8. Which intervention for treating croup at home should be taught to parents as possibly helpful?
a. Have a decongestant available.
b. Have the child sleep in a dry room.
c. Take the child outside.
d. Give the child an antibiotic at bedtime.
ANS: C
Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms.
Decongestants are inappropriate for croup, which affects the middle airway level. A dry environment
may contribute to symptoms. Croup is caused by a virus. Antibiotic treatment is not indicated.
9. A 5-year-old child is brought to the emergency department with copious drooling and a croaking
sound on inspiration. Her mother states that the child is very agitated and only wants to sit upright.
What action by the nurse takes priority?
a. Prepare intubation equipment and call the provider.
b. Examine the child’s oropharynx and call the provider.
c. Obtain a throat culture for respiratory syncytial virus (RSV).
d. Obtain vital signs and listen to breath sounds.
ANS: A
This child has symptoms of epiglottitis, is acutely ill, and requires emergency measures. If epiglottitis
is suspected, the nurse should not examine the child’s throat. Inspection of the epiglottis is only done
by a provider, because it could trigger airway obstruction. A throat culture could precipitate a
complete respiratory obstruction. Vital signs can be assessed after emergency equipment is readied.
10. What intervention can be taught to the parents of a 3-year-old child with pneumonia who is
not hospitalized?
a. Offer the child only cool liquids.
b. Offer the child favorite warm liquid drinks.
c. Use a warm mist humidifier.
d. Report a respiratory rate less than 28 breaths/min.
ANS: B
Offering the child favorite fluids will facilitate oral intake. Warm liquids help loosen secretions. A
humidifier may or may not be helpful. Typically parents are not taught to count their children’s
respirations and report abnormalities to the physician. Even if this were the case, a respiratory rate of
less than 28 breaths/min is normal for a 3-year-old child. The expected respiratory rate for a 3-yearold child is 20 to 30 breaths/min.
11. A nurse is caring for four infants. Which one should the nurse assess first?
a. Nasal flaring
b. Respiratory rate of 55 breaths/min
c. Irregular respiratory pattern
d. Abdominal breathing
ANS: A
Infants have difficulty breathing through their mouths; therefore nasal flaring is usually accompanied
by extra respiratory efforts. A respiratory rate of 55 breaths/min is a normal assessment for an infant.
Irregular respirations are normal in the infant. Abdominal breathing is common because the
diaphragm is the neonate’s major breathing muscle.
12. Once an allergen is identified in a child with allergic rhinitis, the treatment of choice the nurse
educates the parents about is which of the following?
a. Using appropriate medications
b. Beginning desensitization injections
c. Eliminating the allergen
d. Removing the adenoids
ANS: C
The first priority is to attempt to remove the causative agent from the child’s environment. Medications
are not a first -line treatment but can be helpful in controlling allergic rhinitis. Immunotherapy is
usually the final component of controlling allergic rhinitis. Adenoids are tissues that can swell with
constant rhinitis; however, a surgical procedure is not indicated for allergic rhinitis. Dealing with the
cause is the first priority.
13. Which assessment finding after tonsillectomy should be reported to the surgeon?
a. Vomiting bright red blood
b. Pain at surgical site
c. Pain on swallowing
d. The ability to only take small sips of liquids
ANS: A
Vomiting bright red blood and swallowing frequently are signs of bleeding postoperatively and should
be reported to the surgeon. It is normal for the child to have pain at the surgical site and pain with
swallowing after tonsillectomy. Small sips of liquid are preferred.
14. Teaching safety precautions with the administration of antihistamines is important because of
what common side effect?
a. Dry mouth
b. Excitability
c. Drowsiness
d. Dry mucous membranes
ANS: C
Drowsiness is a safety hazard when alertness is needed, especially with a teenage driver.
Nonsedating brands should be used if possible. None of the other three problems is a safety issue.
15. What is an appropriate beverage for the nurse to give to a child who had a
tonsillectomy earlier in the day?
a. Chocolate ice cream
b. Orange juice
c. Fruit punch
d. Apple juice
ANS: D
The child can have clear, cool liquids when fully awake. Ice cream is not a clear liquid, and dairy
products can cause the child to clear the throat repeatedly, increasing the risk of bleeding. Citrus
drinks are not offered because they can irritate the throat. Red liquids are avoided because they give
the appearance of blood if vomited.
16. Which type of croup is always considered a medical emergency?
a. Laryngitis
b. Epiglottitis
c. Spasmodic croup
d. Laryngotracheobronchitis (LTB)
ANS: B
Epiglottitis is always a medical emergency that requires antibiotics and airway support for treatment.
The other illnesses are not medical emergencies although LTB can progress to emergent status in
some children.
17. What information should the nurse teach workers at a daycare center about RSV?
a. RSV is transmitted through particles in the air.
b. RSV can live on skin or paper for up to a few seconds after contact.
c. RSV can survive on nonporous surfaces for about 60 minutes.
d. Frequent handwashing can decrease the spread of the virus.
ANS: D
Meticulous handwashing can decrease the spread of organisms. RSV infection is not airborne. It is
acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to
1 hour. RSV can live on cribs and other nonporous surfaces for up to 6 hours.
18. Which intervention is appropriate for the infant hospitalized with bronchiolitis?
a. Position on the side with neck slightly flexed.
b. Administer antibiotics as ordered.
c. Restrict oral and parenteral fluids if tachypneic.
d. Give cool, humidified oxygen.
ANS: D
Cool, humidified oxygen is given to relieve dyspnea, hypoxemia, and insensible fluid loss from
tachypnea. The infant should be positioned with the head and chest elevated at a 30- to 40-degree
angle and the neck slightly extended to maintain an open airway and decrease pressure on the
diaphragm. The etiology of bronchiolitis is viral. Antibiotics are only given if there is a secondary
bacterial infection. Tachypnea increases insensible fluid loss. If the infant is tachypneic, fluids are
given parenterally to prevent dehydration.
19. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of
respiration. What action by the nurse is most appropriate?
a. Prepare to administer a bronchodilator.
b. Give ordered antibiotics on time.
c. Provide oxygen via face tent.
d. Assess the airway for a foreign body.
ANS: A
Children with asthma usually have these chronic symptoms. The nurse will prepare to administer a
bronchodilator. Antibiotics are not used in asthma unless the child also has a bacterial infection, but
there is no indication that this is the case. There is also no indication the child needs oxygen at this
point. These manifestations do not suggest a foreign body aspiration.
20. The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as
possible. Which of the following best explains the nurse’s rationale?
a. Mothers of hospitalized toddlers often experience guilt.
b. The mother’s presence will reduce anxiety and ease the child’s respiratory efforts.
c. Separation from the mother is a major developmental threat at this age.
d. The mother can provide constant observations of the child’s respiratory efforts.
ANS: B
The family’s presence will decrease the child’s distress, which in turn helps decrease respiratory
efforts. Guilt is not the main rationale. Toddlers do suffer from separation anxiety, but that is not the
primary reason for the mother to stay. The child should have constant monitoring by cardiorespiratory
monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the
hospital.
21.Which statement indicates that a parent of a toddler needs more education about preventing
foreign body aspiration?
a.“I keep objects with small parts out of reach.”
b. “My toddler loves to play with balloons.”
c. “I won’t permit my child to have peanuts.”
d. “I never leave coins where my child could get them.”
ANS: B
Latex balloons account for a significant number of deaths from aspiration every year. The other
statements show good understanding.
22. What is a common trigger for asthma attacks in children?
a. Febrile episodes
b. Dehydration
c. Exercise
d. Seizures
ANS: C
Exercise is one of the most common triggers for asthma attacks, particularly in school-age children.
Febrile episode, dehydration, and seizures are not triggers.
23. Which child requires a Mantoux test?
a. The child who has episodes of nighttime wheezing and coughing
b. The child who has a history of allergic rhinitis
c. The child whose babysitter has received a tuberculosis diagnosis
d. The premature infant who is being treated for apnea of infancy
ANS: C
The Mantoux test is the initial screening mechanism for patients exposed to tuberculosis. Nighttime
wheezing and coughing are consistent with a diagnosis of asthma. Allergic rhinitis requires an allergy
workup. The Mantoux test is not used to evaluate apnea.
32. Which statement made by parents of a child with cystic fibrosis indicates that they understood the
nurse’s teaching on pancreatic enzyme replacement?
a. “Enzymes will improve my child’s breathing.”
b. “I should give the enzymes 1 hour after meals.”
c. “Enzymes should be given with meals and snacks.”
d. “The enzymes are stopped if my child begins wheezing.”
ANS: C
Children with cystic fibrosis need to take enzymes with food for adequate absorption of nutrients.
Pancreatic enzymes do not affect the respiratory system. Pancreatic enzymes are taken within 30
minutes of eating all meals and snacks. Giving the medication 1 hour after meals is inappropriate and
ineffective for absorption of nutrients. Wheezing is not a reason to stop taking enzyme replacements.
33. Why do infants and young children quickly have respiratory distress in acute and chronic
alterations of the respiratory system?
a. They have a widened, shorter airway.
b. There is a defect in their sucking ability.
c. The gag reflex increases mucous production.
d. Mucus and edema obstruct small airways.
ANS: D
The airway in infants and young children is narrow, and respiratory distress can occur quickly
because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily
related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not
produce mucus.
34. Which statement made by a parent indicates an understanding about the genetic transmission of
cystic fibrosis (CF)?
a. “Only one parent carries the cystic fibrosis gene.”
b. “Both parents are carriers of the cystic fibrosis gene.”
c. “The presence of the disease is most likely the result of a genetic mutation.”
d. “The mother is usually the carrier of the cystic fibrosis gene.”
ANS: B
Cystic fibrosis follows a pattern of autosomal recessive transmission. Both parents must be carriers of
the gene for the disease to be transmitted to the child. If both parents carry the CF gene, each
pregnancy has a 25% chance of producing a CF-affected child. The disease will not be present if only
one parent is a carrier of the cystic fibrosis gene. Cystic fibrosis is known to have a definite pattern of
transmission. It is transmitted as an autosomal recessive trait. A carrier parent can transmit the carrier
gene to the child. The disease is present when the carrier gene is transmitted from both parents.
35. A small child with cystic fibrosis cannot swallow pancreatic enzyme capsules. The nurseshould
teach parents to mix enzymes with which food?
a. Macaroni and cheese
b. Tapioca
c. Applesauce
d. Hot chocolate
ANS: C
Enzymes can be mixed with a small amount of nonacidic foods. Macaroni and cheese and hot
chocolate are not good choices because enzymes are inactivated by heat and starchy foods. Tapioca
is also a starchy food.
36. The nurse should teach parents of a child with cystic fibrosis to adjust enzyme dosage according
to which indicator?
a. Stool formation
b. Vomiting
c. Weight
d. Urine output
ANS: A
When there is constipation, less enzyme is needed; with steatorrhea, more enzyme is needed for
digestion of nutrients. Vomiting, weight, and urine output do not affect dosing.
37. Which finding confirms a diagnosis of cystic fibrosis?
a. Chest radiograph shows alveolar hyperinflation.
b. Stool analysis indicates significant amounts of fecal fat.
c. Sweat chloride is greater than 60 mEq/L.
d. Liver function levels are abnormal.
ANS: C
The diagnosis of cystic fibrosis requires a positive sweat test. A chloride level greater than
60 mEq/L is considered diagnostic for cystic fibrosis. Hyperinflation is one of the first
findings on a chest radiograph of a child with cystic fibrosis. It does not confirm a
diagnosis. A 72-hour fecal fat determination may be included in a diagnostic workup.
Inability to secrete digestive enzymes causes steatorrhea. Liver function tests may be part of
the diagnostic workup for cystic fibrosis.