-year-old child with acute laryngotracheobronchitis. What should the nurse instruct the parents to do to control symptoms at home? Mechanically induce vomiting. Call a community emergency service. Administer the prescribed antihistamine. Start a cool-mist humidifier close to the child.
d Immediate treatment for croup is mist therapy; discharge teaching should stress the importance of purchasing a cool-mist humidifier and should provide instructions on how and when to use it. Vomiting may result in aspiration in an already compromised child. If mist therapy is effective, a community emergency service will not be needed. Antihistamines are not of therapeutic value for a child with acute laryngotracheobronchitis.
A child is admitted to the hospital with pneumonia. What is the priority need that must be included in the nursing plan of care for this child? Rest Exercise Nutrition Elimination
Rest reduces the need for oxygen and minimizes metabolic needs during the acute, febrile stage of the disease. The child requiring hospitalization for pneumonia is usually confined to bed and needs to reduce activity to conserve oxygen. Nutrition is not a priority; the child is expected to be anorectic during the febrile phase. Elimination is usually not a problem, except as a result of immobility.
An 8-year-old child with viral pneumonia is admitted to the pediatric unit. The admitting nurse reviews the instructions from the healthcare provider. Which prescription should the nurse question? Encourage oral fluids Chest physiotherapy twice a day Start IV fluids D5% 0.45% NS at 80 mL/hr Aspirin 325 mg every 4 hours prn for fever higher than 101.4° F (38.6° C)
Salicylates, such as aspirin, should not be given to children younger than 16 years with viral infections because of the relationship of aspirin to the development of Reye syndrome. Fluids should be encouraged to meet the fluid needs of the increased basal metabolic rate and to help liquefy respiratory secretions. Chest physiotherapy is appropriate for children with pneumonia; it helps mobilize respiratory secretions. Intravenous fluids may be started to improve hydration status and to help liquefy respiratory secretions.
The nurse is assigned a group of pediatric clients. After receiving shift report, which client should the nurse assess first? a. A 6-month-old with a croupy cough and inspiratory stridor with exertion b. A 2-year-old with asthma who required a PRN albuterol treatment 2 hours ago c. A 3-year-old with cystic fibrosis and pneumonia who required 22% oxygen all night d. A 20-month-old with bronchiolitis and bilateral crackles who is receiving 23% oxygen
a A 6-month-old who exhibits stridor with exertion is demonstrating respiratory distress and needs to be evaluated first. Albuterol is a commonly used as-needed treatment, but the treatment was 2 hours ago, lessening the need for this child to be evaluated first. Clients with cystic fibrosis are often admitted with pneumonia requiring oxygen therapy. Crackles are an expected symptom with bronchiolitis, and 23% is a minimal amount of oxygen.
The nurse is caring for a 4-year-old child who has been hospitalized with an acute asthma exacerbation. Which assessment finding requires action by the nurse? a. Diminished breath sounds b. Pulse rate of 110 beats/min c. Pulse oximetry reading of 95% d. Respiratory rate of 24 breaths/min
a At the beginning of an asthma episode, wheezing may be heard only with a stethoscope. As the severity of the episode increases, wheezing may become audible to the unaided ear. Children in severe respiratory distress may not demonstrate wheezing because of decreased air movement; diminished breath sounds in a child may signal an inability to move air, so this finding requires action. The normal pulse range for a 4-year-old is 80 to 125 beats/min; a pulse of 110 beats/min does not require action. The normal respiratory range for a 4-year-old is 20 to 30 breaths/min, so a respiratory rate of 24 breaths/min does not require action. A pulse oximetry reading of 95% is acceptable. Once the child has been hospitalized with an acute asthma attack, oxygen saturation should be kept at 95% or higher.
A nurse is teaching the parents of an 8-year-old child with recently diagnosed type 1 diabetes about their child's care. What significant complication associated with type 1 diabetes should the nurse include in the teaching plan? a. Obesity b. Ketoacidosis c. Resistance to treatment d. Hypersensitivity to other drugs
b Ketoacidosis is a complication of type 1 diabetes; children require close blood glucose monitoring because of the demands of growth and their erratic diets. Obesity is more often associated with children who have type 2 diabetes. Resistance to treatment during the school-aged years is not common; problems are related to the changing requirements associated with growth. Hypersensitivity to other medications is unrelated to either type 1 or type 2 diabetes.
A male adolescent with cystic fibrosis, whose parents are both carriers of the disease, asks the nurse, "When I have children, could they have cystic fibrosis like me?" What information should the nurse consider before responding? a. Men with cystic fibrosis usually are sterile, although sexual function is not affected. b. Men with cystic fibrosis generally have a 50% chance of having children with the disease. c. Women will pass this disease to their children because it is carried on the sex chromosome. d. Women have a 25% chance of passing the disease to their children if their parents are carriers.
a Because of inadequate development of the vas deferens, epididymis, and seminal vesicles, as well as blockage of the vas deferens with thickened secretions, the production of sperm is diminished or absent in males with cystic fibrosis, and most men with the disease are sterile. Cystic fibrosis is inherited as an autosomal recessive trait; it is not sex linked.
In addition to standard precautions, what protective equipment or precautions should the nurse use when caring for a 4-year-old child admitted with pertussis? Mask Private room Gown and gloves Special air handling
b Droplet precautions are needed for a client with pertussis. In addition to standard precautions, this would include placing the child in a private room. Mask, gown, and gloves are part of standard precautions. Special air handling is for airborne organisms.
A nurse manager is providing a class on cystic fibrosis for the pediatric staff nurses. Physiologic adaptations to cystic fibrosis are a result of which problem? a. Dysfunction of sweat glands b. Inactivity of respiratory tract cilia c. Pathology of mucus-secreting glands d. Overproduction of endocrine gland activity
c Cystic fibrosis is a genetic disorder affecting all mucus-secreting (exocrine) glands. A sweat gland abnormality is not involved in cystic fibrosis; children with cystic fibrosis lose excessive amounts of sodium through perspiration caused by exocrine gland dysfunction. Cilia action may be influenced by the thickened secretions, but the cilia are not affected by cystic fibrosis. Exocrine, not endocrine, glands are involved in cystic fibrosis.
A nurse is planning to teach the parents of a preschool child with recently diagnosed cystic fibrosis why the child has respiratory problems. What should the nurse remember about the underlying pathophysiology? Airway irritability causes spasms. Lung parenchyma becomes inflamed. Excessively thick mucus obstructs airways. Endocrine glands secrete surplus hormones.
Dysfunction of the exocrine glands leads to the secretion of mucus that is thicker and more tenacious than normal. The characteristics of this mucus cause it to pool in the lungs and make expectoration difficult. In addition to airway obstruction, children with cystic fibrosis are more likely to have respiratory infections. Airway irritability is associated with hyperactive airway disease. Inflamed lung parenchyma is associated with pneumonia; this a secondary complication related to stasis of secretions. The endocrine glands are not directly affected in cystic fibrosis.
The parent of a 2-year-old child with just-diagnosed cystic fibrosis expresses concern about the child's frailty and low weight. What is the most appropriate reply by the nurse? a. "Digestive enzymes will be given to help your child digest food." b. "Your child's appetite will improve once respiratory therapy is started." c. "Your child's coughing and shortness of breath prevent adequate chewing of food." d. "I suggest that you offer baby foods to your child because they are more easily digested."
a Because the pancreatic ducts are blocked and fibrotic, oral pancreatic enzymes must be given to make the nutrients digestible and absorbable. Children with cystic fibrosis have good, even voracious, appetites despite respiratory impairment. Chewing is adequate despite coughing and shortness of breath; undernourishment results from inadequate nutrient absorption. It is not the consistency of the foods that leads to inadequate digestion and absorption, but the lack of enzymes from the pancreatic duct.
What is a nurse's most important consideration when formulating a plan of care for a school-aged child undergoing chemotherapy? a. Preventing infection b. Increasing caloric intake c. Limiting nausea and vomiting d. Monitoring hematoma formation
a Chemotherapy suppresses the immune system; the child is in danger of contracting an overwhelming infection. Although increasing caloric intake is important, it is not the priority. Although nausea and vomiting are side effects of chemotherapy, they can be minimized with appropriate pharmacological therapy. Although it is important to check for hematomas, it is not as important as preventing infection; gentle handling helps prevent hematomas.
A young child with acute nonlymphoid leukemia is admitted to the pediatric unit with a fever and neutropenia. What are the most appropriate nursing interventions to minimize the complications associated with neutropenia? Placing the child in a private room, restricting ill visitors, and using strict hand washing techniques Encouraging a well-balanced diet, including iron-rich foods, and helping the child avoid overexertion Avoiding rectal temperatures, limiting injections, and applying direct pressure for 5 minutes after venipuncture Offering a moist, bland, soft diet; using toothettes rather than a toothbrush; and providing frequent saline mouthwashes
a Children with leukemia most often die of infection; a low neutrophil count is associated with myelosuppressant therapy. Placing the child in a private room, restricting ill visitors, and using strict hand washing techniques are the best ways to minimize complications. Encouraging a well-balanced diet, including iron-rich foods, and helping the child avoid overexertion are not appropriate measures to prevent infection resulting from neutropenia; they are appropriate for treating the anemia. Avoiding rectal temperatures, limiting injections, and applying direct pressure for 5 minutes after venipuncture are not appropriate measures to prevent infection resulting from neutropenia; they are more appropriate for preventing bleeding. Offering a moist, bland, soft diet; using toothettes rather than a toothbrush; and providing frequent saline mouthwashes are not appropriate measures to prevent infection resulting from neutropenia; they are used to ease and treat stomatitis.
A nurse is performing a respiratory assessment of an 8-month-old child with the diagnosis of viral pneumonia. The nurse identifies bronchial breath sounds over areas of consolidation, mild substernal retractions, profuse mucus production, pallor, and a temperature of 102° F (38.9° C). What is the priority nursing action? Suctioning the nasopharynx so a patent airway can be maintained Starting an intravenous infusion to provide necessary fluids and electrolytes Calling the respiratory therapist to start preparations for oxygen administration Notifying the practitioner of the fever so a prescription for an antipyretic can be issued
a Establishment and maintenance of a patent airway is always the priority. This intervention follows the ABCs (airway, breathing, circulation) of emergency care. An intravenous infusion will likely be started; however, this is not essential right away. The practitioner, not the respiratory therapist, should be asked for a prescription to begin oxygen administration; this action is not the priority. Taking the time to obtain a prescription for an antipyretic will delay attention to the immediate problem of respiratory distress.
The parents of a 3-year-old child who has recurrent attacks of acute spasmodic laryngitis (spasmodic croup) ask the nurse why this happens to their child. What is the best rationale for the nurse to convey why this is a disorder of young children? They have small airways. They are mouth breathers. They have immature immune systems. They are prone to upper respiratory infections.
a Swelling and edema in airways with small diameters lead to the signs and symptoms of croup. Mouth breathing is not the cause of croup. An immature immune system is too general an explanation; it depends on the specific resistance of the individual child. A tendency to contract upper respiratory infections does not explain why only small children get croup.
A nurse who is caring for a 2-day-old neonate suspects that the infant has cystic fibrosis. What early sign of this disorder did the nurse identify? a. Meconium ileus b. Imperforate anus c. Hemoglobin level of 20 g/dL (200 mmol/L) d. Total bilirubin level of 8 mg/dL (136 mcmol/L)
a The intestines of newborns with cystic fibrosis may be obstructed by thick, tenacious, pasty meconium. Imperforate anus, a congenital malformation in which the anal opening is obliterated, is identified during the newborn's initial assessment; it is not associated with cystic fibrosis. At birth fetal hemoglobin remains in the newborn's circulation for several weeks. The fetal hemoglobin level is high to compensate for the fetus's low oxygenation. A newborn's hemoglobin level is 14.5 to 22.5 g/dL (145 to 225 mmol/L). An increased bilirubin level, which commonly occurs in newborns because of the destruction of fetal erythrocytes, is called physiologic jaundice. This occurs more often in breastfed newborns than in formula-fed newborns.
A 10-year-old girl with diabetes joins the school's soccer team. Her mother is unsure whether to tell the coach of her child's condition. The mother asks the school nurse for guidance. On what information should the nurse base the response? a. Children with diabetes who participate in active sports can have episodes of hypoglycemia. b. Children may have to leave athletic teams if school authorities learn that they have diabetes. c. The school nurse will treat the child if clinical findings of hypoglycemia are recognized early. d. The coach might violate confidentiality by discussing the child's condition with other faculty members.
a The people associated with the school who are interacting with the child should be told about the child's condition. Knowledgeable people can be alert for early signs of hypoglycemia and have snacks available for the child to help prevent a hypoglycemic episode. Forcing the child to leave the team is a form of discrimination; children with diabetes are allowed to engage in activities as long as their diabetes remains under control. The adult who is with the child when the signs of hypoglycemia first appear should be prepared to treat the child; this person may or may not be the nurse. Information about the child's health status is on a "need to know" basis; professionals are expected to honor confidentiality.
The regulation of type 1 diabetes in an 8-year-old child is best attained with a combination of therapeutic modalities in addition to the administration of insulin. Which modalities should a nurse include in the teaching plan? a. Dietary control b. Regular exercise c. Urine testing for glucose d. Blood glucose monitoring e. Use of oral hypoglycemic agents
a, b, d Following a diet that balances protein, carbohydrates, and fats decreases the amount of exogenous insulin needed to regulate type 1 diabetes. Exercise uses glucose for energy, which decreases the amount of exogenous insulin needed to regulate type 1 diabetes. Blood glucose monitoring is used to adjust the amount of exogenous insulin needed. Urine is no longer tested routinely for glucose; occasionally it may be used to detect ketonuria when hyperglycemia is suspected. Oral hypoglycemics are used by individuals with type 2, not type 1, diabetes. Individuals with type 1 diabetes have little or no endogenous insulin and do not respond to stimulation with oral hypoglycemic agents.
When preparing a child with asthma for discharge, what instructions must the nurse emphasize to the family? a. Limit allergens in the home. b. Maintain a dry home environment. c. Avoid placing limits on the child's behavior. d. Continue the medications even if the child is asymptomatic. e. Prevent exposure to infection by having the child tutored at home.
a, d Parents should be taught to limit allergens in the home that can precipitate asthma attacks (e.g., no carpets, no down pillows, no scented products; wet-mopping floors, vacuuming when the child is not in the home). Medications to control inflammation, including inhaled corticosteroids and long-acting β 2-agonists, must be continued to suppress exacerbations of asthma. Environmental moisture is necessary for these children; in addition, cold environments should be avoided. Consistent limits should be placed on the child's behavior, regardless of the illness; a chronic illness does not eliminate the need for limit setting. The child should return to school and continue to interact with schoolmates and friends.
A 30-month-old toddler is brought to the emergency department in acute respiratory distress, and a diagnosis of laryngotracheobronchitis (viral croup) is made. What is the most important equipment for the nurse to have available when the child is admitted to the pediatric unit? Intravenous set Tracheotomy set Nasal cannula for oxygen Crib with padded side rails
b A patent airway is the priority. A tracheotomy set should be kept immediately available in case of complete obstruction of the airway. An intravenous setup may be needed later if the child does not respond to treatment. Humidified mist, not oxygen, is the treatment of choice unless the child does not respond to the treatment. Padded side rails are appropriate for seizures, which are not associated with croup.
A hospitalized 3-year-old child with leukemia is undergoing chemotherapy. The mother tells the nurse that her child is asking for fried chicken. How should the nurse respond? a. Fried foods might cause nausea and vomiting during chemotherapy. b. Any food that is requested should be given because the child needs calories. c. Coatings on foods to be fried may irritate the child's mouth and cause bleeding. d. Foods from outside should not be brought to the unit because of the potential for infection.
b Because chemotherapy can cause nausea, vomiting, and anorexia, the child should be offered any food that is requested. Even if the nutritional quality is minimal, the child will be receiving needed calories. Fried foods can usually be eaten because generally they do not cause nausea and vomiting or irritate the mouth. Food prepared adequately should not be contaminated and therefore should not cause problems for a child undergoing chemotherapy.
A 6-month-old infant is brought to the emergency department in severe respiratory distress. A diagnosis of respiratory syncytial virus (RSV) infection is made, and the infant is admitted to the pediatric unit. What should be included in the nursing plan of care? Place in a warm, dry environment. Maintain standard and contact precautions. Administer prescribed antibiotic immediately. Allow parents and siblings to room in with the infant.
b RSV is highly contagious. The infant should be isolated or placed with other infants with RSV. Standard and contact precautions are instituted to limit the spread of pathogens to others. The infant should receive cool, humidified oxygen by nasal cannula or mask or in a croup tent. Because RSV is extremely contagious, the number of visitors should be limited. Uninfected children should not be allowed near the infant, and as few personnel as possible should care for the infant. Antibiotics are not effective against RSV, and their use is contraindicated.
Which respiratory infections should the nurse monitor the toddler-age client for based on structural differences during this stage of development? select all a. Bronchiolitis b. Ear infection c. Acute sinusitis d. Laryngotracheobronchitis e. Inflammation of the tonsils
b, c, e The toddler-age client remains at risk for ear infection (otitis media), acute sinusitis, and inflammation of the tonsils or tonsillitis; therefore, the nurse should assess the toddler-age client for these infections due to the angle of the Eustachian tube in the ear. Bronchiolitis and laryngotracheobronchitis (croup) are more common during infancy.
When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, "I'm too sick to feed myself." What is the best response by the nurse? "Try to eat as much as you can." "You can eat later when you feel better." "Wait a few minutes, and I will be back to help you." "You're really not that sick, and I'm sure you can feed yourself."
c A few minutes will be enough time for the child to begin self-feeding. The nurse should provide both physical and emotional support because the child's request for help indicates regression and the need for dependence during a period of stress. Telling the child to eat as much as he or she can does not provide the child with the help that may be needed. It may be a while until the child feels better; in the meantime, adequate nourishment to foster healing is needed. Telling the child that he or she is not that sick and can feed himself or herself could cause stress, feelings of guilt, and embarrassment.
A school-aged child with cystic fibrosis has recurrent episodes of bronchitis, and the parents ask the nurse why this happens. What reason should the nurse include in the reply? a. Associated heart defects cause heart failure and respiratory depression. b. Neuromuscular irritability causes spasm and constriction of the bronchi. c. Tenacious secretions that obstruct the respiratory tract provide a favorable medium for growth of bacteria. d. The increased salt content in saliva irritates the mucous membranes, resulting in inflammation of the nasopharynx.
c Cystic fibrosis is characterized by an overproduction of viscous mucus by exocrine glands in the lungs. The mucus traps bacteria and foreign debris that adhere to the lining and cannot be expelled by the cilia, resulting in obstruction of the airway and the development of a favorable environment for the growth of microorganisms, leading to infection. Cardiac defects are not associated with cystic fibrosis. Neuromuscular irritability of the bronchi does not occur in cystic fibrosis. Although there is increased sodium and chloride in the saliva, they do not irritate or inflame the mucous membranes.
A nurse explains to the mother of a 1-year-old with a history of frequent ear infections that the primary cause of otitis media in young children is what? a. Sinusitis b. Recurrent tonsillitis c. An inflamed mastoid process d. An obstructed eustachian tube
d A blocked eustachian tube impairs drainage and creates negative pressure; when the tube opens, bacteria are pulled into the middle ear. Sinusitis is not related to otitis media. Recurrent tonsillitis is not the direct cause of otitis media. Mastoiditis is a complication, not a cause, of otitis media.
A school-aged child is undergoing chemotherapy. How can the nurse best manage a common side effect of chemotherapy? a. Restricting fluid intake b. Instituting contact precautions c. Keeping the hair closely cropped d. Providing meticulous oral hygiene
d Children undergoing chemotherapy are prone to mucosal cell damage that can produce ulcers throughout the gastrointestinal tract; oral ulcers are a common side effect and can cause extreme discomfort. Increased fluid intake is encouraged to enhance the excretion of uric acid crystals. Chemotherapy acts as an immunosuppressant. Contact precautions protect the care provider; it is the child who needs to be protected. Keeping the hair short will not prevent it from falling out while the child is undergoing chemotherapy.