C HAPTER 20: A LTERATIONS IN
R ESPIRATORY F UNCTION
MULTIPLE CHOICE
1. A 3-year-old child is experiencing pain after a tonsillectomy. The child has not
taken in any fluids and does not want to drink anything, saying, My tummy hurts.
The following health care prescriptions are available: acetaminophen (Tylenol)
PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nur se
implement to relieve the childs pain?
a. Ice chips
b. Tylenol PO
c. Tylenol PR
d. Popsicle
ANS: C
The throat is very sore after a tonsillectomy. Most children experience
moderate pain after a tonsillectomy and need pain medication at regular
intervals for at least the first 24 hours. Analgesics may need to be given
rectally or intravenously to avoid the oral route.
2. A 1-year-old child has acute otitis media (AOM) and is being treated with oral
antibiotics. What should the nurse include in the discharge teaching t o the infants
parents?
a. A follow-up visit should be done after all medicine has been given.
b. After an episode of acute otitis media, hearing loss usually occurs.
c. Tylenol should not be given because it may mask symptoms.
, d. The infant will probably need a myringotomy procedure and tubes.
ANS: A
Children with AOM should be seen after antibiotic therapy is complete to
evaluate the effectiveness of the treatment and to identify potential
complications, such as effusion or hearing impairment. Hearing loss does not
usually occur with acute otitis media. Tylenol should be given for pain, and
the infant will not necessarily need a myringotomy procedure.
3. What do the initial signs of respiratory syncytial virus (RSV) infection in an
infant include?
a. Rhinorrhea, wheezing, and fever
b. Tachypnea, cyanosis, and apnea
c. Retractions, fever, and listlessness
d. Poor breath sounds and air hunger
ANS: A
Symptoms such as rhinorrhea and a low-grade fever often appear first. OM
and conjunctivitis may also be present. In time, a cough may develop.
Wheezing is an initial sign as well. Progression of illness brings on the
symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger,
and apnea.
4. The nurse is caring for a 1-month-old infant with respiratory syncytial virus
(RSV) who is receiving 23% oxygen via a plastic hood. The childs SaO2
saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min.
Based on these assessments, what action should the nurse take?
a. Withhold feedings.
, b. Notify the health care provider.
c. Put the infant in an infant seat.
d. Keep the infant in the plastic hood.
ANS: B
The American Academy of Pediatrics practice parameter (2006) recommends
the use of supplemental oxygen if the infant fails to maintain a consistent
oxygen saturation of at least 90%. The health care provider should be notified
of the saturation reading of 88%. Withholding the feedings or placing the
infant in an infant seat would not increase the saturation reading. The infant
should be kept in the hood, but because the saturation reading is 88%, the
health care provider should be notified to obtain orders to increase the oxygen
concentration.
5. A 5-year-old child is admitted with bacterial pneumonia. What signs and
symptoms should the nurse expect to assess with this disease process?
a. Fever, cough, and chest pain
b. Stridor, wheezing, and ear infection
c. Nasal discharge, headache, and cough
d. Pharyngitis, intermittent fever, and eye infection
ANS: A
Children with bacterial pneumonia usually appear ill. Symptoms include
fever, malaise, rapid and shallow respirations, cough, and chest pain. Ear
infection, nasal discharge, and eye infection are not symptoms of bacterial
pneumonia.
6. An infant with a congenital heart defect is to receive a dose of palivizumab
, (Synagis). What is the purpose of this?
a. Prevent RSV infection.
b. Prevent secondary bacterial infection.
c. Decrease toxicity of antiviral agents.
d. Make isolation of infant with RSV unnecessary.
ANS: A
The only product available in the United States for prevention of RSV is
palivizumab, a humanized mouse monoclonal antibody, which is given once
every 30 days (15 mg/kg) between November and March. It is given to high -
risk infants, which includes an infant with a congenital heart defect.
7. A 3-year-old is brought to the emergency department with symptoms of stridor,
fever, restlessness, and drooling. No coughing is observed. Based on these
findings, the nurse should be prepared to assist with what action?
a. Throat culture
b. Nasal pharynx washing
c. Administration of corticosteroids
d. Emergency intubation
ANS: D
Three clinical observations that are predictive of epiglottitis are absence of
spontaneous cough, presence of drooling, and agitation. Nasotracheal
intubation or tracheostomy is usually considered for a child with epiglottitis
with severe respiratory distress. The throat should not be inspected because
airway obstruction can occur, and steroids would not be done first when the
child is in severe respiratory distress.
R ESPIRATORY F UNCTION
MULTIPLE CHOICE
1. A 3-year-old child is experiencing pain after a tonsillectomy. The child has not
taken in any fluids and does not want to drink anything, saying, My tummy hurts.
The following health care prescriptions are available: acetaminophen (Tylenol)
PO (orally) or PR (rectally) PRN, ice chips, clear liquids. What should the nur se
implement to relieve the childs pain?
a. Ice chips
b. Tylenol PO
c. Tylenol PR
d. Popsicle
ANS: C
The throat is very sore after a tonsillectomy. Most children experience
moderate pain after a tonsillectomy and need pain medication at regular
intervals for at least the first 24 hours. Analgesics may need to be given
rectally or intravenously to avoid the oral route.
2. A 1-year-old child has acute otitis media (AOM) and is being treated with oral
antibiotics. What should the nurse include in the discharge teaching t o the infants
parents?
a. A follow-up visit should be done after all medicine has been given.
b. After an episode of acute otitis media, hearing loss usually occurs.
c. Tylenol should not be given because it may mask symptoms.
, d. The infant will probably need a myringotomy procedure and tubes.
ANS: A
Children with AOM should be seen after antibiotic therapy is complete to
evaluate the effectiveness of the treatment and to identify potential
complications, such as effusion or hearing impairment. Hearing loss does not
usually occur with acute otitis media. Tylenol should be given for pain, and
the infant will not necessarily need a myringotomy procedure.
3. What do the initial signs of respiratory syncytial virus (RSV) infection in an
infant include?
a. Rhinorrhea, wheezing, and fever
b. Tachypnea, cyanosis, and apnea
c. Retractions, fever, and listlessness
d. Poor breath sounds and air hunger
ANS: A
Symptoms such as rhinorrhea and a low-grade fever often appear first. OM
and conjunctivitis may also be present. In time, a cough may develop.
Wheezing is an initial sign as well. Progression of illness brings on the
symptoms of tachypnea, retractions, poor breath sounds, cyanosis, air hunger,
and apnea.
4. The nurse is caring for a 1-month-old infant with respiratory syncytial virus
(RSV) who is receiving 23% oxygen via a plastic hood. The childs SaO2
saturation is 88%, respiratory rate is 45 breaths/min, and pulse is 140 beats/min.
Based on these assessments, what action should the nurse take?
a. Withhold feedings.
, b. Notify the health care provider.
c. Put the infant in an infant seat.
d. Keep the infant in the plastic hood.
ANS: B
The American Academy of Pediatrics practice parameter (2006) recommends
the use of supplemental oxygen if the infant fails to maintain a consistent
oxygen saturation of at least 90%. The health care provider should be notified
of the saturation reading of 88%. Withholding the feedings or placing the
infant in an infant seat would not increase the saturation reading. The infant
should be kept in the hood, but because the saturation reading is 88%, the
health care provider should be notified to obtain orders to increase the oxygen
concentration.
5. A 5-year-old child is admitted with bacterial pneumonia. What signs and
symptoms should the nurse expect to assess with this disease process?
a. Fever, cough, and chest pain
b. Stridor, wheezing, and ear infection
c. Nasal discharge, headache, and cough
d. Pharyngitis, intermittent fever, and eye infection
ANS: A
Children with bacterial pneumonia usually appear ill. Symptoms include
fever, malaise, rapid and shallow respirations, cough, and chest pain. Ear
infection, nasal discharge, and eye infection are not symptoms of bacterial
pneumonia.
6. An infant with a congenital heart defect is to receive a dose of palivizumab
, (Synagis). What is the purpose of this?
a. Prevent RSV infection.
b. Prevent secondary bacterial infection.
c. Decrease toxicity of antiviral agents.
d. Make isolation of infant with RSV unnecessary.
ANS: A
The only product available in the United States for prevention of RSV is
palivizumab, a humanized mouse monoclonal antibody, which is given once
every 30 days (15 mg/kg) between November and March. It is given to high -
risk infants, which includes an infant with a congenital heart defect.
7. A 3-year-old is brought to the emergency department with symptoms of stridor,
fever, restlessness, and drooling. No coughing is observed. Based on these
findings, the nurse should be prepared to assist with what action?
a. Throat culture
b. Nasal pharynx washing
c. Administration of corticosteroids
d. Emergency intubation
ANS: D
Three clinical observations that are predictive of epiglottitis are absence of
spontaneous cough, presence of drooling, and agitation. Nasotracheal
intubation or tracheostomy is usually considered for a child with epiglottitis
with severe respiratory distress. The throat should not be inspected because
airway obstruction can occur, and steroids would not be done first when the
child is in severe respiratory distress.
