Deck 45: The Child with a Respiratory Alteration

Question 1

The nurse should assess a child who has had a tonsillectomy for which of the following as the priority?

A) Frequent swallowing
B) Inspiratory stridor
C) Swelling of the throat
D) Abnormal lung sounds

Answer 1

Frequent swallowing

Question 2

Which assessment finding after tonsillectomy should be reported to the surgeon?

A) Vomiting bright red blood
B) Pain at surgical site
C) Pain on swallowing
D) The ability to only take small sips of liquids

Answer 2

Vomiting bright red blood

Question 3

For which problem should the child with chronic otitis media with effusion be evaluated?

A) Brain abscess
B) Meningitis
C) Hearing loss
D) Perforation of the tympanic membrane

Answer 3

Hearing loss

Question 4

Which intervention is appropriate for the infant hospitalized with bronchiolitis?

A) Position on the side with neck slightly flexed.
B) Administer antibiotics as ordered.
C) Restrict oral and parenteral fluids if tachypneic.
D) Give cool, humidified oxygen.

Question 5

A child has had cold symptoms for more than 2 weeks,a headache,nasal congestion with purulent nasal drainage,facial tenderness,and a cough that increases during sleep.The nurse plans to teach the parents about which treatment regime?

A) Antihistamine use
B) Cold washcloths on the face for comfort
C) Antibiotic treatment with amoxicillin
D) Referral for a sinuplasty

Question 6

What intervention can be taught to the parents of a 3-year-old child with pneumonia who is not hospitalized?

A) Offer the child only cool liquids.
B) Offer the child favorite warm liquid drinks.
C) Use a warm mist humidifier.
D) Report a respiratory rate less than 28 breaths/min.

Question 7

The parent of a toddler calls the nurse,asking about croup.What is a distinguishing manifestation of spasmodic croup?

A) Wheezing is heard audibly.
B) It has a harsh, barky cough.
C) It is bacterial in nature.
D) The child has a high fever.

Question 8

A nurse is caring for four infants.Which one should the nurse assess first?

A) Nasal flaring
B) Respiratory rate of 55 breaths/min
C) Irregular respiratory pattern
D) Abdominal breathing

Question 9

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible.Which of the following best explains the nurse's rationale?

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 10

Once an allergen is identified in a child with allergic rhinitis,the treatment of choice the nurse educates the parents about is which of the following?

A) Using appropriate medications
B) Beginning desensitization injections
C) Eliminating the allergen
D) Removing the adenoids

Question 11

An infant has laryngomalacia.What assessment finding correlates with this condition?

A) Stridor
B) High-pitched cry
C) Nasal congestion
D) Spasmodic cough

Question 12

Which statement made by a parent indicates an understanding about treatment of streptococcal pharyngitis?

A) "I guess my child will need to have his tonsils removed."
B) "A couple of days of rest and some ibuprofen will take care of this."
C) "I should give the penicillin three times a day for 10 days."
D) "I am giving my child prednisone to decrease the swelling of the tonsils."

Question 13

What information should the nurse teach workers at a daycare center about RSV?

A) RSV is transmitted through particles in the air.
B) RSV can live on skin or paper for up to a few seconds after contact.
C) RSV can survive on nonporous surfaces for about 60 minutes.
D) Frequent handwashing can decrease the spread of the virus.

Question 14

A 5-year-old child is brought to the emergency department with copious drooling and a croaking sound on inspiration.Her mother states that the child is very agitated and only wants to sit upright.What action by the nurse takes priority?

A) Prepare intubation equipment and call the provider.
B) Examine the child's oropharynx and call the provider.
C) Obtain a throat culture for respiratory syncytial virus (RSV).
D) Obtain vital signs and listen to breath sounds.

Question 15

What is an appropriate beverage for the nurse to give to a child who had a tonsillectomy earlier in the day?

A) Chocolate ice cream
B) Orange juice
C) Fruit punch
D) Apple juice

Question 16

The nurse expects the initial plan of care for a 9-month-old child with an acute otitis media infection to include

A) symptomatic treatment and observation for 48 to 72 hours after diagnosis.
B) an oral antibiotic, such as amoxicillin, five times a day for 7 days.
C) pneumococcal conjugate vaccine.
D) myringotomy with tympanoplasty tubes.

Question 17

Which intervention for treating croup at home should be taught to parents as possibly helpful?

A) Have a decongestant available.
B) Have the child sleep in a dry room.
C) Take the child outside.
D) Give the child an antibiotic at bedtime.

Question 18

Which type of croup is always considered a medical emergency?

A) Laryngitis
B) Epiglottitis
C) Spasmodic croup
D) Laryngotracheobronchitis (LTB)

Question 19

A child has a chronic,nonproductive cough and diffuse wheezing during the expiratory phase of respiration.What action by the nurse is most appropriate?

A) Prepare to administer a bronchodilator.
B) Give ordered antibiotics on time.
C) Provide oxygen via face tent.
D) Assess the airway for a foreign body.

Question 20

Teaching safety precautions with the administration of antihistamines is important because of what common side effect?

A) Dry mouth
B) Excitability
C) Drowsiness
D) Dry mucous membranes

Question 21

Which finding confirms a diagnosis of cystic fibrosis?

A) Chest radiograph shows alveolar hyperinflation.
B) Stool analysis indicates significant amounts of fecal fat.
C) Sweat chloride is greater than 60 mEq/L.
D) Liver function levels are abnormal.

Question 22

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.What home care measure does the nurse educate parents about?

A) Taking the full course of antibiotics
B) Providing humidity and increased fluids
C) Treating any fever with aspirin
D) Isolation from family until symptoms resolve

Question 23

Which statement indicates that a parent of a toddler needs more education about preventing foreign body aspiration?

A) "I keep objects with small parts out of reach."
B) "My toddler loves to play with balloons."
C) "I won't permit my child to have peanuts."
D) "I never leave coins where my child could get them."

Question 24

What explanation should the nurse give to the parent of a child with asthma about using a peak flow meter?

A) It is used to monitor the child's breathing capacity.
B) It measures the child's lung volume.
C) It will help the medication reach the child's airways.
D) It measures the amount of air the child breathes in.

Question 25

What should the nurse teach a child about using an albuterol metered-dose inhaler for exercise-induced asthma?

A) Take two puffs every 6 hours around the clock.
B) Use the inhaler only when the child is short of breath.
C) Use the inhaler 30 minutes before exercise.
D) Take one to two puffs every morning upon awakening.

Question 26

What is a common trigger for asthma attacks in children?

A) Febrile episodes
B) Dehydration
C) Exercise
D) Seizures

Question 27

An infant's parents ask the nurse about preventing OM.What should be recommended?

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

Question 28

Which statement made by parents of a child with cystic fibrosis indicates that they understood the nurse's teaching on pancreatic enzyme replacement?

A) "Enzymes will improve my child's breathing."
B) "I should give the enzymes 1 hour after meals."
C) "Enzymes should be given with meals and snacks."
D) "The enzymes are stopped if my child begins wheezing."

Question 29

The nurse is caring for an infant with bronchopulmonary dysplasia (BPD)who has RSV.Which treatment measure does the nurse prepare to provide?

A) Pancreatic enzymes
B) Cool humidified oxygen
C) Erythromycin intravenously
D) Intermittent positive pressure ventilation

Question 30

The nurse getting an end-of-shift report on a child with status asthmaticus should question which intervention?

A) Administer oxygen by nasal cannula to keep oxygen saturation at 100%.
B) Assess intravenous (IV) maintenance fluids and site every hour.
C) Notify provider for signs of increasing respiratory distress.
D) Organize care to allow for uninterrupted rest periods.

Question 31

Which classification of drugs is used to relieve an acute asthma episode?

A) Short-acting beta2-adrenergic agonist
B) Inhaled corticosteroids
C) Leukotriene blockers
D) Long-acting bronchodilators

Question 32

A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules.The nurse should teach parents to mix enzymes with which food?

A) Macaroni and cheese
B) Tapioca
C) Applesauce
D) Hot chocolate

Question 33

The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according to which indicator?

A) Stool formation
B) Vomiting
C) Weight
D) Urine output

Question 34

The nurse is caring for a child with acute respiratory distress syndrome (ARDS)associated with sepsis.Nursing actions should include which of the following?

A) Forcing fluids
B) Monitoring pulse oximetry
C) Instituting seizure precautions
D) Encouraging a high-protein diet

Question 35

Which statement made by a parent indicates an understanding about the genetic transmission of cystic fibrosis (CF)?

A) "Only one parent carries the cystic fibrosis gene."
B) "Both parents are carriers of the cystic fibrosis gene."
C) "The presence of the disease is most likely the result of a genetic mutation."
D) "The mother is usually the carrier of the cystic fibrosis gene."

Question 36

Which child requires a Mantoux test?

A) The child who has episodes of nighttime wheezing and coughing
B) The child who has a history of allergic rhinitis
C) The child whose babysitter has received a tuberculosis diagnosis
D) The premature infant who is being treated for apnea of infancy

Question 37

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system?

A) They have a widened, shorter airway.
B) There is a defect in their sucking ability.
C) The gag reflex increases mucous production.
D) Mucus and edema obstruct small airways.

Question 38

Which statement is characteristic of acute otitis media (AOM)?

A) The etiology is unknown.
B) Permanent hearing loss often results.
C) It can be treated by intramuscular (IM) antibiotics.
D) It is treated with a broad range of antibiotics.

Question 39

A parent of a child with asthma asks if his child can still participate in sports.What response by the nurse is best?

A) "Children with asthma are usually restricted from physical activities."
B) "Children can usually play any type of sport if their asthma is well controlled."
C) "Avoid swimming because exhaling underwater is dangerous for people with asthma."
D) "Even with good asthma control, I would advise limiting the child to one athletic activity per school year."

Question 40

What is the earliest recognizable clinical manifestation(s)of CF?

A) Meconium ileus
B) History of poor intestinal absorption
C) Foul-smelling, frothy, greasy stools
D) Recurrent pneumonia and lung infections

Question 41

Which vitamin supplements are necessary for children with cystic fibrosis?

A) Vitamin C
B) Vitamin D
C) Vitamin A
D) Vitamin E
E) Vitamin K

Question 42

A nurse is planning care for an asymptomatic child with a positive tuberculin test.What should the nurse include in the plan? (Select all that apply.)

A) Administration of daily isoniazid (INH)
B) Instructing family members about administration of INH to all close contacts of the child
C) Administration of the bacillus Calmette-Guérin vaccine
D) Reporting the case to the health department
E) Administration of INH and rifampin (Rifadin) simultaneously

Question 43

The nurse should implement which interventions for an infant experiencing apnea? (Select all that apply.)

A) Stimulate the infant by gently tapping the foot.
B) Shake the infant vigorously.
C) Have resuscitative equipment available.
D) Suction the infant.
E) Maintain a neutral thermal environment.

Question 44

What information should the nurse teach families about reducing exposure to pollens and dust? (Select all that apply.)

A) Replace wall-to-wall carpeting with wood and tile floors.
B) Use an air conditioner.
C) Put dust-proof covers on pillows and mattresses.
D) Keep humidity in the house above 60%.
E) Keep pets outside.

Question 45

The nurse is assessing a child for epiglottitis.What findings are consistent with this condition? (Select all that apply.)

A) Drooling
B) Dysphagia
C) Dysphonia
D) Distressed inspiratory efforts
E) Decreased oxygenation

Question 46

The mother of a newborn asks the nurse what causes the baby to begin to breathe after delivery.What changes in the respiratory system stimulating respirations postnatally can the nurse explain to the mother? (Select all that apply.)

A) Low oxygen levels in the infant's blood
B) Rubbing the newborn with a towel or blanket
C) Surfactant, a special lubricant in the lungs
D) Increased blood flow to the infant's lungs
E) Cold environment in the delivery room

Question 47

A home health care nurse is doing a home assessment for a family whose child is oxygen dependent.What finding by the nurse requires intervention?

A) Tanks are stored only in an upright position.
B) Oxygen tank is placed 3 feet away from the heater.
C) Smoking is not allowed in the house.
D) Fire extinguisher expires at the end of the month.

Question 48

A child has allergies to animal dander but is distraught at having to give away the family dog.What actions could the nurse suggest that might avoid this? (Select all that apply.)

A) Choose a dander-free pet like a lizard.
B) Keep the dog outside as much as possible.
C) Install air cleaners in the house.
D) Use dust-proof pillow covers.
E) Keep the windows closed in the summer.