Chapter 31 Med surg

The nurse is providing health education to an older adult patient to prevent pneumonia. Which statements made by the patient demonstrate a need for further teaching? Select all that apply.

" i will refrain from drinking nonalcoholic drinks" "i will refrain from obtaining the pneumococcal vaccine"

A patient is being treated with ciprofloxacin 500 mg PO twice daily due to possible exposure to inhalation anthrax. What is the nurse's best answer when the patient asks how long this medication must be taken?

" you will need to take this for about 2 months"

A healthy patient expresses worries about developing tuberculosis (TB) after spending time at a family reunion and learning later that a family member is being treated for the disease. What does the nurse tell this patient?

"Among people exposed to the disease, only a small percentage develop active TB.

A nurse is diagnosed with seasonal influenza, and on the second day of treatment with oseltamivir, she asks the supervising nurse when she may return to work on a hospital unit. What does the supervising nurse tell her?

"If you are feeling well and afebrile in 5 days, you may return to work.

A 75-year-old patient tells the nurse he is not planning to receive a "flu shot" this year because the shot makes him sick. What is the nurse's best response?

"The injectable flu vaccine is not a live virus and cannot cause influenza."

A young adult patient refuses an influenza vaccine, saying, "I'm healthy and won't get that sick if I get the flu." Which is the best response by the nurse?

"You may spread the disease to people who are more at risk for severe symptoms."

The nurse is providing health education to a patient regarding ways to prevent influenza. Which statement made by the patient shows effective learning?

"i will refrain from public meetings if i feel myself getting sick"

The nurse has been instructed to administer tuberculosis (TB) medication to a patient who has been noncompliant by directly observed therapy. Which statement by the nurse will assist the patient in understanding this therapy?

"you must swallow your pills in front of me"

Which patient is most at risk for the development of either community- or hospital-acquired pneumonia?

A 76-year-old who has limited mobility because of osteoarthritis

The occupational nurse is discussing a recent influenza outbreak with employees. Which medications are given to prevent influenza in individuals if they are exposed to someone with influenza? Select all that apply.

Amantadine Rimantadine

The community health nurse is planning tuberculosis treatment for a patient who is homeless and heroin-addicted. Which action will be most effective in ensuring that the patient completes treatment?

Arrange for a health care worker to watch the patient take the medication

A patient with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The patient is febrile and agitated. Which health care provider order should the nurse implement first?

Draw aerobic and anaerobic blood cultures.

Incentive spirometry for the treatment of pneumonia has which outcome objective?

Increased inspiratory muscle action and decreased atelectasis

A nurse is caring for a patient who appears cachectic and pale but appears in no acute distress. The patient tells the nurse that he has had a chronic cough for months and produces a large amount of foul-smelling sputum. He also states that he occasionally suffers from a stabbing pain when taking a deep breath. When reviewing the patient's history, the nurse notes that the patient has a recent history of influenza. Breath sounds reveal decreased sound with rhonchi to the right lower lobe and percussion to the right lower lobe is dull. What procedure does the nurse anticipate preparing for?

Insertion of a thoracentesis needle and drainage

The medical-surgical unit has one negative airflow room. Which of these four newly arrived patients should the charge nurse admit to this room?

Patient with possible pulmonary tuberculosis who currently has hemoptysis

A patient presents with severe throat pain and edema. There is difficulty swallowing as well as difficulty opening the mouth. Place the steps for managing this patient in the correct order.

Percutaneous needle aspiration and drainage of the abscess is performed, and antibiotic therapy is administered to control the infection. IV opioids are administered to relieve the pain, and IV steroids are administered to reduce the swelling. If the infection does not respond to antibiotic therapy, hospitalization is advised. Incision and drainage are performed, along with additional antibiotic therapy to control the infection. To avoid recurrence, tonsillectomy may be performed.

Which viral agent is responsible for the most common community-acquired pneumonia?

Respiratory syncytial virus

Following a bioterrorism attack with anthrax, the emergency department nurse checks the medication room for ample supply of which medications? Select all that appl

Rifampin Amoxicillin Vancomycin Doxycycline Ciprofloxacin

A patient with asthma reports diarrhea and vomiting. Which drug should be used with caution?

Zanamivir

A patient reports severe headache, nausea , and vomiting for one full day. Which drugs would be most effective in the patient? Select all that apply.

Zanamivir Oseltamivir

The nurse performs follow-up care for a group of patients who have previously had tuberculosis. Which patients are most at risk for developing secondary tuberculosis (TB)? Select all that apply.

a y/o undergoing chemotherapy a 75 y/o recovering from hip replacement surgery a 34 y/o with HIV

A female patient presents to the ambulatory clinic with complaints of a cough. Which other signs or symptoms, if present, would cause the nurse to begin wearing an N-95 mask and place the patient in an isolated environment? Select all that apply.

anorexia blood streaked sputum irregular periods

The nurse is reviewing home care instructions for a patient diagnosed with acute viral rhinitis. Which medication order does the nurse question?

antibiotic

What is the nursing priority to provide safe and effective care for the patient with pneumonia?

applying principles of infection control

Stroke patients are at high risk for pneumonia related to what condition?

aspiration

A patient has been started on ethambutol for tuberculosis. What adverse effect requires the patient to notify the provider?

change in vision

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 should the nurse take first?

check their O2 sat

Which symptoms may be observed in an older patient with pneumonia? Select all that apply.

confusion fatigue poor appetite

The nurse is counseling a young woman about drug therapy with isoniazid and rifampin to treat tuberculosis. Before developing the teaching plan, what must the nurse assess for first?

contraception methods

A patient is about to begin drug therapy for the treatment of tuberculosis (TB). What information is most important for the nurse to give to this patient prior to the start of therapy?

do not drink alcohol

Which method is the best way to prevent outbreaks of pandemic influenza?

early recognition and quarantine

The nurse is caring for a patient who has had abdominal surgery. Which action should the nurse take to help prevent pulmonary infection in this patient?

encourage regular use of incentive spirometer

What education will be provided for the family of a patient being treated for tuberculosis convalescing at home?

everyone must undergo tb testing

An older patient has a persistent cough with hemoptysis and has a known exposure to tuberculosis. A tuberculin skin test reveals a reaction of 5 mm. The nurse documents that this test result indicates which condition?

human immunoficiencey disease (HIV)

A community health nurse is preparing a community education class on bioterrorism and the use of inhalation anthrax. When preparing to discuss the manifestations of the fulminant stage of the infection, what manifestation does the nurse include in the teaching?

hypotension

A nurse is caring for a patient who is orally intubated and mechanically ventilated. The nurse understands that this patient is at an increased risk for developing ventilator associated pneumonia. When planning care for this patient, what pathophysiological concepts regarding an artificial airway does the nurse recognize as a contributing factor to the development of this condition? Select all that apply.

it bypasses protective airway mechanisms it allows aspiration of secretions from oropharynx and stomach

An older patient presents to the emergency department (ED) with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The patient never had a pneumococcal vaccine. The patient's chest x-ray shows density in both bases. The patient has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this patient?

it would help decrease the bronchospasms

In a patient with pneumonia, what is the most important nursing intervention?

manage hypoxemia

The nurse has decided to immediately place a patient in respiratory isolation because the patient is exhibiting which signs/symptoms of the prodromal (early) stage of inhalation anthrax? Select all that apply.

mild chest pain fever mediastinal widening

A patient is admitted to the hospital with a streptococcal peritonsillar abscess following incomplete treatment with an oral antibiotic. The nurse notes that the patient is experiencing stridor. Which action should the nurse take next?

notify rapid response team to assist with airway management

A public health nurse is providing education to a community about preparation for a possible influenza epidemic leading to a worldwide pandemic. What does the nurse instruct community members to do upon learning that an influenza outbreak has occurred?

obtain the vaccine against influenza

which pathological findings associated with pneumonia result in an increased respiratory rate and dyspnea? Select all that apply.

pain anxiety activated j receptors

A patient who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, bloody sputum, night sweats, and a low-grade fever. What is the nurse's first action?

place a respiratory mask on the pt

A patient with a recent diagnosis of bacterial pharyngitis caused by group A streptococcal infection calls the health care provider stating his has developed a cough, fever, chills, shortness of breath, and severe chest pain. Which complication does the nurse suspect?

pneumonia

Community health nurses are tasked with providing education on the prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority?

prison staff and inmates

The nurse notices a visitor walking into the room of a patient on airborne isolation with no protective gear. What does the nurse do?

provide a mask to the visitor

A patient who is taking isoniazid and rifampin to treat tuberculosis reports reddish-orange urine. Which action should the nurse take?

reassure patient this is an expected drug effect

The nurse is instructing a patient with tuberculosis about combination drug therapy. What are common instructions that the patient should follow for all the anti-tubercular drugs? Select all that apply.

refrain from alcohol report yellowing of skin and dark urine immediately

A patient admitted to the hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) and chronic malnutrition develops a cough, a temperature of 39°C, an oxygen saturation of 94%, and crackles in both lungs. Which action would the nurse take first?

request chest x ray

Which upper respiratory infection is often triggered by a hypersensitivity reaction to airborne allergens?

rhinitis

The nurse is preparing a patient for discharge who has been treated for the prodromal stage of inhalation anthrax. What information is most important for the nurse to communicate to this patient?

seek medical attention immediately if you feel breathless

The nurse is caring for a patient who was admitted with pneumonia. Which position assumed by the patient leads the nurse to suspect that the patient is developing hypoxia?

sitting in tripod

A patient reports experiencing chest pain, headache, and cough with sputum production, fever, and dyspnea. What does the nurse anticipate upon assessment? Select all that apply.

tachycardia crackles on auscultation decreased chest expansion

What is the most important information for the nurse to convey to a patient who is beginning pharmacological therapy for the treatment of tuberculosis to ensure suppression of the disease?

take medication exactly as prescribed

A nurse is providing discharge instructions for a patient with active tuberculosis (TB) who has been prescribed isoniazid. What information about medication administration does the nurse include when providing discharge instructions?

take on an empty stomach

A previously infected patient with a dormant tuberculosis (TB) infection has experienced a reactivation of the disease. Which was likely a factor in this occurrence?

taking prednisone for 3 weeks

A patient with pulmonary tuberculosis is being started on combination therapy. What does the nurse explain to the patient as the purpose of combination therapy?

to shorten therapy

An older adult patient was diagnosed with influenza 1 week ago. What direction should the nurse include in the teaching plan for the patient? Select all that apply.

use appropriate hand washing increase fluid intake Avoid the use of diphenhydramine.

A patient has been diagnosed with community-acquired pneumonia (CAP). What risk-factors are associated with CAP? Select all that apply.

use of tobacco pneumococcal vaccine over 5 years ago