Unit7: Ch 30 (Porth's 5th Ed) - Respiratory Tract Infections and Neoplasms Flashcards
In understanding the pathology of pneumoccocal pneumonia, what occurs in the gray hepatization stage?
a. The alveolar exudate is removed and the lungs gradually return to normal.
b. Capillary congestion leads to massive outpouring of polymorphonuclear leukocytes and red blood cells, leaving the lung red.
c. Macrophages phagocytose the red blood cells and other cellular debris, leaving the lung firm and less congested.
d. The alveoli become filled with rich edema fluid containing numerous organisms.
Correct Response:Macrophages phagocytose the red blood cells and other cellular debris, leaving the lung firm and less congested.
Rationale:In the gray hepatization stage, macrophages phagocytose the fragmented polymorphonuclear cells, RBCs, and other cellular debris. Alveolar exudate is removed in the resolution stage, while the lung becomes red during the red hepatization phase. The alveoli become filled with rich edema fluid in the edema stage.
A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:
A. Pulling in of the soft tissue surrounding the cartilaginous and bony thorax
B. Nasal obstruction and inhalation occurring through the mouth rather than the nares
C. The collapse of intrathoracic airways because of air trapping
D. Increased turbulence of air moving through the obstructed airways
Correct Response:
D. Increased turbulence of air moving through the obstructed airways
Rationale:The crowing sound of stridor occurs with the increased turbulence of air moving through the obstructed airways. Pulling in of the soft tissue surrounding the cartilaginous and bony thorax describes the mechanisms that produce inspiratory retractions. The collapse of intrathoracic airways because of air trapping describes the mechanism for the production of wheezing.
A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:
A. Lower lung lobe pain
B. Hemoptysis
C. Mild cough and fever
D. Hoarseness and difficulty swallowing
Correct Response:
D. Hoarseness and difficulty swallowing
Rationale:Tumors that invade the mediastinum cause hoarseness, difficulty in swallowing, and retrosternal pain. Hemoptysis may occur but is not specific to mediastinal involvement.
A 3-year-old boy has been diagnosed with croup (acute laryngotracheobronchitis). The nurse anticipates the plan of care to include:
A. Chest physiotherapy to loosen secretions
B. Antibiotics to decrease the infection
C. Cool, humidified air to relieve airway spasms
D. Bronchodilating agents to open bronchioles
Correct Response:
C. Cool, humidified air to relieve airway spasms
Rationale:Acute laryngotracheobronchitis (viral croup) is best treated with cool, humidified air. Chest physiotherapy would not be beneficial because there are no secretions to remove and medications would not be required.
Which assessment findings concern the presence of respiratory distress in an infant? Select all that apply.
A. Sternal retraction
B. Respiratory rate of 95 breaths/min
C. Central cyanosis
D. Wheezing
E. Grunting
Correct Response:
A,B,C,E
Sternal retraction, Respiratory rate of 95 breaths/min, Central cyanosis, Grunting
Rationale:Infants with respiratory distress syndrome (RDS) present with multiple signs of respiratory distress, usually within the first 24 hours of birth. Central cyanosis is a prominent sign. Breathing becomes more difficult, and retractions occur as the infant’s soft chest wall is pulled in as the diaphragm descends. Grunting sounds accompany expiration. As the tidal volume drops because of atelectasis, the respiration rate increases (usually to 60 to 120 beaths/min) in an effort to maintain normal minute ventilation. Fatigue may develop rapidly because of the increased work of breathing. The stiff lungs of infants with RDS also increase the resistance to blood flow in the pulmonary circulation. As a result, a hemodynamically significant patent ductus arteriosus may develop in infants with RDS
A client arrives at the clinic stating he is having “terrible headaches.” What questions would be appropriate for the nurse to ask that may indicate the headaches are related to sinusitis? Select all that apply.
A. “Does bending forward exaggerate the headache?”
B. “When you sneeze, does it make the headache worse?”
C. “Does the headache get worse when you are working at the computer?”
D. “When you cough, is the headache worse?”
E. “Does your neck feel stiff along with the headache?”
Correct Response:
A, B, D
“Does bending forward exaggerate the headache?”, “When you sneeze, does it make the headache worse?”, “When you cough, is the headache worse?”
Rationale:Bending forward, coughing, or sneezing usually exaggerates sinusitis headache. Working at the computer may induce a tension headache. If the client has a stiff neck in addition to a headache and fever, meningitis may be suspected.
Which intervention(s) is important for the nurse caring for a child admitted with bronchiolitis, using the latest evidence in the research literature? Select all that apply.
A. Call a “code blue” if the child displays wheezing and appears listless.
B. Give corticosteroids on time, at least 4 times/day to help with tissue swelling.
C. Administer supplemental oxygen when the oxygen saturation consistently falls below 90%.
D. Administer antibiotics once blood cultures have been obtained and sent to the laboratory.
E. Elevate the head to facilitate respiratory movements.
Correct Response:
C, E
Administer supplemental oxygen when the oxygen saturation consistently falls below 90%., Elevate the head to facilitate respiratory movements.
Rationale:The latest evidence does not recommend that health care providers administer albuterol or corticosteroids to children with a diagnosis of bronchiolitis. However, nebulized hypertonic saline may be given to hospitalized children. Treatment is supportive and includes administration of supplemental oxygen when the oxygen saturation consistently falls below 90%. Elevation of the head facilitates respiratory movements and avoids airway compression. Because the infection is viral, antibiotics are not effective and only given if a secondary bacterial infection occurs. It would be inappropriate to call a “code blue” if the child displays wheezing and appears listless, since these are manifestatins of bronchiolitis and the reason the child was admitted to the hospital in the first place.
The neonatal ICU nurse is assessing a client with severe bronchopulmonary dysplasia (BPD). The nurse knows that this client will likely exhibit which clinical manifestations? Select all that apply.
A. Clubbing of the fingers
B. Chest retractions with accessory muscle use
C. Productive yellow-colored sputum
D. Rapid, shallow breathing
E. Coughing blood
Correct Response:
A, B, D
Clubbing of the fingers, Chest retractions with accessory muscle use, Rapid, shallow breathing
Rationale:The infant with BPD often demonstrates tachycardia, rapid and shallow breathing, chest retractions, cough, and poor weight gain. Clubbing of the fingers occurs in children with severe disease. Yellow-sputum is associated with pneumonia. Blood in sputum could be an infection, trauma in airway, etc
A child is having symptoms of spasmodic croup after a previous bout for the same diagnosis. What care does the parent provide at home that demonstrates understanding of the education given by the nurse during this first bout of croup? Select all that apply.
A. The parent turns on the cold-water room humidifier in the child’s room.
B. The parent brings the child into the bathroom where a warm shower is running to provide humidification.
C. The parent takes a child outside in the cool air.
D. The parent administers an antibiotic that was left over from the previous admission.
E. The parent administers an antihistamine such as diphenhydramine.
Correct Response:
A, B, C
The parent turns on the cold-water room humidifier in the child’s room., The parent brings the child into the bathroom where a warm shower is running to provide humidification., The parent takes a child outside in the cool air.
Rationale:Most children with spasmodic croup can be managed effectively at home. An environment of high humidification (i.e., cold-water room humidifier or taking the child into a bathroom with a warm, running shower) lessens irritation and prevents drying of secretions. Or, if there is no success with opening the airway, the child should be brought outside into the cold air, which, in some cases, can assist the child’s breathing.
Which diagnosis places a child at the greatest risk for airway obstruction?
A. Syncytial virus (RSV)
B. Bronchiolitis
C. Epiglottitis
D. Croup
Correct Response:
C
Epiglottitis
Rationale:The child with epiglottitis is at risk for airway obstruction. Epiglottitis is a life-threatening supraglottic infection that may cause airway obstruction and asphyxia. The child with bronchiolitis is at risk for respiratory failure resulting from impaired gas exchange. Acute bronchiolitis is a viral infection of the lower airways, most commonly caused by the respiratory syncytial virus (RSV). The symptoms of croup usually subside when the child is exposed to moist air.
client presents with atypical pneumonia signs/symptoms and is diagnosed with Mycoplasma pneumoniae. For which characteristics of the cough should the nurse assess this client? Select all that apply.
A. Hacking
B. Fulminating
C. Nonproductive
D. Dry
E. Moist
Correct Response:
A, C, D
Hacking, Nonproductive, Dry
Rationale:Cough, when present (in clients with Mycoplasma pneumoniae), is characteristically dry, hacking, and nonproductive. It is not moist or fulminating.
The health care provider suspects a newly admitted newborn, with a history of premature birth requiring respiratory ventilation, has developed bronchopulmonary dysplasia. Which manifestation(s) correlates with this admitting diagnosis? Select all that apply.
A. Enlarged kidneys palpable bilaterally
B. Use of assessory muscles to breath with sternal retractions
C. Bilateral periorbital edema
D. Respiratory rate of 80 breaths/minute and shallow
E. Heart rate of 200 beats/minute
F. Spasms noted in arms
Your Response:
B, C, D, E
Use of assessory muscles to breath with sternal retractions, Bilateral periorbital edema, Respiratory rate of 80 breaths/minute and shallow, Heart rate of 200 beats/minute
Rationale:In bronchopulmonary dysplasia (BPD), the newborn often demonstrates tachycardia (pulse >180 beats/min), rapid, shallow breathing (respiratory rate >60 breats/min), and chest retractions. If the newborn has developed right heart failure, hepatomegaly and periorbial edema may develop. In BPD, the liver (not the kidneys) enlarges if the newborn has developed right-sided heart failure. Spasms or rigidity in one muscle group, such as fingers, arms, or legs, is a sign of a seizure in a newborn.
The nurse in the emergency department is assessing a toddler suspected of epiglottitis. Which intervention is considered the priority when working with this client?
Get a coworker to help restrain the toddler so blood samples can be obtained.
A. Examine the throat by inserting a tongue blade to see the tonsils.
B. Place the toddler in respiratory isolation due to the possibility of spreading the virus to surrounding clients.
C. Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed.
D. Have the parents lie the toddler on the back to allow for stethoscope examination of all lobes of the lungs.
Correct Response:
D
Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed.
Rationale:Epiglottitis is a medical emergency and immediate establishment of an airway by endotracheal tube or tracheotomy usually is needed. The toddler should be kept calm, if possible. The toddler should never be forced to lie down because this causes the epiglottis to fall backward and may cause complete airway obstruction. Examination of the throat with a tongue blade may cause cardiopulmonary arrest. It is unwise to attempt any procedure, such as drawing blood, which would heighten the toddler’s anxiety, which could precipitate airway spasm and cause death. Isolation is not the priority for this toddler who is having a medical emergency
A 2-year-old child is admitted to a pediatric unit with bronchiolitis. The nurse calls the health care provider fearing the child is going into respiratory failure based on which assessment findings? Select all that apply.
A. Productive cough with white secretions
B. Cyanosis of mucous membranes
C. Sudden absence of breath sounds
D. Faint wheezes noted in the posterior lung base
E. Listlessness
Correct Response:
B,C,E
Cyanosis of mucous membranes, Sudden absence of breath sounds, Listlessness
Rationale:Cyanosis, pallor, listlessness, and sudden diminution or absence of breath sounds indicate impending respiratory failure. Wheezing may occur in infants with severe airway obstruction. Productive cough is not a sign of worsening respiratory failure
Which statements regarding childhood respiratory tract infection are true? Select all that apply.
A. Each exposure to a new pathogen results in an infection.
B. An immature immune system is the usual trigger for such infections.
C. The size of the child has an impact on the seriousness of the symptoms.
D. Impaired airflow and obstructions are common outcomes of these infections.
E. Respiratory tract infections are generally serious in nature
Your Response:
A, B, C, D
Each exposure to a new pathogen results in an infection., An immature immune system is the usual trigger for such infections., The size of the child has an impact on the seriousness of the symptoms., Impaired airflow and obstructions are common outcomes of these infections.
Rationale:Frequent infections occur because the immune system of infants and small children has not been exposed to many common pathogens. Consequently, they tend to contract infections with each new exposure. Although most of these infections are not serious, the small size of an infant’s or child’s airways tends to foster impaired airflow and obstruction. In children, respiratory tract infections are common, and although they are troublesome, they usually are not serious.
