The Child with a Respiratory Alteration

MULTIPLE CHOICE

1. A nurse in the labor and delivery room is assessing respirations on a newborn. The nurse understands that which change in the respiratory system occurs postnatally?

a.
Respirations are stimulated by hypoxemia.
b.
It takes up to 48 hours for most of the alveoli to expand.
c.
Surfactant in the lungs interferes with lung expansion.
d.
Pulmonary blood flow decreases after birth.

ANS: A

A postnatal change in the respiratory system is the stimulation of respiration by hypoxemia, hypercarbia, cold, tactile stimulation, and a possible decrease in the concentration of prostaglandin E2. Inflation of the normal lung is complete within a few breaths, and most alveoli have expanded within the first hour of life. Surfactant in the lungs lowers surface tension and facilitates lung expansion. Pulmonary blood flow increases after birth.

DIF: Cognitive Level: Comprehension REF: p. 482

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

2. Which information should the nurse teach families about reducing exposure to pollens and dust?

a.
Replace wood and tile floors with wall-to-wall carpeting.
b.
Do not use an air conditioner.
c.
Put dust-proof covers on pillows and mattresses.
d.
Keep humidity in the house above 60%.

ANS: C

Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep windows closed and to run the air conditioner. A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house.

DIF: Cognitive Level: Application REF: p. 486

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

3. 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 these symptoms are characteristic of which respiratory condition?

a.
Allergic rhinitis
b.
Bronchitis
c.
Asthma
d.
Sinusitis

ANS: D

Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a low-grade fever, nasal congestion and purulent nasal discharge, headache, tenderness, a feeling of fullness over the affected sinuses, halitosis, and a cough that increases when the child is lying down. The classic symptoms of allergic rhinitis are watery rhinorrhea, itchy nose, eyes, ears, and palate, and sneezing. Symptoms occur as long as the child is exposed to the allergen. Bronchitis is characterized by a gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough. The manifestations of asthma may vary, with wheezing being a classic sign. The symptoms presented in the question do not suggest asthma.

DIF: Cognitive Level: Comprehension REF: p. 487

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

4. The child with chronic otitis media with effusion should be evaluated for which problem?

a.
Brain abscess
b.
Meningitis
c.
Hearing loss
d.
Perforation of the tympanic membrane

ANS: C

Chronic otitis media with effusion is the most common cause of hearing loss in children. The infection of acute otitis media can spread to surrounding tissues, causing a brain abscess or meningitis. Inflammation and pressure from acute otitis media may result in perforation of the tympanic membrane.

DIF: Cognitive Level: Analysis REF: p. 491

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

5. The nurse should expect 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, several times a day for 7 days.
c.
pneumococcal conjugate vaccine.
d.
myringotomy with tympanoplasty tubes.

ANS: A

For select children 6 months of age or older with acute otitis media, as an alternative to initiating antibiotic therapy, once diagnosed, acute otitis media is treated by initiating symptomatic treatment and observation for 48 to 72 hours. Acute otitis media may be treated with a 5- to 10-day course of oral antibiotics. When treatment is indicated, amoxicillin at a divided dose of 80 to 90 mg/kg/day given either every 8 or 12 hours for 5 to 10 days may be ordered. Pneumococcal conjugate vaccine helps to prevent ear infections but is not included in the initial plan of care for a child with acute otitis media. Surgical intervention is considered when the child has persistent ear infections despite antibiotic therapy or with otitis media with effusion that persists for more than 3 months and is associated with hearing loss.

DIF: Cognitive Level: Comprehension REF: p. 488

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

6. Which statement made by a parent indicates 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.”

ANS: C

Streptococcal pharyngitis is best treated with oral penicillin two to three times daily for 10 days. Surgical removal of the tonsils is a controversial issue. It may be warranted in cases of recurrent tonsillitis. It is not indicated for the treatment of acute tonsillitis. Comfort measures such as rest and analgesics are indicated, but these will not treat the bacterial infection. Corticosteroids are not used in the treatment of streptococcal pharyngitis.

DIF: Cognitive Level: Application REF: p. 493

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

7. A nurse is planning care for a child with laryngomalacia. Which symptom should the nurse plan to assess that is characteristic of laryngomalacia?

a.
Stridor
b.
High-pitched cry
c.
Nasal congestion
d.
Irritability

ANS: A

Stridor is usually present at birth but may begin as late as 2 months. Symptoms increase when the infant is supine or crying. High-pitched cries are consistent with neurological abnormalities and are not usually respiratory in nature. Nasal congestion is nonspecific in relation to laryngomalacia. Irritability often occurs with respiratory illnesses; however, it is not the most characteristic symptom of laryngomalacia.

DIF: Cognitive Level: Application REF: p. 495

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

8. The nurse should assess a child who has had a tonsillectomy for which problem?

a.
Frequent swallowing
b.
Inspiratory stridor
c.
Rhonchi
d.
Elevated white blood cell count

ANS: A

Frequent swallowing is indicative of postoperative bleeding. Inspiratory stridor is characteristic of croup. Rhonchi are lower airway sounds indicating pneumonia. Assessment of blood cell counts is part of a preoperative workup.

DIF: Cognitive Level: Application REF: p. 494

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

9. A nurse is teaching parents about manifestations of spasmodic croup. Which is a distinguishing manifestation of spasmodic croup that should be included in the teaching session?

a.
It has a gradual onset.
b.
It is characterized a harsh barky cough.
c.
It is bacterial in nature.
d.
The child has a high fever.

ANS: B

Spasmodic croup is viral in origin with a sudden onset usually at night of a harsh, metallic, barky cough, sore throat, inspiratory stridor, and hoarseness. A gradual onset is indicative of laryngotracheobronchitis. A high fever is not usually present.

DIF: Cognitive Level: Application REF: p. 495

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

10. 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.
Sit with the child in the bathroom with the shower on when an attack occurs.
d.
Give the child an antibiotic at bedtime.

ANS: C

Sitting in the bathroom with the shower on provides humidity for the child, which usually improves symptoms in croup. Decongestants are inappropriate for croup, which affects the mid airway level. A dry environment may contribute to symptoms. Croup is caused by a virus. Antibiotic treatment is not indicated.

DIF: Cognitive Level: Application REF: p. 495

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

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.

ANS: A

The 5-year-old child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. If epiglottitis is suspected, the nurse would never examine the child’s throat. Inspection of the epiglottis is done only by a physician because it could trigger airway obstruction. A throat culture could precipitate a complete respiratory obstruction. Vital signs can be assessed after emergency equipment is readied.

DIF: Cognitive Level: Analysis REF: p. 498

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

12. Which action for care 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 a favorite warm liquid drink.
c.
Use a warm mist humidifier.
d.
Call the physician for a respiratory rate less than 28 breaths/minute.

ANS: B

Offering the child favorite fluids will facilitate oral intake. Warm liquids are preferable as they help loosen secretions. Cool mist humidifiers are preferred to warm mist humidifiers. Warm mist is a safety concern and could cause burns if touched by the child. Typically parents are not taught to count their children’s respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of less than 28 breaths/minute is normal for a 3-year-old child. The expected respiratory rate for a 3-year-old child is 20 to 30 breaths/minute.

DIF: Cognitive Level: Application REF: p. 502|p. 504

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

13. Which sign is indicative of respiratory distress in infants?

a.
Nasal flaring
b.
Respiratory rate of 55 breaths/minute
c.
Irregular respiratory pattern
d.
Abdominal breathing

ANS: A

Infants have difficulty breathing through their mouths; therefore, nasal flaring is usually accompanied by extra respiratory efforts. It also allows more air to enter as the nares flare. A respiratory rate of 55 breaths/minute would be a normal assessment for an infant. Tachypnea would be a respiratory rate of 60 to 80 breaths/minute. Irregular respirations are normal in the infant. Abdominal breathing is common because the diaphragm is the neonate’s major breathing muscle.

DIF: Cognitive Level: Analysis REF: p. 482|p. 502

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

14. Once an allergen is identified in a child with allergic rhinitis, what would be the treatment of choice?

a.
Use appropriate medications.
b.
Begin desensitization injections.
c.
Eliminate the allergen.
d.
Remove the adenoids.

ANS: C

The first priority is to attempt to remove the causative agent from the child’s environment. Medications are not a first-line treatment but can be helpful in controlling allergic rhinitis. Immunotherapy is usually the final component of controlling allergic rhinitis. Adenoids are tissues that can swell with constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the cause is the first priority.

DIF: Cognitive Level: Comprehension REF: p. 486

OBJ: Nursing Process Step: Planning MSC: Health Promotion and Maintenance

15. A child has returned to the postsurgical floor after having had a tonsillectomy. Which assessment finding should the nurse report to the physician?

a.
Vomiting bright red blood
b.
Pain at the surgical site
c.
Pain on swallowing
d.
The ability to only take small sips of liquids

ANS: A

Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should be reported to the physician. It is normal for the child to have pain at the surgical site and on swallowing. Only clear liquids are offered immediately after surgery, and small sips would be preferred.

DIF: Cognitive Level: Application REF: pp. 493-494

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

16. Teaching safety precautions with the administration of antihistamines is important due to which common side effect?

a.
Dry mouth
b.
Excitability
c.
Drowsiness
d.
Dry mucous membranes

ANS: C

Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver. Nonsedating brands should be used. A dry mouth is not a safety issue. Excitability may affect rest or sleep, but drowsiness is the most important safety hazard. Dry mucous membranes are not a safety issue.

DIF: Cognitive Level: Comprehension REF: p. 486

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

17. Which 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

ANS: D

The child can have clear, cool liquids when fully awake. The child can have full liquids on the second postoperative day. Citrus drinks are not offered because they can irritate the throat. Red liquids are avoided because they give the appearance of blood if vomited.

DIF: Cognitive Level: Application REF: p. 494

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

18. Which intervention should the nurse implement as a priority in the management of a child with epiglottitis?

a.
Adequate hydration
b.
Maintaining a patent airway
c.
Cessation of coughing
d.
Decreasing fever

ANS: B

Epiglottitis can rapidly progress to complete airway obstruction and death. The goal of treatment is to maintain a patent airway. The child with epiglottitis will not be able to take fluids orally. Hydration is a concern, but not the priority. Cough is not a symptom of epiglottitis. The child with epiglottitis will have an elevated temperature. Reducing fever is not the priority of care.

DIF: Cognitive Level: Application REF: p. 499

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

19. What information should the nurse teach workers at a day care center about respiratory syncytial virus (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 hand washing can decrease the spread of the virus.

ANS: D

Meticulous hand washing can decrease the spread of organisms. RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour and can live on cribs and other nonporous surfaces for up to 6 hours.

DIF: Cognitive Level: Application REF: p. 502

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

20. 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.

ANS: D

Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. The etiology of bronchiolitis is viral. Antibiotics are given only if there is a secondary bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given parenterally to prevent dehydration.

DIF: Cognitive Level: Application REF: p. 501

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

21. The nurse is caring for a child hospitalized for status asthmaticus. Which assessment finding suggests that the child’s condition is worsening?

a.
Hypoventilation
b.
Thirst
c.
Bradycardia
d.
Clubbing

ANS: A

The nurse would assess the child for signs of hypoxia, including restlessness, fatigue, irritability, and increased heart and respiratory rate. As the child tires from the increased work of breathing hypoventilation occurs leading to increased carbon dioxide levels. The nurse would be alert for signs of hypoxia. Thirst would reflect the child’s hydration status. Bradycardia is not a sign of hypoxia; tachycardia is. Clubbing develops over a period of months in response to hypoxia. The presence of clubbing does not indicate the child’s condition is worsening.

DIF: Cognitive Level: Analysis REF: p. 518

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

22. Which finding is expected when assessing a child hospitalized for asthma?

a.
Inspiratory stridor
b.
Harsh, barky cough
c.
Wheezing
d.
Rhinorrhea

ANS: C

Wheezing is a classic manifestation of asthma. Inspiratory stridor is a clinical manifestation of croup. A harsh, barky cough is characteristic of croup. Rhinorrhea is not associated with asthma.

DIF: Cognitive Level: Comprehension REF: p. 512

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

23. 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.”

ANS: B

Latex balloons account for a significant number of deaths from aspiration every year. Keeping toys with small parts and other small objects out of reach can prevent foreign body aspiration. Peanuts are just one of the foods that pose a choking risk if given to young children. Small objects, such as coins, need to be put out of the small child’s reach.

DIF: Cognitive Level: Application REF: p. 505

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

24. A nurse is teaching a class to parents on respiratory distress syndrome (RDS). Which statement about RDS indicates the parents understood the teaching?

a.
Factors causing chronic fetal stress increase the incidence of RDS.
b.
RDS is the leading cause of respiratory failure in premature infants.
c.
RDS is caused by an overproduction of surfactant in fetal development.
d.
The incidence of RDS is significantly lower as gestational age decreases.

ANS: B

RDS is the leading cause of respiratory failure in premature infants. Things that tend to cause chronic fetal stress, such as maternal hypertension, drug abuse, and prolonged rupture of membranes, decrease the incidence of hyaline membrane disease. RDS occurs in infants with insufficient amounts of surfactant or immature lung development. The incidence of RDS increases as gestational age decreases.

DIF: Cognitive Level: Comprehension REF: p. 507

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

25. What is a common trigger for asthma attacks in children?

a.
Febrile episodes
b.
Dehydration
c.
Exercise
d.
Seizures

ANS: C

Exercise is one of the most common triggers for asthma attacks, particularly in school-age children. Febrile episodes are consistent with other problems, for example, seizures. Dehydration occurs as a result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for asthma. Seizures can result from a too-rapid intravenous infusion of theophylline—a therapy for asthma.

DIF: Cognitive Level: Comprehension REF: p. 514

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

26. Which child would require 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 babysitter is diagnosed with tuberculosis
d.
The premature infant who is being treated for apnea of infancy

ANS: C

The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. Nighttime wheezing and coughing are consistent with a diagnosis of asthma. Allergic rhinitis would require an allergy workup. The premature infant who is being treated for apnea of infancy would require a sleep study as part of the evaluation.

DIF: Cognitive Level: Analysis REF: p. 527

OBJ: Nursing Process Step: Assessment MSC: Health Promotion and Maintenance

27. What explanation should the nurse give to a parent of a child with asthma about using a peak flowmeter?

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.

ANS: A

The peak flowmeter is a device used to monitor breathing capacity in the child with asthma; it measures the flow of air in a forced exhalation in liters per minute. A child with asthma would have a pulmonary function test to measure lung volume. A spacer used with a metered dose inhaler prolongs medication transit so medication reaches the airways.

DIF: Cognitive Level: Application REF: p. 513

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

28. 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.”

ANS: B

Sports that do not require sustained exertion, such as gymnastics, baseball, and weight lifting, are well tolerated. Children can usually play any type of sport if their asthma is well controlled. Children with asthma should not be restricted from physical activity. Swimming is recommended as the ideal sport for children with asthma because the air is humidified and exhaling underwater prolongs exhalation and increases end-expiratory pressure.

DIF: Cognitive Level: Application REF: p. 514

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

29. Which response indicates that a school-age child understands the interpretation of peak flowmeter results?

a.
“When my peak flow is in the green zone, I need more medication.”
b.
“The red zone means my peak flow is 80% to 100%.”
c.
“When my peak flow is in the yellow zone, I might need to take more medicine.”
d.
“The yellow zone means I need to take albuterol right away.”

ANS: C

The yellow zone indicates caution. The child’s peak flow is 50% to 80% of his personal best. A temporary increase in medication may be indicated. The green zone indicates all clear. There are no asthma symptoms present. The child’s exhalation is 80% to 100% of his personal best. The red zone is interpreted as a medical alert. The child’s exhalation is below 50% of his personal best. The child should use a bronchodilator immediately. The child would take an immediate bronchodilator if his peak flow is in the red zone.

DIF: Cognitive Level: Application REF: p. 514

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

30. A nurse is admitting a client with an asthma exacerbation. Which drug should the nurse be prepared to administer to relieve an acute asthma episode?

a.
Systemic corticosteroids
b.
Inhaled corticosteroids
c.
Leukotriene blockers
d.
Long-acting bronchodilators

ANS: A

Systemic corticosteroids decrease airway inflammation in an acute asthma attack. They are given for short burst courses of 5 to 7 days. Inhaled corticosteroids are used for long-term, routine control of asthma. Leukotriene blockers diminish the mediator action of leukotrienes and are used for long-term, routine control of asthma in children older than 12 years. A long-acting bronchodilator would not relieve acute symptoms.

DIF: Cognitive Level: Application REF: p. 513|p. 516

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

31. The nurse is getting an end-of-shift report on a child with status asthmaticus. Which intervention should the nurse question?

a.
Administer oxygen at 6 liters by nasal cannula.
b.
Assess intravenous (IV) maintenance fluids and site every hour.
c.
Notify the physician for signs of increasing respiratory distress.
d.
Organize care to allow for uninterrupted rest periods.

ANS: A

Supplemental oxygen should not exceed 2 L/min and 6 L/min exceeds the recommended flow rate for a nasal cannula. Administration of oxygen to a child with chronic carbon dioxide retention may lead to respiratory depression by decreasing the stimulus to breathe. When the child cannot take oral fluids because of respiratory distress, IV fluids are administered. The child with a continuous IV infusion must be assessed hourly to prevent complications. A physician should be notified of any changes indicating increasing respiratory distress. A child in respiratory distress is easily fatigued. Nursing care should be organized so the child can get needed rest without being disturbed.

DIF: Cognitive Level: Analysis REF: p. 518

OBJ: Nursing Process Step: Evaluation MSC: Physiological Integrity

32. Which intervention should be included in the plan of care for a child hospitalized for an exacerbation of cystic fibrosis?

a.
Perform chest physiotherapy 30 minutes after meals.
b.
Administer low-flow oxygen (less than 2 L/min).
c.
Position with the head lower than the rest of the body.
d.
Provide privacy during coughing episodes.

ANS: B

Low-flow oxygen is administered because in children who are chronically hypoxic, too much oxygen can depress respirations. Chest physiotherapy should be scheduled at least 1 hour before or 2 hours after meals to reduce gastrointestinal upset. The head of the bed should be elevated and the child positioned upright to facilitate breathing. The nurse should stay with the child during coughing episodes.

DIF: Cognitive Level: Application REF: p. 518

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

33. 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 he is short of breath.
c.
Use the inhaler 15 minutes before exercise.
d.
Take one to two puffs every morning on awakening.

ANS: C

The appropriate time to use an inhaled beta2-agonist or cromolyn is before an event that could trigger an attack. Two puffs every 6 hours around the clock will not relieve exercise-induced asthma. Waiting until symptoms are severe is too late to begin using a metered-dose inhaler. One to two puffs every morning on awakening may be the child’s usual schedule for medication. If exercise causes symptoms, additional medication is indicated.

DIF: Cognitive Level: Application REF: p. 514|p. 517

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

34. A preterm infant is being discharged from the hospital. Which immunization should the nurse prepare to administer to protect the infant from the respiratory syncytial virus (RSV)?

a.
Pavilizumab (Synagis)
b.
Ribaviran (Virazole)
c.
Hemophilus influenza type B (HIB)
d.
Pneumococcal (Prevnar)

ANS: A

Intramuscular pavilizumab (Synagis) is the immunization administered monthly throughout the RSV season for premature infants (less than 35 weeks of gestation) younger than 6 months. Ribaviran is an antiviral medication used for treatment of severe cases of RSV. The HIB immunization is given to prevent infections caused by Hemophilusinfluenza type B. The Prevnar vaccination prevents pneumonia by the pneumococcal virus.

DIF: Cognitive Level: Knowledge REF: p. 502

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

35. 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.”

ANS: C

Children with cystic fibrosis need to take enzymes with all food for adequate absorption of nutrients. Pancreatic enzymes do not affect the respiratory system and are taken within 30 minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and ineffective for absorption of nutrients. Wheezing is not a reason to stop taking enzyme replacements.

DIF: Cognitive Level: Application REF: p. 525

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

36. Which vitamin supplements are necessary for children with cystic fibrosis?

a.
Vitamin C and calcium
b.
Vitamins B6 and B12
c.
Magnesium
d.
Vitamins A, D, E, and K

ANS: D

Fat-soluble vitamins are poorly absorbed because of deficient pancreatic enzymes in children with cystic fibrosis; therefore, supplements are necessary. Vitamin C and calcium are not fat soluble. B6 and B12 are not fat-soluble vitamins. Magnesium is not a vitamin.

DIF: Cognitive Level: Comprehension REF: p. 525

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

37. Why do infants and young children develop respiratory distress more quickly 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.

ANS: D

The airway in infants and young children is narrower, not wider; respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not produce mucus.

DIF: Cognitive Level: Comprehension REF: p. 482

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

38. Which statement made by a parent would indicate 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.”

ANS: B

Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each pregnancy has a 25% chance of producing a CF-affected child. Cystic fibrosis will not be present if only one parent is a carrier of the cystic fibrosis gene and is known to have a definite pattern of transmission. It is transmitted as an autosomal recessive trait. A carrier parent can transmit the carrier gene to the child. The disease is present when the carrier gene is transmitted from both parents.

DIF: Cognitive Level: Application REF: p. 522

OBJ: Nursing Process Step: Evaluation MSC: Health Promotion and Maintenance

39. A small child with cystic fibrosis cannot swallow pancreatic enzymes capsules. The nurse would teach parents to mix enzymes with which food?

a.
Macaroni and cheese
b.
Tapioca
c.
Applesauce
d.
Hot chocolate

ANS: C

Enzymes can be mixed with a small amount of nonprotein foods, such as applesauce. Macaroni and cheese and tapioca are not good choices because enzymes are inactivated by heat and starchy foods. Enzymes are less effective if mixed with foods that are hot, such as hot chocolate.

DIF: Cognitive Level: Application REF: p. 526

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

40. 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

ANS: A

When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for digestion of nutrients. Vomiting does not affect enzyme dosaging. The child’s weight does not affect enzyme dosaging. Urine output is not relevant to enzyme replacement.

DIF: Cognitive Level: Comprehension REF: p. 526

OBJ: Nursing Process Step: Implementation

MSC: Health Promotion and Maintenance

41. Which finding would confirm a diagnosis of cystic fibrosis?

a.
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.

ANS: C

The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than 60 mEq/L is considered diagnostic for cystic fibrosis. Hyperinflation is one of the first findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a diagnosis. A 72-hour fecal fat determination may be included in a diagnostic workup. Inability to secrete digestive enzymes causes steatorrhea. Liver function tests may be part of the diagnostic workup for cystic fibrosis.

DIF: Cognitive Level: Application REF: p. 524

OBJ: Nursing Process Step: Assessment MSC: Physiological Integrity

MULTIPLE RESPONSE

1. The nurse should provide what information to the parents of a healthy newborn infant to help prevent sudden infant death syndrome (SIDS)? Select all that apply.

a.
Place the infant on his back to sleep.
b.
Use a soft mattress.
c.
Offer a pacifier for sleep.
d.
Bed sharing with parents is recommended.

ANS: A, C

The American Academy of Pediatrics (AAP) recommends the following to help prevent SIDS in infants: place healthy infants on their backs to sleep, use mattresses with a firm sleeping surface, avoid exposing the infant to second-hand smoke, and offer a pacifier for sleep. In addition, bed sharing is not recommended, and parents are advised to put the infant in a safe bassinet or crib in the parent’s room for sleeping.

DIF: Cognitive Level: Comprehension REF: p. 510

OBJ: Nursing Process Step: Comprehension

MSC: Health Promotion and Maintenance

2. 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.

ANS: A, C, E

An infant having apnea should be stimulated by gently tapping the foot. Resuscitative equipment should be available and the infant should be maintained in a neutral thermal environment. The infant should not be shaken vigorously or suctioned.

DIF: Cognitive Level: Application REF: pp. 509-510

OBJ: Nursing Process Step: Implementation MSC: Physiological Integrity

3. A nurse is planning care for an asymptomatic child with a positive tuberculin test. The nurse should include which in the plan? Select all that apply.

a.
Administration of daily isoniazid (INH)
b.
Instructing family members about administration of isoniazid (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 isoniazid (INH) and rifampin (Rifadin) simultaneously

ANS: A, B, D

After a chest radiograph is obtained, asymptomatic children with positive tuberculin tests and no previous history of TB receive daily isoniazid (INH) for 9 months. Asymptomatic contacts should receive INH for at least 8 to 10 weeks after contact has been broken or until a negative skin test can be confirmed (a second test is taken at least 10 weeks after the last exposure). Reporting cases of TB is required by law in all states in the United States. The Bacillus Calmette-Guérin vaccine is the only anti-TB vaccine available, but it is given only to children who test negative. For asymptomatic TB only isoniazid is administered, not both isoniazid and rifampin together. Rifampin is used if the child has resistance to isoniazid.

DIF: Cognitive Level: Application REF: p. 528

OBJ: Nursing Process Step: Planning MSC: Physiological Integrity

SHORT ANSWER

1. Which childhood vaccine has dramatically reduced the incidence of epiglottitis?

ANS:

H. influenzae type B

HIB

DIF: Cognitive Level: Comprehension REF: p. 500

OBJ: Nursing Process Step: Comprehension

MSC: Health Promotion and Maintenance