Pediatric Respiratory - Critical Thinking

After tonsillectomy, a child begins to vomit bright red blood. The most appropriate initial nursing action would be to •1.Administer the prescribed antiemetic. •2.Turn the child to the side. •3.Notify the physician. •4.Maintain a nothing-by-mouth status.

2 - After tonsillectomy, if bleeding occurs, the nurse turns the child to the side and then notifies the physician. A nothing-by-mouth status would be maintained, and an antiemetic may be prescribed; however, the initial nursing action would be to turn the child to the side. •Test-Taking Strategy:Use the process of elimination. Note the key word "initial" in the stem of the question. Although all of the options may be appropriate, to maintain physiological integrity, the initial action is to turn the child to the side. Review care of the postoperative child who vomits if you had difficulty with this question.

A student nurse is caring for a 2-year-old child diagnosed with croup. A nursing instructor asks the student about the clinical manifestations associated with croup. Which statement by the student indicates a need for further research?1."Symptoms usually worsen at night and are better during the day." 2."Symptoms usually worsen during the day and are relieved during sleep." 3."The cough is harsh and brassy." 4."Inspiratory stridor and a low-grade fever may be present."

2 - Croup often begins at night and may be preceded by several days of upper respiratory infection symptoms. Croup is characterized by a sudden onset of a harsh, brassy cough, sore throat, and inspiratory stridor. Symptoms usually worsen at night and are better in the day. Croup usually is accompanied by a low-grade fever, but occasionally the temperature may be as high as 104°F.

You are the nurse caring for a 4yo child with asthma. you are ordered to administer albuterol to this child. Such drugs are administer to do what?

Dilate the bronchioles

Which of the following respiratory conditions is always considered a medical emergency?

Epiglottitis

A nurse is reviewing the laboratory results for a child scheduled for tonsillectomy. The nurse determines that which of the following laboratory values is most significant to review?1.Prothrombin time 2.Sedimentation rate 3.Blood urea nitrogen 4.Creatinine

1 - Because the tonsillar area is so vascular, postoperative bleeding is a concern. The prothrombin time, partial thromboplastin time, platelet count, hemoglobin and hematocrit, white blood cell count, and urinalysis are performed preoperatively. The prothrombin time results would identify a potential for bleeding. The blood urea nitrogen, creatinine, and sedimentation rate would not determine the potential for bleeding. Test-Taking Strategy: Focus on the issue of the question. The issue of the question relates to the potential for bleeding. Options 3 and 4 can be eliminated because they relate to kidney function. Similarly, option 2 can be eliminated because it is unrelated to the issue of the question. Review preoperative care to the child scheduled for tonsillectomy if you had difficulty with this question.

A nurse is caring for an infant with bronchiolitis. Diagnostic tests have confirmed respiratory syncytial virus. Based on this finding, which of the following would be the most appropriate nursing action? 1.Move the infant to a room with another child with RSV. 2.Leave the infant in the present room because RSV is not contagious. 3.Inform the staff that they must wear a mask when caring for the child. 4.Initiate strict enteric precautions.

1 - Respiratory syncytial virus (RSV) is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands, and meticulous hand washing is necessary to decrease the spread of organisms. The infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precautions are not necessary; however, the nurse should wear a gown when soiling of clothing may occur.

What are the three predictive clinical observations of Epiglottitis? 1. Presence of drooling 2. Child is highly agitated 3.Absense of spontaneous cough 4.Low grade fever

1,2,3 - High grade fever

A nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by the respiratory syncytial virus. Select all interventions that would be included in the plan of care. 1. Place the infant in a private room. 2. Position the infant side-lying with the head lower than the chest. 3. Place the infant in a room near the nurse's station. 4. Place the child in a tent that delivers warm humidified air. 5. Wear a mask at all times when in contact with the infant

1,3 - The infant with RSV should be isolated in a private room or in a room with another infant with RSV infection. The infant should be placed in a room near the nurse's station for easy observation. 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. Contact precautions (wearing gloves and a gown) reduces nosocomial transmission of RSV.

What are the signs and symptoms of Pnemonia in children? 1.Chest Pain 2.Stridor 3.Tachypnea 4.Meningism 5.Headache 6.Drooling 7.Barking Cough

1,3,4,6

A child is scheduled for a tonsillectomy in a day-stay surgical unit. On the day following surgery, the mother calls the surgical unit and expresses concern because the child has a bad mouth odor. Which of the following responses is most appropriate? •1."The child probably has an infection." •2."You need to contact the physician immediately." •3."Bad mouth odor is normal and may be relieved by drinking more liquids." •4."Have the child gargle with mouthwash every 4 hours."

3 - Bad mouth odor is normal following tonsillectomy and may be relieved by drinking more liquids. Options 1, 2, and 4 are incorrect. In addition, mouthwash gargles (option 4) will irritate the throat. •Test-Taking Strategy:Use the process of elimination. Eliminate option 4 first, knowing that mouthwash gargles will irritate the surgical site. Options 1 and 2 are similar and will cause additional concern in the mother. Review postoperative expectations following tonsillectomy if you had difficulty with this question.

An emergency room nurse is caring for a child diagnosed with epiglottitis. Assessing the child, the nurse monitors for which indication that the child may be experiencing airway obstruction?1.The child is leaning backward, supporting himself with the hands and arms. 2.The child has a low-grade fever and complains of a sore throat. 3.The child is leaning forward with the chin thrust out. 4.The child exhibits nasal flaring and bradycardia.

3 - Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, tachycardia, a high fever, and a sore throat.

Ribavirin (Virazole) is prescribed for a hospitalized child with respiratory syncytial virus. The nurse prepares to administer this medication via which of the following routes? 1.Subcutaneous 2.Intramuscular 3.Oxygen tent 4.Oral

3 - Ribavirin (Virazole) is an antiviral respiratory medication used mainly in hospitalized children with severe RSV. Administration is via hood, face mask, or oxygen tent. Ribavirin is not administered subcutaneously, intramuscularly, or orally.

After a tonsillectomy, a nurse reviews the physician's postoperative orders. Which of the following physician's orders does the nurse question? •1.Clear, cool liquids when awake •2.No milk or milk products •3.Monitor for bleeding •4.Suction every 2 hours

4 - 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 oropharynx. Clear, cool liquids are encouraged. 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. Option 3 is an important nursing intervention following any type of surgery. •Test-Taking Strategy:Use the process of elimination. Option 3 can be eliminated first because this is a nursing action, not a medical order. From the remaining options, consider the anatomical location of the surgery. This should direct you easily to option 4. Review postoperative care following tonsillectomy if you had difficulty with this question.

A nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which of the following may indicate that the child is bleeding? •1.A decreased pulse rate •2.An elevation in blood pressure •3.Complaints of discomfort •4.Frequent swallowing

4 - Frequent swallowing, restlessness, a fast and thready pulse, and vomiting bright red blood are signs of bleeding. An elevated blood pressure and complaints of discomfort are not indications of bleeding.•Test-Taking Strategy:Use the concepts related to the signs of shock to assist in answering the question. These concepts should assist in eliminating options 1 and 2. From the remaining options, knowing that discomfort does not indicate bleeding will direct you to option 4. Review the signs of bleeding after tonsillectomy if you had difficulty with this question.

The nurse is caring for a 9 year old child with CF. What is important for the nurse to note while making her care plan?

Pulmonary secretions are thick

The HCP orders Zofran 2mg for a child that weighs 13.6kg. The safe dose of this drug is 0.15 mg/kg. Is this a safe dose?

Yes. 13.6 x 0.15 = 2.04 If given a range for drugs doses, go with the highest range

A child is scheduled for a tonsillectomy. A nurse plans care, knowing that which of the following would present the highest risk of aspiration during surgery? 1.Difficulty in swallowing 2.The presence of loose teeth 3.Bleeding during surgery 4.Exudate in the throat area

2 - In the preoperative period, the child should be observed for the presence of loose teeth to decrease the risk of aspiration during surgery. Options 1 and 4 are incorrect because these are characteristics that may indicate the need for the surgery. Bleeding during surgery will be controlled via packing and suction as needed. •Test-Taking Strategy: Use the process of elimination, noting that the child is scheduled for surgery. The issue of the question relates to aspiration, and note the key words "highest risk" in the stem of the question. Options 1 and 4 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. Therefore eliminate option 3. Review preoperative assessment procedures related to tonsillectomy if you had difficulty with this question.

A clinic nurse is providing instructions to a mother of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement would the nurse make to the mother? 1."The immunization schedule will need to be altered." 2."The child will receive all of the immunizations except for the polio series." 3."The child will receive the recommended basic series of immunizations along with a yearly pneumococcus and influenza vaccination." 4."The child should not receive any hepatitis vaccines."

3 - Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza and possibly a pneumococcus vaccine also are recommended for children with cystic fibrosis.

A hospitalized 2-year-old child with croup is receiving corticosteroid therapy. The mother asks a nurse why the physician did not prescribe antibiotics. The most appropriate response is 1."The child is too young to receive antibiotics." 2."The child still has the maternal antibodies from birth and does not need antibiotics." 3."Antibiotics are not indicated unless a bacterial infection is present." 4."The child may be allergic to antibiotics."

3 - Antibiotics are not indicated in the treatment of croup unless a bacterial infection is present. Options 1, 2, and 4 are incorrect. In addition, no supporting data in the question indicate that the child may be allergic to antibiotics.

A clinic nurse reviews the record of an infant seen in the clinic. The nurse notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record? 1.Severe projectile vomiting 2.Coughing at nighttime 3.Choking with feedings 4.Incessant crying

3 - Any child who exhibits the "3 C's"—coughing and choking with feedings and unexplained cyanosis—should be suspected of tracheoesophageal fistula. Options 1, 2, and 4 are not specifically associated with tracheoesophageal fistula.

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 the acetaminophen (Tylenol) is not effective. The nurse most appropriately tells the mother to 1.Increase the dose of the acetaminophen. 2.Increase the frequency of the acetaminophen. 3.Encourage the child to lie on the right side. 4.Encourage the child to lie on the left side.

3 - Splinting of the affected side by lying on that side may decrease discomfort. To advise the mother to increase the dose or frequency of the acetaminophen is inappropriate. Lying on the left side will not be helpful in alleviating discomfort.

A 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 most appropriate position? •1.Supine •2.Trendelenburg's •3.Side-lying •4.High Fowler's

3 - The child should be placed in a prone or side-lying position following tonsillectomy to facilitate drainage. Options 1, 2, and 4 will not achieve this goal. •Test-Taking Strategy:Use the process of elimination. Visualize each of the positions described in the options. Keeping in mind that the goal is to facilitate drainage will direct you easily to option 3. Review positioning procedures following tonsillectomy if you had difficulty with this question.

A child with 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. The most appropriate nursing action would be to 1.Call the physician and obtain an order for a mild sedative. 2.Tell the mother that the child must stay in the tent. 3.Place a toy in the tent to make the child feel more comfortable. 4.Let the mother hold the child and direct a cool mist over the child's face.

4 - 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. A mild sedative would not be administered to the child. Crying will aggravate laryngospasm and increase hypoxia, which may cause airway obstruction. Options 2 and 3 will not alleviate the child's fear.

A sweat test is performed on a child with a suspected diagnosis of cystic fibrosis. The nurse reviews the test results and determines that which of the following is a positive result for cystic fibrosis? 1.Chloride level of 20 mEq/L 2.Chloride level of 30 mEq/L 3.Chloride level of 40 mEq/L 4.Chloride level of 70 mEq/L

4 - In a sweat test, sweating is stimulated on the child's forearm with pilocarpine, the sample is collected on absorbent material, and the amounts of sodium and chloride are measured. A sample of at least 50 mg of sweat is required for accurate results. A chloride level greater than 60 mEq/L is considered to be a positive test result. A chloride level of 40 mEq/L suggests cystic fibrosis and requires a repeat test.

A nurse caring for an infant with bronchiolitis is assessing for signs of dehydration. The nurse assesses which of the following, knowing that it is the most reliable method of determining fluid loss? 1.Intake and output 2.Fontanels 3.Mucous membranes 4.Weight

4 - Weight is the most reliable method of measurement of body fluid loss or gain. One kilogram of weight change represents 1 L of fluid loss or gain. Although options 1, 2, and 3 identify components of the assessment for dehydration, these are not the most reliable determinants.

You are the nurse caring for a 2 year old child who is now fully awake after a tonsillectomy and adenoidectomy. What are the appropriate nursing interventions for this child? 1. Elevate HOB 15 degrees 2. Keep child in the prone position 3. Allow the child to drink sips of fluid with the help of a straw 4.Examine the throat with a light and a tongue blade 5.Apply ice to the neck for comfort

4,5 HOB should be 45 to 90 degrees Should be Supine Can drink, NOT with a straw Should look with tongue blade and light Use ice