NUR 529 EXAM 2 QUESTIONS WITH
CORRECT ANSWERS
why are infants and children more susceptible to choking? ✅✅ANSW-the airways of the infant
and small child are much smaller than adults and resistance to airflow is inversely related to the 4th
power of the radius causing relatively small amounts of mucus secretions, edema, or airway
constriction to produce marked changes in airway resistance and airflow
specific sequence of upper airway nerve and muscle activity that occurs before and early in
inspiration of infants ✅✅ANSW-the tongue moves forward to prevent airway obstruction; vocal
cords abduct, reducing airway resistance
diaphragm in an infant vs in an adult ✅✅ANSW-diaphragm in an infant inserts more horizontally
than in an adult; as a result the contraction of the diaphragm draws the lower ribs inward (especially
if in horizontal position); in an adult the intercostal muscles function to lift the ribs during
inspiration; in an infant, the intercostal muscles are not fully developed so they function to stabilize
the chest rather than lift the chest wall; during crying, intercostal muscles and diaphragm function
together to splint the chest wall and prevent collapse
high compliance of infants chest wall and decreased activity of intercostal muscles during sleep
✅✅ANSW-causes paradoxical inward movement of upper chest during inspiration (especially
during sleep)
high compliance of lungs during infancy ✅✅ANSW-benefits: only takes small amount of pressure
to inflate a compliant lung;
during respiratory disease, the diaphragm must generate more pressure causing the compliant chest
wall to be sucked inward (retractions which indicate airway obstruction or atelectasis)
why are infants obligatory nose breathers (up to 2-3 months)? ✅✅ANSW-
in the infant, the functional residual capacity (air left in lungs after expiration) occurs at a higher lung
volume than older child or adults due to increased respiration rate aids with ✅✅ANSW-1. holds
the airways open throughout all phases of respiration
2. favors reabsorption of intrapulmonary fluids
3. maintains more uniform lung expansion and enhances gas exchange
,Epiglottitis ✅✅ANSW-life-threatening emergency characterized by sudden inflammatory edema
of supraglottic area including the epiglottis and pharyngeal structures (upper airway)
characteristics of Epiglottitis ✅✅ANSW-child appears: pale, toxic, lethargic, assumes distinctive
position (sitting up with mouth open and chin thrust forward), difficulty swallowing, muffled voice,
drooling, fever, extreme anxiety, inspiratory and sometimes expiratory stridor, nasal flaring,
inspiratory retractions of suprasternal notch and supraclavicular and intercostal spaces
bronchiolitis ✅✅ANSW-acute bronchiolitis is a viral infection of the lower airways, most
commonly caused by RSV, producing inflammatory obstruction of small airways and necrosis of cells
lining the lower airways; usually occurs during first 2 years of life with peak incidence between 3-6
months old; most have hx of mild upper respiratory tract infection; most critical phase first 48-72 hrs
characteristics of bronchiolitis ✅✅ANSW-fever, diminished appetite, gradual development of
respiratory distress characterized by wheezy cough, dyspnea, and irritability; infant able to take in
sufficient air but has trouble exhaling it; typical appearance marked by breathlessness with rapid
respirations, distressing cough, and retractions of lower ribs and sternum exaggerated by crying and
feeding
indication of impending respiratory failure in infant with bronchiolitis ✅✅ANSW-cyanosis, pallor,
listlessness, and sudden diminution or absence of breath sounds
Diagnosis of community acquired pneumonia ✅✅ANSW-infection that begins outside the
hospital or is diagnosed within 48 hours after admission in person who has not resided in long-term
care facility for 14 days or more before admission;
in people < 65 y/o without coexisting disease, diagnosis based on H&P, chest radiograph, and
knowledge of microorganisms currently causing infection in community
Sputum specimen for staining procedures and culture
admission to the hospital is needed if patient is sick enough that blood cultures need to be drawn
most common cause of community acquired pneumonia ✅✅ANSW-S. pneumoniae
(pneumococcus)
, treatment of community acquired pneumonia ✅✅ANSW-use of appropriate antibiotic therapy,
oxygen, hydration, supportive therapy, nutrition
hospital acquired pneumonia ✅✅ANSW-lower respiratory tract infection not present or
incubating on admission (48 hr or more after admission)
hypoxemic respiratory failure ✅✅ANSW-due to failure of gas exchange function of the lung
(movement of gases across the alveolar-capillary membrane)
ex: COPD, interstitial (restrictive) lung disease, severe pneumonia, atelectasis
hypercapnic/hypoxemic respiratory failure ✅✅ANSW-due to ventilatory failure (movement of
gases into and out of alveoli due to action of respiratory muscles, respiratory center in CNS, and
pathways that connect them)
ex: upper airway obstruction, infection, laryngospasm, tumors, weakness/paralysis of respiratory
muscles, brain injury, drug overdose, GBS, muscular dystrophy, spinal cord injury, chest wall injury
why are secondary spontaneous pneumothoraces more serious than primary spontaneous
pneumothoraces? ✅✅ANSW-primary occurs in otherwise healthy people; secondary occurs in
those with underlying lung disease and may be life threatening because of poor compensatory
reserves
COVID 19 receptor physiology ✅✅ANSW-1. virus binds to ACE2 receptor with spike protein and
tricks the cell into swallowing it through endocytosis> infection ensues
2. ACE2 receptor is effectively occupied and unable to perform normal function
3. COVID reduces number of ACE2 receptors which results in increased angiotensin II contributing to
acute respiratory distress
4. ACE2 expressed in lungs, heart, kidneys, intestines, liver, brain, and adipose tissue
COVID 19 clinical progression ✅✅ANSW-STAGE 1: asymptomatic state (1-2 days)
STAGE 2: upper airways and conducting airways response (next few days)
STAGE 3: hypoxia, ground glass infiltrates, and progression to ARDS
Effects of COVID 19 on immune system ✅✅ANSW-1. excessive inflammatory response> cytokine
storms
2. neutrophil dysfunction
CORRECT ANSWERS
why are infants and children more susceptible to choking? ✅✅ANSW-the airways of the infant
and small child are much smaller than adults and resistance to airflow is inversely related to the 4th
power of the radius causing relatively small amounts of mucus secretions, edema, or airway
constriction to produce marked changes in airway resistance and airflow
specific sequence of upper airway nerve and muscle activity that occurs before and early in
inspiration of infants ✅✅ANSW-the tongue moves forward to prevent airway obstruction; vocal
cords abduct, reducing airway resistance
diaphragm in an infant vs in an adult ✅✅ANSW-diaphragm in an infant inserts more horizontally
than in an adult; as a result the contraction of the diaphragm draws the lower ribs inward (especially
if in horizontal position); in an adult the intercostal muscles function to lift the ribs during
inspiration; in an infant, the intercostal muscles are not fully developed so they function to stabilize
the chest rather than lift the chest wall; during crying, intercostal muscles and diaphragm function
together to splint the chest wall and prevent collapse
high compliance of infants chest wall and decreased activity of intercostal muscles during sleep
✅✅ANSW-causes paradoxical inward movement of upper chest during inspiration (especially
during sleep)
high compliance of lungs during infancy ✅✅ANSW-benefits: only takes small amount of pressure
to inflate a compliant lung;
during respiratory disease, the diaphragm must generate more pressure causing the compliant chest
wall to be sucked inward (retractions which indicate airway obstruction or atelectasis)
why are infants obligatory nose breathers (up to 2-3 months)? ✅✅ANSW-
in the infant, the functional residual capacity (air left in lungs after expiration) occurs at a higher lung
volume than older child or adults due to increased respiration rate aids with ✅✅ANSW-1. holds
the airways open throughout all phases of respiration
2. favors reabsorption of intrapulmonary fluids
3. maintains more uniform lung expansion and enhances gas exchange
,Epiglottitis ✅✅ANSW-life-threatening emergency characterized by sudden inflammatory edema
of supraglottic area including the epiglottis and pharyngeal structures (upper airway)
characteristics of Epiglottitis ✅✅ANSW-child appears: pale, toxic, lethargic, assumes distinctive
position (sitting up with mouth open and chin thrust forward), difficulty swallowing, muffled voice,
drooling, fever, extreme anxiety, inspiratory and sometimes expiratory stridor, nasal flaring,
inspiratory retractions of suprasternal notch and supraclavicular and intercostal spaces
bronchiolitis ✅✅ANSW-acute bronchiolitis is a viral infection of the lower airways, most
commonly caused by RSV, producing inflammatory obstruction of small airways and necrosis of cells
lining the lower airways; usually occurs during first 2 years of life with peak incidence between 3-6
months old; most have hx of mild upper respiratory tract infection; most critical phase first 48-72 hrs
characteristics of bronchiolitis ✅✅ANSW-fever, diminished appetite, gradual development of
respiratory distress characterized by wheezy cough, dyspnea, and irritability; infant able to take in
sufficient air but has trouble exhaling it; typical appearance marked by breathlessness with rapid
respirations, distressing cough, and retractions of lower ribs and sternum exaggerated by crying and
feeding
indication of impending respiratory failure in infant with bronchiolitis ✅✅ANSW-cyanosis, pallor,
listlessness, and sudden diminution or absence of breath sounds
Diagnosis of community acquired pneumonia ✅✅ANSW-infection that begins outside the
hospital or is diagnosed within 48 hours after admission in person who has not resided in long-term
care facility for 14 days or more before admission;
in people < 65 y/o without coexisting disease, diagnosis based on H&P, chest radiograph, and
knowledge of microorganisms currently causing infection in community
Sputum specimen for staining procedures and culture
admission to the hospital is needed if patient is sick enough that blood cultures need to be drawn
most common cause of community acquired pneumonia ✅✅ANSW-S. pneumoniae
(pneumococcus)
, treatment of community acquired pneumonia ✅✅ANSW-use of appropriate antibiotic therapy,
oxygen, hydration, supportive therapy, nutrition
hospital acquired pneumonia ✅✅ANSW-lower respiratory tract infection not present or
incubating on admission (48 hr or more after admission)
hypoxemic respiratory failure ✅✅ANSW-due to failure of gas exchange function of the lung
(movement of gases across the alveolar-capillary membrane)
ex: COPD, interstitial (restrictive) lung disease, severe pneumonia, atelectasis
hypercapnic/hypoxemic respiratory failure ✅✅ANSW-due to ventilatory failure (movement of
gases into and out of alveoli due to action of respiratory muscles, respiratory center in CNS, and
pathways that connect them)
ex: upper airway obstruction, infection, laryngospasm, tumors, weakness/paralysis of respiratory
muscles, brain injury, drug overdose, GBS, muscular dystrophy, spinal cord injury, chest wall injury
why are secondary spontaneous pneumothoraces more serious than primary spontaneous
pneumothoraces? ✅✅ANSW-primary occurs in otherwise healthy people; secondary occurs in
those with underlying lung disease and may be life threatening because of poor compensatory
reserves
COVID 19 receptor physiology ✅✅ANSW-1. virus binds to ACE2 receptor with spike protein and
tricks the cell into swallowing it through endocytosis> infection ensues
2. ACE2 receptor is effectively occupied and unable to perform normal function
3. COVID reduces number of ACE2 receptors which results in increased angiotensin II contributing to
acute respiratory distress
4. ACE2 expressed in lungs, heart, kidneys, intestines, liver, brain, and adipose tissue
COVID 19 clinical progression ✅✅ANSW-STAGE 1: asymptomatic state (1-2 days)
STAGE 2: upper airways and conducting airways response (next few days)
STAGE 3: hypoxia, ground glass infiltrates, and progression to ARDS
Effects of COVID 19 on immune system ✅✅ANSW-1. excessive inflammatory response> cytokine
storms
2. neutrophil dysfunction
