CH. 40

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include: (Select all that apply.) A. lung function. B. associated allergies. C. frequency of symptoms. D. frequency and severity of exacerbations.

A. lung function. C. frequency of symptoms. D. frequency and severity of exacerbations. The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.

An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to: A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of infant with RSV unnecessary. C. prevent secondary bacterial infection. D. decrease toxicity of antiviral agents.

A. prevent respiratory syncytial virus (RSV) infection. Synagis is a monoclonal antibody specific for RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. The antibody is specific to RSV, not bacterial infection. This will have no effect on antiviral agents.

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a: A. spacer. B. nebulizer. C. peak expiratory flow meter. D. trial of chest physiotherapy

A. spacer. The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flow meter is a measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration

When caring for a child after a tonsillectomy, the nurse should: A. watch for continuous swallowing. B. encourage gargling to reduce discomfort. C. position the child on the back for sleeping. D. apply warm compresses to the throat.

A. watch for continuous swallowing. This is the most obvious early sign of bleeding from the operative site. Gargling should be avoided because of potential trauma to the suture line. The child should be positioned on the side or abdomen to facilitate drainage. Cold is preferred. Ice collars and cold liquids are encouraged.

A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.) A. Vital signs B. Throat culture C. Medical history D. Assessment of breath sounds E. Emergency airway equipment readily available

A. Vital signs C. Medical history D. Assessment of breath sounds E. Emergency airway equipment readily available Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of: A. pneumothorax. B. bronchodilation. C. carbon dioxide retention. D. increased viscosity of sputum.

A. pneumothorax. The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. He or she needs to be seen as soon as possible. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.

An immediate intervention when an infant chokes on a piece of food would be to: A. have infant lie quietly while a call is placed for emergency help. B. position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades. C. administer mouth-to-mouth resuscitation. D. give water by cup to relieve the obstruction.

B. position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. This is the correct initial sequence of actions for an infant with an obstructed airway. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child's airway is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C. The nurse suspects croup and should recommend: A. controlling fever with acetaminophen and calling if the cough gets worse during the night. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine and coming to the clinic in the morning if there is no improvement. D. admitting to the hospital and observing for impending epiglottitis.

B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency room if they develop. Cool mist is recommended to provide relief. Cough suppressants are not indicated. This is characteristic of laryngotracheobronchitis, not epiglottitis.

Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary? A. C, D B. A, E, K C. A, D, E, K D. C, folic acid

C. A, D, E, K C is not one of the fat-soluble vitamins. D also needs to be supplemented. A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. C and folic acid are not fat soluble.

Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: A. atrophic changes in the mucosal wall of intestines. B. hypoactivity of the autonomic nervous system. C. hyperactivity of the sweat glands. D. mechanical obstruction caused by increased viscosity of mucous gland secretions.

D. mechanical obstruction caused by increased viscosity of mucous gland secretions. Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas

It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent: A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever.

D. acute rheumatic fever. Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for glomerulonephritis, not nephritic syndrome. Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis.

A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: A. confirm the diagnosis of asthma. B. determine the cause of asthma. C. identify "triggers" of asthma. D. assess the severity of asthma.

D. assess the severity of asthma. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child's baseline.

One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection: A. lessens effectiveness of medications. B. encourages exercise-induced asthma. C. increases sensitivity to allergens. D. can trigger an episode or aggravate an asthmatic state.

D. can trigger an episode or aggravate an asthmatic state. The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean.

A 4-year-old girl is brought to the emergency room. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should: A. examine her oral pharynx and report to the physician. B. make her lie down and rest quietly. C. auscultate her lungs and make preparations for placement in a mist tent. D. notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

D. notify the physician immediately and be prepared to assist with a tracheostomy or intubation. Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a froglike cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates: A. liquefying secretions. B. improving oxygenation. C. promoting ventilation. D. soothing inflamed mucous membrane.

D. soothing inflamed mucous membrane. The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.