NURS 2150>PEDS-PREPUCardiopulmonary | Graded A+

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A nurse is teaching a parent how to administer antibiotics at home to a toddler with acute otitis media. Which statement by the parent indicates that teaching has been successful? a) "I'll give the a... ntibiotics for the full 10-day course of treatment." b) "I'll give the antibiotics until my child's ear pain is gone." c) "If the ear pain is gone, there's no need to see the physician for another examination of the ears." d) "Whenever my child is cranky or pulls on an ear, I'll give a dose of antibiotics." Which statement by the parent of a child with otitis media indicates an understanding of the nurse’s discharge instructions about the use of antibiotics? a) “I’ll give the antibiotics when my child has ear pain.” b) “I’ll put antibiotics in the affected ear.” c) “I’ll give my child the full course of antibiotics.” d) “I’ll stop the antibiotics when my child no longer has ear pain.” A mother asks the nurse why her 12-month-old baby gets otitis media more frequently than her 10-year-old son. What should the nurse tell her? a) "The baby is too young to blow his nose when he has a cold." b) "The baby spends more time lying down than his older brother; therefore, more dirt gets in the baby's ear." c) "The baby puts dirty toys in his mouth." d) "The baby's eustachian tubes are shorter and lie more horizontally." Infants and young children are more prone to otitis media because their eustachian tubes are shorter and lie more horizontally. Pathogens from the nasopharynx can more readily enter the eustachian tube of the middle ear. The inability to clear nasal passages by blowing the nose, lying down on the floor, and putting dirty toys in the mouth don’t increase the tendency toward otitis media. A 1-year-old child is brought to the emergency department with a mild respiratory infection and a temperature of 101.3° F (38.5° C). Otitis media is diagnosed. Which sign would the nurse also expect to find? a) High-pitched, barking cough b) Pearl-gray tympanic membrane c) Tugging on the ears d) Excessive drooling Tugging on the ears is a common sign for a child with ear pain. Pearl-gray tympanic membranes are normal. A child with otitis media usually exhibits a discolored membrane (bright red, yellow, or dull gray). A high-pitched barking cough and excessive drooling indicate croup. A toddler develops acute otitis media and is ordered cefpodoxime proxetil 5 mg/kg P.O. every 12 hours. If the child weighs 22 lb (10 kg), how many milligrams will the nurse administer with each dose? a) 220 mg b) 50 mg c) 100 mg d) 110 mg A nurse is preparing to instill ear drops in a 28-year-old client with otitis externa. What is the correct procedure for instillation? a) Pull the pinna up and back b) Separate the palpebral fissures with a clean gauze pad c) Pull the pinna down and back d) Pull the tragus up and back An 18-month-old is diagnosed with otitis media, and his mother asks what she can do to help ease his pain. Which medication would the nurse anticipate for pain relief? a) Children’s chewable acetylsalicylic acid one 80/mg q4h b) Amoxicillin trihydrate 20 mg/kg p0 q8h c) Children’s liquid acetaminophen 5/ml q4h d) Cetirizine 1.3 ml q4h The parents report that their child has a runny nose, fever, and cough and is irritable and constantly rubbing his ears. When assessing the ear, how should the nurse expect the child's tympanic membrane to appear a) scarred b) bulging and red c) clear and inverted d) pearly gray A nurse is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature? a) Tympanic membrane b) External ear canal c) Eustachian tubes d) Nasopharynx A 15-month-old child is being discharged after treatment for severe otitis media and bacterial meningitis. Which statement by the parents indicates effective discharge teaching? a) "We'll go to the physician if our child pulls on the ears or won't lie down." b) "We're just so glad this is all behind us." c) "We'll take our child to the physician's office every week until everything is okay." d) "We should have gone to the physician sooner. Next time, we will." The parents indicate full understanding of discharged teaching by repeating the specific, common signs of otitis media in toddlers. such as pulling on the ears and refusing to lie down. and by verbalizing the need for immediate follow-up care if these signs arise. Option A implies a sense of guilt. Option B addresses only weekly follow-up care. Option D is unrealistic because the child's condition may recur. Which assessment finding puts a client at increased risk for epistaxis? a) History of nasal surgery b) Use of a humidifier at night c) Hypotension d) Cocaine use What is the priority nursing measure for a client with von Willebrand’s disease who is having epistaxis? a) Lay the client supine b) Avoid packing the nostrils c) Avoid pressure to the nose d) Apply pressure to the nose A client is admitted to the emergency department with severe epistaxis. The health care provider inserts posterior packing. Later, the client is anxious and says they do not feel they are breathing right. Which nursing action is priority? a) Cut the packing strings and remove the packing b) Ask the client to fully explain what they mean by “right” c) reassure the client that what they are experiencing is normal d) Use a flashlight and inspect the client’s posterior oral cavity A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: a) hold his nose while bending forward at the waist. b) lie supine with his neck extended. c) sit upright, leaning slightly forward. d) blow his nose and then put lateral pressure on his nose. The nurse is caring for a teen-aged client with a suspected cardiac defect. History and physical 10/15/16 1630 Fifteen-year-old male, admitted to unit at 1415. Reporting headache. Epistaxis just prior to admission. Resting quietly. Blood pressure 120/76 on right arm, 172/98 on left arm, 84/46 on right leg. Pulses +3 in bilaterally in arms and legs. The nurse suspects coarctation of the aorta when the history and physical reveal which findings? Select all they apply. a) Blood pressure of 172/98 mmHg in the left arm b) Blood pressure of 84/46 mmHg in the right leg c) +3 pulses in both arms d) +3 pulses in both legs e) Warm, flushed skin f) Reports headache and nosebleed Which statement obtained from the nursing history of a toddler should alert the nurse to suspect that the child has had a febrile seizure? a) The child has had a low-grade fever for several weeks. b) The seizure resulted in respiratory arrest. c) The family history is negative for convulsions. d) The seizure occurred when the child had a respiratory infection. Which suggestions should the nurse include when teaching the parents of a child who has viral tonsillitis? Select all that apply. a) Gargle with warm salt water. b) Administer aspirin for fever control. c) Offer lots of fluids. d) Offer cough medicine every 4 hours. e) Give acetaminophen for sore throat. f) Supply a regular diet. Treatment for viral tonsillitis consists of supportive care, gargles, encouraging fluids, and administering acetaminophen for fever and sore throat. Aspirin is not used to control fever because of its associated risk of Reye's syndrome. The child's throat is sore, so a regular diet would probably irritate the child's throat. Cough medicine would not be indicated unless the child has a cough. Viral tonsillitis usually does not cause coughing. A college student comes to the campus health care center with reports of headache, malaise, and a sore throat that has worsened over the past 10 days. The nurse measures a temperature of 102.6° F (39.2° C) and finds an enlarged spleen and liver and exudative tonsillitis. Laboratory tests reveal a leukocyte count of 20,000/mm3, antibodies to Epstein-Barr virus, and abnormal liver function tests. What are the nurses priority action(s)? a) Encourage fluids and treat fever. b) Administer antibiotics orally. c) Treat headache and hold food. d) Transfer student to acute care setting. A staff nurse on a pediatric unit has a four-client assignment. Which child should the nurse assess first? a) A 7-year-old child whose mother is waiting for discharge instructions b) A 10-year-old child with asthma whose oxygen saturation levels are dropping c) An 8-year-old child admitted from the postanesthesia care unit who's complaining of pain d) A 9-year-old child with a broken leg who wants help moving from the bed to the chair A nurse should monitor a client with a pelvic fracture receiving an opium derivative, such as morphine, for what common adverse reaction? a) Respiratory depression b) Pupil dilation c) Diarrhea d) High temperature A 19-year-old client comes to the emergency department with acute asthma. His respiratory rate is 44 breaths/min, and he is in acute respiratory distress. What is the nurse’s priority action? a) Take a full medical history b) Provide emotional support to the client c) Give a bronchodilator by nebulizer d) Apply a cardiac monitor to the client The client is having an acute asthma attack and needs to increase oxygen delivery to the lung and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. First resolve the acute phase of the attack ad how to prevent attacks in the future. It may not be necessary to place the client on a cardiac monitor because he’s only 19-years-old, unless he has a past medical history of cardiac problems. A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should: a) administer acetaminophen as ordered. b) administer antibiotics as ordered. c) instruct the client to breathe into a paper bag. d) insert a nasogastric tube (NG) as ordered. A client recovering from an acute asthma attack who experiences respiratory alkalosis should breathe into a paper bag to increase arterial carbon dioxide tension and ease anxiety (which may exacerbate the alkalosis). An NG tube would be indicated for a client with metabolic alkalosis secondary to ingestion of toxic substances; there is no reason to believe that this has occurred. Fever may cause metabolic (not respiratory) alkalosis and would be treated with acetaminophen. A client with sepsis also may have metabolic alkalosis and probably would receive antibiotics; however, this clinical situation doesn't suggest sepsis. After discussing asthma as a chronic condition, which statement by the parent of a child with asthma best reflects the family's positive adjustment to this aspect of the child's disease? a) "We try to keep him happy at all costs; otherwise, he has an asthma attack." b) "We keep our child away from other children to help cut down on infections." c) "Although our child's disease is serious, we try not to let it be the focus of our family." d) "I am afraid that when my child gets older, he will not be able to care for himself like I do." A child has just received a dose of theophylline I.V. for asthma. What assessment finding should the nurse expect? a) Stridor b) White blood cell count of 12,000/?l c) Increased coughing because of postnasal drip d) Decreased pulmonary wheezing A nurse is preparing to teach a 13-year-old adolescent with asthma to administer his own breathing treatments. Which principle should the nurse keep in mind when planning the teaching session? a) Adolescents are worried about appearing different from their peers. b) Adolescents' fine motor coordination isn't sufficiently developed to administer treatments. c) Adolescents are unable to follow detailed instructions. d) Adolescents have a well-developed sense of self-identity. Adolescents have a strong need to belong, and they seek social approval from their peers. Knowing this will help the nurse construct an effective teaching plan. Adolescents are capable of following detailed instructions. According to Piaget, adolescents are at the formal operations stage and are capable of deductive, reflective, and hypothetical reasoning. Fine motor coordination is well developed by adolescence. According to Erikson's stages of psychosocial development, adolescence is the stage of identity versus role confusion. During this stage, the adolescent strives toward establishing a sense of identity. An 11-year-old is admitted for treatment of an asthma attack. Which finding indicates immediate intervention is needed? a) intercostal retractions b) respiratory rate of 20 breaths/minute c) productive cough d) thin, copious mucous secretions The nurse understands that a client with acute respiratory distress related to asthma may experience: a) an exacerbation of goiter and low-pitched stridor. b) nasophaygeal drainage with oxygen saturation of 95%. c) dyspnea, wheezing, and polycythemia. d) acute laryngotracheitis and itchy eyes. When preparing the teaching plan for the mother of a child with asthma, what information should the nurse include as a sign to alert the mother that her child is having an asthma attack? a) tight, productive cough b) temperature of 99.4° F (37.4° C) c) secretion of thin, copious mucus d) wheezing on expiration A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: a) crackles have replaced wheezes. b) the attack is over. c) the swelling has decreased. d) the airways are so swollen that no air can get through. A client with acute asthma is experiencing inspiratory and expiratory wheezing, and decreased forced expiratory volume. What is the nurse’s priority intervention? a) Beta-adrenergic blockers b) Bronchodilators c) Inhaled steroids d) Oral steroids The client, having an acute asthma attack, needs to increase oxygen delivery to the lungs and body. Nebulized bronchodilators will open airways and increase th amount of oxygen delivered. The acute phase of the attack should be resolved, and then a full medical history should be obtained to determine the cuase of the attack and how to prevent attacks in the future. It may not be necessary to place the clinet on a cardiac monitor unless he has a history of cardiac problem. The nurse is caring for a child with asthma. Which symptom would cause the most concern if observed in the child? a) Exercise intolerance b) Diaphoresis c) Diminished breath sounds bilaterally d) Cough The nurse is caring for a client with asthma. The nurse should conduct a focused assessment to detect: a) morning headaches. b) inspiratory and expiratory wheezing. c) normal breath sounds. d) increased forced expiratory volume. A client is experiencing an acute asthmatic attack. Prior to treatment with levalbuterol, respirations were 40 breaths per minute, pulse 132 beats per minute, oxygen saturation 86% on room air, and with audible wheezing. Which findings indicate achievement of the desired outcome of asthma treatment? a) pulse 96 bpm and SpO2 92% on room air b) inspiratory cycle twice as long as the expiratory cycle c) wheezing inaudible with diminished breath sounds d) decreased peak expiratory flow (PEF) rate A nurse is teaching the parents of an infant with cystic fibrosis about chest percussion therapy. Which statement by the nurse is most effective in explaining the rationale for using chest percussion on infants with cystic fibrosis? a) “Chest percussion reduces airway inflammation when done correctly.” b) “Chest percussion helps clear secretions out of the lungs.” c) “Chest percussion is often used to help an infant get to sleep.” d) “Chest percussion can distract an infant who has trouble breathing.” The nurse is caring for a child with cystic fibrosis who is admitted to the floor with an upper respiratory tract infection. The child has labored breathing and a congested, nonproductive cough. Which nursing diagnosis is the immediate priority for the nurse? a) Risk for infection related to bacterial growth and impaired body defenses b) Compromised family coping related to the child’s chronic illness c) Ineffective airway clearance related to thick, tenacious mucus production d) Imbalanced nutrition (less than body requirements) related to impaired absorption A nurse is caring for a 10-year-old child with cystic fibrosis. The child's parents tell the nurse that they're having difficulty coping with their child's disease. Which action should the nurse take? a) Tell the parents they should be glad their child has lived this long. b) Encourage the parents to continue to do as much for their child as they can so that the child is not responsible for his or her own care. c) Counsel the parents on not having any more children because all future children will also have cystic fibrosis. d) Encourage the parents to get connected with support groups such as the Cystic Fibrosis Foundation. A child with cystic fibrosis does not like taking a pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is: a) The child will experience severe diarrhea if the supplement is not taken as prescribed. b) The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear. c) The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates, and proteins. d) The child will become dehydrated if the supplement is not taken with meals and snacks. An adolescent male with cystic fibrosis tells the nurse he wants to marry and raise a large family. How should the nurse respond? a) “Your goal is reasonable once you go three years without disease symptoms.” b) “You should consider adoption to avoid transmitting the disorder.” c) “You may need to consult genetic and reproductive experts.” d) “You need to consider what will happen to your wife when you die young.” The parents of a child with cystic fibrosis express concern about how the disease was transmitted to their child. The nurse should explain that: a) a disease carrier also has the disease. b) a disease carrier and an affected person will have a child with the disease. c) a disease carrier and an affected person will never have children with the disease. d) two parents who are carriers may produce a child who has the disease. When explaining the risk for having a child with cystic fibrosis to a husband and wife, the nurse should tell them: a) the disease does not have a genetic basis. b) the disease will only occur if the child is a male. c) the risk is greatest when both clients have the recessive gene. d) the gene is carried on the X chromosome and there is little risk. The nurse receives a change-of-shift report on the following four clients. Which client should the nurse assess first? a) Client with atrial fibrillation who has a dose of diltiazem due in 15 minutes b) Client with influenza who has a temperature of 100.2° F (37.8° C) c) Immobile client with a sudden onset of shortness of breath d) Client with cystic fibrosis who has pulmonary function testing scheduled A nurse is reviewing a client's prenatal history. Which finding indicates a genetic risk factor? a) The client is 25 years old. b) The client has a history of preterm labor at 32 weeks' gestation. c) The client was exposed to rubella at 36 weeks' gestation. d) The client has a child with cystic fibrosis. The nurse refers the parents of a child with cystic fibrosis to an organization that helps families with children who have this disease. Such organizations are especially beneficial for parents by helping them: a) obtain genetic counseling. b) find tutors to educate their children at home. c) obtain financial assistance to purchase medications for their children. d) meet with other parents of children with cystic fibrosis for mutual support. A 9-year-old child is admitted to the pediatric unit for treatment of cystic fibrosis. A nurse assessing the child's respiratory status should expect to identify: a) production of thick, sticky mucus b) stridor c) unilateral decrease in breath sounds d) harsh, nonproductive cough Cystic fibrosis is associated with the production of thick, sticky mucous. Children with cystic fibrosis often have repeated respiratory infections, including bronchitis and pneumonia. They may develop a chronic cough and wheezing because of obstruction of air passages, and sputum may be bloodstained at times. Other common symptoms include failure to thrive and loss of weight, abdominal discomfort and flatulence, clay-colored stools. Cystic fibrosis results in excessive loss of sodium in perspiration, so children may become easily dehydrated. Parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic enzymes. Which response by the nurse is most appropriate? a) "Pancreatic enzymes prevent intestinal mucus accumulation." b) "Pancreatic enzymes promote absorption of nutrients and fat." c) "Pancreatic enzymes promote adequate rest." d) "Pancreatic enzymes help prevent meconium ileus." Which outcome criteria would the nurse develop for a child with cystic fibrosis who has ineffective airway clearance related to increased pulmonary secretions and inability to expectorate? a) absence of chills and fever b) ability to tolerate usual diet without vomiting c) ability to engage in age-related activities d) respiratory rate and rhythm within expected range A 7-year-old boy is hospitalized with cystic fibrosis. To help him manage secretions and avoid respiratory distress, the nurse should: a) serve a high-calorie diet. b) give pancreatic enzymes as ordered. c) perform chest physiotherapy every 4 hours. d) place the child in an oxygen tent and have oxygen administered continuously. Chest physiotherapy aids in loosening secretions in the entire respiratory tract. Pancreatic enzymes aid in the absorption of necessary nutrients not in managing secretions. Oxygen therapy doesn't aid in loosening secretions and can cause carbon dioxide retention and respiratory distress in children with cystic fibrosis. A high-calorie diet is appropriate but doesn't facilitate respiratory effort. What toy should the nurse included as part of a recreational therapy plan of care for a 3-year-old child hospitalized with pneumonia and cystic fibrosis? a) 100-piece jigsaw puzzle b) child's favorite doll c) fuzzy stuffed animal d) scissors, paper, and paste At a previous visit, the parents of an infant with cystic fibrosis received instruction in the administration of pancrelipase. At a follow-up visit, which finding in the infant suggests that the parents require more teaching about administering the pancreatic enzymes? a) Normal stools b) Fatty stools c) Bloody stools d) Liquid stools Pancreatic enzymes normally aid in food digestion in the intestine. In a child with cystic fibrosis, however, these natural enzymes can't reach the intestine because mucus blocks the pancreatic duct. Without these enzymes, undigested fats and proteins produce fatty stools. Treatment with pancreatic enzymes should result in stools of normal consistency; noncompliance with the treatment produces fatty stools. Noncompliance doesn't cause bloody urine, bloody stools, or glucose in urine. Which finding requires immediate intervention when planning care for an adolescent with cystic fibrosis (CF)? a) delayed puberty b) large, foul-smelling, and bulky stools c) poor weight gain d) chest pain with dyspnea Ceftazidime has been ordered for a client with cystic fibrosis. The order states to give 40 mg/kg q8h. The child is two years old and weighs 38 lb 5 oz (17.5 kg). How many milligrams of the ceftazidime should be given in one dose? a) 260 b) 466 c) 116 d) 233 A nurse is teaching the parents of a child with cystic fibrosis about proper nutrition. Which instruction should the nurse include? a) Encourage foods high in vitamin B. b) Encourage a high-calorie, high-protein diet. c) Limit salt intake to 2 g per day. d) Restrict fluids to 1,500 ml per day. The child should eat a high-calorie, high-protein diet. In cystic fibrosis, the enzymes from the pancreas (lipase, trypsin, and amylase) become so thick that the ducts become plugged. Without these enzymes, the duodenum isn't able to digest fat, protein, and some sugars; therefore, the child can become malnourished. Because fats aren't easily tolerated, they may need to be restricted. The child with cystic fibrosis needs to drink plenty of fluid and take salt supplements, especially on warm days or when exercising. Water-soluble forms of the fat-soluble vitamins (A, D, E, and K) are necessary. A client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine. Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because it: a) is a respiratory stimulant. b) is a respiratory depressant. c) may induce bronchospasm. d) inhibits the cough reflex. A primigravid client admitted to the labor area in early labor tells the nurse that her brother was born with cystic fibrosis and she wonders if her baby will also have the disease. The nurse can tell the client that cystic fibrosis is: a) X-linked dominant and there is no likelihood of the baby having cystic fibrosis. b) X-linked recessive and the disease will only occur if the baby is a boy. c) Autosomal recessive and that unless the baby's father has the gene, the baby will not have the disease. d) Autosomal dominant and there is a 50 per cent chance of the baby having the disease. An adolescent with cystic fibrosis has been hospitalized several times. On the latest admission, the client has labored respirations, fatigue, malnutrition, and failure to thrive. Which initial nursing actions are most important? a) implementing a high-calorie, high-protein, low-fat, vitamin-enriched diet and pancreatic granules b) placing the client on bed rest and obtaining a prescription for a blood gas analysis c) inserting an IV line and initiating antibiotic therapy d) applying an oximeter and initiating respiratory therapy Clients with cystic fibrosis commonly die from respiratory problems. The mucus in the lungs is tenacious and difficult to expel, leading to lung infections and interference with oxygen and carbon dioxide exchange. The client will likely need supplemental oxygen and respiratory treatments to maintain adequate gas exchange, as identified by the oximeter reading. The child will be on bed rest due to respiratory distress. However, although blood gases will probably be prescribed, the oximeter readings will be used to determine oxygen deficit and are, therefore, more of a priority. A diet high in calories, proteins, and vitamins with pancreatic granules added to all foods ingested will increase nutrient absorption and help the malnutrition; however, this intervention is not the priority at this time. Inserting an IV to administer antibiotics is important, and can be done after ensuring adequate respiratory function. A 2-year-old child is brought to the emergency department with suspected croup. The child appears frightened and cries as the nurse approaches him. The nurse needs to assess the child's breath sounds. The best way to approach the 2-year-old child is to: a) expose the child's chest quickly and auscultate breath sounds as quickly and efficiently as possible. b) ask the mother to wait briefly outside until the assessment is over. c) tell the child the nurse is going to listen to his chest with the stethoscope. d) allow the child to handle the stethoscope before listening to his lungs. Toddlers are naturally curious about their environment and letting them handle minor equipment is distracting and helps them gain trust with the nurse. The nurse should expose only one area at a time during assessment and should approach the child slowly and unhurriedly. The caregiver should be encouraged to hold and console her child. Also, comfort the child with objects with which he's familiar. The child should be given limited choices to allow autonomy, such as "Do you want me to listen first to the front of your chest or your back?" A 19-month-old child with croup is crying as a nurse tries to auscultate breath sounds. What is the nurse’s most appropriate intervention? a) Tell the child, in a loud and firm voice, that he must sit still and cooperate b) Hand the stethoscope to the child to examine before auscultating his lungs c) Ignore the crying and listen to breath sounds as best as possible d) Tell the parents that they are upsetting the child and to wait outside the room A two-year-old child comes to the emergency department with inspiratory stridor and a barking cough. A preliminary diagnosis of croup has been made. What is the nurse’s most important intervention? a) Provide oxygen by face mask b) Administer IV antibiotics c) Ask the mother to go to the waiting room d) Establish and maintain the airway A nurse, working in the triage area of an emergency department, sees several pediatric clients arrive simultaneously. Which client should be treated first? a) A crying four-year-old child with a laceration on his scalp b) A three-year-old child with Down syndrome who’s pale and asleep c) A two-year-old child with stridorous breath sounds, sitting up and drooling d) A three-year-old child with a barking cough and flushed appearance A nurse, working in the triage area of an emergency department, sees several pediatric clients arrive simultaneously. Which client should be treated first? a) A crying four-year-old child with a laceration on his scalp b) A three-year-old child with Down syndrome who’s pale and asleep c) A two-year-old child with stridorous breath sounds, sitting up and drooling d) A three-year-old child with a barking cough and flushed appearance What should the nurse do first when admitting a toddler with croup? a) Monitor vital signs. b) Ensure adequate fluid intake. c) Place a tracheostomy set at the bedside. d) Assess respiratory status. Assessment of a term neonate at 2 hours after birth reveals a heart rate of less than 100 bpm, periods of apnea approximately 25 to 30 seconds in length, and mild cyanosis around the mouth. The nurse notifies the health care provider (HCP) based on the interpretation that these findings may lead to which condition? a) bronchial pneumonia b) epiglottitis c) intraventricular hemorrhage d) respiratory arrest A nurse is obtaining a history from a new client in the cardiovascular clinic. When investigating for childhood diseases and disorders associated with structural heart disease, which finding should the nurse consider significant? a) Croup b) Medullary sponge kidney c) Severe staphylococcal infection d) Rheumatic fever Childhood diseases and disorders associated with structural heart disease include rheumatic fever and severe streptococcal (not staphylococcal) infections. Croup — a severe upper airway inflammation and obstruction that typically strikes children ages 3 months to 3 years — may cause latent complications, such as ear infection and pneumonia. However, it doesn't affect heart structures. Likewise, medullary sponge kidney, characterized by dilation of the renal pyramids and formation of cavities, clefts, and cysts in the renal medulla, may eventually lead to hypertension but doesn't damage heart structures. Which of the following is a priority nursing action for a child with croup? a) Continually assessing respiratory status b) Delivering oxygen as prescribed c) Giving antipyretics to alleviate fever d) Encouraging parents to stay with their child A child, age 3, is brought to the emergency department in respiratory distress caused by acute epiglottiditis. Which assessment finding is most concerning for the nurse? a) Low-grade fever, stridor, and a barking cough b) Severe sore throat, drooling, and inspiratory stridor c) Pulmonary congestion, a productive cough, and a fever d) Sore throat, a fever, and general malaise A 2-year-old child is brought to the emergency department with suspected croup. Which assessment finding reflects increasing respiratory distress? a) Bradycardia b) Intercostal retractions c) Flushed skin d) Decreased level of consciousness (LOC) Clinical manifestations of respiratory distress include tachypnea, tachycardia, restlessness, dyspnea, intercostal retractions, and cyanosis. The nurse is caring for a child with a diagnosis of croup. What advice should the nurse give to the parent when concern is expressed about the child waking at night due to the cough? a) Take the child to the bathroom, shut the door, and turn on a hot shower. b) Call 911 for assistance. c) Immediately take the child to an ambulatory care center. d) Administer another dose of medication. When a toddler with croup is admitted to the facility, a physician orders treatment with a mist tent. As the parent attempts to put the toddler in the crib, the toddler cries and clings to the parent. What should the nurse do to gain the child's cooperation with the treatment? a) Let the toddler sit on the parent's lap next to the mist tent. b) Encourage the parent to stand next to the crib and stay with the child. c) Turn off the mist so the noise doesn't frighten the toddler. d) Put the side rail down so the toddler can get into and out of the crib unaided. By encouraging the parent to stand next to the crib and stay with the child, the nurse promotes compliance with treatment while minimizing the toddler’s separation anxiety. Because the mist helps thin secretions and make them easier to clear, turning off the mist or letting the toddler sit next to the mist tent defeats the treatment’s purpose. To prevent falls, the nurse should keep the side rails up and shouldn’t permit the toddler to climb into and out of the crib. The nurse is obtaining data from a new client in the cardiovascular clinic. When asking about childhood diseases and disorders associated with structural heart disease, the nurse should consider which finding significant? a) Rheumatic fever b) Medullary sponge kidney c) Severe staphylococcal infection d) Croup A 4-year-old child who has been ill for 4 hours is admitted to the hospital with difficulty swallowing, a sore throat, and severe substernal retractions. The child's temperature is 104° F (40° C), and the apical pulse is 140 bpm. The white blood cell count is 16,000/mm3 (16,000 X 109/L). What is priority for nursing intervention? a) airway obstruction b) difficulty breathing c) infection d) potential for aspiration The triage nurse in the emergency department must prioritize the care of children waiting to be seen. Which child is in the greatest need of emergency medical treatment? a) a 4-year-old with a fever of 101° F (38.3° C), a hoarse cough, inspiratory stridor, and restlessness b) a 6-year-old with a fever of 104° F (40° C), a muffled voice, no spontaneous cough, and drooling c) a 3-year-old with a fever of 100° F (37.8° C), a barky cough, and mild intercostal retractions d) a 13-year-old with a fever of 104° F (40° C), chills, and a cough with thick yellow secretions A toddler with croup is given a racemic epinephrine treatment because of increasing respiratory distress. The nurse evaluates the treatment as being effective when the child’s: a) retractions are less severe. b) color is normal. c) heart rate is 100 bpm. d) pulse oximeter reads 90. A 21-month-old child admitted with the diagnosis of croup now has a respiratory rate of 48 breaths/minute, a heart rate of 120 bpm, and a temperature of 100.8° F (38.2 ° C) rectally. The nurse is having difficulty calming the child. What should the nurse do next? a) Administer acetaminophen. b) Allow the toddler to continue to cry. c) Notify the health care provider (HCP) immediately. d) Offer clear fluids every few minutes. The nurse is assessing breath sounds of a child admitted to the unit. Based on the following progress notes, which respiratory illness would the nurse suspect? Progress notes 10/15/16 2030 Seven-year-old child admitted from ER. Oxygen via mask at 4 L/min. Frequent, tight cough. A/Ox3. Shortness of breath noted while talking to mom. HEENT normal. Lungs with wheezing in bases. Heart RRR, no murmur. Abdomen soft, flat. Active bowel sounds. Moving all extremities well. a) Asthma b) Pneumonia c) Croup d) Pulmonary edema Which finding would indicate that an infant with a tracheoesophageal fistula (TEF) needs suctioning? a) barking cough b) substernal retractions c) decreased activity level d) increased respiratory rate When assessing a child with bronchiolitis, which finding does the nurse expect? a) Barking cough and stridor b) Barrel chest c) Clubbed fingers d) Productive cough A toddler is admitted to the pediatric unit. Based on the progress notes, which developmental intervention should the nurse implement? 2/10/2017 1000 History and Physical Tab 14- month-old male with croup admitted at 1400. Temperature: 100.5o F (38.1oC), Heart rate: 126, regular, no murmur. Resp. rate 28. Lungs bilaterally clear. Frequent barky cough. Weight: 22.5 lb (10.24 kg) Height: 31.1 in (79 cm) Head circumference: 18.5 in (47 cm). Child is crying but easily consoled by the nurse. Smiles when he hears mom’s voice in the hallway. Able to pass blocks back and forth between hands, but then drops them. Verbalizes “mama” “dada”, but no other words. Mother states child is read to daily, and likes to turn pages. Anterior fontanel closed. Eyes dull. Unable to assess ears due to child’s lack of cooperation. Abdomen soft, flat. Standing in crib. a) Notify the health care provider of the child’s responses b) Suggest occupational/physical therapy services while in the hospital c) Incorporate frequent reading sessions into the nursing care plan. d) Provide normal nursing cares A parent brings their child to the ED reporting difficulty swallowing, increased drooling, restlessness, and stridor. The position of comfort is observed to be tripod-sitting position. What does the nurse suspect may be occurring? a) Bronchiolitis b) Epiglottitis c) Croup d) Asthma A 2-year-old child is brought to the emergency department with a history of upper airway infection that has worsened over the last 2 days. The nurse assesses the child and finds a hoarse voice, inspiratory stridor, fever, and a barking cough. What would the nurse anticipate for admission orders? a) Cool mist humidification b) Antibiotics c) Inhaled bronchodilator d) Acetylsalicylic acid (aspirin) The mother of a child with tetralogy of Fallot asks the nurse why her child has clubbed fingers. The nurse bases the response on the understanding that clubbing is due to which factor? a) destruction of bone marrow b) delayed physical growth c) anemia d) peripheral hypoxia The nurse is planning care with the parents of a 4-month-old infant with heart failure and congenital heart disease. The parents report that their child tires easily. Which intervention is a priority for this child? a) Prevent infection. b) Restrict the child’s movements. c) Have more frequent health check ups. d) Increase the number of rest periods When teaching parents of a toddler with congenital heart disease, the nurse should explain all medical treatments and emphasize which instruction? a) "Reduce your child's caloric intake to decrease cardiac demand." b) "Try to maintain your child's usual lifestyle to promote normal development." c) "Make sure your child avoids contact with small children to reduce overstimulation." d) "Relax discipline and limit-setting to prevent crying." Parents of a child with a congenital heart defect should treat the child normally and allow self-limited activity. Reducing the child's caloric intake wouldn't necessarily reduce cardiac demand. Altering disciplinary patterns and deliberately preventing crying or interactions with other children could foster maladaptive behaviors. Contact with peers promotes normal growth and development A school-age child has a fever, joint inflammation, and a nonpruritic rash. Knowing that these are signs of rheumatic fever, the nurse should ask the parents: a) "Does your child have a congenital heart defect?" b) "Has your child had strep throat recently?" c) "Has your child recently been exposed to other children with rheumatic fever?" d) "Is your child's Haemophilus influenzae vaccine up to date?" The nurse is caring for an infant with a congenital heart defect. What priority health teaching should the nurse offer to the parents of this infant? a) It is dangerous to let your child cry. b) Your child will need oxygen at home. c) There are no restrictions on play. d) Keep feedings small, but frequent. The nurse is talking with the parent of a 3-year-old child who has congenital heart disease. The parent reports feeling concerns that the child does not seem to be maturing emotionally in a manner that is at the same rate as the two older children in the family. Which response by the nurse is most appropriate? a) “You will need to lower your expectations for your child’s level of maturity.” b) “The emotional immaturity you are seeing may just be your child’s manner of acting out in response to being sick so much.” c) “Children who have chronic health issues may experience developmental delays.” d) “All children mature at different rates so comparisons are not really fair.” The parents of a 3-year-old with a congenital heart disease are being seen for a check-up. They report that they are concerned about giving a flu vaccine to their child. Which statement is appropriate for inclusion in the nurse’s response? a) “As long as you are careful who your child is exposed to you should be fine to avoid giving this vaccine.” b) “Since there are troubling side effects in the vaccine for your child I would instead recommend the other members of the household be immunized instead.” c) “You are right to be concerned since this vaccine should be provided to children who are older than 3 years of age.” d) “The flu vaccine is both safe and recommended to children who have chronic illness such as heart disease.” A child, age 4, is admitted with a tentative diagnosis of congenital heart disease. When assessment reveals a bounding radial pulse coupled with a weak femoral pulse, the nurse suspects that the child has: a) coarctation of the aorta. b) a ventricular septal defect. c) patent ductus arteriosus. d) truncus arteriosus. Laboratory results for a child with a congenital heart defect with decreased pulmonary blood flow reveal an elevated hemoglobin (Hb) level, hematocrit (HCT), and red blood cell (RBC) count. These data suggest which condition? a) Jaundice b) Anemia c) Dehydration d) Compensation for hypoxia A child presents with a congenital heart defect and increased pulmonary blood flow. Which of the following signs or symptoms will alert the nurse that congestive heart failure is occurring? Select all that apply. a) Weight loss b) Polyuria c) Course breath sounds d) Tachypnea with feeding e) Coughing After the physician explains the prognosis and medical management for atrial septal defect to a primiparous client whose 2-day-old female neonate was diagnosed with this condition, the nurse determines that the mother needs further instructions when she says which of the following? a) "This condition occurs more commonly in females than in males." b) "About half of the children born with this defect heal spontaneously." c) "As my child grows, she may have increased fatigue and difficulty breathing." d) "My child may need to have antibiotics if she develops an infection." A toddler is hospitalized for evaluation and management of congenital heart disease (CHD). During discharge preparation, the nurse should discuss which topic with the parents? a) When to administer prophylactic antibiotics b) The need to withhold childhood immunizations c) How to perform postural drainage d) The importance of restricting the child's fat intake The school nurse is teaching parents of school-age children about prevention of rheumatic fever. What should be included? a) Monitor for conjunctivitis with exudate b) Take antibiotics until the child feels better c) Take the child to a healthcare provider when strep throat is suspected d) Administer aspirin (acetylsalicylic acid) to control feve A 13-year-old has been admitted with a diagnosis of rheumatic fever and is on bed rest. He has a sore throat. His joints are painful and swollen. He has a red rash on his trunk and is experiencing aimless movements of his extremities. Use the chart above to determine what the nurse should do first. a) Apply lotion to the rash. b) Report the heart rate to the health care provider (HCP). c) Splint the joints to relieve the pain. d) Request a prescription for medication to treat the elevated temperature. When obtaining a health history from the mother of a 7-year-old child diagnosed with acute rheumatic fever, the nurse should focus questions to determine if the child was recently ill with which condition? a) sore throat b) earache c) dysuria d) vomiting Which of the following should the nurse expect to include in the plan of care for a child who is diagnosed with rheumatic fever and carditis and admitted to the hospital? a) Providing the child with periods of rest. b) Advising the child to eat as much as possible. c) Encouraging participation in age-appropriate activities. d) Ensuring continuous parental presence at the child's bedside. A nurse is planning care for a 10-year-old child in the acute phase of rheumatic fever. Which activity is most appropriate for the nurse to schedule in the care plan? a) Climbing on play equipment in the playroom b) Playing ping-pong c) Reading books d) Ambulating without restrictions A nurse is planning care for a 12-year-old with rheumatic fever. The nurse should teach the parents to: a) provide for adequate periods of rest between activities. b) encourage someone in the family to be with the child 24 hours a day. c) observe the child closely. d) allow the child to participate in activities that will not tire him. The nurse is talking with the parent of a 5-year-old child. The parent reports having recently read an article about rheumatic fever and heart disease and questions how to prevent this from happening to the child. What is the best response by the nurse? a) “The pneumococcal vaccine is needed to reduce your child’s risk.” b) “Making sure your child has the annual influenza vaccine is the most important thing you can do.” c) “Prompt treatment of strep infections is a key to preventing this condition.” d) “Your child is not susceptible since there is no history of cardiac problems.” A 14-year-old with rheumatic fever who is on bed rest is receiving an IV infusion of dextrose 5% r administered by an infusion pump. The nurse should verify the alarm settings on the infusion pump at which times? Select all that apply. a) when the child returns from X-ray b) at the beginning of each shift c) when the child moves in the bed d) when the infusion is started e) when the child is sleeping At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer: a) alprazolam. b) propranolol. c) albuterol. d) morphine. The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client's greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It's given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client's breathing. Propranolol is contraindicated in a client who's wheezing because it's a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation. A nurse is reviewing orders for a client having an acute asthma attack. Which of the following medications should the nurse administer? a) Triamcinolone two puffs per metered-dose inhaler b) Methylprednisolone 60 mg IV c) Salmeterol 50 μg per dry-powder inhaler d) Albuterol 2.5 mg per nebulizer Which statement by the mother of a neonate diagnosed with bronchopulmonary dysplasia (BPD) indicates effective teaching? a) "Bronchodilators can cure my baby's condition." b) "BPD is an acute disease that can be treated with antibiotics." c) "My baby may have seizures later on in life because of this condition." d) "My baby may require long-term respiratory support." The family of a client, stung by a bee, is rushed the client to the emergency room. The client is experiencing hives and redness at the site. Upon arrival, the client states, “I feel a lump in my throat and I am sweating. I can’t breathe! I think I am going to die!” The nurse anticipates which emergency treatment next? a) Administer an injection of epinephrine stat. b) Have the client in high Fowler’s position in the bed. c) Administer oxygen 4 liters via nasal cannula. d) Administer Albuterol 2 puffs stat. A client, diagnosed with asthma, is experiencing an anaphylactic reaction to a medication. After administering initial emergency care, the nurse would: a) administer bronchodilators. b) obtain serum electrolyte levels. c) administer beta-adrenergic blockers. d) have the client lie flat in the bed. A client with a history of asthma is brought to the emergency department in respiratory distress. Which is the priority action by the nurse? a) Place in supine position, initiate oxygen, and administer bronchodilators as ordered. b) Position in high Fowler's position and administer bronchodilators as ordered. c) Position in Fowler’s position, initiate oxygen, and administer bronchodilators as ordered. d) Encourage ambulation and administer bronchodilators and steroids as ordered. A client with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/min, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. What should the nurse do first? a) Administer bronchodilators as prescribed. b) Initiate oxygen therapy as prescribed, and reassess the client in 10 minutes. c) Draw blood for an arterial blood gas. d) Encourage the client to relax and breathe slowly through the mouth. A preterm infant born 2 hours ago at 34 weeks' gestation is experiencing rapid respirations, grunting, no breath sounds on one side, and a shift in location of heart sounds. The nurse should prepare to assist with which procedure? a) placement of the neonate on a ventilator b) suctioning of the neonate's nares with wall suction c) administration of bronchodilators through the nares d) insertion of a chest tube into the neonate A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs? a) Monitor the client's theophylline level before administering the medications. b) Administer the salmeterol and then administer the triamcinolone. c) Administer the triamcinolone and then administer the salmeterol. d) Allow the client to choose the order in which the drugs are administered. A toddler is admitted to the facility for treatment of a severe respiratory infection. The child's recent history includes fatty stools and failure to gain weight steadily. The physician diagnoses cystic fibrosis. By the time of the child's discharge, the child's parents must be able to perform which task independently? a) Allergy-proofing the home b) Performing postural drainage c) Maintaining the child in an oxygen tent d) Maintaining the child on a fat-free diet The client with cystic fibrosis is at risk for frequent respiratory infections secondary to increased viscosity of mucus gland secretions. To help prevent respiratory infections, caregivers must perform postural drainage several times daily to loosen and drain secretions. Because exocrine gland dysfunction, not an allergic response, causes bronchial obstruction in cystic fibrosis, allergy-proofing the home isn't necessary. Oxygen therapy may be indicated, but only during acute disease episodes. Also, such therapy must be supervised closely; home oxygen therapy is inappropriate because chronic hypoxemia poses the risk of oxygen toxicity. If steatorrhea can't be controlled, the child should reduce, but not eliminate, dietary fat intake. A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? a) Chest X-ray b) Arterial blood gas (ABG) levels c) Inspection d) Auscultation A 3-year-old client is admitted to the pediatric unit with pneumonia. The child has a productive cough and appears to have difficulty breathing. The parents tell the nurse that the child hasn't been eating or drinking much and has been very inactive. Which interventions to improve airway clearance should the nurse include in the care plan? Select all that apply. a) Maintain humidification with a cool mist humidifier. b) Encourage coughing and deep breathing. c) Restrict fluid intake. d) Perform chest physiotherapy as ordered. e) Keep the head of the bed flat. f) Perform postural drainage. Chest physiotherapy and postural drainage work together to break up congestion and then drain secretions. Coughing and deep breathing are also effective to remove congestion. A cool mist humidifier helps loosen thick mucous and relax airway passages. Fluids should be encouraged, not restricted. The child should be placed in semi-Fowler's to high Fowler's position to facilitate breathing and promote optimal lung expansion. The nurse gives a client 0.25 mg of digoxin instead of the prescribed dose of 0.125 mg. What action should the nurse take after realizing the mistake? a) Hold the next dose of digoxin. b) Assess the client and notify the physician. c) No action is needed because of the small dose difference. d) Give the prescribed 0.125 mg as soon as possible. This is a medication error. The priority is to assess the client and then to notify the physician of the error and seek further guidance from the physician. The other options do not describe the steps the nurse should take to ensure client safety following a medication error. The other options include decisions and judgments that are outside of the nurse's scope of practice. A physician writes an order for a client that says: "Digoxin .125 mg P.O. once daily." To prevent a dosage error, how should the nurse transcribe this order onto the medication administration record? a) "Digoxin 0.125 mg P.O. once daily" b) "Digoxin 0.1250 mg P.O. once daily" c) "Digoxin .125 mg P.O. once daily" d) "Digoxin .1250 mg P.O. once daily" A client is admitted to the cardiac unit with a diagnosis of heart failure. The health care provider prescribes furosemide and digoxin to manage the condition. Which laboratory value should be monitored during hospitalization? a) Potassium b) Calcium c) Chloride d) Sodium A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best? a) "Warfarin prevents clot formation in the atria of clients with atrial fibrillation." b) "It's just a coincidence; most clients with atrial fibrillation don't receive warfarin." c) "Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia." d) "Warfarin controls heart rate in the client with atrial fibrillation." A physician orders digoxin elixir for a toddler with heart failure. Immediately before administering this drug, the nurse must check the toddler's: a) apical pulse. b) urine output. c) weight. d) serum sodium level. A preschooler with a history of heart failure is prescribed digoxin. Which nursing intervention is most important to perform before administering this drug to a child? a) Count the child's respiratory rate for 1 minute. b) Check apical heart rate for 1 minute. c) Measure the child's urine output. d) Obtain the child's blood pressure. A client newly diagnosed with heart failure is placed on bed rest and states, “Why do I have to stay in the bed?” What is the nurse’s best response to this concern? a) “It will improve the heart's pumping action.” b) “It will reduce the heart's workload.” c) “It will decrease fluid volume in the heart.” d) “It will enhance arterial oxygenation.” Before administering digoxin, a nurse reviews information about the drug. She learns that after digoxin is metabolized, the body eliminates remaining digoxin as unchanged drug by way of the: a) kidneys. b) feces. c) lungs. d) skin. The nurse should teach the client that signs of digoxin toxicity include: a) rash over the chest and back. b) increased appetite. c) elevated blood pressure. d) visual disturbances such as seeing yellow spots. colored vision and seeing yellow spots are symptoms of digoxin toxicity. Abdominal pain, anorexia, nausea, and vomiting are other common symptoms of digoxin toxicity. Additional signs of toxicity include arrhythmias, such as atrial fi brilla-tion or bradycardia. Rash, increased appetite, and elevated blood pressure are not associated with digoxin toxicity. A client with chronic heart failure is receiving digoxin, 0.25 mg by mouth daily, and furosemide, 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause: a) taste and smell alterations. b) nocturia and sleep disturbances. c) dry mouth and urine retention. d) visual disturbances. The nurse monitors the serum electrolyte levels of a client who is taking digoxin. Which electrolyte imbalance is a common cause of digoxin toxicity? a) hyponatremia b) hypokalemia c) hypomagnesemia d) hypocalcemia The nurse is preparing to administer oral digoxin to a child and notes that the child has nausea, has vomited, and has a pulse rate of 45 beats per minute. Which of the following is the appropriate nursing action? a) Give the medication and document findings b) Hold the medication until the child has stopped vomiting c) Hold the digoxin and notify the physician of possible toxicity d) Let the child and parents know vomiting and bradycardia are expected with this drug A child who has been treated for an acute episode of bronchial asthma is ready for discharge. The nurse is instructing the parents on medications that the child will need at home for the long-term treatment of asthma. Which of the following medications should the nurse expect to review with the parents regarding long-term treatment of the child’s asthma? a) Montelukast b) Metaproterenol c) Prednisone d) Ipratropium A client is admitted to the emergency department with crushing chest injuries sustained in a car accident. Which sign indicates a possible pneumothorax? a) diminished or absent breath sounds on the affected side b) increased fremitus c) decreased sensation on the affected side d) Cheyne-Stokes respirations A premature infant has been placed on a home apnea monitor. The nurse is giving discharge instructions to the parents. The nurse begins teaching by stating: a) "You can only give your baby sponge baths until monitoring is discontinued because it's dangerous to take the monitor off at any time." b) "Remove the monitor at least 3 hours per day to allow the baby a rest period." c) "Your baby will probably need to be monitored until at least age 1." d) "Using the monitor will help your physician determine the frequency of apneic events and how long monitoring is required." The parent of a 2-week-old infant brings the child to the clinic for a checkup. The parent expresses concern about the baby’s breathing because the infant breathes quickly for a while and then breathes slowly. The nurse interprets this finding as an indication of what factor? a) a need for close monitoring for the mother b) a normal pattern in infants of this age c) the need for a chest radiograph d) the need for an apnea monitor When assessing a client with chest trauma, the nurse notes that the client is taking small breaths at first, then bigger breaths, then a couple of small breaths, then 10 to 20 seconds of no breaths. The nurse should record the breathing pattern as: a) obstructive sleep apnea. b) hyperventilation. c) Cheyne-Stokes respiration. d) Biot's respiration. When reinforcing discharge education for a parent and newborn, which statement made by the parent indicates a need for further instruction? a) I will place my baby in a supine position when napping. b) I will place my baby in a prone position when napping. c) It is acceptable to let my baby lay prone when playing only with supervision. d) I know the importance of correct positioning when my baby is napping. A nurse is preparing for the discharge of a neonate born 7 weeks premature. The neonate has had several apneic episodes and will need a home apnea monitor but will require no other specialized care. Which nursing diagnosis is most appropriate for the neonate's parents? a) Deficient knowledge related to inability to cope. b) Risk for aspiration related to nil orally status. c) Deficient knowledge related to ventilatory support. d) Deficient knowledge related to lack of exposure to apnea monitor. A nurse is monitoring a client for adverse reactions to atropine eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction? a) Tachycardia b) Increased salivation c) Hypotension d) Apnea [Show More]

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