Chapter 25: The Child with a Respiratory Disorder Nursing School Test Banks

Chapter 25: The Child with a Respiratory Disorder

MULTIPLE CHOICE

1. What will the nurse tell parents of a child with a positive throat culture for group A hemolytic streptococcus that the treatment is most likely to be?
a. Acetaminophen and plenty of fluids
b. Oral penicillin for 10 days
c. Penicillin until his sore throat is gone
d. Streptococcus immunization
ANS: B
When a throat culture is positive for group A beta-hemolytic streptococcus, penicillin is administered for 10 days even if symptoms are alleviated before the medication is finished.

DIF: Cognitive Level: Comprehension REF: Page 580 OBJ: N/A
TOP: Acute Pharyngitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

2. Which initial intervention will the nurse suggest to the parents of a child experiencing laryngeal spasm?
a. Take the child outside in the cool air.
b. Bring the child directly to the emergency department.
c. Take the child to the bathroom and turn on a hot shower.
d. Have the child drink plenty of fluids.
ANS: C
The child experiencing laryngeal spasm should be placed in a high-humidity environment, such as the bathroom with a hot shower running. The humidity liquefies secretions and reduces spasm.

DIF: Cognitive Level: Application REF: Page 582 OBJ: 5
TOP: Croup Syndromes KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

3. The nurse would observe a child for frequent swallowing after a tonsillectomy and adenoidectomy (T&A). What might this indicate?
a. Bleeding from the surgical site
b. Pain at the incision area
c. Sore throat from postnasal drip
d. Potential vomiting
ANS: A
Hemorrhage is the most common postoperative complication. Blood trickling down the back of the childs throat could cause frequent swallowing.

DIF: Cognitive Level: Comprehension REF: Page 588 OBJ: 8
TOP: Tonsillitis and Adenoiditis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Reduction of Risk

4. What is the best choice for fluid replacement that the nurse can offer a child who has just had a tonsillectomy?
a. A popsicle
b. Chocolate milk
c. Orange juice
d. Cola drink
ANS: A
Small amounts of clear liquids can be offered to the child. Synthetic fruit juices are not as irritating as natural juices. A popsicle is usually well-tolerated.

DIF: Cognitive Level: Application REF: Page 588 OBJ: 8
TOP: Tonsillitis and Adenoiditis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

5. When auscultating breath sounds of an infant with respiratory syncytial virus, which assessment would the nurse immediately report?
a. Respiration rate decrease from 40 to 32 breaths/min
b. Heart rate decrease from 110 to 100 beats/min
c. Quiet chest from previous assessment of wheezing
d. Oxygen saturation of 90%
ANS: C
A quiet chest after assessment of wheezing indicates occlusion of air pathways and impending respiratory arrest. All other options are within normal range for infants undergoing oxygen administration.

DIF: Cognitive Level: Analysis REF: Page 584 OBJ: 15
TOP: Respiratory Syncytial Virus (RSV)
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. What classic sign would the nurse, auscultating the breath sounds of a child hospitalized for an acute asthma attack, expect to find?
a. Fine crackles
b. Coarse rhonchi
c. Expiratory wheezing
d. Decreased breath sounds at lung bases
ANS: C
The child experiencing an acute asthma attack wheezes as air moves in and out of the narrowed airways. The expiratory wheeze is most pronounced.

DIF: Cognitive Level: Knowledge REF: Page 589-590
OBJ: 12 TOP: Asthma KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

7. What is the best intervention for the nurse caring for a child experiencing an acute asthma attack?
a. Offer plenty of fluids, particularly carbonated beverages.
b. Place the child in a humidified cool mist tent with oxygen.
c. Administer sedatives as ordered to decrease anxiety.
d. Position the child with arms resting on the overbed table.
ANS: D
This position is comfortable and allows maximum use of the accessory muscles for breathing. Sedatives would mask symptoms of increasing air hunger. Carbonated beverages are contraindicated in persons with dyspnea.

DIF: Cognitive Level: Comprehension REF: Page 593 OBJ: 12
TOP: Asthma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

8. What should the nurse explain to the parent of a child with exercise-induced asthma about when to inhale Cromolyn?
a. Before exercise to prevent attacks
b. At the initial onset of the attack
c. During the attack to relieve symptoms
d. As often as 4 times a day
ANS: A
Anti-inflammatory inhalants are taken before exercise to prevent attacks. These drugs can do nothing for the attack in progress. They are meant to be used as prophylactic therapies.

DIF: Cognitive Level: Application REF: Page 593 OBJ: 12
TOP: Asthma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. The parents of a 3-month-old infant with cystic fibrosis (CF) want to know how their child got this disease, because no one in either of their families has CF. What is the nurses best response based on the understanding of CF?
a. Only one parent carries the CF gene.
b. Both parents are carriers of the CF gene.
c. The inheritance pattern is multifactorial.
d. The result is probably a genetic mutation.
ANS: B
Cystic fibrosis is an inherited disease. Both parents must be carriers of the CF gene for the child to have the disease.

DIF: Cognitive Level: Comprehension REF: Page 595 OBJ: 14
TOP: Cystic Fibrosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. Which statement indicates that the childs parents understand how to perform respiratory therapy?
a. We do her postural drainage before the aerosol therapy.
b. We give her respiratory treatments when she is coughing a lot.
c. We give the aerosol followed by postural drainage before meals.
d. She needs respiratory therapy every day when she has an infection.
ANS: C
Postural drainage for the child with CF is done following nebulization. Therapy is best scheduled before meals or at least 1 hour after eating to prevent vomiting.

DIF: Cognitive Level: Analysis REF: Page 599 OBJ: 14
TOP: Cystic Fibrosis KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. What will the nurse teach the child with cystic fibrosis to take in order to facilitate digestion and absorption of nutrients?
a. Pancreatic enzymes
b. Water-soluble minerals
c. Fat-soluble vitamins
d. Salt supplements
ANS: A
An oral pancreatic enzyme is given to the child with every meal and with snacks to replace the pancreatic enzymes that the childs body cannot produce.

DIF: Cognitive Level: Knowledge REF: Page 599 OBJ: 14
TOP: Cystic Fibrosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. How would the nurse advise a mother to clear the nostrils when her infant has a cold?
a. Clear the nasal passages after the infant has a feeding.
b. Use over-the-counter nose drops to clear passages.
c. Remove nasal secretions with a bulb syringe.
d. Instill saline nose drops after clearing away secretions.
ANS: C
The nasal passages can be cleared by instilling a few drops of saline into the nose and then suctioning the secretions with a bulb syringe.

DIF: Cognitive Level: Application REF: Page 580 OBJ: 2
TOP: Nasopharyngitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

13. The nurse offers a variety of fluids to a 5-year-old asthmatic child to compensate for the fluid loss through dyspnea. Which fluids are most appropriate?
a. Room temperature water
b. Carbonated beverages
c. Iced fruit juice
d. Cold milk
ANS: A
Room temperature fluids are the best. Carbonated and iced beverages increase spasm. Milk stimulates mucus production.

DIF: Cognitive Level: Application REF: Page 593 OBJ: 11
TOP: Asthma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. The asthmatic child who has been taking theophylline complains of stomachache and tachycardia and is sweating profusely. What does the nurse recognize as the cause of these symptoms?
a. Severe asthma attack
b. Allergic response to theophylline
c. Onset of bronchitis
d. Drug toxicity
ANS: D
The symptoms described are the signs of theophylline toxicity.

DIF: Cognitive Level: Analysis REF: Page 591, Table 25-2
OBJ: 11 TOP: Asthma KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. The nurse is planning to teach parents about preventing sudden infant death syndrome (SIDS). What significant information would the nurse include?
a. Wrapping the infant snugly for rest periods
b. Positioning the infant prone for sleep
c. Sitting the infant up in an infant seat
d. Placing infants on their backs or sides for sleep
ANS: D
The American Academy of Pediatrics recommends that all healthy infants be placed in the supine or side-lying position on a firm mattress to prevent SIDS.

DIF: Cognitive Level: Comprehension REF: Page 603, Safety Alert
OBJ: 17 TOP: Sudden Infant Death Syndrome
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

16. An infant is hospitalized with RSV bronchiolitis. What is the priority nursing diagnosis?
a. Fatigue related to increased work of breathing
b. Ineffective breathing pattern related to airway inflammation and increased secretions
c. Risk for fluid volume deficit related to tachypnea and decreased oral intake
d. Fear and/or anxiety related to dyspnea and hospitalization
ANS: B
An ineffective breathing pattern is the priority nursing diagnosis for an infant hospitalized with RSV infection.

DIF: Cognitive Level: Analysis REF: Page 583-584
OBJ: 5 TOP: Respiratory Syncytial Virus (RSV)
KEY: Nursing Process Step: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity

17. The nurse is caring for a toddler with acute laryngotracheobronchitis. Which assessment finding would indicate the child is experiencing increased respiratory obstruction?
a. Restlessness
b. Tachycardia
c. Brassy cough
d. Expiratory wheezing
ANS: A
Restlessness is a primary sign of increased respiratory obstruction.

DIF: Cognitive Level: Analysis REF: Page 581, Figure 25-2
OBJ: 5 TOP: Acute Croup KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

18. The teaching plan for the use of a dry powder inhaler for the treatment of asthma should include the warning to rinse the mouth after inhaling the powder. What does this prevent?
a. Discoloration of tooth enamel
b. Halitosis
c. Irritation of oral membranes
d. Candidiasis
ANS: D
Inhalant powders can cause candidiasis (yeast) infection of the mouth.

DIF: Cognitive Level: Comprehension REF: Page 593 OBJ: 12
TOP: Candidiasis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological therapies

19. The nurse is caring for a 3-year-old who suffered a smoke inhalation injury. How long is this patient at the highest risk for pulmonary edema after exposure?
a. 2 hours
b. 4 hours
c. 18 hours
d. 72 hours
ANS: D
Pulmonary edema appears in a child with smoke inhalation injury 6 to 72 hours after exposure.

DIF: Cognitive Level: Comprehension REF: Page 585 OBJ: 15
TOP: Smoke Inhalation KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. Which is the most appropriate nursing action when planning care for a child with cystic fibrosis?
a. Provide chest physiotherapy before meals every day.
b. Assess weight monthly.
c. Administer pancrease with protein food at mealtime.
d. Ensure high-protein, high-calorie diet.
ANS: D
The maintenance of adequate nutrition is essential. The diet is high in protein and calories. Chest physiotherapy should be done between meals. Pancreatic enzyme powder should be given with applesauce or other nonstarch, nonfat, nonprotein food. Children with cystic fibrosis should be weighed daily.

DIF: Cognitive Level: Application REF: Page 599 OBJ: 13
TOP: Cystic Fibrosis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

21. The first child of a couple is being treated for bronchopulmonary dysplasia (BPD). They ask how to prevent this from happening with the child they are currently expecting. What will the nurse explain as the best way to prevent BPD?
a. Maternal intake of folic acid
b. Exercise
c. Prevention of preterm birth
d. Provision of oxygen therapy to the newborn
ANS: C
Bronchopulmonary dysplasia (BPD) is a fibrosis, or thickening, of the alveolar walls and the bronchiolar epithelium. It occurs in premature infants (less than 32 weeks) who have abnormal or arrested lung development and receive ventilation and oxygen for more than 28 days to survive. Respiratory distress in the newborn is the major reason why oxygen and ventilators are used for prolonged periods. The main cause of respiratory distress in the newborn is prematurity. Therefore the prevention of preterm births is the best way to prevent BPD.

DIF: Cognitive Level: Knowledge REF: Page 602 OBJ: 16
TOP: Bronchopulmonary Dysplasia KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Health Promotion/Disease Prevention

MULTIPLE RESPONSE

22. The nurse describes the allergic salute as a cluster of what signs related to chronic allergy? (Select all that apply.)
a. Mouth breathing
b. Transverse nasal crease
c. Dark circles under the eyes
d. Productive cough
e. Reddened conjunctiva
ANS: A, B, C, E
The allergic salute does not include a productive cough.

DIF: Cognitive Level: Comprehension REF: Page 588, Figure 25-4
OBJ: 9 TOP: Allergic Salute
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. The nurse would suggest the parents of an asthmatic child to encourage participation in which sport(s)? (Select all that apply.)
a. Swimming
b. Gymnastics
c. Baseball
d. Cross-country skiing
e. Distance running
ANS: A, B, C
Sports that require bursts of energy rather than long-term output of energy are suitable pursuits for asthmatics. Swimming, gymnastics, and baseball fit this criterion.

DIF: Cognitive Level: Comprehension REF: Page 593 OBJ: 11
TOP: Sports Activities Suitable for Asthmatics
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. The nurse reports which assessments that suggest a meconium ileus in a newborn? (Select all that apply.)
a. Abdominal distention
b. Vomiting
c. Hiccoughing
d. Jaundice
e. Absence of stool
ANS: A, B, E
Distended abdomen, vomiting, and absence of stool are the signs indicating meconium ileus in the newborn.

DIF: Cognitive Level: Comprehension REF: Page 587 OBJ: 1
TOP: Meconium Ileus KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

25. What would the nurse teaching an asthmatic child the technique of pursed-lip breathing include? (Select all that apply.)
a. Inhale deeply through nose with mouth closed.
b. Make exhalation twice as long as inhalation.
c. Use medicated inhaler prior to performing breathing exercise.
d. Exhale through mouth as if whistling.
e. Exhale forcefully.
ANS: A, B, D
The technique requires that breath be inhaled through the nose and exhaled through pursed lips in a nonforceful manner. The exhalation should be twice as long as the inhalation.

DIF: Cognitive Level: Comprehension REF: Page 593 OBJ: 12
TOP: Pursed-Lip Breathing KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. A toddler must maintain bed rest for the diagnosis of pneumonia. What actions will the nurse implement? (Select all that apply.)
a. Maintain strict bed rest.
b. Consider age.
c. Assess developmental level.
d. Implement light play activities.
e. Provide hypnotic medication as ordered.
ANS: B, C, D
Confinement to bed for a child does not always result in physical rest. In pediatrics, bed rest means providing play therapy that promotes minimal activity. The nurse should consider the age and developmental level of the child and the activity level involved in the play when designing appropriate activities and guiding parents in the home care of their child.

DIF: Cognitive Level: Application REF: Page 579 OBJ: 3
TOP: Bed Rest KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

27. The school nurse suspects a first grade student has sinusitis. Which symptoms might lead the nurse to this suspicion? (Select all that apply.)
a. Child reports tooth pain.
b. Severe wheezing is auscultated on inspiration.
c. Child reports, I have had a cold for 2 weeks.
d. Nurse observes periorbital swelling.
e. Halitosis is present.
ANS: A, C, D, E
The proximity of the sinus to the tooth roots often results in tooth pain when the sinus is infected. The maxillary and ethmoid sinuses are most often involved in childhood sinusitis. Therefore the signs and symptoms of sinusitis in children are different from those in adults, depending on the age of the child and which sinus is fully developed. An acute sinusitis is suspected when an upper respiratory infection lasts longer than 10 days, with a daytime cough. Halitosis is often present. Untreated sinusitis can lead to periorbital cellulitis. Severe wheezing is not indicative of sinusitis.

DIF: Cognitive Level: Comprehension REF: Page 581 OBJ: 4
TOP: Sinusitis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

28. The nurse is caring for a 4-year-old child diagnosed with H. influenzae type B. Which signs and symptoms exhibited by the child would alert the nurse to suspect epiglottitis? (Select all that apply.)
a. Harsh cough
b. Restlessness
c. Edematous epiglottis
d. Child insists on lying down
e. Drooling
ANS: B, C, E
H. influenzae type B and most often occurs in children 3 to 6 years of age. It can occur in any season. The course is rapid and progressive. The onset of epiglottitis is abrupt, and the child presents with classic symptoms. The child insists on sitting up, leans forward with the mouth open, and drools saliva because of the difficulty in swallowing. The child appears wide-eyed, anxious, and restless, and he or she may emit a froglike croaking sound on inspiration. Cough is absent. Inspection of the throat shows an enlarged, reddened edematous epiglottis much like a beefy-red thumb. However, the examining tongue blade may trigger a laryngospasm and result in sudden respiratory arrest.

DIF: Cognitive Level: Comprehension REF: Page 582 OBJ: 6
TOP: Epiglottitis KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. What will the nurse discourage when providing education to parents of a child with asthma? (Select all that apply.)
a. Stuffed toys
b. Pet ownership
c. Gymnastics
d. Basketball
e. Cotton blankets
ANS: A, D
Use of stuffed toys is discouraged due to potential allergens. Basketball might not be well tolerated because of the constant physical exertion. Certain pets are encouraged, gymnasitics is usually well tolerated, and cotton blankets are recommended for children with asthma.

DIF: Cognitive Level: Comprehension REF: Page 591 OBJ: 10
TOP: Asthma KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Health Promotion/Disease Prevention

COMPLETION

30. The nurse explains that the ____________________ can sense the oxygen concentration in the blood and signal the brainstem to increase respiration.

ANS:
chemoreceptors

Chemoreceptors can sense the oxygen concentration of the blood and signal the brainstem to increase and deepen respirations to keep an adequate supply of oxygen in the circulating volume.

DIF: Cognitive Level: Knowledge REF: Page 578 OBJ: 2
TOP: Chemoreceptors KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

31. After the 3-month-old child with respiratory syncytial virus is given a protocol of antiviral medications, the nurse explains that routine immunizations will need to be delayed for _______ months.

ANS:
9

After a protocol of antiviral medications, the routine immunizations should be delayed because the antiviral medications affect the integrity of the immunizations.

DIF: Cognitive Level: Knowledge REF: Page 584 OBJ: 5 | 9
TOP: Respiratory Syncytial Virus (RSV)
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

32. The nurse reviews Accolate and Zyflo, which are _______________ _______________; they are capable of blocking the inflammatory response as well as providing bronchodilation.

ANS:
leukotriene modifiers

The leukotriene modifiers are capable of blocking the inflammatory response and can also provide bronchodilation.

DIF: Cognitive Level: Knowledge REF: Page 591, Table 25-2
OBJ: 12 TOP: Leukotriene Modifiers
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

33. Place the three stages of smoke inhalation injury in the correct order (first to last). Put a comma and space between each answer choice (a, b, c, d, etc.)

a. Bronchopneumonia
b. Pulmonary insufficiency
c. Pulmonary edema

ANS:
B, C, A
Smoke inhalation injury may cause carbon monoxide poisoning. Poisonous substances inhaled from burning material may also cause pathological disturbance. There are three stages of inhalation injury:

1. Pulmonary insufficiency in the first 6 hours
2. Pulmonary edema from 6 to 72 hours
3. Bronchopneumonia after 72 hours, which may cause atelectasis

DIF: Cognitive Level: Knowledge REF: Page 585 OBJ: 7
TOP: Smoke Inhalation KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

Leave a Reply