Chapter 31: Care of Patients with Infectious Respiratory Problems
A pt is admitted to the hospital with pneumonia. What does the nurse expect the chest x-ray to reveal? a. patchy areas of increased density b. tension pneumothorax c. thick secretions causing airway obstruction d. large hyper-inflated airways
a
A pt is diagnosed with pneumonia. During auscultation of the lower lung fields, the nurse hears hoarse crackles and identifies the pts problem of impaired oxygenation. What is the underlying physiologic condition associated with the patient's condition? a. hypoxemia b. hyperemia c. hypocapnia d. hypercapnia
a
A pt reports throat soreness and swelling, purulent nasal drainage, post-nasal drip, fever, dental pain and ear pressure. Which disorder does the nurse suspect? a. bacterial rhinosinusitis b. tonsilitis c. viral rhinosinusitis d. pneumonia
a
The female pt is receiving isoniazid (INH) to treat TB. Which teaching points are essential for the nurse to review with the pt? SELECT ALL THAT APPLY a. do not take meds such as Maalox with this medication b. avoid drinking alcoholic beverages c. the urine will be orange in color d. take a multivitamin and B complex e. if going out in the sun, be sure to wear protective clothing and sunscreen f. this drug reduces the effectiveness of oral contraceptives
A B D
A pt with suspected TB is admitted to the hospital. Along with a private room, which nursing intervention is appropriate RELATED TO isolation procedures? a. airborne and contact isolation for sputum only b. strict airborne precautions and use of specially fitted respirator face masks c. airborne isolation with surgical masks until diagnosis is confirmed d. only standard precautions are necessary until the diagnosis is confirmed
B
A pt with a history of frequent and recurrent episodes of tonsillitis now reports a severe sore throat with pain that radiates behind the ear and difficulty swallowing. The nurse suspects the pt may have peritonsillar abscess. On physical assessment, which deviated structure supports the nurse's supposition? a. uvula b. trachea c. tongue d. mucous membranes
a
Which pts are at risk for developing health care acquired pneumonia? SELECT ALL THAT APPLY a. confused pt b. pt with atrial fibrillation who is alert and oriented c. pt with gram negative colonization of the mouth d. pt with hyperthyroid disease e. malnourished pt f. pt with influenza
a c e f
A cluster of H5N1 bird influenza cases occurs. Which intervention is MOST appropriate for this outbreak of flu? a. administer 2 Vepacel injections 28 days apart b. avoid the use of antiviral drugs such as zanamivir c. give oral ABX as directed by HCP d. restrict fluids for all infected individuals
a
A critical concern for a pt returning to the unit after a surgical procedure is related to impaired oxygenation caused by inadequate ventilation. Which ABG value and assessment finding indicates to the nurse that O2 and incentive spirometry must be administered? a. PaO2 is 89 mm Hg with crackles b. PaO2 is 90 mm Hg with wheezing c. PCO2 is 38 mm Hg with clear lung sounds d. PCO2 is 45 mm Hg with atelectasis
a
A pt being treated for pneumonia reports pain that increases on inspiration. The nurses suspects which complication has occurred? a. pleuritic chest pain b. pulmonary emboli c. pleural effusion d. meningitis
a
A pt is admitted to the hospital with cough, purulent sputum production, temperature of 100.3F and reports SOB. Which intervention does the nurse provide first? a. set up O2 equipment and administer O2 b. instruct the pt about the importance of keeping the O2 delivery device on. c. monitor the effectiveness of O2 therapy (pulse ox, ABGs) as appropriate d. monitor the pt's anxiety related to the need for O2 delivery
a
An active 55-year-old schoolteacher with COPD taking prednisone asks if it is necessary to get a flu shot. What is the BEST response by the nurse? a. yes, flu shots are highly recommended for pts with chronic illness and/or pts receiving immunotherapy b. no, flu shots are only recommended for pts 60 years and older c. yes, it will help minimize the risk of triggering an exacerbation of COPD d. no, pts who are active, not living in a nursing home, and not health care providers do not need a flu shot
a
The nurse is conducting an in-service for the hospital staff about practices that help prevent pneumonia among at-risk pts. Which nursing intervention is encouraged as standard practice? a. administering vaccines to pts at risk b. implementing isolation for debilitated pts c. restricting foods from home in immune suppressed pts d. decontaminating respiratory therapy equipment weekly
a
The nurse is providing discharge instructions about pneumonia to a pt and family. Which discharge info must the nurse be sure to include? a. complete antibiotics as prescribed, rest, drink fluids, and minimize contact with crowds b. take all ABX as ordered, resume diet and all activities as before hospitalization c. no restrictions regarding activities, diet and rest because the pt is fully recovered when discharged d. continue ABX only until no further signs of pneumonia are present; avoid exposing immunosupressed individuals
a
Which patient is at most risk for development of rhinosinusitis? a. patient with deviated nasal septum b. pt with ear infection c. pt with an infected heart valve d. pt with cellulitis
a
A pt comes to the walk-in clinic reporting seasonal nasal congestion, sneezing, rhinorrhea, and itchy, watery eyes. The nurse identifies that the pt most likely has rhinosinusitis and should also be assessed for sinusitis. Which manifestations does the nurse assess in a pt with rhinosinusitis? SELECT ALL THAT APPLY a. pain over the cheek radiating to the teeth b. tenderness to percussion over the sinuses c. generalized musculoskeletal achiness d. generalized facial pain when bending over e. referred pain to the temple or back of the head f. generalized swelling of the face and neck
a b d e
An older adult pt often coughs and chokes while eating/trying to take medication. The pt insists that he is ok, but the nurse identifies the priority pt problem of risk for aspiration. Which nursing interventions are used to prevent aspiration pneumonia? SELECT ALL THAT APPLY a. head of the bed should always be elevated during feeding b. monitor the pt's ability to swallow small bites c. give thin liquids to drink in small, frequent amounts d. consult a nutritionist and obtain swallowing studies e. monitor the pt's ability to swallow saliva f. place the pt on NPO status until swallowing is normal
a b d e
Which conditions may cause pts to be at risk for aspiration pneumonia? SELECT ALL THAT APPLY a. continuous tube feedings b. bronchoscopy procedure c. MRI d. decreased LOC e. stroke f. chest tube
a b d e
A 42-year-old pt is admitted with a diagnosis of coccidioidomycosis. Which statements about this diagnosis are accurate? SELECT ALL THAT APPLY a. symptoms of coccidioidomycosis resemble those of other respiratory infections b. coccidioidomycosis is a viral infection caused by the coccidioides organism c. The coccidioides organism is present in the soil, but is inactive d. coccidioidomycosis is sometimes misdiagnosed as flu/pneumonia e. most younger healthy adults recover from the infection without treatment f. severe coccidioidomycosis is treated with drugs such as fluconazole (Diflucan)
a c d e
Drug therapy with first-generation antihistamines to treat sinusitis is used with caution in older adults because of which possible side effect? SELECT ALL THAT APPLY a. reduced clearance b. hypotension c. confusion d. dry mouth e. constipation f. decreased risk of confusion
a c d e
Which factors can contribute to acute rhinosinusitis? SELECT ALL THAT APPLY a. viruses b. coughing c. irritants d. bacteria e. facial trauma f. antibiotic therapy
a c d e
To reduce the spread of colds, which points must the nurse include when teaching pts? SELECT ALL THAT APPLY a. stay home from work, school, or other places where people gather b. seek medical attn at the first site of an oncoming cold c. cover both mouth and nose when coughing/sneezing d. dispose of used tissues properly e. thorough hand washing is essential f. avoid crowds of people
a c d e f
An adult pt is diagnosed with rhinosinusitis. What does the nurse instruct the pt to do? SELECT ALL THAT APPLY a. get plenty of rest, at least 8-10 hours/day b. keep fluid intake between 1000 and 1200 ml/day c. use a humidifier to help relieve congestion d. use nasal saline irrigation to safely relieve symptoms e. try sleeping with the head of your bed flat for better drainage f. limit exposure to any allergic causes
a c d f
Which are examples of a pandemic influenza? SELECT ALL THAT APPLY a. H1N1 (swine flu) b. seasonal flu c. Spanish influenza d. H5N1 (bird flu) e. viral influenza f. H7N9 (avian flu)
a c d f
A pt with rapid onset of severe headache, muscle aches, fever, chills, fatigue and weakness comes to the emergent care unit. On further assessment, he tells the nurse that additional symptoms include sore throat, cough and sneezing. What instructions should be given to the patient for his cough? SELECT ALL THAT APPLY a. be sure to wash your hands carefully whenever you cough/sneeze b. don't try to stop your sneezing because it will get worse c. cover your mouth with a tissue whenever you cough or sneeze d. be sure to perform oral hygiene at least 4x/day e. if you don't have a tissue, cough into your upper sleeve, not your hand f. be sure to dispose of used tissues immediately
a c e f
After several weeks of "not feeling well", a pt is seen in the HCP office for possible TB. If TB is present, which assessment finding does the nurse expect to observe? SELECT ALL THAT APPLY a. fatigue b. weight gain c. night sweats d. chest soreness e. low grade fever f. shortness of breath
a c e f
Which people are at GREATEST risk for developing TB in the US? SELECT ALL THAT APPLY a. an alcoholic homeless man who occasionally stays in a shelter b. a college student sharing a room in a dorm c. a person with immune dysfunction or HIV d. a homemaker who does volunteer work at a homeless shelter e. immigrants (especially those from the Phillipines/Mexico) f. an adult living in a crowded area such as a long-term-care facility
a c e f
A pt is seen in the HCP office and is diagnosed with community acquired pneumonia (CAP). What are the MOST common symptoms associate with CAP? SELECT ALL THAT APPLY a. dyspnea b. abdominal pain c. back pain d. chest discomfort e. increased sputum production f. fever
a d e f
Which statements about the Middle East respiratory syndrome (MERS) are accurate? SELECT ALL THAT APPLY a. MERS is caused by a virus that causes many respiratory illnesses including the common cold. b. The patient with MERS displays only respiratory symptoms such as cough and shortness of breath c. diagnostic tests for MERS include blood, urine and sputum for culture and sensitivity d. interventions for MERS can include IV fluids, mechanical ventilation and dialysis e. a pt being treated for MERS should be maintained on airborne, contact and reverse isolation f. "convalescent serum" may be given if the pt and convalescent person are the same blood type
a d f
Which diagnostic tests are most likely to be done for an older pt suspected of having pneumonia? SELECT ALL THAT APPLY a. sputum gram stain b. pulmonary function test c. fluorescein bronchoscopy d. peak flowmeter measurement e. chest x-ray f. CBC
a e f
The nurse is preparing a community info packet about "bird flu". What info does the nurse include in the packet? SELECT ALL THAT APPLY a. in the event of an outbreak, do not eat any cooked/uncooked poultry products b. prepare a minimum of 2 weeks supply of food, water, and routine prescription drugs c. listen to public health announcements and early warning signs for disease outbreaks d. avoid traveling to areas where there has been a suspected outbreak of disease e. obtain a supply of antiviral drugs such as oseltamivir f. in the event of an outbreak, avoid going to public areas such as churches or schools
b c d f
A parent calls the emergency department about her child who reports a severe sore throat and refuses to drink fluids or to take liquid pain meds. What is the MOST important question for the nurse to ask in order to determine the urgency of seeking immediate medical attention? a. does the child seem to be refusing fluids and meds because of the sore throat? b. is the child drooling or do you hear stridor, a raspy rough sound when the child breathes? c. when did the symptoms start and how long have you been encouraging fluids? d. is the throat red or do you see any white patches in the back of the throat?
b
A pt diagnosed with TB has been receiving treatment for 3 months and has clinically shown improvement. The family asks the nurse if the pt is still infectious. What is the nurse's BEST reply? a. the pt is still infectious until the entire treatment is completed b. the pt is likely not infectious but needs to continue treatment for at least 6 mos c. the pt is infectious until there is a negative chest xray d. the pt may/may not be infectious, a purified protein derivative test (PPD) must be done
b
A pt is admitted to the hospital with a diagnosis of TB. While providing medication teaching, the pt asks the nurse why she must give the drugs by directly observed therapy (DOT). What is the nurse's BEST response? a. DOT can be done by having any person other than the pt observe that the drugs are swallowed b. DOT is to assure that the drug regimen is followed and drug-resistant TB organisms do not occur c. DOT was developed because too many pts do not take their drugs as prescribed d. DOT is used only with homeless people who cannot be trusted to take the drugs as prescribed
b
A pt treated for pneumonia is being prepared for discharge by the nurse. The pt is capable of performing self care and is anxious to return to his job at the construction site. Which discharge instructions does the nurse give to this pt? a. you are not contagious to others, so you can return to work as soon as you like b. you will continue to feel tired and will fatigue easily for the next several weeks c. try to drink 4 quarts of water/day, especially if you are physically active d. you should be able to return to work full time in 2 weeks when your energy level returns
b
A pt with HIV is admitted to the hospital with a temp of 99.6F and reports of bloody sputum, night sweats, feeling of tiredness and SOB. What are theses assessment findings consistent with? a. pneumocystis jiroveci pneumonia (PJP) b. TB c. superinfection as a result of low CD4 count d. severe bronchitis
b
The nurse has identified the problem of ineffective airway clearance with bronchospasms for a pt with pneumonia. The pt has no previous history of chronic respiratory disorders. The nurse obtains an order for which nursing intervention? a. increased liters of humidified O2 via facemask b. scheduled and prn aerosol nebulizer bronchodilator treatments c. handheld bronchodilator inhaler as needed d. corticosteroid via inhaler or IV to reduce the inflammation
b
The nurse is giving discharge instructions to a pt diagnosed with a viral influenza. Which statement by the pt indicates the need for future teaching? a. I should try to rest, increase my fluid intake, and get a humidifier for the house b. I will wait for my test results; then I can get a prescription for ABX c. OTC analgesics like Tylenol or ibuprofen, can be used for pain d. I should gargle several times a day with warm salt water and use throat lozenges
b
The nurse is making home visits to an older adult recovering from a hip fracture and identifies the problem of risk for respiratory infection. Which condition represents a factor of normal aging that would contribute to this INCREASED risk? a. inability to force a cough b. decreased strength of respiratory muscles c. increased elastic recoil of alveoli d. increased macrophages in alveoli
b
What condition INCREASES the risk for the pt to develop community acquired pneumonia? a. pt has received the pneumococcal vaccination b. pt uses tobacco and alcohol often and regularly c. pt lives alone and eats alone d. pt received influenza shot in Nov rather than Sept
b
Which condition causes a pt to have the GREATEST risk for ventilator associated pneumonia? a. history of alcohol use b. presence of feeding tube c. weight loss d. IV therapy with normal saline
b
Which prescribed drug order for an older adult diagnosed with rhinosinusitis would the nurse clarify with the HCP? a. acetaminophen b. diphenhydramine c. montelukast d. cromolyn sodium
b
Which pt is at HIGHEST risk for developing HCA pneumonia? a. any hospitalized pt between the ages of 18 and 65 years b. 32-year-old trauma pt on a mechanical ventilator c. disabled 54-year-old with osteoporosis discharged to home d. any pt who has not received the vaccine for pneumonia
b
Which statement BEST describes pneumonia? a. an infection of just the "windpipe" because the lungs are "clear" of any problems b. a serious inflammation of the bronchioles, alveoli, and interstitial spaces from various causes c. only an infection of the lungs with mild to severe effects on breathing d. an inflammation resulting from lung damage caused by long-term smoking
b
Which test is the most accurate and rapid test for TB? a. chest xray b. nucleic acid amplification test (NAAT) c. tuberculin test (Mantoux test) d. sputum culture
b
A pt with COPD needs instruction in measures to prevent pneumonia. What information does the nurse include? SELECT ALL THAT APPLY a. avoid going outside b. clean all respiratory equipment you have at home c. avoid indoor pollutants such as dust and aerosol d. get plenty of rest and sleep daily e. limit alcoholic beverages to 4-5/week f. be sure to get pneumonia vaccinations
b c d f
Which statements about the precautions of caring for a hospitalized pt with TB are true? SELECT ALL THAT APPLY a. health care workers must wear a mask that covers the face and mouth b. negative air flow rooms are required for these pts c. health care workers must wear a N95 or high-effeiciency particulate air (HEPA) mask d. gown and gloves are included in appropriate barrier protection e. strict contact precautions must be maintained f. careful hand washing is required before and after providing pt care
b c d f
For which complications does the nurse monitor when a pt is diagnosed with rhinosinusitis? SELECT ALL THAT APPLY a. pneumonia b. meningitis c. abscess d. TB e. cellulitis f. tonsilitis
b c e
A pt that has active TB. Which drugs will the HCP order during the initial phase of treatment? SELECT ALL THAT APPLY a. bedaquiline fumarate b. isoniazid c. rifampin d. bacille calmette-guerin e. ethambutol f. pyrazinamide
b c e f
Pts who are at high risk for TB would be asked which questions upon assessment? SELECT ALL THAT APPLY a. what does your diet normally consist of? b. do you have an immune dysfunction/HIV? c. do you use alcohol or inject recreational drugs? d. where do you live in the US? e. do you work in a crowded area such as a prison/mental health facility f. have you ever had a bacille Calmette-Guerin (BCG) vaccine?
b c e f
Which signs and symptoms suggest that a pt's rhinosinusitis is bacterial? SELECT ALL THAT APPLY a. facial trauma b. purulent drainage c. headache d. fever e. drop in BP f. no response to decongestants
b d f
A 30 year old is admitted with severe coughing "fits" lasting several minutes. He tells you that he developed cold symptoms a little over a week ago. Which PRIORITY question would the nurse ask him? a. has your HCP prescribed ABX for your symptoms? b. on average, how often do you experience cold symptoms each winter? c. did you receive the usual childhood immunization when you were a child? d. do you smoke or did you ever smoke or use any tobacco products?
c
A 35-year-old male pt with no health problems state that he had a flu shot last year and asks if it is necessary to have it again this year. What is the BEST response by the nurse? a. No, because once you get a flu shot, it lasts for several years and is effective against many different viruses. b. yes, because the immunity against the virus wears off, increasing your chance of getting the flu c. yes, because the vaccine guards against a specific virus and reduces your chances of acquiring the flu and is only effective for 1 year d. no, flu shots are only for high risk pts and you are not considered to be high risk
c
A patient is admitted to the hospital for treatment of pneumonia. Which nursing assessment finding BEST indicates that the patient is responding to ABX? a. wheezing, O2 at 2L/min, RR 26, , no SOB/chills b. temp 99F, lung sounds clear, pulse ox on 2L/min at 98%, cough with yellow sputum c. cough, clear sputum, temp 99F, pulse ox at 96% on room air d. feeling tired, RR 28 on 2L/min of O2, audible breath sounds
c
A pt has a positive skin test result for TB. What explanation does the nurse give to the pt? a. there is active disease, but you are not yet infectious to others b. there is active disease, and you need immediate treatment c. you have been infected, but this does not mean active disease is present d. a repeat skin test is necessary because the test could give a false-positive result
c
A pt hospitalized for pneumonia has ineffective airway clearance related to fatigue, chest pain, excessive secretions, and muscle weakness. What nursing intervention helps to correct this problem? a. administer O2 to prevent hypoxemia and atelectasis b. push fluids to greater than 3000 ml/day to ensure adequate hydration c. administer bronchodilator therapy in a timely manner to decrease bronchospasms d. maintain semii-Fowler's position to facilitate breathing and prevent further fatigue
c
A pt reporting a "sore throat" also has a temp of 101.4F (38.5C), pus behind the tonsils, and swollen lymph nodes. This pt will most likely be treated for which type of bacterial infection? a. staphylococcus b. pneumococcus c. streptococcus d. epstein-barr virus
c
A pt reports experiencing mild fatigue and a dry, harsh cough. There is a possibility of exposure to inhalation anthrax 3-4 days ago, but the pt currently reports feeling much better. What does the nurse advise the pt to do? a. have a cbc to rule out the disease b. monitor for and immediately seek attention for respiratory symptoms c. consult a HCP for diagnostic testing and ABX therapy d. stay at home, rest, increase fluid intake, and avoid public places
c
A pt who presents with symptoms of influenza that started 24 hours ago is seen by the HCP. Which intervention does the nurse expect for this pt? a. prescription for ABX b. admission to an acute care facility c. an order for an antiviral agent such as oseltmivir d. instructions to rest and decrease fluid intake
c
After being discharged from the hospital, a pt is diagnosed with TB at the outpatient clinic. What is the correct procedure regarding public health policy in this case? a. contact the infection control nurse at the hospital because the hospital is responsible for follow-up of this case b. there are no regulations because the pt was diagnosed at the clinic and not during the hospitalization c. contact the public health nurse so that all individuals who have come in contact with the patient can be screened d. have the pt sign a waiver regarding the hospital and clinic's liability for treatment
c
An older adult pt asks the nurse how often one should receive the pneumococcal vaccine for pneumonia prevention. What is the nurse's BEST response? a. every year, when the pt is receiving the "flu shot" b. the standard is vaccination every 3 years c. it is usually given once 6-12 months after the Prevnar 13 vaccine d. there is no set schedule; it depends upon the pts history and risk factors
c
In a long term care facility caring for older adults and those who are immunocompromised , one employee and several pts have been diagnosed with influenza. What does the supervising nurse do to decrease risk of infection to other pts? a. ask employees who have the flu to stay home for at least 24 hrs b. place any pt with a sore throat, cough, or rhinorrhea into isolation for 1-2 wks c. ask employees with flu symptoms to stay home for up to 5 days after onset of symptoms d. recommend that all pts and employees be immediately vaccinated for the flu
c
In the event of a new severe acute respiratory syndrome (SARS) outbreak, what is the nurse's PRIMARY role? a. immediately report new cases of SARS to the CDC b. administer O2, standard ABX, and supportive therapies to pts c. prevent the spread of infection to other employees and pts d. initiate and strictly enforce contact isolation procedures
c
What nursing intervention may help to prevent the complications of pneumonia for a surgical pt? a. monitoring chest x-rays and WBC counts for early signs of infection b. monitoring lung sounds every shift and encouraging fluids c. teaching coughing, deep-breathing exercises, and use of incentive spriometry d. encouraging hand hygiene among all caregivers, patients and visitors
c
Which pt is the least likely to be at risk for developing pneumonia? a. pt with a 5-year history of smoking b. renal transplant pt c. post-op pt with bedside commode d. post-op pt with a hip replacement
c
The nurse is teaching the pt and family about care of a peritonsillar abscess at home. For what symptoms does the nurse indicate the need for the pt to go to the emergency dept IMMEDIATELY? SELECT ALL THAT APPLY a. persistent cough b. hoarseness c. stridor d. drooling e. N/V f. fever
c d
A pt diagnosed with TB agrees to take the medication as instructed and to complete the therapy. When does the nurse tell the pt is the BEST time to take the medication? a. before breakfast b. after breakfast c. midday d. bedtime
d
A pt has been compliant with drug therapy for TB and has returned as instructed for follow up. Which result indicates that the patient is NO LONGER infectious/communicable? a. negative chest xray b. no clinical symptoms c. negative skin test d. 3 negative sputum cultures
d
After receiving the subcutaneous Mantoux skin test, a pt with no risk factors returns to the clinic in the required 48-72 hours for the test results. Which assessment finding indicates a positive result? a. test area is red, warm, and tender to touch b. there is induration or a hard nodule any size at the site c. induration/hardened area measures 5 mm or greater d. induration/hardened area measures 10 mm or greater
d
The nurse is reviewing lab results for a pt who has pneumonia. Which lab value does the nurse expect to see for this pt? a. decreased Hgb b. increased RBCs c. decreased neutrophils d. increased WBCs
d
The nurse is reviewing the lab results for an older adult pt with pneumonia. Which lab value frequently seen in pts with pneumonia may NOT be seen in this pt? a. RBC 4.0-5.0 b. Hgb 12-16 g/dL c. Hct 36%-48% d. WBC 12,000-18,000 cell/microliter
d
Which statement by the pt indicates correct understanding of drug therapy for rhinosinusitis? a. a side effect of my antihistamine drug can increase itching b. when i am feeling better I can stop taking my ABX c. I will take acetaminophen tablets every 4 hours to prevent fever d. my decongestant will decrease the swelling so I can breathe
d
