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Original Question

Please help to answer these questions 1.A 4-year-old patient presents to the emergency department with a productive cough, tachypnea, crackles, decreased breath sounds, and nasal flaring. A chest x-ray indicates diffuse infiltration with peribronchial distribution. For which disease process might these signs and symptoms be indicative? Pneumonia Pertussis Foreign body aspiration Asthma 2.A nurse assessing a patient’s oxygen saturation notes a level of 90% on room air. What would be an appropriate nursing intervention? Administer oxygen as ordered Ask patient to cough CPT as ordered All of the above 3.An 8-month-old patient has a tracheostomy secondary to cerebral palsy. It is time for the patient’s dressing change. What materials should you make sure to bring to the room? Half-strength hydrogen peroxide New tracheostomy dressing, tracheostomy ties Sterile gloves, sterile field New sterile tracheostomy tube 4.While performing tracheostomy care, one should assess the skin around the stoma for: signs of infection. skin breakdown. drainage. All of the above. 5.A nurse assesses the lung sounds of an 8-month-old patient with a tracheostomy secondary to cerebral palsy and notes rhonchi and crackles. In addition, the nurse assesses vital signs and notes a respiratory rate of 48 and an oxygen saturation of 90%. What might be an appropriate nursing intervention? Suction patient Administer analgesics as ordered Place patient on humidified air None of the above 6.After suctioning a patient, the nurse places him back on humidified air. The patient’s mother asks the nurse why her son has to have humidified air. Which statement would be the best response? A source of humidification is provided because the normal humidification and filtering functions of the airway have been bypassed. A source of humidification is provided because the normal humidification and filtering functions of the airway are not functioning at the optimal level. A source of humidification is provided to enhance your son’s normal humidification and airway filtering functions. A source of humidification is provided to increase your son’s oxygenation. 7.After tracheostomy suctioning, the nurse should evaluate the patient’s: pedal pulses. bowel sounds. lung sounds. ROM. 8.A patient might have a gastrostomy tube and/or tracheostomy secondary to cerebral palsy related to: abnormal oral muscle tone and coordination resulting in feeding problems/aspiration. spastic movements. severe pain upon swallowing. inability to control eye movements. 9.What would be an appropriate focused assessment for Carolina? Extremity assessment Lung assessment Reflex assessment Visual assessment 10.Carolina presented with copious thick green secretions, coarse lung sounds, a saturated tracheostomy dressing, decreased oxygen saturation, an increased respiratory rate, and coughing. What should be your first nursing priority? Administer an IV antibiotic Obtain sputum culture Perform tracheostomy care Suction patient 11.How does one safely suction a tracheostomy? Set suction pressure to 60-100 mm Hg, select catheter diameter half the diameter of the tracheostomy tube, introduce catheter without suction to the end of the tracheostomy tube, apply intermittent suction, pull suction out (no more than 5 seconds). Hyperventilation with 100% oxygen may be performed before and after suctioning. Set suction pressure to 120-150 mm Hg, select catheter diameter half the diameter of the tracheostomy tube, introduce catheter without suction to the end of the tracheostomy tube, apply intermittent suction, pull suction out (no more than 5 seconds). Hyperventilation may be performed before and after suctioning. Set suction pressure to 60-100 mm Hg, select catheter diameter three-fourths the diameter of the tracheostomy tube, introduce catheter without suction to the end of the tracheostomy tube, apply intermittent suction, pull suction out (no more than 5 seconds). Hyperventilation may be performed before and after suctioning. Set suction pressure to 60-100 mm Hg, select catheter diameter half the diameter of the tracheostomy tube, introduce catheter without suction to the end of the tracheostomy tube, apply intermittent suction, pull suction out (no more than 15 seconds). Hyperventilation may be performed before and after suctioning. 12.What would indicate that a patient’s secretions have been effectively cleared following suctioning? Clear lung sounds An increase in O2 sat level A decrease in respiratory effort All of the above 13.Why is it important to obtain a sputum culture before the administration of an antibiotic? An antibiotic kills bacteria. The sputum culture will contain dead bacteria and will therefore not show accurate results. It is not important to obtain a sputum culture before administration of an antibiotic. An antibiotic kills bacteria. In order to get an accurate assessment of the amount and type of bacteria, if any, in the sputum, a sputum culture should be obtained before an antibiotic is started. The analysis of the sputum culture will pick up the antibiotic and not the bacteria. 14.If attempts to clear Carolina’s secretions with suctioning are unsuccessful, what might the nurse do next? Consult respiratory therapy. Stop suctioning and attempt suctioning again in 30 minutes. Administer oxygen as ordered, notify the physician, and consult respiratory therapy. Keep suctioning until secretions are gone. 15.What would be important to document after performing tracheostomy care on Carolina? Skin assessment Bowel sounds Pupillary reflex Oral intake 16.How should the nurse appropriately explain the suctioning procedure to Carolina? “Carolina, I am going to clean out your breathing tube so you will feel better. You might feel a tickle when I put this tube in your tube. It’s okay to cough if you need to; this helps me clean out your tube.” “Carolina, I am going to clean out your breathing tube so you will feel better.” “Carolina, is it okay if I clean out your breathing tube? You might feel a tickle when I put this tube in your tube. It’s okay to cough if you need to. This tube helps me clean out your breathing tube.” “Carolina, I am going to clean out your tracheostomy tube. I will set the suction pressure to 60-100 mm Hg. I will then introduce the catheter without suction to the end of the tracheostomy tube, applying intermittent suction as I pull suction out of tracheostomy tube.” 17.What would be appropriate to communicate to Carolina’s mother before, during, and after suctioning? Carolina needs to be suctioned because she is having a hard time breathing. Suctioning will help clear her airway. Carolina is doing so well with suctioning. I am getting a lot of secretions out. Carolina sounds much clearer now and her oxygen level has risen. All of the above. 18.A 3-year-old patient has just been diagnosed with acute asthma. He has no other significant medical history. Upon admission, the patient presented with audible wheezes and respirations of 36 breaths per minute. Which other vital sign would most likely have been high upon admission? Blood pressure Heart rate Temperature None of the above 19.A patient has just been diagnosed with pneumonia. Upon initial lung assessment, what adventitious lung sounds might you expect to hear? Crackles Rhonchi Stridor None of the above 20.As a nurse walks into a patient’s room, the father of the patient tells the nurse that his daughter has just been diagnosed with otitis media. He asks the nurse, “What is otitis media?” Which answer would be the best response? Otitis media is an inflammation of the middle ear. Otitis media is an inflammation of the outer ear. Otitis media is an inflammation of the inner ear. Otitis media is an inflammation of the outer and middle ear. 21.A nurse is caring for a 14-month-old patient. Which pain scale is an appropriate assessment tool for this patient? FACES pain scale FACES or FLACC pain scale Numeric scale FLACC pain scale 22.A 6-year-old patient was admitted to the floor for seizures of an unknown origin. What safety precautions would be appropriate for this patient? Pad hard objects, such as side rails Keep side rails raised when child is sleeping or resting Remove hazards from room All of the above 23.During tracheostomy care, a nurse assesses a patient’s tracheostomy site and notes that the skin around the tracheostomy is red and swollen. This is a new finding. In addition, a small amount of yellow drainage around the tracheostomy is noted. Which nursing action would be appropriate? Clean the site Clean the site, redress the site, document your findings, and notify the patient’s care provider Clean the site, redress the site, document your findings, and monitor the patient’s progress Clean the site, redress the site, and document your findings 24.An 8-year-old patient has a diagnosis of spastic cerebral palsy. Upon assessment, which would be an expected finding? Dystonic movements Rapid, repetitive movements Wide-based gait Ankle clonus 25.Upon assessment of a 16-month-old patient admitted for pneumonia, a temporal temperature of 38.5 C is found. What would be an appropriate nursing action? Uncover the patient Apply cool packs Administer acetaminophen All of the above 26.A patient who had a G-tube placed for esophageal atresia is about to be discharged. Which educational point should be provided to the parents of this patient? Cleanse area daily to keep the area free of drainage Secure tube to abdomen to prevent pulling Notify your provider if skin breakdown or signs of infection are noted at the site. All of the above 27.A patient’s scheduled bolus G-tube feeding was administered 4 hours ago. It is now time for her next feeding. Before the feeding is initiated, the nurse should evaluate: the residual fluid in the patient’s stomach. the residual fluid in the formula bottle. the amount of fluid in the patient’s mouth. None of the above 28.Upon admission, Carolina’s gastrostomy site was leaking and the skin was very irritated. What focused assessment would need to be performed by the nurse based on this finding? Nutritional assessment Skin assessment Pain assessment All of the above 29.Upon assessment of Carolina, you find that the continuous feeding tube has become disconnected, that the patient is wet, that the patient is moaning, and that the G-tube insertion site appears to have signs of skin breakdown. How would you prioritize the following nursing interventions based on these findings? Stop feeding and clamp tubing, change linens and clean child, provide G-tube site care, hang feeding Change linens and clean child, provide G-tube site care, stop feeding and clamp tubing, hang feeding Stop feeding and clamp tubing, hang feeding, change linens and clean child, provide G-tube site care Provide G-tube site care, stop feeding and clamp tubing, hang feeding, change linens and clean child 30. What are the appropriate steps to teach Carolina’s mother in regards to G-tube site care? Cleanse area weekly, apply antibiotic ointment as directed, secure tube to abdomen, notify the physician if skin breakdown or signs of infection are noted at the site. Cleanse area every other day, apply G-tube dressing, secure tube to abdomen, notify the physician if skin breakdown or signs of infection are noted at the site. Cleanse area daily, apply antibiotic ointment as directed, apply G-tube dressing, secure tube to abdomen, notify the physician if skin breakdown or signs of infection are noted at the site. Cleanse area daily, apply antibiotic ointment as directed, apply G-tube dressing, notify the physician if skin breakdown or signs of infection are noted at the site. 31. How might you assess Carolina’s mother’s knowledge of G-tube site care? Ask her to participate in the care while in your presence Ask her if she has any questions regarding G-tube site care Ask her to verbally explain to you how she would go about caring for the G-tube site All of the above 32.Which seizure precautions should be in place for Carolina? Select all that apply. Remove hazards Place small cushion under child’s head Pad objects such as crib or wheelchair Keep side rails raised when child is sleeping or resting Place waterproof mattress or pad on bed 33.Abnormal findings for which lab tests might indicate malnutrition? Albumin Creatinine Hemoglobin All of the above 34.What might be some signs and symptoms that Carolina is comfortable following G-tube care? Pulse increases BP increases Patient laughs RR increases

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