A nurse in the emergency department is assessing a 4-month-old infant who has suspected pertussis. Which of the following findings should the nurse identify as consistent with this diagnosis? (Select all that apply.)
Apnea and cyanosis during coughing episodes
Inspiratory stridor with a barking cough
Wheezing with shortness of breath during activity
Paroxysmal coughing followed by a high-pitched "whoop" on inspiration
Dry, hacking cough that worsens at night
Correct Answer : A,D,E
A. Infants, especially those under 6 months, may present with apnea and cyanosis during coughing paroxysms instead of the classic “whoop,” as their respiratory muscles are immature. This is a common severe manifestation in young infants.
B. Inspiratory stridor and a barking cough are characteristic of croup, not pertussis. Croup is usually viral in origin and presents with hoarseness and upper airway obstruction, which differs from pertussis.
C. Wheezing with exertional dyspnea is more typical of asthma or bronchiolitis, not pertussis. While pertussis can cause hypoxia, wheezing is not a defining feature.
D. The paroxysmal stage of pertussis is characterized by repetitive coughing spells followed by a high-pitched inspiratory “whoop”. This is classic for older infants and children, though it may be absent in young infants.
E. In the catarrhal stage, pertussis often begins as a mild, dry cough resembling a common cold, which gradually progresses to severe paroxysms. Nighttime exacerbation is common.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
A. Mild fatigue after walking is a common symptom in normal pregnancy and is not specific to preeclampsia. Fatigue alone does not indicate hypertension or organ involvement.
B. Headache with blurred vision is a classic symptom of preeclampsia, indicating possible cerebral involvement due to elevated blood pressure and vasospasm. Persistent or severe headache should always be evaluated in the context of preeclampsia.
C. Blood pressure ≥140/90 mmHg after 20 weeks gestation in a previously normotensive woman is one of the diagnostic criteria for preeclampsia. This patient’s reading of 150/95 mmHg supports the diagnosis.
D. Sudden weight loss is not a feature of preeclampsia. On the contrary, rapid weight gain due to fluid retention is often seen in preeclampsia.
E. Proteinuria (+1 or higher on a urine dipstick or ≥300 mg/24 hours) is another hallmark of preeclampsia. +2 proteinuria indicates significant renal involvement, supporting the diagnosis.
Correct Answer is D
Explanation
A. Fatigue is a common and expected change in pregnancy due to increased metabolic demands and hormonal shifts. It is not specific for heart failure.
B. Mild dyspnea on exertion is common in pregnancy because of increased oxygen demand and diaphragmatic elevation. This alone does not indicate heart failure.
C. Peripheral edema is a typical physiological change in pregnancy, especially in the lower extremities, due to increased blood volume and venous pressure. It is usually not concerning unless accompanied by other signs.
D. These findings are not typical of normal pregnancy and may indicate fluid overload and impaired cardiac function, suggesting heart failure. Pulmonary congestion can cause dyspnea, persistent cough, and orthopnea, while generalized edema (especially in the face and hands) is concerning for cardiac or severe renal involvement.
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