Ch 40 The Child with a Respiratory Alteration

14. Teaching safety precautions with the administration of antihistamines is important because of what common side effect? a. Dry mouth b. Excitability c. Drowsiness d. Dry mucous membranes

ANS: C Feedback A A dry mouth is not a safety issue. B Excitability may affect rest or sleep, but drowsiness is the most important safety hazard. C Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver. Nonsedating brands should be used. D Dry mucous membranes are not a safety issue.

8. Which intervention for treating croup at home should be taught to parents? a. Have a decongestant available to give the child when an attack occurs. b. Have the child sleep in a dry room. c. Take the child outside. d. Give the child an antibiotic at bedtime.

ANS: C Feedback A Decongestants are inappropriate for croup, which affects the middle airway level. B A dry environment may contribute to symptoms. C Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms. D Croup is caused by a virus. Antibiotic treatment is not indicated.

22. What is a common trigger for asthma attacks in children? a. Febrile episodes b. Dehydration c. Exercise d. Seizures

ANS: C Feedback A Febrile episodes are consistent with other problems, for example, seizures. B Dehydration occurs as a result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for asthma. C Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. D Seizures can result from a too-rapid intravenous infusion of theophylline—a therapy for asthma.

38. Which finding confirms a diagnosis of cystic fibrosis? a. Chest radiograph shows alveolar hyperinflation. b. Stool analysis indicates significant amounts of fecal fat. c. Sweat chloride is greater than 60 mEq/L. d. Liver function levels are abnormal.

ANS: C Feedback A Hyperinflation is one of the first findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a diagnosis. B A 72-hour fecal fat determination may be included in a diagnostic workup. Inability to secrete digestive enzymes causes steatorrhea. C The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than 60 mEq/L is considered diagnostic for cystic fibrosis. D Liver function tests may be part of the diagnostic workup for cystic fibrosis.

36. A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules. The nurse should teach parents to mix enzymes with: a. Macaroni and cheese b. Tapioca c. Applesauce d. Hot chocolate

ANS: C Feedback A Macaroni and cheese is not a good choice because enzymes are inactivated by heat and starchy foods. B Tapioca is not a good choice because enzymes are inactivated by starchy foods. C Enzymes can be mixed with a small amount of nonacidic foods. D Enzymes are less effective if mixed with foods that are hot.

2. The childhood vaccine ____________________ has dramatically reduced the incidence of epiglottitis.

ANS: H. influenzae type B (HIB) vaccine The nurse should encourage parents of young children to have their children immunized against H. influenzae to decrease the risk for contracting epiglottitis. Prophylaxis with rifampin is given to underimmunized contacts or family members younger than 4 years old and to any child contact who is immune depressed.

1. As a child with asthma struggles to get enough air, the respiratory rate increases (tachypnea). Tachypnea lowers the carbon dioxide levels in the blood. This is known as _____________.

ANS: hypocapnia As the child tires from the increased work of breathing, hyperventilation occurs and carbon dioxide levels increase. Increased levels of carbon dioxide in the blood (hypercapnia) during an asthma episode may be a sign of severe airway obstruction and impending respiratory failure.

26. 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 a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

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

19. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

ANS: A Feedback A Children with asthma usually have these chronic symptoms. B Pneumonia appears with an acute onset and fever and general malaise. C Bronchiolitis is an acute condition caused by RSV. D Foreign body in the trachea will occur with an acute respiratory distress or failure and maybe stridor.

40. An infant's parents ask the nurse about preventing OM. What 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 Feedback A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. B Nasal decongestants are not useful in preventing OM. C Children with uncomplicated OM are not contagious unless they show other upper respiratory infection (URI) symptoms. D Children should be fed in an upright position to prevent OM.

6. The nurse should assess a child who has had a tonsillectomy for a. Frequent swallowing b. Inspiratory stridor c. Rhonchi d. Elevated white blood cell count

ANS: A Feedback A Frequent swallowing is indicative of postoperative bleeding. B Inspiratory stridor is characteristic of croup. C Rhonchi are lower airway sounds indicating pneumonia. D Assessment of blood cell counts is part of a preoperative workup.

11. What sign is indicative of respiratory distress in infants? a. Nasal flaring b. Respiratory rate of 55 breaths/min c. Irregular respiratory pattern d. Abdominal breathing

ANS: A Feedback A Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied by extra respiratory efforts. It also allows more air to enter as the nares flare. B A respiratory rate of 55 breaths/min is a normal assessment for an infant. Tachypnea is a respiratory rate of 60 to 80 breaths/min. C Irregular respirations are normal in the infant. D Abdominal breathing is common because the diaphragm is the neonate's major breathing muscle.

3. The nurse expects the initial plan of care for a 9-month-old child with an acute otitis media infection to include a. symptomatic treatment and observation for 48 to 72 hours after diagnosis b. an oral antibiotic, such as amoxicillin, five times a day for 7 days c. pneumococcal conjugate vaccine d. myringotomy with tympanoplasty tubes

ANS: A Feedback A Select children 6 months of age or older with acute otitis media are treated by initiating symptomatic treatment and observation for 48 to 72 hours. B Acute otitis media may be treated with a 5- to 10-day course of oral antibiotics. When treatment is indicated, amoxicillin at a divided dose of 80 to 90 mg/kg/day given either every 8 or 12 hours for 5 to 10 days may be ordered. C Pneumococcal conjugate vaccine helps to prevent ear infections but is not included in the initial plan of care for a child with acute otitis media. D Surgical intervention is considered when the child has persistent ear infection despite antibiotic therapy or with otitis media with effusion that persists for more than 3 months and is associated with hearing loss.

27. Which classification of drugs is used to relieve an acute asthma episode? a. Short-acting beta2-adrenergic agonist b. Inhaled corticosteroids c. Leukotriene blockers d. Long-acting bronchodilators

ANS: A Feedback A Short-acting beta2-adrenergic agonist is the first medication administered. Later, systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short courses of 5 to 7 days. B Inhaled corticosteroids are used for long-term, routine control of asthma. C Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. D A long-acting bronchodilator would not relieve acute symptoms.

5. The father of an infant calls the nurse to his son's room because he is "making a strange noise." A diagnosis of laryngomalacia is made. What does the nurse expect to find on assessment? a. Stridor b. High-pitched cry c. Nasal congestion d. Spasmodic cough

ANS: A Feedback A Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying. B High-pitched cries are consistent with neurologic abnormalities and are not usually respiratory in nature. C Nasal congestion is nonspecific in relation to laryngomalacia. D Spasmodic cough is associated with croup; it is not a common symptom of laryngomalacia.

28. The nurse getting an end-of-shift report on a child with status asthmaticus should question which intervention? a. Administer oxygen by nasal cannula to keep oxygen saturation at 100%. b. Assess intravenous (IV) maintenance fluids and site every hour. c. Notify physician for signs of increasing respiratory distress. d. Organize care to allow for uninterrupted rest periods.

ANS: A Feedback A Supplemental oxygen should not be administered to maintain oxygen saturation at 100%. Keeping the saturation around 95% is adequate. Administration of too much oxygen to a child may lead to respiratory depression by decreasing the stimulus to breathe, leading to carbon dioxide retention. B When the child cannot take oral fluids because of respiratory distress, IV fluids are administered. The child with a continuous IV infusion must be assessed hourly to prevent complications. C A physician should be notified of any changes indicating increasing respiratory distress. D A child in respiratory distress is easily fatigued. Nursing care should be organized so the child can get needed rest without being disturbed.

29. What is 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 Feedback 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. B History of malabsorption is a later sign that manifests as failure to thrive. C Foul-smelling stools are a later manifestation of CF. D Recurrent respiratory infections are a later sign of CF.

24. What explanation should the nurse give to the parent of a child with asthma about using a peak flow meter? a. It is used to monitor the child's breathing capacity. b. It measures the child's lung volume. c. It will help the medication reach the child's airways. d. It measures the amount of air the child breathes in.

ANS: A Feedback A The peak flow meter is a device used to monitor breathing capacity in the child with asthma. B A child with asthma would have a pulmonary function test to measure lung volume. C A spacer used with a metered-dose inhaler prolongs medication transit so medication reaches the airways. D The peak flow meter measures the flow of air in a forced exhalation in liters per minute.

9. A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright. What should be the nurse's first action in this situation? a. Prepare intubation equipment and call the physician. b. Examine the child's oropharynx and call the physician. c. Obtain a throat culture for respiratory syncytial virus (RSV). d. Obtain vital signs and listen to breath sounds.

ANS: A Feedback A This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. B If epiglottitis is suspected, the nurse should not examine the child's throat. Inspection of the epiglottis is only done by a physician, because it could trigger airway obstruction. C A throat culture could precipitate a complete respiratory obstruction. D Vital signs can be assessed after emergency equipment is readied.

13. Which assessment finding after tonsillectomy should be reported to the physician? a. Vomiting bright red blood b. Pain at surgical site c. Pain on swallowing d. The ability to only take small sips of liquids

ANS: A Feedback A Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the physician. B It is normal for the child to have pain at the surgical site. C It is normal for the child to have pain on swallowing. D Only clear liquids are offered immediately after surgery, and small sips are preferred.

37. The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator? a. Stool formation b. Vomiting c. Weight d. Urine output

ANS: A Feedback A When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for digestion of nutrients. B Vomiting does not affect enzyme dosaging. C The child's weight does not affect enzyme dosaging. D Urine output is not relevant to enzyme replacement.

2. What information should the nurse teach families about reducing exposure to pollens and dust? Select all that apply. a. Replace wall-to-wall carpeting with wood and tile floors. b. Use an air conditioner. c. Put dust-proof covers on pillows and mattresses. d. Keep humidity in the house above 60%. e. Keep pets outside.

ANS: A, B, C Feedback Correct Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. Incorrect A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander, but will not affect exposure to pollen and dust.

4. A nurse is planning care for an asymptomatic child with a positive tuberculin test. What should the nurse include in the plan? Select all that apply. a. Administration of daily isoniazid (INH) b. Instructing family members about administration of INH to all close contacts of the child c. Administration of the Bacillus Calmette-Guérin vaccine d. Reporting the case to the health department e. Administration of INH and rifampin (Rifadin) simultaneously

ANS: A, B, D Feedback Correct After a chest radiograph is obtained, asymptomatic children with positive tuberculin tests and no previous history of TB receive daily INH for 9 months. Asymptomatic contacts should receive INH for at least 8 to 10 weeks after contact has been broken or until a negative skin test can be confirmed (a second test is taken at least 10 weeks after the last exposure). Reporting cases of TB is required by law in all states in the United States. Incorrect Bacillus Calmette-Guérin vaccine is the only anti-TB vaccine available, but it is given only to children who have negative test results. For asymptomatic TB, only INH is administered, not both isoniazid and rifampin together. Rifampin is used if the child has resistance to isoniazid.

1. The mother of a newborn asks the nurse what causes the baby to begin to breathe after delivery. What changes in the respiratory system stimulating respirations postnatally can the nurse explain to the mother? Select all that apply. a. Low oxygen levels in the infant's blood b. Rubbing the newborn with a towel or blanket c. Surfactant, a special lubricant in the lungs d. Increased blood flow to the infant's lungs e. Cold environment in the delivery room

ANS: A, B, E Feedback Correct A postnatal change in the respiratory system is the stimulation of respiration by hypoxemia, hypercarbia, cold, tactile stimulation, and a possible decrease in the concentration of prostaglandin E2. Incorrect Surfactant in the lungs lowers surface tension and facilitates lung expansion. It does not stimulate respirations. Pulmonary blood flow increases after birth, but this does not stimulate respirations in the newborn.

3. The nurse should implement which interventions for an infant experiencing apnea? Select all that apply. a. Stimulate the infant by gently tapping the foot. b. Shake the infant vigorously. c. Have resuscitative equipment available. d. Suction the infant. e. Maintain a neutral thermal environment.

ANS: A, C, E Feedback Correct An infant with apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available and the infant should be maintained in a neutral thermal environment. Incorrect The infant should not be shaken vigorously nor suctioned.

25. What is the best nursing response to the parent of a child with asthma who asks if his child can still participate in sports? a. "Children with asthma are usually restricted from physical activities." b. "Children can usually play any type of sport if their asthma is well controlled." c. "Avoid swimming because breathing underwater is dangerous for people with asthma." d. "Even with good asthma control, I would advise limiting the child to one athletic activity per school year."

ANS: B Feedback A Children with asthma should not be restricted from physical activity. B Sports that do not require sustained exertion, such as gymnastics, baseball, and weight lifting, are well tolerated. Children can usually play any type of sport if their asthma is well controlled. C Swimming is recommended as the ideal sport for children with asthma because the air is humidified and exhaling underwater prolongs exhalation and increases end-expiratory pressure. D If asthma is well controlled, the child can participate in any type of sport.

21. Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration? a. "I keep objects with small parts out of reach." b. "My toddler loves to play with balloons." c. "I won't permit my child to have peanuts." d. "I never leave coins where my child could get them."

ANS: B Feedback A Keeping toys with small parts and other small objects out of reach can prevent foreign body aspiration. B Latex balloons account for a significant number of deaths from aspiration every year. C Peanuts are just one of the foods that pose a choking risk if given to young children. D Small objects, such as coins, need to be put out of the small child's reach.

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

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

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

31. The infant with bronchopulmonary dysplasia (BPD) who has RSV bronchiolitis is a candidate for which treatment? a. Pancreatic enzymes b. Cool humidified oxygen c. Erythromycin intravenously d. Intermittent positive pressure ventilation

ANS: B Feedback A Pancreatic enzymes are used for patients with cystic fibrosis. B Humidified oxygen is delivered if the oxygen saturation level drops to less than 90%. C Antibiotics are ineffective against viral illnesses. Oxygen can be administered by hood, facemask, or nasal cannula. D Assisted ventilation is not necessary in the treatment of RSV infections.

35. Which statement made by a parent indicates an understanding about the genetic transmission of cystic fibrosis (CF)? a. "Only one parent carries the cystic fibrosis gene." b. "Both parents are carriers of the cystic fibrosis gene." c. "The presence of the disease is most likely the result of a genetic mutation." d. "The mother is usually the carrier of the cystic fibrosis gene."

ANS: B Feedback A The disease will not be present if only one parent is a carrier of the cystic fibrosis gene. B Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each pregnancy has a 25% chance of producing a CF-affected child. C Cystic fibrosis is known to have a definite pattern of transmission. It is transmitted as an autosomal recessive trait. D A carrier parent can transmit the carrier gene to the child. The disease is present when the carrier gene is transmitted from both parents.

20. The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

ANS: B Feedback A This is true, but not the best answer. B The family's presence will decrease the child's distress. C Although true for toddlers, the main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. D 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.

10. What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized? a. Offer the child only cool liquids. b. Offer the child her favorite warm liquid drinks. c. Use a warm mist humidifier. d. Call the physician for a respiratory rate less than 28 breaths/min.

ANS: B Feedback A Warm liquids are preferable because they help loosen secretions. B Offering the child fluids that she likes will facilitate oral intake. Warm liquids help loosen secretions. C Cool mist humidifiers are preferred to warm mist. Warm mist is a safety concern and could cause burns if touched by the child. D Typically parents are not taught to count their children's respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of less than 28 breaths/min is normal for a 3-year-old child. The expected respiratory rate for a 3-year-old child is 20 to 30 breaths/min.

7. The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup? a. Wheezing is heard audibly. b. It has a harsh, barky cough. c. It is bacterial in nature. d. The child has a high fever.

ANS: B Feedback A Wheezing is not a distinguishing manifestation of croup. It can accompany conditions such as asthma or bronchiolitis. B Spasmodic croup is viral in origin; is usually preceded by several days of symptoms of upper respiratory tract infection; often begins at night; and is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness. C Spasmodic croup is viral in origin. D A high fever is not usually present.

12. Once an allergen is identified in a child with allergic rhinitis, the treatment of choice about which to educate the parents is a. Using appropriate medications b. Beginning desensitization injections c. Eliminating the allergen d. Removing the adenoids

ANS: C Feedback A Medications are not a first-line treatment but can be helpful in controlling allergic rhinitis. B Immunotherapy is usually the final component of controlling allergic rhinitis. C The first priority is to attempt to remove the causative agent from the child's environment. D Adenoids are tissues that can swell with constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the cause is the first priority.

23. Which child requires a Mantoux test? a. The child who has episodes of nighttime wheezing and coughing b. The child who has a history of allergic rhinitis c. The child whose baby-sitter has received a tuberculosis diagnosis d. The premature infant who is being treated for apnea of infancy

ANS: C Feedback A Nighttime wheezing and coughing are consistent with a diagnosis of asthma. B Allergic rhinitis requires an allergy workup. C The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. D This infant requires a sleep study as part of the evaluation.

32. Which statement, if made by parents of a child with cystic fibrosis, indicates that they understood the nurse's teaching on pancreatic enzyme replacement? a. "Enzymes will improve my child's breathing." b. "I should give the enzymes 1 hour after meals." c. "Enzymes should be given with meals and snacks." d. "The enzymes are stopped if my child begins wheezing."

ANS: C Feedback A Pancreatic enzymes do not affect the respiratory system. B Pancreatic enzymes are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. C Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients. D Wheezing is not a reason to stop taking enzyme replacements.

4. Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis? a. "I guess my child will need to have his tonsils removed." b. "A couple of days of rest and some ibuprofen will take care of this." c. "I should give the penicillin three times a day for 10 days." d. "I am giving my child prednisone to decrease the swelling of the tonsils."

ANS: C Feedback A Surgical removal of the tonsils is a controversial issue. It may be warranted in cases of recurrent tonsillitis. It is not indicated for the treatment of acute tonsillitis. B Comfort measures such as rest and analgesics are indicated, but these will not treat the bacterial infection. C Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. D Corticosteroids are not used in the treatment of streptococcal pharyngitis.

2. For which problem should the child with chronic otitis media with effusion be evaluated? a. Brain abscess b. Meningitis c. Hearing loss d. Perforation of the tympanic membrane

ANS: C Feedback A The infection of acute otitis media can spread to surrounding tissues, causing a brain abscess. B The infection of acute otitis media can spread to surrounding tissues, causing meningitis. C Chronic otitis media with effusion is the most common cause of hearing loss in children. D Inflammation and pressure from acute otitis media may result in perforation of the tympanic membrane.

30. What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma? a. Take two puffs every 6 hours around the clock. b. Use the inhaler only when the child is short of breath. c. Use the inhaler 30 minutes before exercise. d. Take one to two puffs every morning upon awakening.

ANS: C Feedback A This schedule will not relieve exercise-induced asthma. B Waiting until symptoms are severe is too late to begin using a metered-dose inhaler. C The appropriate time to use an inhaled beta2-agonist or cromolyn is before an event that could trigger an attack. D This may be the child's usual schedule for medication. If exercise causes symptoms, additional medication is indicated.

17. What information should the nurse teach workers at a daycare center about RSV? a. RSV is transmitted through particles in the air. b. RSV can live on skin or paper for up to a few seconds after contact. c. RSV can survive on nonporous surfaces for about 60 minutes. d. Frequent handwashing can decrease the spread of the virus.

ANS: D Feedback A RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. B RSV can live on skin or paper for up to 1 hour. C RSV can live on cribs and other nonporous surfaces for up to 6 hours. D Meticulous handwashing can decrease the spread of organisms.

34. Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? a. They have a widened, shorter airway. b. There is a defect in their sucking ability. c. The gag reflex increases mucus production. d. Mucus and edema obstruct small airways.

ANS: D Feedback A The airway in infants and young children is narrower, not wider. B Sucking is not necessarily related to problems with the airway. C The gag reflex is necessary to prevent aspiration. It does not produce mucus. D The airway in infants and young children is narrower, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways.

15. What is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day? a. Chocolate ice cream b. Orange juice c. Fruit punch d. Apple juice

ANS: D Feedback A The child can have full liquids on the second postoperative day. B Citrus drinks are not offered because they can irritate the throat. C Red liquids are avoided because they give the appearance of blood if vomited. D The child can have clear, cool liquids when fully awake.

1. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse recognizes that these symptoms are characteristic of which respiratory condition? a. Allergic rhinitis b. Bronchitis c. Asthma d. Sinusitis

ANS: D Feedback A The classic symptoms of allergic rhinitis are watery rhinorrhea, itchy nose, eyes, ears, and palate, and sneezing. Symptoms occur as long as the child is exposed to the allergen. B Bronchitis is characterized by a gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough. C The manifestations of asthma may vary, with wheezing being a classic sign. The symptoms presented in the question do not suggest asthma. D Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a low-grade fever, nasal congestion and purulent nasal discharge, headache, tenderness, a feeling of fullness over the affected sinuses, halitosis, and a cough that increases when the child is lying down.

39. Which statement is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

ANS: D Feedback A The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. B Permanent hearing loss is not a frequent cause of properly treated AOM. C Intramuscular antibiotics are not necessary. Oral amoxicillin is the treatment of choice. D Historically AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting.

18. Which intervention is appropriate for the infant hospitalized with bronchiolitis? a. Position on the side with neck slightly flexed. b. Administer antibiotics as ordered. c. Restrict oral and parenteral fluids if tachypneic. d. Give cool, humidified oxygen.

ANS: D Feedback A The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. B The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary bacterial infection. C Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration. D Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea.

33. Which vitamin supplements are necessary for children with cystic fibrosis? a. Vitamin C and calcium b. Vitamin B6 and B12 c. Magnesium d. Vitamins A, D, E, and K

ANS: D Feedback A Vitamin C and calcium are not fat soluble. B B6 and B12 are not fat-soluble vitamins. C Magnesium is not a vitamin. D Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore supplements are necessary.

1. The nurse is providing education related to "Safe Sleep" to the parents of a healthy newborn infant to help prevent sudden infant death syndrome (SIDS). The nurse instructs the parents that bed sharing is not recommended; however, they should put the infant in a safe bassinet or crib in the parent's room for sleeping. Is this statement true or false?

ANS: T The American Academy of Pediatrics (AAP) recommends the following actions to help prevent SIDS in infants: place healthy infants on their backs to sleep, use mattresses with a firm sleeping surface, avoid exposing the infant to secondhand smoke, and offer a pacifier for sleep. In addition, bed sharing is not recommended, and parents are advised to put the infant in a safe bassinet or crib in the parent's room for sleeping.