Test 3 for the Road

Early assessment of RDS in preterm infant will reveal: (select all that apply) a) Nasal flaring b) Respirations greater than 60 c) Seesaw breathing d) Retractions

-A,B,D

A 60-year patient is in Acute Respiratory Distress, the CXR confirms the diagnosis of ARDS. The patient weighs 150lbs. ABG's were drawn and the values are as follow: Ph 7.32 PaCO2 55 HCO3 22 PaO2 80mm/Hg First interpret the result of the ABG's. Based on the patients ABG's interpretation what would be the expected or anticipated ventilator setting for this patient? a) Respiratory Acidosis; TV 680ml, FIO2 60%, SIMV 10, PEEP 5cm, PSV 5cm b) Partially Compensated Respiratory Acidosis; TV 500ml, FIO2 60%, SIMV 10, PEEP 5cm. PSv 5cm c) Respiratory Alkalosis; TV 750ml, FIO2 60%, SIMV 10, PEEP 5cm, PSV 5cm d) Completely Compensated Respiratory Acidosis; TV 1500ML, FIO2 60%, SIMV 10, PEEP 5cm, PSV 5cm.

A

A nurse is caring for a term macrosomic newborn whose mother has poorly controlled type 2 diabetes. The newborn has respiratory distress syndrome. The nurse should be aware that the most likely cause of the respiratory distress is which of the following a) Hyperinsulinemia [glucose inhibits surfactant production] b) Increased deposits of fat in the chest and shoulder are c) Brachial plexus injury d) Increased blood viscosity

A

A young teen has been brought to the ER after falling. She complains of left hip pain and is unable to bear weight on the left side. Mom states that the patient had been having a growth spurt. Her BMI is 90th percentile. Assessment shows that the left leg is turned inward and shorter than the right. Which of the following conditions is this teen likely to have? a) Slipped Capital Femoral Epiphysis [Slipped capital femoral epiphysis (SCFE or skiffy, slipped upper femoral epiphysis, SUFE or souffy, coxa vara adolescentium) is a medical term referring to a fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (epiphysis)] b) Juvenile idiopathic Arthritis [Juvenile rheumatoid arthritis causes persistent joint pain, swelling and stiffness] c) Osteogenic Sarcoma [A type of bone cancer that begins in the cells that form bones. Long Bones distal of the femur]. d) Legg-Calves-Perthes Disease [Legg-Calvé-Perthes disease (LCPD) is a childhood hip disorder initiated by a disruption of blood flow to the ball of the femur called the femoral head. Due to the lack of blood flow, the bone dies (osteonecrosis or avascular necrosis) and stops growing]

A

An adult patient is on the mechanical ventilation and is receiving pancuronium bromide (Pavulon) neuromuscular paralyzing agent. Which assessment finding indicate the need for this drug? a) Fighting the ventilator b) Arterial blood ph 7.35. PaCO 45, HCO3 26 c) Patient is requesting to be re-positioned d) Using fingers and lips to communicate what he/she needs

A

In the initial history and physical examination of a pre-school child, which of the following finding by the nurse would assist the physician in the diagnosis of Acute Glomerulonephritis? [The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture's syndrome, Wegener's disease, and polyarteritis nodosa, or prolonged inflammation process. Early diagnosis and prompt treatment are important to prevent kidney failure] a) Dark amber urine and sore throat last week b) Weakness and disinterest in play activities c) Edema of the abdomen, upper and lower extremities d) T 99.2 orally, RR 22, Pulse 92, BP 70/48

A

The nurse is caring for a patient immediately after removal of the endotracheal tube. The nurse reports which of the following signs immediately if experienced by the patient? a) Stridor b) Occasional pink tinged sputum c) Fine basilar crackles in the right lung d) Respiratory rate 24 breaths/ minute

A

The nurse is teaching home tracheotomy care to the parent of an infant. What information is the most essential to include? a) Have a new replacement trachs with the child at all times b) Discourage the use of baby powder, especially around the trach c) The importance of changing the tracheotomy tube everyday d) How to remove the tracheotomy tube so the child can talk

A

The patient admitting arterial blood gas (ABG) revealed Respiratory Acidosis. The register nurse would know the treatment indicated for this abnormal ABG's and the patient's pH, PaCO2 and HCO3 levels are expected to be? a) Treatment: Increase the SIMV. The nurse would expect the pH, PaCO2 to be Acidic and HCO3 normal b) Treatment: Increase the SIMV. The nurse would expect the pH, PaCO2 to be Acidic and HCO3 Alkaline c) Treatment: Decrease the SIMV. The nurse would expect the pH, PaCO2 to be Acidic and HCO3 normal d) Treatment: Decrease the SIMV. Thte nurse would expect the pH, PaCO2 to be Acidic and HCO3 Alkaline.

A

The physician orders the following ventilator setting for a patient acute respiratory failure. The PaO2 80mmHg, pH 7.35, HCO3 severe alkalosis. The current ventilator setting are : TV 500, FIO2 100%, SIMV 10. Which ventilator Setting would the nurse expect the physician to change if the desire to prevent oxygen toxicity a) Add PEEP and decrease the FIO2 b) Increase the FIO2 and increase SIMV c) Add PSV and maintain present settings d) Increase the tidal volume

A

Which of the following interventions is the most important for the nurse to implement during post-op care of a newborn with esophageal atresia/ TE fistula? [Esophageal atresia (EA) is a congenital defect. This means it occurs before birth. There are several types. In most cases, the upper esophagus ends and does not connect with the lower esophagus and stomach. Most infants with EA have another defect called tracheoesophageal fistula (TEF)] a) Monitor the central line and infusion of TPN (hyperalimentation) b) Restart feeds 10 days later with soy-based formula [with sterile water] c) Allow the parents to hold the neonate while visiting d) Restart GT feeds with breastmilk as soon as the neonate returns from surgery

A

The nurse receives an order from the Health Care Provider to have the respiratory therapist increased PEEP from 5cm to 8cm/ H2O pressure. When PEEP is increased the nurse would monitor and evaluate for what specific changes? Select all that apply a) The PaO2 response as result of the change in the PEEP setting b) BP (MAP) response as result of the change in the PEEP setting c) The change in the basic chemistry panel (increasing BUN and creatinine levels? d) Increasing glomerular filtrate rate

A, B, C

Which of the following condition will increase the risk for Meconium Aspiration Syndrome? Select all that apply a) maternal drug use b) prolonged or difficult labor c) placental insufficiency d) Rheumatoid Arthritis

A, B, C

A primigravida is admitted for induction of labor. The nurse anticipate a LGA infant. Which complications should be considered? Select all that apply a) Hypoglycemia b) Increased incidence of cesarean section c) Breastfeeding difficulties d) Birth trauma

A, B, D

Post-term newborn are at risk for which of the following problems? Select all that apply a) Difficulty with thermoregulation b) Hypoglycemia c) Cleft lip and cleft palate d) Meconium Aspiration e) Polydactyly

A, B, D

The nurse would expect which of the following to true for the diagnosis of ARDS? SATA a) Refractory Hypoxemia b) Non cardiogenic Pulmonary Edema c) PaO2 average between 92-95% d) Ventilation Perfusion Mismatch

A, B, D

The nurse is caring for a patient with a right-sided chest tube due to a pneumothorax. Which intervention should the nurse implement when caring for this patient? Select all that apply a) Assess the water seal chamber ever hour for sign of air leak b) Assess the chest tube drainage system every hour c) Strip the chest tube to facilitate chest drainage without the MDs order d) Include the chest drainage in the collection chambers as a component of the I&Os e) Maintain suction control chamber water level at 20cm

A, B, D, E

A school age child is newly diagnosed as having nephrotic syndrome and is admitted to the unit. Which of the following orders would the nurse expect? Select all that apply a) Call MD if BP < 80/50 b) Antibiotic to treat strep infection c) Diet with no added salt d) Albumin infusion followed by Lasix [IV 25% Albumin] e) Weights on even days

A, C, D

The nurse is educating a school age child and parent with juvenile idiopathic Arthritis on ways to promote mobility. Which of the following interventions should the nurse include in the teaching plan? Select all that apply a) Administer NSAIDS of choice in the morning b) Apply ice pack to joints when painful c) Find a pool where the child can enjoy swimming several times a week for exercise d) Perform joint exercise each day to maintain function of joints e) Maintain a well-balanced diet to maintain a normal weight for the child.

A, C, D, E

A teen is admitted to the unit with complains of pain in the right hip. Which of the following would lead to suspicion of Legg-Calves-Perthes Disease (LCPD)? Select all that apply a) Pain in right knee b) History of temp 100.5 over last 3 days c) History of sickle cell disease d) The teen has developed a limp in their gait on the right side e) WBC within normal range at 5.2

A, C, D, E •

A newborn has been admitted to NICU with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the newborn to this diagnosis? Select all that apply a) Advanced maternal age b) Hyperopia [A vision condition in which nearby objects are blurry AKA Farsighted]. c) Substance abuse d) Gestational Diabetes e) Chronic Hypertension

A, C, E

Which pharmacological agents are most likely to be used in treatment plan for a patient diagnosed with Acute Respiratory Failure who is intubated and mechanical ventilated? Select all that apply a) Anticoagulants b) Bronchodilators c) Antibiotics d) Anti-depressants

A,B,C

A nurse is assessing a newborn 1 hour after birth. Which of the following respiratory rates is within the expected reference range for a newborn? a) 22/min b) 48/min c) 110/min d) 100/min

B

The nurse is caring for a child with acute Respiratory Distress Syndrome (ARDS) secondary too bacterial pneumonia. Priority nursing interventions for this child should include which of the following? a) Encourage a high protein diet and force fluids b) Alternate the patient from the supine to the prone position every 6 hours c) Keep the parents informed of the child's progress daily d) Institute seizure precautions and pad the side rails. •

B

The nurse is discharging a neonate who was diagnosed with imperforate anus shortly after birth and was surgically corrected. Which of the following should the nurse include in discharge teaching with the parents? a) Administer IV hyper-alimentation through central line b) How to empty and change the colostomy bag c) How to insert dilation rods into the rectum several times a day with diaper changes d) How to suction and care for tracheostomy

B

The nurse makes the following observations when admitting a full term, breastfeeding baby into the neonatal nursery: 9lbs 2oz, 2.1 inches long, TPR: 96.6F, BS 62, jittery, pink body with bluish hands and feet, crying. Which of the following should the nurse perform first? a) Swaddle the baby to provide warmth b) Assess the serum glucose level of the baby c) Take the baby to the mother for feeding d) Administer the neonatal medications

B

When receiving a routine urinalysis report of a client with Acute Glomerulonephritis, the nurse would expect to note: a) Decreased specific gravity b) Proteinuria c) Decreased erythrocyte sedimentation rate (ESR) d) Decrease creatinine clearance

B

Which of the following interventions is most likely to cause barotrauma in a patient with ARDS who is mechanically ventilated. a) Decreasing the PEEP b) Increasing the tidal volume c) Use of negative pressure ventilation d) Decreasing PVS

B

Which of the following would distinguish ARDS from other Acute Respiratory Failure Disease? [Condition in which fluid collects in the lungs' air sacs, depriving organs of oxygen] a) Increase infiltration per chest x-ray b) Gravel-like appearance per chest x-ray c) Ph 7.35, PaO2 80, PaCO2 50, HCO3 22 d) Sudden onset of acute respiratory distress

B

The nurse prepares a patient for extubating or liberation from the ventilator. The nurse must assess which of the following to confirm a successful extubating? Select all that apply a) Respiratory rate increased from 10 breaths per minute to 28 breaths of deep shallow breaths b) ABG's values begin to normalize to patient's baseline c) Patients MAP ranging between 5 to 10 mmHg higher than the pre-intubation BP's (Pre BP prior to intubation (80/54) d) Patient is able to generate a tidal volume of 450ml [Normal 4-10]

B,C,D How to calculate MAP to see if that range is appropriate: Initial: 80 [systolic] + 2(54) [diastolic]/3= 62.67 mmHg Increase: 85 [systolic] + 2(60) [diastolic]/3= 68.33 mmHg Increase: 90 [systolic] + 2(64) [diastolic]/3= 72.66 mmHg

A preschooler is admitted with sore throat, high fever, ill appearance, muffled voice, and drooling. Which of the following would be included in the nurses assessment? Select all that apply a) Inspect the child's pharynx b) Observe the child's appearance c) Have the child lay down on the examination table d) Notify physician of child's condition e) Visualize chest movement and auscultate breath sounds [looking for sternal retractions]

B,E [cant notify the MD until you have assessed and have all the information to provide it to the doc]

A one day old neonate, 32 weeks gestation is under an overhead warmer. The nurse assess the axillary temperature as 96.9 degree F. which of the following could explain this assessment finding? a) This is a normal temperature for a preterm neonate b) Axillary temperature are not valid for preterm babies c) The supply of brown adipose tissue is incomplete d) Conduction heat loss is pronounced in the baby

C

A patient has Acute Respiratory Failure with early signs of ARDS developing. The EKG monitor shows a sudden onset of uncontrolled Atrial Fibrillation, ventricular response rate (VRR) of 108 beats per minute. Which of the following would the nurse expect as necessary treatment for the patients? Vital Signs 98.6, Atrial Fibrillation VRR 108, Respiration 20 breaths/min, BP 110/70 (83). a) Dilaudid 2mg IV every 4 hours b) Prepare to insert a temporary pacemaker c) Prepare to administer oxygen and begin IV infusion of Amiodarone (Cardarone) and Heparin d) Continue to monitor, typical findings for patients with Acute Respiratory Failure and Atrial Fibrillation

C

A patient reveals signs of severe acute respiratory distress, the nurse receives an order for a STAT CXR. The chest X-ray impression states: impression/Findings Chest X ray: Increasing bilateral infiltration in the right lung field and 90% pneumothorax in the left lung field. Based on the radio graphic findings what is expected of the registered nurse? a) Repeat a chest X-ray and help the patient stay calm b) Prepare the patient for intubation to be placed on the ventilator c) Collect the equipment and supplies for chest tube insertion by the MD d) Continue to monitor the patient for additional signs of respiratory distress.

C

A preterm newborn with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents? a) "Surfactant is used to reduce episodes of apnea" b) "The drug keeps your baby from requiring too much sedation" c) "Surfactant improves the ability of your baby's lung to exchange oxygen and carbon dioxide" d) "Your baby needs this medication to fight a possible respiratory infection.

C

An infant with a trach is admitted with pneumonia to the pediatric unit. The nurse is walking down the hall and hears the pulse ox alarming. Upon entering the room the nurse finds the infant diaphoretic, cyanotic around the mouth, pulse ox 62%, and retractions present. What is the next action by the nurse? a) Call respiratory therapist b) Pull the old trach and insert brand new one, then bag and suction patient c) Press the call light as prepare to pre-oxygenate and suction d) Increase the oxygen by trach collar to 100%

C

An infant with short bowel syndrome will be discharged home on total parenteral nutrition (TPN) and gastrostomy feedings. Which of the following outcomes would indicate successful management of this child illness? [Short bowel syndrome (SBS, or simply short gut) is a malabsorption disorder caused by a lack of functional small intestine. The primary symptom is diarrhea, which can result in dehydration, malnutrition, and weight loss] a) Chronic diarrhea and skin breakdown in perineal area at one month follow-up appointment b) Admission to hospital for fever and purulent drainage from Broviac insertion site c) Infant sitting up unassisted at 9 months checkup and babbling d) Weight decrease by 3 percent at 6 months check up

C

The goal in treating a patient with the diagnosis of Acute Respiratory Failure is to: a) Discuss with the patient his/her wishes about heroic life saving measures in the event he/she arrests b) Institute placement on the ventilator as first line treatment c) Improve the PaO2 with the lowest O2 concentration possible d) Allow the patient's body to stabilize as it will reset his internal clock to reestablish normal lung gas diffusion.

C

The nurse assessing a newborn baby finds that the baby has fluid filled sac containing nerves located high on the lumbar area of the spinal column. Which is an appropriate nursing action? a) Apply water- moistened clean 2x2s too sac b) Use a larger diaper size so it will fit across the sac and still fasten c) Assess neuro status every two hours and prn d) Wrap the baby in blankets to keep warm.

C

The nurse encourages the mother of a toddler with respiratory distress to stay at the bedside as much as possible. The rational for this action is primarily which of the following? a) Separation from mother is a major developmental threat at this age b) Mothers of hospitalized toddlers often experience guilt c) The mother's presence will reduce anxiety and ease the child's respiratory efforts d) The mother can provide constant observations of the child's respiratory effort

C

Which nursing action is most important when caring for a patient who was admitted with Slipped Capital Femoral Epiphysis? a) Early ambulation with bilateral lower extremity weight bearing following surgery b) Postoperative wound care using clean dressing technique c) Assessment of neurovascular integrity pre and post operatively d) Weight bearing exercises for the affected extremity in the preoperative period.

C

Which of the following children exhibit assessment finding of nephrotic syndrome [A kidney disorder that causes the body to excrete too much protein in the urine]. a) A child with blood tinged urine, multiple WBC'S present on urinalysis, weight gain of 5 pounds in 6 months b) A child with BP 136/78, weight loss of 4 pounds in 2 weeks and 1+ protein on urine dipstick c) A child with 4+ protein in the urine, serum albumin below normal range, weight gain of 20 pounds in a month d) A child with 101.5 temperature, tea-colored urine and minimal protein on urinalysis

C

While changing the diaper of a newborn, the nurse assess meconium in the urine. Which of the following is the nurses next action? a) Prepare the patient for a voiding cystourethrogram b) No further action is needed c) Notify the doctor immediately d) Administer prophylactic antibiotic

C

While talking with an overweight teenager at their well visit, which statement by the teen would be important in the nurse assessment and developing the plan of care? a) "My parents are strict about us all eating dinner together. They tell us not to have our friends call between 5:00 and 6:30 because that is family time." b) "My mom took me shopping last week. She bought me several jeans and shirts that are in style this year." c) " I normally get up 5:45 and rush out the door to catch the bus at 6:30. There is no time for breakfast so I am starving by second period. d) "We are excited about the new neighborhood we moved to. It has walking trails, sidewalks, and a pool."

C

A patient is admitted to the antepartum unit with a diagnosis of PPROM at 32 weeks gestation. The nurse would anticipate the administration of: a) Betamethasone (Celestone ) 12 mg IV BID b) Betamethasone (Celestone) 12 mg IM x 1 dose c) Betamethasone (Celestone) 12 mg IM now, then repeat in 24hours d) Betamethasone (Celestone) 24 mg IM now, then repeat in 12 hours

C •

The nurse is caring for a neonate born with a fluid filled sac on the lower back. The neonate is 36 hours old and has just returned from surgery to fix the defect. Which of the following would the nurse include in the priority assessments? Select all that apply a) sensation in lower extremities b) neurovascular check c) fontanel and head circumference d) vital signs e) the surgical site

C, D, E

A 42-week gestation newborn has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is critical at this time? a) Bathe to remove meconium contaminated fluid from the skin b) Ophthalmic assessment to check for conjunctival irritation c) Rectal temperature to assess for septic hyperthermia d) Respiratory evaluation to monitor for respiratory distress

D

A 6-month old is admitted with wheezing and respiratory distress. Which of the following assessment finding would be most alarming to the nurse? a) Heart rate of 68 per minute b) Nasal flaring c) Sternal retraction d) Respiratory rate of 68 breaths per minute [Normal: 30-60]

D

The nurse is instructing the mother about the dietary restrictions of a child newly diagnosed with celiac disease. Which of the following statements would indicate that the mother needs further teaching? [An immune reaction to eating gluten, a protein found in wheat, barley, and rye] a) " We will switch from eating oatmeal to grits for breakfast." b) " I will start putting fruits in hid lunch for snacks, instead of cookies." c) " It is important that I carefully read the nutrition label of the food I buy." d) "We are going to make his favorite brownies when we get home to make him feel better."

D