Chapter 26

Question 1

1. Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of
   respiratory infections?

a. They are safer.
b. They are less expensive.
c. Respiratory secretions are dried by steam vaporizers.
d. A more comfortable environment is produced.

Answer 1

ANS: A. They are safer

Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to
steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both cool-mist vaporizers and steam vaporizers may promote a more comfortable environment, but cool-mist
vaporizers have decreased risk for burns and growth of organisms.

Question 2

2. Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract
   infection. Instructions for nose drops should include which information?

a. Do not use for more than 3 days.
b. Keep drops to use again for nasal congestion.
c. Administer drops after feedings and at bedtime.
d. Give two drops every 5 minutes until nasal congestion subsides.

Answer 2

ANS: A. Do not use for more than 3 days.

Vasoconstrictive nose drops such as Neo-Synephrine should not be used for more than 3 days to avoid rebound
congestion. Drops should be discarded after one illness and not used for other children because they may
become contaminated with bacteria. Drops administered before feedings are more helpful. Two drops are
administered to cause vasoconstriction in the anterior mucous membranes. An additional two drops are
instilled 5 to 10 minutes later for the posterior mucous membranes. No further doses should be given.

Question 3

3. The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition?
   a. Has a cough
   b. Becomes fussy
   c. Shows signs of an earache
   d. Has a fever higher than 37.5 C (99 F)

Answer 3

ANS: C. Shows signs of an earache

If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and
possibly secondary bacterial infection. The health professional should be contacted to evaluate the infant. Cough can be a sign of nasopharyngitis. Irritability is common in an infant with a viral illness. Fever is
common in viral illnesses.

Question 4

4. It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which
   condition?

a. Otitis media
b. Diabetes insipidus (DI)
c. Nephrotic syndrome
d. Acute rheumatic fever

Answer 4

ANS: D. Acute rheumatic fever

Group A hemolytic streptococcal infection is a brief illness with varying symptoms. It is essential that
pharyngitis caused by this organism be treated with appropriate antibiotics to avoid the sequelae of acute
rheumatic fever and acute glomerulonephritis. The cause of otitis media is either viral or other bacterial
organisms. DI is a disorder of the posterior pituitary. Infections such as meningitis or encephalitis, not
streptococcal pharyngitis, can cause DI. Glomerulonephritis, not nephrotic syndrome, can result from acute
streptococcal pharyngitis.

Question 5

5. When caring for a child after a tonsillectomy, what intervention should the nurse do?
   a. Watch for continuous swallowing.
   b. Encourage gargling to reduce discomfort.
   c. Apply warm compresses to the throat.
   d. Position the child on the back for sleeping.

Answer 5

ANS: A. Watch for continuous swallowing.

Continuous swallowing, especially while sleeping, is an early sign of bleeding. The child swallows the blood
that is trickling from the operative site. Gargling is discouraged because it could irritate the operative site. Ice
compresses are recommended to reduce inflammation. The child should be positioned on the side or abdomen
to facilitate drainage of secretions.

Question 6

6. What statement best represents infectious mononucleosis?
   a. Herpes simplex type 2 is the principal cause.
   b. A complete blood count shows a characteristic leukopenia.
   c. A short course of ampicillin is used when pharyngitis is present.
   d. Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.

Answer 6

ANS: D. Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.

The characteristics of the diseasemalaise, sore throat, lymphadenopathy, central nervous system
manifestations, and skin lesionsare similar to presenting signs and symptoms in other diseases. Hematologic
analysis (heterophil antibody and monospot) can help confirm the diagnosis. However, not all young children
develop the expected laboratory findings. Herpes-like Epstein-Barr virus is the principal cause. Usually, an
increase in lymphocytes is observed. Penicillin, not ampicillin, is indicated. Ampicillin is linked with a discrete
macular eruption in infectious mononucleosis.

Question 7

7. Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a
   temperature of 39 C (102.2 F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media
   (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what
   medication?

a. Decongestants to ease stuffy nose
b. Antihistamines to help the child sleep

c. Aspirin for pain and fever
management

d. Benzocaine ear drops for topical pain relief

Answer 7

ANS: D. Benzocaine ear drops for topical pain relief

Analgesic ear drops can provide topical relief for the intense pain of OM. Decongestants and antihistamines
are not recommended in the treatment of OM. Aspirin is contraindicated in young children because of the
association with Reye syndrome.

Question 8

8. An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. What
   instructions should be given to the parent?

a. Administer all of the prescribed medication.
b. Continue medication until all symptoms subside.
c. Immediately stop giving medication if hearing loss develops.
d. Stop giving medication and come to the clinic if fever is still present in 24 hours

Answer 8

ANS: A. Administer all of the prescribed medication.

Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of OM; antibiotics
should continue to be given. Medication may take 24 to 48 hours to make symptoms subside.

Question 9

9. An infants parents ask the nurse about preventing otitis media (OM). What information should be provided?
   a. Avoid tobacco smoke.
   b. Use nasal decongestants.
   c. Avoid children with OM.
   d. Bottle- or breastfeed in a supine position.

Answer 9

ANS: A. Avoid tobacco smoke.

Eliminating tobacco smoke from the childs environment is essential for preventing OM and other common
childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other symptoms of upper respiratory tract infection. Children should be
fed in a semivertical position to prevent OM.

Question 10

10. Chronic otitis media with effusion (OME) differs from acute otitis media (AOM) because it is usually
    characterized by which signs or symptoms?

a. Severe pain in the ear
b. Anorexia and vomiting
c. A feeling of fullness in the ear
d. Fever as high as 40 C (104 F)

Answer 10

ANS: C. A feeling of fullness in the ear

OME is characterized by a feeling of fullness in the ear or other nonspecific complaints. OME does not cause
severe pain. This may be a sign of AOM. Vomiting, anorexia, and fever are associated with AOM

Question 11

11. A 4-year-old girl is brought to the emergency department. She has a froglike croaking sound on inspiration,
    is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner?

a. Make her lie down and rest quietly.
b. Examine her oral pharynx and report to the physician.
c. Auscultate her lungs and prepare for placement in a mist tent.
d. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

Answer 11

ANS: D. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

This child is exhibiting signs of respiratory distress and possible epiglottitis. Epiglottitis is always a medical
emergency requiring antibiotics and airway support for treatment. Sitting up is the position that facilitates
breathing in respiratory disease. The oral pharynx should not be visualized. If the epiglottis is inflamed, there is
the potential for complete obstruction if it is irritated further. Although lung auscultation provides useful
assessment information, a mist tent would not be beneficial for this child. Immediate medical evaluation and
intervention are indicated.

Question 12

12. The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is
    drooling. Examining the childs throat using a tongue depressor might precipitate what condition?

a. Sore throat
b. Inspiratory stridor
c. Complete obstruction
d. Respiratory tract infection

Answer 12

ANS: C. Complete obstruction

If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be
performed only when immediate intubation can take place. Sore throat and pain on swallowing are early signs
of epiglottitis. Stridor is aggravated when a child with epiglottitis is supine. Epiglottitis is caused by
Haemophilus influenzae in the respiratory tract.

Question 13

13. The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is
37 C (98.6 F). The nurse suspects mild croup and should recommend which intervention?

a. Admit to the hospital and observe for impending epiglottitis.
b. Provide fluids that the child likes and use comfort measures.
c. Control fever with acetaminophen and call if cough gets worse tonight.
d. Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

Answer 13

ANS: B. Provide fluids that the child likes and use comfort measures.

In mild croup, therapeutic interventions include adequate hydration (as long as the child can easily drink) and
comfort measures to minimize distress. The child is not exhibiting signs of epiglottitis. A temperature of 37 C
is within normal limits. Although a return to the clinic may be indicated, the mother is instructed to return if
the child develops noisy respirations or drooling.

Question 14

14. The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. What is the primary rationale for this action?
    a. Mothers of hospitalized toddlers often experience guilt.
    b. The mothers presence will reduce anxiety and ease the childs respiratory efforts.
    c. Separation from the mother is a major developmental threat at this age.
    d. The mother can provide constant observations of the childs respiratory efforts

Answer 14

ANS: B. The mothers presence will reduce anxiety and ease the childs respiratory efforts.

The familys presence will decrease the childs distress. It is true that mothers of hospitalized toddlers often
experience guilt and that separation from mother is a major developmental threat for toddlers, but the main
reason to keep parents at the childs bedside is to ease anxiety and therefore respiratory effort.

Question 15

15. An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation?
    a. Reverse isolation
    b. Airborne isolation
    c. Contact Precautions
    d. Standard Precautions

Answer 15

ANS: C. Contact Precautions

RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact
Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to
touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private
room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria
away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is
not airborne.

Question 16

16. An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia
    includes which intervention?

a. Administration of antibiotics
b. Frequent complete assessment of the infant
c. Round-the-clock administration of antitussive agents
d. Strict monitoring of intake and output to avoid congestive heart failure

Answer 16

ANS: A. Administration of antibiotics

Antibiotics are indicated for bacterial pneumonia. Often the child has decreased pulmonary reserve, and
clustering of care is essential. The childs respiratory rate and status and general disposition are monitored
closely, but frequent complete physical assessments are not indicated. Antitussive agents are used sparingly. It
is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied
as possible

Question 17

17. What consideration is most important in managing tuberculosis (TB) in children?
    a. Skin testing
    b. Chemotherapy
    c. Adequate rest
    d. Adequate hydration

Answer 17

ANS: B. Chemotherapy

Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and isoniazid and
rifampin given two or three times a week by direct observation therapy for the remaining 4 months. Chemotherapy is the most important intervention for TB.

Question 18

18. A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect
    what condition?

a. Allergies
b. Acute pharyngitis
c. Foreign body in the nose
d. Acute nasopharyngitis

Answer 18

ANS: C. Foreign body in the nose

The irritation of a foreign body in the nose produces local mucosal swelling with foul-smelling nasal
discharge, local obstruction with sneezing, and mild discomfort. Allergies would produce clear bilateral nasal
discharge. Nasal discharge is usually not associated with pharyngitis. Acute nasopharyngitis would have
bilateral mucous discharge.

Question 19

19. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child?
    a. Force fluids.
    b. Monitor pulse oximetry.
    c. Institute seizure precautions.
    d. Encourage a high-protein diet.

Answer 19

ANS: B. Monitor pulse oximetry.

Careful monitoring of oxygenation and cardiopulmonary status is an important evaluation tool in the care of
the child with ARDS. Maintenance of vascular volume and hydration is important and should be done
parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is
not helpful.

Question 20

20. The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this childs care?
    a. Monitor pulse oximetry.
    b. Monitor arterial blood gases.
    c. Administer oxygen if respiratory distress develops.
    d. Administer oxygen if childs lips become bright, cherry-red in color

Answer 20

ANS: B. Monitor arterial blood gases.

Arterial blood gases are the best way to monitor CO poisoning. Pulse oximetry is contraindicated in the case of
CO poisoning because the PaO2 may be normal. One hundred percent oxygen should be given as quickly as
possible, not only if respiratory distress or other symptoms develop.

Question 21

21. What diagnostic test for allergies involves the injection of specific allergens?
    a. Phadiatop
    b. Skin testing
    c. Radioallergosorbent tests (RAST)
    d. Blood examination for total immunoglobulin E (IgE)

Answer 21

ANS: B. Skin testing

Skin testing is the most commonly used diagnostic test for allergy. A specific allergen is injected under the
skin, and after a suitable time, the size of the resultant wheal is measured to determine the patients sensitivity. Phadiatop is a screening test that uses a blood sample to assess for IgE antibodies for a group of specific
allergens. RAST determines the level of specific IgE antibodies. Blood examination for total IgE would not
distinguish among allergens.

Question 22

22. What statement is the most descriptive of asthma?
    a. It is inherited.
    b. There is heightened airway reactivity.
    c. There is decreased resistance in the airway.
    d. The single cause of asthma is an allergic hypersensitivity.

Answer 22

ANS: B. There is heightened airway reactivity.

In asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired
respiratory function. Atopy, or development of an immunoglobulin E (IgE)mediated response, is inherited but
is not the only cause of asthma. Asthma is characterized by increased resistance in the airway. Asthma has
multiple causes, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors

Question 23

23. What condition is the leading cause of chronic illness in children?
    a. Asthma
    b. Pertussis
    c. Tuberculosis
    d. Cystic fibrosis

Answer 23

ANS: A. Asthma

Asthma is the most common chronic disease of childhood, the primary cause of school absences, and the third
leading cause of hospitalization in children younger than the age of 15 years. Pertussis is not a chronic illness. Tuberculosis is not a significant factor in childhood chronic illness. Cystic fibrosis is the most common lethal
genetic illness among white children.

Question 24

24. A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests
    what condition?

a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign body in trachea

Answer 24

ANS: A. Asthma

Asthma may have these chronic signs and symptoms. Pneumonia appears with an acute onset, fever, and
general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial virus. Foreign body in the
trachea occurs with acute respiratory distress or failure and maybe stridor.

Question 25

25. A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate?
    a. To assess severity of asthma
    b. To determine cause of asthma
    c. To identify triggers of asthma
    d. To confirm diagnosis of asthma

Answer 25

ANS: A. To assess severity of asthma

Peak expiratory flow rate monitoring is used to monitor the childs current pulmonary function. It can be used
to manage exacerbations and for daily long-term management. The cause of asthma is known. Asthma is
caused by a complex interaction among inflammatory cells, mediators, and the cells and tissues present in the
airways. The triggers of asthma are determined through history taking and immunologic and other testing. The
diagnosis of asthma is made through clinical manifestations, history, physical examination, and laboratory
testing.

Question 26

26. Children who are taking long-term inhaled steroids should be assessed frequently for what potential
    complication?

a. Cough
b. Osteoporosis
c. Slowed growth
d. Cushing syndrome

Answer 26

ANS: C. Slowed growth

The growth of children on long-term inhaled steroids should be assessed frequently to evaluate systemic
effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause
osteoporosis. Cushing syndrome is caused by long-term systemic steroids.

Question 27

27. One of the goals for children with asthma is to maintain the childs normal functioning. What principle of
    treatment helps to accomplish this goal?

a. Limit participation in sports.
b. Reduce underlying inflammation.
c. Minimize use of pharmacologic agents.
d. Have yearly evaluations by a health care provider.

Answer 27

ANS: B. Reduce underlying inflammation.

Children with asthma are often excluded from exercise. This practice interferes with peer interaction and
physical health. Most children with asthma can participate provided their asthma is under control.
Inflammation is the underlying cause of the symptoms of asthma. By decreasing inflammation and reducing
the symptomatic airway narrowing, health care providers can minimize exacerbations. Pharmacologic agents
are used to prevent and control asthma symptoms, reduce the frequency and severity of asthma exacerbations, and reverse airflow obstruction. It is recommended that children with asthma be evaluated every 6 months.

Question 28

28. What drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young
    child?

a. Ephedrine
b. Theophylline
c. Aminophylline
d. Short-acting b2-agonists

Answer 28

ANS: D. Short-acting b2-agonists

Short-acting b2-agonists are the first treatment in an acute asthma exacerbation. Ephedrine and aminophylline
are not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations.

Question 29

29. Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor
    responsible for possible multiple clinical manifestations in CF?

a. Hyperactivity of sweat glands
b. Hypoactivity of autonomic nervous system
c. Atrophic changes in mucosal wall of intestines
d. Mechanical obstruction caused by increased viscosity of mucous gland secretions

Answer 29

ANS: D. Mechanical obstruction caused by increased viscosity of mucous gland secretions

The mucous glands produce a thick mucoprotein that accumulates and results in dilation. Small passages in
organs such as the pancreas and bronchioles become obstructed as secretions form concretions in the glands
and ducts. The exocrine glands, not sweat glands, are dysfunctional. Although abnormalities in the autonomic
nervous system are present, it is not hypoactive. Intestinal involvement in CF results from the thick intestinal
secretions, which can lead to blockage and rectal prolapse

Question 30

30. What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (CF)?
    a. Meconium ileus
    b. History of poor intestinal absorption
    c. Foul-smelling, frothy, greasy stools
    d. Recurrent pneumonia and lung infections

Answer 30

ANS: A. Meconium ileus

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. History of malabsorption is a later sign that manifests as failure to thrive. Foul- smelling stools and recurrent respiratory infections are later manifestations of CF.

Question 31

31. What tests aid in the diagnosis of cystic fibrosis (CF)?
    a. Sweat test, stool for fat, chest radiography
    b. Sweat test, bronchoscopy, duodenal fluid analysis
    c. Sweat test, stool for trypsin, biopsy of intestinal mucosa
    d. Stool for fat, gastric contents for hydrochloride, radiography

Answer 31

ANS: A. Sweat test, stool for fat, chest radiography

A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal
manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates
CF. Bronchoscopy, duodenal fluid analysis, stool tests for trypsin, and intestinal biopsy are not helpful in
diagnosing CF. Gastric contents normally contain hydrochloride; it is not diagnostic.

Question 32

32. A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this
    medication be administered?

a. After chest physiotherapy (CPT)
b. Before chest physiotherapy (CPT)
c. After receiving 100% oxygen
d. Before receiving 100% oxygen

Answer 32

ANS: B. Before chest physiotherapy (CPT)

Bronchodilators should be given before CPT to open bronchi and make expectoration easier. These
medications are not helpful when used after CPT. Oxygen is administered only in acute episodes, with caution, because of chronic carbon dioxide retention.

Question 33

33. A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). What statement
    about DNase is true?

a. Given subcutaneously
b. May cause voice alterations
c. May cause mucus to thicken
d. Not indicated for children younger than age 12 years

Answer 33

ANS: B. May cause voice alterations

One of the only adverse effects of DNase is voice alterations and laryngitis. DNase is given in an aerosolized
form, decreases the viscosity of mucus, and is safe for children younger than 12 years.

Question 34

34. The parent of a child with cystic fibrosis (CF) 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 signs and symptoms are suggestive of what condition?

a. Pneumothorax
b. Bronchodilation
c. Carbon dioxide retention
d. Increased viscosity of sputum

Answer 34

ANS: A. Pneumothorax

Usually the signs of pneumothorax are nonspecific. Tachypnea, tachycardia, dyspnea, pallor, and cyanosis are
significant signs and symptoms and are indicative of respiratory distress caused by pneumothorax. If the
bronchial tubes were dilated, the child would have decreased work of breathing and would most likely be
asymptomatic. Carbon dioxide retention is a result of the chronic alveolar hypoventilation in CF. Hypoxia
replaces carbon dioxide as the drive for respiration progresses. Increased viscosity would result in more
difficulty clearing secretions.

Question 35

35. Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be
    included in the plan of care?

a. Give pancreatic enzymes between meals if at all possible.
b. Do not administer pancreatic enzymes if the child is receiving antibiotics.
c. Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools.

d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the
beginning of a meal.

Answer 35

ANS: D. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the
beginning of a meal.

Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed
whole. Enzymes should be given just before meals and snacks. Pancreatic enzymes are not a contraindication
for antibiotics. The dose of enzymes should be increased if child is having frequent, bulky stools.

Question 36

36. The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4
    hours ago. What statement by the parent indicates a correct understanding of the teaching?

a. I can use an ice collar on my child for pain control along with analgesics.
b. My child should clear the throat frequently to clear the secretions.
c. I should allow my child to be as active as tolerated.
d. My child should gargle and brush teeth at least three times per day.

Answer 36

ANS: A. I can use an ice collar on my child for pain control along with analgesics.

Pain control after a tonsillectomy can be achieved with application of an ice collar and administration of
analgesics. The child should avoid clearing the throat or coughing and does not need to gargle and brush teeth
a certain number of times per day and should avoid vigorous gargling and toothbrushing. Also, the childs
activity should be limited to decrease the potential for bleeding, at least for the first few days

Question 37

37. A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with
    which?

a. Racemic epinephrine and corticosteroids
b. Nebulizer treatments and oxygen
c. Antibiotics and albuterol
d. Chest physiotherapy and humidity

Answer 37

ANS: A. Racemic epinephrine and corticosteroids

Nebulized epinephrine (racemic epinephrine) is now used in children with LTB that is not alleviated with cool
mist. The beta-adrenergic effects cause mucosal vasoconstriction and subsequent decreased subglottic edema. The use of corticosteroids is beneficial because the anti-inflammatory effects decrease subglottic edema. Nebulizer treatments are not effective even though oxygen may be required. Antibiotics are not used because it
is a viral infection. Chest physiotherapy would not be instituted.

Question 38

38. A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in
    the immediate postoperative period. The nurse should take what action?

a. Notify the health care provider.
b. Continue to assess for bleeding.
c. Give the child a red flavored ice pop.
d. Position the child in a Trendelenburg position.

Answer 38

ANS: B. Continue to assess for bleeding.

Some secretions, particularly dried blood from surgery, are common after a tonsillectomy. Inspect all
secretions and vomitus for evidence of fresh bleeding (some blood-tinged mucus is expected). Dark brown
(old) blood is usually present in the emesis, as well as in the nose and between the teeth. Small amounts of dark
brown blood should be further monitored. A red-flavored ice pop should not be given and the Trendelenburg
position is not recommended.

Question 39

39. A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does
    not want to drink anything, saying, My tummy hurts. The following health care prescriptions are available:
    acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse
    implement to relieve the childs pain?

a. Ice chips
b. Tylenol PO
c. Tylenol PR
d. Popsicle

Answer 39

ANS: C. Tylenol PR

The throat is very sore after a tonsillectomy. Most children experience moderate pain after a tonsillectomy and
need pain medication at regular intervals for at least the first 24 hours. Analgesics may need to be given
rectally or intravenously to avoid the oral route.

Question 40

40. A 1-year-old child has acute otitis media (AOM) and is being treated with oral antibiotics. What should the
    nurse include in the discharge teaching to the infants parents?

a. A follow-up visit should be done after all medicine has been given.
b. After an episode of acute otitis media, hearing loss usually occurs.
c. Tylenol should not be given because it may mask symptoms.
d. The infant will probably need a myringotomy procedure and tubes.

Answer 40

ANS: A. A follow-up visit should be done after all medicine has been given.

Children with AOM should be seen after antibiotic therapy is complete to evaluate the effectiveness of the
treatment and to identify potential complications, such as effusion or hearing impairment. Hearing loss does
not usually occur with acute otitis media. Tylenol should be given for pain, and the infant will not necessarily
need a myringotomy procedure.

Question 41

41. What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include?
    a. Rhinorrhea, wheezing, and fever
    b. Tachypnea, cyanosis, and apnea
    c. Retractions, fever, and listlessness
    d. Poor breath sounds and air hunger

Answer 41

ANS: A. Rhinorrhea, wheezing, and fever

Symptoms such as rhinorrhea and a low-grade fever often appear first. OM and conjunctivitis may also be
present. In time, a cough may develop. Wheezing is an initial sign as well. Progression of illness brings on the
symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger, and apnea.

Question 42

42. The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23%
    oxygen via a plastic hood. The childs SaO2 saturation is 88%, respiratory rate is 45 breaths/min, and pulse is
    140 beats/min. Based on these assessments, what action should the nurse take?

a. Withhold feedings.
b. Notify the health care provider.
c. Put the infant in an infant seat.
d. Keep the infant in the plastic hood.

Answer 42

ANS: B. Notify the health care provider.

The American Academy of Pediatrics practice parameter (2006) recommends the use of supplemental oxygen
if the infant fails to maintain a consistent oxygen saturation of at least 90%. The health care provider should be
notified of the saturation reading of 88%. Withholding the feedings or placing the infant in an infant seat
would not increase the saturation reading. The infant should be kept in the hood, but because the saturation
reading is 88%, the health care provider should be notified to obtain orders to increase the oxygen
concentration.

Question 43

43. A 5-year-old child is admitted with bacterial pneumonia. What signs and symptoms should the nurse
    expect to assess with this disease process?

a. Fever, cough, and chest pain
b. Stridor, wheezing, and ear infection
c. Nasal discharge, headache, and cough
d. Pharyngitis, intermittent fever, and eye infection

Answer 43

ANS: A. Fever, cough, and chest pain

Children with bacterial pneumonia usually appear ill. Symptoms include fever, malaise, rapid and shallow
respirations, cough, and chest pain. Ear infection, nasal discharge, and eye infection are not symptoms of
bacterial pneumonia

Question 44

44. An infant with a congenital heart defect is to receive a dose of palivizumab (Synagis). What is the purpose of this?
    a. Prevent RSV infection.
    b. Prevent secondary bacterial infection.
    c. Decrease toxicity of antiviral agents.
    d. Make isolation of infant with RSV unnecessary.

Answer 44

ANS: A. Prevent RSV infection.

The only product available in the United States for prevention of RSV is palivizumab, a humanized mouse
monoclonal antibody, which is given once every 30 days (15 mg/kg) between November and March. It is given
to high-risk infants, which includes an infant with a congenital heart defect.

Question 45

45. A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and
    drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what
    action?

a. Throat culture
b. Nasal pharynx washing
c. Administration of corticosteroids
d. Emergency intubation

Answer 45

ANS: D. Emergency intubation

Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of
drooling, and agitation. Nasotracheal intubation or tracheostomy is usually considered for a child with
epiglottitis with severe respiratory distress. The throat should not be inspected because airway obstruction can
occur, and steroids would not be done first when the child is in severe respiratory distress.

Question 46

46. A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The
    parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup?

a. A bath in tepid water can help resolve this type of croup.
b. Tylenol can help to relieve the cough and stridor.
c. A cool mist vaporizer at the bedside can help prevent this type of croup.
d. Antibiotics need to be given to reduce the inflammation.

Answer 46

ANS: C. A cool mist vaporizer at the bedside can help prevent this type of croup.

Acute spasmodic laryngitis (spasmodic croup, midnight croup, or twilight croup) is distinct from laryngitis and
LTB and characterized by paroxysmal attacks of laryngeal obstruction that occur chiefly at night. The child
goes to bed well or with some mild respiratory symptoms but awakens suddenly with characteristic barking; a
metallic cough; hoarseness; noisy inspirations; and restlessness. However, there is no fever, and the episode
subsides in a few hours. Children with spasmodic croup are managed at home. Cool mist is recommended for
the childs room. A tepid water bath will not help, but steam provided by hot water may relieve the laryngeal
spasm. The child will not need Tylenol, and antibiotics are not given for this type of croup.

Question 47

47. A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infants vital signs
    are T, 101.6 F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs
    frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for
    what reason?

a. Tachypnea
b. Paroxysmal cough
c. Irritability
d. Fever

Answer 47

ANS: A. Tachypnea

Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue. Therefore, IV fluids are
preferred until the acute stage of bronchiolitis has passed. Infants with bronchiolitis may have paroxysmal
coughing, but fluids by mouth would not be contraindicated. Irritability or fever would not be reasons for
fluids by mouth to be contraindicated.

Question 48

48. A child is in the hospital for cystic fibrosis. What health care providers prescription should the nurse clarify
    before implementing?

a. Dornase alfa (Pulmozyme) nebulizer treatment bid
b. Pancreatic enzymes every 6 hours
c. Vitamin A, D, E, and K supplements daily
d. Proventil (albuterol) nebulizer treatments tid

Answer 48

ANS: B. Pancreatic enzymes every 6 hours

The principal treatment for pancreatic insufficiency that occurs in cystic fibrosis is replacement of pancreatic
enzymes, which are administered with meals and snacks to ensure that digestive enzymes are mixed with food
in the duodenum. The enzymes should not be given every 6 hours, so this should be clarified before
implementing this prescription. Dornase alfa (Pulmozyme) is given by nebulizer to decrease the viscosity of
secretions, vitamin supplements are given daily, and Proventil nebulizer treatments are given to open the
bronchi for easier expectoration

Question 49

49. A 6-year-old child is in the hospital for status asthmaticus. Nursing care during this acute period includes
    which prescribed interventions?

a. Prednisolone (Pediapred) PO every day, IV fluids, cromolyn (Intal) inhaler bid
b. Salmeterol (Serevent) PO bid, vital signs every 4 hours, spot check pulse oximetry
c. Triamcinolone (Azmacort) inhaler bid, continuous pulse oximetry, vital signs once a shift

d. Methylprednisolone (Solumedrol) IV every 12 hours, continuous pulse oximetry, albuterol
nebulizer treatments every 4 hours and prn

Answer 49

ANS: D. Methylprednisolone (Solumedrol) IV every 12 hours, continuous pulse oximetry, albuterol
nebulizer treatments every 4 hours and prn

The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure)
and pulse oximetry monitoring. A systemic corticosteroid (oral, IV, or IM) may also be given to decrease the
effects of inflammation. Inhaled aerosolized short-acting b2-agonists are recommended for all patients. Therefore, Solumedrol per IV, continuous pulse oximetry, and albuterol nebulizer treatments are the expected
prescribed treatments. Oral medications would not be used during the acute stage of status asthmaticus. Vital
signs once a shift and spot pulse oximetry checks would not be often enough.

Question 50

50. In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind?
    a. Fats and proteins must be greatly curtailed.
    b. Most fruits and vegetables are not well tolerated.
    c. Diet should be high in calories, proteins, and unrestricted fats.
    d. Diet should be low fat but high in calories and proteins.

Answer 50

ANS: C. Diet should be high in calories, proteins, and unrestricted fats.

Children with CF require a well-balanced, high-protein, high-caloric diet, with unrestricted fat (because of the
impaired intestinal absorption).

Question 51

51. A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative
    of cystic fibrosis (CF)?

a. Less than 18 mEq/L
b. 18 to 40 mEq/L
c. 40 to 60 mEq/L
d. Greater than 60 mEq/L

Answer 51

ANS: D. Greater than 60 mEq/L

Normally sweat chloride content is less than 40 mEq/L, with a mean of 18 mEq/L. A chloride concentration
greater than 60 mEq/L is diagnostic of CF; in infants younger than 3 months, a sweat chloride concentration
greater than 40 mEq/L is highly suggestive of CF.

Question 52

52. A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal?
    a. Encourage increased fluid intake.
    b. Recommend increased use of a budesonide (Pulmicort) inhaler.
    c. Administer an antitussive to suppress coughing.
    d. Encourage the child to blow a pinwheel every 6 hours while awake.

Answer 52

ANS: D. Encourage the child to blow a pinwheel every 6 hours while awake.

Play techniques that can be used for younger children to extend their expiratory time and increase expiratory
pressure include blowing cotton balls or a ping-pong ball on a table, blowing a pinwheel, blowing bubbles, or
preventing a tissue from falling by blowing it against the wall. Increased fluids, increased use of a Pulmicort
inhaler, or suppressing a cough will not increase expiratory effectiveness.

Question 53

53. A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the
    yellow zone, this means that the asthma control is what?

a. 80% of a personal best, and the routine treatment plan can be followed.
b. 50% to 79% of a personal best and needs an increase in the usual therapy.
c. 50 % of a personal best and needs immediate emergency bronchodilators.
d. Less than 50% of a personal best and needs immediate hospitalization

Answer 53

ANS: B. 50% to 79% of a personal best and needs an increase in the usual therapy.

The interpretation of a peak expiratory flow rate that is yellow (50%79% of personal best) signals caution. Asthma is not well controlled. An acute exacerbation may be present. Maintenance therapy may need to be
increased. Call the practitioner if the child stays in this zone.

Question 54

54. A family requires home care teaching with regard to preventative measures to use at home to avoid an
    asthmatic episode. What strategy should the nurse teach?

a. Use a humidifier in the childs room.
b. Launder bedding daily in cold water.
c. Replace wood flooring with carpet.
d. Use an indoor air purifier with HEPA filter.

Answer 54

ANS: D. Use an indoor air purifier with HEPA filter.

Allergen control includes use of an indoor air purifier with HEPA filter. Humidity should be kept low, bedding
laundered in hot water once a week, and carpet replaced with wood floors.

Question 55

55. A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or
    five bowel movements per day. The nurses action in regard to the pancreatic enzymes is based on the
    knowledge that the dosage is what?

a. Adequate
b. Adequate but should be taken between meals
c. Needs to be increased to increase the number of bowel movements per day
d. Needs to be increased to decrease the number of bowel movements per day

Answer 55

ANS: D. Needs to be increased to decrease the number of bowel movements per day

The amount of enzyme is adjusted to achieve normal growth and a decrease in the number of stools to one or
two per day.

Question 56

56. A term infant is delivered, and before delivery, the medical team was notified that a congenital
diaphragmatic hernia (CDH) was diagnosed on ultrasonography. What should be done immediately at birth if
respiratory distress is noted?

a. Give oxygen.
b. Suction the infant.
c. Intubate the infant.
d. Ventilate the infant with a bag and mask

Answer 56

ANS: C. Intubate the infant.

Many infants with a CDH require immediate respiratory assistance, which includes endotracheal intubation
and GI decompression with a double-lumen catheter to prevent further respiratory compromise. At birth, bag
and mask ventilation is contraindicated to prevent air from entering the stomach and especially the intestines,
further compromising pulmonary function. Oxygen and suctioning may be used for mild respiratory distress.

Question 57

57. A child has a streptococcal throat infection and is being treated with antibiotics. What should the nurse
    teach the parents to prevent infection of others?

a. The child can return to school immediately.
b. The organism cannot be transmitted through contact.
c. The child can return to school after taking antibiotics for 24 hours.
d. The organism can only be transmitted if someone uses a personal item of the sick child.

Answer 57

ANS: C. The child can return to school after taking antibiotics for 24 hours.

Children with streptococcal infection are noninfectious to others 24 hours after initiation of antibiotic therapy.
It is generally recommended that children not return to school or daycare until they have been taking
antibiotics for a full 24-hour period. The organism is spread by close contact with affected personsdirect
projection of large droplets or physical transfer of respiratory secretions containing the organism.

Question 58

58. What medication is contraindicated in children post tonsillectomy and adenoidectomy?
    a. Codeine
    b. Ondansetron (Zofran)
    c. Amoxil (amoxicillin)
    d. Acetaminophen (Tylenol)

Answer 58

ANS: A. Codeine

Codeine is contraindicated in pediatric patients after tonsillectomy and adenoidectomy. In 2012, the Food and
Drug Administration issued a Drug Safety Communication that codeine use in certain children after
tonsillectomy or adenoidectomy may lead to rare but life-threatening adverse events or death. Zofran, amoxicillin, and Tylenol are not contraindicated after tonsillectomy and adenoidectomy.