Alterations in Gas/Respiratory Disorders
The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:
A: Epiglottitis
B: Asthma
C: Cystic Fibrosis
D: Tuberculosis
A: Epiglottitis
The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.
The physician orders chest physiotherapy on your patient with cystic fibrosis. This is best performed:
A: Immediately after a meal
B: Right before a meal
C: 1-2 hours after a meal
D: Only at bedtime
C: 1-2 hours after a meal
It is best to perform CPT 1-2 hours after a meal (in between meals). You wouldn’t want to do it immediately after a meal due to aspiration or vomiting risk OR right before because this can alter a patient’s appetite due to the mucous that will be expelled (the mucous can have a foul taste or odor to it), and CPT is done up to 2-4 times a day NOT only at bedtime.
The nurse is obtaining the history from the parents of an infant who is suspected of having infantile glaucoma. Which statement by the parents would help to confirm this suspicion?
A: He opens his eyes quite frequently when he's awake
B: It seems like bright lights really bother him
C: His eye looks about the same size as his other eye
D: His eye doesn't seem to tear much
B: It seems like bright lights really bother him
Photophobia occurs with infantile glaucoma, so bright light may bother the infant. Typically, the infant with infantile glaucoma will keep his eyes closed most of the time. The affected eye may appear enlarged with infantile glaucoma. Tearing is associated with infantile glaucoma.
A 5-year-old child is diagnosed with acute otitis media. Which nursing intervention would be priority?
A: Relieving the child's pain
B: Administer a mydriatic
C: Cautioning the child not to pull on the ear
D: Cautioning the child not to blow the nose
A: Relieving the child's pain
Acute otitis media is caused by a bacterial or viral infection of fluid in the middle ear. The fluid behind the eardrum has difficulty draining back out because of the horizontal positioning of the eustachian tube. This causes increased pain. Antibiotics are prescribed to cure the infection. Children need pain relief until the antibiotic prescribed reduces the inflammation and pressure. Children pull on the ear as an attempt to reduce the pain and equalize the pressure. Pulling on the ears, especially in an infant, is one of the first signs the parent sees to warn of the ear infection. Blowing the nose is also an attempt by the child to equalize the pressure in the ear and help reduce the pain. A mydriatic is a drug that induces dilation of the pupils.
A group of nursing students are reviewing the functions of white blood cells. The students demonstrate an understanding of the information when they identify which white blood cell as responsible for combating allergic disorders?
A: Neutrophils
B: Eosinophils
C: Monocytes
D: Lymphocytes
B: Eosinophils
Eosinophils function to combat allergic disorders and parasitic infestations. Neutrophils function to combat bacterial infections. Lymphocytes function to combat viral infections. Monocytes function to combat severe infections.
What is a true statement regarding varicella zoster virus infection?
A: The incubation period is 7 days
B: Secondary infections of the skin can occur
C: It is transmitted by fecal-oral route
D: It tends to be more severe in children
B: Secondary infections of the skin can occur
Varicella zoster virus infection carries with it the complication of a secondary bacterial infection of the skin. The lesions are intensely pruritic, making the child want to scratch the lesions and opening them to a variety of organisms to invade. The incubation period is 10 to 21 days. It is transmitted by direct contact with the vesicles and by airborne route. It tends to be more severe in adolescents and adults.
The nurse is caring for a child with thickened pulmonary secretions. Which action(s) would the nurse use to assist the child breathe with less effort? Select all that apply.
A: Perform Chest Physiotherapy
B: Encourage oral fluids
C: Avoid humidification of O2
D: Assess pulse oximetry q12h
E: Observe for cyanosis and labored breathing q12h
A: Perform chest physiotherapy
B: Encourage oral fluids
Thickened pulmonary secretions occur with many respiratory disorders and illnesses. Encouraging oral liquids helps to thin the secretions so the child can easily cough them out. Chest physiotherapy is done to mobilize the secretions; therefore, the secretions are easier for the child to expectorate (spit out). Oxygen, if in use, should be humidified to avoid drying out the mucosa. The child should be observed for cyanosis and have pulse oximetry readings taken more frequently than every 12 or 24 hours. Often, the child is observed hourly or more.
A nurse is assessing a child who has asthma. Which of the following are indications of deterioration in the child's respiratory status?
A: O2 saturation 95%
B: Wheezing
C: Retraction of sternal muscles
D: Warm extremeties
E: Nasal Flaring
B: Wheezing
C: Retraction of sternal muscles
E: Nasal Flaring
A child has recently been diagnosed with cataracts. The treatment for cataracts is:
A: Eye drops to lower the pressure
B: Surgery
C: Wearing a patch until the cloudiness clears
D: There is no treatment for cataracts
B: Surgery
A cataract is marked opacity of the lens. It can be present at birth. Treatment for childhood cataracts is surgical removal of the cloudy lens, followed by insertion of an internal intraocular lens.
A nurse is caring for a toddler who has had 3 ear infections in the past 5 months. Which of the following longterm complications is the child at risk for developing?
A: Balance difficulties
B: Rash
C: Speech delays
D: Mastoiditis
C: Speech delays
Mastoiditis can be a result of otitis media. Balance difficulties can be present with otitis media. Rash can indicate antibiotic sensitivity, but is not a longterm complication
A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?
A: The child has had 7 wet diapers in the past 24 hours
B: The child cries when his mother is not in sight
C: The child has had 8 ounces of formula in the past 24 hours
D: The child's birth history indicates he was born at 42 weeks' gestation
C: The child has had 8 ounces of formula in the past 24 hours
Sepsis is a systemic overresponse to infection resulting from bacteria and viruses, which are the most common fungi, viruses, rickettsia, or parasites. It can lead to septic shock, which results in hypotension, low blood flow, and multisystem organ failure. Signs of sepsis include a lack of appetite, lethargy, hypotonia, and temperature elevations.
The nurse is caring for a child diagnosed with hand-foot-mouth disease. When educating the family about this disease, which education by the nurse is most important?
A: Make sure your child drinks plenty of of nonirritating fluids
B: Hand-foot-mouth disease is associated with a high fever
C: You can give acetaminophen every 4-6 hours for pain
D: The lesions should disappear in a few days without scarring
A: Make sure your child drinks plenty of of nonirritating fluids
Children with hand-foot-mouth disease can experience dehydration related to the high fever, anorexia, and painful mouth lesions. The nurse should educate the family to provide nonirritating fluids to encourage the child to drink to avoid dehydration. Hand-foot-mouth disease is associated with a high fever, and parents can provide acetaminophen. The lesions should disappear in a few days; however, the most important education is aimed at prevention of dehydration.
The nurse notes a 3-year-old child is restless, has a respiratory rate of 55 breaths/minute, and has an oxygen saturation of 90%. Which action will the nurse take first?
A: Notify the primary health care provider
B: Consult respiratory therapist
C: Apply oxygen via a non-rebreather mask
D: Apply oxygen via a facemask
D: Apply oxygen via a facemask
Oxygen is the most indicated treatment and is needed to increase low partial pressure of oxygen (PaO2) levels in the blood. The child is showing signs of hypoxemia and needs oxygen. The nurse will notify the health care provider after administering oxygen. Respiratory therapy may be needed based on the child's response to oxygen.
A nurse is discussing risk factors for asthma with a group of newly licensed nurses. Which of the following factors should the nurse include in the teaching?
A: Family history of asthma
B: Family history of allergies
C: Exposure to smoke
D: Low birth weight
E: Being underweight
A: Family history of asthma
B: Family history of allergies
C: Exposure to smoke
D: Low birth weight
The nurse is assessing a 13-year-old boy with an eye injury. The nurse determines that evaluating pupillary response to light and accommodation is not appropriate based on the suspicion of a:
A: Simple Contusion
B: Foreign Body
C: Scleral Hemorrhage
D: Corneal Abrasion
C: Scleral Hemorrhage
Scleral hemorrhage appears as erythema in the sclera and can be quite large initially, but vision is unaffected by it. A simple contusion can affect visual acuity and may cause diplopia or blurred vision. Therefore, the nurse needs to check pupillary response. A foreign body can affect vision, necessitating evaluation of pupillary response. Corneal abrasion can affect vision. Therefore, the nurse should check the boy's pupillary response.
The nurse is performing a physical assessment for an 8-year-old child with an earache. Which sign or symptom indicates external otitis (acute otitis externa or swimmer's ear)?
A: The tympanic membrane reacts to a puff of air
B: Symptoms of upper respiratory infection are present
C: The ear canal is devoid of cerumen
D: The child cries out when the ear is grasped
D: The child cries out when the ear is grasped
External otitis (acute otitis externa or swimmer's ear) is an infection and inflammation of the skin of the external ear canal. The classic sign of external otitis is pain on movement of the pinna or pain on pressure over the tragus. Upon examination, the ear canal is red and swollen. Many times the tympanic membrane cannot be visualized because the swelling does not allow the insertion of an otoscope. Symptoms of upper respiratory infection many times accompany otitis media but are not seen in external otitis. The tympanic membrane reacting to a puff of air is a sign that there is no fluid buildup in the middle ear. The absence of cerumen in the ear canal is not related to external otitis.
The nurse is caring for a child admitted to the hospital for sepsis. Which assessment finding is the most concerning?
A: Oral temperature of 102.3F (39C)
B: White blood cell count of 18,000/mm^3
C: Urine output for 10mL over 3 hours
D: Apical heart rate of 120bpm
C: Urine output for 10mL over 3 hours
Children with sepsis will show alteration in temperature, heart rate, respiratory rate, and white blood cell count. Septic shock with organ dysfunction is more serious and can be manifested by decreased urine output.
A 7-year-old child with an earache comes to the clinic. The child's parent reports that 1 day ago the child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis will be for this child?
A: Measles
B: Fifth disease
C: Rubella
D: Mumps
D: Mumps
Mumps begins with a fever, headache, anorexia, and malaise. Within 24 hours an earache occurs. When pointing to the site of pain, however, the child points to the jawline just in front of the earlobe. Mumps is contagious 1 to 7 days prior to the onset of symptoms and 4 to 9 days after the parotid swelling begins. Fifth disease is also known as the "slapping disease," as the rash on the cheeks look like someone slapped the child's face. Measles does not involve parotid swelling or earaches. Mononucleosis does involve swollen lymph nodes but they are in the neck and the axillary area.
A 4-week-old infant is diagnosed with bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?
A: Do you have allergies in the family?
B: Do any family members have history of asthma?
C: Do you have air conditioning in your house?
D: Has you infant been around any crowds?
D: Has you infant been around any crowds?
Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.
A nurse is performing an admission assessment for a child who has cystic fibrosis. Which of the following instructions should the nurse expect?
A: Wheezing
B: Clubbing of fingers & toes
C: Barrel-shaped chest
D: Thin, watery mucus
E: Rapid growth spurts
A: Wheezing
B: Clubbing of fingers & toes
C: Barrel-shaped chest
Thick, viscous mucus and delayed growth are expected findings of cystic fibrosis
The nurse is teaching a group of parents about eyes and eye concerns. The nurse tells these caregivers about a condition that occurs when unequal curvatures in the cornea bend the light rays in different directions and this causes images to be blurred. The condition the nurse is referring to is:
A: Refraction
B: Astigmatism
C: Myopia
D: Hyperopia
B: Astigmatism
Astigmatism is caused by unequal curvatures in the cornea that bend the light rays in different directions and produce a blurred image. Refraction is the way light rays bend as they pass through the lens to the retina. Myopia is nearsightedness; hyperopia is farsightedness.
A child having myringotomy tubes placed asks, “How and when will the tubes be removed?” What is the nurse's best response?
A: You will have them replaced every 2 months until you reach age 18
B: The tubes remain in place for 6 months and then are dissolved by vinegar
C: The tubes remain in place for 6-12 months until they come out by themselves
D: The tubes are not removed. They grow permanently in place
C: The tubes remain in place for 6-12 months until they come out by themselves
The standard treatment for persistent otitis media with effusion is the placement of pressure-equalizing (PE) tubes via a myringotomy. These tubes stay in place for several months and fall out on their own. They are not replaced after they fall out nor are they meant to be a permanent solution to the child's frequent ear infections. Vinegar should not be placed in the ears.
A chief danger of scarlet fever is that children may develop:
A: Liver destruction
B: Local areas of skin necrosis
C: Acute glomerulonephritis
D: Respiratory obstruction
C: Acute glomerulonephritis
Scarlet fever infection is the result of group A streptococci. It generally starts with a throat infection (strep throat). The bacteria produce a toxin that causes the rash over the body. Because this is a streptococci-based infection, the child will need to be monitored for the development of rheumatic fever or glomerulonephritis following the illness. Scarlet fever does not cause respiratory symptoms, attack the liver, or have open lesions.
A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.
Papular rash
Macular rash
Crusting
Low-grade fever
Vesicle formation
Low-grade fever
Macular rash
Papular rash
Vesicle formation
Crusting
The disease is marked by a low-grade fever, malaise, and, in 24 hours, the appearance of a rash. The lesion begins as a macula, then progresses rapidly within 6 to 8 hours to a papule, then to a vesicle that first becomes umbilicated and then forms a crust.
The nurse working at the child community clinic must administer the influenza vaccine to the high-risk children first. Which child would she choose first?
A: 12-month old client who is very healthy
B: 21-month old client who has a cold
C: 23-month old client who had heart surgery as an infant for a defect
D: 22-month old client who has a wound from touching a hot pan at home
C: 23-month old client who had heart surgery as an infant for a defect
Children who are considered high risk and could benefit from the influenza vaccine are:
The other choices would be considered normal and the child is not at high risk.
Cystic fibrosis is an autosomal recessive genetic disorder. Which option below best describes what most likely happens for a child to develop this condition?
A: One parent, who is a carrier of the mutated gene, has to pass it to the child
B: One of the parents has to have cystic fibrosis in order to pass it to their offspring
C: Both of the parents must have cystic fibrosis in order for the child to develop it
D: Both parents who are carriers of the mutated gene, each pass one mutated gene to the child
D: Both parents who are carriers of the mutated gene, each pass one mutated gene to the child
CF is an autosomal recessive genetic disorder. This means that both of the parents are carriers of the disease (they won’t have signs and symptoms of CF). They each have one healthy gene and one mutated gene. For CF to occur in their offspring, the parents will have to each pass ONE of the mutated genes to the child. In this case, it will be the CFTR gene….so the child receives one mutated gene from each parent and this leads to the child to develop CF.
The nurse in the clinic is providing discharge instructions to the parent of a toddler with conjunctivitis. Which comments by the parents require further instruction? Select all that apply.
A: I'm glad this is not contagious. Otherwise, I would be worried that my child's other eye might get infected.
B: Cold packs will be most helpful in treating this infection
C: I didn't know that conjunctivitis could be related to allergies
D: I bet my child's eye infection is related to her upper respiratory infection
E: I hope my child didn't get this infection from day care
A: I'm glad this is not contagious. Otherwise, I would be worried that my child's other eye might get infected.
B: Cold packs will be most helpful in treating this infection
Inflammation of the bulbar or palpebral conjunctiva is referred to as conjunctivitis, and it can be infectious, allergic, or chemical in nature. Warm compresses are best for treating conjunctivitis, along with medications. Conjunctivitis is very contagious and is often transferred from one eye to the other in this age group because children often touch one eye then the other without washing their hands
A nurse is assessing an infant. Which of the following findings are clinical manifestations of acute otitis media?
A: Decreased pain in the supine position
B: Rolling head side to side
C: Loss of appetite
D: Increased sensitivity to sound
E: Crying
B: Rolling head side to side
C: Loss of appetite
E: Crying
Infants with AOM will roll their heads side to side because of the pain and pressure in the ear. Infants who have AOM will experience loss of appetite because of the pain and pressure in the ear. Infants who have AOM will exhibit crying and irritability from the pain. Infants with AOM will have increased pain in the supine position. Infants with AOM will have a decreased sensitivity to sound.
The parents of a 3-year-old child report he was exposed to pertussis 2 days ago. They are concerned and ask the nurse how long it will take until he becomes ill if he indeed contracted the infection. What response by the nurse is indicated?
A: If your child has contracted the illness, he will become ill in 2 weeks
B: The signs of disease will be noted in 1-3 weeks
C: It normally takes about 3 weeks before symptoms begin
D: If your child had contracted the disease, symptoms would have been noted by this time
B: The signs of disease will be noted in 1-3 weeks
Pertussis is an acute respiratory disorder characterized by paroxysmal cough (whooping cough) and copious secretions. The disease is caused by Bordetella pertussis. The incubation period is 6 to 21 days, usually 7 to 10 days.
The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease?
A: Bull's eye rash around the bite
B: Multiple erythema migrant on the skin
C: Cranial nerve palsies
D: Recurrent arthritis in the large joints
A: Bull's eye rash around the bite
A bull's-eye rash (ring-like rash) around the bite is typical of early localized Lyme disease. Multiple erythema migrans on the skin occurs during early disseminated disease. Cranial nerve palsies are indicative of early disseminated disease. Recurrent arthritis in the large joints occurs in the late stage of the disease.