Respiratory Health Problems Pediatrics
16. When preparing the teaching plan for the mother of a child with asthma, what information should the nurse include as a sign to alert the mother that her child is having an asthma attack?
- wheezing during expiatory.
18. A child who uses an inhaled bronchodilator only when needed for asthma, has a best peak expiratory flow rate of 270 L/min. The child's current peak flow reading is 180 L/min. How does the nurse interpret this reading?
- Her peak flow is in the yellow zone : 50 - 80% of what her best peak flow. Green zone is indicated by > 80%. red is <50%
14. An 11 year old is admitted for treatment of an asthma attack. Which finding indicates immediatate intervention is needed?
- Intercostal Retractions
31. Which factor, if describe by the parents of a child with cystic fibrosis ( CF), indicates understanding the underlying problem of the disease?
- an abnormality in the way the body is secreting its mucus. --> autosomal recessive inherited disorder
26. A child with cystic fibrosis is receiving gentamicin. Which nrusing action is ** most** important?
- monitoring intake and outut because it could be an early indicator of renal damage.
32. Which outcome criterion would the nurse develop for a child with cystic fibrosis who has ineffective airway clearance related to increased pulonary secretions and inability to expectorate?
- respiratory status would be within normal limits --> as evidenced by a respiratory rate and rhythm within normal range
21. When developing a teaching plan for the parent of an asthmatic child concernin gmeasures to reduce allergic triggers, which suggestions should the nurse include?
Humidifier at 50% to 60%. Too little causes a dry enviorment & too high can lead to mold. --> top bunk because of dust mites.
48. A 3 year old is brought into the emergency department in her parent's arms. The child's mouth is open, and she is droolign and lethargic. The parent states that the child becaume ill suddenly within the past 2 hours. What should the nurse do **first**?
- this is a medical emergency and the nurse should try to keep the child calm at all costs. --> the childmay need to be intubated
22. After discussing asthma as a chronic condition, which statement by the parent of a child with asthma, ** best** reflects the family's psitive adjustment to this aspect of the child's disease?
- "Although, our child's disease is lifelong we try to not let it be the main focus in our family."
28. What type of diet should the nurse teach the parents to give an older infant with cystic fibrosis (CF)?
- Because the pancreas is not able to digest fats the child should be placed on a high carbohydrate, high calorie, high protein w/ little fat
63. A 6 month old on the pediatric floor has a respiratory rate of 68, mild intercostal retractions, and oxygen saturation of 89%. The infant has not been feeling well for the last 24 hours and is restless. Using the situation background, assessment, and recommendation (SBAR) technique for communication, the nurse calls the healthcare provider (HCP ) with the recommendation for:
1 The infant is eperiencing signs and symptoms of respiratory distress indicating the need for oxygen therapy. Sedation will not improve the infant's respiratory distress and would likely cause further respiratory depression. If the infant's respiratory status continues to decline, she may need to be transferred to the pediatric intensive care. Oxygen should be the priority as it may improve the infant's respiratory status. A chest CT is not indicated. However, a CXR would be another appropriate recomendation for this infnt
64. A child with cystic fibrosis has been admitted to the pediatric unit. What type of diet should the request for the patient?
2. A high calorie, high protein diet is nessary to ensure adequate growth. Some children require up to two times the recommended daily allowance of calories ( increased calorie diet includes foods high in fat and balanced carbohydrates0. Pancreatic enzyme activity is lost, and malabsoption of fats, proteins, and carbohydrates.
4. The nurse is offering nutritional instruction to the parents of a preschooler who has undergone a tonsillectomy and adeniodectomy. What food choice by the parents woud indicate sucessful teaching?
3. For the first few days after a tonsillectomy and adeniodectomy, liquids and stoft foods are best tolerated by the child while the throat is sore. Children typically do not chew their food thouroughly, and solid foods are to be avoided because theya re difficult to swallow. Although meat loaf would be considered a soft food, uncooked carrots would not be. Pork is frequently difficult to chew Foods that have sharp edges, such as potato chips are contrainindicated because they are hard to chew and may cause more throat discomfort
59. The nurse is preparing to administer the last dose of ceftriaxone before discharge to a 1 year old but finds the IV has occluded. The nurse should:
4 Restarting an IV for one dose of a medicaiton may not be in the infant's best interest when the medication can be given in an altenate form. The prescriber should be contacted to determine IM or PO options. Ceftriaxone may be given IM, but changing the route of a medicaiton administrations requires permission first. While reasons for giving a medicaiton late would be indicated, the failing to complete an entire course of antibiotics contributes to the emergence of antibiotic resistance, and withholding the medicine would rarely be the best option.
58. A charge nurse is making assignments for a group of children on a pediatric unit. The nurse should **most** avoid assigning the same nurse to care for a 2 year old with respiratrory syncytial virus (RSC) and:
A RSV may be spread through both direct and indirect contract. While contact and standard precautions should be employed, a measure to further decrease the risk of nosocomial infections is to avoid assigning the same nurse caring for an RSV patient to a patient at risk for infection. A private room is an option, but if this is not an optiom, the nurse should understand that children 2yrs of age and younger are at greater risk. --> especially with cronic problems such as a heart defect. From an infection control perspective, pairing two patients with RSV is ideal. RSV infections are less likely to pose a serious problem in older children
17, Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply a. coughing b. RR of 35 breaths / min c. heart rate of 95 bpm d. restlessness e. malaise f. diaphoresis-
Coughing at night. restlessness, tachypnea, tachycardia, diaphoresis --> hypertentio, nasal flaring, grunting and wheezing, intercostal retractions
29. At a follow-up appointment after being hospitalized, an adolescent with a history of cystic fibrosis (CF) describes his stools to the nurse. Which description should the nurse interpret as indicative of continued problems with malabsorption?
Large amounts, foul-smelling, bulky --> steatorrhea. A pt. who are doing well will have soft stools that are not foul smelling
15. A 12 year old with asthma wants to exercise, Which activity should the nurse suggest to improve breathing?
Swimming is a sport we should recommend due to it not being a stop and start excersie. stop and start activities trigger asthma: soccer, track, gymnastics
23. A child with asthma states, " I want to play some sports like my friends. What can I do?" The nurse responds to teh child based on the understanding of which information?
The child can still play. His coach and team members must know what to do in case of an emergency. --> short-acting bronchodilators can be used before exerciseng for exercise induced asthma.
20. A 7 year old child with a history of asthma controlled without medications is referred to the school nurse by the teacher because of persistent coughting what should the nurse do ** first***?
call the parent for more information --> the child might only be able to provide limited information
27. When developing the plan of care for a child with cystic fibrosis (CF) who is scheduled to reveice postural drainage, the nurse should anticipate perforrming postural drainage at which times?
postural drainage is done before meals to minimize the child throwing up. --> typically inhalation treatment is given before to loosen the thick mucous
33. A school - age child with cystic fibrosis asks the nurse what soports she can become incolved in as she becomes older. which activity would be appropriate for the nurse to suggest?
swimming because the benefits are still great, but her CF doesn't run a higher risk of being agitated as it would with the other sports
24. A child with cystic fibrosis does not like talking a pancreatic enzyme supplement with meals and snacks. The parent does not liek to force the chil to take the supplement. The **most** important reason for the child to take the pancreatic enzyme supplement with meals and snacks is:
the child should take the medicine to help the body absorb the food --> w/out the enzyme stool is voluminous, foul, fatty
30. What toy should the nurse include as part of a recreational therapy plan of care for a 3 year old child hospitalized with pneumonia and cystic fibrosis?
the child's favorite doll
19. An adolescent with chest pain goes to the nurse. The nurse determines that the teenage has a history of asthma but has had no problems for years. What should the nurse do ** next***?
the nurse should check what the child's peak flow is. --> short acting bronchodiator could be utilized
1. The nurse is inspecting the child's throat. The nurse should: select all that apply a. remove the toungue blade from the child's hands after he has experienced what it feels like in his mouth. b. ask the child to hold the tougue blade with both hands in his lap while the nurse uses anothe toungue blade. c. have the parent hold the child with arms restrained. d. Guide the toungue blade while the child is holding it to depress the toungue to visulaize the throat.
- 4 if the child does not stick out his tongue so the nurse can visualize the throat, it is appropriate to use a tongue blade. Havidng the child participate by holding the tongue blade while the nurse guides it to facilitate visualization of the throat is appropriate technique. It is not useful to remove the toungue blade or hav e the child hodl it because the nurse will need to use the toungue blade to depress the toungue. It is preferable to engage the child's copperation before asking the paretn to restrain the child.
25. An adolescent with cystic fibrosis has been hospitalized several times. On the latest admission, the patient has labored respirations, fatigue, malnutrition, and failure to thrive. Which initiall nursing actions are **most** important?
- Children with cystic fibrosis commonly die from respiratory problems --> due to blockage not allowing the exchange of oxygen and carbon dioxide
51. A child has viral pharyngitis. what should the nurse advice the parents to do? Select all that apply a. use a cool mist vaporizer b. Offer a soft to liquid diet c. Administer amozicillin d. Administer acetaminophen e. Palce the child on secretion precautions
1, 2, 4 Viral pharyngitis is treated with symptomatic, supportive therapy. Treatment includes use of a cool mist vaporizer, feeding a soft or liquid diet, and administeration of acetaminophen for comfort. Viral infections do not respond to antibiotic administration. The child does not need to be on secretion precaustions because viral pharyngitis is not contagious
57. A teaching care plan to prevent the transmission of respiratory syncytial virus (RSV) shold include what information? Select all that apply a. The virus can be spread by direct contact b. The virus can be spread by indirect contract c. Palivizumab is recommended to prevent RSV for all toddlers in day care. d. the virus is typically contagious for 3 weeks e. Older children seldom spread RSV f. Frequent handwashing helps reduce the spread of RSV
1, 2, 6 RSV can be spread through direct contact such as kissing the face of an infected person, and it can be spread through indirect contact by touching surfaces covered with infected secretions. Handwashing is one of the best ways to reduce the risk of disease transmission. Palivizumab can prevent severe RSV infections but is only recomended for the most at risk infants and children. RSV is typically contagious for 3 to 8 days. RSV frequently manifests in older children as cold-like symptoms. Infected school age children fequently spread the virus
60. A nurse administers cefazolin instead of the cefriaxone to an 8 year old with pneumonia. The client has suffered no adverse effects. The nurse tells the charge nurse of the incident but fears disciplinary action from reporting the error. The charge nurse should tell the nurse:
2. Client safety is enhanced when the emphasis on medication errors is to determine the root cause. All errors hsould be reported so systems can identify patterns that contribute to errors. Here, the similar names prob contributed to the error. The nurse who commits the error knows all the relevant information and is in the best position to report it. While the health care provider should be notified. It is a nursign responsibility to report errors, not an HCP's choice. relating mistakes to a nurse's position focuses on personal blame
56. The nurse observes an 18 month old who has been admitted with respiratory tract infection who is drooling. The nurse should first:
2. The nurse should suspect epiglottis in any young child with respiratory infection who sits leaning foward with an open mouth and protuding toungue and is drooling. Epiglottis is medical emergency. The rapid resonse team should be notified to secure the airway. While waiting for the team, the child should remain sitting upright to facilitate brathing; complete obstruction amy occur if the child is placed prone or becomes agitated. Therefore it is important to avoid any procedures that upse tthe child such as suctioning or apllying oxygen.
50. A 21 month old child admitted with the diagnosis of croup now has a respiratory rate of 48 breaths/min, a heart rate of 120bpm, and a temperature of 100.8 degees f (38.2 degrees celcius) rectally. The nruse is having difficulty calming the child. What should the nurse do **next**?
2. The nurse may be having difficulty calming the child because the child is experiencing increasing respiratory distress. the normal respiratory rate for a 21 month old is 25 to 30 breaths/min. The child's RR is 48 breaths/min Therefore, the HCP needs to be notified immediately. Typically acetaminophen is not gicen to a child unless the temperature is 101 degrees F ( 38. 6 degrees C) or higher. Lettign the toddler cry is inappropriate with croup because crying increases respiratory distress. offering fluids every few min to a toder experiencing increasing respiratory distress would do little if anything to calm the child. Also the child would have difficulty coordinating breathing and swallowing, possibly increasing the risk of aspiration.
52. A parent brings a 3 month old infant to the clinic, reporting that the infant has a cold, is having trouble breathing, and "just does not seem to be acting right." Which action shuold the nurse take **first**?
3. In an infant with these symptoms, the first action by the nurse would be to obtain an oxygen saturation reading to determine how well the infant is oxygenating. Because the parent probably can provide no other information, checking the heart rate would be the second action doe by the nurse. Then the nurse would obtain the infant's weights.
5. A nurse is teaching the parents of preschooler about the possibility of postoperative hemorrhage after a tonsillectomy and adenoidectomy. When should the nurse explain that the risk of bleeding is the **greatest**?
3. The risk of hemorrhage forom a tonsillectomy is greatest when the tissue begings slothing and the scabs fall off. This typically happens 7 to 10 days after a tonsillectomy
2. The nurse has identified a problem of anxiety for a 4 year old preparing for a tonsillectomy. The nurse should tell the child:
4. When preparing a child for a procedure the nurse should neutral words, focus on sensory experiences, and emphazixe the positive aspects at the end. Being reunited with parents and having an ice pop would be considered pleasurable events. Children this age fear bodily harm. To reduce anxiety, The nurse hsould use the word " fixed" instead of "removed" to describe what is being done to the otnsils. Using the terms "put to sleep" and "IV" may be threatening. Additionally, directign a play expercence to focus on IV insertion may be counterproductive as the child may have little recollection of this aspec tof the procedure.
3. After a tonsillectomy and adenoidectomy, which finding should alert the nurse to suspect early hemorrhage in a 5 year old child?
1. after a tonsillectomy and adenoidectomy, drooling bright red blood is considered an early sign of hemorrhage. Often because of discomfort in the throat, children tend to aoid swallowing; instead, they drool. Fequent swallowing would also be an indication of hemorrhage because the child attempts to clear the airway of blood by swalling. Secretions may be slightly blood-tinged because a small amount of oozing after surgery. However, bright red secretions idicate bleeding. A pulse rate of 96bpm is within the normal range for a 5 year old child as is a blood pressure of 95/56 mmHg. A small amount of blood that is partially digested, and therefore dark brown is often present in postoperative emesis
8. After insertion of bilateral tympanovstomy tubes in a toddler, which instructions should the nurse include in the child's discharge plan for the parents?
1. Placing ear plugs in the ears will prevent contaminated bathwate from entering the middle ear through the tympanostomy tube and causing an infection. Inserting cotton swabs into the ear canal is not recommended. It is not necessary to administer antibiotics continuously to a child with a tympanostomy tube. Antibiotics are appropriate only when an ear infection is present. Drainage from the ear may be a sign of middle ear infeciton and should be reported to the healthcare provider
49. The parent of a 16 month old child calls the clinic because the child has a low - grade fever, cold symptoms and a hoarse cough. What should the nurse sugest that the parent do?
1. The toddler is exhibing cold symptoms a hourse cough may be part of the upper respiratory tract infection. The best suggestion is to hav ethe father offer the child additional fluids at fequent intervals to help keep secretions loose and membranes moist. There is no evidence presented to suggest that the child needs to be brought to the clinic immediately. Althoug having the father count the child's RR may provide some additional information, it may lead the father to suspect that soehting is seriously wrong, possibly leadig to unde anxiety. Hot air vaporizer is not recommended. However a cool mist vaporizer would cause vasoconstriction of the respiratory passages making it easier for the child to breath and loosening secretions.
9. The nurse caring for a 3 year old with otitis media notes that the client has an allergy to amozicillin that causes wheezing. Which prescription should the nurse question?
2. Cephalexin is the first-generation cephalosporin. Because the patient with a history of anaphylaxis to penicillin, or related antibiotics, have an increased risk of having a cross-reaction to first generation cephalosporin, the nurse should question a prescription for cephalexin. Azithromycin is not usually considered to be a first - line antibiotic for ear infections in pediatric patients but is effective with patients who have an allergy to amoxicillin. Trimethoprim-sulfamethoxzole is effective against middle ear infections and can be used effectively in pediatric patients with allergy to amoxicillin. Second- and third- generatin cephalosporins, like cefdinir, do not have the same rates of cross-sensitivites to penicillins as first generation cephalosporins and may be prescribed for peds patients with an allergy to amoxicillin.
6. An adolescent female is prescribed amoxicillin for an ear infection. The nurse should teach the adolescent about the risks associated with her concurrent use of: a. OTC antihistamines b. Oral contraceptives c. multiple vitamins d. Iburofen
2. When a person is taking amoxicillin as well as an oral contraceptivem it renders the contraceptive less effective. Because pregnancy can occur in such a situation, the nurse should advice the patient to use additional means of birth control durign the time she is taking the antibiotic. There are no risks associated with the concurrent use of amoxicillin and OTC antihistamines, vitamins, or ibuprofen.
61. A 12 year old with cystic fibrosis is being treated in the hospirtal for pneuonia. The health care provider ( HCP) is calling in a telephone prescription for ampicillin. The nurse should take which actions? Select all that apply a. Ask the unit clerk to listen on the speakerphone with the nurse wand write down the prescription. b. ask the HCP to come to the hospital and write the prescription on the medical record. c. Repeat the prescription to the HCP d. Ask the HCP to confirm that the prescription is correct as understood by the nurse e. Ask the nursign supervisor to cosign the telephone prescription as transcribed by the nurse.
3,4 To ensure patient safety in obtaining telephone prescriptions, the prescriptions must be recieved by a registered nurse. The nurse should write the prescription, read the prescription back to the health care provider and recieve confirmation from the HCP that the prescription is correct. It is not necessary to ask the unit clerk to listen to the prescritption, to require the HCP to come to the hospital to write the prescription on the medical record, or to have the nursign supervisor cosign the telephone prescription.
53. A nurse's assessment of a 6 month old infant reveals a respiratory rate of 52 breaths per min, retractions,a nd wheezing. The mother states that her infant was doing fine until yesterday. Which action would be **most** appropriate?
3. Based on the assessment findings of increased respiratory rate, retractions, and wheezing, this ifant needs further evaluation, which could be obtained in an emergency department. Without a definitive diagnosis, administering a nebulizer treatment would be outside the nurse's scope of practice unless there was a prescription for such a treatment. Sending the infant for a radiograph may not be in the nurse's cope of practice. The findings need to be reported to an HCP who can then determine whether or not chest radiograph is warranted. The infant is exhibiting signs and symptoms of respiratory and is too ill to send with just instructions on old care for the mother.
55. In preparation for discharge, the nurse teaches the mother of an infant diagnosed with bronchiolitis abou the condition and its treatmen. Which statement by the mother indicates successful teaching?
4. Handwashing is the best way to prevent respiratory illness and the spread of disease. Bronchiolitis, a viral infection primarily affecting the bronchioles, causing swelling and mucos accumulation of the lumina and subsequent hyperinflation of the lung with air trapping. It is transmitted primatily by direct contact with respiratory secretions as a result of eye - to -hand or nose - to - hand contact or from contaminated fomites. therefore, handwashing minimizes the risk for transmission. Taking the child's temperature is not appropriate in most cases. As long as the child is getting better, taking the temperature will not be helpful. the mother's statements that she hopes she does not get a cold from her child does not indicate understanding of what to do after discharge. For most parents, listening to the child's chest would not be helpful because the parents would not know what they are listening for. Rather, watching for an increased respiratrory rate, fever or evidence of poor eating or drinking would be more helpful in alerting the parent to protential illness
62. The triage nurse in the emergency department must prioritize the children waiting to be seen. which child is the **greatest** need of emergency medical treatment?
1. This child is exhibiting signs and symptoms of epiglottism which is a medical emergency due to the risk of complete airway obstructio, the 3 and 4 year olds are exhibing signs and symptoms of croup. Symptoms often diminish after the child has been taken out in the cool night air. If symptoms do not improve, the child may need a signle dose of examethasone. Fever should also be trated with antipyretics. the 13 year old is exhibing signs and symptoms of bronchitis. Treatment includes rest, antipyretics, and hydration.
7. A toddler is scheduled to have tympanostomy tubes inserted. When approaching the toddler for the first time, which should the nurse do?
1. Toddlers should be approached slowly beacuse they are wary of stangersn and tneed time to get used to someone they do not know. The best approach is to ignore them initially and to focus on talking to the parents. The child will likely resist being held by a stranger, so the nurse should not pick up or hold the child until the child indicates a readiness to be approached or the mother indicates it is okay
54. An infant is being treated at home for bronchiolitis . What should the nurse teach the parent about home care? Select all that apply a. offering small amounts of fluids fequently b. Allowing the infant to sleep prone c. calling the clinic if the infant vomits d. writing down how much the infant dirsnks e. performig chest physiotherapy every 4 hours f. watching for difficulty breathing
1,6 An infant with bronchiolitis will have increased respirations and will tire more quickly, so it is best and easiest for the infant to take fluids more often in smaller amounts. the parents also would be instructed to watch for signs of increased diffulty breathing, which signal possible complications. Healthy infants and even those with bronchiolitis should sleep in supine position. Calling the clinic for an episode of vomiting would not be necessay. However, the parents would be instructed to call if the infant cannot keep down any fluids or liquids for a period of more than 4 hours. Parents would not need to record how much the infant drinks. Chest physiotherapy is not indicated because it does not help and further irritates the infant.
