Pediatrics Respiratory
An important nursing measure for a 6-month old infant with bronchiolitis is: A. Promoting stimulating activities that meet the infant's developmental needs B. Making regular assessments of the infant's skin color, anterior fontanel, and vital signs C. Discouraging visits from the parents during the acute phase to conserve the infant's energy D. Maintaining airborne precautions including wearing a gown, cap, mask, and gloves when giving care to the infant.
B. these assessments are vital to determine the infant's hydration status.
The mother of a 3-year old calls the nurse into the room because she says that her son is choking. What intervention should be the nurse's highest priority? A. Opening the child's mouth and sweeping for foreign materials B. Giving five back blows with the child face down over the nurse's arm C. Assessing whether the child can make vocal sounds D. Performing up to five subdiaphragmatic abdominal thrusts with the child in a supine position
C. Managing a foreign-body airway obstruction begins with assessment, including whether the child is coughing and can make vocal sounds. Finger sweeps should be avoided because they may push the foreign object back into the airway, causing obstructions. Back blows are used on an infant age 1 and younger. If the child can't speak or cough, abdominal thrusts are used.
A 5 year old child is brought into the emergency department with drooling, strident cough, and lethargy. Epiglottitis is suspected. The priority intervention for this child is to: A. Take vital signs B. Secure the child's airway C. Visualize the child's throat with a tongue depressor D. Obtain throat cultures
B. The priority in treating epiglottitis is achieving a patent airway as quickly as possible.
A nurse is caring for a 17-year-old female with cystic fibrosis who has been admitted to the hospital to receive I.V. antibiotic and respiratory treatment for exacerbation of a lung infection. The adolescent has a number of questions about her future and the consequences of the disease. Which statements about the course of cystic fibrosis are true? Select all that apply. A. Breast development is commonly delayed B. The adolescent is at risk for developing diabetes C. Pregnancy and child-bearing aren't affected D. Normal sexual relationships can be expected E. Only males carry the gene for the disease. F. By age 20, the frequency of respiratory treatment should be possible to decrease
A,B,D Cystic fibrosis delays growth and the onset of puberty. Children with cystic fibrosis tend to be smaller that average size and develop secondary sex characteristics later in life. In addition, children with CF are at risk for developing diabetes mellitus because the pancreatic duct becomes obstructed as pancreatic tissues are destroyed. People with CF can expect to have normal sexual relationships, but fertility becomes difficult because thick secretions obstruct the cervix and block sperm entry. Males and females carry the gene for cystic fibrosis. Pulmonary disease commonly progresses as the child ages, requiring additional respiratory treatment - not less.
An 8-month old is admitted is admitted to the pediatric unit with a history of multiple respiratory infections and suspected cystic fibrosis. Which symptom suggests cystic fibrosis? A. Fatty Stools B. Decreased Appetite C. Decreased Respiratory Rate D. Early passage of meconium in the neonatal period
A. Cystic fibrosis causes thick secretions that block pancreatic ducts and prevent essential pancreatic enzymes from reaching the duodenum. This impairs digestion and absorption of nutrients. The lack of available enzymes also causes stools that are greasy, foul smelling, and frothy from undigested fat. Because of respiratory involvement children may have increased respiratory rate. An early sign of cystic fibrosis in infancy is failure to pass meconium.
Factors that increase the risk/frequency of respiratory infections in children include: (choose all that apply) A. Consumption of canned food B. Smaller airway diameter C. Shorter distances between structures of the airway D. Short eustachian tubes E. Repeated exposure to "Baby Mozart"
B,C,D
An 8-year old child with asthma is being assessed by the nurse. An assessment that requires immediate intervention would be: A. A round face B. Audible wheezing C. Regular use of inhalers D. A respiratory rate of 30 per minute
B. Audible wheezing, that is heard without a stethoscope, is an indication that the airways are significantly compromised. This is an expected respiratory rate of an 8 year old child. Individuals who have asthma often receive corticosteroids, which could cause a round face: however, this does not require nursing intervention. The use of inhalant medications is expected.
A 15-month old with croup is admitted to the pediatric unit. The nurse is most concerned that A. An inspiratory stridor is heard B. The mother cannot calm the child C. The toddler has a barking cough D. The toddler is restless while sleeping
B. When a mother can't calm a child with a respiratory problem, assess for increasing hypoxia. Normal symptoms of croup include inspiratory stridor and barking cough. Children are commonly restless in their sleep when ill.
An infant with a history of respiratory tract infection is brought to the emergency department and diagnosed with bronchiolitis and respiratory syncytial virus (RSV) infection. The nurse places the infant in a private room and institutes what type of precautions? A. Droplet precautions B. Standard precautions C. Contact precautions D. Airborne precautions
C. RSV can live on paper for 1 hour and on cribs and other nonporous surfaces for up to 6 hours and is highly communicable. The infant with RSV should be isolated in a single room. Along with standard precautions, the infant should be placed on contact precautions, and gloves and a gown should be worn when entering the room if clothing will contact the infant., Droplet precautions (wearing a amask when entering the room) and airborne precautions (private room with negative air pressure, high efficiency filtration, and shuyt door; visitors required to wear a HEPA-filter mask) aren't necessary.
A 7 year old undergoes tonsillectomy for recurrent tonsillitis. Twenty-four hours after surgery, the child vomits material that resembles coffee grounds. What action by the nurse is most appropriate? A. Notify the physician immediately. B. Maintain nothing-by-mouth status for the next 24 hours C. Maintain nothing-by-mouth status for the next 30 minutes and then resume clear liquids. D. Place the child in a supine position.
C. Vomiting old blood (coffee-ground emesis) is common after tonsillectomy. If vomiting occurs, the nurse should maintain nothing by mouth status for the next 30 minutes and then resume clear liquids. The nurse should assess the child for signs of bleeding (frequent swallowing, restlessness, vomiting bright red blood, and fast thready pulse). If bleeding occurs, turn the child to the side and notify the physician immediately. The child should be placed in a prone or side-lying position to prevent aspiration.
A child experiencing an acute asthma attack presents to the emergency department. Which of the following medications should a nurse prepare to administer to the childe as an intervention for an acute asthma attack? A. Terbutaline (Brethine) B. Beclomethasone dipropionate (QVAR) C. Prednisone (Deltasone) D. Albuterol (Proventil)
D. Albuterol (Proventil) is a beta 2 adrenergic agonist that results in bronchodilation. It's used in acute episodes of asthma. Terbutaline (brethine) is an oral, long-acting medication used for long-term control of asthma. Beclomethasone diproppionate (QVAR) is an inhaled glucocorticdoid used to prevent infllammation, suppress airway mucus production, and promote responsiveness of beta 2 receptors in the bronchial tree. Prednizone (Deltasone) is an oral medication used for 3 to 10 days following an acute asthma attack.
A child who has just returned to the unit after surgery is drowsy and not alert to commands. To maintain an airway the nurse should: A. Have a tongue blade available B. Keep the child in a supine position C. Use nasotracheal suction as needed D. Place the child in a lateral Sims' position
D. The lateral Sims' position will allow emesis or other obstructive fluid to drain from the mouth an prevent aspiration. The supiine position predisposes to aspiration of blood, mucus, or vomitus. Nasotracheal suction might be used in the postanesthesia care unit; when the child is ready to return to the pediatric unit; it should not be needed
A child who had been admitted for status asthmaticus appears to be improving. The most objective way for the nurse to evaluate the child's response to therapy is to: A. Auscultate the child's breath sounds B. Monitor the child's respiratory pattern C. Assess the child's lips for a decrease in cyanosis D. Evaluate the child's current peak expiratory flow rate.
D. The peak expiratory flow meter is an objective tool that measures the maximum flow of air that can be forcefully exhaled in 1 second. The tool individualizes data for the child because after a personal best value has been established it can be compared with current values to determine the present respiratory status.
A child with cystic fibrosis has early signs of an upper respiratory tract infection, including a cough and runny nose. The nurse should teach the child's mother to: A. Make sure the child eats a good diet B. Take the child's temperature twice a day C. Offer the child lots of orange juice to drink D. Increase chest physiotherapy to four times per day
D. With CF, a simple URI may develop into pneumonia if the thick secretions aren't loosened and removed by percussion and postural drainage. Making sure the child has an adequate diet, taking the child's temperature, and giving he child orange juice are important but not as vital as percussion and postural drainage.
