Respiratory (Exam 1)

A 2 year old child is admitted with the diagnosis of croup and now has a respiratory rate of 48 breaths per minute, a heart rate of 132 bpm and a temperature of 100.8 F (38.2 C). The nurse is having difficulty calming the child. Which of the following should the nurse do next? A. Administer acetaminophen B. Check pulse oximetry C. Let the toddler continue to cry D. Offer clear fluids every few minutes

B

A 3 y/o is brought to the ED with coughing and gagging. The parent reports that the child was eating carrots when she began to gag. Which diagnostic evaluation will be used to determine whether the child has aspirated carrots? A. Chest x ray B. Bronchoscopy C. ABG D. Sputum culture

B

A 5 y/o is brought to the ED with a temperature of 99.5 F, a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for? A. Immediate IV placement B. Respiratory treatment of the racemic epinephrine C. A tracheostomy set at the bedside D. Informing the child's parents about a tonsillectomy

B

Which should the nurse instruct children to do to stop the spread of influenza in the classroom? Select all that apply A. Stay home if they have a runny nose and cough B. Wash their hands after using the restroom C. Wash their hands after sneezing D. Have a flu shot annually E. Drink lots of water during the day

B, C

6 y/o Ethan is admitted to the Emergency Room with a severe sore throat, hoarseness and a Temperature of 103.1 F. He is sitting in a tripod position and is drooling. The physician ordered a lateral neck x-ray. Which of the following is the most important nursing intervention? A. Obtain a throat culture to rule out Strep. B. Ensure that his parents remain with him at all times. C. Have the X-ray taken at the bedside instead of transporting to radiology. D. Observe his airway opening using a tongue blade.

C

The parent of a child with CF asks the nurse what will be done to relieve the child's constipation. Which is the nurse's best response? A. "Your child likely has an obstruction and will require surgery" B. "Your child will likely be given IV fluids" C. "Your child will likely be given MiraLax" D. "Your child will be placed on a clear liquid diet"

C

What information should the nurse provide the parent of a child diagnosed with nasopharyngitis? A. Complete the entire prescription of antibiotics B. Avoid sending the child to day care C. Use comfort measures for the child D. Restrict the child to clear liquids for 24 hours

C

A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse's best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation? A. "Children this age rarely get epiglottitis; you should not blame yourself" B. "It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen" C. "Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son's symptoms" D. "Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worse so quickly"

D

The parent of an infant with CF asks the nurse how to meet the child's increased nutritional needs. Which is the nurse's best suggestion? A. "You may need to increase the number of fresh fruits and vegetables you give your infant" B. "You may need to advance your infant's diet to whole cow's milk because it is higher in fat than formula" C. "You may need to change your infant to a higher-calorie formula" D. "You may need to increase your infant's carbohydrate intake"

C

Which breathing exercises should the nurse have the asthmatic 3 y/o child do to increase the expiratory phase? A. Use an incentive spirometer B. Breathe into a paper bag C. Blow a pinwheel D. Take several deep breaths

C

Which information would be the most helpful in teaching parents about the primary prevention of foreign body aspiration? A. Signs and symptoms of foreign body aspiration B. Therapeutic management of foreign body aspiration C. Most common objects that toddlers aspirate D. Risks associated with foreign body aspiration

C

Which is diagnostic for epiglottitis? A. Blood test B. Throat swab C. Lateral neck x-ray of the soft tissue D. Signs and symptoms

C

Which is the nurse's best response to the parent of an infant diagnosed with the first otitis media who wonders about long-term effects? A. "The child could suffer hearing loss" B. "The child could suffer some speech delays" C. "The chid could suffer from recurrent ear infections" D. "The child could require ear tubes"

C

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? Select all that apply. A. Maintaining strict bedrest B. Avoiding contact with family members C. Instilling saline nose drops and bulb suctioning D. Keeping the head of the bed flat E. Providing humidity, and propping the head of the bed up

C, E

A 2 y/o has just been diagnosed with 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? A. "You can expect your child to develop a barrel-shaped chest" B. "You can expect your child to develop a chronic productive cough" C. "You can expect your child to develop bronchiectasis" D. "You can expect your child to develop wheezing respirations"

D

The parent of a 9 month old calls the ED because his child is choking on a marble. The parent asks how to help his child while awaiting EMS. Which is the nurse's best response? A. "You should administer 5 abdominal thrusts followed by 5 back blows" B. "You should try to retrieve the object by inserting your fingers in your child's mouth" C. "You should perform the Heimlich maneuver" D. "You should administer 5 back blows followed by 5 chest thrusts"

D

The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hosptialized. Which is the nurse's best response? A. "Some children just react differently to viruses. It is best to treat each child as an individual" B. "Younger children have wider airways that make it easier for bacteria to enter and colonize" C. "Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections" D. "Children younger than 3 years usually exhibit worse symptoms because their immune systems are not developed"

D

The parents of a 6 y/o 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? A. "Use a humidifier in your child's room" B. "Have your carpet cleaned chemically once a month" C. "Wash household pets weekly" D. "Avoid purchasing upholstered furniture"

D

What should be the nurse's first action with a child who has high fever, dysphagia, drooling, tachycardia, and tachypnea? A. Immediate IV placement B. Immediate respiratory treatment C. Thorough physical assessment D. Lateral neck radiographs (x-rays)

D

Which intervention is most appropriate to teach the mother of a child diagnosed with an upper respiratory infection, and a dry hacking cough that prevents him from sleeping? A. Give cough suppressants at night B. Give an expectorant every 4 hours C. Give cold and flu mediation every 8 hours D. Give 1/2 teaspoon of honey 4-5x per day

D

Which would the nurse explain to parents about the inheritance of cystic fibrosis? A. CF is an autosomal-dominant trait passed on from the child's mother B. CF is an autosomal-dominant trait passed on from the child's father C. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF D. 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

D

Which child with asthma should the nurse see first? 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% B. A 5 y/o who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93% C. A 9 y/o who is quiet, is pale in color, is wheezing bilaterally with an oxygen saturation of 92% D. A 16 y/o who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%

A

Which is the nurse's best response to a parent who asks what can be done at home to help an infant with upper respiratory infection symptoms and a fever get better? A. "Give your child small amounts of fluid every hour to prevent dehydration" B. "Give your child Robitussin at night to reduce his cough and help him sleep" C. "Give your child a baby aspirin every 4-6 hours to help reduce the fever" D. "Give your child an over the counter cold medicine at night"

A

Which statement indicates the parent needs further teaching on how to prevent his other children from contracting RSV? A. "I should make sure that both my children receive palivizumab (Synagis) injections for the remainder of the year" B. "I should be sure to keep my infected child away from his brother until he has recovered" C. "I should insist that all people who come in contact with my children thoroughly wash their hands before playing with them" D. "I should insist that anyone with respiratory illness avoid contact with my children until well"

A

A nurse delegates the task of infant vital-sign assessment to a nurse technician. The nurse should instruct the technician to: A. Report any infant using abdominal muscles to breathe. B. Report any infant with apnea for 7 seconds C. Count respirations for 15 seconds and multiply by 4 D. Report any infant with a breathing pause that lasts 20 seconds or longer.

D

What is the most important piece of information that the nurse must ask the parent of a child in status athmasticus? A. "What time did your child last eat?" B. "Has your child been exposed to any of the usual asthma triggers?" C. "When was your child last admitted to the hospital for asthma?" D. "When was your child's last dose of medication?"

D

Which physical findings would be of most concern in an infant with respiratory distress? A. Tachypnea B. Mild retractions C. Wheezing D. Grunting

D

What does the therapeutic management of CF patients include? Select all that apply. A. Providing a high-protein, high-calorie diet B. Providing a high-fat, high-carbohydrate diet C. Encouraging exercise D. Minimizing pulmonary complications E. Encouraging medication compliance

A, C, D, E

An infant is being treated at home for bronchiolitis. Which of the following would the nurse teach the parent about home care? Select all that apply. A. Offer small amounts of fluids frequently B. Encouraging the infant to sleep prone C. Calling the clinic if the infant vomits D. Performing chest physiotherapy every 4 hours E. Watching for difficulty breathing

A, E

Which would be an early sign of respiratory distress in a 2 month old? A. Breathing shallowly B. Tachypnea C. Tachycardia D. Bradycardia

B

A child is complaining of throat pain. Which statement by the mother indicates that she needs more education regarding the care and treatment of her child's pharyngitis? A. "I will have my child gargle with salt water 3x a day" B. "I will offer my child ice chips several times a day" C. "I will give my child Tylenol every 4-6 hours as needed" D. "I will ask the nurse practitioner for some amoxicillin"

D

A child with severe cerebral palsy is admitted to the hospital for aspiration pneumonia. What is the most beneficial educational information that the nurse can provide to the parents? A. The signs and symptoms of aspiration pneumonia B. The treatment plan for aspiration pneumonia C. The risks associated with recurrent aspiration pneumonia D. The prevention of aspiration pneumonia

D

Following parental teaching, the nurse is evaluating the parent's understanding of environmental control for their child's first asthma management. Teaching has been understood by the parents if they state: A. "We will replace the carpet in our child's bedroom with tile." B. "We're glad the dog can continue to sleep in our child's room." C. "We'll be sure to use the fireplace often to keep the house warm in winter." D. "We'll keep the plants in our child's room dusted."

A

What would the nurse advise the parent of a child with a barky cough that gets worse at night? A. Take the child outside into the more humid night air for 15 min B. Take the child to the ED immediately C. Give the child an over the counter cough suppressant D. Give the child warm liquids to sooth the throat

A

Which child is at highest risk for requiring hospitalization to treat RSV? A. A 2 month old who was born at 32 weeks B. A 16 month old with a tracheostomy C. A 3 y/o with a congenital heart defect D. A 4 y/o who was born at 30 weeks

A

Which is the nurse's best response to the parent of a child diagnosed with epiglottitis who asks the nurse what the treatment will be? A. Complete a course of IV antibiotics B. Surgery to remove the tonsils C. 10 days of aerosolized Ribavirin D. No intervention

A

Which child would benefit most from having ear tubes placed? Select all that apply. A. A 9 month old who has had 1 ear infection B. A 13 month old with recurrent ear infections C. A 2 y/o who has had 5 previous ear infections D. A 3 y/o whose sibling has had 4 ear infections E. A 7 y/o who has had 2 ear infections this year

B, C

Which child is in the greatest need of emergency medical treatment? A. A 3 y/o who has a barky cough, is afebrile, and has mild intercostal retractions B. A 6 y/o who has high fever, no spontaneous cough, and frog-like croaking C. A 7 y/o who has abrupt onset of moderate respiratory distress, a mild fever, and a barky cough D. A 13 y/o who has a high fever, stridor, and purulent secretions

B

A school-age child has been diagnosed with nasopharyngitis. The parent is concerned because the child has had little or no appetite in the last 24 hours. Which is the nurse's best response? A. "Do not be concerned; it is common for children to have a decreased appetite during a respiratory illness" B. "Be sure your child is taking adequate amounts of fluid. The appetite should return soon" C. "Try offering the child some favorite foods. Maybe that will improve appetite" D. "You need to force your child to eat whatever you can; adequate nutrition is essential"

B

An infant has acute otitis media. The nurse will teach the parents to: A. Keep the baby in a flat lying position during sleep B. Administer ibuprofen to relieve discomfort C. Administer a decongestant D. Place baby to sleep with a pacifier

B

How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts os azotorrhea and steatorrhea in a child with cystic fibrosis? A. Not compliant with taking her vitamins B. Not compliant with taking her enzymes C. Eating too many foods high in fat D. Eating too many foods high in fiber

B

The nurse is teaching the parents of a newly diagnosed cystic fibrosis patient how to administer the pancreatic enzymes. The nurse will advise the parents to administer the enzymes: A. BID B. With meals and snacks C. Every six hours around the clock D. QID

B

The parent of a child with frequent ear infections asks the nurse if there is anything that can be done to help avoid future ear infections. Which is the nurse's best response? A. "Your child should be put on a daily dose of montelukast (Singulair)" B. "Your child should be kept away from tobacco smoke" C. "Your child should be kept away from other children with otitis media" D. "Your child should always wear a hat when outside in the cold"

B

Which assessment is of greatest concern in a 15 month old? A. The child is lying down and has moderate retractions, low grade fever, and nasal congestion B. The child is in the tripod position and has diminished breath sounds and a muffled cough C. The child is sitting up and has coarse breath sounds, coughing, and fussiness D. The child is restless and crying, has bilateral wheezes, and is feeding poorly

B

Which laboratory result will provide the most important information regarding the respiratory status of a child with acute asthma exacerbation? A. CBC B. ABG C. BUN D. PTT

B