1601 Infectious Respiratory Problems and Disorders adaptive quizzing

Which actions known as the "ventilator bundle" have been shown to reduce the incidence of ventilator-associated pneumonia (VAP)? Select all that apply. 1 Hand hygiene 2 Careful monitoring of oxygen levels 3 Equipment decontamination 4 Oral care 5 Head-of-bed elevation

1. Hand hygiene 4. Oral care 5. Head-of-bed elevation Hand hygiene, oral care, and head-of-bed elevation are the three interventions known as a "ventilator bundle" aimed at reducing VAP. Diligent oral care using agents to reduce organisms and provide moisture is especially important for nurses to perform to accomplish this goal. Monitoring for hypoxia and diligent equipment decontamination are indeed important in the care of the patient with pneumonia, but not "packaged" as part of the "ventilator bundle."

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? 1 "I am here to receive the yearly pneumonia shot again." 2 "I am here to get my yearly flu shot again." 3 "I should avoid large gatherings during cold and flu season." 4 "I should cough into my upper sleeve instead of my hand."

1. "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 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? 1 "Take the drug on an empty stomach." 2 "Take the drug with food for better absorption." 3 "Take an antacid with the drug for better absorption." 4 "Take the drug with a full glass of water and increase your water intake." 2 "Take the drug with food for better absorption." 3 "Take an antacid with the drug for better absorption." 4 "Take the drug with a full glass of water and increase your water intake."

1. "Take the drug on an empty stomach." Isoniazid is a first-line treatment for tuberculosis (TB). The nurse should teach the patient to take the drug on an empty stomach (1 hour before or 2 hours after meals) and to avoid taking antacids because food and antacids slow or prevent the absorption of the drug from the GI tract. While taking the drug with a full glass of water is not incorrect, this is not a necessary instruction for this drug and will not be included in the discharge instructions.

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? 1 "The injectable flu vaccine is not a live virus and cannot cause influenza." 2 "The virus in the injection is attenuated, meaning it can cause mild symptoms." 3 "If you had a 'flu shot' last year, you should still have immunity to influenza." 4 "If the shot makes you sick, your provider can order an antiviral medication."

1. "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? 1 "Three antibiotics help prevent bacterial drug resistance." 2 "The dose of each drug can be reduced with multidrug therapy." 3 "Taking three drugs has a synergistic effect in eradicating the organism." 4 "You will have fewer drug side effects with multidrug therapy."

1. "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? 1 "Yes, you should receive the influenza vaccination by injection and should receive it every year." 2 "Yes, as long as you are healthy you can receive the intranasal spray influenza vaccine every year." 3 "No, as long as the patient has received the influenza vaccination by injection, you do not need it every year." 4 "No, as long as you are healthy you do not have an increased risk of spreading or becoming infected with influenza."

1. "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 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? 1 Ethambutol 2 Isoniazid 3 Pyrazinamide 4 Rifampin

1. Ethambutol Ethambutol can cause optic neuritis leading to blindness at high doses. When discovered early and when the drug is stopped, problems can usually be reversed. Both isoniazid and pyrazinamide may cause liver failure; side effects of major concern include jaundice, bleeding, and abdominal pain. Rifampin will cause the urine and all other secretions to have a yellowish-orange color; this is harmless. Contact lenses will also be stained, and oral contraceptives will be less effective.

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? 1 "You must swallow your pills in front of me." 2 "It is necessary for you to call me right after you take your medications." 3 "I will check your pill bottles every day to make sure you are taking your medications." 4 "I will meet you at the pharmacy to make sure you are picking up the correct prescriptions."

1. "You must swallow your pills in front of me." Directly observed therapy is used occasionally for patients who are noncompliant or are unable to understand how to regularly take TB medications. The nurse watches the patient as he/she swallows the pills. This technique leads to more treatment successes, fewer relapses, and less drug resistance. Asking the patient to call, checking pill bottles, and meeting the patient at the pharmacy are not examples of directly observed therapy.

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. 1 A 34-year-old with HIV infection 2 A 55-year-old who recently had abdominal surgery 3 A 14-year-old who is recovering from a broken femur 4 A 75-year-old who is recovering from a hip replacement 5 A 7-year-old who is undergoing chemotherapy for leukemia

1. A 34-year-old with HIV infection 4. A 75-year-old who is recovering from a hip replacement 5. A 7-year-old who is undergoing chemotherapy for leukemia Secondary TB is reactivation of the disease in a person previously infected. It is most likely to occur in patients with depressed immune systems such as the individual who has HIV, and the child undergoing chemotherapy. Another group of individuals at risk are older adults, so the 75-year-old recovering from the hip replacement would be at increased risk for developing secondary TB. A 55-year-old patient who recently had abdominal surgery would not be at risk because this patient is neither considered older or immunocompromised. Also a 14-year-old recovering from a broken femur would not be considered high risk because the adolescent is not considered an older adult and is not immunocompromised.

An older patient is diagnosed with pneumonia. To assist with comfort during the admission interview, what does the nurse do? 1 Allow the patient to rest at frequent intervals. 2 Get the interview completed as quickly as possible. 3 Perform the physical assessment quickly and efficiently. 4 Place the patient in the bed immediately after arrival

1. 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.

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? 1 Arrange for a health care worker to watch the patient take the medication. 2 Give the patient written instructions about how to take prescribed medications. 3 Have the patient repeat medication names and side effects. 4 Instruct the patient about the possible consequences of nonadherence

1. 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

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? 1 Assist the patient with all oral intake. 2 Administer prophylactic antibiotic medications. 3 Request an order for bronchodilator medications. 4 Provide postural drainage every 8 hours

1. Assist the patient with all oral intake. Older patients who take H2 blockers (which increase gastric pH) and who are confused are at risk for health-care acquired pneumonia. The nurse should plan to supervise the patient while eating. Prophylactic antibiotics are only used when an actual threat of pneumonia is likely. Bronchodilator medications and postural drainage are treatments for symptoms of pneumonia and are not used prophylactically unless bronchospasm or secretions are present.

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? 1 Check the resident's oxygen saturation. 2 Do a complete neurologic assessment. 3 Give the prescribed PRN lorazepam. 4 Notify the resident's primary care provider.

1. 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.

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? 1 Encourage the patient to drink more fluids. 2 Monitor peak flow levels every 4 hours. 3 Reassure the patient that the infection is improving. 4 Request an order to switch to an oral antibiotic.

1. Encourage the patient to drink more fluids. 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.

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. 1 Increase fluid intake. 2 Increase daily caloric intake. 3 Humidity can worsen symptoms. 4 Use appropriate hand-washing techniques. 5 Avoid the use of diphenhydramine.

1. Increase fluid intake 4. Use appropriate hand-washing techniques. 5. Avoid the use of diphenhydramine It is important to teach patients with influenza rhinitis the importance of increasing fluid intake to at least 2,000 ml/day and appropriate infection prevention techniques such as hand washing. Older patients should avoid diphenhydramine because there is a risk for anticholinergic effects. There is no need to increase caloric intake with influenza. Humidifying the air helps relieve congestion.

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? 1 Isoniazid, rifampin, pyrazinamide (PZA), ethambutol 2 Metronidazole, acyclovir, flunisolide, rifampin 3 Prednisone, guaifenesin, ketorolac, pyrazinamide (PZA) 4 Salmeterol, cromolyn sodium, dexamethasone, isoniazid

1. 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 diseases 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.

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. 1 Left lower lobe 2 Left upper lobe 3 Right lower lobe 4 Right upper lobe 5 Right middle lobe

1. Left lower lobe 3. Right lower lobe 5. 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 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. 1 Medication may cause diarrhea. 2 Take all medication even if symptoms subside. 3 Increase fluids because it may cause constipation. 4 Notify provider if there is no improvement within 24 hours. 5 Notify provider if symptoms are present after completion of antibiotics.

1. Medication may cause diarrhea. 2. Take all medication even if symptoms subside 5. 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.

Which may be the most common feature of pneumonia and lung abscesses? 1 Pleuritic chest pain 2 Rust-colored sputum 3 Foul-smelling sputum 4 Mucopurulent sputum

1. 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? 1 Positive reaction that indicates exposure to and the possible presence of TB infection 2 Positive reaction that indicates the presence of active TB infection 3 Possible false-positive reading; the test will need to be read again at 72 hours 4 Possible false-negative reading; the test will need to be administered again

1. 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? 1 Provide the patient with supplemental oxygen. 2 Encourage the patient to deep breathe and cough. 3 Administer the ordered opioid analgesic medication. 4 Instruct the patient on splinting the chest when breathing.

1. Provide the 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.

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. 1 Ribavirin 2 Zanamivir 3 Oseltamivir 4 Amantadine 5 Rimantadine

1. Ribavirin 2. Zanamivir 3. 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. 1 Tachycardia 2 Sore throat 3 Nasal drainage 4 Diminished chest expansion 5 Crackles upon auscultation

1. Tachycardia 4. Diminished chest expansion 5. 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.

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. 1 "I will refrain from smoking." 2 "I will refrain from drinking nonalcoholic fluids." 3 "I will refrain from exposure to indoor pollutants." 4 "I will refrain from going to public areas during flu season." 5 "I will refrain from obtaining the pneumococcal vaccination."

2. "I will refrain from drinking nonalcoholic fluids." 5. "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.

A 55-year-old patient asks the nurse about getting the live attenuated influenza vaccine instead of the trivalent influenza vaccine. What does the nurse tell this patient? 1 "Either form of the influenza vaccine is acceptable." 2 "The live attenuated influenza vaccine is not recommended for you." 3 "The trivalent influenza vaccine will cause you to have flu symptoms." 4 "The trivalent influenza vaccine is not given to people over age 50."

2. "The live attenuated influenza vaccine is not recommended for you." The live attenuated influenza vaccine (LAIV) is not given to patients age 50 and older, so this patient is only eligible for the trivalent influenza vaccine (TIV). The LAIV can cause flu symptoms in recipients.

A patient who has pneumonia reports having chest pain associated with inspiration. The nurse notifies the provider and anticipates implementing which order? 1 Adding a second antibiotic to the patient's medication regimen 2 Administering analgesic medications to alleviate discomfort 3 Ordering diagnostic cardiac enzyme testing to rule out myocardial infarction 4 Providing supplemental oxygen to reduce the work of breathing

2. 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? 1 An hour before bedtime 2 An hour before breakfast 3 Immediately after breakfast 4 Immediately before breakfast

2. 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

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? 1 Ask the provider for an order for nebulized albuterol. 2 Continue the current plan of care and reassess the patient periodically. 3 Report the patient's worsening condition to the provider. 4 Request an order for a stronger antibiotic to combat bacterial resistance

2. 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 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? 1 Administer levofloxacin 500 mg IV. 2 Draw aerobic and anaerobic blood cultures. 3 Give lorazepam as needed for agitation. 4 Refer to social worker for alcohol counseling.

2. Draw aerobic and anaerobic blood cultures. Obtaining aerobic and anaerobic cultures is the first action the nurse should perform and is standard procedure in a febrile patient for whom antibiotics have been requested. Levofloxacin, an antibiotic, is important to administer, but blood cultures should be drawn before antibiotics are started. Unless this patient is a danger to self or staff, giving lorazepam for agitation is not the first action; the question indicates that the patient is agitated but does not indicate whether other attempts to control agitation have been tried, such as decreasing stimulation. A referral to social work for alcohol counseling will be initiated before the time of discharge; this patient is febrile and agitated, and a referral is not the immediate concern.

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? 1 Administer pain medications on schedule to provide comfort. 2 Encourage an intake of 2 liters of fluid per day. 3 Give intravenous antibiotics as ordered by the provider. 4 Help the patient to ambulate several times daily.

2. 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? 1 Administer low-molecular-weight heparin. 2 Encourage regular use of an incentive spirometer. 3 Give intravenous antibiotics. 4 Provide adequate analgesia.

2. 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 symptom of pneumonia may present differently in the older adult than in the younger adult? 1 Crackles on auscultation 2 Fever 3 Headache 4 Wheezing

2. 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.

What information is important to share with a patient who is being discharged after treatment for pneumonia? Select all that apply. 1 Resume regular activities. 2 Get an annual influenza immunization. 3 Avoid contact with all persons with colds or influenza. 4 Stop or reduce any intake of tobacco and tobacco products. 5 Because you have had pneumonia, you won't need a pneumococcal vaccination.

2. Get an annual influenza immunization. 3. Avoid contact with all persons with colds or influenza. 4. 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.

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? 1 Administer the TIV and remind the patient to receive this annually. 2 Give the TIV and suggest that the patient receive a second PPV23. 3 Notify the provider that this patient does not need the annual TIV. 4 Request an order for the live attenuated influenza virus vaccine.

2. 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.

Incentive spirometry for the treatment of pneumonia has which outcome objective? 1 Improved expiratory air flow and increased respiratory effort 2 Increased inspiratory muscle action and decreased atelectasis 3 Reduced crackles and wheezes and improved oxygenation 4 Reduced sputum production and increased cough

2. 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.

An older patient presents to the emergency department (ED) with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The patient never had a pneumococcal vaccine. The patient's chest x-ray shows density in both bases. The patient has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this patient? 1 It would not be beneficial for this patient. 2 It would help decrease the bronchospasm. 3 It would clear up the density in the bases of the patient's lungs. 4 It would decrease the patient's pain on inspiration.

2. It would help decrease the bronchospasm A bronchodilator would help decrease bronchospasm and would open up the airways, so it would be beneficial for this patient. It would decrease dyspnea and feelings of shortness of breath. A bronchodilator would not be able to clear up the density in the bases of the patient's lung. The cause of the density is unknown; however, an infection such as pneumonia is likely, which bronchodilators do not treat. Although a bronchodilator would help a patient breathe easier, it does not have any analgesic properties.

A patient recovering from pneumonia tells the nurse that his sputum smells bad. The nurse suspects the patient may have developed what condition? 1 Tuberculosis 2 Lung abscess 3 Pulmonary empyema 4 Severe acute respiratory syndrome

2. 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.

In a patient with pneumonia, what is the most important nursing intervention? 1 Decreasing anxiety 2 Managing hypoxemia 3 Teaching safe oxygen management 4 Preventing sepsis

2. Managing hypoxemia Managing hypoxemia is the critical or priority action for nursing care of the patient with pneumonia. Although decreasing anxiety is important, it is not the priority. Preventing sepsis is important but not as urgent as managing hypoxemia. Teaching safe oxygen management would be more important if the patient was being discharged.

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? 1 Attend meetings to learn how to manage the outbreak. 2 Obtain a vaccine if not already vaccinated against influenza. 3 Stock their homes with a 2-week supply of food and medicine. 4 Take antiviral medications to prevent developing symptoms.

2. 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.

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? 1 Side-lying 2 Sitting in tripod position 3 Prone with head of bed at 30° angle 4 Supine with head of bed at 45° angle

2. 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.

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? 1 To allow for missed doses 2 To shorten therapy by 6 months 3 To treat highly resistant cases of tuberculosis 4 To improve the patient's ability to tolerate medications

2. 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.

A patient with asthma reports diarrhea and vomiting. Which drug should be used with caution? 1 Ribavirin 2 Zanamivir 3 Amantadine 4 Rimantadine

2. Zanamivir Nausea, diarrhea, and vomiting are the symptoms of influenza B. Zanamivir should be used with caution in patients with asthma, as it may cause bronchospasms. Ribavirin is used to treat severe influenza B. Amantadine and rimantadine are used to treat influenza A.

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? 1 "As soon as drug therapy is initiated, your parent will not be contagious." 2 "People are infectious to others only when symptoms are present." 3 "Since you have had prolonged contact with your parent, you are most likely infected." 4 "You will need to begin treatment for TB since you have been exposed to your parent."

3. "Since you have had prolonged contact with your parent, you are most likely infected." 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.

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? 1 Dairy 2 Red meat 3 Alcohol 4 Eggs

3. 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.

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? 1 Fatigue 2 Anorexia 3 Changes in vision 4 Aching of the feet

3. Changes 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.

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? 1 Color blindness 2 Susceptibility to sunburn 3 Contraceptive methods used 4 History of gout

3. 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.

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? 1 Bacterial 2 Bronchial 3 Lobar 4 Viral

3. 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.

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? 1 Contact the provider to request an order for an intravenous antibiotic. 2 Notify the provider and request orders for serum electrolytes and kidney function tests. 3 Perform a detailed respiratory assessment including lung sounds, pulse oximetry, and temperature. 4 Reassure the daughter that confusion is common in older patients who are admitted to the hospital.

3. 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 who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? 1 Contact the health care provider for tuberculosis (TB) medications. 2 Perform a TB skin test. 3 Place a respiratory mask on the patient. 4 Test all family members for TB.

3. Place a respiratory mask on the patient. The concern is that this patient has TB. A respiratory mask should be placed on the patient immediately. Requesting medications for TB is not appropriate until the patient has been evaluated and a diagnosis has been made. Performing a TB test will be important, but this is not the top priority. It is important to remember to let the patient know that results will not be available for at least 48 hours after the test is administered. Further testing of this patient needs to be completed and a diagnosis made before family members are tested.

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? 1 Fungal infection 2 Lung abscess 3 Pulmonary empyema 4 Tuberculosis

3. 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.

A patient who is taking isoniazid and rifampin to treat tuberculosis reports reddish-orange urine. Which action by the nurse is correct? 1 Encourage the patient to increase fluids to 2 L or more per day. 2 Notify the provider and request an order for a complete blood count and creatinine clearance. 3 Reassure the patient that this is an expected drug side effect. 4 Request an order to change the isoniazid to another antitubercular drug.

3. Reassure the patient that this is an expected drug side effect. Reddish-orange urine and other body fluids are a common, harmless side effect of rifampin. It does not indicate dehydration or alterations in blood cell levels or kidney function. It is not necessary to change the drug regimen.

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? 1 Vomiting 2 Productive cough 3 Recent onset of confusion 4 Oral temperature of 101.1°F

3. 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.

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? 1 Eat a diet rich in Vitamin K. 2 Do not drink alcoholic beverages. 3 Take the medication exactly as prescribed. 4 Contact the health care provider if you become ill.

3. Take the 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.

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? 1 Allergy testing 6 months ago 2 Pneumonia vaccine 2 months ago 3 Taking prednisone for the past 3 weeks 4 Fracture of a rib 1 week ago

3. Taking prednisone for the past 3 weeks Secondary TB is reactivation of the disease in a previously infected person. This most likely happens when the immune system is lowered, as occurs with corticosteroid drugs such as prednisone, which suppress the immune response. Allergy testing, receiving a vaccination, and fracturing a rib would not suppress the immune system enough to reactivate the disease.

The nurse has taught a patient about influenza infection control. Which patient statement indicates the need for further teaching? 1 "Handwashing is the best way to prevent transmission." 2 "I should avoid kissing and shaking hands." 3 "It is best to cough and sneeze into my upper sleeve." 4 "The intranasal vaccine can be given to everybody in the family."

4. "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 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? 1 "Getting the flu shot causes you to have influenza symptoms." 2 "If you are exposed to influenza, you can take an antiviral medication." 3 "Since you are healthy, you will probably only have a mild case of the flu." 4 "You are putting your patients at increased risk for serious respiratory illness."

4. "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.

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? 1 "If a flu pandemic begins, you should get the vaccine immediately." 2 "If you get the flu, you can always take an antiviral medication." 3 "Not getting the vaccine increases the chances of a worldwide pandemic." 4 "You may spread the disease to people who are more at risk for severe symptoms."

4. "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 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? 1 "Ask your health care provider to prescribe prophylactic antibiotics." 2 "See your health care provider at the first sign of respiratory infection." 3 "Stay away from large groups of people, especially children." 4 "You should get the pneumococcal polysaccharide vaccine."

4. "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? 1 "Directly observed therapy will be necessary in your case." 2 "If a TB skin test is negative, you may stop taking the drugs." 3 "The provider may reduce the number of drugs you are taking." 4 "You will need to continue therapy for at least 6 months."

4. "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. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

A patient is suspected of having pneumonia. The clinical data are given below. What could be the expected age of the patient? Subj. Data: Obj. Data: weakness WBC count 5000mm3 cough Increased resp. rate fever Blood tinged sputum SOB Hypoxemia 1 10 years 2 30 years 3 50 years 4 70 years

4. 70 years This patient would be around 70 years of age because the WBC count is normal. Generally, the WBC count is elevated in all age groups except older adults. Weakness, cough, fever, and shortness of breath are the common symptoms of pneumonia in all age groups. Increased respiratory rate, blood-tinged sputum, and hypoxemia are also seen in all age groups. Therefore, patients who are 10, 30, and 50 years of age may not have an abnormal WBC count

Which patient is most at risk for the development of either community or hospital-acquired pneumonia? 1 An 8-month-old born at 32 weeks gestation 2 A 14-year-old who developed type 1 diabetes at age 9 3 A 59-year-old who works in the textile industry 4 A 76-year-old who has limited mobility because of osteoarthritis

4. 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.

Which virus is a strain of the bird flu? 1 H1N7 2 H1N1 3 H1N5 4 H5N1

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

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? 1 Drug resistance with spread of infection 2 Hemolysis and a potential for anemia 3 Hepatotoxicity caused by drinking alcohol 4 Normal drug side effects of rifampin

4. 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.

Which group of individuals should be encouraged to receive the pneumococcal vaccine as an important health promotion and maintenance intervention? 1 People over 60 years of age 2 Patients who have not received flu vaccine 3 Those who have had ventilator-associated pneumonia 4 Older adults with a chronic health problem

4. 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.

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? 1 Human immunodeficiency disease 2 Latent tuberculosis 3 Immunity to tuberculosis 4 Reduced immune function

4. Reduced immune function Patients with reduced immune function may have a negative skin response even when infected with tuberculosis. This can occur in older adults as well as people who are HIV positive. The negative skin test only represents reduced immune function and does not always indicate HIV. This result does not indicate latent TB or immunity to TB.

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? 1 WBC 5,100/mm3 2 WBC 6,500/mm3 3 WBC 9,500/mm3 4 WBC 12,000/mm3

4. 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