Perry Ch 40 Practice Questions
A 7 y/o child has been prescribed penicillin V for streptococcal pharyngitis. Which of the following information should the nurse teach the parents regarding the medication? a) Once the child starts the medication, he will no longer be contagious b) The child must take all the medication c) The child's fever may persist until all the medicine has been taken d) If given w/ food, the medicine will be ineffective
B In order to prevent the child from developing rheumatic fever or acute glomerular nephritis, he or she must complete the full course of antibiotics.
A 6-week-old is admitted to the hospital with influenza. The child is crying, and the father tells the nurse that his son is hungry. The nurse explains that the baby is not to have anything by mouth. The parent does not understand why the child cannot eat. Which is the nurse's best response to the parent? a) "We are giving your child intravenous fluids, so there is no need for anything by mouth." b) "The shorter and narrower airway of infants increases their chances of aspiration so your child should not have anything to eat now." c) "When your child eats, he burns too many calories; we want to conserve the child's energy." d) "Your child has too much nasal congestion; if we feed the child by mouth, the distress will likely increase."
B Infants are at higher risk of aspiration because their airways are shorter and narrower than those of adults. An infant with influenza has lots of nasal secretions and coughs up mucus. With all the secretions, the infant is at an even higher risk of aspiration.
A school-age child has been diagnosed with nasopharyngitis. The parent is concerned because the child has had little or no appetite for the last 24 hours. Which is the nurse's best response? a) "Do not be concerned; it is common for children to have a decreased appetite during a respiratory illness." b) "Be sure your child is taking an adequate amount of fluids. The appetite should return soon." c) "Try offering the child some favorite food. Maybe that will improve the appetite." d) "You need to force your child to eat whatever you can; adequate nutrition is essential."
B It is common for children to have a decreased appetite when they have a respiratory illness. The nurse is appropriately instructing the parent that the child will be fine by taking in an adequate amount of fluid.
A baby is born 12 weeks preterm. The nurse should determine that which of the following monthly medication injections would be appropriate for this child to receive? a) Hep B immune globulin b) Synagis (palivizumab) c) Pulmozyme (dornase alfa) d) Varicella-zoster immune globulin
B Synagis is a medication that helps to protect preterm and/or chronically ill infants from developing a serious infection from RSV.
Which laboratory result will provide the most important information regarding the respiratory status of a child with an acute asthma exacerbation? a) CBC b) ABG c) BUN d) PTT
B The ABG gives the health-care team valuable information about the child's respiratory status: level of oxygenation, carbon dioxide, and blood pH.
Which child is in the greatest need of emergency medical treatment? a) 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions b) 6-year-old who has high fever, no spontaneous cough, and frog-like croaking c) 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough d) 13-year-old who has a high fever, stridor, and purulent secretions
B This child has signs and symptoms of epiglottitis and should receive immediate emergency medical treatment. The patient has no spontaneous cough and has a frog-like croaking because of a significant airway obstruction.
A 10 y/o who is receiving pre-op teaching from the surgical nurse states, "My friend told me that I will be given lots of ice cream right after the surgery. I can't wait!" Which of the following responses by the nurse is appropriate? a) "You are right. You're going to have to come to the hospital for surgery, but at least we give you a big treat afterwards." b) "Your friend is correct that you'll be able to eat shortly after the surgery. We'll let you eat ice pops, but no ice cream for a day or two." c) "I'm afraid that your friend wasn't correct. We don't want you eat or drink anything cold for at least a week." d) "I bet your friend watched an old movie about children having their tonsils out. I'm afraid these days we won't let you eat or drink for two whole days."
B This statement is correct, this child will be given ice pops on the day of surgery, but no ice cream for a day or two.
A nurse monitoring a preterm baby w/ RSV bronchiolitis notes that the baby is exhibiting signs of respiratory distress. Which of the following signs did the nurse observe? Select all that apply. a) Huffing b) Tachypnea c) Nasal flaring d) Expiratory grunting e) Intercostal retractions
B, C, D, E Over time the infection may enter the bronchioles, causing bronchiolitis. If so, infants may exhibit signs of respiratory distress, including tachypnea, nasal flaring, expiratory grunting, intercostal retractions, and cyanosis.
Which should the nurse administer to provide quick relief to a child with asthma who is coughing, wheezing, and having difficulty catching her breath? a) Prednisone b) Singulair (montelukast) c) Albuterol d) Flovent (fluticasone)
C Albuterol is the quick-relief bronchodilator of choice for treating an asthma attack.
Which should be included in instructions to the parent of a child prescribed amoxicillin to treat an ear infection? a) "Continue the amoxicillin until the child's symptoms subside." b) "Administer an over-the-counter antihistamine with the antibiotic." c) "Administer the amoxicillin until all the medication is gone." d) "Allow your child to administer his own dose of amoxicillin."
C It's essential that all the medication be given.
What information should the nurse provide the parent of a child diagnosed with nasopharyngitis? a) Complete the entire prescription of antibiotics b) Avoid sending the child to day care c) Use comfort measures for the child d) Restrict the child to clear liquids for 24 hours
C Nursing care for nasopharyngitis is primarily supportive.
Which child diagnosed with pneumonia would benefit most from hospitalization? a) 13 y/o who is coughing, has coarse breath sounds, and is not sleeping well b) 14 y/o with a fever of 38.6°C (101.5°F), rapid breathing, and a decreased appetite c) 15 y/o who has been vomiting for 3 days and has a fever of 38.5°C (101.3°F) d) A 16 y/o who has a cough, chills, fever of 38.5°C (101.3°F), and wheezing
C The teen who has been vomiting for several days and is unable to tolerate oral fluids and medication should be admitted for IV hydration.
A 10 y/o has been prescribed an MDI administered bronchodilator. Which of the following actions should the nurse teach the child to perform when taking the medication? a) Take care not to shake the medication container before administering b) Wait no more than 10 seconds between administrations of the medication c) Exhale completely before placing the medication mouthpiece in the mouth d) Compress the container for 30 seconds before inhaling the medication
C This statement is correct. The child should place the medication mouthpiece in the mouth after exhaling.
Which is the nurse's best response to the parent of an infant diagnosed with the first otitis media who wonders about long-term effects? a) "The child could suffer hearing loss." b) "The child could suffer some speech delays." c) "The child could suffer recurrent ear infections." d) "The child could require ear tubes."
C When children acquire an ear infection at such a young age, there is an increased risk of recurrent infections.
A child w/ croup is placed in a cool mist tent. The mother becomes concerned because the child is frightened, consistently crying, and trying to climb out of the tent. Which is the most appropriate nursing action? a) Tell the mother that the child must stay in the tent b) Place a toy in the tent to make the child feel more comfortable c) Call the HCP and obtain a prescription for a mild sedative d) Let the mother hold the child and direct the cool mist over the child's face
D If the use of a tent or hood is causing distress, treatment may be more effective if the child is held by the parent and a cool mist is directed toward the child's face (blow-by).
A new parent expresses concern to the nurse regarding SIDS. She asks the nurse how to position her new infant for sleep. In which position should the nurse tell the parent to place the infant? a) Side or prone b) Back or prone c) Stomach w/ face turned d) Back rather than on the stomach
D Nurses should encourage parents to place the infant on the back (supine) for sleep.
A child has had tympanostomy tubes inserted. Before discharging the child from the hospital, which of the following should be included in the nurse's discharge teaching? a) Elevate the head of the child's bed 30 degrees for the next week b) Bright-red bleeding may drain from the ears for remainder of the day c) Administer narcotic analgesic every 4 hours for the next two days d) Not to allow the child's head to be submerged in bath or pool water
D The child's head should not be allowed to submerge in bath or pool water.
A child with severe cerebral palsy is admitted to the hospital with aspiration pneumonia. What is the most beneficial educational information that the nurse can provide to the parents? a) The S&S of aspiration pneumonia b) The treatment plan for aspiration pneumonia c) The risks associated with recurrent aspiration pneumonia d) The prevention of aspiration pneumonia
D The most valuable information the nurse can give the parents is how to prevent aspiration pneumonia from occurring in the future.
A 2-year-old has just been diagnosed with cystic fibrosis (CF). The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? a) "You can expect your child to develop a barrel-shaped chest." b) "You can expect your child to develop a chronic productive cough." c) "You can expect your child to develop bronchiectasis." d) "You can expect your child to develop wheezing respirations."
D Wheezing respirations and a dry, nonproductive cough are common early symptoms in CF.
The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response? a) "Some children just react differently to viruses. It is best to treat each child as an individual." b) "Younger children have wider airways that make it easier for bacteria to enter and colonize." c) "Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections." d) "Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed."
D Younger children have less developed immune systems and usually exhibit worse symptoms than older children.
What does the therapeutic management of cystic fibrosis (CF) patients include? Select all that apply. a) Providing a high-protein, high-calorie diet b) Providing a high-fat, high-carbohydrate diet c) Encouraging exercise d) Minimizing pulmonary complication e) Encouraging medication compliance
A, C, D, E These children often require up to 150% of the caloric intake of their peers. The nutritional recommendation for CF patients is high-calorie and high-protein. Exercise is effective in helping CF patients clear secretions. Minimizing pulmonary complications is essential to a better outcome for CF patients. Compliance with CPT, nebulizer treatments, and medications are all components of minimizing pulmonary complications. Medication compliance is a necessary part of maintaining pulmonary and GI function.
The parent of a child with cystic fibrosis (CF) is excited about the possibility of the child receiving a double lung transplant. What should the parent understand? a) The transplant will cure the child of CF and allow the child to lead a long and healthy life b) The transplant will not cure the child of CF but will allow the child to have a longer life c) The transplant will help to reverse the multisystem damage that has been caused by CF d) The transplant will be the child's only chance at surviving long enough to graduate college
B A lung transplant doesn't cure CF, but it does offer the patient an opportunity to live a longer life.
Which is diagnostic for epiglottitis? a) Blood test b) Throat swab c) Lateral neck x-ray of the soft tissue d) Signs and symptoms
C A lateral neck x-ray is a definitive test to diagnose epiglottitis.
Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase? a) Use an incentive spirometer b) Breathe into a paper bag c) Blow a pinwheel d) Take several deep breaths
C Blowing a pinwheel is an excellent means of increasing a child's expiratory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child's expiratory phase.
A parent asks the nurse what will need to be done to relieve the constipation of her child who also has cystic fibrosis (CF). Which is the nurse's best response? a) "Your child likely has an obstruction and will require surgery." b) "Your child will likely be given IV fluids." c) "Your child will likely be given MiraLAX." d) "Your child will be placed on a clear liquid diet."
C CF patients with constipation commonly receive a stool softener or an osmotic solution such as polyethylene glycol 3350 (MiraLAX) orally to relieve their constipation.
An infant is not sleeping well, crying frequently, has yellow drainage from the ear, and is diagnosed with an ear infection. Which nursing objective is the priority for the family? a) Educating the parents about signs and symptoms of an ear infection b) Providing emotional support for the parents c) Providing pain relief for the child d) Promoting the flow of drainage from the ear
C Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better.
How will a child with respiratory distress and stridor and who is diagnosed with RSV be treated? a) Intravenous antibiotics b) Intravenous steroids c) Nebulized racemic epinephrine d) Alternating doses of Tylenol and Motrin
C Racemic epinephrine promotes mucosal vasoconstriction.
A 10 y/o has CF. It would be appropriate for the nurse to advise the parents that the child should be monitored yearly for which of the following illnesses? a) Lupus b) Arthritis c) Hyperthyroidism d) Diabetes mellitus
D Children w/ CF often become type 1 diabetics.
The parent of a 9-month-old calls the ER because his child is choking on a marble. The parent asks how to help his child while awaiting Emergency Medical Services. Which is the nurse's best response? a) "You should administer five abdominal thrusts followed by five back blows." b) "You should try to retrieve the object by inserting your finger in your child's mouth." c) "You should perform the Heimlich maneuver." d) "You should administer five back blows followed by five chest thrusts."
D The current recommendation for infants younger than 1 year is to administer five back blows followed by five chest thrusts.
A newborn baby has been diagnosed w/ CF. Regarding which of the following characteristics of the disease should the nurse forewarn the parents? a) Chronic conjunctivitis b) Rapid weight gain c) Recurrent vomiting d) Thick respiratory mucus
D Thick respiratory mucus is seen in children w/ CF.
The nurse is preparing for the admission of an infant w/ a diagnosis of bronchiolitis caused by RSV. Which interventions should the nurse include in the plan of care? a) Place the infant in a private room b) Ensure that the infant's head is in a flexed position c) Wear a mask at all times when in contact w/ the infant d) Place the infant in a tent that delivers warm humidified air e) Position the infant on the side, w/ the head lower than the chest f) Ensure that nurses caring for the infant w/ RSH don't care for other high-risk children
A It's important to ensure that nurses caring for a chid w/ RSV do not care for other high-risk children to prevent the transmission of the infection. An infant w/ RSV should be isolated in a private room or in a room w/ another infant w/ RSV infection.
Which child would benefit most from having ear tubes placed? a) A 2-month-old who has had one ear infection b) A 2-year-old who has had five previous ear infections c) A 3-year-old whose sibling has had four ear infections d) A 7-year-old who has had two ear infections this year
B A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections.
A nurse is educating a group of parents regarding the rationales for the administration of vaccinations. The nurse should advise the parents that the vaccine that prevents infections from which of the following diseases has helped to reduce the numbers of children diagnosed w/ bacterial croup? a) Hepatitis A b) Hemophilus influenzae type B c) Rotavirus d) Neisseria meningitis
B H. influenza type B vaccine prevents upper respiratory infections, including bacterial croup.
A child is complaining of throat pain. Which statement by the mother indicates that she needs more education regarding the care and treatment of her daughter's pharyngitis? a) "I will have my daughter gargle with salt water three times a day." b) "I will offer my daughter ice chips several times a day." c) "I will give my daughter Tylenol every 4 to 6 hours as needed." d) "I will ask the nurse practitioner for some amoxicillin."
D Pharyngitis is a self-limiting viral illness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, including Tylenol, throat sprays, cold liquids, and Popsicles.
The nurse is reviewing discharge instructions with the parents of a child who had a tonsillectomy 24 hours ago. The parents tell the nurse that the child is a big eater, and they want to know what foods to give the child for the next 24 hours. What is the nurse's best response? a) "The child's diet should not be restricted at all." b) "The child's diet should be restricted to clear liquids." c) "The child's diet should be restricted to ice cream and cold liquids." d) "The child's diet should be restricted to soft foods."
D Soft foods are recommended to limit the child's pain and to decrease the risk for bleeding.
The mother of an 8 y/o child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child complains of discomfort on the right side and that ibuprofen isn't effective. Which instruction should the nurse provide to the mother? a) Increase the dose of ibuprofen b) Increase the frequency of ibuprofen c) Encourage the child to lie on the left side d) Encourage the child to lie on the right side
D Splinting of the affected side by lying on that side may decrease discomfort.
The mother of a 3 y/o child who has been diagnosed w/ an ear infection states, "I can't understand why you won't give my child antibiotics. Can't you see that she's sick?" Which of the following responses by the nurse is appropriate at this time? a) "I know how you feel, but the best medicine for your daughter right now is acetaminophen" b) "Your child will get better on her own in a few days" c) "I'm also very surprised that the pediatrician didn't order antibiotics" d) "It is likely that the ear infection is caused by a virus, and antibiotics don't kill viruses"
D This is an appropriate statement for the nurse to make.
A 3 y/o, who has been diagnosed w/ asthma, is being prescribed albuterol (Ventolin) via nebulizer as a rescue medication for acute episodes. The parents should be advised that the child may exhibit which of the following common side effects of the medication? a) Insomnia b) Lethargy c) Constipation d) Weight gain
A Albuterol is a short-acting beta-2 agonist. Insomnia is a common side effect of the medication.
The parent of a 4-month-old with cystic fibrosis (CF) asks the nurse what time to begin the child's first chest physiotherapy (CPT) each day. Which is the nurse's best response? a) "Thirty minutes before feeding the child breakfast." b) "After deep-suctioning the child each morning." c) "Thirty minutes after feeding the child breakfast." d) "Only when the child has congestion or coughing."
A CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting.
Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be? a) Complete a course of IV antibiotics b) Surgery to remove the tonsils c) 10 days of aerosolized ribavirin d) No intervention
A Epiglottitis is bacterial in nature and requires IV antibiotics.
Who is at the highest priority to receive the flu vaccine? a) A healthy 8-month-old who attends day care b) A 3-year-old who is undergoing chemotherapy c) A 7-year-old who attends public school d) An 18-year-old who is living in a college dormitory
A Children between the ages of 6 and 23 months are at the highest risk for having complications as a result of the flu. Their immune systems are not as developed, so they are at a higher risk for influenza-related hospitalizations.
Which would be appropriate nursing care management of a child with the diagnosis of mononucleosis? a) Only family visitors b) Bedrest c) Clear liquids d) Limited daily fluid intake
A Children with mononucleosis are more susceptible to secondary infections. Therefore, they should be limited to visitors within the family, especially during the acute phase of illness.
The clinic nurse reads the results of a TB test on a 3 y/o child. The results indicate an area of induration measuring 10 mm. The nurse should interpret these results as which finding? a) Positive b) Negative c) Inconclusive d) Definitive and requiring a repeat test
A Induration measuring 10 mm or more is considered to be a positive result in children younger than 4 years of age and in children w/ chronic illness or at high risk for exposure to TB.
The parent of a child with influenza asks the nurse when the child is most infectious. Which is the nurse's best response? a) "Twenty-four hours before and after the onset of symptoms. b) "Twenty-four hours after the onset of symptoms." c) "One week after the onset of symptoms." d) "One week before the onset of symptoms."
A Influenza is most contagious 24 hours before and 24 hours after onset of symptoms.
What would the nurse advise the parent of a child with a barky cough that gets worse at night? a) Take the child outside into the more humid night air for 15 minutes b) Take the child to the ER immediately c) Give the child an over-the-counter cough suppressant d) Give the child warm liquids to soothe the throat
A The night air will help decrease subglottic edema, easing the child's respiratory effort.
A 3-year-old is brought to the ER with coughing and gagging. The parent reports that the child was eating carrots when she began to gag. Which diagnostic evaluation will be used to determine if the child has aspirated carrots? a) Chest x-ray b) Bronchoscopy c) ABG d) Sputum culture
B A bronchoscopy will allow the physician to visualize the airway and will help determine if the child aspirated the carrot.
The parent of a child with frequent ear infections asks the nurse if there is anything that can be done to help avoid future ear infections. Which is the nurse's best response? a) "Your child should be put on a daily dose of Singulair (montelukast)." b) "Your child should be kept away from tobacco smoke." c) "Your child should be kept away from other children with otitis media." d) "Your child should always wear a hat when outside."
B Tobacco smoke has been proved to increase the incidence of ear infections.
Which is the nurse's best response to parents who ask what impact asthma will have on the child's future in sports? a) "As long as your child takes prescribed asthma medication, the child will be fine." b) "The earlier a child is diagnosed with asthma, the more significant the symptoms." c) "The earlier a child is diagnosed with asthma, the better the chance the child has of growing out of the disease." d) "Your child should avoid playing contact sports and sports that require a lot of running."
B When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging.
Which assessment is of greatest concern in a 15-month-old? a) The child is lying down, has moderate retractions, low-grade fever, and nasal congestion b) The child is in the tripod position, has diminished breath sounds, and a muffled cough c) The child is sitting up and has coarse breath sounds, coughing, and fussiness d) The child is restless and crying, has bilateral wheezes, and is feeding poorly
B When children are sitting in the tripod position, they are having difficulty breathing.
Which statement by the parents of a toddler with repeated otitis media indicates they need additional teaching? a) "If I quit smoking, my child may have a decreased chance of getting an ear infection." b) "As my child gets older, he should have fewer ear infections, because his immune system will be more developed." c) "My child will have fewer ear infections if he has his tonsils removed." d) "My child may need a speech evaluation."
C Removing children's tonsils may not have any effect on their ear infection.
The mother of an 11-month-old remarks to a nurse at the pediatric clinic, "We are so lucky. Our daughter has never had an ear infection!" Which of the following factors can the nurse tell the mother have protected her daughter from the disease? Select all that apply. a) The family owns no pets b) No one in the family smokes c) The mother breastfeeds her daughter d) Child attends day care only two mornings a week e) The family lives in the southern part of the country
B, C, D Cigarette smoke places children at high risk for ear infections. Breastfeeding has been shown to have a protective effect on the incidence of ear infections. Day-care attendance places children at high risk for ear infections.
A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? a) Maintaining strict bedrest b) Avoiding contact with family members c) Instilling saline nose drops and bulb suctioning d) Keeping the head of the bed flat.
C Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gentle suctioning with a bulb syringe are often recommended.
The mother of a hospitalized 2 y/o child w/ croup asks the nurse why the HCP did not prescribe antibiotics. Which response should the nurse make? a) "The child may be allergic to antibiotics" b) "The child is too young to receive antibiotics" c) "Antibiotics are not indicated unless a bacterial infection is present" d) "The child still has the maternal antibodies from birth and doesn't need antibiotics"
C It can be viral or bacterial. Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present.
Which should the nurse instruct children to do to stop the spread of influenza in the classroom? a) Stay home if they have a runny nose and cough b) Wash their hands after using the restroom c) Wash their hands after sneezing d) Have a flu shot annually
C It is essential that children wash their hands after any contact w/ nasopharyngeal secretions
Which information will be most helpful in teaching parents about the primary prevention of foreign body aspiration? a) S&S of foreign body aspiration b) Therapeutic management of foreign body aspiration c) Most common objects that toddlers aspirate d) Risks associated with foreign body aspiration
C Teaching parents the most common objects aspirated by toddlers will help them the most. Parents can avoid having those items in the household or in locations where toddlers may have access to them.
A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for? a) Immediate IV placement b) Respiratory treatment of racemic epinephrine c) A tracheostomy set at the bedside d) Informing the child's parents about a tonsillectomy
C The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.
A parent asks how to care for a child at home who has the diagnosis of viral tonsillitis. Which is the nurse's best response? a) "You will need to give your child a prescribed antibiotic for 10 days." b) "You will need to schedule a follow-up appointment in 2 weeks." c) "You can give your child Tylenol every 4 to 6 hours as needed for pain." d) "You can place warm towels around your child's neck for comfort."
C Tylenol is recommended PRN for pain relief.
The clinic nurse is providing instructions to a parent of a child w/ cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? a) "The immunization schedule will need to be altered" b) "The child should not receive any hepatitis vaccines" c) "The child will receive all of the immunizations except for the polio series" d) "The child will receive the recommended basic series of immunizations along w/ a yearly influenza vaccination"
D Adequately protecting children w/ CF from communicable diseases by immunization is essential.
A 10 y/o child w/ asthma is treated for acute exacerbation in the ED. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? a) Warm, dry skin b) Decreased wheezing c) Pulse rate of 90 breaths/min d) Respirations of 18 bpm
B Decreased wheezing in w child w/ asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air.
The throat culture of an 8 y/o child grew out 4 bacteria. The nurse should request the primary HCP to prescribe an antibiotic for the child to treat which of the following bacteria? a) Hemophilus influenzae b) Streptococcus pyogenes c) Streptococcus pneumoniae d) Mycoplasms pnuemoniae
B A child would be treated if his/her throat culture grew out S. pyogenes.
Which statement about pneumonia is accurate? a) Pneumonia is most frequently caused by bacterial agents b) Children with bacterial pneumonia are usually sicker than children with viral pneumonia c) Children with viral pneumonia are usually sicker than those with bacterial pneumonia d) Children with viral pneumonia must be treated with a complete course of antibiotics
B Children with bacterial pneumonia are usually sicker than children with viral pneumonia.
Which physical findings would be of most concern in an infant with respiratory distress? a) Tachypnea b) Mild retractions c) Wheezing d) Grunting
D Grunting is a sign of impending respiratory failure and is a very concerning physical finding.
Which child is at highest risk for requiring hospitalization to treat RSV? a) A 2-month-old who was born at 32 weeks b) A 16-month-old with a tracheostomy c) A 3-year-old with a congenital heart defect d) A 4-year-old who was born at 30 weeks
A The younger the child, the greater the risk for developing complications related to RSV.
Which position would be most comfortable for a child with left-sided pneumonia? a) Trendelenburg b) Left side c) Right side d) Supine
B Lying on the left side may provide the patient with the most comfort. Lying on the left splints the chest and reduces the pleural rubbing.
How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts of azotorrhea and steatorrhea in a child with cystic fibrosis (CF)? The values indicate the child is: a) Not compliant with taking her vitamins b) Not compliant with taking her enzymes c) Eating too many foods high in fat d) Eating too many foods high in fiber
B If the child were not taking enzymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool.
The ED nurse is caring for a child diagnosed w/ epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction? a) The child exhibits nasal flaring and bradycardia b) The child is leaning forward, with the chin thrust out c) The child has a low-grade fever and complains of a sore throat d) The child is leaning backward, supporting himself w/ the hands and arms
B Clinical manifestations suggestive of airway obstruction include tripod position, nasal flaring, the use of accessory muscles for breathing, and the presence of stridor.
A child is being sent home after a tonsillectomy. Which of the following actions should the nurse educate the parents to perform? a) Monitor the child for excessive swallowing b) Place warm compresses around the child's neck c) Encourage the child to drink cold citrus juices d) Position the child's supine for the next six hours
A If the child is bleeding from the surgical site, he/she may be swallowing excessively.
Which is the nurse's best response to a parent who asks what can be done at home to help a child with upper respiratory infection (URI) symptoms and a fever get better? a) "Give your child small amounts of fluid every hour to prevent dehydration." b) "Give your child Robitussin at night to reduce his cough and help him sleep." c) "Give your child a baby aspirin every 4 to 6 hours to help reduce the fever." d) "Give your child an over-the-counter cold medicine at night."
A It is essential that parents ensure their children remain hydrated during a URI.
Which statement indicates the parent needs further teaching on how to prevent his other children from contracting RSV? a) "I should make sure that both my children receive Synagis (palivizumab) injections for the remainder of this year." b) "I should be sure to keep my infected child away from his brother until he has recovered." c) "I should insist that all people who come in contact with my children thoroughly wash their hands before playing with them." d) "I should insist that anyone with a respiratory illness avoid contact with my children until well."
A Synagis will not help the child who has already contracted the illness.
The parent of an infant with cystic fibrosis (CF) asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion? a) "You may need to increase the number of fresh fruits and vegetables you give your child." b) "You may need to advance your child's diet to whole cow's milk because it is higher in fat than formula." c) "You may need to change your child to a higher-calorie formula." d) "You may need to increase your child's carbohydrate intake."
C Often infants w/ CF need to have a higher-calorie formula to meet their nutritional needs.
The parent of an 18-month-old child calls the child's primary HCP and states, "My child coughed all night long. She doesn't seem to be too sick, and he has no temperature. What can I do to help her and the rest of us to sleep tonight?" Which of the following responses is appropriate for the nurse to make? a) "It often helps to promote sleep by putting a steam vaporizer right next to the head of the baby's crib" b) "There are a number of very good non-prescription cough and cold medications at the pharmacy" c) "You could try raising the head of the baby's crib by putting books under the crib's front feet" d) "The baby probably needs antibiotics so let's make an appointment for her this afternoon"
C Raising the head of the bed can be helpful for children who are likely suffering from spasmodic croup.
A neonate has been diagnosed w/ CF. The nurse should educate the parents regarding which of the following dietary needs of their baby? a) The baby must receive a dose of folic acid three times each day b) The baby must never consume any milk or milk products c) The baby must receive pancreatic enzymes before bedtime every night d) The baby must consume a predigested formula that is high in calories
D Babies w/ CF are usually fed a predigested formula that is high in calories.
A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation? a) "Children this age rarely get epiglottitis; you should not blame yourself." b) "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen." c) "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms." d) "Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly."
D Epiglottitis is rapidly progressive and cannot be predicted
A school-age child is admitted to the hospital for a tonsillectomy. During the nurse's post-operative assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations would be of most concern to the nurse? a) The child's heart rate and blood pressure are elevated b) The child complains of having a sore throat c) The child is refusing to eat solid foods d) The child is swallowing excessively
D Excessive swallowing is a sign that the child is swallowing blood.
Which would the nurse explain to parents about the inheritance of cystic fibrosis? a) CF is an autosomal-dominant trait passed on from the child's mother b) CF is an autosomal-dominant trait passed on from the child's father c) The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF d) The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF
D If the child is born to a parent with CF and the other parent is a carrier, the child has a 50% chance of acquiring the disease and a 50% chance of being a carrier of the disease.
A child is seen in the ED. The nurse hears a high-pitched squeal every time the child inhales. The parent states that the child's fever is very high and, in addition, the child is gasping for breath and sitting in the tripod position. Which of the following actions would be appropriate for the nurse to perform at this time? a) Provide the child w/ warm liquids to drink b) Inspect the throat w/ a flashlight and tongue blade c) Check the child's vital signs and lung fields d) Get immediate medical attention for the child
D The child is exhibiting three S&S of epiglottis and should be examined immediately by a primary HCP.
Which intervention is most appropriate to teach the mother of a child diagnosed with a URI and a dry hacking cough that prevents him from sleeping? a) Give cough suppressants at night b) Give an expectorant every 4 hours c) Give cold and flu medication every 8 hours d) Give 1/2 teaspoon of honey four to five times per day
D Warm fluids, humidification, and honey are best treatments for a URI.
An 8 y/o child, who has a history of asthma, is seen in the office of the school nurse w/ coughing and wheezing. Which of the following actions should the nurse perform first? a) Assess the child's peak expiratory flow b) Educate the child to avoid triggers c) Transport the child to the ED d) Notify the child's parents of his condition
A This child's condition must be thoroughly assessed, including assessment of lung sounds, respiratory rate, and peak expiratory flow.
The nurse is caring for an infant w/ bronchiolitis, and diagnostic tests have confirmed RSV. On the basis of this finding, which is the most appropriate nursing action? a) Initiate strict enteric precautions b) Move the infant to a room w/ another child w/ RSV c) Leave the infant in the present room because RSV isn't contagious d) Inform the staff that they must wear a mask, gloves, and gown when caring for the child
B An infant w/ RSV is isolated in a single room or placed in a room w/ another child w/ RSV.
Which statement by the parent of a child using an albuterol inhaler leads the nurse to believe that further education is needed on how to administer the medication? a) "I should administer two quick puffs of the albuterol inhaler using a spacer." b) "I should always use a spacer when administering the albuterol inhaler." c) "I should be sure that my child is in an upright position when administering the inhaler." d) "I should always shake the inhaler before administering a dose."
A The parent should always give one puff at a time and wait 1 minute before administering the second puff.
The parents of a child, who has had multiple respiratory infections since birth, tell the nurse, "When we kiss our child, all we can taste is salt." It would be appropriate for the nurse to suggest to the primary HCP that the child be assessed for which of the following illnesses? a) Cystic fibroris b) Asthma c) Bronchiolitis d) Pharyngitis
A There is a high concentration of salt in the sweat of children w/ CF.
A school-age child has been diagnosed with strep throat. The parent asks the nurse when the child can return to school. Which is the nurse's best response? a) "Forty-eight hours after the first documented normal temperature." b) "Twenty-four hours after the first dose of antibiotics." c) "Forty-eight hours after the first dose of antibiotics." d) "Twenty-four hours after the first documented normal temperature."
B Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy.
Which child with asthma should the nurse see first? a) A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93% b) A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93% c) A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92% d) A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%
A This child is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes and now has diminished breath signs.
Which would be an early sign of respiratory distress in a 2-month-old? a) Breathing shallowly b) Tachypnea c) Tachycardia d) Bradycardia
B Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants.
A parent asks the nurse how it will be determined if their child has RSV. Which is the nurse's best response? a) "We will do a simple blood test to determine whether your child has RSV." b) "There is no specific test for RSV. The diagnosis is made based on the child's symptoms." c) "We will swab your child's nose and send that specimen for testing." d) "We will have to send a viral culture to an outside lab for testing."
C The child is swabbed for nasal secretions. The secretions are tested to determine if a child has RSV.
A child's parent asks the nurse what treatment the child will need for the diagnosis of strep throat. Which is the nurse's best response? a) "Your child will be sent home on bedrest and should recover in a few days without any intervention." b) "Your child will need to have the tonsils removed to prevent future strep infections." c) "Your child will need oral penicillin for 10 days and should feel better in a few days." d) "Your child will need to be admitted to the hospital for 5 days of intravenous antibiotics."
C The child will need a 10-day course of penicillin to treat the strep infection. It is essential that the nurse always tell the family that, although the child will feel better in a few days, the entire course of antibiotics must be completed.
What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus? a) "What time did your child eat last?" b) "Has your child been exposed to any of the usual asthma triggers?" c) "When was your child last admitted to the hospital for asthma?" d) "When was your child's last dose of medication?"
D The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.
The parents of a 5-week-old have just been told that their child has cystic fibrosis (CF). The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse about the current projected life expectancy. What is the nurse's best response? a) "The life expectancy for CF patients has improved significantly in recent years." b) "Your child might not follow the same course that the mother's sister did." c) "The physician will come to speak to you about treatment options." d) The nurse answers their questions briefly, listens to their concerns, and is available later after they've processed the information.
D The nurse's best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk.
What should be the nurse's first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea? a) Immediate IV placement b) Immediate respiratory treatment c) Thorough physical assessment d) Lateral neck radiographs
D This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis.
The parents of a 6-year-old who has a new diagnosis of asthma ask the nurse what to do to make their home a more allergy-free environment. Which is the nurse's best response? a) "Use a humidifier in your child's room." b) "Have your carpet cleaned chemically once a month." c) "Wash household pets weekly." d) "Avoid purchasing upholstered furniture."
D Upholstered furniture can harbor large amounts of dust, whereas leather furniture may be wiped off regularly with a damp cloth.
