The Child with Respiratory Dysfunction

1. Which of the following best describes why children 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.

ANS: B
Children have increased immunity after exposure to a virus.

DIF: Cognitive Level: Comprehension REF: Page 755
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

2. Labored breathing is referred to as: a. dyspnea.

b. tachypnea. c. hypopnea. d. orthopnea.

ANS: A
Dyspnea is labored breathing.

DIF: Cognitive Level: Comprehension
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

3. Why are cool-mist vaporizers rather than steam vaporizers recommended in home treatment of respiratory tract infections?
a. They are safer.
b. They are less expensive.

c. Respiratory secretions are dried.
d. A more comfortable environment is produced.

ANS: A
Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam.

REF: Page 757

Test Bank 23-2

DIF: Cognitive Level: Comprehension REF: Page 758
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

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

ANS: A
Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion.

DIF: Cognitive Level: Comprehension REF: Page 758
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

5. What 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.

ANS: D
Preventing dehydration by small frequent feedings is an important intervention in the febrile child.

DIF: Cognitive Level: Application REF: Page 758
TOP: Integrated Process: Nursing Process: Intervention
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

6. The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant:
a. becomes fussy.
b. has a cough.

c. has a fever over 99° F.
d. shows signs of an earache.

ANS: D
If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and should be referred to a practitioner for evaluation.

Test Bank 23-3

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

7. It is generally recommended that a child with acute streptococcal pharyngitis can 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.

ANS: C
After children have taken antibiotics for 24 hours, they are no longer contagious to other children.

DIF: Cognitive Level: Comprehension REF: Page 763
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

8. A child is diagnosed with influenza, probably type A disease. Management includes which of the following?
a. Clear liquid diet for hydration
b. Aspirin to control fever

c. Amantadine hydrochloride to reduce symptoms d. Antibiotics to prevent bacterial infection

ANS: C
Amantadine may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C.

DIF: Cognitive Level: Application REF: Page 765
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

9. Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by which of the following?
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

ANS: D
OME is characterized by feeling of fullness in ear or other nonspecific complaints.

DIF: Cognitive Level: Comprehension REF: Page 766
TOP: Integrated Process: Nursing Process: Problem Identification

Page 762

Test Bank 23-4

MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

10. Which of the following statements is characteristic of AOM? a. The etiology is unknown.
b. Permanent hearing loss often results.
c. It can be treated by intramuscular (IM) antibiotics.

d. It is treated with a broad range of antibiotics.

ANS: D
Historically AOM has been treated with a range of antibiotics. However, new research shows that antibiotics do not improve outcomes in children with uncomplicated AOM.

DIF: Cognitive Level: Comprehension REF: Page 766 | Page 767 TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

11. An 18-month-old child is seen in the clinic with AOM. Trimethoprim- sulfamethoxazole (Bactrim) is prescribed. Which of the following statements made by the parent indicates a correct understanding of the instructions?
a. “I should administer all of 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.”

ANS: A
Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria.

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

12. An infant’s parents ask the nurse about preventing OM. Which of the following should be recommended?
a. Avoid tobacco smoke.
b. Use nasal decongestant.

c. Avoid children with OM.
d. Bottle-feed or breastfeed in supine position.

ANS: A
Eliminating tobacco smoke from the child’s environment is essential for preventing OM and other common childhood illnesses.

DIF: Cognitive Level: Application REF: Page 768
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

Page 767

Test Bank 23-5

13. The nurse is assessing a child with croup. Examining the child’s throat by using a tongue depressor might precipitate which of the following?
a. Inspiratory stridor
b. Complete obstruction

c. Sore throat
d. Respiratory tract infection

ANS: B
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.

DIF: Cognitive Level: Comprehension REF: Page 769
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

14. Which of the following types of croup is always considered a medical emergency? a. Laryngitis

b. Epiglottitis
c. Spasmodic croup
d. Laryngotracheobronchitis (LTB)

ANS: B
Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment.

DIF: Cognitive Level: Comprehension REF: Page 769
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

15. The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse’s rationale for this action is primarily which of the following?
a. Mothers of hospitalized toddlers often experience guilt.

b. The mother’s presence will reduce anxiety and ease child’s respiratory efforts. c. Separation from mother is a major developmental threat at this age.
d. The mother can provide constant observations of the child’s respiratory efforts.

ANS: B
The family’s presence will decrease the child’s distress.

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Psychosocial Adaptation: Coping and Adaptation

Page 771

Test Bank 23-6

16. 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 of the following?

a. Bronchitis
b. Bronchiolitis
c. Viral-induced asthma
d. Acute spasmodic laryngitis

ANS: A
Bronchitis is characterized by these symptoms and occurs in children older than 6 years.

DIF: Cognitive Level: Comprehension REF: Page 772
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

17. Skin testing for tuberculosis (TB) (the Mantoux test) is recommended: 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.

ANS: D
Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years.

DIF: Cognitive Level: Comprehension REF: Page 778
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

18. Which of the following is the most important consideration in managing TB in children?

a. Skin testing
b. Chemotherapy
c. Adequate nutrition d. Adequate hydration

ANS: B
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.

DIF: Cognitive Level: Application REF: Page 780
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

Test Bank 23-7

19. 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 of the following?
a. Gagging
b. Coughing
c. Pulse over 100 beats/min
d. Inability to speak

ANS: D
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.

DIF: Cognitive Level: Application REF: Page 782
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

20. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? a. Force fluids.
b. Monitor pulse oximetry.

c. Institute seizure precautions. d. Encourage high-protein diet.

ANS: B
Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS.

DIF: Cognitive Level: Comprehension REF: Page 783
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

21. The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which of the following is essential in this child’s care?
a. Monitor pulse oximetry.
b. Monitor arterial blood gases.

c. Administer oxygen if respiratory distress develops.
d. Administer oxygen if child’s lips become bright, cherry red.

ANS: B
Arterial blood gases are the best way to monitor carbon monoxide poisoning.

DIF: Cognitive Level: Comprehension REF: Page 783
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

22. Asthma in infants is usually triggered by: a. medications.

b. a viral infection.
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 23-8

c. exposure to cold air.
d. allergy to dust or dust mites.

ANS: B
Viral illnesses cause inflammation that causes increased airway reactivity in asthma.

DIF: Cognitive Level: Comprehension REF: Page 784
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

23. Which of the following statements is the most descriptive of bronchial asthma? a. There is heightened airway reactivity.
b. There is decreased resistance in the airway.
c. The single cause of asthma is an allergic hypersensitivity.

d. It is inherited.

ANS: A
In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function.

DIF: Cognitive Level: Comprehension REF: Page 785
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

24. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following?
a. Asthma
b. Pneumonia

c. Bronchiolitis
d. Foreign body in trachea

ANS: A
Asthma may have these chronic symptoms.

DIF: Cognitive Level: Comprehension REF:
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

25. It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? a. Cough
b. Osteoporosis

c. Slowed growth
d. Cushing syndrome

ANS: C
The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs.

Page 786

Test Bank 23-9

DIF: Cognitive Level: Comprehension REF: Page 788
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

26. β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action?
a. Liquefy secretions
b. Dilate the bronchioles

c. Reduce inflammation of the lungs d. Reduce infection

ANS: B
These medications work to dilate the bronchioles in acute exacerbations.

DIF: Cognitive Level: Comprehension REF: Page 789
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

27. A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend which of the following? a. Soccer
b. Running

c. Swimming d. Basketball

ANS: C
Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming.

DIF: Cognitive Level: Application REF:
TOP: Integrated Process: Teaching/Learning
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

28. Which of the following drugs is usually given first in the emergency treatment of an acute, severe asthma episode in a young child?
a. Ephedrine
b. Theophylline

c. Aminophylline
d. Short-acting â2 agonists

ANS: D
Short-acting β2 agonists are the first treatment in an acute asthma exacerbation.

DIF: Cognitive Level: Application REF: Page 790
Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Page 789

Test Bank

23-10

TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

29. Which statement expresses accurately the genetic implications of cystic fibrosis (CF)?

a. If it is present in a child, both parents are carriers of this defective gene.
b. It is inherited as an autosomal dominant trait.
c. It is a genetic defect found primarily in non-Caucasian population groups.
d. There is a 50% chance that siblings of an affected child also will be affected.

ANS: A
CF is an autosomal recessive gene inherited from both parents.

DIF: Cognitive Level: Comprehension REF: Page 795
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

30. What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus

b. History of poor intestinal absorption
c. Foul-smelling, frothy, greasy stools
d. Recurrent pneumonia and lung infections

ANS: A
The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration.

DIF: Cognitive Level: Comprehension REF: Page 795
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

31. Which of the following tests aid in the diagnosis of CF?
a. Sweat chloride test, stool for fat, chest radiograph films
b. Stool for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis
d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

ANS: A
A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF.

DIF: Cognitive Level: Application REF: Page 797
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

Test Bank

23-11

32. CF is suspected in a toddler. Which of the following tests is essential in establishing this diagnosis?

a. Bronchoscopy
b. Serum calcium
c. Urine creatinine
d. Sweat chloride test

ANS: D
A sweat chloride test result greater than 60 mEq/L is diagnostic of CF.

DIF: Cognitive Level: Comprehension REF: Page 797
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

33. A child with CF receives aerosolized bronchodilator medication. This medication should be administered:
a. before chest physiotherapy (CPT).
b. after CPT.

c. before receiving 100% oxygen. d. after receiving 100% oxygen.

ANS: A
Bronchodilators should be given before CPT to open bronchi and make expectoration easier.

DIF: Cognitive Level: Comprehension REF: Page 798
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

34. A child with CF is receiving recombinant human deoxyribonuclease (rhDNase). This drug:

a. may cause mucus to thicken.
b. may cause voice alterations.
c. is given subcutaneously.
d. is not indicated for children younger than 12 years.

ANS: B
One of the only adverse effects of DNase is voice alterations and laryngitis.

DIF: Cognitive Level: Comprehension REF: Page 798
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

35. Pancreatic enzymes are administered to the child with CF. Nursing considerations should include which of the following?
a. Do not administer pancreatic enzymes if child is receiving antibiotics.

Test Bank

23-12

Decrease dose of pancreatic enzymes if child is having frequent, bulky stools.
Administer pancreatic enzymes between meals if at all possible.
Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of

food taken at the beginning of a meal.

ANS: D
Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole.

DIF: Cognitive Level: Application REF: Page 799
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

36. In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind?
a. Diet should be high in carbohydrates and protein.
b. Diet should be high in easily digested carbohydrates and fats.

c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

ANS: A
Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption.

DIF: Cognitive Level: Application REF: Page 799
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

37. Cardiopulmonary resuscitation (CPR) is begun on a toddler. Which of the following pulses is usually palpated because it is the most central and accessible?
a. Radial
b. Carotid

c. Femoral d. Brachial

ANS: B
In a toddler, the carotid pulse is palpated.

DIF: Cognitive Level: Comprehension
TOP: Integrated Process: Nursing Process: Assessment
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

38. Which of the following drugs is considered the most useful in treating cardiac arrest? a. Bretylium

b. Lidocaine hydrochloride c. Epinephrine hydrochloride d. Naloxone (Narcan)

REF: Page 805

Test Bank

23-13

ANS: C
Epinephrine works on alpha and beta receptors in the heart and is the most useful drug in cardiac arrest.

DIF: Cognitive Level: Application REF: Page 808
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PharmacologicandParenteral Therapies

39. Effective CPR on a 5-year-old child should include which of the following? a. One breath to every five chest compressions
b. Two breaths to every 15 chest compressions
c. Reassessment of child after 50 cycles of compression and ventilation

d. Reassessment of child every 10 minutes that CPR continues

ANS: A
One breath to five chest compressions is the standard for infants.

DIF: Cognitive Level: Comprehension REF: Page 806
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

40. The Heimlich maneuver is recommended for airway obstruction in children older than:

a. 1 year. b. 4 years. c. 8 years. d. 12 years.

ANS: A
The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. Younger than 1 year, back blows and chest thrusts are administered.

DIF: Cognitive Level: Comprehension REF: Page 809
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

MULTIPLE RESPONSE

1. An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? (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

Test Bank

23-14

Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential.

DIF: Cognitive Level: Comprehension REF: Page 777
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation

2. The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which of the following interventions 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 to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest.
f. Place on noninvasive oxygen monitoring.

ANS: D, E, F
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.

DIF: Cognitive Level: Application REF: Page 774
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

3. The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which of the following actions 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.

ANS: A, C, D
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.

DIF: Cognitive Level: Analysis REF: Page 764
TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:ReductionofRiskPotential

OTHER

Test Bank 23-15

1. 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, what steps should the nurse take? Place in correct order.
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.

ANS:
a, d, f, c, e, b
This is the correct sequence for handling an unconscious child.

DIF: Cognitive Level: Analysis REF: Page 805 | Page 806 TOP: Integrated Process: Nursing Process: Implementation
MSC: AreaofClientNeeds:PhysiologicIntegrity:PhysiologicAdaptation