HESI Case Studies: Pediatrics – Asthma

Which of the school nurse’s observations are consistent with the diagnosis of bronchitis?
A dry cough that becomes productive.
Jamey’s mother asks the school nurse to explain the pulmonary function test. Which of the following is the best response?
“Pulmonary function tests are used to detect airflow limitation even when no symptoms are clinically evident.”
Since Jamey has moderate persistent asthma, which symptoms can the school nurse expect at baseline (with no treatment), if Jamey fails to adhere to controller medication use?
Nighttime cough more than once a week but not nightly.
In developing plan of care goals, the school nurse recognizes that what level of activity is appropriate for children with asthma?
Children with asthma should participate fully in all activities, including sports.
What measures can the school nurse take to ensure a trigger-free classroom environment?
Eliminate all sources of dust in the classroom.

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The school nurse recognizes that Jamey is using correct inhaler technique when Jamey does which?
He holds his breath for 10 seconds after inhaling the medication.
How should the school nurse intervene?
Discuss Jamey’s treatment plan with his mother and emphasize the benefits of controller medication.
The school nurse monitors Jamey for response to albuterol. What response might the nurse expect to observe?
Rapid heart rate.
Which of the following signs would alert the RN that respiratory arrest is imminent?
Rapid respirations with no wheezing.
What additional emergency medication should the RN anticipate preparing?
Methylprednisolone sodium succinate IV
Which of the following is a correct interpretation of Jamey’s current PEFR reading
Jamey is in the red zone. There is severe airway narrowing.
In preparing the SBAR report to the unit staff, what are the priority data points the ED RN must communicate?
Acute asthma exacerbation precipitated by an upper respiratory infection, PEFR reading, medications given with response to treatment, and respiratory assessment.
Which of the following nursing diagnoses best describes the underlying pathophysiologic process for a child with an acute asthma exacerbation?
Ineffective airway clearance related to inflammation and constriction of the bronchial tree.
What are the highest priority acute care nursing interventions for the RN to include in Jamey’s plan of care?
Frequent vitals signs with pulse oximetry monitoring, assessing response to medication.
Using knowledge of child development, the RN interprets Jamey’s behavior as which?
Appropriate for age in a preschooler.
Which of the following would be an appropriate play activity for Jamey to express his feelings?
Drawing and painting.
Based on knowledge of asthma as a chronic inflammatory disease, in this case complicated by allergic rhinitis, what is the best response of the RN?
Asthma is not truly outgrown, but we will teach you measures to control symptoms so that Jamey can lead a normal life.
What are the client education priorities during the acute care phase?
How to use the inhaler with spacer.
Parental recognition of early warning signs.
Reducing the risk of upper respiratory tract infections.
Controller and rescue medication use.
Which of the following is the best intervention for the RN to implement to assure partnership with both parents and continuity of care on weekends?
Request an educational session with both parents in the primary pediatric care setting.
The RN should stress which of the following as early signs of impending asthma attack?
Cough in the middle of the night?
Which of the following is the correct method of assessing the level of medication in the inhaler?
Count and record the number of inhalations used.
Which of the following strategies should the RN address to reduce exposure to airborne allergens in the home?
Focus on eliminating dust in the room where Jamey sleeps.
Remove trash daily.
Stop smoking.
Eliminate clutter.
Which of the following would be the best strategy?
Teach Jamey to blow a pin wheel.
The response of the RN is based on what knowledge about salmeterol xinafoate?
Salmeterol xinafoate cannot be used to treat acute symptoms.
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