Chapter 25 - The Child with a Respiratory Disorder
The nurse identifies a nursing diagnosis of ineffective airway clearance related to inflammation and copious thick secretions. Which of the following would be the priority? a) Monitoring oxygen saturation by pulse oximeter b) Administering oxygen as ordered c) Administering analgesics as ordered d) Suctioning secretions from the airway
D.) Suctioning secretions from the airway Explanation: The priority intervention is suctioning secretions to provide a patent airway. Administering oxygen as ordered, monitoring oxygen saturation by pulse oximeter, and administering analgesics as ordered would be secondary interventions.
Marcy is 4 years old with CF. The nurse is trying to pick a method to teach Marcy a good way to exercise her lungs. Which would be the developmentally correct strategy to help Marcy? a) Teach Marcy to jump rope. b) Teach Marcy to hop on one foot. c) Teach Marcy to ride a bike. d) Teach Marcy to blow bubbles.
D.) Teach Marcy to blow bubbles. Explanation: A helpful exercise for Marcy would be to blow bubbles, a horn, or a pinwheel. This would help her exercise her lung capacity and is age appropriate for early childhood. The other exercises are all normal activities for school-aged children.
The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication? a) "I should give the enzymes before each meal or snack." b) "Between meals is the best time to give the enzymes." c) "I should reduce the dose if she has large, malodorous stools." d) "I should stop the enzymes if my child is taking antibiotics."
A.) "I should give the enzymes before each meal or snack." Explanation: The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.
The nurse is reinforcing teaching with a group of caregivers of children diagnosed with asthma. Which of the following statements best indicates an understanding of the management and treatment for this diagnosis? a) "We have taken the carpet out of our house and let my mom take our dog." b) "Even the babysitter helps us keep up the diary with her symptoms." c) "He knows how and even when he needs to use his peak flow meter." d) "The medications she takes are all in one place, ready for her to take at any time."
A.) "We have taken the carpet out of our house and let my mom take our dog." Explanation: Families must make every effort to eliminate any possible allergens from the home. Prevention is the most important aspect in the treatment of asthma. Learning how to use a peak flow meter, using a peak flow and symptom diary, and having the medications available are important aspects of treatment, but prevention is the best.
The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which of the following laboratory/diagnostic tools would likely be used to help determine the diagnosis of this child? a) Purified protein derivative test b) Sweat sodium choloride test c) Pulmonary functions test d) Blood culture and sensitivity
B.) Sweat sodium choloride test Explanation: Sweat sodium choloride tests are used for determining the diagnosis of cystic fibrosis. Purified protein derivative tests are used to detect TB. Blood culture and sensitivity is done to determine the causative agent as well as the antiinfective needed to treat an infection. Pulmonary function tests are diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs.
Which of the following age of children have a trachea 4 cm long? a) Newborn b) Toddler c) Teenager d) School-aged child
A.) Newborn Explanation: Pediatric airways are much smaller in diameter and shorter in length than in adults. A newborn trachea is 4 cm long, a toddler's is 7 cm long, and a teenager's is 12 cm long.
Which of the following is a symptom of allergic rhinitis? a) Sinus pain b) Purulent secretions c) Laryngitis d) Fever
A.) Sinus pain Explanation: The following are the symptoms that occur with allergic rhinitis: sinus pain, family history of atopy, and conjunctival pruritis.
The nurse is working with a group of caregivers of children diagnosed with asthma. Which of the following statements made by the caregivers is most accurate regarding the triggers that may cause an asthmatic attack? a) "One person told me that asthma is caused by using antibiotics for infection." b) "My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." c) "My neighbor told me that asthma attacks are caused by hot weather." d) "I always thought that a lack of exercise caused my child's asthma."
B.) "My sister and her family love animals, and when we go to their house my daughter always has an asthma attack." Explanation: Asthma may be a response to certain foods, or may be triggered by exercise or exposure to cold weather. Irritants such as wood-burning stoves, cigarette smoke, dust, pet dander, and foods such as chocolate, milk, eggs, nuts, and grains may also aggravate the condition. Additionally, infections such as bronchitis and upper respiratory infection can provoke asthma attacks. Using antibiotics to treat infections does not cause an asthmatic attack.
The nurse is admitting a child who is experiencing an asthma attack. Which of the following clinical manifestations would likely be noted in this child? a) Circumoral cyanosis b) Chest retractions c) Hoarseness d) Wheezing
D.) Wheezing Explanation: The onset of an attack can be very abrupt or can progress over several days, as evidenced by a dry hacking cough, wheezing (the sound of expired air being pushed through obstructed bronchioles), and difficulty breathing.
A worried mother calls the nurse and tells her that her son has developed a horrible croupy cough and is having trouble breathing. Which of the following would be the best intervention for the nurse to recommend to the mother? a) Administer an analgesic to the boy b) Administer cough syrup to the boy c) Run a hot shower to fill the bathroom with steam and have the boy stay there d) Have the boy drink a full glass of water to clear out the mucus
C.) Run a hot shower to fill the bathroom with steam and have the boy stay there Explanation: One emergency method of relieving croup symptoms is for a parent to run the shower or hot water tap in a bathroom until the room fills with steam, then keep the child in this warm, moist environment as this relaxes the airway tissues and widens the bronchi lumens. If this does not relieve symptoms, parents should bring the child to an emergency department for further evaluation and care. Caution parents not to give cough syrup routinely to children as many produce little effect and the risk of overdose, incorrect dosing, and adverse events is greater than the benefit of the syrup. An analgesic might help alleviate pain due to inflammation and irritation of the throat from coughing, but it is not the priority intervention in this case. Drinking would likely be painful for this child and would not provide lasting benefit.
A 6-year-old child is diagnosed as having streptococcal pharyngitis. When planning care, you should be aware that the chief danger of such an infection is that a) four out of five children develop nephrosis afterward. b) the infection may spread and cause a tooth abscess. c) lymph nodes will swell and obstruct the airway. d) a small proportion of children develop rheumatic fever.
D.) A small proportion of children develop rheumatic fever. Explanation: Certain strains of streptococci can cause a hypersensitivity reaction that results in either rheumatic fever or glomerulonephritis.
Pneumonia is a disorder involving infection and inflammation of the fine bronchioles and bronchi. a) False b) True
False Explanation: Pneumonia is a disorder involving infection and inflammation of the alveoli. Bronchitis is inflammation and infection of the fine bronchioles and bronchi.
A child is at risk for infection related to a respiratory disorder. What would the nurse educate the family on to prevent infection? a) Hygiene, hand washing b) Which friends can come and play c) The type of medication needed d) The amount of exercise the patient needs
Hygiene, hand washing Explanation: The nurse should evaluate the child and family understanding of techniques to prevent infection (hand washing, hygiene, rest, nutrition, and avoiding sick people). The other choices are important in the care of the patient but are not the number-one way to prevent the spread of infection.
Which of the following is the most accurate regarding the structure and function of the infant or child's respiratory system? a) The respiratory tract in the child is fully developed by age 2 b) Most infants are nasal breathers rather than mouth breathers c) The diameter of the child's trachea is the same as that of adults. d) Infants and young children have smaller tongues in proportion to their mouths.
Most infants are nasal breathers rather than mouth breathers Explanation: The infant is a nasal breath er and it is essential to keep the nasal passages clear to enable the infant to breath and to eat. The diameter of the infant and child's trachea is about the size of the child's little finger. The respiratory tract grows and changes until the child is about 12 years of age. Dur ing the first 5 years infants and young children have larger tongues in proportion to their mouths.
The physician orders fluorescent antibody testing for a child with suspected respiratory syncytial virus infection. The nurse would obtain the specimen for testing from which of the following? a) Nasopharyngeal secretions b) Arterial blood c) Sputum d) Sweat
Nasopharyngeal secretions Explanation: A nasopharyngeal specimen is obtained for fluorescent antibody testing. Arterial blood gases require a specimen of arterial blood. A sputum specimen is used for a sputum culture. Collection of sweat on filter paper after stimulation is used for a sweat chloride test to diagnose cystic fibrosis.
A 6-month-old infant who was born premature is being seen for a follow-up examination. The child is to receive an intramuscular injection monthly through the winter and spring season. Which of the following would the nurse expect to be ordered? a) Nedocromil b) Zanamivir c) Amantadine d) Palivizumab
Palivizumab Explanation: Palivizumab is a monoclonal antibody used for prevention of serious lower respiratory syncytial virus (RSV) disease. RSV bronchiolitis occurs most often in infants and toddlers, with a peak incidence around 6 months of age. Infants born prematurely are more at risk. The peak occurrence of bronchiolitis is in the winter and spring. Nedocromil decreases the frequency and intensity of allergic reactions. Amantadine is used to treat and prevent influenza A. Zanamivir is used to treat and prevent influenza A.
The child has been diagnosed with asthma and the child's physician is using a stepwise approach. Rank the following in order of occurrence as the child's condition worsens. The nurse administers albuterol as needed. The nurse administers a low-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid and salmeterol.
The nurse administers albuterol as needed. The nurse administers a low-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid. The nurse administers a medium-dose inhaled corticosteroid and salmeterol. Explanation: The first step is to administer a short acting beta 2-agonist as needed. The second step is to administer a low-dose inhaled corticosteroid. The third step is to administer a medium-dose inhaled corticosteroid. The fourth step is to administer a medium-dose inhaled corticosteroid and a long-acting beta 2-agonist.
The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with a) A bronchodilator and mast cell stabilizers b) Corticosteroids and leukotriene inhibitors c) Decreased activity and increased fluids d) Removal of allergens in the home and school
A.) A bronchodilator and mast cell stabilizers Explanation: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.
The most common cause of acute bronchiolitis is which of the following? a) Viral infection b) Bacterial infection c) Hereditary factors d) Prenatal complications
A.) Viral infection Explanation: Acute bronchiolitis is caused by a viral infection. Hereditary and prenatal complications do not relate to this disorder and the respiratory syncytial virus which causes the infection is not bacterial.
The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be which of the following? a) Impaired digestive activity b) Chronic lack of oxygen c) Decreased respiratory capacity d) High sodium chloride concentration in the sweat
B.) Chronic lack of oxygen Explanation: In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.
Which acute respiratory condition is the most common in early childhood? a) Asthma b) Croup c) Broncholitis d) Pneumonia
B.) Croup Explanation: Croup is the most common acute respiratory condition in early childhood (6 months to 6 years). The cardinal sign is a "barking cough." Croup is an upper airway obstruction caused by some type of inflammation.
Which of the following is a side effect of bronchodilator medications? a) Muscle cramps b) Increased heart rate c) Hypoactivity d) Smooth tone
B.) Increased heart rate Explanation: Side effects of bronchodilators include an increased heart rate, shakiness or tremors, and hyperactivity.
Pancreatic enzymes are part of the treatment in cystic fibrosis. When should the nurse administer the enzymes? a) Three times a day with water b) At night after dinner c) Before meals and snacks with milk d) Once a day
C.)Before meals and snacks with milk Explanation: Enzymes should be administered before all meals and snacks to help in normal absorption of nutrients from the food. The other choices do not promote absorption of foods or are not taken with food.
The nurse is administering medications to a child with cystic fibrosis. Which of the following methods would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? a) Shake inhaler and hold close to mouth b) Draw up in syringe and administer subcutaneously c) Pour in medication cup and have child drink d) Open capsule and sprinkle on food
D.) Open capsule and sprinkle on food Explanation: Pancreatic enzymes come in capsules that can be swallowed or opened and sprinkled on the child's food.
What is the number-one treatment for hypoxemia? a) Breathing treatment b) Antibiotics c) Fluids d) Oxygen
D.) Oxygen Explanation: Oxygen is the most indicated treatment and is needed to increase low PaO2 levels in the blood. Oxygen can be delivered by mask, nasal cannula, oxygen hood, oxygen tent, or mechanical ventilation.
The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise but the child has been having bouts of constipation and diarrhea. The nurse will teach the caregiver that which of the following likely needs adjustment in the child's diet? The amount of a) Calories from protein b) Saturated fat c) Iodized salt d) Pancreatic enzymes
D.) Pancreatic enzymes Explanation: Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.
What would the appropriate nursing intervention be for a child with an ineffective breathing pattern? a) Only give medications if condition worsens. b) Have everyone leave child's room so it isn't crowded. c) Place child in a supine position in bed. d) Provide oxygen as needed to maintain oxygen saturation above 93%.
D.) Provide oxygen as needed to maintain oxygen saturation above 93%. Explanation: Provide oxygen to increase oxygen saturation. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The other choices do not promote an open airway, decrease anxiety, or give reassurance; medications will not decrease inflammation.
The nurse is caring for a child admitted with asthma. Which of the following clinical manifestations would likely have been noted in the child with this diagnosis? a) Clubbed fingers b) Elevated temperature c) Circumoral cyanosis d) Wheezing
D.) Wheezing Explanation: Symptoms of asthma include dry hacking cough, wheezing (the sound of expired air being pushed through obstructed bronchioles), and difficulty breathing. Elevated temperature is not usually seen. Circumoral cyanosis is seen with a diagnosis of pneumonia, and clubbing of the fingers is seen in cystic fibrosis.
After tonsillectomy surgery, the preferred position of a child until fully awake is on the a) abdomen with a pillow under the chest. b) side with continuous oxygen by cannula at 30%. c) back with warm compresses applied to the throat. d) side with the head elevated.
A.) Abdomen with a pillow under the chest. Explanation: Lowering the child's head slightly and placing the child on the stomach allows mouth and throat secretions to flow out, avoiding possible aspiration and allowing for better assessment of bleeding from the surgery site.
The nurse is obtaining the history from the parents of an infant who suffered an acute life-threatening event. Which of the following would the nurse expect the parents to report? Select all that apply. a) Apnea b) Respiratory distress c) Coughing d) Wheezing e) Change in color
A.) Apnea C.) Coughing E.) Change in color Explanation: An acute life-threatening event is characterized by some combination of apnea, color change, muscle tone alteration, coughing, or gagging. Respiratory distress or wheezing would not be present.
Which of the following measures would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? a) Assisting with racemic epinephrine nebulizer therapy b) Teaching the child to take long, slow breaths c) Administering an oral analgesic d) Urging the child to continue to take oral fluids
A.) Assisting with racemic epinephrine nebulizer therapy Explanation: A bronchodilator increases the lumen of airways.
A 7-year-old child has been scheduled for a tonsillectomy. Which of the following would be most important to assess prior to surgery? a) Bleeding and clotting time b) Blood pressure both lying down and sitting up c) Specific gravity of urine d) Pulse and respiratory rate
A.) Bleeding and clotting time Explanation: Because removal of tonsils leaves a large denuded area, not a simple suture line, hemorrhage following surgery can occur.
Certain respiratory diseases in children result in hypoxia in a child. What should nurses focus on in the nursing care of these children? a) Blood gases b) Diet c) Urine output d) Vital signs
A.) Blood gases Explanation: Infants may respond to low blood oxygen levels with increased respirations followed by a period of apnea. Conditions such as bronchopulmonary dysplasia, pneumonia, and bronchiolitis can put infants at risk. Nursing care should focus on blood oxygen levels. The other choices are basic nursing assessments.
You notice that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. Which of the following would be the best intervention? a) Continue to assess for bleeding. b) Encourage the child to cough. c) Suction the back of the throat. d) Notify the physician immediately.
A.) Continue to assess for bleeding. Explanation: Children will have a small amount of blood mixed with saliva following a tonsillectomy. Suctioning or coughing could irritate the surgical site and cause hemorrhage.
Which of the following childhood diseases used to be fatal and now needs a holistic approach to care? a) Cystic fibrosis b) Pneumonia c) BPD d) Asthma
A.) Cystic fibrosis Explanation: Cystic fibrosis is a highly complex disease that is autosomal and genetic in origin, in which a mucus layer covers and blocks ducts of major organs. Survival rate has greatly improved and life expectancy has risen to 37 years after many new advances.
A nurse is applying a nasal cannula with prongs to a 10-year-old boy. Which of the following should the nurse be careful to observe for in this client? a) Development of necrosis on the nasal septum b) The device slipping and obscuring his view c) The child being scalded by the device d) Development of hypoxia in the child
A.) Development of necrosis on the nasal septum Explanation: Most children do not like nasal prongs or catheters because they are intrusive. Assess their nostrils carefully when using these as the pressure of prongs can cause areas of necrosis, particularly on the nasal septum. Masks, rather than cannulas, tend to slip and obstruct the client's view. Vaporizers, not cannulas, can cause a serious scald burn if children accidentally pull a vaporizer over on themselves. Development of hypoxia while receiving oxygen therapy is highly improbable.
Which of the following is a symptom of bacterial pharyngitis? a) Fever as high as 104 °F b) WBC in normal range c) Symptoms have a gradual onset d) Rhinitis
A.) Fever as high as 104 °F Explanation: A fever of up to 104 °F is a symptom of bacterial pharyngitis; others symptoms are an elevated white blood count (WBC), abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes.
The nurse is preparing a presentation for a local community parent group about measures to prevent the common cold. Which of the following would the nurse stress as a vital prevention measure? a) Frequent hand washing b) Minimizing exposure to crowds, especially during the spring c) Avoiding second-hand smoke d) Antibiotic use for household members with colds
A.) Frequent hand washing Explanation: Frequent hand washing helps to decrease the spread of viruses that cause the common cold. The common cold is caused by viruses, so antibiotics would be of no assistance in preventing them. Although avoiding second-hand smoke is a preventive measure, it is not the most important measure. Crowds should be avoided, especially during the winter when the colds occur more frequently.
A child with a severe lower respiratory tract infection has been prescribed an antibiotics and a bronchodilator. The nurse recognizes that which of the following treatments would be best for delivering the medication directly into the respiratory tract, as well as providing moisture to promote removal of mucus? a) Nebulizer b) Flutter device c) Percussion d) Vaporizer
A.) Nebulizer Explanation: Nebulizers are mechanical devices that provide a stream of moistened air directly into the respiratory tract. Nebulizers also serve as an important means for the delivery of respiratory tract medications. Drugs such as antibiotics or bronchodilators can be combined with the nebulized mist and sprayed into the lungs. Vaporizers humidify the air by emitting a stream of air moistened by fine droplets of water into the air, providing either a cool or a warm mist to the entire room. A mucus-clearing device (a Flutter device), which looks like a small plastic pipe, has a stainless-steel ball inside that moves when the child breathes out, causing vibrations in the lungs, which help loosen mucus so that it can be moved up the airway and expectorated. Percussion involves striking a cupped or curved palm against the chest to determine the consistency of tissue beneath the surface area.
Which of the following is a complication of cystic fibrosis? a) Pneumothorax b) UTI c) Crohn disease d) Kidney disease
A.) Pneumothorax Explanation: A pneumothorax is a complication of cystic fibrosis. A rupture of the subpleural blebs through the visceral pleura takes place. There is also a high reoccurrence rate and incidence increases with age.
Which test in a CF patient would help monitor airway function? a) Pulmonary function b) Peak flow measurement c) Bronchoprovocation d) Pulse oximetry
A.) Pulmonary function Explanation: The pulmonary function tests help measure airway function, lung volumes, and gas exchange. Bronchoprovocation provokes bronchospasms to determine airway constriction. Peak flow measurement measures lung velocity. Pulse oximetry monitors blood level oxygen saturation.
A child is brought to the emergency department late one evening and is diagnosed with croup. The child was noted to have a shrill, harsh respiratory sound when breathing in. This symptom is referred to as which of the following? a) Stridor b) Barking cough c) Hoarseness d) Wheezing
A.) Stridor Explanation: In the child with croup syndrome, inspiratory stridor (shrill, harsh respiratory sound) is often noted.
The nurse is examining a 4-year-old who is injured and crying. What might the nurse document about the child's breathing? a) Tachypnea b) Respirations are slow and shallow c) Tachycardia d) Respirations are regular
A.) Tachypnea Explanation: Tachypnea (rapid breathing or panting) may be observed in a child with fear, anxiety, or stress. Slow, shallow, or regular respirations are normal. Tachycardia is an increased heart rate.
The nurse is taking a respiratory history of a newly admitted child. While documenting the symptoms the child has, what other item is important to document when taking a history on an altered respiratory status? a) The triggers for the environment b) The child's diet c) The child's hospital history d) The child's weight
A.) The triggers for the environment Explanation: When assessing a respiratory history, it is very important for the nurse to find out what in the environment worsens the child's symptoms. These are called "triggers." The other choices would be part of a general health history.
The nurse caring for the child with asthma weighs the child daily. Which of the following is the most important reason for doing a daily weight on this child? a) To determine fluid losses b) To monitor the child's growth pattern c) To determine medication dosages d) To ensure that the child's food intake is adequate
A.) To determine fluid losses Explanation: During an acute attack the child may lose a great quantity of fluid through the respiratory tract and may have poor oral intake because of coughing and vomiting. Theophylline administration also has a diuretic effect, which compounds the problem. Weigh the child daily to help determine fluid losses. The child's weight is used to determine medication dosages, to ensure that the child is appropriately gaining weight and growing, and that the intake is adequate. However, the most important reason for a daily weight is to determine fluid loss.
Newborns who are born more than 24 hours after rupture of the amniotic membranes are particularly prone to developing pneumonia in their first few days of life. a) True b) False
A.) True
An 8-year-old girl presents with drooling and a complaint of painful swallowing. She has a high fever and is lethargic. On examination the nurse sees that her palatine tonsils are bright red and swollen. The girl's mother says that she has never had these symptoms before. A throat culture indicates a streptococcus infection. Which of the following is the course of treatment that the nurse most expects in this situation? a) Tonsillectomy b) Antipyretic, analgesic, and antibiotic c) Adenoidectomy d) Antipyretic and analgesic
B.) Antipyretic, analgesic, and antibiotic Explanation: These symptoms are consistent with bacterial tonsillitis. Therapy for bacterial tonsillitis includes an antipyretic for fever, an analgesic for pain, and a full 7 to 10-day course of an antibiotic such as penicillin or amoxicillin. If the cause is viral, no therapy other than comfort or fever reduction strategies is necessary. Tonsillectomy is removal of the palatine tonsils. Adenoidectomy is removal of the pharyngeal tonsils. In the past, tonsillectomy was recommended for children after an episode of tonsillitis. This is no longer recommended as tonsillar tissue is an important component of the immune system.
The nurse is doing teaching with the caregivers of a child with cystic fibrosis. Of the following, which is most important for the nurse to teach this family? a) Watch for signs that the family unit is stressed. b) Encourage everyone in the family to use good hand washing. c) Avoid overprotecting the child. d) Be sure the patient exercises daily.
B.) Encourage everyone in the family to use good hand washing. Explanation: The child with cystic fibrosis has low resistance especially to respiratory infections. For this reason, take care to protect the child from any exposure to infectious organisms. Good hand washing techniques should be practiced by the whole family; teach the child and family the importance of this first line of defense. Practice and teach other good hygiene habits.
The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting up and leaning forward in a tripod position to breath. The nurse further notes that the child's mouth is open and the tongue is out. The signs the nurse noted indicate the child likely has which of the following? a) Cystic fibrosis b) Epiglottitis c) Asthma d) Tuberculosis
B.) Epiglottitis Explanation: The child with epiglottitis is very anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. This is called the "tripod" position. Immediate emergency attention is necessary.
The caregivers of a child report that their child had a cold and complained of a sore throat. When interviewed further they report that the child has a high fever, is very anxious, and is breathing by sitting up and leaning forward with the mouth open and the tongue out. The nurse recognizes these symptoms as those seen with which of the following disorders? a) Spasmodic laryngitis b) Epiglottitis c) Tonsillitis d) Laryngotracheobronchitis
B.) Epiglottitis Explanation: The child with epiglottitis may have had a mild upper respiratory infection before the development of a sore throat, and then became anxious and prefers to breathe by sitting up and leaning forward with the mouth open and the tongue out. The child with tonsillitis may have a fever, sore throat, difficulty swallowing, hypertrophied tonsils, and erythema of the soft palate. Exudate may be visible on the tonsils. The child with acute laryngotracheobronchitis develops hoarseness and a barking cough with a fever, cyanosis, heart failure and acute respiratory embarrassment can result.
A group of nursing students are reviewing information about variations in the anatomy of a child's respiratory tract structures in comparison to adults. The students demonstrate an understanding of the information when they describe the shape of the larynx in infants as which of the following? a) Spherical b) Funnel c) Cylindrical d) Oval
B.) Funnel Explanation: In infants and children (younger than the age of 10 years), the cricoid cartilage is underdeveloped, resulting in laryngeal narrowing and a funnel-shaped larynx. In teenagers and adults, the larynx is cylindrical and fairly uniform in width.
A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, in addition to the lungs which of the following are most affected by this disease? a) Kidney and bladder b) Pancreas and liver c) Brain and spinal cord d) Heart and blood vessels
B.) Pancreas and liver Explanation: The major organs affected are the lungs, pancreas, and liver. The brain, spinal cord, heart, blood vessels, kidney and bladder are not the most affected organs.
The nurse is caring for a 6-month-old infant who has chronic apneic episodes. Which intervention should the nurse institute? a) Sit infant up in the infant seat to keep airway open. b) Place on a cardiopulmonary monitor and do frequent assessments. c) Place infant in a crib so he can rest and get stronger. d) Help infant's mother do his morning bath.
B.) Place on a cardiopulmonary monitor and do frequent assessments. Explanation: The optimal treatments for kids with chronic apnea are hospitalization, frequent monitoring and observation, and parent education. The nurse should continuously monitor the infant on a cardiopulmonary monitor; frequently assess color, breathing patterns, and effort; and assess tone. The other choices do not include constant monitoring and assessments, which are crucial in treatment.
If there is a foreign body in the larynx, how will the patient present? a) Speaks clearly b) With stridor c) Edematous d) Quietly
B.) With stridor Explanation: If a foreign body is in the larynx, the patient presents with a cough, stridor, trouble with phonation, and maybe severe respiratory distress.
The caregivers of a 2-year-old who has had a common cold for 4 days calls the nurse in the Emergency Department at 2 AM on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; she seems blue around her mouth. The nurse would most appropriately recommend which of the following to the caregiver? a) "Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief." b) "Turn on all of the hot water taps in the bathroom and close the door. Take the child into the steam filled room for 15 minutes. If there is no relief, bring the child to the emergency room." c) "Bring the child to the emergency room immediately." d) "Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there's no relief in an hour."
C.) "Bring the child to the emergency room immediately." Explanation: Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104 to 105 degrees Fahrenheit. As the disease progresses, marked laryngeal edema occurs and the child's breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory embarrassment can result. The child needs to be treated immediately. Humidified air is helpful in reducing laryngospasm; humidifiers may be used in the child's bedroom to provide high humidity. Cool humidifiers are recommended, but vaporizers also may be used. Taking the child into the bathroom and opening the hot water taps with the door closed is a quick method for providing moist air, if the water runs hot enough. Sometimes the spasm is relieved by exposure to cold air: for instance, when the child is taken out into the night to go to the emergency department or to see the physician.
A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. Which of the following would the nurse instruct the mother to do first? a) "Continue to watch his PEFR readings and call back if they go below 40%." b) "You need to take him to the emergency department right away." c) "Have him use his short-acting bronchodilator right away." d) "Have him use his low-dose steroid inhaler now and again in 15 minutes."
C.) "Have him use his short-acting bronchodilator right away." Explanation: The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.
A young child is prescribed pancreatic enzymes as part of his treatment plan for cystic fibrosis. The child has difficulty swallowing medications. After teaching the parents of a young child with cystic fibrosis about how to administer pancreatic enzymes, the parents demonstrate understanding by stating which of the following? a) "We need to dissolve the capsule in water." b) "We should crush the capsule to make it smaller." c) "We can open the capsule and sprinkle it on his cereal." d) "We can puncture the capsule and pour the liquid on his tongue."
C.) "We can open the capsule and sprinkle it on his cereal." Explanation: If the child has difficulty swallowing the pancreatic enzyme capsules, the parents can open the capsule and sprinkle the contents onto the child's cereal or applesauce. Dissolving the capsule in water or crushing it would be appropriate. The capsule does not contain liquid so there would not be any liquid to pour on the child's tongue.
A 4-year-old girl has acute nasopharyngitis (a common cold). Which of the following measures would you want to teach her parents? a) Healthy children rarely have more than one cold per year. b) Typically the child will pull her ear when a cold is present. c) A cough that accompanies a cold should rarely be suppressed. d) An antibiotic is prescribed for children under 5 years of age.
C.) A cough that accompanies a cold should rarely be suppressed. Explanation: Coughing can be therapeutic because it raises respiratory secretions and prevents them from becoming infected.
Which of the following nursing diagnoses would be most appropriate for a child with pneumonia during the acute phase of illness? a) Pain related to swelling of abdominal lymph nodes b) Excess fluid volume related to excessive mucus production c) Activity intolerance related to poor oxygen-carbon dioxide exchange d) Altered urinary elimination related to hypervolemic state
C.) Activity intolerance related to poor oxygen-carbon dioxide exchange Explanation: Children with pneumonia generally feel exhausted during their illness and the immediate period following.
A 4-year-old girl has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. Her parents are extremely distraught over her condition and the fact she has not wanted to eat anything for the past 2 days. Which nursing approach would be most important to take to help alleviate the high anxiety level of these parents? a) Avoid telling the parents unnecessary facts regarding her prognosis. b) Tell the parents that their child is receiving the best care possible. c) Allow the parents to remain with the child as much as possible. d) Encourage the parents to return home and get some rest.
C.) Allow the parents to remain with the child as much as possible. Explanation: Pneumonia is a frightening disease for parents because before the age of antibiotics, it was fatal to children. Encouraging them to visit and offer support can increase self-esteem and decrease anxiety.
Which medication is a bronchodilator? a) Prednisolone b) Spironolactone c) Aminophylline d) Furosemide
C.) Aminophylline Explanation: Aminophylline is a bronchodilator that opens the airway of the lungs. It relaxes the smooth muscles around the airways.
The nurse is caring for a 7-year-old boy who has just had a tonsillectomy. Which intervention is least appropriate for this child? a) Discouraging the child from coughing b) Applying an ice collar c) Providing fluids by straw d) Placing the child on his side
C.) Providing fluids by straw Explanation: Providing fluids by straw may cause trauma to the surgical site and should be avoided. Applying an ice collar, if ordered, helps relieve pain. Placing the child on his side, until he is fully awake, facilitates safe drainage of secretions. The child should be discouraged from coughing, clearing his throat, and blowing his nose to avoid trauma to the surgical site.
In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which of the following reasons? a) Management of chronic pain b) To stabilize the cell membranes c) Relief of acute symptoms d) Prevention of mild symptoms
C.) Relief of acute symptoms Explanation: Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Brochodilators are not effective for pain.
After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify which of the following as a common allergen for asthma? a) Dust mites b) Indoor molds c) Shellfish d) Pet dander
C.) Shellfish Explanation: Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds are a common asthma trigger. Pet dander is a common asthma trigger. Dust mites are a common asthma trigger.
The nurse is reinforcing teaching with the parents of a 2-year-old who has cystic fibrosis regarding medications. The nurse suggest that pancreatic enzymes may be given by which method? a) Using a nebulizer b) Through a gastrostomy tube c) Sprinkled onto the food d) Directly into the vein
C.) Sprinkled onto the food Explanation: Pancreatic enzymes are used in the treatment of cystic fibrosis and are given by opening the capsule and sprinkling the medication on the child's food. If the child with cystic fibrosis has an infection, IV medications may be given, but this is not on a daily basis. Most children do not have a gastrostomy tube. Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose).
What is a definitive test for cystic fibrosis? a) Blood culture b) Blood gas c) Sweat chloride d) Complete blood count
C.) Sweat chloride Explanation: The definitive test in diagnosing CF is the sweat chloride test. This test is performed by stimulating a small patch of sweat glands on the inner aspect of the forearm. There must be two positive tests and clinical symptoms to confirm the diagnosis. The other choices are routine diagnostic tests.
You see a 3-year-old boy in an ambulatory setting for localized wheezing on auscultation. Which statement by his mother would be most important to report? a) She gives the child hard candy as an afternoon treat. b) She likes the child to play by himself for 15 minutes every afternoon. c) The child was eating peanuts yesterday. d) The child has two cousins who have many allergies.
C.) The child was eating peanuts yesterday. Explanation: Localized wheezing suggests only a small portion of a lung is involved, such as occurs following aspiration.
The nurse working at the child community clinic must administer the influenza vaccine to the high-risk kids first. Which child would she choose? a) 12-month-old Sally who is very healthy b) 22-month-old Jared who has a wound from touching a hot pan at home c) 21-month-old Chris who has a cold d) 23-month-old Ava who had heart surgery as an infant for a defect
D.) 23-month-old Ava who had heart surgery as an infant for a defect Explanation: Children who are considered high risk and could benefit from the influenza vaccine are: immunocompromised; have a chronic pulmonary disease; have had a congenital abnormality, chronic renal or metabolic diseases, sickle-cell disease, HIV, and any type of neurological disorder (seizures). The other choices would be considered normal and the child is not at high risk.
The caregiver of a 6-week-old boy calls the nurse, concerned about her child. The child has been vomiting, has diarrhea, and is sneezing. The child's temperature is normal. The nurse suspects that the cause of the symptoms is which of the following? a) Pneumonia b) Cystic fibrosis c) A pollen-based allergy d) A common cold
D.) A common cold Explanation: The child with a common cold sneezes and becomes irritable and restless. The congested nasal passages can interfere with nursing, increasing the infant's irritability. Because an older child can mouth breathe, nasal congestion in him or her is not as great a concern as it is in the infant. The child might have vomiting or diarrhea, which might be caused by mucous drainage into the digestive system. Younger infants usually are afebrile. The child with an allergy will not likely have vomiting and diarrhea. The infant with pneumonia will most likely have an elevated temperature. The child with cystic fibrosis will have a hard, nonproductive chronic cough, a barrel chest, and clubbing of fingers. The abdomen be comes distended, and body muscles become flabby.
Which of the following child's history puts them at increased risk for asthma-related death? a) A child who has never been hospitalized b) Compliance with an asthma treatment plan c) No history of psychosocial or psychiatric disease d) Current use of corticosteroids
D.) Current use of corticosteroids Explanation: Current use of corticosteroids is a risk factor for an asthma-related death. Prior hospitalization, a history of psychosocial issues, and noncompliance with an asthma treatment plan also put children at risk for an asthma-related death.
A 2-year-old boy is seen for acute laryngotracheobronchitis. Which of the following observations would lead you to suspect that airway occlusion is occurring? a) He states he is tired and wants to sleep. b) His nasal discharge is increasing. c) His cough is becoming harsher. d) His respiratory rate is gradually increasing.
D.) His respiratory rate is gradually increasing. Explanation: An increasing respiratory rate is a major sign of airway occlusion (breathing faster because less air is received with each breath).
In caring for the child with asthma, the nurse recognizes that which of the following nursing diagnoses would be the highest priority in this child's plan of care? a) Delayed growth and development related to physical restrictions. b) Risk for infection related to anatomic structures of involved body system c) Risk for fluid volume excess related to medications d) Ineffective airway clearance related to the diagnosis
D.) Ineffective airway clearance related to the diagnosis Explanation: The highest priority for the child with asthma is to keep the airway clear because of the bronch o spasms and increased pulmonary secretions the child may have. The child is more likely to have deficient fluid volume related to tachypnea and diaphoresis. Infections can occur, but they are less of a concern than the airway clearance. Growth and development issues can occur because the child may have to limit activities, but these issues are not the priority.
During a class for caregivers of children with asthma, a caregiver asks the nurse the following question when medications are being discussed. "They told me about a plastic device my child can hold in his a hand which will give him a premeasured and exact amount of his corticosteroid." The nurse recognizes that the caregiver is most likely referring to which of the following devices? a) Nebulizer b) Medication cup c) Needleless syringe d) Metered-dose inhaler
D.) Metered-dose inhaler Explanation: In the treatment of asthma corticosteroids are most often delivered by metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). The medication cup and needleless syringe may deliver PO medications, but most often corticosteroids are not given PO in the treatment of asthma, and those would not be premeasured and an exact dosage like a metered-dose inhaler would be. Corticosteroids are not administered by nebulizer.
