Pediatric Exam Two
A 2-year-old has just been diagnosed with cystic fibrosis (CF). The parents ask the nurse what early respiratory symptoms they should expect to see in their child. Which is the nurse's best response? 1. "You can expect your child to develop a barrel-shaped chest." 2. "You can expect your child to develop a chronic productive cough." 3. "You can expect your child to develop bronchiectasis." 4. "You can expect your child to develop wheezing respirations."
"You can expect your child to develop wheezing respirations." 4. Wheezing respirations and a dry, nonproductive cough are common early symptoms in CF.
The parents of a 6-year-old who has a new diagnosis of asthma ask the nurse what to do to make their home a more allergy-free environment. Which is the nurse's best response? 1. "Use a humidifier in your child's room." 2. "Have your carpet cleaned chemically once a month." 3. "Wash household pets weekly." 4. "Avoid purchasing upholstered furniture."
4. "Avoid purchasing upholstered furniture." Leather furniture is recommended rather than upholstered furniture. Upholstered furniture can harbor large amounts of dust, whereas leather furniture may be wiped off regularly with a damp cloth.
Which assessment is of greatest concern in a 15-month-old? 1. The child is lying down, has moderate retractions, low-grade fever, and nasal congestion. 2. The child is in the tripod position, has diminished breath sounds, and a muffled cough. 3. The child is sitting up and has coarse breath sounds, coughing, and fussiness. 4. The child is restless and crying, has bilateral wheezes, and is feeding poorly.
2. The child is in the tripod position, has diminished breath sounds, and a muffled cough. When children are sitting in the tripod position, they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds are indicative of a worsening condition. A muffled cough indicates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition.
A parent asks the nurse what will need to be done to relieve the constipation of her child who also has cystic fibrosis (CF). Which is the nurse's best response? 1. "Your child likely has an obstruction and will require surgery." 2. "Your child will likely be given IV fluids." 3. "Your child will likely be given MiraLAX." 4. "Your child will be placed on a clear liquid diet."
3. "Your child will likely be given MiraLAX." CF patients with constipation commonly receive a stool softener or an osmotic solution such as polyethylene glycol 3350 (MiraLAX) orally to relieve their constipation.
Which should the nurse administer to provide quick relief to a child with asthma who is coughing, wheezing, and having difficulty catching her breath? 1. Prednisone 2. Singulair (montelukast) 3. Albuterol 4. Flovent (fluticasone)
3. Albuterol Albuterol is the quick-relief bronchodilator of choice for treating an asthma attack.
Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase? 1. Use an incentive spirometer. 2. Breathe into a paper bag. 3. Blow a pinwheel. 4. Take several deep breaths.
3. Blow a pinwheel. Blowing a pinwheel is an excellent means of increasing a child's expiratory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child's expiratory phase.
A 7-month-old has a low-grade fever, nasal congestion, and a mild cough. What should the nursing care management of this child include? 1. Maintaining strict bedrest. 2. Avoiding contact with family members. 3. Instilling saline nose drops and bulb suctioning. 4. Keeping the head of the bed flat.
3. Instilling saline nose drops and bulb suctioning. Infants are nose breathers and often have increased difficulty when they are congested. Nasal saline drops and gentle suctioning with a bulb syringe are often recommended.
17. What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus? 1. "What time did your child eat last?" 2. "Has your child been exposed to any of the usual asthma triggers?" 3. "When was your child last admitted to the hospital for asthma?" 4. "When was your child's last dose of medication?"
4. "When was your child's last dose of medication?" The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.
Which physical findings would be of most concern in an infant with respiratory distress? 1. Tachypnea 2. Mild retractions 3. Wheezing 4. Grunting
4. Grunting. Grunting is a sign of impending respiratory failure and is a very concerning physical finding.
Which would the nurse explain to parents about the inheritance of cystic fibrosis? 1. CF is an autosomal-dominant trait passed on from the child's mother. 2. CF is an autosomal-dominant trait passed on from the child's father. 3. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF. 4. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF.
4. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF. If the child is born to a parent with CF and the other parent is a carrier, the child has a 50% chance of acquiring the disease and a 50% chance of being a carrier of the disease. Richardson, Beth. Pediatric Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 61). F.A. Davis Company. Kindle Edition.
The parents of a 5-week-old have just been told that their child has cystic fibrosis (CF). The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse about the current projected life expectancy. What is the nurse's best response? 1. "The life expectancy for CF patients has improved significantly in recent years." 2. "Your child might not follow the same course that the mother's sister did." 3. "The physician will come to speak to you about treatment options." 4. The nurse answers their questions briefly, listens to their concerns, and is available later after they've processed the information.
4. The nurse answers their questions briefly, listens to their concerns, and is available later after they've processed the information. The nurse's best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk.
What does the therapeutic management of cystic fibrosis (CF) patients include? Select all that apply. 1. Providing a high-protein, high-calorie diet. 2. Providing a high-fat, high-carbohydrate diet. 3. Encouraging exercise. 4. Minimizing pulmonary complication. 5. Encouraging medication compliance.
1, 3, 4, 5. Children with CF have difficulty absorbing nutrients because of the blockage of the pancreatic duct. Pancreatic enzymes cannot reach the duodenum to aid in digestion of food. These children often require up to 150% of the caloric intake of their peers. The nutritional recommendation for CF patients is high-calorie and high-protein. .
Which statement by the parent of a child using an albuterol inhaler leads the nurse to believe that further education is needed on how to administer the medication? 1. "I should administer two quick puffs of the albuterol inhaler using a spacer." 2. "I should always use a spacer when administering the albuterol inhaler." 3. "I should be sure that my child is in an upright position when administering the inhaler." 4. "I should always shake the inhaler before administering a dose."
1. "I should administer two quick puffs of the albuterol inhaler using a spacer." The parent should always give one puff at a time and wait 1 minute before administering the second puff.
The parent of a 4-month-old with cystic fibrosis (CF) asks the nurse what time to begin the child's first chest physiotherapy (CPT) each day. Which is the nurse's best response? 1. "Thirty minutes before feeding the child breakfast." 2. "After deep-suctioning the child each morning." 3. "Thirty minutes after feeding the child breakfast." 4. "Only when the child has congestion or coughing."
1. "Thirty minutes before feeding the child breakfast. CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting.
Which is the nurse's best response to parents who ask what impact asthma will have on the child's future in sports? 1. "As long as your child takes prescribed asthma medication, the child will be fine." 2. "The earlier a child is diagnosed with asthma, the more significant the symptoms." 3. "The earlier a child is diagnosed with asthma, the better the chance the child has of growing out of the disease." 4. "Your child should avoid playing contact sports and sports that require a lot of running."
2. "The earlier a child is diagnosed with asthma, the more significant the symptoms." When a child is diagnosed with asthma at an early age, the child is more likely to have significant symptoms on aging.
16. Which laboratory result will provide the most important information regarding the respiratory status of a child with an acute asthma exacerbation? 1. CBC 2. ABG 3. BUN 4. PTT
2. ABG. The ABG gives the health-care team valuable information about the child's respiratory status: level of oxygenation, carbon dioxide, and blood pH.
How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts of azotorrhea and steatorrhea in a child with cystic fibrosis (CF)? The values indicate the child is: 1. Not compliant with taking her vitamins. 2. Not compliant with taking her enzymes. 3. Eating too many foods high in fat. 4. Eating too many foods high in fiber.
2. Not compliant with taking her enzymes. If the child were not taking enzymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. Pancreatic ducts in CF patients become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes with all meals and snacks to aid in absorption of nutrients. Often, teens are noncompliant with their medication regimen because they want to be like their peers. Richardson, Beth. Pediatric Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&A Success) (Page 61). F.A. Davis Company. Kindle Edition.
25. Which would be an early sign of respiratory distress in a 2-month-old? 1. Breathing shallowly 2. Tachypnea 3. Tachycardia 4. Bradycardia
2. Tachypnea. Tachypnea is an early sign of distress and is often the first sign of respiratory illness in infants.
The parent of a child with cystic fibrosis (CF) is excited about the possibility of the child receiving a double lung transplant. What should the parent understand? 1. The transplant will cure the child of CF and allow the child to lead a long and healthy life. 2. The transplant will not cure the child of CF but will allow the child to have a longer life. 3. The transplant will help to reverse the multisystem damage that has been caused by CF. 4. The transplant will be the child's only chance at surviving long enough to graduate college.
2. The transplant will not cure the child of CF but will allow the child to have a longer life. A lung transplant does not cure CF, but it does offer the patient an opportunity to live a longer life. The concerns are that, after the lung transplant, the child is at risk for rejection of the new organ and for development of secondary infections because of the immunosuppressive therapy.
The parent of an infant with cystic fibrosis (CF) asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion? 1. "You may need to increase the number of fresh fruits and vegetables you give your child." 2. "You may need to advance your child's diet to whole cow's milk because it is higher in fat than formula." 3. "You may need to change your child to a higher-calorie formula." 4. "You may need to increase your child's carbohydrate intake."
3. "You may need to change your child to a higher-calorie formula." 3. Often infants with CF need to have a higher-calorie formula to meet their nutritional needs. Infants may also be placed on hydrolysate formulas that contain medium-chain triglycerides.
A chloride level greater than _____________________ is a positive diagnostic indicator of cystic fibrosis (CF).
60 mEq/L. The definitive diagnosis of CF is made when a child has a sweat chloride level >60 mEq/L. A normal chloride level is <40 mEq/L.
Which child with asthma should the nurse see first? 1. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%. 2. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%. 3. A 9-year-old who is quiet, is pale in color, and is wheezing bilaterally with an oxygen saturation of 92%. 4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.
A. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93% This child is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes and now has diminished breath signs.