Inclass quiz exam 1

What is the most appropriate acute nursing intervention when caring for a 4 year old child with pneumonia? 1) Encourage fluids. 2) Encourage ambulation as much as possible. 3) Control fever with aspirin 4) Preparing for the pneumococcal vaccination (PCV13)

1 Caring for a child or an adult with pneumonia requires supportive care. That means that promoting rest and encouraging fluids are very important. Rest decreases the O2 demand of tissues, while fluids help keep secretions moist and easy to cough up. So fluids are given, but rest is encouraged - not activity. Aspirin is contraindicated at this age for this condition. PCV 13 is given at 2 months, 4 months, 6 months and 12 months. The child should have already received all the vaccinations. If catchup is needed, only 1 dose of PCV 13 would be needed to catchup.

The nurse is caring for an adolescent in the hospital with pneumonia. Which information should the nurse include in the nursing management plan for this patient? Select all that apply. One, some, or all responses may be correct. 1) Provide the patient with oxygen as needed. 2) Plan activities so there are periods of rest during the day. 3) Place the patient on a fluid restriction of 1200 ml/day. 4) Restrict the patient's smoking to 2-3 cigarettes/day. 5) Monitor the patient's pulse oximetry readings once a shift. 6) Encourage the patient to cough into a tissue and dispose of it in the wastebasket.

1) Provide the patient with oxygen as needed. 2) Plan activities so there are periods of rest during the day. 6) Encourage the patient to cough into a tissue and dispose of it in the wastebasket. Yes, a patient with pneumonia would benefit from inhaled oxygen to help improve O2CO2 exchange. If the patient needs O2 and does not have it ordered, the nurse could suggest it. No, fluids will help liquify secretions and should be encouraged with pneumonia unless there is a circulatory problem. No, actually any cigarette smoking should be prohibited because smoke paralyzes cilia that are needed to help bring up secretions and improve gas exchange. Adolescent should not be smoking. No, actually oximetry readings are very helpful in monitoring the status of respiratory disease and should be done more frequently than once/shift - usually continually.

Inspiration involves 1) chest rising and expanding where the diaphragm descends 2) chest falls where the diaphragm rises 3) carbon dioxide is carried back out of the lungs where it can exit through the mouth or nose 4) An asymmetric movement of the chest wall that is paradoxical movement of the diaphragm

1) chest rising and expanding where the diaphragm descends

Perfusion is 1) flow of blood to the alveolar capillaries. 2) exchange of gas in the lung 3) process of supplying oxygenation to the body's cells 4) involves substances moving across concentration gradients from areas of higher concentration to areas of lower concentration

1) flow of blood to the alveolar capillaries.

TB: Question 1 (1 point) The nurse is administering Mantoux tests to a group of clients. Which person would be the most likely to exhibit a false positive reaction? Question 1 options: 1) An immunocompetent patient. 2) A client who has received a TB vaccination in the past. 3) A client previously diagnosed with latent TB. 4) A nurse who was just exposed to TB 2 days ago. Question 2 (1 point) The nurse is writing a tuberculosis (TB) infection control policy for a home healthcare agency. What personal protective equipment would be most beneficial to visit clients with TB? Question 2 options: 1) High-efficiency particular air mask 2) negative pressure rooms 3) UV filters 4) contact isolation gown Question 3 (1 point) The nurse is caring for a client who recently has been diagnosed with active TB for the first time. The nurse can anticipate the use of which medication as part of program? Question 3 options: 1) 1 dose daily regimen of Isoniazid for 9 months 2) Penicillin VK twice a day for 10 days 3) 2 drug regimen twice weekly of Isoniazid and rifampin for 18 weeks 4) 4 dose regimen daily of Isoniazid, rifampin, pyrazinamide, and ethambutol for 8 weeks Question 4 (1 point) The nurse is helping a student to administer a tuberculin test for an initial screening. The client just got out of prison and is requiring a TB test for a new job. Which information regarding this test is accurate and should be given by the nurse to the student? Question 4 options: 1) Inject intramuscularly 1 ml of purified protein derivative. 2) If the first test is negative, a second TST is done in 3 weeks later. 3) Tell the patient to return for a skin test reading in 24 hours. 4) Record the results as negative if there is swelling of 20 mm in size. Question 5 (1 point) What intervention is utilized with high risk individuals to prevent non-compliance with prescribed tuberculosis therapy? Question 5 options: 1) Directly-observed therapy. 2) Combination drug therapy. 3) Bi-monthly sputum cultures. 4) Drug therapy. Question 6 (1 point) A client has just been started on medication for tuberculosis. The nurse is aware that the disease can be transmitted to others until the medications have been taken for how long? Question 6 options: at least 1 week. at least 2 weeks. at least 8 weeks. at least 12 weeks. Question 7 (1 point) A nurse is planning to teach a group from a local homeless shelter about tuberculosis (TB). The nurse should include which of the following statements into the teaching plan? Select all that apply. One, some, or all responses may be correct. Question 7 options: "Tuberculosis is spread through airborne bacteria that can be inhaled into your respiratory system." "It is very unlikely that you will get TB because it rarely is trasmitted in group homes and shelters." "You should be observing yourself and others for cough, unusual fatigue and weakness." "The screening tool used for tuberculosis is simple and should be performed on you annually." "If you cough up blood that could be the early sign that you see if you have tuberculosis." Question 8 (1 point) TB is not highly infectious. Transmission usually requires prolonged close contact with an infected individual. Question 8 options:TrueFalse Question 9 (1 point) What percentage of immunocompetent individuals who have latent TB will develop reactivated tuberculosis in a lifetime? Question 9 options: 10% 30% 50% 70% Question 10 (1 point) Which of the following TB drugs are not hepatotoxic? Question 10 options: Ethambutol Pyranzinamide Rifampin Isoniazid

1. A client who has received a TB vaccination in the past. 2. High-efficiency particular air mask 3. 4 dose regimen daily of Isoniazid, rifampin, pyrazinamide, and ethambutol for 8 weeks 4. If the first test is negative, a second TST is done in 3 weeks later. 5Directly-observed therapy. 6at least 2 weeks. 7"Tuberculosis is spread through airborne bacteria that can be inhaled into your respiratory system." "You should be observing yourself and others for cough, unusual fatigue and weakness." "The screening tool used for tuberculosis is simple and should be performed on you annually." 8True 910% 10Ethambutol

As the diameter of the airways increase, the airway resistance 1) decreases. 2) increases. 3) stays the same. 4) equalizes.

1. decrease

The nurse is caring for an infant with acute laryngotracheobronchitis (LTB). The most important nursing function in the care of children is 1) vigilant observation and accurate assessment of respiratory status 2) providing patients with frequent reassurance 3) treatment with antibiotics 4) ensuring adequate fluid intake

1. vigilant observation and accurate assessment of respiratory status When the upper airway is edematous as it is with LTB, there is always the chance that the airway will be blocked. The child must be monitored for absence of air flow, inability to swallow, increasing distress. The most important nursing function in the care of children with LTB is continuous, vigilant observation and accurate assessment of respiratory status. Cardiac, respiratory, and pulse oximetry monitoring supplement visual observation. Changes in therapy are frequently based on the nurses' observations and assessments of a child's status, response to therapy, and tolerance of procedures. The trend away from early intubation of children with LTB emphasizes the importance of nursing observations and the ability to recognize impending respiratory failure so that intubation can be implemented without delay. Therefore intubation equipment and bag valve mask (BVM) equipment should be readily accessible.

Communicable Disease: Question 1 (1 point) A nurse who serves on an infection-control committee is assessing the adequacy of environmental controls against infection. This nurse would examine which of the following as the first line of defense in medical asepsis? Question 1 options: isolation or barrier procedures handwashing techniques nature of detergent used on unit ventilation system type Question 2 (1 point) A nurse is providing teaching to a client with a communicable infection transmitted by droplet. The nurse tells the client to do which of the following? Question 2 options: A) Cover your mouth when sneezing or coughing. B) Direct contact with any persons is prohibited while in the hospital. C) Stay away from areas known to have high numbers of infections. D) Wear a mask and gloves Question 3 (1 point) A nurse orienting a new certified nursing assistant (CNA) to the unit would evaluate the CNA's ability to use which of the following basic infection control practices? Question 3 options: A) standard precautions B) contact isolation C) droplet isolation D) protective isolation Question 4 (1 point) Which drug is contraindicated when managing the symptoms of a child who has Varicella? Question 4 options: A) Acetaminophen (Tylenol®) B) Ibuprofen (Motrin®) C) Rimantadine (Flumadine®) D) Aspirin Question 5 (1 point) A nursing action that is a secondary prevention strategy regarding communicable disease is Question 5 options: A) teaching ways to prevent the spread of disease B) washing hands before and after patient contact C) giving antibiotics as prescribed by the doctor when the patient has an infectious disease D) a diabetic patient focusing on the control of blood sugar and excellent skin care Question 6 (1 point) Which of the following illnesses is characterized by Koplik spots? Question 6 options: A) Rubeola B) Rubella C) Varicella D) Roseola Question 7 (1 point) A nurse is providing care for 24 year old female who with a temperature of 100.5, headache, sore throat, and a maculopapular rash that first appeared on the face and rapidly spread to the rest of the body. The nurse is aware that the most dangerous complication of this disease is Question 7 options: A) arthritis. B) brain infections. C) Teratogenic effects to the fetus D) bleeding problems. Question 8 (1 point) A nurse is providing care for a client with a diagnosis of herpes zoster. Which of the following histories would the nurse expect to obtain from the client? Question 8 options: A) Previous history of Measles (Rubeola) B) Previous history of Chicken Pox (Varicella) C) Previous history of Mumps D) Previous history of Pertussis (Whooping Cough) Question 9 (1 point) Primary prevention of communicable disease includes which of the following? Question 9 options: Immunizations Treatment of fever with antipyretics Immunoglobulin during the prodromol period Airborne precautions Question 10 (1 point) Select the appropriate nursing problem for the client infected with Varicella-zoster virus. Question 10 options: Decreased cardiac output Impaired mobility Decreased tissue perfusion Impaired skin integrity Question 11 (1 point) A client has mononucleosis. He tells the nurse he is "pretty sure he got this disease from kissing." If his statement is true, the mode of transmission for mononucleos is what? Question 11 options: Direct contact Blood Airborne Sexual contact Question 12 (1 point) A 15 year old has been diagnosed with whooping cough. The mother wanted to know how long can this cough last. The nurse is aware the cough can last up to Question 12 options: 0 to 1 week. 2 to 3 weeks. 4 to 5 weeks. 6 to 10 weeks.

1handwashing techniques 2Cover your mouth when sneezing or coughing. 3standard precautions 4Aspirin 5giving antibiotics as prescribed by the doctor when the patient has an infectious disease 6Rubeola 7Teratogenic effects to the fetus 8Previous history of Chicken Pox (Varicella) 9Immunizations 10Impaired skin integrity 11Direct contact 126 to 10 weeks.

What type of croup is a medical emergency that requires immediate medical attention? 1) Acute Spasmodic Laryngitis 2) Acute Epiglottitis 3) Bronchiolitis 4) Acute Laryngotracheobronchitis (LTB)

2) Acute Epiglottitis

What is contraindicated when examining a patient who may have acute epiglottitis? 1) Moving the head from side to side. 2) Having the patient to refrain from talking. 3) Examination of throat with a tongue depressor 4) Palpating the lymph nodes

3

What is the most common type of croup in very young children? 1) Acute epiglottitis 2) Bronchiolitis 3) Laryngotracheobronchitis 4) Acute spasmotic laryngitis

3

What disease is usually caused by the pathogen: respiratory syncytial virus (RSV)? 1) Acute epiglotitis 2) Infectious Mononucleosis 3) Bacterial Pneumonia 4) Bronchiolitis

4) Bronchiolitis

The number of cases of acute epiglottitis have decreased in recent years due to the routine immunization of infants with which vaccine? 1) Diphtheria Toxoid attenuated pertussis 2) Pneumococcal 3) Quadrivalent Influenza Vaccine 4) Hemophilus influenzae type b

4) Hemophilus influenzae type b Since more and more children are getting immunizations against H. influenzae B, the incidence of epiglottitis has declined. Other organisms can cause epiglottitis, but because of infant immunizations, this disease occurs less in young children and when it does occur in older children, it is not so serious because of larger airways and a better immune system.

What type of pathogen can been seen in school aged children who have been diagnosed with primary atypical pneumonia? 1) Group B streptococci 2) Parainfluenza virus 3) Cytomegalovirus 4) Mycoplasma pneumoniae

4) Mycoplasma pneumoniae

The nurse is preparing the parents of a child for home care. The 7 year-old child just had a tonsillectomy 6 hours post op. Which instruction should the nurse give to these parents? 1) May resume normal activity in 1 to 2 days 2) Recommend saltwater gargles starting 24 hours after day of surgery 3) May use ice pops to soothe the throat that include natural citrus juices 4) Watch carefully for frequent swallowing.

4) Watch carefully for frequent swallowing.

A nurse is caring for a hospitalized child who is unconscious and at risk for aspiration pneumonia. To protect this child from aspiration pneumonia, the nurse will plan to do what? Turn and reposition the child at least every 2 hours. Position clients with altered consciousness in lateral positions. Monitor laboratory values frequently for signs of immunocompromise. Provide for continuous subglottic aspiration in the child receiving enteral feedings.

Position clients with altered consciousness in lateral positions.

Early signs of impending airway obstruction due to acute laryngootracheobronchitis in a child include what? Select all that apply. One, some, or all responses may be correct. Tachypnea Tachycardia. Substernal and intercostal retractions. Stridor Nasal flaring. Hoarseness Increased restlessness

Tachypnea Tachycardia. Substernal and intercostal retractions. Nasal flaring. Increased restlessness

What clinical observations are predictive of acute epiglottitis? Select all that apply. One, some, or all responses may be correct. absence of spontaneous cough presence of drooling paroxysmal croupy cough symptoms awaken but disappear during the day tripod position with chin thrust out, mouth open and tongue protruding agitation

absence of spontaneous cough presence of drooling agitation Three clinical observations that are predictive of epiglottitis are absence of spontaneous cough, presence of drooling, and agitation.

Emergency management for choking in a child younger than 1 year of age include chest compressions. abdominal thrusts. back blows and chest thrusts. having the child forcefully cough it out and perform a finger sweep to remove the foreign body

back blows and chest thrusts. FB aspiration may result in life-threatening airway obstruction, especially in infants because of the small diameters of their airways. Current recommendations for the emergency treatment of the choking child include the use of abdominal thrusts for children older than 1 year of age and back blows and chest thrusts for children younger than 1 year old. An FB is rarely coughed up spontaneously

A nurse is caring for a 5-year-old following a tonsillectomy and assesses the child for signs of active bleeding. Which findings would the nurse expect to observe if the child was bleeding? Select all that apply. One, some, or all responses may be correct. Frequent swallowing Hemoptysis Tachycardia Tachypnea Frequent clearing of the throat Epitaxis Facial flushing Cream-colored membrane in back of throat

frequent swallowing Hemoptysis Tachycardia Frequent clearing of the throat Epitaxis Hide question 18 feedback Postoperative hemorrhage is unusual but may occur between 5 and 10 days after surgery with the sloughing of the primary eschar as the tonsil bed heals (Mitchell et al., 2019). The nurse observes the throat directly for evidence of bleeding, using a good source of light and, if necessary, carefully inserting a tongue depressor. Other signs of hemorrhage are tachycardia, pallor, frequent clearing of the throat or swallowing by a younger child, and vomiting of bright red blood. Restlessness, an indication of hemorrhage, may be difficult to differentiate from general discomfort after surgery. Decreasing blood pressure is a much later sign of shock.