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1

What sentence below 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. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist them. Secondary infections after viral illnesses include Mycoplasma pneumoniae and groups A and B streptococcal infections.

2

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. Steam dries out respiratory secretions.
d. A more comfortable environment is produced.

ANS: A
Cool-mist vaporizers are safer than steam vaporizers, and limited evidence exists to support the idea that there are any advantages to steam. The costs of cool-mist and steam vaporizers are comparable. Steam loosens secretions, it does not dry them. Both may promote a more comfortable environment, but there is a decreased risk for burns and the growth of organisms in cool-mist vaporizers

3

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Which one of the following instructions for nose drops should be included when teaching the parent?
a. Avoid using drops 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 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. Administering the drops before feedings is more helpful.

4

What is the 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 the child wear heavy clothing to prevent chilling.
d. Give small amounts of favourite fluids frequently to prevent dehydration.

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

5

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant exhibits which one of the following symptoms?
a. Becomes fussy
b. Has a cough
c. Has a fever for more than 10 days
d. Shows signs of an earache

ANS: D
If the child has any pain in the ear or any fluid draining from it, the parent should contact their health care professional. If an infant with nasopharyngitis has a fever over 5 days, not 10 days, the health care professional should be notified. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis.

6

When do physicians generally recommend that a child with acute streptococcal pharyngitis can return to school?
a. When the 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, even if the sore throat persists, they are no longer contagious to other children. Thus, they can return to school at that time. Complications may take days to weeks to develop.

7

Which intervention should be used when providing care to a child diagnosed with Avian influenza?
a. 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 the symptoms related to Avian influenza. It is ineffective against type B or C. 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’s syndrome; acetaminophen or ibuprofen is a better choice. Preventive antibiotics are not indicated for influenza unless there is evidence of a secondary bacterial infection.

8

Chronic otitis media with effusion (OME) is different from acute otitis media (AOM) because OME is usually characterized by which one of the following?
a. Fever as high as 40°C
b. Severe pain in the ear
c. Nausea and vomiting
d. A feeling of fullness in the ear

ANS: D
OME is characterized by an immobile or orange-coloured tympanic membrane, non-specific complaints, and does not usually cause severe pain. Fever and severe pain may be signs of AOM. Nausea and vomiting are not associated with otitis media.

9

Which statement best describes acute otitis media (AOM)?
a. The etiology is unknown.
b. Permanent hearing loss often results.
c. It can be treated by intramuscular antibiotics.
d. It can be treated with antibiotics.

ANS: D
Historically, AOM has been treated with a range of antibiotics, and it is the most common disorder treated with antibiotics in the ambulatory setting. The etiology of AOM may be Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, or a viral agent. Recent concerns about drug-resistant organisms have caused authorities to recommend judicious use of antibiotics and that antibiotics are not required for initial treatment. Permanent hearing loss is not a frequent cause of properly treated AOM. Intramuscular antibiotics are not necessary. Oral amoxicillin is the treatment of choice.

10

An infant’s parents ask the nurse about preventing otitis media (OM). What should the nurse recommend?
a. Avoid tobacco smoke.
b. Use nasal decongestant.
c. Avoid children with OM.
d. Bottle-feed or breastfeed in the supine position.

ANS: A
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 infection symptoms. Children should be fed in an upright position, not supine, to prevent OM.

11

Which type 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 that needs treatment with antibiotics and airway support. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and upper respiratory infection symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

12

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the child’s bedside as much as possible. What is the nurse’s primary reason for this suggestion?
a. Mothers of hospitalized toddlers often experience guilt.
b. The mother’s presence will reduce the child’s anxiety and ease 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.

ANS: B
The family’s presence will decrease the child’s distress. The mother may experience guilt, but this is not the best answer. Although separation from the mother is a developmental threat for toddlers, the main reason to keep parents at the child’s bedside is to ease anxiety, and therefore respiratory effort. The child should have constant cardiorespiratory monitor and non-invasive oxygen saturation monitoring, but the parent should not play this role in the hospital.

13

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. What is this description most suggestive of?
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. Bronchiolitis is rare in children younger 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.

14

When is skin testing for tuberculosis (the Mantoux test) 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 regions with a high prevalence of 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.

15

The mother of a toddler yells to the nurse, “Help! He is choking to death on his food.” What finding causes the nurse to determine that lifesaving measures are necessary?
a. Gagging
b. Coughing
c. Pulse over 100 beats/min
d. Inability to speak

ANS: D
The inability to speak indicates a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed to treat 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.

16

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Which of the following nursing actions should be included in the child’s care?
a. Force fluids.
b. Monitor pulse oximetry.
c. Institute seizure precautions.
d. Encourage a high-protein diet.

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

17

The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What is the most essential part of this child’s care?
a. Monitoring pulse oximetry
b. Monitoring arterial blood gases
c. Administering oxygen if respiratory distress develops
d. Administering oxygen if the child’s lips become bright, cherry red

ANS: B
Arterial blood gases and COHb levels are the best way to monitor CO poisoning. PaO2 monitored with pulse oximetry may be normal in the case of CO poisoning.
100% O2 should be given as quickly as possible, not only if respiratory distress or other symptoms develop.

18

Asthma in infants is usually triggered by which of the following?
a. Medications
b. A viral infection
c. Exposure to cold air
d. Allergy to dust or dust mites

ANS: B
Viral illnesses cause inflammation that result in the increased airway reactivity of asthma. Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. Exposure to cold air may exacerbate already existing asthma. Allergy is associated with asthma, but 20 to 40% of children with asthma have no evidence of allergic disease.

19

A child has a chronic, non-productive cough and diffuse wheezing during the expiratory phase of respiration. What do these symptoms suggest?
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. A foreign body in the trachea

ANS: A
Children with asthma usually have these chronic symptoms. Pneumonia has an acute onset with fever and general malaise. Bronchiolitis is an acute condition caused by a respiratory syncytial virus. A foreign body in the trachea will occur with acute respiratory distress or failure, and maybe stridor.

20

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because they may develop which one of the following?
a. Cough
b. Osteoporosis
c. Slowed growth
d. Cushing’s syndrome

ANS: C
The growth of children on long-term inhaled steroids should be checked frequently (at least every 3 to 6 months) to assess for systemic effects of these drugs. Coughing is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing’s syndrome is caused by long-term systemic steroids.

21

β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. How do these medications act on asthma?
a. They liquefy secretions.
b. They dilate the bronchioles.
c. They reduce inflammation in the lungs.
d. They reduce infection.

ANS: B
These medications work to dilate the bronchioles in acute exacerbations; they do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

22

A parent whose two school-age children have asthma asks the nurse what sports, if any, they can participate in. What sport should the nurse recommend?
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 the water. Exercise-induced bronchospasm is more common in sports that involve endurance such as soccer, running, and basketball. Prophylaxis with medications may be necessary.

23

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-White population groups.
d. There is a 50% chance that siblings of an affected child will also be affected.

ANS: A
Cystic Fibrosis (CF) is an autosomal recessive gene inherited from both parents, and is found primarily in White populations. An autosomal recessive inheritance pattern means that there is a 25% chance that a sibling will be infected, but a 50% chance a sibling will be a carrier.

24

What is the earliest recognizable clinical manifestation(s) of cystic fibrosis (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. Other clinical manifestations include abdominal distention, vomiting, failure to pass stools, and the rapid development of dehydration. History of malabsorption is a later sign that manifests as failure to thrive. Foul-smelling stools and recurrent respiratory infections are other later manifestations of CF.

25

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential to confirm 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. Although bronchoscopy is helpful for identifying bacterial infection in children with CF, it is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

26

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (rhDNase). Which of the following statements is true about this drug?
a. It may cause mucus to thicken.
b. It may cause voice alterations.
c. It is given subcutaneously.
d. It is not indicated for children younger than 12 years.

ANS: B
Two of the only adverse effects of DNase are voice alterations and laryngitis. DNase decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger than 12 years of age.

27

What should a nurse know when administering pancreatic enzymes to a child with cystic fibrosis?
a. Do not administer pancreatic enzymes if the child is receiving antibiotics.
b. Decrease the dose of pancreatic enzymes if the child is having frequent, bulky stools.
c. Administer pancreatic enzymes between meals if at all possible.
d. 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. Pancreatic enzymes are not a contraindication for antibiotics. The dose of enzymes should be increased if the child is having frequent, bulky stools.

28

In providing nourishment for a child with cystic fibrosis (CF), which factor 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.

ANS: A
Children with CF require a well-balanced, high-protein, high-calorie diet because they have impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important, and fats and proteins are a necessary part.

29

Cardiopulmonary resuscitation is begun on a toddler. Which pulse 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. The radial pulse is not considered a central pulse. The femoral pulse is not the most central and accessible. The brachial pulse is felt in infants younger than 1 year.

30

Which drug is considered to be the most useful for treating cardiac arrest?
a. Bretylium
b. Lidocaine hydrochloride
c. Epinephrine hydrochloride
d. Naloxone (Narcan)

ANS: C
Epinephrine HCl works on α- and β-receptors in the heart, and is the most useful drug in cardiac arrest. Bretylium is no longer used in pediatric cardiac arrest management. Lidocaine HCl is used for ventricular arrhythmias only. Naloxone is useful only to reverse the effects of opioids.