Chp 40
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates:
soothing inflamed mucous membrane.
The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By
humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.
It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent:
acute rheumatic fever.
Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for
glomerulonephritis, not nephritic syndrome. Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute
glomerulonephritis.
When caring for a child after a tonsillectomy, the nurse should:
watch for continuous swallowing.
This is the most obvious early sign of bleeding from the operative site. Gargling should be avoided because of potential trauma to the suture line. The child
should be positioned on the side or abdomen to facilitate drainage. Cold is preferred. Ice collars and cold liquids are encouraged.
A 4-year-old girl is brought to the emergency room. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insists on sitting
upright. The nurse should:
notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will
increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a
froglike cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C. The nurse suspects croup and should
recommend:
trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of
respiratory distress and tell them to come to the emergency room if they develop. Cool mist is recommended to provide relief. Cough suppressants are not
indicated. This is characteristic of laryngotracheobronchitis, not epiglottitis.
An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to:
prevent respiratory syncytial virus (RSV) infection.
Synagis is a monoclonal antibody specific for RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of
RSV. It will not affect the need to isolate the child if RSV develops. The antibody is specific to RSV, not bacterial infection. This will have no effect on
antiviral agents.
A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:
assess the severity of asthma.
Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm,
and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully
exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child’s baseline.
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he
use a:
spacer.
The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and
breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flow meter is a
measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration.
One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection:
can trigger an episode or aggravate an asthmatic state.
The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of
respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be
kept clean.
Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is:
mechanical obstruction caused by increased viscosity of mucous gland secretions.
Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is
not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic
fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The
nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of:
pneumothorax.
The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. He or she needs to be seen as soon as possible. Bronchodilation
and carbon dioxide retention would not produce the symptoms listed. Bronchodilation and carbon dioxide retention would not produce the symptoms listed.
The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.
Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary?
A, D, E, K
,C is not one of the fat-soluble vitamins. D also needs to be supplemented. A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher
doses. C and folic acid are not fat soluble.
An immediate intervention when an infant chokes on a piece of food would be to:
position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades.
The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. This is the correct initial sequence of
actions for an infant with an obstructed airway. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child’s respiratory
system. If the child’s airway is obstructed, the water will not be able to pass. This will increase the risk of aspiration.
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these
categories include: (Select all that apply.)
lung function.
frequency of symptoms.
frequency and severity of exacerbations.
The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for
classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish
the categories of asthma do not include other allergies.
A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward.
Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.)
Vital signs
Medical history
Assessment of breath sounds
Emergency airway equipment readily available
Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization
status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway
equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected.
Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.
A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:
assess the severity of asthma.
The PEFR measures the maximum amount of air that can be forcefully exhaled in one minute. This can provide an objective measure of pulmonary function
when compared to the child's baseline. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of
asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing.
The health care provider prescribes acetaminophen (Tylenol) to the child with a respiratory tract infection. What instructions should the nurse provide the
parents about the administration of the medicine? Select all that apply.
"Administer the drug at correct intervals."
"Read the label on the medicine before administering."
"Calculate the dose as prescribed."
If the health care provider prescribes acetaminophen, it is necessary to teach the parents about the administration of the medicine. The nurse instructs the
parents to administer the dose at the correct interval for effective drug action. The nurse advises the parents to read the label on the medication so that there is
no medication error. The nurse teaches the parent to calculate the dose as prescribed to prevent overdose and ensure safety. Information about the composition
and the brand of the medicine are not required. It does not affect the treatment.
A child's tonsils and pharynx are inflamed and covered with exudate. The primary health care provider performs a throat culture. How should the nurse explain
the diagnostic test to the concerned parent?
"It is a way to test for Group A Beta-hemolytic Streptococcal Infections or GABHS."
A throat culture or rapid streptococcal identification test is done to rule out Group A Beta-hemolytic streptococcal infections or GABHS. It is not possible to
diagnose bacterial tracheitis, an infection of the mucosa of the upper trachea with this test, because bacterial tracheitis is also caused by M. catarrhalis, S.
pneumonia, and H. influenzae. Common cold occurs due to rhinovirus or enteroviruses. This is virus and not a bacterium, and thus a throat culture is not done.
Similarly, bronchiolitis is an acute viral infection that cannot be detected with this test.
A child in the school frequently puts foreign objects in their mouth. What should be the most appropriate action by the nurse?
Educate parents alone or in groups about hazards of aspiration.
The nurse should educate parents about the hazards of aspiration. This will help them teach their child not to put pins, nails, and toothpicks, in theirlips or
mouth,and thus avoid danger of trauma to the trachea. It is not necessary to take the child immediately for any test, unless the nurse identifies any symptoms of
trauma. Consulting the primary health care provider would also be necessary only if the child is sick. Most nurses are aware of different hazards of diseases.
Only if the nurses in school are not, they would need to be educated.
A child presents with chest pain, labored respirations, and decreased oxygen saturation. After diagnosis, the primary health care provider diagnosis the child
with a pneumothorax. How should the nurse explain this condition to the child's parents? "Your child:
"Has an accumulation of air in the pleural space that causes respiratory distress."
A pneumothorax is a condition in which air accumulates in the pleural space, which increases the intrapleural pressure. It becomes difficult for the patient to
expand the affected lung. Dyspnea, chest pain, labored respirations, and decreased oxygen saturation are some of the clinical manifestations of this condition.
Acute inflammation of the trachea and bronchi is a condition known as bronchiolitis. It occurs due to the M. pneumonia bacteria. A dry, hacking, and
nonproductive cough are the symptoms. Epiglottitis is a completely different condition from pneumothorax when the throat becomes red and inflamed, and
distinctively large. In addition, LTB and epiglottitis cannot occur together.
Parents of a child with nasal congestion ask the nurse about using saline nose drops in order to clear the nasal passages. What should be the nurse's response to
explain the procedure of how to prepare the saline drops? "You can dissolve:
, "1 teaspoon of salt in 1 pint of warm water."
Saline nose drops are used to clear nasal passages. Saline nose drops can be prepared at home by dissolving 1 teaspoon of salt in 1 pint of warm water. Children
older than 6 months use 0.25% phenylephrine. It is not dissolved in water. Similarly, children older than 6 years of age use 1% ephedrine or 0.05%
oxymetazoline. These are medicines prescribed by the primary health care provider.These are not dissolved in warm or cold water to prepare the nose drops.
These medicines are used directly.
A child with bacterial pneumonia is prescribed antibiotics as well as supplemental oxygen. The child also requires sufficient fluids. In addition to this, the child
has chest tube to remove air from the intrathoracic space. What should the nurse include in the plan of care of this child? Select all that apply.
Carefully assess the respiratory status.
Monitor functions of chest tube and drainage device.
Monitor chest tube insertion site to ensure patency.
Nursing care of a child with a chest tube requires constant assessment of the respiratory status to ensure that the chest tube is in position. In addition to this, the
nurse needs to monitor proper functioning of the chest tube and the drainage device. This includes monitoring drainage, so that it is not impeded. The vacuum
setting should be correct and the tubing should be free of kinks. Moreover, chest tube insertion site should always have intact dressing. It can be adjusted as per
the child's requirement but it should remain in place. The nurse does not prescribe medicines to the child.This is done by the primary health care provider.
Pneumococcal conjugate vaccine is administered as a prevention measure. It is approved for use in the children who are aged 6 weeks to 71 months. It is done
to protect against 13 pneumococcal serotypes that cause pneumonia.
A 3-year-old toddler is being discharged post-tonsillectomy and the parents ask what he or she should be allowed to eat and drink. Teaching by the nurse has
been effective if the parents choose which foods and fluids for the first few days at home?
scrambled eggs, banana popsicles, mashed potatoes, sweetened ice tea, and apple juice
Fluids to be avoided include: carbonated drinks, drinks that are red or brown, milk and milk products (cheese, ice cream etc.), citrus drinks, and hot fluids (tea,
soup, etc.). Foods to be avoided include foods with rough edges (toast, crackers, cookies, chips, etc.), anything that has hard edges when cooked (bacon, etc.),
and spicy foods or condiments that are spicy (ketchup, mustard, peppers, etc.). This toddler may have soft/mushy foods such as scrambled eggs, mashed
potatoes, French toast, or pancakes with syrup, which can be soft as long as the edges are trimmed.
Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary?
A, D, E, K
Vitamins A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. Vitamin C is not one of the fat-soluble vitamins. Vitamin D
also needs to be supplemented. Vitamin C and folic acid are not fat soluble.
A child is diagnosed with pulmonary edema and suffering from acute tachydysrhythmia. What should the nurse include in the plan of care as the most
important intervention?
Monitor pulse oximetry
The nursing care for a child with pulmonary edema is the same as that for a child with an acute respiratory condition. The nurse should monitor pulse oximetry
and all the vital signs closely. The results need to be reported to the primary health care provider. Tracheotomy is a surgery in which an incision on the anterior
part of neck is done by a certified primary health care provider. Tracheotomy may be required for children with craniofacial syndromes. In addition, it is not
necessary to administer vaccines for pulmonary edema. Therapy usually includes peak end-expiratory pressure (PEEP) via continuous positive airway pressure
and intubation. Moreover, allergy testing is not prescribed by nor performed by the nurse.
When an infant chokes on a piece of food, an immediate intervention is to:
position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades.
Positing the infant in a head-down, face-down position and administering five quick blows between the shoulder blades is the correct initial sequence of actions
for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction.
Mouth-to-mouth resuscitation should not be used. This may push the object farther into the child's respiratory system. If the child's airway is obstructed, the
water will not be able to pass. This will increase the risk of aspiration.
A child is admitted to the pediatric unit with a respiratory infection. What does the nurse include in a focused assessment? Select all that apply.
Rate, depth, and rhythmof respirations
Heart rate, oxygenation, and temperature
The activity level and level of comfort
Respiratory tract infections are common in children. Infections caused by viruses and bacteria lead to inflammation of the mucosal membranes of the
respiratory tract, which can lead to respiratory distress. Therefore,nursing care should include assessment of the respiratory rate, depth, and rhythm. The nurse
should also assess the heart rate, oxygenation, and temperature of the child.The nurse should assess the child's activity level as well as their level of comfort
and inform the primary health care provider. Normally, fasting blood glucose and hemoglobin are diagnostic blood tests prescribed for a child with diabetes
mellitus. The nurse normally does not assess bladder distention and internal bleeding in a patient with a respiratory tract infection. Respiratory tract infections
have no influence on the circulatory or urinary systems.
The mother of a 6-month-old with a second upper respiratory infection in two and a half months asks the pediatric nurse why these infections are happening so
often at this time. Which response by the nurse is best?
"Your maternal antibodies have been decreasing during this time and your baby hasn't begun making his or her own yet."
This is the time in the infant's life where maternal hormones are decreasing and the infant has not yet manufactured ample amounts of antibodies to ward off
infection. Lymphoid tissue grows in the older child, not in infancy. Thumb sucking and frequent naps do not cause respiratory infections. Eustachian tubes are
short and wide in infancy, allowing organisms to enter the ear more easily.
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these
categories include: Select all that apply.
lung function.
frequency of symptoms.
frequency and severity of exacerbations.
A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates:
soothing inflamed mucous membrane.
The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By
humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed.
It is important that a child with Group A ß-hemolytic streptococci (GABHS) infection be treated with antibiotics to prevent:
acute rheumatic fever.
Otitis media and diabetes insipidus are not sequelae to GABHS. Otitis media and diabetes insipidus are not sequelae to GABHS. Children are at risk for
glomerulonephritis, not nephritic syndrome. Children with Group A ß-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute
glomerulonephritis.
When caring for a child after a tonsillectomy, the nurse should:
watch for continuous swallowing.
This is the most obvious early sign of bleeding from the operative site. Gargling should be avoided because of potential trauma to the suture line. The child
should be positioned on the side or abdomen to facilitate drainage. Cold is preferred. Ice collars and cold liquids are encouraged.
A 4-year-old girl is brought to the emergency room. She has a “froglike” croaking sound on inspiration, is agitated, and is drooling. She insists on sitting
upright. The nurse should:
notify the physician immediately and be prepared to assist with a tracheostomy or intubation.
Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will
increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a
froglike cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37° C. The nurse suspects croup and should
recommend:
trying a cool-mist vaporizer at night and watching for signs of difficulty breathing.
The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of
respiratory distress and tell them to come to the emergency room if they develop. Cool mist is recommended to provide relief. Cough suppressants are not
indicated. This is characteristic of laryngotracheobronchitis, not epiglottitis.
An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to:
prevent respiratory syncytial virus (RSV) infection.
Synagis is a monoclonal antibody specific for RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of
RSV. It will not affect the need to isolate the child if RSV develops. The antibody is specific to RSV, not bacterial infection. This will have no effect on
antiviral agents.
A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:
assess the severity of asthma.
Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm,
and obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully
exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child’s baseline.
A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he
use a:
spacer.
The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and
breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flow meter is a
measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration.
One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection:
can trigger an episode or aggravate an asthmatic state.
The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of
respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be
kept clean.
Cystic fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is:
mechanical obstruction caused by increased viscosity of mucous gland secretions.
Thick mucous secretions are the probable cause of the multiple body system involvement. There is an identified autonomic nervous system anomaly, but it is
not hypoactivity. The sweat glands are not hyperactive. The child loses a greater amount of salt because of abnormal chloride movement. Children with cystic
fibrosis have thick mucous gland secretions. The viscous secretions obstruct small passages in organs such as the pancreas.
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The
nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of:
pneumothorax.
The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. He or she needs to be seen as soon as possible. Bronchodilation
and carbon dioxide retention would not produce the symptoms listed. Bronchodilation and carbon dioxide retention would not produce the symptoms listed.
The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially caused by a pneumothorax.
Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary?
A, D, E, K
,C is not one of the fat-soluble vitamins. D also needs to be supplemented. A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher
doses. C and folic acid are not fat soluble.
An immediate intervention when an infant chokes on a piece of food would be to:
position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades.
The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. This is the correct initial sequence of
actions for an infant with an obstructed airway. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child’s respiratory
system. If the child’s airway is obstructed, the water will not be able to pass. This will increase the risk of aspiration.
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these
categories include: (Select all that apply.)
lung function.
frequency of symptoms.
frequency and severity of exacerbations.
The peak expiratory flow rate is one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for
classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish
the categories of asthma do not include other allergies.
A 5-year-old child is brought to the Emergency Department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward.
Acute epiglottitis is suspected. What are the most appropriate nursing interventions? (Select all that apply.)
Vital signs
Medical history
Assessment of breath sounds
Emergency airway equipment readily available
Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis in addition to knowing immunization
status. Assessment of breath sounds is important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway
equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected.
Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.
A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to:
assess the severity of asthma.
The PEFR measures the maximum amount of air that can be forcefully exhaled in one minute. This can provide an objective measure of pulmonary function
when compared to the child's baseline. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of
asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing.
The health care provider prescribes acetaminophen (Tylenol) to the child with a respiratory tract infection. What instructions should the nurse provide the
parents about the administration of the medicine? Select all that apply.
"Administer the drug at correct intervals."
"Read the label on the medicine before administering."
"Calculate the dose as prescribed."
If the health care provider prescribes acetaminophen, it is necessary to teach the parents about the administration of the medicine. The nurse instructs the
parents to administer the dose at the correct interval for effective drug action. The nurse advises the parents to read the label on the medication so that there is
no medication error. The nurse teaches the parent to calculate the dose as prescribed to prevent overdose and ensure safety. Information about the composition
and the brand of the medicine are not required. It does not affect the treatment.
A child's tonsils and pharynx are inflamed and covered with exudate. The primary health care provider performs a throat culture. How should the nurse explain
the diagnostic test to the concerned parent?
"It is a way to test for Group A Beta-hemolytic Streptococcal Infections or GABHS."
A throat culture or rapid streptococcal identification test is done to rule out Group A Beta-hemolytic streptococcal infections or GABHS. It is not possible to
diagnose bacterial tracheitis, an infection of the mucosa of the upper trachea with this test, because bacterial tracheitis is also caused by M. catarrhalis, S.
pneumonia, and H. influenzae. Common cold occurs due to rhinovirus or enteroviruses. This is virus and not a bacterium, and thus a throat culture is not done.
Similarly, bronchiolitis is an acute viral infection that cannot be detected with this test.
A child in the school frequently puts foreign objects in their mouth. What should be the most appropriate action by the nurse?
Educate parents alone or in groups about hazards of aspiration.
The nurse should educate parents about the hazards of aspiration. This will help them teach their child not to put pins, nails, and toothpicks, in theirlips or
mouth,and thus avoid danger of trauma to the trachea. It is not necessary to take the child immediately for any test, unless the nurse identifies any symptoms of
trauma. Consulting the primary health care provider would also be necessary only if the child is sick. Most nurses are aware of different hazards of diseases.
Only if the nurses in school are not, they would need to be educated.
A child presents with chest pain, labored respirations, and decreased oxygen saturation. After diagnosis, the primary health care provider diagnosis the child
with a pneumothorax. How should the nurse explain this condition to the child's parents? "Your child:
"Has an accumulation of air in the pleural space that causes respiratory distress."
A pneumothorax is a condition in which air accumulates in the pleural space, which increases the intrapleural pressure. It becomes difficult for the patient to
expand the affected lung. Dyspnea, chest pain, labored respirations, and decreased oxygen saturation are some of the clinical manifestations of this condition.
Acute inflammation of the trachea and bronchi is a condition known as bronchiolitis. It occurs due to the M. pneumonia bacteria. A dry, hacking, and
nonproductive cough are the symptoms. Epiglottitis is a completely different condition from pneumothorax when the throat becomes red and inflamed, and
distinctively large. In addition, LTB and epiglottitis cannot occur together.
Parents of a child with nasal congestion ask the nurse about using saline nose drops in order to clear the nasal passages. What should be the nurse's response to
explain the procedure of how to prepare the saline drops? "You can dissolve:
, "1 teaspoon of salt in 1 pint of warm water."
Saline nose drops are used to clear nasal passages. Saline nose drops can be prepared at home by dissolving 1 teaspoon of salt in 1 pint of warm water. Children
older than 6 months use 0.25% phenylephrine. It is not dissolved in water. Similarly, children older than 6 years of age use 1% ephedrine or 0.05%
oxymetazoline. These are medicines prescribed by the primary health care provider.These are not dissolved in warm or cold water to prepare the nose drops.
These medicines are used directly.
A child with bacterial pneumonia is prescribed antibiotics as well as supplemental oxygen. The child also requires sufficient fluids. In addition to this, the child
has chest tube to remove air from the intrathoracic space. What should the nurse include in the plan of care of this child? Select all that apply.
Carefully assess the respiratory status.
Monitor functions of chest tube and drainage device.
Monitor chest tube insertion site to ensure patency.
Nursing care of a child with a chest tube requires constant assessment of the respiratory status to ensure that the chest tube is in position. In addition to this, the
nurse needs to monitor proper functioning of the chest tube and the drainage device. This includes monitoring drainage, so that it is not impeded. The vacuum
setting should be correct and the tubing should be free of kinks. Moreover, chest tube insertion site should always have intact dressing. It can be adjusted as per
the child's requirement but it should remain in place. The nurse does not prescribe medicines to the child.This is done by the primary health care provider.
Pneumococcal conjugate vaccine is administered as a prevention measure. It is approved for use in the children who are aged 6 weeks to 71 months. It is done
to protect against 13 pneumococcal serotypes that cause pneumonia.
A 3-year-old toddler is being discharged post-tonsillectomy and the parents ask what he or she should be allowed to eat and drink. Teaching by the nurse has
been effective if the parents choose which foods and fluids for the first few days at home?
scrambled eggs, banana popsicles, mashed potatoes, sweetened ice tea, and apple juice
Fluids to be avoided include: carbonated drinks, drinks that are red or brown, milk and milk products (cheese, ice cream etc.), citrus drinks, and hot fluids (tea,
soup, etc.). Foods to be avoided include foods with rough edges (toast, crackers, cookies, chips, etc.), anything that has hard edges when cooked (bacon, etc.),
and spicy foods or condiments that are spicy (ketchup, mustard, peppers, etc.). This toddler may have soft/mushy foods such as scrambled eggs, mashed
potatoes, French toast, or pancakes with syrup, which can be soft as long as the edges are trimmed.
Because the absorption of fat-soluble vitamins is decreased in children with cystic fibrosis, supplementation of which vitamins is necessary?
A, D, E, K
Vitamins A, D, E, and K are the fat-soluble vitamins that need to be supplemented in higher doses. Vitamin C is not one of the fat-soluble vitamins. Vitamin D
also needs to be supplemented. Vitamin C and folic acid are not fat soluble.
A child is diagnosed with pulmonary edema and suffering from acute tachydysrhythmia. What should the nurse include in the plan of care as the most
important intervention?
Monitor pulse oximetry
The nursing care for a child with pulmonary edema is the same as that for a child with an acute respiratory condition. The nurse should monitor pulse oximetry
and all the vital signs closely. The results need to be reported to the primary health care provider. Tracheotomy is a surgery in which an incision on the anterior
part of neck is done by a certified primary health care provider. Tracheotomy may be required for children with craniofacial syndromes. In addition, it is not
necessary to administer vaccines for pulmonary edema. Therapy usually includes peak end-expiratory pressure (PEEP) via continuous positive airway pressure
and intubation. Moreover, allergy testing is not prescribed by nor performed by the nurse.
When an infant chokes on a piece of food, an immediate intervention is to:
position the infant in a head-down, face-down position and administer five quick blows between the shoulder blades.
Positing the infant in a head-down, face-down position and administering five quick blows between the shoulder blades is the correct initial sequence of actions
for an infant with an obstructed airway. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction.
Mouth-to-mouth resuscitation should not be used. This may push the object farther into the child's respiratory system. If the child's airway is obstructed, the
water will not be able to pass. This will increase the risk of aspiration.
A child is admitted to the pediatric unit with a respiratory infection. What does the nurse include in a focused assessment? Select all that apply.
Rate, depth, and rhythmof respirations
Heart rate, oxygenation, and temperature
The activity level and level of comfort
Respiratory tract infections are common in children. Infections caused by viruses and bacteria lead to inflammation of the mucosal membranes of the
respiratory tract, which can lead to respiratory distress. Therefore,nursing care should include assessment of the respiratory rate, depth, and rhythm. The nurse
should also assess the heart rate, oxygenation, and temperature of the child.The nurse should assess the child's activity level as well as their level of comfort
and inform the primary health care provider. Normally, fasting blood glucose and hemoglobin are diagnostic blood tests prescribed for a child with diabetes
mellitus. The nurse normally does not assess bladder distention and internal bleeding in a patient with a respiratory tract infection. Respiratory tract infections
have no influence on the circulatory or urinary systems.
The mother of a 6-month-old with a second upper respiratory infection in two and a half months asks the pediatric nurse why these infections are happening so
often at this time. Which response by the nurse is best?
"Your maternal antibodies have been decreasing during this time and your baby hasn't begun making his or her own yet."
This is the time in the infant's life where maternal hormones are decreasing and the infant has not yet manufactured ample amounts of antibodies to ward off
infection. Lymphoid tissue grows in the older child, not in infancy. Thumb sucking and frequent naps do not cause respiratory infections. Eustachian tubes are
short and wide in infancy, allowing organisms to enter the ear more easily.
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these
categories include: Select all that apply.
lung function.
frequency of symptoms.
frequency and severity of exacerbations.
