NCLEX RDS, Bronchiolitis (RSV), Bronchopulmonary dysplasia

Of all the signs seen in infants with respiratory distress syndrome, which sign is especially indicative of the syndrome?

grunting

The mother of an infant diagnosed with bronchiolitis asks the nurse what causes this disease. The nurse's response would be based on the knowledge that the majority of infections that cause bronchiolitis are a result of:

RSV

A nurse is caring for a hospitalized infant with bronchiolitis. Diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which of the following would be the appropriate nursing action?

1. Initiate strict enteric precautions. 2. Wear a mask when caring for the child. 3. Plan to move the infant to a room with another child with RSV. 4. Leave the infant in the present room, because RSV is not contagious. Rationale: RSV is a highly communicable disorder, but it is not transmitted via the airborne route. It is usually transferred by the hands, and meticulous handwashing is necessary to decrease the spread of organisms. The infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precautions are not necessary; however, the nurse should wear a gown when the soiling of clothing may occur.

A nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by the respiratory syncytial virus (RSV). Choose the interventions that would be included in the plan of care. Select all that apply.

1. Place the infant in a private room. 2. Place the infant in a room near the nurses' station. 3. Ensure that the infant's head is in a flexed position. 4. Wear a mask at all times when in contact with the infant. 5. Place the child in a tent that delivers warm, humidified air. 6. Position the infant side-lying, with the head lower than the chest. Rationale: The infant with RSV should be isolated in a private room or in a room with another child with RSV. The infant should be placed in a room near the nurses' station for close observation. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and to decrease pressure on the diaphragm. Cool, humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea. Contact precautions (wearing gloves and a gown) reduce the nosocomial transmission of RSV.

A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome? 1. Hypotension and Bradycardia 2. Tachypnea and retractions 3. Acrocyanosis and grunting 4. The presence of a barrel chest with grunting

2. The infant with respiratory distress syndrome may present with signs of cyanosis, tachypnea or apnea, nasal flaring, chest wall retractions, or audible grunts.

A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by: 1. Subcutaneous injection 2. Intravenous injection 3. Instillation of the preparation into the lungs through an endotracheal tube 4. Intramuscular injection

3. The aim of therapy in RDS is to support the disease until the disease runs its course with the subsequent development of surfactant. The infant may benefit from surfactant replacement therapy. In surfactant replacement, an exogenous surfactant preparation is instilled into the lungs through an endotracheal tube.

5. An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to: A. prevent RSV infection. B. prevent secondary bacterial infection. C. decrease toxicity of antiviral agents. D. make isolation of infant with RSV unnecessary.

A. prevent RSV infection. Synagis is a monoclonal antibody specific for RSV. Monthly administration is initiated to prevent infection with RSV. Given monthly (28-31 days apart)

16. An infant is hospitalized with RSV bronchiolitis. The priority nursing diagnosis is: a. fatigue related to increased work of breathing. b. ineffective breathing pattern related to airway inflammation and increased secretions. c. risk for fluid volume deficit related to tachypnea and decreased oral intake. d. fear and/or anxiety related to dyspnea and hospitalization.

ANS: B An ineffective breathing pattern is the priority nursing diagnosis for an infant hospitalized with RSV infection.

14. The nurse caring for an infant born at 36 weeks of gestation assesses tremors and a weak cry. The nurse is aware that these are symptoms of: a. respiratory distress syndrome. b. hypoglycemia. c. necrotizing enterocolitis. d. renal failure.

ANS: B The preterm infant, before 38 weeks, should be assessed for hypoglycemia because the infant's glycogen stores are not adequate.

5. The nurse auscultating breath sounds of an infant with respiratory syncytial virus would immediately report the assessment of: a. respiration rate decrease from 40 to 32 breaths/min. b. heart rate decrease from 110 to 100 beats/min. c. "quiet chest" from previous assessment of wheezing. d. oxygen saturation of 90%.

ANS: C A "quiet chest" after assessment of wheezing indicates occlusion of air pathways and impending respiratory arrest. All other options are within normal range for infants undergoing oxygen administration.

An infant with bronchiolitis is hospitalized. The causative organism is respiratory syncytial virus (RSV). The nurse knows that a child infected with this virus requires the following isolation: a. reverse isolation. b. airborne isolation. c. Contact Precautions. d. Standard Precautions.

ANS: C RSV is transmitted through droplets. In addition to Standard Precautions and hand washing, Contact Precautions are required. Caregivers must use gloves and gowns when entering the room. Care is taken not to touch their own eyes or mucous membranes with a contaminated gloved hand. Children are placed in a private room or in a room with other children with RSV infections. Reverse isolation focuses on keeping bacteria away from the infant. With RSV, other children need to be protected from exposure to the virus. The virus is not airborne.

4. The nurse carefully assesses the preterm infant for respiratory distress syndrome because of a deficiency of: a. protein. b. estrogen. c. hyaline. d. surfactant.

ANS: D The production of surfactant, necessary for the absorption of oxygen by the lungs, is deficient in the preterm infant.

A neonate experiences meconium aspiration at the time of delivery and develops respiratory distress syndrome (RDS). Which nursing diagnosis would be most appropriate for an infant diagnosed with this disorder? A. Risk for Infection B. Risk for Aspiration C. Impaired Gas Exchange D. Dysfunctional Ventilatory Weaning Response

Answer: C Rationale: Impaired gas exchange is the most appropriate nursing diagnosis because meconium aspiration interferes with the exchange of O2 and CO2. Risk for infection is present but is not as high a priority as impaired gas exchange. Risk for aspiration has already occurred. Dysfunctional ventilatory weaning response may be appropriate i the newborn demonstrates difficulty with the ventilatory weaning process

Which of the following interventions is most appropriate for helping parents to cope with a child newly diagnosed with bronchopulmonary dysplasia? a. Teach cardiopulmonary resuscitation b. Refer them to support groups c. Help parents identify necessary lifestyle changes d. Evaluate and assess parents; stress and anxiety levels

a. Teach cardiopulmonary resuscitation

Which of the following symptoms is seen in a child with bronchopulmonary dysplasia? a. Minimal work of breathing b. Tachypnea and dyspnea c. Easily consolable d. Hypotension

b. Tachypnea and dyspnea

Compared with an infant born vaginally an infant born via cesarean section is more likely to manifest which condition? A. crib death syndrome B. neurological deficits C. failure to thrive syndrome D. Respiratory distress syndrome

Answer: D Rationale: Research has shown that respiratory distress syndrome (RDS) is more common in infants born by cesarean birth without labor than in those born vaginally. The other answer options A, B, and C are not associated with cesarean births

A diabetic multigravida is scheduled for an amniocentesis at 32 weeks gestation to determine the L/S ratio and phosphatidyl glycerol level. The L/S ratio is 1:1 and the presence of phosphatidylglycerol is noted. The nurse's assessment of this data is: The infant is at low risk for congenital anomalies. The infant is at high risk for intrauterine growth retardation. The infant is at high risk for respiratory distress syndrome. The infant is at high risk for birth trauma.

C: The infant is at high risk for respiratory distress syndrome.

Infants with bronchopulmonary dysplasia are commonly treated with bronchodilators such as theophylline. Which of the following adverse effects is common with this drug? a. Lethargy b. Decreased calcium level c. Increased heart rate d. Decreased serum potassium level

c. Increased heart rate

The most important reason to protect the preterm infant from cold stress is that:

it could make respiratory distress syndrome worse.