Quiz 2 Peds respiratory
After multiple upper respiratory infections, a school-aged child undergoes a tonsillectomy and adenoidectomy. Two weeks after surgery the nurse evaluates the child's condition. On what should the nurse focus? (Select all that apply.) Taste Smell Hearing Breathing Facial Symmetry
A, B, C, D: Edematous adenoids interfere with nasal breathing, which affects the sense of taste. Enlarged adenoids usually cause mouth breathing, which affects the sense of smell. Because hearing usually is affected by repeated oropharyngeal infections, this is an important postoperative assessment. Breathing is an important postoperative assessment because one goal of a tonsillectomy and adenoidectomy is to convert mouth breathing to nasal breathing. Facial symmetry is not affected by these procedures.
An 8-year-old child with a history of asthma is brought to the emergency department because of respiratory distress. The nurse immediately places the child in a bed with the head of the bed elevated and administers oxygen by means of a face mask. The healthcare provider performs a physical assessment, writes prescriptions, and admits the child to the pediatric unit. Which instruction should the nurse carry out first? Administer the albuterol Obtain a blood specimen for a complete blood count. Ask pt if they need to use the restroom Teach incentive spirometer use.
Administer the albuterol Albuterol (Proventil) relaxes smooth muscles in the respiratory tract, resulting in bronchodilation. The priority is to facilitate respiration, and this intervention follows the ABCs of emergency care—airway, breathing, and circulation. The use of an incentive spirometer may be taught after the acute episode of respiratory distress has been resolved. It will take time to obtain the device and teach the child about its use, and it should be used after the airway has been opened. Obtaining a blood specimen is not the priority. The results will not influence the priority intervention. Notifying the respiratory therapist is not the priority. Chest physical therapy is performed after the airway has been opened.
With interacting with parents of a SIDS, the nurse should attempt to assist the parents with? Allaying with feelings of guilt and blame Encouraging the parents to breath Encourage the parents to have another baby Encourage them to remain stoic Learn how the event could have been prevented
Allaying with feelings of guilt and blame
Respiratory acidosis is confirmed in a neonate with respiratory distress syndrome when the laboratory report reveals: A pH of 7.35 A potassium level of 4.6 mEq/L An increased PacO2 of 55 mm Hg An arterial O2 pressure of 80 mm Hg
An increased PacO2 of 55 mm Hg In respiratory acidosis the pH decreases and the carbon dioxide level increases. A pH of 7.35 is within the expected range of 7.32 to 7.49 for a neonate. A potassium level of 4.6 mEq/L is within the expected range of 3.5 to 5 mEq/L. The arterial oxygen level may or may not change with acidosis.
A 3 year old arrives at the ER. The child has a temperature of 102.4 'F, respiratory rate of 45, and is agitated. The child is diagnosed with epiglottitis. You note the child is sitting up, positioned forward with chin in the air and the tongue is protruding with the mouth open. Which nursing intervention below is NOT appropriate for this patient? Avoid taking a temperature on the patient orally. Keep child NPO Assist the patient in supine position Keep the patient on parent's lap during tx
Assist the patient in supine position Allow the child to be in a position that allows them to breathe and be comfortable. The child is in the tripod position, which is a common finding with epiglottis. Placing the child in the supine position is contraindicated because it impedes respiratory effort. A nursing goal is to keep the child calm (avoid things that cause the child to cry because this can affect the airway since the epiglottis is inflamed). So, keeping the child in the parent's lap during treatments is appropriate. In addition, NEVER place anything in the patient's mouth due to the risk of causing spasms which will further constrict the airway.
The nurse educates the family of a newly admitted child with cystic fibrosis. The treatment will be the center of what therapy? Antiviral Chest physiotherapy and, aerosol medication Insulin therapy Prevention of diarrhea
Chest physiotherapy and, aerosol medication
A 6-month-old infant is brought to the emergency department with severe respiratory distressed a diagnosis of RSV infection made the infant admitted to the pediatric unit. What should be included in the nursing care plan? Antibiotics Contact precautions and isolation Allowing family and sibling in the room with the patient Keeping the room cold
Contact precautions and isolation
A client is admitted to the hospital with a tentative diagnosis of pneumonia. The client has a high fever and is short of breath. Bed rest, oxygen via nasal cannula, an intravenous antibiotic, and blood and sputum specimens for culture and sensitivity (C&S) are prescribed. Place these interventions in the order in which they should be implemented. Specimens for C&S Bed rest Administration of an antibiotic Oxygen via nasal cannula
Correct order: Bedrest, Oxygen via cannula, Specimens for C&S, Administration of an antibiotic
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? RR of 24 Diminished breath sounds Pulse ox of 97 RA HR 99
Diminished breath sounds 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.
Whenpreparingachildwithasthmafordischarge,whatinstructionsmustthe nurse emphasize to the family? (Select all that apply.) Eliminate allergens in the home. Maintain a dry home environment. Avoid placing limits on the child's behavior. Continue the medications even if the child is asymptomatic. Prevent exposure to infection, have the child tutored at home.
Eliminate allergens in the home. Continue the medications even if the child is asymptomatic. 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 β2 -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. Child should return to school & continue to interact w/ schoolmates & friends.
A nurse is advising a client about the risks associated with failing to seek treatment for acute pharyngitis caused by beta-hemolytic streptococcus. For what health problem is the client at risk? Asthma Anemia Endocarditis Reye syndrome
Endocarditis Streptococcal infection can be spread through the circulation to the heart; endocarditis results and affects the valves of the heart. Asthma, anemia, and Reye syndrome are not caused by beta-hemolytic streptococci.
What is the main characteristic of cystic fibrosis? Excessive thick mucus Multiple UTI Over production of thin watery mucous Po Underactive thyroid
Excessive thick mucus
A 13-year-old child is hospitalized with an exacerbation of chronic bronchitis. What action should a nurse take to decrease retained secretions? Administer oxygen as ordered Increase fluid intake to at least 2000 mL/day Encourage the child to rest in the high Fowler position Teach the child to gargle with a saline solution every 2 hours
Increase fluid intake to at least 2000 mL/day Increased fluids help to liquefy respiratory secretions, which promotes expectoration. Oxygen may be drying and will thicken secretions; it should be administered only when necessary. The high Fowler position causes retention of secretions by gravity; prone and Trendelenburg positions promote removal of secretions via gravity. Teaching the child to gargle with a saline solution every 2 hours would not be helpful because retained secretions are found in the bronchi and trachea; gargling affects the oropharynx.
The lips and oral cavity of a child who ingested a corrosive substance are blistered, peeling, and swollen. The priority action for a nurse in the emergency department is to:
Maintain a patent airway.
On return to the pediatric unit after a tonsillectomy, a nurse notes that a 4-year-old child is swallowing frequently. What is the probable cause of this response? Post operative bleeding Tenacious oral secretion Subglottic stenosis Edema
Post operative bleeding
A nurse is caring for a client with pulmonary tuberculosis who is to receive several antitubercular medications. Which of the first- line antitubercular medications is associated with damage to the eighth cranial nerve? Isoniazid (INH) Rifampin (Rifadin) Streptomycin Ethambutol (Myambutol)
Streptomycin Streptomycin is ototoxic and can cause damage to the eighth cranial nerve, resulting in deafness. Assessment for ringing or roaring in the ears, vertigo, and hearing acuity should be made before, during, and after treatment. Isoniazid does not affect the ear; however, blurred vision and optic neuritis, as well as peripheral neuropathy, may occur. Rifampin does not affect hearing; however, visual disturbances may occur. Ethambutol does not affect hearing; however, visual disturbances may occur.
An infant is admitted to the pediatric unit with bronchiolitis caused by the respiratory syncytial virus (RSV). What medication does the nurse anticipate that the practitioner will prescribe? Ribavirin RespiGam Prednisone Gentamycin
Ribavirin Ribavirin is an antiviral agent. It is the only specific medication approved for hospitalized children with RSV. RespiGam is a prophylactic medication administered to infants who are at high risk for contracting RSV. Corticosteroid therapy is controversial because of its effect on children with significant respiratory distress. Antibiotics are ineffective because the etiological agent is viral, not bacterial.
A 4-month-old infant is admitted to the pediatric unit with severe tachypnea, flaring of the nares, wheezing, and irritability. The parents are told that the child has bronchiolitis and needs to be hospitalized for observation and treatment. While assessing the infant, the nurse determines that the infant is in respiratory failure. What clinical finding supports the nurse's conclusion? Wheezing cough Intercostal retractions Fine crackles on deep inspiration Sudden absence of breath sounds
Sudden absence of breath sounds A sudden absence of breath sounds occurs when bronchioles become obstructed and respiratory failure is imminent. A wheezing cough is a common manifestation of bronchiolitis and is caused by the passage of air through the narrowed airways; it does not herald respiratory failure. Intercostal retractions occur with mild and moderate respiratory distress in infants. Fine crackles are a routine occurrence with bronchiolitis, not a sign of respiratory failure.
The mother of a child with acute laryngotracheobronchitis (LTB) asks why her child must be kept NPO. Which responses would be the most correct? The epinephrine given causes nausea and vomiting The child is being hydrated with IV fluids The child is not hungry The child's rapid respirations pose a risk for aspiration
The child's rapid respirations pose a risk for aspiration Rapid respirations predispose to aspiration. The child is kept hydrated with IV fluids, but this is not the reason that the child must be kept NPO.
A 31 month old toddler is brought to the emergency department in acute respiratory distress a diagnosis of laryngeal tracheal bronchitis is made.What is the most important equipment for the nurse to have available for when the child is admitted to the pediatric unit? Nasal Canula for oxygen Padded crib rails IV start kit Tracheotomy set
Tracheotomy set
A client is receiving albuterol (Proventil) to relieve severe asthma. For which clinical indicators should the nurse monitor the client? (Select all that apply.) Tremors Lethargy Palpitations Visual disturbances Decreased pulse rate
Tremors Palpitations Albuterol's sympathomimetic effect causes central nervous stimulation, precipitating tremors, restlessness, and anxiety. Albuterol's sympathomimetic effect causes cardiac stimulation that may result in tachycardia and palpitations. Albuterol may cause restlessness, irritability, and tremors, not lethargy. Albuterol may cause dizziness, not visual disturbances. Albuterol will cause tachycardia, not bradycardia.
The parents of an infant with newly diagnosed cystic fibrosis ask a nurse what causes the foul-smelling, frothy stool. What is the best response by the nurse? Undigested fat Sodium and chloride Partially digested carbohydrates Lipase, trypsin, and amylase release
Undigested fat Because of a lack of the pancreatic enzyme lipase, fats remain unabsorbed and are excreted in excessive amounts in the stool.
When interacting with the parents of a SIDS infant, the nurse should attempt to assist the parents with: encouraging the parents to have another baby. encouraging the parents to remain stoic. allaying feelings of guilt and blame. learning how the event could have been prevented.
allaying feelings of guilt and blame. As parents try to cope, they have feelings of guilt and blame.
During a 2 month well visit with a patient and her mother you educate the parent on the most common cause of epiglottitis. You explain to the mother the most common cause of this condition is the _______________. In addition, you explain _________ can help prevent most cases of this condition? haemophilus influenzae type b, Hib vaccine Rotavirus / RV vaccine RSV Influenza virus / annual flu shot
haemophilus influenzae type b, Hib vaccine Most common cases of epiglottitis are caused by a bacteria that attacks the epiglottis called haemophilus influenza type B. The Hib vaccine can be given as prevention. Three to four doses are given (depending on the brand used) at 2, 4, 6 months, and 12-15 months.
A client is experiencing severe respiratory distress. What response should the nurse expect the client to exhibit? Generalized edema Bradycardia Tremors tachypnea
tachypnea The heart rate increases in an attempt to compensate for the lack of oxygen to body cells. Tremors are not associated with respiratory distress; tremors are associated with neurologic problems. Severe generalized edema (anasarca) is not associated with respiratory distress; anasarca is associated with renal failure. An increased respiratory rate (tachypnea), not a decreased respiratory rate (bradypnea), is associated with respiratory distress.
