CHAPTER 24: RESPIRATORY ALTERATIONS My Nursing Test Banks

CHAPTER 24: RESPIRATORY ALTERATIONS

MULTIPLE CHOICE

1.Which of the following is the primary function of the respiratory system?

a.

facilitate gas exchange

c.

clean the blood

b.

get rid of carbon dioxide

d.

circulate oxygen

ANS: A

Feedback

A

Correct. The primary function of the respiratory system is to facilitate gas exchange in the body.

B

Incorrect. The removal of carbon dioxide waste is only one part of the gas exchange.

C

Incorrect. Cleaning the blood is euphemistic, and technically incorrect.

D

Incorrect. Circulation of oxygen is one part of the gas exchange.

PTS: 1 REF: p. 792 Respiratory Alterations OBJ: Cognitive Level: Knowledge

2.Which of the following factors are age-related physical differences in infants that most increase this populations risks for developing a respiratory system dysfunction?

a.

small airways and fewer alveoli

c.

abdominal breathing

b.

shape of the chest, smaller ribs

d.

greater weight-to-height ratio

ANS: A

Feedback

A

Correct. Several developmental variations increase the pediatric populations risks for acquiring a respiratory system dysfunction. Small airways, fewer alveoli, and increased chest compliance are leading factors that predispose to respiratory alterations.

B

Incorrect. Among age-related physical differences in infants that most increase this populations risks for developing a respiratory system dysfunction, the shape of the chest and smaller ribs are not factors.

C

Incorrect. Among age-related physical differences in infants that most increase this populations risks for developing a respiratory system dysfunction, abdominal breathing is not a factor (infants are nose breathers).

D

Incorrect. Among age-related physical differences in infants that most increase this populations risks for developing a respiratory system dysfunction, their weight-to-height ratio is not a factor (alveolar surface for gas exchange is more limited in relation to height and weight).

PTS:1REF:p. 792 Respiratory Alterations

OBJ: Cognitive Level: Comprehension

3.During which of the following age periods does a child have the most limited alveolar surface for gas exchange in relation to height and weight?

a.

infancy

c.

preschool years

b.

toddler years

d.

school-age years

ANS: A

Feedback

A

Correct. An infant has a more limited alveolar surface for gas exchange, in relation to height and weight, than at any other stage in life.

B

Incorrect. The toddlers alveolar surface has expanded, and is less limited than an infants.

C

Incorrect. The preschoolers alveolar surface has expanded, and is less limited than an infants.

D

Incorrect. School-aged childrens alveolar surface has expanded, and is less limited than an infants.

PTS:1REF:p. 792 Respiratory Alterations

OBJ: Cognitive Level: Comprehension

4.When an infant is in respiratory distress and having retractions, what causes the retractions?

a.

a deficiency of oxygen and a surplus of carbon dioxide in the lungs

b.

efforts by the infant to take in more air create a negative-pressure pull

c.

soft tissue surrounding the ribs and sternum are drawn inward during inspiration

d.

changes in electrolyte status in the lungs

ANS: C

Feedback

A

Incorrect. A deficiency of oxygen and a surplus of carbon dioxide in the lungs may result during retractions, but is not causative of retractions.

B

Incorrect. Efforts by the infant to take in more air, i.e., expand their lungs, causes the chest wall to contract instead, but does not create a negative-pressure pull.

C

Correct. When infants in distress attempt to increase lung volumes, their pliable chest wall moves inward instead of expanding. Retractions occur as the soft tissue surrounding the ribs and sternum move inward during inhalation.

D

Incorrect. When an infant is in respiratory distress and having retractions, changes in electrolyte status in the lungs do not cause retractions (further, electrolyte status is not measured in reference to the lungs).

PTS:1REF:p. 792 Respiratory Alterations

OBJ: Cognitive Level: Comprehension

5.Compared to that of an adult, which of the following percentages represents a childs oxygen consumption?

a.

25%

c.

100%

b.

50%

d.

200%

ANS: D

Feedback

A

Incorrect. Childrens oxygen consumption is estimated to be 200% higher than adults, not 25%.

B

Incorrect. Childrens oxygen consumption is estimated to be 200% higher than adults, not 50%.

C

Incorrect. Childrens oxygen consumption is estimated to be 200% higher than adults, not 100%.

D

Correct. Metabolic demands, and thus oxygen consumption, are greater in infants and children than in adults. Childrens oxygen consumption is estimated to be 200% higher than adults.

PTS:1REF:p. 793 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

6.When a premature newborn is showing signs of developing respiratory distress syndrome or bronchopulmonary dysplasia, which of the following treatments is most likely given to reduce the chance of the infant having these problems?

a.

exogenous surfactant therapy

c.

hyperbaric chamber treatments

b.

oxygen therapy

d.

light therapy

ANS: A

Feedback

A

Correct. Surfactant production begins around 24 weeks of gestation. Preterm infants lack adequate surfactant for effective lung functioning. Without adequate surfactant, these infants are at high risk for developing respiratory distress syndrome or bronchopulmonary dysplasia. Treatment with exogenous surfactant therapy at birth effectively decreases the incidence of these respiratory alterations.

B

Incorrect. Treatment with humidified oxygen therapy is secondary to the administration of exogenous surfactant therapy.

C

Incorrect. Hyperbaric chamber treatments are not indicated to increase the surfactant level adequate for effective lung functioning.

D

Incorrect. Light therapy is not indicated to increase the surfactant level adequate for effective lung functioning.

PTS:1REF:p. 793 Anatomy and Physiology

OBJ: Cognitive Level: Comprehension

7.Which of the following respiratory alterations is the same as nasopharyngitis?

a.

sinusitis

c.

common cold

b.

bronchitis

d.

strep throat

ANS: C

Feedback

A

Incorrect. Sinusitis is not the same as nasopharyngitis.

B

Incorrect. Bronchitis is not the same as nasopharyngitis.

C

Correct. Nasopharyngitis, also known as rhinosinusitis or the common cold, is a frequently occurring pediatric respiratory alteration. Caused by an infectious agent, this respiratory condition is most prevalent in children in day care and school.

D

Incorrect. Strep throat is not the same as nasopharyngitis.

PTS: 1 REF: p. 794 The Child with Respiratory Difficulty

OBJ: Cognitive Level: Knowledge

8.What is the major cause of nasopharyngitis?

a.

protozoa

c.

bacilli

b.

bacteria

d.

viruses

ANS: D

Feedback

A

Incorrect. Protozoa are not the major cause of nasopharyngitis.

B

Incorrect. Bacteria are not the major cause of nasopharyngitis.

C

Incorrect. Bacilli are not the major cause of nasopharyngitis.

D

Correct. Nasopharyngitis is almost always caused by a microorganism. Viruses are the etiologic agents most of the time.

PTS: 1 REF: p. 794 The Child with Respiratory Difficulty

OBJ: Cognitive Level: Knowledge

9.The nurse assessing a child with nasopharyngitis would most likely find the child to have which of the following signs or symptoms?

a.

elevated white blood count, elevated temperature, and chronic earache

b.

increase in immature white cells, subnormal temperature, and yellow-green discharge

c.

a normal white blood cell count (WBC), stuffy nose, nasal discharge, cough, sore throat, and malaise

d.

a normal CBC, headache, pain around the sinuses, and lethargy

ANS: C

Feedback

A

Incorrect. The child with nasopharyngitis would present with a normal white blood count, fever, and nasal stuffiness can lead to an earache (but, chronic earache?).

B

Incorrect. The child with nasopharyngitis would not present with an increase in immature white cells, a subnormal temperature, or yellow-green discharge.

C

Correct. Assessing a child with nasopharyngitis, the nurse would most likely find the child to have the following signs or symptoms: nasal stuffiness, rhinitis, sneezing, nasal discharge, coughing, sore throat, fever, irritability, and malaise. They will have a normal white blood cell count (WBC).

D

Incorrect. The child with nasopharyngitis would not present with a normal CBC, but may present with headache, pain around the sinuses, and lethargy.

PTS: 1 REF: p. 794 The Child with Respiratory Difficulty

OBJ: Cognitive Level: Comprehension

10.When the nurse is teaching the parents how to relieve nasal congestion in their infant, the nurse will recommend which of the following?

a.

saline nasal drops instilled every 3 to 4 hours

b.

over-the-counter cold remedies for children

c.

humidifier with concurrent use of a camphor product

d.

applying a camphor product in and around the nostrils

ANS: A

Feedback

A

Correct. Teaching the parents how to relieve nasal congestion in their infant, the nurse will recommend saline nasal drops instilled every 3 to 4 hours, particularly before feeding.

B

Incorrect. Teaching the parents how to relieve nasal congestion in their infant, the nurse will not recommend over-the-counter cold remedies for the infant.

C

Incorrect. Teaching the parents how to relieve nasal congestion in their infant, the nurse will not recommend a humidifier with concurrent use of a camphor product for infants.

D

Incorrect. Teaching the parents how to relieve nasal congestion in their infant, the nurse will not recommend applying a camphor product in and around the nostrils for the infant.

PTS: 1 REF: p. 795 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

11.The pediatric nurse is assessing a child with nasopharyngitis. The parents ask about the possibility of the child getting an antibiotic. Which of the following is the nurses best answer?

a.

We need to be careful about starting antibiotics in children because we are creating more antibiotic-resistant organisms.

b.

There is no need to buy expensive antibiotics because we have other treatments that are less expensive.

c.

Antibiotics are not effective in the treatment of nasopharyngitis.

d.

There is a risk of your child being allergic to the antibiotic.

ANS: C

Feedback

A

Incorrect. The issue is efficacy and effectiveness, not the concern about over usage.

B

Incorrect. The issue is efficacy and effectiveness, not the cost.

C

Correct. Antibiotics are not effective in the treatment of viruses and are not indicated in the treatment of viral nasopharyngitis.

D

Incorrect. The issue is efficacy and effectiveness, not the risk of allergy.

PTS: 1 REF: p. 794 The Child with Respiratory Difficulty

OBJ: Cognitive Level: Application

12.The nurse will teach parents of a young infant who has nasopharyngitis to modify the feedings. Which modification would be most important and helpful?

a.

Make a steam tent, and feed the baby while in warm, moist air.

b.

Administer nasal drops containing a mild antihistamine prior to each feeding.

c.

With a calm and patient approach, feed the infant with frequent rest periods during each feeding.

d.

Thicken the formula with some infant rice cereal, and feed less at each regularly scheduled feeding.

ANS: C

Feedback

A

Incorrect. Teaching the parents of a young infant who has nasopharyngitis to modify the feedings, the nurse will not recommend a steam tent, as this may agitate the infant more.

B

Incorrect. Teaching the parents of a young infant who has nasopharyngitis to modify the feedings, the nurse will not recommend the use of nasal drops containing a mild antihistamine prior to each feeding (But, for infants, use only saline drops without antihistamine, prior to each feeding is a good recommendation).

C

Correct. Teaching the parents of a young infant who has nasopharyngitis to modify the feedings, the nurse will advise a calm and patient approach, and to feed the infant with frequent rest periods during each feeding.

D

Incorrect. Teaching the parents of a young infant who has nasopharyngitis to modify the feedings, the nurse will not recommend that the parents thicken the formula with some infant rice cereal, and feed less at each regularly scheduled feeding.

PTS: 1 REF: p. 795 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

13.Which of the following makes children prone to tonsillitis and pharyngitis?

a.

not brushing their teeth and flossing after meals and at bedtime

b.

frequent upper respiratory tract infections and being around other children who may be infected

c.

eating large amounts of sugar and drinking high-sugar content drinks that encourage growth of pathogens

d.

not bathing properly or frequently

ANS: B

Feedback

A

Incorrect. Brushing their teeth and flossing are unrelated to making children more prone to tonsillitis and pharyngitis.

B

Correct. Children are prone to tonsillitis because they have a large amount of lymphoid tissue in the pharyngeal cavity, tend to have frequent upper respiratory tract infections, and are around other children who may have been infected.

C

Incorrect. High sugar intake is unrelated to making children more prone to tonsillitis and pharyngitis.

D

Incorrect. Infrequent or improper bathing is unrelated to making children more prone to tonsillitis and pharyngitis.

PTS: 1 REF: p. 795 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

14.The school nurse encourages the parents of a student who has a severe sore throat to take the child to the pediatrician. The nurse is especially concerned about the possibility of streptococcal tonsillitis mainly because of which of the following?

a.

If streptococcal tonsillitis is not treated adequately it may lead to scarlet fever, otitis media, or more serious complications.

b.

The student may miss a lot of school, risking falling behind in schoolwork and homework assignments, which would negatively impact self-esteem.

c.

Other children may also get sore throats if this student is not aggressively treated.

d.

If untreated, streptococcal tonsillitis may cause anemia, weight loss, and lethargy.

ANS: A

Feedback

A

Correct. Untreated streptococcal tonsillitis and pharyngitis infections may lead to health problems such as scarlet fever, otitis media, and suppurative (pus forming) infections of surrounding tissues. More serious complications include acute glomerulonephritis, meningitis, and rheumatic fever.

B

Incorrect. Encouraging the parents of a student who has a severe sore throat to take the child to the pediatrician, the nurse is not especially concerned about the childs school work.

C

Incorrect. Encouraging the parents of a student who has a severe sore throat to take the child to the pediatrician, the nurse is not first concerned about the risk of spreading to others.

D

Incorrect. Encouraging the parents of a student who has a severe sore throat to take the child to the pediatrician, the nurse is concerned about more serious health issues than anemia, weight loss, or lethargy.

PTS: 1 REF: p. 795 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

15.The mother of a 2-1/2-year old child who has had tonsillitis asks about the possibility of a tonsillectomy for the child. The nurse informs the mother that tonsillectomies are usually performed when the child is over 3 years old. The mother wants to know why children younger than 3 have to wait for a tonsillectomy. Which of the following is the nurses best answer?

a.

Surgery is too difficult on a younger child, because their mouths are so small, making it difficult to get to the tonsils.

b.

It is too scary for younger children, and they dont understand what is happening.

c.

Younger children are more prone to excessive blood loss and the tonsils growing back.

d.

Separation from the parents or caregivers is much more difficult in the child under 3.

ANS: C

Feedback

A

Incorrect. The nurses best answer has nothing to do with the difficulty of reaching the tonsils for their removal.

B

Incorrect. The nurses best answer has nothing to do with how scary it is or that they cannot understand what is happening.

C

Correct. Tonsillectomies are performed on children over 3 years of age since excessive blood loss is more apt to occur in younger children. Also, there is a potential for the tonsils to grow back or other lymphoid tissue to hypertrophy when the surgery is performed on the very young.

D

Incorrect. The nurses best answer is not the issue of early separation from the parents or caregivers.

PTS: 1 REF: p. 796 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

16.The nurse explains to parents why an adenoidectomy is sometimes indicated with the tonsillectomy. Which of the following is the nurses best explanation?

a.

An adenoidectomy is justified when a childs enlarged adenoids block the flow of air through the nasal passages.

b.

Some surgeons prefer to take out the adenoids at the same time as the tonsillectomy because it saves the child from a second surgery.

c.

Without the tonsils to screen out foreign proteins, the adenoids are more easily infected.

d.

It is hard to take out the tonsils without removing the adenoids, because they often are adhered to each other.

ANS: A

Feedback

A

Correct. The surgical removal of the adenoids, or adenoidectomy, is indicated when a childs enlarged adenoids block air flow through nasal passages.

B

Incorrect. The nurses best explanation is not that some surgeons prefer to take out the adenoids at the same time as the tonsillectomy, adenoidectomy is only required when the air flow is blocked by the adenoids.

C

Incorrect. The nurses best explanation is not that the adenoids become more easily infected without the tonsils.

D

Incorrect. The nurses best explanation is not that the tonsils and adenoids are not separable during surgery.

PTS: 1 REF: p. 796 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

17.Which of the following positions does the nurse use for the child who has just returned to the room from a tonsillectomy?

a.

elevated head and legs

c.

on the back and flat

b.

on the abdomen or side

d.

on the back or sitting up

ANS: B

Feedback

A

Incorrect. Postoperatively, the nurse does not position the child so that head and legs are elevated.

B

Correct. Postoperatively, the child is positioned on their side to facilitate drainage of secretions. Once fully awakened, the child may sit up if so desired.

C

Incorrect. Postoperatively, the nurse does not position the child so that they are on their back and flat.

D

Incorrect. Postoperatively, the nurse does not position the child so that they are on their back or sitting up.

PTS: 1 REF: p. 796 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

18.A child who is in the first postoperative day after a tonsillectomy starts to cough and wants to blow his nose. Which of the following actions by the nurse would be best?

a.

Offer the child some tissue, and give instructions on its disposal.

b.

Remind the child not to cough or blow his nose.

c.

Tell him he can cough but not to blow his nose.

d.

Inform the child that he can blow his nose but not cough.

ANS: B

Feedback

A

Incorrect. Postoperatively, once fully awakened, the nurse does not offer the child some tissue, and give instructions on its disposal.

B

Correct. Postoperatively, once fully awakened, the nurse reminds the child not to cough often or not to blow their nose, as this can disrupt an operative clot and cause bleeding.

C

Incorrect. Postoperatively, once fully awakened, the nurse does not inform the child that he can cough but not blow his nose, instead recommends he do neither.

D

Incorrect. Postoperatively, once fully awakened, the nurse does not inform the child that he can blow his nose but not cough, instead recommends he do neither.

PTS: 1 REF: p. 796 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

19.The nurse is assigned to care for a child who had a tonsillectomy yesterday. The child complains of a sore throat and wants something cool. Which of the following cool drinks or foods would be acceptable to offer the child?

a.

chilled tomato juice

c.

lime sherbet

b.

cold cola

d.

cherry-flavored gelatin

ANS: C

Feedback

A

Incorrect. The nurse will not offer chilled tomato juice as it is acidic, will not be soothing.

B

Incorrect. The nurse will not offer cold cola as it is a brown liquid and it will interfere with assessment of bleeding.

C

Correct. Initially, cool noncarbonated, non-acidic liquids are encouraged. Red and brown liquids are avoided as they interfere with assessment of bleeding.

D

Incorrect. The nurse will not offer cherry-flavored gelatin as it is red and it will interfere with assessment of bleeding.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

20.Which of the following signs or symptoms is the earliest manifestation of bleeding in a child who has had a tonsillectomy?

a.

frequent swallowing

c.

coffee-ground emesis

b.

spitting up blood

d.

complaint of thirst

ANS: A

Feedback

A

Correct. Frequent swallowing following tonsillectomy is the earliest manifestations of bleeding, as the child swallows more often because of trickling blood.

B

Incorrect. Spitting up blood is not the earliest manifestation of bleeding in a child who has had a tonsillectomy.

C

Incorrect. Coffee-ground emesis is not the earliest manifestation of bleeding in a child who has had a tonsillectomy.

D

Incorrect. Complaint of thirst is not the earliest manifestation of bleeding in a child who has had a tonsillectomy.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

21.Which of the following outcomes is the most important for a child who has had a tonsillectomy?

a.

absence of pain

c.

drinking sufficient water

b.

bonding with the nursing staff

d.

no postoperative bleeding

ANS: D

Feedback

A

Incorrect. Absence of pain is not the most important outcome for a child who has had a tonsillectomy.

B

Incorrect. Bonding with the nursing staff is not the most important outcome for a child who has had a tonsillectomy.

C

Incorrect. Drinking sufficient water is not the most important outcome for a child who has had a tonsillectomy.

D

Correct. No postoperative bleeding is a critical outcome for these children because of the risk for hemorrhage following tonsillectomies.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

22.Which of the following instructions is the most important discharge teaching for the caregivers of a child who is postoperative from a tonsillectomy?

a.

The pain medication must be given in amounts sufficient to permit the child to swallow and take nourishment without any difficulty.

b.

Between 4 and 10 days postoperatively, a membrane that formed over the surgical site may hemorrhage and require immediate medical attention.

c.

Limit the childs activity, and include several rest periods during the day.

d.

The child must be encouraged to drink at least 8 glasses of fluid a day and eat sufficient calories to maintain or gain weight.

ANS: B

Feedback

A

Incorrect. The most important discharge teaching for the caregivers of a child who is postoperative from a tonsillectomy is not focused upon pain medication.

B

Correct. Caregivers and children need to be aware of a critical period and be ready to seek medical treatment as indicated. The membrane that forms over the operative site immediately after surgery begins to pull apart around 4-10 days. During this time frame, the surgical site may hemorrhage.

C

Incorrect. The most important discharge teaching for the caregivers of a child who is postoperative from a tonsillectomy is not focused upon limits on the childs activity or rest periods.

D

Incorrect. The most important discharge teaching for the caregivers of a child who is postoperative from a tonsillectomy is not focused upon caloric or fluid intake.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

23.Otitis media can occur with or without an effusion. Which of the following best describes an effusion?

a.

accumulation of fluid such as in the middle ear or pleural cavity

b.

movement of fluid back and forth between the outer ear and inner ear

c.

a blocked eustachian tube causes pressure in the middle ear

d.

escape of fluid from the middle ear into surrounding tissues

ANS: A

Feedback

A

Correct. Otitis media can occur with or without an effusion. An effusion is best described as an accumulation of fluid such as in the middle ear or pleural cavity.

B

Incorrect. An effusion is not best described as a movement of fluid back and forth between the outer ear and inner ear.

C

Incorrect. An effusion is not best described as a blocked eustachian tube causing pressure in the middle ear.

D

Incorrect. An effusion is not best described as an escape of fluid from the middle ear into surrounding tissues.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

24.Which of the following characterizes the course of acute otitis media?

a.

lengthy duration after slow onset

c.

exacerbations and remissions

b.

insidious onset and varied duration

d.

sudden onset and short duration

ANS: D

Feedback

A

Incorrect. The course of acute otitis media is not characterized by a lengthy duration after slow onset.

B

Incorrect. The course of acute otitis media is not characterized by an insidious onset and varied duration.

C

Incorrect. The course of acute otitis media is not characterized by exacerbations and remissions.

D

Correct. Acute otitis media (AOM) is an infectious process caused by pathogen invasion through the eustachian tube and into the middle ear with a sudden onset and short duration.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

25.Chronic otitis media is an inflammation of the middle ear that persists beyond which of the following time periods?

a.

1 week

c.

2 months

b.

6 weeks

d.

3 months

ANS: D

Feedback

A

Incorrect. Chronic otitis media is an inflammation of the middle ear that persists beyond 3 months, not 1 week.

B

Incorrect. Chronic otitis media is an inflammation of the middle ear that persists beyond 3 months, not 6 weeks.

C

Incorrect. Chronic otitis media is an inflammation of the middle ear that persists beyond 3 months, not 2 months.

D

Correct. Chronic otitis media is an inflammation of the middle ear that persists beyond 3 months and may or may not have effusion.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

26.The nurse is talking with parents about the prevention of otitis media. Which of the following would the nurse identify as preventive measures?

a.

immunizations and breastfeeding

b.

daily vitamin and mineral supplement

c.

providing the child with adequate calories and a balanced diet

d.

side-lying position for sleep

ANS: A

Feedback

A

Correct. Immunizations and breastfeeding have been identified as preventive measures of otitis media.

B

Incorrect. Daily vitamin and mineral supplement are not effective prevention.

C

Incorrect. Providing the child with adequate calories and a balanced diet does not prevent otitis media.

D

Incorrect. Side-lying position for sleep does not prevent otitis media.

PTS: 1 REF: p. 797 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

27.The nurse who is teaching parents about reducing risk factors for otitis media in children would mention which of the following as putting children most at risk for otitis media?

a.

household plants

c.

overtiring the child

b.

secondhand smoke

d.

exposure to a cool climate

ANS: B

Feedback

A

Incorrect. Teaching parents about reducing risk factors for otitis media in children, the nurse would not mention household plants.

B

Correct. Teaching parents about reducing risk factors for otitis media in children, the nurse would mention passive smoking and poor feeding techniques.

C

Incorrect. Teaching parents about reducing risk factors for otitis media in children, the nurse would not mention overtiring the child.

D

Incorrect. Teaching parents about reducing risk factors for otitis media in children, the nurse would not mention exposure to a cool climate.

PTS: 1 REF: p. 799 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

28.A parent asks the nurse to explain why children under the age of 3 are more vulnerable to otitis media. The nurse explains that this is mainly due to which of the following?

a.

They are exposed to many more small children who are prone to otitis media.

b.

The outer ear is more conducive to receiving and hosting microorganisms.

c.

Young children have wider, shorter, and straighter eustachian tubes than older children and adults.

d.

Parents tend not to clean the ears of small children properly or sufficiently.

ANS: C

Feedback

A

Incorrect. Explaining why children under the age of 3 are more vulnerable to otitis media, the nurse would not explain that they are exposed to many more small children who are prone to otitis media.

B

Incorrect. Explaining why children under the age of 3 are more vulnerable to otitis media, the nurse would not explain that the outer ear is more conducive to receiving and hosting microorganisms.

C

Correct. Children under the age of 3 years are especially vulnerable to otitis media since they have eustachian tubes that are wider, shorter, and straighter than those of older children and adults.

D

Incorrect. Explaining why children under the age of 3 are more vulnerable to otitis media, the nurse would not explain that parents tend not to clean the ears of small children properly or sufficiently.

PTS: 1 REF: p. 799 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

29.A child with acute otitis media is put on antibiotics. The caregivers ask when the child will be better. The nurse will explain that, then treated with antibiotics, an acute otitis media will begin to resolve in how many days?

a.

2 to 3

c.

7

b.

4 to 5

d.

14

ANS: A

Feedback

A

Correct. When treated with antibiotics, acute otitis media begins to resolve in 2-3 days.

B

Incorrect. When treated with antibiotics, acute otitis media begins to resolve in 2-3 days, not 4 to 5 days.

C

Incorrect. When treated with antibiotics, acute otitis media begins to resolve in 2-3 days, not 7 days.

D

Incorrect. When treated with antibiotics, acute otitis media begins to resolve in 2-3 days, not 14 days.

PTS: 1 REF: p. 799 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

30.The treatment of chronic fluid collections in the middle ear that take more than 3 or 4 months to resolve are treated with antibiotics or which of the following procedures?

a.

adenoidectomy

c.

placement of tubes

b.

tonsillectomy

d.

packing the ears

ANS: C

Feedback

A

Incorrect. Otitis media with effusion (OME) not responding to antibiotics, lasting longer than 3 or 4 months, does not require an adenoidectomy.

B

Incorrect. Otitis media with effusion (OME) not responding to antibiotics, lasting longer than 3 or 4 months, does not require a tonsillectomy.

C

Correct. Tympanostomy (surgical incision in the tympanic membrane for draining fluid) tubes are indicated if an episode of otitis media with effusion (OME) lasts for longer than 3 to 4 months.

D

Incorrect. Otitis media with effusion (OME) not responding to antibiotics, lasting longer than 3 or 4 months, does not require packing the ears.

PTS: 1 REF: p. 799 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

31.The nurse inspecting the tympanic membrane of a child with acute otitis media will find a tympanic membrane that is best described as:

a.

thin and translucent with a pearl-like color

b.

obscured by wax or purulent material

c.

yellow in color and no longer opaque in character

d.

red and bulging with full or absent light reflex

ANS: D

Feedback

A

Incorrect. The tympanic membrane is normally thin and translucent with a pearl-like color, not red and bulging with full or absent light reflex like the tympanic membrane of a child with acute otitis media.

B

Incorrect. The tympanic membrane of a child with acute otitis media will not appear obscured by wax or purulent material.

C

Incorrect. The tympanic membrane of a child with acute otitis media will not appear yellow in color and no longer opaque in character.

D

Correct. The tympanic membrane of a child with acute otitis media is described as red and bulging with full or absent light reflex.

PTS: 1 REF: p. 798 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

32.The nurse is assessing a preverbal child who keeps pulling on his ear. The nurse knows that this behavior is one way that children express:

a.

frustration

c.

hunger

b.

irritability

d.

pain

ANS: D

Feedback

A

Incorrect. Frustration is not a common manifestation of acute otitis media, expressed by the child pulling on his ear.

B

Incorrect. Irritability is another common manifestation of acute otitis media, but expressed by the child pulling on his ear.

C

Incorrect. Hunger is not an expression of acute otitis media.

D

Correct. A primary characteristic of acute otitis media is pain. Nonverbal and preverbal children may express pain by tugging or pulling at their ears.

PTS: 1 REF: p. 798 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

33.Which of the following is the primary complication of otitis media?

a.

conductive hearing loss

c.

septicemia

b.

abscess in adjacent tissues

d.

meningitis

ANS: A

Feedback

A

Correct. The primary complication of otitis media is conductive hearing loss and related speech problems.

B

Incorrect. The primary complication of otitis media is not an abscess in adjacent tissues.

C

Incorrect. The primary complication of otitis media is not septicemia.

D

Incorrect. The primary complication of otitis media is not meningitis.

PTS: 1 REF: p. 798 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

34.The nurse assessing a child with a respiratory problem finds stridor, which is best described by which of the following?

a.

excursion of the chest wall beyond that normally seen in the healthy child

b.

substernal retractions and nasal flaring

c.

a high-pitched sound produced by an obstruction of the trachea or larynx

d.

a triad of respiratory symptoms

ANS: C

Feedback

A

Incorrect. The respiratory problem stridor is not best described as an excursion of the chest wall beyond that normally seen in the healthy child.

B

Incorrect. The respiratory problem stridor is not best described by substernal retractions and nasal flaring.

C

Correct. Inspiratory stridor is best described as a high-pitched sound produced by an obstruction of the trachea or larynx that can be heard during inspiration or expiration.

D

Incorrect. The respiratory problem stridor is not best described as a triad of respiratory symptoms.

PTS: 1 REF: p. 800 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

35.Which of the following body structures is infected then a child has croup?

a.

epiglottis

c.

alveoli, bronchioles, and pleura

b.

lungs

d.

larynx, trachea, and large bronchi

ANS: D

Feedback

A

Incorrect. The epiglottis is not infected then a child has croup.

B

Incorrect. The large bronchi of the lungs are infected then a child has croup, but not the entire lung.

C

Incorrect. The alveoli, bronchioles, and pleura are not infected then a child has croup.

D

Correct. Croup is a common viral syndrome manifested by a croupy or barking cough, inspiratory stridor, and some degree of respiratory stress. The syndrome is an infection of the larynx, trachea, and large bronchi, i.e., the upper respiratory system.

PTS: 1 REF: p. 800 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

36.Examination of the throat of a child with acute epiglottis by depressing the tongue is:

a.

a good idea because there is a characteristic patchy redness that aids in diagnosis

b.

contraindicated due to the possibility of causing complete airway obstruction

c.

impossible because the tongue is too swollen and tender to allow it

d.

to be done carefully because of the possibility of causing additional pain

ANS: B

Feedback

A

Incorrect. Examination of the throat of a child with acute epiglottis by depressing the tongue is not a good idea, but not because there is a characteristic patchy redness that aids in diagnosis.

B

Correct. Acute epiglottis, sometimes classified as a croup syndrome, is a life-threatening bacterial infection that can lead to complete airway obstruction. Examination of the throat of a child with acute epiglottis by depressing the tongue is contraindicated due to the possibility of causing complete airway obstruction.

C

Incorrect. Examination of the throat of a child with acute epiglottis by depressing the tongue is not impossible because the tongue is too swollen and tender to allow it, but is contraindicated due to the possibility of causing complete airway obstruction.

D

Incorrect. Examination of the throat of a child with acute epiglottis by depressing the tongue is not to be done at all, but not because of the possibility of causing additional pain.

PTS: 1 REF: p. 800 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

37.The nurse is assessing a child with croup. Which of the following signs or symptoms would the nurse associate with croup and most expect to find?

a.

bark-like cough, hoarseness, inspiratory stridor

b.

expiratory stridor, irregular breathing, and weak cough

c.

Cheyne-Stokes respirations and substernal retraction

d.

almost continual cough and complete laryngitis

ANS: A

Feedback

A

Correct. Assessing a child with croup, the nurse will most expect to find as symptoms bark-like cough, hoarseness, inspiratory stridor.

B

Incorrect. Assessing a child with croup, the nurse will not most expect to find as symptoms expiratory stridor (inspiratory), irregular breathing, and weak cough (barking cough is not weak).

C

Incorrect. Assessing a child with croup, the nurse will not most expect to find as symptoms Cheyne-Stokes respirations and substernal retraction.

D

Incorrect. Assessing a child with croup, the nurse will not most expect to find as symptoms an almost continual cough and complete laryngitis.

PTS: 1 REF: p. 801 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

38.Which of the following statements best describes croup?

a.

a common viral syndrome

c.

a life-threatening bacterial infection

b.

an autoimmune-initiated infection

d.

a respiratory condition similar to a cold

ANS: A

Feedback

A

Correct. Croup is best described as a common viral syndrome.

B

Incorrect. Croup is not best described as an autoimmune-initiated infection.

C

Incorrect. Croup is not best described as a life-threatening bacterial infection.

D

Incorrect. Croup is not best described as a respiratory condition similar to a cold.

PTS: 1 REF: p. 800 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Knowledge

39.The nurse is assessing the skin moisture of a child with laryngotracheobronchitis. Which of the following explains why the nurse assessed the skin moisture in this case?

a.

to get some measure of how dehydrated the child might become

b.

increased skin moisture will signal danger of ketoacidosis

c.

skin moisture is a relatively good measure of the degree of infection

d.

diaphoresis is associated with increased respiratory effort

ANS: D

Feedback

A

Incorrect. The nurse assessing a child with laryngotracheobronchitis is not checking the skin moisture to get a measure of hydration levels.

B

Incorrect. The nurse assessing a child with laryngotracheobronchitis is not checking the skin moisture because she is suspecting ketoacidosis.

C

Incorrect. The nurse assessing a child with laryngotracheobronchitis is not checking the skin moisture as a measure of the degree of infection.

D

Correct. Skin moisture is assessed because diaphoresis is associated with increased respiratory effort when the child has laryngotracheobronchitis.

PTS: 1 REF: p. 800 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

40.The nurse working with a child with laryngotracheobronchitis is offering the child tiny medicine cups of fluid and giving stickers and prizes for meeting goals related to intake of fluid. All this effort on the part of the nurse to get the child to drink more fluid is because the fluid is needed to:

a.

prevent diarrhea

c.

maintain electrolyte balance

b.

loosen secretions

d.

keep kidneys functioning

ANS: B

Feedback

A

Incorrect. The nurse does not offer the child with laryngotracheobronchitis tiny medicine cups of fluid stickers and prizes for meeting goals related to intake of fluid to prevent diarrhea.

B

Correct. For many children, the amount of fluid necessary to loosen secretions seems overwhelming. The nurse can assist the child to reach the desired goal by offering a medicine cup full of liquid and when charting the data on a tracking board in his or her room. The intervention can be introduced as a game with the child every trying to exceed the previous records. Stickers or other prizes may be awarded for new records.

C

Incorrect. The nurse does not offer the child with laryngotracheobronchitis tiny medicine cups of fluid stickers and prizes for meeting goals related to intake of fluid to maintain electrolyte balance.

D

Incorrect. The nurse does not offer the child with laryngotracheobronchitis tiny medicine cups of fluid stickers and prizes for meeting goals related to intake of fluid to keep kidneys functioning.

PTS: 1 REF: p. 801 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

41.Which of the following pathogens causes bronchiolitis?

a.

viruses

c.

spirochete

b.

bacteria

d.

protozoa

ANS: A

Feedback

A

Correct. Bronchiolitis is an acute, typically viral, infection of the bronchioles.

B

Incorrect. Bronchiolitis is not caused by bacteria.

C

Incorrect. Bronchiolitis is not caused by spirochete.

D

Incorrect. Bronchiolitis is not caused by protozoa.

PTS: 1 REF: p. 801 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Knowledge

42.The nurse assessing a child with acute epiglottitis looks up the disorder as a review and is most likely to find which of the following classic symptoms associated with this disorder?

a.

clubbing of the fingers, poor circulation of extremities, and bluish color

b.

bark\-like cough and thick yellow nasal discharge

c.

patchy rash on the body, rapid respirations, and exhaustion

d.

respiratory distress, drooling, fever, agitation, and lethargy

ANS: D

Feedback

A

Incorrect. Classic manifestations of acute epiglottitis do not include clubbing of the fingers, poor circulation of extremities, and bluish color.

B

Incorrect. Classic manifestations of acute epiglottitis do not include bark\-like cough and thick yellow nasal discharge.

C

Incorrect. Classic manifestations of acute epiglottitis do not include patchy rash on the body, rapid respirations, and exhaustion.

D

Correct. Classic manifestations of acute epiglottitis include respiratory distress, fever, sore throat, dysphagia (difficulty swallowing), drooling, agitation and lethargy.

PTS: 1 REF: p. 800 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

43.Which of the following therapies is the only specific therapy for respiratory syncytial virus (RSV) bronchiolitis?

a.

ribavirin (Virazole)

c.

an oxygen tent

b.

chest percussion

d.

antibiotics

ANS: A

Feedback

A

Correct. Ribavirin (Virazole) is the only specific therapy for respiratory syncytial virus (RSV) bronchiolitis.

B

Incorrect. Chest percussion is not the only specific therapy for respiratory syncytial virus (RSV) bronchiolitis.

C

Incorrect. An oxygen tent is not the only specific therapy for respiratory syncytial virus (RSV) bronchiolitis.

D

Incorrect. Antibiotics are not the only specific therapy for respiratory syncytial virus (RSV) bronchiolitis.

PTS: 1 REF: p. 802 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

44.The nurse is caring for a child who is on ribavirin. Which of the following people most need to be discouraged from visiting?

a.

children

c.

the very elderly population

b.

pregnant health care workers

d.

anyone who is under stress

ANS: B

Feedback

A

Incorrect. Children are not most in need of discouragement to visit a child who is on ribavirin therapy.

B

Correct. Ribavirin may be hazardous to those who come in contact with it, and has been proven to be teratogenic (producing physical defects during pregnancy) in animals. Consequently, it is recommended that pregnant health care providers not care for children on ribavirin therapy.

C

Incorrect. The elderly population is not most in need of discouragement to visit a child who is on ribavirin therapy.

D

Incorrect. Anyone who is under stress is not most in need of discouragement to visit a child who is on ribavirin therapy.

PTS: 1 REF: p. 802 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

45.The nurse is caring for a child with a diagnosis of bronchiolitis who is being managed at home. Which of the following strategies to foster adequate ventilation would be best for the nurse to suggest to the family?

a.

installing an attic fan

c.

administering oxygen therapy

b.

having the child take a walk twice a day

d.

raising the head of the childs bed

ANS: D

Feedback

A

Incorrect. Installing an attic fan would not be the best strategy to foster adequate ventilation for the child with bronchiolitis.

B

Incorrect. Having the child take a walk twice a day would not be the best strategy to foster adequate ventilation for the child with bronchiolitis.

C

Incorrect. Administering oxygen therapy would not be the best strategy to foster adequate ventilation for the child with bronchiolitis (although may be appropriate for infants).

D

Correct. Raising the head of the childs bed would be the best strategy to foster adequate ventilation for the child with bronchiolitis, as this allows for improved chest expansion.

PTS: 1 REF: p. 803 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

46.Which of the following outcomes is the primary criterion for evaluating the resolution of ineffective airway clearance?

a.

regular respirations

c.

clear airway sounds

b.

ability to cough effectively

d.

resolved coughing

ANS: C

Feedback

A

Incorrect. The primary criterion for evaluating the resolution of ineffective airway clearance is not the regularity of respirations.

B

Incorrect. The primary criterion for evaluating the resolution of ineffective airway clearance is not the ability to cough effectively.

C

Correct. Clear lung sounds is a primary criteria for evaluating the resolution of ineffective airway clearance.

D

Incorrect. The primary criterion for evaluating the resolution of ineffective airway clearance is not that coughing has resolved.

PTS: 1 REF: p. 803 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

47.Pneumonia in children appears:

a.

in a more primitive form, which is easier to cure than that found in adults

b.

as a secondary disease

c.

as a tertiary disease

d.

as a primary disease or a complication of another disease

ANS: D

Feedback

A

Incorrect. Pneumonia in children is not more primitive nor easier to cure than in adults.

B

Incorrect. Pneumonia in children can appear as a primary disease or as a secondary disease, but not only as a secondary disease.

C

Incorrect. Pneumonia in children does not appear as a tertiary disease.

D

Correct. Pneumonia in children can appear as a primary disease or as a complication of another dysfunction.

PTS: 1 REF: p. 803 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Knowledge

48.What is meant by the ventilation/perfusion ratio?

a.

the strength with which a person can blow a stream of air

b.

a comparison of oxygen in the body with that in the heart

c.

the comparison of alveolar ventilation to capillary perfusion

d.

how quickly the oxygen taken in circulates once through the body

ANS: C

Feedback

A

Incorrect. The ventilation/perfusion ratio is not the strength with which a person can blow a stream of air.

B

Incorrect. The ventilation/perfusion ratio is not a comparison of oxygen in the body with that in the heart.

C

Correct. The ventilation/perfusion ratio is the comparison of alveolar ventilation to capillary perfusion. This ratio becomes abnormal in the patient with pneumonia as the toxins released by pathogens and the by-products of the bodys secondary and tertiary defenses both do damage to the pulmonary mucous membranes and cause the accumulation of debris and exudate in the airways.

D

Incorrect. The ventilation/perfusion ratio is not how quickly the oxygen taken in circulates once through the body.

PTS: 1 REF: p. 803 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

49.The treatment of pneumonia most depends on:

a.

the presence or absence of fever

b.

the etiologic agent

c.

what the insurance companies will pay for

d.

what drugs the child received in the past

ANS: B

Feedback

A

Incorrect. The treatment of pneumonia does not most depend on the presence or absence of fever.

B

Correct. The treatment of pneumonia most depends on the etiologic agent. The management of viral pneumonia is supportive. In addition, children with bacterial pneumonia are treated with antibiotics.

C

Incorrect. The treatment of pneumonia does not most depend on what the insurance companies will pay for.

D

Incorrect. The treatment of pneumonia does not most depend on what drugs the child received in the past.

PTS: 1 REF: p. 806 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

50.Which of the following types of pneumonia would be treated with antibiotics?

a.

viral

c.

bacterial

b.

adenoviral

d.

aspiration

ANS: C

Feedback

A

Incorrect. Children with viral pneumonia are not treated with antibiotics, as they are not efficacious.

B

Incorrect. Children with adenoviral pneumonia are not treated with antibiotics, as they are not efficacious.

C

Correct. Children with bacterial pneumonia are treated with antibiotics.

D

Incorrect. Children with aspiration pneumonia are not treated with antibiotics, as they are not efficacious. In this instance, the appropriate treatment is mechanical, i.e., immediate suctioning to remove the aspirated debris and the administration of 100% oxygen.

PTS: 1 REF: p. 806 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Knowledge

51.The nurse is assessing a child with a diagnosis of pneumonia. The child is taking shallow respirations. Which of the following is the most likely explanation?

a.

an attempt to minimize pain

c.

exhaustion and lack of energy

b.

a deficiency of carbon dioxide

d.

strained chest muscles

ANS: A

Feedback

A

Correct. Pleuritic pain (stabbing with sensation of shortness of breath) is increased by coughing or deep breathing. In an attempt to minimize pain, children with pneumonia may take shallow breaths and resist coughing.

B

Incorrect. The most likely explanation for why the child with pneumonia is taking shallow respirations is not a deficiency of carbon dioxide.

C

Incorrect. The most likely explanation for why the child with pneumonia is taking shallow respirations is not exhaustion and lack of energy.

D

Incorrect. The most likely explanation for why the child with pneumonia is taking shallow respirations is not strained chest muscles.

PTS: 1 REF: p. 807 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

52.The nurse is making home visits to a child who is being treated for a diagnosis of pneumonia. The nurse notices that the family has a large amount of garlic on hand. Which of the following most likely explains why the garlic is present?

a.

for cooking to enhance flavor and entice the child to eat

b.

to be eaten raw to treat the cough and to serve as an antibiotic

c.

as a deterrent to evil spirits and possibly even vampires

d.

to be served as a weak garlic tea to reduce fever

ANS: B

Feedback

A

Incorrect. The presence of a large amount of garlic in the home of the child with pneumonia is not best explained as it is to be used for cooking to enhance flavor and entice the child to eat.

B

Correct. Visiting the home of a child being treated for pneumonia, the nurse notices a large amount of garlic. The most likely explanation for the presence of the garlic is that it is being used as an herbal remedy. It is eaten raw to treat the cough and has antibiotic properties.

C

Incorrect. The presence of a large amount of garlic in the home of the child with pneumonia is not best explained as a deterrent to evil spirits and possibly even vampires.

D

Incorrect. The presence of a large amount of garlic in the home of the child with pneumonia is not best explained as it is to be served as a weak garlic tea to reduce fever.

PTS: 1 REF: p. 807 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

53.Which of the following is an herbal substance that is mixed with water and taken orally to soothe and relax the airway and relieve cough?

a.

licorice

c.

mullein

b.

lavender

d.

rosemary

ANS: C

Feedback

A

Incorrect. Licorice is not mixed with water and taken orally to soothe and relax the airway and relieve cough.

B

Incorrect. Lavender is not mixed with water and taken orally to soothe and relax the airway and relieve cough.

C

Correct. Mullein, mixed with water and taken orally, soothes and relaxes the airway and relieves coughing; used for asthma, tuberculosis, and as a cough suppressant.

D

Incorrect. Rosemary is not mixed with water and taken orally to soothe and relax the airway and relieve cough.

PTS: 1 REF: p. 807 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Comprehension

54.Which of the following is the nurses best course of action when he or she finds out that a family is using herbal remedies?

a.

Ignore the use of herbs because there is little time to research them.

b.

Question the caregiver about the herb(s) because some herbs are not safe or have adverse interactions with prescribed medications.

c.

Encourage the family to use alternative medications and treatments to supplement traditional medicine.

d.

Advise the family to cut the adult dose of herbal remedies down by three-fourths or one-half, depending on the age and weight of the child.

ANS: B

Feedback

A

Incorrect. Health care professionals cannot ignore the use of herbs and there is enough information to know which are not safe and which may interact with prescribed medications.

B

Correct. Health care professionals need to incorporate questions about the use of herbal remedies in their history taking. This is important because some of these remedies are not considered safe and others may have adverse interactions with prescribed medications.

C

Incorrect. Finding out that a family is using herbal remedies, the best course of action is not to encourage the family to use alternative medications and treatments to supplement traditional medicine.

D

Incorrect. Finding out that a family is using herbal remedies, the best course of action is not to advise the family to cut the adult dose of herbal remedies down by three-fourths or one-half, depending on the age and weight of the child.

PTS: 1 REF: p. 807 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

55.In assessing a client with allergic rhinitis and in teaching the caregivers, the nurse will keep in mind that perennial allergic rhinitis is most often related to sensitivity to which of the following allergens?

a.

food substances such as nuts, shellfish, and hot peppers

b.

outdoor allergens such as tree, grass, and weed pollen

c.

animals such as cats, dog, birds, lizards, and monkeys

d.

indoor allergens such as dust mites and mold

ANS: D

Feedback

A

Incorrect. Perennial allergic rhinitis is not most often related to sensitivity to food substances such as nuts, shellfish, and hot peppers.

B

Incorrect. Perennial allergic rhinitis is not most often related to sensitivity to outdoor allergens such as tree, grass, and weed pollen.

C

Incorrect. Perennial allergic rhinitis is not most often related to sensitivity to animals such as cats, dog, birds, lizards, and monkeys.

D

Correct. Perennial allergic rhinitis is most often related to sensitivity to indoor allergens such as dust mites and mold.

PTS: 1 REF: p. 808 Common Acute Respiratory Alterations

OBJ: Cognitive Level: Application

56.The nurse who is teaching the caregivers of children who are going to be skin tested for allergies will teach them to avoid giving the child which of the following medications for several days to weeks before the test?

a.

Tylenol and like products

c.

antacid medications

b.

antihistamines

d.

vitamin supplements

ANS: B

Feedback

A

Incorrect. Teaching the caregivers of children who are going to be skin tested for allergies will not teach them to avoid giving the child Tylenol and like products.

B

Correct. Teaching the caregivers of children who are going to be skin tested for allergies will teach them to avoid giving the child antihistamines for several days to weeks before the testing is conducted.

C

Incorrect. Teaching the caregivers of children who are going to be skin tested for allergies will not teach them to avoid giving the child antacid medications.

D

Incorrect. Teaching the caregivers of children who are going to be skin tested for allergies will not teach them to avoid giving the child vitamin supplements.

PTS: 1 REF: p. 809 Common Chronic Respiratory Alterations

OBJ: Cognitive Level: Application

57.The nurse who is teaching a caregiver about avoiding triggers of asthma for a child. The nurse will evaluate the caregiver as having understood the instruction when the caregiver comes back in 2 weeks and gives which of the following reports?

a.

We have several new house plants that are producing carbon dioxide.

b.

We only allow the cat to be in the family room, which is carpeted.

c.

I launder the bed linens and clothing in water that is at least 54.4 degrees C (130 degrees F).

d.

We have turned off the air conditioner and opened the windows.

ANS: C

Feedback

A

Incorrect. The avoidance of house plants is one means of reducing allergen exposure inside the home, hence the caregiver saying they have added house plants indicates they have not understood the nurses teachings.

B

Incorrect. The avoidance of pets on carpet is one means of reducing allergen exposure inside the home, hence the caregiver saying they have the cat to be in the carpeted family room indicates they have not understood the nurses teachings.

C

Correct. The nurse will teach the caregiver to launder bed linens and favorite stuffed animals at least weekly in laundry water at least 54.4 degrees C (130 degrees F) to reduce triggers of asthma for a child, hence this statement best indicates that the caregivers have understood the nurses teachings.

D

Incorrect. Closing the windows and using air conditioners are two means of reducing allergen exposure inside the home, hence the caregiver saying they have opened the windows and turned off the air conditioner indicates they have not understood the nurses teachings.

PTS: 1 REF: p. 811 Common Chronic Respiratory Alterations

OBJ: Cognitive Level: Application

58.Which of the following conditions is the leading cause of pediatric chronic illness?

a.

asthma

c.

heart disease

b.

diabetes

d.

tuberculosis

ANS: A

Feedback

A

Correct. Asthma is the most common pediatric chronic illness, affecting almost 9 million children, and is the leading cause of admissions to the emergency room and hospital.

B

Incorrect. Diabetes is not the leading cause of pediatric chronic illness.

C

Incorrect. Heart disease is not the leading cause of pediatric chronic illness.

D

Incorrect. Tuberculosis is not the leading cause of pediatric chronic illness.

PTS: 1 REF: p. 811 Common Chronic Respiratory Alterations

OBJ: Cognitive Level: Knowledge

59.Which of the following statements best defines cystic fibrosis?

a.

an acquired lung condition that occurs at birth due to oxygen deficiency

b.

a congenital anomaly occurring during fetal development as a result of dietary deficiencies of the mother

c.

an autosomal recessive disorder that mainly affects the exocrine glands and does multiple system damage

d.

a respiratory condition affecting people of Mediterranean descent, involving mainly exchange at a microscopic level in the lungs

ANS: C

Feedback

A

Incorrect. Cystic fibrosis (CF) is not best defined as an acquired lung condition that occurs at birth due to oxygen deficiency.

B

Incorrect. Cystic fibrosis (CF) is not best defined as a congenital anomaly occurring during fetal development as a result of dietary deficiencies of the mother.

C

Correct. Cystic fibrosis (CF) is genetically inherited and best described as an autosomal recessive disorder that mainly affects the exocrine glands. Alterations in sweat electrolytes and mucus production in the body lead to multiple system damages.

D

Incorrect. Cystic fibrosis (CF) is not best defined as a respiratory condition affecting people of Mediterranean descent, involving mainly exchange at a microscopic level in the lungs.

PTS: 1 REF: p. 829 Common Chronic Respiratory Alterations

OBJ: Cognitive Level: Comprehension

60.Which of the following represents the life-expectancy of a child with cystic fibrosis?

a.

7 years

c.

21 years

b.

12 years

d.

30 years +

ANS: D

Feedback

A

Incorrect. The life-expectancy of a child with cystic fibrosis can be greater than 7 years.

B

Incorrect. The life-expectancy of a child with cystic fibrosis can be greater than 12 years.

C

Incorrect. The life-expectancy of a child with cystic fibrosis can be greater than 21 years.

D

Correct. With aggressive therapy most children with cystic fibrosis live until they are 30 are older.

PTS: 1 REF: p. 831 Less Common Respiratory Alterations

OBJ: Cognitive Level: Application

MULTIPLE RESPONSE

1.A nurse working in the health clinic is performing the initial history for an adopted Chinese child who has recently immigrated to the United States. The nurse anticipates exploring which of the following priority questions with the childs parents? Select all that apply.

a.

Tell me about the childs immunization history.

b.

Has the child been exposed to any known communicable illnesses?

c.

Has the childs health care experience been positive in the past?

d.

Tell me about genetic illnesses in your family.

ANS: A, B

Feedback

Correct

Children who have recently moved to the United States from other countries may not be up-to-date with immunizations. Further, the history of the childs immunizations may be unknown when the child is adopted.

Exploring any known exposure to communicable illnesses can be valuable information when performing the initial history and physical.

Incorrect

The knowledge of whether the health care experience has been positive would not be a priority question during the initial history.

Knowledge of genetic illnesses in the adoptive family are irrelevant, as the childs genetic background would not reflect similarities.

PTS:1REF:p. 793 Anatomy and Physiology

OBJ: Cognitive Level: Application

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