Question 1

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition?
A) Inspiratory stridor
B) Complete obstruction
C) Sore throat
D) Respiratory tract infection

Accepted Answer

If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.

Question 2

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action?
A) Avoid using for more than 3 days.
B) Keep drops to use again for nasal congestion.
C) Administer drops until nasal congestion subsides.
D) Administer drops after feedings and at bedtime.

Accepted Answer

Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

Question 3

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

Accepted Answer

Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Bronchiolitis is rare in children older than 2 years. Asthma is a chronic inflammation of the airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children between 3 months and 3 years of age.

Question 4

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which symptom?
A) Gagging
B) Coughing
C) Pulse over 100 beats/min
D) Inability to speak

Accepted Answer

The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. Gagging indicates irritation at the back of the throat, not obstruction. Coughing does not indicate a complete airway obstruction. Tachycardia may be present for many reasons.

Question 5

When is it generally recommended that a child with acute streptococcal pharyngitis may return to school?
A) When sore throat is better.
B) If no complications develop.
C) After taking antibiotics for 24 hours.
D) After taking antibiotics for 3 days.

Accepted Answer

After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

Question 6

Which type of croup is always considered a medical emergency?
A) Laryngitis
B) Epiglottitis
C) Spasmodic croup
D) Laryngotracheobronchitis (LTB)

Accepted Answer

Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

Question 7

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What is the priority nursing intervention?
A) Forcing fluids
B) Monitoring pulse oximetry
C) Instituting seizure precautions
D) Encouraging a high-protein diet

Accepted Answer

Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. Maintenance of vascular volume and hydration is important and should be done parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a high-protein diet is not helpful.

Question 8

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older?
A) The amount of lymphoid tissue decreases.
B) Repeated exposure to organisms causes increased immunity.
C) Viral organisms are less prevalent in the population.
D) Secondary infections rarely occur after viral illnesses.

Accepted Answer

Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A b-hemolytic streptococcal infections.

Question 9

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections?
A) They are safer.
B) They are less expensive.
C) Respiratory secretions are dried.
D) A more comfortable environment is produced.

Accepted Answer

Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. The cost of cool-mist and steam vaporizers is comparable. Steam loosens secretions, not dries them. Both may promote a more comfortable environment, but cool-mist vaporizers present decreased risk for burns and growth of organisms.

Question 10

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions?
A) "I should administer all the prescribed medication."
B) "I should continue medication until the symptoms subside."
C) "I will immediately stop giving medication if I notice a change in hearing."
D) "I will stop giving medication if fever is still present in 24 hours."

Accepted Answer

Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria. Symptoms may subside before the full course is given. Hearing loss is a complication of AOM. Antibiotics should continue to be given. Medication may take 24 to 48 hours to make symptoms subside. It should be continued.

Question 11

Parents have understood teaching about prevention of childhood otitis media if they make which statement?
A) "We will only prop the bottle during the daytime feedings."
B) "Breastfeeding will be discontinued after 4 months of age."
C) "We will place the child flat right after feedings."
D) "We will be sure to keep immunizations up to date."

Accepted Answer

Parents have understood the teaching about preventing childhood otitis media if they respond they will keep childhood immunizations up to date. The child should be maintained upright during feedings and after. Otitis media can be prevented by exclusively breastfeeding until at least 6 months of age. Propping bottles is discouraged to avoid pooling of milk while the child is in the supine position.

Question 12

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature?
A) Give tepid water baths to reduce fever.
B) Encourage food intake to maintain caloric needs.
C) Have child wear heavy clothing to prevent chilling.
D) Give small amounts of favorite fluids frequently to prevent dehydration.

Accepted Answer

Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

Question 13

A child is diagnosed with influenza. Management includes which recommendation?
A) Clear liquid diet for hydration
B) Aspirin to control fever
C) Oseltamivie (Tamiflu)
D) Antibiotics to prevent bacterial infection

Accepted Answer

Oseltamivie (Tamiflu) may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. A clear liquid diet is not necessary for influenza, but maintaining hydration is important. Aspirin is not recommended in children because of increased risk of Reye syndrome. Acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

Question 14

Which consideration is the most important in managing tuberculosis (TB) in children?
A) Skin testing annually
B) Pharmacotherapy
C) Adequate nutrition
D) Adequate hydration

Accepted Answer

Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. Pharmacotherapy is the most important intervention for TB.

Question 15

How is chronic otitis media with effusion (OME) differentiated from acute otitis media (AOM)?
A) A fever as high as 40° C (104° F)
B) Severe pain in the ear
C) Nausea and vomiting
D) A feeling of fullness in the ear

Accepted Answer

OME is characterized by feeling of fullness in the ear or other nonspecific complaints. Fever is a sign of AOM. OME does not cause severe pain. This may be a sign of AOM. Nausea and vomiting are associated with otitis media.

Question 16

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing?
A) Dyspnea
B) Tachypnea
C) Hypopnea
D) Orthopnea

Accepted Answer

Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in an upright position.

Question 17

An infant's parents ask the nurse about preventing OM. Which should be recommended?
A) Avoid tobacco smoke.
B) Use nasal decongestant.
C) Avoid children with OM.
D) Bottle-feed or breastfeed in a supine position.

Accepted Answer

Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

Question 18

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement?
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.

Accepted Answer

The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt but this is not the best answer. The main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

Question 19

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation?
A) Fussiness
B) Coughing
C) A fever over 99° F
D) Signs of an earache

Accepted Answer

If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

Question 20

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test?
A) Every year for all children older than 2 years
B) Every year for all children older than 10 years
C) Every 2 years for all children starting at age 1 year
D) Periodically for children who reside in high-prevalence regions

Accepted Answer

Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Annual testing is not necessary. Testing is not necessary unless exposure is likely or an underlying medical risk factor is present.

Quiz 21: The Child with Respiratory Dysfunction

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition?

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action?

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 which diagnosis?

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which symptom?

When is it generally recommended that a child with acute streptococcal pharyngitis may return to school?

Which type of croup is always considered a medical emergency?

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. What is the priority nursing intervention?

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older?

Which explains why cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of childhood respiratory tract infections?

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions?

Parents have understood teaching about prevention of childhood otitis media if they make which statement?

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature?

A child is diagnosed with influenza. Management includes which recommendation?

Which consideration is the most important in managing tuberculosis (TB) in children?

How is chronic otitis media with effusion (OME) differentiated from acute otitis media (AOM) ?

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing?

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

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement?

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation?

Which frequency is recommended for childhood skin testing for tuberculosis (TB) using the Mantoux test?