Ch 30 Respiratory Tract Infections and Childhood Disorders

The neonatal ICU nurse is assessing a client with severe bronchopulmonary dysplasia (BPD). The nurse knows that this client will likely exhibit which clinical manifestations? Select all that apply.

Correct Response: - Chest retractions with accessory muscle use - Clubbing of the fingers - Rapid, shallow breathing Rationale:The infant with BPD often demonstrates tachycardia, rapid and shallow breathing, chest retractions, cough, and poor weight gain. Clubbing of the fingers occurs in children with severe disease. Yellow-sputum is associated with pneumonia. Blood in sputum could be an infection, trauma in airway, etc.

The community health nurse is developing a program to decrease the amount of pulmonary tuberculosis that has recently risen in her area. Which populations at risk will the nurse target? Select all that apply.

Correct Response: - HIV-infected people - Residents of high-risk congregate settings - Foreign-born people from countries with a high incidence of tuberculosis Rationale:Tuberculosis is a particular threat among HIV-infected people, foreign-born people from countries with a high incidence of tuberculosis, and residents of high-risk congregate settings such as correctional facilities, drug treatment facilities, and homeless shelters.

The health care provider suspects a newly admitted newborn, with a history of premature birth requiring respiratory ventilation, has developed bronchopulmonary dysplasia. Which manifestation(s) correlates with this admitting diagnosis? Select all that apply.

Correct Response: - Respiratory rate of 80 breaths/minute and shallow - Bilateral periorbital edema - Heart rate of 200 beats/minute - Use of assessory muscles to breath with sternal retractions Rationale:In bronchopulmonary dysplasia (BPD), the newborn often demonstrates tachycardia (pulse >180 beats/min), rapid, shallow breathing (respiratory rate >60 breats/min), and chest retractions. If the newborn has developed right heart failure, hepatomegaly and periorbial edema may develop. In BPD, the liver (not the kidneys) enlarges if the newborn has developed right-sided heart failure. Spasms or rigidity in one muscle group, such as fingers, arms, or legs, is a sign of a seizure in a newborn.

Which assessment findings concern the presence of respiratory distress in an infant? Select all that apply.

Correct Response: - Respiratory rate of 95 breaths/min - Central cyanosis - Sternal retraction - Grunting Rationale:Infants with respiratory distress syndrome (RDS) present with multiple signs of respiratory distress, usually within the first 24 hours of birth. Central cyanosis is a prominent sign. Breathing becomes more difficult, and retractions occur as the infant's soft chest wall is pulled in as the diaphragm descends. Grunting sounds accompany expiration. As the tidal volume drops because of atelectasis, the respiration rate increases (usually to 60 to 120 beaths/min) in an effort to maintain normal minute ventilation. Fatigue may develop rapidly because of the increased work of breathing. The stiff lungs of infants with RDS also increase the resistance to blood flow in the pulmonary circulation. As a result, a hemodynamically significant patent ductus arteriosus may develop in infants with RDS.

A 2-year-old child is admitted to a pediatric unit with bronchiolitis. The nurse calls the health care provider fearing the child is going into respiratory failure based on which assessment findings? Select all that apply.

Correct Response: - Sudden absence of breath sounds - Listlessness - Cyanosis of mucous membranes Rationale:Cyanosis, pallor, listlessness, and sudden diminution or absence of breath sounds indicate impending respiratory failure. Wheezing may occur in infants with severe airway obstruction. Productive cough is not a sign of worsening respiratory failure.

A child is having symptoms of spasmodic croup after a previous bout for the same diagnosis. What care does the parent provide at home that demonstrates understanding of the education given by the nurse during this first bout of croup? Select all that apply.

Correct Response: - The parent takes a child outside in the cool air. - The parent turns on the cold-water room humidifier in the child's room. - The parent brings the child into the bathroom where a warm shower is running to provide humidification. Rationale:Most children with spasmodic croup can be managed effectively at home. An environment of high humidification (i.e., cold-water room humidifier or taking the child into a bathroom with a warm, running shower) lessens irritation and prevents drying of secretions. Or, if there is no success with opening the airway, the child should be brought outside into the cold air, which, in some cases, can assist the child's breathing.

Which statements regarding childhood respiratory tract infection are true? Select all that apply.

Correct Response: - The size of the child has an impact on the seriousness of the symptoms. - An immature immune system is the usual trigger for such infections. - Impaired airflow and obstructions are common outcomes of these infections. - Each exposure to a new pathogen results in an infection. Rationale:Frequent infections occur because the immune system of infants and small children has not been exposed to many common pathogens. Consequently, they tend to contract infections with each new exposure. Although most of these infections are not serious, the small size of an infant's or child's airways tends to foster impaired airflow and obstruction. In children, respiratory tract infections are common, and although they are troublesome, they usually are not serious.

A client presents with atypical pneumonia signs/symptoms and is diagnosed with Mycoplasma pneumoniae. For which characteristics of the cough should the nurse assess this client? Select all that apply.

Correct Response: Dry, Nonproductive, Hacking Rationale: Cough, when present (in clients with Mycoplasma pneumoniae), is characteristically dry, hacking, and nonproductive. It is not moist or fulminating.

In understanding the pathology of pneumoccocal pneumonia, what occurs in the gray hepatization stage?

Correct Response: Macrophages phagocytose the red blood cells and other cellular debris, leaving the lung firm and less congested. Rationale:In the gray hepatization stage, macrophages phagocytose the fragmented polymorphonuclear cells, RBCs, and other cellular debris. Alveolar exudate is removed in the resolution stage, while the lung becomes red during the red hepatization phase. The alveoli become filled with rich edema fluid in the edema stage.

The nurse in the emergency department is assessing a toddler suspected of epiglottitis. Which intervention is considered the priority when working with this client?

Correct Response: Assess if airway is compromised and call for health care provider assistance with intubation to establish an airway, if needed. Rationale:Epiglottitis is a medical emergency and immediate establishment of an airway by endotracheal tube or tracheotomy usually is needed. The toddler should be kept calm, if possible. The toddler should never be forced to lie down because this causes the epiglottis to fall backward and may cause complete airway obstruction. Examination of the throat with a tongue blade may cause cardiopulmonary arrest. It is unwise to attempt any procedure, such as drawing blood, which would heighten the toddler's anxiety, which could precipitate airway spasm and cause death. Isolation is not the priority for this toddler who is having a medical emergency.

The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be:

Correct Response:Antipyretic medications and rest Rationale:The common cold virus does not respond to antibiotics and should be treated with antipyretic medications and rest. Bed rest is recommended, but complete isolation is not required.

A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:

Correct Response:Hoarseness and difficulty swallowing Rationale:Tumors that invade the mediastinum cause hoarseness, difficulty in swallowing, and retrosternal pain. Hemoptysis may occur but is not specific to mediastinal involvement.

A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:

Correct Response:Increased turbulence of air moving through the obstructed airways Rationale:The crowing sound of stridor occurs with the increased turbulence of air moving through the obstructed airways. Pulling in of the soft tissue surrounding the cartilaginous and bony thorax describes the mechanisms that produce inspiratory retractions. The collapse of intrathoracic airways because of air trapping describes the mechanism for the production of wheezing.

A client arrives in the clinic with a cough, fever, and chest discomfort and is diagnosed with community-acquired pneumonia. What education does the nurse anticipate providing prior to discharging the client from the clinic?

Correct Response:The use of antibiotics Rationale:Treatment for community-acquired pneumonia involves the use of appropriate antibiotic therapy. Empiric antibiotic therapy, based on knowledge regarding an antibiotic's spectrum of action and ability to penetrate bronchopulmonary secretions, often is used for people with community-acquired pneumonia who do not require hospitalization.

Which acute respiratory infection in children poses the greatest threat of severe hypoxia caused by inflammatory edema? Croup Bronchiolitis Asthma Epiglottitis

Epiglottitis Among the respiratory tract infections that affect small children are croup, epiglottitis, and bronchiolitis. Croup or acute laryngotracheobronchitis is a viral infection that affects the larynx, trachea, and bronchi. Epiglottitis is a life-threatening supraglottic infection with inflammatory edema and possible airway obstruction. Acute bronchiolitis is a viral infection of the lower airways, most commonly caused by the respiratory syncytial virus. Asthma is a reactive airway disease rather than an infection.

Which respiratory infection in children is associated with the poorest outcomes? Epiglottitis Rhinosinusitis Spasmodic croup Viral croup

Epiglottitis Croup is normally benign and self-limiting, whereas epiglottitis is a life-threatening emergency. Rhinosinusitis may become chronic, but is not associated with life-threatening complications.

A parent calls 911 and states her child is having trouble breathing. The child is rushed to the emergency department. Upon assessment, the child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. The parent states that the child just developed a sore throat and fever today. The health care provider determines that the child is experiencing: Epiglottitis Bronchitis Pneumonitis Tracheobronchitis

Epiglottitis Epiglottitis typically presents with an acute onset of sore throat and fever. The child appears pale, toxic, and lethargic and assumes a distinctive position-sitting up with the mouth open and the chin thrust forward. Symptoms rapidly progress to difficulty swallowing, a muffled voice, drooling, and extreme anxiety. Moderate to severe respiratory distress is evident. The other options do not have these manifestations.

The nurse in a hospital is caring for a child with respiratory distress. What oxygen delivery method would be appropriate for the child when the oxygen saturation consistently falls below 90%? Endotracheal tube Non-rebreather mask Venturi mask High-flow oxygen via nasal cannula

High-flow oxygen via nasal cannula Treatment is supportive and includes administration of supplemental oxygen if the oxygen saturation consistently falls below 90%. Evidence suggests that children with respiratory distress needing oxygen should first be given high-flow oxygen via a nasal cannula since it tends to increase oxygen saturation, increase comfort, and increase the overall respiratory condition.

What diagnostic test does the nurse explain to the client will assist with the diagnosis of disseminated histoplasmosis? Chest x-ray Histoplasma urine antigen assay Liver biopsy Complete blood count

Histoplasma urine antigen assay The type of test that is used depends on the type of involvement that is present. In pulmonary disease, sputum cultures are rarely positive, whereas blood or bone marrow cultures from immunocompromised people with acute disseminated disease are positive in 80% to 90% of cases. Some people may need a surgical biopsy on their suspicious lung nodule to rule out malignancy. Antigen tests can be performed on blood, urine, cerebrospinal fluid, or bronchoalveolar lavage fluid. A histoplasma urine antigen assay is particularly useful in detecting disseminated histoplasmosis.

What is the underlying cause of respiratory failure in a child with bronchiolitis? Obstructive process Metabolic acidosis Impaired gas exchange Ischemia

Impaired gas exchange

When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis? Complete blood count (CBC) Sputum or bronchial cultures Computed tomography (CT) of the chest CD4+ T-cell serum levels

Sputum or bronchial cultures A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. CT scans help determine the extent of lung involvement. CBC and CD4+ T-cell testing will show extent of body's response to the infection and if antigens are activated.

An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function? Beta-hemolytic streptococcus Eosinophilic bacillus subtilis Gram-positive bacilli Haemophilus influenzae Staphylococcus aureus

Staphylococcus aureus Neutropenia and impaired granulocyte function, as occurs in persons with leukemia, chemotherapy, and bone marrow depression, predispose to infections caused by S. aureus, Aspergillus, Gram-negative bacilli, and Candida. All the other organisms can cause pneumonia, but they are not usually seen in people with neutropenia and impaired granulocyte function.

A client has developed bacterial pneumonia and is admitted to the hospital. The nurse obtains sputum cultures upon admission. What bacteria does the nurse anticipate finding when the results are complete? Escherichia coli Streptococcus pneumoniae Staphylococcus aureus Pseudomonas aeruginosa

Streptococcus pneumoniae Streptococcus pneumoniae (pneumococcus) remains the most common cause of bacterial pneumonia.S. pneumoniae is a gram-positive diplococcus, possessing a capsule of polysaccharide. The virulence of the pneumococcus is a function of its capsule, which prevents or delays digestion by phagocytes.

A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply. Surgery to remove tumor Monoclonal antibody Chemotherapy Stem cell transplant Radiation therapy

Surgery to remove tumor Chemotherapy Radiation therapy

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be: "Have you eaten anything unusual to cause this reaction?" "This result definitely confirms the diagnosis; we will begin treatment now." "Wait until tomorrow to see if things change." "A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."

"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. Culture remains the gold standard for laboratory confirmation of infection and is required for drug sensitivity testing. The local reaction is not influenced by food consumption.

The nurse is performing a health history for a male client who is having a series of diagnostic tests to determine the presence of squamous cell carcinoma. What question would be most beneficial for the nurse to ask that would correlate with this suspicion? "Do you work in construction and have you been digging soil?" "Have you been around any chemicals that may have been inhaled?" "Do you have a history of smoking, and if so, how much?" "Do you have a history of cancer in your family?"

"Do you have a history of smoking, and if so, how much?" Squamous cell carcinoma is found most commonly in men and is closely correlated with a smoking history.

A client from Texas is suspected of being infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions. When performing a health history, which question would be most valuable to assist with diagnosis? "Do you smoke?" "Do you have a history of cancer?" "Do you have cats and clean litter boxes?" "Do you work in construction and dig soil?"

"Do you work in construction and dig soil?" Coccidioidomycosis resembles tuberculosis, and its mechanisms of infection are similar to those of histoplasmosis. It is most prevalent in the deserts in southwestern United States, principally in parts of California, Arizona, Nevada, New Mexico, and Texas. The C. immitis and C. posadasii organisms live in soil and can establish new sites in the soil. Events such as dust storms and digging for construction have been associated with increased incidence of the disease.

While educating a smoking cessation class, a client asks the nurse, "If I can still get lung cancer, what should I be looking for?" Which response by the nurse is best? "The earliest symptoms relate to a chronic cough and shortness of breath." "When you can no longer get up or have the energy to go to work [fatigue], you should make an appointment with your physician." "If you wake up with dried blood on your pillow, call your doctor right away." "If you start losing weight without trying and coughing up thick, yellow sputum, you should seek medical attention

"The earliest symptoms relate to a chronic cough and shortness of breath." The earliest symptoms usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels. Later symptoms include coughing up blood, extreme fatigue, and weight loss.

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply. A. Bluish discoloration of the skin and mucous membranes (central cyanosis) B. Expiratory grunting C. Clubbed fingers D. Substernal retractions with each breath E. Periorbital edema

A. Bluish discoloration of the skin and mucous membranes (central cyanosis) B. Expiratory grunting D. Substernal retractions with each breath Infants with RDS present with multiple signs of respiratory distress, usually within the first 24 hours of birth. Central cyanosis is a prominent sign. Breathing becomes more difficult, and retractions occur as the infant's soft chest wall is pulled in as the diaphragm descends. Grunting sounds accompany expiration. Periorbital edema is usually associated with kidney disease in infants. Clubbed fingers occur over a long period of time (years) in clients with COPD.

A 3-year-old boy has been diagnosed with croup (acute laryngotracheobronchitis). The nurse anticipates the plan of care to include: A. Cool, humidified air to relieve airway spasms B. Chest physiotherapy to loosen secretions C. Antibiotics to decrease the infection D. Bronchodilating agents to open bronchioles

A. Cool, humidified air to relieve airway spasms Rationale:Acute laryngotracheobronchitis (viral croup) is best treated with cool, humidified air. Chest physiotherapy would not be beneficial because there are no secretions to remove and medications would not be required.

An adult comes to the urgent care clinic reporting facial pain, headache, and copious amounts of thick purulent nasal discharge. Based on these symptoms, the nurse practitioner suspects the client is experiencing which condition? Common cold Mastoiditis Acute viral rhinosinusitis Blocked Eustachian tube

Acute viral rhinosinusitis The symptoms of acute viral rhinosinusitis often are similar to those of the common cold and allergic rhinitis. They include facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever. The discharge from a common cold is clear and watery; ear pain is the primary symptom with a blocked Eustachian tube. Mastoiditis is swelling on one side of the neck.

Which individual should have priority for receiving a seasonal influenza vaccination? A neonate who was born in a busy hospital in late October An adolescent who was admitted to a hospital for an appendectomy An older adult hospitalized for flu symptoms An older adult resident of a long-term care facility

An older adult resident of a long-term care facility An older adult who lives in a nursing facility is a high-priority candidate for influenza vaccination. Rates of infection are highest among children and older adults, but rates of serious illness and death are highest among people 65 years of age or older. Infants younger than 6 months and persons who are acutely ill should not receive immunizations. Younger hospital clients may be vaccinated but are usually of lower priority than older adults.

client has presented to a clinic reporting a persistent headache. What assessment should the clinician conduct to differentiate between rhinosinusitis and other health problems? Palpate the client's lymph nodes and inspect the ears with an otoscope. Compare the client's oral, tympanic, and axillary temperatures and order a white blood cell count. Ask the client if bending forward exacerbates the headache. Take a sputum sample for culture and sensitivity.

Ask the client if bending forward exacerbates the headache. Sinusitis headache usually is exaggerated by bending forward, coughing, or sneezing. The other cited assessments do not differentiate between rhinosinusitis and other health problems.

Which intervention(s) is important for the nurse caring for a child admitted with bronchiolitis, using the latest evidence in the research literature? Select all that apply. A. Give corticosteroids on time, at least 4 times/day to help with tissue swelling. B, Administer supplemental oxygen when the oxygen saturation consistently falls below 90%. C, Elevate the head to facilitate respiratory movements. D. Call a "code blue" if the child displays wheezing and appears listless. E. Administer antibiotics once blood cultures have been obtained and sent to the laboratory.

B, Administer supplemental oxygen when the oxygen saturation consistently falls below 90%. C. Elevate the head to facilitate respiratory movements. Rationale: The latest evidence does not recommend providers administer albuterol or corticosteroids to children with a diagnosis of bronchiolitis. However, nebulized hypertonic saline may be given to hospitalized children. Treatment is supportive and includes administration of supplemental oxygen when the oxygen saturation consistently falls below 90%. Elevation of the head facilitates respiratory movements and avoids airway compression. Because the infection is viral, antibiotics are not effective and only given if a secondary bacterial infection occurs. It would be inappropriate to call a "code blue" if the child displays wheezing and appears listless, since these are manifestations of bronchiolitis and the reason the child was admitted to the hospital in the first place.

The nurse working in the health department recognizes which clients in her group meet the criteria for beginning antimycobacterial therapy for tuberculosis? Select all that apply. A. A client with a productive cough B. A client who has had contact with a family member with active tuberculosis C. A client with active tuberculosis D. A client who has had a positive skin test E. A client who is HIV positive and has not been exposed to the infection

B. A client who has had contact with a family member with active tuberculosis C. A client with active tuberculosis E. A client who is HIV positive and has not been exposed to the infection Two groups meet the criteria established for the use of antimycobacterial therapy for tuberculosis: people with active tuberculosis and people who have had contact with cases of active tuberculosis and who are at risk for development of an active form of the disease.

A client has developed community-acquired pneumonia and is being treated at home. What does the nurse recognize are the methods in the diagnosis of community-acquired pneumonia? Select all that apply. A. Gender B. Age C. Severity of illness D. Cultural background E. Coexisting health problems

B. Age C. Severity of illness E. Coexisting health problems The methods used in the diagnosis of community-acquired pneumonia depends on age, coexisting health problems, and the severity of illness. In people younger than 65 years of age and without coexisting disease, diagnosis is usually based on history and physical examination, chest radiographs, and knowledge of the microorganisms currently causing infections in the community. Sputum specimens may be obtained for staining procedures and cultures. Blood cultures may be done for people requiring hospitalization.

A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that: A. corticosteroids can perform anti-inflammatory acts that may prevent infections. B. cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. C. corticosteroids cause blood glucose levels to rise, thus preventing hypoglycemia in premature infants. D. cortisol administration will enhance the secretion of insulin, which is needed for surfactant production.

B. cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. Surfactant synthesis is influenced by several hormones, including insulin and cortisol. Insulin tends to inhibit surfactant production. Cortisol can accelerate maturation of type II cells and formation of surfactant. These observations have led to administration of corticosteroid drugs before delivery to mothers with infants at high risk for development of respiratory distress syndrome.

An infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks. What condition should the nurse monitor the infant for related to the long-term ventilatory support? Blastomycosis Bacterial tracheitis Spasmodic croup Bronchopulmonary dysplasia

Bronchopulmonary dysplasia Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in premature infants who were treated with long-term mechanical ventilation, mainly for RDS. The condition is considered to be present if the neonate is oxygen dependent at 36 weeks after gestation.

An infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks. What condition should the nurse monitor the infant for related to the long-term ventilatory support? Bronchopulmonary dysplasia Bacterial tracheitis Spasmodic croup Blastomycosis

Bronchopulmonary dysplasia Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in premature infants who were treated with long-term mechanical ventilation, mainly for RDS. The condition is considered to be present if the neonate is oxygen dependent at 36 weeks after gestation.

A client asks the nurse if it is possible to contract influenza by being exposed to wound secretions. On what knowledge should the nurse base her response to the client? Influenza may be contracted by touching a surface that an infected person has touched. Influenza is transmitted by exposure to urine, blood, and body secretions. Influenza transmission occurs by inhalation of droplet nuclei. Influenza transmission occurs through contact with the skin of an infected person.

Influenza transmission occurs by inhalation of droplet nuclei. As with many viral respiratory tract infections, influenza is more contagious than bacterial respiratory tract infections. In contrast to the rhinoviruses, transmission occurs by inhalation of droplet nuclei rather than touching contaminated objects.

Which of the following is/are a lower airway disease? (Select all that apply.)

b. Acute bronchiolitis c. Asthma

Tuberculosis is a highly destructive disease because the tubercle bacillus activates a tissue hypersensitivity to the tubercular antigens. What does the destructive nature of tuberculosis cause in a previously unexposed immunocompetent person?

b. Caseating necrosis and cavitation

The early stages of influenza pass by as if the infection were any other viral infection. What is the distinguishing feature of an influenza viral infection that makes it different from other viral infections?

b. Rapid onset of profound malaise

Coccidioidomycosis is a pulmonary fungal infection resembling tuberculosis. Less severe forms of the infection are treated with oral antifungal medications. For persons with progressive disease, what is the drug of choice?

c. IV amphotericin B

Non-small cell lung cancers (NSCLCS) mimic small cell lung cancers (SCLCS) through their abilities to do what?

d. Synthesize bioactive products and produce paraneoplastic syndromes

An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function?

e. Staphylococcus aureus

A client recovered from influenza 2 days ago and informs the nurse that she is feeling better but now has a fever, chills, pain when breathing, and a productive cough. What complication does the nurse anticipate the client will be treated for? A. A secondary bacterial pneumonia B. A relapse of the flu C. Reye syndrome D. Tuberculosis

A. A secondary bacterial pneumonia People in whom secondary bacterial pneumonia develops usually report that they were beginning to feel better when they experienced a return of fever, shaking chills, pleuritic chest pain, and productive cough. Reye syndrome is a complication, though rare, of influenza, particularly in young children who have been given aspirin as an antipyretic agent. Tuberculosis is not a complication of influenza.

Which clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply. A. A college female who is pregnant (unplanned) and who has been consuming alcohol prior to positive pregnancy test B. A school-aged child with severe asthma controlled by steroids admitted for an exacerbation C. A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation D. A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food E. A teenager who spends a lot of time at local coffee shops using Wi-Fi to chat with friends

C, A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation B. A school-aged child with severe asthma controlled by steroids admitted for an exacerbation D. A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food Persons requiring intubation and mechanical ventilation are particularly at risk, as are those with compromised immune function, chronic lung disease (like asthma), and airway instrumentation, such as endotracheal intubation or tracheotomy. Ventilator-associated pneumonia is pneumonia that develops in mechanically ventilated clients more than 48 hours after intubation. Neutropenia and impaired granulocyte function predispose to infections caused by S. aureus, Aspergillus, gram-negative bacilli, and Candida. Pneumonia in immunocompromised persons remains a major source of morbidity and mortality. The epithelial cells of critically and chronically ill persons are more receptive to binding microorganisms that cause pneumonia.

When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression? A. Administer intravenous fluids. B. Administer antibiotics. C. Elevate the head of the bed. D. Handle the child frequently to keep her stimulated to breathe.

C. Elevate the head of the bed. Elevation of the head of the bed facilitates respiratory movements and avoids airway compression. Handling is kept at a minimum to avoid tiring. Administration of IV fluids will prevent dehydration from insensible loss from rapid respirations but will not facilitate respiratory movements or prevent airway compression. Because the infection is viral, antibiotics are not effective and are given only for a secondary bacterial infection.

Which description of the onset of symptoms is most characteristic of epiglottitis? A. Follows typical cold symptoms B. Preceded by nasal congestion C. Sudden onset D. Follows a viral infection

C. Sudden onset Epiglottitis is characterized by a sudden onset with no apparent relationship to a previous illness. Both croup and bronchiolitis are preceded by viral infections that present with symptoms.

The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on? Ghon tuberculosis Mycobacterium tuberculosis Pneumocystis jirovecii tuberculosis Mycobacterium avium-intracellulare complex

Mycobacterium tuberculosis

A client arrives at the clinic stating he is having "terrible headaches." What questions would be appropriate for the nurse to ask that may indicate the headaches are related to sinusitis? Select all that apply.

Correct Response: - "When you sneeze, does it make the headache worse?" - "When you cough, is the headache worse?" - "Does bending forward exaggerate the headache?" Rationale:Bending forward, coughing, or sneezing usually exaggerates sinusitis headache. Working at the computer may induce a tension headache. If the client has a stiff neck in addition to a headache and fever, meningitis may be suspected.

Which problem in neonates can result in increased upper airway resistance and decreased airflow into the lungs? Productive coughing Nasal congestion Sleeping supine Frequent crying

Nasal congestion The neonate (0 to 4 weeks of age) breathes predominantly through the nose and does not adapt well to mouth breathing. Small amounts of mucus secretion, edema, or airway constriction may increase upper airway resistance and increase the work of breathing. While sleeping, the neonate's face should remain away from any surface or cloth in order to maintain an open nasal airway.

Which diagnosis places a child at the greatest risk for airway obstruction? Epiglottitis Bronchiolitis Syncytial virus (RSV) Croup

Correct Answer: Epiglottitis Rationale:The child with epiglottitis is at risk for airway obstruction. Epiglottitis is a life-threatening supraglottic infection that may cause airway obstruction and asphyxia. The child with bronchiolitis is at risk for respiratory failure resulting from impaired gas exchange. Acute bronchiolitis is a viral infection of the lower airways, most commonly caused by the respiratory syncytial virus (RSV). The symptoms of croup usually subside when the child is exposed to moist air.

A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which factor most likely had the greatest impact on development of the lung cancer? Cigarette smoke Asbestos Radiation Air pollution

Cigarette smoke Cigarette smoking causes more than 80% of cases of lung cancer. The risk for lung cancer among cigarette smokers increases with duration of smoking and the number of cigarettes smoked per day. Cigarette smokers can benefit at any age from smoking cessation. Industrial hazards also contribute to the incidence of lung cancer. A commonly recognized hazard is exposure to asbestos. The mean risk for lung cancer is significantly greater in asbestos workers compared to the general population. In addition, tobacco smoke contributes heavily to the development of lung cancer in people exposed to asbestos.

An client who has just suffered an acute stroke has no cough reflex. What is the nurse's priority intervention to prevent the client from developing pneumonia? Reposition the client every 2 hours. Do not offer the client anything by mouth. Auscultate the client's lungs every 4 hours. Ensure the head of the bed is maintained at 30 degrees.

Do not offer the client anything by mouth The cough reflex exists to protect against aspiration of secretions, bacteria, or objects into the tracheo-bronchial tree. A client who has lost the cough reflex is at greatest risk for aspiration if food, fluids, or medications are introduced into the oral cavity. During the acute phase of stroke, the nurse must maintain the client as NPO (nothing per mouth) until a swallowing assessment can determine if the client can swallow safely. Listening to the breath sounds cannot prevent aspiration. Although the head of bed being elevated can also prevent aspiration, this is not as effective and refraining from introducing objects into the oral cavity. Repositioning can help prevent respiratory secretion stasis, but this will not be as effective as avoiding aspiration for preventing pneumonia.

In assessing the infant's respiratory system, which finding confirms to the nurse that the infant is having trouble breathing? Barrel chest shape Abdominal breathing Expiratory grunting Rapid respiratory rate

Expiratory grunting The infant's respiratory system is immature and has small airway structures. Infants who are having trouble breathing often grunt to increase their expiratory airway pressures and keep their airways open. The rapid respiratory rate and abdominal breathing are not cited as placing the infant at risk. Barrel chest shape is often present in infants and toddlers.

A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis. Community-acquired pneumonia Typical pneumonia Antibiotic-resistant pneumonia Nosocomial pneumonia

Nosocomial pneumonia Pneumonia can be classified according to the type of organism causing the infection (typical or atypical), location of the infection—lobar pneumonia or bronchopneumonia—and setting in which it occurs—community- or nosocomial/hospital-acquired pneumonia. Community-acquired pneumonia involves infections from organisms that are present more often in the community than in the hospital or nursing home. Hospital-acquired (nosocomial) pneumonia is defined as a lower respiratory tract infection occurring 48 hours or more after admission.

The nurse is educating the client with a cold about the use of over-the-counter (OTC) decongestants. What expected outcome does the nurse anticipate with the use of this medication? Decrease in cough Relief of excess lacrimation Reduction of nasal swelling Decrease in fever

Reduction of nasal swelling Decongestant drugs are available in OTC nasal sprays, drops, and oral cold medications. These drugs constrict the blood vessels in the swollen nasal mucosa and reduce nasal swelling. They will not reduce the excess lacrimation that often accompanies a cold. Coughing is not affected by the use of these drugs. Fever reduction occurs with acetaminophen.

The neonatologist explains to the parents of a neonate born at 35 weeks' gestation that their premature infant will be monitored for complications. Which respiratory complication is the most common? Periodic breathing Asthma Intraventricular hemorrhage Respiratory distress syndrome

Respiratory distress syndrome The respiratory distress syndrome is the most common complication of prematurity (neonates born before 37 weeks' gestation). In these neonates, pulmonary immaturity, together with surfactant deficiency, leads to alveolar collapse. Periodic breathing, asthma, and intraventricular hemorrhage may also be complications of prematurity, but are not the most common.

A nurse is assessing a 2-week-old infant with pulmonary edema. Which symptom indicates the infant is experiencing respiratory distress? Coughing Grunting during expiration Frequent sneezing and hiccups Respiratory rate of 45 breaths/min

Grunting during expiration

The nurse is assessing a client who states he felt fine all day and then, within 5 minutes, began to feel extremely weak and tired and began having a fever. What do these symptoms indicate that the client may be experiencing? Reye syndrome Viral pneumonia Common cold Influenza

Influenza One distinguishing feature of an influenza viral infection is the rapid onset, sometimes in as little as 1 to 2 minutes, of profound malaise. Viral pneumonia is a complication of influenza. Reye syndrome is a complication of influenza that is extremely rare and is found mostly in children after being give aspirin as an antipyretic. The common cold has more of a slow onset.

Influenza A subtype H5N1 (avian flu) has been documented in poultry in both East and Southeast Asian countries. This form of avian flu is highly contagious from bird to bird but rarely is passed from human to human. There is a large amount of concern that the H5N1 strain might mutate, making it easier to be passed from human to human, carrying with it a high mortality rate. What is the main concern if the H5N1 strain does mutate? An epidemic in Southeast Asia Inability to develop a vaccine for the newly infected poultry Several small pockets of infection so widespread it will be difficult to control them Initiation of a pandemic

Initiation of a pandemic Recently, a highly pathogenic influenza A subtype H5N1 was found in poultry in East and Southeast Asian countries. Although the H5N1 strain is highly contagious from one bird to another, the transmission from human to human is relatively inefficient and not sustained. The result is only rare cases of person-to-person transmission. Most cases occur after exposure to infected poultry or surfaces contaminated with poultry droppings. Because infection in humans is associated with high mortality, there exists considerable concern that H5N1 strain might mutate and initiate a pandemic.

A nurse is assessing a 1-year-old child diagnosed with croup. Which manifestation would most likely be present? Drooling and wheezing Low-pitched stridor and difficulty swallowing Inspiratory stridor and barking cough High fever and dry cough

Inspiratory stridor and barking cough Croup is characterized by inspiratory stridor, hoarseness, and a barking cough.

Older adults are very susceptible to pneumonia in all its varieties. The symptoms that older adults exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are older adults with pneumonia less likely to experience than people with pneumonia in other age groups? Pleuritic pain Loss of appetite Marked elevation in temperature Deterioration in mental status

Marked elevation in temperature Older adults are less likely to experience marked elevations in temperature; in these persons, the only sign of pneumonia may be a loss of appetite and deterioration in mental status. Pleuritic pain, a sharp pain that is more severe with respiratory movements, is common. With antibiotic therapy, fever usually subsides in approximately 48 to 72 hours, and recovery is uneventful.

A 3-year-old child has been admitted to the pediatric unit for the treatment of croup. The nurse should include which action in the child's plan of care? Providing cool, moist air for the child to breathe Providing a low-stimulation environment to relieve bronchospasm Administering antiviral medications such as zanamivir and oseltamivir as ordered Establishing IV access and administering sulfa antibiotics as ordered

Providing cool, moist air for the child to breathe Moist air is effective in relieving the bronchospasm associated with croup for many children. Croup has a viral etiology, so antibiotics are ineffective. Zanamivir and oseltamivir are antiviral medications given to treat influenza, not croup. A low-stimulation environment is of no significant clinical benefit.

Premature infants who are treated with mechanical ventilation, mostly for respiratory distress syndrome, are at risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease. What are the signs and symptoms of BPD? Rapid and shallow breathing and chest retractions Tachycardia and slow, shallow breathing Weight loss and a barrel chest A barrel chest and rapid weight gain

Rapid and shallow breathing and chest retractions The infant with BPD often demonstrates a barrel chest, tachycardia, rapid and shallow breathing, chest retractions, cough, and poor weight gain. Other signs and symptoms listed are not those of BPD.

The early stages of influenza pass by as if the infection were any other viral infection. What is the distinguishing feature of an influenza viral infection that makes it different from other viral infections? Rapid onset of productive cough Rapid onset of profound malaise Slow onset of fever and chills Slow onset of upper respiratory symptoms

Rapid onset of profound malaise One distinguishing feature of an influenza viral infection is the rapid onset, sometimes in as little as 1 to 2 minutes, of profound malaise. None of the other answers are distinguishing characteristics of an influenza viral infection.

A client diagnosed with the common cold has been taking an over-the-counter antihistamine for the control of symptoms. What should the client be aware may occur if the drugs are used too frequently over too many days? Sinusitis Rebound symptoms Nasal polyps Pneumonia

Rebound symptoms Antihistamines are popular OTC drugs because of their action in drying nasal secretions. However, they may dry up bronchial secretions and worsen the cough, and they may cause dizziness, drowsiness, and impaired judgement. If these drugs are used too frequently over too many days, they can cause rebound symptoms.

A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which possible diagnosis? Tuberculosis due to long period of coughing Small cell lung cancer due to smoking history Pulmonary embolism due to blood in sputum Pneumothorax related to chronic lung infection weakening the alveoli

Small cell lung cancer due to smoking history Small cell lung cancer has the strongest association with cigarette smoking and is rarely observed in someone who has not smoked; brain metastasis is common. The earliest symptoms (of lung cancer) usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels. There is no indication the client has risk factors for TB. Pulmonary emboli result from blood clots traveling to the lungs. Pneumothorax would cause different symptoms and be an acute, abrupt onset.

Which characteristic of the lungs of infants and small children creates an increased risk of respiratory disorders? Type II alveoli in children may overproduce surfactant. There are fewer chemoreceptors in the young medulla. The pneumotaxic center in the pons is underdeveloped until 8 years of age. Smaller airways create a susceptibility to changes in airway resistance and airflow.

Smaller airways create a susceptibility to changes in airway resistance and airflow. Because the resistance to airflow is inversely related to the fourth power of the radius (resistance = 1/radius), relatively small amounts of mucus secretion, edema, or airway constriction can produce marked changes in airway resistance and airflow. Surfactant production is low early in life, and the respiratory center and chemoreceptors are present and functional in infants and children.

A social worker is counseling the family of an 85-year-old woman who has just been diagnosed with non-small cell lung cancer. What concerns should she convey to the family regarding the unintended effects of treating the disease? Surgical treatment may have the consequence of weakening the client. Older adults cannot tolerate radiation, and therefore it is not used. The client will react to the therapy exactly the same as a younger client. Older adults cannot metabolize chemotherapeutic agents, resulting in a buildup of medication.

Surgical treatment may have the consequence of weakening the client. Surgery remains the mainstay for older persons with stages I to III NSCLC. Curative resection is feasible in older persons. The challenge for surgical treatment for older persons is age-related physiologic changes in cardiovascular and respiratory systems that may affect tolerance of surgery. Radiation can be given with curative intent for older persons who are not surgical candidates, and older persons with good performance status may receive standard chemotherapy for limited disease and combination chemotherapy for extensive-stage disease.

A parent of a toddler is concerned about possible side effects of influenza immunizations. What will the nurse teach the parent regarding the influenza vaccine? Mercury-based preservatives are no longer used in vaccine administration, so the influenza vaccine is safe for all individuals. Parents can win lawsuits if side effects occur following an influenza vaccine. The evidence of vaccines leading to autism is only linked to the measles, mumps, and rubella (MMR) vaccine, not the influenza vaccine. The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine.

The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine. The Centers for Disease Control and Prevention recommends all people 6 months of age and older in the United States receive the annual influenza vaccine. To date, there has been no valid evidence linking any vaccine to the development of autism. Thimerosal, a mercury-based preservative, is still being utilized, and there are no proven interactions. Side effects occur with most medications. Lawsuits are not necessarily won if side effects occur.

A client had a tuberculin skin test (TST) performed as part of the immigration process and is surprised that the results are positive. How should the nurse best interpret this result? The client has a genetic susceptibility to infection by Mycobacterium tuberculosis. The client has had contact with a person who has active or latent tuberculosis in the past 12 to 18 months. The client was exposed to the tubercle bacillus at an indefinite point in the past. The client will likely develop symptoms of primary tuberculosis within the next several months unless treated prophylactically.

The client was exposed to the tubercle bacillus at an indefinite point in the past. A positive reaction to the TST does not mean that a person has active tuberculosis, only that there has been exposure to the bacillus and that cell-mediated immunity to the organism has developed. Tuberculosis has no genetic component to its etiology and a positive TST does not guarantee an active future infection.

A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. Which education will the nurse provide based on the most likely treatment course for this client? The client will need education about the administration of isoniazid and the importance of taking it as prescribed. The client will be instructed to take ethambutol and pyrazinamide and be informed of the side effects. The client should be instructed that the urine will turn orange, as well as the tears. The client will be required to take antibiotics for a minimum of 10 days.

The client will need education about the administration of isoniazid and the importance of taking it as prescribed. People who are 35 years of age or younger with a positive reaction of unknown duration are considered to harbor a small number of microorganisms and usually are treated with isoniazid. It is important to inform the client that they should take the medication as directed and not skip doses or stop the medication without discussing it with the physician. The client will not be required to take a short course (10 days) of antibiotics. The urine and tears turn orange when taking rifampin. This does not occur when taking isoniazid. Ethambutol and pyrazinamide are not the typical treatments for the client scenario provided.

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse? The nurse is likely asymptomatic. The nurse can spread TB to others. The nurse is now immune to more severe TB infection. The nurse has active TB infection.

The nurse is likely asymptomatic. Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others. It does not confer immunity. However, small numbers of organisms may remain viable for years. Later, if immune mechanisms decline or fail, latent TB infection has the potential to develop into secondary TB.

An older adult client admitted to the hospital with tuberculosis becomes cyanotic, tachycardic, and develops a fever and cough. Chest x-ray reveals pus in the pleural space. What is the most likely diagnosis? Pneumococcal pneumonia with pulmonary edema Legionnaire disease Fungal infection Tuberculous empyema due to primary progressive tuberculosis

Tuberculous empyema due to primary progressive tuberculosis Primary progressive tuberculosis represents either reinfection from inhaled droplet nuclei or reactivation of a previously healed primary lesion. It often occurs in situations of impaired body defense mechanisms. In primary progressive tuberculosis, the cell-mediated hypersensitivity reaction can be an aggravating factor, as evidenced by the frequency of cavitation and bronchial dissemination. The cavities may coalesce to a size of up to 10 to 15 cm in diameter. Pleural effusion and tuberculous empyema are common as the disease progresses.

The nurse is performing a physical assessment on a client who is suspected to have sinusitis. What assessment findings does the nurse correlate with this infection? Select all that apply. Nosebleed Nasal crusts Purulence of the nasal cavity Pale mucous membranes Turbinate edema

Turbinate edema Nasal crusts Purulence of the nasal cavity Physical examination findings in acute bacterial sinusitis include turbinate edema, nasal crusts, and purulence of the nasal cavity. Nosebleeds may occur during winter months due to dryness of the mucous membranes and may not be associated with sinusitis. Pale mucous membranes may be indicative of anemic states and not significant for sinusitis.

Community-acquired pneumonia can be categorized according to several indexes. What are these indexes? (Select all that apply.)

a. Radiologic findings c. Age d. Presence of coexisting disease

A 23-year-old woman goes to the drugstore to buy a medication to ease the symptoms of her cold. Her friends have told her to buy a medication with an antihistamine in it to help dry up her runny nose and make it easier to breathe. The woman talks with the pharmacist, who has known her many years. The pharmacist recommends that this young woman not buy a cold medication with a decongestant in it. Why would he do that?

a. The client has a history of hyperthyroidism.