Question 1

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.

Accepted Answer

Cystic fibrosis is an inherited autosomal recessive disorder that causes the production of thick mucus that blocks exocrine glands and affects several body systems,including the respiratory,gastrointestinal,and reproductive systems.It does not lead to a type of dementia.

Question 2

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

Accepted Answer

African American children have a 60% higher prevalence of asthma,a 260% higher rate of emergency department visits,a 250% higher hospitalization rate,and a 500% higher mortality rate than white children.To have the greatest impact on this chronic disease,the nurse should target African American children and their parents/guardians and caretakers.Up to 40% of children with asthma have no allergies.Low socioeconomic status is a risk factor,not living in an inner city specifically.Children of all ages are affected.

Question 3

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

Accepted Answer

Protuberant abdomen,barrel chest,wasted buttocks,and thin extremities are common features in children with cystic fibrosis.

Question 4

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

Accepted Answer

The child's symptoms place him or her in the moderate persistent category.

Question 5

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?"

Accepted Answer

Causes of sinusitis include allergies,exposure to other sick people (e.g.,siblings or children at day care),exposure to cigarette smoke,and exposure to allergens.Eliminating these factors would help decrease the number of episodes of sinusitis,so it is appropriate to ask questions about these topics.Term versus premature birth is not a contributing factor.

Question 6

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

Accepted Answer

An "allergic shiner" is a dark periorbital swelling noted in some children who have allergies.Extra grooves in the lower eyelid and skin problems due to rubbing itchy eyes are also possible symptoms of allergies.

Question 7

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

Accepted Answer

Priorities in any emergency are airway,breathing,and circulation.Because the respiratory status is now stable,attention is placed on ensuring that the child is hydrated.This is important for two reasons: first,hydration helps liquefy secretions; second,the mouth-breathing child will have lost a great deal of fluid through insensible loss,which needs to be replaced.All other options are important parts of care of this child; however,hydration is the priority.

Question 8

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.

Accepted Answer

The seasonal nature of common viruses leading to respiratory infections includes the following correlations: adenovirus is common in winter and spring,coronavirus is common in winter and spring,parainfluenza is common in winter,respiratory syncytial virus is common in winter and spring,and rhinovirus is common in early fall and late spring.

Question 9

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."

Accepted Answer

The proper way to use the peak flow meter is to blow hard and fast when exhaling.The nurse should intervene when the student states otherwise.The other instructions are correct.

Question 10

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

Accepted Answer

According to this scale,the child has four determinants of unstable status (increased breathing rate,increased breathing effort,wheezing,and pale pink mucous membranes).An open airway with secretions and presence of fever both characterize the potentially unstable category.The nurse would classify this child as unstable.

Question 11

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

Accepted Answer

Preoperatively,care for an infant with EA and TEF includes assessing IV sites,frequent suctioning to prevent aspiration (as needed,not on an every-2-hours schedule),raising the head of the bed 30-40°and turning the head to the side to help prevent aspiration,and possibly administering antibiotics,as aspiration pneumonia is likely.If the infant has a nasogastric or orogastric tube inserted into the blind pouch,the nurse does not irrigate it,as this increases the risk of aspiration.Contrast radiology studies can be done with dilute water-soluble contrast,but not barium.

Question 12

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

Accepted Answer

Commonly,mild cases of croup are treated with cool mist.In the hospital setting,oxygen hoods for infants and oxygen tents for toddlers are used.Nebulized racemic epinephrine (Adrenalin)and l-epinephrine are equally effective in inducing mucosal vasoconstriction,with a consequent decrease in subglottic edema,thus relieving the symptoms.Antibiotics are not used in the management of croup,as it is primarily viral in nature.Cool-mist humidifiers should be used rather than warm mist due to the potential for bacterial growth in the warm-mist system.

Question 13

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?"

Accepted Answer

Use of inhalers for asthma,especially corticosteroids,can cause yeast infection (candidiasis)if the patient does not rinse the mouth afterward.The other questions are not helpful in this situation.

Question 14

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

Accepted Answer

The catarrhal stage of pertussis is characterized by upper respiratory symptoms and low-grade fever.Sweating,fatigue,and intense coughing with vomiting are characteristic of the paroxysmal stage.A chronic cough lasting weeks is seen in the convalescent stage.

Question 15

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.

Accepted Answer

The signs and symptoms of sinusitis include a cold lasting more than 10-14 days,sometimes with low-grade fever,thick yellow-green nasal discharge,and postnasal drip leading to sore throat; cough (worse at night or when lying down); bad breath; nausea and vomiting; headaches; irritability and fatigue; and swelling around eyes.

Question 16

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

Accepted Answer

The following factors lead to otitis media in children: the eustachian tubes are short,wide,and straight and lie in a horizontal plane; the cartilage lining is undeveloped,making the tubes more distensible; the normally abundant pharyngeal lymphoid tissue readily obstructs the eustachian tube openings in the nasopharynx; immature humoral defense mechanisms increase the risk of infections; and the lying-down position of infants favors the pooling of fluid,such as formula,in the pharyngeal cavity.

Question 17

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

Accepted Answer

The low pH indicates acidosis; the high CO₂ level indicates respiratory involvement.The child is also hypoxemic.

Question 18

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

Accepted Answer

The allergen antigen binds to the allergen-specific immunoglobulin E surface,causing activation of the resident airway mast cells and macrophages.This begins the cycle of an asthmatic exacerbation.

Question 19

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

Accepted Answer

The lower respiratory tract is composed of the lungs,bronchi,bronchioles,and alveoli.The larynx and pharynx are part of the upper respiratory system.

Question 20

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

Accepted Answer

The initial presentation of cystic fibrosis in the neonate appears in the gastrointestinal system.The newborn may have a meconium ileus,with meconium so thick that it causes obstruction and requires surgical removal.The infant may initially have bulky stools that are frothy and foul-smelling.Prolapse of the rectum may also occur in infancy and childhood.Malnutrition,anemia,and growth failure persists despite normal caloric intake.

Quiz 23: Caring for the Child With a Respiratory Condition

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

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

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?

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

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?

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

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

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?

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 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?

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

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?

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?