Pediatric vNursing, vA vCase-Based vApproach, v2nd vEdition vBy vTagher
yy yy yy yy yy yy yy yy
vKnapp
yy
TEST BANK yy v
PEDIATRIC NURSING, A CASE- yy v yy v yy v
ND
BASED APPROACH, 2
yy v yy v yy v
EDITION BYTAGHER KNAPP
yy v yy v vy v
yy
, Pediatric vNursing, vA vCase-Based vApproach, v2nd vEdition vBy vTagher
yy yy yy yy yy yy yy yy
vKnapp
yy
Chapter v1: vBronchiolitis yy yy
1. Which vintervention vis vappropriate vfor vthe vinfant vhospitalized vwith vbronchiolitis?
yy yy yy yy yy yy yy yy yy
a. Position von vthe vside vwith vneck vslightly vflexed.
yy yy yy yy yy yy yy
b. Administer vantibiotics vas vordered. yy yy yy
c. Restrict voral vand vparenteral vfluids vif vtachypneic.
yy yy yy yy yy yy
d. Give vcool, vhumidified voxygen. vANS: vD
yy yy yy yy yy
Cool, vhumidified voxygen vis vgiven vto vrelieve vdyspnea, vhypoxemia, vand vinsensible vfluid vloss vfrom
yy yy yy yy yy yy yy yy yy yy yy yy yy
tachypnea. vThe vinfant vshould vbe vpositioned vwith vthe vhead vand vchest velevated vat va v30- vto
yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy
v40-degree vangle vand vthe vneck vslightly vextended vto vmaintain van vopen vairway vand vdecrease
yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vpressure von vthe vdiaphragm. vThe vetiology vof vbronchiolitis vis vviral. vAntibiotics vare vgiven vonly vif
yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vthere vis va vsecondary vbacterial vinfection. vTachypnea vincreases vinsensible vfluid vloss. vIf vthe
yy yy yy yy yy yy yy yy yy yy yy yy yy
vinfant vis vtachypneic, vfluids vare vgivenvparenterally vto vprevent vdehydration.
yy yy yy yy yy yy y yy yy yy
2. An vinfant vwith vbronchiolitis vis vhospitalized. vThe vcausative vorganism vis vrespiratory
yy yy yy yy yy yy yy yy yy yy
vsyncytial vvirusv(RSV). vThe vnurse vknows vthat va vchild vinfected vwith vthis vvirus vrequires vwhat vtype
yy yy y yy yy yy yy yy yy yy yy yy yy yy yy yy
vof visolation?
yy yy
a. Reverse visolation yy
b. Airborne visolation yy
c. Contact vPrecautions yy
d. Standard vPrecautions vANS: vC yy yy yy
RSV vis vtransmitted vthrough vdroplets. vIn vaddition vto vStandard vPrecautions vand vhand vwashing,
yy yy yy yy yy yy yy yy yy yy yy yy
Contact vPrecautions vare vrequired. vCaregivers vmust vuse vgloves vand vgowns vwhen ventering vthe
yy yy yy yy yy yy yy yy yy yy yy yy
vroom. vCarevis vtaken vnot vto vtouch vtheir vown veyes vor vmucous vmembranes vwith va vcontaminated
yy yy y yy yy yy yy yy yy yy yy yy yy yy yy yy
vgloved vhand. vChildren vare vplaced vin va vprivate vroom vor vin va vroom vwith vother vchildren vwith
yy yy yy y yy yy yy yy yy yy yy yy yy yy yy yy yy
vRSV vinfections. vReverse visolation
yy yy yy yy
, Pediatric vNursing, vA vCase-Based vApproach, v2nd vEdition vBy vTagher
yy yy yy yy yy yy yy yy
vKnapp
yy
focuses von vkeeping vbacteria vaway vfrom vthe vinfant. vWith vRSV, vother vchildren vneed vto vbe
yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vprotected vfromvexposure vto vthe vvirus. vThe vvirus vis vnot vairborne.
yy yy y yy yy yy yy yy yy yy yy
3. A vchild vhas va vchronic vcough vand vdiffuse vwheezing vduring vthe vexpiratory vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vrespiration. vThisvsuggests vwhat vcondition?
yy yy y yy yy
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign vbody vin vtrachea vANS: vA
yy yy yy yy yy
Asthma vmay vhave vthese vchronic vsigns vand vsymptoms. vPneumonia vappears vwith van
yy yy yy yy yy yy yy yy yy yy yy
yy v acute vonset,vfever, vand vgeneral vmalaise. vBronchiolitis vis van vacute vcondition vcaused vby
yy y yy yy yy yy yy yy yy yy yy yy
yy v respiratory vsyncytial yy
virus. vForeign vbody vin vthe vtrachea voccurs vwith vacute vrespiratory vdistress vor vfailure vand vmaybe
yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vstridor.
yy
4. Which vnursing vdiagnosis vis vmost vappropriate vfor van vinfant vwith vacute vbronchiolitis
yy yy yy yy yy yy yy yy yy yy yy
vdue vtovrespiratory vsyncytial vvirus v(RSV)?
yy yy y yy yy yy
a. Activity vIntolerance yy
b. Decreased vCardiac vOutput yy yy
c. Pain, vAcute yy
d. Tissue vPerfusion, vIneffective v(peripheral) vANS. vA
yy yy yy yy yy
Rationale v1: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
Rationale v2: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
, Pediatric vNursing, vA vCase-Based vApproach, v2nd vEdition vBy vTagher
yy yy yy yy yy yy yy yy
vKnapp
yy
Rationale v3: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
Rationale v4: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
Global vRationale: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vandvdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof vbronchiolitis.
yy yy y yy yy yy yy yy yy yy yy yy yy yy
vPain vis vnot vusually vassociated vwith vacute vbronchiolitis. vTissue vperfusion v(peripheral) vis vnot
yy yy yy yy yy yy yy yy yy yy yy yy yy
vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy
Chapter v2: vAsthma yy yy
1. The vnurse vis vcaring vfor va vchild vhospitalized vfor vstatus vasthmaticus. vWhich
yy yy yy yy yy yy yy yy yy yy yy
vassessment vfindingvsuggests vthat vthe vchilds vcondition vis vworsening?
yy yy y yy yy yy yy yy yy
a. Hypoventilation
b. Thirst
c. Bradycardia
d. Clubbing vANS: vA yy yy
The vnurse vwould vassess vthe vchild vfor vsigns vof vhypoxia, vincluding vrestlessness, vfatigue, virritability,
yy yy yy yy yy yy yy yy yy yy yy yy yy
vand vincreased vheart vand vrespiratory vrate. vAs vthe vchild vtires vfrom vthe vincreased vwork vof
yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vbreathing vhypoventilation voccurs vleading vto vincreased vcarbon vdioxide vlevels. vThe vnurse vwould vbe
yy yy yy yy yy yy yy yy yy yy yy yy yy
valert vfor vsigns vof
yy yy yy yy
yy yy yy yy yy yy yy yy
vKnapp
yy
TEST BANK yy v
PEDIATRIC NURSING, A CASE- yy v yy v yy v
ND
BASED APPROACH, 2
yy v yy v yy v
EDITION BYTAGHER KNAPP
yy v yy v vy v
yy
, Pediatric vNursing, vA vCase-Based vApproach, v2nd vEdition vBy vTagher
yy yy yy yy yy yy yy yy
vKnapp
yy
Chapter v1: vBronchiolitis yy yy
1. Which vintervention vis vappropriate vfor vthe vinfant vhospitalized vwith vbronchiolitis?
yy yy yy yy yy yy yy yy yy
a. Position von vthe vside vwith vneck vslightly vflexed.
yy yy yy yy yy yy yy
b. Administer vantibiotics vas vordered. yy yy yy
c. Restrict voral vand vparenteral vfluids vif vtachypneic.
yy yy yy yy yy yy
d. Give vcool, vhumidified voxygen. vANS: vD
yy yy yy yy yy
Cool, vhumidified voxygen vis vgiven vto vrelieve vdyspnea, vhypoxemia, vand vinsensible vfluid vloss vfrom
yy yy yy yy yy yy yy yy yy yy yy yy yy
tachypnea. vThe vinfant vshould vbe vpositioned vwith vthe vhead vand vchest velevated vat va v30- vto
yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy
v40-degree vangle vand vthe vneck vslightly vextended vto vmaintain van vopen vairway vand vdecrease
yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vpressure von vthe vdiaphragm. vThe vetiology vof vbronchiolitis vis vviral. vAntibiotics vare vgiven vonly vif
yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vthere vis va vsecondary vbacterial vinfection. vTachypnea vincreases vinsensible vfluid vloss. vIf vthe
yy yy yy yy yy yy yy yy yy yy yy yy yy
vinfant vis vtachypneic, vfluids vare vgivenvparenterally vto vprevent vdehydration.
yy yy yy yy yy yy y yy yy yy
2. An vinfant vwith vbronchiolitis vis vhospitalized. vThe vcausative vorganism vis vrespiratory
yy yy yy yy yy yy yy yy yy yy
vsyncytial vvirusv(RSV). vThe vnurse vknows vthat va vchild vinfected vwith vthis vvirus vrequires vwhat vtype
yy yy y yy yy yy yy yy yy yy yy yy yy yy yy yy
vof visolation?
yy yy
a. Reverse visolation yy
b. Airborne visolation yy
c. Contact vPrecautions yy
d. Standard vPrecautions vANS: vC yy yy yy
RSV vis vtransmitted vthrough vdroplets. vIn vaddition vto vStandard vPrecautions vand vhand vwashing,
yy yy yy yy yy yy yy yy yy yy yy yy
Contact vPrecautions vare vrequired. vCaregivers vmust vuse vgloves vand vgowns vwhen ventering vthe
yy yy yy yy yy yy yy yy yy yy yy yy
vroom. vCarevis vtaken vnot vto vtouch vtheir vown veyes vor vmucous vmembranes vwith va vcontaminated
yy yy y yy yy yy yy yy yy yy yy yy yy yy yy yy
vgloved vhand. vChildren vare vplaced vin va vprivate vroom vor vin va vroom vwith vother vchildren vwith
yy yy yy y yy yy yy yy yy yy yy yy yy yy yy yy yy
vRSV vinfections. vReverse visolation
yy yy yy yy
, Pediatric vNursing, vA vCase-Based vApproach, v2nd vEdition vBy vTagher
yy yy yy yy yy yy yy yy
vKnapp
yy
focuses von vkeeping vbacteria vaway vfrom vthe vinfant. vWith vRSV, vother vchildren vneed vto vbe
yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vprotected vfromvexposure vto vthe vvirus. vThe vvirus vis vnot vairborne.
yy yy y yy yy yy yy yy yy yy yy
3. A vchild vhas va vchronic vcough vand vdiffuse vwheezing vduring vthe vexpiratory vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vrespiration. vThisvsuggests vwhat vcondition?
yy yy y yy yy
a. Asthma
b. Pneumonia
c. Bronchiolitis
d. Foreign vbody vin vtrachea vANS: vA
yy yy yy yy yy
Asthma vmay vhave vthese vchronic vsigns vand vsymptoms. vPneumonia vappears vwith van
yy yy yy yy yy yy yy yy yy yy yy
yy v acute vonset,vfever, vand vgeneral vmalaise. vBronchiolitis vis van vacute vcondition vcaused vby
yy y yy yy yy yy yy yy yy yy yy yy
yy v respiratory vsyncytial yy
virus. vForeign vbody vin vthe vtrachea voccurs vwith vacute vrespiratory vdistress vor vfailure vand vmaybe
yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vstridor.
yy
4. Which vnursing vdiagnosis vis vmost vappropriate vfor van vinfant vwith vacute vbronchiolitis
yy yy yy yy yy yy yy yy yy yy yy
vdue vtovrespiratory vsyncytial vvirus v(RSV)?
yy yy y yy yy yy
a. Activity vIntolerance yy
b. Decreased vCardiac vOutput yy yy
c. Pain, vAcute yy
d. Tissue vPerfusion, vIneffective v(peripheral) vANS. vA
yy yy yy yy yy
Rationale v1: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
Rationale v2: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
, Pediatric vNursing, vA vCase-Based vApproach, v2nd vEdition vBy vTagher
yy yy yy yy yy yy yy yy
vKnapp
yy
Rationale v3: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
Rationale v4: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vand vdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof
yy yy yy yy yy yy yy yy yy yy yy yy yy
vbronchiolitis. vPain vis vnot vusuallyvassociated vwith vacute vbronchiolitis. vTissue vperfusion
yy yy yy yy yy y yy yy yy yy yy
v(peripheral) vis vnot vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy yy yy yy
Global vRationale: vActivity vintolerance vis va vproblem vbecause vof vthe vimbalance vbetween voxygen
yy yy yy yy yy yy yy yy yy yy yy yy
vsupply vandvdemand. vCardiac voutput vis vnot vcompromised vduring van vacute vphase vof vbronchiolitis.
yy yy y yy yy yy yy yy yy yy yy yy yy yy
vPain vis vnot vusually vassociated vwith vacute vbronchiolitis. vTissue vperfusion v(peripheral) vis vnot
yy yy yy yy yy yy yy yy yy yy yy yy yy
vaffected vby vthis vrespiratory- vdisease vprocess.
yy yy yy yy yy yy
Chapter v2: vAsthma yy yy
1. The vnurse vis vcaring vfor va vchild vhospitalized vfor vstatus vasthmaticus. vWhich
yy yy yy yy yy yy yy yy yy yy yy
vassessment vfindingvsuggests vthat vthe vchilds vcondition vis vworsening?
yy yy y yy yy yy yy yy yy
a. Hypoventilation
b. Thirst
c. Bradycardia
d. Clubbing vANS: vA yy yy
The vnurse vwould vassess vthe vchild vfor vsigns vof vhypoxia, vincluding vrestlessness, vfatigue, virritability,
yy yy yy yy yy yy yy yy yy yy yy yy yy
vand vincreased vheart vand vrespiratory vrate. vAs vthe vchild vtires vfrom vthe vincreased vwork vof
yy yy yy yy yy yy yy yy yy yy yy yy yy yy yy
vbreathing vhypoventilation voccurs vleading vto vincreased vcarbon vdioxide vlevels. vThe vnurse vwould vbe
yy yy yy yy yy yy yy yy yy yy yy yy yy
valert vfor vsigns vof
yy yy yy yy
