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PEEP is intended to do which of the following? A. Improve ventilation/perfusion matching B. Decrease functional residual capacity C. Increased venous return to the heart D. Increased cardiac output - correct answer ✅✅ A. Improve ventilation/perfusion matching
- PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and increasing functional residual capacity.
- A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to the heart and a subsequent decrease in cardiac output. In an infant with sepsis, factors that impair the release of oxygen by negatively affecting oxyhemoglobin dissociation include: A. Hyperthermia B. Metabolic acidosis
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C. Respiratory acidosis D. Hypothermia - correct answer ✅✅ D. Hypothermia
- To answer this question, you must consider the factors that would cause a left shift of the oxyhemoglobin curve.
- Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift.
- Hyperthermia and acidosis would cause a right shift of the curve In which condition might you observe a decreased V/Q ratio (<0.8)? A. Status asthmaticus B. Sepsis C. Pulmonary emboli D. Tricuspid atresia - correct answer ✅✅ A. Status asthmaticus
- A V/Q ratio of <0.8 is indicative of perfusion exceeding ventilation. Air trapping from diseases such as asthma is a common cause of this scenario
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B. Adequate cough and gag reflexes C. Persistent coma D. PEEP > 8 - correct answer ✅✅ B. Adequate cough and gag reflexes
- Before being extubated, a child needs to have an adequate level of consciousness to protect his or her airway. This includes having an adequate cough and gag; hemodynamic stability (not instability); and a PEEP <5, with an oxygen requirement generally less than an FiO2 of 0.4. A toddler who was found unresponsive in a swimming pool is in respiratory distress. On chest x-ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190. These findings suggest: A. Aspiration pneumonia B. Viral pneumonia C. Acute respiratory distress syndrome D. Pneumothorax - correct answer ✅✅ C. Acute respiratory distress syndrome
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- This child has signs of acute respiratory distress syndrome (ARDS), which include bilateral infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among other things.
- Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct answer for this question.
- The symptoms described are not consistent with a pneumothorax. An infant with bronchiolitis is intubated due to an acute respiratory failure. Post-intubation ABG results demonstrate: pH 7. PaCO2 62 PaO2 75 HCO3 22 O2 sat 90% This blood gas reflects:
AACN) Question and Answers A+
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- Your first priority is assessing the patency of the ETT.
- Once you have confirmed whether the tube is or is not patent, that will help to direct your next interventions.
- The alarms for high peak pressure may indicate that the ETT is kinked or blocked with secretions. The most important intervention when caring for the patient with epiglottitis and who is in significant respiratory distress is to: A. Keep the child quiet and comfortable B. Administer racemic epinephrine C. Place the child in a supine position D. Administer antibiotics - correct answer ✅✅ A. Keep the child quiet and comfortable
- The goal is to keep the child quiet, comfortable, and in whatever position that allows them to maintain their own airway until a skilled provider who can control the airway is present and ready to do so.
AACN) Question and Answers A+
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- Racemic epinephrine might be helpful for the patient with croup
- Although the patient with epiglottitis needs antibiotics, that's not the priority intervention until the airway is secure. Which of the following is the first action to take in the case of a patient with a suspected tension pneumothorax? A. Assess blood pressure B. Prepare for intubation C. Obtain a chest radiograph D. Prepare for needle thoracostomy - correct answer ✅✅ D. Prepare for needle thoracostomy Tension pneumothorax is an emergency requiring needle decompression. The child will require monitoring of vital signs during the procedure and an x-ray post-procedure. The need for intubation will be determined based on the child's clinical exam following evacuation of the tension pneumothorax.
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C. Pneumothorax D. Congenital heart defect - correct answer ✅✅ B. Diaphragmatic hernia A baby with diaphragmatic hernia will appear to have a scaphoid abdomen because the abdominal contents have shifted up into the thorax. The lungs are hypoplastic and the heart may be shifted to the right. Intubation and positive pressure ventilation are high-risk therapies in the pediatric asthmatic patient due to possible: A. Infection B. Oxygen toxicity C. Pneumothorax D. Ventilator dependence - correct answer ✅✅ C. Pneumothorax These patients typically have thick secretions, mucosal edema, and bronchoconstriction, all of which put them at risk for increased airway resistance and air trapping. This, in turn, places them at higher risk for the development of
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pneumothoraces associated with positive pressure ventilation. A patient with status asthmatics is increasingly somnolent and only able to speak one word between breaths. The priority intervention is: A. Increasing the beta-agonist B. Chest tube placement C. Inhaled nitric oxide D. Intubation - correct answer ✅✅ D. Intubation This patient is exhibiting changes in level of consciousness and worsening respiratory distress. The priority intervention at this point is intubation and airway protection. A chest tube may be needed if a pneumothorax develops. The primary objective in the treatment of an infant with pulmonary hypertension is to: A. Maintain the pH level <7.
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small vessel occlusion and, ultimately, infarction of areas of the pulmonary parenchyma. A baby with BPD will have: A. Left-sided heart failure B. Increased fluid requirements C. Decreased pulmonary vascular resistance D. Increased caloric needs - correct answer ✅✅ D. Increased caloric needs -Infants with BPD have increased caloric needs because of the chronic increased work of breathing distress. -They require diuretics and generally do not tolerate fluid overload. - And, they experience increased pulmonary vascular resistance and resultant right-sided heart failure. Cerebrospinal fluid is produced by the: A. Choroid plexus
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B. Cerebral ventricles C. Arachnoid villi D. Pia mater - correct answer ✅✅ A. Choroid plexus Cerebrospinal fluid is formed in the choroid plexus and reabsorbed in the arachnoid villi. Problems with CSF production or absorption can result in hydrocephalus. A child is admitted after falling off a golf cart. The child was initially awake and alert, but now is unresponsive. The nurse should suspect which condition? A. Hydrocephalus B. Epidural hematoma C. Subdural hematoma D. Diffuse axonal injury - correct answer ✅✅ B. Epidural hematoma Epidural hematomas result from hemorrhage into the extradural
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with medical imaging and the child may require surgery to correct the problem. A traumatically injured 8-year-old is being cared for in the ICU. The nurse notes the child has an ICP of 18 mmHg, arterial blood pressure of 112/72 mmHg, with MAP of 86 mmHg and central venous pressure of 7 mmHg. The nurse calculates the cerebral perfusion pressure and anticipates which intervention? A. MRI evaluation B. Ongoing monitoring C. Emergent surgery D. Fluid bolus - correct answer ✅✅ B. Ongoing monitoring -This child has age-appropriate values for blood pressure, MAP, and CVP. The calculated CPP is 68 mmHg (MAP minus ICP). -Based on the information given in this scenario, there is no indication for additional brain imaging, surgical intervention, or fluid bolus. -The nurse should continue monitoring the patient and supporting vital functions.
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The priority management strategy for an epidural hematoma is: A. Surgery B. ICP monitoring C. Steroids D. Pain control - correct answer ✅✅ A. Surgery
- Large epidural hematomas are treated with surgery.
- Depending on the child's condition, ICP monitoring may be indicated, but surgical removal is the priority.
- Steroids are not indicated in this scenario.
- The child will need pain assessed and treated in the postoperative period. Which is the initial independent nursing intervention to maintain cerebral perfusion? A. Hypertonic saline administration B. Maintain head midline
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-ICP monitoring and placement of an intraventricular catheter are not indicated in this scenario. -Restraints may be needed, but they could further agitation. A child is admitted to the ICU following a motor vehicle collision in which he was an unrestrained passenger. He is complaining of numbness and tingling in his legs and feet, and has decreased sensation. Preliminary imaging studies are normal. The nurse anticipates: A. Removal of the cervical collar B. Discontinuation of log rolling C. Administration of anti-anxiety medications D. Ongoing spinal cord protective measures - correct answer ✅✅ D. Ongoing spinal cord protective measures. -This patient's clinical picture is consistent with spinal cord injury, even though there were no findings on imaging studies. He may have Spinal Cord Injury Without Radiograph Abnormality (SCIWORA).
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-The patient should have spinal cord protective measures in place (eg, log rolling, cervical collar) at this point. Which is a required element of the exam for brain death determination? A. Apnea test B. EEG C. MRI D. Spinal cord reflexes - correct answer ✅✅ A. Apnea test -Brain death determination requires two exams separated by an observation period based on the child's age. Apnea testing must occur with each exam, unless the patient's condition prevents it. -In that case, an ancillary test such as four-vessel cerebral angiography or EEG is needed. -MRI and testing of spinal cord reflexes are not part of the brain death exam. A patient is admitted with status epilepticus. After arrival, the SpO2 decreases to 85%. The priority response is:
