Question 1

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.)
A) Place in a mist tent.
B) Administer antibiotics.
C) Administer cough syrup.
D) Encourage the child to drink 8 ounces of formula every 4 hours.
E) Cluster care to encourage adequate rest.
F) Place on noninvasive oxygen monitoring.

Accepted Answer

Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

Question 2

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made?
A) "I will record the average of the readings."
B) "I should be sitting comfortably when I perform the readings."
C) "I will record the readings at the same time every day."
D) "I will repeat the routine two times."

Accepted Answer

Instructions for use of a peak flowmeter include standing up straight before performing the reading, recording the highest of the three readings (not the average), measuring the peak expiratory flow rate (PEFR) close to the same time each day, and repeating the entire routine three times, waiting 30 seconds between each routine.

Question 3

A nurse is interpreting the results of a child's peak expiratory flow rate. Which percentage, either at this number or less than this number, is considered to be a red zone? (Record your answer in a whole number.)

Accepted Answer

The answer of A nurse is interpreting the results of...

Question 4

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.)
A) Positioning child on the right side
B) Assessing the chest tube and drainage device for correct settings
C) Administering prescribed doses of analgesia
D) Clamping the chest tube when child ambulates
E) Monitoring for need of supplemental oxygen

Accepted Answer

Nursing care of the child with a chest tube requires close attention to respiratory status; the chest tube and drainage device used are monitored for proper function (i.e., drainage is not impeded, vacuum setting is correct, tubing is free of kinks, dressing covering chest tube insertion site is intact, water seal is maintained, and chest tube remains in place). Movement in bed and ambulation with a chest tube are encouraged according to the child's respiratory status, but children require frequent doses of analgesia. Supplemental oxygen may be required in the acute phase of the illness and may be administered by nasal cannula, face mask, flow-by, or face tent. The child should be positioned on the left side, not the right. Lying on the affected side if the pneumonia is unilateral ("good lung up") splints the chest on that side and reduces the pleural rubbing that often causes discomfort. The chest tube should never be clamped; this can cause a pneumothorax. The chest tube should be maintained to the underwater seal at all times.

Question 5

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test?
A) ?5 mm
B) ?10 mm
C) ?15 mm
D) ?20 mm

Accepted Answer

Clinical evidence of a positive TST in children receiving immunosuppressive therapy, including immunosuppressive doses of steroids or who have immunosuppressive conditions, including HIV infection is an induration of ?5 mm. Children younger than 4 years of age: (a) with other medical risk conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition; (b) born or whose parents were born in high-prevalence (TB) regions of the world; (c) frequently exposed to adults who are HIV infected, homeless, users of illicit drugs, residents of nursing homes, incarcerated or institutionalized, or migrant farm workers; and (d) who travel to high-prevalence (TB) regions of the world are positive when the induration is ?10 mm. Children 4 years of age or older without any risk factors are positive when the induration is ?20 mm.

Question 6

The nurse enters a room and finds a 6-year-old child who is unconscious. After calling for help and before being able to use an automatic external defibrillator, which steps should the nurse take? Place in correct order. Provide answer using lowercase letters separated by commas (e.g., a, b, c, d, e, f).
A) Place on a hard surface.
B) Administer 30 chest compressions with two breaths.
C) Feel carotid pulse while maintaining head tilt with the other hand.
D) Use the head tilt-chin lift maneuver and check for breathing.
E) Place heel of one hand on lower half of sternum with other hand on top.
F) Give two rescue breaths.

Accepted Answer

The answer of The nurse enters a room and finds...

Question 7

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status?
A) Continuous
B) Every 30 minutes
C) Every hour
D) Every 2 hours

Accepted Answer

The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring.

Question 8

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.)
A) Cluster care to conserve energy
B) Round-the-clock administration of antitussive agents
C) Strict intake and output to avoid congestive heart failure
D) Administration of antibiotics

Accepted Answer

Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential. Antitussive agents are used sparingly. It is desirable for the child to cough up some of the secretions. Fluids are essential to kept secretions as liquefied as possible.

Question 9

A nurse is caring for a child in acute respiratory failure. Which blood gas analysis indicates the child is still in respiratory acidosis? A) pH 7.50, CO₂ 48 B) pH 7.30, CO₂ 30 C) pH 7.32, CO₂ 50 D) pH 7.48, CO₂ 33

Accepted Answer

Respiratory failure is a process that involves pulmonary dysfunction generally resulting in impaired alveolar gas exchange, which can lead to hypoxemia or hypercapnia. Acidosis indicates the pH is less than 7.35 and the CO₂ is greater than 45. If the pH is less than 7.35 but the CO₂ is low, it is metabolic acidosis. Alkalosis is when the pH is greater than 7.45. If the pH is high and the CO₂ is high, it is metabolic alkalosis. When the pH is high and the CO₂ is low, it is respiratory alkalosis.

Question 10

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.)
A) Notify the surgeon if the child swallows frequently.
B) Apply a heat collar to the child for pain relief.
C) Place the child on the abdomen until fully wake.
D) Allow the child to have diluted juice after the procedure.
E) Encourage the child to cough frequently.

Accepted Answer

Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure. An ice collar should be used after surgery. Frequent coughing and nose blowing should be avoided.

Question 11

Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate?
A) Level of parents' education
B) Presence of two parents in the home
C) Preparation and training of family
D) Family's ability to assume all health care costs

Accepted Answer

One of the essential elements is the family's training and preparation. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

Quiz 21: The Child with Respiratory Dysfunction

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which intervention should be included in the child's care? (Select all that apply.)

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made?

A nurse is interpreting the results of a child's peak expiratory flow rate. Which percentage, either at this number or less than this number, is considered to be a red zone? (Record your answer in a whole number.)

A nurse is caring for a school-age child with left unilateral pneumonia and pleural effusion. A chest tube has been inserted to promote continuous closed chest drainage. Which interventions should the nurse implement when caring for this child? (Select all that apply.)

A nurse is interpreting the results of a tuberculin skin test (TST) on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test?

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status?

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which interventions? (Select all that apply.)

A nurse is caring for a child in acute respiratory failure. Which blood gas analysis indicates the child is still in respiratory acidosis?

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which action should the nurse include in the child's postoperative care plan? (Select all that apply.)

Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate?