Pediatric Nursing- A Case-Based Approach
TESTBANK
,Pediatric Nursing- A Case-Based Approach
, Pediatric Nursing- A Case-Based Approach
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.
ANSWER: 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
ANSWER: 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.
, Pediatric Nursing- A Case-Based Approach
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
ANSWER: 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 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.
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.
TESTBANK
,Pediatric Nursing- A Case-Based Approach
, Pediatric Nursing- A Case-Based Approach
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.
ANSWER: 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
ANSWER: 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.
, Pediatric Nursing- A Case-Based Approach
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
ANSWER: 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 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.
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.
