Chapter 27&28 - Respiratory Dysfunction Flashcards
A 5-month-old infant is in respiratory distress. What should the nurse expect to find?
a.
Nasal flaring
b.
Bradycardia
c.
Abdominal breathing
d.
Capillary refill of 2 seconds
ANS: A
Nasal flaring is a sign of respiratory distress and a significant finding in an infant. The enlargement of the nostrils helps reduce nasal resistance and maintains airway patency. Nasal flaring may be intermittent or continuous and should be described as minimum or marked. The infant would have tachycardia, not bradycardia, in respiratory distress. Abdominal breathing and a capillary refill are normal findings in an infant
A child is in uncompensated metabolic alkalosis. What should the nurse expect the arterial blood gas to be?
a.
HCO3, 24; pH, 7.35
b.
HCO3, 28; pH, 7.50
c.
HCO3, 20; pH, –7.30
d.
HCO3, 26; pH, 7.40
ANS: B
Metabolic alkalosis results in an elevated plasma pH (normal pH is 7.35–7.45) that occurs when there is an excess of bicarbonate (normal HCO3 is 22–26).
What consideration is most important in managing tuberculosis (TB) in children?
a.
Skin testing
b.
Chemotherapy
c.
Adequate rest
d.
Adequate hydration
ANS: B
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.
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.
ANS: B
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.
What medication is contraindicated in children post tonsillectomy and adenoidectomy?
a.
Codeine
b. Ondansetron (Zofran)
b.
Amoxil (amoxicillin)
c.
Acetaminophen (Tylenol)
ANS: A
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.
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
ANS: B
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
A child is in uncompensated respiratory alkalosis. What should the nurse expect the arterial blood gas to be?
a.
CO2, 30; pH, 7.50
b.
CO2, 55; pH, 7.30
c.
CO2, 35; pH, 7.28
d.
CO2, 54; pH, 7.35
ANS: A
Laboratory findings in respiratory alkalosis include reduced PCO2 (7.45).
The nurse is analyzing an arterial blood gas of pH, 7.30; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas?
a.
Fully compensated respiratory acidosis
b.
Partially compensated respiratory acidosis
c.
Fully compensated metabolic acidosis
d.
Partially compensated metabolic acidosis
ANS: B
When the fundamental acid–base ratio is altered for any reason, the body attempts to correct the deviation. In a simple disturbance, a single primary factor affects one component of the acid–base pair and is usually accompanied by a compensatory or secondary change in the component that is not primarily affected. In respiratory acidosis, the pH is low (?6?7.35), and the PCO2 is high (?7?45). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the HCO3 is high (?7?26), indicating an attempt at compensation.
What condition is the leading cause of chronic illness in children?
a.
Asthma
b.
Pertussis
c.
Tuberculosis
d.
Cystic fibrosis
ANS: A
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.
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 mother’s presence will reduce anxiety and ease the child’s respiratory efforts.
c.
Separation from the mother is a major developmental threat at this age.
d.
The mother can provide constant observations of the child’s respiratory efforts.
ANS: B
The family’s presence will decrease the child’s 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 child’s bedside is to ease anxiety and therefore respiratory effort.
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
ANS: A
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
The nurse is reviewing factors that affect lung development. What factor delays surfactant production and maturation of alveolar cells?
a.
Thyroxine
b.
Prolactin
c.
Glucocorticosteroids
d.
Excess of endogenous insulin
ANS: D
An excess of endogenous insulin can delay surfactant production and delays maturation of alveolar cells. Glucocorticosteroids, thyroxine, and prolactin enhance lung development.
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.
ANS: C
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 child’s 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.
The nurse is preparing to admit a 7-year-old child with acute laryngotracheobronchitis (LTB). What clinical manifestations should the nurse expect to observe? (Select all that apply.)
a.
Dysphagia
b.
Brassy cough
c.
Low-grade fever
d.
Toxic appearance
e.
Slowly progressive
ANS: B, C, E
Clinical manifestations of LTB include a brassy cough, low-grade fever, and slow progression. Dysphagia and a toxic appearance are characteristics of acute epiglottitis.
What conditions can produce hyperventilation? (Select all that apply.)
a.
Hysteria
b.
Narcotics
c.
Atelectasis
d.
Salicylate intoxication
e.
Mechanical ventilation
ANS: A, D, E
Hysteria, salicylate intoxication, and mechanical ventilation can produce hyperventilation. Narcotics and atelectasis produce inadequate gas exchange, not hyperventilation.
An infant’s 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.
ANS: A
Eliminating tobacco smoke from the child’s 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.
The nurse is evaluating arterial blood gas results. What condition can cause an increase in PCO2?
a.
Hypoxia
b.
Hyperventilation
c.
Pulmonary embolism
d.
Obstructive lung disease
ANS: D
Obstructive lung disease causes an increase in PCO2. Hypoxia, hyperventilation, and pulmonary embolism cause a decrease in PCO2.
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.
ANS: D
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.
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 child’s 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.
ANS: B
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.
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.
ANS: A
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.
A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant’s 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
A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant’s 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
A child is in the hospital for cystic fibrosis. What health care provider’s 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
ANS: B
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.
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.
ANS: C
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
The mother of a toddler yells to the nurse, “Help! He is choking to death on his food!” The nurse determines that lifesaving measures are necessary based on which finding?
a.
Gagging
b.
Coughing
c.
Pulse over 100 beats/min
d.
Inability to speak
ANS: D
The inability to speak is indicative of a foreign body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging, not obstruction, indicates irritation at the back of the throat. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.