Otitis Media
The nurse is caring for a child who presents with fussiness and tugging at the left ear. The provider diagnoses the child with acute otitis media. Which of the following positions is appropriate for the child to rest?
A. Right
B. Left Side
C. Back
D. Stomach
A
Right side Positioning the child on the affected side can increase swelling and pain, so this should be avoided. The appropriate side for a child to lie if the left ear is affected is the right side.
A nurse is working as part of a multidisciplinary team to help a 16-year-old client with cystic fibrosis. In addition to physical care, which activity is most important for a client of this age with cystic fibrosis?
A. Reminding the teen that despite the condition, he or she will still be able to stay in school
B. Explaining and educating the client on facts surrounding the condition
C. Helping the teen to transition to adult care services by promoting independence in decision making
D. Assisting the client to play games with peers of the same age
C.
Helping the teen to transition to adult care services by promoting independence in decision making
A teen client with cystic fibrosis faces many challenges in association with a changing body and feelings as well as with physical health. The nurse who works with an adolescent who has a chronic disease such as cystic fibrosis can help the teen with physical needs but can also help as the client learns to make independent health decisions. A client this age will soon be transitioning to adult care and can learn to make more choices about what is best.
When assessing the respiratory rate of a 6-month-old who has been admitted with bronchitis, the nurse knows to count breath sounds for how long to ensure accuracy?
A. 30 seconds
B. 90 seconds
C. 45 seconds
D. 60 seconds
D
60 seconds
Infants are irregular breathers so respirations should be counted for a full minute to insure accuracy.
The nurse caring for a 4-month-old with bronchiolitis knows that which of the following complications commonly occurs with this respiratory illness?
A. Peritonsillar abscess
B. Retinopathy
C. Dehydration
D. Malnutrition
C
Dehydration
Bronchiolitis is associated with copious nasal secretions and tachypnea which can make it difficult for infants to feed.
The nurse is caring for a client who has been taking erythromycin. For which of the following side effects should the nurse monitor?
A. Nausea and vomiting
B. Constipation
C. Rash
D. Increased urinary output
A
Nausea and vomiting
Erythromycin is a macrolide antibiotic that carries the common side effects of nausea and vomiting, abdominal pain, and cramps.
A client’s mother is upset that after 24 hours no antibiotics have been prescribed for an earache and fever. Which explanation is the best for the nurse to provide
A. “Antibiotics should only be used if there are signs of tinnitus”
B. Antibiotics aren’t helpful unless your child has had a fever for 72 hours”
C. Administration of antibiotics is avoided because they can cause gastrointestinal distress” D. “Administration of antibiotics is usually delayed for 72 hours because of concerns about drug resistance”
D
Administration of antibiotics is usually delayed for 72 hours because of concerns about drug resistance”
Because of concerns regarding drug resistance, it is not recommended to only use antibiotics when less than 6 months old or children who have persistent acute symptoms.
The nurse caring for a newborn who has just been diagnosed with cystic fibrosis knows that which of the following statements would best explain this diagnosis to the parents?
A. “It is an inherited disease that causes digestive problems and bronchospasms which affects breathing”
B. “It is an inherited disease that causes bronchospasms secondary to exposure to allergens”
C. “It is an inherited disease that causes your child’s mucus to be very thick, which affects their breathing and digestion”
D. “It is an acquired disease that causes fluid to move into the alveoli secondary to severe hypertension”
C
“It is an inherited disease that causes your child’s mucus to be very thick, which affects their breathing and digestion”
Cystic fibrosis is an autosomal recessive trait that causes a mutation in the CFTR gene which causes an increase in the viscosity of mucus that causes an obstruction in pulmonary and gastrointestinal systems.
The nurse caring for a 6-year-old with bronchitis knows which of the following symptoms are commonly associated with this diagnosis?
A. A cough that worsens with exercise
B. Dry, hacking cough that worsens at night
C. Cough that sounds like a seal barking
D. Cough spasms followed by a “whooping” sound
B
The cough associated with bronchitis tends to be dry and gets worse at night.
The nurse caring for a 6-month-old diagnosed with bronchiolitis knows which of the following is most likely the cause?
A. Respiratory Syncytial Virus
B. Rotavirus
C. Haemophilus influenzae type B
D. Varicella zoster virus
A
Respiratory Syncytial Virus
RSV is the most common cause of bronchiolitis in children.
The nurse is assessing a 10-month-old child who was brought to the ER by parents because is having a difficult time breathing. Upon examination, the child is in no distress, airway is intact and skin is pink, warm, dry. The provider orders a breathing treatment and some steroids. When the nurse enters the room to administer the medications, the child is drooling and red in the face. What is the first action the nurse should take?
A. Give the breathing treatment
B. Reposition the child by sitting the child up
C. Tell the child to stop drooling
D. Call a rapid response
D
Call a rapid response
When a child is drooling and having breathing problems, they are having symptoms of epiglottitis. This is a medical emergency and the nurse should activate the rapid response team, call for emergency airway equipment, and administer oxygen. The nurse should not leave the child.
The nurse providing care to a client who has been experiencing otalgia and fever for 24 hours. Which of the following should be the top nursing priority?
A. Providing pain relief
B. Tightly packing sterile gauze packs into the affected ears
C. Administering antibiotic ear drops
D. Monitoring for signs of serious airway edema
A
Providing pain relief
Acute otitis media can be quite painful for children causing restlessness and irritability in the child and should be the priority.
The nurse is caring for a client with cystic fibrosis (CF). Which diagnosis is the most concerning for them?
A. Blood clots
B. UTI
C. Cellulitis
D. Sinusitis
D
Sinusitis
Cystic fibrosis is a disorder in which a genetic mutation causes thickening of mucous and affects the lungs, GI system, and endocrine system. These clients are at a high risk for pulmonary infections. A goal of management of this client is to prevent pulmonary infections, because these lead to complications and are difficult to treat.
A nurse is caring for a 5-year-old child who has been diagnosed with bronchiectasis. Based on the nurse’s understanding of this condition, the nurse knows to expect signs and symptoms of which of the following?
A. Absence of respiratory effort
B. Sharp chest pain with each breath
C. Wheezing and a barrel chest
D. Chronic cough that produces green sputum
D
Chronic cough that produces green sputum
Bronchiectasis is a lung condition that causes permanent dilation of the bronchi, resulting in breathing difficulties and pooling of sputum in the bronchial tree that can progressively worsen. The nurse should assess for signs and symptoms of a productive cough with thick or green sputum. Occasionally, the client may also cough up blood. As the disease progresses, sputum production tends to increase.
A nurse is expecting an 18-month-old with bronchiolitis from the emergency department, Which of the following protective gear should be worn when entering the child’s room? Select all that apply.
A. Gloves
B. Shoe covers
C. Mask
D. Gown
E. Respirator Mask
A, C, D
A bronchiolitis is most commonly caused by a respiratory syncytial virus which is spread through droplets that can live on surfaces, therefore droplet and contact precautions are required.
A bronchiolitis is most commonly caused by a respiratory syncytial virus which is spread through droplets that can live on surfaces, therefore droplet and contact precautions are required.
A bronchiolitis is most commonly caused by a respiratory syncytial virus which is spread through droplets that can live on surfaces, therefore droplet and contact precautions are required.
The nurse caring for a 2-year-old who presented to an urgent care center with stridor and excessive drooling knows that which of the following interventions should be given top priority?
A. Place an IV in preparation for giving IV antibiotics
B. Keep the child calm until emergency airway equipment is available
C. Place the child on 2L via NC and prepare for intubation
D. Assess the throat for signs of a cherry red epiglottis
B
Keep the child calm until emergency airway equipment is available
If the child becomes upset or cries it could cause the airway to spasm more resulting in complete airway obstruction. Children with possible epiglottis should only be examined in a setting that has emergency airway equipment readily available.
The nurse knows which of the following indicates the potential need for a tympanostomy and adenoidectomy?
A. Loss of appetite and refusal to feed when otitis media occurs
B. Two occurrences of acute otitis media within the first year of life
C.Frequent occurrences of otitis media and signs of hearing loss
D.Signs of otalgia and otorrhea for 72 hours
C
Frequent occurrences of otitis media and signs of hearing loss
Signs of hearing loss indicate Otitis Media with Effusion. If this isn’t corrected the child could continue to have problems with loss of hearing and language development.
The nurse is caring for a pregnant client. After genetic testing, the fetus is found to have cystic fibrosis (CF). Which of the following is accurate information for the nurse to tell the client about the disorder?
A. Males are more often affected than females
B. The couple has a 1 in 4 chance of having another child with CF
C. Children with cystic fibrosis rarely live past seven years of age
D. This disorder is an autosomal dominant disorder
B
Cystic fibrosis is a condition marked by the production of thick mucus which clogs the lungs and digestive tract. It is an autosomal recessive disorder, which means that one out of every four children born to a parent with the gene are affected. Males and females are equally affected. Due to advances in medical treatment, a person with CF lives to adulthood in most cases.
A student nurse caring for a 6-year-old diagnosed with bronchitis asks what this means. Which of the following is the best explanation of the diagnosis related to where inflammation and infection occur?
A. The bronchioles
B. The trachea
C. The upper airways
D. The lower airways
D
Bronchitis is when there is inflammation in the large airways, the trachea and bronchi, which are part of the lower airways.
An infant in the pediatrics unit has been diagnosed with respiratory syncytial virus (RSV). The nurse should include which of the following precautions in caring for this infant? Select all that apply.
A. Wear a surgical mask for close contact with the client
B. Keep the client in a private room
C. Have staff wear an N95 respirator when providing care for the client
D. Wear goggles if there is potential for splashing of body fluids
E. Ensure the client's room has negative-pressure ventilatio
A, B, D
Keep the client in a private room
Respiratory syncytial virus is an infectious condition that affects infants and young children. Standard plus contact precautions should be used, which includes wearing personal protective equipment whenever there is potential for contact with blood or body fluids. This includes keeping the client in a private room and wearing a gown, gloves, and goggles when providing care, and a surgical mask for close contact if the client is coughing or sneezing.
Respiratory syncytial virus is an infectious condition that affects infants and young children. Standard plus contact precautions should be used, which includes wearing personal protective equipment whenever there is potential for contact with blood or body fluids. This includes keeping the client in a private room and wearing a gown, gloves, and goggles when providing care, and a surgical mask for close contact if the client is coughing or sneezing.
Respiratory syncytial virus is an infectious condition that affects infants and young children. Standard plus contact precautions should be used, which includes wearing personal protective equipment whenever there is potential for contact with blood or body fluids. This includes keeping the client in a private room and wearing a gown, gloves, and goggles when providing care, and a surgical mask for close contact if the client is coughing or sneezing
The nurse caring for a 5-year-old assesses the following assessment findings: stridor, drooling, high fever, toxic appearance, increased heart rate, and respiratory rate. Which of the following should be avoided during the assessment?
A. Assessing the throat
B. Applying a continuous pulse ox monitor
C. Checking the child’s capillary refill time
D. Auscultating the lung sounds
A
Assessing the throat
This could upset the child and cause spasms in the airway leading to complete airway obstruction.
The nurse is educating the parents of an infant on ways to prevent the occurrence of acute otitis media. Which of the following should be included in the teaching? Select all that apply.
A. Feeding in an upright position
B. The benefits of giving prophylactic antibiotics
C.Avoiding exposure to secondhand smoke
D.The importance of routine immunizations
E. No bottle propping during feeds
A, C, D, E
Feeding in this position helps to prevent the fluids from refluxing up the eustachian tubes which can cause Acute Otitis Media.
Exposure to secondhand smoke is shown to increase a child’s risk of developing an ear infection.
No bottle propping during feedsPropping bottles up during feeds increase the likeliness that the milk will reflux into the eustachian tubes which can lead to inflammation and infection.
The importance of routine immunizationsPrevention of influenza and pneumococcal infections is key to reducing the risk of Otitis Media.
The nurse is caring for a client with cystic fibrosis. Which of the following is an appropriate nursing intervention? Select all that apply.
A.Provide a high calorie diet
B.Feed a high protein diet
C.Feed a low calorie diet
D. Avoid carbohydrates in the diet
E.Give pancreatic enzyme replacement
E, B, C
Give pancreatic enzyme replacement
The client with cystic fibrosis must be provided adequate nutrition for growth, because they have a defective amino acid which causes obstructions throughout the body due to the build-up of thick, sticky mucus. The obstructions occur primarily in the lungs, GI system, and other organs.
High protein is necessary for the client with CF. These clients use more calories than persons without cystic fibrosis, and have trouble keeping muscle mass and a normal weight.
Provide a high calorie dietThese clients use more calories than persons without cystic fibrosis, and have trouble keeping muscle mass and a normal weight.
The mother of a 10-year-old diagnosed with bronchitis asks the nurse about treatment options. Which of the following is the best response?
A. “Treatment is focused on managing your child’s allergies”
B. “Treatment is focused on managing your child’s symptoms”
C. “Your child will need to start oral antibiotics”
D. “Your child will need one dose of steroids”
B
“Treatment is focused on managing your child’s symptoms”
Bronchitis is usually a self-limiting disease that is caused by a virus. Treatment focuses on managing symptoms like fever and discomfort.
A nurse has been assigned to float to the pediatrics unit for a shift. The nurse has been assigned three clients, including an infant with rotavirus, a child recovering from an appendectomy, and a baby with respiratory syncytial virus. Which practices should be implemented that would best protect the nurse from contracting an infectious disease? Select all that apply.
A. The nurse keeps one set of vital sign equipment in each client room to avoid cross-contamination
B. The nurse considers every client to be infected with transmittable disease whether their diagnosis is known or not
C. The nurse does not recap needles after use
D. The nurse practices hand hygiene before and after providing client care
E. The nurse asks for a different assignment than the infant because the nurse has not been vaccinated against rotavirus
A, B, C, D
The nurse considers every client to be infected with transmittable disease whether their diagnosis is known or not
When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container.
Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client, as if each client has an infectious condition.
When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container. Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client as if each client has an infectious condition.
When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container. Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client as if each client has an infectious condition.
When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container. Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client as if each client has an infectious condition.
A three-year-old child has been brought in to the hospital with a diagnosis of Haemophilus influenza B. After testing, the provider determines that the child has epiglottitis and treatment is started. Which information would the nurse provide to the parents of this child about caring for this condition? Select all that apply.
A. Gently use a tongue depressor to keep the mouth open
B. Encourage the child to eat plenty of cold foods
C. The child should not lie flat
D. Use a cool mist humidifier in the room
E. Encourage the child not to cry
C, D, E
The child should not lie flat
Epiglottitis is a life-threatening condition because the client's epiglottis becomes swollen and can obstruct the airway. It occurs most often in children ages two to eight, often from Haemophilus influenzae type B or streptococcus pneumoniae. Treatment is centered on maintaining airway patency and administration of antibiotics. The child should be kept calm, because agitation can lead to further airway compromise. The head of the bed should be raised because when the child lies flat, it affects respiratory status.
The child should be kept calm, because agitation can lead to further airway compromise.
Use a cool mist humidifier in the roomThe nurse should place a cool mist humidifier in the room to help decrease swelling.