Question 1

What test should the nurse do as a precautionary measure before doing an arterial puncture to obtain an arterial blood sample?

Accepted Answer

The Allen test determines the adequacy of collateral circulation in the extremity distal to the proposed puncture site.If the child does not have satisfactory circulation when the proposed artery is occluded,that extremity is not used.The Smith test,venipuncture,and a cold compress are not done before arterial blood gas sampling.

Question 2

How much oxygen is contained in ambient air (room air)?

Accepted Answer

Room air is composed of 21% oxygen,trace amounts of carbon dioxide,and 79% nitrogen.

Question 3

What respiratory condition or disease results in both increased compliance and increased resistance?

Accepted Answer

Compliance is a measure of the relative ease with which the chest wall expands.Resistance is determined primarily by airway size.Asthma results in increased compliance and increased resistance,both of which increase the work of breathing.Atelectasis and surfactant deficiency both decrease compliance but do not affect resistance.Bronchopulmonary dysplasia increases resistance but does not affect compliance.

Question 4

Effective cardiopulmonary resuscitation (CPR)on a 5-year-old child should include what technique?

Accepted Answer

Two breaths to 15 compressions is the standard for infants and children when two rescuers are present.One breath to every five chest compressions is not the appropriate ratio for CPR in this age group.Reassessment of the child should take place after 20 cycles or 1 minute.

Question 5

The nurse is planning home care for a 2-year-old child with a tracheostomy.What recommendation should be included?

Accepted Answer

A plugged,clogged,or obstructed tracheostomy tube is a life-threatening circumstance.Parents are taught the signs and symptoms,how to suction,and how to change the tube.Clean technique and thorough hand washing are sufficient for suctioning,cleaning the tracheostomy site,and changing the tracheostomy tube.The child who is physically able can engage in activities appropriate to age.Young children who may spill food near the stoma should wear a fabric bib without a plastic lining or other device to prevent dribbled food and crumbs from being aspirated.

Question 6

The nurse must suction a 6-month-old infant with a tracheostomy.What intervention should be included?

Accepted Answer

Suctioning should require no longer than 5 seconds per pass.Otherwise,the airway may be occluded for too long.An infant would be unable to cooperate with instructions to cough up secretions.The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal.Then the process is repeated until the trachea is clear.The catheter should have a diameter one half the size of the tracheostomy tube.If it is too large,it might block the child's airway.

Question 7

Respiratory failure can result from many causes.What condition is a specific primary cause of inefficient gas transfer?

Accepted Answer

Respiratory failure is defined as the inability of the respiratory system to maintain adequate oxygenation of the blood.In primary inefficient gas transfer,there is insufficient alveolar ventilation.Anemia,which is characterized by low hemoglobin levels,results in an inability to adequately oxygenate the blood.Pneumothorax and cystic fibrosis are examples of restrictive lung disease.Laryngospasm is an example of obstructive lung disease.

Question 8

Cardiopulmonary resuscitation is begun on a toddler.What pulse is usually palpated because it is the most central and accessible?

Accepted Answer

In a toddler,the carotid pulse is palpated.The radial pulse is not considered a central pulse.The femoral pulse is not the most central and accessible.Brachial pulse is felt in infants younger than 1 year of age.

Question 9

What intervention is necessary when weaning a child from the ventilator?

Accepted Answer

A cool mist or noninvasive oxygen therapy is initiated immediately after extubation.Steroids may be administered to minimize any laryngeal edema.Analgesics may be given,but sedation is not usually indicated.The child is suctioned just before extubation to ensure that the airway is clear.Chest physiotherapy and suctioning are performed before extubation.

Question 10

What is the best explanation for using pulse oximetry on young children to determine oxygen saturation?

Accepted Answer

Pulse oximetry is a noninvasive measure of oxygen saturation of hemoglobin.Capnography measures carbon dioxide inhalation and exhalation.It does not provide information about oxygen saturation.Arterial blood gases provide additional clinical information,including pH,PCO_2,bicarbonate,base excess,and PO₂.An arterial puncture is required,which can be painful,and continuous monitoring cannot be done without an arterial line.Pulse oximetry can be either intermittent or continuous.

Question 11

The nurse is caring for a child with a tracheostomy.What clinical manifestation should the nurse recognize as an early sign of impending respiratory distress or failure?

Accepted Answer

Signs of hypoxemia are initially subtle.Cardinal signs of impending respiratory failure include restlessness,tachypnea,tachycardia,and diaphoresis.Cyanosis is a sign of severe hypoxia.Stridor and crowing respirations are indicative of inflammation.Sternal retractions are an early but less obvious sign.

Question 12

What nursing consideration is most important in the care of a child on a mechanical ventilator?

Accepted Answer

The ventilator will do the work of breathing,but the nurse must position the child with attention to achieving optimum gas exchange.The reason for mechanical ventilation and the child's comfort are part of the assessment.Mechanical ventilation is usually achieved by intubation or tracheostomy.These routes bypass the humidification that occurs in the upper airway.The ventilator provides some information about the work of breathing,but patient assessment must be done by the nurse.Support and reassurance are always important for both the child and family.Opioids and anxiolytics are often used to decrease the child's anxiety.Careful assessment is indicated.

Question 13

It is important to make certain that sensory connectors and oximeters are compatible because incompatible wiring can cause which condition?

Accepted Answer

Incompatible wiring can generate considerable heat at the tip of the sensor,resulting in partial- and full-thickness burns.Heat may be generated at the site of the sensor,but it will not result in generalized hyperthermia.Electrocution is not a possibility with oximeters.Pressure necrosis can occur from improperly applied sensors but not from incompatible wiring.

Question 14

When is bronchial (postural)drainage generally performed?

Accepted Answer

The therapy should be done at bedtime and before meals or 1 to 1 1/2 hours after meals to avoid stomach upset.Postural drainage is most effective when it is performed after other respiratory therapy interventions,including bronchodilator and nebulizer treatments.Immediately on arising and at bedtime are appropriate times,but postural drainage is usually carried out at least three times each day.Thirty minutes after meals may induce vomiting.

Question 15

A 3-year-old child with a tracheostomy will soon be discharged.What recommendation should the nurse share with the family?

Accepted Answer

The child with a tracheostomy should not be exposed to noxious fumes such as paint,varnish,or hair spray or to substances such as talc.The parent and child must be cautioned about safety measures around bodies of water.Baths can be taken,but parents must observe the necessary safety precautions.The child may play outdoors with a scarf or other protection that allows air through.

Question 16

Arterial blood gases have just been drawn on a child.What should the nurse do next?

Accepted Answer

Arterial blood gases require careful handling for accurate results.Immediately after obtaining the specimen,the nurse packs it in ice to reduce cellular metabolism and takes it to the laboratory.

Question 17

What medication is considered to be the most useful in treating cardiac arrest?

Accepted Answer

Epinephrine is considered one of the most useful drugs in treating cardiac arrest.As an adrenergic agent,it acts on both a- and b-receptors in the heart.Epinephrine is rapidly cleared from the bloodstream.Bretylium is no longer used in pediatric cardiac arrest management.Lidocaine is used for ventricular arrhythmias only.Naloxone is useful only to reverse effects of opioids.

Question 18

The continuous administration of mist,or aerosolized water,for the treatment of inflammatory conditions of the airways is a common practice that functions in which manner?

Accepted Answer

Aerosol therapy or mist therapy with water is not a treatment of choice for inflammatory airway conditions.Some questionable benefit may occur in mild viral croup.The parent and child may experience a reduction in anxiety in a cool,humid environment.Upper airway secretions may be moistened; however,inhaled mist does not affect the viscosity of mucus.Humidity may worsen bronchospasm.Aerosolized medications are able to reduce inflammation of the lower airways,but water does not have this effect.

Question 19

During a respiratory assessment,the nurse notes a sinking in of soft tissues relative to the cartilaginous and bony thorax.What is the term for this finding?

Accepted Answer

Retractions are defined as the sinking of soft tissue relative to the cartilaginous or bony thorax.Retractions can be extreme in severe airway obstruction as the work of breathing increases.Grunting can be a sign of pain in older children with respiratory issues.It serves to increase the end-respiratory pressure,which prolongs the period of oxygen and carbon dioxide exchange across the membrane.Tachypnea is an increase in the respiratory rate above the child's baseline.Nasal flaring,the enlargement of the nostrils,helps reduce nasal resistance and maintains airway patency.

Question 20

What test measures the amount of air inhaled and exhaled during any respiratory cycle?

Accepted Answer

Tidal volume is defined as the amount of air inhaled and exhaled during any respiratory cycle.When it is multiplied by the respiratory rate,the minute volume is obtained.Forced vital capacity is the maximum amount of air that can be expired after maximum inspiration.It is used to monitor individuals with obstructive airway disease.Dynamic compliance is the relationship between the change in volume and pressure difference.Pulmonary resistance measures the changes in pressure with changes in flow on inspiration and expiration.

Quiz 27: Overview of Oxygen and Carbon Dioxide Exchange