Deck 45: The Child With a Respiratory Alteration

Question 1

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.

Answer 1

It has a harsh, barky cough.

Question 2

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."

Answer 2

"I should give the penicillin three times a day for 10 days."

Question 3

A child has a chronic,nonproductive cough and diffuse wheezing during the expiratory phase of respiration.This suggests

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

Answer 3

Asthma

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

The nurse should assess a child who has had a tonsillectomy for

A) Frequent swallowing
B) Inspiratory stridor
C) Rhonchi
D) Elevated white blood cell count

Question 6

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 7

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

Question 8

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 9

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 recognizes that these symptoms are characteristic of which respiratory condition?

A) Allergic rhinitis
B) Bronchitis
C) Asthma
D) Sinusitis

Question 10

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 11

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 should be the nurse's first action in this situation?

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

Question 12

Which type of croup is always considered a medical emergency?

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

Question 13

What sign is indicative of respiratory distress in infants?

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

Question 14

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible.The nurse's rationale for this action is primarily that

A) Mothers of hospitalized toddlers often experience guilt.
B) The mother's presence will reduce anxiety and ease child's respiratory efforts.
C) Separation from mother is a major developmental threat at this age.
D) The mother can provide constant observations of the child's respiratory efforts.

Question 15

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 her favorite warm liquid drinks.
C) Use a warm mist humidifier.
D) Call the physician for a respiratory rate less than 28 breaths/min.

Question 16

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

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

Question 17

The father of an infant calls the nurse to his son's room because he is "making a strange noise." A diagnosis of laryngomalacia is made.What does the nurse expect to find on assessment?

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

Question 18

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 19

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

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

Question 20

Once an allergen is identified in a child with allergic rhinitis,the treatment of choice about which to educate the parents is

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

Question 21

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

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

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.This is most suggestive of

A) Bronchitis
B) Bronchiolitis
C) Viral-induced asthma
D) Acute spasmodic laryngitis

Question 23

What is a common trigger for asthma attacks in children?

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

Question 24

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 baby-sitter has received a tuberculosis diagnosis
D) The premature infant who is being treated for apnea of infancy

Question 25

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 26

Which statement is characteristic of 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 27

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 28

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 physician for signs of increasing respiratory distress.
D) Organize care to allow for uninterrupted rest periods.

Question 29

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 30

Which vitamin supplements are necessary for children with cystic fibrosis?

A) Vitamin C and calcium
B) Vitamin B₆ and B₁₂
C) Magnesium
D) Vitamins A, D, E, and K

Question 31

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 32

The infant with bronchopulmonary dysplasia (BPD)who has RSV bronchiolitis is a candidate for which treatment?

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

Question 33

Which statement,if 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 34

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 mucus production.
D) Mucus and edema obstruct small airways.

Question 35

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 36

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 37

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 38

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 39

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 40

What is the best nursing response to the parent of a child with asthma who asks if his child can still participate in sports?

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 breathing 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 41

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 42

The nurse is providing education related to "Safe Sleep" to the parents of a healthy newborn infant to help prevent sudden infant death syndrome (SIDS).The nurse instructs the parents that bed sharing is not recommended; however,they should put the infant in a safe bassinet or crib in the parent's room for sleeping.Is this statement true or false?

Question 43

As a child with asthma struggles to get enough air,the respiratory rate increases (tachypnea).Tachypnea lowers the carbon dioxide levels in the blood.This is known as _____________.

Question 44

The childhood vaccine ____________________ has dramatically reduced the incidence of epiglottitis.

Question 45

The nurse is caring for a child with acute respiratory distress syndrome (ARDS)associated with sepsis.Nursing actions should include:

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

Question 46

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 47

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 48

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.