Question 1

The pediatric nurse explains to the parents of a 1-year-old patient with pneumonia that the differences between the adult's and child's respiratory system affect function and subsequent respiratory conditions.Which difference does the nurse include in the discussion with the patient's parents?
A)Infants are obligate nose breathers until 6 months of age.
B)The epiglottis in the child under 8 is shorter and more rigid.
C)The larynx and the glottis are higher in the younger child's neck.
D)In the child,there are more functional muscles in the neck and less soft tissue.

Accepted Answer

Until about age 4 weeks,infants are obligate nose breathers and do not open their mouths to breathe.The epiglottis in the younger (usually age 8 years and younger)child is longer and flaccid (floppy),which makes it more susceptible to swelling.The larynx and the glottis are higher in the younger child's neck,which makes the child more prone to aspiration.There are fewer functional muscles in the neck,and the increased amount of soft tissue makes the younger child more susceptible to infection and edema.

Question 2

A nurse is caring for a child who has a chest tube.After ambulating and returning the child to bed,the nurse notes that the child has dyspnea and decreasing oxygen saturation readings.Which nursing action is the priority?
A)Assess the tubing for kinks.
B)Call the rapid response team.
C)Facilitate a portable chest x-ray.
D)Provide bag-valve-mask breathing.

Accepted Answer

In order to function properly,the chest tube system should be at least 1 ft below the level of the lungs,and the tubing must be free of kinks.After positioning the child in bed,the potential for kinking the tubing is fairly high,so the nurse should quickly assess the tubing before taking any other actions.If the system is working,other interventions need to occur,including calling the rapid response team.

Question 3

The parents of a child diagnosed with cystic fibrosis (CF)consult the nurse,stating they want to have more children but are worried about subsequent children also having the disease.Which information does the nurse provide the parents?
A)"Each child has a 25% chance of inheriting the disease."
B)"This disease is rare,so other children should not be affected."
C)"Unfortunately,there is no way to predict if they will have it."
D)"You should have genetic testing to see who the carrier is."

Accepted Answer

Cystic fibrosis is an inherited autosomal recessive disorder.When both parents carry the defective gene,each child has a 25% chance of inheriting the defective gene from both parents and manifesting the disease.It is a common disorder,especially in Caucasians,affecting 1 in 3,000 live births.

Question 4

The mother of a 5-year-old girl describes her daughter's symptoms to the nurse in the emergency room.She states that her daughter has had "a dry,hacking cough for the past 3 days that gets worse during the night." She further states that "now she is coughing up phlegm." Which discharge instruction does the nurse plan to provide?
A)"Do not be surprised if she vomits her secretions."
B)"Give your child cough drops as often as needed."
C)"Return if she is not better after 3 days of antibiotics."
D)"You can use a warm-mist humidifier in her room."

Accepted Answer

This child has manifestations of bronchitis,which is frequently viral in nature.A dry,hacking cough gives way to a productive cough.Older children can be encouraged to cough up their secretions,but younger children often swallow them,leading to vomiting.Cough drops are not generally used,so as to encourage secretion mobilization.Because this disease is usually viral in nature,antibiotics are not routinely used.Cool-mist humidifiers are preferred over warm.

Question 5

A 4-year-old girl is brought to the emergency department.She has a "frog-like" croaking sound on inspiration,is agitated,and is drooling.She insists on sitting upright.Which nursing action is the priority for this patient?
A)Maintain the airway.
B)Obtain a throat culture.
C)Start an intravenous line.
D)Transport for a chest x-ray.

Accepted Answer

Airway,breathing,and circulation are the primary concerns for all patients.When a patient has acute respiratory distress,the most important nursing intervention is maintaining an airway.Starting an IV is important,but it is not the primary concern.Obtaining a throat culture would be contraindicated at this time,as it could cause vomiting or occlusion of the airway.The child should not be transported for x-ray;it should be done with portable equipment.

Question 6

A 5-year-old child is brought into the clinic by a parent,who reports the child has a "sore throat." Which assessment finding would require immediate notification to the health-care provider?
A)Difficulty swallowing
B)Inflamed,red pharynx
C)Refusing to eat the last 2 days
D)Strawberry-colored tongue

Accepted Answer

A strawberry-red tongue,petechiae on the palate,and a fine red rash on the trunk or abdomen are consistent with pharyngitis caused by Streptococcus A infection,which needs immediate treatment.The other manifestations are seen with viral pharyngitis infections.

Question 7

A nurse working in a pediatric clinic is collecting data on children as part of a research study.What action by the nurse is most appropriate?
A)Do not inform children or parents of the data collection.
B)Obtain parental consent only for all children enrolled.
C)Obtain written assent from children 12 and older.
D)Only inform the parents of the research study and methods.

Accepted Answer

Children in research studies are considered vulnerable subjects and extra care must be taken to ensure their rights.This includes obtaining written assent from older children (generally 12-13 or older).

Question 8

The nursing student studying respiratory anatomy and physiology learns that which tissue or organ grows faster than any other tissue or organ in a child?
A)Diaphragm
B)Epiglottis
C)Lungs
D)Tonsils

Accepted Answer

The lymphoid tissue of the tonsils is absent at birth,but grows more rapidly in a child than any other tissue.

Question 9

The nurse is caring for a child with bronchopulmonary dysplasia receiving furosemide (Lasix).Which finding would lead the nurse to conclude the child has a side effect of this drug?
A)Acidosis
B)Hypercarbia
C)Hypokalemia
D)Thrombocytopenia

Accepted Answer

A side effect of Lasix is hypokalemia.The other laboratory abnormalities are not associated with this drug.

Question 10

The nurse suspects a pediatric patient is experiencing acute respiratory distress syndrome (ARDS).What laboratory finding correlates to this condition? A)HCO₃ of 22 mEq/L B)PCO₂ of 88 mm Hg C)pH of 7.34 D)PO₂ of 60 mm Hg

Accepted Answer

Arterial blood gas results in a child with ARDS include hypoxemia,hypercarbia,and acidosis.All values here are normal except for the PCO₂,which is high (hypercarbia).

Question 11

A nurse is educating the parents of a 5-year-old with bacterial otitis media.Which discharge instruction is most important?
A)"Bring her back if she is not better in 1 week."
B)"Do not allow your child to swim in the future."
C)"Give the full course of antibiotics even if she is better."
D)"Ice packs are a good way to manage her ear pain."

Accepted Answer

Giving the full course of antibiotics is crucial to prevent the development of resistant bacteria.If the child is not showing improvement in 48 to 72 hours,she should be reassessed.Swimming is not prohibited after the infection heals.Heat is a better option for ear pain.

Question 12

A diabetic mother delivers an infant at 36 weeks' gestation who has Apgar scores of 5 and 6,has central cyanosis,and has a respiratory rate of 66 breaths/minute.What medication does the nurse anticipate the child will receive?
A)Albuterol (Ventolin)
B)Caffeine (Cafergot)
C)Epinephrine (Adrenalin)
D)Surfactant (Surfaxin)

Accepted Answer

This child most likely has respiratory distress syndrome (RDS),which is treated with surfactant.

Question 13

The mother of a 5-year-old child calls the clinic to ask if her child has a mild respiratory infection or needs to be seen.Which question by the nurse would elicit the most helpful information?
A)"Can your child swallow without pain?"
B)"Does the child have a sore throat?"
C)"Is your child coughing occasionally?"
D)"Was the onset gradual or sudden?"

Accepted Answer

Common "colds" or nasopharyngitis usually have a gradual onset.A rapid onset would indicate a more serious condition.The other manifestations are commonly seen in this disorder.

Question 14

A father brings his 1-year-old son to the clinic and states that when he kisses the child's cheek,it tastes salty.Which diagnostic test does the nurse educate the father on based on the father's statement?
A)Large bowel barium series
B)Pancreatic enzyme analysis
C)Pulmonary function studies
D)Quantitative sweat chloride test

Accepted Answer

Salty-tasting sweat and tears are a characteristic finding in cystic fibrosis.The diagnostic test for this disorder is the quantitative sweat chloride test.Pancreatic enzyme studies are invasive and not usually performed on children.Pulmonary function studies are done in older children who can cooperate.Large bowel barium studies are not needed.

Question 15

A nurse is caring for an infant diagnosed with esophageal atresia (EA)and a tracheoesophageal fistula (TEF)prior to surgical correction.Which assessment finding indicates that a priority goal is being met?
A)Airway patent with frequent suction
B)Gavage feedings tolerated well
C)Identification of support system by parents
D)Temperature within normal range

Accepted Answer

All assessments indicate that goals for important nursing diagnoses have been met;however,airway takes priority.Maintaining a patent airway is the most important goal.

Question 16

A nurse is teaching the parents of a 10-year-old child diagnosed with cystic fibrosis.Which instruction by the nurse is most appropriate?
A)"For Pseudomonas infections,we can use penicillin antibiotics."
B)"Preventing respiratory infections is crucial for quality of life."
C)"Unfortunately,your child is sterile and unable to have children."
D)"With pancreatic enzymes,vitamin replacement is not needed."

Accepted Answer

Cystic fibrosis (CF)is characterized by frequent,severe respiratory infections,often caused by Pseudomonas,which is treated with tobramycin (TOBI)or azithromycin (Zithromax).Preventing respiratory infections is a crucial part of caring for the child with CF.Reproduction is often affected in people with CF,but without testing,it is impossible to say that the child is sterile.Vitamin replacement is needed along with pancreatic enzyme replacement.

Question 17

A pediatric clinic nurse teaches parents how to care for their toddler who has nasal congestion.What anatomical difference between children and adults is a concern with congestion in children?
A)Children this age should not have congestion.
B)Larger tonsils trap mucus,leading to gagging.
C)The narrow trachea can become obstructed easily.
D)Phlegm can migrate into the eustachian tubes.

Accepted Answer

Excess mucus production can lead to airway obstruction in children due to the narrowed lumen size of their tracheas.

Question 18

The pediatric nurse examines a neonate and documents that the baby is pink in color when crying but turns bluish when quiet.Which question would be most appropriate to ask the parent?
A)"Does the baby have trouble when eating?"
B)"Have your other children had this problem?"
C)"How many respiratory infections has she had?"
D)"You don't ever prop her bottle,do you?"

Accepted Answer

Choanal atresia is a congenital malformation of the nose in which there is blockage of the posterior side of the nose.It often is associated with bony abnormalities and may affect one side or both sides of the nose.A child with bilateral choanal atresia usually displays respiratory problems during development.A newborn who is pink in color when crying,yet turns bluish when quiet should be suspected of having bilateral choanal atresia or another defect impeding the nasal airway.Another sign of this disorder is feeding difficulties and resultant lack of weight gain.Because this is not genetic,asking about other children with the condition is irrelevant.The number of respiratory infections will not give information as to the possible diagnosis.Because of the potential for aspiration,the baby should be fed in a semi-upright to upright position;however,the wording of the question might make the parent feel defensive.

Question 19

A school-age child has asthma and lives in a home where both parents smoke.The nurse has provided extensive education to the parents on the dangers of second-hand smoke.Which assessment by the nurse indicates that goals for a family nursing diagnosis have been met?
A)Child's clothing no longer smells of cigarette smoke
B)Father states he has quit smoking;mother has cut down
C)Parents state they smoke only in the basement now
D)Significant decrease in asthma "attacks" over a year

Accepted Answer

An important goal for this family is understanding how to avoid exposing their child to second-hand smoke.The only objective assessment data to show that the child is not exposed to smoke is the decrease in asthma "attacks" the child has had in the last year.New clothing will not smell like smoke;if the mother continues to smoke even in lesser amounts,the child will still be exposed;and smoking anywhere in the house pollutes all the air in the house.

Question 20

Which statement by the nursing student indicates a correct understanding of the anatomy and physiology of the respiratory system?
A)Air passes through the trachea into the bronchus.
B)Oxygen exchange with the bloodstream occurs in the veins.
C)Oxygen passes from the larynx to the pharynx.
D)The bronchus divides into smaller branches or acini.

Accepted Answer

The oxygen passes from the pharynx to the larynx.From the larynx,air passes through the trachea,which branches into the left and right bronchi.Each bronchus divides into smaller branches called bronchioles.The bronchioles end in a cluster of air sacs called acini.Oxygen exchange with the bloodstream occurs in the capillaries.

Quiz 23: Caring for the Child With a Respiratory Condition

The pediatric nurse explains to the parents of a 1-year-old patient with pneumonia that the differences between the adult's and child's respiratory system affect function and subsequent respiratory conditions.Which difference does the nurse include in the discussion with the patient's parents?

A nurse is caring for a child who has a chest tube.After ambulating and returning the child to bed,the nurse notes that the child has dyspnea and decreasing oxygen saturation readings.Which nursing action is the priority?

The parents of a child diagnosed with cystic fibrosis (CF) consult the nurse,stating they want to have more children but are worried about subsequent children also having the disease.Which information does the nurse provide the parents?

A 4-year-old girl is brought to the emergency department.She has a "frog-like" croaking sound on inspiration,is agitated,and is drooling.She insists on sitting upright.Which nursing action is the priority for this patient?

A 5-year-old child is brought into the clinic by a parent,who reports the child has a "sore throat." Which assessment finding would require immediate notification to the health-care provider?

A nurse working in a pediatric clinic is collecting data on children as part of a research study.What action by the nurse is most appropriate?

The nursing student studying respiratory anatomy and physiology learns that which tissue or organ grows faster than any other tissue or organ in a child?

The nurse is caring for a child with bronchopulmonary dysplasia receiving furosemide (Lasix) .Which finding would lead the nurse to conclude the child has a side effect of this drug?

The nurse suspects a pediatric patient is experiencing acute respiratory distress syndrome (ARDS) .What laboratory finding correlates to this condition?

A nurse is educating the parents of a 5-year-old with bacterial otitis media.Which discharge instruction is most important?

A diabetic mother delivers an infant at 36 weeks' gestation who has Apgar scores of 5 and 6,has central cyanosis,and has a respiratory rate of 66 breaths/minute.What medication does the nurse anticipate the child will receive?

The mother of a 5-year-old child calls the clinic to ask if her child has a mild respiratory infection or needs to be seen.Which question by the nurse would elicit the most helpful information?

A father brings his 1-year-old son to the clinic and states that when he kisses the child's cheek,it tastes salty.Which diagnostic test does the nurse educate the father on based on the father's statement?

A nurse is caring for an infant diagnosed with esophageal atresia (EA) and a tracheoesophageal fistula (TEF) prior to surgical correction.Which assessment finding indicates that a priority goal is being met?

A nurse is teaching the parents of a 10-year-old child diagnosed with cystic fibrosis.Which instruction by the nurse is most appropriate?

A pediatric clinic nurse teaches parents how to care for their toddler who has nasal congestion.What anatomical difference between children and adults is a concern with congestion in children?

The pediatric nurse examines a neonate and documents that the baby is pink in color when crying but turns bluish when quiet.Which question would be most appropriate to ask the parent?

A school-age child has asthma and lives in a home where both parents smoke.The nurse has provided extensive education to the parents on the dangers of second-hand smoke.Which assessment by the nurse indicates that goals for a family nursing diagnosis have been met?

Which statement by the nursing student indicates a correct understanding of the anatomy and physiology of the respiratory system?