Med Surg

The nurse working in the emergency department recognizes that the results of a rapid influenza diagnostic test (RIDT) is usually available within which time frame? 1. 30 minutes 2. 60 minutes 3. 12 hours 4. 24 hours

1

Which statement by the patient being discharged after hospitalization for influenza indicated the need for further teaching? 1. "I do not need to get a flu shot next year because I am now immune." 2. "I still need to get flu shots every year." 3. "I understand that the flu vaccine changes every year." 4. "I need to get my flu shot every year in the early fall."

1

On assuming care for a patient being treated for tuberculosis, which assessment finding requires immediate attention by the nurse? 1. Dyspnea 2. Fatigue 3. Night sweats 4. Rust-colored sputum

1 Initial symptoms of tuberculosis (TB) are relatively nonspecific and consist of fatigue, weight loss, and night sweats, followed by the development of a cough that produces a rusty-colored or blood-streaked sputum. As the disease progresses, dyspnea, orthopnea, and rales become evident as signs of respiratory compromise.

The nurse develops the nursing diagnosis, "Ineffective Airway Clearance related to thick purulent secretions." This nursing diagnosis is most relevant to the patient with which medical diagnosis? 1. Tuberculosis 2. Bacterial pneumonia 3. Influenza A 4. Influenza C

1 Secretions/sputum in patients with tuberculosis are typically rust colored. 2 Secretions in bacterial pneumonia are usually purulent and/or bloody secretions that result from buildup of exudate in the alveoli.

The nurse caring for a homeless patient at risk for tuberculosis (TB) includes which clinical manifestations of the disease when educating the patient? Select all that apply. 1. Fatigue 2. Green-tinged sputum 3. Productive cough that later turns to a dry, hacking cough 4. Weight loss 5. Night sweats

1,,4,5 Feedback 1 This is correct. Manifestations of tuberculosis often develop insidiously and are initially nonspecific. Fatigue, weight loss, and night sweats are common. It is often at this stage that the patient first seeks medical attention. 2 This is incorrect. Rusty-colored, not greenish, sputum occurs as a result of the destruction of lung tissue during granuloma formation. 3 This is incorrect. A dry cough develops, which later becomes productive of purulent and/or blood-tinged sputum. 4 This is correct. Manifestations of tuberculosis often develop insidiously and are initially nonspecific. Fatigue, weight loss, and night sweats are common. It is often at this stage that the patient first seeks medical attention. 5 This is correct. Manifestations of tuberculosis often develop insidiously and are initially nonspecific. Fatigue, weight loss, and night sweats are common. It is often at this stage that the patient first seeks medical attention.

The nurse is assessing a patient with acute malaise and muscle aches. Which questions should the nurse ask to determine whether the patient is experiencing influenza? Select all that apply. 1. "Have you had a flu shot this year?" 2. "Is your cough productive?" 3. "Have you been exposed to anyone with the flu?" 4. "Have you had a recent weight loss?" 5. "Do you have dizziness?"

1,2,3

In providing teaching for a patient recently diagnosed with an active tuberculosis (TB) infection, the nurse incorporates teaching about which medications? Select all that apply. 1. Ethambutol 2. Isoniazid 3. Pyrazinamide 4. Rifampin 5. Vancomycin

1,2,3,4

The school nurse is planning a teaching session with the parents of students to reduce the spread of the influenza virus throughout the school. What should the nurse include when teaching the parents about minimizing the chance of spread of influenza? Select all that apply. 1. "Cover your cough" education 2. Appropriate hand hygiene 3. Safe food preparation and storage 4. Sanitizing high-touch items to kill pathogens 5. Getting the influenza vaccine in the early summer

1,2,4

The nurse correlates which risk factors with tuberculosis? Select all that apply. 1. Homelessness 2. Incarceration 3. Caucasian race 4. Hispanic race 5. Obesity

1,2,4 1 This is correct. Populations at risk for tuberculosis (TB) include low socioeconomic groups with obstacles to accessing healthcare, the homeless, and incarcerated populations. There is an increased incidence among blacks, Hispanics, and Asians. Immunosuppression is also a risk factor for TB.

How does the nurse interpret the following arterial blood gases in the patient admitted with influenza? pH 7.48 PaO2 85 mm Hg PaCO2 30 mm Hg HCO3 24 mEq/L 1. Respiratory alkalosis 2. Respiratory acidosis 3. Hypoxemia 4. Normal arterial blood result

1.

Which statement made by the patient with an active tuberculosis (TB) infection who is discharged to home receiving directly observed therapy indicates that teaching was effective? 1. "The home-health nurse will come to my home daily to make sure that I take my medications." 2. "I need to be on home isolation for about 2 weeks." 3. "I only have to take these medications for about 6 months." 4. "I will not need to be tested for TB after the infection is cured."

1. Once the patient with tuberculosis (TB) has been stabilized and has started on therapy, treatment can continue at home. National TB treatment guidelines strongly recommend using directly observed therapy (DOT) when treating persons with active TB disease. DOT is in place when a trained healthcare worker, home healthcare nurse, aide, or designated and trained individual provides the prescribed TB drugs and watches the patient swallow every dose

The nurse is assessing a patient who is diagnosed with tuberculosis. Which assessment finding correlates with this diagnosis? 1. Wheezing 2. Hemoptysis 3. Yellowish sputum 4. Slightly whitish sputum

2

The nurse provides education to a patient who is prescribed an antiviral medication, oseltamivir (Tamiflu), for the treatment of influenza. Which patient statement indicates to the nurse a correct understanding of the administration of this medication? 1. "This medication is administered by an IV." 2. "This medication is administered by mouth." 3. "This medication is administered by injection." 4. "This medication is administered by inhalation."

2

The nurse recognizes which medication is indicated to treat community-acquired pneumonia in the patient who was previously healthy and has not received antibiotics in the last 3 months? 1. b-Lactam antibiotics 2. Macrolides 3. Respiratory fluoroquinolones 4. Vancomycin

2

The nurse is caring for a patient who is admitted to the unit with tuberculosis (TB). The patient is placed in isolation. To protect the caregivers and other patients on the unit, which type of isolation room is most appropriate? 1. Single-door room with positive air flow (air flows out of the room) 2. Isolation room with an anteroom and negative air flow (air flows into the room) 3. Isolation room with an anteroom and normal airflow 4. Single-door room with normal airflow

2 Patients with airborne infections such as meningococcemia, severe acute respiratory syndrome (SARS), or tuberculosis are placed in an isolation room with an anteroom and negative pressure airflow. Air flows into the room and is vented in a special manner to prevent the organism from entering the rest of the unit.

The nurse monitors for which clinical manifestation in the patient admitted with tuberculosis? 1. Greenish-colored sputum 2. Rust-colored sputum 3. Whitish-colored sputum 4. Yellowish-colored sputum

2 Blood-tinged or rust-colored sputum is present as a result of the destruction of lung parenchyma tissue.

Which statement by the patient recently diagnosed with an influenza infection indicates that teaching was effective? 1. "I am infectious for 4 days." 2. "I am infectious for up to 10 days." 3. "I am not infectious now that I am on antibiotics." 4. "I am not infectious unless I cough up a lot of secretions."

2 Virus shedding usually ends 2 to 5 days after symptoms first appear; therefore, it is important to remember that individuals are infectious for up to 7 to 10 days.

A patient is with a severe influenza infection is placed on droplet precautions. What actions by the nurse are relevant for this type of isolation? Select all that apply. 1. N95 mask 2. Surgical mask 3. Negative airflow room 4. Private room 5. Gown and gloves

2,4,5

The nurse reads tuberculin skin test (TST) results for a group of patients. Which patient does the nurse document as a positive result in the medical record? 1. The adult patient diagnosed with HIV whose induration is 3 mm. 2. The adult who recently had contact with a person with tuberculosis whose induration is 4 mm. 3. The patient who uses intravenous (IV) drugs whose induration is 11 mm. 4. The adult who recently immigrated from a high-prevalence country whose induration is 8 mm.

3

The nurse working in the community health clinic places a purified protein derivative (PPD, or Mantoux) test on an adult's forearm and instructs him to return when for reading of the response? 1. The following day 2. Between 24 and 48 hours after placement of the PPD 3. Between 48 and 72 hours after placement of the PPD 4. Between 72 and 96 hours after placement of the PPD

3

On assuming care for a patient being treated for bacterial pneumonia, which assessment finding requires immediate attention by the nurse? 1. Fever 2. Productive cough 3. Restlessness 4. Arthralgia

3 Agitation, restlessness, anxiety, lethargy, and fatigue are the result of decreased tissue perfusion from altered alveolar gas exchange and require immediate action by the nurse. Clinical manifestations of bacterial pneumonia include fever, chills, tachypnea, tachycardia, cough (productive or non-productive), pleuritic pain, fatigue, and myalgias. Dyspnea, particularly at rest, is an indication that the patient's respiratory status is deteriorating.

The nurse correlates which clinical manifestation as the earliest compensatory mechanism in the patient with influenza? 1. Oliguria 2. Tachycardia 3. Tachypnea 4. Fever

3 Tachypnea, increased respiratory rate and depth, is the body's first compensatory mechanism to decreased oxygen delivery.

The nurse is assessing several patients at a community clinic. The nurse questions administration of the annual influenza vaccination in which patient? 1. A 3-year-old with cystic fibrosis 2. A 25-year-old pregnant woman at 20 weeks' gestation 3. A 35-year-old man with a severe allergy to eggs 4. A 65-year-old woman with diabetes

3 A 35-year-old man with a severe allergy to eggs should not get a flu shot, because the annual vaccine contains an inactive ingredient with an egg protein. This patient needs to be assessed for an alternative form of vaccine without this egg protein.

The patient recently released from the hospital after recovering from complications related to influenza is being seen in the outpatient clinic. Which patient statement indicates the need for further intervention? 1. "I went back to work." 2. "I am drinking at least 8 glasses of water daily. " 3. "I continue to wake up coughing at night." 4. "I only had a low-grade fever once since I left the hospital."

3 A patient who continues to be awakened during the night because of coughing requires further assessment, particularly in relation to the color and viscosity of secretions. Primary viral pneumonia from influenza can cause coughing that lasts up to 2 weeks. Secretions that are white are consistent with viral infection. Purulent nasal discharge/sputum indicates a secondary bacterial infection.

Which interventions does the nurse implement when providing care for a patient who is admitted for the treatment of active tuberculosis? Select all that apply. 1. Places the patient on droplet precautions 2. Wears a surgical mask when providing patient care 3. Places the patient in a private, negative airflow room 4. Wears eye protection when collecting sputum samples 5. Places a surgical mask on the patient to transport to radiology

3,4,5 Feedback 1 This is incorrect. The patient who is admitted for the treatment of active tuberculosis requires airborne, not droplet, precautions. 2 This is incorrect. The nurse wears an N95 mask when providing care to the patient with active tuberculosis. 3 This is correct. Immediate isolation of the patient with suspected or confirmed TB infection in a private room with negative airflow capabilities is a priority. Negative airflow occurs when air moves into the contaminated area or into the patient's room from bordering areas. 4 This is correct. Eye protection is personal protective equipment that is used for implementing standard precautions when respiratory sprays may occur. This is an appropriate nursing action. 5 This is correct. The patient's movement and transportation to other departments should be limited to essential needs only. Patients who must leave the negative pressure room should also wear a surgical mask.

The nurse is caring for a patient who was recently treated for an empyema that developed secondary to pneumonia. Which procedure does the nurse prepare the patient to decrease recurrence once the empyema has been drained? 1. Bronchoscopy 2. Chest tube insertion 3. Pleurodesis 4. Thoracentesis

3. Pleurodesis

The nurse is preparing an educational program pneumonia and includes information about which pathogen that is the major pathogen associated with hospital-acquired pneumonia (HAP)? 1. Haemophilus influenzae 2. Mycoplasma pneumoniae 3. Pseudomonas aeruginosa 4. Streptococcus pneumoniae

3. Pseudomonas aeruginosa is the major pathogen associated with hospital-acquired pneumonia (HAP).

The nurse is planning care for a patient diagnosed with influenza. Which intervention by the nurse is the priority when planning this patient's care? 1. Restricting all visits from family and friends 2. Providing staff with N95 mask respirators 3. Placing the patient in a negative air flow room 4. Placing the patient on droplet precaution

4

The nurse questions which order for the patient admitted with the flu who is experiencing tachypnea? 1. Maintain adequate hydration. 2. Keep the head of the bed elevated. 3. Teach the patient coughing, deep breathing, and hydration. 4. Prepare the patient for intubation.

4

The nurse provides care to patients in the urgent care center. Which patient has the greatest risk for developing influenza? 1. A patient aged 26 years with a history of systemic lupus erythematosus (SLE) who works as an accountant 2. A patient aged 44 years who is a nurse 3. A patient aged 60 years with a history of asthma 4. A patient aged 66 years with a history of diabetes mellitus

4 This patient has two risk factors for influenza (age and diabetes); therefore, this patient is at the greatest risk for developing influenza.

h a left lung infiltration. In what position does the nurse place the patient to maximize pThe nurse is caring for a patient hospitalized for severe bacterial pneumonia water fusion to functional alveolar units? 1. Prone 2. Supine with head of bed elevated 30 degrees 3. On the left side 4. On the right side

4. For infiltrates of only one lung, when turning, preferentially position the patient with the good lung down to maximize perfusion to functional alveolar units. Because this patient has a left lung infiltrate, the right side is preferred.

In reviewing arterial blood gas results on a patient admitted with a severe influenza infection, the nurse correlates which value to the patients' respiratory acidosis? 1. pH 7.50 2. PaO2 75 mm Hg 3. PaCO2 50 mm Hg 4. O2 Saturation 88%

ANS: 3