Chapter 1: Bronchiolitis
1. Which intervention is appropriate for the infant hospitalized with bronchiolitis?
a. Position on the side with neck slightly
... [Show More] flexed.
b. Administer antibiotics as ordered.
c. Restrict oral and parenteral fluids if tachypneic.
d. Give cool, humidified oxygen.
ANS: D
Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from
tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree
angle and the neck slightly extended to maintain an open airway and decrease pressure on the
diaphragm. The etiology of bronchiolitis is viral. Antibiotics are given only if there is a
secondary bacterial infection. Tachypnea increases insensible fluid loss. If the infant is
tachypneic, fluids are given parenterally to prevent dehydration.
2. An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial
virus (RSV). The nurse knows that a child infected with this virus requires what type of
isolation?
a. Reverse isolation
b. Airborne isolation
c. Contact Precautions
d. Standard Precautions
ANS: C
RSV is transmitted through droplets. In addition to Standard Precautions and hand washing,
Contact Precautions are required. Caregivers must use gloves and gowns when entering the
room. Care is taken not to touch their own eyes or mucous membranes with a contaminated
gloved hand. Children are placed in a private room or in a room with other children with RSV
infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other
children need to be protected from exposure to the virus. The virus is not airborne.
3. A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration.
This suggests what condition?
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign body in trachea
ANS: A
Asthma may have these chronic signs and symptoms. Pneumonia appears with an acute onset,
fever, and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial
virus. Foreign body in the trachea occurs with acute respiratory distress or failure and maybe
stridor.
4. Which nursing diagnosis is most appropriate for an infant with acute bronchiolitis due to
respiratory syncytial virus (RSV)?
a. Activity Intolerance
b. Decreased Cardiac Output
c. Pain, Acute
d. Tissue Perfusion, Ineffective (peripheral)
ANS. A
Rationale 1: Activity intolerance is a problem because of the imbalance between oxygen supply
and demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is
not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by
this respiratory-disease process.
Rationale 2: Activity intolerance is a problem because of the imbalance between oxygen supply
and demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is
not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by
this respiratory-disease process.
Rationale 3: Activity intolerance is a problem because of the imbalance between oxygen supply
and demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is
not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by
this respiratory-disease process.
Rationale 4: Activity intolerance is a problem because of the imbalance between oxygen supply
and demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is
not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by
this respiratory-disease process.
Global Rationale: Activity intolerance is a problem because of the imbalance between oxygen
supply and demand. Cardiac output is not compromised during an acute phase of bronchiolitis.
Pain is not usually associated with acute bronchiolitis. Tissue perfusion (peripheral) is not
affected by this respiratory-disease process.
Chapter 2: Asthma
1. The nurse is caring for a child hospitalized for status asthmaticus. Which assessment finding
suggests that the childs condition is worsening?
a. Hypoventilation
b. Thirst
c. Bradycardia
d. Clubbing
ANS: A
The nurse would assess the child for signs of hypoxia, including restlessness, fatigue, irritability,
and increased heart and respiratory rate. As the child tires from the increased work of breathing
hypoventilation occurs leading to increased carbon dioxide levels. The nurse would be alert for
signs of hypoxia. Thirst would reflect the childs hydration status. Bradycardia is not a sign of
hypoxia; tachycardia is. Clubbing develops over a period of months in response to hypoxia. The
presence of clubbing does not indicate the childs condition is worsening.
2. Which finding is expected when assessing a child hospitalized for asthma?
a. Inspiratory stridor
b. Harsh, barky cough
c. Wheezing
d. Rhinorrhea
ANS: C
Wheezing is a classic manifestation of asthma. Inspiratory stridor is a clinical manifestation of
croup. A harsh, barky cough is characteristic of croup. Rhinorrhea is not associated with asthma.
3. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with
purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse
recognizes these symptoms are characteristic of which respiratory condition?
a. Allergic rhinitis
b. Bronchitis
c. Asthma
d. Sinusitis
ANS: D
Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a
low-grade fever, nasal congestion and purulent nasal discharge, headache, tenderness, a feeling
of fullness over the affected sinuses, halitosis, and a cough that increases when the child is lying
down. The classic symptoms of allergic rhinitis are watery rhinorrhea, itchy nose, eyes, ears, and
palate, and sneezing. Symptoms occur as long as the child is exposed to the allergen. Bronchitis
is characterized by a gradual onset of rhinitis and a cough that is initially nonproductive but may
change to a loose cough. The manifestations of asthma may vary, with wheezing being a classic
sign. The symptoms presented in the question do not suggest asthma.
4. What is a common trigger for asthma attacks in children?
a. Febrile episodes
b. Dehydration
c. Exercise
d. Seizures
ANS: C
Exercise is one of the most common triggers for asthma attacks, particularly in school-age
children. Febrile episodes are consistent with other problems, for example, seizures. Dehydration
occurs as a result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for
asthma. Seizures can result from a too-rapid intravenous infusion of theophyllinea therapy for
asthma.
5.The practitioner changes the medications for the child with asthma to salmeterol (Serevent).
The mother asks the nurse what this drug will do. The nurse explains that salmeterol (Serevent)
is used to treat asthma because the drug produces which characteristic?
1. Decreases inflammation
2. Decreases mucous production
3. Controls allergic rhinitis
4. Dilates the bronchioles
Correct Answer: 4
Rationale 1: Salmeterol (Serevent) is a long-acting beta2-agonist that acts by bronchodilating.
Steroids are anti-inflammatory, anticholinergics decrease mucous production, and antihistamines
control allergic rhinitis.
Rationale 2: Salmeterol (Serevent) is a long-acting beta2-agonist that acts by bronchodilating.
Steroids are anti-inflammatory, anticholinergics decrease mucous production, and antihistamines
control allergic rhinitis.
Rationale 3: Salmeterol (Serevent) is a long-acting beta2-agonist that acts by bronchodilating.
Steroids are anti-inflammatory, anticholinergics decrease mucous production, and antihistamines
control allergic rhinitis.
Rationale 4: Salmeterol (Serevent) is a long-acting beta2-agonist that acts by bronchodilating.
Steroids are anti-inflammatory, anticholinergics decrease mucous production, and antihistamines
control allergic rhinitis.
Global Rationale: Salmeterol (Serevent) is a long-acting beta2-agonist that acts by
bronchodilating. Steroids are anti-inflammatory, anticholinergics decrease mucous production,
and antihistamines control allergic rhinitis.
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO 20.6 Create a nursing care plan for a child with a common acute
respiratory condition.
6.Following parental teaching, the nurse is evaluating the parents understanding of
environmental control for their childs asthma management. Which statement by the parents
indicates appropriate understanding of the teaching?
1. We will replace the carpet in our childs bedroom with tile.
2. Were glad the dog can continue to sleep in our childs room.
3. Well be sure to use the fireplace often to keep the house warm in the winter.
4. Well keep the plants in our childs room dusted.
Correct Answer: 1
Rationale 1: Control of dust in the childs bedroom is an important aspect of environmental
control for asthma management. When possible, pets and plants should not be kept in the home.
Smoke from fireplaces should be eliminated.
Rationale 2: Control of dust in the childs bedroom is an important aspect of environmental
control for asthma management. When possible, pets and plants should not be kept in the home.
Smoke from fireplaces should be eliminated.
Rationale 3: Control of dust in the childs bedroom is an important aspect of environmental
control for asthma management. When possible, pets and plants should not be kept in the home.
Smoke from fireplaces should be eliminated.
Rationale 4: Control of dust in the childs bedroom is an important aspect of environmental
control for asthma management. When possible, pets and plants should not be kept in the home.
Smoke from fireplaces should be eliminated.
Global Rationale: Control of dust in the childs bedroom is an important aspect of environmental
control for asthma management. When possible, pets and plants should not be kept in the home.
Smoke from fireplaces should be eliminated.
7.A child with asthma will be receiving an oral dose of prednisone. The order reads prednisone 2
mg/kg per day. The child weighs 50 lbs. The child will receive milligrams daily. (Round
the answer.)
Standard Text: Round the answer to the nearest whole number.
Correct Answer: 45.5 = 46
Rationale: 22.7 2 = 45.5 (46)
Global Rationale: 22.7 2 = 45.5 (46)
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub: Pharmacological and Parenteral Therapies
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: LO 07. Plan the nursing care for the child with a chronic respiratory
condition.
8.Parents of a child admitted with respiratory distress are concerned because the child wont lie
down and wants to sit in a chair leaning forward. Which response by the nurse is the most
appropriate?
1. This helps the child feel in control of his situation.
2. The child needs to be encouraged to lie flat in bed.
3. This position helps keep the airway open.
4. This confirms the child has asthma.
Correct Answer: 3
Rationale 1: Leaning forward helps keep the airway open. The child is not in control just
because he is leaning forward. Lying flat in bed will increase the respiratory distress. This
position does not confirm asthma.
Rationale 2: Leaning forward helps keep the airway open. The child is not in control just
because he is leaning forward. Lying flat in bed will increase the respiratory distress. This
position does not confirm asthma.
Rationale 3: Leaning forward helps keep the airway open. The child is not in control just
because he is leaning forward. Lying flat in bed will increase the respiratory distress. This
position does not confirm asthma.
Rationale 4: Leaning forward helps keep the airway open. The child is not in control just
because he is leaning forward. Lying flat in bed will increase the respiratory distress. This
position does not confirm asthma.
Global Rationale: Leaning forward helps keep the airway open. The child is not in control just
because he is leaning forward. Lying flat in bed will increase the respiratory distress. This
position does not confirm asthma.
9.A school nurse is planning care for a school-age child recently diagnosed with asthma. Which
items will the school nurse include in the plan of care at the school?
Standard Text: Select all that apply.
1. Maintain a log of quick-relief medication administration.
2. Call the parents if quick-relief medications work appropriately.
3. Assess for symptoms of exercise-induced bronchospasm.
4. Coordinate education of the childs teachers.
5. Conduct a support group for all children with asthma.
Correct Answer: 1,3,4,5
Rationale 1: Appropriate interventions for the school nurse to include in the plan of care
include: keeping a log of the quick-relief medications administered; assessing the child for
exercise-induced bronchospasms and reporting, if needed; coordinating education of the childs
teachers; and conducting a support group for all children in the school with asthma. The nurse
would only call the parents if the quick-relief mediation was not effective in treating the childs
symptoms.
Rationale 2: Appropriate interventions for the school nurse to include in the plan of care
include: keeping a log of the quick-relief medications administered; assessing the child for
exercise-induced bronchospasms and reporting, if needed; coordinating education of the childs
teachers; and conducting a support group for all children in the school with asthma. The nurse
would only call the parents if the quick-relief mediation was not effective in treating the childs
symptoms.
Rationale 3: Appropriate interventions for the school nurse to include in the plan of care
include: keeping a log of the quick-relief medications administered; assessing the child for
exercise-induced bronchospasms and reporting, if needed; coordinating education of the childs
teachers; and conducting a support group for all children in the school with asthma. The nurse
would only call the parents if the quick-relief mediation was not effective in treating the childs
symptoms.
Rationale 4: Appropriate interventions for the school nurse to include in the plan of care
include: keeping a log of the quick-relief medications administered; assessing the child for
exercise-induced bronchospasms and reporting, if needed; coordinating education of the childs
teachers; and conducting a support group for all children in the school with asthma. The nurse
would only call the parents if the quick-relief mediation was not effective in treating the childs
symptoms.
Rationale 5: Appropriate interventions for the school nurse to include in the plan of care
include: keeping a log of the quick-relief medications administered; assessing the child for
exercise-induced bronchospasms and reporting, if needed; coordinating education of the childs
teachers; and conducting a support group for all children in the school with asthma. The nurse
would only call the parents if the quick-relief mediation was not effective in treating the childs
symptoms.
Global Rationale: Appropriate interventions for the school nurse to include in the plan of care
include: keeping a log of the quick-relief medications administered; assessing the child for
exercise-induced bronchospasms and reporting, if needed; coordinating education of the childs
teachers; and conducting a support group for all children in the school with asthma. The nurse
would only call the parents if the quick-relief mediation was not effective in treating the childs
symptoms.
Chapter 3: Ulnar Fracture
1. Which is an accurate statement concerning a childs musculoskeletal system and how it may be
different from adults?
a. Growth occurs in children as a result of an increase in the number of muscle fibers.
b. Infants are at greater risk for fractures because their epiphyseal plates are not fused.
Because soft tissues are resilient in children, dislocations and sprains are less common than in
c. adults.
d. Their bones have less blood flow.
ANS: C
Because soft tissues are resilient in children, dislocations and sprains are less common than in
adults. A childs growth occurs because of an increase in size rather than an increase in the
number of the muscle fibers. Fractures in children younger than 1 year are unusual because a
large amount of force is necessary to fracture their bones. A childs bones have greater blood flow
than an adults bones.
2. When infants are seen for...........................................................................................CONTINUED [Show Less]
