Nurse Veronica is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature?
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Solution
Eustachian tubes
B: In a child, Eustachian tubes are short and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media.
A,C,D: The nasopharynx, tympanic membrane, external ear canal have no unusual features that would predispose a child to otitis media.
Which of the following is the best method for performing a physical examination on a toddler
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Solution
From least to most intrusive
D: When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive.
A: Starting at the head or abdomen is intrusive and should be avoided.
B: Proceeding from distal to proximal is inappropriate at any age.
When assessing a child’s cultural background, the nurse in charge should keep in mind that:
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Solution
Behavioral patterns are passed from one generation to the next
D: A family’s behavioral patterns and values are passed from one generation to the next.
A: Although heritage plays a role in culture, it does not dictate a group’s shared values and its effect on culture is weaker than that of behavioral patterns.
B: Physical characteristics do not indicate a child’s culture.
C: Cultural background commonly plays a major role in determining a family’s health practices.
Which of the following respiratory conditions is always considered a medical emergency?
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Solution
Epiglottiditis
C: Epiglottiditis, acute and severe inflammation of the epiglottis, is always considered an acute medical emergency because it can lead to acute, life-threatening airway obstruction.
A: Asthma is a chronic disease; however, status asthmaticus and acute attacks require prompt treatment.
B: CF is a chronic disease and is not considered an emergency.
D: Acute LTB requires close observation for airway obstruction, but this condition is not always an emergency.
Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions?
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Solution
Epiglottitis
C: Epiglottitis is a bacterial infection of the epiglottis primarily caused by Hib. Administration of the vaccine has decreased the incidence of epiglottitis.
A: Bronchiolitis is usually caused by Respiratory Syncytial Virus (RSV).
B: Acute LTB is of viral origin.
D: The most common bacterial organisms causing pneumonia in children are pneumococci, streptococci, and staphylococci.
Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media?
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Solution
Avoiding contact with people who have upper respiratory tract infections
D: Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection.
A: A bottle-fed child should be fed in an upright position because feeding the child in the supine position may actually precipitate otitis by allowing the formula to pool in the pharyngeal cavity.
B: Amoxicillin, when prescribed, should be given with food to prevent stomach upset.
C: Cotton swabs can cause injuries such as tympanic perforation. They may be used to clean the outer ear, but they should never be inserted into the ear canal.
The Andrews family has been taking good care of their youngest, Archie, who was diagnosed with asthma. Which of the following statements indicate a need for further home care teaching?
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Solution
“We’ll make sure that he avoids exercise to prevent attacks.”
B: Additional teaching is needed if the family states that the child with asthma should avoid exercise to prevent attacks. Children with asthma should be encouraged to exercise as tolerated.
A,C,D: Identifying triggers, using a bronchodilator inhaler before a steroid inhaler, and increasing fluid intake are appropriate measures to be included in a home care teaching program for the child with asthma and his family.
Archie who weighs 44 lb has been given an order for amoxicillin 500 mg b.i.d. The drug text notes that the daily dose of amoxicillin is 50 mg/kg/day in two divided doses. What dose in milligrams is safest for this child?
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Solution
500 mg
C: First, calculate the child’s weight in kg: 44/2.2 = 20 kg. Then calculate the appropriate daily dose according to the drug text: 50 mg/kg/day = 50 mg × 20 kg = 1,000 mg/day. the abbreviation b.i.d. means twice daily; therefore 1,000 divided by 2 equals 500 mg.
Baby Melody is a neonate who has a very low-birth-weight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following?
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Solution
Bronchopulmonary dysplasia (BPD)
B: Close monitoring of inspiratory pressure and O2 concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O2 concentrations especially in very low-birth-weight and extremely low-birth-weight neonates with lung disorders.
A: Meconium aspiration syndrome is a respiratory disorder created by the aspiration of meconium in perinatal period.
C: RSV is a group of viruses that cause respiratory tract infections, such as bronchiolitis and pneumonia.
D: RDS, a disorder caused by lack of surfactant, usually is found in premature neonates.
Fred is a 12-year-old boy diagnosed with pneumococcal pneumonia. Which of the following would Nurse Nica expect to assess?
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Solution
Chest pain
C: Older children with pneumococcal pneumonia may complain of chest pain.
A,B: A mild cough and slight fever are commonly assessed with viral pneumonia.
D: A bulging fontanel may be seen in infants with meningitis or increased intracranial pressure.