Online Nursing Practice Test about Respiratory Diseases (11-13)

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Situation: Joey has been brought to the hospital with acute laryngotracheobronchitis. He received epinephrine in the emergency room 2 hours ago.

11. While completing discharge teaching with Joey's parents. The nurse teaches the parents that Joey may have recurrence of uncontrolled coughing. The nurse should instruct the parents that if this happened, they should first:

a) call the emergency room
b) increase his fluid intake to liquefy secretion
c) administer the prescribed dose of guaifenesin
d) sit with the child in the bathroom with a basin of hot water and the door closed

12. Joey became very upset and agitated when he is placed in a mist tent. His aunt, who is staying with him, asks the nurse, "Isn't there something we can do?" The best response for the nurse is:

a) he'll settle down once he get used of it
b) would you like to sit with him under the tent
c) he has to stay here. I'll get him some toys
d) go ahead and take him out, but let him back in the tent when you leave

13. The initial nursing action for the nurse admitting Joey to the pediatric unit is to:

a) familiarize Joey with the unit
b) assess respiratory status
c) offer fluids
d) administered oxygen as ordered


ANSWERS AND RATIONALE

11) D
- Before discharging a child who had a croup attack, the nurse should provide anticipatory guidance to the parent in case croup happens again in the future. Bring child in the bathroom with a basin of hot water to fill the room with steam. This moist warm air will help to cause bbronchodilation and relieve spasms. Another way is to fill the bath tub with hot water or let faucet run with hot water.
Laryngotracheobronchitis or croup is inflammation of the larynx, trachea and bronchi. The most common cause in children below 3 years old is viral infection and between three to six years old, it is often due to H. influenzae.

Signs and symptoms of laryngotracheobronchitis include:

begins as a mild upper respiratory infection without fever or low grade fever

child awakens during the night in respiratory distress: barking cough, inspiratory stridor, and retractions which frightens the parents who rush the child to the emergency room

emergency management in the E.R. is to give the child racemic epinephrine by nebulizer to cause bronchodilation and maintain patent airway.

12) B
- a child having croup is placed inside the mist tent to promote bronchodilation and liquefy secretions. If the child feels afraid bein inside the plastic enclosure alone, it is allowable to tuck the parent or caregiver inside the mist tent with the child to reduce child's anxiety and prevent crying.
13) B
- the major danger of croup is airway occlusion from laryngospasm, therefore it is important to check the respiratory status of the child frequently.

• the nurse should take the vital signs closely every 15 minutes. Cyanosis, child thrashing, increased respiratory and pulse rate are signs of respiratory obstruction which requires intubation to maintain airway
• in addition, the nurse should provide comfort to the child and reduce the child's anxiety or fear. She can advise parent to hold child as necessary in order to prevent crying. This is because crying can result in laryngospasm and total occlusion of the aiway
• it is also contraindicated to stimulate the gag reflex as this can also result in laryngospasm
• if the child can tolerate it, the child should be allowed to drink or sip fluid from a straw to keep secretions moist.

Related Topics:

• Fundamentals of Nursing  Concepts
• Medical-Surgical Concepts
• Maternal and Child Concepts

• Online Nursing Practice Test about Respiratory Diseases (14-20)
• Go back to Online Nursing Practice Test about Respiratory Diseases (1-6) to start the test from the beginning.