Saunders Peds Respiratory

The normal pulse rate in a 10-year-old is

70 to 110 beats/minute.

A pediatric nurse in the *ambulatory surgery unit* is caring for a child following a tonsillectomy. The child is complaining of a dry throat. Which item should the nurse offer to the child?

Green gelatin Following tonsillectomy, cool, clear liquids should be administered. Citrus flavored, carbonated, and extremely hot or cold liquids should be avoided because they may irritate the throat. Red liquids are avoided because they give the appearance of blood if the child vomits. Milk and milk products, including pudding, are avoided because they coat the throat and cause the child to clear his or her throat, thus increasing the risk of bleeding.

The nurse is caring for a hospitalized infant with a diagnosis of bronchiolitis. In which position should the nurse place the infant?

Head and chest at a 30-degree angle with the neck slightly extended The nurse should position the infant with the head and the chest at a 30- to 40-degree angle with the neck slightly extended to maintain an open airway and to decrease pressure of the diaphragm.

The nurse in the ambulatory care unit is caring for a child after a tonsillectomy. The child's mother tells the nurse that the child is complaining of a dry throat and would like something to relieve the dryness. Which item should the nurse provide for the mother to give to the child?

After tonsillectomy, clear, cool liquids should be given. Citrus, carbonated, and extremely hot or cold liquids should be avoided because they may irritate the throat. Milk and milk products, including pudding, are avoided because they coat the throat, which causes the child to clear the throat, thereby increasing the risk of bleeding. Red liquids should be avoided because they give the appearance of blood if the child vomits.

The clinic nurse reads the results of a tuberculin skin test (TST) on a 3-year-old child. The results indicate an area of induration measuring 10 mm. The nurse should interpret these results as which finding?

positive Induration measuring *10 mm* or more is considered to be a *positive* result in children *younger than 4 years* of age and in children with *chronic illness* or at *high risk* for exposure to tuberculosis.

The nurse is reviewing the laboratory results for a child scheduled for a tonsillectomy. The nurse determines that which laboratory value is most significant to review?

prothrombin time A tonsillectomy is the surgical removal of the tonsils. Because the tonsillar area is so vascular, postoperative bleeding is a concern. Prothrombin time partial thromboplastin time platelet count hemoglobin hematocrit white blood cell count urinalysis are performed preoperatively. The prothrombin time results would identify a potential for bleeding.

The nurse is preparing to care for a child after a tonsillectomy. The nurse documents on the plan of care to place the child in which position?

side lying tonsillectomy is the surgical removal of the tonsils. The child should be placed in a prone or side-lying position after the surgical procedure to facilitate drainage.

A primary concern with epiglottis is

that it can progress to acute respiratory distress. ALWAYS AN EMERGENCY!!!

The results of a tuberculin skin test (TST) reaction of 5 mm or more is considered to be a positive result for

the highest risk groups, such as a child with an immunosuppressive condition or a child with human immunodeficiency virus (HIV) infection.

Pneumonia is an inflammation of

the pulmonary parenchyma or alveoli, or both

The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the child is bleeding?

frequent swallowing

The mother of a hospitalized 2-year-old child with viral laryngotracheobronchitis (croup) asks the nurse why the health care provider did not prescribe antibiotics. Which response should the nurse make?

"Antibiotics are not indicated unless a bacterial infection is present." Laryngotracheobronchitis (croup) is the inflammation of the larynx, trachea, and bronchi and is the most common type of croup. *It can be viral or bacterial*. Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. *Test-Taking Strategy*: Focus on the subject, indications for the use of antibiotics. Eliminate option 1 because there are no supporting data in the question regarding the potential for allergies. Noting the word viral in the question and noting the age of the child will assist in eliminating options 2 and 4.

A child is scheduled for a tonsillectomy in a day surgical unit. On the day after surgery, the mother calls the surgical unit and expresses concern because the child has a bad mouth odor. Which response is most appropriate?

"Bad mouth odor is normal and may be relieved by drinking more liquids." tonsillectomy is the surgical removal of the tonsils. Bad mouth odor is normal after tonsillectomy and may be relieved by drinking more liquids. There is no more information that would indicate an infection. Mouthwash gargles will irritate the throat. There is no need to contact the health care provider immediately because bad mouth odor is common and expected after tonsillectomy.

Pneumonia is caused by

1. a virus 2. mycoplasmal agents 3. bacteria 4 aspiration of foreign substances.

Clinical manifestations suggestive of airway obstruction include

1. tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), 2. nasal flaring 3. use of accessory muscles for breathing 4. Retractions on Inspiration 5. presence of stridor.

The normal respiratory rate in a 10-year-old is

16 to 20 breaths/minute.

The mother of a child with cystic fibrosis (CF) asks the clinic nurse about the disease. What should the nurse tell the mother about CF?

A chronic multisystem disorder affecting the exocrine glands CF is a chronic multisystem disorder that affects the exocrine glands. The mucus produced by these glands (particularly those of the bronchioles, small intestine, and pancreatic and bile ducts) is abnormally thick, causing obstruction of the small passageways of these organs. It is transmitted as an autosomal recessive trait. It does not cause the formation of multiple cysts in the lungs. Options 1, 3, and 4 are incorrect.

A school nurse is teaching parents about emergency treatment for epistaxis. Which best action should the nurse take to assist the parents in understanding the emergency treatment?

Ask the parents to demonstrate, on a mannequin, where to apply continuous pressure if a nosebleed occurs.

An ambulatory care nurse is preparing a list of instructions for the parents of a child who is being discharged after a tonsillectomy. The nurse should place which instructions on the list? Select all that apply.

Avoid hot fluids. Avoid raw vegetables. Rest in bed or on a couch for 24 hours. After tonsillectomy, the client is instructed to advance the diet from cool, clear liquids to full liquids. Hot fluids and carbonated beverages should be avoided because they may be irritating to the throat. Milk and milk products (pudding) are avoided because they may cause the client to cough, which could cause pain at the surgical site. Foods and snacks that are rough in texture, such as raw fruits or vegetables, should be *avoided for 10 days* to protect the operative site and prevent bleeding. The client should be instructed to rest in bed or on a couch for 24 hours after the surgical procedure and gradually resume full activity.

A new parent expresses concern to the nurse regarding sudden infant death syndrome (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?

Back rather than on the stomach SIDS is the unexpected death of an apparently healthy infant younger than 1 year for whom an investigation of the death and a thorough autopsy fail to show an adequate cause of death. Several theories are proposed regarding the cause, but the exact cause is unknown. Nurses should encourage parents to place the infant on the back (supine) for sleep. Infants in the prone position (on the stomach) may be unable to move their heads to the side, increasing the risk of suffocation. The infant may have the ability to turn to a prone position from the side-lying position.

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition?

Decreased wheezing. Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats/minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths/minute.

The nurse has provided instructions to the mother of a child with cystic fibrosis about appropriate dietary measures. Which statement by the mother indicates an understanding of these dietary measures?

Diet needs to be high in calories Children with cystic fibrosis are managed with a high-calorie, high-protein diet. Pancreatic enzyme replacement therapy and water-soluble vitamin supplements (A, D, E, and K) are administered. If nutritional problems are severe, supplemental tube feedings or parenteral nutrition is administered. Fats are not restricted unless steatorrhea cannot be controlled by administration of increased pancreatic enzymes.

The mother of an 8-year-old 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 is not effective. Which instruction should the nurse provide to the mother?

Encourage the child to lie on the right side. Pneumonia is an inflammation of the pulmonary parenchyma or alveoli, or both, caused by a virus, mycoplasmal agents, bacteria, or aspiration of foreign substances. Splinting of the affected side by lying on that side may decrease discomfort. It would be inappropriate to advise the mother to increase the dose or frequency of the ibuprofen. Lying on the left side would not be helpful in alleviating discomfort.

The nurse is providing instructions to the mother of a child with *croup* regarding treatment measures if an *acute spasmodic episode* occurs. Which statement made by the mother indicates a need for further teaching?

I should place a steam vaporizer in my child's room." Steam from running water in a closed bathroom will assist in keeping secretions thin so that they can be easily expectorated. Steam from a vaporizer however can present a danger of scald burns because of the more direct effect than that provided from steam from running water. A cool mist from a bedside humidifier may be effective in reducing mucosal edema. Cool-mist humidifiers are recommended over steam vaporizers. Taking the child out into the cool, humid night air may also relieve mucosal swelling.

A mother calls the health care provider's office requesting an appointment for her *8-year-old* child. She states he has *asthma* and is telling her he had *trouble breathing last night* and does not want to go to school. In triaging this child, which is the most important question to *initially* ask the mother?

Is your child telling you at this time he is having trouble breathing?" Airway is always the most important indicator to determine if the child can be seen in the health care provider's office or needs to be taken to the emergency department. Although all the assessment questions address manifestations of asthma, asking if the child says he has difficulty breathing specifically addresses airway.

The results of a tuberculin skin test (TST) reaction of 15 mm or more is considered to be a positive result for

Kids 4 years or older without any risk factors.

A child with laryngotracheobronchitis (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?

Let the mother hold the child and direct a cool mist over the child's face

The student nurse is caring for an infant with a *tracheostomy* and is preparing to suction the infant. The *nursing instructor should intervene* if the nursing student stated she would take which action to perform this procedure?

Limit insertion and suctioning time to 15 seconds to prevent hypoxia

The nurse is caring for an infant with *bronchiolitis*, and diagnostic tests have confirmed respiratory syncytial virus (*RSV*) On the basis of this finding, which is the most appropriate nursing action?

Move the infant to a room with another child with RSV. RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves and gowns are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precautions are unnecessary.

The nurse reviews the health record of a 2-year-old child. The health care provider has documented that the results of a tuberculin skin test have indicated an area of induration measuring 5 mm. How should the nurse interpret these results?

Negative Induration measuring 10 mm or greater is considered to be a positive result in children younger than 4 years. A reaction of 5 mm or greater is considered to be a positive result for the highest risk groups.

A mother arrives at the hospital emergency department with her child, in whom a diagnosis of epiglottitis is documented. Which prescription, if written by the health care provider, should the *nurse question*?

Obtain a throat culture. The throat of a child with suspected epiglottitis should not be examined or cultured because any stimulation with a tongue depressor or culture swab could cause laryngospasm, thus completing airway obstruction. Humidified oxygen and antipyretics are components of management. Axillary rather than oral temperatures should be taken to avoid stimulation and resultant laryngospasm.

A nursing student is conducting a clinical conference about measures that assist in preventing sudden infant death syndrome. The student plans to write on a handout that it is best to place an infant in which position for sleep?

On the back, or supine Healthy infants should only be placed on their backs for sleep. This is also referred to as the supine position. Prone or on the stomach are not suggested recommendations to assist in preventing sudden infant death syndrome.

Breathing exercises and postural drainage are prescribed for a hospitalized child with cystic fibrosis. What instruction should the nurse include in the client's teaching plan?

Perform the postural drainage first and then the breathing exercises. Breathing exercises are recommended for a majority of children with cystic fibrosis (CF), even those with minimal pulmonary involvement. The exercises usually are performed twice daily, and they are preceded by postural drainage. The postural drainage will mobilize secretions, and the breathing exercises will then assist with expectoration. Exercises to assist in assuming correct postures and in maximizing thoracic mobility, such as swinging the arms and bending and twisting the trunk, are included. The ultimate aim of these exercises is to establish a good

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply.

Place the infant in a private room. Ensure that nurses caring for the infant with RSV do not care for other high-risk children. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the *neck slightly extended* to maintain an *open airway* and *decrease pressure on the diaphragm*. Cool humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea.

After a tonsillectomy, a child is brought to the pediatric unit. The nurse should appropriately place the child in which position?

Prone The child should be placed in a prone or side-lying position after tonsillectomy to facilitate drainage

After a tonsillectomy, the nurse reviews the health care provider's (HCP's) postoperative prescriptions. Which prescription should the nurse question?

Suction every 2 hours. tonsillectomy is the surgical removal of the tonsils. After tonsillectomy, suction equipment should be available, but suctioning is not performed unless there is an airway obstruction because of the risk of trauma to the surgical site. Monitoring for bleeding is an important nursing intervention after any type of surgery. Milk and milk products are avoided initially because they coat the throat, cause the child to clear the throat, and increase the risk of bleeding. Clear, cool liquids are encouraged.

T he nurse is reviewing the health care provider's prescriptions for a child following a tonsillectomy. Which prescription should the nurse question?

Suction fq if coughing Following tonsillectomy, suction equipment should be available, but the child is not suctioned unless there is an airway obstruction. Clear, cool liquids are encouraged. Milk and milk products are avoided initially because they coat the throat, causing the child to clear his or her throat and thereby increasing the risk of bleeding. Discharge to home when the child is alert and tolerating fluids is an appropriate intervention following tonsillectomy.

The nurse is caring for a child following a tonsillectomy. The nurse should reposition the child on return from the operating room if the child is in which position?

Supine U know why ;)

A mother arrives at the clinic with her 3-year-old child. The mother tells the nurse that the child has had a *fever and a cough* for the past *2 days* and that this morning the child began to *wheeze*. Viral pneumonia is diagnosed. Based on the diagnosis, the nurse anticipates that which will be a component of the treatment plan?

Supportive treatment With viral pneumonia, treatment is supportive. More severely ill children may be hospitalized and given oxygen, chest physiotherapy, and IV fluids. Antibiotics are not given. Bacterial pneumonia, however, is treated with antibiotic therapy.

The emergency department nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse should monitor for which indication that the child may be experiencing airway obstruction?

The child is leaning forward, with the chin thrust out.

The clinic nurse is providing instructions to a parent of a child with *cystic fibrosisi regarding the immunization schedule for the child. Which statement should the nurse make to the parent?

The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

A child is scheduled for a tonsillectomy. The nurse plans care, knowing that which condition would be a priority because it presents the highest risk of aspiration during surgery?

The presence of loose teeth A tonsillectomy is the surgical removal of the tonsils. In the *preoperative period*, the child should be observed for the presence of loose teeth to decrease the risk of aspiration during surgery. Bleeding *during surgery* will be controlled via packing and suction as needed. Difficulty in swallowing and exudate in the throat area are incorrect because these are characteristics that may indicate the need for the surgery. *Test-Taking Strategy*: Note that the child is scheduled for surgery. The *subject* of the question relates to aspiration; note the *strategic word* "priority". Although difficulty in swallowing and exudate in the throat area could potentially cause a risk for aspiration, these options can be eliminated easily because these are characteristics that may indicate the need for the surgery. Recall that the tonsillar area is vascular; bleeding during surgery is expected and would be controlled, so this option can be eliminated.

During clinical conference, a nursing student is discussing care for a child with a diagnosis of cystic fibrosis (CF). Which comment by a student indicates the need for *further review* of information about CF?

This disease causes dilation of the passageways of many organs. CF is a chronic multisystem disorder affecting the exocrine glands. The mucus produced by these glands (particularly those of the bronchioles, small intestine, and pancreatic and bile ducts) is abnormally thick, causing obstruction (not dilation) of the small passageways of these organs. It is transmitted as an autosomal recessive trait.

After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action?

Turn the child to the side After tonsillectomy, if bleeding occurs, the nurse immediately turns the child to the side to prevent aspiration and then notifies the HCP. NPO status would be maintained, and an antiemetic may be prescribed; however, the initial nursing action would be to turn the child to the side.

RSV is a *highly communicable disorder* transmitted via the hands (usually)

Use CONTACT & STANDARD PRECAUTIONS!!! Using good hand-washing technique and wearing *gloves* and *gowns* are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV.

The nurse employed in an emergency department is monitoring a child diagnosed with epiglottitis. The nurse notes that the child is leaning forward with the chin thrust out. How should the nurse interpret this finding?

airway obstruction Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward supported by arms, chin thrust out, mouth open), nasal flaring, tachycardia, a high fever, and sore throat. The remaining options are inaccurate interpretations of the child's position.

Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal

an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10-year-old is 70 to 110 beats/minute. The normal respiratory rate in a 10-year-old is 16 to 20 breaths/minute.

A tonsillectomy is the surgical removal of the tonsils. 1. Frequent swallowing 2. restlessness 3. fast and thready pulse 4. vomiting bright red blood

are signs of bleeding.

Epiglottitis is a____ form of croup.

bacterial

Cystic fibrosis is a

chronic multisystem disorder (*autosomal recessive* trait disorder) characterized by *exocrine gland* dysfunction. The mucus produced by the exocrine glands is abnormally *thick, tenacious*, and *copious*, causing *obstruction* of the *small passageways* of the affected organs, particularly in the 1. respiratory 2. gastrointestinal 3. reproductive systems. Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza immunization is recommended for children with cystic fibrosis. L

Evaluation of the patient teaching is done by

eliciting feedback to ensure that parents understand the information. Use of a hands-on return demonstration is the best method to encourage mastery of skills and to determine whether the parents have understood what was taught. Telling the parents the steps to take when a nosebleed occurs, showing a video, and giving a brochure are actions that fall under the category of relating information but would not allow the nurse to determine whether the parents understood the content.

Children with cystic fibrosis are managed with a

high-calorie high-protein diet. Pancreatic enzyme replacement therapy and FAT-soluble vitamin supplements (A, D, E, and K) are administered. If nutritional problems are severe, supplemental tube feedings or parenteral nutrition is administered. Fats are not restricted unless steatorrhea cannot be controlled by administration of increased pancreatic enzymes.

Crying in a child would

increase hypoxia and aggravate laryngospasm—-> which may lead to airway obstruction.

Laryngotracheobronchitis (croup) is the

inflammation of the larynx, trachea, and bronchi *most common* type of croup. Cool mist therapy may be prescribed to liquefy secretions and to assist in breathing. 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).

Correct suctioning procedures for an infant include

inserting the catheter the *length of the tracheostomy tube* with the suction OFF applying intermittent suction and withdrawing the catheter with a twisting motion, (NO MORE THAN 5 SEC) and reoxygenating between suction catheter passage.

When suctioning a tracheostomy in an infant, it is necessary to

limit insertion and suctioning time to *5 seconds* to prevent hypoxia.

epistaxis

nosebleed

Breathing exercises are recommended for a majority of children with cystic fibrosis (CF), even those with minimal pulmonary involvement. The exercises usually are performed

twice daily, and they are *preceded* by postural drainage. The postural drainage will *mobilize secretions*, and the *breathing exercises* will then assist with *expectoration*. Exercises to assist in assuming correct postures and in maximizing thoracic mobility, such as 1- swinging the arms 2- bending and twisting the trunk are included. The ultimate aim of these exercises is to establish a good habitual breathing pattern.