Ch. 32 (STUDY GUIDE) Flashcards
1
Q
Group A beta-hemolytic streptococcus (GABHS) infection of the upper airway?
A
Strep throat
2
Q
Determines the extent to which the pt’s serum will agglutinate sheep RBCs; used to DX infectious MONO (titer of 1:160 required for DX); rapid, sensitive, inexpensive, and easy to perform?
A
Heterophil antibody testing
2
Q
Barrel chest indicates?
A
Severe obstructive lung disease (CF, asthma)
3
Q
An inflammation of the middle ear and mastoid; characterized by perforation and discharge (otorrhea) lasting up to 6 mo?
A
Chronic suppurative OM
3
Q
Diaphragmatic differences in infants under 5 years of age?
A
Diaphragmatic abdominal breathing
4
Q
Assesses the mobility of the tympanic membrane, using air transmission?
A
Pneumatic otoscopy
4
Q
When are respirations (ventilations) best to assess and best determined in a child/infant?
A
While sleeping or quietly awake
5
Q
The test to assess mobility of the tympanic membrane using sound transmission?
A
Tympanometry
5
Q
When should an infant be able to hold their head up?
A
4-5 mo
6
Q
An acute viral infection with MAX effect at the bronchiolar level?
A
Respiratory syncytial virus (RSV)
6
Q
Tachypnea often occurs with?
A
AnxietyElevated tempSevere anemiaMetabolic acidosisMAY be assoc. w/resp alkalosis d/t psychoneurosis and w/CNS disturbances.
7
Q
The type of pneumonia in which the inflammatory process is confined w/in the alveolar walls and the peribronchial and interlobular tissues?
A
Interstitial pneumonia
7
Q
Hyperpnea is assoc. with?
A
FeverSevere anemiaRespiratory alkalosis assoc. w/psychosisCNS disturbancesResp acidosis that accompanies DKA/diarrhea
8
Q
NEBU epinephrine; used in children with stridor at rest, retractions, acute epiglottitis, or difficulty breathing?
A
Racemic epinephrine
8
Q
Head bobbing in a sleeping or exhausted infant is a sign of ?
A
Dyspnea
9
Q
A sx complex characterized by hoarseness, a resonant cough described as “barking” of “brassy”, inspiratory stridor, and respiratory distress from swelling in the region of the larynx?
A
Croup
9
Q
COMMON causes of stridor?
A
CroupEpiglottitisFBTracheitis
10
Q
An antiviral agent; the only specific therapy approved for hospitalized children with RSV?
A
Ribavirin
10
Q
Grunting in older children is frequently a sign of?
A
Pain, suggesting pneumonia or pleural involvement.
11
Q
RSV monoclonal antibody; the only product available in the U.S. for prevention of RSV; administered monthly IM; used to prevent RSV in HIGH-RISK infants?
A
Palivizumab
11
Q
GRUNTING from an infant or newborn is a characteristic sign of?
A
Respiratory distress
12
Q
Inflammation of the large airways, frequently associated with an URI; primarily caused by VIRAL agents?
A
Tracheobronchitis
12
Q
What causes wheezing in infants?
A
Increased airway resistance and a compliant chest wall.Inflammatory mediators (histamines, leukotrienes, interleukins)
13
Q
- The largest percentage of respiratory tract infection in children are caused by?
A
Viruses
13
Older children often have wheezing because of?
A LRI as a result of inflammation, bronchospasm, and secretions
14
7. The most likely reason that the respiratory tract infection rate increases drastically in the age range from 3 to 6 months is that the:
a. infant's exposure to pathogens is greatly increased during this time
b. viral agents that are mild in older children are severe in infants
c. maternal antibodies have disappeared and the infant's own antibody production is immature.
d. diameter of the airways is smaller in the infant than in the older child.
C
14
Criteria for the presence of clubbing?
Angle \> 160 degrees and decided curvature of the nail
15
8. A febrile seizure is least likely to be associated with:
A. fever in a 2 y/o child
B. a family HX of febrile seizures
C. fever in an 8 y/o child
D. all of the above
C
15
8. Of the following resp system structures, the one that does not distribute air is the:a. bronchialb. alveolusc. bronchusd. trachea
B
16
10. Bobby is a child w/a respiratory disorder who needs BR but who is not cooperating. The RN's best choice is to:
A. be sure his mother takes the advice seriously
B. allow him to play quietly on the floor
C. insist that he play quietly in bed
D. allow him to cry until he stays in bed
B
16
9. The general shape of the chest at birth is:a. relatively roundb. flattened from side to sidec. flattened from front to backd. the same shape as an adult's
A
17
11. For an older child who can tolerate decongestants & who is having difficulty breathing through his stuffy nose, the RN should recommend:
A. dextromethorphan nose drops
B. phenylephrine nose drops
C. dextromethorphan cough squares
D. steroid nose drops
B
17
10. The infant relies primarily on:a. mouth breathingb. intercostal muscles for breathingc. diaphragmatic abdominal breathingd. all of the above
C
18
12. Children w/nasopharyngitis may be treated with:
A. decongestants
B. antihistamines
C. expectorants
D. all of the above
A
18
11. Because of the position of the diaphragm in the newborn:a. there is additional abd dist from gas and fluid in the stomach.b. the diaphragm does not contract as forcefully as that of an older infant or child.c. diaphragmatic fatigue is uncommond. lung volume is increased
B
19
13. The best technique to prevent spread of nasopharyngitis is:
A. prompt immunization
B. to avoid contact with infected persons
C. mist vaporization
D. to ensure adequate fluid intake
B
19
12. Which of the following is true in regard to the anatomy of an infant's nasopharyngeal area?a. the glottis is deeping in infants than older childrenb. the laryngeal reflexes are weaker in infants than older childrenc. the epiglottis is longer and projects more posteriorly in infants than adults.d. the infant and youg child are both less susceptible than adults to edema formation in the nasopharyngeal region.
C
20
14. Group A β-hemolytic streptococci infection is usually a:
A. serious infection of the upper airway
B. Common cause of pharyngitis in children over the age of 15 years.
C. brief illness that leaves the child at risk for serious sequelae.
D. disease of the heart, lungs, joints, & CNS.
C
20
13. List four anatomic factors that significantly affect the development of respiratory disorders in infants.
Fewer # of alveoliSmaller size of alveoliMore shallow air sacksDecreased surface area for gas exchange
21
15. The diagnosis of group A β-hemolytic streptococcus should be based on:
A. antibody responses
B. antistreptolysin O responses
C. CBC
D. throat culture
D
21
14. The condition that is most likely to reduce the # of alveoli in the newborn is:a. maternal heroin useb. increased prolactinc. hyperthyroidismd. kyphoscoliosis
D
22
17. Offensive mouth odor, persistent dry cough, & a voice with a muffled nasal quality are commonly the result of:
A. pneumonia
B. otitis externa
C. tonsillitis
D. OM
C
22
15. As a child grows, chest wall comopliance:a. increasesb. decreases
B
23
18. An adenoidectomy would be contraindicated in a child:
A. with recurrent OM
B. with malignancy
C. with thrombocytopenia
D. under the age of 3 years
C
23
16. As the child grows, elastic recoil of the lungs:a. increasesb. decreases
A
24
19. In the post-op period following a tonsillectomy, the child should be:
A. placed in Trendelenburg position
B. encouraged to C&DB
C. suctioned vigorously to clear the airway
D. observed for signs of hemorrhage
D
24
17. Relaxation of the bronchial smooth muscles occurs in response to:a. parasympathetic stimulationb. inhalation of irritating substancesc. sympathetic stimulationd. histamine release
C
25
20. Pain meds for the child in the post-op period following a tonsillectomy should be administered:
A. PO at regular intervals
B. PO PRN
C. PR or IV at regular intervals
D. PR or IV PRN
C
25
18. Room air (ambient air) consists of:a. 7% O2b. 21% O2c. 50% O2d. 79% O2
B
26
21. Of the following foods, the most appropriate to offer 1st to an alert child in the post-op period following a tonsillectomy would be:
A. ice cream
B. red gelatin
C. flavored ice pops
D. all of the above
C
26
19. A child with anemia tends to be fatigued and breathe more rapidly, b/c the majority of O2 is carried through blood as:a. a solute dissolved in the plasma and the H2O of the RBCsb. bicarbonate and hydrogen ionsc. carbonic acidd. oxyhemoglobin
D
27
23. In about half of all cases of infectious mono, there will be:
A. skin rash
B. OM
C. splenomegaly
D. FTT
C
27
21. In a child, cough may be absent in the early stages of:a. CFb. measlesc. pneumoniad. croup
C
28
24. DX of infectious mono is established when the:
A. RBC count is depressed
B. leukocyte count is depressed
C. heterophil agglutination test is positive
D. heterophil agglutination test is negative
C
28
A sign of dyspnea in the infant who is sleeping or exhausted?
Head bobbing
29
25. Infectious mono is usually a:
A. disease complicated by pneumonitis & anemia.
B. self-limiting disease
C. disabling disease
D. difficult and prolonged disease
B
29
Respirations are too deep?
Hyperpnea
30
26. Clinical manifestations of influenza usually include all of the following EXCEPT:
A. N/V
B. fever and chills
C. sore throat & dry mucous membranes
D. photophobia and myalgia
A
30
Respirations are too shallow?
Hypopnea
31
27. The infant is predisposed to developing OM because the eustachian tubes:
A. lie in a relatively horizontal plane
B. have a limited amount of lymphoid tissue.
C. are long and narrow
D. are underdeveloped
A
31
May be a complaint of older children; may be caused by disease of any of the chest structures?
Chest pain
32
28. List at least 5 complications of OM.
Tympanic membrane retraction Tympanosclerosis Tympanic perforation Adhesive OM Chronic suppurative OM Labyrinthitits Mastoiditis Meningitis Cholesteatoma
32
May be referred to the base of the neck posteriorly and anteriorly or to the abdomen?
Diaphragmatic pleural irritation
33
29. The clinical manifestations of OM include:
A. purulent discharge in the external auditory canal.
B. clear discharge in the external auditory canal
C. enlarged axillary lymph nodes
D. enlarged cervical lymph nodes
D
33
Significant finding in an infant; helps reduce resistance and maintain airway patency?
Nasal flaring
34
30. An abnormal otoscopic exam would reveal:
A. visible landmarks
B. a light reflex
C. Orange tympanic membrane
D. mobile tympanic membrane
C
34
Proliferation of tissue at the terminal phalanges; associated with chronic hypoxia; does NOT reflect disease progression?
Clubbing
35
16. A strategy for the prevention of strep disease would be for the RN to recommend that children w/strep infection: A. not return to school until after 48hr of abx TX B. discard & replace toothbrush after 24hr of abx TX C. not return to school until after 36hr of abx TX D. discard & replace toothbrush as soon as the streptococcus is identified
B
35
Frequently associated with hypertrophied adenoidal tissue, choanal obstruction, polysps, or foreign body in the nasal passages?
Noisy breathing
36
31. ABX most likely to be prescribed for uncomplicated OM?
Amoxicillin
36
Usually localized over the affected area and aggravated by respiratory movement?
Parietal pleural pain
37
32. To help alleviate the discomfort & fever of OM, the nurse may administer:
A. acetaminophen or ibuprofen
B. antihistamines and decongestants
C. analgesic ear drops
D. all of the above
A
37
Frequently a sign of chest pain; suggests acute pneumonia, pleural involvement, pulmonary edema, or respiratory distress syndrome; increases end-respiratory pressure and prolongs gas exchange?
Grunting
38
34. Children with tympanostomy tubes should:
A. swim only in freshwater lakes w/o earplugs
B. keep bath water out of the ear
C. notify Dr. immediately if a grommet appears
D. never allow any water to enter their ears
B
38
Performed to assess adequacy of collateral circulation?
Allen test
39
36. Most children with croup syndromes:
A. require hospitalization
B. will need to be intubated
C. can be cared for at home
D. are over 6 years old
C
39
HgB saturated with O2?
Oxyhemoglobin
40
37. Of the following croup syndromes, the one that is potentially life-threatening is:
A. spasmodic croup
B. laryngotracheobronchitis
C. acute spasmodic laryngitis
D. epiglottitis
D
40
A noninvasive method of continuously monitoring partial pressure of O2 in arterial blood; may also be used to measure CO2?
Transcutaneous monitoring
41
38. The RN should suspect epiglottitis if the child has:
A. cough, sore throat, and agitation
B. cough, drooling, and retractions
C. drooling, agitation, and absence of cough
D. hoarseness, retractions, and absence of cough
C
41
HgB capable of carrying O2?
Functional HgB
42
39. If a child is suspected of having epiglottitis, the nurse should:
A. have intubation equipment available
B. prepare to immunize the child for H. influenzae.
C. obtain a throat culture
D. all of the above.
A
42
HgB that is not saturated with O2?
Deoxyhemoglobin
43
40. Since the advent of immunization for H. influenzae, there has been a decrease in the incidence of:
A. laryngotracheobronchitis
B. epiglottitis
C. Reye syndrome
D. croup syndrome
B
43
Reduced blood oxygenation?
Hypoxemia
44
41. Of the following children, the one who is most likely to be hospitalized for TX of croup is:
A. a 2 y/o whose croupy cough worsens @ night
B. a 5 y/o whose croupy cough worsens @ night
C. a 2 y/o using the accessory muscles to breath
D. a child w/inspiratory stridor during physical exam
A
44
A hazard of O2 therapy; may occur in persons with chronic pulmonary disease; seldom encountered in children except those with CF?
Oxygen-induced CO2 narcosis
45
42. The primary therapeutic regimen for croup usually includes:
A. vigilant assessment, racemic epinephrine, & corticosteroids.
B. vigilant assessment, racemic epinephrine, & abx.
C. intubation, racemic epinephrine, & corticosteroids.
D. intubation, racemic epinephrine, & abx.
A
45
Examples: Passy-Muir, Kistner, and Tucker; not appropriate for use in seriously ill children, children using a trach cuff, or children with copious secretions?
Speaking valves
46
43. The condition that is most likely to require intubation is:
A. acute spasmodic laryngitis
B. bacterial tracheitis
C. acute laryngotracheobronchitis
D. acute laryngitis
B
46
Used to help move secretions toward the head during exhalation?
Vibration
47
44. RSV is:
A. an uncommon virus that usually causes bronchiolitis.
B. an uncommon virus that usually does not require hospitalization.
C. a common virus that usually causes severe bronchiolitis.
D. a common virus that usually does NOT require hospitalization.
D
47
A new type of MDI that does NOT require a spacer device?
Rotahaler or Turbuhaler
48
45. In the infant who is admitted with possible RSV, the RN would expect the lab to perform:
A. the ELISA antibody test on nasal secretions
B. a viral culture of the stool.
C. a bacterial culture of nasal secretions.
D. an anaerobic culture of the blood.
A
48
A form of CPB; provides both pulmonary and cardiac support?
ECMO
49
46. Nursing care for pts with severe acute respiratory syndrome predominantly involves:
A. ABX
B. antivirals
C. supportive care
D. steroids
C
49
Techniques that are useful with older motivated children with kyphoscoliosis, CF, asthma, or bronchiectasis?
Breathing and postural exercises
50
47. What is the most common cause of pneumonia in EACH of the following age groups:
1. ) Over 5 years of age
2. ) 3 months to 5 years old
3. ) Under 3 months
1.) M. pneumoniae 2.) H. influenzae 3.) Streptococcus pneumoniae
50
The method of O2 administration that is BEST tolerated by infants?
O2 hood
51
48. Closed chest drainage is most likely to be used with the type of pneumonia that is caused by:
A. H. influenzae
B. M. pneumoniae
C. S. pneumoniae
D. Staphylococcus pneumoniae
D
51
A generic term for devices that use a rapid cycling rate and deliver small tidal volumes with each cycle?
High-frequency ventilation
52
Two of the more serious sequelae of strep throat?
Acute Rheumatic Fever AGN
52
A method of O2 administration that is NOT usually well tolerated by children?
Oxygen mask
53
Absence of airflow (or absence of breathing that lasts for more than 20 seconds?)
Apnea
54
Occurs in 2 conditions: (1) when there is increased work of breathing with near-normal gas exchange function, and (2) when hypoxemia and acidosis develop secondary to CO2 retention?
Respiratory insufficiency
55
Absence of air flow that occurs when no respiratory efforts are present?
Central apnea
56
Condition in which components of central and obstructive apnea are present?
Mixed apnea
57
The cessation of respiration?
Respiratory Arrest
58
Disease involving increased resistance to airflow?
Obstructive lung disease
59
Disease involving impaired lung expansion?
Restrictive lung disease
60
May be caused by cerebral trauma, intracranial tumors, CNS infection, tetanus?
Respiratory center depression
61
Includes pulmonary edema, fibrosis, embolism?
Pulmonary diffusion defect
62
Used to relieve FB obstruction in infants; involves hand placement over the spine b/w the shoulder blades?
Back blows
63
Involves a series of nondiaphragmatic abdominal thrusts; recommended for children over 1 y/o?
Heimlich maneuver
64
25. When an infant's digits are connected to a pulse ox, the part of the sensor that is placed on the top of the nail is called the:a. photodetectorb. microprocessorc. Light-emitting diode (LED)d. electrode
C
65
31. In children, O2-induced CO2 narcosis is encountered most frequently with:a. prematurityb. asthmac. CFd. congenital heart disease
C
66
32. For a child under 5 y/o who needs intermittent delivery of an aerosolized med, the nurse should consider using a:a. hand-held NEBUb. MDI with a spacer devicec. humidified mist tent with low-flow O2d. MDI w/o a spacer device
B
67
33. Postural drainage should be performed:a. before meals but after other respiratory therapyb. after meals but before other respiratory therapyc. before meals and before other respiratory therapyd. after meals and after other respiratory therapy
A
68
35. Which of the following pts is likely to benefit from CPT that includes forced expiration combined with postural drainage?a. pts with pneumoniab. uncomplicated surgical ptsc. pts with increased sputum productiond. all of the above
C
69
36. Chest percussion is being performed correctly if:a. it makes a slapping soundb. it is painfulc. a soft circular mask is usedd. it is performed over the rib cage & diaphragm
C
70
37. The BEST method to stimulate deep breathing in a child is to:a. have child cover mouth & suppress coughb. have child cough repeatedlyc. use games that extend expiratory time& pressured. leave some balloons at the bedside for the child to blow up
C
71
38. To avoid barotrauma when using the bag-valve-mask device, the nurse shoulda. use the type without a reservoirb. use the type with a pop-off valvec. use a low O2 concentrationd. hyperextend the infant's neck
B
72
40. The MOST severe complication that can occur during intubation is:a. infectionb. sore throatc. laryngeal stenosisd. hypoxia
D
73
41. Of the following vacuum pressures, the MOST acceptable pressure to use to suction the trach of a child is:a. 30 mm hgb. 50 mm hgc. 70 mm hgd. 120 mm hg
C
74
44. For a trach dressing, it would be INCORRECT to use:a. DuoDERM CGFb. Allevyn dressingc. a wet 4X4 gauze pad cut into the needed shape.d. Hollister Restore
C
75
45. After the initial post-op change, the trach tube is usually changed:a. Weekly by the surgeonb. Weekly by the nurse or familyc. Monthly by the surgeond. Monthly by the nurse or family
B
76
47. A trach with a speaking valve:a. decreases secretionsb. decreases child's sense of taste and smellc. limits gas exchanged. has no effect on the ability to swallow
A
77
50. Of the following strategies, the one that is LEAST likely to decrease the O2 demand of the child with respiratory distress is:a. maintain child's body temp WNLb. place child in supine positionc. control paind. maintain a warm room temp
B
78
51. Cardiac arrest in the pediatric population is MOST often a result of:a. atherosclerosisb. congenital heart diseasec. prolonged hypoxiad. undiagnosed cardiac conditions
C
79
53. The nurse should place the bag-valve-mask over both the mouth & nose for individuals whose age is:a. birth to 1 yrb. 1 to 3 yrsc. birth to 3 yrsd. birth to 2 yrs
A
80
54. The brachial pulse is the preferred site to use to assess circulation in the:a. infantb. school-aged childc. adolescentd. adult
A
81
55. In a child who is conscious & choking, the RN should attempt to relieve the obstruction if the child:a. is making soundsb. has an effective coughc. has stridord. all of the above
C
82
Increases CO and HR by blocking vagal stimulation in the heart?
Atropine
83
The first choice for V-Tach that is refractory to defibrillation is ?
Amiodarone
84
Used for hypermagnesemia; needed for normal cardiac contractility?
Calcium chloride
85
Causes vasoconstriction and increases CO?
Dopamine
86
Used for ventricular dysrhythmias?
Lidocaine
87
Acts on alpha and beta receptors, causing contraction, especially at the site of the heart, vascular, and other smooth muscle?
Epinephrine
88
Administered rapidly; causes a temporary block through the AV node?
Adenosine
89
Used to buffer the pH?
Sodium bicarbonate
90
The Heimlich maneuver is recommended for children over the age of:a. 4 yrsb. 3 yrsc. 2 yrsd. 1 yr
D
