remembering case law but also understanding its application in different contexts. Law students often need to
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Pediatric Nursing, A Case-
Based Approach, 1st 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
remembering case law but also understanding its application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without
experience in the field.Moreover, law exams
Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from
tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree
angle and the neck slightly extended to maintain an open airway and decrease pressure on the
diaphragm. The etiology of bronchiolitis is viral. Antibiotics are given only if there is a secondary
bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are given
parenterally to prevent dehydration.
2. An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus
(RSV). The nurse knows that a child infected with this virus requires what type of isolation?
a. Reverse isolation
b. Airborne isolation
c. Contact Precautions
d. Standard Precautions ANS: C
RSV is transmitted through droplets. In addition to Standard Precautions and hand washing,
Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care
is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children
are placed in a private room or in a room with other children with RSV infections. Reverse isolation
focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from
exposure to the virus. The virus is not airborne.
3. A child has a chronic cough and diffuse wheezing during the expiratory phase of respiration. This
suggests what condition?
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign body in trachea ANS: A
Asthma may have these chronic signs and symptoms. Pneumonia appears with an acute onset,
fever, and general malaise. Bronchiolitis is an acute condition caused by respiratory syncytial
virus. Foreign body in the trachea occurs with acute respiratory distress or failure and maybe stridor.
remembering case law but also understanding its application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without
experience in the field.Moreover, law exams
4. Which nursing diagnosis is most appropriate for an infant with acute bronchiolitis due
to respiratory syncytial virus (RSV)?
a. Activity Intolerance
b. Decreased Cardiac Output
c. Pain, Acute
d. Tissue Perfusion, Ineffective (peripheral) ANS. A
Rationale 1: Activity intolerance is a problem because of the imbalance between oxygen supply and
,demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory-
disease process.
Rationale 2: Activity intolerance is a problem because of the imbalance between oxygen supply and
demand. Cardiac output is not compromised during an acute phase of bronchiolitis. Pain is not usually
associated with acute bronchiolitis. Tissue perfusion (peripheral) is not affected by this respiratory-
disease process.
remembering case law but also understanding its application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without
experience in the field.Moreover, law exams\
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. remembering case law but also understanding its application in different contexts. Law students often need to differentiate between nuanced legal principles,
which can be difficult for those without experience in the field.Moreover, law exams
Chapter 2: Asthma
1. The nurse is caring for a child hospitalized for status asthmaticus. Which assessment finding
suggests that the childs condition is worsening?
a. Hypoventilation
b. Thirst
c. Bradycardia
d. Clubbing ANS: A
The nurse would assess the child for signs of hypoxia, including restlessness, fatigue, irritability, and
increased heart and respiratory rate. As the child tires from the increased work of breathing
hypoventilation occurs leading to increased carbon dioxide levels. The nurse would be alert for signs of
, hypoxia. Thirst would reflect the childs hydration status. Bradycardia is not a sign of hypoxia; tachycardia
is. Clubbing develops over a period of months in response to hypoxia. The presence of clubbing does not
indicate the childs condition is worsening.
remembering case law but also understanding its application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without
experience in the field.Moreover, law exams
2. Which finding is expected when assessing a child hospitalized for asthma?
a. Inspiratory stridor
b. Harsh, barky cough
c. Wheezing
d. Rhinorrhea ANS: C
Wheezing is a classic manifestation of asthma. Inspiratory stridor is a clinical manifestation of
croup. A harsh, barky cough is characteristic of croup. Rhinorrhea is not associated with asthma.
3. A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with
purulent nasal drainage, facial tenderness, and a cough that increases during sleep. The nurse
recognizes these symptoms are characteristic of which respiratory condition?
a. Allergic rhinitis
b. Bronchitis
c. Asthma
d. Sinusitis ANS: D
Sinusitis is characterized by signs and symptoms of a cold that do not improve after 14 days, a
low-grade fever, nasal congestion and purulent nasal discharge, headache, tenderness, a feeling of
fullness over the affected sinuses, halitosis, and a cough that increases when the child is lying down. The
classic symptoms of allergic rhinitis are watery rhinorrhea, itchy nose, eyes, ears, and palate, and
sneezing. Symptoms occur as long as the child is exposed to the allergen. Bronchitis is characterized by a
gradual onset of rhinitis and a cough that is initially nonproductive but may change to a loose cough. The
manifestations of asthma may vary, with wheezing being a classic sign. The symptoms presented in the
question do not suggest asthma.
4. What is a common trigger for asthma attacks in children?
a. Febrile episodes
b. Dehydration
c. Exercise
d. Seizures ANS: C
Exercise is one of the most common triggers for asthma attacks, particularly in school-age children.
Febrile episodes are consistent with other problems, for example, seizures. Dehydration occurs as a
result of diarrhea; it does not trigger asthma attacks. Viral infections are triggers for asthma. Seizures
can result from a too-rapid intravenous infusion of theophyllinea therapy for asthma.
remembering case law but also understanding its application in different contexts. Law students often need to differentiate between nuanced legal principles, which can be difficult for those without
experience in the field.Moreover, law exams
5. The practitioner changes the medications for the child with asthma to salmeterol (Serevent).
The mother asks the nurse what this drug will do. The nurse explains that salmeterol (Serevent) is used
to treat asthma because the drug produces which characteristic?