Question 1

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?

Accepted Answer

Guidelines for feeding a child with respiratory distress revolve around preventing aspiration.The child should be fed in an upright position and given small amounts,perhaps more often.An elevated temperature is usually seen in RSV.Antibiotics are not generally used for this disease.Parents needs to know how to use the bulb suction to help manage the accompanying rhinitis.

Question 2

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?

Accepted Answer

Because the duration of therapy for TB is so long,noncompliance is an issue that must be addressed by the nurse.Directly observed therapy (DOT)helps with compliance,which reduces relapses,treatment failure,and drug resistance,especially in children and adolescents.Because all members of the family must take the medication,and because they are immigrants who may have limited English proficiency,limited health literacy,and perhaps values and beliefs that contradict Western medical care,directly observed therapy is vital to ensure cure and to prevent spread of the disease.Drugs used include isoniazid and rifampin for 9 months.Pyrazinamide can be added,decreasing the treatment time to 6 months.

Question 3

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?

Accepted Answer

For acute tonsillitis,penicillin,amoxicillin,or erythromycin are the most commonly prescribed antibiotics.However,with the history of this child spitting up lumps of foul-smelling material,it is more likely he or she has chronic tonsillitis,which is best treated with cephalosporin or clindamycin.

Question 4

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?

Accepted Answer

For this invasive procedure,written consent is required.Documenting teaching is important,but does not take priority.Allowing the child to simulate the bronchoscopy with a doll with help alleviate fears,but again does not take priority.Telling the child that he or she will not remember the procedure is false reassurance and may not end up being true,causing the child to lose trust in the nurse.

Question 5

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?

Accepted Answer

This child has manifestations of acute epiglottitis.The nurse should not look into the child's throat,as this may precipitate laryngeal spasm and total airway obstruction.The experienced nurse should intervene if the new nurse attempts to do so.The other interventions are appropriate.

Question 6

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?

Accepted Answer

The correct dose of racemic epinephrine is 0.25-0.5 mg in 3 mL of normal saline.The nurse should have the student look up the dosing information again.The other actions would be appropriate if the student had the correct dose.

Question 7

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?

Accepted Answer

Children with severe pertussis are occasionally prescribed steroids to reduce the severity of the symptoms.Steroids,including prednisone,can mask signs of infection (including temperature).A child who is lethargic and not feeding well should be seen immediately for a sepsis workup.The child is acutely ill and needs evaluation,not sleep or waiting until tomorrow to be seen.The child's temperature may be normal or subnormal due to the immune-suppressive effects of the steroids and is not a reliable indicator of infection.

Question 8

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?

Accepted Answer

Medications containing aspirin products (salicylates)should not be given to children with viral illnesses due to the correlation with Reye syndrome.If a parent is asking about an over-the-counter medication,the nurse should advise the parent to ensure it does not contain this compound.The other responses are not appropriate.

Question 9

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?

Accepted Answer

The dose of Tamiflu for children weighing over 88 lb (40 kg)is 75 mg twice a day.The nurse should advise the father that the dose is appropriate.

Question 10

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?

Accepted Answer

The Heimlich maneuver for a child over 1 year of age consists of giving abdominal thrusts until the object is dislodged or the child becomes unconscious.Abdominal thrusts are done by standing behind the child,wrapping your arms around the child,and placing the fist of one hand thumb side down into the child's abdomen,slightly above the umbilicus.You then squeeze the child's abdomen using rapid,forceful thrusting motions directed upward and inward.If the child becomes unconscious,begin CPR.

Question 11

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

Accepted Answer

After tonsillectomy,children are placed on their side to facilitate drainage and prevent aspiration.Maintaining a patent airway is the priority.Red-colored foods or fluids are not given,as the nurse may not be able to differentiate between the food and bloody drainage; however,this is not a priority for safety.Activity should be limited,but this does not take priority over maintaining the airway.Ice cream and other dairy products are not given because they coat the throat and usually cause coughing or throat clearing,which can lead to bleeding.

Question 12

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?

Accepted Answer

The child's confusion and agitation indicate hypoxemia,which is common in victims of fires.The nurse should treat the child first as an emergency,and then obtain consent when the parents arrive (if they are conscious and able to give consent).A head injury can cause confusion and agitation,but with the history of being in a fire,inhalation injuries would be suspected first.A complete history of the fire can wait,but will ultimately be important to obtain.

Question 13

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?

Accepted Answer

This child has manifestations of otitis externa.Often called swimmer's ear,it is not always associated with swimming.However,the parents need to investigate strategies for keeping the ears dry,including using a hair dryer set on low,wearing ear plugs or a swimming cap,or using solutions designed to promote drying.The parents should not insert anything into the ear canal.Antibiotics are not used with this condition.Swimming is not prohibited.

Question 14

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?

Accepted Answer

An induration of 10 mm or more is a positive result in children under 4 years of age,so this result is not diagnostic for TB in an 8-year-old child.Knowing what country the child was from originally might provide useful information because if the child received bacille Calmette-Guerin vaccine for TB (common in some foreign countries)the skin test results will be inaccurate.However,the nurse would need to know which countries use the vaccine in order for this information to be useful.Because the result is not positive for TB,the child does not need to wear a mask,nor does the mother need instruction on directly observed therapy.

Question 15

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?

Accepted Answer

All children with a chronic cough lasting longer than 3 weeks should have diagnostic testing for pertussis,including nasal washings for culture and PCR tests.This child has the risk factor for pertussis of inadequate immunizations; he should have had a second vaccination at 4 months.The best action by the nurse is to collect the specimens.If positive,both child and caretakers will need antibiotics,as pertussis is highly contagious.The child should receive a booster shot as soon as he is recovered.All children should be weighed and measured and findings documented in the chart.

Question 16

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

Accepted Answer

Children with RSV are placed in contact isolation due to the ease of spreading the disease.Of course nurses should adhere to facility policy on hand washing,but further action is required.There is no precaution against pregnant caregivers.Standard precautions are used on all patients,but a child with RSV needs contact isolation.

Question 17

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?

Accepted Answer

Cough medication is used with caution in children with bronchitis in order to facilitate secretion removal.However,if the child cannot sleep due to coughing,a dose at night would be appropriate.Many cough medications contain alcohol,which could lead to sleepiness.

Question 18

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

Accepted Answer

This child not only has a respiratory problem,he or she is also dehydrated and is the sickest of the four.The nurse should see this patient first.The child with the barky cough is afebrile and has no signs of respiratory distress.Pulling on the ear indicates an ear infection,and these children often run high fevers.The child with salty-tasting sweat and poor weight gain is demonstrating a chronic condition,most likely cystic fibrosis.

Question 19

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?

Accepted Answer

In foreign body aspiration (FBA),wheezing would more likely be heard unilaterally.In an asthma exacerbation,wheezing would be bilateral.The other measures are appropriate care measures in either case,but the quickest way to assess for FBA is to auscultate the lungs.

Question 20

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?

Accepted Answer

Tamiflu is contraindicated in children younger than 1 year old.The nurse should advise the parent of this fact.

Quiz 23: Caring for the Child With a Respiratory Condition

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?