#7: pediatric asthma Flashcards
One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection:
A. lessens effectiveness of medications.
B. encourages exercise-induced asthma.
C. increases sensitivity to allergens.
D. can trigger an episode or aggravate an asthmatic state.
D. can trigger an episode or aggravate an asthmatic state.
(The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean and free from mold.)
When caring for a child after a tonsillectomy, the nurse should:
A. watch for continuous swallowing.
B. offer ice cream and pudding.
C. position the child on the back for sleeping.
D. give warm water or soup to soothe the throat.
A. watch for continuous swallowing.
(Continuous swallowing is the most obvious early sign of bleeding from the operative site. Milk products should be avoided as they can cause throat clearing, which induces bleeding. The child should be positioned on the side or abdomen to facilitate secretion drainage. Cool fluids, such as crushed ice, popsicles, or diluted fruit juice, are preferred to help reduce throat pain.)
It is important that a child with group A beta-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent:
A. otitis media.
B. diabetes insipidus.
C. nephrotic syndrome.
D. acute rheumatic fever.
D. acute rheumatic fever.
(Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for glomerulonephritis, not nephritic syndrome. Children with GABHS infection are at risk for acute rheumatic fever and acute glomerulonephritis.)
A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:
A. confirm the diagnosis of asthma.
B. determine the cause of asthma.
C. identify “triggers” of asthma.
D. assess the severity of asthma.
D. assess the severity of asthma.
(Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and airflow limitation or obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 second. This can provide an objective measure of pulmonary function when compared to the child’s baseline.)
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of:
A. pneumothorax.
B. bronchodilation.
C. carbon dioxide retention.
D. increased viscosity of sputum.
A. pneumothorax.
(The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. A pneumothorax may result from a ruptured bronchial cyst secondary to repeated infection and inflammation. The child needs to be seen as soon as possible. Bronchodilation and carbon dioxide retention would not produce the symptoms listed. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.)
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a:
A. spacer.
B. nebulizer.
C. peak expiratory flow meter.
D. trial of chest physiotherapy.
A. spacer.
(The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flow meter is a measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration.)
A 5-year-old child is brought to the emergency department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions?
Select all that apply.
A. Vital signs
B. Throat culture
C. Medical history
D. Assessment of breath sounds
E. Emergency airway equipment readily available
A. Vital signs
(Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis, in addition to knowing immunization status. Assessment of breath sounds is also important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.)
C. Medical history
Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis, in addition to knowing immunization status. Assessment of breath sounds is also important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.
D. Assessment of breath sounds
(Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis, in addition to knowing immunization status. Assessment of breath sounds is also important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.)
E. Emergency airway equipment readily available
(Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis, in addition to knowing immunization status. Assessment of breath sounds is also important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.)
Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is:
A. atrophic changes in the mucosal wall of intestines.
B. hypoactivity of the autonomic nervous system.
C. decrease in the sweat electrolytes.
D. mechanical obstruction caused by increased viscosity of mucous gland secretions.
D. mechanical obstruction caused by increased viscosity of mucous gland secretions.
(Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The sweat electrolytes are greatly elevated. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas and bronchioles.)
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates:
A. liquefying secretions.
B. improving oxygenation.
C. promoting ventilation.
D. soothing inflamed mucous membrane.
A. liquefying secretions
A 4-year-old girl is brought to the emergency room. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should:
A. examine her oral pharynx and report to the physician.
B. make her lie down and rest quietly.
C. auscultate her lungs and make preparations for placement in a mist tent.
D. notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
D. soothing inflamed mucous membrane.
(The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed, providing symptomatic relief.)
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37°C. The nurse suspects croup and should recommend:
A. controlling fever with acetaminophen and calling if the cough gets worse during the night.
B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
C. trying over-the-counter cough medicine and coming to the clinic in the morning if there is no improvement.
D. admitting to the hospital and observing for impending epiglottitis.
B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
(The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency room if these signs develop. Cool mist is recommended to provide relief. Cough suppressants are not indicated for a child under the age of 6 years. This cough is characteristic of laryngotracheobronchitis, not epiglottitis.)
An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to:
A. prevent respiratory syncytial virus (RSV) infection.
B. make isolation of an infant with RSV unnecessary.
C. prevent secondary bacterial infection.
D. decrease toxicity of antiviral agents.
A. prevent respiratory syncytial virus (RSV) infection.
(Synagis is a monoclonal antibody specific for RSV. Monthly intramuscular administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV in infants who are at the highest risk for severe lung infection. It will not affect the need to isolate the child if RSV develops. The antibody is specific to RSV, not bacterial infection. Synagis will have no effect on antiviral agents.)
Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary?
A. C, D
B. A, E, K
C. A, D, E, K
D. C, folic acid
B. A, E, K
(Vitamin C is not one of the fat-soluble vitamins. Vitamin D also needs to be supplemented. Vitamins A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. Vitamin C and folic acid are not fat soluble.)
