San Jacinto College - RNSG 2201

Chapter 21: The Child with Respiratory Dysfunction

Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older?

1. 1. The amount of lymphoid tissue decreases.
   2. Repeated exposure to organisms causes increased immunity.
   3. Viral organisms are less prevalent in the population.
   4. Secondary infections rarely occur after viral illnesses.

2. A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing?

1. 1. Dyspnea
   2. Tachypnea
   3. Hypopnea
   4. Orthopnea

3. Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections?
   1. They are safer.
   2. They are less expensive.
   3. Respiratory secretions are dried.
   4. A more comfortable environment is produced.

4. Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action?
   1. Avoid using for more than 3 days.
   2. Keep drops to use again for nasal congestion.
   3. Administer drops until nasal congestion subsides.
   4. Administer drops after feedings and at bedtime.

5. Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature?
   1. Give tepid water baths to reduce fever.
   2. Encourage food intake to maintain caloric needs.
   3. Have child wear heavy clothing to prevent chilling.
   4. Give small amounts of favorite fluid frequently to prevent dehydration.

6. The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation?
   1. Fussiness
   2. Coughing
   3. A fever over 99° F
   4. Signs of an earache

7. When is it generally recommended that a child with acute streptococcal pharyngitis may return to school?
   1. When sore throat is better.
   2. If no complications develop.
   3. After taking antibiotics for 24 hours.
   4. After taking antibiotics for 3 days.

8. A child is diagnosed with influenza. Management includes which recommendation?
   1. Clear liquid diet for hydration
   2. Aspirin to control fever
   3. Oseltamivie (Tamiflu)
   4. Antibiotics to prevent bacterial infection

9. How is chronic otitis media with effusion (OME) differentiated from acute otitis media (AOM)?
   1. A fever as high as 40° C (104° F)
   2. Severe pain in the ear
   3. Nausea and vomiting
   4. A feeling of fullness in the ear

10. Parents have understood teaching about prevention of childhood otitis media if they make which statement?
    1. “We will only prop the bottle during the daytime feedings.”
    2. “Breastfeeding will be discontinued after 4 months of age.”
    3. “We will place the child flat right after feedings.”
    4. “We will be sure to keep immunizations up to date.”

11. An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions?
    1. “I should administer all the prescribed medication.”
    2. “I should continue medication until the symptoms subside.”
    3. “I will immediately stop giving medication if I notice a change in hearing.”
    4. “I will stop giving medication if fever is still present in 24 hours.”

12. An infant’s parents ask the nurse about preventing OM. Which should be recommended?
    1. Avoid tobacco smoke.
    2. Use nasal decongestant.
    3. Avoid children with OM.
    4. Bottle-feed or breastfeed in a supine position.

13. The nurse is assessing a child with acute epiglottitis. Examining the child’s throat by using a tongue depressor might precipitate which symptom or condition?
    1. Inspiratory stridor
    2. Complete obstruction
    3. Sore throat
    4. Respiratory tract infection

14. Which type of croup is always considered a medical emergency?
    1. Laryngitis
    2. Epiglottitis
    3. Spasmodic croup
    4. Laryngotracheobronchitis (LTB)

15. The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse’s rationale for this action is described primarily in which statement?
    1. Mothers of hospitalized toddlers often experience guilt.
    2. The mother’s presence will reduce anxiety and ease the child’s respiratory efforts.
    3. Separation from the mother is a major developmental threat at this age.
    4. The mother can provide constant observations of the child’s respiratory efforts.

16. 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. This is most suggestive of which diagnosis?
    1. Bronchitis
    2. Bronchiolitis
    3. Viral-induced asthma
    4. Acute spasmodic laryngitis

17. Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test?
    1. Every year for all children older than 2 years
    2. Every year for all children older than 10 years
    3. Every 2 years for all children starting at age 1 year
    4. Periodically for children who reside in high-prevalence regions

18. Which consideration is the most important in managing tuberculosis (TB) in children?
    1. Skin testing annually
    2. Pharmacotherapy
    3. Adequate nutrition
    4. Adequate hydration

19. 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 symptom?
    1. Gagging
    2. Coughing
    3. Pulse over 100 beats/min
    4. Inability to speak

20. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What is the priority nursing intervention?
    1. Forcing fluids
    2. Monitoring pulse oximetry
    3. Instituting seizure precautions
    4. Encouraging a high-protein diet

21. The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which is essential in this child’s care?
    1. Monitor pulse oximetry.
    2. Monitor arterial blood gases.
    3. Administer oxygen if respiratory distress develops.
    4. Administer oxygen if child’s lips become bright, cherry red.

22. A nurse is admitting an infant with asthma. What usually triggers asthma in infants?

1. 1. Medications
   2. A viral infection
   3. Exposure to cold air
   4. Allergy to dust or dust mites

23. A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma?
    1. There is heightened airway reactivity.
    2. There is decreased resistance in the airway.
    3. The single cause of asthma is an allergic hypersensitivity.
    4. It is inherited.

24. A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis?
    1. Nonproductive cough, wheezing
    2. Fever, general malaise
    3. Productive cough, rales
    4. Stridor, substernal retractions

25. It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop?
    1. Cough
    2. Osteoporosis
    3. Slowed growth
    4. Cushing syndrome

26. -Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. Which describes their action?
    1. Liquefy secretions
    2. Dilate the bronchioles
    3. Reduce inflammation of the lungs
    4. Reduce infection

27. Parents of two school-age children with asthma ask the nurse, “What sports can our children participate in?” The nurse should recommend which sport?
    1. Soccer
    2. Running
    3. Swimming
    4. Basketball

28. Which drug is usually given first in the emergency treatment of an acute, severe asthma episode in a young child?

1. 1. Ephedrine
   2. Theophylline
   3. Aminophylline
   4. Short-acting 2 agonists

29. Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications?
    1. If it is present in a child, both parents are carriers of this defective gene.
    2. It is inherited as an autosomal dominant trait.
    3. It is a genetic defect found primarily in non-Caucasian population groups.
    4. There is a 50% chance that siblings of an affected child also will be affected.

30. A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF?
    1. Meconium ileus
    2. History of poor intestinal absorption
    3. Foul-smelling, frothy, greasy stools
    4. Recurrent pneumonia and lung infections

31. A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect?
    1. Sweat chloride test, stool for fat, chest radiograph films

1. 2. Stool test for fat, gastric contents for hydrochloride, chest radiograph films
   3. Sweat chloride test, bronchoscopy, duodenal fluid analysis
   4. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

32. Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis?
    1. Bronchoscopy
    2. Serum calcium
    3. Urine creatinine
    4. Sweat chloride test

33. A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?
    1. Before chest physiotherapy (CPT)
    2. After CPT
    3. Before receiving 100% oxygen
    4. After receiving 100% oxygen

34. A child with cystic fibrosis (CF) is receiving recombinant human deoxyribonuclease (DNase). Which is an adverse effect of this medication?
    1. Mucus thickens
    2. Voice alters

1. 3. Tachycardia
   4. Jitteriness

35. Pancreatic enzymes are administered to the child with cystic fibrosis (CF). What nursing considerations should be included?
    1. Do not administer pancreatic enzymes if the child is receiving antibiotics.
    2. Decrease dose of pancreatic enzymes if the child is having frequent, bulky stools.
    3. Administer pancreatic enzymes between meals if at all possible.
    4. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

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

37. Cardiopulmonary resuscitation (CPR) is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible?
    1. Radial
    2. Carotid
    3. Femoral

1. 4. Brachial

38. Which drug is considered the most useful in treating childhood cardiac arrest?
    1. Bretylium tosylate (Bretylium)
    2. Lidocaine hydrochloride (Lidocaine)
    3. Epinephrine hydrochloride (Adrenaline)
    4. Naloxone (Narcan)

39. Effective lone-rescuer CPR on a 5N-yUeRaSrI-NoGldTcBh.CilOdMshould include
    1. two breaths to every 30 chest compressions.
    2. two breaths to every 15 chest compressions.
    3. reassessment of the child after 50 cycles of compression and ventilation.
    4. reassessment of the child every 10 minutes that CPR continues.

40. The Heimlich maneuver is recommended for airway obstruction in children older than           year(s).
    1. 1
    2. 4
    3. 8
    4. 12

41. A nurse is caring for a child in acute respiratory failure. Which blood gas analysis indicates the child is still in respiratory acidosis?

a.   pH 7.50, CO2 48

b.   pH 7.30, CO2 30

c.   pH 7.32, CO2 50

d.   pH 7.48, CO2 33

42. A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made?
    1. “I will record the average of the readings.”
    2. “I should be sitting comfortably when I performe the readings.”
    3. “I will record the readings at the same time every day.”
    4. “I will repeat the routine two times.”

43. A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child’s pulse oximetry status?
    1. Continuous
    2. Every 30 minutes
    3. Every hour
    4. Every 2 hours

44. A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test?
    1. 5 mm
    2. 10 mm
    3. 15 mm
    4. 20 mm

45. Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate?
    1. Level of parents’ education
    2. Presence of two parents in the home
    3. Preparation and training of family
    4. Family’s ability to assume all health care costs

MULTIPLE RESPONSE

1. An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions?
   1. Cluster care to conserve energy
   2. Round-the-clock administration of antitussive agents
   3. Strict intake and output to avoid congestive heart failure
   4. Administration of antibiotics

2. The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child’s care?

1. 1. Place in a mist tent.
   2. Administer antibiotics.
   3. Administer cough syrup.

1. 4. Encourage the child to drink 8 ounces of formula every 4 hours.
   5. Cluster care to encourage adequate rest.
   6. Place on noninvasive oxygen monitoring.

3. The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child’s postoperative care plan?
   1. Notify the surgeon if the child swallows frequently.
   2. Apply a heat collar to the child for pain relief.
   3. Place the child on the abdomen until fully wake.
   4. Allow the child to have diluted juice after the procedure.

1. 5. Encourage the child to cough frequently.

4. A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child?
   1. Positioning child on the right side
   2. Assessing the chest tube and drainage device for correct settings
   3. Administering prescribed doses of analgesia
   4. Clamping the chest tube when child ambulates
   5. Monitoring for need of supplemental oxygen

SHORT ANSWER

1. A nurse is interpreting the results of a child’s peak expiratory flow rate. Which percentage, either at this number or less than this number, is considered to be a red zone? (Record your answer in a whole number.)

OTHER

1. The nurse enters a room and finds a 6-year-old child who is unconscious. After calling for help and before being able to use an automatic external defibrillator, which steps should the nurse take? Place in correct order. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e, f).

1. 1. Place on a hard surface.
   2. Administer 30 chest compressions with two breaths.
   3. Feel carotid pulse while maintaining head tilt with the other hand.
   4. Use the head tilt–chin lift maneuver and check for breathing.
   5. Place heel of one hand on lower half of sternum with other hand on top.
   6. Give two rescue breaths.