My notes (RESP)

Question 1

The causative agent of acute epiglottitis is?

Answer 1

bacterial, usually H. influenzae

Question 2

The primary management goal of epiglottitis is to?

Answer 2

stabilize the airway by intubation or tracheostomy.

Question 3

The presence of daily symptoms or nighttime symptoms, more than once per week, but not nightly, places a child over 5 years of age in which category of asthma?

Answer 3

Moderate persistent asthma

Question 4

Bill needs instructions about using a metered-dose inhaler (MDI). The nurse should explain that the MDI is used to: A. improve circulation. B. distribute med directly to airways. C. assess severity of breathing difficulty. D. distribute med systemically w/o the need for inj.

Answer 4

B

Question 5

Instructions for using the MDI include:

A. breathe medication in slowly.

B. avoid breathing too deeply.

C. hold inhaler at about a 45-degree angle to the mouth.

D. breathe in through nose and out through mouth.

Instructions for using the MDI include:

breathe medication in slowly.
avoid breathing too deeply.
hold inhaler at about a 45-degree angle to the mouth.
breathe in through nose and out through mouth.

Answer 5

A

A slow, deep inspiration held for 5 to 10 seconds will allow the medication to reach the narrow, deep airways.

Rapid inspirations cause the medication to move through the unobstructed bronchioles to patent airways, where they are less needed.

The inhaler should be held upright with the mouthpiece in the mouth.

Question 6

Bill’s father asks the nurse if his son can still participate in sports. The nurse’s response should be based on an understanding that:

A. exercise should be encouraged.

B. avoid breathing too deeply.

C. organized sports are too strenuous for children with asthma.

D. quiet activities such as reading are best for children with asthma.

Answer 6

A

It has been found that moderate or even strenuous exercise is advantageous for children with asthma, provided the asthma is under control.

Restrictions on exercise are invoked only when the child’s condition makes it necessary.

Prophylactic TX with β-adrenergics or cromolyn before exercise will usually permit full participation in strenuous exercise.

Question 7

What is the most prevalent etiologic agent causing bronchiolitis in young infants?

Answer 7

RSV

Rationale: RSV is responsible for at least 50% of children admitted for bronchiolitis.

Question 8

________________________is a croup syndrome with paroxysmal attacks of laryngeal obstruction that occur chiefly at night; it is usually caused by a viral agent.

Answer 8

Acute spasmodic laryngitis

Question 9

_________________is an acute viral infection that occurs primarily in the winter and spring. The symptoms begin with rhinorrhea and fever, often spreading to a lower respiratory tract infection.

Answer 9

Bronchiolitis

Question 10

How is the diagnosis of RSV established?

Answer 10

ELISA of nasal secretions

Rationale: Either the rapid immunofluorescent antibody (IFA) or the ELISA technique for RSV detection can be used.

These techniques are rapid and have sensitivities and specificities of about 90%

Question 11

Repeated episodes of bronchiolitis not associated with RSV in young children require follow-up testing for which disorders?

Answer 11

Asthma, cystic fibrosis.

Rationale: Because of the nature of asthma and CF, the airways are more reactive and/or mucus production is increased, causing a perfect medium for bacterial growth. Children with asthma/CF are more likely to display repeated sxs of bronchiolitis before the dx of a chronic disorder.

Question 12

What type of isolation measures are indicated for health personnel when caring for a child with RSV?

Answer 12

Good hand-washing; use of gowns and gloves to prevent cross contamination.

Rationale: RSV is highly virulent, and health care personnel should take precautions to avoid spreading the virus to uninfected hospital personnel, visitors, and patients in the hospital.

Question 13

Discuss the guidelines for use of ribavirin aerosol therapy.

Answer 13

It is used for infants at high risk because of other abnormalities, especially chronic lung disorders and immunodeficiency; infants less than 6 months old; and severely ill infants.

Special precautions such as mask and goggles are required for caregivers; no pregnant personnel should be involved.

Rationale: Because of the potential toxic effects of the drug to health care workers and the unclear evidence of the drug’s benefit, the American Academy of Pediatrics recommends the preceding criteria for use of ribavirin.

Question 14

What disease is inherited as an autosomal recessive gene; requiring inheritance of the defective gene from both parents?

Answer 14

CF

Question 15

Can fertility therapy contribute to the newborn developing CF?

Answer 15

NO

Question 16

What is the significance of sodium and chloride in diagnosing CF?

Answer 16

A clinical feature of CF is a striking elevation of sweat electrolytes. Although sodium and chloride are affected, the defect appears to be primarily a result of abnormal chloride movements.

Question 17

What are the effects of increased viscosity of mucous gland secretions on each of the following?

A. Bronchi

B. Small intestine

C. Pancreatic ducts

D. Bile ducts

Answer 17

A. Chronic pneumonia and emphysema

B. Meconium ileus

C. Malabsorption syndrome

D. Portal hypertension

Increased mucous gland secretion and mucus viscosity result in mechanical obstruction, which leads to chronic complications of the bronchi, small intestine, pancreatic ducts, and bile ducts.

These complications are outlined in Fig. 32-14.

Question 18

David is the 3-year-old son of parents who are 38 and 40 y/o. They have been married for 15 years and underwent fertility therapy to have a child. David has a HX of frequent colds increasing in severity during the past year. He also has been losing wt although he eats well. David has been having large loose bowel movements during the past year. David is admitted to the pediatric unit for a workup for CF.

List seven nursing diagnoses appropriate for David.

Answer 18

Ineffective Airway Clearance r/t secretion of thick, tenacious mucus

Ineffective Breathing Pattern r/t mechanical airway obstruction

Altered Nutrition, Less Than Body Requirements, r/t inability to digest nutrients

High Risk for Infection r/t impaired body defenses

Activity Intolerance r/t imbalance between oxygen supply and demand

Altered Growth and Development r/t chronic illness

Altered Family Processes r/t child with chronic illness

Question 19

Lisa is 7 y/o & has CF. She lives w/both parents & a 4 y/o sister who also has CF.

Lisa’s mother tearfully tells the RN that she is pregnant & worried that this child will also have CF. The nurse should understand that:

A. CF is usually not inherited.

B. CF can be diagnosed prenatally.

C. there is a 50% chance this child will be affected.

D. there is a 100% chance this child will be affected if it is a female.

Answer 19

B

Rationale:

CF is inherited as an autosomal recessive trait; the affected child inherits the defective gene from both parents.

Genetic discoveries have allowed for better screening techniques, and prenatal testing continues to be studied.

The autosomal recessive defective gene is inherited from both parents with an overall incidence of 1:4 (25% chance a child will be affected).

The autosomal recessive defective gene is inherited from both parents with an overall incidence of 1:4 (25% chance a child will be affected). The defective gene is not sex linked; therefore CF can occur in any sex.

Question 20

Lisa tells the RN that she would like to play soccer “like her friends.” The RN’s recommendation should be based on knowledge that physical exercise is:

A. important because it encourages effective breathing.

B. important because it stimulates underactive sweat glands.

C. contraindicated because it causes coughing.

D. contraindicated because it causes forced expiration.

Answer 20

A

Physical exercise is an important adjunct to daily chest physical therapy to maintain pulmonary hygiene. It stimulates mucus secretion and provides a sense of well-being and increased self-esteem in the child.

Question 21

Lisa’s father calls the clinic and tells the RN that Lisa “must be very sick.” Her sx’s include tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The RN should recognize that this is:

A. suggestive of pneumothorax.

B. suggestive of bronchospasms.

C. terminal stage of the disease.

D. normal progression of the disease.

Answer 21

A

Pneumothorax is often caused by rupture of sub-pleural blebs through the visceral pleura and usually causes nonspecific sxs, which include tachypnea, tachycardia, dyspnea, pallor, and cyanosis.

Question 22

Symptoms of bronchospasm usually include?

Answer 22

dyspnea, wheezing, and pallor

Question 23

Supplementation of vitamins A, D, E, & K are important for people with CF because:

A. pancreatic enzymes are administered with meals.

B. children with CF cannot receive a well-balanced diet.

C. uptake of fat-soluble vitamins is decreased in CF.

D. excretion of water-soluble vitamins is increased in CF.

Answer 23

C

The uptake of fat-soluble vitamins is decreased because of pancreatic insufficiency.

Question 24

Ms. Drew is admitted to the hospital to prevent the spread of mono. Which of the following precautions should be taken by the nurses caring for her?

A. Respiratory isolation

B. Enteric isolation

C. Strict isolation

D. Good hand-washing techniques only

Answer 24

D

Question 25

Tommy is 5 years old and is hospitalized for a tonsillectomy and adenoidectomy.

In completing a nursing care plan for Tommy, which of the following interventions would be inappropriate to include?

A. Applying an ice collar

B. Administering acetaminophen elixir

C. Offering cool liquids as tolerated

D. Suctioning the posterior pharynx

Answer 25

D

Suction equipment should be available in the event a hemorrhage occurs. However, the posterior pharynx should NOT be suctioned due to the potential trauma to the operative site.

An ice collar may provide relief of pain from the soreness in the throat after surgery (although many children find it bothersome and prefer not to have it).

Most children experience moderate pain after a tonsillectomy and should receive pain medication for at least the first 24 hours.

When the child is alert with no signs of hemorrhage, cool water and crushed ice are given, progressing to clear liquids as tolerated (avoiding fluids with a red or brown color to distinguish fresh or old blood in emesis from the ingested liquid).

Question 26

Nursing considerations r/t the admin of O2 in an infant include which of the following?

A. Discontinue during feedings so child can be held.

B. Assess infant to determine how much oxygen should be given.

C. Ensure uninterrupted delivery of the appropriate oxygen concentration.

D. Direct oxygen flow so that it blows directly into the infant’s face in a hood.

Answer 26

C

Question 27

The RN is teaching a mother how to perform CPT and postural drainage on her 3 y/o child, who has CF. To perform percussion, the RN should instruct her to:

A. strike the chest wall with a flat-hand position.

B. percuss before and after positioning for postural drainage.

C. percuss over the entire trunk anteriorly and posteriorly.

D. cover the skin with a shirt or gown before percussing.

Answer 27

D

The child should wear a light shirt to protect the skin from the percussion.

The hand is cupped when the child’s chest wall is struck.

Percussion is done after the position change.

There are identified positions and sequence for postural drainage.

Question 28

Which of the following situations places infants at risk for developing vitamin D–deficiency rickets?

A. Exclusively formula fed

B. Exposure to daily sunlight

C. Mothers who are lacto-ovovegetarians

D. Families using yogurt as primary source of milk

Answer 28

D

Yogurt does not contain adequate amounts of vitamins A and D.

Question 29

Deficiency of which of the following vitamins correlates with increased morbidity and mortality in children with measles and increased complications from diarrhea and infections?

A. Vitamin A

B. Vitamin C

C. Niacin

D. Folic acid

Answer 29

A

Vitamin A deficiency contributes to increased morbidity in measles, diarrhea, and infections. The American Academy of Pediatrics recommends supplementation be considered in children with measles and related disorders.

Question 30

Which of the following foods should the nurse recommend as a good source of potassium for a child receiving diuretics?

A. Grains

B. Grains and legumes

C. Dairy products

D. Dark green vegetables

Answer 30

B

One combination of foods that provides the appropriate amounts of essential amino acids is grains (cereal, rice, pasta) and legumes (beans, peas, lentils, peanuts).

Question 31

Although infants may be allergic to a variety of foods, the most common allergens are:

A. fruit, eggs, and rice.

B. fruit, vegetables, and wheat.

C. Eggs, cow’s milk, and peanuts.

D. cow’s milk and green vegetables.

Answer 31

C

Milk products, eggs, and peanuts are three of the most common food allergens. Ingestion of these products can cause sensitization and, with subsequent exposure, an allergic reaction.

Question 32

Parent guidelines for relieving colic in an infant include which of the following?

A. Avoid using a pacifier.

B. Avoid touching abdomen.

C. Change infant’s position frequently.

D. Place infant where family cannot hear the crying.

Answer 32

C

Changing the infant’s position frequently may be beneficial. The parent can walk holding the child face down and with the child’s abdomen across the parent’s arm. The parent’s hand can support the child’s abdomen, applying gentle pressure.

Question 33

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it:

A. liquefies secretions.

B. improves oxygenation.

C. promotes less labored ventilation.

D. Soothes inflamed mucous membranes.

Answer 33

D

Warm or cold mist is useful to soothe the inflamed mucous membranes. Humidification is most useful when hoarseness or laryngeal involvement occurs.

Normal saline nose drops should be used to liquefy secretions. The mist particles do not penetrate in sufficient amounts to accomplish this.

Question 34

What is an 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 child wear heavy clothing to prevent chilling.

D. Give small amounts of favorite fluids frequently to prevent dehydration.

Answer 34

D

Preventing dehydration by small, frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting.

Question 35

When planning care for a 4-mo-old child admitted with respiratory distress caused by RSV and bronchiolitis, it is essential to include which of the following?

A. Give antibiotics.

B. Ensure adequate hydration.

C. Administer cough syrup.

D. Feed 4 oz of formula every 4 hours.

Answer 35

B

When respiratory distress is present, hydration is an essential consideration. Usually infants cannot take fluids by the oral route b/c of the difficulty breathing. IVF’s may be necessary. RSV is a virus. Antibiotics are not beneficial. Although fluid and calories are important, the infant with respiratory distress is usually unable to drink this amount of fluid.

Question 36

Which statement accurately expresses the genetic implications of CF?

A. It is inherited as an autosomal dominant trait.

B. It is a genetic defect found primarily in non-Caucasian population groups.

C. If it is present in a child, both parents are carriers of this defective gene.

D. There is a 50% chance that siblings of an affected child will also be affected.

Answer 36

C

CF is an autosomal recessive gene inherited from both parents. CF is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected, but a 50% chance a sibling will be a carrier.

Question 37

In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind?

A. Fats and proteins must be greatly curtailed.

B. Diet should be high in calories and protein.

C. Most fruits and vegetables are not well tolerated.

D. Diet should be high in easily digested carbohydrates and fats.

Answer 37

B

Children with CF require a well-balanced, high-protein, high-calorie diet b/c of impaired intestinal absorption. Fats and proteins are a necessary part of a well-balanced diet. A well-balanced diet containing fruits and vegetables is important. Enzyme supplementation helps digest foods; other modifications are not necessary.

Question 38

Bacterial or viral infection that puts person at risk for serious sequelae (AGN, acute rheumatic fever, Scarlet fever ), and may cause skin manifestations (impetigo, pyoderma)?

Answer 38

Acute Streptococcal Pharyngitis

Question 39

A child with acute streptococcal pharyngitis develops an erythematous sandpaper like rash. The RN knows this is a characteristic symptom indicative of what complication?

Answer 39

Scarlet fever

Question 40

What other complications/disease can strep pharyngitis cause?

Answer 40

rheumatic fever

glomerulonephritis

scarlet fever

Question 41

After the onset of GABHS, when would you suspect the following complications to occur if they happened to:

1. AGN
2. Rheumatic fever

Answer 41

1. ) 10 days
2. ) 18 days

Question 42

Why is it so important not to administer PCN-G procaine/benzathine by IV SUSP? How should they be administered?

Answer 42

Can cause PE or toxic reaction with death in minutes!!

Administer deep into large muscle (vastus lateralis/ventrogluteal)

Question 43

When can a child who has a streptococcal infection return to school?

Answer 43

24 hours After antibiotics are initiated