NUR 438 RESPIRATORY STUDY GUIDE QUESTIONS AND ANSWERS LATEST DOWNLOAD 2024/2025 A COMPLETE, Exams of Nursing

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Airway in children < 8 years - CORRECT ANSWERS Has a smaller and more narrow airway with smallesr portion at the cricoid space Leads to risk of obstruction and respiratory distress Lungs in children - CORRECT ANSWERS Small lung capacity (10 mL/kg) and underdeveloped intercostal = less reserve Respiratory distress signs - CORRECT ANSWERS Tachypnea, retractions, nasal flaring, grunting, head bobbing, restlessness/anxiety, and tachycardia Imminent Respiratory Arrest signs - CORRECT ANSWERS Bradypnea/severe dyspnea, bradycardia/hypotension, cyanosis, and somnolence/coma Pulse Oximetry - CORRECT ANSWERS Measures hemoglobin saturation Non-invasive Can read false desaturations with movement or cold extremity Respiratory Cultures - CORRECT ANSWERS Nasal swab for Respiratory viral panel-rotate against anterior hairs. Can detect a number of viryses. Including pertussis and RSV. Polymerase chain reaction (PCR), great specificty > 92% Chest Radiograph - CORRECT ANSWERS Quick, painless Needs to remain still for quality image

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Parent can be present Used to identify respiratory concers like atelectasis/ infiltrates/ fluid What are we concerned about in kids with RR > 60 bpm - CORRECT ANSWERS Risk of aspiration. The patient needs to be NPO Tachypnea is always the first respiratory sign in a young child with a respiratory concern. Breathing in 1st six weeks of life - CORRECT ANSWERS Obligate nose breather What type of breathers are infants and young children - CORRECT ANSWERS Diaphragmatic breathers with pliable ribs leads to retractions with respiratory distress Cannot increase depth so compensates with increased RR (tachypnea) Brief Resolved Unexplained Event Pathophysiology - CORRECT ANSWERS A brief event that occurs in children under the age of 1 that resolves. Has a combination of apnea, change in color, change in muscle tone, or choking. A significant intervention such as CPR is normally required Brief Resolved Unexplained Event Clinical Manifestations - CORRECT ANSWERS May be scary to observer Brief < 1 min episode of what is noted above Brief Resolved Unexplained Event Risk Factors - CORRECT ANSWERS Prior history of ALTE/BRUE, history of cyanosis, SIDS sibling, premature infants, wieghing less than 1750 g, Age < 10 week, seizures, GI (GER), ENT abnormalities

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Brief Resolved Unexplained Event Therapeutic Management - CORRECT ANSWERS May require initial CPR by person witnessing event Depends on underlying condition/symptoms Testing for UTI is highly recommended If the cause of the ALTE cannot be determined, then home monitoring is recommended Brief Resolved Unexplained Event Nursing Care - CORRECT ANSWERS Parental support and education (verbal/written) n regarding equipment (including home apnea monitor), status of infant, and infant CPR. sudden infant death syndrome (SIDS) - CORRECT ANSWERS Sudden death of an infant younger than 1 year of age that remains unexplained after a complete postmortem examination Cause remains unknown, some hypothesis #1 brainstem abnormality involving cardiorespiratory control, genetic predisposition. SIDS Risk Factors - CORRECT ANSWERS Low birth weight, preterm birth, low APGAR, recent viral illness, sibs of 2 or more SIDS victim, male, Native American or African American ethnicity, maternal smoking, co-sleeping, prone sleeping, soft bedding, previous ATLE/BRUE SIDS Therapeutic Managment - CORRECT ANSWERS No management really about prevention. SIDS Nursing Care - CORRECT ANSWERS Prevention: Educating families about risk of prone position and importance of safe sleep (birth to 6 mo) to prevent SIDS, firm mattress, sleep supine, object free beds, sleep alone (no co-sleeping) Nurses also need to model these safe sleep practices in the hospital

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Encourage breastfeeding and pacifier use for first 6 months to reduce incidence Surgical management- Strep Pharyngitis/Tonsillitis=Tonsillectomy with Post-operative Tonsillectomy care - CORRECT ANSWERS Monitor for s/sx of obstruction (respiratory distress, tachycardia, tachypnea, decreased SpO2 with sleep, & agitation). May need to consider gentle suction at front of mouth and overnight stay in hospital to monitor pulse oximeter. Monitor for bleeding: Initially, dark brown blood is common continue to monitor. Signs/symptoms of concern: fresh bleeding usually emesis (bright red), Tachycardia, pallor, frequent swallowing need to contact provider. Avoid strong coughs Pain management: assess/treat with acetaminophen/opioid for management scheduled ATC for first 24-48 hours then change to PRN. May progress to acetaminophen only. Codeine is contraindicated efficacy problems related to genetic variability in biotransformation →↑ risk of death. Diet: advance from clears to soft. Need to really encourage PO intake to assist with hydration/pain. We use IV hydration in the hospital to avoid concerns of dehydration. Avoid straws, citrus, and red-colored juices. For foods, no spicy or hard, crunchy Discharge teaching: Recovery is 7-10 days teach pain management teach alternate acetaminophen/ibuprofen (may have temporary increased pain when scabs fall off), encourage PO intake with appropriate diet avoid same foods, and monitor for bleeding symptoms. Contact provider with bleeding, uncontrolled pain, fever not relieved by antipyretic. Strep Pharyngitis - CORRECT ANSWERS Group A Beta-Hemolytic Streptococci infection of the pharynx and invades the tonsils. If left untreated, children are at risk for serious sequale: --Acute rheumatic fever for about 2 week --Acute glomerulonephritis for about 10 days

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Clinical Manifestations of Strep Pharyngitis - CORRECT ANSWERS Tonsillar exudate with white spots, odynophagia to dysphagia, dry cough, foul smelling breath Lab diagnostics of Strep Pharyngitis - CORRECT ANSWERS + rapid strep test (throat swab) Increase in anti-streptolysin (ASO) titer CBC high WBC/neutrophils indicates infection Strep Pharyngitis Medications and Management - CORRECT ANSWERS Meds: Antibiotics to treat infection and analgesic (nonopiod) antipyretic for pain and temperature Management: Consider ice collar or Na+ gargling in older child, may require IV hydration, with repeated infection may require tonsillectomy, with tonsillar hypertrophy may need O for decreased SPO2 with sleep due to upper airway obstruction. Strep Pharyngitis Nursing Diagnosis - CORRECT ANSWERS Deficeint fluid volume, Altered/Imapired Comfort, and Risk for infection/sepsis Deficient Fluid Volume (Strep pharyngitis) - CORRECT ANSWERS Monitor I/O and daily weight, provide PO fluids of choice, monitor for signs of dehydration. By discharge, the patient will maintain a urine output WNL for age and intake apropriate for weight. HR/BP WNL for age. No signs of hypovolemia. Altered/Impaired Comfort (Strep pharyngitis) (LTB) (RSV) - CORRECT ANSWERS Monitor VS/temp/comfort, cool fluids, medicate as needed, consider distraction, and encourage parent prescence. By discharge the patient will maintain an acceptable level of comfort, pain level 0-2 on age appropriate scale. Temp < 38.0 C. No s/sx of anxiety present. Patient engages in play.

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Risk for infection/sepsis (Strep pharyngitis) (Epiglottitis) - CORRECT ANSWERS Monitor Temp for S/sx of infection, droplet precautions, and teach prevention with immunization By discharge patient has temp < 38.0 C, no s/s of infection, WBC and neutrophils are WNL for age. Resp focus: LS improved but remain coarse. Laryngotracheobronchitis (LTB) /croup - CORRECT ANSWERS Viral infection Inflammation of the lining of the larynx/trachea/subglottic area ---> significant narrowing Clinical manifestations of LTB - CORRECT ANSWERS Inspiratory stridor and barking cough with increased WOB (sub/suprasternal retractions) Hoarse voice Gradual onset and low grade fever Non-toxic appearance Agitation and night may exacerbate symptoms LTB Labs/Diagnostics - CORRECT ANSWERS RVP+ for viral infection CBC may have increased WBC/lymphocytes due to viral infection CXR shows steeple sign due to narrowing of the airway LTB Nursing Diagnosis - CORRECT ANSWERS Risk for fluid volume deficit, altered/impaired comfort, and ineffective breathing pattern Ineffective breathing pattern nursing diagnosis (LTB) - CORRECT ANSWERS Monitor RR/SPO to evaluate distress, respiratory assessment, position for comfort, and parent presence to decrease anxiety. By discharge RR WNL for age, resp are easy and non labored, SPO

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LTB Medications by class - CORRECT ANSWERS Moderate to severe croup due to loud audible stridor: Nebulize racemic epinephrine to reduce subglottic edema (observe for rebound swelling, will cause tachycardia) Oral/IV corticosteroid (dexamethasone) single dose Antipyretic/non-opiod analgesic for temperature/irritability LTB management - CORRECT ANSWERS Mild Croup: Manage with cool mist may need O (Constricts edematous vessels and decreases viscosity of secretions) May require IV hydration Epiglottis - CORRECT ANSWERS Acute swelling (r/t infection or inflammation) of the area around the epiglottis ---> narrowing of airways Medical Emergency Clinical manifestations of epiglottis - CORRECT ANSWERS Frog like croaking sound on inspiration with acute respiratory distress (tachypnea, tachycardia with sub/suprasternal retractions) Tripod positioning (upright and leaning forward mouth open) Drooling r/t dysphagia Fever Anxiety Severe sore throat Labs/Diagnostics for Epiglottis - CORRECT ANSWERS Looks like a thumb on lateral neck x-ray. CBC increase WBC, neutrophil (bacterial) and platelet count, increase CRP/procalcitonin Nursing diagnosis for epiglottis - CORRECT ANSWERS Ineffective breathing pattern, altered/impaired comfort, and risk for infection/sepsis

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Risk for infection/sepsis nursing diagnosis - CORRECT ANSWERS Monitor temp for s/sx infection, droplet precautions (infectious x 24 hours), teach prevention with immunization By discharge the patient has a temp < 38.0 c no s/s of infection (lethargy, loss of appetite) WBC and neutrophil are WNL for age. Resp focus: LS improved but remain coarse. Epiglottis Medications by class - CORRECT ANSWERS Antibiotic to treat infection Analgesics (opioid/nonopioid)/antipyretic for pain and temperature Epiglottis Management - CORRECT ANSWERS Need to secure airway/prepare for intubation in the interim with low SPO2 apply oxygen as patient tolerates (consider blow-by/fun mask) May require IV hydration/NG feedings while NPO Pertussis - CORRECT ANSWERS Bacteria causes paralysis of the cilia in the respiratory tract ---> inflammation and impaired clearing of pulmonary secretions. Can prevent with immunization Pertussis Clinical Manifestations - CORRECT ANSWERS Initial: Sneezing, coughing, and rinorrhea (lasts 1-2 weeks), coarse lung sounds and increased WOB, and low grade fever Progression: Short rapid cough that ends in whoop, and post-tussive emesis and fatigue (Greatest risk for other complications in this phase) Pertussis Lab/diagnostics - CORRECT ANSWERS RVP+ for bordetella, CBC high WBC/neutrophil due to bacteria, and CXR - extent of disease Pertussis Nursing Diagnosis - CORRECT ANSWERS Ineffective airway clearance, risk for infection, and risk for fluid volume deficit

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Ineffective airway clearance (Epiglottitis) (Pertussis) (RSV) - CORRECT ANSWERS Monitor RR/O2/Resp assessment of s/s of obstruction, suction prn, position for comfort, encourage po but monitor risk for aspiration By discharge, RR WNL for age and are nonlabored. Saturations > 94% room air. LS sl coarse and equal. Cough controlled Risk for infection (Pertussis) - CORRECT ANSWERS Monitor VS/temp, S/sx of infection - lung sounds, droplet precautions Discharge patient has temp <38 C, no s/sx of infection (lethargy, loss of appetite) WBC and neutrophils are WNL for age. LS are sl coarse/equal Risk for fluid volume deficit (Pertussis) (RSV) - CORRECT ANSWERS Monitor I/O, VS, and daily weight along with signs of volume deficit. Provide PO intake with RR< 60. By discharge the patient will maintain a urine output at min. for age and intake appropriate for weight. HR and BP within normal limits for age. Pertussis Medications by class - CORRECT ANSWERS Antibiotic to treat infection Pertussis management - CORRECT ANSWERS If SpO2 low administer O May require IV hydration/NG feedings Respiratory syncytial virus (RSV) - CORRECT ANSWERS Viral infection of the lining of the bronchials. They swell/fill with mucus and dead epithelial cells (fuse to make the giant "syncital" cells) --> obstruction/air trapping. Symptoms peak day 3-5 (can worsen) resolve 7-10 days.

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Clinical Manifestations (RSV) - CORRECT ANSWERS Early: Low-grade fever, profuse rhinorrhea, expiratory wheezing and crackles in bases. Intermittent tachycardia (RR often > 60)/ tachycardia and substernal retractions Progression: Increase WOB with nasal flaring, suprasternal retractions, and grunting with tachypnea (> 70 bpm) Late: Cyanosis, minimal breath sounds, and dehydration. RSV Labs and diagnostics - CORRECT ANSWERS RVP+ for RSV Diagnostic CXR denotes infiltrates/hyperinflation RSV Nursing Diagnosis - CORRECT ANSWERS Ineffective airway clearance, altered/impaired comfort, and risk for fluid volume deficit RSV medications by class - CORRECT ANSWERS 3% saline neb to assist mucus clearance-hold for bronchospasm Analgesic/antipyretic for low-grade temp/irritability Vaccine in development RSV Management - CORRECT ANSWERS If SpO2 low administer O2, may require high flow nasal cannula (HFNC) to decrease WOB May require IV hydration/NG feedins Quality outcomes: Saturations > 90%, RR < 60 bpm, and adequate oral intake Asthma - CORRECT ANSWERS Chronic disorder involving a complex interactions of hyper bronchial responsiveness to (+) stimuli (trigger) --> airway edema and increased accumulation of mucus (airway obstruction) --> bronchospasm of smooth muscle (air trapping/decrease airway size) --> mast cell degranulation (release of histamine, leukotrienes, etc.) --> increased airway resistance and airway remodeling.

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Asthma clinical manifestations - CORRECT ANSWERS Wheeze on expiration ( + on inspiration patient is clinically worse), increase in WOB with retractions/nasal flaring, tachypnea, and CO2 retained with long expiratory phase Chronic rhinorrhea with allergies Non-productive cough worse at night Chest-tightness, restless Tachycardia (may have pulses paradoxus) Asthma Labs/diagnostics - CORRECT ANSWERS +RVP with URI trigger only CBC may have increase WBC/lymphocytes Note eosinophils and basophils increase may indicate future risks for exacerbation CXR denotes air trapping (hyperinflation) and potential infiltrates Ashtma nursing diagnosis - CORRECT ANSWERS Risk for fluid volume deficit, knowledge deficit, and ineffective breathing pattern/ineffective airway clearance (depends on trigger) Risk for fluid volume deficit (LTB) (RSV) - CORRECT ANSWERS Monitor I/O and daily weight Provide PO fluids of choice make a game if needed or IVF if indicated Monitor for signs of dehydration By discharge the patient will maintain a urine output WNL for age and intake appropriate for weight. HR/BP WNL for age. No signs of hypovolemia Knowledge Deficit (Asthma) - CORRECT ANSWERS Teach to identify triggers, teach disease process to increase self-efficacy, teach medication information, and assess current knowledge and learning style

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By discharge patient and/or family can teach back > 90% of the information regarding prevention of disease, disease process, diet, activity, and medications Ineffective breathing pattern/ineffective airway clearance (depends on trigger) (Asthma) (Cystic fibrosis) - CORRECT ANSWERS Monitor RR/SpO2 to evaluate distress, respiratory assessment, position for comfort, parent presence to decrease anxiety, and encourage hydration/mobility By discharge RR WNL for age, Resp are easy and non labored, SpO2 lung sounds are clear/sl course with minimal exp. wheezes Asthma medications by class - CORRECT ANSWERS For persistent asthma: long acting Beta agonists (albuterol/salmeterol) anticholinergic (ipratropium) or mast cell stabilizer with inhaled corticosteroid (fluticasone) r/t ongoing airway remodeling For exacerbation: Short acting beta 2 agonist (albuterol consider levalbuterol with increased HR) to decrease bronchoconstriction and IV/PO systemic corticosteroids (methylprednisone.prednisolone (decrease airway edema) may use magnesium sulfate IVBP x1 (relax smooth muscle of the airway) Management: Allergen control h1 antagonist (2nd gen) (loratadine) 7/or leukotriene modifiers to decrease chronic airway inflammation Management of Asthma - CORRECT ANSWERS O2 as needed May require IV hydration with additional KCI if on continuous albuterol (will drop K+ serum levels) CPT/Vest therapy for URI trigger Quality indicator - children who were identified as having moderate to severe persistent asthma and were appropriately prescribed medication during the measurement period. Cystic fibrosis - CORRECT ANSWERS An autosomal recessive disease --> mutation of CFTR gene --> impairment of Na and Cl transportation (Cl is stuck in cells) in the exocrine system

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(mucus producing glands) --> increase in viscosity/production of secretions --> buildup of mucus in lungs and pancreas/small intestine Cystic fibrosis clinical manifestations - CORRECT ANSWERS Respiratory: Progressive chronic obstructive lung disease --> infection due to overgrowth of bacteria (wheezing, dyspnea, and chronic cough) --> barrel shaped chest --> decreased aeration --> cyanosis and clubbing of the fingers/toes GI: Maldigestion r/t pancreatic insufficiency (enzymes to process food are blocked from entering duodenum) --> foul, floaty, fatty stool with growth failure/small stature Concern for intestinal obstruction initially from meconcium ileus later can be from mucus plus and GERD Cystic fibrosis labs/diagnostics - CORRECT ANSWERS Chloride sweat test is + for increase Cl with DNA test for mutation Infection: CBC (Increase WBC/neutrophils) decrease H/H results from iron absorption issue. Sputum cx (concern gm - rods- pseudomonas) Chest x-ray infiltrates + Cystic fibrosis nursing diagnosis - CORRECT ANSWERS Nutrition < body requirements, risk for infection, ineffective airway clearance Nutrition < body requirements (cystic fibrosis) - CORRECT ANSWERS Monitor I/O and daily weight, provide PO fluids/foods of choice, GI assessment, stool assessment for pancreatic enzyme effectiveness. By discharge patient is consuming appropriate kcals/kg/day. Weight stable +/- 20- gm/day. Patient able to assist with care and play

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Risk for infection (Cystic fibrosis) - CORRECT ANSWERS Monitor temp and s/s of infection including PICC site, may need droplet/contact precautions, monitor labs, encourage dietary intake, administer antibiotics as ordered By discharge patient &/or family can teach back > 90% of the information regarding prevention of disease (transmission/immunizations), disease process, diet, activity, and medications Ineffective airway clearance - CORRECT ANSWERS Monitor RR/Spo2 to evaluate distress. Respiratory assessment, position for comfort, parent presence to decrease anxiety. CPT/vest therapy. Suction prn. Encourage hydration/mobility By discharge RR WNL for age, resp are easy and non labored, SpO2 lung sounds are clear/sl course with minimal exp. wheezes Cystic fibrosis medications by class - CORRECT ANSWERS IV antibiotics w/ PICC line, inhaled tobramycin (direct tx of pseudomonas), short acting Beta 2 agonist (albuterol), anticholinergic (ipratropium) or mast cell stabilizer (cromolyn) for bronchodilation, mucolytic (dormase alpha) breaks up mucus, oral pancreatic enzymes with meals/snacks to absorb nutrients, and water-soluble vitamin ADEK Cystic fibrosis management - CORRECT ANSWERS Airway clearance with Vest therapy/flutter valve, O2 therapy prn with caution due to chronic CO2 retention, CPT/Vest therapy, and unrestricted fat high protein and calorie diet to combat growth failure consider overnight NG feedings if needed.