Download NURS 652- Module 3 Management of Respiratory Disorders Exam and more Exams Nursing in PDF only on Docsity!
Gonzaga University NURS 652- Module 3 Management of Respiratory Disorders Exam
- Important prescribing principles in a cough include all except: Answers: a. In a child >1 year old honey is recommended for coughs. b. Cough suppressants are recommended to aid in clearing secretions. c. Cough suppressants should be used cautiously because the cough is a protectivemechanism to clear secretions.
d. Water is one of the most effective expectorants.ANS: B
Cough suppressants are recommended to aid in clearing secretions. The most likely organism in Bronchiolitis is: Answers: a. Pertussis b. Haemophilus influenza
c. Respiratory Syncytial Virus [RSV]* d. S. Pneumonia ANS: c Respiratory Syncytial Virus [RSV]* In Bronchiolitis _______ can be prominent on exam and the reason it can be referred toas infectious asthma or asthmatic bronchitis.
Answers: a. Conjunctival inflammation b. Fever c. Rhinitis d. Wheezing ANS: D Wheezing
Croup characteristics include:
b. Croup c. Pertussis d. Pnuemoniae. All of these diagnoses can start with URI symptoms. ANS: e.All of these diagnoses can start with URI symptoms.
This diagnosis can present with a cough that can end in an inspiratory whoop andvomiting.
Answers: a. Bronchiolitis b. Croup c. Pertussis d. Pnuemonia ANS: c. Pertussis Culture is the gold standard for Pertussis. What item/s below are important whenobtaining a culture?
Answers:
a. Collection comes from the oropharynx. b. Culture can be negative if the patient has been ill for 4 weeks. c. The organism is best found in the Catarrhal phase. d. Polymerase chain reaction or PCR a nasal swab has good sensitivity and rapid result.e. All of the above are correct. f. B, C and D are correct. ANS: f.B, C and D are correct -Culture can be negative if the patient has been ill for 4 weeks. -The organism is best found in the Catarrhal phase.-Polymerase chain reaction or PCR a nasal swab has good sensitivity and rapid result. Management of Pertussis includes: Answers: a. Azithromycin 10mg/kg/day 1 then 5mg/kg/day on days 2 to 5 for an infant over 6months.
b. Albuterol nebulizer every 4-6 hours. c.Dexamethasone at 0.6mg/kg for 2 days. d. OTC cough medicine ANS: a.
b. Neonate to 3 months of age c. Tachypnea > 60 breaths/min < 2months and > 50 breaths/min in infants up to 11months and > 40 breaths/min in children 1 to 5 years of age.
d. Oxygen saturation less than 92% e. All of the above are criteria for hospitalization.ANS: e.
All of the above are criteria for admission. Outpatient treatment a CXR should be part of your routine in: Answers: a. Croup b. Pertussis c. Pneumoniae d. RSV e. All outpatient routine treatment of the above warrant a CXR. f. All outpatient routine treatment of the above CXR is not warranted.
ANS: f. All outpatient routine treatment of the above CXR is not warranted.
0-4 age group Classification of Asthma Severity: Intermittent - How many nighttimeawakenings occur in this classification?
Answers: a. 0 X per month b. 1-2X per month c. 3-4X per month d. >1X a weekANS: a. 0 X per month
In a child age group 5-11 Moderate Persistent Asthma Classification the FEV1 equals? Answers: a. FEV1 > 80% predicated
HPI: Shae is a 4 y o female new to your clinic presents accompanied by mom with c/o ofdifficulty breathing and cough starting this morning. Over the past 3 days she has had nasal congestion and runny nose. Upon further question Shae has had about 5 episodesof similar episodes over the past 1.5 years. Mom states he seems to have a lot of colds that last a long time. Treatment has included albuterol inhaler as needed. She has neverhad a CXR or hospitalization. Sometimes at daycare, she has to stop running and catch her breath. PMH: Normal vaginal delivery no other hospitalizations. FH: Dad allergy to dust and pollen. History of eczema. NKDA Immunizations: UTD (except what is needed at age 4). Social: lives with parents no siblings. Secondhand smoke exposure dad smokes inhouse. Pets 2 dogs in house. Attends daycare 3 days a week.
ROS: No fever, No change in appetite Exam: Ht 45th percentile & wt 85th percentile Temp 98.1 HR 90 RR 24 O2 sat 92% Appearance: pink warm and dry, sitting in mom's lap HEENT: unremarkable. Boggy turbinates clear rhinorrhea small amount of post nasaldrip.
Neck supple with full ROM, no lymphadenopathy Lungs: mild accessory muscle retractions, expiratory wheezes all fields and prolongedexpiratory phase. Good air movement. Abdomen scaphoid BTX4 no tenderness to palpation, masses or hepatosplenomegaly. What would you suggest for ordering a CXR? Briefly justify your decision in onesentence.
Identify her current Asthma Classification [above patient]. What would you include in atreatment plan for Shae (no more than 5 concise points)?
What component/s describe the pathophysiology of asthma? Answers: a. Airway inflammation b. Bronchial hyper-responsivenessc. Intermittent airflow obstruction d. All of the above ANS: d. All of the above List some causes of wheezing in children and infants. Answers: a. Asthma
B. Pneumothorax C. A normal finding D. Pleural effusionANS: C
The posterior lung fields should be percussed, starting superiorly and then movinginferiorly down to the diaphragmatic levels. The normal sound on percussion is resonance. Hyperresonance indicates air trapping, occurring with COPD or tensionpneumothorax. Dullness to percussion is heard over the area directly over consolidated lung or pleural fluid. It also occurs with pneumonia, severe atelectasis, or pleuraleffusion.
Which of the following is a "red flag" when diagnosing a patient with pneumonia? A. Fever of 102 B. Infiltrates on chest x-ray C. Pleural effusion on chest x-ray D. Elevated white blood cell count ANS: C In pneumonia, the chest film usually shows an area of infiltrate. A pleural effusion seenon X-ray along with this is a red flag, and appropriate follow-up is required to rule out formation of an empyema. This may include urgent consultation with a pulmonologistregarding the possible need for thoracentesis. Generally, sputum cultures and Gram stains are not ordered on outpatients. The white blood cell count is often elevated.
A 2-month-old infant has a staccato cough and fever. Which history element is mostimportant to establish a diagnosis?
A. Day care attendance B. Immunization history C. Medication history D. Past medical history ANS: B. Immunization history The primary care pediatric nurse practitioner is reviewing a WBC count and suspects aviral infection when which WBC element is elevated?
A. Bands B. Leukocytes C. Lymphocytes D. Neutrophils ANS: C. Lymphocytes
Which of the following lab values is most concerning for an infant with fever and a
A. Those with greater proportions of Asians B. Those with a greater proportion of graduate degrees C. Those with lower poverty ratesD. Those with lower numbers of primary providers ANS:B. Those with a greater proportion of graduate degrees
The parent of a 2-month-old infant is resistant to having the baby immunized. What is aninitial response to these concerns?
A. The parent can be informed that all vaccines can be given without thimerosol. B. Vaccine Information Statements can be provided for the parent to read. C. The parent can be asked why he or she is concerned about immunizations. D. The parent can be reminded that he or she is constantly exposed to several thousandgerms daily ANS: C. Question the parent's reasons for concern about immunizations. A parent is concerned that vaccines have harmful side effects. Based on an Institute ofMedicine report, which of the following statements is the most likely response by a primary care pediatric nurse practitioner? A. The risk for the development of type 1 diabetes is increased with the simultaneousvaccinations.
B. The MMR may cause febrile seizures in children who are immunocompromised. C. There is a possible risk for CNS disorders with the hepatitis B vaccine. D. Thimerosol-containing vaccines are linked to pervasive developmental disorders. ANS: B. The MMR may be linked to febrile seizures in immunocompromised children. An infant who is 2 months of age is scheduled to receive initial immunizations and theparent inquires about administering medications to enhance the comfort of the infant and minimize fever. What will the pediatric nurse practitioner suggest? A. Administering ibuprofen or acetaminophen as needed B. If at all possible avoid the use of antipyretics to achieve better immunity C. Administering ibuprofen and acetaminophen only after the vaccines D. Pretreating the infant with both ibuprofen and acetaminophen ANS: A. Administering ibuprofen or acetaminophen only as needed The parent of an infant asks why some vaccines, such as MMR, are not given along with the other series of immunizations at 2, 4, and 6 months of age. What will theprimary care pediatric nurse practitioner tell this parent?
C. Recommend the next dose of MMR vaccine at 4 to 5 years of age. D. Repeat the MMR vaccine since the first dose was given too soon ANS: C. Recommend the next dose of MMR vaccine at 4 to 5 years of age.
A 5 year old child who has a history of pertussis infection as an infant is in the clinic for8immunizations prior to kindergarten*. Which vaccine will be given?
A. DTaP B. DTP C. Td D. TdapANS:
A. DTaP
An adolescent female who is sexually active and who has not had the HPV vaccine asks if she may have it. What will the primary care pediatric nurse practitionertell her?
A. She can be treated now and it will still protect her from the oncogenic types of HPVeven if she has already been exposed
B. HPV vaccine series will eliminate the need for routine cervical cancer screening C. Papanicolaou and pregnancy screening will be required before vaccineadministration
D. She will not be protected against any previously acquired oncogenic types of HPV ANS: D. She will not be protected from any of the oncogenic types of HPV that she has alreadyacquired
The client is an 18 month old with bronchopulmonary dysplasia. For the preventionof pneumococcal disease, which vaccine will be ordered? A. PCV B. PCV13C. PCV D. PCV ANS:B. PCV
A 5 year old child who received VariZIG after exposure to varicella while
