Chapter 45: The Child with a Respiratory Alteration (Part 1- Upper Airway)

Question 1

Croup patients with these four symptoms should be taken to the emergency room immediately

Answer 1

stridor at rest
cyanosis
retractions
inability to take PO fluids

Question 2

pink, sandpaper rash on trunk indicates this

Answer 2

scarlet fever

Question 3

peritonsillar abscess has a higher risk for ____________________ and _________________

Answer 3

airway obstruction, dehydration

Question 4

most common cause of neonatal stridor

Answer 4

laryngomalacia

Question 5

two drugs of choice to treat sinusitis

Answer 5

amoxicillin
amoxicillin-potassium clavulanate

Question 6

viral or bacterial pharyngitis: abrupt onset (may be gradual in children younger than 2 years)

Answer 6

bacterial

Question 7

four cardinal signs of epiglottitis

Answer 7

drooling, dysphagia, dysphonia, distressed respiratory efforts

Question 8

When treating sinusitis, _____________ can be used to treat allergic rhinitis but tend to _____________ secretions and impair ______________.

Answer 8

antihistamines, thicken, sinus drainage

Question 9

viral or bacterial pharyngitis: fever usually high (39.4 to 40 degrees C)

Answer 9

bacterial

Question 10

Care for pharyngitis/tonsillitis includes ____________, gargling _______________, ________ and ________ foods and liquids, and _______________ applied to the neck.

Answer 10

antipyretics, warm salt water, cool, bland, warm compress

Question 11

treatment for bacterial pharyngitis includes these antibiotics of ______ doses orally daily over a course of ______ days

Answer 11

penicillins, 2-3, 10

Question 12

The tonsillectomy patient is most at risk for postoperative hemorrhage in these two time periods after surgery

Answer 12

first 24 hours
days 7-10

Question 13

these two openings in the fetal heart must close shortly after birth to establish effective pulmonary and circulatory systems

Answer 13

foramen ovale, ductus arteriosus

Question 14

After a tonsillectomy, avoid the use of ___________________ unless absolutely necessary, when they should be __________.

Answer 14

tongue depressors, sterile

Question 15

pharyngitis/tonsillitis peaks between the ages of _________

Answer 15

4-7 years

Question 16

to help relieve mucus buildup in nares, teach parents how to use these

Answer 16

saline drops and bulb syringe for suction

Question 17

ideal treatment for allergic rhinitis

Answer 17

remove the allergen

Question 18

In the postoperative period after a tonsillectomy, the child should be placed in a _________ or _____________ position to facilitate drainage

Answer 18

prone, side-lying

Question 19

infants <6 months are obligatory ________ breathers

Answer 19

nose

Question 20

these children will always test positive for strep throat even if there is not an active infection

Answer 20

carriers/colonized

Question 21

viral or bacterial pharyngitis: usually low grade fever but may be high

Answer 21

viral

Question 22

a child with croup should be monitored in the emergency room for about ________ in case of ______________.

Answer 22

3 hours, rebound stridor

Question 23

surfactant starts to be produced at this point in pregnancy

Answer 23

mid pregnancy

Question 24

viral or bacterial pharyngitis: manifestations include abdominal pain, headache, vomiting

Answer 24

bacterial

Question 25

In a child with croup, __________ can aggravate symptoms and make respiratory distress worse

Answer 25

crying

Question 26

rapid strep antigen tests have a false negative rate of this

Answer 26

20%

Question 27

viral or bacterial pharyngitis: sometimes accompanied with a pink, sandpaper rash on trunk

Answer 27

bacterial

Question 28

For treating croup, a single dose of this drug is also indicated to reduce airway inflammation and reduce necessity for hospitalization

Answer 28

dexamethasone

Question 29

_____________ occur more likely in pediatrics with respiratory distress

Answer 29

retractions

Question 30

crease across the bridge of the nose from wiping the nose upward with the palm of the hand

Answer 30

allergic salute

Question 31

viral or bacterial pharyngitis: usually lasts 3-5 days

Answer 31

bacterial

Question 32

untreated strep throat increases the risk of developing this inflammatory heart condition

Answer 32

rheumatic fever

Question 33

sudden onset of harsh, metallic, barky cough; sore throat; inspiratory stridor; hoarseness

Answer 33

croup

Question 34

Parents of children with laryngomalacia should be educated about signs of ________________ and ___________________, which can make symptoms worse.

Answer 34

respiratory distress, respiratory infections

Question 35

epiglottitis is typically caused by this pathogen

Answer 35

H. influenza

Question 36

allergic rhinitis onset is _________________ but rarely occurs before the age of _____

Answer 36

during childhood, 2 years

Question 37

eustachian tubes are relatively _______________ and ____________ in pediatric patients

Answer 37

horizontal, shorter

Question 38

the average age of occurrence of epiglottitis

Answer 38

3-7 years

Question 39

incidences of epiglottitis decreased substantially since the introduction of this vaccine

Answer 39

Hib

Question 40

pulmonary function tests can sometimes be difficult on young children for this reason

Answer 40

inability to follow commands

Question 41

Parents of children with laryngomalacia should use a (smaller, larger) nipple if bottle feeding and may tolerate (small, large) and (less, more) frequent feedings better.

Answer 41

smaller, small, more

Question 42

___________________ emesis is common, but emesis that contains ____________________ is a sign of postoperative hemorrhage (tonsillectomy)

Answer 42

Coffee-ground, bright red blood

Question 43

pediatric patients have __________________ intercostal muscles, which can cause ____________ breathing and (increased, decreased) respiratory rate

Answer 43

underdeveloped, abdominal, increased

Question 44

croup typically occurs in this age group

Answer 44

6 months to 6 years

Question 45

In a patient with laryngomalacia, the nurse should assess for __________________, __________ difficulties, and pattern of _____________ and ________.

Answer 45

respiratory distress, feeding, weight gain, growth

Question 46

viral or bacterial pharyngitis: vesicles or ulcers on tonsils

Answer 46

viral

Question 47

viral or bacterial pharyngitis: early manifestations include hoarseness, cough, rhinitis, conjunctivitis, malaise, anorexia

Answer 47

viral

Question 48

viral or bacterial pharyngitis: cervical lymph nodes may be enlarged, tender

Answer 48

viral and bacterial

Question 49

this test measures vital capacity and expiratory flow rate

Answer 49

pulmonary function test (via spirometry)

Question 50

In the postoperative period after a tonsillectomy, the nurse should assess the child for excess __________ and the ability to __________________.

Answer 50

bleeding, swallow secretions

Question 51

caused by immature neuromuscular development of the airway

Answer 51

laryngomalacia

Question 52

manifestations include cold-like symptoms that do not improve after 10-14 days, low grade fever, nasal congestion with purulent drainage, halitosis, and cough that worsens when lying flat, headache

Answer 52

sinusitis

Question 53

only reliable and accurate diagnostic for bacterial pharyngitis

Answer 53

throat culture

Question 54

children have (more, less) flexible larynx, (decreasing, increasing) susceptibility to spasms and their complications

Answer 54

more, increasing

Question 55

pediatric patients have __________ airways and ____________ cartilage, increasing the risk for these three things

Answer 55

smaller, undeveloped foreign body aspiration, edema, mucus obstruction

Question 56

these drugs are not recommended for treatment of respiratory disorders due to adverse side effects

Answer 56

decongestants

Question 57

tonsillectomies should not be performed under ________ of age and are contraindicated in _________________ and those with a ____________.

Answer 57

3 years, active infection, cleft palate

Question 58

manifestations include refusal to talk, swallow, or eat due to severe pain, which may radiate up to the ear

Answer 58

peritonsillar abscess

Question 59

pediatric patients have a(n) _________ respiratory rate due to ______________ metabolic needs

Answer 59

faster, increased

Question 60

end tidal carbon dioxide, used with the pulse oximeter, is useful in the patient in these three conditions

Answer 60

intubated under procedural sedation evaluating asthma severity

Question 61

newborns can have brief periods of _________ which can last up to 15 seconds; this is normal until ___________

Answer 61

apnea, 1 month

Question 62

croup occurs most often during the _______ (time of day) in the __________ (season)

Answer 62

night, winter

Question 63

symptoms of laryngomalacia usually resolve spontaneously between _____________________ of age.

Answer 63

18-24 months

Question 64

_________________ studies and a thorough history should be done prior to a tonsillectomy because the tonsils are a highly ___________ area.

Answer 64

Bleeding, vascular

Question 65

sinusitis often follows a(n) ____________________________ but may also occur after ______________ or _________________

Answer 65

upper respiratory infection, allergic rhinitis, otitis media

Question 66

viral or bacterial pharyngitis: usually lasts 3-4 days

Answer 66

viral

Question 67

if the child is not responsive to treatments for allergic rhinitis, this therapy may be used

Answer 67

immunotherapy

Question 68

noisy, crowing, respiratory sounds with or without retractions in the neonatal period

Answer 68

laryngomalacia

Question 69

assessment findings include stridor with or without retractions, acyanotic, and worsening symptoms with laying down or crying

Answer 69

laryngomalacia

Question 70

unilateral abscess that displaces the uvula to the opposite side

Answer 70

peritonsillar abscess

Question 71

ABGs are more reliable for patients with these two problems

Answer 71

chronic pulmonary alteration decreased peripheral perfusion

Question 72

diagnosis of pharyngitis

Answer 72

rapid antigen test and throat culture

Question 73

In a patient with laryngomalacia, stridor can be reduced by placing the child's neck in this position

Answer 73

hyperextended

Question 74

characterized by flaccidity of epiglottis and weakness along airway walls

Answer 74

laryngomalacia

Question 75

most effective drug treatment for allergic rhinitis

Answer 75

antihistamines, intranasal corticosteroids

Question 76

alveoli are expanded within the first ________ after birth

Answer 76

hour

Question 77

manifestations include clear rhinorrhea; itching of nose, eyes, and ears; and paroxysmal sneezing

Answer 77

allergic rhinitis

Question 78

inflammation and infection of the sinuses

Answer 78

sinusitis

Question 79

After a tonsillectomy, after the child is fully awake, provide _____________ liquids and avoid ___________, ____________, and extreme ______ or ______ liquids.

Answer 79

clear cool, carbonated, citrus, hot, cold

Question 80

this medication is given to decrease laryngeal swelling and bronchospasms in croup

Answer 80

nebulized racemic epinephrine

Question 81

tonsils in children are naturally (smaller, larger) than in adults

Answer 81

larger

Question 82

dark circles under the eyes caused by edema

Answer 82

allergic shiners

Question 83

pediatric patients have __________ surfactant

Answer 83

decreased

Question 84

Interventions and teaching for sinusitis include increasing _____________ intake, using a bedside ___________, placing a ______________ on the face for pain relief, and _________________ for pain and fever control.

Answer 84

clear fluid, humidifier, warm compress, acetaminophen

Question 85

viral or bacterial pharyngitis: erythema, inflammation of pharynx and tonsils

Answer 85

viral and bacterial

Question 86

After a tonsillectomy, have ____________ equipment available, but do not use unless there is a(n) __________________.

Answer 86

suction, airway obstruction

Question 87

diagnostic test that checks oxygen and carbon dioxide levels through electrodes on the patient's skin

Answer 87

transcutaneous monitoring

Question 88

children with strep throat are infectious until this

Answer 88

24 hours after antibiotics are started

Question 89

Before a tonsillectomy, teach the child and parents of the presence of a ______________ after the procedure and the importance of _____________________.

Answer 89

sore throat, drinking fluids

Question 90

most cases of sinusitis are ___________________, but some cases may require _____________

Answer 90

self-limiting, antibiotics

Question 91

Treat epiglottitis with ______________, the drugs _______________ and ______________, and place child on _______ status.

Answer 91

intubation, antipyretics, IV antibiotics, NPO

Question 92

diagnostic test that assesses acid base balances

Answer 92

arterial blood gas (ABG)

Question 93

four common viruses that cause pharyngitis

Answer 93

adenovirus coronavirus enterovirus respiratory syncytial virus (RSV)

Question 94

tonsillectomies should be reserved in cases of upper airway ____________, ____________________, ____________ sleep apneas, or other serious problems.

Answer 94

obstruction, peritonsillar abscesses, obstructive

Question 95

pulmonary function tests are used to assess the _________ of disease, response to _____________, or presence of ______________________ pulmonary disease

Answer 95

degree, therapy, restrictive or obstructive

Question 96

If epiglottitis is suspected, do not do these two things

Answer 96

leave child unattended examine or attempt to obtain culture

Question 97

viral or bacterial pharyngitis: gradual onset with sore throat

Answer 97

viral

Question 98

may be preceded by several days of symptoms of upper respiratory tract infection

Answer 98

croup

Question 99

electrodes in transcutaneous monitoring must be changed every ___________, and the machine must be ____________ each time they are changed

Answer 99

3-4 hours, recalibrated

Question 100

seasonal, recurrent inflammatory disorder of the nasal mucosa

Answer 100

allergic rhinitis

Question 101

total inflation of a normal lung is complete within the first _____________________

Answer 101

few breaths of life

Question 102

viral or bacterial pharyngitis: usually severe sore throat

Answer 102

bacterial