practice questions wk10 ch31 pn and tb
Which conditions may cause patients to be at risk for aspiration pneumonia? Select all that apply. a. Continuous tube feedings b. Bronchoscopy procedure c. Magnetic resonance imaging (MRI) procedure d. Decreased level of consciousness e. Stroke f. Chest tube
A, b, d, e
Which are examples of a pandemic influenza? Select all that apply a. H1N1 "swine flu" b. Seasonal flu c. Spanish influenza d. H5N1 "bird flu" e. Viral influenza f. H7N9 "avian flu"
A, c, d, f
A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective? a. "I need to take extra vitamin C while on INH." b. "I should take this medicine with milk or juice." c. "I will take this medication on an empty stomach." d. "My contact lenses will be permanently stained."
ANS: C INH needs to be taken on an empty stomach, either 1 hour before or 2 hours after meals. Extra vitamin B needs to be taken while on the drug. Staining of contact lenses commonly occurs while taking rifampin (Rifadin).
A client is admitted with suspected pneumonia from the emergency department. The client went to the primary care provider a "few days ago" and shows the nurse the results of what the client calls "an allergy test," as shown below: What action by the nurse takes priority? a. Assess the client for possible items to which he or she is allergic. b. Call the primary care provider's office to request records. c. Immediately place the client on Airborne Precautions. d. Prepare to begin administration of intravenous antibiotics.
ANS: C This "allergy test" is actually a positive tuberculosis test. The client should be placed on Airborne Precautions immediately. The other options do not take priority over preventing the spread of the disease.TB
A client is being discharged on long-term therapy for tuberculosis (TB). What referral by the nurse is most appropriate? a. Community social worker for Meals on Wheels b. Occupational therapy for job retraining c. Physical therapy for homebound therapy services d. Visiting Nurses for directly observed therapy
ANS: D Directly observed therapy is often utilized for managing clients with TB in the community. Meals on Wheels, job retraining, and home therapy may or may not be appropriate.
A patient diagnosed with tuberculosis (TB) has been receiving treatment for 3 months and has clinically shown improvement. The family asks the nurse if the patient is still infectious. What is the nurse's best reply? a. "The patient is still infectious until the entire treatment is completed." b. "The patient is likely not infectious but needs to continue treatment for at least 6 months." c. "The patient is infectious until there is a negative chest x-ray." d. "The patient may or may not be infectious; a purified protein derivative test (PPD) must be done."
B
The nurse has identified the problem of ineffective airway clearance with bronchospasms for a patient with pneumonia. The patient has no previous history of chronic respiratory disorders. The nurse obtains an order for which nursing intervention? a. Increased liters of humidified oxygen via face mask b. Scheduled and prn aerosol nebulizer brochodilator treatments c. Handheld bronchodilator inhaler as needed d. Corticosteroid via inhaler or IV to reduce the inflammation
B
Which condition causes a patient to have the greatest risk for ventilator-associated pneumonia? a. History of alcohol use b. Presence of feeding tube c. Weight loss d. IV therapy with normal saline
B
Which patien is at highest risk for developing health care acquired pneumonia? a. Any hospitalized patient between the ages 18-65 b. 32-year-old trauma patient on a mechanical ventilator c. Disabled 54-year-old with osteoporosis, discharged to home d. Any patient who has not received the vaccine for pneumonia
B
Which test is the most accurate and rapid test for tuberculosis (TB)? a. Chest x-ray b.Nucleic acid amplification test (NAAT) c. Tuberculin test (Mantoux test) d. Sputum cultures
B
A patient diagnosed with tuberculosis agrees to take the medication as instructed and to complete therapy. When does the nurse tell the patient is the best time to take the medication? a. Before breakfast b. After breakfast c. Midday d. Bedtime
D
The nurse is reviewing lab results for a patient who has pneumonia. Which lab value does the nurse expect to see for this patient? a. Decreased hemoglobin b. Increased RBCs c. Decreased neutrophils d. Increased WBCs
d
A critical concern for a patient returning to the unit after a surgical procedure is related to impaired oxygenation caused by inadequate ventilation. Which arterial blood gas value and assessment finding indicates to the nurse that oxygen and incentive spirometry must be administered? a. PaO2 is 89 mm Hg with crackles b. PaO2 is 90 mm Hg with wheezing c. PcO2 is 38 mm Hg with clear lung sounds d. PcO2 is 45 mm Hg with atelectasis
A
A patient being treated for pneumonia reports pain that increases on inspiration. The nurse suspects which complication has occurred? a. Pleuritic chest pain b. Pulmonary emboli c. Pleural effusion d. Meningitis
A
A patient is admitted to the hospital with pneumonia. What does the nurse expect the chest x-ray to reveal? a. Patchy areas of increased density b. Tension pneumothroax c. Thick secretions causing airway obstructions d. Large hyperinflated airways
A
A patient is diagnosed with pneumonia. During auscultation of the lower lung fields, the nurse hears course crackles and identifies the patient problem of impaired oxygenation. What is the underlying physiologic condition associated with the patient's condition? a. Hypoxemia b. Hyperemia c. Hyocapnia d. Hypercapnia
A
An active 55-year old schoolteacher with COPD taking prednisone asks if it is necessary to get a flu shot. What is the best response by the nurse? a. "Yes, flu shots are highly recommended for patients with chronic illness and/or patient who are receiving immunotherapy" b. "No, flu shots are only recommended for patients 60 years old and older" c. "Yes, it will help minimize the risk of triggering an exacerbation of COPD" d. "No, patient who are active, not living in a nursing home, and not health care providers do not need a flu shot"
A
The nurse is conducting an in-service for the hospital staff about practices that help prevent pneumonia among at-risk patients. Which nursing intervention is encouraged as standard practice? a. Administering vaccines to patients at risk b. Implementing isolation for debilitated patients c. Restricting foods form home in immunosuppressed patients d. Decontaminating respiratory therapy equipment weekly
A
The nurse is providing discharge instructions about pneumonia to a patient and family. Which discharge information must the nurse be sure to include? a. Complete antibiotics as prescribed, rest, drink fluids, and minimize contact with crowds. b. Take all antibiotics as ordered, resume diet and all activities as before hospitalization. c. No restrictions regarding activities, diet, and rest because the patient is fully recov- ered when discharged. signs of pneumonia are present; avoid d. Continue antibiotics only until no further exposing immunosuppressed individuals.
A
Which intervention does the (100.3°F), and reports of short- sputum production, tempera- A patient is admitted to the hospital with nurse provide first? a. Set up oxygen equipment and administer oxygen. b. Instruct the patient about the importance of keeping the oxygen delivery device on. c. Monitor the effectiveness of oxygen ther- d. Monitor the patient's anxiety related to the apy (pulse oximetry, ABGS) as appropriate. need for oxygen delivery.
A
The female patient is receiving isoniazid (INH) to treat tuberculosis (TB). Which points are essential for the nurse to review teaching with the patient? Select all that with this medication. a. Do apply. not take medications such as Maalox b. Avoid drinking alcoholic beverages. c. The urine will be orange in color d. Take a multivitamin with B complex. e. If going out in the sun, be sure to wear protective clothing and sunscreen. f. This drug reduces the effectiveness of oral contraceptives.
A, b, d
An older adult patient often coughs tion. The patient insists that chokes while eating or trying to take an a risk for aspiration. Which nursing nurse identifies the priority patient e medica- he is okay, but the problem of interven- aspiration pneum tions are used to prevent nia? Select all that apply. a.Head of bed should always be elevated during feeding. b. Monitor the patient's ability to swallo small bites. C. Give thin liquids to drink in small, frequent amounts. d. Consult a nutritionist and obtain swallowing studies. e. Monitor the patient's ability to swallow saliva. f. Place the patient on NPO (nothing by mouth) status until swallowing is normal
A, b, d, e
A patient with rapid onset of severe headache, muscle aches, fever, chills, fatigue, and weakness comes to the emergent care unit. On further assessment, he tells the nurse that additional symptoms include sore throat and sneezing cough. What instructions should be given to the patient for his cough? Select all that apply a. Be sure to wash your hands carefully whenever you cough or sneeze b. Don't try to stop your sneezing because it will get worse c. Cover your mouth with a tissue whenever you cough or sneeze d. Be sure to perform oral hygiene at least four times every day e. If you don't have a tissue, cough into your upper sleeve, not your hand f. Be sure to dispose of used tissues immediately
A, c, e, f
After several weeks of "not feeling well," a patient is seen in the health care provider's office for possible tuberculosis (TB). If TB present, which assessment findings does the is nurse expect to observe? Select all that apply. a. Fatigue b. Weight gain c. Night sweats d. Chest soreness e. Low-grade fever f. Shortness of breath
A, c, e, f
Which patients are at risk for developing health care-acquired pneumonia? Select all that apply a. Confused patient b. Patient with atrial fibrillation who is alert and oriented c. Patient with Gram-negative who is alert and oriented d. Patient with hyperthyroid disease e. Malnourished patient f. Patient with influenza
A, c, e, f
Which people are at greatest risk for develop- ing tuberculosis (TB) in the United States? Select all that apply. a. An alcoholic homeless man who occasionally stays in a shelter b. A college student sharing a room in a dormitory с. A person with immune dysfunction or HIV d. A homemaker who does volunteer work at a homeless shelter e. Immigrants (especially those from the Philippines and Mexico) f. An adult living in a crowded area such as a long-term-care facility
A, c, e, f
A patient is seen in the HCPs office and is diagnosed with community acquired pneumonia. What are the most common symptoms associated with CAP? Select all that apply a. Dyspnea b. Abdomincal pain c. Back pain d. Chest discomfort e. Increased sputum production f. Fever
A, d, e, f
Which diagnostic tests are most likely to be done for an older patient suspected of having pneumonia? Select all that apply a. Sputum Gram stain b. Pulmonary function test c. Fluorescein bronchoscopy d. Peak flowmeter measurement e. Chest x-ray f. Complete blood count
A, e, f
A nurse admits a client from the emergency department. Client data are listed below: History Physical Assessment Laboratory Values 70 years of age History of diabetes On insulin twice a day Reports new-onset dyspnea and productive cough Crackles and rhonchi heard throughout the lungs Dullness to percussion LLL Afebrile Oriented to person only WBC: 5,200/mm3 PaO2 on room air 65 mm Hg What action by the nurse is the priority? a. Administer oxygen at 4 liters per nasal cannula. b. Begin broad-spectrum antibiotics. c. Collect a sputum sample for culture. d. Start an IV of normal saline at 50 mL/hr.
ANS: A All actions are appropriate for this client who has manifestations of pneumonia. However, airway and breathing come first, so begin oxygen administration and titrate it to maintain saturations greater than 95%. Start the IV and collect a sputum culture, and then begin antibiotics.
The emergency department (ED) manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia. What outcome demonstrates that goals for this client type have been met? a. Antibiotics started before admission b. Blood cultures obtained within 20 minutes c. Chest x-ray obtained within 30 minutes d. Pulse oximetry obtained on all clients
ANS: A Goals for treatment of community-acquired pneumonia include initiating antibiotics prior to inpatient admission or within 6 hours of presentation to the ED. Timely collection of blood cultures, chest x-ray, and pulse oximetry are important as well but do not coincide with established goals.
A client has been hospitalized with tuberculosis (TB). The client's spouse is fearful of entering the room where the client is in isolation and refuses to visit. What action by the nurse is best? a. Ask the spouse to explain the fear of visiting in further detail. b. Inform the spouse the precautions are meant to keep other clients safe. c. Show the spouse how to follow the isolation precautions to avoid illness. d. Tell the spouse that he or she has already been exposed, so it's safe to visit.
ANS: A The nurse needs to obtain further information about the spouse's specific fears so they can be addressed. This will decrease stress and permit visitation, which will be beneficial for both client and spouse. Precautions for TB prevent transmission to all who come into contact with the client. Explaining isolation precautions and what to do when entering the room will be helpful, but this is too narrow in scope to be the best answer. Telling the spouse it's safe to visit is demeaning of the spouse's feelings.
A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority? a. Educating the client on adherence to the treatment regimen b. Encouraging the client to eat a well-balanced diet c. Informing the client about follow-up sputum cultures d. Teaching the client ways to balance rest with activity
ANS: A The treatment regimen for TB ranges from 6 to 12 months, making adherence problematic for many people. The nurse should stress the absolute importance of following the treatment plan for the entire duration of prescribed therapy. The other options are appropriate topics to educate this client on but do not take priority.
A nurse is providing pneumonia vaccinations in a community setting. Due to limited finances, the event organizers must limit giving the vaccination to priority groups. What clients would be considered a priority when administering the pneumonia vaccination? (Select all that apply.) a. 22-year-old client with asthma b. Client who had a cholecystectomy last year c. Client with well-controlled diabetes d. Healthy 72-year-old client e. Client who is taking medication for hypertension
ANS: A, C, D, E Clients over 65 years of age and any client (no matter what age) with a chronic health condition would be considered a priority for a pneumonia vaccination. Having a cholecystectomy a year ago does not qualify as a chronic health condition.
A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately? a. Albumin: 5.1 g/dL b. Alanine aminotransferase (ALT): 180 U/L c. Red blood cell (RBC) count: 5.2/mm3 d. White blood cell (WBC) count: 12,500/mm3 .
ANS: B INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of the liver enzymes) is extremely high and needs to be reported immediately. The albumin and RBCs are normal. The WBCs are slightly high, but that would be an expected finding in a client with an infection
A client in the emergency department is taking rifampin (Rifadin) for tuberculosis. The client reports yellowing of the sclera and skin and bleeding after minor trauma. What laboratory results correlate to this condition? (Select all that apply.) a. Blood urea nitrogen (BUN): 19 mg/dL b. International normalized ratio (INR): 6.3 c. Prothrombin time: 35 seconds d. Serum sodium: 130 mEq/L e. White blood cell (WBC) count: 72,000/mm3
ANS: B, C Rifampin can cause liver damage, evidenced by the client's high INR and prothrombin time. The BUN and WBC count are normal. The sodium level is low, but that is not related to this client's problem.
A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia. To reduce this risk, what activity should the nurse delegate to the unlicensed assistive personnel (UAP)? a. Encourage between-meal snacks. b. Monitor temperature every 4 hours. c. Provide oral care every 4 hours. d. Report any new onset of cough.
ANS: C Oral colonization by gram-negative bacteria is a risk factor for healthcare-associated pneumonia. Good, frequent oral care can help prevent this from developing and is a task that can be delegated to the UAP. Encouraging good nutrition is important, but this will not prevent pneumonia. Monitoring temperature and reporting new cough in clients is important to detect the onset of possible pneumonia but do not prevent it.
A patient is admitted to the hospital with a diagnosis of tuberculosis (TB). While providing medication teaching, the patient asks the nurse why she must give the drugs by directly observed therapy (DOT). What is the nurse's best response? a. "DOT can be done by having any person other than the patient observe that the drugs are swallowed." b. "DOT is to assure that the drug regimen is followed and drug-resistant TB organisms do not occur." c. "DOT was developed because too many patients do not take their drug as prescribed." d. "DOT is used only with homeless people who cannot be trusted to take the drugs as prescribed."
B
A patient treated for pneumonia is being prepared for discharge by the nurse. The patient is capable of performing self-care and is anxious to return to his job at the construction site. Which discharge instructions does the nurse give to this patient? a. "You are not contagious to others, so you can return to work as soon as you like." b. "You will continue to feel tired and will fatigue easily for the next several weeks." c. "Try to drink 4 quarts of water per day, especially if you are very physically active." d. "You should be able to return to work full-time in 2 weeks when your energy returns."
B
A patient with suspected tuberculosis (TB) is admitted to the hospital. Along with a private room, which nursing intervention is appropri- ate related to isolation procedures? a. Airborne and contact isolation for sputum only b. Strict airborne precautions and use of specially fitted respirator face masks c. Airborne isolation with surgical masks until diagnosis is confirmed d. Only standard precautions are necessary until the diagnosis is confirmed
B
The nurse is giving discharge instructions to a patient diagnosed with a viral influenza. Which statement by the patient indicates the need for further teaching? a. I should try to rest, increase my fluid intake, and get a humidifier for the house b. I will wait for my test results; then I can get a prescription for antibiotics c. Over-the-counter analgesics, like Tylenol or ibuprofen, can be used for pain d. I should gargle several times a day with warm salt water and use throat lozenges
B
The nurse is making home visits to an older adult recovering from a hip fracture and iden- tifies the problem of risk for respiratory infec- tion. Which condition represents a factor of normal aging that would contribute to this increased risk? a. Inability to force a cough b. Decreased strength of respiratory muscles c. Increased elastic recoil of alveoli d. Increased macrophages in alveoli
B
Which condition increases the risk for a patient to develop community-acquired pneumonia? a. Patient has received the pneumococcal vaccination b. Patient uses tobacco and alcohol often and regularly c. Patient lived alone and eats alone d. Patient received influenza shot in November rather than September
B
Which statement best describes pneumonia? a. An infection of just the "windpipe" because the lungs are "clear" of any problems b. A serious inflammation of the bronchioles, alveoli, and interstitial spaces from various causes c. Only an infection of the lungs with mild to severe effects on breathing d. An inflammation resulting from lung damage caused by long-term smoking
B
A patient with COPD needs instruction in measures to prevent pneumonia. What information does the nurse include? Select all that apply a. Avoid going outside b. Clean all respiratory equipment you have at home c. Avoid indoor pollutants such as dust and aerosols d. Get plenty of rest and sleep daily e. Limit alcoholic beverages to 4-5 times per week f. Be sure to get eh pneumonia vaccinations
B, c, d, f
Which statements caring for a hospitalized about the precautions of patient with tubercu- losis (TB) are true? Select all that apply. a. Health care workers must wear a mask that covers the face and mouth. b. Negative airflow rooms are required for these patients. c. Health care workers must wear an N95 or high-efficiency particulate air (HEPA) mask. d. Gown and gloves are included in appro- priate barrier protection. e. Strict contact precautions must be main- tained. f. Careful handwashing is required before and after providing patient care.
B, c, d, f
A patient has active tuberculosis (TB). Which drugs will the health care provider order during the initial phase of treatment? Select all that apply. a. Bedaquiline fumarate b. Isoniazid c. Rifampin d. Bacille Calmette-Guérin е. Ethambutol f. Pyrazinamide
B, c, e, f
Patients who are at high risk for tuberculosis (TB) would be asked which questions upon assessment? Select all that apply. a. "What does your diet normally consist of?" b. "Do you have an immune dysfunction or HIV?" c. "Do you use alcohol or inject recreational drugs?" d. "Where do you live in the United States?" e. "Do you work in a crowded area such as a prison or mental health facility?" f. "Have you ever had a bacille Calmette- Guérin (BCG) vaccine?"
B, c, e, f
A 30-year-old is admitted with severe coughing "fits" lasting several minutes. He tells you that he developed cold symptoms a little over a week ago. Which priority question would the nurse ask him? a. "Has your health care provider prescribed antibiotics for your symptoms?" b. "On average, how often do you experience cold symptoms each winter?" c. "Did you receive the usual childhood immunization when you were a child?" d. "Do you smoke or did you ever smoke or use any tobacco products?"
C
A 35-year old male patient with no health problems states that he had a flu shot last year and asks if it is necessary to have it again this year. What is the best response by the nurse? a. "No because once you get a flu shot, it lasts for several years and is effective against many different viruses" b. "Yes, because the immunity against the virus wears off, increasing your chances of getting the flu" c. "Yes, because the vaccine guards against a specific virus and reduces your chances of acquiring flu and is only effective for one year" d. "No, flu shots are only for high-risk patients and you are not considered to be high risk"
C
A patient has a positive skin test result for tuberculosis (TB). What explanation does the nurse give to the patient? a. "There is active disease, but you are not yet infectious to others." b. "There is active disease, and you need immediate treatment." с. "You have been infected, but this does not mean active disease is present." d. "A repeat skin test is necessary because the test could give a false-positive result."
C
A patient hospitalized for pneumonia has ineffective airway clearance related to fatigue, chest pain, excessive secretions, and muscle weakness. What nursing intervention helps to correct this problem? 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-Fowler's position to facilitate breathing and prevent further fatigue
C
A patient is admitted to the hospital for treatment of pneumonia Which nursing assessment finding best indicates that the patient is responding to antibiotics? a. Wheezing, oxygen at 2 L/min, respiratory rate 26, no shortness of breath or chills b. Temperature 99F, lung sounds clear, pulse oximetry at 96% on room air d. Feeling tired, respiratory rate 28 on 2 L/min of oxygen, audible breath sounds
C
A patient who presents with symptoms of influenza that started 24 hours ago is seen by the health care provider. Which intervention does the nurse expect for this patient? a. Prescription for antibiotics b. Admission to an acute care facility c. An order for an antiviral agent such as oseltamivir d. Instructions to rest and decrease fluid intake
C
After being discharged from the hospital, a patient is diagnosed with tuberculosis (TB) at the outpatient clinic. What is the correct procedure regarding public health policy in this case? a. Contact the infection control nurse at the hospital because the hospital is responsible for follow-up of this case b. There are no regulations because the patient was diagnosed at the clinic and not during hospitalization. c. Contact the public health nurse so that all individuals who have come in contact with the patient can be screened. d. Have the patient sign a waiver regarding the hospital and clinic's liability for treatment.
C
An older adult patient asks the nurse how often one should receive the pneumococcal vaccine for pneumonia prevention. What is the nurse's best response? a. Every year, when the patient is receiving the "flu shot." b. The standard is vaccination every 3 years. c. It is usually given once 6-12 months after the Prevnar 13 vaccine. d. There is no set schedule; it depends on the patient's history and risk factors.
C
In a long-term care facility caring for older adults and those who are immunocompromised, one employee and several patients have been diagnosed with influenza. What does the supervising nurse do to decrease risk of infection to other patients? a. Ask employees who have the flu to stay home for at least 24 hours b. Place any patient with a sore throat, cough, or rhinorrhea, into isolation for 1-2 weeks c. Ask employees with flu symptoms to stay home for up to 5 days after onset of symptoms d. Recommend that all patients and employees be immediately vaccinated for flu
C
What nursing intervention may help to prevent the complication of pneumonia for a surgical patient? a. Monitoring cest x-rays and WBC counts for early signs of infection b. Monitoring lung sounds every shift and encouraging fluids c. Teaching coughing, deep-breathing exercises, and use of incentive spirometry d. Encouraging hand hygiene among all caregivers, patients, and visitors
C
Which patient is the least likely to be at risk for developing pneumonia? a. Patient with a 5-year history of smoking b. Renal transplant patient c. Postoperative patient with a bedside commode d. Postoperative patient with a hip replacement
C
A patient has been compliant with drug therapy for tuberculosis (TB) and has returned as instructed for follow-up. Which result indicates that the patient is no longer infectious/ communicable? a. Negative chest x-ray b. No clinical symptoms с. Negative skin test d. Three negative sputum cultures
D
After receiving the subcutaneous Mantoux skin test, a patient with no risk factors returns to the clinic in the required 48-72 hours for the test results. Which assessment finding indicates a positive result? a. Test area is red, warm, and tender to touch. b. There is induration or a hard nodule of any size at the site, c. Induration/hardened area measures 5 mm or greater. d. Induration/hardened area measures 10 mm or greater.
D
The nurse is reviewing the lab results for an older adult patient with pneumonia. Which lab value frequently seen in patients with pneumonia may not be seen in this patient? a. RBC 4-5 b. Hgb 12-16 c. Hct 36%-48% d. WBC 12,000-18,000 cells/uL
D
