1.
A child experiencing an acute asthma attack presents to the emergency department. Which of the following medications should a nurse prepare to administer to the child as an intervention for an acute asthma attack?
Correct Answer
D. Albuterol (Proventil)
Explanation
Albuterol (Proventil) is a beta 2 adrenergic agonist that results in bronchodilation. It's used in acute episodes of asthma. Terbutaline (brethine) is an oral, long-acting medication used for long-term control of asthma. Beclomethasone diproppionate (QVAR) is an inhaled glucocorticdoid used to prevent infllammation, suppress airway mucus production, and promote responsiveness of beta 2 receptors in the bronchial tree. Prednizone (Deltasone) is an oral medication used for 3 to 10 days following an acute asthma attack.
2.
If you suspect respiratory distress in a child, never leave them alone.
Correct Answer
A. True
Explanation
Changes may occur rapidly. NEVER EVER EVER leave them alone.
3.
Which of the following are signs of airway obstruction/respiratory distress? Hypoxia is a gimme. Check all boxes that apply:
Correct Answer(s)
A. Diaphoresis
B. Tachypnea
C. Tachycardia
D. Restlessness
Explanation
TTDR Tachypnea, Tachycardia, Diaphoresis, Restlessness
4.
Goal for a child with respiratory infection: "The child will exhibit adequate oxygenation and ___________ airway. Keep O2 sats >92-93%
Correct Answer(s)
patent, PATENT, Patent
Explanation
The goal for a child with respiratory infection is to exhibit adequate oxygenation and maintain a patent airway. This means that the airway should remain open and unobstructed, allowing for proper airflow and oxygen exchange. It is important to keep the oxygen saturation levels above 92-93% to ensure sufficient oxygen supply to the body.
5.
A 5-year-old child is brought into the emergency department with drooling, strident cough, and lethargy. Epiglottitis is suspected. The priority intervention for this child is to:
Correct Answer
B. Secure the child's airway
Explanation
The priority in treating epiglottitis is achieving a patent airway as quickly as possible.
6.
An 8-month-old is admitted to the pediatric unit with a history of multiple respiratory infections and suspected cystic fibrosis. Which symptom suggests cystic fibrosis?
Correct Answer
A. Fatty Stools
Explanation
Cystic fibrosis causes thick secretions that block pancreatic ducts and prevent essential pancreatic enzymes from reaching the duodenum. This impairs digestion and absorption of nutrients. The lack of available enzymes also causes stools that are greasy, foul smelling, and frothy from undigested fat. Because of respiratory involvement children may have increased respiratory rate. An early sign of cystic fibrosis in infancy is failure to pass meconium.
7.
A 10-year-old student comes to the school nurse's office. He says he is unable to breathe. The first action is to:
Correct Answer
D. Listen to the student's lungs
Explanation
The child is probably having an asthma attack, and the nurse needs to auscultate his lungs to determine how well he's exchanging air. She should assess for dyspnea, coughing, and wheezing. Vital signs are taken after the pulmonary assessment. The nurse should call the student's mother, but this isn't the first priority. The aerosol treatment is appropriate if prescribed by the child's physician, but it should be done after the nurse assesses the child.
8.
A child who has just returned to the unit after surgery is drowsy and
not alert to commands. To maintain an airway, the nurse should:
Correct Answer
D. Place the child in a lateral Sims' position
Explanation
The lateral Sims' position will allow emesis or other obstructive fluid to drain from the mouth an prevent aspiration. The supiine position predisposes to aspiration of blood, mucus, or vomitus. Nasotracheal suction might be used in the postanesthesia care unit; when the child is ready to return to the pediatric unit; it should not be needed
9.
A 2-year-old is admitted with croup, and 1/4L oxygen via nasal canula is administered because it:
Correct Answer
B. Decreases the effort required for breathing and also allows for rest.
Decreases the effort required for breathing and also allows for rest
Explanation
Administering oxygen via nasal cannula limits the energy required for breathing, thus allowing the child to conserve energy that can be used for fluid and nutrient intake.
10.
A result of repeated infections in children with cystic fibrosis is:
Correct Answer
D. Being prone to developing type 1 diabetes
Explanation
Children with cystic fibrosis are at an increased risk of developing type 1 diabetes. Cystic fibrosis affects the pancreas, leading to a deficiency in insulin production. This deficiency can increase the likelihood of developing type 1 diabetes, which is characterized by a lack of insulin production altogether. Therefore, being prone to developing type 1 diabetes is a result of repeated infections in children with cystic fibrosis.
11.
A child who was rescued from a burning building is brought to the hospital via emergency medical services. Smoke inhalation has caused the child's condition to deteriorate within 24 hours. The nurse should be particularly alert for signs of:
Correct Answer
B. Tracheobronchial edema
Explanation
Heat and inhaled smoke-product antigens may cause fluid to shift from the intravascular compartment into the interstitial compartment resulting in edema, which obstructs the airway. *remember that clinical manifestations from inhalation injuries may be delayed as long as 24-48 hours (that's in Reklau's notes). Question is from ATI though.
12.
An 8-year-old child with asthma is being assessed by the nurse. An assessment that requires immediate intervention would be:
Correct Answer
B. Audible wheezing
Explanation
Audible wheezing, that is heard without a stethoscope, is an indication that the airways are significantly compromised. This is an expected respiratory rate of an 8 year old child. Individuals who have asthma often receive corticosteroids, which could cause a round face: however, this does not require nursing intervention. The use of inhalant medications is expected.
13.
The nurse organizes care for an infant with bronchiolitis to allow for uninterrupted periods of rest. This plan would be:
Correct Answer
D. Appropriate because this action promotes decreased oxygen demands
Explanation
The infant is having difficulty with breathing: disturbing the infant frequently causes an increased expenditure of energy, thus increasing oxygen needs.Cool mist does not promote hydration; it limits inflammation and lowers fever.
14.
A child who had been admitted for status asthmaticus appears to be improving. The most objective way for the nurse to evaluate the child's response to therapy is to:
Correct Answer
D. Evaluate the child's current peak expiratory flow rate.
Explanation
The peak expiratory flow meter is an objective tool that measures the maximum flow of air that can be forcefully exhaled in 1 second. The tool individualizes data for the child because after a personal best value has been established it can be compared with current values to determine the present respiratory status.
15.
A 10-year-old child who is developmentally delayed and blind must be fed all meals. The child has problems swallowing and frequently chokes and coughs during the feeding. When feeding this child, the nurse should:
Correct Answer
D. Seat the child in the wheelchair, give small bites of food with metal tableware, and encourage the child's participation.
Explanation
An upright position helps prevent aspiration; metal tableware is safer than plastic because it is unbreakable; encouraging participation, attempting to socialize and treating the child with dignity should be part of the meal
16.
An important nursing measure for a 6-month-old infant with bronchiolitis is:
Correct Answer
B. Making regular assessments of the infant's skin color, anterior fontanel, and vital signs
Explanation
these assessments are vital to determine the infant's hydration status.
17.
A 15-month-old with croup is admitted to the pediatric unit. The nurse is most concerned that:
Correct Answer
B. The mother cannot calm the child
Explanation
When a mother can't calm a child with a respiratory problem, assess for increasing hypoxia. Normal symptoms of croup include inspiratory stridor and barking cough. Children are commonly restless in their sleep when ill.
18.
A nurse is caring for a 17-year-old female with cystic fibrosis who has been admitted to the hospital to receive I.V. antibiotic and respiratory treatment for exacerbation of a lung infection. The adolescent has a number of questions about her future and the consequences of the disease. Which statements about the course of cystic fibrosis are true?
Correct Answer(s)
A. Breast development is commonly delayed
B. The adolescent is at risk for developing diabetes
D. Normal sexual relationships can be expected
Explanation
Cystic fibrosis delays growth and the onset of puberty. Children with cystic fibrosis tend to be smaller that average size and develop secondary sex characteristics later in life. In addition, children with CF are at risk for developing diabetes mellitus because the pancreatic duct becomes obstructed as pancreatic tissues are destroyed. People with CF can expect to have normal sexual relationships, but fertility becomes difficult because thick secretions obstruct the cervix and block sperm entry. Males and females carry the gene for cystic fibrosis. Pulmonary disease commonly progresses as the child ages, requiring additional respiratory treatment - not less.
19.
A child with cystic fibrosis has early signs of an upper respiratory tract infection, including a cough and runny nose. The nurse should teach the child's mother to:
Correct Answer
D. Increase chest physiotherapy to four times per day
Explanation
With CF, a simple URI may develop into pneumonia if the thick secretions aren't loosened and removed by percussion and postural drainage. Making sure the child has an adequate diet, taking the child's temperature, and giving he child orange juice are important but not as vital as percussion and postural drainage.
20.
A nurse is caring for a child with a burn injury sustained in a house fire. Which assessment finding suggests that the child has suffered smoke inhalation?
Correct Answer
A. Hoarseness
Explanation
Smoke inhalation should be suspected when the child has burns on the face and neck, singed nasal hair, wheezing, carbonaceous secretions, a hoarse voice, and crackles throughout the lung fields. Hypotension may occur if the child is in shock, but isn't an indicator of smoke inhalation.
21.
A 10-year-old with a history of asthma is diagnosed with status asthmaticus. This child:
Correct Answer
B. Hasn't responded to treatment
Explanation
Status asthmaticus is asthma with moderate to sever airway obstruction that doesn't respond to initial treatment. The asthma "stays in place" rather than improving with treatment. A child's wheezing stops when status asthmaticus develops because the airways are obstructed.
22.
An infant with a history of respiratory tract infection is brought to the emergency department and diagnosed with bronchiolitis and respiratory syncytial virus (RSV) infection. The nurse places the infant in a private room and institutes what type of precautions?
Correct Answer
C. Contact precautions
Explanation
RSV can live on paper for 1 hour and on cribs and other nonporous surfaces for up to 6 hours and is highly communicable. The infant with RSV should be isolated in a single room. Along with standard precautions, the infant should be placed on contact precautions, and gloves and a gown should be worn when entering the room if clothing will contact the infant., Droplet precautions (wearing a amask when entering the room) and airborne precautions (private room with negative air pressure, high efficiency filtration, and shuyt door; visitors required to wear a HEPA-filter mask) aren't necessary.
23.
A nurse is caring for a 10 year old with CF. The child reports that he feels like he isn't getting enough air. Which finding indicates that the child is compensating for decreased serum oxygen levels?
Correct Answer
D. Clubbing of the fingers and toes
Explanation
Clubbing of the fingers and toes indicates that the body has compensated for low serum oxygen levels by building collateral circulation. A sunken abdomen, distended jugular veins, and edema in the upper extremities aren't signs of compensation for a decreased oxygen concentration.
24.
A nurse is working a 0700 to 1500 shift a pediatric floor, and her duties include giving the morning dose of the pancreatic enzyme to a 12-year-old with cystic fibrosis. This medication should be administered:
Correct Answer
A. With breakfast
Explanation
pancreatic enzymes help digest fat in the diet. They should be given with meals and snacks to help break down fat and increase its absorption by the body.
25.
A nurse is working with a group of parents whose infants have died from sudden infant death syndrome (SIDS). Which statement by a parent indicates the need for further teaching?
Correct Answer
B. "If I'd checked on my baby in the middle of the night he wouldn't have died"
Explanation
The statement "If I'd checked on my baby in the middle of the night he wouldn't have died" indicates a misunderstanding of sudden infant death syndrome (SIDS). SIDS is a sudden and unexplained death of an infant, typically during sleep. It is not caused by neglect or lack of checking on the baby. The parent's belief that checking on the baby would have prevented the death suggests a need for further teaching to clarify the causes and risk factors of SIDS.
26.
The mother of a 3-year-old calls the nurse into the room because she says that her son is choking. What intervention should be the nurse's highest priority?
Correct Answer
C. Assessing whether the child can make vocal sounds
Explanation
Managing a foreign-body airway obstruction begins with assessment, including whether the child is coughing and can make vocal sounds. Finger sweeps should be avoided because they may push the foreign object back into the airway, causing obstructions. Back blows are used on an infant age 1 and younger. If the child can't speak or cough, abdominal thrusts are used.
27.
A 7-year-old undergo tonsillectomy for recurrent tonsillitis. Twenty-four hours after surgery, the child vomits material that resembles coffee grounds. What is action by the nurse most appropriate?
Correct Answer
C. Maintain nothing-by-mouth status for the next 30 minutes and then resume clear liquids.
Explanation
Vomiting old blood (coffee-ground emesis) is common after tonsillectomy. If vomiting occurs, the nurse should maintain nothing by mouth status for the next 30 minutes and then resume clear liquids. The nurse should assess the child for signs of bleeding (frequent swallowing, restlessness, vomiting bright red blood, and fast thready pulse). If bleeding occurs, turn the child to the side and notify the physician immediately. The child should be placed in a prone or side-lying position to prevent aspiration.
28.
A 4-year-old is brought to the emergency department by his parents, who report that he swallowed a small toy. What symptom suggests complete airway obstruction by a foreign body?
Correct Answer
C. Inability to speak
Explanation
With complete airway obstruction, the child can't cough, speak, or breathe. Gagging and coughing may be associated with such problems as laryngotracheal obstruction. Bronchial obstruction produces cough, wheezing, syspnea, decreased airway entry, and asymmetrical breath sounds.
29.
A 2-year-old is suffering from poor oxygenation due to streptococcal pneumonia and requires an endotracheal (ET) tube. Which outcome indicates that ET intubation is successful?
Correct Answer
A. Bilateral breath sounds on auscultation are heard
Explanation
When bilateral breath sounds are heard on auscultation, it indicates that the endotracheal (ET) tube has been successfully placed in the trachea. This means that the air is able to flow freely into both lungs, ensuring proper oxygenation. The presence of bilateral breath sounds suggests that the ET intubation has effectively secured the airway and is delivering oxygen to the lungs.
30.
The nurse giving oxygen to an infant with respiratory distress syndrome should give high priority to administering oxygen that is warmed and humidified.
Correct Answer
A. True
Explanation
Delivering warm, humidified oxygen prevents cold stress and fluid loss through the respiratory tract.
31.
A clear mucus may indicate that the infection is most likely.
Correct Answer
B. Viral
Explanation
A clear mucus is often associated with viral infections. Viral infections, such as the common cold or flu, can cause the body to produce clear mucus as a response to the infection. This is because the body's immune system is working to fight off the virus and clear out any excess mucus or secretions. Bacterial infections, on the other hand, typically cause yellow or green mucus. Fungal infections may have other symptoms such as itching or a thick, white discharge. Therefore, based on the given information, the most likely explanation for the clear mucus is a viral infection.
32.
Which of the following statements is true according to Mrs. Reklau's Notes?
Correct Answer
B. Higher Fever with Bacterial, Lower with Viral
Explanation
According to Mrs. Reklau's Notes, it is true that higher fever is associated with bacterial infections, while lower fever is associated with viral infections.
33.
Which of the following Medicines is commonly not used in treating children's respiratory symptoms? (choose all that apply)
Correct Answer(s)
A. Antitussives
C. Decongestants
Explanation
Antitussives suppress/depress the cough reflex and increase risk for aspiration. Decongestants increase agitation.
34.
The 4 "D's" of Eppiglottitis are: Dysphonia (muffled voice), Drooling,and ___________ (impairment of speech)
Correct Answer(s)
dysphasia, Dysphasia, DYSPHASIA
Explanation
The correct answer is "dysphasia, Dysphasia, DYSPHASIA." Dysphasia refers to an impairment of speech and is one of the 4 "D's" of Eppiglottitis, along with dysphonia (muffled voice) and drooling.
35.
Meningismus is nuchal rigidity and photophobia without the presence of a headache.
Correct Answer
B. False
Explanation
Meningismus is the classic triad of Nuchal Rigidity, photophobia, and headache.
36.
Croup symptoms may include: Ronchi, Rales and a "barky" or "bark like" __________
Correct Answer
cough, Cough, COUGH
Explanation
The correct answer is "cough, Cough, COUGH". The question is asking for a symptom of croup, a condition that affects the respiratory system, particularly in children. Croup is characterized by a distinctive "barky" or "bark like" cough, which can be described as a repetitive, harsh, and often loud cough. The repetition of the word "cough" in different capitalizations ("cough, Cough, COUGH") emphasizes the severity and intensity of the cough associated with croup.
37.
Some structural differences in the airway in children compared to adults are: Larynx and glottis are located higher in the neck, tonsils are larger, and some cartilage is less developed.
Correct Answer
A. True
Explanation
The statement is true because it accurately describes some structural differences in the airway between children and adults. The larynx and glottis being located higher in the neck in children is due to their smaller anatomy. Additionally, children have larger tonsils and less developed cartilage in their airway compared to adults. These differences can affect the way air flows through the airway and can have implications for respiratory health in children.
38.
Factors that increase the risk/frequency of respiratory infections in children include: (choose all that apply)
Correct Answer(s)
B. Smaller airway diameter
C. Shorter distances between structures of the airway
D. Short eustachian tubes
Explanation
Smaller airway diameter, shorter distances between structures of the airway, and short eustachian tubes can all contribute to an increased risk/frequency of respiratory infections in children. A smaller airway diameter can make it more difficult for air to flow freely, increasing the likelihood of infections. Shorter distances between structures of the airway can make it easier for infections to spread from one area to another. Short eustachian tubes can lead to fluid buildup in the middle ear, which can increase the risk of ear infections.
39.
Postural drainage is typically performed 1 hour before meals or 2 hours after meals.
Correct Answer
A. True
Explanation
It should be done 1 hour before meals or 2 hours after to decrease the risk of aspiration or vomiting
40.
Respiratory treatment that involves percussion, vibration, and postural drainage to mobilize secretions. A cupped hand or special device over the chest wall/rib cage is used to break up secretions.
Correct Answer
B. Chest Pysiotherapy CPT)
Explanation
Chest physiotherapy (CPT) is a respiratory treatment that involves percussion, vibration, and postural drainage to mobilize secretions. It uses a cupped hand or a special device over the chest wall/rib cage to break up secretions. This technique helps to loosen and remove mucus from the lungs, making it easier for the patient to breathe.
41.
Eppiglottitis is almost always caused by Haemophilus influenza
Correct Answer
A. True
Explanation
HiB vaccine recommended for prevention
42.
If epiglottitis is suspected, the nurse should attempt to visualize the epiglottis without the use of a tongue depressor.
Correct Answer
B. False
Explanation
Only MD. Nurse need to have emergency ETT/Tradch set at bedside. There will likely be Lateral neck film in ER
43.
If a patient with Status Asthmaticus is not responding to standard meds (Beta-2, Albuterol, Corticosteroids (IV), Aminophylline drips (IV), the MD may consider subcutaneous epinephrine 1:1000 at a dose of 0.01mL/kg max dose of 0.3 mL. That is just a fact. The true or false question is: is it true or false that the use of Bicarb may be indicated for the correction of acidosis secondary to status asthmaticus????
Correct Answer
A. True
Explanation
I just thought we should read through this once since it was bolded on her notes.
44.
Absence of breath sounds accompanied by a sudden rise in respiratory rate is an ominous sign for Status Asthmaticus.
Correct Answer
A. True
Explanation
The absence of breath sounds, along with a sudden increase in respiratory rate, is a concerning sign for Status Asthmaticus. This condition is a severe and life-threatening form of asthma that does not respond well to standard treatments. The absence of breath sounds suggests a significant airway obstruction, while the sudden rise in respiratory rate indicates the body's attempt to compensate for the lack of oxygen. Therefore, recognizing these signs is crucial in identifying and managing this potentially fatal condition.
45.
Cystic fibrosis is inherited as an Autosomal recessive trait. So in order for a child to present with a diagnosis of Cystic Fibrosis who had the Gene???
Correct Answer
C. Both the mom and dad
Explanation
Cystic fibrosis is inherited as an autosomal recessive trait, which means that both copies of the gene responsible for the condition must be inherited - one from the mother and one from the father. If only one parent carries the gene, the child will not develop cystic fibrosis but may become a carrier of the gene. Therefore, for a child to present with a diagnosis of cystic fibrosis, both the mom and dad must have the gene.
46.
CF is primarily a Mechanical obstruction.
Correct Answer
A. True
Explanation
CF is primarily a mechanical obstruction caused by increased viscosity of mucous gland secretion and is responsible for many of the clinical manifestations.
47.
In patients with CF, abnormally thick mucous leads to obstruction of the secretory ducts of the ____________ that can contribute to malnutrition and diabetes.
Correct Answer
pancreas, Pancreas, PANCREAS
Explanation
In patients with CF, the abnormally thick mucous obstructs the secretory ducts of the pancreas. This obstruction can lead to malnutrition and diabetes. The pancreas plays a crucial role in producing digestive enzymes and regulating blood sugar levels. When the ducts are blocked, the enzymes cannot reach the intestines to aid in digestion, resulting in malnutrition. Additionally, the pancreas produces insulin, which helps regulate blood sugar levels. When the ducts are obstructed, insulin production can be affected, leading to diabetes.
48.
CF patients excrete excessive electrolytes (specifically sodium and chloride) from their sweat and salivary glands.
Correct Answer
A. True
Explanation
The statement is true because patients with cystic fibrosis (CF) have a defective gene that affects the movement of salt and water in and out of cells, leading to the production of thick and sticky mucus. This defect also affects the sweat and salivary glands, causing them to excrete excessive electrolytes, particularly sodium and chloride. This is why CF patients have salty-tasting skin and sweat, which can be measured through a sweat test.
49.
Clinical manifestations of Cystic Fibrosis may include: (check all that apply)
Correct Answer(s)
A. Bile stained Vomiting
B. Meconium Ileus
C. Large bulky, loose, frothy stools that float
D. Wheezy respirations
E. Barrel chest
F. Clubbing of fingers and toes
Explanation
The clinical manifestations of Cystic Fibrosis may include bile stained vomiting, meconium ileus, large bulky, loose, frothy stools that float, wheezy respirations, barrel chest, and clubbing of fingers and toes. These symptoms are commonly seen in individuals with Cystic Fibrosis and can help in the diagnosis of the condition. Bile stained vomiting may occur due to the blockage of the bile ducts, while meconium ileus is a common gastrointestinal complication in newborns with Cystic Fibrosis. The abnormal consistency and appearance of stools are a result of impaired digestion and absorption of nutrients. Wheezy respirations, barrel chest, and clubbing of fingers and toes are respiratory symptoms associated with the condition.
50.
CF often shows up as "Patchy" atelectasis on chest x-ray
Correct Answer
A. True
Explanation
unlike pneumonia or emphysema. Patches of the sticky mucus scattered throughout.