Respiratory Quiz

Which nursing diagnosis is most appropriate for an infant with acute bronchiolitis due to respiratory syncytial virus (RSV)? 1. Activity Intolerance 2. Decreased Cardiac Output 3. Pain, Acute 4. Tissue Perfusion, Ineffective (peripheral)

1 Global Rationale: Activity intolerance is a problem because of the imbalance between oxygen supply and demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory-disease process.

Following parental teaching, the nurse is evaluating the parents understanding of environmental control for their childs asthma management. Which statement by the parents indicates appropriate understanding of the teaching? 1. We will replace the carpet in our childs bedroom with tile. 2. Were glad the dog can continue to sleep in our childs room. 3. Well be sure to use the fireplace often to keep the house warm in the winter. 4. Well keep the plants in our childs room dusted.

1 Global Rationale: Control of dust in the childs bedroom is an important aspect of environmental control for asthma management. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

58. A teaching care plan to prevent the transmission of respiratory syncytial virus (RSV) should include which of the following? Select all that apply. 1.The virus can be spread by direct contact. 2.The virus can be spread by indirect contact. 3.Palivizumab (Synagis) is recommended to prevent RSV for all toddlers in day care. 4.The virus is typically contagious for 3 weeks. 5.Older children seldom spread RSV. 6.Frequent hand washing helps reduce the spread of RSV.

1, 2, 6. R: RSV can be spread through direct contact such as kissing the face of an infected person, and it can be spread through indirect contact by touching surfaces covered with infected secretions. Handwashing is one of the best ways to reduce the risk of disease transmission. Palivizumab can prevent severe RSV infections but is only recommended for the most at-risk infants and children. RSV is typically contagious for 3 to 8 days. RSV frequently manifests in older children as cold-like symptoms. Infected school-age children frequently spread the virus to other family members.

The nurse educator is teaching a group of nursing students how to perform a respiratory assessment for a newborn in the newborn intensive care unit (NICU) diagnosed with respiratory distress syndrome (RDS). Which normal characteristics of the newborns respiratory system increase the risk for obstruction? Standard Text: Select all that apply. 1. Shorter and narrower airway 2. Higher trachea 3. Bronchial branching at different angles 4. Inadequate smooth muscle bundles 5. Diaphragmatic breather

1,2,3 Global Rationale: Normal characteristics of the pediatric respiratory system that increase the risk for obstruction include a shorter and narrower airway, a higher trachea, and a different angle for bronchial branching. Inadequate smooth muscle bundles and being diaphragmatic breathers are characteristics that do not increase the risk of obstruction.

34. Which one of the following children is at most risk for sudden infant death syndrome (SIDS)? 1.Infant who is 3 months old. 2.2-year-old who has apnea lasting up to 5 seconds. 3.First-born child whose parents are in their early forties. 4.6-month-old who has had two bouts of pneumonia.

1. R: The highest incidence of SIDS occurs in infants between ages 2 and 4 months. About 90% of SIDS occurs before the age of 6 months. Apnea lasting longer than 20 seconds has also been associated with a higher incidence of SIDS. SIDS occurs with higher frequency in families where a child in the family has already died of SIDS, but the age of the parents has not been shown to contribute to SIDS. A respiratory infection such as pneumonia has not been shown to cause a higher incidence of SIDS.

30. Which of the following, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease? 1.An abnormality in the body's mucus-secreting glands. 2.Formation of fibrous cysts in various body organs. 3.Failure of the pancreatic ducts to develop properly. 4.Reaction to the formation of antibodies against streptococcus.

1. R: CF is characterized by a dysfunction in the body's mucus-producing exocrine glands. The mucus secretions are thick and sticky rather than thin and slippery. The mucus obstructs the bronchi, bronchioles, and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine, resulting in poor digestion and poor absorption of various food nutrients. Fibrous cysts do not form in various organs. Cystic fibrosis is an autosomal recessive inherited disorder and does not involve any reaction to the formation of antibodies against streptococcus.

A nurse is assessing a neonate. Which assessment finding indicates that the neonates respiratory status is worsening? 1. Acrocyanosis 2. Arterial CO2 of 40 3. Periorbital edema 4. Grunting respirations with nasal flaring

4 Global Rationale: Grunting respirations with nasal flaring indicates respiratory status is becoming worse. Acrocyanosis (cyanosis of the extremities) is a normal finding in a neonate. CO2 of 40 is within a normal range. Periorbital edema does not necessarily mean deterioration in respiratory status.

9.After teaching the parents of a toddler about commonly aspirated foods, which of the following foods, if identified by the parents as easily aspirated, would indicate the need for additional teaching? 1.Popcorn. 2.Raw vegetables. 3.Round candy. 4.Crackers.

4. R: Crackers, because they crumble and easily dissolve, are not commonly aspirated. Because children commonly eat popcorn hulls or pieces that have not popped, popcorn can be easily aspirated. Toddlers frequently do not chew their food well, making raw vegetables a commonly aspirated food. Round candy is often difficult to chew and comes in large pieces, making it easily aspirated.

22. An 8-year-old child with asthma states, "I want to play some sports like my friends. What can I do?" The nurse responds to the child based on the understanding of which of the following? 1.Physical activities are inappropriate for children with asthma. 2.Children with asthma must be excluded from team sports. 3.Vigorous physical exercise frequently precipitates an asthmatic episode. 4.Most children with asthma can participate in sports if the asthma is controlled.

4. R: Physical activities are beneficial to asthmatic children, physically and psychosocially. Most children with asthma can engage in school and sports activities that are geared to the child's condition and within the limits imposed by the disease. The coach and other team members need to be aware of the child's condition and know what to do in case an attack occurs. Those children who have exercise-induced asthma usually use a short-acting bronchodilator before exercising.

36. When planning a visit to the parents of an infant who died of sudden infant death syndrome (SIDS) at home, the nurse should visit the parents at which of the following times? 1.A few days after the funeral. 2.Two weeks after the funeral. 3.As soon as the parents are ready to talk. 4.As soon after the infant's death as possible.

4. R: The community health nurse should visit as soon after the death as possible, because the parents may need help to deal with the sudden, unexpected death of their infant. Parents often have a great deal of guilt in these situations and need to express their feelings to someone who can provide counseling.

28. At a follow-up appointment after being hospitalized, an adolescent with a history of cystic fibrosis (CF) describes his stools to the nurse. Which of the following descriptions should the nurse interpret as indicative of continued problems with malabsorption? 1.Soft with little odor. 2.Large and foul-smelling. 3.Loose with bits of food. 4.Hard with streaks of blood.

"2. In children with CF, poor digestion and absorption of foods, especially fats, results in frequent bowel movements that are bulky, large, and foul-smelling. The stools also contain abnormally large quantities of fat, which is called steatorrhea. An adolescent experiencing good control of the disease would describe soft stools with little odor. Stool described as loose with bits of food indicates diarrhea. Stool described as hard with streaks of blood may indicate constipation.

A child is showing signs of acute respiratory distress. Which position will the nurse place this child? 1. Upright 2. Side-lying 3. Flat 4. In semi-Fowlers

1 Global Rationale: Upright is correct because it allows for optimal chest expansion. Side-lying, flat, and semi-Fowlers (head up slightly) do not allow for as optimal chest expansion as the upright position.

16. Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply. 1.Coughing. 2.Respiratory rate of 35 breaths/min. 3.Heart rate of 95 beats/min. 4.Restlessness. 5.Malaise. 6.Diaphoresis.

1, 2, 4, 6. R: Coughing, especially at night and in the absence of an infection, is a common symptom of asthma. Early signs of respiratory distress include restlessness, tachypnea, tachycardia, and diaphoresis. Other signs also include hypertension, nasal flaring, grunting, wheezing, and intercostal retractions. A heart rate of 95 bpm is normal for a toddler. Malaise typically does not indicate respiratory distress.

33. When explaining to parents how to reduce the risk of Sudden Infant Death Syndrome (SIDS) the nurse should teach about which of the following measures? Select all that apply. 1.Maintain a smoke-free environment. 2.Use a wedge for side-lying positions. 3.Breast-feed the baby. 4.Place the baby on his back to sleep. 5.Use bumper pads over the bed rails. 6.Have the baby sleep in the parent's bed.

1, 3, 4. R: Exposure to environmental tobacco increases the risk for SIDS. Sleeping on the back and breast-feeding both decrease the risk of SIDS. The side-lying position is not recommended for sleep. It is recommended that babies be dressed in sleepers and that cribs are free of blankets, pillows, bumper pads, and stuffed animals. Co-bedding with parents is not recommended as parents may roll on the child.

A school nurse is planning care for a school-age child recently diagnosed with asthma. Which items will the school nurse include in the plan of care at the school? Standard Text: Select all that apply. 1. Maintain a log of quick-relief medication administration. 2. Call the parents if quick-relief medications work appropriately. 3. Assess for symptoms of exercise-induced bronchospasm. 4. Coordinate education of the childs teachers. 5. Conduct a support group for all children with asthma.

1,3,4,5 Global Rationale: Appropriate interventions for the school nurse to include in the plan of care include: keeping a log of the quick-relief medications administered; assessing the child for exercise-induced bronchospasms and reporting, if needed; coordinating education of the childs teachers; and conducting a support group for all children in the school with asthma. The nurse would only call the parents if the quick-relief mediation was not effective in treating the childs symptoms.

31. Which of the following outcome criteria would the nurse develop for a child with cystic fibrosis who has ineffective airway clearance related to increased pulmonary secretions and inability to expectorate?" "1.Respiratory rate and rhythm within expected range. 2.Absence of chills and fever. 3.Ability to engage in age-related activities. 4.Ability to tolerate usual diet without vomiting.

1. R: After treatment, the client outcome would be that respiratory status would be within normal limits, as evidenced by a respiratory rate and rhythm within expected range. Absence of chills and fever, although related to an underlying problem causing the respiratory problem (eg, the infection), do not specifically relate to the respiratory problem of ineffective airway clearance. The child's ability to engage in age-related activities may provide some evidence of improved respiratory status. However, this outcome criterion is more directly related to activity intolerance. Although the child's ability to tolerate his or her usual diet may indirectly relate to respiratory function, this outcome is more specifically related to an imbalanced nutrition that may or may not be related to the child's respiratory status.

25. A child with cystic fibrosis is receiving gentamicin. Which of the following nursing actions is most important? 1.Monitoring intake and output. 2.Obtaining daily weights. 3.Monitoring the client for indications of constipation. 4.Obtaining stool samples for hemoccult testing.

1. R: Monitoring intake and output is the most important nursing action when administering an aminoglycoside, such as gentamicin, because a decrease in output is an early sign of renal damage. Daily weight monitoring is not indicated when the client is receiving an aminoglycoside. Constipation and bleeding are not adverse effects of aminoglycosides.

32. A school-age child with cystic fibrosis asks the nurse what sports she can become involved in as she becomes older. Which of the following activities would be appropriate for the nurse to suggest? 1.Swimming. 2.Track. 3.Baseball. 4.Javelin throwing.

1. R: Swimming would be the most appropriate suggestion because it coordinates breathing and movement of all muscle groups and can be done on an individual basis or as a team sport. Because track events, baseball, and javelin throwing usually are performed outdoors, the child would be breathing in large amounts of dust and dirt, which would be irritating to her mucous membranes and pulmonary system. The strenuous activity and increased energy expenditure associated with track events, in conjunction with the dust and possible heat, would play a role in placing the child at risk for an upper respiratory tract infection and compromising her respiratory function.

37. When developing the ongoing plan of care for the parents whose infant died of sudden infant death syndrome (SIDS), the nurse should plan to accomplish which of the following on the second home visit? 1.Allow the parents to express their feelings. 2.Have the parents gain an understanding of the disease. 3.Assess the impact of the infant's death on their other children. 4.Deal with issues such as having other children.

1. R: The goal of the second home visit is to help the parents express their feelings more openly. Many parents are reluctant to express their grief and need help. The goal of the first visit is to help the parents understand the disease and what happened. The first visit also provides time to help the parents understand that they are not to blame. Although it is important to assess the impact of SIDS on siblings, this is not the primary goal for the second visit. However, the nurse must be flexible in case problems involving this area arise. Typically, parents are unable to deal with decisions such as having other children during the second visit because they are grieving for the child that they lost. This topic may be discussed later in the course of care.

50. The father of a 16-month-old child calls the clinic because the child has a low-grade fever, cold symptoms, and a hoarse cough. Which of the following should the nurse suggest that the father do? 1.Offer extra fluids frequently. 2.Bring the child to the clinic immediately. 3.Count the child's respiratory rate. 4.Use a hot air vaporizer.

1. R: The toddler is exhibiting cold symptoms. A hoarse cough may be part of the upper respiratory tract infection. The best suggestion is to have the father offer the child additional fluids at frequent intervals to help keep secretions loose and membranes moist. There is no evidence presented to suggest that the child needs to be brought to the clinic immediately. Although having the father count the child's respiratory rate may provide some additional information, it may lead the father to suspect that something is seriously wrong, possibly leading to undue anxiety. A hot air vaporizer is not recommended. However, a cool mist vaporizer would cause vasoconstriction of the respiratory passages, making it easier for the child to breathe and loosening secretions.

20. When developing a teaching plan for the mother of an asthmatic child concerning measures to reduce allergic triggers, which of the following suggestions should the nurse include? 1.Keep the humidity in the home between 50% and 60%. 2.Have the child sleep in the bottom bunk bed. 3.Use a scented room deodorizer to keep the room fresh. 4.Vacuum the carpet once or twice a week.

1. R: To help reduce allergic triggers in the home, the nurse should recommend that the humidity level be kept between 50% and 60%. Doing so keeps the air moist and comfortable for breathing. When air is dry, the risk for respiratory infections increases. Too high a level of humidity increases the risk for mold growth. Typically, the child with asthma should sleep in the top bunk bed to minimize the risk of exposure to dust mites. The risk of exposure to dust mites increases when the child sleeps in the bottom bunk bed because dust mites fall from the top bed, settling in the bottom bed. Scented sprays should be avoided because they may trigger an asthmatic episode. Ideally, carpeting should be avoided in the home if the child has asthma. However, if it is present, carpeting in the child's room should be vacuumed often, possibly daily, to remove dust mites and dust particles.

10. A toddler who has been treated for a foreign body aspiration begins to fuss and cry when the parents attempt to leave the hospital for an hour. The parents will be returning to take the toddler home. As the nurse tries to take the child out of the crib, the child pushes the nurse away. The nurse interprets this behavior as indicating separation anxiety involving which of the following? 1.Protest. 2.Despair. 3.Regression. 4.Detachment.

1. R: Young children have specific reactions to separation and hospitalization. In the protest stage, the toddler physically and verbally attacks anyone who attempts to provide care. Here, the child is fussing and crying and visibly pushes the nurse away. In the despair stage, the toddler becomes withdrawn and obviously depressed (eg, not engaging in play activities and sleeping more than usual). Regression is a return to a developmentally earlier phase because of stress or crisis (eg, a toddler who could feed himself before this event is not doing so now). Denial or detachment occurs if the toddler's stay in the hospital without the parent is prolonged because the toddler settles in to the hospital life and denies the parents' existence (eg, not reacting when the parents come to visit).

The nurse is teaching the parents of a newly diagnosed cystic fibrosis patient how to administer the pancreatic enzymes. How often will the nurse teach the parents to administer the enzymes? 1. Two times per day 2. With meals and snacks 3. Every 6 hours around the clock 4. Four times per day

2 Global Rationale: Pancreatic enzymes are administered with meals and large snacks. A scheduled time would not be appropriate because the enzymes are used to assist in digestion of nutrients.

The nurse is teaching a group of mothers of infants about the benefits of immunization. Which immunization will the nurse teach to the mothers that can assist in preventing the life-threatening disease epiglottitis? 1. Measles, mumps, and rubella (MMR) 2. Haemophilus influenzae type B (HIB) 3. Hepatitis B 4. Polio

2 Global Rationale: The Haemophilus influenzae type B (HIB) immunization can assist in prevention of epiglottitis. Hepatitis B, measles, mumps, rubella, and the polio virus are not causative agents for epiglottitis.

The nurse is providing care to an infant in the emergency department. Upon assessment, the infant is noted to have to be experiencing tachypnea, wheezing, retractions, and nasal flaring. The infant is irritability and the parents state the infant has had poor fluid intake for two days. Pulse ox reading is currently at 85% on room air. The infants blood gas is pending. Which diagnosis does the nurse anticipate for this infant? 1. Bronchitis 2. Bronchiolitis 3. Pneumonia 4. Active pulmonary tuberculosis

2 Global Rationale: The nurse anticipates the infant will be diagnosed with bronchiolitis. Symptoms of bronchiolitis include mild respiratory symptoms that progress to tachypnea, wheezing, retractions, nasal flaring, irritability, poor fluid intake, hypoxia, cyanosis, and decreased mental status. Symptoms of bronchitis include a dry hacking cough, increases in severity at night, painful chest and ribs. Symptoms of pneumonia include initial rhinitis and cough, followed by fever, crackles, wheezes, dyspnea, tachypnea, restlessness, diminished breath sounds. Symptoms of active pulmonary tuberculosis include persistent cough, decreased appetite, weight loss or failure to gain weight, low-grade fever, night sweats, chills, enlarged lymph nodes.

The nurse is providing care to an infant who is diagnosed with bronchiolitis. Which breath sounds indicate the infant is experiencing respiratory distress? Standard Text: Select all that apply. 1. Tachypnea 2. Wheezing 3. Grunting 4. Retractions 5. Eupnea

2,3 Global Rationale: Wheezing and grunting are adventitious respiratory sounds that indicates respiratory distress in the neonate. Tachypnea is the term used to indicate a respiratory rate of greater than 60 breaths per minute in an infant. While this does indicate respiratory distress, tachynpea is not a type of breath sound. Retractions, or the use of accessory muscles, are indicative of respiratory distress in the neonate, but this is not a type of breath sound. Eupnea is the medical term for normal breathing.

26. When developing the plan of care for a child with cystic fibrosis (CF) who is scheduled to receive postural drainage, the nurse should anticipate performing postural drainage at which of the following times? 1.After meals. 2.Before meals. 3.After rest periods. 4.Before inhalation treatments.

2. R: Postural drainage, which aids in mobilizing the thick, tenacious secretions commonly associated with CF, is usually performed before meals to avoid the possibility of vomiting or regurgitating food. Although the child with CF needs frequent rest periods, this is not an important factor in scheduling postural drainage. However, the nurse would not want to interrupt the child's rest period to perform the treatment. Inhalation treatments are usually given before postural drainage to help loosen secretions.

14. A 12-year-old with asthma wants to exercise. Which of the following activities should the nurse suggest to improve breathing? 1.Soccer. 2.Swimming. 3.Track. 4.Gymnastics.

2. R: Swimming is appropriate for this child because it requires controlled breathing, assists in maintaining cardiac health, enhances skeletal muscle strength, and promotes ventilation and perfusion. Stop-and-start activities, such as soccer, track, and gymnastics, commonly trigger symptoms in asthmatic clients.

23. A 9-month-old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is: 1.The child will become dehydrated if the supplement is not taken with meals and snacks. 2.The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins. 3.The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear. 4.The child will experience severe diarrhea if the supplement is not taken as prescribed.

2. R: The child must take the pancreatic enzyme supplement with meals and snacks to help absorb nutrients so he can grow and develop normally. In cystic fibrosis, the normally liquid mucus is tenacious and blocks three digestive enzymes from entering the duodenum and digesting essential nutrients. Without the supplemental pancreatic enzyme, the child will have voluminous, foul, fatty stools due to the undigested nutrients and may experience developmental delays due to malnutrition. Dehydration is not a problem related to cystic fibrosis. The pancreatic enzymes have no effect on the viscosity of the tenacious mucus. Diarrhea is not caused by failing to take the pancreatic enzyme supplement.

29. When developing a recreational therapy plan of care for a 3-year-old child hospitalized with pneumonia and cystic fibrosis, which of the following toys would be appropriate? 1.100-piece jigsaw puzzle. 2.Child's favorite doll. 3.Fuzzy stuffed animal. 4.Scissors, paper, and paste.

2. R: The child's favorite doll would be a good choice of toys. The doll provides support and is familiar to the child. Although a 3-year-old may enjoy puzzles, a 100-piece jigsaw puzzle is too complicated for an ill 3-year-old child. In view of the child's lung pathology, a fuzzy stuffed animal would not be advised because of its potential as a reservoir for dust and bacteria, possibly predisposing the child to additional respiratory problems. Scissors, paper, and paste are not appropriate for a 3-year-old unless the child is supervised closely.

51. A 21-month-old child admitted with the diagnosis of croup now has a respiratory rate of 48 breaths/minute, a heart rate of 120 bpm, and a temperature of 100.8°F (38.2°C) rectally. The nurse is having difficulty calming the child. Which of the following should the nurse do next? 1.Administer acetaminophen (Tylenol). 2.Notify the primary care provider immediately. 3.Allow the toddler to continue to cry. 4.Offer clear fluids every few minutes.

2. R: The nurse may be having difficulty calming the child because the child is experiencing increasing respiratory distress. The normal respiratory rate for a 21-month-old is 25 to 30 breaths/min. The child's respiratory rate is 48 breaths/min. Therefore the primary care provider needs to be notified immediately. Typically, acetaminophen is not given to a child unless the temperature is 101°F (38.6°C) or higher. Letting the toddler cry is inappropriate with croup because crying increases respiratory distress. Offering fluids every few minutes to a toddler experiencing increasing respiratory distress would do little, if anything, to calm the child. Also, the child would have difficulty coordinating breathing and swallowing, possibly increasing the risk of aspiration.

17. A 10-year-old child who is 5′ 4″ (138 cm) tall with a history of asthma uses an inhaled bronchodilator only when needed. He/she takes no other medications routinely. His/her best peak expiratory flow rate is 270 L/min. The child's current peak flow reading is 180 L/min. The nurse interprets this reading as indicating which of the following? 1.The child's asthma is under good control, so the routine treatment plan should continue. 2.The child needs to use his/her short-acting inhaled beta2-agonist medication. 3.This is a medical emergency requiring a trip to the emergency department for treatment. 4.The child needs to use his/her inhaled cromolyn sodium (Intal).

2. R: The peak flow of 180 L/min is in the yellow zone, or 50% to 80% of the child's personal best. This means that the child's asthma is not well controlled, thereby necessitating the use of a short-acting beta2-agonist medication to relieve the bronchospasm. A peak flow reading greater than 80% of the child's personal best (in this case, 220 L/min or better) would indicate that the child's asthma is in the green zone or under good control. A peak flow reading in the red zone, or less than 50% of the child's personal best (135 L/min or less), would require notification of the health care provider or a trip to the emergency department. Cromolyn sodium (Intal) is not used for short-term treatment of acute bronchospasm. It is used as part of a long-term therapy regimen to help desensitize mast cells and thereby help to prevent symptoms.

A newborn is suspected of having cystic fibrosis. As the child is being prepared for transfer to a pediatric hospital, the mother asks the nurse which symptoms made the practitioner suspect cystic fibrosis. Which response by the nurse is the most appropriate? 1. Steatorrheic stools 2. Constipation 3. Meconium ileus 4. Rectal prolapse

3 Global Rationale: Newborns with cystic fibrosis may present in the first 48 hours with meconium ileus. Steatorrhea, constipation, and rectal prolapse may be signs of cystic fibrosis seen in an older infant or child.

Parents of a child admitted with respiratory distress are concerned because the child wont lie down and wants to sit in a chair leaning forward. Which response by the nurse is the most appropriate? 1. This helps the child feel in control of his situation. 2. The child needs to be encouraged to lie flat in bed. 3. This position helps keep the airway open. 4. This confirms the child has asthma.

3 Global Rationale: Leaning forward helps keep the airway open. The child is not in control just because he is leaning forward. Lying flat in bed will increase the respiratory distress. This position does not confirm asthma.

19. A 7-year-old child with a history of asthma controlled without medications is referred to the school nurse by the teacher because of persistent coughing. Which of the following should the nurse do first? 1.Obtain the child's heart rate. 2.Give the child a nebulizer treatment. 3.Call a parent to obtain more information. 4.Have a parent come and pick up the child.

3. R: Because persistent coughing may indicate an asthma attack and a 7-year-old child would be able to provide only minimal history information, it would be important to obtain information from the parent. Although determining the child's heart rate is an important part of the assessment, it would be done after the history is obtained. More information needs to be obtained before giving the child a nebulizer treatment. Although it may be necessary for the parent to come and pick up the child, a thorough assessment including history information should be obtained first.

35. Parents bring their child to the emergency department because the child has stopped breathing. A nurse obtains a brief history of events occurring before and after the parents found the infant not breathing. Which of the following questions should the nurse ask the parents first? 1."Was the infant sleeping while wrapped in a blanket?" 2."Was the infant lying on his stomach?" 3."What did the infant look like when you found him?" 4."When had you last checked on the infant?

3. R: Because this is an especially disturbing and upsetting time for the parents, they must be approached in a sensitive manner. Asking what the infant looked like when found allows the parents to verbalize what they saw and felt, thereby helping to minimize their feelings of guilt without implying any blame, neglect, wrongdoing, or abuse. Asking if the child was wrapped in a blanket or lying on his stomach, or when the parents last checked on the infant, implies that the parents did something wrong or failed in their care of the infant, thus blaming them for the event.

24. A client's diagnosis of cystic fibrosis was made 13 years ago, and he/she has since been hospitalized several times. On the latest admission, the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which nursing actions are most important initially? 1.Placing the client on bed rest and prescribing a blood gas analysis. 2.Prescribing a high-calorie, high-protein, low-fat, vitamin-enriched diet and pancreatic granules. 3.Applying an oximeter and initiating respiratory therapy. 4.Inserting an IV line and initiating antibiotic therapy.

3. R: Clients with cystic fibrosis commonly die from respiratory problems. The mucus in the lungs is tenacious and difficult to expel, leading to lung infections and interference with oxygen and carbon dioxide exchange. The client will likely need supplemental oxygen and respiratory treatments to maintain adequate gas exchange, as identified by the oximeter reading. The child will be on bed rest due to respiratory distress. However, although blood gases will probably be prescribed, the oximeter readings will be used to determine oxygen deficit and are, therefore, more of a priority. A diet high in calories, proteins, and vitamins with pancreatic granules added to all foods ingested will increase nutrient absorption and help the malnutrition; however, this intervention is not the priority at this time. Inserting an IV to administer antibiotics is important, and can be done after ensuring adequate respiratory function.

13. An 11-year-old is admitted for treatment of an asthma attack. Which of the following indicates immediate intervention is needed? 1.Thin, copious mucous secretions. 2.Productive cough. 3.Intercostal retractions. 4.Respiratory rate of 20 breaths/minute.

3. R: Intercostal retractions indicate an increase in respiratory effort, which is a sign of respiratory distress. During an asthma attack, secretions are thick, the cough is tight, and respiration is difficult (and shortness of breath may occur). If mucous secretions are copious but thin, the client can expectorate them, which indicates an improvement in the condition. If the cough is productive it means the bronchospasms and the inflammation have been resolved to the extent that the mucus can be expectorated. A respiratory rate of 20 breaths/min would be considered normal and no intervention would be needed.

21. After discussing asthma as a chronic condition, which of the following statements by the father of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease? 1."We try to keep him happy at all costs; otherwise, he has an asthma attack." 2."We keep our child away from other children to help cut down on infections." 3."Although our child's disease is serious, we try not to let it be the focus of our family." 4."I'm afraid that when my child gets older, he won't be able to care for himself like I do."

3. R: Positive adjustment to a chronic condition requires placing the child's illness in its proper perspective. Children with asthma need to be treated as normally as possible within the scope of the limitations imposed by the illness. They also need to learn how to manage exacerbations and then resume as normal a life as possible. Trying to keep the child happy at all costs is inappropriate and can lead to the child's never learning how to accept responsibility for behavior and get along with others. Although minimizing the child's risk for exposure to infections is important, the child needs to be with his or her peers to ensure appropriate growth and development. Children with a chronic illness need to be involved in their care so that they can learn to manage it. Some parents tend to overprotect their child with a chronic illness. This overprotectiveness may cause a child to have an exaggerated feeling of importance or later, as an adolescent, to rebel against the overprotectiveness and the parents.

18. An adolescent with chest pain goes to the school nurse. The nurse determines that the teenager has a history of asthma but has had no problems for years. Which of the following should the nurse do next? 1.Call the adolescent's parent. 2.Have the adolescent lie down for 30 minutes. 3.Obtain a peak flow reading. 4.Give two puffs of a short-acting bronchodilator.

3. R: Problems of chest pain in children and adolescents are rarely cardiac. With a history of asthma, the most likely cause of the chest pain is related to the asthma. Therefore, the nurse should check the adolescent's peak flow reading to evaluate the status of the air flow. Calling the adolescent's parent would be appropriate, but this would be done after the nurse obtains the peak flow reading and additional assessment data. Having the adolescent lie down may be an option, but more data need to be collected to help establish a possible cause. Because the adolescent has not experienced any asthma problems for a long time, it would be inappropriate for the nurse to administer a short-acting bronchodilator at this time

12. The father of a 2-year-old phones the emergency room on a Sunday evening and informs the nurse that his son put a bead in his nose. What is the most appropriate recommendation made by the nurse?

3. R: The bead should be removed by a health care professional as soon as possible to prevent the risk of aspiration and tissue necrosis. Unskilled individuals should not attempt to remove an object from the nose as they may push the object further increasing the risk for aspiration. Two-year-old children are not skilled at blowing their nose and may breathe in, further increasing the risk of aspiration.

15. When preparing the teaching plan for the mother of a child with asthma, which of the following should the nurse include as signs to alert the mother that her child is having an asthma attack? 1.Secretion of thin, copious mucus. 2.Tight, productive cough. 3.Wheezing on expiration. 4.Temperature of 99.4°F (37.4°C).

3. R: The child who is experiencing an asthma attack typically demonstrates wheezing on expiration initially. This results from air moving through narrowed airways secondary to bronchoconstriction. The child's expiratory phase is normally longer than the inspiratory phase. Expiration is passive as the diaphragm relaxes. During an asthma attack, secretions are thick and are not usually expelled until the bronchioles are more relaxed. At the beginning of an asthma attack the cough will be tight but not productive. Fever is not always present unless there is an infection that may have triggered the attack.

A child is admitted to the hospital with the diagnosis of laryngotracheobronchitis (LTB). Which nursing intervention is the priority for this child? 1. Administer nebulized epinephrine and oral or IM dexamethasone. 2. Administer antibiotics and assist with possible intubation. 3. Swab the throat for a throat culture. 4. Obtain a sputum specimen.

4 Global Rationale: Nebulized epinephrine and dexamethasone are given for LTB. Antibiotic administration and possible intubation are associated with epiglottitis. Throat cultures are not obtained for LTB because it is viral and swabbing the throat could cause complete obstruction to occur. Sputum specimens will not assist in the diagnosis of LTB.

The practitioner changes the medications for the child with asthma to salmeterol (Serevent). The mother asks the nurse what this drug will do. The nurse explains that salmeterol (Serevent) is used to treat asthma because the drug produces which characteristic? 1. Decreases inflammation 2. Decreases mucous production 3. Controls allergic rhinitis 4. Dilates the bronchioles

4 Global Rationale: Salmeterol (Serevent) is a long-acting beta2-agonist that acts by bronchodilating. Steroids are anti-inflammatory, anticholinergics decrease mucous production, and antihistamines control allergic rhinitis.

A nurse delegates the task of neonatal vital-sign assessment to a nurse technician. Which instruction will the nurse give to the technician prior to assign care? 1. Report any neonate using abdominal muscles to breathe. 2. Report any neonate with apnea for 10 seconds. 3. Count respirations for 15 seconds and multiply by 4 to get the rate for 1 minute. 4. Report any neonate with a breathing pause that lasts 20 seconds or longer.

4 Global Rationale: The abnormal assessment finding for vital signs that the nurse should instruct a nurse technician to report is any breathing pause by a neonate lasting longer than 20 seconds. This can indicate apnea and could lead to an apparent life-threatening event (ALTE). A breathing pause of 10 seconds or less is called periodic breathing and is a normal pattern for a neonate. Respirations should be counted for 1 minute, not 15 seconds. It is normal for neonates to use abdominal muscles for breathing.

27. When teaching the parents of an older infant with cystic fibrosis (CF) about the type of diet the child should consume, which of the following would be appropriate? 1.Low-protein diet. 2.High-fat diet. 3.Low-carbohydrate diet. 4.High-calorie diet.

4. R: CF affects the exocrine glands. Mucus is thick and tenacious, sticking to the walls of the pancreatic and bile ducts and eventually causing obstruction. Because of the difficulty with digestion and absorption, a high-calorie, high-protein, high-carbohydrate, moderate-fat diet is indicated.

11. After teaching the parents of an 18-month-old who was treated for a foreign body obstruction about the three cardinal signs indicative of choking, the nurse determines that the teaching has been successful when the parents state that a child is choking when he or she cannot speak, turns blue, and does which of the following? 1.Vomits. 2.Gasps. 3.Gags. 4.Collapses.

4. R: The three cardinal signs indicating that a child is truly choking and requires immediate life-saving interventions include inability to speak, blue color (cyanosis), and collapse. Vomiting does not occur while a child is unable to breathe. Once the object is dislodged, however, vomiting may occur. Gasping, a sudden intake of air, indicates that the child is still able to inhale. When a child is choking, air is not being exchanged, so gagging will not occur.

49. A 3-year-old is brought into the emergency department in her mother's arms. The child's mouth is open and she is drooling and lethargic. Her mother states that she became ill suddenly within the past 2 hours. What should the nurse do first? 1.Draw blood cultures for complete blood count. 2.Start an intravenous line. 3.Inspect the child's throat with a tongue blade. 4.Maintain the child in an undisturbed, upright position.

4. R: This child is in severe respiratory distress with the potential for complete airway obstruction. The nurse should refrain from disturbing the child at this time to avoid irritating the epiglottis and causing it to completely obstruct the child's airway. The child may be intubated or undergo a tracheotomy. However, initially, the child should be kept as calm as possible with as little disruption as possible. Any attempt to restrain the child, draw blood, insert an IV, or examine her throat could result in total airway obstruction.