Deck 23: Caring for the Child With a Respiratory Condition

Question 1

A father brings his 1-year-old son to the clinic and states that when he kisses the child's cheek,it tastes salty.Which diagnostic test does the nurse educate the father on based on the father's statement?

A) Large bowel barium series
B) Pancreatic enzyme analysis
C) Pulmonary function studies
D) Quantitative sweat chloride test

Answer 1

Quantitative sweat chloride test

Question 2

A nurse working in a pediatric clinic is collecting data on children as part of a research study.What action by the nurse is most appropriate?

A) Do not inform children or parents of the data collection.
B) Obtain parental consent only for all children enrolled.
C) Obtain written assent from children 12 and older.
D) Only inform the parents of the research study and methods.

Answer 2

Obtain written assent from children 12 and older.

Question 3

A nurse is caring for an infant diagnosed with esophageal atresia (EA)and a tracheoesophageal fistula (TEF)prior to surgical correction.Which assessment finding indicates that a priority goal is being met?

A) Airway patent with frequent suction
B) Gavage feedings tolerated well
C) Identification of support system by parents
D) Temperature within normal range

Answer 3

Airway patent with frequent suction

Question 4

A nurse is caring for a child who has a chest tube.After ambulating and returning the child to bed,the nurse notes that the child has dyspnea and decreasing oxygen saturation readings.Which nursing action is the priority?

A) Assess the tubing for kinks.
B) Call the rapid response team.
C) Facilitate a portable chest x-ray.
D) Provide bag-valve-mask breathing.

Question 5

The mother of a 5-year-old child calls the clinic to ask if her child has a mild respiratory infection or needs to be seen.Which question by the nurse would elicit the most helpful information?

A) "Can your child swallow without pain?"
B) "Does the child have a sore throat?"
C) "Is your child coughing occasionally?"
D) "Was the onset gradual or sudden?"

Question 6

The nursing student studying respiratory anatomy and physiology learns that which tissue or organ grows faster than any other tissue or organ in a child?

A) Diaphragm
B) Epiglottis
C) Lungs
D) Tonsils

Question 7

A pediatric clinic nurse teaches parents how to care for their toddler who has nasal congestion.What anatomical difference between children and adults is a concern with congestion in children?

A) Children this age should not have congestion.
B) Larger tonsils trap mucus, leading to gagging.
C) The narrow trachea can become obstructed easily.
D) Phlegm can migrate into the eustachian tubes.

Question 8

Which statement by the nursing student indicates a correct understanding of the anatomy and physiology of the respiratory system?

A) Air passes through the trachea into the bronchus.
B) Oxygen exchange with the bloodstream occurs in the veins.
C) Oxygen passes from the larynx to the pharynx.
D) The bronchus divides into smaller branches or acini.

Question 9

The parents of a child diagnosed with cystic fibrosis (CF)consult the nurse,stating they want to have more children but are worried about subsequent children also having the disease.Which information does the nurse provide the parents?

A) "Each child has a 25% chance of inheriting the disease."
B) "This disease is rare, so other children should not be affected."
C) "Unfortunately, there is no way to predict if they will have it."
D) "You should have genetic testing to see who the carrier is."

Question 10

The pediatric nurse explains to the parents of a 1-year-old patient with pneumonia that the differences between the adult's and child's respiratory system affect function and subsequent respiratory conditions.Which difference does the nurse include in the discussion with the patient's parents?

A) Infants are obligate nose breathers until 6 months of age.
B) The epiglottis in the child under 8 is shorter and more rigid.
C) The larynx and the glottis are higher in the younger child's neck.
D) In the child, there are more functional muscles in the neck and less soft tissue.

Question 11

A 5-year-old child is brought into the clinic by a parent,who reports the child has a "sore throat." Which assessment finding would require immediate notification to the health-care provider?

A) Difficulty swallowing
B) Inflamed, red pharynx
C) Refusing to eat the last 2 days
D) Strawberry-colored tongue

Question 12

A 4-year-old girl is brought to the emergency department.She has a "frog-like" croaking sound on inspiration,is agitated,and is drooling.She insists on sitting upright.Which nursing action is the priority for this patient?

A) Maintain the airway.
B) Obtain a throat culture.
C) Start an intravenous line.
D) Transport for a chest x-ray.

Question 13

The nurse is caring for a child with bronchopulmonary dysplasia receiving furosemide (Lasix).Which finding would lead the nurse to conclude the child has a side effect of this drug?

A) Acidosis
B) Hypercarbia
C) Hypokalemia
D) Thrombocytopenia

Question 14

A diabetic mother delivers an infant at 36 weeks' gestation who has Apgar scores of 5 and 6,has central cyanosis,and has a respiratory rate of 66 breaths/minute.What medication does the nurse anticipate the child will receive?

A) Albuterol (Ventolin)
B) Caffeine (Cafergot)
C) Epinephrine (Adrenalin)
D) Surfactant (Surfaxin)

Question 15

A nurse is educating the parents of a 5-year-old with bacterial otitis media.Which discharge instruction is most important?

A) "Bring her back if she is not better in 1 week."
B) "Do not allow your child to swim in the future."
C) "Give the full course of antibiotics even if she is better."
D) "Ice packs are a good way to manage her ear pain."

Question 16

A nurse is teaching the parents of a 10-year-old child diagnosed with cystic fibrosis.Which instruction by the nurse is most appropriate?

A) "For Pseudomonas infections, we can use penicillin antibiotics."
B) "Preventing respiratory infections is crucial for quality of life."
C) "Unfortunately, your child is sterile and unable to have children."
D) "With pancreatic enzymes, vitamin replacement is not needed."

Question 17

The nurse suspects a pediatric patient is experiencing acute respiratory distress syndrome (ARDS).What laboratory finding correlates to this condition?

A) HCO₃ of 22 mEq/L
B) PCO₂ of 88 mm Hg
C) pH of 7.34
D) PO₂ of 60 mm Hg

Question 18

A school-age child has asthma and lives in a home where both parents smoke.The nurse has provided extensive education to the parents on the dangers of second-hand smoke.Which assessment by the nurse indicates that goals for a family nursing diagnosis have been met?

A) Child's clothing no longer smells of cigarette smoke
B) Father states he has quit smoking; mother has cut down
C) Parents state they smoke only in the basement now
D) Significant decrease in asthma "attacks" over a year

Question 19

The pediatric nurse examines a neonate and documents that the baby is pink in color when crying but turns bluish when quiet.Which question would be most appropriate to ask the parent?

A) "Does the baby have trouble when eating?"
B) "Have your other children had this problem?"
C) "How many respiratory infections has she had?"
D) "You don't ever prop her bottle, do you?"

Question 20

The mother of a 5-year-old girl describes her daughter's symptoms to the nurse in the emergency room.She states that her daughter has had "a dry,hacking cough for the past 3 days that gets worse during the night." She further states that "now she is coughing up phlegm." Which discharge instruction does the nurse plan to provide?

A) "Do not be surprised if she vomits her secretions."
B) "Give your child cough drops as often as needed."
C) "Return if she is not better after 3 days of antibiotics."
D) "You can use a warm-mist humidifier in her room."

Question 21

An infant is being discharged from the hospital after treatment for respiratory syncytial virus (RSV).The infant still has some mild respiratory distress at times.Which discharge instruction is the priority for this infant?

A) "Bring the child back if she runs a temperature."
B) "Feed baby small amounts while she is sitting up."
C) "Give her antibiotics right after feeding her."
D) "If you need to use the bulb suction, bring her back."

Question 22

All members of a newly arrived immigrant family from a third-world country have received positive tuberculosis skin test results.The family consists of parents,a 2-year-old,and a 7-year-old.Which therapy regimen does the family practice nurse coordinate for this family?

A) A course of intravenous pyrazinamide (PZA) given once a month in the clinic
B) Directly observed therapy with isoniazid (INH) and rifampin (Rifadin) for 9 months
C) Isoniazid and rifampin once a week for 6 months, given by the nurse in the clinic
D) Isoniazid daily for 9 months, followed by rifampin once a week for 3 months

Question 23

A 7-year-old child is brought to the clinic with what the parent describes as "tonsillitis." The child has a moderate fever,foul breath,and dysphagia,and occasionally spits up lumps of foul-smelling material.Which medication does the nurse prepare to instruct the parents on based on the child's symptoms?

A) Amoxicillin (Amoxil)
B) Clindamycin (Cleocin)
C) Erythromycin (Erythrocin)
D) Tetracycline (Sumycin)

Question 24

A 6-year-old child is admitted after being in a fire at school.The physician plans to perform a bronchoscopy to assess for airway damage.Which nursing action is the priority for this child?

A) Document any teaching done in the child's chart.
B) Let the child perform the procedure on a doll.
C) Obtain written consent from the parent/guardian.
D) Tell the child he or she won't remember the procedure.

Question 25

A new nurse in the emergency department is examining a 4-year-old child who is sitting upright,is drooling,and is restless.Which action by the new nurse causes an experienced nurse to intervene?

A) Attaches a cardiac monitor and oximeter
B) Attempts to assess throat with a tongue blade
C) Permits child to remain in an upright position
D) Prepares to administer racemic epinephrine (MicroNefrin)

Question 26

An emergency department nurse is supervising a nursing student who is preparing a racemic epinephrine (MicroNefrin)nebulizer treatment for a child with stridor from suspected epiglottitis.The student prepares 0.75 mg in 2 mL of normal saline.Which action by the registered nurse is most appropriate?

A) Allow the student to administer the nebulizer treatment.
B) Have the student explain the action and side effects of the drug.
C) Remind the student to assess lung sounds after the treatment.
D) Tell the student to look up the drug dosage information again.

Question 27

A child with severe pertussis has been prescribed erythromycin (Erythrocin)and prednisone (Deltasone).Four days later,the parent informs the clinic nurse the child is sleeping more than usual and is not eating well.Which response by the nurse is the most appropriate?

A) "Go to the emergency department for an infection workup."
B) "Let her sleep; she is just exhausted from having pertussis."
C) "Stop the prednisone for now and see how she does tomorrow."
D) "Take her temperature; if it's normal bring her in tomorrow."

Question 28

The mother of a child diagnosed with influenza in the emergency department last night calls the family practice clinic to ask if she can give the child store-brand "flu medicine." Which response by the nurse is the most appropriate?

A) "If your child is that sick she should take Tamiflu."
B) "No, your child should not be sick enough for medicine."
C) "Yes, if it's labeled for children you can give it to her."
D) "You must make sure it does not contain salicylates."

Question 29

A father calls the pediatric clinic to report that his child was diagnosed with influenza at an urgent care facility yesterday and was prescribed oseltamivir (Tamiflu).The father worries that the dose of 75 mg twice a day is too high.He reports that his child weighs 90 lb (40.9 kg).Which response by the nurse is best?

A) "No, that is an appropriate dose for your child."
B) "No, that is way too little medicine for your child."
C) "Tamiflu should not be used in children under 100 lb."
D) "Yes, that is double the normal dose for a child."

Question 30

A 2-year-old child in a pediatric unit accidentally swallows a loose toy part and begins to exhibit signs of choking and wheezing.The pediatric nurse begins the Heimlich maneuver.After performing abdominal thrusts,what action does the nurse take next?

A) Begin performing cardiopulmonary resuscitation (CPR).
B) Activate the rapid response team then return to the child.
C) Continue until the object is dislodged or the child becomes unconscious.
D) Give five back blows, then alternate back blows and abdominal thrusts.

Question 31

A child had a tonsillectomy this morning.What action by the nurse is most important for the child's safety?

A) Avoid giving her red popsicles.
B) Limit activity the first night.
C) Offer ice cream when awake.
D) Position the child on her side.

Question 32

A 10-year-old child is brought to the emergency department by the rescue squad from the scene of a house fire.The child is confused and agitated.Which action by the nurse is the priority for this child?

A) Assess the child for a head injury.
B) Give the child 100% oxygen.
C) Obtain a complete history of the fire.
D) Wait for the parents to obtain consent.

Question 33

A child in the family practice clinic reports that "my ear itches." On otoscopic exam,the ear canal is swollen,red,and full of debris.Which instruction does the nurse anticipate giving the parent?

A) Clean the ear canals occasionally with a cotton swab.
B) Dry the ear canals with a hair dryer set on low heat.
C) Give the full course of antibiotics even if the child is better.
D) Your child should not be allowed to swim in the future.

Question 34

A mother brings her newly adopted non-English-speaking 8-year-old daughter to the clinic for follow-up after a complete physical and immunizations before starting school.The child's tuberculin skin test results in redness and induration of 12 mm.Which response by the nurse is best?

A) Ask the mother what country the child was adopted from.
B) Give the child a mask to wear while in the clinic.
C) Instruct the mother on directly observed TB therapy.
D) Tell the mother the result does not show tuberculosis.

Question 35

A 5-month-old child is brought to the pediatric clinic by the parent,who reports the child has had a cough for 4 weeks.When reviewing the child's history,the nurse assesses that the child's last DTaP vaccination was at 2 months of age.Which action by the nurse is the most appropriate?

A) Inform the provider that both child and parent need antibiotics.
B) Make an appointment for the next vaccination at 6 months.
C) Obtain nasal washings for a culture and PCR testing.
D) Weigh and measure the child; document all findings in the chart.

Question 36

A child is admitted to the pediatric unit with respiratory syncytial virus (RSV).Which action by the nurse is best for infection control?

A) Adhere to policy on hand hygiene.
B) Do not assign pregnant caregivers.
C) Place the child in contact isolation.
D) Use meticulous standard precautions.

Question 37

A child has been seen in the clinic and diagnosed with bronchitis.The next day,the mother calls the clinic to ask about using cough medicine to decrease the child's cough.Which response by the nurse is the most appropriate?

A) "Children should never use cough medicine for bronchitis."
B) "If she can't sleep due to a cough, a dose would be okay at night."
C) "It would be alright to use, but watch her for hyperactivity."
D) "Yes, give her over-the-counter cough medicine every 4 hours."

Question 38

Four children are in the pediatric clinic waiting to be seen.Which patient should the nurse see first?

A) Afebrile, parent reports harsh barky cough
B) Pulling on ear, temperature 103°F (39.5°C)
C) Salty-tasting sweat, poor weight gain
D) Wheezing, retracting, no wet diapers today

Question 39

A 3-year-old child is brought to the emergency department with sudden onset of hoarseness,wheezing,and cough.The child has a history of asthma,but the parent is worried about an aspirated toy part.Which action by the nurse would quickly differentiate between the two?

A) Administer an inhaled bronchodilator.
B) Auscultate lungs for unilateral wheezing.
C) Obtain a stat portable chest x-ray.
D) Quickly obtain an oxygen saturation.

Question 40

The parent of a 7-month-old baby who has been diagnosed with influenza asks the nurse if the baby can have Tamiflu (oseltamivir).Which response by the nurse is the most appropriate?

A) "Children younger than 1 year old cannot take this medication,"
B) "I'm not sure; let's see how much your baby weighs today."
C) "No, children can't take it because it contains aspirin products."
D) "Yes, and you can take it, too, if you develop flu symptoms."

Question 41

The pediatric nurse describes the effects of cystic fibrosis on the body systems to the parents of a child recently diagnosed with the disease.Which statements does the nurse include to the parents?

A) Altered protein and vitamin metabolism causes a type of dementia in older children.
B) Increased mucus obstructs the airways, and stasis of fluid causes infections.
C) Pancreatic ducts are often blocked by mucus, leading to poor nutrition.
D) Reproduction is affected, as ovarian ducts and the vas deferens are occluded.
E) Thick mucus affects several body systems, preventing some organs from working.

Question 42

A nurse is planning a seminar to address asthma in the community.To have the greatest impact,which demographic group should the nurse target?

A) African American children
B) Children with allergies
C) Inner-city youth, all ethnicities
D) School-age children

Question 43

The nurse is assessing a patient diagnosed with cystic fibrosis.Which findings support the patient's diagnosis?

A) Concave chest
B) Dry, scaly skin
C) Protuberant abdomen
D) Wasted buttocks
E) Thick extremities

Question 44

A nurse is assessing a 10-year-old child with asthma.The child and parents report daily
Symptoms,but the child only wakes up coughing once or twice a week,uses an albuterol (Ventolin)inhaler daily,and is occasionally prevented from participating in physical activity by symptoms.What asthma severity classification does the nurse assign to the child?

A) Intermittent
B) Mild persistent
C) Moderate persistent
D) Severe persistent

Question 45

The parents of a school-age child with frequent sinus infections ask the nurse how to prevent the infections from occurring.Which questions by the nurse to the parents would elicit helpful information as to the cause of the problem?

A) "Do your other children have frequent infections?"
B) "Has your child ever had allergy testing?"
C) "Is your child around anyone who smokes?"
D) "Was your child born prematurely or at term?"
E) "Who watches your child before and after school?"

Question 46

The nurse checking a pediatric patient into the clinic says to a nursing student,"Wow-does that kid have some allergic shiners!" Which interpretation by the student nurse is correct?

A) Dark periorbital swelling from allergies
B) Extra grooves in the lower eyelids
C) Macerated eyelids from rubbing eyes
D) Shiny, taut skin from response to histamine

Question 47

A child is admitted after a severe asthma attack.Respiratory status is stable at this time.Which is the priority intervention for this child?

A) Determining the trigger
B) Ensuring hydration
C) Promoting rest
D) Providing support

Question 48

The pediatric clinic nurse cares for many children with viral upper respiratory infections.Which seasonal characteristics of these infections would the clinic nurse include when educating parents?

A) Adenovirus is very prevalent in the winter.
B) Coronavirus is commonly seen in the spring.
C) Infections with parainfluenza are seen in autumn.
D) Respiratory syncytial virus is a problem in summer.
E) Rhinovirus is more common in the early fall.

Question 49

The pediatric nurse is observing a student nurse teach a child how to use a peak flow meter.Which instruction by the student requires intervention by the pediatric nurse?

A) "Exhale for as long as you can to empty your lungs."
B) "Keep your tongue away from the mouthpiece."
C) "Stand up straight and tall when using the meter."
D) "Write down the highest of the three readings."

Question 50

A nurse is using the CUPS method of assessing a child's respiratory status and documents the following: open airway containing secretions,increased respiratory rate and effort,wheezing,mucous membranes pale pink in color,and fever.Based on this system,which is the appropriate rating for this child?

A) Critical
B) Potentially unstable
C) Stable
D) Unstable

Question 51

A nurse is caring for an infant born with esophageal atresia (EA)and tracheoesophageal fistula (TEF)prior to surgery.Which actions taken by a student nurse cause the registered nurse to intervene?

A) Assesses the infant's intravenous site
B) Irrigates the orogastric tube as needed
C) Raises the head of the bed at least 30°
D) Suctions the trachea every 2 hours
E) Teaches parents about barium contrast

Question 52

A 2-year-old child has croup.Which nursing interventions are appropriate for this child?

A) Administering oral or intravenous antibiotics
B) Administering racemic epinephrine (Micronefrin)
C) Applying oxygen via an oxygen tent
D) Teaching the parents how to give cough medication
E) Using a warm-mist humidifier

Question 53

An 11-year-old child who has a history of asthma is brought to the family practice clinic by a parent who reports that the child has white plaque over the inside of the mouth and coating the tongue.Which question by the nurse would elicit the most useful information?

A) "Are you brushing your teeth and tongue regularly?"
B) "Do you rinse your mouth after using your inhaler?"
C) "Have you ever had something like this before?"
D) "When was the last time you went to the dentist?"

Question 54

A child with pertussis is in the catarrhal stage of the disease.Which assessment findings correlate with this condition?

A) Chronic cough lasting weeks
B) Intense cough causing vomiting
C) Low-grade fever
D) Sweating and fatigue after coughing
E) Upper respiratory symptoms

Question 55

Parents of a 3-year-old call the clinic and ask for information on sinusitis.Which symptoms will the nurse include in the explanation to the parents?

A) "Cold" lasting more than 5 days
B) Cough worse when lying down
C) Periorbital swelling
D) Postnasal drip
E) Thin, clear nasal discharge.

Question 56

The nurse is caring for a child who experiences frequent ear infections.The child's mother wants to know why this is occurring.Which anatomical differences in the pediatric patient increase the risk for otitis media?

A) Impaired drainage
B) Longer, thinner eustachian tubes
C) Shorter, horizontal eustachian tubes
D) Typical lying-down position of infants
E) Underdeveloped cartilage lining

Question 57

A 1-year-old child has the following arterial blood gas values (ABGs): pH: 7.28,PCO₂: 58 mm Hg,PO₂: 77 mm Hg,HCO₃: 14 mEq/L,O₂ saturation: 88%.Which interpretation of the results by the nurse is the most accurate?

A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Question 58

The nurse caring for children with asthma recognizes which immunoglobulin to be involved in causing activation of the airway mast cells and macrophages?

A) IgA
B) IgE
C) IgG
D) IgM

Question 59

The nursing student reads the diagnosis of a lower respiratory infection in a patient's chart.The student knows that the lower respiratory system is composed of which structures?

A) Alveoli
B) Bronchi
C) Larynx
D) Lungs
E) Pharynx

Question 60

The pediatric nurse is providing care to a neonate diagnosed with cystic fibrosis.When discussing the clinical manifestations of this disease process,which topics will the nurse include in the teaching session?

A) Anemia
B) Malnutrition
C) Scant, hard stools
D) Meconium ileus
E) Rectal prolapse

Question 61

The pediatric clinic nurse is teaching a parent home-care measures for a 12-year-old child diagnosed with viral pharyngitis.Which information is appropriate for the nurse to include in the teaching session?

A) Bedrest for a couple days will help recovery.
B) Have the child gargle with warm saline.
C) Make sure your child continues to eat.
D) Offer fluids in small amounts, frequently.
E) Warm liquids are better tolerated than cold.

Question 62

A parent brings a 2-year-old child to the clinic,reporting that the child has an ear infection.Which assessment information leads the nurse to suspect a diagnosis of bacterial otitis media?

A) Acute otalgia
B) Dull, throbbing pain
C) Fever of 104°F (40°C)
D) High-pitched crying
E) Poor feeding
F) Rubbing the ear

Question 63

A nurse is providing anticipatory guidance to parents of a toddler.Which objects does the nurse include as a frequent cause of aspiration?

A) Balloons
B) Hot dog bits
C) Licorice sticks
D) Peanuts
E) Popcorn

Question 64

A child who weighs 32 lb (14.5 kg)is prescribed erythromycin (Sumycin)every 8 hours.Calculate the dose range for a single dose of this drug.(Round to the nearest hundredth).