peds respiratory questions--2 different resources used

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

ANS: A ans: A Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which is essential in this childs care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if childs lips become bright, cherry red.

ANS: B Arterial blood gases are the best way to monitor carbon monoxide poisoning. Pulse oximetry is contraindicated in the case of carbon monoxide poisoning because the PaO2 may be normal. The child should receive 100% oxygen as quickly as possible, not only if respiratory distress or other symptoms develop.

A 3-year-old female is admitted to the ER with drooling, difficulty swallowing, sore throat, and a fever of 39°C (102.2° F). The physician suspects epiglottitis. The parents ask the nurse how the physician will know for sure if their daughter has epiglottitis. Which is the nurse's best response? 1. "A simple blood test will tell us if your daughter has epiglottitis." 2. "We will swab your daughter's throat and send it for culture." 3. "We will do a lateral neck x-ray of the soft tissue." 4. "The diagnosis is made based on your daughter's signs and symptoms."

3. A lateral neck x-ray is the method used to diagnose epiglottitis definitively. The child is at risk for complete airway obstruction and should always be accompanied by a nurse to the x-ray department.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a. Fussiness b. Coughing c. A fever over 99° F d. Signs of an earache

ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? a. Dyspnea b. Tachypnea c. Hypopnea d. Orthopnea

ANS: A Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in upright position.

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Bronchoscopy, although helpful for identifying bacterial infection in children with CF, is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

Parents have understood teaching about prevention of childhood otitis media if they make which statement? a. "We will only prop the bottle during the daytime feedings." b. "Breastfeeding will be discontinued after 4 months of age." c. "We will place the child flat right after feedings." d. "We will be sure to keep immunizations up to date."

ANS: D Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

A 2-month-old is diagnosed with otitis. The parent asks the nurse if the otitis will have any long-term effects for the child. Understanding the complications that can occur with otitis, which is the nurse's best response? 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."

3. When children acquire an ear infection at such a young age, there is an increased risk of recurrent infections.

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.

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.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

ANS: A Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which diagnosis? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

ANS: A Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

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.

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 disease and a 50% chance of being a carrier of the disease.

A school-age child is admitted to the hospital for a tonsillectomy. The nurse caring for this patient is assessing the child 8 hours after surgery. During the nurse's assessment, the child's parent tells the nurse that the child is in pain. Which of the following observations should 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.

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.

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."

1. Synagis will not help the child who has already contracted the illness. Synagis is an immunization and a method of primary prevention.

The parent of a pediatric client who has had frequent ear infections asks the nurse if there is anything that can be done to help the child avoid future ear infections. Which is the nurse's best response? 1. "Your child should be put on a daily dose of Singulair." 2. "Your child should be kept away from tobacco smoke." 3. "Your child should be kept away from other children with otitis." 4. "Your child should always wear a hat when outside."

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

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. Before chest physiotherapy (CPT) b. After CPT c. Before receiving 100% oxygen d. After receiving 100% oxygen

ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier. Aerosolized bronchodilator medications are not helpful when used after CPT. Oxygen administration is necessary only in acute episodes with caution because of chronic carbon dioxide retention.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

ANS: A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

An infant's parents ask the nurse about preventing OM. Which should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools are a later manifestation of CF. Recurrent respiratory tract infections are a later sign of CF.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: a. forcing fluids. b. monitoring pulse oximetry. c. instituting seizure precautions. d. encouraging a high-protein diet.

ANS: B Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

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

2. The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.

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.

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 the patient the highest risk.

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."

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.

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 1-2 hours 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."

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

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

60 mEq/L.

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. 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.

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.

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.

A 2-year-old is admitted to the hospital with croup. The parent tells the nurse that her 7-year-old just had croup and it cleared up in a couple of days without intervention. She asks the nurse why her 2-year-old 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."

4. Younger children have less developed immune systems and usually exhibit worse symptoms than older children.

A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool test for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. Gastric contents contain hydrochloride normally; it is not diagnostic. Bronchoscopy and duodenal fluid are not diagnostic. Stool test for trypsin and intestinal biopsy are not helpful in diagnosing CF.

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions? a. "I should administer all the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

ANS: A Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of AOM. Antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside. It should be continued.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurses rationale for this action is described primarily in which statement? a. Mothers of hospitalized toddlers often experience guilt. b. The mothers presence will reduce anxiety and ease childs respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the childs respiratory efforts.

ANS: B The familys presence will decrease the childs distress. It is true that mothers of hospitalized toddlers often experience guilt but this is not the best answer. The main reason to keep parents at the childs bedside is to ease anxiety and therefore respiratory effort. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). Nursing considerations should include to: a. not administer pancreatic enzymes if child is receiving antibiotics. b. decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. administer pancreatic enzymes between meals if at all possible. d. pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. Pancreatic enzymes are not a contraindication for antibiotics. The dosage of enzymes should be increased if child is having frequent, bulky stools. Enzymes should be given just before meals and snacks

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the childs care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

ANS: D, E, F Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

A pediatric client is diagnosed with epiglottitis. The parents ask the nurse what treatment their child will receive. Which is the nurse's best response? 1. "Your child will need to complete a course of intravenous antibiotics." 2. "Your child will need to have surgery to remove her tonsils." 3. "Your child will need 10 days of aerosolized ribavirin." 4. "Your child will recover without any intervention in about 5 days."

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.

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

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

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.

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. 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.

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."

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.

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."

3. The child is swabbed for nasal secretions. The secretions are tested to determine if a child has RSV.

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

1. 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.

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.

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. 3

A physician prescribes 10 days of amoxicillin to treat a 6-year-old male with an ear infection. The nurse is reviewing discharge instructions with the parent. Which information should be included in the discharge instructions? 1. "Administer 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."

3. It is essential that all the medication be given.

The nurse is caring for a 22-month-old male who has had repeated bouts of otitis media. The nurse is educating the parents about otitis media. Which of the following statements from the parents indicates they need additional teaching? 1. "If I quit smoking, my child may have less 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."

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.

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the childs postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

ANS: A, C, D Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided.

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A b-hemolytic streptococcal infections.

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by: a. a fever as high as 40° C (104° F). b. severe pain in the ear. c. nausea and vomiting. d. a feeling of fullness in the ear.

ANS: D OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

Which of the following children 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 7-year-old who has had two ear infections this year. 4. A 3-year-old whose sibling has had four 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.

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.

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

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. Racemic epinephrine promotes mucosal vasoconstriction.

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. 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.

A pediatric client was seen at the pediatrician's office and was diagnosed with viral tonsillitis. The parent asks how to care for the child at home. 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."

3. Tylenol is recommended prn for pain relief.

A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase). Which is an adverse effect of this medication? a. Mucus thickens b. Voice alters c. Tachycardia d. Jitteriness

ANS: B One of the only adverse effects of DNase is voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years. b2 agonists can cause tachycardia and jitteriness.

A pediatric client had a tonsillectomy 24 hours ago. The nurse is reviewing discharge instructions with the parents. 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."

4. Soft foods are recommended to limit the child's pain and to decrease the risk for bleeding.

A 2-year-old child is brought to the ER with a high fever, dysphagia, drooling, rapid pulse, and tachypnea. What should the nurse's first action be? 1. Prepare for immediate IV placement. 2. Prepare for immediate respiratory treatment. 3. Place the child on a stretcher for a thorough physical assessment. 4. Allow the child to sit in the parent's lap while awaiting an x-ray.

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.

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."

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

Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected

ANS: A CF is an autosomal recessive gene inherited from both parents and is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children

The nurse is assessing a child with acute epiglottitis. Examining the childs throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

ANS: B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.