Ch. 21: The Child with Respiratory Dysfunction

1. Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections? A.) They are safer. B.) They are less expensive. C.) Respiratory secretions are dried by steam vaporizers. D.) A more comfortable environment is produced.

A.) They are safer. Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both cool-mist vaporizers and steam vaporizers may promote a more comfortable environment, but cool-mist vaporizers have decreased risk for burns and growth of organisms.

8. An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. What instructions should be given to the parent? A.) Administer all of the prescribed medication. B.) Continue medication until all symptoms subside. C.) Immediately stop giving medication if hearing loss develops. D.) Stop giving medication and come to the clinic if fever is still present in 24 hours.

A.) Administer all of the prescribed medication. Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of OM; antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside.

16. An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which intervention? A.) Administration of antibiotics B.) Frequent complete assessment of the infant C.) Round-the-clock administration of antitussive agents D.) Strict monitoring of intake and output to avoid congestive heart failure

A.) Administration of antibiotics Antibiotics are indicated for bacterial pneumonia. Often the child has decreased pulmonary reserve, and clustering of care is essential. The child's respiratory rate and status and general disposition are monitored closely, but frequent complete physical assessments are not indicated. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

9. An infants parents ask the nurse about preventing otitis media (OM). What information should be provided? A.) Avoid tobacco smoke. B.) Use nasal decongestants. C.) Avoid children with OM. D.) Bottle- or breastfeed in a supine position.

A.) Avoid tobacco smoke. Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be fed in a semivertical position to prevent OM.

2. Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which information? A.) Do not use for more than 3 days. B.) Keep drops to use again for nasal congestion. C.) Administer drops after feedings and at bedtime. D.) Give two drops every 5 minutes until nasal congestion subsides.

A.) Do not use for more than 3 days. Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness and not used for other children because they may become contaminated with bacteria. Drops administered before feedings are more helpful. Two drops are administered to cause vasoconstriction in the anterior mucous membranes. An additional two drops are instilled 5 to 10 minutes later for the posterior mucous membranes. No further doses should be given.

5. When caring for a child after a tonsillectomy, what intervention should the nurse do? A.) Watch for continuous swallowing. B.) Encourage gargling to reduce discomfort. C.) Apply warm compresses to the throat. D.) Position the child on the back for sleeping.

A.) Watch for continuous swallowing. Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen to facilitate drainage of secretions.

17. What consideration is most important in managing tuberculosis (TB) in children? A.) Skin testing B.) Chemotherapy C.) Adequate rest D.) Adequate hydration

B.) Chemotherapy Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and isoniazid and rifampin given two or three times a week by direct observation therapy for the remaining 4 months. Chemotherapy is the most important intervention for TB.

20. The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this child's care? A.) Monitor pulse oximetry. B.) Monitor arterial blood gases. C.) Administer oxygen if respiratory distress develops. D.) Administer oxygen if child's lips become bright, cherry-red in color.

B.) Monitor arterial blood gases.

19. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child? A.) Force fluids. B.) Monitor pulse oximetry. C.) Institute seizure precautions. D.) Encourage a high-protein diet.

B.) Monitor pulse oximetry. Careful monitoring of oxygenation and cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

3. The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition? A.) Has a cough B.) Becomes fussy C.) Shows signs of an earache D.) Has a fever higher than 37.5 C (99 F)

C.) Shows signs of an earache If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant. Cough can be a sign of nasopharyngitis. Irritability is common in an infant with a viral illness. Fever is common in viral illnesses.

4. It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition? A.) Otitis media B.) Diabetes insipidus (DI) C.) Nephrotic syndrome D.) Acute rheumatic fever

D.) Acute rheumatic fever Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute streptococcal pharyngitis.

7. Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39 C (102.2 F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication? A.) Decongestants to ease stuffy nose B.) Antihistamines to help the child sleep C.) Aspirin for pain and fever management D.) Benzocaine ear drops for topical pain relief

D.) Benzocaine ear drops for topical pain relief Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the association with Reye syndrome.

13. The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37 C (98.6 F). The nurse suspects mild croup and should recommend which intervention? A.) Admit to the hospital and observe for impending epiglottitis. B.) Provide fluids that the child likes and use comfort measures. C.) Control fever with acetaminophen and call if cough gets worse tonight. D.) Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

B.) Provide fluids that the child likes and use comfort measures. In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37 C is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if the child develops noisy respirations or drooling.

14. The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. What is the primary rationale for this action? A.) Mothers of hospitalized toddlers often experience guilt. B.) The mothers presence will reduce anxiety and ease the child's respiratory efforts. C.) Separation from the mother is a major developmental threat at this age. D.) The mother can provide constant observations of the child's respiratory efforts.

B.) The mothers presence will reduce anxiety and ease the child's respiratory efforts. The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt and that separation from mother is a major developmental threat for toddlers, but the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort.

10. Chronic otitis media with effusion (OME) differs from acute otitis media (AOM) because it is usually characterized by which signs or symptoms? A.) Severe pain in the ear B.) Anorexia and vomiting C.) A feeling of fullness in the ear D.) Fever as high as 40 C (104 F)

C.) A feeling of fullness in the ear OME is characterized by a feeling of fullness in the ear or other nonspecific complaints. OME does not cause severe pain. This may be a sign of AOM. Vomiting, anorexia, and fever are associated with AOM.

12. The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition? A.) Sore throat B.) Inspiratory stridor C.) Complete obstruction D.) Respiratory tract infection

C.) Complete obstruction If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Sore throat and pain on swallowing are early signs of epiglottitis. Stridor is aggravated when a child with epiglottitis is supine. Epiglottitis is caused by Haemophilus influenzae in the respiratory tract.

15. An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation? A.) Reverse isolation B.) Airborne isolation C.) Contact Precautions D.) Standard Precautions

C.) Contact Precautions RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

18. A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect what condition? A.) Allergies B.) Acute pharyngitis C.) Foreign body in the nose D.) Acute nasopharyngitis

C.) Foreign body in the nose The irritation of a foreign body in the nose produces local mucosal swelling with foul-smelling nasal discharge, local obstruction with sneezing, and mild discomfort. Allergies would produce clear bilateral nasal discharge. Nasal discharge is usually not associated with pharyngitis. Acute nasopharyngitis would have bilateral mucous discharge.

6. What statement best represents infectious mononucleosis? A.) Herpes simplex type 2 is the principal cause. B.) A complete blood count shows a characteristic leukopenia. C.) A short course of ampicillin is used when pharyngitis is present. D.) Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.

D.) Clinical signs and symptoms and blood tests are both needed to establish the diagnosis. The characteristics of the diseasemalaise, sore throat, lymphadenopathy, central nervous system manifestations, and skin lesionsare similar to presenting signs and symptoms in other diseases. Hematologic analysis (heterophil antibody and monospot) can help confirm the diagnosis. However, not all young children develop the expected laboratory findings. Herpes-like Epstein- Barr virus is the principal cause. Usually, an increase in lymphocytes is observed. Penicillin, not ampicillin, is indicated. Ampicillin is linked with a discrete macular eruption in infectious mononucleosis.

11. A 4-year-old girl is brought to the emergency department. She has a frog-like croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner? A.) Make her lie down and rest quietly. B.) Examine her oral pharynx and report to the physician. C.) Auscultate her lungs and prepare for placement in a mist tent. D.) Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

D.) Notify the physician immediately and be prepared to assist with a tracheostomy or intubation. This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and intervention are indicated.