Deck 28: The Child with Respiratory Dysfunction

Question 1

The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C (98.6° F). The nurse suspects mild croup and should recommend which intervention?

A) Admit to the hospital and observe for impending epiglottitis.
B) Provide fluids that the child likes and use comfort measures.
C) Control fever with acetaminophen and call if cough gets worse tonight.
D) Try over-the-counter cough medicine and come to the clinic tomorrow if no improvement.

Answer 1

Provide fluids that the child likes and use comfort measures.

Question 2

What statement best represents infectious mononucleosis?

A) Herpes simplex type 2 is the principal cause.
B) A complete blood count shows a characteristic leukopenia.
C) A short course of ampicillin is used when pharyngitis is present.
D) Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.

Answer 2

Clinical signs and symptoms and blood tests are both needed to establish the diagnosis.

Question 3

A 4-year-old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should intervene in which manner?

A) Make her lie down and rest quietly.
B) Examine her oral pharynx and report to the physician.
C) Auscultate her lungs and prepare for placement in a mist tent.
D) Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

Answer 3

Notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

Question 4

The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What intervention is essential in this child's care?

A) Monitor pulse oximetry.
B) Monitor arterial blood gases.
C) Administer oxygen if respiratory distress develops.
D) Administer oxygen if child's lips become bright, cherry-red in color.

Question 5

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires what type of isolation?

A) Reverse isolation
B) Airborne isolation
C) Contact Precautions
D) Standard Precautions

Question 6

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What nursing action should be included in the care of the child?

A) Force fluids.
B) Monitor pulse oximetry.
C) Institute seizure precautions.
D) Encourage a high-protein diet.

Question 7

An infant has been diagnosed with staphylococcal pneumonia. Nursing care of the child with pneumonia includes which intervention?

A) Administration of antibiotics
B) Frequent complete assessment of the infant
C) Round-the-clock administration of antitussive agents
D) Strict monitoring of intake and output to avoid congestive heart failure

Question 8

A toddler has a unilateral foul-smelling nasal discharge and frequent sneezing. The nurse should suspect what condition?

A) Allergies
B) Acute pharyngitis
C) Foreign body in the nose
D) Acute nasopharyngitis

Question 9

Why are cool-mist vaporizers rather than steam vaporizers recommended in the home treatment of respiratory infections?

A) They are safer.
B) They are less expensive.
C) Respiratory secretions are dried by steam vaporizers.
D) A more comfortable environment is produced.

Question 10

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent which condition?

A) Otitis media
B) Diabetes insipidus (DI)
C) Nephrotic syndrome
D) Acute rheumatic fever

Question 11

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant shows signs or symptoms of which condition?

A) Has a cough
B) Becomes fussy
C) Shows signs of an earache
D) Has a fever higher than 37.5° C (99° F)

Question 12

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. What is the primary rationale for this action?

A) Mothers of hospitalized toddlers often experience guilt.
B) The mother's presence will reduce anxiety and ease the child's 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.

Question 13

The nurse is assessing a child with croup in the emergency department. The child has a sore throat and is drooling. Examining the child's throat using a tongue depressor might precipitate what condition?

A) Sore throat
B) Inspiratory stridor
C) Complete obstruction
D) Respiratory tract infection

Question 14

Chronic otitis media with effusion (OME) differs from acute otitis media (AOM) because it is usually characterized by which signs or symptoms?

A) Severe pain in the ear
B) Anorexia and vomiting
C) A feeling of fullness in the ear
D) Fever as high as 40° C (104° F)

Question 15

When caring for a child after a tonsillectomy, what intervention should the nurse do?

A) Watch for continuous swallowing.
B) Encourage gargling to reduce discomfort.
C) Apply warm compresses to the throat.
D) Position the child on the back for sleeping.

Question 16

What consideration is most important in managing tuberculosis (TB) in children?

A) Skin testing
B) Chemotherapy
C) Adequate rest
D) Adequate hydration

Question 17

An 18-month-old child is seen in the clinic with otitis media (OM). Oral amoxicillin is prescribed. What instructions should be given to the parent?

A) Administer all of the prescribed medication.
B) Continue medication until all symptoms subside.
C) Immediately stop giving medication if hearing loss develops.
D) Stop giving medication and come to the clinic if fever is still present in 24 hours.

Question 18

Parents bring their 15-month-old infant to the emergency department at 3:00 AM because the toddler has a temperature of 39° C (102.2° F), is crying inconsolably, and is tugging at the ears. A diagnosis of otitis media (OM) is made. In addition to antibiotic therapy, the nurse practitioner should instruct the parents to use what medication?

A) Decongestants to ease stuffy nose
B) Antihistamines to help the child sleep
C) Aspirin for pain and fever management
D) Benzocaine ear drops for topical pain relief

Question 19

An infant's parents ask the nurse about preventing otitis media (OM). What information should be provided?

A) Avoid tobacco smoke.
B) Use nasal decongestants.
C) Avoid children with OM.
D) Bottle- or breastfeed in a supine position.

Question 20

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which information?

A) Do not use for more than 3 days.
B) Keep drops to use again for nasal congestion.
C) Administer drops after feedings and at bedtime.
D) Give two drops every 5 minutes until nasal congestion subsides.

Question 21

A child is admitted with acute laryngotracheobronchitis (LTB). The child will most likely be treated with which?

A) Racemic epinephrine and corticosteroids
B) Nebulizer treatments and oxygen
C) Antibiotics and albuterol
D) Chest physiotherapy and humidity

Question 22

A 1-year-old child has acute otitis media (AOM) and is being treated with oral antibiotics. What should the nurse include in the discharge teaching to the infant's parents?

A) A follow-up visit should be done after all medicine has been given.
B) After an episode of acute otitis media, hearing loss usually occurs.
C) Tylenol should not be given because it may mask symptoms.
D) The infant will probably need a myringotomy procedure and tubes.

Question 23

A 3-year-old child is experiencing pain after a tonsillectomy. The child has not taken in any fluids and does not want to drink anything, saying, "My tummy hurts." The following health care prescriptions are available: acetaminophen (Tylenol) PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nurse implement to relieve the child's pain?

A) Ice chips
B) Tylenol PO
C) Tylenol PR
D) Popsicle

Question 24

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

A) Ephedrine
B) Theophylline
C) Aminophylline
D) Short-acting b2-agonists

Question 25

Cystic fibrosis (CF) may affect single or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations in CF?

A) Hyperactivity of sweat glands
B) Hypoactivity of autonomic nervous system
C) Atrophic changes in mucosal wall of intestines
D) Mechanical obstruction caused by increased viscosity of mucous gland secretions

Question 26

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered?

A) After chest physiotherapy (CPT)
B) Before chest physiotherapy (CPT)
C) After receiving 100% oxygen
D) Before receiving 100% oxygen

Question 27

The nurse is giving discharge instructions to the parents of a 5-year-old child who had a tonsillectomy 4 hours ago. What statement by the parent indicates a correct understanding of the teaching?

A) "I can use an ice collar on my child for pain control along with analgesics."
B) "My child should clear the throat frequently to clear the secretions."
C) "I should allow my child to be as active as tolerated."
D) "My child should gargle and brush teeth at least three times per day."

Question 28

What condition is the leading cause of chronic illness in children?

A) Asthma
B) Pertussis
C) Tuberculosis
D) Cystic fibrosis

Question 29

The parent of a child with cystic fibrosis (CF) calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these signs and symptoms are suggestive of what condition?

A) Pneumothorax
B) Bronchodilation
C) Carbon dioxide retention
D) Increased viscosity of sputum

Question 30

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

Question 31

What diagnostic test for allergies involves the injection of specific allergens?

A) Phadiatop
B) Skin testing
C) Radioallergosorbent tests (RAST)
D) Blood examination for total immunoglobulin E (IgE)

Question 32

What tests aid in the diagnosis of cystic fibrosis (CF)?

A) Sweat test, stool for fat, chest radiography
B) Sweat test, bronchoscopy, duodenal fluid analysis
C) Sweat test, stool for trypsin, biopsy of intestinal mucosa
D) Stool for fat, gastric contents for hydrochloride, radiography

Question 33

A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This suggests what condition?

A) Asthma
B) Pneumonia
C) Bronchiolitis
D) Foreign body in trachea

Question 34

A 6-year-old child has had a tonsillectomy. The child is spitting up small amounts of dark brown blood in the immediate postoperative period. The nurse should take what action?

A) Notify the health care provider.
B) Continue to assess for bleeding.
C) Give the child a red flavored ice pop.
D) Position the child in a Trendelenburg position.

Question 35

A child with asthma is having pulmonary function tests. What rationale explains the purpose of the peak expiratory flow rate?

A) To assess severity of asthma
B) To determine cause of asthma
C) To identify "triggers" of asthma
D) To confirm diagnosis of asthma

Question 36

Pancreatic enzymes are administered to the child with cystic fibrosis. What nursing consideration should be included in the plan of care?

A) Give pancreatic enzymes between meals if at all possible.
B) Do not administer pancreatic enzymes if the child is receiving antibiotics.
C) Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools.
D) Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

Question 37

One of the goals for children with asthma is to maintain the child's normal functioning. What principle of treatment helps to accomplish this goal?

A) Limit participation in sports.
B) Reduce underlying inflammation.
C) Minimize use of pharmacologic agents.
D) Have yearly evaluations by a health care provider.

Question 38

Children who are taking long-term inhaled steroids should be assessed frequently for what potential complication?

A) Cough
B) Osteoporosis
C) Slowed growth
D) Cushing syndrome

Question 39

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (DNase). What statement about DNase is true?

A) Given subcutaneously
B) May cause voice alterations
C) May cause mucus to thicken
D) Not indicated for children younger than age 12 years

Question 40

What statement is the most descriptive of asthma?

A) It is inherited.
B) There is heightened airway reactivity.
C) There is decreased resistance in the airway.
D) The single cause of asthma is an allergic hypersensitivity.

Question 41

A 6-year-old child is in the hospital for status asthmaticus. Nursing care during this acute period includes which prescribed interventions?

A) Prednisolone (Pediapred) PO every day, IV fluids, cromolyn (Intal) inhaler bid
B) Salmeterol (Serevent) PO bid, vital signs every 4 hours, spot check pulse oximetry
C) Triamcinolone (Azmacort) inhaler bid, continuous pulse oximetry, vital signs once a shift
D) Methylprednisolone (Solumedrol) IV every 12 hours, continuous pulse oximetry, albuterol nebulizer treatments every 4 hours and prn

Question 42

A 5-year-old child is admitted with bacterial pneumonia. What signs and symptoms should the nurse expect to assess with this disease process?

A) Fever, cough, and chest pain
B) Stridor, wheezing, and ear infection
C) Nasal discharge, headache, and cough
D) Pharyngitis, intermittent fever, and eye infection

Question 43

A child has a streptococcal throat infection and is being treated with antibiotics. What should the nurse teach the parents to prevent infection of others?

A) The child can return to school immediately.
B) The organism cannot be transmitted through contact.
C) The child can return to school after taking antibiotics for 24 hours.
D) The organism can only be transmitted if someone uses a personal item of the sick child.

Question 44

A 3-year-old child woke up in the middle of the night with a croupy cough and inspiratory stridor. The parents bring the child to the emergency department, but by the time they arrive, the cough is gone, and the stridor has resolved. What can the nurse teach the parents with regard to this type of croup?

A) A bath in tepid water can help resolve this type of croup.
B) Tylenol can help to relieve the cough and stridor.
C) A cool mist vaporizer at the bedside can help prevent this type of croup.
D) Antibiotics need to be given to reduce the inflammation.

Question 45

A school-age child with cystic fibrosis takes four enzyme capsules with meals. The child is having four or five bowel movements per day. The nurse's action in regard to the pancreatic enzymes is based on the knowledge that the dosage is what?

A) Adequate
B) Adequate but should be taken between meals
C) Needs to be increased to increase the number of bowel movements per day
D) Needs to be increased to decrease the number of bowel movements per day

Question 46

A school-age child has asthma. The nurse should teach the child that if a peak expiratory flow rate is in the yellow zone, this means that the asthma control is what?

A) 80% of a personal best, and the routine treatment plan can be followed.
B) 50% to 79% of a personal best and needs an increase in the usual therapy.
C) 50 % of a personal best and needs immediate emergency bronchodilators.
D) Less than 50% of a personal best and needs immediate hospitalization.

Question 47

A 3-month-old infant is admitted to the pediatric unit for treatment of bronchiolitis. The infant's vital signs are T, 101.6° F; P, 106 beats/min apical; and R, 70 breaths/min. The infant is irritable and fussy and coughs frequently. IV fluids are given via a peripheral venipuncture. Fluids by mouth were initially contraindicated for what reason?

A) Tachypnea
B) Paroxysmal cough
C) Irritability
D) Fever

Question 48

The nurse is caring for a newborn with suspected congenital diaphragmatic hernia. What of the following findings would the nurse expect to observe? (Select all that apply.)

A) Loud, harsh murmur
B) Scaphoid abdomen
C) Poor peripheral pulses
D) Mediastinal shift
E) Inguinal swelling
F) Moderate respiratory distress

Question 49

A quantitative sweat chloride test has been done on an 8-month-old child. What value should be indicative of cystic fibrosis (CF)?

A) Less than 18 mEq/L
B) 18 to 40 mEq/L
C) 40 to 60 mEq/L
D) Greater than 60 mEq/L

Question 50

A family requires home care teaching with regard to preventative measures to use at home to avoid an asthmatic episode. What strategy should the nurse teach?

A) Use a humidifier in the child's room.
B) Launder bedding daily in cold water.
C) Replace wood flooring with carpet.
D) Use an indoor air purifier with HEPA filter.

Question 51

A child is in the hospital for cystic fibrosis. What health care provider's prescription should the nurse clarify before implementing?

A) Dornase alfa (Pulmozyme) nebulizer treatment bid
B) Pancreatic enzymes every 6 hours
C) Vitamin A, D, E, and K supplements daily
D) Proventil (albuterol) nebulizer treatments tid

Question 52

The nurse is preparing a staff education program about pediatric asthma. What concepts should the nurse include when discussing the asthma severity classification system? (Select all that apply.)

A) Children with mild persistent asthma have nighttime signs or symptoms less than two times a month.
B) Children with moderate persistent asthma use a short-acting b-agonist more than two times per week.
C) Children with severe persistent asthma have a peak expiratory flow (PEF) of 60% to 80% of predicted value.
D) Children with mild persistent asthma have signs or symptoms more than two times per week.
E) Children with moderate persistent asthma have some limitations with normal activity.
F) Children with severe persistent asthma have frequent nighttime signs or symptoms.

Question 53

A 3-year-old is brought to the emergency department with symptoms of stridor, fever, restlessness, and drooling. No coughing is observed. Based on these findings, the nurse should be prepared to assist with what action?

A) Throat culture
B) Nasal pharynx washing
C) Administration of corticosteroids
D) Emergency intubation

Question 54

In providing nourishment for a child with cystic fibrosis (CF), what factors should the nurse keep in mind?

A) Fats and proteins must be greatly curtailed.
B) Most fruits and vegetables are not well tolerated.
C) Diet should be high in calories, proteins, and unrestricted fats.
D) Diet should be low fat but high in calories and proteins.

Question 55

A term infant is delivered, and before delivery, the medical team was notified that a congenital diaphragmatic hernia (CDH) was diagnosed on ultrasonography. What should be done immediately at birth if respiratory distress is noted?

A) Give oxygen.
B) Suction the infant.
C) Intubate the infant.
D) Ventilate the infant with a bag and mask.

Question 56

What medication is contraindicated in children post tonsillectomy and adenoidectomy?

A) Codeine
B) Amoxil (amoxicillin)
C) Ondansetron (Zofran)
D) Acetaminophen (Tylenol)

Question 57

What do the initial signs of respiratory syncytial virus (RSV) infection in an infant include?

A) Rhinorrhea, wheezing, and fever
B) Tachypnea, cyanosis, and apnea
C) Retractions, fever, and listlessness
D) Poor breath sounds and air hunger

Question 58

The nurse is caring for a 1-month-old infant with respiratory syncytial virus (RSV) who is receiving 23% oxygen via a plastic hood. The child's SaO₂ saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min. Based on these assessments, what action should the nurse take?

A) Withhold feedings.
B) Notify the health care provider.
C) Put the infant in an infant seat.
D) Keep the infant in the plastic hood.

Question 59

A preschool child has asthma, and a goal is to extend expiratory time and increase expiratory effectiveness. What action should the nurse implement to meet this goal?

A) Encourage increased fluid intake.
B) Recommend increased use of a budesonide (Pulmicort) inhaler.
C) Administer an antitussive to suppress coughing.
D) Encourage the child to blow a pinwheel every 6 hours while awake.

Question 60

An infant with a congenital heart defect is to receive a dose of palivizumab (Synagis). What is the purpose of this?

A) Prevent RSV infection.
B) Prevent secondary bacterial infection.
C) Decrease toxicity of antiviral agents.
D) Make isolation of infant with RSV unnecessary.

Question 61

The nurse is interpreting a tuberculin skin test. If the nurse finds a result of an induration 5 mm or larger, in which child should the nurse document this finding as positive? (Select all that apply.)

A) A child with diabetes mellitus
B) A child younger than 4 years of age
C) A child receiving immunosuppressive therapy
D) A child with a human immunodeficiency virus (HIV) infection
E) A child living in close contact with a known contagious case of tuberculosis

Question 62

The nurse is calculating the amount of expected urinary output for a 24-hour period on a child with laryngotracheobronchitis who weighs 33 lb. The nurse recognizes the formula to be used is 1 ml/kg/hr. What is the expected 24-hour urinary output for this child in milliliters? Record your answer below in a whole number.
_____________

Question 63

The nurse is calculating the amount of expected urinary output for a 24-hour period on a child with bacterial pneumonia who weighs 22 lb. The nurse recognizes the formula to be used is 1 ml/kg/hr. What is the expected 24-hour urinary output for this child in milliliters? Record your answer below in a whole number.
_____________

Question 64

A child is diagnosed with active pulmonary tuberculosis. What medications does the nurse anticipate to be prescribed for the first 2 months? (Select all that apply.)

A) Isoniazid (INH)
B) Cefuroxime (Ceftin)
C) Rifampin (Rifadin)
D) Pyrazinamide (PZA)
E) Ethambutol (Myambutol)

Question 65

The clinic nurse is administering influenza vaccinations. Which children should not receive the live attenuated influenza vaccine (LAIV)? (Select all that apply.)

A) A child with asthma
B) A child with diabetes
C) A child with hemophilia A
D) A child with cancer receiving chemotherapy
E) A child with gastroesophageal reflux disease

Question 66

What interventions can the nurse teach parents to do to ease respiratory efforts for a child with a mild respiratory tract infection? (Select all that apply.)

A) Cool mist
B) Warm mist
C) Steam vaporizer
D) Keep child in a flat, quiet position
E) Run a shower of hot water to produce steam

Question 67

A tonsillectomy or adenoidectomy is contraindicated in what conditions? (Select all that apply.)

A) Cleft palate
B) Seizure disorders
C) Blood dyscrasias
D) Sickle cell disease
E) Acute infection at the time of surgery

Question 68

The nurse is preparing to admit a 7-year-old child with pulmonary edema. What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Fever
B) Bradycardia
C) Diaphoresis
D) Pink frothy sputum
E) Respiratory crackles

Question 69

The health care provider prescribes vancomycin 200 mg per intravenous piggy back (IVPB) every 6 hours for a child with cystic fibrosis. The pharmacy sends the medication to the unit in a 150-ml bag with directions to run the medication over 120 minutes. What milliliters per hour will the nurse set the intravenous pump to run the medication over 120 minutes? Fill in the blank and record your answer in a whole number.
_____________

Question 70

The health care provider prescribes ceftazidime (Fortaz) 75 mg per intravenous piggy back (IVPB) every 8 hours for a child with cystic fibrosis. The pharmacy sends the medication to the unit in a 100-ml bag with directions to run the medication over 30 minutes. What milliliters per hour will the nurse set the intravenous pump to run the medication over 30 minutes? Fill in the blank and record your answer in a whole number.
_____________

Question 71

The nurse is preparing to admit a 3-year-old child with acute spasmodic laryngitis. What clinical features of hepatitis B should the nurse recognize? (Select all that apply.)

A) High fever
B) Croupy cough
C) Tendency to recur
D) Purulent secretions
E) Occurs sudden, often at night

Question 72

The nurse is preparing to admit a 7-year-old child with acute laryngotracheobronchitis (LTB). What clinical manifestations should the nurse expect to observe? (Select all that apply.)

A) Dysphagia
B) Brassy cough
C) Low-grade fever
D) Toxic appearance
E) Slowly progressive