Pediatric Nursing, A Case-Based Approach, 2st Edition By Tagher Knapp
Chapter 1: Bronchiolitis
1. Which intervention is appropriate for the infant hospitalized with bronchiolitis?
a. Position on the side with neck slightly flexed.
b. Administer antibiotics as ordered.
c. Restrict oral and parenteral fluids if tachypneic.
d. Give cool, humidified oxygen. ANS: D
Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from
tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree
angle and the neck slightly extended to maintain an open airway and decrease pressure on the
diaphragm. The etiology of bronchiolitis is viral. Antibiotics are given only if there is a secondary
bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given
parenterally to prevent dehydration.
2. An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus
(RSV). The nurse knows that a child infected with this virus requires what type of isolation?
a. Reverse isolation
b. Airborne isolation
c. Contact Precautions
d. Standard Precautions ANS: C
RSV is transmitted through droplets. In addition to Standard Precautions and hand washing,
Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care
is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children
are placed in a private room or in a room with other children with RSV infections. Reverse isolation
,focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from
exposure to the virus. The virus is not airborne.
3. A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This
suggests what condition?
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign body in trachea ANS: A
d. Tissue Perfusion, Ineffective (peripheral) ANS. A
Rationale 1: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory -
disease process.
Rationale 2: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by th is respiratory-
disease process.
,Rationale 3: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory -
disease process.
Rationale 4: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory -
disease process.
Global Rationale: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory-
disease process.
c. Bradycardia
d. Clubbing ANS: A
The nurse would assess the child for signs of hypoxia, including restlessness, fatigue, irritability, and
increased heart and respiratory rate. As the child tires from the increased work of breathing
hypoventilation occurs leading to increased carbon dioxide levels. The nurse would be alert for signs of
, hypoxia. Thirst would reflect the childs hydration status. Bradycardia is not a sign of hypoxia; tachycardia
is. Clubbing develops over a period of months in response to hypoxia. The presence of clubbing does not
indicate the childs condition is worsening.
2. Which finding is expected when assessing a child hospitalized for asthma?
a. Inspiratory stridor
b. Harsh, barky cough
c. Wheezing
d. Rhinorrhea ANS: C
Wheezing is a classic manifestation of asthma. Inspiratory stridor is a clinical manifestation of
croup. A harsh, barky cough is characteristic of croup. Rhinorrhea is not associated with asthma.
3. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with
purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse
recognizes these symptoms are characteristic of which respiratory condition?
a. Allergic rhinitis
b. Bronchitis
c. Asthma
d. Sinusitis ANS: D
Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a
Chapter 1: Bronchiolitis
1. Which intervention is appropriate for the infant hospitalized with bronchiolitis?
a. Position on the side with neck slightly flexed.
b. Administer antibiotics as ordered.
c. Restrict oral and parenteral fluids if tachypneic.
d. Give cool, humidified oxygen. ANS: D
Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from
tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree
angle and the neck slightly extended to maintain an open airway and decrease pressure on the
diaphragm. The etiology of bronchiolitis is viral. Antibiotics are given only if there is a secondary
bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given
parenterally to prevent dehydration.
2. An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus
(RSV). The nurse knows that a child infected with this virus requires what type of isolation?
a. Reverse isolation
b. Airborne isolation
c. Contact Precautions
d. Standard Precautions ANS: C
RSV is transmitted through droplets. In addition to Standard Precautions and hand washing,
Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care
is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children
are placed in a private room or in a room with other children with RSV infections. Reverse isolation
,focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from
exposure to the virus. The virus is not airborne.
3. A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This
suggests what condition?
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign body in trachea ANS: A
d. Tissue Perfusion, Ineffective (peripheral) ANS. A
Rationale 1: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory -
disease process.
Rationale 2: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by th is respiratory-
disease process.
,Rationale 3: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory -
disease process.
Rationale 4: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory -
disease process.
Global Rationale: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory-
disease process.
c. Bradycardia
d. Clubbing ANS: A
The nurse would assess the child for signs of hypoxia, including restlessness, fatigue, irritability, and
increased heart and respiratory rate. As the child tires from the increased work of breathing
hypoventilation occurs leading to increased carbon dioxide levels. The nurse would be alert for signs of
, hypoxia. Thirst would reflect the childs hydration status. Bradycardia is not a sign of hypoxia; tachycardia
is. Clubbing develops over a period of months in response to hypoxia. The presence of clubbing does not
indicate the childs condition is worsening.
2. Which finding is expected when assessing a child hospitalized for asthma?
a. Inspiratory stridor
b. Harsh, barky cough
c. Wheezing
d. Rhinorrhea ANS: C
Wheezing is a classic manifestation of asthma. Inspiratory stridor is a clinical manifestation of
croup. A harsh, barky cough is characteristic of croup. Rhinorrhea is not associated with asthma.
3. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with
purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse
recognizes these symptoms are characteristic of which respiratory condition?
a. Allergic rhinitis
b. Bronchitis
c. Asthma
d. Sinusitis ANS: D
Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a
