Respiratory - NCLEX-Style Questions

Which would be an early sign of respiratory distress in a 2-month-old? 1. Breathing shallowly. 2. Tachypnea. 3. Tachycardia. 4. Bradycardia.

2. Tachypnea. Shallow breathing is a late sign of respiratory distress. Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants. Tachycardia is a compensatory response by the body. When a child has respiratory distress and is not oxygenating well, the body increases the heart rate in an attempt to improve oxygenation. Bradycardia is a late sign of respiratory distress.

Which assessment is of greatest concern in a 15-month-old? 1. The child is lying down and has moderate retractions, low-grade fever, and nasal congestion. 2. The child is in the tripod position and has diminished breath sounds and a muffled cough. 3. The child is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The child is restless and crying, has bilateral wheezes, and is feeding poorly.

2. The child is in the tripod position and has diminished breath sounds and a muffled cough.

Which is diagnostic for epiglottitis? 1. Blood test. 2. Throat swab. 3. Lateral neck x-ray of the soft tissue. 4. Signs and symptoms.

3. Lateral neck x-ray of the soft tissue.

How will a child with respiratory distress and stridor who is diagnosed with RSV be treated? 1. Intravenous antibiotics. 2. Intravenous steroids. 3. Nebulized racemic epinephrine. 4. Alternating doses of acetaminophen (Tylenol) and ibuprofen (Motrin).

3. Nebulized racemic epinephrine. Racemic epinephrine promotes mucosal vasoconstriction. Acetaminophen (Tylenol) and ibuprofen (Motrin) can be given to the child for comfort, but they do not improve the child's respiratory status.

A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse ' s best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation? 1. "Children this age rarely get epiglottitis; you should not blame yourself." 2. "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen." 3. "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son ' s symptoms." 4. "Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly."

4. "Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly."

The nurse in the emergency department has provided discharge education for the parents of a 4-year-old child with croup. Which statement by the parent indicates an understanding of the information? A) "I will make sure the air in the home is humidified and cool." B) "I will remove the pillow in the bed so my child can lay flat when sleeping." C) "I will make a follow-up appointment just if my child's symptoms get worse." D) "I will come back to the emergency department if my child develops a fever."

A) "I will make sure the air in the home is humidified and cool." Rationale: For clients with croup, cool, humidified air keeps the secretions in the airway moistened, decreases the viscosity, and soothes the inflamed airways.

The nurse is teaching the parents of a small child about causes of airway obstruction. Which should the nurse include? *Select all that apply* A) Pharyngeal mass B) Laryngeal edema C) Neck trauma D) Anaphylactic reaction E) Foreign body

A) Pharyngeal mass B) Laryngeal edema C) Neck trauma D) Anaphylactic reaction E) Foreign body

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions would the nurse include in the plan of care? *Select all that apply* A) Place the infant in a private room. B) Ensure the infant's head is in a flexed position. C) Wear a mask, gown, and gloves when in contact with the infant. D) Place the infant in a tent that delivers warm, humidified air. E) Position the infant on the side, with the head lower than the chest. F) Ensure that the nurses caring for the infant with RSV do not care for other high-risk children.

A) Place the infant in a private room. C) Wear a mask, gown, and gloves when in contact with the infant. F) Ensure that the nurses caring for the infant with RSV do not care for other high-risk children.

Which child with asthma should the nurse see first? 1. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 2. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. 3. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. 4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.

1. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 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 sounds.

Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be? 1. Complete a course of intravenous antibiotics. 2. Surgery to remove the tonsils. 3. 10 days of aerosolized ribavirin. 4. No intervention.

1. Complete a course of intravenous antibiotics.

Which should the nurse administer to provide quick relief to a child with asthma who is coughing, wheezing, and having difficulty catching her breath? 1. Prednisone. 2. Montelukast (Singulair). 3. Albuterol. 4. Fluticasone (Flovent).

3. Albuterol.

Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase? 1. Use an incentive spirometer. 2. Breathe into a paper bag. 3. Blow a pinwheel. 4. Take several deep breaths.

3. Blow a pinwheel.

An infant is not sleeping well, is crying frequently, has yellow drainage from the ear, and is diagnosed with an ear infection. Which nursing objective is the priority for the family? 1. Educating the parents about signs and symptoms of an ear infection. 2. Providing emotional support for the parents. 3. Providing pain relief for the child. 4. Promoting the flow of drainage from the ear.

3. Providing pain relief for the child. Providing pain relief for the infant is essential. With pain relief, the child will likely stop crying and rest better, as will the parents.

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

2. "Your child should be kept away from tobacco smoke."

A 5-year-old is brought to the ED with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention 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. Respiratory treatment of racemic epinephrine. The child is exhibiting signs and symptoms of croup and is in mild respiratory distress. The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.

The nurse is preparing to teach a client about cystic fibrosis. Which statement should the nurse use to describe the condition? A) Cystic fibrosis is an inherited, chronic and progressive condition characterized by dysfunction of the parathyroid glands, primarily in the musculoskeletal system. B) Cystic fibrosis is not an inherited, chronic and progressive condition characterized by dysfunction of the adrenal glands, primarily in the renal and cardiovascular systems. C) "Cystic fibrosis is an inherited, chronic and progressive condition characterized by dysfunction of the endocrine glands, primarily in the respiratory, and reproductive systems." D) "Cystic fibrosis is an inherited, chronic and progressive condition characterized by dysfunction of the exocrine glands, primarily in the respiratory, gastrointestinal, and reproductive systems."

D) "Cystic fibrosis is an inherited, chronic and progressive condition characterized by dysfunction of the exocrine glands, primarily in the respiratory, gastrointestinal, and reproductive systems."

The nurse is providing education about epiglottitis with an infant's parents. Which statement regarding modifiable risk factors should the nurse include in the teaching? A) "Avoid smoking in the home and around the infant." B) "Male infants are more prone to epiglottitis." C) "It is important to lay your infant on their back when they sleep." D) "It is important that your child receives the haemophilus b vaccine."

D) "It is important that your child receives the haemophilus b vaccine." Rationale: The most common cause of epiglottitis used to be Haemophilus influenzae type b, but this has become less common due to an increase in childhood vaccination. The nurse should reinforce the importance of the infant receiving their scheduled vaccinations to prevent epiglottitis.

The clinic nurse is providing instructions to the parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement would the nurse make to the parent? A) "The immunization schedule will need to be altered." B) "The child should not receive any hepatitis vaccines." C) "The child will receive all of the immunizations except for the polio series." D) "The child will receive all the recommended basic series of immunizations along with a yearly influenza vaccination."

D) "The child will receive all the recommended basic series of immunizations along with a yearly influenza vaccination." Rationale: Adequately protecting children w/ cystic fibrosis from communicable diseases by immunization is essential.

The pediatric nurse is reviewing the common causes of bronchiolitis with a group of new parents. Which topic(s) should the nurse include in the teaching? *Select all that apply.* A) Measles B) Conjunctivitis C) Varicella D) Adenovirus E) Respiratory syncytial virus (RSV)

D) Adenovirus E) Respiratory syncytial virus (RSV) Rationale: Inflammation of the bronchioles, which are the smallest airways of the lungs, is known as bronchiolitis. It commonly occurs during the colder months of fall, winter, and early spring, and is most often caused by the respiratory syncytial virus (RSV). Other causes include viruses like adenovirus, parainfluenza virus, or rarely, from bacteria-like Mycoplasma pneumoniae.

The nurse is educating a parent of a toddler on how to prevent foreign body aspiration. Which information should the nurse include in the teaching? A) Handwashing B) Serve soft foods only C) Locking up household chemicals D) Chopping food into smaller pieces

D) Chopping food into smaller pieces Rationale: Foreign body aspiration can happen to anyone, but most commonly occurs in young children because they have smaller airway diameters than adults. Chopping up food into smaller pieces will help prevent foreign body aspiration.

The parent of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The parent tells the nurse that the child complains of discomfort on the right side and that ibuprofen is ineffective. Which instruction would the nurse provide to the parent? A) Increase the dose of ibuprofen B) Increase the frequency of ibuprofen C) Encourage the child to lie on the left side D) Encourage the child to lie on the right side

D) Encourage the child to lie on the right side Rationale: Splinting of the affected side by lying on that side may decrease discomfort.

What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus? 1. "What time did your child eat last?" 2. "Has your child been exposed to any of the usual asthma triggers?" 3. "When was your child last admitted to the hospital for asthma?" 4. "When was your child ' s last dose of medication?"

4. "When was your child ' s last dose of medication?" The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.

A child with severe cerebral palsy is admitted to the hospital with aspiration pneumonia. What is the most beneficial educational information that the nurse can provide to the parents? 1. The signs and symptoms of aspiration pneumonia. 2. The treatment plan for aspiration pneumonia. 3. The risks associated with recurrent aspiration pneumonia. 4. The prevention of aspiration pneumonia.

4. The prevention of aspiration pneumonia.

The parent of a pediatric client who is newly diagnosed with asthma asks, "What caused my child to develop this?" Which response(s) by the nurse help to explain the risk factors associated with asthma? Select all that apply. A) "Early childhood exposure to adenovirus can cause asthma." B) "Asthma can develop due to exposure to tobacco smoke." C) "Females are more likely to develop asthma than males." D) "Genetics can play a role in developing asthma." E) "Early exposure to steroids increases the risk."

A) "Early childhood exposure to adenovirus can cause asthma." B) "Asthma can develop due to exposure to tobacco smoke." D) "Genetics can play a role in developing asthma." Rationale: Tobacco smoke is considered particulate matter and is a modifiable risk factor in the development of asthma. Modifiable risk factors can be changed or modified by clients to prevent the disease process. Non-modifiable risk factors include factors that cannot be changed, such as disease processes or genetics.

The nurse is caring for the mother of a preterm infant who says, "I don't understand how lung surfactant can help my baby breathe." Which is the best response by the nurse? A) "Surfactant prevents the inner walls of the lungs from sticking to each other." B) "Surfactant stimulates the respiratory center of the brain." C) "Surfactant helps break down the carbon dioxide in the lungs." D) "Surfactant increases the pressure in the lungs to help move oxygen quickly through the lung tissue."

A) "Surfactant prevents the inner walls of the lungs from sticking to each other." Rationale: Lung surfactants work by forming a film that coats the inner walls of the alveoli, which are the smallest unit of the lung structure responsible for oxygen exchange. This film decreases the surface tension, which helps maintain the alveolar shape by preventing the inner walls from sticking to each other and collapsing during expiration. If the alveoli collapse, oxygen exchange can not occur.

The nurse is preparing to educate a client diagnosed with asthma and recently prescribed a beclomethasone inhaler. Which instruction should the nurse include in the teaching? A) "Your inhaler is intended to prevent asthma attacks, not treat them." B) "If you develop a respiratory infection, the beclomethasone will help prevent pneumonia from developing." C) "Use your inhaler when you feel like you are experiencing acute symptoms associated with asthma." D) "You can take an additional puff of your inhaler if you have an acute asthma attack."

A) "Your inhaler is intended to prevent asthma attacks, not treat them." Rationale: It is important for clients to understand the intended use of prescribed treatment. The inhaled corticosteroid beclomethasone is used only as a preventative therapy.

A parent asks the nurse what factors contributed to their 2-month-old infant contracting bronchiolitis. Which non-modifiable risk factor should the nurse discuss with the parent? A) Age B) Crowded living conditions C) Inhalation of secondhand smoke D) Gender

A) Age Rationale: A non-modifiable risk factor for bronchiolitis is a young age. The condition mostly affects children under 2 years of age, with infants less than 3 months being at the highest risk.

The nurse is assessing a 2-year-old client with croup 30 minutes after administering humidified oxygen, racemic epinephrine through a nebulizer, and dexamethasone IM. Which clinical finding should the nurse *immediately* report to the health provider? A) Diminished breath sounds B) Excessive crying C) Temperature of 101.6℉ (38.6℃) D)Respirations of 36

A) Diminished breath sounds Rationale: The nurse should immediately notify the health care provider of the client's diminished breath sounds. Diminished breath sounds are a symptom associated with severe croup and occur because the client is experiencing an inability to keep up with an adequate respiratory effort. Inadequate ventilation can lead to respiratory acidosis and failure.

The nurse is preparing to assess an infant with respiratory syncytial virus (RSV) bronchiolitis. Which finding(s) should the nurse anticipate? *Select all that apply* A) Diminished breath sounds B) Intercostal retractions C) Wheezing D) Muffled heart sounds E) Distended abdomen

A) Diminished breath sounds B) Intercostal retractions C) Wheezing Rationale: As the respiratory syncytial virus (RSV) enters the body, it travels down the respiratory tract to the bronchioles and invades its epithelial cells, turning them into a virus factory and ultimately killing them. This viral invasion attracts immune cells which cause an inflammatory reaction that leads to swelling and narrowing of the airway, as well as increased mucus production. The mucus, along with the dead epithelial cells, creates a plug that can obstruct the airway and cause the alveoli to deflate, leading to atelectasis. The plug can also allow air to enter the lungs via inhalation but not leave via exhalation. As a result, the lungs become more inflated with each inhalation, known as air-trapping. When this occurs, wheezing, dyspnea, intercostal retractions, and diminished breath sounds can be noted.

The nurse is monitoring a client receiving treatment for cystic fibrosis. Which assessment finding should the nurse immediately report to the health care provider? A) Fasting glucose 145 mg/dL B) Temperature of 99.8℉ (37.6℃) C) Oxygen saturation 96% D) White blood cell count of 5500mm3

A) Fasting glucose 145 mg/dL Rationale: The nurse should report abnormal laboratory findings such as fasting glucose greater than 130 mg/dL. Elevated fasting glucose indicates that the pancreas may not be producing enough insulin because injury has occurred from the disease.

Which nursing diagnosis is the nurse's priority when caring for a small child diagnosed with epiglottitis? A) Ineffective airway clearance related to airway inflammation B) Compromised parental coping related to sudden onset of child's acute illness C) Risk for deficient fluid volume related to decreased intake, fever, and increased work of breathing D) Anxiety related to sudden onset of acute illness

A) Ineffective airway clearance related to airway inflammation Rationale: In clients diagnosed with epiglottitis, ineffective airway clearance related to airway inflammation is the nurse's priority. Using the prioritization model of airway, breathing, circulation (ABC), protecting and maintaining clients' airways is the main concern.

A 5-year-old client is brought to the emergency department by their mother for a persistent cough. The child is diagnosed with pertussis. Which instruction(s) should the nurse include in their teaching plan? Select all that apply. A) Infection can recur if the child does not get vaccinated B) Difficulty breathing is expected and does not require emergency treatment C) Humidified air can help relieve cough symptoms D) The child may continue to cough despite treatment E) Spread of infection can be prevented through handwashing

A) Infection can recur if the child does not get vaccinated C) Humidified air can help relieve cough symptoms D) The child may continue to cough despite treatment E) Spread of infection can be prevented through handwashing Rationale: Family education should teach them that infection with pertussis does not provide lifelong protection from future illness and that scheduled immunizations and boosters are still recommended. Also, the nurse should encourage them to verify or update their immunization status. One of the best ways to prevent whooping cough in the newborn is to ensure pregnant women are vaccinated before delivery to spread passive immunity to the fetus since n newborns cannot receive their first vaccination against pertussis until two months old and are vulnerable to the disease.Next, the nurse should let them know that their child's cough symptoms may linger after treatment and that they can reduce cough symptoms by avoiding environmental triggers like dust and smoke by keeping a humidifier in the room and encouraging the child to rest.The nurse should be sure to remind them of the importance of preventing the spread of infection by practicing frequent hand washing, covering their mouth when coughing or sneezing, wearing a mask, and socially distancing.Lastly, the nurse should instruct them to notify the healthcare provider if their child has difficulty breathing or if there's a change in their child's behavior, such as listlessness or not wanting to eat or drink.

A 6-year-old client is brought to the emergency room by the caregiver with reports of a sore throat and fever and is diagnosed with epiglottitis. Which symptom(s) should the nurse anticipate will be present during the assessment? *Select all that apply.* A) Inspiratory stridor B) Drooling C) Bronchorrhea D) Muffled voice E) Diaphoresis

A) Inspiratory stridor B) Drooling D) Muffled voice E) Diaphoresis

The nurse is preparing to assess a 3-year-old client with croup. Which clinical finding(s) should the nurse correlate with the diagnosis? *Select all that apply.* A) Inspiratory stridor B) Hoarse voice C) Myalgia D) Barking cough E) Neck rigidity

A) Inspiratory stridor B) Hoarse voice C) Myalgia D) Barking cough Rationale: Clients with croup experience inflammation, edema, and mucus secretion, leading to narrowing of the subglottic area, which is composed of the lower part of the vocal cords and the upper trachea. When the airway becomes significantly narrowed, it results in hoarseness, a harsh, high-pitched sound during inspiration referred to as inspiratory stridor and a distinctive seal-like, barking cough. Nasal flaring, substernal, subcostal, or intercostal retractions occur as the child works hard to breathe past the narrowed airway.

The nurse is providing parental education about croup. Which sign(s) or symptom(s) should the nurse include in the teaching? *Select all that apply.* A) Sore throat B) Poor appetite C) Fever D) Rhinorrhea E) Rash

A) Sore throat B) Poor appetite C) Fever D) Rhinorrhea Rationale: Signs and symptoms of croup include hoarseness, a harsh, high-pitched sound during inspiration referred to as inspiratory stridor, and a distinctive seal-like barking cough. Nasal flaring, substernal, subcostal, or intercostal retractions occur as the child works hard to breathe in air past the narrowed airway. Crying and agitation causes increased oxygen demand and further airway obstruction.

The nurse is caring for a child diagnosed with epiglottitis. The child's mother asks the nurse, "How did my child get sick with this?" Which common cause(s) should the nurse include in the response? *Select all that apply* A) Staphylococcus aureus B) Streptococcus pneumoniae C) Pet dander D) Hot liquids E) Escherichia coli

A) Staphylococcus aureus B) Streptococcus pneumoniae D) Hot liquids Rationale: The most common cause of epiglottitis used to be Haemophilus influenzae type b, but this has become less common due to increased childhood vaccination. Streptococcus pneumoniae and Staphylococcus aureus are now the most common causes in the United States. Epiglottitis can also be caused by viral and fungal infections or non-infectious triggers such as smoke, hot foods or liquids, and foreign bodies.

The nurse has described the physiology of the exocrine glands to a nursing student. Which statement made by the student indicates an understanding of the teaching? A) "The cystic fibrosis transmembrane conductance regulator protein (CFTR) is responsible for thickening exocrine secretions." B) "Exocrine glands are found throughout the body. They are responsible for secretion like when bile is secreted in the gastrointestinal tract." C) "Exocrine glands are responsible for creating and secreting hormones throughout the body." D) "Cystic fibrosis transmembrane conductance regulator protein (CFTR) is a protein that pumps sodium ions out of the cell to help draw water out."

B) "Exocrine glands are found throughout the body. They are responsible for secretion like when bile is secreted in the gastrointestinal tract."

The nurse is conducting health promotion teaching with a parent of a 6-month-old client with respiratory syncytial virus (RSV) bronchiolitis. Which statement made by the parent indicates further education is needed? A) "I will notify the healthcare provider if my baby has less than six wet diapers a day." B) "If my baby has a pause in breathing for more than ten seconds, I will seek help immediately. " C) "I will keep my baby home from the daycare center until he is better." D) "If my baby turns blue, I will call emergency services."

B) "If my baby has a pause in breathing for more than ten seconds, I will seek help immediately. " Rationale: If the infant has a pause in breathing for more than 15-20 seconds, the parent should seek treatment for the client immediately. Prolonged pauses in respirations result in a decrease in oxygenation. A ten second pause is an acceptable finding.

The nurse is educating a nursing student about the pathological process of airway obstruction in children. Which statement by the student indicates teaching has been successful? A) "The gag reflex is not fully developed in children under two-years-old." B) "In children, the airway is smaller in diameter than in adults." C) "The mucous membranes of the upper respiratory tract are more easily inflamed in children." D) "The cough reflex is slower in children than adults."

B) "In children, the airway is smaller in diameter than in adults." Rationale: It can happen to anyone, but airway obstruction occurs most commonly in young children who have smaller airway diameters than adults. An airway that is small in diameter puts children at risk for airway obstruction because small foreign objects, such as nuts or coins, can easily get lodged in the airway.

A pediatric client presents to the emergency department with an ongoing cough following recent exposure to pertussis. The child's parent is concerned that the child may have pertussis and asks the nurse, "What is pertussis?" What is the nurse's best response? A) "Pertussis is an inflammatory condition which results in inflammation of blood vessels throughout the body." B) "Pertussis is also known as whooping cough. It is an acute respiratory infection caused by the bacteria Bordetella pertussis." C) "Pertussis is a bacterial infection of the lower lung that causes fluid to accumulate in the parenchyma of the lung." D) "Pertussis is an infection of the upper airways that causes a 'barking' cough."

B) "Pertussis is also known as whooping cough. It is an acute respiratory infection caused by the bacteria Bordetella pertussis." Rationale: Pertussis, also known as whooping cough, is an acute respiratory infection caused by Bordetella pertussis. The disease is characterized by paroxysmal cough, which includes fits of sudden and periodic cough and abundant respiratory secretions. It can affect people of all ages, but it can be particularly severe and even life-threatening in children younger than six months.

The nurse is caring for a young child diagnosed with bacterial epiglottitis. Which clinical finding(s) indicate(s) to the nurse that the client is likely experiencing a serious complication of epiglottitis? *Select all that apply.* A) Pyrexia B) Acidosis C) Hypercapnia D) Hypoxia E) loss of consciousness

B) Acidosis C) Hypercapnia D) Hypoxia E) loss of consciousness Rationale: Severe airway obstruction is a potential complication of epiglottitis and can lead to hypoxia, hypercapnia, and acidosis, followed by loss of consciousness and death.

Which organism(s) should the nurse recognize as a common cause of croup? *Select all that apply* A) Varicella zoster virus B) Adenovirus C) Respiratory syncytial virus D) Human papillomavirus E) Parainfluenza

B) Adenovirus C) Respiratory syncytial virus E) Parainfluenza Rationale: Croup is an inflammation of the upper airway, typically caused by a virus, such as parainfluenza, adenovirus, influenza A or B, or respiratory syncytial virus (RSV).

A pediatric client is diagnosed with pertussis. The child's mother asks the nurse how the child developed this condition. Which risk factor for pertussis should the nurse educate the child's mother? A) Head injury before the age of five B) Close contact with an infected individual C) Group B streptococcus infection D) Secondhand smoking in the household

B) Close contact with an infected individual Rationale: Because pertussis is a bacterial infection spread through respiratory droplets, close contact with infected individuals puts clients at risk of contracting the infection.

A ten-year-old w/ asthma is treated for acute exacerbation in the ED. The nurse caring for the child would monitor for which sign, knowing that it indicates a worsening of the condition? A) Warm, dry skin B) Decreased wheezing C) Pulse rate of 90 BPM D) Respirations of 18 breaths per min

B) Decreased wheezing Rationale: Decreased wheezing in a child w/ asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode.

The nurse is caring for a 6-month-old infant diagnosed with respiratory syncytial virus (RSV) bronchiolitis. Which complication is the highest priority for the nurse to monitor the client for? A) Pyrexia B) Hypoxia C) Weight loss D) Irritability

B) Hypoxia

The nurse is caring for a 2-year-old client newly diagnosed with croup. Which is the priority nursing diagnosis for this client? A) Fear related to difficulty breathing and unfamiliar surroundings B) Ineffective breathing pattern related to upper airway inflammation and obstruction C) Deficient parental knowledge related to unfamiliarity with the disease process and treatments D) Fluid volume deficit related to decreased fluid intake, fever, and increased respiratory rate

B) Ineffective breathing pattern related to upper airway inflammation and obstruction Rationale: Ineffective breathing pattern related to upper airway inflammation and obstruction is the priority nursing diagnosis. When prioritizing nursing diagnosis, the nurse should focus on immediate, life-threatening situations, such as the ineffective breathing pattern resulting from airway inflammation and obstruction. Airway inflammation and obstruction are associated with a risk for respiratory arrest.

The pediatric nurse is reviewing medications prescribed to treat respiratory syncytial virus (RSV) with a nursing student. Which classification of medication should the nurse include in the teaching? A) Anticholinergic bronchodilators B) Monoclonal antibodies C) Protease inhibitors D) Aminoglycosides

B) Monoclonal antibodies Rationale: There are two main classes of medication used in the treatment of RSV infection; these include monoclonal antibodies like palivizumab, and antiviral medications like ribavirin.

The nurse is caring for a infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the *most appropriate* nursing action? A) Initiate strict enteric precautions B) Move the infant to a private room C) Leave the infant in the present room, because RSV is not contagious D) Inform the staff that using standard precautions is all that is necessary when caring for the child

B) Move the infant to a private room

When auscultating the lungs of a client with croup, the nurse hears a high-pitched, whistling sound when the client inhales. When documenting the client's lung sounds, which term should the nurse use? A) Rhonchi B) Stridor C) Wheezing D) Fine crackles

B) Stridor

When auscultating the lungs of a client with croup, the nurse hears a high-pitched, whistling sound when the client inhales. When documenting the client's lung sounds, which term should the nurse use? A) Fine crackles B) Stridor C) Wheezing D) Rhonchi

B) Stridor Rationale: When the airway of a client with croup becomes significantly narrowed, it results in hoarseness, a harsh, high-pitched sound during inspiration referred to as inspiratory stridor, and a distinctive seal-like barking cough.

An 11-month-old male is brought to the emergency department and is experiencing a partial airway obstruction. His parents state, "Our son was playing on the floor when he started to cough and choke!" Which assessment finding indicates that the child may be experiencing a major complication of foreign body aspiration? A) Continuous drooling B) Sudden absence of stridor C) Hoarse voice D) Inconsolable crying

B) Sudden absence of stridor Rationale: A sudden absence of breath sounds, including stridor, indicates clients have a fully obstructed airway. Clients with a partially obstructed airway may have diminished breath sounds or stridor because they can still breathe in air. A sudden resolution of stridorous breathing may indicate the partial airway obstruction has advanced to complete airway obstruction. This is a medical emergency.

The ED nurse is caring for a child diagnosed with epiglottitis. In assessing the child, the nurse would monitor for which indication that the child may be experiencing airway obstruction? A) The child exhibit nasal flaring and bradycardia. B) The child is leaning forward, with the chin thrust out. C) The child has a low-grade fever and complains of a sore throat. D) The child is leaning backward, supporting self with the hands and arms.

B) The child is leaning forward, with the chin thrust out. Rationale: Clinical manifestations of airway obstruction include tripod positioning, nasal flaring, the use of accessory muscles for breathing, and the presence of stridor. Epiglottitis causes tachycardia and a high fever.

The parent of a hospitalized 2-year-old child with viral croup asks the nurse why the pediatrician did not prescribe antibiotics. Which response would the nurse make? A) "The child may be allergic to antibiotics." B) "The child is too young to receive antibiotics." C) "Antibiotics are not indicated unless bacterial infection is present." D) "the child still has the maternal antibodies from birth and does not need antibiotics."

C) "Antibiotics are not indicated unless bacterial infection is present."

The nurse in the emergency department has provided discharge education for the parents of a 4-year-old child with croup. Which statement by the parent indicates an understanding of the information? A) "I will remove the pillow in the bed so my child can lay flat when sleeping." B) "I will make a follow-up appointment just if my child's symptoms get worse." C) "I will make sure the air in the home is humidified and cool." D) "I will come back to the emergency department if my child develops a fever."

C) "I will make sure the air in the home is humidified and cool." Rationale: For clients with croup, cool, humidified air keeps the secretions in the airway moistened, decreases the viscosity, and soothes the inflamed airways.

A nursing student asks the nurse, "What medications are used to treat respiratory syncytial virus (RSV)?" How should the nurse respond? Select the correct answer for each fill-in-the-blank. "The most common medications used to treat RSV are ______________ *(palivizumab / doxycycline / fluconazole)* which is a monoclonal antibody and ______________ *(ribavirin / mebendazole / valacyclovir)* which is an antiviral medication."

"The most common medications used to treat RSV are *palivizumab* which is a monoclonal antibody and *ribavirin* which is an antiviral medication."

Which is the nurse ' s best response to a parent who asks what can be done at home to help an infant with upper respiratory infection (URI) symptoms and a fever get better? 1. "Give your child small amounts of fluid every hour to prevent dehydration." 2. "Give your child Robitussin at night to reduce his cough and help him sleep." 3. "Give your child a baby aspirin every 4 to 6 hours to help reduce the fever." 4. "Give your child an over-the-counter cold medicine at night."

1. "Give your child small amounts of fluid every hour to prevent dehydration." It is essential that parents ensure their children remain hydrated during a URI. The best way to accomplish this is by giving small amounts of fl uid frequently.

Which would be appropriate nursing care management of a child with the diagnosis of mononucleosis? 1. Only family visitors. 2. Bedrest. 3. Clear liquids. 4. Limited daily fluid intake.

1. Only family visitors. Children with mononucleosis are more susceptible to secondary infections. Therefore, they should be limited to visitors within the family, especially during the acute phase of illness.

What does the therapeutic management of cystic fibrosis (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 complications. 5. Encouraging medication compliance.

1. Providing a high-protein, high-calorie diet. 3. Encouraging exercise. 4. Minimizing pulmonary complications. 5. Encouraging medication compliance.

What would the nurse advise the parent of a child with a barky cough that gets worse at night? 1. Take the child outside into the more humid night air for 15 minutes. 2. Take the child to the ED immediately. 3. Give the child an over-the-counter cough suppressant. 4. Give the child warm liquids to soothe the throat.

1. Take the child outside into the more humid night air for 15 minutes. The humid 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.

Which laboratory result will provide the most important information regarding the respiratory status of a child with an acute asthma exacerbation? 1. CBC. 2. ABG. 3. BUN. 4. PTT.

2. ABG.

Which is the nurse's best response to the parent of an infant diagnosed with *the first* otitis media who wonders about long-term effects? 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. "The child could suffer recurrent ear infections." When children acquire an ear infection at such a young age, there is an increased risk of recurrent infections.

The parent of a child with cystic fibrosis (CF) asks the nurse what will be done to relieve the child ' s constipation. Which is the nurse ' s best response? 1. "Your child likely has an obstruction and will require surgery." 2. "Your child will likely be given IV fl uids." 3. "Your child will likely be given MiraLAX." 4. "Your child will be placed on a clear liquid diet."

3. "Your child will likely be given MiraLAX."

A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? Select all that apply. 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. 5. Providing humidity, and propping the head of the bed up.

3. Instilling saline nose drops and bulb suctioning. 5. Providing humidity, and propping the head of the bed up.

Which physical findings would be of most concern in an infant with respiratory distress? 1. Tachypnea. 2. Mild retractions. 3. Wheezing. 4. Grunting.

4. Grunting.

A chloride level greater than _____________________ is a positive diagnostic indicator of cystic fibrosis (CF).

60 mEq/L

The nurse has explained the pathophysiology of cystic fibrosis to a nursing student. Which statement indicates an understanding of the information? A) "A client with cystic fibrosis is at risk for gallstone formation because peristalsis in the digestive system is decreased." B) "In the female reproductive system, abnormal mucus production can block the fallopian tubes causing infertility." C) "Impaired bone development can occur due to a combination of factors associated with cystic fibrosis." D) "The lack of digestive enzymes in the small intestine can cause malabsorption related to diarrhea."

C) "Impaired bone development can occur due to a combination of factors associated with cystic fibrosis." Rationale: In the skeletal system, a combination of factors, including frequent infections, poor absorption of calcium and fat-soluble vitamins like vitamin D and K, and reproductive abnormalities, can impair bone development, causing lower bone mineral density and osteoporosis.

The nurse is preparing to educate a client diagnosed with asthma and recently prescribed a beclomethasone inhaler. Which instruction should the nurse include in the teaching? A) "You can take an additional puff of your inhaler if you have an acute asthma attack." B) "If you develop a respiratory infection, the beclomethasone will help prevent pneumonia from developing." C) "Your inhaler is intended to prevent asthma attacks, not treat them." D) "Use your inhaler when you feel like you are experiencing acute symptoms associated with asthma."

C) "Your inhaler is intended to prevent asthma attacks, not treat them." Rationale: It is important for clients to understand the intended use of prescribed treatment. The inhaled corticosteroid beclomethasone is used only as a preventative therapy.

The nurse is preparing to review the electronic health record (EHR) of a client with respiratory syncytial virus (RSV) bronchiolitis. When evaluating the laboratory findings, which test result should the nurse associate with the client's condition? A) Throat culture positive for streptococcus A B) Infiltrates noted on a chest X-ray C) A positive rapid antigen detection test (RADT) D) Pulmonary lesions noted on a chest computed tomography (CT) scan

C) A positive rapid antigen detection test (RADT) Rationale: A client with RSV will have a positive RADT, which detects the presence of a virus.

The nurse is caring for a 3-month-old client who has respiratory syncytial virus (RSV) bronchiolitis, nasal congestion, and is receiving intravenous (IV) fluid to correct dehydration. Current Vital Signs: Heart rate 128/min Respiratory rate 38/min Pulse oximetry 98% on room air Temperature 37.1℃ (98.8℉) Neonatal/Infants Pain Scale score 0 Based on the assessment findings, which treatment intervention should the nurse implement? A) Administer supplemental oxygen B) Administer a prescribed acetaminophen C) Set up a cool-mist humidifier D) Hold feedings until the IV infusion is complete

C) Set up a cool-mist humidifier Rationale: The nurse should set up a cool-mist humidifier to help keep the client more comfortable. The purpose of a cool-mist humidifier is to add moisture to the air to help decrease congestion. The client does not require supplemental oxygen. The respiratory rate is within the acceptable limits of 30 to 60 breaths per minute and the oxygen saturation rate is within the acceptable range of 95% to 100%. There is no indication the client requires acetaminophen. Acetaminophen is administered to infants with RSV bronchiolitis to help decrease fever and pain. The client does not have a fever as the temperature is within an acceptable range of 36.5°C (97.8°F) to 37.2°C (99.0°F) and the Neonatal/Infants Pain Scale score is 0. There is no reason to hold any feedings unless the infant is experiencing respiratory distress. The client is being treated for dehydration and requires feedings to promote hydration and nutritional intake for healing.

An 11-month-old male is brought to the emergency department and is experiencing a partial airway obstruction. His parents state, "Our son was playing on the floor when he started to cough and choke!" Which assessment finding indicates that the child may be experiencing a major complication of foreign body aspiration? A) Continuous drooling B) Inconsolable crying C) Sudden absence of stridor D) Hoarse voice

C) Sudden absence of stridor Rationale: A sudden absence of breath sounds, including stridor, indicates clients have a fully obstructed airway. Clients with a partially obstructed airway may have diminished breath sounds or stridor because they can still breathe in air. A sudden resolution of stridorous breathing may indicate the partial airway obstruction has advanced to complete airway obstruction. This is a medical emergency.

The nurse is caring for a client suspected of having cystic fibrosis. Which diagnostic testing should the nurse prepare for the client? A) Polymerase chain reaction (PCR) B) Rapid plasma reagin (RPR) C) Sweat chloride test D) 24-hour urine cortisol

C) Sweat chloride test Rationale: The gold standard test to diagnose cystic fibrosis is a sweat chloride test, which helps detect high amounts of chloride ions in the sweat of a client with cystic fibrosis.

The nurse is caring for a 2-year-old client newly diagnosed with croup. Which is the priority nursing diagnosis for this client? A) Deficient parental knowledge related to unfamiliarity with the disease process and treatments B) Fear related to difficulty breathing and unfamiliar surroundings C) Fluid volume deficit related to decreased fluid intake, fever, and increased respiratory rate D) Ineffective breathing pattern related to upper airway inflammation and obstruction

D) Ineffective breathing pattern related to upper airway inflammation and obstruction Rationale: Ineffective breathing pattern related to upper airway inflammation and obstruction is the priority nursing diagnosis. When prioritizing nursing diagnosis, the nurse should focus on immediate, life-threatening situations, such as the ineffective breathing pattern resulting from airway inflammation and obstruction. Airway inflammation and obstruction are associated with a risk for respiratory arrest.

A child with croup is placed in a cool mist tent. The parent becomes concerned because the child is frightened, consistently crying and trying to climb out of the tent. Which is the *most appropriate* nursing action? A) Tell the parent the child must stay in the tent. B) Pace a toy in the tent to make the child feel more comfortable. C) Call the pediatrician and request a mild sedative. D) Let the parent hold the child and direct the cool mist over the child's face.

D) Let the parent hold the child and direct the cool mist over the child's face.

The nurse is reviewing the medication list of a client with chronic bronchial asthma. Which medication should the nurse recognize as a leukotriene modifier? A) Ipratropium bromide B) Albuterol C) Salmeterol/fluticasone D) Montelukast

D) Montelukast Rationale: Montelukast is a leukotriene modifier that interferes with the inflammatory process of the airways. The medication suppresses leukotrienes which cause bronchoconstriction and vasodilation. Leukotriene modifiers improve airflow and are maintenance medications for chronic asthma.

The nurse has admitted a client to the unit with a history of cystic fibrosis who has developed pneumonia. What is the nurse's *priority* action? A) Prepare the client for chest x-ray B) Obtain a blood glucose C) Initiate the administration of prescribed aerosolized gentamicin 80 mg D) Perform a focused respiratory assessment

D) Perform a focused respiratory assessment Rationale: The nurse's priority for a client with cystic fibrosis admitted for pneumonia is to begin by assessing the client's vital signs, focusing on their respiratory status. The nurse should check for chest congestion, cough, and sputum production, then assess the oxygen saturation, rate and depth of breathing, breath sounds, and use of accessory muscles.