Med Surg 1 Chapter 31 (Respiratory Disorders)

A healthy patient expresses worries about developing tuberculosis (TB) after spending time at a family reunion and learning later that a family member is being treated for the disease. What does the nurse tell this patient?

"Among people exposed to the disease, only a small percentage develop active TB.

Stroke patients are at high risk for pneumonia related to what condition?

Aspiration

A patient who is taking isoniazid and rifampin to treat tuberculosis reports reddish-orange urine. Which action by the nurse is correct?

Reassure the patient that this is an expected drug side effect

A clinic nurse is providing teaching for a patient who has been diagnosed with a peritonsillar abscess. What does the nurse include in this patient's teaching?

"Go to the emergency department if drooling or stridor occur.

Which virus is a strain of the bird flu?

H5N1 H5N1 is the viral strain that causes bird flu. H1N7, H1N1, and H1N5 are the virus types that cause swine flu

The nurse is instructing a nursing student on how to prevent pneumonia in an older adult who is receiving mechanical ventilation. Which statement by the student indicates a need for further teaching?

"I will provide meticulous oral care every 24 hours and as needed Should be preformed q 12 hrs.

A nurse is diagnosed with seasonal influenza, and on the second day of treatment with oseltamivir, she asks the supervising nurse when she may return to work on a hospital unit. What does the supervising nurse tell her?

"If you are feeling well and afebrile in 5 days, you may return to work." Individuals with influenza are contagious from 24 hours before the onset of symptoms and up to 5 days after symptoms begin. Antiviral medication only shortens the duration of symptoms but does not affect contagiousness. Those who continue to have symptoms, especially fever, should remain off work until those symptoms clear.

A newly admitted patient with pneumonia has an oral temperature of 102° F, an oxygen saturation of 93%, diminished breath sounds bilaterally, and the patient is unable to cough effectively. The nurse has received orders for oxygen therapy, intravenous antibiotics, antipyretic medication, and sputum specimen collection. What is the nurse's first action?

Give IV antibodics

Which statements by the patient with rhinitis indicate ineffective learning about reducing the risk of spreading colds? Select all that apply.

"I will stop my cough reflex when I am in a crowded place or with the family." "I will have minimal contact with people who have chronic respiratory problems."

Of these patients waiting for an influenza immunization, which one would be eligible to receive the live attenuated vaccine (Flumist) instead of the trivalent inactivated vaccine (Fluzone)?

35-year-old with allergies

The nurse performs follow-up care for a group of patients who have previously had tuberculosis. Which patients are most at risk for developing secondary tuberculosis (TB)? Select all that apply.

A 34-year-old with HIV infection A 75-year-old who is recovering from a hip replacement A 7-year-old who is undergoing chemotherapy for leukemia

Which patient is most at risk for the development of either community or hospital-acquired pneumonia?

A 76-year-old who has limited mobility because of osteoarthritis A 76-year-old patient with limited mobility is at high risk for both community- and hospital-acquired pneumonia. The 8-month-old is at a slightly increased risk but not as high as the 76-year-old who is limited in mobility. An individual who works in the textile industry is at an increased risk for community-acquired pneumonia, but not hospital-acquired pneumonia, as is the adolescent who has type 1 diabetes.

A patient with pneumonia is producing a smaller volume of thicker secretions than the day before. The patient is receiving intravenous antibiotics. What action does the nurse take?

Encourage the patient to drink more fluid Thick secretions indicate decreased hydration and the patient is at risk for airway obstruction if these secretions cannot be cleared easily; the nurse should encourage increased fluid intake. Peak flow levels are used to monitor relative airway obstruction in patients with obstructive lung disease. A decrease in secretions does not necessarily indicate improvement in the infection, especially if the secretions are thick and not easily mobilized. The patient should continue intravenous antibiotics until there is evidence that the infection is improving.

A patient who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the patient?

Isoniazid, rifampin, pyrazinamide (PZA), ethambutol The combination of isoniazid, rifampin, pyrazinamide, and ethambutol is used to treat tuberculosis. Metronidazole is used to treat anaerobic bacteria and some parasites, but is not effective against tuberculosis. Acyclovir is used to treat viral infection. Flunisolide is a corticosteroid that is useful in asthma or other airway disease to prevent wheezing. Prednisone is a steroid. Guaifenesin is a mucolytic. Ketorolac is an NSAID that is used for short-term pain relief. Salmeterol and cromolyn sodium would most likely be given to patients with respiratory difficulties such as poorly controlled asthma from allergic sources. Dexamethasone is a steroid.

The patient has been prescribed anti-infective azithromycin for community-acquired pneumonia. What information should the nurse include when educating the patient? Select all that apply.

Medication may cause diarrhea. Take all medication even if symptoms subside Notify provider if symptoms are present after completion of antibiotics.

What is a key difference between seasonal influenza and pandemic influenza?

Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans Mutated animal and bird viruses can be highly infectious to humans and spread globally very quickly because humans have no natural resistance to the mutated virus. Both seasonal and pandemic influenza are caused by viruses. Although there is the potential to develop a monovalent vaccine to a given mutated virus, widespread prophylactic vaccination is not realistic as a preventive measure. People over age 50 with chronic illnesses and those who are immunocompromised should receive a yearly flu vaccine for the seasonal variety.

A patient reports severe coughing for the last few weeks. The patient reports coughing long and hard with vomiting. What disease does the nurse suspect that this patient may have?

Pertussis Symptoms of pertussis include severe coughing "fits" that can last several minutes. During this time, the patient may turn red and vomit. The patient is frequently exhausted by the coughing. Anthrax is characterized by fever, fatigue, mild chest pain, and a dry, harsh cough. Pneumonia patients experience fever, chills, headache, chest pain, and sputum production. Coccidioidomycosis is a fungal infection, and symptoms include fever, cough, chest pain, and night sweats

A patient with a recent diagnosis of bacterial pharyngitis caused by group A streptococcal infection calls the health care provider stating his has developed a cough, fever, chills, shortness of breath, and severe chest pain. Which complication does the nurse suspect?

Pneumonia

A patient with pneumonia develops increased fever, chills, and night sweats. The nurse auscultates decreased breath sounds in the right lung and observes decreased chest wall movement in that area. The nurse reports these findings to the provider and suspects which secondary infection has likely developed?

Pulmonary empyema These are signs of pulmonary empyema, an infection in the pleural space. A fungal infection may occur anywhere, often as an abscess in the lungs, which is characterized by fever, cough, and foul-smelling sputum. Tuberculosis is characterized by cough and blood-tinged sputum.

An older patient has a persistent cough with hemoptysis and has a known exposure to tuberculosis. A tuberculin skin test reveals a reaction less than 5 mm. The nurse documents that this test result indicates which condition?

Reduced immune function

The nurse is instructing a patient with tuberculosis about combination drug therapy. What are the most common instructions that the patient should follow for all the antitubercular drugs? Select all that apply.

Report yellowing of the skin and any darkened urine immediately. "Refrain from drinking alcoholic beverages

The nurse is caring for an 80-year-old patient with chronic obstructive pulmonary disease (COPD) who was admitted for treatment of malnutrition. The patient develops a cough and the nurse notes a temperature of 39° C, an oxygen saturation of 94%, and crackles in both lungs. What is the nurse's priority action?

Request chest x-ray

A patient presenting with fever and muscle aches is diagnosed with influenza B. What antiviral medication does the nurse expect the health care provider to prescribe? Select all that apply.

Ribavirin Zanamivir Oseltamivir Ribavirin has been used in the treatment of influenza B. Zanamivir and oseltamivir have been used to shorten the duration of influenza A and influenza B. Amantadine and rimantadine are used in the prevention and treatment of influenza A.

A patient reports experiencing chest pain, headache, and cough with sputum production, fever, and dyspnea. What does the nurse anticipate upon assessment? Select all that apply.

Tachycardia Diminished chest expansion Crackles upon auscultation This patient has symptoms of pneumonia. Symptoms include tachycardia due to hypoxemia, chest pain with decreased or unequal chest expansion, and crackles upon auscultation due to fluid in the interstitial and alveolar areas. A sore throat and nasal drainage are symptoms of an upper respiratory disorder.

A previously infected patient with a dormant tuberculosis (TB) infection has experienced a reactivation of the disease. Which was likely a factor in this occurrence?

Taking prednisone for the past 3 weeks

A patient who has acute viral rhinitis cares for an older family member who is susceptible to respiratory infections. Which action does the nurse suggest to this patient to help prevent the spread of infection?

Thoroughly wash hands after touching the face

A patient with pulmonary tuberculosis is being started on combination therapy. What does the nurse explain to the patient as the purpose of combination therapy?

To shorten therapy by 6 months

A patient with a history of pain and difficulty swallowing ignored the symptoms and later developed neck swelling, muffled voice, and bad breath. What could the original symptoms have been?

Untreated tonsillitis Neck swelling, muffled voice, and bad breath are symptoms of peritonsillar abscess. Untreated or partially treated acute tonsillitis may lead to the complication of peritonsillar abscess. Untreated rhinitis, untreated sinusitis, and untreated pharyngitis will not cause peritonsillar abscess

The nurse has decided to immediately place a patient in respiratory isolation because the patient is exhibiting which sign/symptoms of the prodromal (early) stage of inhalation anthrax? Select all that apply.

fEVER, mild chest pain, and Mediastinal "widening" (chest x-ray)

Which symptom of pneumonia may present differently in the older adult than in the younger adult?

fever Older adults may not have a fever and may have a lower-than-normal temperature with pneumonia. Crackles on auscultation may be present in all age groups as the result of fluid in the lungs. All age ranges may have a headache with pneumonia. Wheezing is an indication of narrowed airways and can be found in all age groups.

A patient is admitted with a diagnosis of avian influenza (H5N1). For what symptoms specific to avian influenza does the nurse assess the patient?

shortness of breath, diarrhea, and bleeding

An older patient is diagnosed with pneumonia. To assist with comfort during the admission interview, what does the nurse do?

Allow the patient to rest at frequent intervals Patients with pneumonia often have pain, fatigue, and dyspnea, which can cause anxiety. The nurse should allow frequent rest periods and should pace the interview and assessment according to the patient's fatigue level. The patient should be allowed to choose whether to get into bed or remain up in a chair.

Following a bioterrorism attack with anthrax, the emergency department nurse checks the medication room for ample supply of which medications? Select all that apply.

Ciprofloxacin Doxycycline Amoxicillin Rifampin Vancomycin Ciprofloxacin, in combination therapy with one or more of the drugs doxycycline, amoxicillin, rifampin, and vancomycin, is used for exposure and actual infection. Therefore all of these medications should be on hand. Gentamicin is not a drug used to treat anthrax infection.

A patient has a sore throat; fever; enlarged, red tonsils; and tender, swollen lymph nodes. A rapid antigen test (RAT) performed in the clinic is negative for group A beta-hemolytic streptococcus. What does the nurse tell this patient?

"The provider will have final results of a culture in 2 days."

A patient with active tuberculosis is ordered to take isoniazid (INH), pyrazinamide (PZA), and rifampin (RIF) and asks the nurse why it is necessary to take three antibiotics. What is the nurse's best answer?

"Three antibiotics help prevent bacterial drug resistance.

A patient presents pain and difficulty swallowing, swelling in the throat, difficulty in opening the mouth, and a history of tonsillectomy performed 20 days ago. What should be the order of the treatment?

1. Antibiotic therapy 2. Incision and drainage 3. Additional antibiotic therapy 4. Intravenous (IV) opioids and IV steroids 5. Percutaneous needle aspiration and drainage of the abscess 6. Hospitalization, if the patient is showing slow response to the drugs Pain and difficulty swallowing, swelling, and difficulty in opening the mouth are manifestations of peritonsillar abscess (PTA). Percutaneous needle aspiration and drainage of the abscess is performed, and antibiotic therapy is administered to control the infection. IV opioids are administered to relieve the pain and IV steroids are administered to reduce the swelling. If the infection does not respond to antibiotic therapy, hospitalization is advised. Incision and drainage are performed, along with additional antibiotic therapy to control the infection. To avoid recurrence, tonsillectomy may be performed.

Which is a serious complication of pharyngitis caused by group A streptococcal bacteria?

Acute glomerulonephritis Acute glomerulonephritis is a serious complication of a streptococcal group A infection, which may occur 7-10 days after the infection. Pulmonary empyema is a collection of pus in the pleural space caused by pneumonia or an infected effusion. Meningitis is an infection of the meninges of the brain and can be caused by bacteria, but is not a result of having had a group A streptococcal infection. Laryngitis can be a common result of an upper respiratory infection, but is not considered a serious complication of group A streptococcus.

The nurse is teaching a patient about isoniazid (INH) and rifampin (RIF) drug therapy for tuberculosis (TB). The nurse instructs that while on these medications, the patient should avoid consuming which food?

Alcohol Isoniazid and rifampin can damage the liver, so alcohol should be avoided for the duration of the medication regimen, which can be 6 months to 2 years. Consuming foods high in tyramine while on these drugs can cause a severe increase in blood pressure. However, not all dairy products need to be avoided; only aged cheeses are high in tyramine. Red meat and eggs are not high in tyramine and can be consumed freely.

Which statements about anthrax infection are correct? Select all that apply.

Although rarely occurring naturally, inhalation anthrax is nearly 100% fatal without treatment. As macrophages in the lungs engulf the anthrax spores, the organism leaves its capsule and replicates. Toxins produced by the organisms in the lungs create massive edema, suppressing neutrophil action Dyspnea, diaphoresis, and sudden onset of breathlessness are common in late stages of the disease

The nurse is caring for a pregnant patient who has a coccidioidomycosis fungal infection, which is also known as "valley fever." What medication would most likely be ordered for this patient?

Amphotericin B IV Patients with valley fever who are pregnant or have a severe infection will receive amphotericin B IV. Non-pregnant patients with mild infection may receive fluconazole, ketoconazole, or voriconazole PO. Amoxicillin is an antibiotic and is not used to treat fungal infections.

The nurse is reviewing home care instructions for a patient diagnosed with acute viral rhinitis. Which medication order does the nurse question?

Antibiotic

The nurse is planning care for an 80-year-old long-term care patient who takes a histamine-2 blocker and who is confused most of the time. To help prevent pulmonary infection in this patient, which nursing action is included in the plan of care?

Assist the patient with all oral intake

A patient taking ethambutol for tuberculosis is receiving discharge teaching from the nurse. What is the most important sign or symptom of a serious adverse reaction to this medication that the nurse should teach this patient?

Change in vision Ethambutol can cause optic neuritis leading to blindness. The damage can be reversed if the problem is caught in time, so the patient should be instructed to immediately report any changes in vision to the health care provider. Severe nausea and vomiting can occur in the presence of alcohol but fatigue and anorexia are not worrisome signs on their own. This drug may precipitate gout, which causes aching of the feet, so the patient should be taught to increase fluid intake; however, this adverse reaction is not as serious as potential blindness.

A patient with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Select all that apply.

Combination drug therapy is effective in preventing transmission. Combination drug therapy is the most effective method of treating TB. Multiple drug regimens destroy organisms as quickly as possible. The use of multiple drugs reduces the emergence of drug-resistant organisms.

Which statements about acute viral rhinitis are correct? Select all that apply.

Complications are more common in immunosuppressed individuals It is most often caused by many different viruses.

A patient with pneumococcal pneumonia is being treated with intravenous antibiotics. On the fifth day of treatment, the nurse notes a productive cough with white mucus. Which nursing action is correct?

Continue the current plan of care and reassess the patient periodically The cough with pneumococcal pneumonia is typically productive of purulent rusty brown or yellow mucus; white mucus production indicates resolution of the infection. It is not necessary to administer a bronchodilator or a different antibiotic. The provider does not need to be notified.

A patient is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The patient calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes?

Ethambutol

What information is important to share with a patient who is being discharged after treatment for pneumonia? Select all that apply.

Get an annual influenza immunization. Avoid contact with all persons with colds or influenza. Stop or reduce any intake of tobacco and tobacco products Individuals who have had pneumonia need to be instructed to avoid contact with ill persons, stop or reduce smoking, and get an annual influenza immunization and a pneumococcal immunization as recommended by the health care provider. The patient recovering from pneumonia is advised to avoid crowded places such as malls and churches, so the patient would not be able to resume all regular activities. Pneumococcal immunizations are usually given once after age 65 and may be given 5 years after that if the patient is at high risk.

A 76-year-old patient who is recovering from influenza A reports severe dry mouth and constipation. After reviewing the patient's medication list, the nurse suspects the patient is experiencing the anticholinergic effect of which medication?

Hydroxyzine

An elderly patient was diagnosed with influenza one week ago. What should the nurse include in the teaching plan for the patient? Select all that apply.

Increase fluid intake Use appropriate hand-washing techniques. Avoid the use of diphenhydramine

Incentive spirometry for the treatment of pneumonia has which outcome objective?

Increased inspiratory muscle action and decreased atelectasis Incentive spirometry helps improve inspiratory muscle action and prevents or reverses atelectasis. It does not increase respiratory effort, reduce crackles and wheezes, or reduce sputum production.

Which groups are at greatest risk for drug-resistant Streptococcus pneumoniae? Select all that apply.

Individuals older than age 65 years Older adults exposed to children from a daycare environmenT

What are the rare complications of pharyngitis? Select all that apply.

Infection of supraglottic structures Infection of epiglottic structures

A febrile patient presents to the emergency department with a headache, chills, fatigue, nausea, vomiting, and diarrhea. What illness does the nurse suspects that the patient has?

Influenza B Symptoms of influenza B may include nausea, vomiting, and diarrhea. The influenza viruses (A, B, and C) all include headache, muscle aches, fever, chills, fatigue, and weakness. Influenza is identified as A, B, or C; there is no combination or AB.

A nurse is caring for a patient who appears cachectic and pale but appears in no acute distress. The patient tells the nurse that he has had a chronic cough for months and produces a large amount of foul-smelling sputum. He also states that he occasionally suffers from a stabbing pain when taking a deep breath. When reviewing the patient's history, the nurse notes that the patient has a recent history of influenza. Breath sounds reveal decreased sound with rhonchi to the right lower lobe and percussion to the right lower lobe is dull. What procedure does the nurse anticipate preparing for?

Insertion of a thoracentesis needle and drainage

A nurse is caring for a patient who is orally intubated and mechanically ventilated. The nurse understands that this patient is at an increased risk for developing ventilator associated pneumonia. When planning care for this patient, what pathophysiological concepts regarding an artificial airway does the nurse recognize as a contributing factor to the development of this condition? Select all that apply.

It bypasses the protective airway mechanisms It allows aspiration of secretions from the oropharynx and stomach

Which statements about pulmonary tuberculosis (TB) are correct? Select all that apply.

Mycobacterium tuberculosis is transmitted from person to person via the airborne route. Infected people are not infectious to others until manifestations of the disease occur. An asymptomatic period of up to years or decades can follow the time of primary infection Foreign immigrants, especially from Mexico, the Philippines, and Vietnam, are at greatest risk

A patient who has begun standard multidrug treatment for tuberculosis (TB) reports orange-tinged sputum and urine. The nurse tells the patient that this symptom represents which response to the treatment regimen?

Normal drug side effects of rifampin Orange-colored body secretions are an expected side effect of rifampin, one of the standard medications used for TB treatment. The orange color does not indicate spread of infection or hemolysis. Although alcohol and rifampin can cause hepatotoxicity, the orange color is not a sign of this complication.

A patient has recently been released from prison and has just tested positive for tuberculosis (TB). What teaching points does the community health nurse want to stress for this patient regarding medications? Select all that apply.

Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance. The medications may cause nausea. The patient should take them at bedtime

Which findings indicate that a patient is suffering from bacterial pharyngitis? Select all that apply.

Positive throat culture White blood cell (WBC) count of 14,000/mm3

A patient with the common cold used an over-the-counter (OTC) nasal decongestant for 12 days but still reports headache, sneezing, and nasal congestion. What could be the possible diagnosis?

Rhinitis medicamentosa The common cold usually subsides within 7 to 10 days, so when a drug is used for more than 7 days, it may be considered overuse. Overuse of nasal decongestants and chronic nasal inhalation of cocaine may cause rhinitis medicamentosa. Viruses cause viral rhinitis, also known as the common cold. Allergic rhinitis and perennial rhinitis (a type of allergic rhinitis) is caused by contact with allergens.

Which symptom indicates that a patient's pharyngitis is most likely bacterial and not viral?

Scarlatiniform rash

An adult has been diagnosed as having pulmonary tuberculosis. What education should the nurse provide before the patient is started on isoniazid (INH) therapy? Select all that apply.

Take a daily multivitamin. Avoid alcoholic beverages

What is the most important information for the nurse to convey to a patient who is beginning pharmacological therapy for the treatment of tuberculosis to ensure suppression of the disease?

Take medication exactly as prescribed It is most important for the nurse to teach the patient to take the medication regularly, exactly as prescribed, for as long as it is prescribed to ensure adequate suppression of the disease. The patient should be instructed to eat a diet rich in Vitamins B and C. A diet rich in Vitamin K will not assist the patient in any way. Staying away from alcoholic beverages will prevent liver damage from the medications but will not ensure suppression of the disease. It is important for the patient to understand that the health care provider should be contacted in the case of illness; however, it will not ensure suppression of the disease.

The nurse is reviewing the influenza criteria to see if a newly admitted patient meets vaccination requirements. Which findings would lead the nurse to recommend that the patient receive the vaccine? Select all that apply.

The patient has asthma. The patient has diabetes. The patient is being treated for canceR The patient lives in a nursing home

The nurse is caring for a patient who comes to the clinic because of a cough. What symptom of the cough will lead the nurse to believe that the health care practitioner will order testing for pertussis?

The patient reports that the cough has lasted more than 3 week An individual who reports a cough that lasts longer than 3 weeks should be tested for pertussis. The pertussis cough is not accompanied with wheezing, does not have green or yellow sputum, and is not caused by a "tickle" (drainage).

Upon assessment of a patient with chest pain, the nurse finds unequal chest expansion, crackles with diminished breath sounds, tachypnea, and a fever. Which laboratory data finding would lead the nurse to believe the patient has pneumonia?

WBC 12,000/mm3 An elevated white blood count is associated with bacterial infections such as pneumonia. A WBC of 12,000/mm3 is elevated. Any WBC below 10,000/mm3 is considered normal.

The nurse is caring for a patient with severe acute respiratory syndrome (SARS). What is the most important precaution the nurse should take when preparing to suction this patient?

Wearing a disposable particulate mask respirator and protective eyewear

A patient is being treated with ciprofloxacin 500 mg PO twice daily due to possible exposure to inhalation anthrax. What is the nurse's best answer when the patient asks how long this medication must be taken?

"You will need to take the medication for about 2 months." When medication is given for prophylaxis related to inhalation anthrax exposure, the patient will need to take it for 60 days and may take it longer if exposure was heavy. Ten days is not enough time for adequate prevention, and 6 and 12 months are too long.

The nurse is providing teaching to a patient who has been diagnosed with bacterial rhinosinusitis. Which instruction does the nurse include when teaching this patient about his diagnosis?

"Be sure to complete the full course of antibiotics." Treatment for bacterial rhinosinusitis includes the use of broad-spectrum antibiotics. Facial pain that is worse when bending forward is a common manifestation of rhinosinusitis. Decongestants are commonly prescribed for rhinosinusitis. Fluids should be increased unless the patient has other medical conditions that require fluid restriction.

A 70-year-old patient has a complicated medical history including chronic obstructive pulmonary disease (COPD). Which patient statement indicates the need for further teaching about the disease?

"I am here to receive the yearly pneumonia shot again." Patients 65 years and older , as well as those who have chronic health problems, should be encouraged to receive the pneumonia vaccine, which is not given annually but only once. Older patients are encouraged to receive a flu shot annually because the vaccine changes, depending on anticipated strains for the upcoming year. It is a good idea to avoid large gatherings during cold and flu season. New recommendations from the Centers for Disease Control and Prevention (CDC) for controlling the spread of flu include coughing or sneezing into the upper sleeve rather than into the hand.

A patient who works in a warehouse has developed acute viral pharyngitis after inhaling noxious fumes. After counseling the patient about treatment for this condition, which statement by the patient indicates a need for further teaching?

"I will need to take antibiotics." Nursing management of acute viral pharyngitis focuses on supportive interventions. The patient should be taught to increase fluid intake, humidify the air, and use analgesics for pain. Gargling several times per day with saline can increase comfort. Viral pharyngitis is not infectious and does not need antibiotic therapy.

The nurse is providing health education to a patient regarding ways to prevent influenza. Which statement made by the patient shows effective learning?

"I will refrain from attending public meetings if I feel I am getting sick. As the infected person may spread the disease, he or she must avoid public meetings to reduce the risk of spreading the disease. Drugs prescribed should be taken to reduce the risk of influenza. Paying attention to public health announcement will reduce the risk of spreading the disease. Similarly, giving nonperishable food to family members will avoid going out, thus reducing the risk of spreading the disease.

The nurse is providing health education to an elderly patient to prevent pneumonia. Which statements made by the patient demonstrate ineffective learning? Select all that apply.

"I will refrain from drinking nonalcoholic fluids. "I will refrain from obtaining the pneumococcal vaccination." Since drinking at least 3 liters of nonalcoholic fluids per day will reduce the risk for pneumonia, the patient needs to follow this guideline. In addition, not getting the pneumococcal vaccination will increase the risk of developing pneumonia; therefore the patient should obtain the vaccination. Smoking is a precipitating factor for pneumonia; therefore, to prevent pneumonia the patient should stay away from smoking. Indoor pollutants like dust and aerosols should also be avoided to prevent pneumonia. Staying away from public areas during flu season will decrease the spread of the disease.

The nurse is counseling a patient whose parent has just been diagnosed with tuberculosis (TB). The patient tells the nurse that the parent was exposed several years ago, but developed symptoms only recently. What does the nurse tell this patient about his or her risk of contracting the disease?

"People are infectious to others only when symptoms are present." It is important to remind patients that people with TB are infectious only when manifestations of the disease occur. Patients being treated for TB are not considered contagious after 2-3 weeks of drug therapy. The only way to diagnose TB is with testing and by evaluation of symptoms. Treatment is initiated when the disease is confirmed.

A nurse is providing discharge instructions for a patient with active tuberculosis (TB) who has been prescribed isoniazid. What information about medication administration does the nurse include when providing discharge instructions?

"Take the drug on an empty stomach.

A 75-year-old patient tells the nurse he is not planning to receive a "flu shot" this year because the shot makes him sick. What is the nurse's best response?

"The injectable flu vaccine is not a live virus and cannot cause influenza. The influenza vaccine is not a live virus and cannot cause disease. The intranasal vaccine is a live, attenuated vaccine and is not given to people over age 49. Immunity to influenza is not conferred in subsequent years because the strains of influenza virus change each year

A patient with active tuberculosis is ordered to take isoniazid (INH), pyrazinamide (PZA), and rifampin (RIF) and asks the nurse why it is necessary to take three antibiotics. What is the nurse's best answer?

"Three antibiotics help prevent bacterial drug resistance. Multidrug therapy provides quicker destruction of organisms and combats drug resistance. It does not allow for lower dosing or decrease side effects. Taking these three drugs does not produce a synergistic effect.

A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient's 52-year-old caregiver asks the nurse if she should receive an annual influenza vaccination. What is the nurse's best response?

"Yes, you should receive the influenza vaccination by injection and should receive it every year. Yearly vaccination is recommended for those older than 50 years as well as those who care for those with chronic conditions. The live attenuated influenza vaccine (LAIV) by intranasal spray is recommended only for those who are healthy and only for those age 49 years or younger.

A co-worker tells the nurse that she will not get the flu shot because she believes it is better to develop her own immunity to the flu. What does the nurse tell this co-worker?

"You are putting your patients at increased risk for serious respiratory illness." All people who provide direct care to patients should get the influenza vaccine to prevent the spread of influenza to patients who are at risk for serious respiratory illness. The flu vaccine does not cause influenza symptoms. Antiviral medications are only effective if given early and do not cure influenza. Even young, relatively healthy individuals can have severe influenza.

The nurse has been instructed to administer tuberculosis (TB) medication to a patient who has been noncompliant by directly observed therapy. Which statement by the nurse will assist the patient in understanding this therapy?

"You must swallow your pills in front of me."

A 65-year-old patient with chronic obstructive pulmonary disease (COPD) asks the nurse about the best way to prevent pneumonia. What is the nurse's best response?

"You should get the pneumococcal polysaccharide vaccine." Older patients with chronic lung disease should receive at least one PPV23 vaccine to prevent pneumonia. Prophylactic antibiotics are not widely used because of the increased risk of bacterial resistance. Making an appointment with the provider at the first sign of infection and staying away from large groups of people may be recommended, but are not the most important.

A patient tells the nurse that after 3 weeks of multidrug therapy to treat tuberculosis (TB), the symptoms seem to have resolved. What does the nurse tell this patient?

"You will need to continue therapy for at least 6 months." Even though patients feel better and are no longer contagious, TB drug therapy must continue for 6 months or longer to avoid relapse and drug resistance. Directly observed therapy is used for patients who may have difficulty complying with treatment. It is important to continue taking all drugs in the regimen to avoid drug resistance.

A patient is admitted with symptoms of periorbital and facial edema, swelling of the hands and feet, bilateral crackles in the lungs, and reddish-brown urine. The patient reports having had a fever and sore throat 10 days prior to developing symptoms. The nurse suspects that this patient may have which condition?

Acute glomerulonephritis One complication of streptococcal pharyngitis is acute glomerulonephritis, which manifests about 7-10 days after the throat infection and is characterized by edema, fluid overload, and hematuria. Patients with streptococcal pharyngitis who do not improve with antibiotic therapy may have HIV and should be tested. A peritonsillar abscess is characterized by pain, swelling, and fever of the affected tonsil. Rheumatic fever is characterized by tremors, rash, and cardiovascular symptoms.

A patient who has pneumonia reports having chest pain associated with inspiration. The nurse notifies the provider and anticipates implementing which order?

Administering analgesic medications to alleviate discomfort Pleuritic chest pain occurs with inspiration and is a common clinical manifestation in patients with pneumonia; analgesic medications are given to alleviate discomfort. This pain is caused by inflammation of the parietal pleura, not by an increase in infection, so another antibiotic is not indicated. Because the pain is associated with inspiration, it is not due to myocardial infarction, so cardiac enzyme testing is not indicated. Supplemental oxygen is used for hypoxemia.

The nurse is caring for a patient who has just been diagnosed with pulmonary tuberculosis and will be discharged with a prescription for isoniazid 300 mg orally each day. At what time should the nurse teach this patient to take this medication?

An hour before breakfast Isoniazid must be taken on an empty stomach to ensure adequate medication absorption so the best time for the patient to take this medication is an hour before breakfast. The patient would need to fast for two hours before taking the medication prior to bedtime to ensure that the stomach is empty. Taking the medication immediately before or after breakfast would not allow the stomach to be empty while the medication is absorbed.

A family member of a patient who has been diagnosed with severe acute respiratory syndrome (SARS) asks the nurse why the patient is not receiving an antibiotic. How does the nurse respond to this family member?

Antibiotics are not effective because SARS is caused by a virus. SARS is a viral infection and antibiotics are not useful for treating this disease. Patients are provided with supportive care to allow their immune systems to fight the disease. Antibiotics are given only when a secondary infection is present.

The community health nurse is planning tuberculosis treatment for a patient who is homeless and heroin-addicted. Which action will be most effective in ensuring that the patient completes treatment?

Arrange for a health care worker to watch the patient take the medication Because this patient is unlikely to adhere to long-term treatment unless directly supervised while taking medications, the best option is to arrange for directly observed therapy (DOT). Giving a patient who is homeless and addicted to heroin written instructions on how to take prescribed medications is placing too much responsibility on the patient to follow through. Also, the question does not indicate whether the patient can read. Simply because the patient can state the names and side effects of medications does not mean that the patient understands what the medications are and why he or she needs to take them. A patient who is homeless may be more concerned with obtaining shelter and food than with properly taking his or her medication.

An older patient with pneumonia has become more confused during the initial assessment. What action will the nurse take initially?

Assess the patient's oxygen saturation Patients who have altered level of consciousness are often hypoxic. The nurse should assess oxygen saturation to evaluate the possible cause if this occurs. The nurse may evaluate orientation, but the oxygen saturation is more important and should be performed initially. It is not necessary to notify the Rapid Response Team. A bronchodilator medication is not indicated.

A patient has lobar pneumonia. To help ensure that the expected outcome of maintaining an oxygen saturation of 95% or greater is met, which nursing intervention is most important?

Assist with coughing, deep-breathing, and incentive spirometry every 2 hours Assisting the patient to clear the airway of secretions is most important for increasing oxygen saturation because it allows improved oxygenation. Assessing breath sounds and respiratory effort; monitoring vital signs; and obtaining a complete blood count, sputum, and blood cultures are important interventions but are not the priority.

A patient has an endotracheal tube in place for mechanical ventilation. Which nursing action is most important to prevent infection in this patient?

Brushing the patient's teeth every 12 hour

A patient has been started on ethambutol for tuberculosis. What adverse effect requires the patient to notify the provider?

Changes in vision When taking ethambutol for tuberculosis, the patient should report any vision changes to the provider as the medication can cause optic neuritis. Darkening of the urine, yellowing appearance of the skin, and increased bleeding or bruising is associated with liver toxicity or failure and may be seen with isoniazid, rifampin, and pyrazinamide.

An older adult resident in a long-term care facility becomes confused and agitated, telling the nurse "Get out of here! You're going to kill me!" Which action will the nurse take first?

Check the resident's oxygen saturation A common reason for sudden confusion in older patients is hypoxemia caused by undiagnosed pneumonia. The nurse's first action should be to assess oxygenation by checking the pulse oximetry. Determining the cause of the confusion is the primary goal of the RN. A complete neurologic examination may give the RN other indicators of the cause for the patient's confusion and agitation; this will take several minutes to complete. Administering lorazepam may make the patient more confused and agitated because antianxiety drugs may cause a paradoxical reaction, or opposite effect, in some older patients. Depending on the results of the patient's pulse oximetry and neurologic examination, this may be an appropriate next step. Notifying the resident's primary care provider is not a primary measure.

The nurse is counseling a young woman about drug therapy with isoniazid and rifampin to treat tuberculosis. Before developing the teaching plan, what must the nurse assess for first?

Contraceptive methods used Rifampin can interfere with oral contraceptives, and women using these should be taught to use a backup method of contraception during treatment and up to 1 month after treatment ends. Ethambutol can have effects on vision, including color vision, but isoniazid and rifampin do not. Other drugs can increase the risk of gout. Pyrazinamide can cause increased sensitivity to sunlight.

Which statement about pharyngitis is correct?

Development of stridor or indications of airway obstruction should be considered a medical emergency. Pharyngitis can lead to stridor and other indications of airway obstruction due to the swelling of the tissues; this can lead to a medical emergency requiring intubation if not identified early and treated urgently. Diphtheria is a bacterial infection, not viral. Organisms spread throughout the throat can actually be varied and thus a thorough throat culture is needed to facilitate accurate diagnosis. Viral and bacterial pharyngitis are difficult to differentiate on physical examination alone.

A patient who has been using a nasal decongestant spray to treat symptoms of rhinitis is experiencing severe rhinitis medicamentosa. The nurse notes significant nasal swelling and notifies the provider. Which treatment does the nurse expect the provider to order for this patient?

Discontinue the drug Discontinuation of the drug is the treatment of rebound rhinitis caused by overuse of decongestant nasal drops or spray. Antihistamines, leukotriene inhibitors, and mast cell stabilizers are used to treat symptoms of allergic rhinitis.

A patient is about to begin drug therapy for the treatment of tuberculosis (TB). What information is most important for the nurse to give to this patient prior to the start of therapy?

Do not drink alcohol It is most important for patients who are beginning drug therapy for tuberculosis to refrain from the use of alcohol. This is because all medications that treat tuberculosis can cause damage to the liver. Medications for TB should be taken at bedtime to help prevent nausea. The diet should include vitamins C and B and be rich in iron and protein, not carbohydrates.

A patient with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The patient is febrile and agitated. Which health care provider order should the nurse implement first?

Draw aerobic and anaerobic blood cultures

Which method is the best way to prevent outbreaks of pandemic influenza?

Early recognition and quarantine The recommended approach to disease prevention consists of early recognition of new cases and implementing community and personal quarantine to reduce exposure to the virus. Public gatherings should be avoided only if a widespread outbreak has occurred in a community. No vaccine is available for pandemic influenza. The pneumonia vaccine is recommended for high-risk populations because pneumonia may be a complication of influenza. The current influenza vaccine is updated, reevaluated, and changed yearly to meet anticipated changes in the virus. When a cluster of cases is discovered in an area, the antiviral drugs oseltamivir and zanamivir should be widely distributed to help reduce the severity of the infection and to decrease mortality.

A patient with pneumonia has difficulty clearing secretions from the airway. Which nursing intervention does the nurse include in this patient's plan of care?

Encourage an intake of 2 liters of fluid per day Hydration is essential to help liquefy secretions so they can be mobilized more easily. The alert patient should be encouraged to drink at least 2 L per day. The other interventions may help indirectly and are part of the overall nursing management of pneumonia.

The nurse is caring for a patient who has had abdominal surgery. Which action does the nurse take to help prevent pulmonary infection in this patient?

Encourage regular use of an incentive spirometer Postoperative patients, especially those who have had abdominal surgery, are less likely to take deep breaths and cough, so they do not clear their lungs of mucus, increasing their risk of pulmonary infection. Encouraging use of an incentive spirometer can help with this. Low-molecular-weight heparin is given to prevent blood clots and pulmonary emboli, but not infection. Intravenous antibiotics are usually not given prophylactically unless there is increased risk. Adequate analgesia may be a necessary adjunct to incentive spirometry to assist with comfort while taking deep breaths.

Which nursing interventions are critical in caring for individuals with influenza? Select all that apply

Encouraging the patient to rest and increase fluid intake Supporting the patient and preventing the spread of the disease Monitoring pulse rate and quality and urine output during rehydration in a patient with diarrhea Encouraging rest and promoting an increase in fluids is essential to promote healing. Influenza is highly contagious and emphasis should be placed on providing symptomatic support while preventing the spread of the disease to others. Assessment of pulse rate and quality and urine output will aid the health care team in monitoring the rehydration of patients who have lost significant body fluids secondary to diarrhea with the flu. Oxygen may be indicated as part of supportive care in an individual with hypoxia secondary to respiratory infections with the flu. The patient with influenza should be placed in isolation to prevent airborne spread of the disease to others.

The patient has been prescribed anti-infective azithromycin for community-acquired pneumonia. What information should the nurse include when educating the patient? Select all that apply.

Medication may cause diarrhea. Take all medication even if symptoms subside Notify provider if symptoms are present after completion of antibiotics Azithromycin may cause diarrhea as a side effect. It is important that the patient take the entire prescription of azithromycin even if symptoms subside to help eradicate the organism and prevent development of resistant bacterial strains. If symptoms are still present after completion of the antibiotics, the provider should be notified. Azithromycin does not cause constipation. The patient should notify the health care provider if there is no improvement of symptoms within 3 days, not 24 hours.

The nurse is preparing to administer a trivalent influenza vaccine (TIV) to a 70-year-old patient with chronic obstructive pulmonary disease (COPD). While reviewing the patient's immunization record, the nurse notes that the patient received a pneumococcal polysaccharide vaccine (PPV23) 10 years prior. Which action does the nurse take?

Give the TIV and suggest that the patient receive a second PPV23 There is some evidence that a second PPV23 is helpful for preventing pneumonia in patients with chronic lung disease if more than 5 years have passed since the initial PPV23. The nurse should suggest this to the patient or the provider. Administering the TIV and reminding the patient to receive this annually is correct, but the nurse should recommend a second PPV23 since this patient meets criteria for this booster. All patients over 50 years and those with chronic lung disease should receive the flu vaccine annually. Patients over 50 years of age cannot receive the live virus vaccine.

Which statement is true about community-acquired pneumonia (CAP) as compared to health care-associated pneumonia (HAP)?

HAPs are more likely to be resistant to some antibiotics HAPs are more likely to be resistant to some antibiotics, most likely related to the widespread use of antibiotics in the health care environment. Pneumonias acquired in the community are less likely to be caused by organisms that have been exposed to antibiotics and developed resistance. The fibrin and edema that accompanies the inflammation with pneumonia can stiffen the lung in both CAP and HAP. As red blood cells and fibrin move into the alveoli with pneumonia, the infection spreads to other areas of the lung in both CAP and HAP.

Which actions known as the "ventilator bundle" have been shown to reduce the incidence of ventilator-associated pneumonia (VAP)? Select all that apply.

HOB Oral Care Hand Hygiene

A patient with suspected initial infection of tuberculosis (TB) is admitted to the respiratory intensive care unit (ICU). The nurse caring for the patient reviews the patient's recent chest x-ray. Where on the patient's chest x-ray will the nurse most likely find evidence of the patient's infection? Select all that apply.

Left lower lobe Right lower lobe Right middle lobe Initial infection of tuberculosis (TB) is most often seen in the middle or lower lobes of the lung. The upper lobes of the lung are not the primary location of initial infection of TB.

The radiology report of a patient who has had a chest x-ray shows consolidation in a segment of the patient's left lung. This is typical of which type of pneumonia?

Lobar Lobar pneumonia manifests as consolidation in a segment or an entire lobe of the lung. Bronchopneumonia manifests as diffusely scattered patches around the bronchi. While lobar pneumonia is generally bacterial, the pattern of lung involvement does not necessarily indicate the etiology.

A patient recovering from pneumonia tells the nurse that his sputum smells bad. The nurse suspects the patient may have developed what condition?

Lung abscess A lung abscess may occur after pneumonia, aspiration, or obstruction. It is characterized by pleuritic chest pain, fever, and foul-smelling sputum. Tuberculosis is an airborne disease that produces sputum, cough, weight loss, and hemoptysis. Pulmonary empyema is a collection of pus in the pleural space commonly caused by an infection or a pulmonary abscess. Severe acute respiratory syndrome is an inflammatory respiratory disorder that is easily spread airborne.

The nurse is caring for a pediatric patient with pertussis who is currently in the catarrhal phase of the illness. What manifestations will the nurse most likely find on assessment of this patient?

Mild cough Pertussis occurs in three distinct phases. During the first (catarrhal) phase, the patient may present with signs and symptoms of the common cold, including a mild cough. After 1 or 2 weeks, the paroxysmal phase occurs, characterized by a severe cough and bloody sputum, and potentially complicated by pneumonia. The third phase is the convalescent phase, which can last for several months.

A patient taking antibiotics to treat rhinosinusitis reports facial pain over the affected sinuses. Which comfort measure does the nurse suggest in addition to the antibiotic therapy?

Moist heat packs over the affected sinuses Moist heat packs over the sinuses can alleviate some discomfort. Decongestant medications are also indicated. Frequent nose-blowing is not recommended. Patients should be taught to avoid placing the sinuses in a dependent position.

A patient is admitted to the hospital with a streptococcal peritonsillar abscess following incomplete treatment with an oral antibiotic. The nurse notes that the patient is experiencing stridor. Which action does the nurse take next?

Notify the Rapid Response Team to assist with airway management. If a patient with pharyngitis develops stridor or other indications of airway obstruction, the Rapid Response Team should be notified. Elevating the head of the bed is useful, but will not be sufficient to open the airway. Steroid medications will likely be ordered by the provider after the airway is opened. Offering liquids will increase the risk of aspiration.

A public health nurse is providing education to a community about preparation for a possible influenza epidemic leading to a worldwide pandemic. What does the nurse instruct community members to do upon learning that an influenza outbreak has occurred?

Obtain a vaccine if not already vaccinated against influenza People should be taught to receive vaccinations if not already vaccinated if an outbreak occurs. People should stay home as much as possible and avoid crowds. Stockpiling food and medicines should occur in anticipation of an outbreak, not at the onset when people should be advised to stay home. Antiviral medications are given to those who contract the virus to limit symptoms.

Which group of individuals should be encouraged to receive the pneumococcal vaccine as an important health promotion and maintenance intervention?

Older adults with a chronic health problem Individuals older than age 65 and those with chronic health problems should be encouraged to receive PPV 23 to prevent pneumonia. Since pneumonia often follows influenza among older adults, these individuals should also be encouraged to receive the seasonal influenza vaccination yearly. Although many individuals who develop ventilator-associated pneumonia (VAP) are older individuals with chronic illnesses, VAP in a younger individual is not a primary indication for pneumococcal vaccine.

The medical-surgical unit has one negative airflow room. Which of these four newly arrived patients should the charge nurse admit to this room?

Patient with possible pulmonary tuberculosis who currently has hemoptysis A patient with possible tuberculosis should be admitted to the negative airflow room to prevent airborne transmission of tuberculosis. A patient with bacterial pneumonia does not require a negative airflow room but should be placed in Droplet Precautions. A patient with neutropenia should be in a room with positive airflow. The patient with a right empyema who also has a chest tube and a fever should be placed in Contact Precautions but does not require a negative airflow room.

Which of these patients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit?

Patient with pulmonary tuberculosis who is receiving multiple medications The LPN/LVN scope of practice includes medication administration, so a patient receiving multiple medications can be managed appropriately by an LPN/LVN. Stridor is an indication of respiratory distress; this patient needs to be managed by the RN. A patient in the immediate postoperative period requires frequent assessments by the RN to watch for deterioration. A patient with a thick-sounding voice and difficulty swallowing is at risk for deterioration and needs careful assessment and monitoring by the RN.

The nurse is performing an admission assessment on a 90-year-old patient and notes confusion with poor orientation to person, place, and time. The patient's daughter tells the nurse that this isn't normal. Which initial action by the nurse is correct?

Perform a detailed respiratory assessment including lung sounds, pulse oximetry, and temperature In older patients, a frequent first indication of pneumonia is a change in mental status due to hypoxemia. The nurse should first perform a respiratory assessment and then notify the provider of the findings. Antibiotics are not indicated unless an assessment and tests indicate an infection is present. Lab work may be ordered by the provider as part of the ongoing evaluation of this patient. Nurses should listen to family members' reports about the usual status of patients and respond if a patient is not acting normally.

A patient is admitted to the emergency department (ED) with a possible diagnosis of avian influenza ("bird flu"). Which of these actions included in the hospital protocol for avian influenza will the nurse take first?

Place the patient in a negative air pressure room If a patient is exhibiting symptoms of avian flu or any other pandemic influenza, he or she is assumed to be contagious until proven otherwise. Protecting the spread of disease to the community is the top priority, so placing the patient in a negative air pressure room is the nurse's first action. If avian influenza is diagnosed, it is important that those exposed receive oseltamivir or zanamivir within 48 hours of contact with the patient. Obtaining specimens will be important to determine whether the patient has avian influenza; this test takes approximately 40 minutes to complete. A patient with avian flu will become dehydrated because of diarrhea so starting an IV to administer rehydration fluid is important, but is not the first priority.

Which may be the most common feature of pneumonia and lung abscesses?

Pleuritic chest pain Pleuritic chest pain is the most common feature of pneumonia and lung abscesses. Rust-colored sputum is seen in pneumonia. Foul-smelling sputum is seen in lung abscesses. Mucopurulent sputum is seen in tuberculosis.

A patient returns to the clinic to have the tuberculosis (TB) Mantoux test analyzed by the nurse, which was administered 2 days ago. The patient's left forearm shows a red raised area, which measures 10 mm in diameter. How does the nurse document this finding?

Positive reaction that indicates exposure to and the possible presence of TB infection An area of induration (raised soft tissue) measuring 10 mm or greater in diameter at 48-72 hours after the injection indicates exposure to and possible infection with TB. A positive reaction does not in itself mean TB is present until that has been confirmed with a chest x-ray and sputum culture. There are no false-positive readings, but the incidence of false-negative readings is greater at 48 hours and will need to be read again at 72 hours to confirm. The test will not be administered again in this situation.

A nurse is caring for a patient with community-acquired pneumonia. The patient's oxygen saturation is 88% on room air. The patient is writhing in pain and cries out, "It hurts so bad to take a deep breath. I can't even cough it hurts so bad." Understanding the patient's condition, what is the nurse's priority intervention for this patient?

Provide patient with supplemental oxygen The patient in the described scenario is experiencing impaired gas exchange, a potential life-threatening condition. The nurse's priority intervention is to provide the patient with supplemental oxygen. Encouraging the patient to deep breathe and cough, administering the ordered opioid analgesic medication, and instructing the patient on splinting the chest when breathing are all appropriate nursing interventions; however, these are not the priority interventions for this patient.

Which points does the nurse include when educating an older patient and family about pneumonia prevention? Select all that apply.

Receiving an annual influenza vaccine Decreasing exposure to air pollutants Avoiding crowded public places Avoiding dehydration Since pneumonia often follows influenza, an annual vaccination for the flu is important. It may also be beneficial to repeat the pneumonia vaccine if it has been more than 5 years since vaccination. Individuals with pneumonia or who are at risk for pneumonia are at increased risk for respiratory problems when exposed to air pollutants. Crowded public places should be avoided, especially during cold and flu season because of the risk of exposure to causative organisms. Dehydration, especially in older adults, will increase the difficulty of adequate bronchial hygiene. Although monitoring vital signs may be beneficial, blood pressure is probably less critical than monitoring for the presence of a fever

The nurse in the long-term care facility is concerned about the health status of an 80-year-old resident. What early symptom would alert the nurse that this patient is developing pneumonia?

Recent onset of confusion The most common manifestation of pneumonia in the older adult is acute confusion caused by hypoxia. Other symptoms may include poor appetite (not vomiting), lethargy, fatigue, and weakness. Fever and cough may be absent.

The nurse is preparing a patient for discharge who has been treated for the prodromal stage of inhalation anthrax. What information is most important for the nurse to communicate to this patient?

Seek medical attention immediately if you begin to feel breathless The fulminant stage of inhalation anthrax usually begins after the patient has been feeling better for a day or so. This stage often begins with the patient experiencing breathlessness so it is important for the patient to seek help immediately if this symptom develops. A nurse should never encourage a patient to refill any medications unless it has been ordered by the health care practitioner. The patient should be given information about all of the symptoms of the fulminating stage, not given the impression that it is normal to feel worse before feeling better, so that any symptom will cause the patient to seek appropriate medical attention. Mild chest pain is expected with the prodromal stage of inhalation anthrax.

The nurse is caring for a patient who was admitted with pneumonia. Which position assumed by the patient leads the nurse to suspect that the patient is developing hypoxia?

Sitting in tripod position A patient with hypoxia will assume the tripod position (seated and positioned leaning on the hands, often leaning on an over-the-bed table). The patient who is hypoxic will not assume a side-lying or prone position because these positions will only increase a patient's feelings of inability to obtain enough air. Elevating the head of the bed 45° will not be adequate to relieve the smothering feelings associated with hypoxia

The nurse has taught a patient about influenza infection control. Which patient statement indicates the need for further teaching?

The intranasal vaccine can be given to everybody in the family. The intranasal flu vaccine is approved for healthy patients ages 2-49 who are not pregnant. Washing hands frequently is the best way to prevent the spread of illnesses such as the flu. Avoiding kissing and shaking hands are two ways to prevent transmission of the flu. A new recommendation from the Centers for Disease Control and Prevention (CDC) for controlling the spread of the flu is to sneeze or cough into the upper sleeve rather than into the hand.

A patient comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first?

Throat culture A throat culture is important for distinguishing a viral infection from a group A beta-hemolytic streptococcal infection. A chest x-ray or TB skin test are not indicated by the symptoms given. A CBC might be indicated to evaluate infection and dehydration, but would not be the first action.

A patient with pulmonary tuberculosis is being started on combination therapy. What does the nurse explain to the patient as the purpose of combination therapy?

To shorten therapy by 6 months Combination medication shortens therapy by 6 to 12 months. Tuberculosis medications should be taken as ordered without missing a dose. Combination therapy is not related to disease resistance. Medications may be changed based upon the patient's ability to tolerate drugs.

Which nursing interventions are focused on preventing the spread of severe acute respiratory syndrome (SARS) caused by coronaviruses? Select all that apply.

Using strict airborne isolation techniques Handwashing before and after all patient care Using Contact Precautions with people suspected to have SARS Disinfecting contaminated surfaces and equipment Since the SARS virus is spread via airborne droplets from infected people through sneezing, coughing, and talking, strict Airborne Precautions are essential. Hand hygiene and the use of gloves decrease the likelihood of spread to the mucous membranes, nose, and mouth and contamination of surfaces outside the patient's room. Individuals suspected to have SARS should be placed in Contact Precautions until a definitive diagnosis is made. Diagnosis is confirmed by the manifestation of symptoms and the use of a rapid SARS test within 2 days after symptoms begin. All equipment and surfaces that potentially have been contaminated must be disinfected by an individual wearing gloves. Although careful monitoring of the occurrence of SARS is important, preventing its spread is the initial focus to decrease the likelihood of a widespread epidemic.

A young adult patient refuses an influenza vaccine, saying, "I'm healthy and won't get that sick if I get the flu." Which is the best response by the nurse?

You may spread the disease to people who are more at risk for severe symptoms." Young children, older adults, and those with underlying chronic conditions are at risk for pneumonia and death if they become ill with influenza. Patients who refuse the influenza vaccine should be told that they are putting others at risk. Pandemic influenzas typically originate from mutated animal and bird viruses, and prevention is handled separately from seasonal influenza—pandemic influenza vaccines are typically stockpiled and not part of general influenza vaccination. Antiviral medications are useful when given 24-48 hours after onset of symptoms, but usually shorten rather than cure the disease.

A patient with asthma reports diarrhea and vomiting. Which drug should be used with caution?

Zanamivir

A community health nurse is preparing a community education class on bioterrorism and the use of inhalation anthrax. When preparing to discuss the manifestations of the fulminant stage of the infection, what manifestation does the nurse include in the teaching?

hypotension Inhalation anthrax infection has two stages: prodromal (early) and fulminant (late). Hypotension may occur in the fulminant stage of inhalation anthrax infection. Fever, fatigue, and dry cough occur in the prodromal stage of inhalation anthrax infection.

A nurse is caring for a patient with coccidioidomycosis who has recently migrated from Mexico. When planning care for this patient, what manifestation noted on assessment does the nurse recognize as a sign of more severe coccidioidomycosis infection?

joint pain Coccidioidomycosis, also known as valley fever, is a fungal infection that is caused by an organism commonly found in the desert southwest regions of the United States, Mexico, and Central and South America. Joint pain is a symptom of more serious coccidioidomycosis infection. Cough, chest pain, and night sweats are symptoms of coccidioidomycosis; however, these are common in all infections and are not symptoms of more serious infection.

Which upper respiratory infection is often triggered by a hypersensitivity reaction to airborne allergens?

rhinitis Allergic rhinitis (hay fever or allergies) is triggered by a hypersensitive reaction to airborne allergens, especially plant pollens or molds. These infections can occur in the sinuses (sinusitis) or throat (pharyngitis); however, the initial trigger is the hypersensitive allergic reaction. Tonsillitis is a contagious airborne infection that has settled in the tonsils on either side (or both sides) of the throat.

A patient with nasal congestion, fever, and cough has been using over-the-counter medications for a week without improvement. The patient exhibits tenderness to percussion over the sinuses and referred pain to the back of the head. These findings may indicate which condition?

rhinosinusitis Prolonged upper respiratory symptoms can indicate that a sinus infection has developed. Tenderness to percussion over the sinuses and referred pain to the back of the head are common manifestations of rhinosinusitis. Manifestations of rhinitis include headache, nasal irritation, sneezing, nasal congestion, rhinorrhea, and itchy, watery eyes. The patient with pharyngitis has throat soreness and dryness, throat pain, odynophagia, difficulty swallowing, and may have a fever. Tonsillitis is manifested by a sudden sore throat, fever, muscle aches, chills, and dysphagia. The tonsils are visibly swollen and red.