FINAL EXAM PEDI 2023/ PrepU CH18

An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. What is the course of treatment that the nurse would expect in this situation? Antipyretic, analgesic, and antibiotic Antipyretic and analgesic Tonsillectomy Adenoidectomy

Antipyretic, analgesic, and antibiotic Explanation: These symptoms are consistent with bacterial tonsillitis. Therapy for bacterial tonsillitis includes an antipyretic for fever, an analgesic for pain, and a full 7- to 10-day course of an antibiotic such as penicillin or amoxicillin

The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet? Iodized salt Saturated fat Pancreatic enzymes Calories from protein

Pancreatic enzymes

The nurse is reinforcing teaching about medications with the parents of a 2-year-old who has cystic fibrosis. The nurse suggests that pancreatic enzymes may be given by which method? Directly into the vein Through a gastrostomy tube Using a nebulizer Sprinkled onto the food

Sprinkled onto the food Explanation: Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia? The child is a triplet. The child was a postmaturity date infant. The child has diabetes. The child attends day care

The child attends day care. Explanation: Attending day care is a known risk factor for pneumonia

The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment? The child is pale and has vomited. The child has pale, elevated patches on the skin. The child is irritable and tachycardiac. The child is in tripod position.

The child is in tripod position.

A 6-year-old child was diagnosed as having streptococcal pharyngitis. At the follow-up visit, the nurse will assess the child for which potential complication? swollen lymph nodes that obstruct the airway infection that may cause a tooth abscess development of rheumatic fever nephrosis of the kidney

development of rheumatic fever Explanation: The Group A strain of streptococci causing streptococcal pharyngitis can cause a hypersensitivity reaction that results in either rheumatic fever or glomerulonephritis.

A nurse is teaching a group of parents about possible signs and symptoms of respiratory disorders. The nurse emphasizes that early detection is important in preventing more serious problems. The nurse determines that the teaching was successful when the group identifies which sign as often the first sign of a respiratory illness? increased respirations cough with mucus blue coloring around the lips irregular breathing pattern

increased respirations Explanation: Often the first sign of respiratory illness in infants and children is tachypnea (increased respiratory rate). Cyanosis is a late sign.

The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client? tachycardia hypoactivity bronchial muscle relaxation increased appetite

tachycardia Explanation: Adverse reactions of albuterol, a bronchodilator, include tachycardia, nervousness, tremors, hyperactivity, malaise, palpitations, increased appetite, hypokalemia, and muscle cramps.

The nurse is working with a group of caregivers of children diagnosed with asthma. Which statement made by a caregiver is most accurate regarding the triggers that may cause an asthma attack? "My neighbor told me that asthma attacks are caused by hot weather." "I always thought that a lack of exercise caused my child's asthma." "My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." "One person told me that asthma is caused by using antibiotics for infection."

"My sister and her family love animals, and when we go to their house my daughter always has an asthma attack."

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress? 3-year-old child with croup 11-month-old infant with nasopharyngitis 2-year-old child with epiglottitis 16-year-old adolescent with asthma

2-year-old child with epiglottitis Explanation: Epiglottitis is a medical emergency due to the swelling of the epiglottis covering the larynx. This client needs frequent assessment for respiratory distress, especially since young children have smaller, more compliant airways.

What measure at home could help a child with an upper respiratory infection breathe more easily? Increasing room humidity Limiting fluid intake Enforcing strict bed rest Playing "rapid breathing" games

Increasing room humidity Explanation: A moist environment helps prevent respiratory secretions from drying and becoming difficult to raise.

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? Medication cup Metered-dose inhaler Nebulizer Needleless syringe

Metered-dose inhaler Explanation: 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 nurse is collecting data on a child with a diagnosis of tonsillitis. Which clinical manifestation would likely have been noted in the child with this diagnosis? bark-like cough hoarseness erythema of the pharynx inability to make audible voice sounds

erythema of the pharynx Explanation: The child with tonsillitis may have a fever of 101°F (38.4°C) or higher, a sore throat, often with dysphagia (difficulty swallowing), hypertrophied tonsils, and erythema of the pharynx

In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason? Relief of acute symptoms Management of chronic pain To stabilize the cell membranes Prevention of mild symptoms

Relief of acute symptoms Explanation: Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms.

What is the most common debilitating disease of childhood among those of European descent? Cystic fibrosis Asthma Pneumonia BPD

Cystic fibrosis

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? "We will keep an albuterol inhaler with our child at all times." "It is okay for our child to do chores such as sweeping the floor." "We will both enroll in smoking cessation classes." "Our family dog will need to go live with a grandparent.

"It is okay for our child to do chores such as sweeping the floor." Explanation: Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections.

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? Brain and spinal cord Pancreas and liver Heart and blood vessels Kidney and bladder

Pancreas and liver Explanation: The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.

The nurse is caring for a 6-month-old infant who has chronic apneic episodes. Which intervention should the nurse place in the plan of care? Place on a cardiopulmonary monitor and do frequent assessments. Teach the infant's parents how to perform infant cardiopulmonary resuscitation (CPR). Sit the infant upright in the infant seat to keep the airway open. Recommend surgical removal of tonsils and adenoids.

Place on a cardiopulmonary monitor and do frequent assessments.

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child? Respiratory stridor Wheezing in the bases Rales in the middle lobe Rhonchi throughout the lung

Respiratory stridor Explanation: Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe.

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? Purified protein derivative test Sweat sodium chloride test Blood culture and sensitivity Pulmonary functions test

Sweat sodium chloride test

The nurse caring for the child with asthma weighs the child daily. What is the most important reason for doing a daily weight on this child? To determine medication dosages To monitor the child's growth pattern To ensure that the child's food intake is adequate To determine fluid losses

To determine fluid losses Explanation: During an acute asthma attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting.

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? Directly into the vein Through a gastrostomy tube Using a nebulizer Sprinkled onto the food

Using a nebulizer

the caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with: decreased activity and increased fluids. corticosteroids and leukotriene inhibitors. removal of allergens in the home and school. a bronchodilator and mast cell stabilizers.

a bronchodilator and mast cell stabilizers. Explanation: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used.

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: epiglottitis. asthma. cystic fibrosis. tuberculosis (TB).

epiglottitis. Explanation: The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.

What is a complication of cystic fibrosis? pneumothorax urinary tract infection kidney disease Crohn disease

pneumothorax Explanation: Cystic fibrosis (CF) is a genetic disorder causing thickened tenacious secretions of the sweat glands, gastrointestinal tract, pancreas, respiratory tract and exocrine tissues. The treatment is aimed at minimizing pulmonary complications, maximizing lung function, preventing infection, and facilitating growth. A pneumothorax is a complication of CF

The young child is wearing a nasal cannula. The oxygen is set at 3 L/minute. Calculate the percentage of oxygen the child is receiving. Record your answer using a whole number.

33 Explanation: Room air is 21%. Each 1 liter of oxygen flow is equal to an additional 4% of oxygen. The child is receiving 3 liters of oxygen. 21% (room air) + 3(4%) = 33% of oxygen.

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? Arterial blood gas (ABG) Complete blood count (CBC) Electroencephalogram (EEG) Pulmonary function test

Arterial blood gas (ABG) Explanation: The most useful diagnostic test in respiratory distress is an ABG. Knowing normal blood gas values for children is very important for evaluation and proper treatment. A CBC is a blood test used to test for disorders including anemia, infection, and leukemia. An EEG is a test used to find problems related to electrical activity of the brain. A pulmonary function test is performed to evaluate the respiratory system. Based on the findings, the child is experiencing respiratory distress and has an elevated temperature. Airway and breathing are priority over an elevated temperature. The child's blood pressure is within normal range for this age.

A child is prescribed a medication for his asthma that is supplied in a Turbuhaler. The child demonstrates its use properly by performing the following actions. Place these steps in the order in which they would occur. Correct response: Loads the dose in the Turbuhaler Twists the grip to the left until hearing a click Exhales out fully Holds Turbuhaler horizontally Places mouth around mouthpiece Inhales deeply and forcefully

Correct response: Loads the dose in the Turbuhaler Twists the grip to the left until hearing a click Exhales out fully Holds Turbuhaler horizontally Places mouth around mouthpiece Inhales deeply and forcefully

The nurse is teaching the caregivers of a child with cystic fibrosis. What is most important for the nurse to teach this family? Be sure the child exercises daily. Watch out for signs that family members are overly stressed. Avoid overprotecting the child. Encourage everyone in the family to use good handwashing techniques.

Encourage everyone in the family to use good handwashing techniques.

A nurse is providing supplemental oxygen therapy to a young child. Based on the nurse's understanding of oxygen delivery methods, what would the nurse expect to be used to deliver the highest concentration of oxygen to the child? nonrebreather (face) mask oxygen hood partial rebreather mask Venturi mask

nonrebreather (face) mask Explanation: A nonrebreather (face) mask provides 95% oxygen concentration. An oxygen hood provides up to 80% to 90% oxygen concentration. This delivery method is used only for infants. A partial rebreather mask provides 50% to 60% oxygen concentration. A Venturi mask provides 24% to 50% oxygen concentration.

The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent and immediate intervention? Compliance with therapy is diminished. The family becomes overvigilant. The child feels fearful and isolated. Siblings are jealous and worried.

Compliance with therapy is diminished.

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: impaired digestive activity. high sodium chloride concentration in the sweat. chronic lack of oxygen. decreased respiratory capacity.

chronic lack of oxygen.

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication? "I should give the enzymes before each meal or snack." "I should stop the enzymes if my child is taking antibiotics." "I should reduce the dose if she has large, malodorous stools." "Between meals is the best time to give the enzymes."

"I should give the enzymes before each meal or snack." Explanation: The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.

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 emergency room nurse should first____________then_________

assess airway Intravenous (IV) methylprednisolone Explanation: 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.