Pneumonia and rsv NCLEX Questions
The nurse is examining a child with bronchiolitis. Which symptom should the nurse interpret as a sign of dehydration? (Select all that apply.) A. Intercostal muscle retractions B. Weak peripheral pulses C. Decreased urine output D. Dry, sticky mucous membranes E. Delayed capillary refill
Answer: B, C, D, E
Which nursing care would most likely be effective in alleviating the irritation and fretfulness of a 5-year-old girl hospitalized with pneumonia? A.Give her a jigsaw puzzle. B.Remove parent from the room. C.Let her play with a doll. Put her in a room by herself.
Answer: C
Which pt is at higher risk for developing pneumonia? A. any hospitalized pt between 19 - 64 y.o. B. 36 y.o. trauma pt on mechanical ventilator C. disabled 51 y.o. with abdominal pain, d/c home D. Any pt who has not received the pneumonia vaccine
B 36 y.o. trauma pt on mechanical ventilator
Which instruction should the nurse provide to a client who has pneumonia and is being discharged for home care? (Select all that apply.) A. "Maintain adequate fluid intake." B. "Avoid smoking or exposure to secondhand smoke." C. "Limit activities and increase rest." D. "Clean surfaces with household disinfectant." E. "Wear a mask when in contact with other household members."
Answer: A, B, C
A nurse is auscultating the lower lung fields of a pneumonia pt. She hears coarse crackles and ids the problem as impaired oxygenation. She knows the underlying physiologic condition associated with pt condition is A. hypoxemia B. hyperemia C. hypocapnia D. hypercapnia
A hypoxemia
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? A) Check the resident's oxygen saturation. B) Do a complete neurologic assessment. C) Give the prescribed PRN lorazepam (Ativan). D) Notify the resident's primary care provider.
A) Check the resident's oxygen saturation.
A nurse is caring for an 89-year-old client admitted with pneumonia. He has an IV of normal saline running at 100 mL/hr and antibiotics that were initiated in the emergency department 3 hours ago. He has oxygen at 2 liters/nasal cannula. What assessment finding by the nurse indicates that goals for a priority diagnosis have been met for this client? A) The client is alert and oriented to person, place, and time. B) Blood pressure is within normal limits and client's baseline. C) Skin behind the ears demonstrates no redness or irritation. D) Urine output has been >30 mL/hr per Foley catheter
A) The client is alert and oriented to person, place, and time.
A pt is seen in the HCP office and dx with community-acquired pneumonia. The nurse knows the most common symptoms that this pt may have is A. dyspnea B. abdominal pain C. back pain D. hypoxemia E. chest discomfort F. a smoker
A, D, E dyspnea hypoxemia chest discomfort
A pt is suspected on having community-acquired pneumonia. The nurse anticipates which of the following tests to be done to dx pt A. sputum gram stain B. Pulmonary function test C. fluorescein bronchoscopy D. peak flow meter measurement E. chest x-ay
A, E sputum gram stain CXR
On auscultation of a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding? a. Inspiratory crackles at the bases b. Expiratory wheezes in both lungs c. Abnormal lung sounds in the apices of both lungs d. Pleural friction rub in the right and left lower lobes
ANS: A Crackles are low-pitched, bubbling sounds usually heard on inspiration. Wheezes are high-pitched sounds. They can be heard during the expiratory or inspiratory phase of the respiratory cycle. The lower third of both lungs are the bases, not apices. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration.
During a home visit, the nurse assesses a 2-year-old child. Which factor should the nurse identify as putting the child at risk for contracting respiratory syncytial virus (RSV)? (Select all that apply.) A. Both parents are unemployed. B. Both parents smoke cigarettes. C. The toddler shares a drinking cup with older brother. D. There is an absence of soap at the kitchen sink. E. The toddler wears clean but rumpled pants and shirt.
Answer: A, B, C, D
Which factor should the nurse identify as a risk factor for the development of bronchiolitis? (Select all that apply.) A. Cigarette smoke exposure B. Chronic lung disease C. Attends daycare D. Premature birth E. Age 4 or older
Answer: A, B, C, D
After the nurse has received change-of-shift report, which patient should the nurse assess first? a. A patient with pneumonia who has crackles in the right lung base b. A patient with possible lung cancer who has just returned after bronchoscopy c. A patient with hemoptysis and a 16-mm induration with tuberculin skin testing d. A patient with chronic obstructive pulmonary disease (COPD) and pulmonary function testing (PFT) that indicates low forced vital capacity
ANS: B Because the cough and gag are decreased after bronchoscopy, this patient should be assessed for airway patency. The other patients do not have clinical manifestations or procedures that require immediate assessment by the nurse.
The nurse caring for a client with pneumonia reviews the medical administration record and order sheet. Which agent should the nurse expect to administer? (Select all that apply.) A. Oxygen B. Mucolytic agent C. Broad-spectrum antibiotic D. Laxative E.Bronchodilator
Answer: A, B, C, E
A patient with a chronic cough has a bronchoscopy. After the procedure, which intervention by the nurse is most appropriate? a. Elevate the head of the bed to 80 to 90 degrees. b. Keep the patient NPO until the gag reflex returns. c. Place on bed rest for at least 4 hours after bronchoscopy. d. Notify the health care provider about blood-tinged mucus.
ANS: B Risk for aspiration and maintaining an open airway is the priority. Because a local anesthetic is used to suppress the gag/cough reflexes during bronchoscopy, the nurse should monitor for the return of these reflexes before allowing the patient to take oral fluids or food. Blood-tinged mucus is not uncommon after bronchoscopy. The patient does not need to be on bed rest, and the head of the bed does not need to be in the high-Fowler's position.
The nurse in the emergency department is caring for a client with a temperature of 39°C (102.5°F), productive cough, chills, shortness of breath, and malaise. Which diagnostic test should the nurse expect to prepare the client for? (Select all that apply.) A. Chest x-ray B. Sputum culture and sensitivity C. Polysomnography D. Arterial blood gases E. MRI of the chest
Answer: A, B, D
A client with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The client is febrile and agitated. Which health care provider order should the nurse implement first? A) Administer levofloxacin (Levaquin) 500 mg IV. B) Draw aerobic and anaerobic blood cultures. C) Give lorazepam (Ativan) as needed for agitation. D) Refer to social worker for alcohol counseling.
B) Draw aerobic and anaerobic blood cultures.
pneumonia may present differently in the older adult than in the younger adult? A) Crackles on auscultation B) Fever C) Headache D) Wheezing
B) Fever
The nurse is teaching the parents of a 9-month-old client with respiratory syncytial virus (RSV) about ways to help the child recover quickly from the disorder. Which information should the nurse include? (Select all that apply.) A. Provide frequent, small meals throughout the day. B. Use a bulb syringe to clear the nose before giving a bottle. C. Help the child to blow the nose to clear the airway. D. Wash hands thoroughly after caring for the child. E. Permit the child to rest and nap throughout the day.
Answer: A, B, E
The nurse is caring for an infant who is recovering from bronchiolitis. The parents ask if there will be any future risk for the child. Which condition should the nurse describe? A. Decreased lung capacity B. Asthma C. Chronic respiratory infections D. Chronic obstructive pulmonary disease (COPD)
Answer: B
The nurse is preparing discharge instructions for the parents of a young child recovering from pneumonia. Which information should the nurse provide to help prevent the reoccurrence of the disease? A. "Report worsening of symptoms to the provider." B. "Complete all prescribed medications." C. "Ensure that all vaccinations are up to date." D. "Provide for periods of rest."
Answer: B
A 5-year-old is brought to the ER with a temperature of 99.5°F (37.5°C), a barky cough, stridor, and hoarseness. Which nursing intervention should be completed first? A. Immediate IV placement. B. Respiratory treatment of racemic epinephrine. C. A tracheostomy set at the bedside. D. Informing the child's parents about a tonsillectomy.
Answer: B The child has stridor, indicating airway edema, which can be relieved by (inhaled) aerosolized racemic epinephrine.
The nurse informs a client with pneumonia that a respiratory therapist is scheduled to perform chest physiotherapy. The client asks, "What does that mean?" Which response by the nurse is best? A. "Chest physiotherapy will help move the liquid out of your lungs." B. "Chest physiotherapy will help you breathe better." C. "Chest physiotherapy will help prevent excessive coughing so you can rest better." D. "Chest physiotherapy will help remove the infecting organism from your lungs."
Answer: A
A parent asks the nurse how it will be determined if their child has respiratory syncytial virus (RSV). Which is the nurse's best response? A."We will do a simple blood test to determine whether your child has RSV." B."There is no specific test for RSV. The diagnosis is made based on the child's symptoms." C. "We will swab your child's nose and send that specimen for testing." D. "We will have to send a viral culture to an outside lab for testing."
Answer: C The child is swabbed for nasal secretions. The secretions are tested to determine if a child has RSV.
A client with pneumonia is prescribed 100% oxygen. Which type of oxygen delivery device should the nurse use? A. Simple face mask B. Venturi mask C. Nasal cannula D. Nonrebreather mask
Answer: D
The nurse is caring for a client with pneumonia-related atelectasis. Which action would be most appropriate for the nurse to implement to improve oxygen saturation? A.Initiating oxygen using a high-flow system B. Implementing postural drainage C. Performing vibration and percussion D. Instructing the client how to use the incentive spirometer
Answer: D
Which intervention should the nurse identify as a preventive measure for bronchiolitis? A. Antibiotic therapy B. Immunization C. Sputum culture D. Palivizumab
Answer: D
A nurse is monitoring a group of clients for increased risk for developing pneumonia. Which of the following clients should the nurse expect to be at risk? Select all that apply. A.Client who has dysphagia B.Client who has AIDS C.Client recently vaccinated with pneumococcus vaccination 6 months age D.Client who is bedbound following surgery E.Client who practices good hand hygiene
Answers: A, B, D
Which statement best describes pneumonia? A. an infection of just the windpipe because the lungs are clear of any problems B. a serious inflammation, caused by various things, of the bronchioles C. only an infection of the lungs with mild to severe effects on breathing D. an inflammation resulting from damage to the lungs due to long-term smoking
B a serious inflammation, caused by various things, of the bronchioles
The pt with pneumonia has a priority problem of ineffective airway clearance with bronchospasms. Pt has no previous chronic resp disorders. The nurse will obtain an order for which intervention? A. increased liters of humidified oxygen via facemask B. scheduled and prn aerosol nebulizer bronchodilator treatments C. handheld bronchodilator inhaler prn D. corticosteroid via inhaler or IV to reduce inflammation
B scheduled and prn aerosol nebulizer bronchodilator treatments
An older client presents to the emergency department with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The client never had a pneumococcal vaccine. The client's chest x-ray shows density in both bases. The client has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this client? A) It would not be beneficial for this client. B) It would help decrease the bronchospasm. C) It would clear up the density in the bases of the client's lungs. D) It would decrease the client's pain on inspiration.
B) It would help decrease the bronchospasm.
The nurse should observe for side effects associated with the use of bronchodilators. A common side effect of bronchodilators is: A.) Tinnitus B.) Nausea C.) Ataxia D.) Hypotension
B.) Nausea Option B: A side effect of bronchodilators is nausea. Options A and C: Answers A and C are not associated with bronchodilators; therefore, they are incorrect. Option D: Answer D is incorrect because hypotension is a sign of toxicity, not a side effect.
The nurse assesses a male client's respiratory status. Which observation indicates that the client is experiencing difficulty breathing? A.) Diaphragmatic breathing. B.) Use of accessory muscles. C.) Pursed-lip breathing. D.) Controlled breathing.
B.) Use of accessory muscles. Option B: The use of accessory muscles for respiration indicates the client is having difficulty breathing. Options A, C, and D: Diaphragmatic and pursed-lip breathing are two controlled breathing techniques that help the client conserve energy.
The nurse identifies the priority nursing dx for a pneumonia pt to be ineffective airway clearance related to fatigue, CP, excessive secretions and muscle weakness. To correct the problem the nurse will implement which intervention A. administer oxygen to prevent hypoxemia and atelectasis B. push fluids to greater than 3000 mL/day to ensure adequate hydration C. administer bronchodilator therapy in a timely manner to decrease bronchospasms D. maintain semi-fowlers position to facilitate breathing and prevent further fatigue
C bronchodilator
A patient is presenting with mild symptoms of pneumonia. The doctor diagnoses the patient with "walking pneumonia". From your nursing knowledge, you know this type of pneumonia is caused by what type of infectious agent? A. Fungi B. Streptococcus pneumoniae C. Mycoplasma pneumoniae D. Influenza
C. Mycoplasma pneumoniae
The most reliable index to determine the respiratory status of a client is to: A.) Observe the chest rising and falling. B.) Observe the skin and mucous membrane color. C.) Listen and feel the air movement. D.) Determine the presence of a femoral pulse.
C.) Listen and feel the air movement. Option C: To check for breathing, the nurse places her ear and cheek next to the client's mouth and nose to listen and feel for air movement. Option A: The chest rising and falling is not conclusive of a patent airway. Options B and D: Observing skin color is not an accurate assessment of respiratory status, nor is checking the femoral pulse.
Veronica's parents were told that their daughter needs ribavirin (Virazole). This drug is used to treat which of the following? A.) Cystic fibrosis B.) Otitis media C.) Respiratory syncytial virus (RSV) D.) Bronchitis
C.) RSV Option C: Ribavirin is an antiviral medication used for treating RSV infection and for children with RSV who are compromised (such as children with bronchopulmonary dysplasia or heart disease). Options A, B, and D: The drug is not used to treat bronchiolitis, otitis media, or CF.
Basilar crackles are present in a client's lungs on auscultation. The nurse knows that these are discrete, non continuous sounds that are: A. Caused by the sudden opening of alveoli. B. Usually more prominent during expiration. C. Produced by airflow across passages narrowed by secretions. D. Found primarily in the pleura.
Correct Answer: A. Caused by the sudden opening of alveoli Basilar crackles are usually heard during inspiration and are caused by sudden opening of the alveoli. Basilar crackles are a bubbling or crackling sound originating from the base of the lungs. They may occur when the lungs inflate or deflate. They're usually brief, and may be described as sounding wet or dry. Excess fluid in the airways causes these sounds.
An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings? A. It is likely that the client is developing a secondary bacterial pneumonia. B. The assessment findings are consistent with influenza and are to be expected. C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions D. The client has not been taking her decongestants and bronchodilators as prescribed.
Correct Answer: A. It is likely that the client is developing a secondary bacterial pneumonia. Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent cough and crackles may be indicative of a bacterial infection that is not consistent with a diagnosis of influenza.
Auscultation of a client's lungs reveals crackles in the left posterior base. The nursing intervention is to: A. Repeat auscultation after asking the client to deep breathe and cough. B. Instruct the client to limit fluid intake to less than 2000 ml/day. C. Inspect the client's ankles and sacrum for the presence of edema. D. Place the client on bedrest in a semi-Fowler's position.
Correct Answer: A. Repeat auscultation after asking the client to deep breathe and cough. Although crackles often indicate fluid in the alveoli, they may also be related to hypoventilation and will clear after a deep breath or a cough. Assess cough effectiveness and productivity. Coughing is the most effective way to remove secretions. Pneumonia may cause thick and tenacious secretions to patients.
A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? A. Encouraging additional fluids for the next 24 hours B. Ensuring the return of the gag reflex before offering foods or fluids C. Administering atropine intravenously D. Administering small doses of midazolam (Versed).
Correct Answer: B. Ensuring the return of the gag reflex before offering foods or fluids After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Although bronchoscopy can be done without sedation, most procedures are done under moderate conscious sedation with the use of various sedatives based on the clinician's preference (e.g., benzodiazepines, opioids, dexmedetomidine).
An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed? A. Face tent B. Venturi mask C. Aerosol mask D. Tracheostomy collar
Correct Answer: B. Venturi mask The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. An air-entrainment (also known as venturi) mask can provide a pre-set oxygen to the patient using jet mixing. As the percent of inspired oxygen increases using such a mask, the air to oxygen ratio decreases, causing the maximum concentration of oxygen provided by an air-entrainment mask to be around 40%. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.
Nurse Joy is caring for a client after a bronchoscopy and biopsy. Which of the following signs, if noticed in the client, should be reported immediately to the physician? A. Dry cough B. Hematuria C. Bronchospasm D. Blood-streaked sputum
Correct Answer: C. Bronchospasm If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Cardiac arrhythmias may also occur especially in patients with pre-existing cardiac disease.
Before administering ephedrine, Nurse Tony assesses the patient's history. Because of ephedrine's central nervous system (CNS) effects, it is not recommended for: A. Patients with an acute asthma attack. B. Patients with narcolepsy. C. Patients under age D. Elderly patients.
Correct Answer: D. Elderly patients Ephedrine is not recommended for elderly patients, who are particularly susceptible to CNS reactions (such as confusion and anxiety) and to cardiovascular reactions (such as increased systolic blood pressure, coldness in the extremities, and anginal pain). Ephedrine is also arrhythmogenic, and caution should be used during administration to patients who are predisposed to arrhythmias or taking other arrhythmogenic medications, particularly digitalis.
Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: A. Maintain a fluid intake of 800 ml every 24 hours. B. Experience chills only once a day. C. Cough productively without chest discomfort. D. Experience less nasal obstruction and discharge.
Correct Answer: D. Experience less nasal obstruction and discharge. A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Decongestants and combination antihistamine/decongestant medications can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in children. H1-receptor antagonists may offer a modest reduction of rhinorrhea and sneezing during the first 2 days of a cold in adults. Option A: Daily fluid intake should be increased to more than 1 L every 24 hours to liquefy secretions. Topical and oral nasal decongestants (i.e., topical oxymetazoline, oral pseudoephedrine) have moderate benefit in adults and adolescents in reducing nasal airway resistance. Evidence-based data does not support the use of antibiotics in the treatment of the common cold because they do not improve symptoms or shorten the course of illness. Option B: The temperature should be below 100*F (37.8*C) with no chills or diaphoresis. According to a Cochrane Review, vitamin C used as daily prophylaxis at doses of =0.2 grams or more had a "modest but consistent effect" on the duration and severity of common cold symptoms (8% and 13% decreases in duration for adults and children, respectively). Option C: A productive cough with chest pain indicated pulmonary infection, not an URI. The presence of classical features for rhinovirus infection, coupled with the absence of signs of bacterial infection or serious respiratory illness, is sufficient to make the diagnosis of the common cold. The common cold is a clinical diagnosis, and diagnostic testing is not necessary.
Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug? A. Constipation B. Bradycardia C. Diplopia D. Restlessness
Correct Answer: D. Restlessness Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic effects on the CNS. The most common CNS effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular side effects include tachycardia, hypertension, palpitations, and arrhythmias.
The nurse is reviewing the lab results for an older adult pneumonia pt. The lab value frequently seen in pneumonia pts that may not be seen in this pt is A. RBC 4.0 - 5.0 B. Hgb 12 - 16 C. Hct 36 - 48 D. WBC 12 - 18
D WBC
The nurse is reviewing a pneumonia pts lab results. What does she expect to see A. decreased Hgb B. increased RBCs C. decreased neutrophils D. increased WBCs
Dincr WBCs
toddler vital signs
Temp - 96.0 - 99 Pulse 70 - 150 RR 20 -40 BP 88/42
Newborn vital signs
Temp - 97.2 - 99.9 Pulse 95-170 RR - 30-60 BP - 60-70/40
Child vital signs
Temp 96 - 99 Pulse 65 -130 RR 15-25 BP 95/57
Infant vital signs
Temp 96.0 - 99.7 Pulse 85-170 RR 30-50 BP 85/37
A patient is being discharged home on Doxycyline for treatment of pneumonia. Which statement by the patient indicates they understood your education material? A. "I will wear sunscreen when outdoors." B. "I will avoid green leafy vegetables while taking this medication." C. "I will monitor my blood glucose regularly due to the side effects of hypoglycemia." D. "I will take this medication with a full glass of milk."
The answer is A. Doxycycline increases the skin's sensitivity to the sun, so the patient should wear sunscreen when outdoors. Also, the patient should not take this medication with antacids or milk products because this affects the absorption of the medication. Options B and C are incorrect statements.
A 25 year-old female patient with pneumonia is prescribed Doxycycline. What question is important to ask the patient prior to administration of this medication? A. "Do you take birth control pills?" B. "Are you allergic to Penicillin?" C. "Are you allergic to eggs?" D. "Do you have a history of diabetes?"
The answer is A. Doxycycline is part of the Tetracycline antibiotic family. This medication can decrease the effectiveness of birth control pills. Since the patient is female and within child-bearing age, the question should be asked if she is taking birth control pills so you can educate her on using another form of birth control to prevent pregnancy.
A patient is admitted with pneumonia. Sputum cultures show that the patient is infected with a gram positive bacterium. The patient is allergic to Penicillin. Which medication would the patient most likely be prescribed? A. Macrolide B. Cephalosporins C. Pencillin G D. Tamiflu
The answer is A. Marcolides are used to treat gram-positive bacterial infections and are used in patients with penicillin allergies. Penicillin G is a penicillin antibiotic and would not be used because of the patient's allergy. In addition, usually if a patient is allergic to penicillin there is an increased chance they are allergic to cephalosporin....therefore it would not be used as well.
You're caring for a patient with pneumonia. The patient has just started treatment for pneumonia and is still experiencing hypoxemia. You know that respiratory acidosis is very common with patients with pneumonia. Which arterial blood gas readings below represent respiratory acidosis that is NOT compensated? A. pH 7.29, PaCO2 55, HCO3 23, PO2 85 B. pH 7.48, PaCO2 35, HCO3 22, PO2 85 C. pH 7.20, PaCO2 20, HCO3 28, PO2 85 D. pH 7.55, PaCO 63, HCO3 19, PO2 85
The answer is A. This is the only ABG result that represents respiratory acidosis. If you are unfamiliar with how to interpret ABGs, please read and review this article that explains how to do this: https://www.registerednursern.com/respiratory-acidosis-nclex-review-notes-with-mnemonic-quiz-acid-base-imbalance-notes/
You're providing discharge teaching to a patient who was admitted for pneumonia. You are discussing measures the patient can take to prevent pneumonia. Which of the following statements by the patient indicates they did NOT understand your education material? A. "I'll use hand sanitizer regularly while I'm out in public." B. "It is important I don't receive the Pneumovax vaccine since I'm already immune to pneumonia." C. "I will try to avoid large crowds of people during the peak of flu season." D. "It is important I try to quit smoking."
The answer is B. All the other options are correct statements regarding the prevention of pneumonia. However, option B is incorrect because although the patient has had pneumonia they should still receive the Pneumovax vaccine to prevent other forms of pneumonia.
A patient is admitted with rupture of the Achilles tendon. The patient was recently treated with antibiotics for pneumonia. Which of the following medications below can cause this adverse effect? A. Penicillin B. Fluroquinolones C. Tetracyclines D. Macrolides
The answer is B. Fluroquinolones can cause tendon rupture along with c.diff infection and cardiac arrhythmia such as prolonged QT interval.
A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is known as what type of pneumonia? A. Aspiration pneumonia B. Ventilator acquired pneumonia C. Hospital-acquired pneumonia D. Community-acquired pneumonia
The answer is C. The key words to let you know this is hospital-acquired pneumonia and NOT community-acquired is that the patient was admitted with a gunshot wound AND has been hospitalized for 48 hours. If the patient presents with signs and symptoms of pneumonia 48-72 hours after admission it is classified as hospital-acquired. This is not ventilator acquired because the patient is not on mechanical ventilation and there is nothing in the scenario that leads us to think it is aspiration pneumonia.
You're educating a patient with pneumonia on how to deep breathe by using an incentive spirometer. Which of the following is the correct way to use this device? A. Encourage the patient to use it twice a day. B. The patient exhales into the device rapidly and then coughs. C. The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and exhales. D. The patient rapidly inhales 10 times from the device and then exhales for 6 seconds.
The answer is C. The patient will inhale slowly from the device until no longer able, and then hold breath for 6 seconds and exhale. The patient should use the device at least 10 times every 1-2 hours while awake. The other options are incorrect ways to use the device. For a video demonstration on how to use an incentive spirometer, watch this video: https://www.youtube.com/watch?v=pZxq6oroGhk
You are about to hang a bag of intravenous Vancomycin for a patient who has severe pneumonia. Which statement by the patient causes you to hold the bag of Vancomycin and notify the doctor immediately? A. "I'm seeing yellow halos around the light." B. "My mouth tastes like metal." C. "My head hurts." D. "I have this constant ringing in my ears."
The answer is D. Vancomycin can cause ototoxicity. Roaring or ringing in the ears are a possible sign/symptom of this adverse effect. Option A happens with Digoxin toxicity. Options B and C are vague and are not a common adverse reaction to Vancomycin.
Select all the medications used to treat pneumonia that are narrow-spectrum? A. Macrolides B. Tamiflu C. Fluroquinolones D. Penicillins
The answers are A and D. These are the only options that are considered narrow spectrum antibiotics which means they target specific family of bacteria.
Which of the following patients are MOST at risk for developing pneumonia? Select-all-that-apply: A. A 53 year old female recovering from abdominal surgery. B. A 69 year old patient who recently received the pneumococcal conjugate vaccine. C. A 42 year old male with COPD and is on continuous oxygen via nasal cannula. D. A 8 month old with RSV (respiratory syncytial virus) infection.
The answers are A, C, and D. Risks factors for pneumonia include: recent surgery, lung disorder (ex: COPD), and viral infection (ex: RSV). Option B is a preventive measure in preventing pneumonia.
Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply: A. Stridor B. Coarse crackles C. Oxygen saturation less than 90% D. Non-productive, nagging cough E. Elevated white blood cells F. Low PCO2 of less than 35 G. Tachypnea
The answers are B, C, E, and G. These are typical signs and symptoms of pneumonia. Stridor is not very common. A PRODUCTIVE cough that can be nagging is very typical, and there is usually a HIGH PCO2 of 45 or greater due to the lungs retaining carbon dioxide.
7. A 72 year-old male patient who is diagnosed with bilateral lower lobe pneumonia is admitted to your unit. The patient has a history of systolic heart failure and arthritis. On assessment, you note the patient has a respiratory rate of 21, oxygen saturation 93% on 2L nasal cannula, is alert & oriented, and has a productive cough with green/yellowish sputum. Which of the following nursing interventions will you provide to this patient based on your assessment findings and the patient's diagnosis? Select-all-that-apply: A. Keep head-of-the-bed less than 30 degrees at all times. B. Collect sputum cultures. C. Encourage 3L of fluids a day to keep secretions thin. D. Encourage incentive spirometer usage E. Provide education about receiving the Pneumovax vaccine every 5 years.
The answers are B, D, and E. You would not keep the head-of-bed less than 30 degrees because this impedes breathing and increases the risk of aspiration. Also, since the patient has systolic heart failure you would NOT encourage 3L of fluids per day because the patient would not tolerate the extra fluid. However, in normal situations (if a patient does not have heart failure etc.) you would want to encourage fluids to keep secretions thin.
A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention? A. Airway maintenance and 100% oxygen by mask. B. 50% oxygen and pulse oximetry monitoring. C. Airway maintenance and continued reassessment. D. Soothe the baby to promote oxygen conservation.
The correct response is A. Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation.
A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. Which nursing intervention takes the highest priority? A. Attempt to calm the infant by placing him in his mother's lap and offering him a bottle. B. Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest radiograph. C. Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure. D. Bring the emergency equipment to the room and begin bag-valve-mask ventilation.
The correct response is C. Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation. Children who experience respiratory distress often deteriorate quickly, and the nurse must be prepared in the event of respiratory failure or arrest.
