Misc-Ped from Sills

Question 1

You are called to the ER to help evaluate a pediatric patient. On entering the room, you observe the patient’s breathing effort and can hear a harsh, high-pitched sound on inspiration. Which of the following are true?
A. Sounds are tracheal & normal
B. Sounds are bronchovesicular and not normal
C. Sounds are stridorous and indicate a respiratory emergency
D. Sounds are bronchial and indicate a respiratory emergency

Answer 1

C. Sounds are stridorous and indicate a respiratory emergency

Question 2

A tension pneumothorax is identified by which of the following?
1. Chest x-ray film shows a shift of the mediastinum toward the affected lung.
2. Chest x-ray film shows elevation of the hemidiaphragm on the affected side
3. The patient’s vital signs suddenly deteriorate
4. Chest x-ray film shows a depression of the hemidiaphragm on the affected side
5. Chest x-ray film shows a shift of the mediastinum away from the affected lung
6. Vital signs are essentially unchanged
A. 1, 2, 6
B. 3, 4, 5
C. 1, 2, 3
D. 1, 3, 4

Answer 2

B. 3, 4, 5
Patient’s vital sign suddenly deteriorate
Chest xray shows a depression of the hemidiaphragm on the affected side
Chest x-ray film shows a shift of the mediastinum away from the affected lung

Question 3

Your patient is complaining of localized pain over the lower right area of the chest while breathing.  When you auscultate her chest, you hear a rasping noise at the point of pain on both inspiration and expiration.  This is most likely 
A.  Pleural friction rub
B.  Normal breath sounds
C.  Wheeze
D.  Rhonchi

Answer 3

A. Pleural friction rub

Question 4

All of the following could result in a mediastinal shift on a chest x-ray film except:
A.  Right sided hemothorax
B.  Bilateral lower lobe pneumonia
C.  Left sided tension pneumothorax
D.  Right lower lobe atelectasis

Answer 4

B. Bilateral lower lobe pneumonia

Question 5

A patient who is suffering respiratory distress would exhibit all of the following except
A. Normal respiratory rate
B. Nasal flaring
C. Intercostal retractions
D. Use of accessory muscles of inspiration

Answer 5

A. Normal respiratory rate

Question 6

A recently home-delivered baby is brought in to the ER.  The physician asks you to help evaluate her condition.  Normal vital signs for a term newborn include all of the following except
A.  HR of 130 min
B.  Rectal temperature of 36.5 C
C.  BP of 60/40 mmHg
D.  RR of 20 min

Answer 6

D. RR of 20 min

Question 7

You are assisting with the delivery of a high risk infant. After evaluating the infant, you give it a 5 min APGAR score of 8 and recommend that the assisting nurse & physician:
A. Give the infant supplemental oxygen
B. Give themother supplemental O2
C. Begin bag-mask rescue breathing on the infant
D. Give the infant to the mother as soon as possible for bonding.

Answer 7

D. Give the infant to the mother as soon as possible for bonding

Question 8

A young adult who had surgery for deviated nasal spetum was accidentally given 2 L of IV fluind in 1 hour.  Which of the following signs cause you to suspect that the patient is fluid overloaded?
1.  Tachycardia
2.  Bradycardia
3.  High urine specific gravity
4.  Peripheral edema in the dependent parts of the body
5.  Low urine specific gravity
A.  1, 4, 5
B.  3, 4
C.  1, 3
D.  2, 5

Answer 8

A. 1, 4, 5
Tachycardia
Peripheral edema in dependent parts of body
Low urine specific gravity

Question 9

You are called to pediatrics dept to help in evaluation and care of 4 yr old girl who has been sick with a bad cold for the past 2 days.  The nurse shows you a lateral neck radiograph of the child and asks for your opinion.  You notice a clear air column through the upper airway but a pointed narrowing of the tracheal air column below the larynx.  You tell the nurse that you suspect the child has
A.  Laryngotracheobronchitis
B.  Aspirated a coin
C.  Epiglottitis
D.  Bilateral upper lobe pneumonia

Answer 9

A. Laryngotreacheobronchitis

Question 10

A 3 day old newborn is brought into the ER with her father after they were involved in a car accident.  The newborn is showing signs of respiratory distress with cyanosis and tachycardia.  What test would you recommend to determine whether she has a pneumothroax?
A.  ABG
B.  APGAR score
C.  Transillumination
D.  Thoracentesis

Answer 10

C. Transillumination

Question 11

You have been assisting with the insertion of a flow directed, balloon-tipped pulmonary artery catheter.  After the procedure, a chest x-ray was taken.  It would be acceptable to take a mixed-venous blood sample from the catheter if the tip were found in the?
A.  Right pulmonary artery
B.  Superioror Vena Cava
C.  Aortic Arch
D.  Right ventricle

Answer 11

A. Right pulmonary artery

Question 12

You are assisting in the delivery of a high risk neonate. At 1 minute after birth, the following are noted:
HR is 90 bpm
There is a weak cry
Arms & legs show some flexion
The baby grimaces when a nasal catheter is inserted into a nostril
Extremities are blue with a pink body (acrocyanosis)
You would give the neonate an Apgar score of:
A. 3
B. 5
C. 7
D. 9

Answer 12

B. Apgar score would be 5