Elsevier Adaptive Quizzing - Quiz performance respiratory

10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Performance Exit Final Score 58% 47 out of 81 questions answered correctly Completed on Oct 22, 2024 2:38 pm Incorrect (34) Report content error Which symptom would the nurse expect to find in a child with acute laryngotracheobronchitis (LTB)? Drooling of saliva Protruding tongue Barky, brassy cough 1/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Thick, muffled voice Rationale Acute LTB is characterized by a low, barky, brassy cough caused by inflammation of the mucosa lining the larynx and trachea, which leads to a narrowing of the airway. Clinical manifestations of epiglottitis include drooling of saliva, a protruding tongue, and a thick, muffled voice. The child has pain and difficulty in swallowing accompanied by excess secretions; as a result, the child sits upright with protruding tongue and drools saliva. The voice is thick and muffled, with a froglike croaking sound on inspiration. p. 629 Report content error Which are common signs of a pneumothorax in a child with cystic fibrosis? Cyanosis, bradycardia Tachypnea, bradycardia, pallor Tachypnea, tachycardia, dyspnea, cyanosis Tachypnea, subtle increase in oxygen saturation Rationale Signs of a pneumothorax in a child with cystic fibrosis include tachypnea, tachycardia, dyspnea, and cyanosis. Bradycardia is not a sign of a 2/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance pneumothorax in a child with cystic fibrosis. A subtle decrease, rather than an increase, in oxygen saturation is a sign of a pneumothorax. p. 635 Report content error Which type of diet do children with cystic fibrosis (CF) require? A diet low in fruits and vegetables A special gluten-free, high-calorie diet A low-protein, high-carbohydrate diet A well-balanced, high-protein, high-calorie diet Rationale A well-balanced, high-protein, high-calorie diet is important for a child with CF because of the impaired intestinal absorption that is part of the disease. Children with CF require a diet with adequate amounts of fruits and vegetables. Children with CF do not need a special gluten-free diet. Children with CF need a high-protein, not a low-protein, diet. p. 660 Report content error 3/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which statement by the parents would the nurse associate with cystic fibrosis in the child? The infant has diarrhea. The infant tastes "salty." The infant has loss of appetite. The infant has a flat abdomen. Rationale The parents of the infant with cystic fibrosis may report that their infant tastes "salty" when they kiss the infant. A positive sweat chloride test helps evaluate the presence of cystic fibrosis in the child. The infant fails to pass stools and may have large, bulky, loose, frothy, and extremely foulsmelling stools. Meconium ileus and meconium ileus equivalent, or total or partial intestinal obstruction, can occur at any age. The child is often constipated as a result of a combination of malabsorption, either from inadequate pancreatic enzyme dosage or a failure to take the enzymes, decreased intestinal motility, and abnormally viscous intestinal secretions. Initially the infant has a voracious appetite, which is now reduced. The child has a distended abdomen caused by intestinal obstruction. pp. 656-657 Report content error 4/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which postoperative nursing care must be provided for the child who had a tonsillectomy? Place the child on the abdomen when fully alert. Provide analgesics rectally or intravenously. Offer milk, ice cream, or pudding for comfort. Allow the child to cough out secretions. Rationale Most children experience moderate pain after a tonsillectomy and need pain medication. Analgesics are administered rectally or intravenously to avoid the oral route. Until the child is fully awake, the child is placed on the abdomen or side to facilitate drainage of secretions. When fully alert, the child may prefer to sit up. Milk products coat the mouth and throat and may cause the child to clear the throat, which can initiate bleeding. Therefore milk, ice cream, or pudding should not be offered to the child. The child is discouraged from coughing frequently, clearing the throat, blowing the nose, and any other activity that may aggravate the operative site. STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it. pp. 621-622 Report content error 5/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which therapeutic management methods would the nurse expect will be applied for a child with bronchiolitis? Humidified mist Chest percussion Postural drainage Oral fluid intake Rationale Administration of humidified mist or humidified oxygen moistens secretions and prevents drying of the airways. Routine chest percussion and postural drainage are not recommended for children. Oral fluid intake may be contraindicated because of tachypnea, weakness, and fatigue; therefore intravenous fluids may be used until the acute stage of the disease has passed. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic but scoring an 85% may be a better goal. pp. 631-632 Report content error 6/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which would the nurse suggest for a 4-year-old child who needs to use a metered-dose inhaler for asthma but cannot coordinate breathing to use it effectively? Spacer Nebulizer Peak expiratory flow meter Trial of chest physiotherapy Rationale The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a device for administering medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters are used to measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration. pp. 648-651 Report content error Which syndrome would a 3-year-old child who has rapidly progressing dysphagia and stridor, a high fever, and a rapid pulse and respirations most likely have? Acute tracheitis Acute epiglottitis 7/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Acute spasmodic laryngitis Acute laryngotracheobronchitis Rationale Symptoms of progressive dysphagia, stridor, high fever, rapid pulse, and rapid respirations in a 3-year-old child are highly suggestive of acute epiglottitis. Acute tracheitis is moderately progressive and includes a croupy cough. Acute spasmodic laryngitis occurs suddenly at night; the symptoms tend to wake the child up at night and disappear during the day. Laryngotracheobronchitis is slowly progressive. Test-Taking Tip: The night before the examination, you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early. pp. 627-628 Report content error Which trigger tends to precipitate or aggravate asthma in children? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Exercise Breast milk 8/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Tobacco smoke Thyroid disease A smoke-free home Rationale Triggers that precipitate or aggravate asthma in children include exercise, tobacco smoke, and thyroid disease. A smoke-free home and breast milk do not trigger or aggravate asthma symptoms in children; rather, they decrease the likelihood of an asthma exacerbation. pp. 645-648 Report content error Which condition is prevented when by treating acute streptococcal pharyngitis with antibiotics? Otitis media Diabetes insipidus Nephrotic syndrome Acute rheumatic fever Rationale Children with group A β-hemolytic Streptococcus (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have https://eaqng.elsevier.com/#/quizPerformance/67568460 9/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome. pp. 619-620 Report content error The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse, suspecting croup, would recommend what? Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing Bringing the child to the hospital to be admitted and to be observed for impending epiglottitis Trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement Controlling the fever with acetaminophen and calling the primary care provider if the cough gets worse tonight Rationale Because the child is not experiencing difficulty breathing, the nurse would teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will help open up the child's airways. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis. Cough suppressants are not indicated by the symptoms, and https://eaqng.elsevier.com/#/quizPerformance/67568460 10/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance the American Pediatrics Association no longer recommends over-thecounter cough medicines for children under the age of 2 years. The child does not have a temperature and therefore does not require management with acetaminophen. p. 628 Report content error The nurse is performing discharge teaching for the parents of an infant with an upper respiratory tract infection. Which respiratory complication would prompt the parents to notify the health care practitioner? Dry cough Waking up during naps Decreasing irritability with fever Refusal to drink and decreased urination Rationale The health care professional would be notified of any refusal to take oral fluids and decreased urination so that dehydration, which could further complicate respiratory problems, may be prevented. Although a dry cough does not warrant contacting a health care professional, persistent cough or exacerbating cough does. Waking up during naps does not warrant contacting the health care professional; however, restlessness and a poor sleep pattern does. Decreasing irritability with fever does not warrant contacting a health care professional; however, increasing irritability with or without fever does. https://eaqng.elsevier.com/#/quizPerformance/67568460 11/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance p. 617 Report content error Which is the first line of treatment for the child with epiglottitis and severe respiratory distress? Antibiotics Corticosteroids Humidified oxygen via mask Nasotracheal intubation or tracheostomy Rationale The first line of treatment for the child with epiglottitis and severe respiratory distress is nasotracheal intubation or tracheostomy. Antibiotics are given for 24 hours after the child's airway is patent and maintained. Corticosteroids are given to reduce edema in the early treatment phase. Humidified oxygen delivered by way of a mask is offered after intubation or tracheostomy is performed. Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question. pp. 627-628 https://eaqng.elsevier.com/#/quizPerformance/67568460 12/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which are a trigger that precipitates or aggravates asthma exacerbations? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Lethargy Medications Strong emotions Indoor allergens Mild, consistent weather Rationale Exercise, strong emotions, starting a new school or moving to a new home, cold air, outdoor and indoor allergens, irritants, exposure to occupational chemicals, changes in weather or temperature, environmental changes, animals, colds and infections, medications, food additives, foods, and endocrine factors can all trigger or worsen an asthma exacerbation. Lethargy and mild, consistent weather are not triggers. pp. 645-648 https://eaqng.elsevier.com/#/quizPerformance/67568460 13/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which is the asthma severity classification of a 3-year-old child with asthma whose parents state that the child has symptoms three times a week, once a day, and they give the child a short-acting β-agonist for symptom control 1 day a week? Intermittent Mild persistent Severe persistent Moderate persistent Rationale Symptoms three times a week, once a day, and use of a short-acting βagnostic for symptom control 1 day a week suggest mild persistent asthma. Intermittent asthma includes symptoms less than 2 days a week and use of a short-acting β-agonist less than 2 days a week. Moderate persistent asthma includes daily symptoms and use of a short-acting βagonist daily. Severe persistent asthma includes continually symptoms throughout the day and use of short-acting β-agonist several times a day. pp. 645-648 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 14/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which would the nurse teach the parents of the child with cystic fibrosis about the use of pancreatic enzymes? Extra enzymes must be taken with high-fat foods. Enteric-coated beads may be chewed or crushed. Mix the powder-form enzyme with the entire meal. Fat-soluble forms of vitamins are added with the food. Rationale The child with cystic fibrosis is unable to digest the fat content in foods. Therefore the child must be encouraged to take extra enzymes when highfat foods are eaten. Enteric-coated beads must not be chewed or crushed because destroying the enteric coating can lead to inactivation of the enzymes and excoriation of oral mucosa. The beads prevent the neutralization of enzymes by gastric acids, thus allowing activation to occur in the alkaline environment of the small bowel. The powder form should be mixed with only a small amount of food to be taken at the beginning of the meal, because it predigests the food, making it unpalatable. Enzymes must be taken within 30 minutes of eating. Watersoluble forms of vitamins are given along with the food and enzymes because the uptake of fat-soluble forms of vitamins is decreased. STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms. p. 660 https://eaqng.elsevier.com/#/quizPerformance/67568460 15/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Arrange the sequence in which the peak expiratory flow meter (PEFM) is prepared to assess changes in pulmonary function. 1. The patient stands up straight and close lips tightly around the mouthpiece. 2. Ensure that the sliding marker on the PEFM points to zero. 3. The patient blows out hard and quickly, with a "fast, hard puff." 4. Note the number by the marker on the numbered scale. 5. Record the highest of the three readings obtained. 6. Repeat the routine three times at 30-second intervals. Rationale Before each use, the sliding marker on the PEFM must point to zero to prevent erroneous readings. The patient must stand up straight and close the lips tightly around the mouthpiece. There must be no gum or food in the mouth and the tongue must be kept away from the mouthpiece. The patient must blow out as hard and as quickly as possible. The number on https://eaqng.elsevier.com/#/quizPerformance/67568460 16/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance the scale by the marker must be noted. The entire routine is repeated thrice with an interval of 30 seconds between each routine. The highest of the three readings, not the average, is recorded. The patient must repeat the routine at the same time and in the same way each day and maintain a chart of the readings. p. 648 Report content error Which is a clinical manifestation of acute epiglottitis? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Pain Fever Drooling Tripod position Hepatosplenomegaly Rationale Clinical manifestations of acute epiglottitis include fever, tripod position, drooling, pain, irritability, restlessness, anxious, apprehensive, frightened expression, suprasternal and substernal retractions, froglike croaking sound, slow quiet breathing, red throat, and an edematous epiglottis. Hepatosplenomegaly is not a common clinical manifestation of acute epiglottitis. pp. 627-628 https://eaqng.elsevier.com/#/quizPerformance/67568460 17/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which nursing intervention would help prevent ventilatorassociated pneumonia in children? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Evaluating the patient daily for extubation Draining condensate from the ventilator circuit every 8 hours Draining the ventilator circuit before repositioning the patient Performing hand hygiene before and after contact with the ventilator circuit Changing the ventilator circuits and inline suction catheters every 24 hours to prevent infection Rationale Nursing interventions to prevent ventilator-associated pneumonia in children include evaluating the patient daily for extubation, draining the ventilator circuit before repositioning the patient, and performing hand hygiene before and after contact with the ventilator circuit. Condensate needs to be drained from ventilator circuits more frequently than every 8 hours. Ventilator circuits and inline suction catheters only need to be changed when soiled, not every 24 hours. p. 634 https://eaqng.elsevier.com/#/quizPerformance/67568460 18/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error A 4-year-old child brought to the emergency department exhibits a froglike croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. Which is the priority action by the nurse? Make the child lie down and rest quietly. Auscultate the child's lungs and make preparations for placement in a mist tent. Examine the child's oropharynx and report the assessment to the health care provider. Notify the health care provider immediately and monitor airway patency. Rationale Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may result in total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out. pp. 627-628 https://eaqng.elsevier.com/#/quizPerformance/67568460 19/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 20/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which complication would the nurse expect in a child with cystic fibrosis? Increased insulin production Passage of watery stools Prolapse of the rectum Frequent episodes of diarrhea Rationale Prolapse of the rectum occurs in infancy and childhood and is related to large, bulky stools; malnutrition; and increased abdominal pressure secondary to paroxysmal cough. Clinical manifestations of cystic fibrosis are related to increased viscosity of the mucous gland secretions. Thick secretions block the pancreatic duct and cause severe insulin deficiency. The blockage prevents essential pancreatic enzymes from reaching the duodenum, which causes marked impairment in the digestion and absorption of nutrients. The disturbed function is reflected in bulky stools that are frothy from undigested fat and foul smelling from putrefied protein. Affected children of all ages are subject to intestinal obstruction from impacted feces. Gumlike masses can obstruct the bowel and produce a partial or complete obstruction. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, "I will study for the exam." Specify how many hours, what day and time, and what material you will cover. pp. 656-657 https://eaqng.elsevier.com/#/quizPerformance/67568460 21/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which clinical manifestation in the child would the nurse relate to asthma? Select all that apply. One, some, or all responses may be correct. Barrel chest Sandpaper rash Elevated shoulders Edematous tongue Flattened malar bones Rationale The child with asthma has a barrel chest with an increase in the anteroposterior diameter of the chest caused by infiltration and hyperexpansion of the airways. The child develops elevated shoulders and flattened malar bones as a result of repeated episodes of asthma. The child with scarlet fever may develop a fine sandpaper rash on the trunk, axillae, elbows, and groin. This child may also have edematous and red tongue caused by streptococcal infection. pp. 645-648 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 22/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which intervention would the nurse perform when caring for an infant with respiratory syncytial virus (RSV) infection? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Offer formula if infant stops breastfeeding. Teach parents to instill normal saline drops in the nares. Teach parents to suction the mucus with a bulb syringe. Offer small amounts of fluids at frequent intervals. Administer intramuscular injections of palivizumab. Rationale The nurse must teach the parents of the infant to instill normal saline drops and suction the mucus with a bulb syringe. This procedure is done before feedings and at bedtime so that the infant may eat and sleep better. Small amounts of fluids may be offered at frequent intervals to prevent dehydration from decreased fluid intake. Infants with RSV have copious nasal secretions, which makes breastfeeding difficult. However, mothers are encouraged to breastfeed to prevent the infant from stopping breastfeeding altogether. Intramuscular injections of palivizumab are administered to prevent, not treat, RSV. pp. 631-632 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 23/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which would the nurse teach the parents of a school-age child with nasal blockage about the use of vasoconstrictive nose drops? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Administer the drops 15 to 20 minutes before feeding. Instill two drops followed by two more drops after an hour. Avoid using the same bottle for more than one illness. Avoid using the same bottle for more than one child. Instill nose drops for no more than 5 consecutive days. Rationale The child is able to eat and sleep comfortably when the nasal passage is clear. Therefore nose drops are administered 15 to 20 minutes before feeding and at bedtime. Nose drops are easily contaminated with bacteria and viruses; therefore they must not be used for more than one illness or more than one child. Initially, two drops are instilled in each nostril, and, because this shrinks only the anterior mucous membranes, two more drops are instilled 5 to 10 minutes later. Nose drops would not be administered for more than 3 days to prevent rebound congestion. p. 618 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 24/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance A child who has a history of being born preterm is prescribed an intramuscular injection of palivizumab. Which would the nurse interpret from this finding about the child’s current acute condition? The patient has cystic fibrosis (CF). The patient has acute spasmodic laryngitis. The patient has acute laryngotracheobronchitis. The patient has respiratory syncytial virus infection (RSV). Rationale Children who are premature and have preexisting chronic respiratory conditions such as CF are at high risk for developing RSV. Palivizumab is a monoclonal antibody that is administered intramuscularly every month to prevent respiratory syncytial virus infection. The patient with acute spasmodic laryngitis will have allergic and hypersensitive reactions but not lower respiratory tract infections. Acute laryngotracheobronchitis is a croup syndrome in which the patient will have narrowed airways. The patient will have treatment with steroids and epinephrine, not palivizumab. The child who has an RSV infection will not receive palivizumab; this medication is administered as prevention, not treatment. pp. 658-659 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 25/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Asthma is classified in four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Which is a clinical feature used to determine these categories? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Lung function Associated allergies Frequency of symptoms Frequency and severity of exacerbations Degree of interference with normal activities Rationale Peak expiratory flow rate, frequency of symptoms, frequency and severity of exacerbations, and degree of interference with normal activities are all used to categorize asthma. Allergies are not among the clinical features used to distinguish the categories of asthma. p. 645-648 Report content error Which manifestation would the nurse first observe to evaluate for an obstruction when caring for a child with foreign body aspiration? Coughing and gagging https://eaqng.elsevier.com/#/quizPerformance/67568460 26/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Wheezing and paroxysmal cough Asymmetric breath sounds and dyspnea Inability to speak or breathe and unilateral nasal drainage Rationale Initially, a foreign body in the air passages produces choking, gagging, wheezing, or coughing. Laryngotracheal obstruction most commonly causes dyspnea, cough, stridor, and hoarseness because of decreased air entry. Bronchial obstruction usually produces paroxysmal cough, wheezing, asymmetric breath sounds, decreased airway entry, and dyspnea. When an object is lodged in the larynx, the child is unable to speak or breathe. Cyanosis may occur if the obstruction becomes worse. Nasal foreign bodies often manifest by unilateral purulent drainage. pp. 640-641 Report content error Which intervention after a tonsillectomy would cause difficulty breathing and swallowing in a patient? Placing the patient in prone position Instructing the patient to gently gargle with warm water Providing some orange juice twice a day for the patient Administering rectal or intravenous analgesic medication Rationale https://eaqng.elsevier.com/#/quizPerformance/67568460 27/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Citrus juice is very acidic and will irritate the surgical site. Therefore citrus juice would not be consumed by the patient. Gently gargling with warm water will reduce pain and provide comfort to the patient. Placing the patient in a prone position until awake will ensure that all of the secretions are draining. The patient will be in pain after surgery, so the patient will require analgesic medication. However, oral medication will increase pain, so administering rectal or intravenous analgesic medication is appropriate. pp. 621-622 Report content error How does the nurse distinguish nasopharyngitis from pharyngitis in a young child on the basis of clinical manifestations? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Breathes through the mouth Has vomiting and diarrhea Has mild to moderate hyperemia Has vasodilation of the mucosa Has a moderate sore throat Rationale The child with nasopharyngitis experiences discomfort related to nasal obstruction. The child has abundant nasal mucus and breathes through the mouth. The child may be vomiting and have diarrhea along with poor https://eaqng.elsevier.com/#/quizPerformance/67568460 28/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance feeding and decreased fluid intake. Physical assessment also reveals edema and vasodilation of the mucosa. The child with pharyngitis has mild to moderate hyperemia with a moderate sore throat. pp. 617-619 Report content error Which nursing intervention would help prevent ventilatorassociated pneumonia in children? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Evaluating the patient daily for extubation Draining condensate from the ventilator circuit every 8 hours Draining the ventilator circuit before repositioning the patient Performing hand hygiene before and after contact with the ventilator circuit Changing the ventilator circuits and inline suction catheters every 24 hours to prevent infection Rationale Nursing interventions to prevent ventilator-associated pneumonia in children include evaluating the patient daily for extubation, draining the ventilator circuit before repositioning the patient, and performing hand hygiene before and after contact with the ventilator circuit. Condensate needs to be drained from ventilator circuits more frequently than every 8 https://eaqng.elsevier.com/#/quizPerformance/67568460 29/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance hours. Ventilator circuits and inline suction catheters only need to be changed when soiled, not every 24 hours. p. 634 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 30/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which are a trigger that precipitates or aggravates asthma exacerbations? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Lethargy Medications Strong emotions Indoor allergens Mild, consistent weather Rationale Exercise, strong emotions, starting a new school or moving to a new home, cold air, outdoor and indoor allergens, irritants, exposure to occupational chemicals, changes in weather or temperature, environmental changes, animals, colds and infections, medications, food additives, foods, and endocrine factors can all trigger or worsen an asthma exacerbation. Lethargy and mild, consistent weather are not triggers. pp. 645-648 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 31/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance The nurse is performing discharge teaching for the parents of an infant with an upper respiratory tract infection. Which respiratory complication would prompt the parents to notify the health care practitioner? Dry cough Waking up during naps Decreasing irritability with fever Refusal to drink and decreased urination Rationale The health care professional would be notified of any refusal to take oral fluids and decreased urination so that dehydration, which could further complicate respiratory problems, may be prevented. Although a dry cough does not warrant contacting a health care professional, persistent cough or exacerbating cough does. Waking up during naps does not warrant contacting the health care professional; however, restlessness and a poor sleep pattern does. Decreasing irritability with fever does not warrant contacting a health care professional; however, increasing irritability with or without fever does. p. 617 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 32/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Why is a humidified atmosphere recommended for a young child with an upper respiratory tract infection? It liquefies secretions. It promotes ventilation. It improves oxygenation. It soothes inflamed mucous membrane. Rationale Humidified inspired air soothes membranes inflamed by the infection and dry air. The size of the droplets in humidified air is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. pp. 616-617 Report content error Which clinical manifestation would the nurse expect to note when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation? Wheezing Barrel chest Thermal instability Nasal flaring and retractions https://eaqng.elsevier.com/#/quizPerformance/67568460 33/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Rationale Nasal flaring, retractions, and grunting are signs of respiratory distress in a neonate. Barrel chest develops with chronic obstructive pulmonary disease, not acute pneumothorax. Wheezing has a greater association with bronchopulmonary dysplasia or an obstruction in the airways than with an acute pneumothorax. An acute pneumothorax would not affect the neonate's thermal stability. p. 635 Correct (47) Report content error Which assessment finding would the nurse recognize as a manifestation of acute otitis media (AOM)? Tinnitus or a feeling of fullness Rhinitis, cough, and diarrhea Fever and otalgia, or earache Discolored tympanic membrane Rationale An inflammation of the middle ear space with a rapid onset fever and otalgia indicates AOM. A diagnosis of AOM is made if inspection of the tympanic membrane reveals a purulent discolored effusion and a bulging or full, opacified, or reddened immobile membrane. The patient with chronic otitis media has a feeling of fullness, tinnitus, or vertigo. https://eaqng.elsevier.com/#/quizPerformance/67568460 34/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Nonspecific symptoms such as rhinitis, cough, or diarrhea are often present in otitis media with effusion (OME). An immobile tympanic membrane or an orange, discolored membrane also indicates OME. pp. 623-624 Report content error Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary? C, D A, E, K A, D, E, K C, folic acid Rationale A, D, E, and K—all fat-soluble vitamins—need to be supplemented in higher dosages for the child with cystic fibrosis. Vitamin C and folic acid are not fat-soluble vitamins. pp. 658-659 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 35/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which is the most profound complication of prolonged middle ear disorders? Loss of hearing Failure to thrive Visual impairment Tympanic membrane rupture Rationale Loss of hearing is the principal functional consequence of prolonged middle ear infection. Diminished hearing has an adverse effect on the development of speech, language, and cognition. During the active infection, loss of appetite typically occurs, and sucking or chewing tends to aggravate the pain. This is a short-term issue; when the otitis media resolves, the child resumes previous dietary intake. Ear infections do not have an effect on vision. Rupture of the eardrum may occur, but the loss of hearing and subsequent effect on speech is of greater concern. pp. 623-624 Report content error Which endocrine disorder is commonly found in children with cystic fibrosis? Addison disease Diabetes mellitus Cushing syndrome https://eaqng.elsevier.com/#/quizPerformance/67568460 36/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Congenital adrenal hyperplasia Rationale Diabetes mellitus is more common in children with cystic fibrosis because of changes in pancreatic architecture and diminished blood supply over time. Addison disease, Cushing syndrome, and congenital adrenal hyperplasia are not commonly found in children with cystic fibrosis. p. 661 Report content error Which would the nurse recognize as the primary factor responsible for multiple clinical manifestations of cystic fibrosis? Hyperactivity of sweat glands Atrophic changes in mucosal wall of intestines Hypoactivity of the autonomic nervous system Increased viscosity of mucous gland secretions Rationale The primary factor responsible for clinical manifestations of cystic fibrosis is the mechanical obstruction caused by increased viscosity of mucous gland secretions, not hyperactivity of sweat glands, atrophic changes in intestinal mucosal wall, or hypoactivity of the autonomic nervous system. pp. 656-657 https://eaqng.elsevier.com/#/quizPerformance/67568460 37/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which therapeutic management would the nurse expect the primary health care provider to prescribe for an infant with nasopharyngitis? Antipyretic Antihistamine Antibiotic Pseudoephedrine Rationale Antipyretics may be prescribed for infants with mild fever and discomfort caused by nasopharyngitis. Antihistamines are largely ineffective in the treatment of nasopharyngitis. They have a weak atropine-like effect that dries secretions, but they can cause drowsiness or have a stimulatory effect. Antibiotics are not indicated because most infections are viral. An over-the-counter cold preparation such as pseudoephedrine is not appropriate for infants and toddlers; they have been associated with death in infants. p. 617-618 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 38/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which is the priority of care for a child with acute viral nasopharyngitis? Patent airway Risk for infection Labored breathing Family's ability to cope with illness Rationale The priority of care is patency of the child's airway. A child can survive with labored breathing, an increased risk for infection, and inability of the family to cope, but without a patent airway the child will not survive. p. 618 Report content error Which is the most appropriate nursing intervention for a child after tonsillectomy? Watching for continuous swallowing Applying warm compresses to the throat Encouraging gargling to reduce discomfort Positioning the child on the back for sleeping https://eaqng.elsevier.com/#/quizPerformance/67568460 39/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Rationale Frequent swallowing is the most obvious early sign of bleeding from the surgical site in a child who has undergone tonsillectomy. Ice collars and cold liquids are encouraged for the child who has had a tonsillectomy. Cold therapy soothes and anesthetizes the area, easing the pain. Heat or warmth would increase the risk for bleeding. Gargling would be avoided after a tonsillectomy because of the potential for trauma to the suture line. The child would be positioned on the side or abdomen to facilitate drainage after a tonsillectomy. pp. 621-622 Report content error The parent of a child with cystic fibrosis calls the clinic nurse to report that the child is experiencing tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse would tell the parent to bring the child to the clinic because these symptoms are suggestive of what? Pneumothorax Bronchodilation Carbon dioxide retention Increased viscosity of sputum Rationale The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax and needs to be seen as soon as possible. https://eaqng.elsevier.com/#/quizPerformance/67568460 40/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Bronchodilation or carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status may be the result of a pneumothorax. p. 635 Report content error Which predominant characteristic would the nurse recognize as a manifestation of bronchitis? Wheezing with cough Labored respirations Persistent, dry, hacking cough Increased nasal mucus Rationale Bronchitis, or tracheobronchitis, is inflammation of the large airways, which is frequently associated with upper respiratory infections. A dry, hacking, nonproductive cough that worsens at night and becomes productive in 2 or 3 days characterizes this condition. Respiratory syncytial virus infections in the first year of life are a risk factor for the development of asthma. Wheezing and cough is common in asthma. Bronchiolitis is a common, acute viral infection with maximum effect at the bronchiolar level. Manifestations of bronchiolitis include labored respirations and increased nasal mucus. p. 630 https://eaqng.elsevier.com/#/quizPerformance/67568460 41/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which would the nurse teach about immediate measures to relieve an emergency obstruction in a 2-year-old child when educating a group of parents about the hazards of aspiration of foreign bodies (FBs)? Back blows Chest thrusts Abdominal thrust Sweep the mouth Rationale An abdominal thrust is used as an emergency measure to relieve a FB obstruction in children older than 1 year of age. Back blows and chest thrusts are applied in infants or children younger than 1 year of age. These methods help dislodge the FB if it has not penetrated deep into the trachea. A blind sweep of the child's mouth would never be performed because it may lodge the FB farther into the airway. An FB is rarely coughed up spontaneously. Most often, it must be removed instrumentally by endoscopy. pp. 668-669 https://eaqng.elsevier.com/#/quizPerformance/67568460 42/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which is the most appropriate way to administer penicillin G procaine or penicillin G benzathine suspension? Orally Intravenously Intramuscularly Subcutaneously Rationale Deep into the intramuscular tissue is the most appropriate way to administer penicillin G procaine or penicillin G benzathine; this will decrease the likelihood of a localized reaction and help lessen pain. p. 619 Report content error Which would the nurse teach the family about reducing the risk for otitis media (OM) in the child younger than 2 years of age? Select all that apply. One, some, or all responses may be correct. Maintain routine childhood immunizations. Wash the child's hair with bathtub water. https://eaqng.elsevier.com/#/quizPerformance/67568460 43/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Put the child to bed with a feeding bottle. Breastfeed the child until 6 months of age. Eliminate tobacco smoke and allergens. Rationale The nurse emphasizes the need to maintain routine childhood immunizations to reduce the risk for OM in children. The child must be breastfed until at least 6 months of age because human milk offers protection from infection. Tobacco smoke and allergens must be eliminated from the surroundings to reduce the risk for OM. The child's hair must be washed with fresh water from the tap instead of water from the bathtub to prevent soap and unclean water from entering the ear. Propping bottles must be discouraged to avoid pooling of milk while the child is in the supine position. pp. 623-624 Report content error Which care would the nurse take when performing the tuberculin skin test for a child? Use 10 tuberculin units of purified protein derivative (PPD). Administer medication intramuscularly in the upper arm. Use a 14-gauge needle and a 1-mL syringe for the procedure. Inject in such a way that a visible wheal appears on the skin. https://eaqng.elsevier.com/#/quizPerformance/67568460 44/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Rationale The nurse injects the PPD so that a visible wheal appears on the skin. A wheal 6 to 10 mm in diameter should form between the layers of the skin when the solution is injected properly. If the wheal is not formed, the procedure is repeated. A 27-gauge needle and a 1-mL syringe are used to administer 5 tuberculin units of PPD. It is generally injected intradermally in the volar or dorsal aspect of the forearm. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience. p. 638 Report content error Which oral rehydration measure must the nurse teach the parents of an infant with a respiratory tract infection? Provide water at regular intervals. Continue to breastfeed the infant. Provide sips of low carbohydrate drink. Awaken the infant to take fluids. Rationale Infants would continue to be breastfed because human milk provides some degree of protection from infection. Oral rehydration solutions, such as Infalyte or Pedialyte, would be considered for infants, and water or a low https://eaqng.elsevier.com/#/quizPerformance/67568460 45/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance carbohydrate flavored drink would be considered for older children. Fluids would not be forced, and infants should not be awakened to take fluids to prevent aspiration. p. 617 Report content error Which statement by the parents would the nurse associate with cystic fibrosis in the child? The infant has diarrhea. The infant tastes "salty." The infant has loss of appetite. The infant has a flat abdomen. Rationale The parents of the infant with cystic fibrosis may report that their infant tastes "salty" when they kiss the infant. A positive sweat chloride test helps evaluate the presence of cystic fibrosis in the child. The infant fails to pass stools and may have large, bulky, loose, frothy, and extremely foulsmelling stools. Meconium ileus and meconium ileus equivalent, or total or partial intestinal obstruction, can occur at any age. The child is often constipated as a result of a combination of malabsorption, either from inadequate pancreatic enzyme dosage or a failure to take the enzymes, decreased intestinal motility, and abnormally viscous intestinal secretions. Initially the infant has a voracious appetite, which is now reduced. The child has a distended abdomen caused by intestinal obstruction. pp. 656-657 https://eaqng.elsevier.com/#/quizPerformance/67568460 46/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 47/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which postoperative nursing care must be provided for the child who had a tonsillectomy? Place the child on the abdomen when fully alert. Provide analgesics rectally or intravenously. Offer milk, ice cream, or pudding for comfort. Allow the child to cough out secretions. Rationale Most children experience moderate pain after a tonsillectomy and need pain medication. Analgesics are administered rectally or intravenously to avoid the oral route. Until the child is fully awake, the child is placed on the abdomen or side to facilitate drainage of secretions. When fully alert, the child may prefer to sit up. Milk products coat the mouth and throat and may cause the child to clear the throat, which can initiate bleeding. Therefore milk, ice cream, or pudding should not be offered to the child. The child is discouraged from coughing frequently, clearing the throat, blowing the nose, and any other activity that may aggravate the operative site. STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it. pp. 621-622 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 48/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which therapeutic management methods would the nurse expect will be applied for a child with bronchiolitis? Humidified mist Chest percussion Postural drainage Oral fluid intake Rationale Administration of humidified mist or humidified oxygen moistens secretions and prevents drying of the airways. Routine chest percussion and postural drainage are not recommended for children. Oral fluid intake may be contraindicated because of tachypnea, weakness, and fatigue; therefore intravenous fluids may be used until the acute stage of the disease has passed. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic but scoring an 85% may be a better goal. pp. 631-632 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 49/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which would the nurse suggest for a 4-year-old child who needs to use a metered-dose inhaler for asthma but cannot coordinate breathing to use it effectively? Spacer Nebulizer Peak expiratory flow meter Trial of chest physiotherapy Rationale The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a device for administering medications, but it cannot be used with metered-dose inhalers. Peak expiratory flow meters are used to measure pulmonary function but are not related to medication administration. Chest physiotherapy is unrelated to medication administration. pp. 648-651 Report content error Which syndrome would a 3-year-old child who has rapidly progressing dysphagia and stridor, a high fever, and a rapid pulse and respirations most likely have? Acute tracheitis Acute epiglottitis https://eaqng.elsevier.com/#/quizPerformance/67568460 50/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Acute spasmodic laryngitis Acute laryngotracheobronchitis Rationale Symptoms of progressive dysphagia, stridor, high fever, rapid pulse, and rapid respirations in a 3-year-old child are highly suggestive of acute epiglottitis. Acute tracheitis is moderately progressive and includes a croupy cough. Acute spasmodic laryngitis occurs suddenly at night; the symptoms tend to wake the child up at night and disappear during the day. Laryngotracheobronchitis is slowly progressive. Test-Taking Tip: The night before the examination, you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early. pp. 627-628 Report content error Which trigger tends to precipitate or aggravate asthma in children? Select all that apply. One, some, or all responses may be correct. Exercise Breast milk Tobacco smoke https://eaqng.elsevier.com/#/quizPerformance/67568460 51/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Thyroid disease A smoke-free home Rationale Triggers that precipitate or aggravate asthma in children include exercise, tobacco smoke, and thyroid disease. A smoke-free home and breast milk do not trigger or aggravate asthma symptoms in children; rather, they decrease the likelihood of an asthma exacerbation. pp. 645-648 Report content error Which manifestation in a child with croup syndrome would the nurse distinguish as a sign of acute epiglottitis? Select all that apply. One, some, or all responses may be correct. Drooling Low-grade fever Brassy cough Stridor when supine Toxic appearance Rationale Croup syndromes can affect the larynx, trachea, and bronchi. Drooling, the presence of stridor when supine, and toxic appearances are major https://eaqng.elsevier.com/#/quizPerformance/67568460 52/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance manifestations that are predictive of epiglottitis. Drooling of saliva is common because of the difficulty or pain in swallowing and excessive secretions. The child has high fever, appears sicker than clinical findings suggest, and insists on sitting upright and leaning forward with the chin thrust out, mouth open, and tongue protruding. Low-grade fever and brassy cough are signs of acute laryngotracheobronchitis. pp. 627-628 Report content error Which condition would the nurse suspect in a young child in the emergency department who drools, is agitated, and sounds like a frog during inhalation? Otitis media Acute epiglottitis Infectious mononucleosis Acute streptococcal pharyngitis Rationale Drooling and agitation are two of the three clinical symptoms associated with acute epiglottis; absence of a spontaneous cough is the third. The patient with acute epiglottitis presents with a froglike croaking sound on inspiration, but the child is not hoarse. Otitis media is an infection of the middle ear. It is not associated with the presence of drooling and agitation, or a spontaneous cough. Infectious mononucleosis and acute streptococcal pharyngitis are associated with fever and pharyngitis, not the presence of drooling and agitation. https://eaqng.elsevier.com/#/quizPerformance/67568460 53/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance pp. 627-628 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 54/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which would the nurse teach the parents of a child with streptococcal pharyngitis? The child is not considered infectious until antibiotic therapy is started. The child can return to daycare after antibiotic therapy is started. A new toothbrush must be used as soon as antibiotic therapy is started. Orthodontic appliances used by the child must be washed thoroughly. Rationale Orthodontic appliances must be washed thoroughly because they may harbor organisms. The child is considered infectious to others at the onset of symptoms and up to 24 hours after initiation of antibiotic therapy. The child must not return to school or daycare until the child has been taking antibiotics for a full 24-hour period. An old toothbrush must be discarded and replaced with a new one after the child has been taking antibiotics for 24 hours. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter. pp. 619-620 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 55/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which manifestation helps the nurse identify severe persistent asthma? The child has a peak expiratory flow (PEF) less than 60%. The child uses short-acting β-agonist more than 2 days a week. The child has fewer than or equal to two nighttime symptoms per month. The child has symptoms fewer than or equal to 2 days a week. Rationale The child with severe persistent asthma has a PEF less than 60%. The child has frequent nighttime symptoms, often more than once a week. The child uses short-acting β-agonist several times a week and has continual symptoms throughout the day. The child with mild persistent asthma uses short-acting β-agonist more than 2 days a week. The child with intermittent asthma has nighttime symptoms or awakenings fewer than or equal to 2 nights per month. Daytime symptoms are usually fewer than or equal to 2 days a week. pp. 645-648 Report content error Which intervention would the nurse perform first when caring for a child who is breathing well and admitted to the health care facility after a fire accident? Prepare for intubation. https://eaqng.elsevier.com/#/quizPerformance/67568460 56/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Plan for tracheostomy. Administer intravenous (IV) fluids. Assess for obstruction. Rationale Often patients who are breathing well on admission may suddenly develop respiratory distress. The nurse must keep the intubation equipment readily available. Transient edema of the airways can occur at any level in the tracheobronchial tree. Assessment and localization of the obstruction would be accomplished before severe swelling of the head, neck, or oropharynx occurs. Intubation is often necessary when edema causes obstruction, the patient has difficulty handling secretions, or respiratory distress requires artificial ventilation. Early intubation helps maintain ventilation and maximize oxygen delivery. Tracheostomy may be performed when the obstruction is proximal to the larynx; reserve nasotracheal intubation for lower tract involvement. Children experiencing inhalation injury need fluid replacement. Therefore accurate monitoring of fluid intake and output is essential. pp. 643-644 Report content error Which manifestation in a child with asthma would the nurse recognize as severe respiratory distress requiring immediate intervention? Select all that apply. One, some, or all responses may be correct. Prefers to lie down https://eaqng.elsevier.com/#/quizPerformance/67568460 57/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Sweats profusely Is severely agitated Has pink nail beds Has prolonged expiration Rationale The child with severe respiratory distress sweats profusely, is severely agitated, and has prolonged expiration. The child refuses to lie down and sits upright in a hunched-over position. If the agitated child suddenly becomes quiet, the child may have serious hypoxia and requires immediate intervention. The child who prefers to lie down and has pink nail beds does not have any respiratory difficulties. p. 651 Report content error Which would the nurse teach the parents of the child with cystic fibrosis about the use of pancreatic enzymes? Extra enzymes must be taken with high-fat foods. Enteric-coated beads may be chewed or crushed. Mix the powder-form enzyme with the entire meal. Fat-soluble forms of vitamins are added with the food. Rationale https://eaqng.elsevier.com/#/quizPerformance/67568460 58/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance The child with cystic fibrosis is unable to digest the fat content in foods. Therefore the child must be encouraged to take extra enzymes when highfat foods are eaten. Enteric-coated beads must not be chewed or crushed because destroying the enteric coating can lead to inactivation of the enzymes and excoriation of oral mucosa. The beads prevent the neutralization of enzymes by gastric acids, thus allowing activation to occur in the alkaline environment of the small bowel. The powder form should be mixed with only a small amount of food to be taken at the beginning of the meal, because it predigests the food, making it unpalatable. Enzymes must be taken within 30 minutes of eating. Watersoluble forms of vitamins are given along with the food and enzymes because the uptake of fat-soluble forms of vitamins is decreased. STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms. p. 660 Report content error Arrange the sequence in which the peak expiratory flow meter (PEFM) is prepared to assess changes in pulmonary function. 1. Ensure that the sliding marker on the PEFM points to zero. https://eaqng.elsevier.com/#/quizPerformance/67568460 59/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance 2. The patient stands up straight and close lips tightly around the mouthpiece. 3. The patient blows out hard and quickly, with a "fast, hard puff." 4. Note the number by the marker on the numbered scale. 5. Repeat the routine three times at 30-second intervals. 6. Record the highest of the three readings obtained. Rationale Before each use, the sliding marker on the PEFM must point to zero to prevent erroneous readings. The patient must stand up straight and close the lips tightly around the mouthpiece. There must be no gum or food in the mouth and the tongue must be kept away from the mouthpiece. The patient must blow out as hard and as quickly as possible. The number on the scale by the marker must be noted. The entire routine is repeated thrice with an interval of 30 seconds between each routine. The highest of the three readings, not the average, is recorded. The patient must repeat the routine at the same time and in the same way each day and maintain a chart of the readings. p. 648 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 60/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which is a clinical manifestation of acute epiglottitis? Select all that apply. One, some, or all responses may be correct. Pain Fever Drooling Tripod position Hepatosplenomegaly Rationale Clinical manifestations of acute epiglottitis include fever, tripod position, drooling, pain, irritability, restlessness, anxious, apprehensive, frightened expression, suprasternal and substernal retractions, froglike croaking sound, slow quiet breathing, red throat, and an edematous epiglottis. Hepatosplenomegaly is not a common clinical manifestation of acute epiglottitis. pp. 627-628 Report content error A 4-year-old child brought to the emergency department exhibits a froglike croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. Which is the priority action by the nurse? Make the child lie down and rest quietly. https://eaqng.elsevier.com/#/quizPerformance/67568460 61/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Auscultate the child's lungs and make preparations for placement in a mist tent. Examine the child's oropharynx and report the assessment to the health care provider. Notify the health care provider immediately and monitor airway patency. Rationale Sitting upright, drooling, agitation, and a froglike cough are indicative of epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary. Examination of the oropharynx may result in total obstruction and should not be done when a child manifests signs indicating potential epiglottitis. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase respiratory distress and anxiety. Interventions should be planned once the diagnosis of epiglottitis has been made or ruled out. pp. 627-628 Report content error Which complication would the nurse expect in a child with cystic fibrosis? Increased insulin production Passage of watery stools Prolapse of the rectum Frequent episodes of diarrhea https://eaqng.elsevier.com/#/quizPerformance/67568460 62/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Rationale Prolapse of the rectum occurs in infancy and childhood and is related to large, bulky stools; malnutrition; and increased abdominal pressure secondary to paroxysmal cough. Clinical manifestations of cystic fibrosis are related to increased viscosity of the mucous gland secretions. Thick secretions block the pancreatic duct and cause severe insulin deficiency. The blockage prevents essential pancreatic enzymes from reaching the duodenum, which causes marked impairment in the digestion and absorption of nutrients. The disturbed function is reflected in bulky stools that are frothy from undigested fat and foul smelling from putrefied protein. Affected children of all ages are subject to intestinal obstruction from impacted feces. Gumlike masses can obstruct the bowel and produce a partial or complete obstruction. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, "I will study for the exam." Specify how many hours, what day and time, and what material you will cover. pp. 656-657 Report content error Which clinical manifestation in the child would the nurse relate to asthma? Select all that apply. One, some, or all responses may be correct. Barrel chest Sandpaper rash Elevated shoulders Edematous tongue https://eaqng.elsevier.com/#/quizPerformance/67568460 63/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Flattened malar bones Rationale The child with asthma has a barrel chest with an increase in the anteroposterior diameter of the chest caused by infiltration and hyperexpansion of the airways. The child develops elevated shoulders and flattened malar bones as a result of repeated episodes of asthma. The child with scarlet fever may develop a fine sandpaper rash on the trunk, axillae, elbows, and groin. This child may also have edematous and red tongue caused by streptococcal infection. pp. 645-648 Report content error Which intervention would the nurse perform when caring for an infant with respiratory syncytial virus (RSV) infection? Select all that apply. One, some, or all responses may be correct. Offer formula if infant stops breastfeeding. Teach parents to instill normal saline drops in the nares. Teach parents to suction the mucus with a bulb syringe. Offer small amounts of fluids at frequent intervals. Administer intramuscular injections of palivizumab. Rationale https://eaqng.elsevier.com/#/quizPerformance/67568460 64/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance The nurse must teach the parents of the infant to instill normal saline drops and suction the mucus with a bulb syringe. This procedure is done before feedings and at bedtime so that the infant may eat and sleep better. Small amounts of fluids may be offered at frequent intervals to prevent dehydration from decreased fluid intake. Infants with RSV have copious nasal secretions, which makes breastfeeding difficult. However, mothers are encouraged to breastfeed to prevent the infant from stopping breastfeeding altogether. Intramuscular injections of palivizumab are administered to prevent, not treat, RSV. pp. 631-632 Report content error Which would the nurse teach the parents of a school-age child with nasal blockage about the use of vasoconstrictive nose drops? Select all that apply. One, some, or all responses may be correct. Administer the drops 15 to 20 minutes before feeding. Instill two drops followed by two more drops after an hour. Avoid using the same bottle for more than one illness. Avoid using the same bottle for more than one child. Instill nose drops for no more than 5 consecutive days. Rationale The child is able to eat and sleep comfortably when the nasal passage is clear. Therefore nose drops are administered 15 to 20 minutes before https://eaqng.elsevier.com/#/quizPerformance/67568460 65/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance feeding and at bedtime. Nose drops are easily contaminated with bacteria and viruses; therefore they must not be used for more than one illness or more than one child. Initially, two drops are instilled in each nostril, and, because this shrinks only the anterior mucous membranes, two more drops are instilled 5 to 10 minutes later. Nose drops would not be administered for more than 3 days to prevent rebound congestion. p. 618 Report content error A child who has a history of being born preterm is prescribed an intramuscular injection of palivizumab. Which would the nurse interpret from this finding about the child’s current acute condition? The patient has cystic fibrosis (CF). The patient has acute spasmodic laryngitis. The patient has acute laryngotracheobronchitis. The patient has respiratory syncytial virus infection (RSV). Rationale Children who are premature and have preexisting chronic respiratory conditions such as CF are at high risk for developing RSV. Palivizumab is a monoclonal antibody that is administered intramuscularly every month to prevent respiratory syncytial virus infection. The patient with acute spasmodic laryngitis will have allergic and hypersensitive reactions but not lower respiratory tract infections. Acute laryngotracheobronchitis is a croup syndrome in which the patient will have narrowed airways. The patient will https://eaqng.elsevier.com/#/quizPerformance/67568460 66/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance have treatment with steroids and epinephrine, not palivizumab. The child who has an RSV infection will not receive palivizumab; this medication is administered as prevention, not treatment. pp. 658-659 Report content error Asthma is classified in four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Which is a clinical feature used to determine these categories? Select all that apply. One, some, or all responses may be correct. Lung function Associated allergies Frequency of symptoms Frequency and severity of exacerbations Degree of interference with normal activities Rationale Peak expiratory flow rate, frequency of symptoms, frequency and severity of exacerbations, and degree of interference with normal activities are all used to categorize asthma. Allergies are not among the clinical features used to distinguish the categories of asthma. p. 645-648 https://eaqng.elsevier.com/#/quizPerformance/67568460 67/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which manifestation would the nurse first observe to evaluate for an obstruction when caring for a child with foreign body aspiration? Coughing and gagging Wheezing and paroxysmal cough Asymmetric breath sounds and dyspnea Inability to speak or breathe and unilateral nasal drainage Rationale Initially, a foreign body in the air passages produces choking, gagging, wheezing, or coughing. Laryngotracheal obstruction most commonly causes dyspnea, cough, stridor, and hoarseness because of decreased air entry. Bronchial obstruction usually produces paroxysmal cough, wheezing, asymmetric breath sounds, decreased airway entry, and dyspnea. When an object is lodged in the larynx, the child is unable to speak or breathe. Cyanosis may occur if the obstruction becomes worse. Nasal foreign bodies often manifest by unilateral purulent drainage. pp. 640-641 Report content error https://eaqng.elsevier.com/#/quizPerformance/67568460 68/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Which intervention after a tonsillectomy would cause difficulty breathing and swallowing in a patient? Placing the patient in prone position Instructing the patient to gently gargle with warm water Providing some orange juice twice a day for the patient Administering rectal or intravenous analgesic medication Rationale Citrus juice is very acidic and will irritate the surgical site. Therefore citrus juice would not be consumed by the patient. Gently gargling with warm water will reduce pain and provide comfort to the patient. Placing the patient in a prone position until awake will ensure that all of the secretions are draining. The patient will be in pain after surgery, so the patient will require analgesic medication. However, oral medication will increase pain, so administering rectal or intravenous analgesic medication is appropriate. pp. 621-622 Report content error Which is the first line of treatment for the child with epiglottitis and severe respiratory distress? Antibiotics Corticosteroids Humidified oxygen via mask https://eaqng.elsevier.com/#/quizPerformance/67568460 69/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Nasotracheal intubation or tracheostomy Rationale The first line of treatment for the child with epiglottitis and severe respiratory distress is nasotracheal intubation or tracheostomy. Antibiotics are given for 24 hours after the child's airway is patent and maintained. Corticosteroids are given to reduce edema in the early treatment phase. Humidified oxygen delivered by way of a mask is offered after intubation or tracheostomy is performed. Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question. pp. 627-628 Report content error Which is the asthma severity classification of a 3-year-old child with asthma whose parents state that the child has symptoms three times a week, once a day, and they give the child a short-acting β-agonist for symptom control 1 day a week? Intermittent Mild persistent https://eaqng.elsevier.com/#/quizPerformance/67568460 70/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Severe persistent Moderate persistent Rationale Symptoms three times a week, once a day, and use of a short-acting βagnostic for symptom control 1 day a week suggest mild persistent asthma. Intermittent asthma includes symptoms less than 2 days a week and use of a short-acting β-agonist less than 2 days a week. Moderate persistent asthma includes daily symptoms and use of a short-acting βagonist daily. Severe persistent asthma includes continually symptoms throughout the day and use of short-acting β-agonist several times a day. pp. 645-648 Report content error Which condition is prevented when by treating acute streptococcal pharyngitis with antibiotics? Otitis media Diabetes insipidus Nephrotic syndrome Acute rheumatic fever Rationale Children with group A β-hemolytic Streptococcus (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media https://eaqng.elsevier.com/#/quizPerformance/67568460 71/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome. pp. 619-620 Report content error The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse, suspecting croup, would recommend what? Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing Bringing the child to the hospital to be admitted and to be observed for impending epiglottitis Trying over-the-counter cough medicine and coming to the clinic tomorrow if there is no improvement Controlling the fever with acetaminophen and calling the primary care provider if the cough gets worse tonight Rationale Because the child is not experiencing difficulty breathing, the nurse would teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will help open up the child's airways. A https://eaqng.elsevier.com/#/quizPerformance/67568460 72/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance barking cough is characteristic of laryngotracheobronchitis, not epiglottitis. Cough suppressants are not indicated by the symptoms, and the American Pediatrics Association no longer recommends over-thecounter cough medicines for children under the age of 2 years. The child does not have a temperature and therefore does not require management with acetaminophen. p. 628 Report content error Which are the most important nursing interventions for a 5year-old child brought to the emergency department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward with acute epiglottitis suspected? Select all that apply. One, some, or all responses may be correct. Vital signs Throat culture Medical history Assessment of breath sounds Ready availability of emergency airway equipment Rationale Vital signs would always be taken as a part of the assessment. Medical history is important because it aids diagnosis and allows the medical team to know the child's immunization status. Assessment of breath sounds is https://eaqng.elsevier.com/#/quizPerformance/67568460 73/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance important because it aids diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture would never be done when epiglottitis is suspected. Manipulation of the throat could stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that could occlude the airway. pp. 627-628 Report content error Which symptom would the nurse expect to find in a child with acute laryngotracheobronchitis (LTB)? Drooling of saliva Protruding tongue Barky, brassy cough Thick, muffled voice Rationale Acute LTB is characterized by a low, barky, brassy cough caused by inflammation of the mucosa lining the larynx and trachea, which leads to a narrowing of the airway. Clinical manifestations of epiglottitis include drooling of saliva, a protruding tongue, and a thick, muffled voice. The child has pain and difficulty in swallowing accompanied by excess secretions; as a result, the child sits upright with protruding tongue and drools saliva. The voice is thick and muffled, with a froglike croaking sound on inspiration. p. 629 https://eaqng.elsevier.com/#/quizPerformance/67568460 74/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which developmental factor increases the risk for infection in infants and young children? The reduced exposure of infants to organisms increases their chance of infection. The narrowed airways of young children mean that organisms move slowly down the respiratory tract. The relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear. The diameter of the airways in young children is big and therefore subject to edema of the mucous membranes. Rationale The relatively short and open eustachian tube in young children allows pathogens easy access to the middle ear. The narrowed airways in young children promote quick, not slow, movement of organisms down the respiratory tract. Increased exposure to organisms would increase the chance of infection. The diameter of the airways in young children is not big but small and therefore are subject to edema of the mucous membranes. pp. 623-624 https://eaqng.elsevier.com/#/quizPerformance/67568460 75/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Report content error Which are a trigger that precipitates or aggravates asthma exacerbations? Select all that apply. One, some, or all responses may be correct. Lethargy Medications Strong emotions Indoor allergens Mild, consistent weather Rationale Exercise, strong emotions, starting a new school or moving to a new home, cold air, outdoor and indoor allergens, irritants, exposure to occupational chemicals, changes in weather or temperature, environmental changes, animals, colds and infections, medications, food additives, foods, and endocrine factors can all trigger or worsen an asthma exacerbation. Lethargy and mild, consistent weather are not triggers. pp. 645-648 1 topics covered https://eaqng.elsevier.com/#/quizPerformance/67568460 76/77 10/22/24, 2:38 PM Elsevier Adaptive Quizzing - Quiz performance Chapter 21, The Child with Respiratory Dys…Proficient Hockenberry: Wong's Essentials of Pediatric Nursing, Eleventh Edition Novice Intermediate You Proficient Questions answered 100 Quiz me on this topic https://eaqng.elsevier.com/#/quizPerformance/67568460 77/77