Pediatric Respiratory (Week 1)

During an assessment, a child exhibits an audible high-pitched inspiratory noise, a tripod stance and intercostal retractions. Using SBAR communication, the nurse notifies the health care provider and states which breath sounds that are congruent with the clinical presentation of the child? A. Respiratory stridor B. Wheezing in the bases C. Rales in the middle lobe D. Rhonchi throughout the lung

A. Respiratory stridor Rationale: Stridor is a high-pitched, readily audible inspiration noise that indicates an upper airway obstruction. The child presents in severe respiratory compromise and struggles to breathe. A wheeze is a high-pitched sound heard on auscultation, usually on expiration. It is due to obstruction in the lower trachea or bronchioles. Rales are crackling sounds heard on auscultation when the alveoli become fluid filled. Rhonchi is a snoring sound heard throughout the lung field when inflammation occurs.

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

A. Stridor Rationale: Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying.

What assessment finding after a 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

A. Vomiting bright red blood Rationale: Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the physician

What is a common trigger for asthma attacks in children? A. febrile episodes B. Dehydration C. Exercise D. Seizures

C. Exercise Rationale: Exercise is one of the most common triggers for asthma attacks particularly in school-aged children

A nurse is administering 100% oxygen to a child with a pneumothorax based on the understanding that this treatment is used primarily for which reason? A. Improve gas exchange B. Bypass the obstruction C. Hasten air reabsorption D. Prevent hypoxemia

C. Hasten air reabsorption Rationale: Administration of 100% oxygen is used to treat pneumothorax primarily because it hastens the reabsorption of air. Generally this is used only for a few hours. Although the oxygen also improves gas exchange and prevents hypoxemia, these are not the reasons for its use in this situation. There is no obstruction with a pneumothorax.

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

C. Hearing loss Rationale: Chronic otitis media with effusion is the most common cause of hearing loss in children

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

C. I should give the penicillin three times a day for 10 days Rationale: Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days

The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which drug would the nurse identify as an adjunct to a β2-adrenergic agonist for treatment of bronchospasm? A. Ipratropium B. Montelukast C. Cromolyn D. Theophylline

A. Ipratropium Rationale: Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a β2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation.

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

A. Nasal flaring Rationale: 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.

The nurse is administering medications to a child with cystic fibrosis. Which method would the nurse most likely use to give medications to treat the pancreatic involvement seen in this disease? A. Open capsule and sprinkle on food. B. Shake inhaler and hold close to mouth. C. Draw up in syringe and administer subcutaneously. D. Pour in medication cup and have the child drink.

A. Open capsule and sprinkle on food. Rationale: Pancreatic enzymes should be administered at all meals and snacks to promote adequate digestion and absorption of nutrients. They are supplied in capsule form. For the infant and young child, they can be opened and sprinkled on foods such cereal, pudding, or applesauce. They also can be swallowed whole. They are not supplied in liquid form, so the child could not take them in a medication cup. They are not supplied for injection or inhalation, only oral use.

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which finding? A. Children's demand for oxygen is lower than that of adults. B. Children develop hypoxemia more rapidly than adults do. C. An increase in oxygen saturation leads to a much larger decrease in pO2. D. Children's bronchi are wider in diameter than those of an adult.

B. Children develop hypoxemia more rapidly than adults do. Rationale: Children develop hypoxemia more rapidly than adults do because they have a significantly higher metabolic rate and faster resting respiratory rates than adults do, which leads to a higher demand for oxygen. A smaller decrease in oxygen saturation reflects a disproportionately much larger decrease in pO2. The bronchi in children are narrower than in adults, placing them at higher risk for lower airway obstruction.

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

B. Cool humidified oxygen Rationale: Humidified oxygen is delivered if the oxygen saturation level drops to less than 90%

Which type of croup is always considered a medical emergency? A. Laryngitis B. Epiglottitis C. Spasmodic croup D. Laryngotracheobronchitis (LTB)

B. Epiglottitis Rationale: Epiglottitis is always a medical emergency that requires antibiotics and airway support for treatment

A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? A. IgA B. IgE C. IgG D. IgM

B. IgE Rationale: The immunoglobulin involved in the immune response associated with allergic rhinitis is IgE. IgA, IgG, and IgM are not involved in this response.

The nurse is caring for a child who has been admitted with a possible diagnosis of cystic fibrosis. Which laboratory/diagnostic tools would most likely be used to help determine the diagnosis of this child? A. Purified protein derivative test B. Sweat sodium chloride test C. Blood culture and sensitivity D. Pulmonary functions test

B. Sweat sodium chloride test Rationale: Sweat sodium chloride 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 anti-infective 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.

An 8-year-old with cystic fibrosis has had a noted decline on the growth chart. Which nursing intervention is best for maintaining adequate nutrition? A. Provide high caloric meals to the client's liking. B. Delay pancreatic enzymes until food enters the small intestine. C. Encourage high calorie, high protein snacks. D. Limit sodium to a 2 gram sodium restricted diet

C. Encourage high calorie, high protein snacks. Rationale: The best nursing intervention is a high calorie, high protein snack. Calories can be obtained from non-nutritious foods. It is not only that the client needs calories for energy, but nutrition needs to be present. Pancreatic enzymes aid in digestion so they need to be available for foods; thus they are given prior to ingestion. Sodium is encouraged due to the high sodium loss.

Which clinical manifestation of acute nasopharyngitis is more of a concern for the infant than the older child? A. Fever B. Vomiting C. Nasal congestion D. Diarrhea

C. Nasal congestion Rationale: The infant has smaller airways, making it more difficult to breathe when nasal congestion occurs. The older child can tolerate the congestion better than the infant with smaller airways. Depending upon the age of the child, younger infants are afebrile. Vomiting and diarrhea can occur at any age as the mucus from the nasal drainage enters the gastrointestinal tract.

The nurse is examining a 5-year-old. Which sign or symptom is a reliable first indication of respiratory illness in children? A. Slow, irregular breathing B. A bluish tinge to the lips C. Increasing lethargy D. Rapid, shallow breathing

D. Rapid, shallow breathing Rationale: Tachypnea, or increased respiratory rate, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing and increasing listlessness are signs that the child's condition is worsening. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.

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

D. Sinusitis Rationale: 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 sinus, halitosis, and a cough that increases when the child is lying down.

What is a symptom of bacterial pharyngitis? A. fever B. rhinitis C. symptoms have gradual onset D. white blood cell (WBC) count in normal range

A. fever Rationale: Bacterial pharyngitis is most often caused by group A streptococcus. Fever is a symptom of bacterial pharyngitis. Other symptoms are an elevated WBC count, abrupt onset, headache, sore throat, abdominal discomfort, enlargement of tonsils, and firm cervical lymph nodes. It must be treated with an antibiotic. Penicillin is the drug of choice. Symptoms of rhinitis, a normal WBC count, and slow onset are indicative of viral pharyngitis.

The nurse is discussing discharge instructions with the parents of a 6-year-old who had a tonsillectomy. What is the most important thing to stress? A. Administer analgesics. B. Encourage the child to drink liquids. C. Inspect the throat for bleeding. D. Apply an ice collar.

C. Inspect the throat for bleeding. Rationale: Inspecting the throat for bleeding is the most important discharge information to give the parents. Hemorrhage is unusual postoperatively but may occur any time from the immediate postoperative period to as late as 10 days after surgery. The nurse should inspect the throat for bleeding. Mucus tinged with blood may be expected, but fresh blood in the secretions indicates bleeding. Administering analgesics, encouraging fluids and applying an ice color are important but not as important as assessing for bleeding.

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 tells the caregiver to increase the amount of which substance in the child's diet? A. Iodized salt B. Saturated fat C. Pancreatic enzymes D. Calories from protein

C. Pancreatic enzymes Rationale: 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.

The health care provider has prescribed beclomethasone for long term control of asthma. The nurse is most correct to advise the client that beclomethasone is a: A. mast cell stabilizer. B. xanthine derivative. C. corticosteroid. D. leukotriene inhibitor.

C. corticosteroid. Rationale: Beclomethasone is a corticosteroid prescribed for long-term asthma control. Mast cell stabilizers help to decrease bronchospasm and mucous membrane inflammation. A xanthine derivative such as theophylline is a time-released bronchodilator. Leukotriene inhibitors help with bronchodilation and decrease airway edema.

Which statement, if made by parents of a child with cystic fibrosis, indicates that they understood the nurses teaching on pancreatic enzyme replacement? A. enzymes will improve my childs 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

C. enzymes should be given with meals and snacks Rationale: Children with CF need to take enzymes with food for adequate absorption of nutrients

The nurse is collecting data on a child with a diagnosis of tonsillitis. Which clinical manifestation would likely have been noted in the child with this diagnosis? A. bark-like cough B. hoarseness C. erythema of the pharynx D. inability to make audible voice sounds

C. erythema of the pharynx Rationale: The child with tonsillitis may have a fever of 101°F (38.4°C) or higher, a sore throat, often with dysphagia (difficulty swallowing), hypertrophied tonsils, and erythema of the pharynx. The child with spasmodic laryngitis has a bark-like cough, hoarseness, and an inability to make audible voice sounds.

Which measure would be most effective in aiding bronchodilation in a child with laryngotracheobronchitis? A. Urging the child to continue to take oral fluids B. Administering an oral analgesic C. Teaching the child to take long, slow breaths D. Assisting with racemic epinephrine nebulizer therapy

D. Assisting with racemic epinephrine nebulizer therapy Rationale: Croup is a viral infection that causes inflammation and edema of the larynx, trachea, and bronchi. One form of treatment is the use of nebulized racemic epinephrine. Racemic epinephrine is an alpha adrenergic agent. It works on the mucosal vasoconstriction to reduce the edema. This increases the lumen of airways, allowing for better intake of air. A child in respiratory distress is unable to take slow, deep breaths. The child should not be offered fluids because this is an aspiration risk and analgesics will not reduce swelling.

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 disorder? A. Spasmodic laryngitis B. Tonsillitis C. Laryngotracheobronchitis D. Epiglottitis

D. Epiglottitis Rationale: 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; acute respiratory embarrassment can also result.

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

D. Frequent handwashing can decrease the spread of the virus Rationale: Meticulous handwashing can decrease the spread of organisms

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

D. Give cool, humidified oxygen Rationale: Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea

The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child? A. Purified protein derivative test B. Sweat sodium chloride test C. Blood culture and sensitivity D. Pulmonary functions test

D. Pulmonary functions test Rationale: Pulmonary function tests are valuable 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. Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection.

The nurse is assessing the site of a client's Mantoux skin test. The client is HIV positive. The nurse notes the induration to be 10 mm. Which action will the nurse take next? A. Document the finding in the client's medical record B. Determine if the client has been exposed to tuberculosis. C. Place the client on droplet precaution. D. Schedule the client for a chest x-ray.

D. Schedule the client for a chest x-ray. Rationale: Diagnosis of tuberculosis (TB) is confirmed with a positive Mantoux test. An induration of 5 mm is considered positive for clients with HIV. If a client's Mantoux test is positive, the client is next scheduled for a chest x-ray to look for lung changes related to TB, or for a sputum smear test. These tests are done to determine if a client has latent or active TB, which will then determine the course of action for the client. The nurse will document the results; however, documentation is not priority. There is no need to ask about exposure since the test results indicate exposure. The client with active TB will be placed on airborne precautions.

The nurse is taking a health history for a 3-year-old girl suspected of having pneumonia who presents with a fever, chest pain, and cough. Which information places the child at risk for pneumonia? A. The child is a triplet. B. The child was a postmaturity date infant. C. The child has diabetes. D. The child attends day care.

D. The child attends day care. Rationale: Attending day care is a known risk factor for pneumonia. Being a triplet is a factor for bronchiolitis. Prematurity rather than postmaturity is a risk factor for pneumonia. Diabetes is a risk factor for influenza.

The nurse has assessed a 6-year-old child as having respiratory distress due to swelling of the epiglottis and surrounding structures. Which signs and symptoms would support this assessment? A. The child is pale and has vomited. B. The child has pale, elevated patches on the skin. C. The child is irritable and tachycardiac. D. The child is in tripod position.

D. The child is in tripod position. Rationale: Inflammation and swelling of the epiglottis and surrounding structures are common in children ages 2 to 7 years. The child will attempt to improve his/her airway by sitting forward and extending the neck forward with the jaw up, in a "sniffing position" (tripod position). Being pale, vomiting, and having elevated patches on the skin are not associated with epiglottis. Stridor, tachycardia, and the rapid onset are classical signs of epiglottitis.

The nurse is admitting a child who is experiencing an asthma attack. Which clinical manifestation would likely be noted in this child? A. Wheezing B. Chest retractions C. Hoarseness D. Circumoral cyanosis

A. Wheezing Rationale: 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. Chest retractions can be seen when there is severe respiratory distress. Hoarseness is most commonly seen with illness such as laryngitis. Circumoral cyanosis is seen with children with poor perfusion, such as a child with a congenital heart defect.

The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has: A. epiglottitis. B. asthma. C. cystic fibrosis. D. tuberculosis (TB).

A. epiglottitis. Rationale: The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.

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: A. funnel. B. cylindrical. C. oval. D. spherical.

A. funnel. Rationale: 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 child has been admitted to the pediatric unit with pneumonia. The nurse is preparing to administer the prescribed medication to the child to help reduce the viscosity of the child's secretions. Which medication would the nurse most likely give? A. guaifenesin B. albuterol C. dextromethorphan D. ipratropium

A. guaifenesin Rationale: An expectorant, such as guaifenesin, reduces viscosity of thickened secretions by increasing respiratory tract fluid. Albuterol is a short-acting beta-adrenergic agonist that acts as a bronchodilator. Dextromethorphan is a cough suppressant. Ipratropium is an anticholinergic agent that acts as a bronchodilator.

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 childs breathing capacity B. it measures the childs lung volume C. it will help the medication reach the childs airway D. it measures the amount of air the child breaths in

A. it is used to monitor the childs breathing capacity Rationale: The peak flow meter is a device used to monitor breathing capacity in the child with asthma

What is the earliest recognizable clinical manifestations of CF? A. meconium ileus B. history of poor intestinal absorption C. foul-smelling, frothy, greasy stools D. recurrent pneumonia and lung infection

A. meconium ileus Rationale: 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.

A community health nurse is conducting a parenting class on respiratory syncytial virus (RSV). What statement made by a parent indicates that the teaching has been successful? A. "RSV season occurs primarily April through September." B. "Exposure to second- or third-hand smoke increases the risk for developing RSV." C. "Infants are less affected by RSV than older children." D. "Early initiation of antibiotics can lessen the severity of the infection."

B. "Exposure to second- or third-hand smoke increases the risk for developing RSV." Rationale: An infant exposed to second- or third-hand smoke is at risk for developing respiratory syncytial virus (RSV). RSV season runs from September through April. Current treatment recommendations for RSV do not include antibiotics. Infants are susceptible to RSV much more than older children.

The nurse is teaching home care to the parents of a 4-year-old client diagnosed with asthma. The nurse knows additional teaching is needed if the parents make which statement? A. "We will not enroll our child in preschool this year." B. "It is important for us to know what triggers an attack." C. "We feel confident we can administer medication with a nebulizer." D. "Emergency instructions and phone numbers are posted in our home."

A. "We will not enroll our child in preschool this year." Rationale: Enrolling in preschool is fine for children with asthma. There is the risk for increased exposure to illness; however, asthma should not limit the child from living a normal, active life. Should the child enroll, the nurse can assist in meeting the asthma education needs of the preschool staff through counseling the parents and providing access to accurate asthma education materials. The parents should know what triggers an asthma attack in their child, have emergency information and numbers posted in the home for emergency situations, and should know how to use a nebulizer as needed.

The nurse is caring for a 5-year-old client and notes respiratory rate of 45 breaths per minute, blood pressure 100/70 mm Hg, heart rate 115, temperature 101°F (38.3°C), and oxygen saturation 86%. Which diagnostic test is priority for the nurse to complete? A. Arterial blood gas (ABG) B. Complete blood count (CBC) C. Electroencephalogram (EEG) D. Pulmonary function test

A. Arterial blood gas (ABG) Rationale: The most useful diagnostic test in respiratory distress is an ABG. Knowing normal blood gas values for children is very important for evaluation and proper treatment. A CBC is a blood test used to test for disorders including anemia, infection, and leukemia. An EEG is a test used to find problems related to electrical activity of the brain. A pulmonary function test is performed to evaluate the respiratory system. Based on the findings, the child is experiencing respiratory distress and has an elevated temperature. Airway and breathing are priority over an elevated temperature. The child's blood pressure is within normal range for this age.

The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect? A. Increased heart rate and restlessness B. Increased mucus expectoration C. Increased nonproductive cough D. Drowsiness causing a nap

A. Increased heart rate and restlessness Rationale: The nurse instructs the parents on the side effects of the bronchodilator, albuterol sulfate. The side effect of this medication is restlessness, anxiety, fear, palpitations, and tremors. It is important for the parents to realize this so they understand the actions of the 4-year-old. Once the bronchial tree is open, cough is decreased but mucus expectoration could increase. The medication does not cause drowsiness.

A child presents to the health clinic with a temperature of 101.8°F (38.8°C), dysphagia, headache, and a sore, erythematous throat. Which collaborative intervention will the nurse complete first? A. Obtain a throat culture. B. Begin saltwater gargles. C. Assess the child for a rash. D. Administer oral antibiotics.

A. Obtain a throat culture. Rationale: A child presenting with fever, dysphagia, headache, and a sore, erythematous throat may have viral or bacterial pharyngitis. The nurse's first action should be to obtain a throat culture to determine if the child has a bacterial or viral infection. If the throat culture is negative, the child will not require antibiotics. If the culture is positive, the child will need antibiotics. Saltwater gargles will help relieve pain, but this is not a priority. Children with streptococcal pharyngitis may develop a sandpaper rash, but this information alone is not conclusive, and a throat culture should be obtained prior to administering antibiotics.

The nurse is caring for a 6-week-old with symptoms of irritability, nasal stuffiness, difficulty drinking and occasional vomiting. Which assessment finding produces important information regarding the medical and nursing treatment plan? A. Obtain testing for respiratory syncytial virus. B. Screen for the "allergic salute." C. Obtain vital signs to determine an infection. D. Draw a blood count to see if the client is septic.

A. Obtain testing for respiratory syncytial virus. Rationale: The symptoms presented are of acute nasopharyngitis. Many times this is viral in nature and can be common in the very young from respiratory syncytial virus (RSV). RSV is tested by obtaining nasal secretions and sending to the lab. A 6-week-old may rub his/her face but is too young for the "allergic salute," which is done to relieve itching and open nasal pathways. Vital signs can be helpful to note the beginning of an infectious process.

Which nursing diagnosis would best apply to a child with allergic rhinitis? A. Pain related to sinus edema and headache B. Ineffective tissue perfusion related to frequent nosebleeds C. Disturbed self-esteem related to inherited tendency for illness D. Risk for infection related to blocked eustachian tubes

A. Pain related to sinus edema and headache Rationale: Many children with allergic rhinitis develop sinus headaches from edema of the upper airway. In younger children the maxillary and ethmoid sinuses are involved. In children aged 10 years and older the frontal sinuses are also involved. The pain comes from mucosal swelling, decreased ciliary movement and a thickened nasal discharge. Nosebleeds are not common with either allergic rhinitis or sinusitis nor are either of these inherited. The eustachian tubes would cause symptoms of otitis, not of the nasal passage.

A 5-year-old child is brought to the ED 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 nurses first action in this situation? A. Prepare intubation equipment and call the physician B. Examine the child oropharynx and call the physician C. Obtain a throat culture for RSV D. Obtain vital signs and listen to breath sounds

A. Prepare intubation equipment and call the physician Rationale: This child has symptoms of epiglottis, is acutely ill, and requires emergency measures

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. Providing fluids by straw B. Applying an ice collar C. Placing the child on his side D. Discouraging the child from coughing

A. Providing fluids by straw Rationale: 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.

A child requires supplemental oxygen therapy at 8 liters per minute. Which delivery device would the nurse most likely expect to be used? A. Simple mask B. Venturi mask C. Nasal cannula D. Oxygen hood

A. Simple mask Rationale: A simple mask would be used to deliver a flow rate of 8 liters per minute. A Venturi mask would be used to deliver a specific percentage of oxygen, from 24% to 50%. A nasal cannula would be used to deliver no more than 4 liters per minute. An oxygen hood requires a liter flow of 10 to 15 liters per minute.

The nurse is caring for a 3-year-old girl with a respiratory disorder. The nurse anticipates the need for providing supplemental oxygen to the child when performing which action? A. Suctioning a tracheostomy tube B. Administering drugs with a nebulizer C. Providing tracheostomy care D. Suctioning with a bulb syringe

A. Suctioning a tracheostomy tube Rationale: Supplemental oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen.

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

A. Symptomatic treatment and observation for 48 to 72 hours after diagnosis Rationale: Select children 6 months of age or older with acute otitis media are treated by initiation symptomatic treatment and observation for 48 to 72 hours

The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma? A. "I'm going to have the respiratory therapist get some of the mucus from your lungs." B. "I'm going to have this hospital worker take a picture of your lungs." C. "We're going to go take a look at your lungs to see if there are any sores on them." D. "I'm going to hold your hand while the phlebotomist gets blood from your arm."

B. "I'm going to have this hospital worker take a picture of your lungs." Rationale: The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? A. "We will keep an albuterol inhaler with our child at all times." B. "It is okay for our child to do chores such as sweeping the floor." C. "We will both enroll in smoking cessation classes." D. "Our family dog will need to go live with a grandparent."

B. "It is okay for our child to do chores such as sweeping the floor." Rationale: Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement. An inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.

A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A. Salmeterol B. Albuterol C. Ipratropium D. Cromolyn

B. Albuterol Rationale: Albuterol is a short-acting β2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting β2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to β2-adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.

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

B. Children can usually play any type of sport if their asthma is well controlled Rationale: 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.

A nurse is caring for an infant admitted with a diagnosis of bronchiolitis. After completing an assessment, the nurse creates a plan of care for the infant. Which client goal would be priority in the plan of care? A. The infant will attain oxygen saturation of 90% on room air. B. The infant's airway will remain clear and free of mucus. C. The infant's breathing will be less labored. D. The infant will have decreased nasal stuffiness.

B. The infant's airway will remain clear and free of mucus. Rationale: Keeping the infant's airway clear is the top priority. An O2 saturation of 90% on room air is minimally acceptable. It is important that the infant's breathing be less labored and that there is decreased nasal stuffiness, but having the airway clear and free of mucus is most important.

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurses rationale for this action is primarily that A. Mothers of hospitalized toddlers often experience guilt B. The mothers presence will reduce anxiety and ease child respiratory efforts C. Separation from mother is a major developmental threat at this age D. The mother can provide constant observations of the childs respiratory efforts

B. The mothers presence will reduce anxiety and ease child respiratory efforts Rationale: The familys presence will decrease the childs distress

The nurse is assessing a 5-year-old girl who is anxious, has a high fever, speaks in a whisper, and sits up with her neck thrust forward. Based on these findings, what would be least appropriate for the nurse to perform? A. Providing 100% oxygen B. Visualizing the throat C. Having the child sit forward D. Auscultating for lung sounds

B. Visualizing the throat Rationale: The child is exhibiting signs and symptoms of epiglottitis, which can be lifethreatening. Under no circumstances should the nurse attempt to visualize the throat. Reflex laryngospasm may occur, precipitating immediate airway occlusion. Providing 100% oxygen in the least invasive manner that is most acceptable to the child is a sound intervention, as is allowing the child to assume a position of sitting forward with the neck extended. Auscultation would reveal breath sounds consistent with an obstructed airway.

A child with a pneumothorax has a chest tube attached to a water seal system. When assessing the child, the nurse notices that the chest tube has become disconnected from the drainage system. What would the nurse do first? A. Notify the physician. B. Apply an occlusive dressing. C. Clamp the chest tube. D. Perform a respiratory assessment.

C. Clamp the chest tube. Rationale: If a chest tube becomes disconnected from the water seal drainage system, the nurse would first clamp the chest tube to prevent air from entering the child's chest cavity. Then the nurse would perform a respiratory assessment and notify the physician. An occlusive dressing would be applied first if the chest tube became dislodged from the child's chest.

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

C. Drowsiness Rationale: Drowsiness is a safety hazard when alertness is needed, especially with a teenage drive. Nonsedating brands should be used.

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

C. Eliminating the allergen Rationale: The first priority is to attempt to remove the causative agent from the child's environment

The nurse is assessing several children. Which child is most at risk for dysphagia? A. 7-month-old with erythematous rash B. 8-year-old with fever and fatigue C. 5-year-old with epiglottitis D. 2-month-old with toxic appearance

C. 5-year-old with epiglottitis Rationale: The 5-year-old with epiglottitis has a sore, swollen throat placing the child at risk for dysphagia (difficulty swallowing). Erythematous rash and mild toxic appearance are typical of influenza. Fever and fatigue are symptoms of a common cold. Influenza and the common cold may cause sore throats but would not be the highest risk for dysphagia.

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

A. Asthma Rationale: Children with asthma usually have these chronic symptoms

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 child's weight B. The child's diet C. The child's hospital history D. The triggers in the environment

D. The triggers in the environment Rationale: 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.

When the nurse is reinforcing teaching with the caregiver of a 3-year-old child being discharged following a tonsillectomy, the caregiver states to the nurse, "I understand why there might be bleeding in the first 24 hours, but I do not understand why there might be bleeding in 1 week or so." What is the most appropriate explanation for the nurse to give this caregiver? A. "Bleeding can occur at this time because the clots dissolve and new tissue is not yet present." B. "We do not usually do this surgery until the child is older, so postoperative bleeding is a possible complication because of the child's age." C. "By next week the child will be eating regular foods again, and the salt content may cause bleeding." D. "The child will have forgotten about the surgery by that time and might start coughing, and the pressure of coughing can cause bleeding."

A. "Bleeding can occur at this time because the clots dissolve and new tissue is not yet present." Rationale: Hemorrhage is the most common complication of a tonsillectomy. Bleeding is most often a concern within the first 24 hours after surgery and up to the 10th postoperative day. Bleeding late postoperatively can occur when the clots dissolve and new tissue is not yet present. A tonsillectomy can be done at any age so stating that bleeding is a complication of age is incorrect. By 10 days postoperatively the child may still have a slight sore throat or have difficulty eating some solid foods so the child has not forgotten about the surgery. The pressure of coughing is most likely to cause bleeding early postoperatively. Salt will not cause bleeding and telling that to a parent is providing false information.

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. What would the nurse instruct the mother to do first? A. "Have him use his short-acting bronchodilator right away." B. "You need to take him to the emergency department right away." C. "Continue to watch his PEFR readings and call back if they go below 40%." D. "Have him use his low-dose steroid inhaler now and again in 15 minutes."

A. "Have him use his short-acting bronchodilator right away." Rationale: 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 the 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: A. "We can open the capsule and sprinkle it on his cereal." B. "We need to dissolve the capsule in water." C. "We should crush the capsule to make it smaller pieces." D. "We can puncture the capsule and pour the liquid on our child's tongue."

A. "We can open the capsule and sprinkle it on his cereal." Rationale: 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.

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.

A. Administer oxygen by nasal cannula to keep oxygen saturation at 100%. Rationale: 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 breath, leading to carbon dioxide retention.

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? A. Administer the bronchodilator via a nebulizer. B. Give the antibiotic as prescribed. C. Apply oxygen at 2 liters via a nasal cannula. D. Apply a cardiac monitor to the child.

A. Administer the bronchodilator via a nebulizer. Rationale: The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.

A 4-year-old child has been admitted to the hospital with a diagnosis of pneumococcal pneumonia. The parents are extremely distraught over the child's condition and the fact that the child 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 the parents? A. Allow the parents to remain with the child as much as possible. B. Encourage the parents to return home and get some rest. C. Tell the parents that their child is receiving the best care possible. D. Avoid telling the parents unnecessary facts regarding the child's prognosis.

A. Allow the parents to remain with the child as much as possible. Rationale: Pneumonia may be caused by many reasons: bacteria, viruses, fungus, and aspiration. If the child has mild symptoms (no respiratory distress) he or she may be treated at home. Hospitalization is required if the child has oxygen requirements, shows signs of respiratory distress, has poor oral intake, and has lethargy. Oxygen supplementation, IV fluids, and antibiotics will be necessary. It is very frightening for the parents to see their child so ill, and it is very frightening for the child to be so sick and be in a strange environment. The parents should be allowed to remain with their child at all times and their concerns should be addressed. The nurse should explain that not eating is part of the illness, but the child is being hydrated with IV fluids and will start eating as the illness improves. Telling the parents the child is receiving the best care possible does not address their concern of not eating. Parents should be educated on all aspects of the child's condition and prognosis.

The nurse is teaching the parents about medications for their 9-year-old boy who has a respiratory disorder. The nurse would be alert for an increased need for medications if the child was exposed to second-hand smoke and has which condition? A. Asthma B. Common cold C. Pneumonia D. Allergic rhinitis (hay fever)

A. Asthma Rationale: In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, exposure to second-hand smoke increases the need for medications in children with asthma and increases the frequency of asthma exacerbations. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with a cold. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with pneumonia. In general, it is important for any child with a respiratory illness to avoid second-hand smoke. However, the presence of smoke does not increase the medication needs for children with allergic rhinitis (hay fever).

A school-aged child has had an upper RTI 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

A. Bronchitis Rationale: Bronchitis is characterized by these symptoms and occurs in children older than 6 years

The nurse is caring for a 14-month-old boy with cystic fibrosis. Which sign of ineffective family coping requires urgent and immediate intervention? A. Compliance with therapy is diminished. B. The family becomes overvigilant. C. The child feels fearful and isolated. D. Siblings are jealous and worried.

A. Compliance with therapy is diminished. Rationale: Until the family adjusts to the demands of the disease, they can become overwhelmed and exhausted, leading to noncompliance, resulting in worsening of symptoms. Typical challenges to the family are becoming overvigilant, the child feeling fearful and isolated, and the siblings being jealous or worried, but these are not a priority over the noncompliance.

What is the most common debilitating disease of childhood among those of European descent? A. Cystic fibrosis B. Asthma C. Pneumonia D. BPD

A. Cystic fibrosis Rationale: Cystic fibrosis is the most common debilitating disease of childhood among those of European descent. Medical advances in recent years have greatly increased the length and quality of life for affected children, with median age for survival being the late 30s.

The nurse should assess a child who has had a tonsillectomy for A. Frequent swallowing B. Inspiratory stridor C. Rhonchi D. Elevated WBC count

A. Frequent swallowing Rationale: Frequent swallowing is indicative of postoperative bleeding

A female nurse of childbearing ages caring for a 2-year-old child diagnosed with bacterial pneumonia. The child has been placed in a mist tent. In caring for the child, it is important for the nurse to: A. monitor the child regularly for signs of cyanosis. B. avoid contact with the mist. C. use contact transmission precautions. D. check for hyperthermia related to enclosure in the tent.

A. monitor the child regularly for signs of cyanosis. Rationale: In some treatment of bacterial pneumonia a croupette or mist tent is used. When a child is in a mist tent, the nurse must be constantly observed for cyanosis. Studies how that children have become cyanotic in mist tents and have suffer subsequent arrest, due to the lack of visibility while in the tent. Treatments for bacterial pneumonia do not carry risk for teratogenicity. Ribavirin is an antiviral drug that may be used to treat certain children with respiratory syncytial virus. It is administered as an inhalant by hood, mask, or tent and has a high risk for teratogenicity. In treating a client with bacterial pneumonia, the client may need to be placed on infection control precautions according to the policy of the health care facility; in most facilities, these will be droplet precautions. Although the nurse should look for hyperthermia related to the infection process, there is no risk for hyperthermia related to the child being enclosed in the tent.

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 what as a common allergen for asthma? A. shellfish B. indoor molds C. pet dander D. dust mites

A. shellfish Rationale: Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds, pet dander, and dust mites are common asthma triggers.

What classification of drugs is sued to relieve an acute asthma episode? A. short-acting beta2-adrenergic agonist B. inhaled corticosteroids C. leukotriene blockers D. long-acting bronchodilators

A. short-acting beta2-adrenergic agonist Rationale: 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 5-7 days.

The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? A. suctioning secretions from the airway B. administering oxygen as ordered C. monitoring oxygen saturation by pulse oximeter D. administering analgesics as ordered

A. suctioning secretions from the airway Rationale: 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.

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.

B. It has a harsh, barky cough. Rationale: Spasmodic croup is viral in origin; is usually preceded by several days of symptoms of upper RTI; often begins at night; and is marked by a harsh, metallic, barky cough; core throat; inspiratory stridor; and hoarseness

What statement is the most accurate regarding the structure and function of the newborn's respiratory system? A. The diameter of the child's trachea is the same as that of adults. B. Most infants are nasal breathers rather than mouth breathers. C. The respiratory tract in the child is fully developed by age 2. D. Infants and young children have smaller tongues in proportion to their mouths.

B. Most infants are nasal breathers rather than mouth breathers. Rationale: Newborns are obligatory nose breathers until at least 4 weeks of age. 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. During the first 5 years of life, infants and young children have larger tongues in proportion to their mouths.

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

B. My toddler loves to play with balloons Rationale: Latex balloons account for a significant number of deaths from aspiration every year

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 liquids C. Use a warm mist humidifier D. Call the physician for a respiratory rate less than 28 breaths/min

B. Offer the child her favorite warm liquids Rationale: Offering the child fluids that she likes will facilitate oral intake. Warm liquids help loosen secretions.

A group of nurses is reviewing the diagnosis of cystic fibrosis. With regard to the effect of this disease on the body, which parts of the body (besides the lungs) are most affected by this disease? A. Brain and spinal cord B. Pancreas and liver C. Heart and blood vessels D. Kidney and bladder

B. Pancreas and liver Rationale: 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 examining an 8-year-old boy with tachycardia and tachypnea. The nurse anticipates which test as most helpful in determining the extent of the child's hypoxia? A. Pulmonary function test B. Pulse oximetry C. Peak expiratory flow D. Chest radiograph

B. Pulse oximetry Rationale: Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest radiographs can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size.

A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? A. "She really doesn't need the vaccine until she reaches 1 year of age." B. "She will probably receive it the next time she is to get her routine shots." C. "Since your daughter is older than 6 months, she should get the vaccine every year." D. "The vaccine has many side effects, so she wouldn't get it until she's ready to go to school."

C. "Since your daughter is older than 6 months, she should get the vaccine every year." Rationale: The current recommendations are for all children older than 6 months of age to be immunized yearly against influenza.

The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress? A. 3-year-old child with croup B. 11-month-old infant with nasopharyngitis C. 2-year-old child with epiglottitis D. 16-year-old adolescent with asthma

C. 2-year-old child with epiglottitis Rationale: Epiglottitis is a medical emergency due to the swelling of the epiglottis covering the larynx. This client needs frequent assessment for respiratory distress, especially since young children have smaller, more compliant airways. The 3-year-old child has more developed respiratory passages than a 2-year-old child, and although croup may cause respiratory distress, the likelihood of airway obstruction is lower when compared to epiglottitis. The 11-month-old infant has a common cold, typically from a virus. The 16-year-old adolescent with asthma has fully developed respiratory airways, which are less likely to be obstructed.

The nurse working at the child community clinic must administer the influenza vaccine to the high-risk children first. Which child would she choose first? A. 12-month-old client who is very healthy B. 21-month-old client who has a cold C. 23-month-old client who had heart surgery as an infant for a defect D. 22-month-old client who has a wound from touching a hot pan at home

C. 23-month-old client who had heart surgery as an infant for a defect Rationale: 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 disease, sickle-cell disease, HIV, any type of neurological disorder (seizures). The other choices would be considered normal and the child is not at high risk.

Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? A. Fever B. Oxygen saturation level of 96% C. Tachypnea with retractions D. Pale skin color

C. Tachypnea with retractions Rationale: Pneumonia is usually a self-limiting disease. Children with bacterial pneumonia can be successfully managed at home if the work of breathing is not severe and oxygen saturation is within normal limits. Hospitalization would most likely be required for the child with tachypnea, significant retractions, poor oral intake, or lethargy for the administration of supplemental oxygen, intravenous hydration, and antibiotics. Fever, although common in children with pneumonia, would not necessitate hospitalization. An oxygen saturation level of 96% would be within normal limits. Pallor (pale skin color) occurs as a result of peripheral vasoconstriction in an effort to conserve oxygen for vital functions; this finding also would not necessitate hospitalization.

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

C. Take the child outside Rationale: Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms

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

C. The child whose baby-sitter has received a tuberculosis diagnosis Rationale: The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis

The nurse is performing an abdominal assessment on a child. Which assessment techniques demonstrated by the nurse are appropriate when performing an abdominal assessment? Select all that apply. A. The nurse palpates the abdomen for the presence of any tenderness followed by auscultation of bowel sounds. B. The nurse determines a child has absent bowel sounds after listening to each quadrant for 1 full minute. C. The nurse uses percussion and notes dullness along the costal margins and tympany over the remainder of the abdomen. D. The nurse uses the technique of inspection to assess for the presence of an umbilical hernia. E. The nurse auscultates for bowel sounds in all four quadrants of the abdomen.

C. The nurse uses percussion and notes dullness along the costal margins and tympany over the remainder of the abdomen. D. The nurse uses the technique of inspection to assess for the presence of an umbilical hernia. E. The nurse auscultates for bowel sounds in all four quadrants of the abdomen. Rationale: Correct techniques include percussion of the abdomen to determine dullness along the costal margins and tympany over the remainder of the abdomen, inspection to visualize an umbilical hernia, and auscultation of all 4 quadrants of the abdomen. Auscultation should occur prior to palpation in order to not alter bowel sounds, and absence of bowel sounds can only be determined when listening for at least 5 minutes in each quadrant.

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 waking

C. Use the inhaler 30 minutes before exercise Rationale: The appropriate time to use an inhaled beta2-agonist or cromolyn is before an event that could trigger an asthma attack

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method? A. Directly into the vein B. Through a gastrostomy tube C. Using a nebulizer D. Sprinkled onto the food

C. Using a nebulizer Rationale: 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). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis.

The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse? A. "I understand that appointments can be annoying but steroid use can cause your child to have high blood sugar, peptic ulcers, slowed growth rate, and various other problems." B. "An adult should never give a child their medication. The doses may be very different." C. "As long as you only occasionally give your child the medication it shouldn't be a problem." D. "I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms."

D. "I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms." Rationale: Showing empathy for the parent is important when explaining the possibility of the steroid's side effects and the importance of the physician monitoring the child's asthma. Just listing all of the side effects of the steroid is not therapeutic communication and doesn't address the need for the child to be seen by the physician. Scolding the parent by telling her that she should never give her child her medication does not encourage good rapport. Giving the child the mother's medication even "occasionally" is not advisable.

The nurse is providing care to several children who have been brought to the clinic by the parents reporting cold-like symptoms. The nurse would most likely suspect sinusitis in which child? A. A 2-year-old with thin watery nasal discharge B. A 3-year-old with sneezing and coughing C. A 5-year-old with nasal congestion and sore throat D. A 7-year-old with halitosis and thick, yellow nasal discharge

D. A 7-year-old with halitosis and thick, yellow nasal discharge Rationale: The frontal sinuses, those most commonly associated with sinus infection, develop by age 6 to 8 years. Therefore, the 7-year-old would most likely experience sinusitis. In addition, this child also exhibits halitosis and a thick, yellow nasal discharge, other findings associated with sinusitis. Thin watery discharge in a 2-year-old is more likely to indicate allergic rhinitis. A 3-year-old with coughing and sneezing or a 5-year-old with nasal congestion and sore throat suggests the common cold

The nurse caring for the child with asthma weighs the child daily. What is the most important reason for doing a daily weight on this child? A. To determine medication dosages B. To monitor the child's growth pattern C. To ensure that the child's food intake is adequate D. To determine fluid losses

D. To determine fluid losses Rationale: During an acute asthma 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.

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. decreased activity and increased fluids. B. corticosteroids and leukotriene inhibitors. C. removal of allergens in the home and school. D. a bronchodilator and mast cell stabilizers.

D. a bronchodilator and mast cell stabilizers. Rationale: 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.

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

D. apple juice Rationale: The child can have clear, cool liquids when fully awake

Which vitamin supplements are necessary for children with CF? A. vitamin C and calcium B. vitamin B6 and B12 C. magnesium D. vitamins A, D, E, and K

D. vitamins A, D, E, and K Rationale: Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with CF, therefore supplements are necessary