PEDs EAQ Chapter 26

Which clinical manifestation is appropriate when evaluating for a foreign body aspiration? a. Cough and hoarseness b. Wheezing and paroxysmal cough c. Asymmetric breath sounds d. Inability to speak or breathe

ANS: A Rationale Initially, a foreign body in the air passages produces choking, gagging, wheezing, or coughing. Laryngotracheal obstruction most commonly causes dyspnea, cough, stridor, and hoarseness because of decreased air entry. Bronchial obstruction usually produces paroxysmal cough, wheezing, asymmetric breath sounds, decreased airway entry, and dyspnea. When an object is lodged in the larynx, the child is unable to speak or breathe. Cyanosis may occur if the obstruction becomes worse.

Which manifestation is appropriate to identify severe persistent asthma? a. The child has a peak expiratory flow less than 60%. b. The child uses short-acting -agonist more than 2 days a week. c. The child has fewer than or equal to two nighttime symptoms per month. d. The child has symptoms fewer than or equal to 2 days a week.

ANS: A Rationale The child with severe persistent asthma has a peak expiratory flow (PEF) less than 60%. The child has frequent nighttime symptoms, often more than once a week. The child uses a short-acting -agonist several times a week and has continual symptoms throughout the day. The child with mild persistent asthma uses a short- acting -agonist more than 2 days a week. The child with intermittent asthma has nighttime symptoms or awakenings fewer than or equal to 2 nights per month. Daytime symptoms are usually fewer than or equal to 2 days a week.

Which recommendation is appropriate for a 20-month-old with a barking cough at night, a temperature of 37°C (98.6°F), and no difficulty breathing? a. Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing b. Bringing the child to the hospital to be admitted and to be observed for impending epiglottitis c. Trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement d. Controlling the fever with acetaminophen (Tylenol) and calling the primary care provider if the cough gets worse tonight

ANS: A Rationale Because the child is not experiencing difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will help open up the child's airways. The child does not have a temperature and therefore does not require management with acetaminophen. Cough suppressants are not indicated by the symptoms, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.

Which nursing intervention is appropriate for a child after tonsillectomy? a. Watching for continuous swallowing b. Applying warm compresses to the throat c. Encouraging gargling to reduce discomfort d. Positioning the child on the back for sleeping

ANS: A Rationale Frequent swallowing is the most obvious early sign of bleeding from the surgical site in a child who has undergone tonsillectomy. Gargling would be avoided after a tonsillectomy because of the potential for trauma to the suture line. The child would be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, easing the pain. Heat or warmth would increase the risk of bleeding.

Which method is appropriate when determining if a nonhospitalized child with respiratory infection is dehydrated? a. Insufficient voiding b. Insufficient fluid intake c. Complaint of dry mouth d. Decreased level of energy

ANS: A Rationale In a child who is not acutely ill and not hospitalized, a count of the number of voids in a 24-hour period is done to assess the level of hydration. The child may have a sore throat; therefore, the child has a decreased urge to drink fluids. Fever increases the total body fluid turnover and generally causes dry mouth. Often a child suffering from respiratory tract infection has a complaint of lack of energy.

Which medical device is appropriate for a 4-year-old boy who cannot coordinate his breathing to effectively use a metered-dose inhaler for asthma? a. Spacer b. Nebulizer c. Peak expiratory flow meter d. Trial of chest physiotherapy

ANS: A Rationale The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a device for administering medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters are used to measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration.

Which time is appropriate when performing bronchial postural drainage? a. Before meals and at bedtime b. Immediately on arising and at bedtime c. Immediately before all aerosol therapy d. Thirty minutes after meals and at bedtime

ANS: A Rationale The most effective time for bronchial drainage is before meals and before bedtime to prevent the interaction of excessive amounts of mucus and food, which increases the risk of vomiting. Bronchial drainage is more effective after other respiratory therapies such as bronchodilator or nebulizer treatments. These treatments open the airways thereby facilitating the movement of mucus with the positioning of bronchial drainage. Bronchial drainage should be performed three or four times each day to be effective. When bronchial drainage is completed after meals, it may cause the child to vomit.

Which action is appropriate when understanding the peak expiratory flow rate test? a. Assess the severity of asthma b. Determine the cause of asthma c. Identify the triggers of asthma d. Confirm the diagnosis of asthma

ANS: A Rationale The peak expiratory flow rate (PEFR) test is a measure of the maximal amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.

Which method is appropriate for the nurse to continue care management for a child that is hospitalized with cystic fibrosis and often refuses nursing interventions? a. Develop a daily schedule of events with the child. b. Perform the interventions even if the child resists. c. Avoid waking up the child to perform any activities. d. Use a little force to make the child allow the activities.

ANS: A Rationale There are several therapies, tests, and medication regimens to be followed in a child with cystic fibrosis. If the child resists some interventions, the nurse would develop a daily schedule of events with the child. This gives the child some control. The exclusion of any intervention from the daily regimen can worsen the child's condition; therefore, the nurse should develop a way to do all the required activities even though the child resists. However, as much as possible, the interventions should be performed with the child's consent and cooperation. The activities would be performed on time. Therefore, if it is required, the child would be awakened to perform the activity. The nurse would have a frank discussion with the child. The child would not be forced to cooperate, or the child may become more resistant to any interventions being performed.

The nurse understands that guidelines for administering the tuberculin skin test (TST) include: a. Periodic administration for children who are at high risk b. Annual administration for all children older than 2 years c. Annual administration for all children older than 10 years d. Annual administration for all children starting at age 1 year

ANS: A Rationale Children who are at high risk for contacting tuberculosis are tested periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents, no matter the age of the child.

Which complication is appropriate for prolonged middle ear disorders? a. Loss of hearing b. Failure to thrive c. Visual impairment d: Tympanic membrane rupture

ANS: A Rationale Loss of hearing is the principal functional consequence of prolonged middle ear infection. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech is of greater concern.

Which clinical manifestations are appropriate for acute epiglottitis? Select all that apply. a. Pain b. Fever c. Drooling d. Tripod position e. Hepatosplenomegaly

ANS: A, B, C, D Rationale Clinical manifestations of acute epiglottitis include fever, tripod position, drooling, pain, irritability, restlessness, anxiousness, apprehensiveness, frightened expression, suprasternal and substernal retractions, froglike-croaking sound, slow quiet breathing, red throat, and an edematous epiglottis. Hepatosplenomegaly is not a common clinical manifestation of acute epiglottitis.

Which findings are appropriate to assess before discharge for the child with chronic respiratory illness that is being transferred to home care? Select all that apply. a. The child's medical, nursing, and other therapeutic needs b. Family members' coping skills and adjustment needs c. Family's access to respite care and emergency plans d. Access to emergency care and transport plans e. The child's ability to perform self-care

ANS: A, B, C, D Rationale Predischarge assessment includes identifying the child's medical, nursing, and other therapeutic needs so that there is no confusion in case of an emergency. The nurse also assesses the family's coping skills to ensure that the family adjusts to the stressors effectively. The nurse ensures that the family has access to respite care and emergency plans so that there is no risk to the child. The nurse also ensures that the family has access to emergency care and the transportation for it so that any emergency can be promptly addressed. Assessing the child's ability to perform self-care is not a requirement of predischarge assessment, because it can be taught while providing care.

Which nursing responsibilities are appropriate for the child in a home care setting? Select all that apply. a. Monitoring the child's medical condition b. Identifying and accessing resources c. Managing chronic sorrow d. Recognizing stressors e. Teaching technology to the family

ANS: A, B, C, D Rationale The nurse would monitor the child's medical condition by assessing the child's condition and identifying the potential risks to the child. The nurse identifies and accesses resources such as emergency services and transportation services to meet the child's needs. The nurse also manages chronic sorrow by identifying proper coping strategies. The nurse recognizes stressors so that they do not hinder care. The family members may not be literate enough to use technology such as the Internet or email for communication; therefore, the nurse provides care instructions in a way that is understood by the family.

Which clinical manifestations are appropriate in the young child with nasopharyngitis from pharyngitis? Select all that apply. a. Breathes through the mouth b. Vomiting and diarrhea c. Mild to moderate hyperemia d. Vasodilation of the mucosa e. Moderate sore throat

ANS: A, B, D Rationale The child with nasopharyngitis experiences discomfort related to nasal obstruction. The child has abundant nasal mucus and breathes through the mouth. The child may be vomiting and have diarrhea along with poor feeding and decreased fluid intake. Physical assessment also reveals edema and vasodilation of the mucosa. The child with pharyngitis has mild to moderate hyperemia with a moderate sore throat.

Which nursing interventions are appropriate when preventing ventilator-associated pneumonia in children? Select all that apply. a. Evaluating the patient daily for extubation b. Draining condensate from the ventilator circuit every 8 hours c. Draining the ventilator circuit before repositioning the patient d. Hand hygiene before and after contact with the ventilator circuit e. Changing the ventilator circuits and in-line suction catheters every 24 hours to prevent infection

ANS: A, C, D Rationale Nursing interventions to prevent ventilator-associated pneumonia in children include evaluating the patient daily for extubation, draining the ventilator circuit before repositioning the patient, and performing hand hygiene before and after contact with the ventilator circuit. Condensate needs to be drained from ventilator circuits more frequently than every 8 hours. Ventilator circuits and in-line suction catheters only need to be changed when soiled, not every 24 hours.

Which nurse teaching information is appropriate for the parents of a school-age child with nasal blockage about the use of vasoconstrictive nose drops? Select all that apply. a. Administer the drops 15 to 20 minutes before feeding. b. Instill two drops followed by two more drops after an hour. c. Avoid using the same bottle for more than one illness. d. Avoid using the same bottle for more than one child. e. Instill nose drops for no more than 5 consecutive days.

ANS: A, C, D Rationale The child is able to eat and sleep comfortably when the nasal passage is clear. Therefore, nose drops are administered 15 to 20 minutes before feeding and at bedtime. Nose drops are easily contaminated with bacteria and viruses; therefore, they must not be used for more than one illness or more than one child. Initially, two drops are instilled in each nostril, and, because this shrinks only the anterior mucous membranes, two more drops are instilled 5 to 10 minutes later. Nose drops should not be administered for more than 3 days to prevent rebound congestion.

Which triggers tend to precipitate or aggravate asthma in children? Select all that apply. a. Exercise b. Breast milk c. Tobacco smoke d. Thyroid disease e. A candle-free home

ANS: A, C, D Rationale Triggers that precipitate or aggravate asthma in children include exercise, tobacco smoke, and thyroid disease. A candle-free home and breast milk do not trigger or aggravate asthma symptoms in children; rather, they decrease the likelihood of an asthma exacerbation.

Which clinical features are used to determine the four asthma categories? Select all that apply. a. Lung function b. Associated allergies c. Frequency of symptoms d. Frequency and severity of exacerbations e. Degree of interference with normal activities

ANS: A, C, D, E Rationale Peak expiratory flow rate, frequency of symptoms, frequency and severity of exacerbations, and degree of interference with normal activities are all used to categorize asthma. Allergies are not among the clinical features used to distinguish the categories of asthma.

Which nursing intervention is appropriate when a 5-year-old child is brought to the emergency department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward with acute epiglottitis suspected? Select all that apply. a. Vital signs b. Throat culture c. Medical history d. Assessment of breath sounds e. Ready availability of emergency airway equipment

ANS: A, C, D, E Rationale Vital signs should always be taken as a part of the assessment. Medical history is important because it aids diagnosis and allows the medical team to know the child's immunization status. Assessment of breath sounds is important because it aids diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when epiglottis is suspected. Manipulation of the throat could stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that could occlude the airway.

Which clinical manifestations are appropriate in the child with asthma? Select all that apply. a. Barrel chest b. Sandpaper rash c. Elevated shoulders d. Edematous tongue e. Increased use of accessory muscles

ANS: A, C, E Rationale The child with asthma has a barrel chest, with an increase in the anteroposterior diameter of the chest due to infiltration and hyperexpansion of the airways. The child develops elevated shoulders and increased use of accessory muscles. The child with scarlet fever may develop a fine, sandpaper rash on the trunk, axillae, elbows, and groin. This child may also have edematous and red tongue due to streptococcal infection.

Which clinical manifestations are appropriate to identify in a child that indicates the need for an adenoidectomy? Select all that apply. a. Chronic otitis media with effusion b. Recurrent tonsil infections c. Persistent foul taste or breath d. Recurrent sinusitis e. Sleep-disordered breathing

ANS: A, D, E Rationale Adenoidectomy is recommended for children who have chronic otitis media (OM) with effusion, recurrent sinusitis, hypertrophied adenoids that obstruct nasal breathing, and airway obstruction and subsequent sleep-disordered breathing. Additional indications for adenoidectomy include current adenoiditis and sinusitis, persistent mouthbreathing, and nasal speech. Some of the indications for a tonsillectomy include three or more tonsil infections per year and persistent foul taste or breath caused by chronic tonsillitis.

Which clinical manifestations are appropriate signs of acute epiglottitis in a croup syndrome? Select all that apply. a. Drooling b. Low-grade fever c. Brassy cough d. Stridor when supine e. Toxic appearance

ANS: A, D, E Rationale Croup syndromes can affect the larynx, trachea, and bronchi. Drooling, the presence of stridor when supine, and toxic appearances are major manifestations that are predictive of epiglottitis. Drooling of saliva is common because of the difficulty or pain in swallowing and excessive secretions. The child has high fever, appears sicker than clinical findings suggest, and insists on sitting upright and leaning forward with the chin thrust out, mouth open, and tongue protruding. Low-grade fever and brassy cough are signs of acute laryngotracheobronchitis.

How are the symptoms of acute otitis media (AM) different from that of otitis media with effusion (OME)? a. Hearing impairment is common in AOM. b. Symptoms of acute infection are common in AOM. c. The tympanic member looks orange colored in AOM. d. Rhinitis, cough, or diarrhea are often present with AOM.

ANS: B Rationale AOM is an inflammation of the middle ear space. AOM is accompanied by symptoms of acute infection like fever, otalgia, and so forth. Hearing impairment can happen in both AOM and otitis media with effusion (OME). In OME, the tympanic membrane is immobile or orange colored. Nonspecific symptoms like rhinitis, cough, or diarrhea are often present in OME.

Which category of medication is the first-line therapy for inflammation in children with asthma? a. Theophylline b. Corticosteroids c. Anticholinergics d. Cromolyn sodium

ANS: B Rationale Corticosteroids are the first-line therapy for inflammation in children with asthma. Theophylline is used primarily in the emergency department when the child is not responding to other therapies. Anticholinergics relieve bronchospasm. Cromolyn sodium stabilizes mast cell membranes

Which reason is appropriate for the nurse to discourage the parent from giving the child an over-the-counter cough suppressant to a 5-year-old child who has fever, nasal discharge, and productive cough? a. Cough suppressant can cause addiction. b. Cough is a protective way of clearing secretions. c. Cough suppressants have doubtful effectiveness. d. Cough medicines can lead to confusion, nausea, and sedation.

ANS: B Rationale Cough is a natural mechanism to clear secretions from the body. The nurse would do chest physiotherapy and encourage the patient to cough in order to remove secretions. Cough suppressants may be prescribed for a dry, hacking cough rather than a productive cough. An over-the-counter cough suppressant used when not needed may result in addiction and may be detrimental to the health. The effectiveness of cough suppressants is doubtful. Some cough suppressants contain up to 22% alcohol and can cause confusion, hyperexcitability, dizziness, nausea, and sedation. Hence, health care providers carefully evaluate the benefits and risks of recommending these medicines to children under 6 years of age.

Which nursing advice is appropriate for the child being treated for infectious mononucleosis to avoid strenuous and contact sports? a. May infect others b. Has splenomegaly c. Needs to have a lot of rest d. Is too weak for these activities

ANS: B Rationale In infectious mononucleosis, for about half the cases, the spleen is enlarged. Splenic hemorrhage or rupture may occur due to trauma during contact sports and strenuous activities. The virus is believed to be transmitted by direct contact with oral secretions, blood transfusion, or transplantation. It is mildly contagious. The child should limit exposure to persons outside the family, especially during the acute phase of illness, to prevent secondary infection. Physical activities are not restricted in mononucleosis; rather, the child should be encouraged to maintain limited activities to prevent deconditioning. The patient may be in considerable pain, but activities can be undertaken as tolerated.

Which classification is appropriate for the child that has symptoms three times a week, once a day and receives a short-acting ß-agonist for symptom control 1 day a week? a. Intermittent b. Mild persistent c. Severe persistent d. Moderate persistent

ANS: B Rationale Symptoms three times a week once a day and use of a short-acting B-agonist for symptom control 1 day a week suggest mild persistent asthma. Intermittent asthma includes symptoms less than 2 days a week and use of a short-acting ß-agonist less than 2 days a week. Moderate persistent asthma includes daily symptoms and use of a short-acting -agonist daily. Severe persistent asthma includes continual symptoms throughout the day and use of short-acting -agonist several times a day.

Which statement by the parents does the nurse associate with cystic fibrosis in the child? a. The infant has diarrhea. b. The infant tastes "salty. c. The infant has loss of appetite. d. The infant has a flat abdomen.

ANS: B Rationale The parents of the infant with cystic fibrosis may report that their infant tastes "salty.! A positive sweat chloride test helps to evaluate the presence of cystic fibrosis in the child. The infant fails to pass stools and may have large, bulky, loose, frothy, and extremely foul-smelling stools. Meconium ileus and meconium ileus equivalent, or total or partial intestinal obstruction, can occur at any age. The child is often constipated as a result of a combination of malabsorption either from inadequate pancreatic enzyme dosage or a failure to take the enzymes, decreased intestinal motility, and abnormally viscous intestinal secretions. Initially the infant has a voracious appetite, which is now reduced. The child has a distended abdomen due to intestinal obstruction.

Which is the first step appropriate for managing the condition of a child who comes to the hospital with pharyngitis and a low-grade fever? a. Administer oral penicillin. b. Perform rapid antigen testing. c. Give an antipyretic like acetaminophen d. Monitor if the symptoms are self-limiting.

ANS: B Rationale Though upper respiratory tract infections are mostly viral, streptococcal infection has more severe clinical manifestations than a viral infection. Rapid antigen testing is done to rule out group A beta-hemolytic streptococcus (GABHS) pharyngitis Infection. If streptococcal sore throat infection is present after a confirmatory throat culture, oral penicillin may be prescribed and administered. If streptococcal infection is not present, then the symptoms are managed by giving an antipyretic to relieve discomfort, and symptoms are monitored, though most viral symptoms are self- limiting. This is done after rapid antigen testing.

Which nursing interventions are appropriate for the child after atonsillectomy and adenoidectomy procedure? Select all that apply. a. Encourage coughing to remove any secretions. b. Administer pain medication at regular intervals. c. Notify the surgeon if there is frequent swallowing. d. Restrict movement by making the child lie down in the bed. e. Notify the surgeon if there is dark brown blood in the emesis.

ANS: B, C Rationale The throat remains sore after surgery. Most children experience moderate pain and need pain medication at regular intervals for the first 24 to 48 hours. If there is fresh bleeding, it will trickle down the throat. This will lead to the child swallowing excessively. This is the most obvious sign of bleeding and the nurse should immediately notify the surgeon. The child would not cough to clear the throat, because it may aggravate the operative site. The child's movement would be restricted, but if the child prefers, the child may be allowed to sit up in the bed. There will be dark brown old blood in the emesis, in the nose, and between the teeth. This is common and there is no need of urgent intervention.

Which clinical manifestations are appropriate in a child with asthma experiencing severe respiratory distress requiring immediate intervention? Select all that apply. a. Prefers to lie down b. Sweating profusely c. Severely agitated d. Pink nail beds e. Prolonged expiration

ANS: B, C, E Rationale The child with severe respiratory distress sweats profusely, is severely agitated, and has prolonged expiration. The child refuses to lie down and sits upright in a hunched-over position. If the agitated child suddenly becomes quiet, the child may have serious hypoxia and requires immediate intervention. The child who prefers to lie down and has pink nail beds does not have any respiratory difficulties.

Which clinical manifestations are commonly seen in both acute spasmodic laryngitis and acute tracheitis? Select all that apply. a. Dyspnea b. Croupy cough c. Purulent discharge d. Sudden onset of symptoms e. Upper respiratory tract infections f. Disappearance of symptoms during the day

ANS: B, E Rationale Croupy cough and upper respiratory tract infections are common in both acute spasmodic laryngitis and acute tracheitis. Dyspnea is common in acute spasmodic laryngitis. Because acute tracheitis may be of either viral or bacterial origin with allergic component, it may be associated with purulent discharge. This is not seen in acute spasmodic laryngitis because it is of viral origin with an allergic component. Acute tracheitis has a moderately progressive onset of symptoms. In acute spasmodic laryngitis, the onset of symptoms occurs suddenly at night; the symptoms often disappear during the day.

Why should ibuprofen be given with food or milk? a. To reduce dehydration b. To suppress the bad taste c. To prevent stomach upset d. To enhance the drug action

ANS: C Rationale Ibuprofen irritates the stomach, so it is always advisable to take the drug with food or milk. Food or milk reduces dehydration. This action is irrespective of the action of the drug. However, when food or milk is given along with the drug, it protects the stomach from irritation. Food or milk is not given to suppress the bad taste, but to avoid side effects of the drug. The drug action does not depend on taking food or milk.

Which method is appropriate to prevent pulmonary infection in a child who was recently diagnosed with pulmonary involvement in cystic fibrosis? a. Nasal lavaging b. Aerobic exercises c. Airway clearance therapy (ACT) d. Therapy with antimicrobial agent

ANS: C Rationale In cystic fibrosis, the mucous secretions remain obstructed and are retained in the lungs. Bacteria thrive in this stagnant mucus. ACT is helpful in removing secretions and prevents infection as a whole. Nasal lavaging is performed to irrigate the nasal cavity. It is limited to the nasal cavity only; it may not prevent pulmonary infections. Aerobic exercises help maintain healthy lung tissue and effective ventilation and can be used as an adjunct to ACT. Antimicrobial agents are used after an infection occurs and help to control disease progression. These agents do not prevent pulmonary infections.

Which step is appropriate when providing nutrition for a child with nasopharyngitis who is not taking any food or fluids? a. Feed food to the child forcefully. b. Wait for the symptoms to subside. c. Encourage the child to take fluids only. d. Provide intravenous hydration instead.

ANS: C Rationale Maintaining hydration is the most essential step. The nurse would encourage the child to take any preferred liquid. The nurse would not force the child to eat solid foods. It may result in nausea and vomiting and cause an aversion to feeding. As opposed to waiting until symptoms subside, the nurse would monitor and try to maintain the hydration level in the body. Airway compromise may occur with tonsillar swelling and the child may require intravenous hydration. However, first oral hydration would be tried by encouraging the child to take enough fluids.

Which is the earliest postnatal manifestation of cystic fibrosis? a. Steatorrhea b. Azotorrhea c. Meconium ileus d. Pancreatic fibrosis

ANS: C Rationale Meconium ileus is the most common earliest postnatal manifestation of cystic fibrosis. Steatorrhea is the term used to describe bulky stools from undigested fat; it is not the earliest postnatal manifestation of cystic fibrosis. Azotorrhea, foul-smelling stools resulting from putrefied protein, is not the earliest postnatal manifestation of cystic fibrosis. In pancreatic fibrosis, thick secretions block the ducts; this condition is not the earliest postnatal manifestation of cystic fibrosis.

Which complication is appropriate in the child with cystic fibrosis? a. Increased insulin production b. Passage of watery stools c. Prolapse of the rectum d. Frequent episodes of diarrhea

ANS: C Rationale Prolapse of the rectum occurs in infancy and childhood and is related to large, bulky stools; malnutrition; and increased abdominal pressure secondary to paroxysmal cough. Clinical manifestations of cystic fibrosis are related to increased viscosity of the mucous gland secretions. Thick secretions block the pancreatic duct and cause severe insulin deficiency. The blockage prevents essential pancreatic enzymes from reaching the duodenum, which causes marked impairment in the digestion and absorption of nutrients. The disturbed function is reflected in bulky stools that are frothy from undigested fat and foul smelling from putrefied protein. Affected children of all ages are subject to intestinal obstruction from impacted feces. Gum- like masses can obstruct the bowel and produce a partial or complete obstruction.

Which fluid is inappropriate when attempting to rehydrate a young child? a. Water b. Infalyte c. Sports drink d. Low-carbohydrate flavored drink

ANS: C Rationale The American Academy of Pediatrics does not recommend sports drinks or energy drinks for rehydration. Water and low-carbohydrate flavored drinks are recommended for older children who need to be rehydrated. Infalyte or Pedialyte is recommended for infants.

Which nursing intervention is appropriate when promoting compliance in an adolescent with superior lymphadenitis (extrapulmonary tuberculosis)? a. Advise to use devices for cueing. b. Recounsel about the importance of the medicines. c. Start the patient on directly observed therapy (DOT). d. Increase the frequency of followup visits and start pill counts.

ANS: C Rationale The best thing for the noncompliant adolescent would be to use the DOT program. The compliance is important because of the rates of relapse, treatment failures, and drug resistance among tuberculosis patients. A health care worker or other responsible individual will be present when the medications are administered to the patient on a regular basis. This ensures better medication compliance. The devices of cueing are helpful in medicine compliance, but because of the severity of tuberculosis, this method is not adequately reliable for a noncompliant patient. The adolescent may be noncompliant even if the nurse stresses the importance of taking medicines on each followup visit. Direct observation is, therefore, a better option. Pill count is not a reliable method because the patient can alter the medicine count.

Which nursing advice is appropriate for the family of a child with a respiratory tract infection that is having bouts of vomiting and refuses oral fluids? a. "Give thick fruit juice to provide high calorie intake b. "Force the child to drink fluids to maintain hydration level." c. "Offer the child's favorite beverages to promote hydration." d. "Give oral fluids at fixed intervals even if the child is sleeping."

ANS: C Rationale The nurse should advise the family to maintain an optimum level of hydration in the child. The child can be offered favorite or preferred beverages. Though the beverage may not have any nutritional content, it will help in the child's hydration. High calorie or thick fruit juices may not be palatable and easy to digest, because the child is vomiting. The child should not be forced to drink fluids. It is likely that the child may develop more aversion to take food or fluids. In addition, forcing fluids may result in vomiting. The child should not be awakened to take fluids because this may have the same result as forcing the child to take fluids.

Which developmental factor increases the risk of infection in infants and young children? a. The reduced exposure of infants to organisms increases their chance of infection. b. The narrowed airways of young children mean that organisms move slowly down the respiratory tract. c. The relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear. d. The diameter of their airways in young children is big and therefore subject to edema of the mucous membranes.

ANS: C Rationale The relatively short and open eustachian tube in young children allows pathogens easy access to the middle ear. The narrowed airways in young children promote quick, not slow, movement of organisms down the respiratory tract. Increased exposure to organisms would increase the chance of infection. The diameter of the airways in young children is not big, but small, and therefore subject to edema of the mucous membranes.

Which symptoms distinguish seasonal allergies from common colds? Select all that apply. a. Allergies are mostly accompanied by fever. b. Severe bouts of sneezing are common in colds. c. Nasal itching is common in case of allergic rhinitis. d. Atopic dermatitis or asthma often accompanies allergic rhinitis. e. Children may display dark circles beneath their eyes with allergies.

ANS: C, D, E Rationale In case of allergic rhinitis, nasal itching is common. The nurse can often distinguish allergies from other types of rhinitis by the presence of nasal itching. Often a child develops atopic dermatitis or asthma with seasonal allergies. There is an obstruction of normal outflow from regional lymphatics and veins, because of which a child displays "allergic shiners" or dark circles beneath the eyes in case of allergies. Allergies are rarely accompanied by fever. Severe bouts of sneezing are common in allergies and not in colds.

Which reason is appropriate when preventing respiratory tract infections in children with asthma? a. Increase sensitivity to allergens b. Lessen effectiveness of medications c. Encourage exercise-induced asthma d. Can trigger an episode or aggravate an asthmatic state

ANS: D Rationale A respiratory tract infection can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection, not the medications, affects the asthma. Exercise-induced asthma is caused by vigorous activity, not respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.

Which therapeutic management treatments are appropriate when caring for a 2-year-old admitted with bacterial tracheitis? a. Oxygen and rehydration b. Diuretics and antibiotics c. Oxygen and mechanical ventilation d. Oxygen therapy, antipyretics, and antibiotics

ANS: D Rationale Bacterial tracheitis is an infection of the mucosa of the upper trachea with features of both croup and epiglottitis. This disease occurs in children younger than 3 years and requires vigorous management with oxygen therapy, antipyretics, and antibiotics. Rehydration is not one of the top priorities for bacterial tracheitis. Diuretics are not used as treatment. Mechanical ventilation may be required in some patients.

Which discharge information is appropriate for the child post tonsillectomy that is being discharged from the hospital to the home setting? a. Ice cream should be avoided. b. Diluted citrus juice can be given. c. A straw can be used to help drink fluids. d. Fluids with a red or brown color should be avoided.

ANS: D Rationale Following tonsillectomy surgery, the child's secretions or vomit may contain fresh or old blood. Fluids with a red or brown color are generally avoided to distinguish any fresh or old blood from a hemorrhage. Ice cream leaves a milk coating in the mouth and throat. It may cause the child to clear the throat, which may irritate the operative site and cause bleeding. It can be given once clear fluids are retained by the child. Sour food is not well tolerated at this time, so citrus fruit juice should be avoided. A straw may hurt the operative site and it should not be used postoperatively.

Which clinical manifestation is appropriate when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? a. Wheezing b. Barrel chest c. Thermal instability d. Nasal flaring and retractions

ANS: D Rationale Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.

Which route is appropriate for penicillin G procaine to be administered? a. Orally b. Intravenously c. Subcutaneously d. Intramuscularly

ANS: D Rationale Penicillin G procaine and penicillin G benzathine suspensions should only be administered into the deep muscle tissue to decrease the chance of localized reaction and pain. Penicillin G procaine should never be given subcutaneously, orally, or intravenously. If penicillin G procaine is given intravenously, death may result in minutes because of embolism or toxic reaction.

Which nursing action is appropriate for the 4-year-old child who is exhibiting a "froglike" croaking sound on inspiration, is agitated, is drooling, and insists on sitting upright? a. Make the child lie down and rest quietly. b. Auscultate the child's lungs and make preparations for placement in a mist tent. c. Examine the child's oropharynx and report the assessment to the health care provider. d. Notify the health care provider immediately and be prepared to assist with a tracheostomy or intubation.

ANS: D Rationale Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may result in total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out.

Which nursing intervention is appropriate to promote maximum ventilatory function in a child with acute asthma exacerbation? a. Administer humidified oxygen. b. Encourage oral fluids frequently. c. Initiate a peripheral intravenous line. d. Allow the child to assume a position of comfort.

ANS: D Rationale The child would be allowed to assume the tripod position or other comfortable position. This allows maximum ventilatory function. This is the first step to follow in case of an asthma exacerbation. Humidified oxygen is administered to enhance oxygenation of the tissues. Frequent, small amounts of oral fluids are given to maintain hydration. Initiating a peripheral intravenous line is a more aggressive intervention that may need to be done when initial rescue medication fails.

Which respiratory complication is appropriate when performing discharge teaching for the parents of an infant with an upper respiratory tract infection? a. Dry cough b. Waking up during naps c. Decreasing irritability with fever d. Refusal to drink and decreased urination

ANS: D Rationale The health professional should be notified of any refusal to take oral fluids and decreased urination so that dehydration, which could further complicate respiratory problems, may be prevented. Although a dry cough does not warrant contacting a health professional, persistent cough or an exacerbated cough does. Waking up during naps does not warrant contacting the health professional; however, restlessness and a poor sleep pattern do. Decreasing irritability with fever does not warrant contacting a health professional; however, increasing irritability with or without fever does.

Which reason is appropriate to discourage an 11-year-old child with acute nasopharyngitis from using a nasal drop containing phenylephrine 0.25% and ephedrine 1% for more than 3 days? a. Needs to be replaced with nasal sprays b. Can easily get contaminated with bacteria c. Is unsafe in children under 12 years of age d. Can cause rebound congestion of nasal mucosa

ANS: D Rationale The nurse discourages the use of nasal drops for more than 3 days primarily because it can cause rebound congestion of the nasal mucosa. Older children often prefer nasal sprays to nasal drops because they can learn to compress the plastic container at the moment of inspiration. Both sprays and drops should be used for no more than 3 days. Bottles of nasal drops easily get contaminated with bacteria and viruses. Hence, such bottles should be used only for one child and only for one illness. Though nasal drops and sprays are more effective and safe in children over 12 years of age, these can be used in children over 6 years of age.

Which nursing action is appropriate when performing the tuberculin skin test for a child? a. Use 10 tuberculin units of purified protein derivative (PPD). b. Administer medication intramuscularly in the upper arm. c. Use a 14-gauge needle and a 1-mL syringe for the procedure. Inject in such a way that a visible wheal appears on the skin.

ANS: D Rationale The nurse injects the PPD so that a visible wheal appears on the skin. A wheal 6 mm to 10 mm in diameter should form between the layers of the skin when the solution is injected properly. If the wheal is not formed, the procedure is repeated. A 27-gauge needle and a 1-mL syringe are used to administer 5 tuberculin units of PPD. It is generally injected intradermally in the volar or dorsal aspect of the forearm.

Which condition is appropriate for the newborn who has respiratory distress, cyanosis, a scaphoid abdomen, and a possible mediastinal shift at birth? a. Asthma b. Choanal atresia c. Pierre Robin sequence (PRS) d. Congenital diaphragmatic hernia (CDH)

ANS: D Rationale The nurse would be alert if a newborn infant has a scaphoid abdomen, moderate to severe respiratory distress, decreased breath sounds unilaterally, and a history of polyhydramnios. The nurse would suspect CDH and should investigate further. Asthma is mostly caused by allergens. Infants may display supraclavicular, intercostal, suprasternal, subcostal, and sternal retractions. However, clinical symptoms of asthma may be less obvious in infancy. Choanal atresia is a congenital defect of the nose. A bony and/or membranous septum develops between the nose and the pharynx. When the neonate is at rest, the neonate may become cyanotic and apneic. Once the infant cries, the infant breathes in through the mouth and cyanosis disappears. PRS is a defect where the tongue may be large and frequently fall over the neonate's airway, causing respiratory distress.

Which primary factor is responsible for multiple clinical manifestations of cystic fibrosis? a. Hyperactivity of sweat glands b. Atrophic changes in mucosal wall of intestines c. Hypoactivity of the autonomic nervous system d. Increased viscosity of mucous gland secretions

ANS: D Rationale The primary factor responsible for clinical manifestations of cystic fibrosis is the mechanical obstruction caused by increased viscosity of mucous gland secretions, not hyperactivity of sweat glands, atrophic changes in the intestinal mucosal wall, or hypoactivity of the autonomic nervous system

Which nursing intervention is appropriate for the 5-year-old child brought to the emergency department with signs of apprehension, whose voice is thick and muffled, and also has drooling, agitation, and no spontaneous cough? a. Keep the child in close monitoring for 24 hours. b. Perform a throat examination using a tongue depressor. c. Swab both tonsils and posterior pharynx for throat culture. d. Have the child seen by a primary cáre provider immediately.

ANS: D Rationale The symptoms suggest that the child may have epiglottitis. In this case, the child needs immediate medical intervention, because the symptoms are rapidly progressive. The child should be taken to the primary care provider who can start effective antibiotic therapy. The child should not simply be kept under observation. An immediate care plan for airway protection should be in place. Treatment with humidified oxygen, fluids, and antibiotics are given as needed. Because the child is suspected to have epiglottitis, a throat examination and a swab should not be performed due to the chance of airway compromise.

Which nursing information is appropriate when teaching the parents of the child with streptococcal pharyngitis? a. The child is not considered infectious until antibiotic therapy is started. b. The child can return to daycare after antibiotic therapy is started. c. A new toothbrush must be used as soon as antibiotic therapy is started. d. Orthodontic appliances used by the child must be washed thoroughly.

ANS:D Rationale Orthodontic appliances must be washed thoroughly because they may harbor organisms. The child is considered infectious to others at the onset of symptoms and up to 24 hours after initiation of antibiotic therapy. The child must not return to school or daycare until the child has been taking antibiotics for a full 24-hour period. An old toothbrush must be discarded and replaced with a new one after the child has been taking antibiotics for 24 hours.