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
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.
4. Which iinursing iidiagnosis iiis iimost iiappropriate iifor iian iiinfant iiwith iiacute iibronchiolitis
iidue iito iirespiratory iisyncytial iivirus ii(RSV)?
a. Activity iiIntolerance
b. Decreased iiCardiac iiOutput
c. Pain, iiAcute
d. Tissue iiPerfusion, iiIneffective
ii(peripheral) iiANS. iiA
Rationale ii1: iiActivity iiintolerance iiis iia iiproblem iibecause iiof iithe iiimbalance iibetween iioxygen
iisupply iiand iidemand. iiCardiac iioutput iiis iinot iicompromised iiduring iian iiacute iiphase iiof
iibronchiolitis. iiPain iiis iinot iiusually iiassociated iiwith iiacute iibronchiolitis. iiTissue iiperfusion
ii(peripheral) iiis iinot iiaffected iiby iithis iirespiratory-disease iiprocess.
Rationale ii2: iiActivity iiintolerance iiis iia iiproblem iibecause iiof iithe iiimbalance iibetween iioxygen
iisupply iiand iidemand. iiCardiac iioutput iiis iinot iicompromised iiduring iian iiacute iiphase iiof
iibronchiolitis. iiPain iiis iinot iiusually iiassociated iiwith iiacute iibronchiolitis. iiTissue iiperfusion
ii(peripheral) iiis iinot iiaffected iiby iithis iirespiratory-disease iiprocess.
Rationale ii3: iiActivity iiintolerance iiis iia iiproblem iibecause iiof iithe iiimbalance iibetween iioxygen
iisupply iiand iidemand. iiCardiac iioutput iiis iinot iicompromised iiduring iian iiacute iiphase iiof
iibronchiolitis. iiPain iiis iinot iiusually iiassociated iiwith iiacute iibronchiolitis. iiTissue iiperfusion
ii(peripheral) iiis iinot iiaffected iiby iithis iirespiratory-disease iiprocess.
Rationale ii4: iiActivity iiintolerance iiis iia iiproblem iibecause iiof iithe iiimbalance iibetween iioxygen
iisupply iiand iidemand. iiCardiac iioutput iiis iinot iicompromised iiduring iian iiacute iiphase iiof
iibronchiolitis. iiPain iiis iinot iiusually iiassociated iiwith iiacute iibronchiolitis. iiTissue iiperfusion
ii(peripheral) iiis iinot iiaffected iiby iithis iirespiratory-disease iiprocess.
Global iiRationale: iiActivity iiintolerance iiis iia iiproblem iibecause iiof iithe iiimbalance iibetween
iioxygen iisupply iiand iidemand. iiCardiac iioutput iiis iinot iicompromised iiduring iian iiacute iiphase
iiof iibronchiolitis. iiPain iiis iinot iiusually iiassociated iiwith iiacute iibronchiolitis. iiTissue iiperfusion
ii(peripheral) iiis iinot iiaffected iiby iithis iirespiratory-disease iiprocess.
Chapter ii2: iiAsthma
1. The iinurse iiis iicaring iifor iia iichild iihospitalized iifor iistatus iiasthmaticus. iiWhich iiassessment
iifinding iisuggests iithat iithe iichilds iicondition iiis iiworsening?
a. Hypoventilation
b. Thirst
c. Bradycardia
d. Clubbing
iiANS: iiA
,The iinurse iiwould iiassess iithe iichild iifor iisigns iiof iihypoxia, iiincluding iirestlessness, iifatigue,
iiirritability, iiand iiincreased iiheart iiand iirespiratory iirate. iiAs iithe iichild iitires iifrom iithe
iiincreased iiwork iiof iibreathing iihypoventilation iioccurs iileading iito iiincreased iicarbon iidioxide
iilevels. iiThe iinurse iiwould iibe iialert iifor iisigns iiof iihypoxia. iiThirst iiwould iireflect iithe iichilds
iihydration iistatus. iiBradycardia iiis iinot iia iisign iiof iihypoxia; iitachycardia iiis. iiClubbing
iidevelops iiover iia iiperiod iiof iimonths iiin iiresponse iito iihypoxia. iiThe iipresence iiof iiclubbing
iidoes iinot iiindicate iithe iichilds iicondition iiis iiworsening.
2. Which iifinding iiis iiexpected iiwhen iiassessing iia iichild iihospitalized iifor iiasthma?
a. Inspiratory iistridor
b. Harsh, iibarky iicough
c. Wheezing
d. Rhinorrhea
iiANS: iiC
Wheezing iiis iia iiclassic iimanifestation iiof iiasthma. iiInspiratory iistridor iiis iia iiclinical iimanifestation iiof
croup. iiA iiharsh, iibarky iicough iiis iicharacteristic iiof iicroup. iiRhinorrhea iiis iinot iiassociated iiwith iiasthma.
3. A iichild iihas iihad iicold iisymptoms iifor iimore iithan ii2 iiweeks, iia iiheadache, iinasal
iicongestion iiwith iipurulent iinasal iidrainage, iifacial iitenderness, iiand iia iicough iithat
iiincreases iiduring iisleep. iiThe iinurse iirecognizes iithese iisymptoms iiare iicharacteristic iiof
iiwhich iirespiratory iicondition?
a. Allergic iirhinitis
b. Bronchitis
c. Asthma
d. Sinusitis
iiANS: iiD
Sinusitis iiis iicharacterized iiby iisigns iiand iisymptoms iiof iia iicold iithat iido iinot iiimprove iiafter ii14 iidays, iia
low-grade iifever, iinasal iicongestion iiand iipurulent iinasal iidischarge, iiheadache, iitenderness, iia
iifeeling iiof iifullness iiover iithe iiaffected iisinuses, iihalitosis, iiand iia iicough iithat iiincreases iiwhen
iithe iichild iiis iilying iidown. iiThe iiclassic iisymptoms iiof iiallergic iirhinitis iiare iiwatery iirhinorrhea,
iiitchy iinose, iieyes, iiears, iiand iipalate, iiand iisneezing. iiSymptoms iioccur iias iilong iias iithe iichild
iiis iiexposed iito iithe iiallergen. iiBronchitis iiis iicharacterized iiby iia iigradual iionset iiof iirhinitis
iiand iia iicough iithat iiis iiinitially iinonproductive iibut iimay iichange iito iia iiloose iicough. iiThe
iimanifestations iiof iiasthma iimay iivary, iiwith iiwheezing iibeing iia iiclassic iisign. iiThe iisymptoms
iipresented iiin iithe iiquestion iido iinot iisuggest iiasthma.
4. What iiis iia iicommon iitrigger iifor iiasthma iiattacks iiin iichildren?
a. Febrile iiepisodes
b. Dehydration
c. Exercise
d. Seizures
iiANS: iiC
, Exercise iiis iione iiof iithe iimost iicommon iitriggers iifor iiasthma iiattacks, iiparticularly iiin iischool-
age iichildren. iiFebrile iiepisodes iiare iiconsistent iiwith iiother iiproblems, iifor iiexample, iiseizures.
iiDehydration iioccurs iias iia iiresult iiof iidiarrhea; iiit iidoes iinot iitrigger iiasthma iiattacks. iiViral
iiinfections iiare iitriggers iifor iiasthma. iiSeizures iican iiresult iifrom iia iitoo-rapid iiintravenous
iiinfusion iiof iitheophyllinea iitherapy iifor iiasthma.
5. The iipractitioner iichanges iithe iimedications iifor iithe iichild iiwith iiasthma iito iisalmeterol
ii(Serevent). iiThe iimother iiasks iithe iinurse iiwhat iithis iidrug iiwill iido. iiThe iinurse iiexplains iithat
iisalmeterol ii(Serevent) iiis iiused iito iitreat iiasthma iibecause iithe iidrug iiproduces iiwhich
iicharacteristic?
1. Decreases iiinflammation
2. Decreases iimucous iiproduction
3. Controls iiallergic iirhinitis
4. Dilates iithe iibronchioles
Correct iiAnswer: ii4
Rationale ii1: iiSalmeterol ii(Serevent) iiis iia iilong-acting iibeta2-agonist iithat iiacts iiby
iibronchodilating. iiSteroids iiare iianti-inflammatory, iianticholinergics iidecrease iimucous
iiproduction, iiand iiantihistamines iicontrol iiallergic iirhinitis.
Rationale ii2: iiSalmeterol ii(Serevent) iiis iia iilong-acting iibeta2-agonist iithat iiacts iiby
iibronchodilating. iiSteroids iiare iianti-inflammatory, iianticholinergics iidecrease iimucous
iiproduction, iiand iiantihistamines iicontrol iiallergic iirhinitis.
Rationale ii3: iiSalmeterol ii(Serevent) iiis iia iilong-acting iibeta2-agonist iithat iiacts iiby
iibronchodilating. iiSteroids iiare iianti-inflammatory, iianticholinergics iidecrease iimucous
iiproduction, iiand iiantihistamines iicontrol iiallergic iirhinitis.
Rationale ii4: iiSalmeterol ii(Serevent) iiis iia iilong-acting iibeta2-agonist iithat iiacts iiby
iibronchodilating. iiSteroids iiare iianti-inflammatory, iianticholinergics iidecrease iimucous
iiproduction, iiand iiantihistamines iicontrol iiallergic iirhinitis.
Global iiRationale: iiSalmeterol ii(Serevent) iiis iia iilong-acting iibeta2-agonist iithat iiacts iiby
iibronchodilating. iiSteroids iiare iianti-inflammatory, iianticholinergics iidecrease iimucous
iiproduction, iiand iiantihistamines iicontrol iiallergic iirhinitis.
Cognitive iiLevel: iiAnalyzing
Client iiNeed: iiPhysiological iiIntegrity
Client iiNeed iiSub: iiPharmacological iiand iiParenteral iiTherapies
Nursing/Integrated iiConcepts: iiNursing iiProcess: iiImplementation
Learning iiOutcome: iiLO ii20.6 iiCreate iia iinursing iicare iiplan iifor iia iichild iiwith iia iicommon
iiacute iirespiratory iicondition.
6. Following iiparental iiteaching, iithe iinurse iiis iievaluating iithe iiparents iiunderstanding iiof
iienvironmental iicontrol iifor iitheir iichilds iiasthma iimanagement. iiWhich iistatement iiby iithe
iiparents iiindicates iiappropriate iiunderstanding iiof iithe iiteaching?
1. We iiwill iireplace iithe iicarpet iiin iiour iichilds iibedroom iiwith iitile.
2. Were iiglad iithe iidog iican iicontinue iito iisleep iiin iiour iichilds iiroom.
3. Well iibe iisure iito iiuse iithe iifireplace iioften iito iikeep iithe iihouse iiwarm iiin iithe iiwinter.
4. Well iikeep iithe iiplants iiin iiour iichilds iiroom iidusted.
Correct iiAnswer: ii1