NR-328 Pediatric Nursing - Set 2 - Part 1

Correct Answer: The infant's narrower airway magnifies the effect of swelling

Airway resistance climbs steeply as the radius shrinks, so a millimeter of edema that barely narrows an 8-year-old's trachea slashes the infant's lumen and multiplies the work of moving air. Option b is incorrect because immature immunity governs how readily a child catches the virus, not how sick the airway becomes once infected. Both children caught the same organism; only the infant's caliber turned it into obstruction. Option c is incorrect because mucus volume is roughly comparable across ages with a common virus. The decisive factor is the tube it must pass through, since a small lumen chokes on secretions an older child clears easily. Option d is incorrect because a weak cough would leave secretions pooled and produce coarse rattling sounds rather than the high-pitched inspiratory noise heard here. Stridor points to a narrowed larynx, not to failed clearance.

Correct Answer: The findings may signal digoxin toxicity

Refusing to eat and vomiting are the first signs of digoxin toxicity in a baby, who cannot describe nausea or visual changes. The nurse arranges evaluation with a serum level and a rate check. Option a is incorrect because assuming a viral illness in a child on a narrow margin drug is the trap this scenario sets. Without fever or diarrhea, the medication deserves suspicion before anything else. Option b is incorrect because slowed absorption would show up as a weaker effect on the heart, not as gastrointestinal upset. Food does delay uptake, which is why doses are timed away from feedings. Option d is incorrect because pushing more milk into an infant who is already vomiting adds risk without addressing the cause. Volume was never the problem here; the drug level is what needs checking.

Correct Answer: Bringing the emergency airway cart to the room

Fetching equipment involves no assessment and no contact with the airway, so it fits the assistive role and shortens the response if the child obstructs. The nurse keeps every airway decision. Option b is incorrect because placing anything in the mouth of a child with a swollen epiglottis risks spasm and closure. Temperatures in this situation are taken by a route that leaves the mouth alone. Option c is incorrect because supine positioning lets the swollen tissue fall across the glottis, and this child must stay upright. Films are delayed until an airway is secured, and they are never an assistive task. Option d is incorrect because a culture swab reaches straight to the inflamed tissue and can provoke complete obstruction. Every member of the team leaves the throat untouched until intubation is complete.

Correct Answer: Apply suction only while withdrawing the catheter

Suction is applied on the way out only, which limits how long oxygen is pulled from the airway. Each pass in an infant stays near five seconds, and the nurse stops if the heart rate falls. Option a is incorrect because suctioning on the way in strips oxygen from the airway and scrapes the tracheal lining. Mucosal trauma and desaturation follow, and neither helps the infant breathe more easily. Option b is incorrect because repeated passes cause hypoxia, vagal bradycardia, and swelling of the airway. Three passes is the usual limit, with reoxygenation between them and a pause if the infant tires. Option d is incorrect because instilling saline is not a substitute for hydration and humidified gas, which thin secretions more reliably. Extra fluid down the tube can also push material deeper into the airway.

Correct Answer: Ventricular septal defect with left to right shunting

Blood driven from the higher pressure left ventricle through a septal opening makes a coarse sound across all of systole at the lower left border, and the turbulence is strong enough to feel. Option a is incorrect because an atrial opening produces a softer ejection sound high on the chest, with the second sound split and unchanging. Nothing in that description accounts for a palpable thrill low along the sternum. Option b is incorrect because ductal flow continues into diastole and would sound continuous rather than confined to systole. The bounding pulses and widened pulse pressure that mark a duct are absent in this infant. Option c is incorrect because narrowing of the aorta shows itself in the pulses and pressures, with strong arms and weak legs. Equal pulses in this infant rule that lesion out before the murmur is even considered.

Correct Answer: A high chloride level in the sweat

The defective channel keeps sweat glands from reabsorbing chloride, so the sweat is abnormally salty. Chloride measured after pilocarpine iontophoresis at sixty millimoles per liter or above confirms cystic fibrosis. Option a is incorrect because a low value points away from the disease. Sweat chloride below thirty millimoles per liter makes cystic fibrosis unlikely, since the glands are reclaiming chloride normally. Option b is incorrect because serum sodium is not the diagnostic measure here. Children with this disease more often lose salt through sweat and can arrive dehydrated with low sodium during hot weather. Option d is incorrect because urine chemistry plays no part in confirming this disorder. The abnormality lies in exocrine gland secretion, and the sweat gland is the accessible place to measure it.

Correct Answer: "If she throws up the dose, I will not repeat it"

There is no way to know how much drug was absorbed before the vomiting, so repeating it risks a double dose. The parent withholds it and reports vomiting that keeps happening. Option b is incorrect because re-dosing after vomiting can push an infant into toxicity, since some of the first dose almost certainly reached the bloodstream. Guessing at the amount absorbed is never safe with this drug. Option c is incorrect because doubling is the one action families must never take with digoxin. Two doses at once can drop the heart rate dangerously, and the correct move is to resume the regular schedule. Option d is incorrect because a dose remembered more than four hours late is skipped rather than given. Giving it that far behind schedule stacks it too close to the next dose and invites an excessive effect.

Correct Answer: Collateral air channels between alveoli are still sparse

The pores and canals that let air reach an alveolus around a blocked bronchiole stay undeveloped until about age two or three. Without that side route, the lung beyond a plug simply collapses. Option a is incorrect because airway smooth muscle is poorly developed in infancy, which is one reason bronchodilators work unpredictably in wheezing infants. Muscle maturity would not keep an obstructed segment inflated anyway. Option b is incorrect because a newborn carries only a fraction of the adult alveolar count, roughly twenty to fifty million against three hundred million. Less surface means less reserve, not a denser network. Option d is incorrect because treatment effectiveness explains nothing about why the segment collapsed in the first place. Physiotherapy is applied at many ages, and its usefulness depends on the diagnosis rather than the child's years.

Correct Answer: Apply oxygen and call for immediate help

A wheeze needs moving air, so a fading sound with rising effort means airflow has nearly stopped. Oxygen goes on first while the team is called for continuous bronchodilator therapy and possible intubation. Option a is incorrect because a quiet chest in a child working this hard signals loss of airflow, not relief. Telling the caregiver the attack has broken delays the escalation this child needs within minutes. Option b is incorrect because films confirm complications such as pneumothorax long after the airway crisis is settled. Sending an exhausted child to radiology removes them from oxygen and monitoring at the worst possible moment. Option c is incorrect because forcing a supine position takes away the upright posture that eases the work of breathing. Children in severe distress refuse to lie down for a reason, and that instinct should be respected.

Correct Answer: Bronchodilator, then vest therapy, then breakfast with enzymes

The bronchodilator opens airways so clearance moves more mucus, and clearance comes before eating to prevent vomiting. Enzymes go with the first bites of the meal, so breakfast lands last in this order. Option b is incorrect because percussion and vest oscillation on a full stomach make a child vomit. Therapy is scheduled before meals or a full two hours afterward, which this arrangement ignores. Option c is incorrect because starting the vest on constricted airways wastes the treatment. Opening the airway first lets oscillation reach mucus deeper in the lungs, and enzymes given after the meal miss the food they must digest. Option d is incorrect because enzymes taken before any airway therapy leave the child eating first and clearing later. Mucus stays in place through the morning, and the meal sits in a stomach about to be shaken.

Correct Answer: Reposition the head and lift the chin

A child's tongue is large for the oral cavity and falls against the posterior pharynx as consciousness fades. Head tilt with chin lift pulls it forward, and the snoring sound clears with the airway. Option a is incorrect because rigid suctioning treats secretions, and nothing here suggests the mouth is full of them. Stimulating the pharynx of a drowsy toddler can also provoke gagging, vomiting, and laryngospasm. Option c is incorrect because lying flat lets the tongue drop farther back and worsens the very obstruction producing the snore. Position supports the airway in children rather than threatening it. Option d is incorrect because a blood gas measures the damage after it has happened and takes minutes the toddler cannot spare. Open the airway first, then decide whether any laboratory study adds information.

Correct Answer: "If she starts wheezing at night I will give the fluticasone."

Fluticasone is a controller that suppresses inflammation over days and cannot open a tight airway during an attack. Reaching for it instead of albuterol at the first wheeze leaves the child untreated while symptoms build. Option b is incorrect because the rescue inhaler belongs wherever the child is, and schools expect one on site. Sending albuterol with her shows the caregiver understands which drug answers a sudden attack. Option c is incorrect because daily dosing during well periods is exactly how an inhaled steroid works, quieting inflammation before it flares. Stopping the drug when a child feels fine is the classic error, not this. Option d is incorrect because a short-acting beta agonist does relax airway muscle within minutes, which is why it is the rescue agent. Naming that speed correctly shows sound understanding rather than confusion.

Correct Answer: Place the infant knee to chest

Folding the knees onto the chest kinks the femoral arteries and raises systemic resistance, so blood is pushed into the pulmonary artery instead of across the septal defect. Repositioning comes before every other step. Option a is incorrect because oxygen cannot enrich blood that never reaches the alveoli. It is given during a spell, but only after position has redirected flow toward the lungs, and it is never the opening move. Option b is incorrect because morphine follows positioning and calming in the sequence. It settles the hard fast breathing and eases spasm of the outflow tract, yet reaching for a drug first delays the maneuver that works immediately. Option d is incorrect because a fluid bolus improves filling later in the response, once simpler measures are underway. Venous access takes time and the needle stick itself would deepen the crying that provoked this episode.

Correct Answer: Begin assisted ventilation with a bag and mask

A falling heart rate in a tiring infant signals hypoxia and a pre-arrest state, not calm. Effective ventilation with oxygen is the treatment, and compressions follow if the rate stays low with poor perfusion. Option a is incorrect because a slowing pulse in a child who has been working this hard is the opposite of recovery. Charting the trend while the infant goes limp delays the ventilation that prevents arrest. Option b is incorrect because a quiet environment helps an anxious child but does nothing for an infant losing the ability to breathe. Limpness with a falling rate calls for hands on the airway. Option c is incorrect because cultures answer a question about infection over the next day, while this infant has minutes. Bronchiolitis is viral anyway, so the specimen would neither change therapy nor restore oxygenation.

Correct Answer: Sweating on the forehead during feeding

Feeding is the infant's hardest work, so the strain shows there first. A baby who dampens the scalp and forehead while sucking is signaling a heart that cannot keep up with demand. Option a is incorrect because ankle swelling belongs to adults who spend the day upright. Fluid in a baby who is carried and lying down settles around the eyes and over the sacrum instead. Option c is incorrect because frothy pink sputum marks florid pulmonary edema, a late and dramatic event. Parents watching for early trouble need something they can notice long before the lungs flood. Option d is incorrect because an infant cannot report breathlessness. The nurse must translate that adult symptom into what a baby shows, namely fast breathing, tiring at the breast or bottle, and poor weight gain.

Correct Answer: Report any chickenpox or influenza exposure

Aspirin taken during chickenpox or influenza raises the risk of Reye syndrome. Telling the team about an exposure lets the provider weigh holding the drug before the child becomes ill. Option a is incorrect because skin shedding has no bearing on how long antiplatelet therapy runs. Low dose aspirin continues for six to eight weeks, and longer still when the coronary arteries look abnormal. Option b is incorrect because pairing the tablet with food is a comfort measure for stomach upset. That habit addresses nothing about the clotting risk or the viral exposures that make this drug dangerous. Option d is incorrect because a family cannot trade one drug for the other on their own. Aspirin here is preventing platelet clumping inside injured coronary arteries, a job ibuprofen does not perform.

Correct Answer: Wheezing with nasal flaring and retractions

Bronchiolitis inflames the small airways, so the infant wheezes, breathes fast, and recruits the nostrils and chest wall. Copious nasal secretions and poor feeding usually accompany the picture in the first year. Option a is incorrect because hoarseness with a brassy cough locates the trouble in the larynx and subglottis, the signature of croup. Bronchiolitis sits far lower, in the bronchioles, and produces wheeze instead. Option b is incorrect because focal dullness suggests consolidated lung tissue, the hallmark of bacterial pneumonia with a lobar pattern. Bronchiolitis scatters air trapping and crackles through both lungs rather than filling one segment. Option c is incorrect because drooling with painful swallowing describes supraglottic inflammation and belongs to the epiglottitis picture. An infant with bronchiolitis swallows normally and struggles instead with a blocked nose during feeds.

Correct Answer: Infants consume oxygen at roughly twice the adult rate

An infant burns oxygen at about double the adult rate while holding a smaller reserve in the lungs, so saturation falls within seconds of an interrupted breath. Passes stay short and oxygen is given between them. Option b is incorrect because functional residual capacity is proportionally smaller in infancy, not larger. The lung holds less standing oxygen, which is exactly why a prolonged pass empties the reserve so fast. Option c is incorrect because tolerance runs the other way; infants decompensate sooner and slide into bradycardia and arrest while an older child still compensates. Assuming tolerance would justify exactly the practice being corrected here. Option d is incorrect because vagal stimulation during suctioning commonly drops the heart rate in small children, and the nurse must stop the pass when it happens. Expecting a stable rate would delay that response.

Correct Answer: Droplet precautions with azithromycin therapy

Paroxysms ending in a whoop with post-tussive vomiting describe pertussis. The organism spreads in respiratory droplets, so droplet precautions apply, and azithromycin treats the child and limits spread to others. Option a is incorrect because ribavirin is an antiviral held in reserve for severe respiratory syncytial virus in high-risk infants. Pertussis is bacterial, and its droplets do not require a respirator or a negative pressure room. Option b is incorrect because amoxicillin covers ear infections and pneumococcal pneumonia rather than Bordetella. Contact barriers also miss the route of spread, since this organism launches from the airway during those violent coughing fits. Option c is incorrect because leaving a coughing child on standard precautions exposes everyone nearby, and untreated pertussis stays contagious for weeks. Comfort measures help, yet an antibiotic is still needed to shorten transmission.

Correct Answer: "I will stop the feeding after about thirty minutes"

Beyond roughly half an hour the infant burns more energy sucking than the milk supplies, so the parent ends the feed and offers smaller amounts more often through the day. Option a is incorrect because an unlimited feed exhausts a baby whose heart is already working overtime. The longer the effort drags on, the more calories are spent on the work of eating rather than on growth. Option b is incorrect because cereal thickens the milk without adding much usable energy and makes sucking harder. Calorie density is raised by fortifying breast milk or concentrating formula exactly as the cardiology team prescribes. Option d is incorrect because large widely spaced feeds are the opposite of what this infant tolerates. A stomach filled too full presses on the diaphragm and the effort of a long feed brings on tiring.