Pediatric Success (Asthma, Bronchiolitis, CF)

2. The ABG gives the health-care team valuable information about the child's respiratory status: level of oxygenation, carbon dioxide, and blood pH.

16. A pediatric client is admitted to the ER with an acute asthma exacerbation. The nurse tells the parents that blood will have to be drawn for some diagnostic laboratory studies. Which laboratory result will provide the health-care team with the most important information regarding the child's respiratory status? 1. A CBC. 2. An ABG. 3. A BUN. 4. A PTT.

4. The nurse needs to know what med ication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.

17. A pediatric client is admitted in status asthmaticus. The parent reports that the child is currently taking Singulair, albuterol, and Flovent. What is the most important piece of information that the nurse must ask the parent in order to best treat the patient? 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?"

2. When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging.

18. A 2-year-old is diagnosed with asthma. The parents are big sports fans and want their child to play sports. The parents ask the nurse what impact asthma will have on the child's future in sports. Which is the nurse's best response? 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."

19. 1. The parent should always give one puff at a time and should wait 1 minute be fore administering the second puff.

19. The parent of a pediatric client with asthma is talking to the nurse about administering the child's albuterol inhaler. Which statement by the parent leads the nurse to believe that the parent needs further education 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."

52. 1. The child is exhibiting signs and symp toms of croup and is not in any significant 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 chil dren who have recurrent tonsillitis.

52. 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 of the following nursing interventions 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.

3. 1. CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting.

3. The parent of a 4-month-old with CF asks the nurse what time to begin the child's first CPT each day. Which is the nurse's best response? 1. "You should do the first CPT 30 minutes before feeding the child breakfast." 2. "You should do the first CPT after deep-suctioning the child each morning." 3. "You should do the first CPT 30 minutes after feeding the child breakfast." 4. "You should do the first CPT only when the child has congestion or coughing."

62. 60 mEq/L. The definitive diagnosis of CF is made when a patient has a sweat chloride test with a chloride level >60 mEq/L. A normal chloride level is <40 mEq/L.

62. A sweat chloride test is used to diagnose CF. A chloride level greater than _____________________ is a positive diagnostic indicator of CF.

2. If the patient were not taking her en zymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. CF patients must take digestive enzymes with all meals and snacks. Pancreatic ducts become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes to aid in absorption of nutri ents. Often, teens are noncompliant with their medication regimen because they want to be like their peers.

1. The nurse caring for a female pediatric client with CF sends a stool for analysis. The results show an excessive amount of azotorrhea and steatorrhea. What does the nurse realize about the laboratory values? 1. They reflect that the patient is not compliant with taking her vitamins. 2. They reflect that the patient is not compliant with taking her enzymes. 3. They reflect that the patient is eating too many foods high in fat. 4. They reflect that the patient is eating too many foods high in fiber.

4. If the child is born to a mother with CF and a father who is a carrier, the child has a 50% chance of acquiring the dis ease and a 50% chance of being a carrier of the disease.

2. Which of the following statements about the inheritance of CF is most accurate? 1. CF is an autosomal-dominant trait that is passed on from the child's mother. 2. CF is an autosomal-dominant trait that is 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.

3. Albuterol is the quick-relief bron chodilator of choice for treating an asthma attack.

20. A 7-year-old female with asthma is playing a soccer game in gym class. During the game the child begins to cough, wheeze, and have difficulty catching her breath. The school nurse is called to the soccer field. Which of the following should the nurse administer to provide quick relief? 1. Prednisone. 2. Singulair. 3. Albuterol. 4. Flovent.

3. 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.

21. There are several children in the ER waiting area who all have asthma. The nurse has only one room left in the ER. Based on the following information, which child should be seen first? 1. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. 2. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. 3. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.

3. Blowing a pinwheel is an excellent means of increasing a child's expira tory 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.

22. A 3-year-old female is admitted to the hospital with asthma. The nurse is trying to work with the child on breathing exercises to increase her expiratory phase. What should the nurse have the child do? 1. Use an incentive spirometer. 2. Breathe into a paper bag. 3. Blow a pinwheel. 4. Take several deep breaths.

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.

23. The parents of a 6-year-old who has a new diagnosis of asthma asks the nurse what to do to make their home a more allergy-free environment for the child. 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."

2. Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants.

25. A 2-month-old is seen in the pediatrician's office for his 2-month well-child checkup. The nurse is assessing the patient and reports to the physician that the child is exhibiting early signs of respiratory distress. Which of the following would indicate an early sign of distress? 1. The infant is breathing shallowly. 2. The infant has tachypnea. 3. The infant has tachycardia. 4. The infant has bradycardia.

27. 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 de crease 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 en sure they receive flu shots. Children of this age are often frightened of shots and would not likely pass that information on to their parents.

27. The school nurse is planning to educate kindergarten children on how to stop the spread of influenza in the classroom. Which of the following should the nurse instruct the children? 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.

28. *1. 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.* 2. 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 so developed, so they are at a higher risk for influenza-related hospitalizations.* 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 should not be given to anyone who is immunocompromised.

28. Which of the following is the highest priority for receiving the flu vaccine? 1. An 18-year-old who is living in a college dormitory. 2. A healthy 8-month-old who attends day care. 3. A 7-year-old who attends public school. 4. A 3-year-old who is undergoing chemotherapy.

29. *1. Influenza is most contagious 24 hours before and 24 hours after onset of symptoms.* 2. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms. 3. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms. 4. Influenza is most contagious 24 hours be fore and 24 hours after onset of symptoms.

29. The parent of a pediatric client with influenza is concerned about when the child will be able to return to school. The parent asks the nurse when the child is most infectious. Which is the nurse's best response? 1. "24 hours before and after the onset of symptoms." 2. "1 week after the onset of symptoms." 3. "1 week before the onset of symptoms." 4. "24 hours after the onset of symptoms."

30. 1. The child is receiving intravenous fluids, so he is being hydrated. However, this re sponse 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 an adult.* 3. Eating burns calories, but if the baby is upset and crying he is also expending en ergy. 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 bulb suction an infant with nasal congestion before feeding.

30. A 6-week-old male 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 taking nothing 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." 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 dis tress will likely increase."

38. 1. RSV is not diagnosed by a blood draw. 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.

38. A 2-year-old is admitted to the hospital in respiratory distress. The physician tells the parents that the child probably has RSV. The parents ask the nurse how they will determine if their child has RSV. Which is the nurse's best response? 1. "We will need to 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 those secretions for testing." 4. "We will have to send a viral culture to an outside lab for testing."

39. *1. Synagis will not help the child who has already contracted the illness. Synagisis 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

39. An 8-month-old male twin is in the hospital with RSV. The nurse educated the parent on how to prevent the healthy twin at home from contracting RSV. Which statement indicates the parent needs further teaching? 1. "I should make sure that both my children receive Synagis injections for the remainder of this year." 2. "I should be sure to keep my infected son away from his brother until he has recovered." 3. "I should insist that all people who come in contact with my twins thoroughly wash their hands before playing with them." 4. "I should insist that anyone with a respiratory illness avoid contact with my children until the children are well."

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 added medium-chain triglycerides.

4. The parent of a 10-month-old with 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 each day." 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 each day."

40. 1. Most children with RSV can be managed at home. Children 2 years and younger are at highest risk for developing complica tions related to RSV. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitalization. The 3-year-old with a congenital heart disease is not the highest risk among this group of patients. *2. The younger the child, the greater the risk for developing complications related to RSV. The age and the premature status of this child make the thepatient the highest risk.* 3. Children who were premature, have cardiac conditions, or have chronic lung disease are also at a higher risk for needing hospitaliza tion. This child was a former premature in fant but is now 4 years of age. 4. This child has a tracheostomy, but this is not an indication that the child cannot be managed at home.

40. Which of the following patients is at highest risk for requiring hospitalization as a result of RSV? 1. A 3-year-old with a congenital heart defect. 2. A 2-month-old who is a former 32-week preemie. 3. A 4-year-old who is a former 30-week preemie. 4. A sixteen-month-old with a tracheostomy.

41. 1. Tachypnea, an increase in respiratory rate, should be monitored but is a common symptom of RAD. 2. Retractions should be monitored, but they are a common symptom of respiratory distress and RAD. 3. Wheezing should be monitored but is a common symptom of RAD. *4. Grunting is a sign of impending respiratory failure and is a very concerning physical finding.*

41. A 6-month-old is admitted to the hospital with RAD. The nurse is assessing the child. Which of the following physical findings should be of most concern? 1. The baby has tachypnea. 2. The baby has mild retractions. 3. The baby is wheezing. 4. The baby is grunting.

42. 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.

42. A 6-year-old presents to the ER with respiratory distress and stridor. The child is diagnosed with RSV. The parent asks the child's nurse how the child will be treated. Which is the nurse's best response? 1. "We will treat your child with intravenous antibiotics." 2. "We will treat your child with intravenous steroids." 3. "We will treat your child with nebulized racemic epinephrine." 4. "We will treat your child with alternating doses of Tylenol and Motrin."

3. CF patients with constipation commonly receive a stool softener or an osmotic so lution orally to relieve their constipation.

7. A female child with CF is hospitalized with constipation. The parent asks the nurse what will need to be done to relieve the child's constipation. 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 to relieve her constipation." 3. "Your child will likely be given GoLYTELY to relieve her constipation." 4. "Your child will be placed on a clear liquid diet to relieve her constipation."

43. *1. The night air will help decrease sub glottic edema, easing the child's respi ratory 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 liquids or a popsicle are the best choice.

43. The parent of a pediatric client calls the ER. The parent reports that the child has had a barky cough for the last 3 days and it always gets worse at night. The parent asks the nurse what to do. Which is the nurse's best response? 1. "Take your child outside in the night air for 15 minutes." 2. "Bring your child to the ER immediately." 3. "Give your child an over-the-counter cough suppressant." 4. "Give your child warm liquids to soothe the throat."

46. 1. Retractions, low-grade fever, and nasal congestion are common symptoms of a respiratory illness and are not overly concerning. *2. When children are sitting in the tripod position, that is an indication they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds indicate that there is fluid in* the lungs and 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 common signs and symptoms of a respiratory illness

46. A 15-month-old is brought to the ER. The parents tell the nurse that the child has not been eating well and has had an increased respiratory rate. Which of the following assessments is of greatest concern? 1. The patient is lying down and has moderate retractions, low-grade fever, and nasal congestion. 2. The patient is in the tripod position and has diminished breath sounds and a muffled cough. 3. The patient is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The patient is restless, crying, has bilateral wheezes and poor feeding.

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 infec tions because of the immunosuppressive therapy.

5. The parent of an 18-year-old with 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 already been caused by CF. 4. The transplant will be the child's only chance at surviving long enough to graduate college.

4. Wheezing respirations and a dry non productive cough are common early symptoms in CF.

6. A 2-year-old has just been diagnosed with 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." 50

58. 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 physi cian 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 pneumo nia. Aspiration pneumonia may take several days or a week to develop following aspiration.

58. 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. What diagnostic evaluation will be used to determine if the child has aspirated the carrot? 1. A chest x-ray will be taken. 2. A bronchoscopy will be performed. 3. A blood gas will be drawn. 4. A sputum culture will be done.

59. 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 should be performed only on adults. *4. The current recommendation for in fants younger than 1 year is to admin ister five back blows followed by five chest thrusts.*

59. The parent of a 9-month-old calls the ER because his child is choking on a marble. The parent tells the nurse that he knows cardiopulmonary resuscitation. The parent asks how to help his child while waiting for 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 daughter's mouth." 3. "You should perform the Heimlich maneuver." 4. "You should administer five back blows followed by five chest thrusts."

60. 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.

60. The community health nurse is teaching a child-safety class to parents of toddlers. Which information will be most helpful in teaching the parents about the primary prevention of foreign body aspiration? 1. Knowledge of the signs and symptoms of foreign body aspiration. 2. Knowledge of the therapeutic management of foreign body aspiration patients. 3. Knowledge of the most common objects that toddlers aspirate. 4. Knowledge of the risks associated with foreign body aspiration.

61. 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.*

61. What does the therapeutic management of 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.

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.

8. The parents of a 5-week-old have just been told that their child has 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 several questions about CF and the current projected life expectancy. What is the nurse's best initial intervention? 1. The nurse should tell the parents that the life expectancy for CF patients has improved significantly in recent years. 2. The nurse should tell the parents that their child might not follow the same course that the mother's sister did. 3. The nurse should listen to the parents and tell them that the physician will come to speak to them about treatment options. 4. The nurse should listen to the parents and be available to them anytime during the day to answer their questions.

3. Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gen tle suctioning with a bulb syringe are often recommended.

9. A 7-month-old is taken to the pediatrician's office with a low-grade fever, nasal congestion, and a mild cough. Which 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.