Download 31-1 Test Bank Hockenberry: Wong`s Nursing Care of Infants and

Hockenberry: Wong's Nursing Care of Infants and Children, 9th Edition
Chapter 31: The Child with Disturbance of Oxygen and Carbon Dioxide Exchange
Test Bank
MULTIPLE CHOICE
1. Which of the following respiratory conditions or diseases result in both increased
compliance and increased resistance?
a. Asthma
b. Atelectasis
c. Surfactant deficiency
d. Bronchopulmonary dysplasia
ANS: A
Compliance is a measure of the relative ease with which the chest wall expands.
Resistance is determined primarily by airway size. Asthma results in increased
compliance and increased resistance, both of which increase the work of breathing.
Atelectasis and surfactant deficiency both decrease compliance but do not affect
resistance. Bronchopulmonary dysplasia increases resistance but does not affect
compliance.
DIF: Cognitive Level: Comprehension
REF: p. 1185
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
2. Ambient air (room air) contains how much oxygen?
a. 15%
b. 21%
c. 30%
d. 42%
ANS: B
Room air is composed of 21% oxygen, trace amounts carbon dioxide, and 79% nitrogen.
DIF: Cognitive Level: Comprehension
REF: p. 1186
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
3. During a respiratory assessment the nurse notes a sinking in of soft tissues relative to the
cartilaginous and bony thorax. This finding is termed:
a. grunting.
b. tachypnea.
c. retractions.
d. nasal flaring.
ANS: C
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-2
Retractions are defined as the sinking of soft tissue relative to the cartilaginous or bony
thorax. Retractions can be extreme in severe airway obstruction as the work of breathing
increases. Grunting can be a sign of pain in older children with respiratory issues. It
serves to increase the end-respiratory pressure, which prolongs the period of oxygen and
carbon dioxide exchange across the membrane. Tachypnea is an increase in the
respiratory rate above the child’s baseline. Nasal flaring, the enlargement of the nostrils,
helps reduce nasal resistance and maintains airway patency.
DIF: Cognitive Level: Comprehension
REF: p. 1188
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
4. Which of the following tests measures the amount of air inhaled and exhaled during any
respiratory cycle?
a. Tidal volume
b. Vital capacity
c. Dynamic compliance
d. Pulmonary resistance
ANS: A
Tidal volume is defined as the amount of air inhaled and exhaled during any respiratory
cycle. When it is multiplied by the respiratory rate, the minute volume is obtained.
Forced vital capacity is the maximum amount of air that can be expired after maximum
inspiration. It is used to monitor individuals with obstructive airway disease. Dynamic
compliance is the relationship between the change in volume and pressure difference.
Pulmonary resistance measures the changes in pressure with changes in flow on
inspiration and expiration.
DIF: Cognitive Level: Comprehension
REF: p. 1190
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
5. The best explanation for using pulse oximetry on young children to determine oxygen
saturation is that it:
a. is noninvasive.
b. is better than capnography.
c. is more accurate than arterial blood gases.
d. provides intermittent measurements of oxygen.
ANS: A
Pulse oximetry is a noninvasive measure of oxygen saturation of hemoglobin.
Capnography measures carbon dioxide inhalation and exhalation. It does not provide
information about oxygen saturation. Arterial blood gases provide additional clinical
information, including pH, PCO2, bicarbonate, base excess, and PO2. An arterial puncture
is required, which can be painful, and continuous monitoring cannot be done without an
arterial line. Pulse oximetry can be either intermittent or continuous.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
REF: p. 1190
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-3
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
6. It is important to make certain that sensory connectors and oximeters are compatible
because incompatible wiring can cause which of the following?
a. Hyperthermia
b. Electrocution
c. Pressure necrosis
d. Burns under sensors
ANS: D
Incompatible wiring can generate considerable heat at the tip of the sensor, resulting in
partial- and full-thickness burns. Heat may be generated at the site of the sensor, but it
will not result in generalized hyperthermia. Electrocution is not a possibility with
oximeters. Pressure necrosis can occur from improperly applied sensors, but not from
incompatible wiring.
DIF: Cognitive Level: Comprehension
REF: p. 1194
TOP: Nursing Process:
Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
7. Which of the following should the nurse do as a precautionary measure before doing an
arterial puncture to obtain an arterial blood sample?
a. Allen test
b. Smith test
c. Venipuncture
d. Cold compress
ANS: A
The Allen test determines the adequacy of collateral circulation in the extremity distal to
the proposed puncture site. If the child does not have satisfactory circulation when the
proposed artery is occluded, that extremity is not used. The Smith text, venipuncture, and
a cold compress are not done before arterial blood gas sampling.
DIF: Cognitive Level: Comprehension
REF: p. 1194
TOP: Nursing Process:
Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
8. Arterial blood gases have just been drawn on a child. The nurse should:
a. take the sample to the laboratory immediately.
b. pack it in ice and take it to laboratory immediately.
c. place sample in brown bag until it can be taken to laboratory.
d. refrigerate sample until it can be taken to laboratory.
ANS: B
Arterial blood gases require careful handling for accurate results. Immediately after
obtaining the specimen, the nurse packs it in ice to reduce cellular metabolism and takes
it to the laboratory.
DIF: Cognitive Level: Comprehension
REF: p. 1194
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-4
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
9. The continuous administration of mist, or aerosolized water, for the treatment of
inflammatory conditions of the airways is a common practice that:
a. has no proven benefit.
b. decreases viscosity of mucus.
c. decreases bronchoconstriction.
d. reduces inflammation of lower airways.
ANS: A
Aerosol therapy or mist therapy with water is not a treatment of choice for inflammatory
airway conditions. Some questionable benefit may occur in mild viral croup. The parent
and child may experience a reduction in anxiety in a cool, humid environment. Upper
airway secretions may be moistened; however, inhaled mist does not affect the viscosity
of mucus. Humidity may worsen bronchospasm. Aerosolized medications are able to
reduce inflammation of the lower airways, but water does not have this effect.
DIF: Cognitive Level: Application
REF: p. 1196
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
10. When is bronchial (postural) drainage generally performed?
a. Before meals and at bedtime
b. Right before all aerosol therapy
c. Immediately on arising and at bedtime
d. Thirty minutes after meals and at bedtime
ANS: A
The therapy should be done at bedtime and before meals or 1 to 1 1/2 hours after meals to
avoid stomach upset. Postural drainage is most effective when it is performed after other
respiratory therapy interventions, including bronchodilator and nebulizer treatments.
Immediately on arising and at bedtime are appropriate times, but postural drainage is
usually carried out at least three times each day. Thirty minutes after meals may induce
vomiting.
DIF: Cognitive Level: Application
REF: p. 1197
TOP: Nursing Process:
Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
11. Which of the following is an important nursing consideration in the care of a child on a
mechanical ventilator?
a. Humidification is not necessary.
b. Respiratory assessment is done by the ventilator.
c. Positioning the child for comfort and optimum ventilation is necessary.
d. Support and reassurance are not as important because the child is unconscious.
ANS: C
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-5
The ventilator will do the work of breathing, but the nurse must position the child with
attention to achieving optimum gas exchange. The reason for mechanical ventilation and
the child’s comfort are part of the assessment. Mechanical ventilation is usually achieved
by intubation or tracheostomy. These routes bypass the humidification that occurs in the
upper airway. The ventilator provides some information about the work of breathing, but
patient assessment must be done by the nurse. Support and reassurance are always
important for both the child and family. Opioids and anxiolytics are often used to
decrease the child’s anxiety. Careful assessment is indicated.
DIF: Cognitive Level: Application
REF: p. 1201
TOP: Nursing Process:
Planning
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
12. Care of the child who is to be weaned from a ventilator includes which of the following?
a. Light sedation before scheduled extubation
b. No suctioning before scheduled extubation
c. Cool mist begun immediately after extubation
d. Vigorous chest physiotherapy and suctioning performed immediately after
extubation
ANS: C
A cool mist or noninvasive oxygen therapy is initiated immediately after extubation.
Steroids may be administered to minimize any laryngeal edema. Analgesics may be given,
but sedation is not usually indicated. The child is suctioned just before extubation to
ensure that the airway is clear. Chest physiotherapy and suctioning are performed before
extubation.
DIF: Cognitive Level: Analysis
REF: p. 1201
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
13. The nurse must suction a 6-month-old infant with a tracheostomy. Interventions should
include which of the following?
a. Encourage child to cough to raise the secretions before suctioning.
b. Each pass of the suction catheter should take no longer than 5 seconds.
c. Allow child to rest after every five times the suction catheter is passed.
d. Select a catheter with a diameter three quarters of the diameter of the tracheostomy
tube.
ANS: B
Suctioning should require no longer than 5 seconds per pass. Otherwise the airway may
be occluded for too long. An infant would be unable to cooperate with instructions to
cough up secretions. The child is allowed to rest for 30 to 60 seconds after each
aspiration to allow oxygen tension to return to normal. Then the process is repeated until
the trachea is clear. The catheter should have a diameter one half the size of the
tracheostomy tube. If it is too large, it might block the child’s airway.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Implementation
REF: p. 1204
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-6
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
14. A 3-year-old child with a tracheostomy will soon be discharged. Which of the following
should the nurse recommend to the family?
a. Tub baths cannot be given.
b. Child cannot be allowed to play outdoors.
c. Avoid exposure to noxious fumes such as paint or varnish.
d. Cover tracheostomy with a plastic bib when exposed to cold air.
ANS: C
The child with a tracheostomy should not be exposed to noxious fumes such as paint,
varnish, or hair spray, or to substances such as talc. The parent and child must be
cautioned about safety measures around bodies of water. Baths can be taken, but parents
must observe the necessary safety precautions. The child may play outdoors with a scarf
or other protection that allows air through.
DIF: Cognitive Level: Application
REF: p. 1207
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
15. The nurse is planning home care for a 2-year-old child with a tracheostomy.
Recommendations should include which of the following?
a. Sterile technique is essential in home care of the tracheostomy.
b. Parents are able to change tracheostomy tube when needed.
c. Play activities must be sedentary such as listening to music and working on
puzzles.
d. Child must wear a plastic bib when eating or drinking to prevent aspiration into the
stoma.
ANS: B
A plugged, clogged, or obstructed tracheostomy tube is a life-threatening circumstance.
Parents are taught the signs and symptoms, how to suction, and how to change the tube.
Clean technique and thorough hand washing are sufficient for suctioning, cleaning the
tracheostomy site, and changing the tracheostomy tube. The child who is physically able
can engage in activities appropriate to age. Young children who may spill food near the
stoma should wear a fabric bib without a plastic lining or other device to prevent dribbled
food or crumbs from being aspirated.
DIF: Cognitive Level: Application
REF: p. 1207
TOP: Integrated Process: Teaching/Learning
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
16. Respiratory failure can result from many causes. Which of the following is a specific
condition that causes primary inefficient gas transfer?
a. Anemia
b. Pneumothorax
c. Cystic fibrosis
d. Laryngospasm
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-7
ANS: A
Respiratory failure is defined as the inability of the respiratory system to maintain
adequate oxygenation of the blood. In primary inefficient gas transfer, there is
insufficient alveolar ventilation. Anemia, which is characterized by low hemoglobin
levels, results in an inability to adequately oxygenate the blood. Pneumothorax and cystic
fibrosis are examples of restrictive lung disease. Laryngospasm is an example of
obstructive lung disease.
DIF: Cognitive Level: Comprehension
REF: pp. 1208, 1209
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
17. The nurse is caring for a child with a tracheostomy. Which of the following should the
nurse recognize as an early sign of impending respiratory distress or failure?
a. Cyanosis
b. Restlessness
c. Audible stridor
d. Crowing respirations
ANS: B
Signs of hypoxemia are initially subtle. Cardinal signs of impending respiratory failure
include restlessness, tachypnea, tachycardia, and diaphoresis. Cyanosis is a sign of severe
hypoxia. Stridor and crowing respirations are indicative of inflammation. Sternal
retractions are an early but less obvious sign.
DIF: Cognitive Level: Comprehension
REF: p. 1209
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
18. Cardiopulmonary resuscitation is begun on a toddler. Which of the following pulses is
usually palpated because it is the most central and accessible?
a. Radial
b. Carotid
c. Femoral
d. Brachial
ANS: B
In a toddler, the carotid pulse is palpated. The radial pulse is not considered a central
pulse. The femoral pulse is not the most central and accessible. Brachial pulse is felt in
infants younger than 1 year.
DIF: Cognitive Level: Comprehension
REF: p. 1214
TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
19. Which of the following drugs is considered to be the most useful in treating cardiac
arrest?
a. Bretylium
b. Lidocaine
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-8
c. Epinephrine
d. Naloxone (Narcan)
ANS: C
Epinephrine is considered one of the most useful drugs in treating cardiac arrest. As an
adrenergic agent, it acts on both α- and β-receptors in the heart. Epinephrine is rapidly
cleared from the bloodstream. Bretylium is no longer used in pediatric cardiac arrest
management. Lidocaine is used for ventricular arrhythmias only. Naloxone is useful only
to reverse effects of opioids.
DIF: Cognitive Level: Application
REF: p. 1216
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
20. Effective cardiopulmonary resuscitation (CPR) on a 5-year-old child should include
which of the following?
a. Provide one breath to every five chest compressions.
b. Provide two breaths to every 15 chest compressions.
c. Reassess child every 10 minutes while CPR continues.
d. Evaluate child after 50 cycles of compression and ventilation.
ANS: B
Two breaths to 15 compressions is the standard for infants and children when two
rescuers are present. One breath to every five chest compressions is not the appropriate
ratio for CPR in this age-group. Reassessment of the child should take place after 20
cycles or 1 minute.
DIF: Cognitive Level: Comprehension
REF: p. 1215
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Physiologic Adaptation
21. A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is
recommended for airway obstruction in children older than:
a. 1 year.
b. 4 years.
c. 8 years.
d. 12 years.
ANS: A
A series of subdiaphragmatic abdominal thrusts (the Heimlich maneuver) is
recommended for airway obstruction in children older than 1 year. For children younger
than 1 year, back blows and chest thrusts are administered.
DIF: Cognitive Level: Comprehension
REF: p. 1216
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-9
22. The mother of a toddler yells to the nurse, “Help! He is choking to death on his food.”
The nurse determines that lifesaving measures are necessary based on which of the
following?
a. Gagging
b. Coughing
c. Pulse over 100 beats/min
d. Inability to speak
ANS: D
The inability to speak is indicative of a foreign body airway obstruction of the larynx.
Abdominal thrusts are needed for treatment of the choking child. Gagging indicates
irritation at the back of the throat, not obstruction. Coughing does not indicate a complete
airway obstruction. Tachycardia may be present for many reasons.
DIF: Cognitive Level: Application
REF: p. 1215
TOP: Nursing Process: Implementation
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
23. The nurse is caring for a 4-year-old who is receiving 2 L of oxygen per nasal cannula.
Which of the following disadvantages should the nurse consider when planning care for
the child?
a. The child may need to have high humidity administered with the oxygen.
b. The child may not be able to eat and drink comfortably.
c. A nasal cannula may cause an accumulation of moisture on the face.
d. A nasal cannula may cause abdominal distention.
ANS: D
All oxygen-delivery systems have advantages and disadvantages. One disadvantage of a
nasal cannula is possible abdominal distention and discomfort, which could lead to
vomiting. The advantages include that the child is able to eat and drink more comfortably,
there is no need for a high humidity environment, and there is no accumulation of
moisture causing skin irritation.
DIF: Cognitive Level: Application
REF: p. 1195
TOP: Nursing Process:
Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
COMPLETION
1. The nurse is participating in a code blue on a 12-year-old child in a full respiratory arrest.
The child weighs 110 lb. The health care provider has ordered an initial dose of
epinephrine hydrochloride (1:10,000) given intravenously. Calculate the correct initial
dose of epinephrine. Record your answer using one decimal place.
_____ mg
ANS:
0.5
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
31-10
The correct calculation is:
110 lb/2.2 kg = 50 kg
Initial dose of 1:10,000 epinephrine is 0.01 mg/kg
0.01 mg
50 = 0.5 mg
DIF: Cognitive Level: Application
REF: p. 1216
TOP: Nursing Process:
Planning
MSC: Client Needs: Physiological Integrity: Reduction of Risk Potential
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.