Unit L-Pediatric Respiratory Flashcards
(38 cards)
Which statement 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 invading organisms. Secondary infections after viral illnesses include
Mycoplasma pneumoniae and groups A and B streptococcal infections.
Instructions for decongestant nose drops should include what recommendation?
a. Avoiding use for more than 3 days.
b. Keeping drops to use again for nasal congestion.
c. Administering drops until nasal congestion subsides.
d. Administering drops after feedings and at bedtime.
ANS: A
Vasoconstrictive nose drops should not be used for more than 3 days to avoid rebound
congestion. Drops should be discarded after one illness because they may become
contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3
days of use. Drops administered before feedings are more helpful
When caring for an infant with an upper respiratory tract infection and elevated temperature,
which appropriate nursing intervention should the nurse implement?
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. Tepid water baths may induce shivering, which raises temperature. Food should not be
forced; it may result in the child vomiting. The febrile child should be dressed in light, loose
clothing.
When should the parent of an infant with nasopharyngitis be instructed to notify the health care professional? 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 has a fever over 101° F, there is early evidence of respiratory
complications. Irritability and a slight fever are common in an infant with a viral illness.
Cough can be a sign of nasopharyngitis.
When it is generally recommended that a child being treated for acute streptococcal pharyngitis may 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. Complications may take days to weeks to develop.
An 8-year-old child is diagnosed with influenza, probably type A disease. What intervention
should be included in the plan of care?
a. Clear liquid diet for hydration
b. Aspirin to control fever
c. Oseltamivir to reduce symptoms
d. Antibiotics to prevent bacterial infection
ANS: C
Oseltamivir may reduce symptoms related to influenza type A if administered within 48 hours
of onset of symptoms. It is effective against type A or B. 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.
A nurse providing care to a child diagnosed with chronic otitis media with effusion (OME) will assess for which sign/symptom? 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 an immobile or orange-discolored tympanic membrane and
nonspecific complaints of fullness in the ear. OME does not generally cause severe pain.
Fever and severe pain may be signs of AOM. Nausea and vomiting are associated with otitis
media.
An infant’s parents ask the nurse about preventing otitis media (OM). What intervention
should the nurse recommend?
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. 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 to prevent OM
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 needing antibiotics and airway support for
treatment. 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.
The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to
stay at the bedside as much as possible. What is the nurse’s primary rationale for this action?
a. Mothers of hospitalized toddlers often experience guilt.
b. The mother’s presence will reduce anxiety and ease the child’s respiratory efforts.
c. Separation from the mother is a major developmental threat at this age.
d. The mother can provide constant observations of the child’s respiratory efforts.
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 monitoring and
noninvasive oxygen saturation monitoring, but the parent should not play this role in the
hospital.
A school-age child has 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 assessment is most suggestive of what respiratory airway
disorder?
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 older than 2 years. Asthma is a chronic inflammation of the
airways that may be exacerbated by a virus. Acute spasmodic laryngitis occurs in children
between 3 months and 3 years.
The nurse is caring for a child diagnosed with acute respiratory distress syndrome (ARDS)
associated with sepsis. What nursing intervention should be included in the plan of 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 tool in the care of the child
with ARDS. Maintenance of vascular volume and hydration is important and should be done
parenterally. Seizures are not a side effect of ARDS. Adequate nutrition is necessary, but a
high-protein diet is not helpful.
The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke
inhalation. What intervention is essential in this child’s care?
a. Monitor pulse oximetry
b. Monitor arterial blood gases (ABGs)
c. Administer oxygen if respiratory distress develops
d. Administer oxygen if child’s lips become bright, cherry red
ANS:B
Arterial blood gases (ABGs) 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. Oxygen at
100% should be given as quickly as possible, not only if respiratory distress or other
symptoms develop.
A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase
of respiration. This suggests which respiratory condition?
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign body in the trachea
ANS: A
Children with asthma usually have these chronic symptoms. Pneumonia appears with an acute
onset and fever and general malaise. Bronchiolitis is an acute condition caused by respiratory
syncytial virus. Foreign body in the trachea will manifest with acute respiratory distress or
failure and maybe stridor.
It is now recommended that children with asthma who are taking long-term inhaled steroids
should be assessed frequently to monitor for what increased risk?
a. Cough
b. Osteoporosis
c. Slowed growth
d. Cushing’s syndrome
ANS: C
The growth of children on long-term inhaled steroids should be assessed frequently to assess
for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists
that inhaled steroids cause osteoporosis. Cushing’s syndrome is caused by long-term systemic
steroids.
-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma
attack for what resulting action?
a. Liquefaction of secretions
b. Dilation of the bronchioles
c. Reduction of inflammation of the lungs
d. Reduction of existing infection
ANS: B
These medications work to dilate the bronchioles in acute exacerbations. These medications
do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce
inflammation in the lungs.
A parent whose two school-age children diagnosed with exercise-induced bronchospasm
(EIB) asks the nurse in what sports, if any, they can participate. The nurse should recommend
which sport?
a. Soccer
b. Running
c. Swimming
d. Basketball
ANS: C
Swimming is well tolerated in children with EIB because they are breathing air fully saturated
with moisture and because of the type of breathing required in swimming. Exercise-induced
bronchospasm is more common in sports that involve endurance, such as soccer, running, and
basketball. Prophylaxis with medications may be necessary
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 and is found primarily in
Caucasian 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.
What are the earliest recognizable clinical manifestations 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. Clinical manifestations include abdominal distention, vomiting, failure to
pass stools, and 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
later manifestations of CF.
Cystic fibrosis (CF) is suspected in a toddler. Which test 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. 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.
A child diagnosed with cystic fibrosis is prescribed recombinant human deoxyribonuclease
(rhDNase). What information should be included in the medication education provided the
child and family?
a. May cause mucus to thicken
b. May cause minor voice alterations
c. Is given subcutaneously
d. Is not indicated for children younger than 12 years
ANS: B
Two of the only adverse effects of rhDNase are voice alterations and laryngitis. rhDNase
decreases viscosity of mucus, is given in an aerosolized form, and is safe for children younger
than 12 years of age
Pancreatic enzymes are administered to the child with cystic fibrosis. What information
should be included in patient education concerning the administration of these enzymes?
a. Do not administer pancreatic enzymes if the child is receiving antibiotics.
b. Decrease 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 or swallowed whole at the
beginning of a meal, not between meals. Pancreatic enzymes are not contraindicated with
antibiotics. The dose of enzymes should be increased if the child is having frequent, bulky
stools.
In providing nourishment for a child with cystic fibrosis (CF), what diet consideration should
be stressed to both the child and caregivers?
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. Enzyme supplementation helps digest foods; other modifications are not
necessary. A well-balanced diet containing fruits and vegetables is important. Fats and
proteins are a necessary part of a well-balanced diet.
Abdominal thrusts are recommended for airway obstruction in children older than:
a. 1 year.
b. 4 years.
c. 8 years.
d. 12 years.
ANS: A
Abdominal thrusts are recommended for airway obstruction in children older than 1 year. In
children younger than 1 year, back blows and chest thrusts are administered
