Chapter 27&28 - Respiratory Dysfunction

Question 1

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

Answer 1

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

Question 1

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

Answer 1

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).

Question 1

What consideration is most important in managing tuberculosis (TB) in children?

a.

Skin testing

b.

Chemotherapy

c.

Adequate rest

d.

Adequate hydration

Answer 1

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.

Question 1

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 1

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.

Question 1

What medication is contraindicated in children post tonsillectomy and adenoidectomy?

a.

Codeine

b. Ondansetron (Zofran)

b.

Amoxil (amoxicillin)

c.

Acetaminophen (Tylenol)

Answer 1

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.

Question 2

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 2

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

Question 3

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

Answer 3

ANS: A

Laboratory findings in respiratory alkalosis include reduced PCO2 (7.45).

Question 3

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

Answer 3

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.

Question 3

What condition is the leading cause of chronic illness in children?

a.

Asthma

b.

Pertussis

c.

Tuberculosis

d.

Cystic fibrosis

Answer 3

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.

Question 4

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.

Answer 4

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.

Question 5

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 5

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

Question 6

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

Answer 6

ANS: D

An excess of endogenous insulin can delay surfactant production and delays maturation of alveolar cells. Glucocorticosteroids, thyroxine, and prolactin enhance lung development.

Question 6

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 6

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.

Question 6

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

Answer 6

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.

Question 7

What conditions can produce hyperventilation? (Select all that apply.)

a.

Hysteria

b.

Narcotics

c.

Atelectasis

d.

Salicylate intoxication

e.

Mechanical ventilation

Answer 7

ANS: A, D, E

Hysteria, salicylate intoxication, and mechanical ventilation can produce hyperventilation. Narcotics and atelectasis produce inadequate gas exchange, not hyperventilation.

Question 7

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.

Answer 7

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.

Question 9

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

Answer 9

ANS: D

Obstructive lung disease causes an increase in PCO2. Hypoxia, hyperventilation, and pulmonary embolism cause a decrease in PCO2.

Question 9

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 9

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.

Question 9

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.

Answer 9

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.

Question 9

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 9

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.

Question 9

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

Answer 9

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

Question 9

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

Answer 9

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.

Question 9

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 9

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

Question 11

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

Answer 11

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.

Question 13

The nurse is caring for an intubated child on mechanical ventilation. What interventions should the nurse implement to prevent ventilator-assisted pneumonia (VAP)? (Select all that apply.)

a.

Routine oral hygiene

b.

Appropriate hand hygiene

c.

Limit oropharyngeal suctioning of secretions

d.

Elevating the head of the bed 30 to 45 degrees

e.

Wearing gloves to handle respiratory secretions

Answer 13

ANS: A, B, D, E

Critically ill children on mechanical ventilation are at risk for acquisition of VAP. To prevent VAP, recommendations for nurses working with mechanically ventilated patients include appropriate hand hygiene measures; wearing gloves to handle respiratory secretions or contaminated objects; elevating the head of the bed 30 to 45 degrees; and routine oral hygiene, which includes oropharyngeal suctioning of secretions.

Question 13

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

a.

Sore throat

b.

Inspiratory stridor

c.

Complete obstruction

d.

Respiratory tract infection

Answer 13

ANS: C

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 14

Respiratory failure can result from many causes. What condition is a specific primary cause of inefficient gas transfer?

a.

Anemia

b.

Pneumothorax

c.

Cystic fibrosis

d.

Laryngospasm

Answer 14

ANS: A

Respiratory failure is defined as the inability of the respiratory system to maintain adequate oxygenation of the blood. In primary inefficient gas transfer, there is insufficient alveolar ventilation. Anemia, which is characterized by low hemoglobin levels, results in an inability to adequately oxygenate the blood. Pneumothorax and cystic fibrosis are examples of restrictive lung disease. Laryngospasm is an example of obstructive lung disease.

Question 14

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 14

ANS: B

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 14

The nurse is preparing to admit a 7-year-old child with pulmonary edema. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

a.

Fever

b.

Bradycardia

c.

Diaphoresis

d.

Pink frothy sputum

e.

Respiratory crackles

Answer 14

ANS: C, D, E

Clinical manifestations of pulmonary edema include diaphoresis, pink frothy sputum, and respiratory crackles. Fever or bradycardia are not manifestations of pulmonary edema

Question 16

A child is in uncompensated metabolic acidosis. 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

Answer 16

ANS: C

Laboratory findings of uncompensated metabolic acidosis include lowered plasma pH (

Question 16

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 16

ANS: C

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 17

A 3-year-old child with a tracheostomy will soon be discharged. What recommendation should the nurse share with the family?

a.

Tub baths cannot be given.

b.

The child cannot be allowed to play outdoors.

c.

Avoid exposure to noxious fumes such as paint or varnish.

d.

Cover the tracheostomy with a plastic bib when exposed to cold air.

Answer 17

ANS: C

The child with a tracheostomy should not be exposed to noxious fumes such as paint, varnish, or hair spray or to substances such as talc. The parent and child must be cautioned about safety measures around bodies of water. Baths can be taken, but parents must observe the necessary safety precautions. The child may play outdoors with a scarf or other protection that allows air through.

Question 18

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 18

ANS: A

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 19

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 19

ANS: A

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 20

The nurse recognizes that oxygen mist tents are rarely used for a child with respiratory distress. What are reasons for not using an oxygen mist tent? (Select all that apply.)

a.

Poor access to the child

b.

Cool and wet tent environment

c.

Oxygen levels fall when tent is entered

d.

Child may not tolerate it around the crib/bed

e.

Lower oxygen concentrations cannot be achieved

Answer 20

ANS: A, B, C, D

The disadvantages of using a mist tent include poor access to the child, a cool and wet tent environment, oxygen levels fall when the tent is entered, and the child may not tolerate it around the crib or bed. Lower oxygen concentrations can be achieved in the tent and is an advantage.

Question 22

A nurse is calculating the correlation of Pao2 with Sao2 according to the oxyhemoglobin dissociation curve. What parameter should indicate that the Pao2 is less than 50 to 60 mm Hg?

a.

Coarse lung sounds

b.

Temperature of 100° F

c.

Respiratory rate of 58

d.

Pulse oximetry reading of 90% or less

Answer 22

ANS: D

The Pao2 can be correlated with the Sao2 by means of the oxyhemoglobin dissociation curve, although changes in Pao2 do not cause identical (linear) changes in Sao2. The curve represents the relationship between Pao2 (measured in the blood) and Sao2 (measured by the pulse oximeter). When the Pao2 is 60?9?mm?9?Hg, the Sao2 is 90%. The oxyhemoglobin dissociation curve does not correlate with lung sounds, temperature, or respiratory rate.

Question 23

Cardiopulmonary resuscitation is begun on a toddler. What pulse is usually palpated because it is the most central and accessible?

a.

Radial

b.

Carotid

c.

Femoral

d.

Brachial

Answer 23

ANS: B

In a toddler, the carotid pulse is palpated. The radial pulse is not considered a central pulse. The femoral pulse is not the most central and accessible. Brachial pulse is felt in infants younger than 1 year of age.

Question 24

The nurse is analyzing an arterial blood gas of pH, 7.29; PCO2, 30; and HCO3, 20. 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

Answer 24

ANS: D

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 metabolic acidosis, the pH is low (?6?7.35), and the HCO3 is low (?6?22). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the PCO2 is low (?6?35), indicating an attempt at compensation.

Question 26

What medication is considered to be the most useful in treating cardiac arrest?

a.

Bretylium tosylate (Bretylium)

b.

Xylocaine (lidocaine)

c.

Adrenaline (epinephrine)

d.

Naloxone (Narcan)

Answer 26

ANS: C

Epinephrine is considered one of the most useful drugs in treating cardiac arrest. As an adrenergic agent, it acts on both a- and b-receptors in the heart. Epinephrine is rapidly cleared from the bloodstream. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only to reverse effects of opioids.

Question 27

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 27

ANS: A

Peak expiratory flow rate monitoring is used to monitor the child’s 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 29

The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.)

a.

A child with asthma

b.

A child with diabetes

c.

A child with hemophilia A

d.

A child with cancer receiving chemotherapy

e.

A child with gastroesophageal reflux disease

Answer 29

ANS: A, B, D

The live attenuated influenza vaccine (LAIV) is an acceptable alternative to the IM vaccine (IIV) for ages 2 to 49 years. It is a live vaccine administered via nasal spray. Several groups are excluded from receiving it, including children with a chronic heart or lung disease (asthma or reactive airways disease), diabetes, or kidney failure; children who are immunocompromised or receiving immunosuppressants; children younger than 5 years of age with a history of recurrent wheezing; children receiving aspirin; patients who are pregnant; children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components; or children with a history of Guillain-Barré Syndrome after a previous dose. A child with hemophilia A or gastroesophageal reflux disease would not be immunocompromised so they can receive the LAIV.

Question 30

The nurse is caring for a newborn with suspected congenital diaphragmatic hernia. What of the following findings would the nurse expect to observe? (Select all that apply.)

a.

Loud, harsh murmur

b.

Scaphoid abdomen

c.

Poor peripheral pulses

d.

Mediastinal shift

e.

Inguinal swelling

f.

Moderate respiratory distress

Answer 30

ANS: B, D, F

Clinical manifestations of a congenital diaphragmatic hernia include a scaphoid abdomen, a mediastinal shift, and moderate to severe respiratory distress. The infant would not have a harsh, loud murmur or poor peripheral pulses. Inguinal swelling is indicative of an inguinal hernia.

Question 31

The nurse is caring for a child in respiratory distress. What is an early but less obvious sign of respiratory failure?

a.

Stupor

b.

Headache

c.

Bradycardia

d.

Somnolence

Answer 31

ANS: B

An early but less obvious sign of respiratory failure is a headache. Stupor, bradycardia, and somnolence are signs of more severe hypoxia.

Question 32

What condition or disease decreases lung compliance? (Select all that apply.)

a.

Asthma

b.

Atelectasis

c.

Pneumothorax

d.

Pulmonary edema

e.

Lobar emphysema

Answer 32

Atelectasis, pneumothorax, and pulmonary edema decrease lung compliance. Asthma and lobar emphysema increase lung compliance.

Question 32

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 32

ANS: C

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 32

What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild respiratory tract infection? (Select all that apply.)

a.

Cool mist

b.

Warm mist

c.

Steam vaporizer

d.

Keep child in a flat, quiet position

e.

Run a shower of hot water to produce steam

Answer 32

ANS: A, B, C, E

Warm or cool mist is a common therapeutic measure for symptomatic relief of respiratory discomfort. The moisture soothes inflamed membranes and is beneficial when there is hoarseness or laryngeal involvement. A time-honored method of producing steam is the shower. Running a shower of hot water into the empty bathtub or open shower stall with the bathroom door closed produces a quick source of steam. Keeping a child in this environment for 10 to 15 minutes may help ease respiratory efforts. A small child can sit on the lap of a parent or other adult. The child should be quiet but upright, not flat. The use of steam vaporizers in the home is often discouraged because of the hazards related to their use and limited evidence to support their efficacy.

Question 33

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 33

ANS: B

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 patient’s 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 34

The nurse is caring for a child on oxygen being delivered by a nasal cannula. What is the advantage of delivering oxygen in this manner?

a.

It can deliver mist if desired.

b.

It is less likely to cause abdominal distention.

c.

The child is able to eat and talk while getting oxygen.

d.

This method can deliver a higher concentration of oxygen.

Answer 34

ANS: C

An advantage of delivering oxygen by nasal cannula is that the child is able to eat and talk while getting oxygen. This method cannot deliver mist or higher concentrations of oxygen. A disadvantage of this method is that it may cause abdominal distention.

Question 34

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 34

ANS: D

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 36

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 36

ANS: C

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 persons—direct projection of large droplets or physical transfer of respiratory secretions containing the organism.

Question 37

It is important to make certain that sensory connectors and oximeters are compatible because incompatible wiring can cause which condition?

a.

Hyperthermia

b.

Electrocution

c.

Pressure necrosis

d.

Burns under sensors

Answer 37

ANS: D

Incompatible wiring can generate considerable heat at the tip of the sensor, resulting in partial- and full-thickness burns. Heat may be generated at the site of the sensor, but it will not result in generalized hyperthermia. Electrocution is not a possibility with oximeters. Pressure necrosis can occur from improperly applied sensors but not from incompatible wiring.

Question 38

What test measures the amount of air inhaled and exhaled during any respiratory cycle?

a.

Tidal volume

b.

Vital capacity

c.

Dynamic compliance

d.

Pulmonary resistance

Answer 38

ANS: A

Tidal volume is defined as the amount of air inhaled and exhaled during any respiratory cycle. When it is multiplied by the respiratory rate, the minute volume is obtained. Forced vital capacity is the maximum amount of air that can be expired after maximum inspiration. It is used to monitor individuals with obstructive airway disease. Dynamic compliance is the relationship between the change in volume and pressure difference. Pulmonary resistance measures the changes in pressure with changes in flow on inspiration and expiration.

Question 40

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 40

ANS: A

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 42

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 42

ANS: D

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 44

What test should the nurse do as a precautionary measure before doing an arterial puncture to obtain an arterial blood sample?

a.

Allen test

b.

Smith test

c.

Venipuncture

d.

Cold compress

Answer 44

ANS: A

The Allen test determines the adequacy of collateral circulation in the extremity distal to the proposed puncture site. If the child does not have satisfactory circulation when the proposed artery is occluded, that extremity is not used. The Smith test, venipuncture, and a cold compress are not done before arterial blood gas sampling.

Question 44

The nurse is evaluating arterial blood gas results. What condition can cause an increase in HCO3?

a.

Renal failure

b.

Lactic acidosis

c.

Diabetic ketoacidosis

d.

Fluid loss from upper gastrointestinal tract

Answer 44

ANS: D

Fluid loss from an upper gastrointestinal tract causes an increase in HCO3. Renal failure, lactic acidosis, and diabetic ketoacidosis cause a decrease in HCO3

Question 46

One of the goals for children with asthma is to maintain the child’s 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 46

ANS: B

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 48

The nurse is analyzing an arterial blood gas of pH, 7.50; PCO2, 50; and HCO3, 29. What result should the nurse document for this blood gas?

a.

Fully compensated metabolic alkalosis

b.

Partially compensated metabolic alkalosis

c.

Fully compensated respiratory alkalosis

d.

Partially compensated respiratory alkalosis

Answer 48

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 metabolic alkalosis, the pH is high (?7?7.45), and the HCO3 is high (?7?26). When the pH is restored to normal, the disturbance is described as compensated. It is partially compensated because the pH remains abnormal, but the PCO2 is high (?7?45), indicating an attempt at compensation.

Question 49

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 49

ANS: D

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 50

What is the best explanation for using pulse oximetry on young children to determine oxygen saturation?

a.

Pulse oximetry is noninvasive.

b.

Pulse oximetry is better than capnography.

c.

Pulse oximetry is more accurate than arterial blood gases.

d.

Pulse oximetry provides intermittent measurements of oxygen.

Answer 50

ANS: A

Pulse oximetry is a noninvasive measure of oxygen saturation of hemoglobin. Capnography measures carbon dioxide inhalation and exhalation. It does not provide information about oxygen saturation. Arterial blood gases provide additional clinical information, including pH, PCO2, bicarbonate, base excess, and PO2. An arterial puncture is required, which can be painful, and continuous monitoring cannot be done without an arterial line. Pulse oximetry can be either intermittent or continuous.

Question 52

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 52

ANS: D

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 53

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 53

ANS: A

Antibiotics are indicated for bacterial pneumonia. Often the child has decreased pulmonary reserve, and clustering of care is essential. The child’s 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 54

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 54

ANS: A

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 55

The nurse must suction a 6-month-old infant with a tracheostomy. What intervention should be included?

a.

Encourage the child to cough to raise the secretions before suctioning.

b.

Perform each pass of the suction catheter for no longer than 5 seconds.

c.

Allow the child to rest after every five times the suction catheter is passed.

d.

Select a catheter with a diameter three quarters of the diameter of the tracheostomy tube.

Answer 55

ANS: B

Suctioning should require no longer than 5 seconds per pass. Otherwise, the airway may be occluded for too long. An infant would be unable to cooperate with instructions to cough up secretions. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear. The catheter should have a diameter one half the size of the tracheostomy tube. If it is too large, it might block the child’s airway.

Question 57

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 57

ANS: C

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 58

The nurse is interpreting a tuberculin skin test. If the nurse finds a result of an induration 5 mm or larger, in which child should the nurse document this finding as positive? (Select all that apply.)

a.

A child with diabetes mellitus

b.

A child younger than 4 years of age

c.

A child receiving immunosuppressive therapy

d.

A child with a human immunodeficiency virus (HIV) infection

e.

A child living in close contact with a known contagious case of tuberculosis

Answer 58

ANS: C, D, E

A tuberculin skin test with an induration of 5 mm or larger is considered to be positive if the child is receiving immunosuppressive therapy, has an HIV infection, or is living in close contact with a known contagious case of tuberculosis. The test would be considered positive in a child who has diabetes mellitus or is younger than 4 years of age if the tuberculin skin test had an induration of 10 mm or larger.

Question 59

The nurse is caring for a child with a tracheostomy. What clinical manifestation should the nurse recognize as an early sign of impending respiratory distress or failure?

a.

Cyanosis

b.

Restlessness

c.

Audible stridor

d.

Crowing respirations

Answer 59

ANS: B

Signs of hypoxemia are initially subtle. Cardinal signs of impending respiratory failure include restlessness, tachypnea, tachycardia, and diaphoresis. Cyanosis is a sign of severe hypoxia. Stridor and crowing respirations are indicative of inflammation. Sternal retractions are an early but less obvious sign.

Question 60

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 infant’s 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 60

ANS: A

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 61

What intervention is necessary when weaning a child from the ventilator?

a.

Light sedation before scheduled extubation

b.

No suctioning before scheduled extubation

c.

Cool mist begun immediately after extubation

d.

Vigorous chest physiotherapy and suctioning performed immediately after extubation

Answer 61

ANS: C

A cool mist or noninvasive oxygen therapy is initiated immediately after extubation. Steroids may be administered to minimize any laryngeal edema. Analgesics may be given, but sedation is not usually indicated. The child is suctioned just before extubation to ensure that the airway is clear. Chest physiotherapy and suctioning are performed before extubation.

Question 62

A tonsillectomy or adenoidectomy is contraindicated in what conditions? (Select all that apply.)

a.

Cleft palate

b.

Seizure disorders

c.

Blood dyscrasias

d.

Sickle cell disease

e.

Acute infection at the time of surgery

Answer 62

ANS: A, C, E

Contraindications to either tonsillectomy or adenoidectomy are (1) cleft palate because both tonsils help minimize escape of air during speech, (2) acute infections at the time of surgery because the locally inflamed tissues increase the risk of bleeding, and (3) uncontrolled systemic diseases or blood dyscrasias. Tonsillectomy or adenoidectomy is not contraindicated in sickle cell disease or seizure disorders.

Question 64

A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is recommended for airway obstruction in children older than which age?

a.

1 year

b.

4 years

c.

8 years

d.

12 years

Answer 64

ANS: A

A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is recommended for airway obstruction in children older than 1 year. For children younger than 1 year, back blows and chest thrusts are administered.

Question 65

The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse include when discussing the asthma severity classification system? (Select all that apply.)

a.

Children with mild persistent asthma have nighttime signs or symptoms less than two times a month.

b.

Children with moderate persistent asthma use a short-acting b-agonist more than two times per week.

c.

Children with severe persistent asthma have a peak expiratory flow (PEF) of 60% to 80% of predicted value.

d.

Children with mild persistent asthma have signs or symptoms more than two times per week.

e.

Children with moderate persistent asthma have some limitations with normal activity.

f.

Children with severe persistent asthma have frequent nighttime signs or symptoms.

Answer 65

ANS: D, E, F

Children with mild persistent asthma have signs or symptoms more than two times per week and nighttime signs or symptoms three or four times per month. Children with moderate persistent asthma have some limitations with normal activity and need to use a short-acting b-agonist for sign or symptom control daily. Children with severe persistent asthma have frequent nighttime signs or symptoms and have a PEF of less than 60%.

Question 66

A child is in uncompensated respiratory acidosis. What should the nurse expect the arterial blood gas to be?

a.

O2, 95; CO2, 45; pH, 7.40

b.

O2, 88; CO2, 55; pH, 7.30

c.

O2, 88; CO2, 35; pH, 7.28

d.

O2, 92; CO2, 54; pH, 7.35

Answer 66

ANS: B

Respiratory acidosis results from diminished or inadequate pulmonary ventilation that causes an elevation in plasma Pco2 and thus an increased concentration of dissolved carbonic acid, which leads to elevated carbonic acid and hydrogen ion concentration. This tends to lower the pH. CO2 of 55 is elevated (normal CO2 is 35–45), and a pH of 7.30 is low (normal pH is 7.35–7.45).

Question 68

The continuous administration of mist, or aerosolized water, for the treatment of inflammatory conditions of the airways is a common practice that functions in which manner?

a.

Has no proven benefit

b.

Decreases the viscosity of mucus

c.

Decreases bronchoconstriction

d.

Reduces the inflammation of the lower airways

Answer 68

ANS: A

Aerosol therapy or mist therapy with water is not a treatment of choice for inflammatory airway conditions. Some questionable benefit may occur in mild viral croup. The parent and child may experience a reduction in anxiety in a cool, humid environment. Upper airway secretions may be moistened; however, inhaled mist does not affect the viscosity of mucus. Humidity may worsen bronchospasm. Aerosolized medications are able to reduce inflammation of the lower airways, but water does not have this effect.

Question 69

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 69

ANS: C

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 71

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 71

ANS: A

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 73

The nurse is planning home care for a 2-year-old child with a tracheostomy. What recommendation should be included?

a.

Sterile technique is essential in home care of the tracheostomy.

b.

Parents are able to change the tracheostomy tube when needed.

c.

Play activities must be sedentary such as listening to music and working on puzzles.

d.

The child must wear a plastic bib when eating or drinking to prevent aspiration into the stoma.

Answer 73

ANS: B

A plugged, clogged, or obstructed tracheostomy tube is a life-threatening circumstance. Parents are taught the signs and symptoms, how to suction, and how to change the tube. Clean technique and thorough hand washing are sufficient for suctioning, cleaning the tracheostomy site, and changing the tracheostomy tube. The child who is physically able can engage in activities appropriate to age. Young children who may spill food near the stoma should wear a fabric bib without a plastic lining or other device to prevent dribbled food and crumbs from being aspirated.

Question 73

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 73

ANS: A

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 74

When is bronchial (postural) drainage generally performed?

a.

Before meals and at bedtime

b.

Right before all aerosol therapy

c.

Immediately on arising and at bedtime

d.

Thirty minutes after meals and at bedtime

Answer 74

ANS: A

The therapy should be done at bedtime and before meals or 1 to 1 1/2 hours after meals to avoid stomach upset. Postural drainage is most effective when it is performed after other respiratory therapy interventions, including bronchodilator and nebulizer treatments. Immediately on arising and at bedtime are appropriate times, but postural drainage is usually carried out at least three times each day. Thirty minutes after meals may induce vomiting.

Question 75

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 child’s pain?

a.

Ice chips

b.

Tylenol PO

c.

Tylenol PR

d.

Popsicle

Answer 75

ANS: C

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 76

Effective cardiopulmonary resuscitation (CPR) on a 5-year-old child should include what technique?

a.

Provide one breath to every five chest compressions.

b.

Provide two breaths to every 30 chest compressions.

c.

Reassess the child every 10 minutes while CPR continues.

d.

Evaluate the child after 50 cycles of compression and ventilation.

Answer 76

ANS: B

Two breaths to 15 compressions is the standard for infants and children when two rescuers are present. One breath to every five chest compressions is not the appropriate ratio for CPR in this age group. Reassessment of the child should take place after 20 cycles or 1 minute.

Question 77

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 77

ANS: D

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 78

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 78

ANS: A

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 79

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 79

ANS: A

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 80

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 80

ANS: C

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

Question 82

The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this child’s care?

a.

Monitor pulse oximetry.

b.

Monitor arterial blood gases.

c.

Administer oxygen if respiratory distress develops.

d.

Administer oxygen if child’s lips become bright, cherry-red in color.

Answer 82

ANS: B

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 83

The nurse is caring for a 4-year-old child who is receiving 2 L of oxygen per nasal cannula. What disadvantage should the nurse consider when planning care for the child?

a.

The child may need to have high humidity administered with the oxygen.

b.

The child may not be able to eat and drink comfortably.

c.

A nasal cannula may cause an accumulation of moisture on the face.

d.

A nasal cannula may cause abdominal distention.

Answer 83

ANS: D

All oxygen delivery systems have advantages and disadvantages. One disadvantage of a nasal cannula is possible abdominal distention and discomfort, which could lead to vomiting. The advantages include that the child is able to eat and drink more comfortably, there is no need for a high humidity environment, and there is no accumulation of moisture causing skin irritation.

Question 84

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 nurse’s 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 84

ANS: D

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 85

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 85

ANS: B

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 86

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 86

ANS: D

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 87

A child is diagnosed with active pulmonary tuberculosis. What medications does the nurse anticipate to be prescribed for the first 2 months? (Select all that apply.)

a.

Isoniazid (INH)

b.

Cefuroxime (Ceftin)

c.

Rifampin (Rifadin)

d.

Pyrazinamide (PZA)

e.

Ethambutol (Myambutol)

Answer 87

ANS: A, C, D, E

For the child with clinically active pulmonary and extrapulmonary TB, the goal is to achieve sterilization of the tuberculous lesion. The American Academy of Pediatrics (2012) recommends a 6-month regimen consisting of INH, rifampin, ethambutol, and PZA given daily or twice weekly for the first 2 months followed by INH and rifampin given two or three times a week by DOT for the remaining 4 months (Mycobacterium tuberculosis). Cefuroxime is not part of the regimen.

Question 88

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 88

ANS: D

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 90

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 child’s room.

b.

Launder bedding daily in cold water.

c.

Replace wood flooring with carpet.

d.

Use an indoor air purifier with HEPA filter.

Answer 90

ANS: D

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 91

The nurse is preparing to admit a 3-year-old child with acute spasmodic laryngitis. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.)

a.

High fever

b.

Croupy cough

c.

Tendency to recur

d.

Purulent secretions

e.

Occurs sudden, often at night

Answer 91

ANS: B, C, E

Clinical features of acute spasmodic laryngitis include a croupy cough, a tendency to recur, and occurring sudden, often at night. High fever is a feature of acute epiglottitis and purulent secretions are seen with acute tracheitis.

Question 93

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 93

ANS: A

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 child’s activity should be limited to decrease the potential for bleeding, at least for the first few days.

Question 94

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 94

ANS: B

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 95

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 95

ANS: B

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 96

Arterial blood gases have just been drawn on a child. What should the nurse do next?

a.

Take the sample to the laboratory immediately.

b.

Pack the sample in ice and take it to the laboratory immediately.

c.

Place the sample in a brown bag until it can be taken to laboratory.

d.

Refrigerate the sample until it can be taken to the laboratory.

Answer 96

ANS: B

Arterial blood gases require careful handling for accurate results. Immediately after obtaining the specimen, the nurse packs it in ice to reduce cellular metabolism and takes it to the laboratory.

Question 97

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 97

ANS: C

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 98

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 98

ANS: B

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 99

The nurse is analyzing an arterial blood gas of pH, 7.50; PCO2, 30; and HCO3, 20. What result should the nurse document for this blood gas?

a.

Fully compensated metabolic alkalosis

b.

Partially compensated metabolic alkalosis

c.

Fully compensated respiratory alkalosis

d.

Partially compensated respiratory alkalosis

Answer 99

ANS: D

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 alkalosis, the pH is high (?7?7.45), and the PCO2 is low (?6?35). 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 low (?6?22), indicating an attempt at compensation.

Question 100

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 100

ANS: D

The characteristics of the disease—malaise, sore throat, lymphadenopathy, central nervous system manifestations, and skin lesions—are 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 102

How much oxygen is contained in ambient air (room air)?

a.

15%

b.

21%

c.

30%

d.

42%

Answer 102

ANS: B

Room air is composed of 21% oxygen, trace amounts of carbon dioxide, and 79% nitrogen.

Question 103

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 103

ANS: D

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 104

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 104

ANS: D

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 105

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 105

ANS: A

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 107

During a respiratory assessment, the nurse notes a sinking in of soft tissues relative to the cartilaginous and bony thorax. What is the term for this finding?

a.

Grunting

b.

Tachypnea

c.

Retractions

d.

Nasal flaring

Answer 107

ANS: C

Retractions are defined as the sinking of soft tissue relative to the cartilaginous or bony thorax. Retractions can be extreme in severe airway obstruction as the work of breathing increases. Grunting can be a sign of pain in older children with respiratory issues. It serves to increase the end-respiratory pressure, which prolongs the period of oxygen and carbon dioxide exchange across the membrane. Tachypnea is an increase in the respiratory rate above the child’s baseline. Nasal flaring, the enlargement of the nostrils, helps reduce nasal resistance and maintains airway patency

Question 108

What nursing consideration is most important in the care of a child on a mechanical ventilator?

a.

Humidification is not necessary.

b.

Respiratory assessment is done by the ventilator.

c.

Positioning the child for comfort and optimum ventilation is necessary.

d.

Support and reassurance are not as important because the child is unconscious.

Answer 108

ANS: C

The ventilator will do the work of breathing, but the nurse must position the child with attention to achieving optimum gas exchange. The reason for mechanical ventilation and the child’s comfort are part of the assessment. Mechanical ventilation is usually achieved by intubation or tracheostomy. These routes bypass the humidification that occurs in the upper airway. The ventilator provides some information about the work of breathing, but patient assessment must be done by the nurse. Support and reassurance are always important for both the child and family. Opioids and anxiolytics are often used to decrease the child’s anxiety. Careful assessment is indicated.

Question 109

What respiratory condition or disease results in both increased compliance and increased resistance?

a.

Asthma

b.

Atelectasis

c.

Surfactant deficiency

d.

Bronchopulmonary dysplasia

Answer 109

ANS: A

Compliance is a measure of the relative ease with which the chest wall expands. Resistance is determined primarily by airway size. Asthma results in increased compliance and increased resistance, both of which increase the work of breathing. Atelectasis and surfactant deficiency both decrease compliance but do not affect resistance. Bronchopulmonary dysplasia increases resistance but does not affect compliance.

Question 110

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 110

ANS: A

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.