chapter 45: Respiratory dysfunction

Question 1

1. What sentence below best describes why children have fewer respiratory tract infections as they grow older?
   a. The amount of lymphoid tissue decreases.
   b. Repeated exposure to organisms causes increased immunity.
   c. Viral organisms are less prevalent in the population.
   d. Secondary infections rarely occur after viral illnesses.

Answer 1

ANS: B
Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist them. Secondary infections after viral illnesses include Mycoplasma pneumoniae and groups A and B streptococcal infections.

Question 2

2. Why are cool-mist vaporizers rather than steam vaporizers recommended in home treatment of respiratory tract infections?
   a. They are safer.
   b. They are less expensive.
   c. Steam dries out respiratory secretions.
   d. A more comfortable environment is produced.

Answer 2

ANS: A
Cool-mist vaporizers are safer than steam vaporizers, and limited evidence exists to support the idea that there are any advantages to steam. The costs of cool-mist and steam vaporizers are comparable. Steam loosens secretions, it does not dry them. Both may promote a more comfortable environment, but there is a decreased risk for burns in cool-mist vaporizers. They must be disinfected daily.

Question 3

3. Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Which instruction for nose drops should be included when teaching the parent?
   a. Avoid using drops for more than 3 days.
   b. Keep drops to use again for nasal congestion.
   c. Administer drops until nasal congestion subsides.
   d. Administer drops after feedings and at bedtime.

Answer 3

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 because they may become contaminated with bacteria. Administering the drops before feedings is more helpful.

Question 4

4. What is the appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature?
   a. Give tepid water baths to reduce fever.
   b. Encourage food intake to maintain caloric needs.
   c. Have the child wear heavy clothing to prevent chilling.
   d. Give small amounts of favourite fluids frequently to prevent dehydration.

Answer 4

ANS: D
Preventing dehydration using small, frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises the child’s temperature. Food should not be forced, as it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

Question 5

5. When teaching a parent group about respiratory complications, which symptom should be reported to the health care provider?
   a. Becomes fussy
   b. Has a cough
   c. Has a fever for more than 3 days
   d. Shows signs of an earache

Answer 5

ANS: D
If the child has any pain in the ear or any fluid draining from it, the parent should contact their health care provider. If an infant with nasopharyngitis has a fever over 5 days, not 3 days, the health care provider should be notified. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis.

Question 6

6. When do physicians generally recommend that a child with acute streptococcal pharyngitis can return to school?
   a. When the sore throat is better
   b. If no complications develop
   c. After taking antibiotics for 24 hours
   d. After taking antibiotics for 3 days

Answer 6

ANS: C
After children have taken antibiotics for 24 hours, even if the sore throat persists, they are no longer contagious to other children. Thus, they can return to school at that time. Complications may take days to weeks to develop.

Question 7

7. Which characteristic regarding chronic otitis media with effusion (OME) differentiates if from acute otitis media (AOM)?
   a. Fever as high as 40°C
   b. Severe pain in the ear
   c. Nausea and vomiting
   d. A feeling of fullness in the ear

Answer 7

ANS: D
OME is characterized by an immobile or orange-coloured tympanic membrane and nonspecific complaints and does not usually cause severe pain. Fever and severe pain may be signs of AOM. Nausea and vomiting are not associated with otitis media.

Question 8

8. Which best describes acute otitis media (AOM)?
   a. The etiology is unknown.
   b. Permanent hearing loss often results.
   c. It can be treated by intramuscular antibiotics.
   d. It can be treated with antibiotics.

Answer 8

ANS: D
Historically, AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting. The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to advise judicious use of antibiotics and that antibiotics are not required for initial treatment. Permanent hearing loss is not a frequent cause of properly treated AOM. Intramuscular antibiotics are not necessary. Oral amoxicillin is the treatment of choice.

Question 9

9. An infant’s parents ask the nurse about preventing otitis media (OM). What should the nurse recommend?
   a. Avoid tobacco smoke.
   b. Use nasal decongestant.
   c. Avoid children with OM.
   d. Bottle-feed or breastfeed in the supine position.

Answer 9

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 upper respiratory infection symptoms. Children should be fed in an upright position, not supine, to prevent OM.

Question 10

10. Which type of croup is always considered a medical emergency?
    a. Laryngitis
    b. Epiglottitis
    c. Spasmodic croup
    d. Laryngotracheobronchitis (LTB)

Answer 10

ANS: B
Acute epiglottitis is always a medical emergency that needs treatment with antibiotics and airway support. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory infection symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

Question 11

11. The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the child’s bedside as much as possible. What is the nurse’s primary reason for this suggestion?
    a. Mothers of hospitalized toddlers often experience guilt.
    b. The mother’s presence will reduce the child’s anxiety and ease 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 11

ANS: B
The family’s presence will decrease the child’s distress. The mother may experience guilt, but this is not the best answer here. Although separation from the mother is a developmental threat for toddlers, the main reason to keep parents at the child’s bedside is to ease anxiety, and therefore respiratory effort. The child should have constant cardiorespiratory and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

Question 12

12. A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. What is this description most suggestive of?
    a. Bronchitis
    b. Bronchiolitis
    c. Viral-induced asthma
    d. Acute spasmodic laryngitis

Answer 12

ANS: A
Bronchitis is characterized by these symptoms and occurs in children older than 6 years of age. Bronchiolitis is rare in children younger than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years.

Question 13

13. When is skin testing (the Mantoux test) for tuberculosis (TB) recommended?
    a. Every year for all children older than 2 years
    b. Every year for all children older than 10 years
    c. Every 2 years for all children starting at age 1 year
    d. Periodically for children who reside in high-prevalence regions

Answer 13

ANS: D
Children who reside in regions with a high prevalence of TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

Question 14

14. The mother of a toddler yells to the nurse, “Help! He is choking to death on his food.” What finding causes the nurse to determine that life-saving measures are necessary?
    a. Gagging
    b. Coughing
    c. Pulse over 100 beats/min
    d. Inability to speak

Answer 14

ANS: D
The inability to speak indicates a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed to treat the choking child. Gagging indicates irritation at the back of the throat, not obstruction. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.

Question 15

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

Answer 15

ANS: B
Monitoring cardiopulmonary status is an important evaluation in the care of a child with ARDS. Maintenance of vascular volume and hydration is also important and should be done parenterally. Seizures are not an adverse effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

Question 16

16. The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What is the most essential part of this child’s care?
    a. Monitoring pulse oximetry
    b. Monitoring arterial blood gases
    c. Administering oxygen if respiratory distress develops
    d. Administering oxygen if the child’s lips become bright cherry red

Answer 16

ANS: B
Arterial blood gases and COHb levels are the best way to monitor CO poisoning. PaO2 monitored with pulse oximetry may be normal in the case of CO poisoning. And 100% O2 should be given as quickly as possible, not only if respiratory distress or other symptoms develop.

Question 17

17. Which is a common trigger for the development of asthma in infants?
    a. Medications
    b. A viral infection
    c. Exposure to cold air
    d. Allergy to dust or dust mites

Answer 17

ANS: B
Viral illnesses cause inflammation that result in the increased airway reactivity of asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20 to 40% of children with asthma have no evidence of allergic disease.

Question 18

18. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. What do these symptoms suggest?
    a. Asthma
    b. Pneumonia
    c. Bronchiolitis
    d. A foreign body in the trachea

Answer 18

ANS: A
Children with asthma usually have these chronic symptoms. Pneumonia has an acute onset with fever and general malaise. Bronchiolitis is an acute condition caused by a respiratory syncytial virus. A foreign body in the trachea will occur with acute respiratory distress or failure and maybe stridor.

Question 19

19. Which should be frequently assessed in children with asthma who are taking long-term inhaled steroids?
    a. Cough
    b. Osteoporosis
    c. Slowed growth
    d. Cushing’s syndrome

Answer 19

ANS: C
The growth of children on long-term inhaled steroids should be checked frequently (at least every 3 to 6 months) to assess for systemic effects of these drugs. Coughing is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing’s syndrome is caused by long-term systemic steroids.

Question 20

20. â-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. How do these medications act on asthma?
    a. They liquefy secretions.
    b. They dilate the bronchioles.
    c. They reduce inflammation in the lungs.
    d. They reduce infection.

Answer 20

ANS: B
These medications work to dilate the bronchioles in acute exacerbations; they do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

Question 21

21. A parent whose two school-age children have asthma asks the nurse what sports, if any, they can participate in. What sport should the nurse recommend?
    a. Soccer
    b. Running
    c. Swimming d. Basketball

Answer 21

ANS: C
Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in the water. Exercise-induced bronchospasm is more common in sports that involve endurance such as soccer, running, and basketball. Prophylaxis with medications may be necessary.

Question 22

22. Which statement expresses accurately the genetic implications of cystic fibrosis (CF)?
    a. If it is present in a child, both parents are carriers of this defective gene.
    b. It is inherited as an autosomal dominant trait.
    c. Seventy percent of individuals with CF in Canada are children.
    d. There is a 50% chance that siblings of an affected child will also be affected.

Answer 22

ANS: A
Cystic fibrosis (CF) is an autosomal recessive gene inherited from both parents. In Canada, 60% of CF patients are adults, 40% are children. An autosomal recessive inheritance pattern means that there is a 25% chance that a sibling will be infected, but a 50% chance a sibling will be a carrier.

Question 23

23. 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 23

ANS: A
The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Some other clinical manifestations include abdominal distention, vomiting, failure to pass stools, and the 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 other later manifestations of CF.

Question 24

24. Cystic fibrosis (CF) is suspected in a toddler. Which test is essential to confirm this diagnosis?
    a. Bronchoscopy
    b. Serum calcium
    c. Urine creatinine
    d. Sweat chloride test

Answer 24

ANS: D
A sweat chloride test result greater than 60 mmol/L is diagnostic of CF. Although bronchoscopy is helpful for identifying bacterial infection in children with CF, it is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

Question 25

25. A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). Which is true about this drug? a. It may cause mucus to thicken.
    b. It may cause voice alterations.
    c. It is given subcutaneously.
    d. It is not indicated for children younger than 12 years.

Answer 25

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

Question 26

26. What should a nurse know when administering pancreatic enzymes to a child with cystic fibrosis?
    a. Do not administer pancreatic enzymes if the child is receiving antibiotics.
    b. Decrease the dose of pancreatic enzymes if the child is having frequent, bulky
    stools.
    c. Administer pancreatic enzymes between meals, if at all possible.
    d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of
    food taken at the beginning of a meal.

Answer 26

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

Question 27

27. In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein.
    b. Diet should be high in easily digested carbohydrates and fats.
    c. Most fruits and vegetables are not well tolerated.
    d. Fats and proteins must be greatly curtailed.

Answer 27

ANS: A
Children with CF require a well-balanced, high-protein, high-calorie diet because they have impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important, and fats and proteins are a necessary part.

Question 28

28. Cardiopulmonary resuscitation is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible?
    a. Radial
    b. Carotid
    c. Femoral
    d. Brachial

Answer 28

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. The brachial pulse is felt in infants younger than 1 year.

Question 29

29. Subdiaphragmatic abdominal thrusts are recommended for airway obstruction in children older than which age?
    a. 1 year
    b. 4 years
    c. 8 years
    d. 12 years

Answer 29

ANS: A
Subdiaphragmatic abdominal thrusts are recommended for airway obstruction in children older than 1 year. For children younger than 1 year, back blows and chest thrusts should be administered.

Question 30

30. What is the priority nursing intervention when caring for a child with pneumonia?
    a. Encourage rest.
    b. Encourage the child to lie on the affected side.
    c. Administer an opioid.
    d. Place the child in the Trendelenburg position.

Answer 30

ANS: B
Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing. Rest and quiet activity are encouraged but are not the priority intervention. Analgesics may be given but opioids are not indicated. Children with pneumonia should be placed in a semi-erect position or a position of comfort.

Question 31

31. What should be included in nursing care for a child with staphylococcal pneumonia?
    a. Nursing care should be supportive and directed at relieving symptoms.
    b. Nursing care should include round-the-clock administration of antitussive agents.
    c. Nursing care should include strict intake and output to avoid heart failure.
    d. Nursing care should include administration of opioids.

Answer 31

ANS: A
Nursing care of the hospitalized child with pneumonia is primarily supportive and symptomatic. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Round-the-clock antitussive agents and strict intake and output are not included in the care of the child with pneumonia. It is not routine to include the administration of opioids in nursing care for a child with pneumonia.

Question 32

32. The nurse is caring for a 10-month-old infant with mild acute respiratory distress syndrome (ARDS). Which initial intervention should be included in the child’s care?
    a. Place in a mist tent.
    b. Administer antibiotics.
    c. Administer cough syrup.
    d. Place on noninvasive oxygen monitoring.

Answer 32

ANS: D
Noninvasive oxygen monitoring is recommended for children with ARDS, along with adequate hydration and nutrition, maintenance of patient comfort, and prevention of complications. Antibiotics may be ordered, but this would only occur after the underlying cause has been identified; therefore, it is not an initial intervention for the child with ARDS.

Question 33

33. The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. What action should the nurse include in the child’s postoperative care plan?
    a. Notify the surgeon if the child swallows frequently.
    b. Apply a heat collar to the child for pain relief.
    c. Place the child in prone supine position until fully awake.
    d. Encourage the child to cough frequently.

Answer 33

ANS: A
Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed prone or lateral to facilitate drainage, not supine. The child can drink diluted juice, cool water, or popsicles after the procedure.

Question 34

1. When doing discharge teaching with parents of a 9-year-old child who had a tonsillectomy 10 hours ago, which will the nurse include? Select all that apply. Express answer in small numbers followed by a comma and a space—e.g., a, b, c.
   a. Gargle with warm water TID
   b. Avoid vigorous brushing of the teeth
   c. Use straws when providing clear fluid drinks
   d. Use an ice collar for pain
   e. Drink at least 1 L of fluid per day
   f. Offer chewing gum
   g. Provide orange juice at least once per day

Answer 34

ANS: B, D, E, F
Discharge instructions include avoidance of irritating or highly seasoned food; encouraging at least 4 cups of fluid per day; avoiding gargling and vigorous brushing of the teeth, avoiding use of straws; use of analgesics or an ice collar for pain; and limiting activity. Chewing gum may prevent throat and ear pain in older children. Citrus juices should be avoided for 7 to 10 days.

Question 35

2. Which are true in relation to the influenza vaccination? Select all that apply. Express answer in small numbers followed by a comma and a space—e.g., a, b, c.
   a. Annual vaccination is recommended for all children age 6 months or older.
   b. Vaccination is not recommended for immunocompromised children.
   c. Trivalent vaccines are preferred over quadrivalent vaccines.
   d. Children with neurological disorders are high risk and should have an annual
   vaccination.
   e. Children aged 6 months to 8 years receive their initial vaccine in two doses, 4
   weeks apart.
   f. Indigenous peoples are identified as high risk and should receive annual
   vaccinations.

Answer 35

ANS: A, D, E, F
The Canadian Paediatric Society recommends annual influenza vaccination for all children age 6 months and older and specific high-risk populations (e.g., Indigenous peoples, those with neurological disorders, immunocompromised children). Quadrivalent vaccines are preferred over trivalent vaccines.