NUR 810 FINAL EXAM 2026/2027 – NURSING STUDY GUIDE, PRACTICE
QUESTIONS, COMPREHENSIVE REVIEW & TEST PREP
What type of coverage do you need for aspiration pneumonia in the medically complex child? - correct
answer ✔✔coverage for anaerobes and gram - bacteria
What type of abx do you treat aspiration pneumonia with? - correct answer ✔✔IV - Ampicillin-sulbactam
(Unasyn)
PO - Augmentin
What is tracheitis? - correct answer ✔✔Rare bacterial infection involving the trachea that you have to
worry about in medically complex children
Presentation of tracheitis - correct answer ✔✔Increased thickened or purulent secretions
Fever
Increased WBCs
S/S of systemic infection
Diagnostics/TX for tracheitis - correct answer ✔✔CBC
Culture of secretions (prone to colonization with morexella and staph)
CXR: No consolidation
IV ABX for 10-14 days
What is automonic storming? - correct answer ✔✔paroxysmal autonomic instability with dystonia and
sympathetic hyperactivity that is uncontrolled and comes and goes
Presentation of autonomic storming - correct answer ✔✔Fevers
Irritability
Tachypnea
Dystonic posturing
Diaphoresis
HTN
Tachycardia
Vomiting
Retching
WOP with autonomic storming - correct answer ✔✔CBC, ESR, CrP, cultures
Procalcitonin
Management of autonomic storming - correct answer ✔✔-Identify the trigger (pain is common)
-Daily controller med like gabapentin for pain
-Clonidine or propranolol for S/S of overactive sympathetic system
-Baclofen for muscle rigidity
-PRN tx with benzos and or narcotics
,What are the most common organisms that lead to shunt infections? - correct answer ✔✔Staph
epidermis (coag negative staph = most common)
Staph aureus
Can be from gram - organisms such as E. coli or klebsiella (common with VP shunts where the bacteria
was in the gut and progressed its way up)
Presentation of a shunt malfunction - correct answer ✔✔HA
Change in vision
N/V
Behavior change
Sleepiness
Irritability
Abnormal gait
Seizures
***All of S/S of increased ICP***
What are the S/S of a shunt infection? - correct answer ✔✔Fever
S/S of malfunction
Irritability
When is the most common time to get a shunt infection? - correct answer ✔✔In the first few mos after
placement or after a revision
When is the most common time to experience shunt malfunction? - correct answer ✔✔More common
later on
When should you evaluate a shunt? - correct answer ✔✔When the H&P suggests malfunction or
infection
Diagnostics with shunt malfunction - correct answer ✔✔-Pumping of reservoir (risk for obstruction and
not commonly performed)
-Shunt series (Series of x-rays that follow the course of the shunt from the skull to the distal end looking
for dislodgment)
-CT or MRI to look at ventricle size (most common)
Diagnostics for shunt infection - correct answer ✔✔-Testing of fluid from the shunt
-Watch for pleocytosis on CSF fluid
-CSF sent for cell count, glucose, protein, gram stain
-Blood cultures
What would indicate a probable shunt infection in regard to your WBCs in CSF? - correct answer ✔✔-If
you have pleocytosis of > 50 on your cell count and you have isolation of bacteria with at least 1 S/S of
shunt infection, this is enough for dx
-If there is > 100 on your cell count, then there is a 96% specificity for infection
How do you treat a shunt infection? - correct answer ✔✔Empiric coverage with Vanco and cefepime OR
Vanco and meropenem
,Management of shunt infection - correct answer ✔✔ABX
Repeat CSF culture until negative
Consider shunt removal and temporary external ventricular device until they have negative cultures
How many different patterns of pneumonia are there and what are they? - correct answer ✔✔5 but she
highlights 4
Lobar
Bronchopneumonia
Necrotizing
Interstitial and peribronchilar
What pattern is lobar pneumonia and what is the most common cause? - correct answer
✔✔Involvement of a single lobe or segment
Most common type
If not separated by age, it is most commonly caused by strep pneumo
What pattern is bronchopneumonia and what is the most common cause? - correct answer
✔✔Involvement of the smaller airways surrounding the interstitium
Strep pyogenes and staph aureus
Necrotizing pneumonia - correct answer ✔✔Secondary to staph or strep infection
Interstitial and peribronchiolar - correct answer ✔✔Atypical bacteria (mycoplasma)
Viral
What are the most common pathogens that lead to pneumonia in neonates (0-4 weeks)? - correct
answer ✔✔Group B strep
E.coli
Staph aureus
HSV
What are the most common pathogens that lead to pneumonia in infants (1 mos to 1 year)? - correct
answer ✔✔Chlamydia
Pertussis
Viral (RSV, influenza, metapneumovirus)
Strep pneumo
What are the most common pathogens that lead to pneumonia in children (3 mos to 5 years)? - correct
answer ✔✔RSV/viral
Strep pneumo
Mycoplasma
What are the most common pathogens that lead to pneumonia in children > 5 y/o? - correct answer
✔✔Mycoplasma (most common)
Strep pneumo (second most common)
, What are the most common pathogens that lead to pneumonia in immunocompromised pts? - correct
answer ✔✔Staph aureus
Gram negative bacilli
Aspergillus
CMV
HSV
Complications of viral and bacterial pneumonia - correct answer ✔✔Pleural effusion/empyema (more
common with bacterial pneumonia)
Pneumo
Meningitis
CNS abscess
Peri/endocarditis
Sepsis
S/S of pneumonia - correct answer ✔✔Cough
Fever/chills
HA
Irritability
Tachypnea
Hypoxemia
PE:
-Decreased breath sounds (esp if effusion)
-Crackles
-Course breath sounds
-Bacterial in nature, will look for a focal point (ex. crackles in the LLL)
What would be characteristic of lung sounds in a viral pneumonia? - correct answer ✔✔Diffuse pattern
with no focal findings on exam
S/S of viral pneumonia? - correct answer ✔✔More vague
Cough
Wheezing
Stridor
Lower grade fever
In a child who is 2 weeks to 4 mos with increased resp effort, rhinorrhea, staccato cough, what is their
pneumonia likely to be caused by? - correct answer ✔✔Afebrile pneumonia of infancy caused by
chlamydia trachomatis
When should you consider a CXR and inpatient tx for pts with presumed pneumonia? - correct answer
✔✔Worsening S/S: ill appearing, toxic, significant resp distress
Should you get follow up films if the pt is improving? - correct answer ✔✔No
What is the most common cause of bacterial pneumonia and what would you see on CXR? - correct
answer ✔✔Streptococcus pneumoniae
QUESTIONS, COMPREHENSIVE REVIEW & TEST PREP
What type of coverage do you need for aspiration pneumonia in the medically complex child? - correct
answer ✔✔coverage for anaerobes and gram - bacteria
What type of abx do you treat aspiration pneumonia with? - correct answer ✔✔IV - Ampicillin-sulbactam
(Unasyn)
PO - Augmentin
What is tracheitis? - correct answer ✔✔Rare bacterial infection involving the trachea that you have to
worry about in medically complex children
Presentation of tracheitis - correct answer ✔✔Increased thickened or purulent secretions
Fever
Increased WBCs
S/S of systemic infection
Diagnostics/TX for tracheitis - correct answer ✔✔CBC
Culture of secretions (prone to colonization with morexella and staph)
CXR: No consolidation
IV ABX for 10-14 days
What is automonic storming? - correct answer ✔✔paroxysmal autonomic instability with dystonia and
sympathetic hyperactivity that is uncontrolled and comes and goes
Presentation of autonomic storming - correct answer ✔✔Fevers
Irritability
Tachypnea
Dystonic posturing
Diaphoresis
HTN
Tachycardia
Vomiting
Retching
WOP with autonomic storming - correct answer ✔✔CBC, ESR, CrP, cultures
Procalcitonin
Management of autonomic storming - correct answer ✔✔-Identify the trigger (pain is common)
-Daily controller med like gabapentin for pain
-Clonidine or propranolol for S/S of overactive sympathetic system
-Baclofen for muscle rigidity
-PRN tx with benzos and or narcotics
,What are the most common organisms that lead to shunt infections? - correct answer ✔✔Staph
epidermis (coag negative staph = most common)
Staph aureus
Can be from gram - organisms such as E. coli or klebsiella (common with VP shunts where the bacteria
was in the gut and progressed its way up)
Presentation of a shunt malfunction - correct answer ✔✔HA
Change in vision
N/V
Behavior change
Sleepiness
Irritability
Abnormal gait
Seizures
***All of S/S of increased ICP***
What are the S/S of a shunt infection? - correct answer ✔✔Fever
S/S of malfunction
Irritability
When is the most common time to get a shunt infection? - correct answer ✔✔In the first few mos after
placement or after a revision
When is the most common time to experience shunt malfunction? - correct answer ✔✔More common
later on
When should you evaluate a shunt? - correct answer ✔✔When the H&P suggests malfunction or
infection
Diagnostics with shunt malfunction - correct answer ✔✔-Pumping of reservoir (risk for obstruction and
not commonly performed)
-Shunt series (Series of x-rays that follow the course of the shunt from the skull to the distal end looking
for dislodgment)
-CT or MRI to look at ventricle size (most common)
Diagnostics for shunt infection - correct answer ✔✔-Testing of fluid from the shunt
-Watch for pleocytosis on CSF fluid
-CSF sent for cell count, glucose, protein, gram stain
-Blood cultures
What would indicate a probable shunt infection in regard to your WBCs in CSF? - correct answer ✔✔-If
you have pleocytosis of > 50 on your cell count and you have isolation of bacteria with at least 1 S/S of
shunt infection, this is enough for dx
-If there is > 100 on your cell count, then there is a 96% specificity for infection
How do you treat a shunt infection? - correct answer ✔✔Empiric coverage with Vanco and cefepime OR
Vanco and meropenem
,Management of shunt infection - correct answer ✔✔ABX
Repeat CSF culture until negative
Consider shunt removal and temporary external ventricular device until they have negative cultures
How many different patterns of pneumonia are there and what are they? - correct answer ✔✔5 but she
highlights 4
Lobar
Bronchopneumonia
Necrotizing
Interstitial and peribronchilar
What pattern is lobar pneumonia and what is the most common cause? - correct answer
✔✔Involvement of a single lobe or segment
Most common type
If not separated by age, it is most commonly caused by strep pneumo
What pattern is bronchopneumonia and what is the most common cause? - correct answer
✔✔Involvement of the smaller airways surrounding the interstitium
Strep pyogenes and staph aureus
Necrotizing pneumonia - correct answer ✔✔Secondary to staph or strep infection
Interstitial and peribronchiolar - correct answer ✔✔Atypical bacteria (mycoplasma)
Viral
What are the most common pathogens that lead to pneumonia in neonates (0-4 weeks)? - correct
answer ✔✔Group B strep
E.coli
Staph aureus
HSV
What are the most common pathogens that lead to pneumonia in infants (1 mos to 1 year)? - correct
answer ✔✔Chlamydia
Pertussis
Viral (RSV, influenza, metapneumovirus)
Strep pneumo
What are the most common pathogens that lead to pneumonia in children (3 mos to 5 years)? - correct
answer ✔✔RSV/viral
Strep pneumo
Mycoplasma
What are the most common pathogens that lead to pneumonia in children > 5 y/o? - correct answer
✔✔Mycoplasma (most common)
Strep pneumo (second most common)
, What are the most common pathogens that lead to pneumonia in immunocompromised pts? - correct
answer ✔✔Staph aureus
Gram negative bacilli
Aspergillus
CMV
HSV
Complications of viral and bacterial pneumonia - correct answer ✔✔Pleural effusion/empyema (more
common with bacterial pneumonia)
Pneumo
Meningitis
CNS abscess
Peri/endocarditis
Sepsis
S/S of pneumonia - correct answer ✔✔Cough
Fever/chills
HA
Irritability
Tachypnea
Hypoxemia
PE:
-Decreased breath sounds (esp if effusion)
-Crackles
-Course breath sounds
-Bacterial in nature, will look for a focal point (ex. crackles in the LLL)
What would be characteristic of lung sounds in a viral pneumonia? - correct answer ✔✔Diffuse pattern
with no focal findings on exam
S/S of viral pneumonia? - correct answer ✔✔More vague
Cough
Wheezing
Stridor
Lower grade fever
In a child who is 2 weeks to 4 mos with increased resp effort, rhinorrhea, staccato cough, what is their
pneumonia likely to be caused by? - correct answer ✔✔Afebrile pneumonia of infancy caused by
chlamydia trachomatis
When should you consider a CXR and inpatient tx for pts with presumed pneumonia? - correct answer
✔✔Worsening S/S: ill appearing, toxic, significant resp distress
Should you get follow up films if the pt is improving? - correct answer ✔✔No
What is the most common cause of bacterial pneumonia and what would you see on CXR? - correct
answer ✔✔Streptococcus pneumoniae
