Pediatric Respiratory questions with rationale

A 2-year-old has just been diagnosed with cystic fibrosis (CF). The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? 1. "You can expect your child to develop a barrel-shaped chest." 2. "You can expect your child to develop a chronic productive cough." 3. "You can expect your child to develop bronchiectasis." 4. "You can expect your child to develop wheezing respirations."

4. Wheezing respirations and a dry, nonproductive cough are common early symptoms in CF. TEST-TAKING HINT: Answer 2 can be eliminated because of the word "chronic." "Chronic" implies that the disease process is advanced rather than in the initial stages. Answers 1 and 3 can be eliminated if the test taker has knowledge of signs and symptoms of advanced lung disease.

Who is at the highest priority to receive the flu vaccine? 1. A healthy 8-month-old who attends day care. 2. A 3-year-old who is undergoing chemotherapy. 3. A 7-year-old who attends public school. 4. An 18-year-old who is living in a college dormitory.

ANS 1 1. Children between the ages of 6 and 23 months are at the highest risk for having complications as a result of the flu. Their immune systems are not as developed, so they are at a higher risk for influenza-related hospitalizations. 2. The flu vaccine should not be given to anyone who is immunocompromised. 3. The flu vaccine is recommended for all ages, but the 7-year-old is not the highest priority. A child this age will likely recover without any complications 4. The flu vaccine is recommended for all ages, but the 18-year-old is not the highest priority. A person this age will likely recover without any complications. TEST-TAKING HINT: The test taker can eliminate answers 2 and 3 by knowing that infants and the elderly are at highest risk for complications related to the flu

The parent of a 4-month-old with cystic fibrosis (CF) asks the nurse what time to begin the child's first chest physiotherapy (CPT) each day. Which is the nurse's best response? 1. "Thirty minutes before feeding the child breakfast." 2. "After deep-suctioning the child each morning." 3. "Thirty minutes after feeding the child breakfast." 4. "Only when the child has congestion or coughing."

1. CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting. TEST-TAKING HINT: Answer 4 can be eliminated because of the word "only." There are very few times in health care when an answer will be "only." Answer 3 can be eliminated when one considers the risk of vomiting and aspiration that may occur if percussion is performed following eating

The parent of an infant with cystic fibrosis (CF) asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion? 1. "You may need to increase the number of fresh fruits and vegetables you give your child." 2. "You may need to advance your child's diet to whole cow's milk because it is higher in fat than formula." 3. "You may need to change your child to a higher-calorie formula." 4. "You may need to increase your child's carbohydrate intake."

3. Often infants with CF need to have a higher-calorie formula to meet their nutritional needs. Infants may also be placed on hydrolysate formulas that contain medium-chain triglycerides. TEST-TAKING HINT: Answers 1, 2, and 4 can be eliminated with understanding of the nutritional needs of the child with CF. Answer 2 can also be eliminated because whole cow's milk is not recommended until 12 months of age.

A parent asks the nurse what will need to be done to relieve the constipation of her child who also has cystic fibrosis (CF). Which is the nurse's best response? 1. "Your child likely has an obstruction and will require surgery." 2. "Your child will likely be given IV fluids." 3. "Your child will likely be given MiraLAX." 4. "Your child will be placed on a clear liquid diet."

3. CF patients with constipation commonly receive a stool softener or an osmotic solution such as polyethylene glycol 3350 (MiraLAX) orally to relieve their constipation TEST-TAKING HINT: Answer 1 can be eliminated because surgery is not indicated for constipation.

How will a child with respiratory distress and stridor and who is diagnosed with RSV be treated? 1. Intravenous antibiotics. 2. Intravenous steroids. 3. Nebulized racemic epinephrine. 4. Alternating doses of Tylenol and Motrin.

ANS 3 1. RSV is a viral illness and is not treated with antibiotics. 2. Steroids are not used to treat RSV. 3. Racemic epinephrine promotes mucosal vasoconstriction. 4. Tylenol and Motrin can be given to the child for comfort, but they do not improve the child's respiratory status. TEST-TAKING HINT: This is a knowledgelevel question that requires the test taker to know how RSV is treated.

The parents of a 5-week-old have just been told that their child has cystic fibrosis (CF). The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse about the current projected life expectancy. What is the nurse's best response? 1. "The life expectancy for CF patients has improved significantly in recent years." 2. "Your child might not follow the same course that the mother's sister did." 3. "The physician will come to speak to you about treatment options." 4. The nurse answers their questions briefly, listens to their concerns, and is available later after they've processed the information.

4. The nurse's best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk. TEST-TAKING HINT: When parents are given information that their child has a chronic life-threatening disease, they are not capable of processing all the information right away; they need time. The parents are often given more information than they can possibly understand and often just need someone to listen to their concerns and needs.

A chloride level greater than _____________________ is a positive diagnostic indicator of cystic fibrosis (CF).

60 mEq/L. The definitive diagnosis of CF is made when a child has a sweat chloride level >60 mEq/L. A normal chloride level is <40 mEq/L. TEST-TAKING HINT: The test taker must have knowledge of tests and normal values used to identify a diagnosis of CF.

The parent of a child with cystic fibrosis (CF) is excited about the possibility of the child receiving a double lung transplant. What should the parent understand? 1. The transplant will cure the child of CF and allow the child to lead a long and healthy life. 2. The transplant will not cure the child of CF but will allow the child to have a longer life. 3. The transplant will help to reverse the multisystem damage that has been caused by CF. 4. The transplant will be the child's only chance at surviving long enough to graduate college.

2. A lung transplant does not cure CF, but it does offer the patient an opportunity to live a longer life. The concerns are that, after the lung transplant, the child is at risk for rejection of the new organ and for development of secondary infections because of the immunosuppressive therapy. TEST-TAKING HINT: Answer 4 can be eliminated because of the word "only." There are very few times in health care when an answer will be "only." Answers 1 and 3 can be eliminated if the test taker has a basic knowledge of the pathophysiology of CF.

Which would be appropriate nursing care management of a child with the diagnosis of mononucleosis? 1. Only family visitors. 2. Bedrest. 3. Clear liquids. 4. Limited daily fluid intake.

ANS 1 1. Children with mononucleosis are more susceptible to secondary infections. Therefore, they should be limited to visitors within the family, especially during the acute phase of illness. 2. Children with mononucleosis do not need to be forced to be on bedrest. Children usually self-limit their behavior. 3. Children with mononucleosis do not need a restricted diet. Often they are very tired and are not interested in eating. The nurse and family must ensure that the children are taking in adequate nutrition. 4. Children with mononucleosis usually have decreased appetite, but it is essential that they remain hydrated. There is no reason to restrict fluid. TEST-TAKING HINT: The test taker can eliminate answers 2 and 3 by understanding mononucleosis. Children with mononucleosis are usually very tired, are not interested in engaging in vigorous activity, and are rarely interested in eating.

Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be? 1. Complete a course of intravenous antibiotics. 2. Surgery to remove the tonsils. 3. 10 days of aerosolized ribavirin. 4. No intervention.

ANS 1 1. Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intravenous course of antibiotics. 2. Surgery is not the course of treatment for epiglottitis. Epiglottal swelling usually diminishes after 24 hours of intravenous antibiotics. 3. Ribavirin is an antiviral medication used to treat RSV. 4. Epiglottitis is a bacterial infection; a course of intravenous antibiotics is indicated. TEST-TAKING HINT: Understanding that epiglottitis is bacterial in nature will lead the test taker to choose the correct answer.

The parent of a child with influenza asks the nurse when the child is most infectious. Which is the nurse's best response? 1. "Twenty-four hours before and after the onset of symptoms." 2. "Twenty-four hours after the onset of symptoms." 3. "One week after the onset of symptoms." 4. "One week before the onset of symptoms."

ANS 1 1. Influenza is most contagious 24 hours before and 24 hours after onset of symptoms. 2. Influenza is most contagious 24 hours before and 24 hours after onset of symptoms. 3. Influenza is most contagious 24 hours before and 24 hours after onset of symptoms. 4. Influenza is most contagious 24 hours before and 24 hours after onset of symptoms. TEST-TAKING HINT: This question requires the test taker to have knowledge of the communicability of influenza.

Which is the nurse's best response to a parent who asks what can be done at home to help a child with upper respiratory infection (URI) symptoms and a fever get better? 1. "Give your child small amounts of fluid every hour to prevent dehydration." 2. "Give your child Robitussin at night to reduce his cough and help him sleep." 3. "Give your child a baby aspirin every 4 to 6 hours to help reduce the fever." 4. "Give your child an over-the-counter cold medicine at night."

ANS 1 1. It is essential that parents ensure their children remain hydrated during a URI. The best way to accomplish this is by giving small amounts of fluid frequently. 2. Over-the-counter cough and cold medicine is not recommended for any child younger than 6 years. 3. Aspirin is not given to children to treat a viral infection because of the risk of developing Reye syndrome. 4. Over-the-counter cough and cold medicine is not recommended for any child younger than 6 years. TEST-TAKING HINT: The test taker can eliminate answers 2 and 4 because overthe-counter cold and cough medications are not recommended for infants.

Which child is at highest risk for requiring hospitalization to treat respiratory syncytial virus (RSV)? 1. A 2-month-old who was born at 32 weeks. 2. A 16-month-old with a tracheostomy. 3. A 3-year-old with a congenital heart defect. 4. A 4-year-old who was born at 30 weeks.

ANS 1 1. The younger the child, the greater the risk for developing complications related to RSV. This infant is at highest risk because of age and premature status. 2. This child has a tracheostomy, but this is not an indication that the child cannot be managed at home. 3. Most children with RSV can be managed at home. Children 2 years and younger are at highest risk for developing complications related to RSV. Children who were born prematurely, have cardiac conditions, or have chronic lung disease are also at higher risk for needing hospitalization. The 3-year-old with a congenital heart disease is not the highest risk among this group of patients. 4. Children who were born prematurely, have cardiac conditions, or have chronic lung disease are at a higher risk for needing hospitalization. This child was a premature infant but is now 4 years of age. TEST-TAKING HINT: The test taker must consider that all of these children have some amount of risk for requiring hospitalization. The 2-month-old has two of the noted risk factors of being premature and a very young infant.

What would the nurse advise the parent of a child with a barky cough that gets worse at night? 1. Take the child outside into the more humid night air for 15 minutes. 2. Take the child to the ER immediately. 3. Give the child an over-the-counter cough suppressant. 4. Give the child warm liquids to soothe the throat.

ANS 1 1. The night air will help decrease subglottic edema, easing the child's respiratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider. 2. There is no immediate need to bring the child to the ER. The child's symptoms will likely improve on the drive to the hospital because of the child's exposure to the night air. 3. Over-the-counter cough suppressants are not recommended for children because they reduce their ability to clear secretions. 4. Warm liquids may increase subglottic edema and actually aggravate the child's symptoms. Cool liquid or a Popsicle is the best choice. TEST-TAKING HINT: The test taker must accurately identify that the question is describing a child with croup and know how croup is treated.

Which statement by the parent of a child using an albuterol inhaler leads the nurse to believe that further education is needed on how to administer the medication? 1. "I should administer two quick puffs of the albuterol inhaler using a spacer." 2. "I should always use a spacer when administering the albuterol inhaler." 3. "I should be sure that my child is in an upright position when administering the inhaler." 4. "I should always shake the inhaler before administering a dose."

ANS 1 1. The parent should always give one puff at a time and wait 1 minute before administering the second puff. 2. A spacer is recommended when administering medications by metered dose inhaler (MDI) to children. 3. The child should be in an upright position when medications are administered by MDI. 4. The inhaler should always be shaken before administering a dose of the medication. TEST-TAKING HINT: The test taker evaluates how the parents administer the MDI

Which child with asthma should the nurse see first? 1. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 2. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. 3. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. 4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.

ANS 1 1. This child is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes and now has diminished breath signs. 2. This child is exhibiting symptoms of mild asthma and should not be seen before the other children. 3. This child is exhibiting signs of moderate asthma and should be watched but is not the patient of highest priority. 4. This child is exhibiting signs of moderate asthma and is not the patient of highest priority. TEST-TAKING HINT: The test taker can eliminate answers 2, 3, and 4 by knowing that diminished breath sounds are a sign the patient has a worsening condition. The other bit of information that is essential in this problem is the child's age. The younger the child, the faster the respiratory status can diminish.

Which statement indicates the parent needs further teaching on how to prevent his other children from contracting respiratory syncytial virus (RSV)? 1. "I should make sure that both my children receive Synagis (palivizumab) injections for the remainder of this year." 2. "I should be sure to keep my infected child away from his brother until he has recovered." 3. "I should insist that all people who come in contact with my children thoroughly wash their hands before playing with them." 4. "I should insist that anyone with a respiratory illness avoid contact with my children until well."

ANS 1 1. Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention. 2. RSV is spread through direct contact with respiratory secretions, so it is a good idea to keep the ill child away from the healthy one. 3. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have all persons coming in contact with the child wash their hands. 4. RSV is spread through direct contact with respiratory secretions, so it is a good idea to have ill persons avoid any contact with the children until they are well. TEST-TAKING HINT: This question requires the test taker to understand how RSV is transmitted and how to prevent the spread of the virus.

What does the therapeutic management of cystic fibrosis (CF) patients include? Select all that apply. 1. Providing a high-protein, high-calorie diet. 2. Providing a high-fat, high-carbohydrate diet. 3. Encouraging exercise. 4. Minimizing pulmonary complication. 5. Encouraging medication compliance.

ANS 1,3,4,5 1. Children with CF have difficulty absorbing nutrients because of the blockage of the pancreatic duct. Pancreatic enzymes cannot reach the duodenum to aid in digestion of food. These children often require up to 150% of the caloric intake of their peers. The nutritional recommendation for CF patients is high-calorie and high-protein. 2. A high-fat, high-carbohydrate diet is not recommended for adequate nutrition. 3. Exercise is effective in helping CF patients clear secretions. 4. Minimizing pulmonary complications is essential to a better outcome for CF patients. Compliance with CPT, nebulizer treatments, and medications are all components of minimizing pulmonary complications. 5. Medication compliance is a necessary part of maintaining pulmonary and gastrointestinal function. TEST-TAKING HINT: The test taker can eliminate answer 2 because patients are not placed on high-fat diets.

A 3-year-old is brought to the ER with coughing and gagging. The parent reports that the child was eating carrots when she began to gag. Which diagnostic evaluation will be used to determine if the child has aspirated carrots? 1. Chest x-ray. 2. Bronchoscopy. 3. Arterial blood gas (ABG). 4. Sputum culture.

ANS 2 1. A chest x-ray will only show radiopaque items (items that x-rays cannot go through easily), so it is not helpful in determining if the child aspirated a carrot. 2. A bronchoscopy will allow the physician to visualize the airway and will help determine if the child aspirated the carrot. 3. A blood gas will identify whether the child has suffered any respiratory compromise, but the blood gas cannot definitively determine the cause of the compromise. 4. A sputum culture may be helpful several days later to determine if the child has developed aspiration pneumonia. Aspiration pneumonia may take several days or a week to develop following aspiration. TEST-TAKING HINT: Answer 1 can be eliminated because items that are not radiopaque (opaque to x-rays) cannot be seen on an x-ray. Answers 3 and 4 can be eliminated because they do not provide confirmation regarding whether the child aspirated.

10. A school-age child has been diagnosed with nasopharyngitis. The parent is concerned because the child has had little or no appetite for the last 24 hours. Which is the nurse's best response? 1. "Do not be concerned; it is common for children to have a decreased appetite during a respiratory illness." 2. "Be sure your child is taking an adequate amount of fluids. The appetite should return soon." 3. "Try offering the child some favorite food. Maybe that will improve the appetite." 4. "You need to force your child to eat whatever you can; adequate nutrition is essential."

ANS 2 1. It is common for children to have a decreased appetite when they have a respiratory illness. However, the nurse needs to instruct the parent to offer fluids to ensure the child stays hydrated. 2. It is common for children to have a decreased appetite when they have a respiratory illness. The nurse is appropriately instructing the parent that the child will be fine by taking in an adequate amount of fluid. 3. The child may want to eat some favorite foods; however, the child will be fine if an adequate amount of fluid is maintained. 4. The parent should not force the child to eat; the child's appetite should return in a couple of days. TEST-TAKING HINT: Answer 4 can be eliminated because one should not force the child to eat. If the word had been "encourage," it would have been a better choice, although still not the best answer. Answer 1 can be eliminated because the nurse did not inform the parent of the importance of maintaining adequate fluid intake.

A school-age child has been diagnosed with strep throat. The parent asks the nurse when the child can return to school. Which is the nurse's best response? 1. "Forty-eight hours after the first documented normal temperature." 2. "Twenty-four hours after the first dose of antibiotics." 3. "Forty-eight hours after the first dose of antibiotics." 4. "Twenty-four hours after the first documented normal temperature."

ANS 2 1. School systems require that children remain home for 24 hours after having a documented fever. However, in this question the child has been diagnosed with strep throat. Even if the child is fever-free, the child must have completed a 24-hour course of antibiotics before returning to school. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy. 2. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy. 3. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy. 4. School systems require that children remain home for 24 hours after having a documented fever. However, in this question the child has been diagnosed with strep throat. Even if the child is fever-free, the child must have completed a 24-hour course of antibiotics before returning to school. Children with strep throat are no longer contagious 24 hours after initiation of antibiotic therapy. TEST-TAKING HINT: The test taker can eliminate answers 1 and 4 given knowledge of the communicability of strep throat.

Which child would benefit most from having ear tubes placed? 1. A 2-month-old who has had one ear infection. 2. A 2-year-old who has had five previous ear infections. 3. A 3-year-old whose sibling has had four ear infections. 4. A 7-year-old who has had two ear infections this year.

ANS 2 1. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections. 2. A 2-year-old who has had multiple ear infections is a perfect candidate for ear tubes. The other issue is that a 2-year-old is at the height of language development, which can be adversely affected by recurrent ear infections. 3. Surgery is not a prophylactic treatment. Just because the sibling has had several ear infections does not suggest that the 3-year-old will also have frequent ear infections. The 3-year-old has not had an ear infection yet. 4. A 7-year-old who has had two ear infections is not the appropriate candidate. Surgical intervention is usually reserved for children who have suffered from recurrent ear infections. TEST-TAKING HINT: The test taker must also consider the developmental level of the child in this question. The 2-year-old has had multiple infections and is also at a stage when language development is essential. If this child is not hearing appropriately, speech will also be delayed. Surgical intervention is reserved for those who have had recurrent infections.

Which laboratory result will provide the most important information regarding the respiratory status of a child with an acute asthma exacerbation? 1. CBC. 2. ABG. 3. BUN. 4. PTT.

ANS 2 1. The CBC gives the health-care team information about the child's red and white blood cell count and hemoglobin and hematocrit levels. The CBC indicates if the child has or is developing an infection but nothing about the child's current respiratory status. 2. The ABG gives the health-care team valuable information about the child's respiratory status: level of oxygenation, carbon dioxide, and blood pH. 3. The BUN provides information about the patient's kidney function but nothing regarding the patient's respiratory status. 4. The PTT provides information about how long it takes the patient's blood to clot but nothing about the patient's respiratory status. TEST-TAKING HINT: The test taker can eliminate answers 1, 2 and 3 with a knowledge of common laboratory tests.

Which position would be most comfortable for a child with left-sided pneumonia? 1. Trendelenburg. 2. Left side. 3. Right side. 4. Supine.

ANS 2 1. The Trendelenburg position is not effective for improving respiratory difficulty. Patients with pneumonia are usually most comfortable in a semi-erect position. 2. Lying on the left side may provide the patient with the most comfort. Lying on the left splints the chest and reduces the pleural rubbing. 3. It is most comfortable for the patient to lie on the affected side. Lying on the left splints the chest and reduces the pleural rubbing. 4. Lying in the supine position does not provide comfort for the patient and does not improve the child's respiratory effort. TEST-TAKING HINT: The test taker can eliminate answers 1 and 4 because neither of them would improve the child's respiratory effort. Both these positions may actually cause the patient increased respiratory distress.

Which is the nurse's best response to parents who ask what impact asthma will have on the child's future in sports? 1. "As long as your child takes prescribed asthma medication, the child will be fine." 2. "The earlier a child is diagnosed with asthma, the more significant the symptoms." 3. "The earlier a child is diagnosed with asthma, the better the chance the child has of growing out of the disease." 4. "Your child should avoid playing contact sports and sports that require a lot of running."

ANS 2 1. It is essential that the child take all of the scheduled asthma medications, but there is no guarantee the child will be fine and be able to play all sports. 2. When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging. 3. Children diagnosed at an early age usually exhibit worse symptoms than those diagnosed later in life. 4. Children with asthma are encouraged to participate in sports and don't necessarily need bronchodilator medication before, sports activities. . TEST-TAKING HINT: The test taker can eliminate answer 4 because not all asthmatics also have exercise-induced asthma necessitating use of a fast-acting bronchodilator before playing.

Which statement about pneumonia is accurate? 1. Pneumonia is most frequently caused by bacterial agents. 2. Children with bacterial pneumonia are usually sicker than children with viral pneumonia. 3. Children with viral pneumonia are usually sicker than those with bacterial pneumonia. 4. Children with viral pneumonia must be treated with a complete course of antibiotics.

ANS 2 1. Pneumonia is most frequently caused by viruses but can also be caused by bacteria such as Streptococcus pneumoniae. 2. Children with bacterial pneumonia are usually sicker than children with viral pneumonia. Children with bacterial pneumonia can be treated effectively, but they require a course of antibiotics. 3. Children with viral pneumonia are not usually as ill as those with bacterial pneumonia. Treatment for viral pneumonia includes maintaining adequate oxygenation and comfort measures. 4. Treatment for viral pneumonia includes maintaining adequate oxygenation and comfort measures. TEST- TAKING HINT: The test taker must have an understanding of the differences between viral and bacterial infections.

Which assessment is of greatest concern in a 15-month-old? 1. The child is lying down, has moderate retractions, low-grade fever, and nasal congestion. 2. The child is in the tripod position, has diminished breath sounds, and a muffled cough. 3. The child is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The child is restless and crying, has bilateral wheezes, and is feeding poorly.

ANS 2 1. Retractions indicate some degree of respiratory distress but more information needs to be obtained. Other common symptoms of a respiratory illness include, low-grade fever, and nasal congestion and are not overly concerning. 2. When children are sitting in the tripod position, they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds are indicative of a worsening condition. A muffled cough indicates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition. 3. Coarse breath sounds, cough, and fussiness are common signs and symptoms of a respiratory illness. 4. Restlessness, wheezes, poor feeding, and crying are signs and symptoms of a respiratory illness. TEST-TAKING HINT: The test taker can eliminate answers 1, 3, and 4 if familiar with common signs and symptoms of respiratory illness.

Which would be an early sign of respiratory distress in a 2-month-old? 1. Breathing shallowly. 2. Tachypnea. 3. Tachycardia. 4. Bradycardia.

ANS 2 1. Shallow breathing is a late sign of respiratory distress. 2. Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants. 3. Tachycardia is a compensatory response by the body. When a child has respiratory distress and is not oxygenating well, the body increases the heart rate in an attempt to improve oxygenation. 4. Bradycardia is a late sign of respiratory distress. TEST-TAKING HINT: The test taker must know the signs and symptoms of respiratory distress and be able to recognize them. 26

The parent of a child with frequent ear infections asks the nurse if there is anything that can be done to help avoid future ear infections. Which is the nurse's best response? 2. "Your child should be kept away from tobacco smoke." 3. "Your child should be kept away from other children with otitis media." 4. "Your child should always wear a hat when outside."

ANS 2 1. Singulair is an allergy medication, but it has not been proven to help reduce the number of ear infections in children. 2. Tobacco smoke has been proved to increase the incidence of ear infections. The tobacco smoke damages mucociliary function, prolonging the inflammatory process and impeding drainage through the eustachian tube. 3. Otitis media is not transmitted from one child to another. Otitis is often preceded by a URI, so children who are around other children with URIs may contract one, increasing their chances of developing an ear infection. 4. Wearing a hat outside will have no impact on whether a child contracts an ear infection. TEST-TAKING HINT: The test taker can eliminate answer 3 by understanding that otitis media is not a contagious disease process. Answer 4 can be eliminated if the test taker understands that otitis media is not caused by exposing the child to cold air.

A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for? 1. Immediate IV placement. 2. Respiratory treatment of racemic epinephrine. 3. A tracheostomy set at the bedside. 4. Informing the child's parents about a tonsillectomy.

ANS 2 1. The child is exhibiting signs and symptoms of croup and is in mild respiratory distress. 2. The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine. 3. A tracheostomy is not indicated for this child. A tracheostomy would be indicated for a child with a complete airway obstruction. 4. This child is exhibiting signs and symptoms of croup and has no indication of tonsillitis. A tonsillectomy is usually reserved for children who have recurrent tonsillitis. TEST-TAKING HINT: The test taker must accurately identify that the question is describing a child with croup and know the accepted treatments.

A 6-week-old is admitted to the hospital with influenza. The child is crying, and the father tells the nurse that his son is hungry. The nurse explains that the baby is not to have anything by mouth. The parent does not understand why the child cannot eat. Which is the nurse's best response to the parent? 1. "We are giving your child intravenous fluids, so there is no need for anything by mouth." 2. "The shorter and narrower airway of infants increases their chances of aspiration so your child should not have anything to eat now." 3. "When your child eats, he burns too many calories; we want to conserve the child's energy." 4. "Your child has too much nasal congestion; if we feed the child by mouth, the distress will likely increase."

ANS 2 1. The child is receiving intravenous fluids, so he is being hydrated. However, this response does not explain to the father why his son cannot eat. 2. Infants are at higher risk of aspiration because their airways are shorter and narrower than those of adults. An infant with influenza has lots of nasal secretions and coughs up mucus. With all the secretions, the infant is at an even higher risk of aspiration. 3. Eating burns calories, but if the baby is upset and crying he is also expending energy. Therefore, this is not the best choice of answers. 4. If the child has nasal congestion, that may make it difficult for him to feed. However, the recommendation to parents is to bulbsuction an infant with nasal congestion before feeding. TEST-TAKING HINT: The test taker can eliminate answer 1 because it does not give the father an explanation of why his son cannot eat.

Which child is in the greatest need of emergency medical treatment? 1. 3-year-old who has a barky cough, is afebrile, and has mild intercostal retractions. 2. 6-year-old who has high fever, no spontaneous cough, and frog-like croaking. 3. 7-year-old who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough. 4. 13-year-old who has a high fever, stridor, and purulent secretions.

ANS 2 1. This child has signs and symptoms of acute laryngitis and is not in a significant amount of distress. 2. This child has signs and symptoms of epiglottitis and should receive immediate emergency medical treatment. The patient has no spontaneous cough and has a frog-like croaking because of a significant airway obstruction. 3. This child has signs and symptoms of LTB and is not in significant respiratory distress. 4. This child has signs and symptoms of bacterial tracheitis and should be treated with antibiotics but is not the patient in the most significant amount of distress. TEST-TAKING HINT: The test taker must accurately identify that the question is describing a child with epiglottitis. The test taker must also understand that epiglottitis is a pediatric emergency and can cause the child to have complete airway obstruction

How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts of azotorrhea and steatorrhea in a child with cystic fibrosis (CF)? The values indicate the child is 1. Not compliant with taking her vitamins. 2. Not compliant with taking her enzymes. 3. Eating too many foods high in fat. 4. Eating too many foods high in fiber.

ANS 2 2. If the child were not taking enzymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. Pancreatic ducts in CF patients become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes with all meals and snacks to aid in absorption of nutrients. Often, teens are noncompliant with their medication regimen because they want to be like their peers. TEST-TAKING HINT: The test taker needs to understand the pathophysiology of CF and the impact it has on the gastrointestinal system. The test taker also must be familiar with the conditions azotorrhea and steatorrhea.

Which is diagnostic for epiglottitis? 1. Blood test. 2. Throat swab. 3. Lateral neck x-ray of the soft tissue. 4. Signs and symptoms.

ANS 3 1. A blood test does not indicate a diagnosis of epiglottitis. A CBC may show an increased white blood cell count indicating the child has some sort of infection. 2. A throat culture is not done to diagnose epiglottitis. It is contraindicated to insert anything into the mouth or throat of any child who is suspected of having epiglottitis. Inserting anything into the throat could cause the child to have a complete airway obstruction. 3. A lateral neck x-ray is a definitive test to diagnose epiglottitis. The child is at risk for complete airway obstruction and should always be accompanied by a nurse to the x-ray department. 4. Epiglottitis is not diagnosed based on signs and symptoms. A lateral neck film makes the diagnosis. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because epiglottitis is diagnosed by lateral neck films.

Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase? 1. Use an incentive spirometer. 2. Breathe into a paper bag. 3. Blow a pinwheel. 4. Take several deep breath

ANS 3 1. A child of 3 years old is too young to comply with incentive spirometry, and this activity won't increase the expiratory phase anyway. 2. Breathing into a paper bag results in a prolonged inspiratory and expiratory phase. 3. Blowing a pinwheel is an excellent means of increasing a child's expiratory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child's expiratory phase. 4. Taking deep breaths results in a prolonged inspiratory phase. TEST-TAKING HINT: The test taker can eliminate answers 1 and 4 because they do not increase the expiratory phase. Play is one of the best ways to engage young children in therapeutic activities.

A parent asks how to care for a child at home who has the diagnosis of viral tonsillitis. Which is the nurse's best response? 1. "You will need to give your child a prescribed antibiotic for 10 days." 2. "You will need to schedule a follow-up appointment in 2 weeks." 3. "You can give your child Tylenol every 4 to 6 hours as needed for pain." 4. "You can place warm towels around your child's neck for comfort."

ANS 3 1. A viral illness does not require antibiotics. The patient would need to complete a course of antibiotics for bacterial tonsillitis. 2. Viral tonsillitis is usually a self-limiting disease and does not require a follow-up appointment unless the child's symptoms worsen. 3. Tylenol is recommended PRN for pain relief. 4. Warm compresses to the neck are not recommended, as they may in fact increase the inflammation. Cold compresses or ice packs are recommended for comfort. TEST-TAKING HINT: The test taker can eliminate answer 1 by knowing that antibiotics are not given for viral illnesses. Answer 4 can be eliminated by knowing that swelling and inflammation increase with heat. Cold causes vasoconstriction of the vessels, aiding in decreasing the amount of inflammation.

Which should the nurse instruct children to do to stop the spread of influenza in the classroom? 1. Stay home if they have a runny nose and cough. 2. Wash their hands after using the restroom. 3. Wash their hands after sneezing. 4. Have a flu shot annually.

ANS 3 1. Children do not need to stay home unless they have a fever. However, the children should be taught to cough or sneeze into their sleeve and to wash their hands after sneezing or coughing. 2. Children should always wash their hands after using the restroom. In order to decrease the spread of influenza, however, it is more important for the children to wash their hands after sneezing or coughing. 3. It is essential that children wash their hands after any contact with nasopharyngeal secretions. 4. Children should have a flu shot annually, but that information is best included in an educational session for the parents. There is little that children can do directly to ensure they receive flu shots. Children of this age are often frightened of shots and would not likely pass that information on to their parents. TEST-TAKING HINT: Answers 1 and 4 can be eliminated because both situations are under parental control.

An infant is not sleeping well, crying frequently, has yellow drainage from the ear, and is diagnosed with an ear infection. Which nursing objective is the priority for the family? 1. Educating the parents about signs and symptoms of an ear infection. 2. Providing emotional support for the parents. 3. Providing pain relief for the child. 4. Promoting the flow of drainage from the ear.

ANS 3 1. It is important to educate the family about the signs and symptoms of an ear infection, but that is not the priority at this time. The infant has already been diagnosed with the infection. 2. The parents may need emotional support because they are likely suffering from a lack of sleep because their infant is ill. However, this will not solve their current problems with their infant. 3. Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better. 4. Promoting drainage flow from the ear is important, but providing pain relief is the highest priority. TEST-TAKING HINT: The test taker needs to consider the needs of the child and the parent at this time. If the pain is controlled, the parents and child will both be in a better state. The other items are all essential in providing care for the child with otitis, but pain relief offers the best opportunity for the child and the parent to return to normal conditions.

What information should the nurse provide the parent of a child diagnosed with nasopharyngitis? 1. Complete the entire prescription of antibiotics. 2. Avoid sending the child to day care. 3. Use comfort measures for the child. 4. Restrict the child to clear liquids for 24 hours.

ANS 3 1. Nasopharyngitis is a viral illness and does not require antibiotic therapy. 2. Children who attend day care are more prone to catching viral illnesses, but it is not the nurse's place to tell the parents not to send their child to day care. Often families do not have a choice about using day care. 3. Nursing care for nasopharyngitis is primarily supportive. Keeping the child comfortable during the course of the illness is all the parents can do. Nasal congestion can be relieved using normal saline drops and bulb suction. Tylenol can also be given for discomfort or a mild fever. 4. There is no reason to restrict the child to clear liquids. Many children have a decreased appetite during a respiratory illness, so the most important thing is to keep them hydrated. TEST-TAKING HINT: This question requires the test taker to understand how nasopharyngitis is treated.

Which should the nurse administer to provide quick relief to a child with asthma who is coughing, wheezing, and having difficulty catching her breath? 1. Prednisone. 2. Singulair (montelukast). 3. Albuterol. 4. Flovent (fluticasone).

ANS 3 1. Prednisone, a corticosteroid, is often given to children with asthma, but it is not a quick-relief medication. The prednisone will take time to relieve the child's symptoms. 2. Singulair is an allergy medication that should be taken daily by asthmatics with significant allergies. Allergens are often triggers for asthmatics, so treating the child for allergies can help avoid an asthma attack. Singulair, however, does not help a child immediately with the symptoms of a particular asthma attack. 3. Albuterol is the quick-relief bronchodilator of choice for treating an asthma attack. 4. Flovent is a long-term therapy medication for asthmatics and is used daily to help prevent asthma attacks. TEST-TAKING HINT: The test taker must know the medications used to treat asthma and which are used in which situations.

A parent asks the nurse how it will be determined if their child has respiratory syncytial virus (RSV). Which is the nurse's best response? 1. "We will do a simple blood test to determine whether your child has RSV." 2. "There is no specific test for RSV. The diagnosis is made based on the child's symptoms." 3. "We will swab your child's nose and send that specimen for testing." 4. "We will have to send a viral culture to an outside lab for testing."

ANS 3 1. RSV is not diagnosed by a blood test. 2. Nasal secretions are tested to determine if a child has RSV. 3. The child is swabbed for nasal secretions. The secretions are tested to determine if a child has RSV. 4. Viral cultures are not done very often because it takes several days to receive results. The culture does not have to be sent to an outside lab for evaluation. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because the child's nasal sections will be swabbed

Which information will be most helpful in teaching parents about the primary prevention of foreign body aspiration? 1. Signs and symptoms of foreign body aspiration. 2. Therapeutic management of foreign body aspiration. 3. Most common objects that toddlers aspirate. 4. Risks associated with foreign body aspiration.

ANS 3 1. Teaching the parents signs and symptoms of foreign body aspiration is important, but it is a tertiary means of prevention and will not help the parents prevent the aspiration. 2. Teaching the parents the therapeutic management of foreign body aspiration is important, but it is a tertiary means of prevention and will not help the parents prevent the aspiration. 3. Teaching parents the most common objects aspirated by toddlers will help them the most. Parents can avoid having those items in the household or in locations where toddlers may have access to them. 4. Teaching the parents the risks associated with foreign body aspiration is important but it is a tertiary means of prevention and will not help the parents prevent the aspiration. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because they are all forms of tertiary prevention. Primary prevention is key to preventing foreign body aspiration.

A child's parent asks the nurse what treatment the child will need for the diagnosis of strep throat. Which is the nurse's best response? 1. "Your child will be sent home on bedrest and should recover in a few days without any intervention." 2. "Your child will need to have the tonsils removed to prevent future strep infections." 3. "Your child will need oral penicillin for 10 days and should feel better in a few days." 4. "Your child will need to be admitted to the hospital for 5 days of intravenous antibiotics."

ANS 3 1. The child may need bedrest. However, the child does need antibiotics to treat the strep infection. 2. The child does not need the tonsils removed; the child has strep throat. Surgical removal of the tonsils is done only following recurrent bouts of infection. 3. The child will need a 10-day course of penicillin to treat the strep infection. It is essential that the nurse always tell the family that, although the child will feel better in a few days, the entire course of antibiotics must be completed. 4. Strep throat can be treated at home with oral penicillin and does not require IV antibiotics and hospitalization. TEST-TAKING HINT: Answer 2 can be eliminated because it is a treatment for recurrent tonsillitis, not strep throat. Answer 1 can be eliminated if the test taker understands that bacterial infections need to be treated with antibiotics.

Which child diagnosed with pneumonia would benefit most from hospitalization? 1. 13-year-old who is coughing, has coarse breath sounds, and is not sleeping well 2. 14-year-old with a fever of 38.6°C (101.5°F), rapid breathing, and a decreased appetite. 3. 15-year-old who has been vomiting for 3 days and has a fever of 38.5°C (101.3°F). 4. A 16-year-old who has a cough, chills, fever of 38.5°C (101.3°F), and wheezing.

ANS 3 1. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization. Most people with pneumonia are treated at home, with a focus on treating the symptoms and keeping the patient comfortable. Comfort measures include cool mist, chest physiotherapy (CPT), antipyretics, fluid intake, and family support. 2. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization. 3. The teen who has been vomiting for several days and is unable to tolerate oral fluids and medication should be admitted for intravenous hydration. 4. These are all common symptoms of pneumonia and should be monitored but do not require hospitalization. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 if familiar with the common signs and symptoms of pneumonia.

Which is the nurse's best response to the parent of an infant diagnosed with the first otitis media who wonders about long-term effects? 1. "The child could suffer hearing loss." 2. "The child could suffer some speech delays." 3. "The child could suffer recurrent ear infections." 4. "The child could require ear tubes."

ANS 3 1. Hearing loss is not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop hearing loss. 2. Speech delays are not an issue that would be discussed following one ear infection. Children with recurrent untreated ear infections are more likely to develop some hearing loss, which often results in delayed language development. 3. When children acquire an ear infection at such a young age, there is an increased risk of recurrent infections. 4. Surgical intervention is not a first line of treatment. Surgery is usually reserved for children who have suffered from recurrent ear infections. TEST-TAKING HINT: Answers 1, 2, and 4 can be eliminated if the test taker understands that these are all long-term effects of recurrent ear infections. The question is asking about a single incident of otitis.

Which statement by the parents of a toddler with repeated otitis media indicates they need additional teaching? 1. "If I quit smoking, my child may have a decreased chance of getting an ear infection." 2. "As my child gets older, he should have fewer ear infections, because his immune system will be more developed." 3. "My child will have fewer ear infections if he has his tonsils removed." 4. "My child may need a speech evaluation."

ANS 3 1. Repeated exposure to smoke damages the cilia in the ear, making the child more prone to ear infections. 2. Children experience fewer ear infections as they age because their immune system is maturing. 3. Removing children's tonsils may not have any effect on their ear infection. Children who have repeated bouts of tonsillitis can have ear infections secondary to the tonsillitis, but there is no indication in this question that the child has a problem with tonsillitis. 4. Children who have repeated ear infections are at a higher risk of having decreased hearing during and between infections. Hearing loss directly affects a child's speech development. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 4 because those options are true.

Which should be included in instructions to the parent of a child prescribed amoxicillin to treat an ear infection? 1. "Continue the amoxicillin until the child's symptoms subside." 2. "Administer an over-the-counter antihistamine with the antibiotic." 3. "Administer the amoxicillin until all the medication is gone." 4. "Allow your child to administer his own dose of amoxicillin."

ANS 3 1. The parent should administer all of the medication. Stopping the medication when symptoms subside may not clear up the ear infection and may actually cause more severe symptoms. 2. Antihistamines have not been shown to decrease the number of ear infections a child gets. 3. It is essential that all the medication be given. 4. The child is old enough to participate in the administration of medication but should only do so in the presence of the parents. TEST-TAKING HINT: Answer 1 can be eliminated because a course of antibiotics should always be completed as ordered, no matter what the age of the child. Answer 4 can be eliminated because children would not be expected to administer their own medications without supervision by an adult.

A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? 1. Maintaining strict bedrest. 2. Avoiding contact with family members. 3. Instilling saline nose drops and bulb suctioning. 4. Keeping the head of the bed flat.

ANS 3 1. Strict bedrest is not necessary. Children with respiratory illnesses usually self-limit their activity. Parents just need to ensure that their children are getting adequate rest. 2. It is not necessary to avoid contact with family members. Nasopharyngitis is spread by contact with the secretions, so hand washing is the key to limiting the spread of the virus. 3. Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gentle suctioning with a bulb syringe are often recommended. 4. The head of the bed should be elevated in order to help with the drainage of secretions. TEST-TAKING HINT: The test taker can eliminate answer 4 given a basic understanding of interventions to improve respiratory function.

The nurse is reviewing discharge instructions with the parents of a child who had a tonsillectomy 24 hours ago. The parents tell the nurse that the child is a big eater, and they want to know what foods to give the child for the next 24 hours. What is the nurse's best response? 1. "The child's diet should not be restricted at all." 2. "The child's diet should be restricted to clear liquids." 3. "The child's diet should be restricted to ice cream and cold liquids." 4. "The child's diet should be restricted to soft foods."

ANS 4 1. A child should be restricted to soft foods for the first couple of days post-operatively. Soft foods are recommended because the child will have a sore throat for several days following surgery. Soft foods will decrease the risk of bleeding. 2. Most children self-limit their food intake post-operatively. Children can have solids, but soft foods are recommended for the first several post-operative days. 3. Most children prefer to eat cold foods, but they are not restricted to them. 4. Soft foods are recommended to limit the child's pain and to decrease the risk for bleeding. TEST-TAKING HINT: The test taker can eliminate answer 1 by knowing there are usually some dietary restrictions following any surgical procedure

The parent of a 9-month-old calls the ER because his child is choking on a marble. The parent asks how to help his child while awaiting Emergency Medical Services. Which is the nurse's best response? 1. "You should administer five abdominal thrusts followed by five back blows." 2. "You should try to retrieve the object by inserting your finger in your child's mouth." 3. "You should perform the Heimlich maneuver." 4. "You should administer five back blows followed by five chest thrusts."

ANS 4 1. Abdominal thrusts are not recommended for children younger than 1 year. 2. Inserting a finger in the child's mouth may cause the object to be pushed further down the airway, making it more difficult to remove. 3. The Heimlich maneuver should be performed only on adults. 4. The current recommendation for infants younger than 1 year is to administer five back blows followed by five chest thrusts. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 3 if familiar with CPR in infants and children. 60

Which intervention is most appropriate to teach the mother of a child diagnosed with a URI and a dry hacking cough that prevents him from sleeping? 1. Give cough suppressants at night. 2. Give an expectorant every 4 hours. 3. Give cold and flu medication every 8 hours. 4. Give 1/2 teaspoon of honey four to five times per day.

ANS 4 1. Cough suppressants are not recommended for children. Coughing is a protective mechanism, so do not try to stop it. 2. Expectorants are not recommended for children younger than 6 years of age. There is no research information that they are effective. 3. Cold and flu medications are not indicated for children younger than 6 years of age as there is no indication they are effective. 4. Warm fluids, humidification, and honey are best treatments for a URI. TEST-TAKING HINT: The latest recommendations for treatment of URIs in children are to treat the symptoms because cough medications are not effective.

The parents of a 6-year-old who has a new diagnosis of asthma ask the nurse what to do to make their home a more allergy-free environment. Which is the nurse's best response? 1. "Use a humidifier in your child's room." 2. "Have your carpet cleaned chemically once a month." 3. "Wash household pets weekly." 4. "Avoid purchasing upholstered furniture."

ANS 4 1. It is better to maintain 30% to 50% humidity in homes of asthmatic children. However, humidifiers are not recommended because they can harbor mold as a result of lack of proper cleaning. 2. Chemical cleaning is not recommended because the chemicals used can be a trigger and actually cause the child to have an asthma attack. The best recommendation is to remove all carpet from the house, if possible. 3. Household pets are not recommended for children with asthma. 4. Leather furniture is recommended rather than upholstered furniture. Upholstered furniture can harbor large amounts of dust, whereas leather furniture may be wiped off regularly with a damp cloth. TEST-TAKING HINT: The test taker can eliminate answer 3 because there is no known way to make a pet allergy-free. Household pets are discouraged for all children with asthma or severe allergies. Answer 2 can be eliminated if the test taker understands that chemical agents are triggers to asthma for many children.

What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus? 1. "What time did your child eat last?" 2. "Has your child been exposed to any of the usual asthma triggers?" 3. "When was your child last admitted to the hospital for asthma?" 4. "When was your child's last dose of medication?"

ANS 4 1. The nurse needs to know when the child ate last in the event that the child may need to be intubated for severe respiratory distress, but it is not the most vital piece of information to best treat the child for the current state of distress. 2. The nurse needs to know if the child was exposed to anything that usually triggers the asthma, but that is not the most important information for treating the child's immediate need. 3. Knowing when the child was admitted last will give the nurse an idea of the severity of the child's asthma, but that is not the most important information for treating the child's immediate need. 4. The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition. TEST-TAKING HINT: Whereas all of the information here is essential, answer 4 gives the most important information. The test taker can eliminate answers 2 and 3 because the responses to these inquiries have no direct impact on the immediate treatment of the child. These two answers give information about the severity of the child's illness, but they do not affect the immediate treatment plan. Answer 4 is essential to deciding what medication should be given the child to relieve the current symptoms.

A school-age child is admitted to the hospital for a tonsillectomy. During the nurse's post-operative assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations would be of most concern to the nurse? 1. The child's heart rate and blood pressure are elevated. 2. The child complains of having a sore throat. 3. The child is refusing to eat solid foods. 4. The child is swallowing excessively.

ANS 4 1. The patient is complaining of pain so it is not unusual that there is an elevated heart rate and blood pressure. The nurse should address the pain by giving any PRN pain medications ordered or calling the physician for an order. 2. Most children will complain after a tonsillectomy. This is expected. 3. Oral intake is usually limited to Popsicles, ice chips, and cold liquids following a tonsillectomy. The child is in pain and should not be expected to be eating solid foods 8 hours after surgery. 4. Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emergency, and the physician should be contacted immediately. The child is likely bleeding and will need to return to surgery. TEST-TAKING HINT: Answer 1 can be eliminated if the test taker understands the common vital-sign changes that occur when a person is experiencing pain.

What should be the nurse's first action with a child who has a high fever, dysphagia, drooling, tachycardia, and tachypnea? 1. Immediate IV placement. 2. Immediate respiratory treatment. 3. Thorough physical assessment. 4. Lateral neck radiographs..

ANS 4 1. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. 2. Respiratory treatments often frighten children. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. 3. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. Agitating the child may cause increased airway swelling and may lead to complete obstruction. The child should be allowed to remain on the parent's lap and kept as comfortable as possible until a lateral neck film is obtained. 4. This child is exhibiting signs and symptoms of epiglottitis and should be kept as comfortable as possible. The child should be allowed to remain in the parent's lap until a lateral neck film is obtained for a definitive diagnosis. TEST-TAKING HINT: The test taker must accurately identify that the question is describing a child with epiglottitis and understand that agitation in this child can result in complete airway obstruction.

The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse's best response? 1. "Some children just react differently to viruses. It is best to treat each child as an individual." 2. "Younger children have wider airways that make it easier for bacteria to enter and colonize." 3. "Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections." 4. "Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed."

ANS 4 1. All children should be treated as individuals when they are being treated for a particular illness. However, most children exhibit similar symptoms when they have the same diagnosis. Younger children have worse symptoms than older children because their immune systems are less developed. 2. Children have airways that are shorter and narrower than those of adults. As children age, their airways begin to grow in length and diameter. 3. Children are more prone to ear infections because they have eustachian tubes that are short and wide and lie in a horizontal plane. 4. Younger children have less developed immune systems and usually exhibit worse symptoms than older children. TEST-TAKING HINT: Answer 1 can be eliminated because it does not directly address the mother's question. Answer 2 can be eliminated if the test taker has knowledge of the anatomical structure of a child's airway. Answer 3 can be eliminated because the eustachian tubes have no direct relationship to acquiring croup

A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation? 1. "Children this age rarely get epiglottitis; you should not blame yourself." 2. "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen." 3. "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms." 4. "Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly."

ANS 4 1. Epiglottitis is most common in children from 2 to 5 years of age. The onset is very rapid. Telling parents not to blame themselves is not effective. Parents tend to blame themselves for their child's illnesses even though they are not responsible. 2. The nurse should not tell the parent to seek medical attention for any and all signs of illness. 3. Epiglottitis is rapidly progressive and cannot be predicted. 4. Epiglottitis is rapidly progressive and cannot be predicted. TEST-TAKING HINT: When something happens to a child, the parents always blame themselves. Telling them epiglottitis is rapidly progressive may be helpful.

A child is complaining of throat pain. Which statement by the mother indicates that she needs more education regarding the care and treatment of her daughter's pharyngitis? 1. "I will have my daughter gargle with salt water three times a day." 2. "I will offer my daughter ice chips several times a day." 3. "I will give my daughter Tylenol every 4 to 6 hours as needed." 4. "I will ask the nurse practitioner for some amoxicillin.

ANS 4 1. Gargling with warm salt water is a recommended treatment to relieve some of the discomfort associated with pharyngitis. 2. Encouraging ice chips is a recommended treatment to relieve some of the discomfort associated with pharyngitis. 3. Tylenol is a suggested treatment for relief of discomfort related to pharyngitis 4. Pharyngitis is a self-limiting viral illness that does not require antibiotic therapy. Pharyngitis should be treated with rest and comfort measures, including Tylenol, throat sprays, cold liquids, and Popsicles. TEST-TAKING HINT: Answers 1, 2, and 3 are comfort measures. The question requires that the student have knowledge regarding pharyngitis.

A child with severe cerebral palsy is admitted to the hospital with aspiration pneumo- nia. What is the most beneficial educational information that the nurse can provide to the parents? 1. The signs and symptoms of aspiration pneumonia. 2. The treatment plan for aspiration pneumonia. 3. The risks associated with recurrent aspiration pneumonia. 4. The prevention of aspiration pneumonia.

ANS 4 1. The nurse should teach the parents about the signs and symptoms of aspiration pneumonia, . The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 2. The nurse should instruct the parents on the treatment plan of aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 3. The nurse should instruct the parents on the risks associated with recurrent aspiration pneumonia, but that is not the most beneficial piece of information the nurse can provide. The most valuable information relates to preventing aspiration pneumonia from occurring in the future. 4. The most valuable information the nurse can give the parents is how to prevent aspiration pneumonia from occurring in the future. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 3 because they are all forms of tertiary prevention. Primary prevention is key to maximizing this child's function.

Which would the nurse explain to parents about the inheritance of cystic fibrosis? 1. CF is an autosomal-dominant trait passed on from the child's mother. 2. CF is an autosomal-dominant trait passed on from the child's father. 3. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF. 4. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF.

ANS 4 4. If the child is born to a parent with CF and the other parent is a carrier, the child has a 50% chance of acquiring the disease and a 50% chance of being a carrier of the disease. TEST-TAKING HINT: Answers 1 and 2 can be eliminated with knowledge of the genetic inheritance of CF. CF is inherited as an autosomal-recessive trait.

Which physical findings would be of most concern in an infant with respiratory distress? 1. Tachypnea. 2. Mild retractions. 3. Wheezing. 4. Grunting.

ANS 4 1. Tachypnea, an increase in respiratory rate, should be monitored but is a common symptom of respiratory distress. 2. Retractions should be monitored; they can occur with respiratory distress. 3. Wheezing should be monitored, and can occur with respiratory distress. 4. Grunting is a sign of impending respiratory failure and is a very concerning physical finding. TEST-TAKING HINT: The test taker can eliminate answers 1, 2, and 3 by knowing the signs of respiratory distress. They warrant frequent respiratory assessment, but they are not the most concerning physical signs.