Infection Control

The nurse is caring for a TB pt. She knows that which statements about TB pt care are true Select All That Apply A. HCPs must wear a mask covering face and mouth B. Negative airflow room is required C. HCP must wear an N95 or HEPA mask D. Gloves and Gown are included in PPEs for this pt E. Strict contact precautions must be maintained at all times

B, C, D

A man presents to the providers office with reports of not feeling well for the past several weeks. A TB test is given in the office. If it is positive, which assessment findings does the nurse expect to find Select All That Apply A. Wt gain B. Fatigue C. Chest soreness D. Low-grade fever E. Night sweats

B, D, E Fatigue Night sweats Fever

A pt is seen in the HCP office and dx with community-acquired pneumonia. The nurse knows the most common symptoms that this pt may have is A. dyspnea B. abdominal pain C. back pain D. hypoxemia E. chest discomfort F. a smoker

A, D, E dyspnea hypoxemia chest discomfort

A pt is suspected on having community-acquired pneumonia. The nurse anticipates which of the following tests to be done to dx pt A. sputum gram stain B. Pulmonary function test C. fluorescein bronchoscopy D. peak flow meter measurement E. chest x-ay

A, E sputum gram stain CXR

The nurse is giving med instructions to a TB pt. The nurse knows the teaching was effective when the pt states A. I will take 3 drugs--isoniazid, rifampin, and pyrazinamide, then ethambutol may be added later B. The isoniazid combines with the TB bacteria. I may have to take rifampin and pyrazinamide if my symptoms continue C. combining the drugs all in one pill is a convenient way for me to take all the medications. D. combining the meds is best so I will take the isoniazid, rifampin, and pyrazinamide all at the same time

A 3 drugs--isoniazid, rifampin, and pyrazinamide, then ethambutol may be added later

An older adult resident in a long-term-care facility becomes confused and agitated, telling the nurse, "Get out of here! You're going to kill me!" Which action will the nurse take first? A. Check the resident's oxygen saturation. B. Do a complete neurologic assessment. C. Give the prescribed PRN lorazepam (Ativan). D. Notify the resident's primary care provider

A A common reason for sudden confusion in older clients is hypoxemia caused by undiagnosed pneumonia. The nurse's first action should be to assess oxygenation by checking the pulse oximetry. Determining the cause of the confusion is the primary goal of the RN.

A pt is being admitted for pneumonia. The sputum culture is positive for streptococcus, and the pt asks the nurse how long the treatment will be. The nurse knows? A. The pt will be treated for 5 to 7 days. B. The pt will require IV antibiotics for 7 to 10 days. C. The pt will complete 6 days of therapy. D. The pt must be afebrile for 24 hours.

A Anti-infectives usually are used for 5 to 7 days in uncomplicated community-acquired pneumonia, and for up to 21 days in an immunocompromised pt or one with hospital-acquired pneumonia

A pt is taking isoniazid, rifampin, pyrazinamide, and ethambutol for TB. The pt calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? A. Ethambutol B. Isoniazid C. Pyrazinamide D. Rifampin

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

An elderly client with pneumonia may appear with which of the following symptoms first? A. Altered mental status and dehydration B. Fever and chills C. Hemoptysis and dyspnea D. Pleuritic chest pain and cough

A Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.

A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The nurse suggests that the client increase intake of: A. Meats and citrus fruits B. Grains and broccoli C. Eggs and spinach D. Potatoes and fish

A Needs to increase intake of protein, iron, and vitamin C

A critical concern for a post op pt returning to the floor is r/t impaired oxygenation caused by inadequate ventilation. The ABG and assessment finding that alerts the nurse to use oxygen and the ICS is A. PaO2 is 90mm Hg with crackles B. PaO2 is 45mm Hg with atelectasis C. PaO2 is 90mm Hg with wheezing D. PaO2 is 38mm Hg with clear lung sounds

A PaO2 is 90mm Hg with crackles

A nurse is caring for an 89-year-old client admitted with pneumonia. He has an IV of normal saline running at 100 mL/hr and antibiotics that were initiated in the emergency department 3 hours ago. He has oxygen at 2 liters/nasal cannula. What assessment finding by the nurse indicates that goals for a priority diagnosis have been met for this client? A. The client is alert and oriented to person, place, and time. B. Blood pressure is within normal limits and client's baseline. C. Skin behind the ears demonstrates no redness or irritation. D. Urine output has been >30 mL/hr per Foley catheter.

A Rationale: One of the first manifestations of pneumonia in an older adult is acute confusion as a result of impaired gas exchange. A client with pneumonia who is alert and oriented to person, place, and time is responding well to appropriate therapy for the disorder. The blood pressure is not an indicator of effective management of pneumonia, and neither is urine output. The skin behind his ears being intact is important and desirable but is not an outcome indicator for pneumonia management.

A client was infected with TB 10 years ago but never developed the disease. He's now being treated for cancer. The client begins to develop signs of TB. This is known as which of the following types of infection? A. Active infection B. Primary infection C. Superinfection D. Tertiary infection

A Some people carry dormant TB infections that may develop into active disease. In addition, primary sites of infection containing TB bacilli may remain inactive for years and then activate when the client's resistance is lowered, as when a client is being treated for cancer. There's no such thing as tertiary infection, and superinfection doesn't apply in this case.

The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin-addicted. Which action will be most effective in ensuring that the client completes treatment? A. Arrange for a health care worker to watch the client take the medication. B. Give the client written instructions about how to take prescribed medications. C. Have the client repeat medication names and side effects. D. Instruct the client about the possible consequences of nonadherence.

A The client is unlikely to adhere to long-term treatment unless med administration is directly supervised. The best option is to arrange for DOT.

A pt who has spent the past 9 months living in homeless shelters has been dx with confirmed tuberculosis (TB). The nurse anticipates the physician will order which medications for the pt? A. Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Zinamide), ethambutol (Myambutol) B. Metronidazole (Flagyl), acyclovir (Zovirax), flunisolide (AeroBid), rifampin (Rifadin) C. Prednisone (Prednisone), guaifenesin (Organidin), ketorolac (Toradol), pyrazinamide (Zinamide) D. Salmeterol (Serevent), cromolyn sodium (Intal), dexamethasone (Decadron), isoniazid (INH)

A The combination of isoniazid, rifampin, pyrazinamide, and ethambutol is used to treat TB. Metronidazole is used to treat anaerobic bacteria and some parasites, but is not effective against TB. Acyclovir is used to treat viral infection. Flunisolide is a corticosteroid that is useful in asthma or other airway disease to prevent wheezing. Prednisone is a steroid. Guaifenesin is a mucolytic. Ketorolac is a nonsteroidal anti-inflammatory drug that is used for short-term pain relief. Salmeterol and cromolyn sodium would most likely be given to clients with respiratory difficulties such as poorly controlled asthma from allergic sources. Dexamethasone is a steroid.

When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation? A. Bronchial B. Bronchovesicular C. Tubular D. Vesicular

A Bronchial Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchovesicular are normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly heard in the bases of the lung fields.

This TB test is a done with a sputum sample and can show TB and drug resistance to the main drug for treating it. The results are ready in 2 hours or less. A. Nucleic Acid Amplification Test (NAAT) B. Quantiferon-TB Gold (QFT-G) C. Mantoux test D. CXR

A NAAT

Which pneumonia complication does the nurse recognize as creating pain that increases on inspiration because of inflammation of the parietal pleura? A. pleuritic CP B. meningitis C. COPD D. Pulmonary emboli

A Pleuritic CP

A nurse is auscultating the lower lung fields of a pneumonia pt. She hears coarse crackles and ids the problem as impaired oxygenation. She knows the underlying physiologic condition associated with pt condition is A. hypoxemia B. hyperemia C. hypocapnia D. hypercapnia

A hypoxemia

Which test results are indicative of active TB? A. induration of 11mm and positive sputum B. sputum tests positive for blood C. positive chest x-ray for TB D. positive chest x-ray and clinical symptoms

A induration 11mm and positive sputum

The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin-addicted. Which action will be most effective in ensuring that the client completes treatment? A) Arrange for a health care worker to watch the client take the medication. B) Give the client written instructions about how to take prescribed medications. C) Have the client repeat medication names and side effects. D) Instruct the client about the possible consequences of nonadherence.

A) Arrange for a health care worker to watch the client take the medication.

An older adult resident in a long-term-care facility becomes confused and agitated, telling the nurse, "Get out of here! You're going to kill me!" Which action will the nurse take first? A) Check the resident's oxygen saturation. B) Do a complete neurologic assessment. C) Give the prescribed PRN lorazepam (Ativan). D) Notify the resident's primary care provider.

A) Check the resident's oxygen saturation.

A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Select all that apply. A) Combination drug therapy is effective in preventing transmission. B) Combination drug therapy is the most effective method of treating TB. C) Combination drug therapy will decrease the length of required treatment to 2 months. D) Multiple drug regimens destroy organisms as quickly as possible. E) The use of multiple drugs reduces the emergence of drug-resistant organisms.

A) Combination drug therapy is effective in preventing transmission. B) Combination drug therapy is the most effective method of treating TB. D) Multiple drug regimens destroy organisms as quickly as possible. E) The use of multiple drugs reduces the emergence of drug-resistant organisms.

A client is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The client calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? A) Ethambutol B) Isoniazid C) Pyrazinamide D) Rifampin

A) Ethambutol

A client who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the client? A) Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Zinamide), ethambutol (Myambutol) B) Metronidazole (Flagyl), acyclovir (Zovirax), flunisolide (AeroBid), rifampin (Rifadin) C) Prednisone (Prednisone), guaifenesin (Organidin), ketorolac (Toradol), pyrazinamide (Zinamide) D) Salmeterol (Serevent), cromolyn sodium (Intal), dexamethasone (Decadron), isoniazid (INH)

A) Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Zinamide), ethambutol (Myambutol)

The nurse recognizes that isoniazid, rifampin and pyrazinamide can cause impairment of the liver. She will look for the following s/s of liver impairment: A. dark urine B. weight gain C. diarrhea D. tremors E. yellowing of skin, eyes , and/or hard palate

A,, E will have anorexia not wt gain diarrhea and tremors are not s/s of liver issues pt wil have clay-colored stools

A client has recently been released from prison and has just tested positive for tuberculosis (TB). What teaching points does the community health nurse want to stress for this client regarding medications? Select all that apply. A) Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance. B) The medications may cause nausea. The client should take them at bedtime. C) The client is generally not contagious after 2 to 3 consecutive weeks of treatment. D) These medications must be taken for 2 years. E) These medications may cause kidney failure.

A) Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance. B) The medications may cause nausea. The client should take them at bedtime.

A client has been admitted to the hospital with suspected TB. What drugs should the nurse plan to teach the client about before discharge? Select all that apply. A) Rifampin (Rifadin); contact lenses can become stained orange B) Isoniazid (INH); report yellowing of the skin or darkened urine C) Pyrazinamide (PZA); maintain a fluid restriction of 1200 mL/day D) Ethambutol (Myambutol); report any changes in vision E) Amoxicillin (Amoxil); take this drug with food or milk

A) Rifampin (Rifadin); contact lenses can become stained orange B) Isoniazid (INH); report yellowing of the skin or darkened urine D) Ethambutol (Myambutol); report any changes in vision

A nurse is caring for an 89-year-old client admitted with pneumonia. He has an IV of normal saline running at 100 mL/hr and antibiotics that were initiated in the emergency department 3 hours ago. He has oxygen at 2 liters/nasal cannula. What assessment finding by the nurse indicates that goals for a priority diagnosis have been met for this client? A) The client is alert and oriented to person, place, and time. B) Blood pressure is within normal limits and client's baseline. C) Skin behind the ears demonstrates no redness or irritation. D) Urine output has been >30 mL/hr per Foley catheter

A) The client is alert and oriented to person, place, and time.

A pt recently released from prison has just tested positive for TB. What teaching points does the community health nurse want to stress for this pt about the meds? Select All That Apply A. Not taking the meds could lead to an infection that is difficult to treat or to total drug resistance. B. The meds may cause nausea, so take them at bedtime. C. The pt is not contagious after 2 to 3 consecutive weeks of treatment. D. These meds have to be taken for 2 years.

A, B, C Not taking the meds as prescribed can lead to an infection that is difficult to treat or to total drug resistance. The meds may cause nausea and are best taken at bedtime to prevent this. The pt is generally not contagious after 2 to 3 weeks of consecutive treatment BUT must show improvement in the condition. The combination regimen for treatment of TB has decreased treatment time from 6 to 12 months to 6 months. TB meds can cause liver failure, but not kidney failure.

The TB pt is receiving isoniazid (INH). The nurse should include which important teaching points A. Do not take meds such as Maalox with INH B. Avoid alcohol C. Urine may be orange D. Need to take a B complex vitamin E. Wear protective clothing and sunscreen when outdoors F. INH can reduce oral contraceptive effectiveness

A, B, D No Maalox No alcohol Need vit B complex supplement

A client has been admitted to the hospital with suspected TB. What drugs should the nurse plan to teach the client about before discharge? Select all that apply. A. Rifampin (Rifadin); contact lenses can become stained orange B. Isoniazid (INH); report yellowing of the skin or darkened urine C. Pyrazinamide (PZA); maintain a fluid restriction of 1200 mL/day D. Ethambutol (Myambutol); report any changes in vision E. Amoxicillin (Amoxil); take this drug with food or milk

A, B, D Rationale: Amoxicillin is not prescribed for TB. Pyrazinamide, although prescribed for TB, calls for an increase in fluids, not fluid restriction. Rifampin, isoniazid, and ethambutol are first-line drugs for TB therapy and have side effects. The side effects listed with these drugs are appropriate to teach the client.

The nurse is caring for a pt who often coughs and chokes while eating and taking his meds, but the pt insists he is fine. The nurse recognizes this as a priority pt problem of risk for aspiration. The nursing interventions she would implement to prevent aspiration pneumonia are Select All That Apply A. HOB always elevated during meals B. Monitor pt ability to swallow small bites C. Give small frequent drinks of thin liquid D. Consult a nutritionist and obtain swallow studies E. Monitor the patient's ability to swallow saliva F. Place pt on NPO status til swallowing returns to normal

A, B, D, E

A pt with TB is homeless and been living in shelters for the past 7 months, he asks the nurse why he must take so many meds. What information will the nurse provide in answering this question? Select All That Apply A. Combination drug therapy is effective in preventing transmission. B. Combination drug therapy is the most effective method of treating TB. C. Combination drug therapy will decrease the length of required treatment to 2 months. D. Multiple drug regimens destroy organisms as quickly as possible. E. The use of multiple drugs reduces the emergence of drug-resistant organisms.

A, B, D, E Combination drug therapy is the most effective method for treating TB and preventing transmission. Multiple drug regimens can destroy organisms as quickly as possible and reduce the emergence of drug-resistant organisms. Combination drug therapy will decrease the required length of time for treatment, the length of treatment is decreased to 6 months from 6 to 12 months.

The nurse knows, in caring for her ventilated pt, that the goal is to prevent VAP. She identifies the following as important in reaching this goal. Select All That Apply A. she should avoid wearing jewelry B. HOB should be up C. Administer chest physiotherapy D. Provide oral care every 12 hours E. Hand hygeine

A, B, E chest physiotherapy is not an intervention for this pt oral care should be provided every 8 hours, not 12 hours

Which conditions does the nurse recognize as a risk for developing aspiration pneumonia? Select All That Apply A. continuous tube feed B. bronchoscopy procedure C. MRI D. decreased LOC E. stroke F. chest tube

A, B. D. E continuous tube feed bronchoscopy procedure decreased LOC stroke

The nurse is speaking at a community event about the risks of getting TB. She acknowledges that which of the following people are at greatest risk? Select All That Apply A. an alcoholic homeless man that stays in a shelter sometimes B. A college dormitory resident with a roommate C. A man with HIV or other immune dysfunction D. A woman that does volunteer work at a local homeless shelter E. Foreign immigrants (esp from Mexico and Phillipines)

A, C, E alcoholic, homeless HIV, other immune dysf foreign immigrants

A pt who has recently traveled to Mexico comes to the ED with fatigue, night sweats, lethargy, and a low-grade fever. What is the nurse's first action? A. Contact the physician for tuberculosis (TB) medications. B. Give the pt a TB skin test. C. Place a respiratory mask on the pt. D. Test all family members for TB.

C The concern is that this client has TB. A respiratory mask should be placed on the client immediately.

The pneumonia pt asks the nurse why she needs to draw labs to check his electrolytes. The nurses correct response is A. To monitor for possible acidosis B. To check for elevated WBCs C. To evaluate the sodium level for possible hypernatremia D. To check for possible septicemia

C Because of dehydration from fever, may be hypernatemic/ dehydrated Electrolytes don't show acidosis, that is ABGS It is important to check the WBC count but its not an electrolyte A blood culture would need to be done for septicemia

This TB test shows if the pt has been exposed to TB, with a positive result being an induration that's 10mm or larger. A. Nucleic Acid Amplification Test (NAAT) B. Quantiferon-TB Gold (QFT-G) C. Mantoux test D. CXR

C Mantoux test aka PPD purified protein derivative Nurse reads it 48-72 hours after the injection under the skin

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

B) It would help decrease the bronchospasm.

An older adult pt presents to the ED with a 4-day history of cough, SOB, pain on inspiration, and dyspnea. The pt never had a pneumococcal vaccine. The chest x-ray shows density in bilateral lung bases. The pt has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this pt? A. It would not be beneficial for this pt. B. It would help decrease the bronchospasm. C. It would clear up the density in the pts lung bases. D. The pt would have a decrease in the pain on inspiration.

B A bronchodilator would would open up the airways and help decrease bronchospasm , so it would be beneficial for this pt. It would decrease dyspnea and feelings of shortness of breath.

INH treatment is associated with the development of peripheral neuropathies. Which of the following interventions would the nurse teach the client to help prevent this complication? A. Adhere to a low cholesterol diet B. Supplement the diet with pyridoxine (vitamin B6) C. Get extra rest D. Avoid excessive sun exposure

B INH competes with the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed.

Which of these clients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? A) Client with group A beta-hemolytic streptococcal pharyngitis who has stridor B) Client with pulmonary tuberculosis who is receiving multiple medications C) Client with sinusitis who has just arrived after having endoscopic sinus surgery D) Client with tonsillitis who has a thick-sounding voice and difficulty swallowing

B) Client with pulmonary tuberculosis who is receiving multiple medications

A client with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The client is febrile and agitated. Which health care provider order should the nurse implement first? A) Administer levofloxacin (Levaquin) 500 mg IV. B) Draw aerobic and anaerobic blood cultures. C) Give lorazepam (Ativan) as needed for agitation. D) Refer to social worker for alcohol counseling.

B) Draw aerobic and anaerobic blood cultures.

pneumonia may present differently in the older adult than in the younger adult? A) Crackles on auscultation B) Fever C) Headache D) Wheezing

B) Fever

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

C) Place a respiratory mask on the client.

Which one of the following are incorrect about TB? Select All That Apply A. The bacterium that causes TB is aerobic, rod shaped and secretes niacin B. Primarily affects the pulmonary system, especially the lower lobes. C. The goal of treatment is to cure the TB D. It is spread via the airborne route E. It is an acid-fast strain

B, C It does primarily affect the pulmo system, but it especially affect the UPPER lobes, where O2 content is highest The goal of treatment is to prevent transmission, control symptoms, and prevent progression of the disease

A pt with HIV is admitted to the hospital with reports of bloody sputum, feeling very tired, night sweats, SOB and has a temp of 99.8F. The nurse recognizes these assessment findings as A. Asthma B. Tuberculosis C. Superinfection resulting from a low CD4 count D. Chronic brochitis

B

The nurse has just been assigned the client with pneumonia caused by aspiration after alcohol intoxication recently admitted. The client is agitated and febrile. Which physician order is the nurse's priority? A. Administer the banana bag IV route. B. Draw aerobic and anaerobic blood cultures. C. Give lorazepam (Ativan) as needed for agitation. D. Administer levofloxacin (Levaquin) 500 mg IV.

B Obtaining aerobic and anaerobic cultures is the first action the nurse should perform and is standard procedure in a febrile client for whom antibiotics have been requested. Levofloxacin, an antibiotic, is important to administer, but blood cultures should be drawn before antibiotics are started. Unless this client is a danger to self or staff, giving lorazepam (Ativan) for agitation is not the first action; the question indicates that the client is agitated but does not indicate whether other attempts to control agitation have been tried, such as decreasing stimulation.

Which symptom of pneumonia may present differently in the older adult pt than in the younger adult pt? A. Crackles on auscultation B. Fever C. Headache D. Wheezing

B Older adults may not have fever and may have a lower-than-normal temperature with pneumonia. The other answers may be seen in all age groups of pneumonia pts

A pt with TB has taken the med treatment correctly for 3 weeks and showing signs of clinical improvement. The pt wife asks the nurse if the pt is still infectious. The nurses reply should be A. Pt is still infectious until the entire treatments is complete B. Pt is not infectious but needs to continue treatment for at least 6 months C. Pt may or may not be infectious, so a PPD test needs to be performed D. Pt is infectious until there is a neg chest x-ray result

B Pt is not infectious but needs to continue treatment for at least 6 months

This TB test is used in acute care settings to test a symptomatic patient, with results being available within 24 hours A. Nucleic Acid Amplification Test (NAAT) B. Quantiferon-TB Gold (QFT-G) C. Mantoux test D. CXR

B Quantiferon-TB Gold (QFT-G)

Which of these clients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? A. Client with acute ashma who has stridor B. Client with pulmonary tuberculosis who is receiving multiple medications C. Client that has returned to the unit after his bronchoscopy procedure 8 hours ago. D. Client with chronic bronchitis with congestion and difficulty swallowing

B The LPN/LVN scope of practice includes medication administration, so a client receiving multiple medications can be managed appropriately by an LPN/LVN. Stridor is an indication of respiratory distress; this client needs to be managed by the RN. A client in the immediate postoperative period requires frequent assessments by the RN to watch for deterioration. A client with a difficulty swallowing is at risk for deterioration and needs careful assessment and monitoring by the RN

A pt is being d/c home with active TB. Which information does the nurse include in the discharge teaching? A. "You are not contagious unless you stop taking your medication." B. "You will not be contagious to the people you have been living with." C. "You will have to take these medications for at least 1 year." D. "Your sputum may turn a rust color as your condition gets better."

B The people the pt has been living with have already been exposed and need to be tested. They cannot be re-exposed just b/c the dx has been confirmed. The pt w/ active TB is contagious, even while taking medication. The length of time for treatment is 6 months Rust-colored sputum is indication of worsening TB

A nurse evaluates the blood theophylline level of a client receiving aminophylline (theophylline) by intravenous infusion. The nurse would determine that a therapeutic blood level exists if which of the following were noted in the laboratory report? A. 5 mcg/mL B. 15 mcg/mL C. 25 mcg/mL D. 30 mcg/mL

B The therapeutic theophylline blood level range from 10-20 mcg/mL.

Which statement best describes pneumonia? A. an infection of just the windpipe because the lungs are clear of any problems B. a serious inflammation, caused by various things, of the bronchioles C. only an infection of the lungs with mild to severe effects on breathing D. an inflammation resulting from damage to the lungs due to long-term smoking

B a serious inflammation, caused by various things, of the bronchioles

The clinical instructor is reviewing common complications of pneumonia with the students. She knows that further instruction is needed when the students identify which of these? A. sepsis B. ventilation/perfusion issues C. hypoxemia D. pleural effusion E. respiratory failure F. atelectasis

B pneumonia is a ventilation problem not perfusion

The pt with pneumonia has a priority problem of ineffective airway clearance with bronchospasms. Pt has no previous chronic resp disorders. The nurse will obtain an order for which intervention? A. increased liters of humidified oxygen via facemask B. scheduled and prn aerosol nebulizer bronchodilator treatments C. handheld bronchodilator inhaler prn D. corticosteroid via inhaler or IV to reduce inflammation

B scheduled and prn aerosol nebulizer bronchodilator treatments

Which pt is at higher risk for developing pneumonia? A. any hospitalized pt between 19 - 64 y.o. B. 36 y.o. trauma pt on mechanical ventilator C. disabled 51 y.o. with abdominal pain, d/c home D. Any pt who has not received the pneumonia vaccine

B 36 y.o. trauma pt on mechanical ventilator

A HIV pt has a TB result of induration less than 10mm and no clinical TB symptoms. The nurse anticipates that the physician will prescribe which med for the pt to take for a 12 month period? A. Baccille Calmette-Guerin (BCG) vaccine B. Isoniazid (INH) C. Streptomycin D. Ethambutol

B INH

The home health nurse is visiting the home of an older adult pt recovering from a knee replacement. She ids a priority pt problem of risk for respiratory infection. Which is a normal aging factor contributing to the risk A. inability of a forced cough B. decreased strength of resp. muscles C. increased macrophages in alveoli D. increased elastic recoil of alveoli

B decr strength resp muscles

A client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? A) "You are not contagious unless you stop taking your medication." B) "You will not be contagious to the people you have been living with." C) "You will have to take these medications for at least 1 year." D) "Your sputum may turn a rust color as your condition gets better."

B) "You will not be contagious to the people you have been living with."

The nurse identifies the priority nursing dx for a pneumonia pt to be ineffective airway clearance related to fatigue, CP, excessive secretions and muscle weakness. To correct the problem the nurse will implement which intervention A. administer oxygen to prevent hypoxemia and atelectasis B. push fluids to greater than 3000 mL/day to ensure adequate hydration C. administer bronchodilator therapy in a timely manner to decrease bronchospasms D. maintain semi-fowlers position to facilitate breathing and prevent further fatigue

C bronchodilator

A pt is admitted to the hospital with bronchopneumonia. The nurse knows that this pt has pneumonia that A. has only affected a certain lobe of the lung B. has affected bilateral lower lobes C. is scattered throughout the lung, with affected patches throughout. D. will cause aspiration, so pt should be monitored

C bronchopneumonia is scattered affected areas throughout multiple lobes of the lungs A. = a definition of lobar pneumonia

The medical-surgical unit has one negative-airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room? A) Client with bacterial pneumonia and a cough productive of green sputum B) Client with neutropenia and pneumonia caused by Candida albicans C) Client with possible pulmonary tuberculosis who currently has hemoptysis D) Client with right empyema who has a chest tube and a fever of 103.2° F

C) Client with possible pulmonary tuberculosis who currently has hemoptysis

The nurse reads the pts skin test and tells him it is positive for TB. The pt asks the nurse what that means. The nurse explains A. There is active disease but you are not yet infectious to others you are in contact with B. you will need immediate treatment for the active disease C. you have been infected but does not mean active TB is present D. you will need a repeat skin test b/c the test could be a false-positive result

C

The medical-surgical unit has one negative-airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room? A. Client with bacterial pneumonia and a cough productive of green sputum B. Client with neutropenia and pneumonia caused by Candida albicans C. Client with possible pulmonary tuberculosis who currently has hemoptysis D. Client with right empyema who has a chest tube and a fever of 103.2° F

C A client with possible tuberculosis should be admitted to the negative-airflow room to prevent airborne transmission of tuberculosis. A client with bacterial pneumonia does not require a negative-airflow room but should be placed in Droplet Precautions. A client with neutropenia should be in a room with positive airflow. The client with a right empyema who also has a chest tube and a fever should be placed in Contact Precautions but does not require a negative-airflow room.

A 70-year-old client who has been treated for cellulitis of the leg asks the nurse how to improve resistance to infection. Which measures should the nurse reinforce in the teaching plan? Select all that apply. 1. Take a hot bath or shower twice daily. 2. Balance activity, rest, and avoid stress. 3. Eat mainly organic fruits and vegetables. 4. Keep skin on arms and legs well lubricated. 5. Wash any breaks in the skin with soap and water. 6. Receive recommended vaccines against influenza and pneumonia.

Correct Answer: 2, 4, 5, 6

In preparing to care for a hospitalized child with a diagnosis of measles (rubeola), which supplies should the nurse bring to the child's room to prevent the transmission of the virus? 1. Mask and gloves 2. Gown and gloves 3. Goggles and gloves 4. Gown, gloves, and goggles

Correct Answer: 1

The nurse has reinforced instructions to a client with tuberculosis about proper handling and disposal of respiratory secretions. The nurse determines that the client understands the instructions if the client verbalizes to take which measure? 1. Discard used tissues in a plastic bag. 2. Wash hands at least four times a day. 3. Brush teeth and rinse the mouth once a day. 4. Turn the head to the side if coughing or sneezing.

Correct Answer: 1

Following a cleft lip repair, the nurse reinforces instructions to the parents of the infant. Which of the instructions should be given to the parents of the infant? Select all that apply. 1. Monitor frequency of diaper changes. 2. Cleanse the surgical site with normal saline 3. Offer the infant a pacifier in between feedings. 4. Do not use a car seat until the incision is healed. 5. Apply prescribed antibiotic ointment to the surgical site.

Correct Answer: 1, 2, 5

The nurse performs an audit in the hospital intensive care unit of clients who have indwelling urinary catheters. Which observations, found in the audit, pose a risk for a health care-associated infection? Select all that apply. 1. Drainage bag port touching the floor 2. Dependent loop in the catheter tubing 3. Cleansing around the catheter with soap and water twice daily 4. A stabilizing device in place to keep the catheter from moving 5. Use of one measuring container between two clients with the same pathogen in the urine 6. Using a sterile syringe through the tubing port cleansed with antiseptic to obtain a urine specimen

Correct Answer: 1, 2, 5

The nurse receives the culture test results for a client who developed a bloodstream infection from a central venous device. The culture report indicates that the infection is exogenous. The client asks the nurse how she could have contracted this infection. Which should the nurse include in the explanation of potential sources of infectious organisms? Select all that apply. 1. The health care facility 2. The nurse caring for the client 3. The client's use of homeopathy 4. The use of high doses of antibiotic therapy 5. The use of contaminated intravenous fluids 6. The reactivation of a previous dormant organism

Correct Answer: 1, 2, 5

A client is seen in the health care clinic, and a diagnosis of conjunctivitis is made. The nurse reinforces discharge instructions to the client regarding care of the disorder while at home. Which statement by the client indicates a need for further teaching? 1. "I can use an ophthalmic analgesic ointment at night if I have eye discomfort." 2. "I do not need to be concerned about spreading this infection to others in my family." 3. "I should apply a warm compress before instilling antibiotic drops if purulent discharge is present in my eye." 4. "I should perform a saline eye irrigation before instilling the antibiotic drops into my eye if purulent discharge is present."

Correct Answer: 2

A client with tuberculosis, whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. What should the nurse tell the client? 1. "Five sputum cultures must be negative before returning to work." 2. "Three sputum cultures must be negative before returning to work." 3. "A sputum culture and a chest x-ray must be negative before returning to work." 4. "A sputum culture and a Mantoux test must be negative before returning to work."

Correct Answer: 2

A hospitalized child with leukemia has received chemotherapy by the intravenous (IV) route, and a discharge to home is being planned. Laboratory values indicate that the child is neutropenic. The child is being treated daily by cleansing and the application of a topical antibiotic on an open area from an old IV site. The nurse reinforces instructions to the mother regarding the signs of infection at this affected site. Which statement by the mother indicates that the mother understands the instructions? 1. "Pus at the site means that an infection is present." 2. "I will clean the site and apply the topical ointment every day." 3. "If I see redness at the site, I don't need to worry as long as there is no pus." 4. "If the temperature is elevated, I don't need to be concerned, because this is normal with affected white blood cells."

Correct Answer: 2

The nurse is preparing to set up a sterile field using the principles of aseptic technique to perform a dressing change. Which should the nurse include in the preparations? Select all that apply. 1. Use a dry table that is below waist level. 2. Open the distal flap of a sterile package first. 3. Prepare the sterile field just before the planned procedure. 4. Don clean gloves before touching items on the sterile field. 5. Place the sterile field 1 foot behind the working area and out of view of the client. 6. Avoid placing items within 1 inch of any area surrounding the outer edge of the sterile field.

Correct Answer: 2, 3, 6

The nurse is changing a dressing on the wound of a postsurgical client who is receiving contact precautions because of a history of methicillin-resistant Staphylococcus aureus (MRSA) from a previous surgery. Which interventions should the nurse follow? Select all that apply. 1. Wear a mask and apply a mask to the client. 2. Observe the incision line for redness and drainage. 3. Medicate the client for pain after the dressing change. 4. Press firmly on the incision to determine if drainage is present. 5. Change gloves between removal of the old dressing and applying the new.

Correct Answer: 2, 5

A client with tuberculosis (TB) who is being prepared for discharge to home should be instructed to follow which practice to decrease the possibility of spreading the infection? 1. Wear a mask when at home with family members. 2. Have a weekly sputum culture to follow the course of the infection. 3. Wear a mask when in contact with people outside of the family until medications are effective. 4. Have a bacille Calmette-Guérin (BCG) vaccination to protect other people from exposure.

Correct Answer: 3

In developing a plan of care for a client hospitalized with tuberculosis (TB), the nurse should place emphasis on which intervention? 1. Instructions on deep-breathing techniques 2. An increase in fluid intake to at least 3000 mL a day 3. The strict adherence to following airborne precautions 4. Special assistance in order to perform activities of daily living (ADLs)

Correct Answer: 3

The nurse is assigned to care for a client on contact precautions. On review of the client's record, the nurse notes that the client has a hospital-acquired infection caused by methicillin-resistant Staphylococcus aureus (MRSA). The client has an abdominal wound that requires irrigation and has a tracheostomy attached to a mechanical ventilator and requires frequent suctioning. The nurse gathers supplies before entering the client's room and obtains which necessary protective items? 1. Gloves and a gown 2. Gloves, mask, and goggles 3. Gloves, mask, gown, and goggles 4. Gloves, gown, and shoe protectors

Correct Answer: 3

The nurse is caring for a client with a diagnosis of cancer who is immunosuppressed. Neutropenic precautions have been implemented. Which activity should the nurse question if observed while caring for this client? 1. The family brings a bouquet of plastic flowers to brighten the client's room. 2. The family member with a cold wears a mask while visiting for a short period of time. 3. The client orders lunch of soup, salad with tomatoes and cucumbers, and an apple. 4. The client wears a mask while being transported to the interventional radiology department.

Correct Answer: 3

The nurse is told that an assigned client is suspected of having methicillin-resistant Staphylococcus aureus (MRSA). Which precautions should the nurse institute during the care of the client? 1. Wear gloves only. 2. Wear a mask and gloves. 3. Wear a gown and gloves. 4. Avoid touching the client's clothes.

Correct Answer: 3

The nurse should institute which interventions for a client diagnosed with Clostridium difficile? Select all that apply. 1. Wear a mask if within 3 feet of the client. 2. Place a mask on the client when client is outside the room. 3. Wear gloves and gown while in the room caring for the client. 4. Use soap and water, not alcohol-based hand rub, for hand hygiene. 5. Keep the door of the room shut except when entering or exiting the client's room.

Correct Answer: 3, 4

A health care worker who signed a waiver and never received the hepatitis B vaccine receives a needle stick from a client who has hepatitis B. Which treatments are indicated for the health care worker under this situation? Select all that apply. 1. Vitamin C orally 2. Ciprofloxacin orally 3. Hepatitis B immune globulin 4. Initiate hepatitis B vaccine series 5. Cleanse needlestick site with soap and water

Correct Answer: 3, 4, 5

A child is diagnosed with bacterial conjunctivitis and antibiotic eye drops are prescribed for the child. The parent asks the nurse when the child can return to school. The nurse should make which response to the parent? 1. "The child can return to school immediately." 2. "The child cannot return to school until seen by the primary health care provider (PHCP) in 1 week." 3. "The child should be kept home until the antibiotic eye drops have been administered for 1 week." 4. "The child should be kept home until the antibiotic eye drops have been administered for 24 hours."

Correct Answer: 4

A pregnant woman has a positive history of genital herpes, but she has not had lesions during her pregnancy. The nurse plans to provide which information to the client? 1. "You will be isolated from your newborn after delivery." 2. "There is little risk to your baby during your pregnancy, birth, and after delivery." 3. "Vaginal deliveries can reduce neonatal infection risk, even if you have an active lesion at birth." 4. "You will be evaluated at the time of delivery for herpetic genital tract lesions. If they are present, a cesarean delivery will be needed."

Correct Answer: 4

The nurse is preparing to care for a client with acquired immunodeficiency syndrome (AIDS) who has Pneumocystis jiroveci pneumonia. In planning infection control for this client, which should be the appropriate form of isolation to use to prevent the spread of infection to others? 1. Droplet precautions isolation 2. Enteric precautions 3. Contact precautions 4. Standard precautions

Correct Answer: 4

The nurse prepares the client for irrigation of an abdominal wound. Refer to video. Click on the Question Video button to view a video showing preparation procedures. After preparation, the nurse should appropriately don which article(s) to perform the procedure? 1. Gloves 2. Gloves and a gown 3. Gloves and goggles 4. Gloves, gown, and goggles

Correct Answer: 4

Which instructions should be included in the teaching plan for a mother whose newborn is human immunodeficiency virus (HIV) positive? 1. Instruct the mother to check the anterior fontanel for bulging and sutures for widening each day. 2. Instruct the mother to feed the newborn in an upright position with the head and chest tilted slightly back to avoid aspiration. 3. Instruct the mother to feed the newborn with a special nipple and burp the newborn frequently to decrease the tendency to swallow air. 4. Instruct the mother and family to provide meticulous skin care to the newborn and to change the newborn's diaper after each voiding or stool.

Correct Answer: 4

A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this? A. Acute asthma B. Chronic bronchitis C. Pneumonia D. Spontaneous pneumothorax

D A spontaneous pneumothorax occurs when the client's lung collapses, causing an acute decrease in the amount of functional lung used in oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. An asthma attack would show wheezing breath sounds, and bronchitis would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation.

The nurse notices a visitor walking into the room of a pt on airborne isolation with no protective gear. What does the nurse do? A. Ensures that the pt is wearing a mask B. Tells the visitor that the pt cannot receive visitors at this time C. Gives a particulate air respirator to the visitor D. Gives a mask to the visitor

D Because the visitor is entering the pt's isolation environment, the visitor must wear a mask. The pt typically must wear a mask only when he or she is outside of an isolation environment. Turning the visitor away is inappropriate and unnecessary. It would not be necessary for the visitor to wear an air respirator.

A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and symptoms would the client show if therapy is inadequate? A. Decreased shortness of breath B. Improved chest x-ray C. Nonproductive cough D. Positive acid-fast bacilli in a sputum sample after 2 months of treatment

D Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.

A client's ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg, and HCO3- of 24 mEq/L. What do these values indicate? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Respiratory acidosis

D Respiratory Acidosis

The nurse is reviewing the lab results for an older adult pneumonia pt. The lab value frequently seen in pneumonia pts that may not be seen in this pt is A. RBC 4.0 - 5.0 B. Hgb 12 - 16 C. Hct 36 - 48 D. WBC 12 - 18

D WBC

A pt is dx with TB, agrees to therapy as prescribed. In the teaching the nurse should instruct the pt to take the meds when A. before breakfast B. midday C. after breakfast D. bedtime

D bedtime

The nurse is reviewing a pneumonia pts lab results. What does she expect to see A. decreased Hgb B. increased RBCs C. decreased neutrophils D. increased WBCs

D incr WBCs

A pt returns to the office in the 48 to 72 hour period to have the subcutaneous mantoux skin test results read. The nurse knows that which finding is indicative of a positive result? A. test area is red, warm and tender when touched B. induration/hardened area measures 6mm or greater C. induration/hardened nodule of any size at the site D. induration/hardened area measuring 10mm or greater

D induration 10 mm or greater

A pt is at the office for a follow up visit and has been compliant with drug therapy for TB. Which result indicates the TB is no longer infectious A. a negative chest x-ray B. three negative sputum cultures and a negative chest x-ray C. no clinical symptoms present D. three negative sputum cultures

D three negative sputum cultures