RNSG 2201 Care of Children and Family Evolve Ch 26

Which nurse teaching information is appropriate for the parents of a school-age child with nasal blockage about the use of vasoconstrictive nose drops? Select all that apply.

Administer the drops 15 to 20 minutes before feeding. Avoid using the same bottle for more than one illness. Avoid using the same bottle for more than one child. (The child is able to eat and sleep comfortably when the nasal passage is clear. Therefore, nose drops are administered 15 to 20 minutes before feeding and at bedtime. Nose drops are easily contaminated with bacteria and viruses; therefore, they must not be used for more than one illness or more than one child. Initially, two drops are instilled in each nostril, and, because this shrinks only the anterior mucous membranes, two more drops are instilled 5 to 10 minutes later. Nose drops should not be administered for more than 3 days to prevent rebound congestion.)

Which endocrine disorder is commonly found in children with cystic fibrosis?

Diabetes mellitus (Diabetes mellitus is more common in children with cystic fibrosis because of changes in pancreatic architecture and diminished blood supply over time. Addison disease, Cushing syndrome, and congenital adrenal hyperplasia are not commonly found in children with cystic fibrosis.)

Which step is appropriate when providing nutrition for a child with nasopharyngitis who is not taking any food or fluids?

Encourage the child to take fluids only. (Maintaining hydration is the most essential step. The nurse would encourage the child to take any preferred liquid. The nurse would not force the child to eat solid foods. It may result in nausea and vomiting and cause an aversion to feeding. As opposed to waiting until symptoms subside, the nurse would monitor and try to maintain the hydration level in the body. Airway compromise may occur with tonsillar swelling and the child may require intravenous hydration. However, first oral hydration would be tried by encouraging the child to take enough fluids.)

Which clinical manifestation is appropriate when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation?

Nasal flaring and retractions (Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability.)

Which clinical manifestations are appropriate for acute epiglottitis? Select all that apply.

Pain. Fever. Drooling. Tripod position. (Clinical manifestations of acute epiglottitis include fever, tripod position, drooling, pain, irritability, restlessness, anxiousness, apprehensiveness, frightened expression, suprasternal and substernal retractions, froglike-croaking sound, slow quiet breathing, red throat, and an edematous epiglottis. Hepatosplenomegaly is not a common clinical manifestation of acute epiglottitis.)

The nurse understands that guidelines for administering the tuberculin skin test (TST) include:

Periodic administration for children who are at high risk (Children who are at high risk for contacting tuberculosis are tested periodically. Annual testing is only indicated for children with human immunodeficiency virus infection and incarcerated adolescents, no matter the age of the child.)

Which complication is appropriate to prevent when instructing the parents of an asthmatic child to avoid the use of aspirin in the child?

Reye syndrome (Parents should avoid giving aspirin to the child because of its association with Reye syndrome. The administration of aspirin to a child should be specifically recommended by and under the supervision of a health practitioner. Corticosteroids are given to children with cystic fibrosis and may cause linear growth restriction. Other analgesic-antipyretic drugs, which do not contain aspirin, can be used. Aspirin, though not less effective, may cause aspirin-induced asthma. Aspirin is avoided because of its link to Reye syndrome and not because of any drug reaction.)

Which fluid is inappropriate when attempting to rehydrate a young child?

Sports drink (The American Academy of Pediatrics does not recommend sports drinks or energy drinks for rehydration. Water and low-carbohydrate flavored drinks are recommended for older children who need to be rehydrated. Infalyte or Pedialyte is recommended for infants.)

How are the symptoms of acute otitis media (AOM) different from that of otitis media with effusion (OME)?

Symptoms of acute infection are common in AOM. (AOM is an inflammation of the middle ear space. AOM is accompanied by symptoms of acute infection like fever, otalgia, and so forth. Hearing impairment can happen in both AOM and otitis media with effusion (OME). In OME, the tympanic membrane is immobile or orange colored. Nonspecific symptoms like rhinitis, cough, or diarrhea are often present in OME.)

Which developmental factor increases the risk of infection in infants and young children?

The relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear. (The relatively short and open eustachian tube in young children allows pathogens easy access to the middle ear. The narrowed airways in young children promote quick, not slow, movement of organisms down the respiratory tract. Increased exposure to organisms would increase the chance of infection. The diameter of the airways in young children is not big, but small, and therefore subject to edema of the mucous membranes.)

Which clinical manifestations are appropriate signs of acute epiglottitis in a croup syndrome? Select all that apply.

Drooling. Stridor when supine. Toxic appearance. (Croup syndromes can affect the larynx, trachea, and bronchi. Drooling, the presence of stridor when supine, and toxic appearances are major manifestations that are predictive of epiglottitis. Drooling of saliva is common because of the difficulty or pain in swallowing and excessive secretions. The child has high fever, appears sicker than clinical findings suggest, and insists on sitting upright and leaning forward with the chin thrust out, mouth open, and tongue protruding. Low-grade fever and brassy cough are signs of acute laryngotracheobronchitis.)

Which complication is appropriate in the child with cystic fibrosis?

Prolapse of the rectum (Prolapse of the rectum occurs in infancy and childhood and is related to large, bulky stools; malnutrition; and increased abdominal pressure secondary to paroxysmal cough. Clinical manifestations of cystic fibrosis are related to increased viscosity of the mucous gland secretions. Thick secretions block the pancreatic duct and cause severe insulin deficiency. The blockage prevents essential pancreatic enzymes from reaching the duodenum, which causes marked impairment in the digestion and absorption of nutrients. The disturbed function is reflected in bulky stools that are frothy from undigested fat and foul smelling from putrefied protein. Affected children of all ages are subject to intestinal obstruction from impacted feces. Gum-like masses can obstruct the bowel and produce a partial or complete obstruction.)

Which nursing measures are appropriate when caring for a 10-year-old child who is suffering from dyspnea, has difficulty in vocalizing, and has adventitious breath sounds? Select all that apply.

Provide humidified oxygen. Perform suctioning of the airway as necessary. Perform chest physiotherapy to facilitate secretion removal. (The child has respiratory discomfort. Humidified oxygen helps moisten secretions and prevents drying of the airway. If it is necessary, the nurse would perform suctioning of the airway to remove secretions. The nurse would try to make efforts to keep the child's airways patent. Chest physiotherapy helps remove secretions. As the symptoms suggest, the child may have epiglottitis. If epiglottitis is suspected, the nurse would avoid throat examination to prevent airway compromise. The nurse would consider cough enhancement because a cough is a protective way of clearing secretions.)

Which diagnosis is appropriate for an 1½-month-old infant who is refusing to nurse, is fussy, crying, pulling at the ears, rolling the head from side-to-side, has nasal discharge, and a rectal temperature of 39oC?

Acute otitis media (AOM) (Most episodes of AOM occur within the first 24 months of age. Pulling the ear and rolling the head from side to side indicate discomfort and pain in the ear. Because there is associated fever, the child most likely has AOM. In most cases of influenza, there is dryness of the throat and nasal mucosa and a dry cough. Fever may be accompanied by chills, flushed face, and photophobia. Pharyngitis is characterized by an acute onset of sore throat, exudates on the pharynx, and fever. Because there is no sore throat, pharyngitis can be ruled out. In some cases, residual middle ear effusions remain after episodes of AOM and cause otitis media with effusion (OME). In OME, severe pain or fever are usually absent.)

Which method is appropriate to prevent pulmonary infection in a child who was recently diagnosed with pulmonary involvement in cystic fibrosis?

Airway clearance therapy (ACT) (In cystic fibrosis, the mucous secretions remain obstructed and are retained in the lungs. Bacteria thrive in this stagnant mucus. ACT is helpful in removing secretions and prevents infection as a whole. Nasal lavaging is performed to irrigate the nasal cavity. It is limited to the nasal cavity only; it may not prevent pulmonary infections. Aerobic exercises help maintain healthy lung tissue and effective ventilation and can be used as an adjunct to ACT. Antimicrobial agents are used after an infection occurs and help to control disease progression. These agents do not prevent pulmonary infections.)

Which nursing intervention is appropriate to promote maximum ventilatory function in a child with acute asthma exacerbation?

Allow the child to assume a position of comfort. (The child would be allowed to assume the tripod position or other comfortable position. This allows maximum ventilatory function. This is the first step to follow in case of an asthma exacerbation. Humidified oxygen is administered to enhance oxygenation of the tissues. Frequent, small amounts of oral fluids are given to maintain hydration. Initiating a peripheral intravenous line is a more aggressive intervention that may need to be done when initial rescue medication fails.)

Which clinical manifestations are appropriate in the child with asthma? Select all that apply.

Barrel chest. Elevated shoulders. Increased use of accessory muscles. (The child with asthma has a barrel chest, with an increase in the anteroposterior diameter of the chest due to infiltration and hyperexpansion of the airways. The child develops elevated shoulders and increased use of accessory muscles. The child with scarlet fever may develop a fine, sandpaper rash on the trunk, axillae, elbows, and groin. This child may also have edematous and red tongue due to streptococcal infection.)

Which clinical manifestations are appropriate in the young child with nasopharyngitis from pharyngitis? Select all that apply.

Breathes through the mouth. Vomiting and diarrhea. Vasodilation of the mucosa. (The child with nasopharyngitis experiences discomfort related to nasal obstruction. The child has abundant nasal mucus and breathes through the mouth. The child may be vomiting and have diarrhea along with poor feeding and decreased fluid intake. Physical assessment also reveals edema and vasodilation of the mucosa. The child with pharyngitis has mild to moderate hyperemia with a moderate sore throat.)

Which triggers tend to precipitate or aggravate asthma in children? Select all that apply.

Exercise. Tobacco smoke. Thyroid disease. (Triggers that precipitate or aggravate asthma in children include exercise, tobacco smoke, and thyroid disease. A candle-free home and breast milk do not trigger or aggravate asthma symptoms in children; rather, they decrease the likelihood of an asthma exacerbation.)

Which reason is appropriate to discourage an 11-year-old child with acute nasopharyngitis from using a nasal drop containing phenylephrine 0.25% and ephedrine 1% for more than 3 days?

Can cause rebound congestion of nasal mucosa (The nurse discourages the use of nasal drops for more than 3 days primarily because it can cause rebound congestion of the nasal mucosa. Older children often prefer nasal sprays to nasal drops because they can learn to compress the plastic container at the moment of inspiration. Both sprays and drops should be used for no more than 3 days. Bottles of nasal drops easily get contaminated with bacteria and viruses. Hence, such bottles should be used only for one child and only for one illness. Though nasal drops and sprays are more effective and safe in children over 12 years of age, these can be used in children over 6 years of age.)

Which reason is appropriate when preventing respiratory tract infections in children with asthma?

Can trigger an episode or aggravate an asthmatic state (A respiratory tract infection can trigger an asthmatic attack. An annual influenza vaccine is recommended. All respiratory equipment should be kept clean. Respiratory tract infection, not the medications, affects the asthma. Exercise-induced asthma is caused by vigorous activity, not a respiratory tract infection. Sensitivity to allergens is independent of respiratory tract infection.)

Which condition is appropriate for the newborn who has respiratory distress, cyanosis, a scaphoid abdomen, and a possible mediastinal shift at birth?

Congenital diaphragmatic hernia (CDH) (The nurse would be alert if a newborn infant has a scaphoid abdomen, moderate to severe respiratory distress, decreased breath sounds unilaterally, and a history of polyhydramnios. The nurse would suspect CDH and should investigate further. Asthma is mostly caused by allergens. Infants may display supraclavicular, intercostal, suprasternal, subcostal, and sternal retractions. However, clinical symptoms of asthma may be less obvious in infancy. Choanal atresia is a congenital defect of the nose. A bony and/or membranous septum develops between the nose and the pharynx. When the neonate is at rest, the neonate may become cyanotic and apneic. Once the infant cries, the infant breathes in through the mouth and cyanosis disappears. PRS is a defect where the tongue may be large and frequently fall over the neonate's airway, causing respiratory distress.)

Which clinical manifestation is appropriate when evaluating for a foreign body aspiration?

Cough and hoarseness (Initially, a foreign body in the air passages produces choking, gagging, wheezing, or coughing. Laryngotracheal obstruction most commonly causes dyspnea, cough, stridor, and hoarseness because of decreased air entry. Bronchial obstruction usually produces paroxysmal cough, wheezing, asymmetric breath sounds, decreased airway entry, and dyspnea. When an object is lodged in the larynx, the child is unable to speak or breathe. Cyanosis may occur if the obstruction becomes worse.)

Which reason is appropriate for the nurse to discourage the parent from giving the child an over-the-counter cough suppressant to a 5-year-old child who has fever, nasal discharge, and productive cough?

Cough is a protective way of clearing secretions. (Cough is a natural mechanism to clear secretions from the body. The nurse would do chest physiotherapy and encourage the patient to cough in order to remove secretions. Cough suppressants may be prescribed for a dry, hacking cough rather than a productive cough. An over-the-counter cough suppressant used when not needed may result in addiction and may be detrimental to the health. The effectiveness of cough suppressants is doubtful. Some cough suppressants contain up to 22% alcohol and can cause confusion, hyperexcitability, dizziness, nausea, and sedation. Hence, health care providers carefully evaluate the benefits and risks of recommending these medicines to children under 6 years of age.)

Which clinical manifestations are commonly seen in both acute spasmodic laryngitis and acute tracheitis? Select all that apply.

Croupy cough. Upper respiratory tract infections. (Croupy cough and upper respiratory tract infections are common in both acute spasmodic laryngitis and acute tracheitis. Dyspnea is common in acute spasmodic laryngitis. Because acute tracheitis may be of either viral or bacterial origin with allergic component, it may be associated with purulent discharge. This is not seen in acute spasmodic laryngitis because it is of viral origin with an allergic component. Acute tracheitis has a moderately progressive onset of symptoms. In acute spasmodic laryngitis, the onset of symptoms occurs suddenly at night; the symptoms often disappear during the day.)

Which nursing advice is appropriate for the child being treated for infectious mononucleosis to avoid strenuous and contact sports?

Has splenomegaly (In infectious mononucleosis, for about half the cases, the spleen is enlarged. Splenic hemorrhage or rupture may occur due to trauma during contact sports and strenuous activities. The virus is believed to be transmitted by direct contact with oral secretions, blood transfusion, or transplantation. It is mildly contagious. The child should limit exposure to persons outside the family, especially during the acute phase of illness, to prevent secondary infection. Physical activities are not restricted in mononucleosis; rather, the child should be encouraged to maintain limited activities to prevent deconditioning. The patient may be in considerable pain, but activities can be undertaken as tolerated.)

Which statement is appropriate for infectious mononucleosis?

Herpes-like Epstein-Barr virus is the principal cause. (Herpes-like Epstein-Barr virus accounts for most cases of mononucleosis. A complete blood count in an adolescent with mononucleosis would indicate a lymphocytic leukocytosis with atypical lymph, not leukopenia. The monospot test is a highly specific test for mononucleosis.)

Which method is appropriate when determining if a nonhospitalized child with respiratory infection is dehydrated?

Insufficient voiding (In a child who is not acutely ill and not hospitalized, a count of the number of voids in a 24-hour period is done to assess the level of hydration. The child may have a sore throat; therefore, the child has a decreased urge to drink fluids. Fever increases the total body fluid turnover and generally causes dry mouth. Often a child suffering from respiratory tract infection has a complaint of lack of energy.)

Which recommendation is appropriate for a 20-month-old with a barking cough at night, a temperature of 37ºC (98.6ºF), and no difficulty breathing?

Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing (Because the child is not experiencing difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will help open up the child's airways. The child does not have a temperature and therefore does not require management with acetaminophen. Cough suppressants are not indicated by the symptoms, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.)

Which nursing intervention is appropriate for a child after tonsillectomy?

Watching for continuous swallowing (Frequent swallowing is the most obvious early sign of bleeding from the surgical site in a child who has undergone tonsillectomy. Gargling would be avoided after a tonsillectomy because of the potential for trauma to the suture line. The child would be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, easing the pain. Heat or warmth would increase the risk of bleeding.)