Chapter 40: Nursing Care of the Child with an Alteration in Gas Exchange/Respiratory Disorder

A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond? A. "Has your infant been around any crowds?" B. "Do you have allergies in the family?" C. "Do any family members have history of asthma?" D. "Do you have air conditioning in your house?"

A. "Has your infant been around any crowds?" Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.

The health care provider prescribes fluorescent antibody testing for a child. Which statement by the nurse demonstrates an accurate understanding of this diagnostic test? A. "I need to obtain nasopharyngeal secretions and place in a sterile specimen cup." B. "I need the child to cough and spit a specimen into the sterile specimen cup." C. "I will apply a probe to the child's finger for this test." D. "I will need a respiratory therapist to perform this test."

A. "I need to obtain nasopharyngeal secretions and place in a sterile specimen cup." A nasopharyngeal specimen is obtained for fluorescent antibody testing. To obtain a nasopharyngeal specimen, the nurse will instill 1 to 3 ml of sterile normal saline into one nostril, aspirate the contents using a small sterile bulb syringe, place the contents in sterile container, and immediately send them to the laboratory. Collecting a nasopharyngeal specimen is within the nursing scope of practice. There is no need for a respiratory therapist to perform this test. A sputum specimen is used for a sputum culture and must be true sputum, not mucus from the mouth or nose. The child can deep breathe, cough, and spit the sputum into the specimen container. Probes are attached to the child's finger to attain pulse oximetry or oxygen saturation.

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete? A. ABG B. EEG C. CBC D. PFT (pulm. function test)

A. ABG

What statement is the most accurate regarding the structure and function of the newborn's respiratory system? A. Most infants are nasal breathers rather than mouth breathers. B. The respiratory tract in the child is fully developed by age 2. C. The diameter of the child's trachea is the same as that of adults. D. Infants and young children have smaller tongues in proportion to their mouths.

A. Most infants are nasal breathers rather than mouth breathers.

What is a definitive test for cystic fibrosis? A. Sweat chloride B. blood culture C. blood gas D. CBC

A. Sweat chloride

The nurse is caring for a newly admitted 3-year-old child who has been diagnosed with tuberculosis. When reviewing the child's records which finding(s) is consistent with this disease? Select all that apply. A. The child and the family were homeless for a period of time in the past 3 months. B. The child has been experiencing a sore throat for the past few weeks. C. The child has been experiencing night sweats. D. The child has had recent weight loss. E. The child currently lives at home with parents and one sibling.

A. The child and the family were homeless for a period of time in the past 3 months. C. The child has been experiencing night sweats. D. The child has had recent weight loss. Tuberculosis is a highly contagious respiratory infection. A child who has been living in crowded locations, who is impoverished, or homeless is at an increased risk. Signs and symptoms of the disease include weight loss, night sweats, anorexia and pain. A child living in a household with parents and one sibling does not have an increased risk for infection. A sore throat is not associated with tuberculosis.

The child has been admitted to the hospital with a possible diagnosis of pneumonia. Which finding(s) is consistent with this diagnosis? Select all that apply. A. The child's respiratory rate is rapid. B. The child's temperature is 98.4° F (36.9°C). C. The child's white blood cell count is elevated. D. The child's chest x-ray indicates the presence of perihilar infiltrates. E. The child is producing yellow purulent sputum.

A. The child's respiratory rate is rapid. C. The child's white blood cell count is elevated. D. The child's chest x-ray indicates the presence of perihilar infiltrates. E. The child is producing yellow purulent sputum. Children with pneumonia may exhibit the following: a chest x-ray with perihilar infiltrates, an elevated leukocyte level, an increased respiratory rate, and a productive cough. The child with pneumonia typically has a fever.

How is wheezing in children best heard? A. as the child exhales B. with the child supine C. as the child cries D. without a stethoscope

A. as the child exhales

A 9-year-old female child was brought to the emergency department after experiencing wheezing and shortness of breath while playing soccer. The parents administered two puffs of albuterol metered dose inhaler (MDI) with little effect, and 911 was notified. Paramedics applied oxygen 2 liters by nasal cannula for oxygen saturation of 90% on room air, and administered an albuterol nebulizer treatment. Audible wheezing was heard, and a 20-gauge intravenous (IV) catheter was inserted. Vital signs upon arrival at the emergency room: temperature, 98.8°F (37.1°C); heart rate, 125 beats/min; blood pressure, 88/50 mm Hg; respiratory rate, 32 breaths/min; oxygen saturation, 92% on simple face mask. Child appears anxious. The ER nurse should first _________________ then _________________________.

Assess airway; administer IV methylprednisolone The nurse should assess the child's airway first. Assessment should always be prioritized using the ABCs (airway, breathing, and circulation).Intravenous (IV) methylprednisolone should be administered promptly to decrease inflammation in the lungs, which will improve air flow. Circulation would be assessed after airway and breathing.Level of consciousness is simultaneously checked with ABCs (airway, breathing, and circulation), but the nurse must first perform a focused respiratory assessment and implement interventions promptly to prevent respiratory arrest.Metered-dose inhalers would not be used in status asthmaticus. Aerosol nebulizer treatments would be administered.Because the child is in severe respiratory distress, the nurse would not perform peak flow meter instruction at this time.

A client asks the nurse why a healthy newborn would be at risk for hypoxemia. How should the nurse reply? A. "The shape of the chest and the smaller airway structures place the newborn at higher risk." B. "A newborn only has half of the number of alveoli developed, placing the newborn at risk." C. "The newborn does not take in as much oxygen with each breath, placing the newborn more at risk." D. "A newborn would be at risk because the newborn has smaller lung volumes."

B. "A newborn only has half of the number of alveoli developed, placing the newborn at risk."

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma? A. "We're going to go take a look at your lungs to see if there are any sores on them." B. "I'm going to have this hospital worker take a picture of your lungs." C. "I'm going to hold your hand while the phlebotomist gets blood from your arm." D. "I'm going to have the respiratory therapist get some of the mucus from your lungs."

B. "I'm going to have this hospital worker take a picture of your lungs." The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

The nurse is assisting in the development of a plan of care for a child with asthma. In planning care, many goals would be appropriate for this child and/or family caregiver. Which two goals would be the highest priority for this child or family? A. The child and family will connect with families living with the same diagnosis. B. The child will have adequate fluid intake C. The child and family will improve knowledge and understanding of varied pharmacologic options. D. The child will maintain a clear airway E. The child will maintain adequate pain control

B. The child will have adequate fluid intake D. The child will maintain a clear airway

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has: A. asthma B. epiglottis C. TB D. cystic fibrosis

B. epiglottis

During a class for caregivers of children with asthma, a caregiver asks the nurse the following question when medications are being discussed. "They told me about a plastic device my child can hold in his a hand which will give him a premeasured and exact amount of his corticosteroid." The nurse recognizes that the caregiver is most likely referring to which device? A. nebulizer B. metered-dose inhaler C. medication cup D. needleless syringe

B. metered-dose inhaler In the treatment of asthma, corticosteroids are most often delivered by metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). The medication cup and needleless syringe may deliver PO medications, but most often corticosteroids are not given PO in the treatment of asthma, and those would not be premeasured and an exact dosage like a metered-dose inhaler would be. Corticosteroids are not administered by nebulizer.

What is a complication of cystic fibrosis? A. UTI B. pneumothorax C. Crohn disease D. kidney disease

B. pneumothorax

An 8-year-old client is suffering from allergic rhinitis (hay fever). Which statement will the nurse include when providing education to the client's caregiver? A. "When bathing, your child needs to use a mild soap, free of dye and fragrance." B. "Penicillin is the treatment of choice. Be sure your child takes the entire prescribed amount." C. "Pollen is a cause of these symptoms. Allergy medicine may help your child." D. "Your child needs to avoid peanuts until further testing is completed."

C. "Pollen is a cause of these symptoms. Allergy medicine may help your child."

The nurse working at the child community clinic must administer the influenza vaccine to the high-risk children first. Which child would she choose first? A. 12-month-old client who is very healthy B. 21-month-old client who has a cold C. 23-month-old client who had heart surgery as an infant for a defect D. 22-month-old client who has a wound from touching a hot pan at home

C. 23-month-old client who had heart surgery as an infant for a defect Children who are considered high risk and could benefit from the influenza vaccine are: immunocompromised have a chronic pulmonary disease have had a congenital abnormality chronic renal or metabolic disease sickle-cell disease HIV any type of neurological disorder (seizures) The other choices would be considered normal and the child is not at high risk.

The school nurse is caring for a 12-year-old boy with a bloody nose. Which action would be most appropriate for the nurse to do? A. With the child lying on his back, apply pressure to the bridge of the nose. B. Seat the child with his head tipped back and apply ice or a cold cloth to the nose. C. Seat the child leaning forward and pinch the anterior portion of the nose closed. D. With the child lying on his back, pinch the anterior portion of the nose closed.

C. Seat the child leaning forward and pinch the anterior portion of the nose closed.

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? A. give the antibiotic as ordered B. apply O2 at 2L via NC C. administer the bronchodilator via nebulizer D. apply a cardiac monitor to the child

C. administer the bronchodilator via nebulizer The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.

The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect? A. increased nonproductive cough B. drowsiness causing a nap C. increased HR and restlessness D. increased mucus expectoration

C. increased HR and restlessness

The nurse sees a 3-year-old child in the ambulatory setting for localized wheezing on auscultation. Which statement by the parent would be most important to report to the health care provider? A. the child has two cousins who have many allergies B. the parent has supervised the child in the same room for the past 24 hours C. the child was eating peanuts yesterday D. the child received the pneumococcal vaccine series within his or her first year

C. the child was eating peanuts yesterday Aspiration can cause airway mucosal inflammation. When aspiration from a small object occurs, the child may cough and gasp for a few seconds to a few minutes. Following that, the child may not be symptomatic for a day or longer. The aspiration of a foreign body may mimic an asthma attack, but an asthma attack would have generalized wheezing. Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration. Allergic situations cause early symptoms such as rash development and are generally not genetic or inherited in nature. The US Centers for Disease Control and Prevention recommends children receive pneumococcal vaccine series before 2 years of age, usually at 2, 4, and 6 months.

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method? A. directly into the vein B. through a G-tube C. using a nebulizer D. sprinkled onto the food

C. using a nebulizer Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis.

Which piece of equipment is most helpful in determining airway obstruction in the client with asthma? A. nebulizer B. an incentive spironometer C. an inhaler D. a peak flow meter

D. a peak flow meter

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be: A. high sodium chloride concentration in the sweat. B. decreased respiratory capacity. C.impaired digestive activity. D. chronic lack of oxygen.

D. chronic lack of oxygen

What is a symptom of bacterial pharyngitis? A. WBC count in normal range B. symptoms have gradual onset C. rhinitis D. fever

D. fever Bacterial pharyngitis is most often caused by group A streptococcus. Fever is a symptom of bacterial pharyngitis. Other symptoms are an elevated WBC count, abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes. It must be treated with an antibiotic. Penicillin is the drug of choice. Symptoms of rhinitis, a normal WBC count, and slow onset are indicative of viral pharyngitis.

A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, which parts of the body (besides the lungs) are most affected by this disease? A. brain and spinal cord B. heart and blood vessels C. kidney and bladder D. pancreas and liver

D. pancreas and liver

After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify what as a common allergen for asthma? A. dust mites B. indoor molds C. pet dander D. shellfish

D. shellfish

The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? A. administering O2 as ordered B. administering analgesics as ordered C. monitoring O2 saturation by pulse ox D. suctioning secretions from the airway

D. suctioning secretions from the airway

The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child? A. blood culture and sensitivity B. purified protein derivative test C. pulmonary functions test D. sweat sodium chloride test

D. sweat sodium chloride test Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.