Chapter 27: Alterations of Pulmonary Function in Children My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 27: Alterations of Pulmonary Function in Children

Test Bank

MULTIPLE CHOICE

1. A 1-year-old female is diagnosed with croup. When the parent asks what caused this, what is the nurses best response? The most likely cause of this disease is:

a.

Bacteria

b.

Acute hyperventilation

c.

Allergy

d.

Viral infection

ANS: D

The cause of croup is a viral infection.

The cause of croup is viral, not bacterial.

Croup is due to a viral infection, not to acute hyperventilation.

Croup is due to a viral infection, not to allergy.

REF: p. 707

2. While planning care, a nurse recalls respiratory distress and hypoxemia in laryngotracheobronchitis are caused by:

a.

Infectious pulmonary edema

b.

Mucosal edema

c.

Decreased surfactant

d.

Nasopharyngeal obstruction

ANS: B

Edema leads to obstruction of the airway and respiratory distress.

Pulmonary edema does not occur; it is due to edema of the mucosa.

Laryngotracheobronchitis is not a problem of surfactant.

The obstruction is in the airway, not the nasopharyngeal area.

REF: p. 708

3. A 5-year-old male presents with high fever, inspiratory stridor, severe respiratory distress, drooling, and dysphagia. Which of the following behaviors by the student nurse would be a cause for concern?

a.

The student nurse tries to keep the child calm.

b.

The student nurse examines the throat for redness.

c.

The student nurse auscultates the childs respiratory rate.

d.

The student nurse counts the heart rate apically.

ANS: B

Examination of the throat should not be attempted as it may trigger laryngospasm and cause respiratory collapse.

Keeping the child calm is appropriate.

Auscultating the respiratory rate is appropriate.

Assessing the heart rate apically is appropriate.

REF: p. 709

4. A 10-year-old male was diagnosed with obstructive sleep apnea. When the parents ask what treatment comes next, how should the nurse respond? The treatment that will most likely be tried first is:

a.

Tonsillectomy and adenoidectomy (T&A)

b.

Weight loss

c.

Continuous positive airway pressure

d.

Drug therapy

ANS: A

Children with sleep apnea are most often referred for T&A.

Children with sleep apnea are most often referred for T&A. Weight loss is secondary.

Children with sleep apnea are most often referred for T&A. Continuous positive airway pressure is secondary.

Children with sleep apnea are most often referred for T&A. Drug therapy is secondary.

REF: p. 710

5. A newborn has respiratory distress syndrome. When obtaining the patients history, which of the following is the most important predisposing factor for this condition?

a.

Low birth weight

b.

Alcohol consumption by the mother during pregnancy

c.

Premature birth

d.

Smoking by the mother during pregnancy

ANS: C

Respiratory distress syndrome in the newborn is more often due to premature birth.

Newborn respiratory distress occurs almost exclusively in premature infants, not low birth weight.

Newborn respiratory distress occurs almost exclusively in premature infants, not from alcohol use by the mother.

Newborn respiratory distress occurs almost exclusively in premature infants, not from smoking by the mother during pregnancy.

REF: p. 710

6. A newborn has respiratory distress syndrome. A nurse monitors the newborn for atelectasis because of:

a.

A lack of surfactant

b.

Pulmonary edema

c.

Airway obstruction

d.

Pulmonary fibrosis

ANS: A

Atelectasis in newborn respiratory distress is due to lack of surfactant.

Atelectasis in newborn respiratory distress is due to lack of surfactant, not pulmonary edema.

Atelectasis in newborn respiratory distress is due to lack of surfactant, not airway obstruction.

Atelectasis in newborn respiratory distress is due to lack of surfactant, not pulmonary fibrosis.

REF: p. 711

7. A newborn has respiratory distress syndrome. A nurse recalls cardiovascular alterations seen in respiratory distress syndrome include:

a.

Left-to-right shunt

b.

Left ventricular dilation

c.

Pulmonary hypotension

d.

Opening of fetal shunt pathways

ANS: D

Increased pulmonary vascular resistance may even cause a partial return to fetal circulation, with right-to-left shunting of blood through the ductus arteriosus and foramen ovale.

A left-to-right shunt does not occur but vice versa.

A return to fetal shunting occurs, not ventricular dilation.

A return to fetal shunting occurs, not pulmonary hypotension.

REF: p. 711

8. A newborn has respiratory distress syndrome (RDS). The nurse reports this condition appeared:

a.

Within minutes of birth

b.

2 to 3 hours after birth

c.

Within the first 12 to 24 hours after birth

d.

24 to 48 hours after exposure to an infectious organism

ANS: A

Signs of RDS appear within minutes of birth.

Signs of RDS appear within minutes of birth, not 2 to 3 hours.

Signs of RDS appear within minutes of birth, not within the first 24 hours.

Signs of RDS appear within minutes of birth; it is not associated with an infectious organism.

REF: p. 712

9. During a respiratory assessment of an infant with respiratory distress syndrome, a sinking in the supraclavicular and intercostal areas of the thorax was noted with inspiration. This observation is documented as:

a.

Grunting

b.

Tachypnea

c.

Retractions

d.

Nasal flaring

ANS: C

The sinking of supraclavicular and intercostal areas is termed retractions.

The symptoms describe retractions, not grunting.

The symptoms describe retractions, not tachypnea.

The symptoms describe retractions, not nasal flaring.

REF: p. 712

10. An infant was born 10 weeks premature and put on mechanical ventilation. Two months later he presents with hypoxemia and hypercapnia. Which of the following is the most likely diagnosis the nurse will observe documented on the chart?

a.

Respiratory distress syndrome of the newborn

b.

Bronchopulmonary dysplasia (BPD)

c.

Bronchiolitis

d.

Pneumonia

ANS: B

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD.

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD. Respiratory distress might have led to the intubation, but BPD is the diagnosis.

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD, not bronchiolitis.

Mechanical ventilation can result in a proinflammatory state that may contribute to the development of chronic lung disease, such as BPD, not pneumonia.

REF: p. 712

11. A 6-month-old female presents with rhinorrhea, cough, poor feeding, lethargy, and fever. She is diagnosed with bronchiolitis. Which of the following will the nurse most likely observe on the culture report?

a.

Parainfluenza virus

b.

Haemophilus B influenzae

c.

Respiratory syncytial virus

d.

Group A beta-hemolytic streptococcus

ANS: C

The most common cause of bronchiolitis is respiratory syncytial virus.

The most common cause of bronchiolitis is respiratory syncytial virus, not parainfluenza virus.

The most common cause of bronchiolitis is respiratory syncytial virus, not Haemophilus B influenzae.

The most common cause of bronchiolitis is respiratory syncytial virus, not strep.

REF: p. 714

12. A 2-year-old male presents with fever and cough. He is diagnosed with pneumonia. While planning treatment for this patient, the nurse recognizes that which of the following is the most likely cause?

a.

Bacteria

b.

Viruses

c.

Mycoplasma species

d.

Toxic inhalations

ANS: B

Viral pneumonia is more common than bacterial pneumonia, and children are 2 to 3 times more likely than adults to acquire these viruses.

Viral pneumonia is more common than bacterial pneumonia, and children are 2 to 3 times more likely than adults to acquire these viruses.

Viral pneumonia is more common in children than Mycoplasma species.

Viral pneumonia is more common in children than toxic inhalations.

REF: p. 714

13. An 11-year-old female presents with a low-grade fever and cough. She is diagnosed with atypical pneumonia. What type of pneumonia does the nurse suspect the patient is experiencing?

a.

Pneumococcal pneumonia

b.

Viral pneumonia

c.

Mycoplasma pneumonia

d.

Streptococcal pneumonia

ANS: C

Chlamydophila pneumonia is clinically indistinguishable from and is typically grouped with Mycoplasma as atypical pneumonia.

Bacterial pneumonia would not be atypical.

Viral pneumonia is not an atypical pneumonia.

Bacterial pneumonia is not part of atypical pneumonia.

REF: p. 714

14. A 2-week-old female presents with fever, cough, respiratory distress, and empyema. Which of the following is the most likely diagnosis the nurse will observe on the chart?

a.

Viral pneumonia

b.

Pneumococcal pneumonia

c.

Staphylococcal pneumonia

d.

Mycoplasma pneumonia

ANS: C

Staphylococcal and group A streptococcal pneumonia can be particularly fulminant (sudden, severe) and necrotizing (causing cell death) with a high incidence of accompanying empyema, pneumatocele, and sepsis.

Staphylococcal pneumonia is the more likely diagnosis than viral.

Staphylococcal pneumonia is more likely to cause empyema than pneumococcal.

Staphylococcal pneumonia is more likely to cause empyema than Mycoplasma.

REF: p. 714

15. A 9-year-old male contracted influenza. Which of the following complications is of greatest concern to the nurse?

a.

Chronic bronchitis

b.

Bronchiolitis obliterans

c.

Emphysema

d.

Respiratory distress syndrome (RDS)

ANS: B

Bronchiolitis obliterans most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

Bronchiolitis obliterans, not just chronic bronchitis, most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

Bronchiolitis obliterans, not emphysema, most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

Bronchiolitis obliterans, not RDS, most often occurs as a sequelae of a severe viral pulmonary infection (e.g., influenza, adenovirus, pertussis [whooping cough], or measles).

REF: p. 715

16. While planning care for a child with asthma, which of the following is characteristic of asthma?

a.

Increased lung volumes

b.

Prolonged expirations

c.

Air trapping

d.

Dead space

ANS: B

On physical examination, there is expiratory wheezing that is often described as high pitched and musical, and there is prolongation of the expiratory phase of the respiratory cycle.

Lung volumes are decreased.

Air trapping occurs in emphysema, not asthma.

Dead space occurs in emphysema, not asthma.

REF: p. 716

17. A 14-year-old male is experiencing an asthma exacerbation. When reviewing the lab results, which of the following cells in the submucosa promote this inflammatory response and will be elevated?

a.

Neutrophils

b.

Eosinophils

c.

Macrophages

d.

Lymphocytes

ANS: B

In the late asthmatic response, there are areas of epithelial damage and shedding caused at least in part by toxicity of eosinophil products.

Eosinophils, not neutrophils, promote the inflammatory response.

Eosinophils, not macrophages, promote the inflammatory response.

Eosinophils, not lymphocytes, promote the inflammatory response.

REF: p. 716

18. A 13-year-old female is diagnosed with asthma. Which of the following should the nurse teach the patient to recognize as part of an asthmatic attack?

a.

Headache

b.

Chest pain

c.

Wheezing

d.

Low heart rate

ANS: C

Wheezing occurs in asthma, due to narrowing of airways.

Headache is not a part of an asthma attack.

Wheezing is part of an asthma attack, not chest pain.

The heart rate will be increased, not decreased.

REF: p. 716

19. A geneticist is discussing cystic fibrosis (CF). Which information should be included? CF is an _____ disease.

a.

Autosomal recessive

b.

Autosomal dominant

c.

X-linked recessive

d.

X-linked dominant

ANS: A

CF is an autosomal recessive disease.

CF is an autosomal recessive disease, not dominant.

CF is not X-linked.

CF is not X-linked.

REF: p. 718

20. A 2-year-old female fell in a swimming pool and nearly drowned. She then developed acute respiratory distress syndrome (ARDS). Which of the following should the nurse assess the patient for?

a.

Decreased heart rate

b.

Increased lung compliance

c.

Increased surfactant production

d.

Hypoxemia

ANS: D

The child with ARDS will experience severe hypoxemia.

The child with ARDS will have an elevated, not decreased, heart rate.

The child with ARDS has decreased, not increased, lung compliance.

Surfactant production is not affected in ARDS.

REF: p. 718

21. While reviewing lab results, to help confirm a diagnosis of cystic fibrosis in a 1-year-old child which substance will be present in the childs sweat?

a.

Potassium

b.

Sodium chloride

c.

Magnesium

d.

Carbonic acid

ANS: B

The standard method of diagnosis is the sweat test, which reveals sweat chloride concentration in excess of 60 mEq/L.

Sodium chloride, not potassium, is present in the sweat.

Sodium chloride, not magnesium, is present in the sweat.

Sodium chloride, not carbonic acid, is present in the sweat.

REF: p. 719

22. A 7-month-old male presents with cystic fibrosis (CF) accompanied by failure to thrive and frequent, loose, and oily stools. Sweat testing reveals increased chloride. Which of the following should the nurse observe for that would accompany this disease?

a.

Autoantibodies that target the lungs and pancreas

b.

A thick mucus

c.

Enzymes that degrade surfactant in the alveoli

d.

A toxic amount of electrolytes from secretory glands

ANS: B

In CF, thick mucus is present.

Thick mucus is present, not autoantibodies.

Thick mucus is present; CF does not involve surfactant.

Thick mucus is present, not elevated electrolytes.

REF: p. 719

23. A young patient is admitted to the pediatric unit with cystic fibrosis (CF) exacerbation. The nurse monitors the patient closely because the main cause of death in a child with CF is:

a.

Airway rigidity

b.

Pulmonary edema

c.

Respiratory failure

d.

Asthma-like bronchospasms

ANS: C

Although CF is a multi-organ disease, its most important effects are on the lungs, and respiratory failure is almost always the cause of death.

Although CF is a multi-organ disease, its most important effects are on the lungs, and respiratory failure is almost always the cause of death; airway rigidity does not occur.

Mucus plugging, not pulmonary edema, occurs.

Mucus plugging, not asthma-like symptoms, occurs.

REF: p. 719

24. A nurse is teaching about sudden infant death syndrome (SIDS). Which information should the nurse include? SIDS peaks between _____ and ____months of age.

a.

1, 2

b.

3, 4

c.

6, 8

d.

10, 12

ANS: B

SIDS peaks in children 3 to 4 months of age.

SIDS peaks in children 3 to 4 months of age, not 1 and 2 months of age.

SIDS peaks in children 3 to 4 months of age, not 6 and 8 months of age.

SIDS peaks in children 3 to 4 months of age, not 10 and 12 months of age.

REF: p. 720

25. A 5-month-old female is found dead in her crib. The coroner ruled sudden infant death syndrome (SIDS) as the cause of death. Which of the following risk factors is most likely associated with SIDS?

a.

Congenital heart disease

b.

Female gender

c.

Caucasian race

d.

Frequent respiratory infections

ANS: D

A higher rate of respiratory tract infection during those months will likely decreases sleep arousal, making it a risk factor for SIDS.

Congenital anomalies play a role, but respiratory infections play a greater role.

SIDS occurs in males more than females.

Genetic factors may play a role, but ethnicity does not.

REF: p. 720

26. To prevent sudden infant death syndrome, the nurse should instruct parents to:

a.

Place infants on a soft mattress for sleeping.

b.

Always lay infants down on their backs to sleep.

c.

Breast-feed their infants.

d.

Keep the infants room very warm.

ANS: B

Infants should be laid on their backs to sleep.

A soft mattress is a possible contributing factor to SIDS.

Feeding method does not play as great a role as positioning during sleep.

Sleeping position is the most preventable risk factor.

REF: p. 720

MULTIPLE RESPONSE

1. A 1-year-old female is diagnosed with croup. Which of the following symptoms is most likely to be present when the nurse performs an assessment? (Select all that apply.)

a.

Barking cough

b.

Stridor

c.

Hoarseness

d.

Drooling

e.

Truncal rash

ANS: A, B, C

Typically, the child experiences rhinorrhea, sore throat, and low-grade fever for a few days, then develops a harsh (seal-like) barking cough, inspiratory stridor, and hoarse voice.

REF: p. 709

COMPLETION

1. A nurse remembers bronchiolitis mainly occurs in children under the age of _____.

ANS:

1

one

Bronchiolitis is a common, viral lower respiratory tract infection that occurs almost exclusively in infants and young toddlers.

REF: p. 714

2. Asthma affects ____% of children between 5 and 17 years of age.

ANS:

10

It is the most prevalent chronic disease in childhood, affecting 10% of U.S. children between 5 and 17 years of age.

REF: p. 716

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

Leave a Reply