Cystic Fibrosis
Which would the nurse explain to parents about the inheritance of cystic fibrosis?
1. CF is an autosomal-dominant trait passed on from the child’s mother.
2. CF is an autosomal-dominant trait passed on from the child’s father.
3. The child of parents who are both carriers of the gene for CF has a 50% chance of acquiring CF.
4. The child of a mother who has CF and a father who is a carrier of the gene for CF has a 50% chance of acquiring CF.
What is 4?
Rationale: If the child is born to a parent with CF and the other parent is a carrier, the child has a 50% chance of acquiring the disease and a 50% chance of being a carrier of the disease
What is the most important piece of information that the nurse must ask the parent of a child in status asthmaticus?
1. “What time did your child eat last?”
2. “Has your child been exposed to any of the usual asthma triggers?”
3. “When was your child last admitted to the hospital for asthma?”
4. “When was your child’s last dose of medication?”
What is 4?
Rationale:
The nurse needs to know what medication the child had last and when the child took it in order to know how to begin treatment for the current asthmatic condition.
If a child is choking and stops breathing do you do?
1. Call the doctor
2. Administer oxygen
3. Activate the Emergency response system and initiate CPR
4. Check the child's pulse
What is 3?
Rationale: If the child stops breathing CPR must be initiated immediately! Remember that the compression rate is 100/minute for CPR. For a single rescuer, it would be 30 compressions to 2 breaths. For 2 rescuers, it would be 15 compressions to 2 breaths.
A new graduate nurse is caring for a child who is suspected to have epiglottitis. Which nursing intervention by the new nurse should the charge nurse intervene?
1. Having a crash cart by the bedside
2. Attempting to visualize the throat with a tongue depressor
3. Preparing the child for a lateral neck radiography
4. Calling the assigned doctor on the unit
What is 2?
Rationale: The nurse should not attempt to visualize the throat but the child should be seen by the doctor immediately. Visualizing the throat should lead to bronchospasms/constriction which could lead to death or other complications.
Which would be an early sign of respiratory distress in a 2-month-old?
1. Breathing shallowly.
2. Tachypnea.
3. Tachycardia.
4. Bradycardia.
What is 2?
Rationale:
Tachypnea is an early sign of distress
and is often the first sign of respiratory
illness in infants.
The parents of a 5-week-old have just been told that their child has cystic fibrosis (CF). The mother had a sister who died of CF when she was 19 years of age. The parents are sad and ask the nurse about the currently projected life expectancy. What is the nurse’s best response?
1. “The life expectancy for CF patients has improved significantly in recent years.”
2. “Your child might not follow the same course that the mother’s sister did.”
3. “The physician will come to speak to you about treatment options.”
4. The nurse answers their questions briefly, listens to their concerns, and is available later after they’ve processed the information.
What is 4?
Rationale: The nurse’s best intervention is to let the parents express their concerns and fears. The nurse should be available if the parents have any other concerns or questions or if they just need someone with whom to talk.
The parents of a 6-year-old who has a new diagnosis of asthma ask the nurse what to do to make their home a more allergy-free environment. Which is the nurse’s best response?
1. “Use a humidifier in your child’s room.”
2. “Have your carpet cleaned chemically once a month.”
3. “Wash household pets weekly.”
4. “Avoid purchasing upholstered furniture.”
What is 4?
Rationale:
Leather furniture is recommended rather than upholstered furniture. Upholstered furniture can harbor large amounts of dust, whereas leather furniture may be wiped off regularly with a damp cloth.
The parent of a 9-month-old calls the ER because his child is choking on a marble. The parent asks how to help his child while awaiting Emergency Medical Services.
Which is the nurse’s best response?
1. “You should administer five abdominal thrusts followed by five back blows.”
2. “You should try to retrieve the object by inserting your finger in your child’s mouth.”
3. “You should perform the Heimlich maneuver.”
4. “You should administer five back blows followed by five chest thrusts.”
What is 4?
Rationale: The current recommendation for infants younger than 1 year is to administer five back blows followed by five chest thrusts.
A mother is crying and tells the nurse that she should have brought her son in yesterday when he said his throat was sore. Which is the nurse’s best response to this parent whose child is diagnosed with epiglottitis and is in severe distress and in need of intubation?
1. “Children this age rarely get epiglottitis; you should not blame yourself.”
2. “It is always better to have your child evaluated at the first sign of illness rather than wait until symptoms worsen.”
3. “Epiglottitis is slowly progressive, so early intervention may have decreased the extent of your son’s symptoms.”
4. “Epiglottitis is rapidly progressive; you could not have predicted his symptoms would worsen so quickly.”
What is 4?
Rationale: Epiglottitis is rapidly progressive and cannot be predicted.
Which assessment is of greatest concern in a 15-month-old?
1. The child is lying down, has moderate retractions, low-grade fever, and nasal congestion.
2. The child is in the tripod position, has diminished breath sounds, and a muffled cough.
3. The child is sitting up and has coarse breath sounds, coughing, and fussiness.
4. The child is restless and crying has bilateral wheezes and is feeding poorly.
What is 2?
Rationale: When children are sitting in the tripod position, they are having difficulty breathing. The child is sitting and leaning forward in order to breathe more easily. Diminished breath sounds are indicative of a worsening condition. A muffled cough indicates that the child has some subglottic edema. This child has several signs and symptoms of a worsening respiratory condition.
Which of the following is NOT true about Cystic Fibrosis?
1. Pancreatic enzymes is needed with every meal and snack.
2. Fat-soluble vitamins (ADEK) are needed for digestion
3. A sweat chloride test of 60 or greater is indicative of Cystic Fibrosis
4. The child may require a low protein, low-calorie diet
What is 4?
Rationale: Since the child lack the digestive enzymes, a high protein, high-calorie diet is needed to ensure adequate nutrition.
Which breathing exercises should the nurse have an asthmatic 3-year-old child do to increase her expiratory phase?
1. Use an incentive spirometer.
2. Breathe into a paper bag.
3. Blow a pinwheel.
4. Take several deep breaths.
What is 3?
Rationale:
Blowing a pinwheel is an excellent means of increasing a child’s expiratory phase. Play is an effective means of engaging a child in therapeutic activities. Blowing bubbles is another method to increase the child’s expiratory phase.
Which is the nurse’s best response to the parent of a child diagnosed with epiglottitis who asks what the treatment will be?
1. Complete a course of intravenous antibiotics.
2. Surgery to remove the tonsils.
3. 10 days of aerosolized ribavirin.
4. No intervention.
What is 1?
Rationale: Epiglottitis is bacterial in nature and requires intravenous antibiotics. A 7- to 10-day course of oral antibiotics is usually ordered following the intravenous course of antibiotics.
How will a child with respiratory distress and stridor and who is diagnosed with RSV be treated?
1. Intravenous antibiotics.
2. Intravenous steroids.
3. Nebulized racemic epinephrine.
4. Alternating doses of Tylenol and Motrin.
What is 3?
Rationale: Racemic epinephrine promotes mucosal vasoconstriction.
Which physical findings would be of most concern in an infant with respiratory distress?
1. Tachypnea.
2. Mild retractions.
3. Wheezing.
4. Grunting.
What is 4?
Rationale: Grunting is a sign of impending respiratory failure and is a very concerning physical finding.
The parent of a 4-month-old with cystic fibrosis (CF) asks the nurse what time to begin the child’s first chest physiotherapy (CPT) each day. Which is the nurse’s best response?
1. “Thirty minutes before feeding the child breakfast.”
2. “After deep-suctioning the child each morning.”
3. “Thirty minutes after feeding the child breakfast.”
4. “Only when the child has congestion or coughing.”
What is 1
Rationale: CPT should be done in the morning prior to feeding to avoid the risk of the child vomiting.
Which should the nurse administer to provide quick relief to a child with asthma who is coughing, wheezing, and having difficulty catching her breath?
1. Prednisone.
2. Singulair (montelukast).
3. Albuterol.
4. Flovent (fluticasone).
What is 3?
Rationale:
Albuterol is the quick-relief bronchodilator of choice for treating an asthma attack.
What would the nurse advise the parent of a child with a barky cough that gets worse at night?
1. Take the child outside into the more humid night air for 15 minutes.
2. Take the child to the ER immediately.
3. Give the child an over-the-counter cough suppressant.
4. Give the child warm liquids to soothe the throat.
What is 1?
Rationale:
The night air will help decrease subglottic edema, easing the child’s respiratory effort. The coughing should diminish significantly, and the child should be able to rest comfortably. If the symptoms do not improve after taking the child outside, the parent should have the child seen by a health-care provider.
Which child is at the highest risk for requiring hospitalization to treat respiratory syncytial virus (RSV)?
1. A 2-month-old who was born at 32 weeks.
2. A 16-month-old with a tracheostomy.
3. A 3-year-old with a congenital heart defect.
4. A 4-year-old who was born at 30 weeks.
What is 1?
The younger the child, the greater the risk for developing complications related to RSV. This infant is at the highest risk because of age and premature status.
Which child is in the greatest need of emergency medical treatment?
1. 3-year-old who has a barky cough, is afebrile and has mild intercostal retractions.
2. 6-year-old who has a high fever, no spontaneous cough, and frog-like croaking.
3. 7-year-old who has an abrupt onset of moderate respiratory distress, a mild fever, and a barky cough.
4. 13-year-old who has a high fever, stridor, and purulent secretions.
What is 2?
Rationale:
This child has signs and symptoms of epiglottitis and should receive immediate emergency medical treatment. The patient has no spontaneous cough and has a frog-like croaking because of significant airway obstruction.
How does the nurse interpret the laboratory analysis of a stool sample containing excessive amounts of azotorrhea and steatorrhea in a child with cystic fibrosis (CF)? The values indicate the child is
1. Not compliant with taking her vitamins.
2. Not compliant with taking her enzymes.
3. Eating too many foods high in fat.
4. Eating too many foods high in fiber.
What is 2?
Rationale: If the child were not taking enzymes, the result would be a large amount of undigested food, azotorrhea, and steatorrhea in the stool. Pancreatic ducts in CF patients become clogged with thick mucus that blocks the flow of digestive enzymes from the pancreas to the duodenum. Therefore, patients must take digestive enzymes with all meals and snacks to aid in the absorption of nutrients. Often, teens are noncompliant with their medication regimen because they want to be like their peers.
A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should the nurse prepare for?
1. Immediate IV placement.
2. Respiratory treatment of racemic epinephrine.
3. A tracheostomy set at the bedside.
4. Informing the child’s parents about a tonsillectomy.
What is 2?
Rationale: The child has stridor, indicating airway edema, which can be relieved by aerosolized racemic epinephrine.
The parent of a child with croup tells the nurse that her other child just had croup and it cleared up in a couple of days without intervention. She asks the nurse why this child is exhibiting worse symptoms and needs to be hospitalized. Which is the nurse’s best response?
1. “Some children just react differently to viruses. It is best to treat each child as an individual.”
2. “Younger children have wider airways that make it easier for bacteria to enter and colonize.”
3. “Younger children have short and wide eustachian tubes, making them more susceptible to respiratory infections.”
4. “Children younger than 3 years usually exhibit worse symptoms because their immune systems are not as developed.”
What is 4?
Younger children have less developed immune systems and usually exhibit worse symptoms than older children.
Which statement indicates the parent needs further teaching on how to prevent his other children from contracting the respiratory syncytial virus (RSV)?
1. “I should make sure that both my children receive Synagis (palivizumab) injections for the remainder of this year.”
2. “I should be sure to keep my infected child away from his brother until he has recovered.”
3. “I should insist that all people who come in contact with my children thoroughly wash their hands before playing with them.”
4. “I should insist that anyone with a respiratory illness avoid contact with my children until well.”
What is 1?
Rationale: Synagis will not help the child who has
already contracted the illness.
Which child with asthma should the nurse see first?
1. A 12-month-old who has a mild cry, is pale in color, has diminished breath sounds, and has an oxygen saturation of 93%.
2. A 5-year-old who is speaking in complete sentences, is pink in color, is wheezing bilaterally, and has an oxygen saturation of 93%.
3. A 9-year-old who is quiet, is pale in color and is wheezing bilaterally with an oxygen saturation of 92%.
4. A 16-year-old who is speaking in short sentences, is wheezing, is sitting upright, and has an oxygen saturation of 93%.
What is 1?
Rationale: This child is exhibiting signs of severe asthma. This child should be seen first. The child no longer has wheezes and now has diminished breath signs.