Clinical Reasoning Cases in Nursing
7th EditionJulie S Snyder, Mariann M Harding
2,512 solutions
The Human Body in Health and Disease
7th EditionGary A. Thibodeau, Kevin T. Patton
1,505 solutions
Pharmacology and the Nursing Process
7th EditionJulie S Snyder, Linda Lilley, Shelly Collins
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Introduction to Global Health
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Terms in this set (183)
A child with asthma is undergoing pulmonary function tests. What is the purpose of the peak expiratory flow rate test?
Used to assess the severity of asthma
What is the peak expiratory flow rate (PERF) test?
a measure of the maximal amount of air that can be forcefully exhaled in 1 minute.
What does a PERF provide?
an objective measure of pulmonary function when compared with the child's baseline
What is the diagnosis of asthma made on?
the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR.
T/F: PERF is used for diagnosis asthma
FALSE
What is the cause of asthma?
inflammation, bronchospasm, and obstruction
T/F: PERF is capable of identifying inflammation, bronchospasm, and obstruction associated with asthma
FALSE
What test is done to identify some of the triggers of asthma?
allergy testing NOT PERF
What category of medication is the first-line therapy for inflammation in children with asthma?
corticosteroids
When is theophylline used to aid in treatment of asthma?
primarily in the emergency department when the child is not responding to other therapies.
What do anticholinergics do to aid in treatment of asthma?
relieve bronchospasm
What developmental factor increases the risk of infection in infants and young children?
The relatively short and open eustachian tubes of young children give pathogens easy access to the middle ear.
What does the narrowed airway of young children promote?
infection by allowing quick movement of organisms down the respiratory tract
What is the small airway of a child susceptible to?
edema of the mucous membranes
One of the goals for children with asthma is to prevent respiratory tract infection because of which effect?
Can trigger an episode or aggravate an asthmatic state
What is recommended for a child with asthma to receive?
annual influenza vaccine to prevent respiratory tract infections
The nurse is assessing a young child in the emergency department who drools and is agitated. The patient sounds like a frog during inhalation. Which condition should the nurse suspect in the patient?
acute epiglottitis
What are the clinical symptoms of acute epiglottitis?
drooling
agitation
frog-like sounds during inhalation
absence of spontaneous cough
What symptoms are Infectious mononucleosis and acute streptococcal pharyngitis associated with?
fever and pharyngitis
What oral rehydration measure must the nurse teach the parents of an infant with a respiratory tract infection?
continue to breastfeed the infant
Why should infants with respiratory tract infection continue to breastfeed?
human milk provides some degree of protection from infection
T/F: infants with a respiratory infection should be awaken to take fluids
FALSE
they should not be-- prevents aspiration
The nurse is performing discharge teaching for the parents of an infant with an upper respiratory tract infection. Which respiratory complication should prompt the parents to notify the health care practitioner?
Refusal to drink and decreased urination
What could further complicate respiratory problems in a child with a respiratory tract infection?
dehydration
What type of coughing with a respiratory infection warrants contacting the doctor?
a persistent or exacerbating cough
What should the nurse teach the family about reducing the risk of otitis media (OM) in the child younger than 2 years of age? Select all that apply.
Maintain routine childhood immunizations.
Breastfeed the child until 6 months of age.
Eliminate tobacco smoke and allergens.
How should the infants hair be washed in order to prevent otitis media?
with fresh water from the tap instead of water from the bathtub to prevent soap and unclean water from entering the ear
What does the nurse recognize as the primary factor responsible for multiple clinical manifestations of cystic fibrosis?
Increased viscosity of mucous gland secretions
What is the primary factor responsible for clinical manifestations of cystic fibrosis?
mechanical obstruction caused by increased viscosity of mucous gland secretions
What are common signs of a pneumothorax in a child with cystic fibrosis?
Tachypnea, tachycardia, dyspnea, cyanosis
subtle decrease in oxygen saturation
What age group is most affected by bronchitis?
children ages 4 and under
When is bronchitis most common?
during the first 4 years of life
In the planning of care for a 2-year-old admitted with bacterial tracheitis, what are the priorities of care in the therapeutic management of this respiratory dysfunction?
Oxygen therapy, antipyretics, and antibiotics
What is bacterial tracheitis?
infection of the mucosa of the upper trachea with features of both croup and epiglottitis
When does bacterial tracheitis occur?
children younger than 3 years
What does bacterial tracheitis require?
vigorous management with oxygen therapy, antipyretics, and antibiotics.
T/F: rehydration is a top priority for management of bacterial tracheitis
FALSE
What are some triggers that precipitate or aggravate asthma exacerbations? Select all that apply.
medications
strong emotions
indoor allergens
What therapeutic management methods would the nurse expect will be applied for a child with bronchiolitis?
humidified mist
What is the function of humidified mist in treatment of bronchiolitis?
moistens secretions and prevents drying of the airways
Why might fluid intake be contraindicated in a child with bronchiolitis?
because of tachypnea, weakness, and fatigue; therefore, intravenous fluids may be used until the acute stage of the disease has passed
What is the first line of treatment for the child with epiglottitis and severe respiratory distress?
Nasotracheal intubation or tracheostomy
The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37º C (98.6º F). The mother states the child is not having difficulty breathing. The nurse, suspecting croup, should recommend what?
Trying a cool-mist vaporizer at night and watching for signs of difficulty breathing
Why is cool mist recommended for use in a child with respiratory issues (barking cough at night specifically)?
it will help open up the child's airways
What is a barking cough characteristic of in children?
laryngotracheobronchitis
A nurse is caring for a child with acute viral nasopharyngitis. What is the priority of care for this patient?
patent airway
What interventions must the nurse perform when caring for an infant with respiratory syncytial virus (RSV) infection? Select all that apply.
Teach parents to instill normal saline drops in the nares.
Teach parents to suction the mucus with a bulb syringe.
Offer small amounts of fluids at frequent intervals.
When should the nose of an infant with RSV be suctioned out?
before feedings and at bedtime
What is present in infants with RSV?
copious nasal secretions, causing complications with breastfeeding
When is administration of palivizumab (synagis) done?
before the infant gets RSV in order to prevent it
What is the most appropriate way to administer penicillin G procaine or penicillin G benzathine suspension? Why this specific way?
intramuscularly
decrease the likelihood of a localized reaction and help lessen pain.
Because the absorption of fat-soluble vitamins is decreased in cystic fibrosis, which vitamin supplementation is necessary?
A, D, E, K
A 4-year-old boy needs to use a metered-dose inhaler for asthma. He cannot coordinate his breathing to use it effectively. What should the nurse suggest that he use?
spacer
A 4-year-old child is brought to the emergency department. The child exhibits a "froglike" croaking sound on inspiration, is agitated, and is drooling. The child insists on sitting upright. What is the priority action by the nurse?
Notify the health care provider immediately and monitor airway patency.
T/F: epiglottitis is not a medical emergency
FALSE
it is
When a child has epiglottitis, what does examination of the oropharynx possibly result in?
total obstruction and should not be done when a child manifests signs indicating potential epiglottitis
What does forcing a child with epiglottitis to lie down cause?
increase respiratory distress and anxiety
The nurse is caring for a child with foreign body aspiration. For which manifestation does the nurse first observe to evaluate for an obstruction?
coughing and gagging
What does a foreign body in the air passages initially cause?
choking, gagging, wheezing, or coughing.
What does laryngotracheal obstruction most commonly cause?
dyspnea, cough, stridor, and hoarseness because of decreased air entry
What does bronchial obstruction usually produce?
paroxysmal cough, wheezing, asymmetric breath sounds, decreased airway entry, and dyspnea
T/F: a child with an object lodged in the larynx is able to speak and breathe
FALSE
they cannot speak or breathe
The parent of a child with cystic fibrosis calls the clinic nurse to report that the child is experiencing tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of what?
pneumothorax
A child who has a history of being born preterm is prescribed an intramuscular injection of palivizumab. What should the nurse interpret from this finding about the child's current acute condition?
the pt has cystic fibrosis
What makes an infant at high risk for developing RSV?
premature and have preexisting chronic respiratory conditions such as cystic fibrosis (CF)
What is palivizumab?
monoclonal antibody which is administered intramuscularly every month to prevent respiratory syncytial virus infection
What nursing interventions will help prevent ventilator-associated pneumonia in children? Select all that apply.
Evaluating the patient daily for extubation
Draining the ventilator circuit before repositioning the patient
Hand hygiene before and after contact with the ventilator circuit
Why is a humidified atmosphere recommended for a young child with an upper respiratory tract infection?
soothes inflamed mucous membranes
What conditions weaken the defenses of the respiratory tract and predispose children to infection?
Asthma, history of respiratory syncytial virus infection, cystic fibrosis
T/F: diabetes and renal disease are conditions that weaken the defenses of the respiratory tract
FALSE
they are not
Which statement by the parents does the nurse associate with cystic fibrosis in the child?
the infant tastes "salty"
What helps evaluate the presence of cystic fibrosis in a child?
a positive sweat chloride test
What is commonly seen in a child with cystic fibrosis pertaining to bowel movements?
fails to pass stools and may have large, bulky, loose, frothy, and extremely foul-smelling stools.
Following a tonsillectomy, the charge nurse finds that the patient has difficulty breathing and swallowing. Which action by the new nurse is responsible for this?
Providing some orange juice twice a day for the patient
irritates the surgical site
What assessment finding does the nurse recognize as a manifestation of acute otitis media (AOM)?
Presence of fever and otalgia, or earache
What endocrine disorder is commonly found in children with cystic fibrosis?
diabetes mellitus
Why is diabetes mellitus more common in children with cystic fibrosis?
because of changes in pancreatic architecture and diminished blood supply over time
What therapeutic management would the nurse expect the primary health care provider to prescribe for an infant with nasopharyngitis?
antipyretic (treat mild fever and discomfort)
T/F: antihistamines can be used in treatment of nasopharyngitis?
FALSE
largely ineffective in treatment of nasopharyngitis
What must the nurse teach the parents of the child with cystic fibrosis about the use of pancreatic enzymes?
Extra enzymes must be taken with high-fat foods.
What is a child with cystic fibrosis unable to digest?
fat content in food, thus the need for extra enzymes when high-fat foods are eaten
When do enzymes need to be administered for a child with cystic fibrosis?
within 30 minutes of eating
What are some clinical manifestations of acute epiglottitis? Select all that apply.
pain, fever, drooling, tripod position
Which predominant characteristic does the nurse recognize as a manifestation of bronchitis?
persistent dry hacking cough
What is bronchitis frequently associated with?
upper respiratory infections.
What is characteristic of bronchitis?
dry, hacking, nonproductive cough that worsens at night and becomes productive in 2 or 3 days
Asthma is classified in four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. What are the clinical features used to determine these categories? Select all that apply.
lung function
frequency of symptoms
frequency and severity of exacerbations
degree of
interference with normal activities
A 5-year-old child is brought to the emergency department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? Select all that apply.
vitals signs
medical hx
assessment of breath sounds
ready availability of emergency airway
equipment
An infant with a congenital heart defect is being given palivizumab. What is the purpose of this medication?
Prevent respiratory syncytial virus (RSV) infection
The nurse is caring for a 3-year-old with asthma. The parents state that the child has symptoms three times a week, once a day. They give the child a short-acting β-agonist for symptom control 1 day a week. What is this child's asthma severity classification?
mild persistent
How is intermittent asthma described?
symptoms less than 2 days a week and use of a short-acting β-agonist less than 2 days a week
What does moderate persistent asthma include?
daily symptoms and use of a short-acting β-agonist daily.
What does severe persistent asthma include?
continually symptoms throughout the day and use of short-acting β-agonist several times a day.
What fluid should be avoided in attempts to rehydrate a child?
sports drink
What manifestation helps the nurse to identify severe persistent asthma?
The child has a peak expiratory flow less than 60%.
It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent what?
acute rheumatic fever
Who is at risk for acute rheumatic fever?
Children with group A β-hemolytic Streptococcus (GABHS)
What is the most appropriate nursing intervention for a child after tonsillectomy?
watching for continuous swallowing
What does frequent swallowing indicate?
early sign of bleeding from the surgical site
T/F: a child should gargle after a tonsillectomy
FALSE
it should be avoided after a tonsillectomy because of the potential for trauma to the suture line
How should a child be positioned after a tonsillectomy?
side or abdomen to facilitate drainage
What is the most profound complication of prolonged middle ear disorders?
loss of hearing
What type of diet do children with cystic fibrosis require?
A well-balanced high-protein, high-calorie diet
Why is a A well-balanced high-protein, high-calorie diet important for a child with cystic fibrosis?
the impaired intestinal absorption that is part of the disease
What clinical manifestation would the nurse expect to note when a pneumothorax occurs in a neonate who is undergoing mechanical ventilation?
nasal flaring and retractions
What are the signs of respiratory distress in a neonate?
nasal flaring, retractions, and grunting
A nurse is caring for a 3-year-old child who has rapidly progressing dysphagia and stridor. The child also has a high fever and rapid pulse and respirations. What syndrome does this child most likely have?
acute epiglottitis
What manifestations in a child with asthma does the nurse recognize as severe respiratory distress requiring immediate intervention? Select all that apply.
the child is sweating profusely
the child is
severely agitated
the child has prolonged expiration
sits in a hunched-over position
child becomes quiet
What must the nurse teach the parents of the child with streptococcal pharyngitis?
Orthodontic appliances used by the child must be washed thoroughly.
Which statement best represents infectious mononucleosis?
Herpes-like Epstein-Barr virus is the principal cause.
What is an early sign of congestive heart failure that the nurse should recognize?
tachypnea
What is one of the early signs of congestive heart failure that should be identified?
tachypnea
What are symptoms of congestive heart failure?
Tachycardia at rest, dyspnea, retractions, and activity intolerance
tachypnea-most common
The nurse is assessing the cholesterol levels of the patient and finds that the patient has low-density lipoprotein (LDL) levels of 140 mg/dL. What instruction would be most appropriate for the nurse to give to the patient?
"You should include olive oil and green vegetables in your diet."
What is a normal LDL level?
less than 110 mg/dl
How often should someone with high LDL exercise?
60 minutes a day, 5 days a week.
Which heart defect causes narrowing of the aortic valve?
aortic stenosis
What does aortic stenosis cause?
narrowing of the aortic valve, which in turn results in resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion
What is atrial septal defect?
abnormal opening between the atria that allows blood from the higher-pressure left atrium to flow into the lower-pressure right atrium.
What is coarctation of the aorta?
an obstructive defect in which there is narrowing near the insertion of the ductus arteriosus.
What is patent ductus arteriosus?
failure of the fetal ductus arteriosus to close during the first few weeks of life.
What is an important nursing responsibility when a dysrhythmia is suspected?
Counting the apical pulse for 1 full minute and comparing the rate with the radial pulse rate
What occurs to the radial pulse rate if there is a dysrhythmia occurring?
radial pulse rate may be lower than the apical pulse rate
What position does the nurse caring for a young child with tetralogy of Fallot see the child assuming in an attempt to compensate for the congenital heart defect?
knee-chest
Why should a child with tetralogy of fallot be in the knee-chest position?
decreases the amount of blood returning to the heart and allows the child time to compensate.
What nursing intervention is the most important in preventing complications of digoxin administration?
Checking the apical pulse for 60 seconds before administering the medication
When should digoxin be held?
apical pulse is below 90 to 110 beats/min in infants and young children or below 70 beats/min in older children
What is the primary therapy for secondary hypertension in children?
treatment of the cause
What should the nurse teach the parents of a child who has a history of bacterial infective endocarditis (IE)?
institute prophylactic antibiotic therapy 1 hour before certain procedures (dentist)
T/F: treatment if bacterial infective endocarditis requires short-term oral drug therapy
FALSE
requires long-term parenteral drug therapy
What condition is defined as sepsis with organ dysfunction and hypotension?
septic shock
In what procedure are high-frequency sound waves directed through a transducer to produce an image of cardiac structures?
echocardiography
In which procedure for cardiac diagnosis are radiopaque catheters placed in a peripheral blood vessel and advanced into the heart to measure pressures and oxygen levels in heart chambers?
cardiac cath
A child presents to the emergency department with an urticarial rash and laryngeal edema. What do these clinical symptoms suggest?
anaphylaxis
What does shock result in?
hypotension, tissue hypoxia, and metabolic acidosis.
What is an early sign of heart failure?
Resting tachypnea
What is the major cause of death in the first year of life besides preterm birth?
congenital heart defect
T/F: you should assess the apical pulse for 60 seconds before administering digoxin
TRUE
What is a priority patient outcome for a child with congestive heart failure?
the child will not have distended neck veins
What should the nurse recognize as an early clinical sign of compensated shock in a child?
apprehensiveness
What is indicative of uncompensated shock?
confusion
What is a symptom of irreversible shock?
hypotension
What clinical manifestation should the nurse expect to find in a child with infective endocarditis?
splinter hemorrhages under the nails
What causes the splinter hemorrhages under the nails with infective endocardiitis?
extracardiac emboli formation
The patient has had a persistent fever for the last 5 days, inflammation of lips and conjunctiva, and reddening of the tongue. The patient also has cervical lymphadenopathy and erythema in the palms and soles. What diagnosis does the nurse expect to find in the medical record?
Kawasaki disease
What symptoms are bacterial endocarditis associated with?
weight loss, anorexia, and splinter hemorrhages,
A nurse caring for a child with a chest tube notes drainage from the chest tube of 4 mL/kg/hr for the past 3 hours. What does this finding suggest?
The child may be at risk for cardiac tamponade.
Describe the drainage associated with postoperative hemorrhages and risk for cardiac tamponade?
Drainage from the chest tube of more than 3 mL/kg/hr for more than 3 consecutive hours
What is cardiac tamponade?
a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise
What is the primary therapy for essential hypertension?
a low-salt diet
weight reduction
improved exercise and fitness
A diagnosis of rheumatic fever is being ruled out in a child. Which laboratory test is the most reliable?
antistreptolysin-O titer
(antistreptococcal antibodies)
How is patent ductus arteriosus effectively treated?
ligation through thoracotomy
What conditiion should Blalock-Taussing surgery be used?
tetralogy of Fallot in premature children
What assessment findings help the nurse recognize and evaluate the presence of toxic shock syndrome (TSS) in a patient? Select all that apply.
It is indicated by Staphylococcus aureus in the blood culture.
It causes desquamation of palms and soles. (1-2 weeks after the onset of the illness)
It is accompanied by elevated temperatures. (102)
What care should the nurse take when obtaining a blood pressure measurement for a child with systemic hypertension?
Quiet the child when the blood pressure is measured.
What is the priority nursing intervention for reducing the chance of perfusion problems after cardiac catheterization?
Checking the pulses distal to the catheterization site
Before discharge, what teaching should the nurse give to the parents of a child who has been implanted with a pacemaker? Select all that apply.
Understand the settings of the pacemaker inserted. (to detect possible problems)
Learn cardiopulmonary resuscitation (CPR). (for emergencies)
Ensure that the child wears a Medic-Alert device.
take a pulse
While reviewing the laboratory reports of a patient, the nurse finds that the patient has a total cholesterol level of 220 mg/dL and low-density lipoprotein (LDL) level of 140 mg/dL. Which instruction does the nurse give to the patient after reviewing his or her prescription?
"Take the statin medications in the evening." (most effective at this time because they effectively optimize LDL levels)
What is the normal level of total cholesterol?
less than 170 mg/dl, with LDL less than 110 mg/dl
A nurse is caring for a child who has just undergone cardiac catheterization. What interventions should the nurse implement with this child? Select all that apply.
keep the site clean and dry
administer acetaminophen or ibuprofen to relieve the child's pain
Assess pulses, temperature, and color of extremities. (decreases the risk of complications)
Remove the pressure dressing the day after catheterization and cover the site with an adhesive bandage.
The nurse is caring for a child with a bedside cardiac monitor for electrocardiogram (ECG). What intervention should the nurse perform for this child?
Ensure that the white electrode is on the right of the chest.
Which congenital heart defect is described as the incomplete fusion of the endocardial cushions?
atrioventricular canal defect
What preprocedural interventions should the nurse implement for a child who is prescribed a cardiac catheterization? Select all that apply.
assess for any symptoms for infection
obtain hx for any allergic reactions
obtain an accurate height of the child
What postoperative care should the nurse include for a child immediately after surgery?
Ensure the child is warm immediately after surgery. (d/t hypothermia being expected immediately after surgery from hypothermia proocedures, effects of anesthesia, and loss of body heat to the cool environment)
Which medications are diuretics that are used in the management of heart failure? Select all that apply.
furosemide
chlorothiazide
spironolactone
What should nurses stress when counseling parents regarding the home care of the child with a cardiac defect before corrective surgery?
The desirability of promoting normalcy within the limits of the child's condition
Surgical repair for patent ductus arteriosus (PDA) is performed to prevent the complication of what?
A worsening of pulmonary vascular congestion- which is the primary complication (due to blood shunting from the aorta (high pressure) to the pulmonary artery (low pressure)
What type of blood shunting is associated with PDA?
left-to-right-shunting
The nurse is caring for a child with an atrial septal defect. What clinical manifestation should the nurse expect to find in this child?
Systolic murmur with a fixed split second heart sound.
With what cardiac defect would you expect Loud holosystolic murmur at the left sternal border?
ventricular septal defect
What cardiac complications has loud systolic murmur and presence of mild cyanosis?
atrioventricular canal defect
What clinical manifestation should the nurse expect to find during the assessment of an infant with coarctation of the aorta?
cooler lower extremities due to localized narrowing near the insertion of the ductus arteriosus
The nurse is caring for a child with heart failure. What teaching should the nurse give to the parents of the child about reducing the workload on the child's heart?
use medication to safely sedate the child
minimize the metabolic needs for the child.
After a patient returns from cardiac catheterization the nurse notes that the pulse distal to the catheter insertion site is weaker (+1). What is the most appropriate nursing intervention?
Documenting the findings and continuing to monitor the child (this is normal for the first few hours after catheterization)
A child with a severe peanut allergy accidentally ate a candy bar that contained peanuts. The child is now experiencing progressively worsening respiratory distress. What is the priority nursing intervention for this child?
establishing an airway
Which term describes the thickening and flattening of the tips of the fingers and toes that is thought to occur as a result of chronic tissue hypoxemia?
clubbing
The nurse is caring for a child with circulatory failure or shock. In which order does the nurse perform the interventions in the child's plan of care?
establish
a patent airway
administer 100% oxygen
restore the fluid volume
administer epinephrine
The nurse, preparing to give digoxin to a 9-month-old infant, checks the dosage and sees that 4 mL of the drug is to be drawn up. What is the most appropriate action by the nurse, drawing on knowledge of this medication and safe pediatric dosages?
Refrain from drawing up dose because there is an error in the dosage
T/F: the dosage for digoxin is typically greater than 1 mL
FALSE
it is rarely more than 1 mL for infants
How would you administer digoxin to an infant?
through a nipple in which the baby will suck it from OR
by placing it at the back and side of the mouth
Congenital heart defects have traditionally been divided into acyanotic and cyanotic defects. The nurse knows which information about this system in clinical practice?
Problematic because children with acyanotic heart defects may experience cyanosis
What teaching should the nurse give to the principal caregiver of a child about the administration of digoxin? Select all that apply.
administer
the drug every 12 hours
report frequent vomiting or poor feeding
give water after administering the drug
A patient has a blood pressure of 40 mm Hg at rest in the pulmonary arteries. The nurse also finds that the patient is not showing any response to vasodilator testing. Which treatment strategy may be beneficial for the patient?
Bosentan (endothelin-receptor antagonist)
reduces pulmonary artery pressure and resistance (the pt is experiencing pulmonary artery hypertension)
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