Ch, 31 Infectious Respiratory Problems

6. The nurse has determined that a client has an acute sore throat. What is the nurse's best action? a. Assess whether the client can speak. b. Call an ear-nose-throat specialist. c. Administer an antibiotic. d. Give the client ice chips.

ANS: A A dry cough and difficulty swallowing may indicate that the client is developing laryngitis. The nurse should assess whether the client can speak or shows any changes in his or her voice. The other interventions are not appropriate.

21.A nurse admits a client from the emergency department. Client data are listed below: History: 70 years of age, History of diabetes, On insulin twice a day, Reports new-onset dyspnea and productive cough Physical Assessment: Crackles and rhonchi heard throughout the lungs, Dullness to percussion LLL, Afebrile, Oriented to person only Laboratory Values: WBC: 5,200/mm3 PaO2 on room air 65 mm Hg What action by the nurse is the priority? a. Administer oxygen at 4 liters per nasal cannula. b. Begin broad-spectrum antibiotics. c. Collect a sputum sample for culture. d. Start an IV of normal saline at 50 mL/hr.

ANS: A All actions are appropriate for this client who has manifestations of pneumonia. However, airway and breathing come first, so begin oxygen administration and titrate it to maintain saturations greater than 95%. Start the IV and collect a sputum culture, and then begin antibiotics.

1. A client has acute rhinitis. What is the most important intervention for the nurse to perform? a. Assess for symptoms of infection. b. Ascertain whether the client has allergies. c. Question the client on the use of nasal sprays. d. Do blood and urine screenings for drug use.

ANS: A Bacterial infection often occurs with acute rhinitis. The nurse should assess for symptoms because treatment may be warranted. It is not essential to assess for allergies or the use of nasal spray, or to determine whether drug use is occurring. All of these interventions are focused on determining a cause for repeated acute rhinitis and are primarily the responsibility of the health care provider. The nurse should focus on client assessment and should determine whether a secondary infection is present.

10. An older adult is admitted to the emergency department with respiratory symptoms. Which client symptom requires the nurse to intervene immediately? a. Confusion b. Scattered wheezing c. Crackles d. Flushed cheeks

ANS: A Confusion in an older adult can signify hypoxia. If the nurse waited to intervene until the older adult showed more traditional symptoms of pneumonia, the client may become critically ill. The other manifestations also require intervention but not as the priority.

11.The emergency department (ED) manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia. What outcome demonstrates that goals for this client type have been met? a. Antibiotics started before admission b. Blood cultures obtained within 20 minutes c. Chest x-ray obtained within 30 minutes d. Pulse oximetry obtained on all clients

ANS: A Goals for treatment of community-acquired pneumonia include initiating antibiotics prior to inpatient admission or within 6 hours of presentation to the ED. Timely collection of blood cultures, chest x-ray, and pulse oximetry are important as well but do not coincide with established goals.

18. The nurse is worried that a client who is not entirely reliable is being discharged home on therapy for multidrug-resistant tuberculosis. What strategy is the best to use for this client? a. Directly observed therapy b. IV drug administration c. Remaining in the hospital d. Isolation

ANS: A If a client is "not reliable," the risk is that the client will not take medications as required, causing spread of an organism that may become more drug resistant. The other answers are not correct.

23. An older adult client with heart failure asks if she should get a flu shot. Which is the nurse's best response? a. "Yes, because of your heart failure you are at greater risk for complications." b. "Yes, if it has been longer than 5 years since your last flu vaccination." c. "No, your heart failure makes you too weak to get the live virus vaccine." d. "No, the vaccine will interact with your heart medications."

ANS: A People older than 50 years and those with chronic disease should be vaccinated against the flu each year early in the fall because they are at higher risk of developing complications if they do get ill. Flu shots appear to be effective for only one flu season, so the client should get one annually. The live vaccine is recommended only for healthy people up to age 49. This vaccination should not have interactions with heart medications.

6.A client admitted for pneumonia has been tachypneic for several days. When the nurse starts an IV to give fluids, the client questions this action, saying "I have been drinking tons of water. How am I dehydrated?" What response by the nurse is best? a. "Breathing so quickly can be dehydrating." b. "Everyone with pneumonia is dehydrated." c. "This is really just to administer your antibiotics." d. "Why do you think you are so dehydrated?"

ANS: A Tachypnea and mouth breathing, both seen in pneumonia, increase insensible water loss and can lead to a degree of dehydration. The other options do not give the client useful information.

15.A client has been hospitalized with tuberculosis (TB). The client's spouse is fearful of entering the room where the client is in isolation and refuses to visit. What action by the nurse is best? a. Ask the spouse to explain the fear of visiting in further detail. b. Inform the spouse the precautions are meant to keep other clients safe. c. Show the spouse how to follow the isolation precautions to avoid illness. d. Tell the spouse that he or she has already been exposed, so it's safe to visit.

ANS: A The nurse needs to obtain further information about the spouse's specific fears so they can be addressed. This will decrease stress and permit visitation, which will be beneficial for both client and spouse. Precautions for TB prevent transmission to all who come into contact with the client. Explaining isolation precautions and what to do when entering the room will be helpful, but this is too narrow in scope to be the best answer. Telling the spouse it's safe to visit is demeaning of the spouse's feelings.

5. A client who has had acute tonsillitis develops drooling and reports severe throat pain. What is the nurse's priority intervention? a. Assess the throat for deviation of the uvula. b. Prepare the client for surgery. c. Teach the client about antibiotic therapy. d. Prepare the client for percutaneous needle aspiration.

ANS: A The nurse should first assess the throat for signs of peritonsillar abscess. If present, the nurse should call the health care provider immediately because aspiration of the abscess may be needed to maintain the airway.

8.A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority? a. Educating the client on adherence to the treatment regimen b. Encouraging the client to eat a well-balanced diet c. Informing the client about follow-up sputum cultures d. Teaching the client ways to balance rest with activity

ANS: A The treatment regimen for TB ranges from 6 to 12 months, making adherence problematic for many people. The nurse should stress the absolute importance of following the treatment plan for the entire duration of prescribed therapy. The other options are appropriate topics to educate this client on but do not take priority.

2.A hospital nurse is participating in a drill during which many clients with inhalation anthrax are being admitted. What drugs should the nurse anticipate administering? (Select all that apply.) a. Amoxicillin (Amoxil) b. Ciprofloxacin (Cipro) c. Doxycycline (Vibramycin) d. Ethambutol (Myambutol) e. Sulfamethoxazole-trimethoprim (SMX-TMP) (Septra)

ANS: A, B, C Amoxicillin, ciprofloxacin, and doxycycline are all possible treatments for inhalation anthrax. Ethambutol is used for tuberculosis. SMX-TMP is commonly used for urinary tract infections and other common infections.

2. A client enters the clinic with an acute sore throat and a temperature of 101.5° F (38.5° C). What diagnostic testing does the nurse educate the client about? (Select all that apply.) a. Complete blood count (CBC) b. Throat culture c. Monospot test d. Arterial blood gas e. Biopsy f. HIV testing

ANS: A, B, C CBC, throat culture, and monospot testing can help to determine the causes of sore throat and fever. A biopsy is not needed. Human immune deficiency virus (HIV) testing would not be indicated unless the symptoms were a recurrent problem. Arterial blood gases would not be performed unless the client had dyspnea and a low oxygen saturation reading.

4.A client has been diagnosed with an empyema. What interventions should the nurse anticipate providing to this client? (Select all that apply.) a. Assisting with chest tube insertion b. Facilitating pleural fluid sampling c. Performing frequent respiratory assessment d. Providing antipyretics as needed e. Suctioning deeply every 4 hours

ANS: A, B, C, D The client with an empyema is often treated with chest tube insertion, which facilitates obtaining samples of the pleural fluid for analysis and re-expands the lungs. The nurse should perform frequent respiratory system assessments. Antipyretic medications are also used. Suction is only used when needed and is not done deeply to prevent tissue injury.

4. A client who previously had a bacillus Calmette-Guérin (BCG) vaccine has a positive tuberculosis (TB) test. What symptoms assist in determining that the client has active disease? (Select all that apply.) a. Nausea b. Weight loss c. Insomnia d. Ankle edema e. Night sweats f. Increased urination

ANS: A, B, E TB symptoms include nausea and weight loss, as well as night sweats. Inability to sleep and ankle edema are not typical symptoms. Increased urination also is not a typical symptom.

1.A nurse is providing pneumonia vaccinations in a community setting. Due to limited finances, the event organizers must limit giving the vaccination to priority groups. What clients would be considered a priority when administering the pneumonia vaccination? (Select all that apply.) a. 22-year-old client with asthma b. Client who had a cholecystectomy last year c. Client with well-controlled diabetes d. Healthy 72-year-old client e. Client who is taking medication for hypertension

ANS: A, C, D, E Clients over 65 years of age and any client (no matter what age) with a chronic health condition would be considered a priority for a pneumonia vaccination. Having a cholecystectomy a year ago does not qualify as a chronic health condition.

1. What teaching is appropriate for a client with acute rhinitis and sinusitis? (Select all that apply.) a. Using hot packs over the sinuses b. Fluid restriction c. Saline irrigations d. Staying in a dry climate e. Taking echinacea f. Antifungal medications

ANS: A, C, E Treatment of sinusitis includes the use of broad-spectrum antibiotics (e.g., amoxicillin), analgesics for pain and fever, decongestants, steam humidification, hot and wet packs over the sinus area, and nasal saline irrigations. As complementary therapy, echinacea is recommended for the symptom of rhinitis. Antifungal medications, fluid restrictions, and staying in a dry climate are not recommended.

5. A client started on therapy for tuberculosis infection is reporting nausea. What does the nurse teach this client? (Select all that apply.) a. Eat a diet rich in protein, iron, and vitamins. b. Do not drink fluids with medications. c. Take medications at bedtime. d. Space medications 12 hours apart. e. Take medications with milk. f. Take an antiemetic daily.

ANS: A, C, F Taking the daily dose of medications at bedtime may help to decrease nausea. A well-balanced diet with foods rich in iron, protein, and vitamins C and B also helps to decrease nausea. Antiemetics are often prescribed. Drinking fluids with medications should not influence the nausea; neither should taking medications with milk. Spacing medications 12 hours apart is not recommended therapy.

24. Which person is at greatest risk for developing a community-acquired pneumonia? a. Middle-aged teacher who typically eats a diet of Asian foods b. Older adult who smokes and has a substance abuse problem c. Older adult with exercise-induced wheezing d. Young adult aerobics instructor who is a vegetarian

ANS: B Although age is a factor in the development of community-acquired pneumonia, other lifestyle and exposure factors increase the risk to a greater extent than age. Two conditions that heavily predispose to the development of pneumonia are cigarette smoking and alcoholism. Dietary choices typically do not predispose to the development of pneumonia. Cigarette smoking interferes with the ciliary function of removal of invasive materials. Alcoholism usually results in unbalanced nutrition, as well as decreased immune function. A middle-aged adult, an older adult with wheezing induced by exercise, and a young adult vegetarian would not be at risk for community-acquired pneumonia because they have no predisposing conditions.

3.Which teaching point is most important for the client with bacterial pharyngitis? a. Gargle with warm salt water. b. Take all antibiotics as directed. c. Use a humidifier in the bedroom. d. Wash hands frequently.

ANS: B Any client on antibiotics must be instructed to complete the entire course of antibiotics. Not completing them can lead to complications or drug-resistant strains of bacteria. The other instructions are appropriate, just not the most important.

9. The nurse assesses a client with pneumonia and notes decreased lung sounds on the left side and decreased lung expansion. What is the nurse's best action? a. Have the client cough and deep breathe. b. Check oxygen saturation and notify the health care provider. c. Perform an arterial blood gas analysis. d. Increase oxygen flow to 10 L/min.

ANS: B Decreased lung sounds and decreased lung expansion could indicate the development of a complication such as empyema or pus in the pleural space. The nurse should check the client's oxygen saturation and notify the provider. Infection can also move into the bloodstream and result in sepsis, so quick treatment is needed.

13.A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately? a. Albumin: 5.1 g/dL b. Alanine aminotransferase (ALT): 180 U/L c. Red blood cell (RBC) count: 5.2/mm3 d. White blood cell (WBC) count: 12,500/mm3

ANS: B INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of the liver enzymes) is extremely high and needs to be reported immediately. The albumin and RBCs are normal. The WBCs are slightly high, but that would be an expected finding in a client with an infection.

7.An older adult is brought to the emergency department by a family member, who reports a moderate change in mental status and mild cough. The client is afebrile. The health care provider orders a chest x-ray. The family member questions why this is needed since the manifestations seem so vague. What response by the nurse is best? a. "Chest x-rays are always ordered when we suspect pneumonia." b. "Older people often have vague symptoms, so an x-ray is essential." c. "The x-ray can be done and read before laboratory work is reported." d. "We are testing for any possible source of infection in the client."

ANS: B It is essential to obtain an early chest x-ray in older adults suspected of having pneumonia because symptoms are often vague. Waiting until definitive manifestations are present to obtain the x-ray leads to a costly delay in treatment. Stating that chest x-rays are always ordered does not give the family definitive information. The x-ray can be done while laboratory values are still pending, but this also does not provide specific information about the importance of a chest x-ray in this client. The client has manifestations of pneumonia, so the staff is not testing for any possible source of infection but rather is testing for a suspected disorder.

11. Which is the highest priority goal to set for a client with pneumonia? a. Absence of cyanosis b. Maintenance of SaO2 of 95% c. Walking 20 feet three times daily d. Absence of confusion

ANS: B Maintenance of an SaO2 of at least 95% is a clear goal that indicates that the client has adequate oxygenation. Absence of cyanosis and the presence of confusion are assessment factors that contribute to evaluation of oxygen; however, they are not absolute measures. Likewise, walking three times a day does not directly address oxygenation.

20. Which client does the nurse caution to avoid taking over-the-counter decongestants for manifestations of a cold or flu? a. Young man with a latex allergy b. Middle-aged woman with hypertension c. Teenage woman who is taking oral contraceptives d. Older man who has had type 1 diabetes mellitus for 20 years

ANS: B Most decongestants work by increasing blood vessel constriction. This action increases peripheral vascular resistance and blood pressure. The client who already has hypertension may develop dangerously high blood pressure when taking a decongestant. The client who has a latex allergy, is taking oral contraceptives, or has type 1 diabetes would not be likely to be affected by the decongestant in such a life-threatening manner as the client who is hypertensive.

19.A client is in the family medicine clinic reporting a dry, sore throat. The provider asks the nurse to assess for odynophagia. What assessment technique is most appropriate? a. Ask the client what foods cause trouble swallowing. b. Assess the client for pain when swallowing. c. Determine if the client can swallow saliva. d. Palpate the client's jaw while swallowing.

ANS: B Odynophagia is painful swallowing. The nurse should assess the client for this either by asking or by having the client attempt to drink water. It is not related to specific foods and is not assessed by palpating the jaw. Being unable to swallow saliva is not odynophagia, but it would be a serious situation.

17.A client is in the family practice clinic reporting a severe cough that has lasted for 5 weeks. The client is so exhausted after coughing that work has become impossible. What action by the nurse is most appropriate? a. Arrange for immediate hospitalization. b. Facilitate polymerase chain reaction testing. c. Have the client produce a sputum sample. d. Obtain two sets of blood cultures.

ANS: B Polymerase chain reaction testing is used to diagnose pertussis, which this client is showing manifestations of. Hospitalization may or may not be needed but is not the most important action. The client may or may not be able to produce sputum, but sputum cultures for this disease must be obtained via deep suctioning. Blood cultures will be negative.

5.The charge nurse on a medical unit is preparing to admit several "clients" who have possible pandemic flu during a preparedness drill. What action by the nurse is best? a. Admit the "clients" on Contact Precautions. b. Cohort the "clients" in the same area of the unit. c. Do not allow pregnant caregivers to care for these "clients." d. Place the "clients" on enhanced Droplet Precautions.

ANS: B Preventing the spread of pandemic flu is equally important as caring for the clients who have it. Clients can be cohorted together in the same set of rooms on one part of the unit to use distancing to help prevent the spread of the disease. The other actions are not appropriate.

19. A client is admitted with suspected avian influenza. The family asks the nurse what kind of care the client will get. Which statement by the nurse is correct? a. "He will be given standard antibiotic agents and will be placed in contact isolation." b. "He will be placed on airborne and contact isolation." c. "Oseltamivir (Tamiflu) will reduce complications of this infection." d. "All family members should be tested for evidence of the same disease."

ANS: B The client who is experiencing avian influenza should be on both airborne and contact isolation. Standard antibiotic agents would be ineffective with this disease process, as would most of the standard antiviral medications commonly used for influenza. Human-to-human contact through family members is likely only in very close living arrangements, so only specific members of the client's family should consider diagnostic testing.

27. A client is admitted with left lower lung pneumonia. Which assessment finding does the nurse correlate with this condition? a. Expiratory wheeze on the right side b. Dullness to percussion on the lower left side c. Crepitus of the skin around the left lung d. Crackles heard on expiration bilaterally

ANS: B The client with pneumonia may have dullness to percussion on the affected side. The other options are all inconsistent with pneumonia.

14.A client seen in the emergency department reports fever, fatigue, and dry cough but no other upper respiratory symptoms. A chest x-ray reveals mediastinal widening. What action by the nurse is best? a. Collect a sputum sample for culture by deep suctioning. b. Inform the client that antibiotics will be needed for 60 days. c. Place the client on Airborne Precautions immediately. d. Tell the client that directly observed therapy is needed.

ANS: B This client has manifestations of early inhalation anthrax. For treatment, after IV antibiotics are finished, oral antibiotics are continued for at least 60 days. Sputum cultures are not needed. Anthrax is not transmissible from person to person, so Standard Precautions are adequate. Directly observed therapy is often used for tuberculosis.

8. A client is worried about contracting influenza. What is the nurse's best response to the client? a. "Flu is no longer a prevalent problem." b. "Did you receive a flu vaccine this year?" c. "Current flu strains are generally mild." d. "If you develop symptoms, antibiotics will cure you."

ANS: B Vaccines for influenza are widely available and are recommended to prevent flu. Flu continues to be a major problem, affecting up to 20% of the U.S. population and causing 36,000 deaths annually.

3.A client in the emergency department is taking rifampin (Rifadin) for tuberculosis. The client reports yellowing of the sclera and skin and bleeding after minor trauma. What laboratory results correlate to this condition? (Select all that apply.) a. Blood urea nitrogen (BUN): 19 mg/dL b. International normalized ratio (INR): 6.3 c. Prothrombin time: 35 seconds d. Serum sodium: 130 mEq/L e. White blood cell (WBC) count: 72,000/mm3

ANS: B, C Rifampin can cause liver damage, evidenced by the client's high INR and prothrombin time. The BUN and WBC count are normal. The sodium level is low, but that is not related to this client's problem.

3. What is the best way for the nurse to decrease the risk of ventilator-associated pneumonia (VAP) in a ventilator-dependent client? (Select all that apply.) a. Provide prophylactic antibiotics. b. Provide frequent oral care. c. Keep the head of the bed elevated. d. Maintain good hand hygiene. e. Perform chest percussion frequently.

ANS: B, C, D Providing frequent oral care, keeping the head of the bed elevated, and maintaining good hand hygiene are currently stated as the best ways to help prevent VAP. Prophylactic antibiotics are not recommended; neither is taking the client off the ventilator. Likewise, frequent chest percussion is not stated as an intervention to decrease VAP.

6. The nurse is caring for a client who is suspected of having severe acute respiratory syndrome (SARS). What actions by the nurse are most appropriate? (Select all that apply.) a. Wash hands when entering the client's room and use Standard Precautions. b. Wear a gown and goggles when entering the client's room. c. Teach the client to wear a mask at all times when someone is in the room. d. Use a disposable particulate mask respirator when the client is coughing. e. Keep the door to the client's room open to allow close monitoring. f. Place the client in a negative airflow room, if available in the facility.

ANS: B, D, F The nurse should follow Airborne Precautions when caring for clients suspected of SARS. Wear a gown and goggles when in the room and caring for the client. Use a disposable particulate mask respirator if the client is coughing, or if particles are being aerosolized. Handwashing and Standard Precautions are not enough. The client does not have to wear a mask while others are in the room because they should be protecting themselves by using Airborne Precautions.

25. Which is the nurse's best response to an older adult client who is hesitant to take the pneumococcal vaccination and influenza vaccine in the same year? a. "You need both injections. A risk factor for getting pneumonia is infection with influenza." b. "Take both injections. They will protect you against respiratory problems for this year." c. "The flu shot may protect you against influenza but not against bacteria that cause pneumonia." d. "You should get the pneumococcal vaccination so you won't infect other people."

ANS: C Although influenza can lead to pneumonia, and preventing influenza with a flu shot reduces the risk for a secondary pneumonia, bacterial pneumonia can be acquired without influenza as a precipitating event and can be life threatening. Getting both injections will not protect the client from respiratory problems, nor will it prevent the client from being infectious to other people.

1.A nurse working in a geriatric clinic sees clients with "cold" symptoms and rhinitis. Which drug would be appropriate to teach these clients to take for their symptoms? a. Chlorpheniramine (Chlor-Trimeton) b. Diphenhydramine (Benadryl) c. Fexofenadine (Allegra) d. Hydroxyzine (Vistaril)

ANS: C First-generation antihistamines are not appropriate for use in the older population. These drugs include chlorpheniramine, diphenhydramine, and hydroxyzine. Fexofenadine is a second-generation antihistamine.

12.A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective? a. "I need to take extra vitamin C while on INH." b. "I should take this medicine with milk or juice." c. "I will take this medication on an empty stomach." d. "My contact lenses will be permanently stained."

ANS: C INH needs to be taken on an empty stomach, either 1 hour before or 2 hours after meals. Extra vitamin B needs to be taken while on the drug. Staining of contact lenses commonly occurs while taking rifampin (Rifadin).

7. A client who is immune compromised develops muscle aches and fever. The client is admitted to the hospital for several days and is diagnosed with influenza. At discharge, the client asks when he can go back to work. What is the nurse's best response? a. "You should be able to return to work in 5 days." b. "You can return to work as soon as you feel ready." c. "You cannot return to work for several weeks." d. "You will need to have cultures performed before returning to work."

ANS: C Immune compromised clients are contagious for several weeks. The client should remain at home until he is not contagious.

12. The nurse is teaching a client with pneumonia ways to clear secretions. Which intervention is the most effective? a. Administering an antitussive medication b. Administering an antiemetic medication c. Increasing fluids to 2 L/day if tolerated d. Having the client cough and deep breathe hourly

ANS: C Increasing fluids has been proven to decrease the thickness of secretions, thus allowing them to be expectorated quickly. The other interventions would not be as effective.

10.A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia. To reduce this risk, what activity should the nurse delegate to the unlicensed assistive personnel (UAP)? a. Encourage between-meal snacks. b. Monitor temperature every 4 hours. c. Provide oral care every 4 hours. d. Report any new onset of cough.

ANS: C Oral colonization by gram-negative bacteria is a risk factor for healthcare-associated pneumonia. Good, frequent oral care can help prevent this from developing and is a task that can be delegated to the UAP. Encouraging good nutrition is important, but this will not prevent pneumonia. Monitoring temperature and reporting new cough in clients is important to detect the onset of possible pneumonia but do not prevent it.

15. The newly employed nurse received a bacillus Calmette-Guérin (BCG) vaccine before moving to the United States. The nurse needs to receive a tuberculin (TB) test as part of the pre-employment physical. What does the nurse do? a. The nurse should not receive the tuberculin test. b. The nurse will need a two-step TB test. c. The nurse will need a chest x-ray instead. d. A physician should examine the nurse before the TB test is given.

ANS: C The bacillus Calmette-Guérin (BCG) vaccine contains attenuated tubercle bacilli and is used in many countries to produce increased resistance to TB. The nurse will have a positive skin test. The client should be evaluated for TB with a chest x-ray. A physician examination is not necessary.

17. A client has multidrug-resistant tuberculosis (TB). What is the most important fact for the nurse to teach the client? a. "You will need to take medications longer than clients with other strains." b. "You will need to remain in the hospital until cultures are negative." c. "You will need to wear a mask when you go out in public." d. "You will need to have drug cultures done weekly."

ANS: C The client should wear a mask when out of the home environment and in crowds to prevent spread of the infection. The other statements are not accurate.

13. A client who works in a day care facility is admitted to the emergency department. The client is diagnosed with pneumonia, and a sputum culture is taken. Infection with Streptococcus pneumoniae is confirmed. What is the nurse's primary action? a. Have emergency intubation equipment nearby. b. Teach the client about the treatment. c. Isolate the client. d. Perform chest physiotherapy.

ANS: C The client who works in a day care facility and is infected with Streptococcus pneumoniae may have a drug-resistant pneumonia. It is extremely important that this organism does not spread to other clients; the client should be isolated.

14. What is the priority nursing intervention when caring for a client with severe acute respiratory syndrome (SARS)? a. Maintaining Standard Precautions b. Administering antibiotics c. Assessing oxygenation d. Making sure the client stays hydrated

ANS: C The client with SARS can rapidly develop hypoxia. Assessing oxygenation is a priority because intubation and mechanical ventilation may be needed. Maintaining precautions is essential for preventing the spread of this illness, but oxygenation and client safety are the highest priorities. Antibiotics are administered if bacterial pneumonia occurs with this disease. Hydration is important to make sure secretions stay liquefied; this is also secondary to oxygenation.

28. The nurse auscultates the following lung sound in the client with pneumonia. What is the best intervention? (Click the media button to hear the audio clip.) a. Have the client cough and deep breathe. b. Prepare to administer a bronchodilator. c. Have the client use an incentive spirometer. d. Administer IV fluids.

ANS: C The sound heard is crackles. Crackles often indicate atelectasis, which can be reversed by using an incentive spirometer. If no spirometer is available, coughing and deep breathing is the next best option. This client does not have wheezing, so bronchodilators are not indicated. IV fluids would not help atelectasis.

20.A client is admitted with suspected pneumonia from the emergency department. The client went to the primary care provider a "few days ago" and shows the nurse the results of what the client calls "an allergy test," as shown below: What action by the nurse takes priority? a. Assess the client for possible items to which he or she is allergic. b. Call the primary care provider's office to request records. c. Immediately place the client on Airborne Precautions. d. Prepare to begin administration of intravenous antibiotics.

ANS: C This "allergy test" is actually a positive tuberculosis test. The client should be placed on Airborne Precautions immediately. The other options do not take priority over preventing the spread of the disease.

2.A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is worse when bending over, tenderness across the cheeks, and postnasal discharge. What instruction will be most helpful? a. "Ice packs may help with the facial pain." b. "Limit fluids to dry out your sinuses." c. "Try warm, moist heat packs on your face." d. "We will schedule you for a computed tomography scan this week."

ANS: C This client has rhinosinusitis. Comfort measures for this condition include breathing in warm steam, hot packs, nasal saline irrigations, sleeping with the head elevated, increased fluids, and avoiding cigarette smoke. The client does not need a CT scan.

7. The nurse is caring for a client who has inhalation anthrax. What nursing actions are of the highest priority? (Select all that apply.) a. Placing the client in an isolation room b. Teaching the client how to use a mask c. Teaching the client about long-term antibiotic therapy d. Using handwashing and other Standard Precautions e. Reporting suspected cases to the proper authorities

ANS: C, D, E The client should not stop the drug merely because he or she has no manifestations. The client will need to be on the drug for longer than 1 month. The nurse should teach the client about long-term antibiotic therapy to help with compliance. Inhalation anthrax is not spread by person-to-person contact, so isolation would not be necessary. The client would not need a mask. Health care providers need only use handwashing and Standard Precautions. Always report inhalation anthrax to authorities because it is considered an intentional act of terrorism.

18.A client has the diagnosis of "valley fever" accompanied by myalgias and arthralgias. What treatment should the nurse educate the client on? a. Intravenous amphotericin B b. Long-term anti-inflammatories c. No specific treatment d. Oral fluconazole (Diflucan)

ANS: D "Valley fever," or coccidioidomycosis, is a fungal infection. Many people do not need treatment and the disease resolves on its own. However, the presence of joint and muscle pain indicates a moderate infection that needs treatment with antifungal medications. IV amphotericin is reserved for pregnant women and those with severe infection. Anti-inflammatory medications may be used to treat muscle aches and pain but are not used long term.

3. It is suspected that a client has bacterial pharyngitis. What is the best intervention? a. Administer a broad-spectrum antibiotic. b. Have the client produce a sputum specimen. c. Obtain samples for culture and sensitivity. d. Assess a rapid antigen test (RAT).

ANS: D A common cause of bacterial pharyngitis is group A streptococcal virus, which can lead to serious complications. Both RATs and culture and sensitivity can diagnose this bacterium; however, with an RAT, the health care provider can obtain results in about 15 minutes, and definitive treatment can begin much sooner. A broad-spectrum antibiotic would not be administered before it was determined whether the infection was bacterial. A sputum specimen is needed for lung infection but not for throat infection.

16.A client is being discharged on long-term therapy for tuberculosis (TB). What referral by the nurse is most appropriate? a. Community social worker for Meals on Wheels b. Occupational therapy for job retraining c. Physical therapy for homebound therapy services d. Visiting Nurses for directly observed therapy

ANS: D Directly observed therapy is often utilized for managing clients with TB in the community. Meals on Wheels, job retraining, and home therapy may or may not be appropriate.

2. A client has pharyngitis. Which symptom helps the nurse determine whether the infection is bacterial versus viral? a. Redness in the back of the throat b. Enlarged lymph glands in the neck c. Nasal discharge d. Skin rash

ANS: D Generally a rash can appear with bacterial pharyngitis, but not with viral. The other symptoms are characteristic of both.

9.A client has been admitted for suspected inhalation anthrax infection. What question by the nurse is most important? a. "Are any family members also ill?" b. "Have you traveled recently?" c. "How long have you been ill?" d. "What is your occupation?"

ANS: D Inhalation anthrax is rare and is an occupational hazard among people who work with animal wool, bone meal, hides, and skin, such as taxidermists and veterinarians. Inhalation anthrax seen in someone without an occupational risk is considered a bioterrorism event and must be reported to authorities immediately. The other questions are appropriate for anyone with an infection.

4. The nurse is caring for a client with recurrent bacterial pharyngitis. Which is the nurse's highest priority intervention? a. Assess for symptoms of human immune deficiency virus (HIV). b. Ask about exposure to allergens. c. Perform nasal cultures. d. Teach the client about antibiotic therapy.

ANS: D Management of bacterial pharyngitis involves the use of antibiotics and the same supportive care provided for viral pharyngitis. Stress the importance of completing the entire antibiotic prescription, even when symptoms improve or subside. Failure to take all prescribed antibiotics is often the cause of recurrent infections. Although it is important for overall health that the client know his or her HIV status, it is not the highest priority intervention in the treatment plan. Allergens do not cause bacterial infections. Nasal cultures would not be a high priority unless the client had "failed" treatment with more than one antibiotic and was compliant with treatment.

26. Which is a priority teaching intervention for the client who is using a nicotine patch? a. "Abruptly discontinuing this patch can cause high blood pressure." b. "Abruptly discontinuing this patch can cause nausea and vomiting." c. "Smoking while using this patch increases the risk for pneumonia." d. "Smoking while using this patch increases the risk for a heart attack."

ANS: D Nicotine constricts blood vessels, increases mean arterial pressure, and increases afterload. Smoking while using a nicotine patch increases afterload to such an extent that the myocardium must work harder (with the coronary arteries constricted) and may cause a myocardial infarction. Abruptly discontinuing the patch will not necessarily cause hypertension or nausea and vomiting. Smoking while using the patch will not increase the risk for pneumonia.

4.A client is in the family practice clinic reporting a severe "cold" that started 4 days ago. On examination, the nurse notes the client also has a severe headache and muscle aches. What action by the nurse is best? a. Educate the client on oseltamivir (Tamiflu). b. Facilitate admission to the hospital. c. Instruct the client to have a flu vaccine. d. Teach the client to sneeze in the upper sleeve.

ANS: D Sneezing and coughing into one's sleeve helps prevent the spread of upper respiratory infections. The client does have manifestations of the flu (influenza), but it is too late to start antiviral medications; to be effective, they must be started within 24 to 48 hours of symptom onset. The client does not need hospital admission. The client should be instructed to have a flu vaccination, but now that he or she has the flu, vaccination will have to wait until next year.

16. The nurse is caring for several clients on a respiratory floor. The nurse should place the client with which condition in isolation? a. Fever and weight loss b. Negative QuantiFERON TB gold test c. Negative acid-fast bacillus (AFB) stain d. Positive nucleic acid amplification test (NAAT)

ANS: D The NAAT is a new rapid test for the diagnosis of tuberculosis (TB). Results are available in less than 2 hours. A positive test is conclusive for TB, and the client should be placed in isolation per facility policy. A client with a negative QuantiFERON gold test would not have tuberculosis. Likewise, a client with a negative AFB would not have tuberculosis. The client with fever and weight loss could have tuberculosis, but diagnostic tests would be needed because these are nonspecific manifestations.

21. An older client reports having a cold and a "full bladder." What does the nurse obtain for or from the client? a. Order for a Foley catheter b. Order for a one-time catheterization c. Urine specimen d. History focusing on current medications

ANS: D The nurse needs to assess more before intervening. Clients often take antihistamines for a "cold." Antihistamines are often composed of anticholinergic drugs. In older adult clients, these medications can cause or worsen urinary retention.

29. A client has a tuberculin skin test as a pre-employment physical requirement. Which statement by the nurse is best made to the client who has the test result seen in the photograph below? a. "Your PPD is negative. No further follow-up is necessary." b. "You will need to have a second PPD." c. "You will need to have titers drawn." d. "You will need further testing."

ANS: D The tuberculin test (Mantoux test) result is the most commonly used reliable test of TB infection. The photo shows a positive reaction. A positive reaction does not mean that active disease is present but indicates exposure to TB or the presence of inactive (dormant) disease. Conclusive evidence of TB is not provided through an examination of the chest or a chest x-ray. Only a sputum specimen will provide definitive evidence of the disease process.

22. A client has a peritonsillar abscess. Which priority instruction does the nurse provide to this client? a. "If you notice an enlarged node on the side of your neck where the abscess is, call your health care provider." b. "Stay home from work or school until your temperature has been normal for 24 hours." c. "You may gargle with warm water that has a teaspoon of salt in it as often as you like." d. "Take the antibiotic for the entire time it is prescribed, not just until you feel better."

ANS: D Untreated or ineffectively treated peritonsillar abscesses can extend throughout the pharyngeal area, causing swelling that may jeopardize the client's airway. Therefore, the client should take his antibiotic for the entire time prescribed to maximize the therapeutic effect. Gargling with warm water and refraining from normal activities may provide symptomatic relief for the client but would not be considered priority instructions. Also, swelling, pain, and inflammation could be noted by the client on the same side of the neck as the abscess.