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PNP-AC Respiratory/EENT Pediatric Nurse
Practitioner - Acute Care 2024 Exam Review
Questions and Answers 100% Pass
Mallampati scoring of difficult airway - Answer>> Class 3 or > People with these genetic conditions are _______ risk for intubating: Pierre Robin (small jaw), Treacher collin, turners, downs, Beckwith-Weiderman (large tongue) - Answer>> High What type of ETT has this formula for sizing: (age in years/4) + 4 - Answer>> Uncuffed What type of ETT has this formula for sizing: (age in years/4) + 3 - Answer>> Cuffed phase of pertussis URI symptoms lasting 1-2 weeks. Most contagious during this phase, infants may only present with apnea. older kids present with fever, fatigue, rhinorrhea, conjunctivitis - Answer>> Catarrhal Phase of pertussis with staccato cough and resolution of fever, makes the whooping couch sound. Non-toxic appearing - Answer>> Paroxysmal Phase of pertussis in which the residual cough persists for weeks to months and is usually triggered by exposure to another upper respiratory infection or irritant. - Answer>> Convalescent Treatment for pertussis - Answer>> Erythromycin (1st line), Azithro, Clarithro
complications of hyphema - Answer>> vision loss and glaucoma appropriate tidal volumes in infants - Answer>> 6-7 mL/kg type of ventilation that indicates that the patient can initiate breaths spontaneously and is determining the volume of theses breaths on their own - Answer>> pressure support what complication is the result of distal alveolar rupture and is associated with high ventilator pressures and severe lung disease
- Answer>> air leak syndromes s/s of this: hemopytsis, respiratory sitress, hypoxia with subcutaneous emphysema and consolidatin on CXR - Answer>> pulmonary contusion what is the most accurate way to estimate energy requirements of a child who is mechanically ventilated (exceptions to this are those on hemodialysis, CRRT, FiO2 <60%, or sig ET tube leak) - Answer>> indirect calorimetry what type of x-ray do you need to assess for pleural effusions? - Answer>> lateral decubitus what respiratory complication will have cardiomegaly, pulmonary edema, and blunting of the right costophrenic angle without a mediastinal shift on x-ray? - Answer>> pleural effusion what is the best way to confirm ET tube placement? - Answer>> capnography
what are the three most common causes of congenital hearing loss? - Answer>> meningitis, congenital CMV, genetic syndrome what percentage does FiO2 need to be at to wean off the ventilator? - Answer>> 40% What is the most common cause of croup? - Answer>> Parainfluenza What radiographic finding is diagnostic for croup? - Answer>> Steeple sign Dexamethasone dosing for croup - Answer>> 0.6 mg/kg what age group is most likely to get PNA caused by group b strep, e coli, HSV, ureaplasma, and listeria? - Answer>> Newborns what age group is most likely to get PNA from RSV, paraflu, chlamydia, pertussis, and strep pneumoniae? - Answer>> 1 to 3 months what is the abx of choice for presumed community pneumonia? - Answer>> Amoxicillin what is the abx of choice for presumed atypical pnuemonia? - Answer>> Azithromycin what is the antibiotic treatment of hcoice for complicated pneumonia? - Answer>> ceftriaxone with vancomycin or clindamycin what is the antibiotic treatment of choice for aspiration pneumonia? - Answer>> augmentin, unasyn, or clindamycin
s/s of this: pleuritic chest pain, respiratory distress, persistent fevers, expiratory friction rub, diminished breath sounds, dullness to percussions, symptoms don't improve on antibiotics dx: CXR, US or CT of chest, pleural fluid analysis (fluid protein > serum protein by 50% is diagnostic) tx: IV abx, thoracentesis w/chest tube, fibrinolytic therapy, VATS procedure - Answer>> Empyema Typically in kids 2- Can occur after dental procedure Typically polymicrobial history may have recent intubation, oral foreign object, or recent infection of any structures that drain into the retropharyngeal space s/s Nonspecific Fever, sore throat, neck stiffness, poor feeding, unilateral neck swelling, potato voice Stridor Dysphagia Chest pain with inspiration Dx CBC Lateral neck films CT= gold standard Need ENT referral, stat ED!! Tx Beta lactamase penicillins Third gen cephalosporins
tx: 3rd gen cephalosporin, steroids for inflammation, vanc if concerned for staph aureus. tx for 7-10 days - Answer>> Epiglottitis inflammation of the trachea commonly caused by staph aureus or community MRSA s/s: high fever with toxic appearance, leukocytosis, stridor, barky cough, several day croup like history dx: lateral neck x-ray tx: intubation, empiric antibiotic therapy - Answer>> tracheitis abscess that forms behind the tonsil, a local cellulitis s/s: recent hx of strep throat, fever, lymphadenopathy, uvula deviation, drooling, muffled speech, neck swelling, ear pain on affected side, tripod positioning dx: throat culture, neck I&D, CT with contrast tx: I&D, unasyn, clindamycin MEDICAL EMERGENCY - Answer>> Peritonsillar abscess Patho: inflammation of the eyelid and surrounding tisues Common in kids <5 yo Pathogens: Haemophilus influenza, s. pneumonie Often d/t trauma, insect bites, severe sinusitis, conjunctivitis, or dental abscess S/s +/- fever lymphadenopathy
Discharge from eye Redness and swelling around infected eye dx Blood cx CBC Head CT to see extend of infection Tx: medical emergency!!! If untreated can lead to meningitis IV abx to avoid loss of vision - Answer>> Periorbital cellulitis type of apnea that is d/t immaturity of the respiratory center - Answer>> central type of apnea that is d/t OSA, craniofacial abnormalities, obesity, adenoid or tonsillar hypertrophy, aspirated foreign body, or vocal cord paralysis - Answer>> obstructive what is the most appropriate antibiotic choice for RPA? - Answer>> Ampicillin/Sulbactam (Unasyn) or vancomycin long term use of what medication requires frequent hearing screenings later in life - Answer>> lasix Pleural fluid LDH levels greater then what is suggestive of empyema? - Answer>> 1000 An OI > _____ = ARDS - Answer>> 16 what needs to be done to evaluate for ARDS to make sure there isn't a cardiac cause for symptoms - Answer>> Echo
classification of asthma that has symptoms fewer then twice per week and nighttime symptoms occur less then two days per month - Answer>> Intermittent Class of asthma that symptoms occur > twice per week, but not daily, night symptoms more then 2x/month - Answer>> Mild persistent daily symptoms of asthma with nighttime symptoms having
1x/week but not daily - Answer>> Moderate persistent Type of asthma with daily symptoms that limit physical activity and nighttime symptoms happen often, sometimes nightly - Answer>> Severe persistent what type of wheezing occurs in a severe asthma exacerbation? - Answer>> biphasic Which respiratory illness has chest x-ray finidings of hyperinflation with flattened diaphragm, peribronchial thickening, and narrowed cardiac silhouette - Answer>> Asthma what is the first priority treatment for asthma patients? - Answer>> oxygen what is the most common adverse reaction to magnesium sulfate in asthma patients? - Answer>> Hypotension what asthma adjunct therapy needs to have cardiac enzymes and EKG monitored because it can cause myocardia ischemia? - Answer>> Terbutaline this respiratory illness is typically caused by RSV
s/s: rhinorrhea, congestion, low grade fever, cough, tachypnea, diffuse crackles/rhonchi, expiratory wheeze tx: supportive care - Answer>> Bronchiolitis a chronic lung condition that occurs in premature infants from prematurity, IUGR<=, family hx of lung disease, ventilator trauma, oxygen toxicity s/s: tachypnea, retractions, scattered rales, hypoxemia, cyanosis, hypercarbia, increased anterior-posterior chest diameter, long standing oxygen reuirement will often see resp acidosis on ABG tx: NG tube for feedings, supportive care, lung protective ventilator strategies - Answer>> bronchopulmonary dysplasia inadequate respiratory drive d/t mutation of PHOX2B gene s/s: apnea, respiratory arrest, hypopnea, cyanosis, tachycardia, diaphoresis, lethargy, hypercarbia, hypoxemia will not show classic signs of resp distress tx: trach - Answer>> Congenital Central Hypoventilation Syndrome s/s: hypercarbia, hypoxia, retractions, tachypnea, grunting, cyanosis, absent breaths on one side with increased sounds on other side, heart sounds shifted to contralateral side, scaphoid abdomen dx: on fetal ultrasound, common in kids with polyhydramnios
tx: oxygen, diuretics - Answer>> pulmonary edema what is the diagnostic study of choice for smoke inhalation? - Answer>> direct bronchoscopy
