Exam #2 Peds Chapter 27 Flashcards
What respiratory condition or disease results in both increased compliance and increased resistance?
a. Asthma
b. Atelectasis
c. Surfactant deficiency
d. Bronchopulmonary dysplasia
a. Asthma
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.
How much oxygen is contained in ambient air (room air)?
a. 15%
b. 21%
c. 30%
d. 42%
b. 21%
Room air is composed of 21% oxygen, trace amounts of carbon dioxide, and 79% nitrogen.
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
c. Retractions
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.
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
a. Tidal volume
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.
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.
a. Pulse oximetry is noninvasive.
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.
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
d. Burns under sensors
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.
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
a. Allen test
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.
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.
b. Pack the sample in ice and take it to the laboratory immediately.
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.
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
a. Has no proven benefit
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.
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
a. Before meals and at bedtime
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.
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.
c. Positioning the child for comfort and optimum ventilation is necessary.
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.
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
c. Cool mist begun immediately after extubation
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.
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.
b. Perform each pass of the suction catheter for no longer than 5 seconds.
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.
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.
c. Avoid exposure to noxious fumes such as paint or varnish.
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.
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.
b. Parents are able to change the tracheostomy tube when needed.
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.
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
a. Anemia
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.
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
b. Restlessness
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.
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
b. Carotid
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.
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)
c. Adrenaline (epinephrine)
Epinephrine is considered one of the most useful drugs in treating cardiac arrest. As an adrenergic agent, it acts on both α- and β-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.
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.
b. Provide two breaths to every 30 chest compressions.
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.
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
a. 1 year
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.
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
d. Inability to speak
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.
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.
d. A nasal cannula may cause abdominal distention.
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.
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
a. Nasal flaring
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.
