Random Respiratory

A client has had a chest tube placed for 10 hours and the nurse is assessing the color of the drainage. Which color would be most concerning to the nurse?

Bright red If the drainage is bright red, this could indicate active hemorrhage. This is an urgent situation, and the provider should be called.

A client in the hospital lacks the resources for obtaining medical equipment that is needed for the client's COPD. Which action best describes the role of the case management nurse in this situation?

Make a referral to the social worker to offer guidelines for financial assistance When a client has difficulties maintaining their health, there are many potential reasons. These may include a lack of resources, poor knowledge, or lack of motivation. A client who needs medical equipment in this situation would best be helped by receiving information about financial assistance to support their own health management.

A school is offering tuberculosis testing for all of its employees. The health nurse administers the injections to each of the employees using a tuberculin syringe. At which angle does the nurse administer the injections into the skin?

10 degree When a nurse administers an intradermal injection to test for tuberculosis, she should insert the needle at a 5 to 15-degree angle (or nearly flat against the skin). Inserting the needle at this angle will allow the nurse to inject the solution just under the skin to create a wheal for testing.

A client has fluid in the pleural space and the nurse is preparing for a chest tube insertion. The nurse knows that the insertion site will be located at which of the following locations?

8th or 9th intercostal space When a client has a chest tube placed to remove fluid, the insertion site is around the 8th or 9th intercostal space.

The nurse is assessing a client in the emergency department who states, "I have COPD and usually require 2L of oxygen. I was eating yesterday and choked on a piece of ham and have been coughing ever since, like it's stuck in my throat. Now I feel like I have been needing more oxygen, so I have turned my tank up to 5L." Which part of this statement is priority and needs to be immediately investigated?

"I have turned my tank up to 5L" This statement specifically demonstrates that the choking has affected the client's oxygenation status. The nurse would be concerned with this and investigate further.

The nurse is discharging a client with tuberculosis. The client asks if it is possible to stop taking the tuberculosis medication once she feels better. Which of the following is the most appropriate response?

"If you don't finish the entire treatment course, it can lead to drug resistance and complications in the future" Noncompliance with treatment may lead to drug resistance (MDR-TB), therefore strict adherence to the regimen is important. This statement by the nurse is most accurate, and offers the most amount of information for the client.

The nurse is caring for a client with tuberculosis and is giving report to the oncoming nurse. Which of the following statements is most appropriate?

"The client is positive for TB and will require airborne precautions" Tuberculosis requires airborne precautions.

The mother of a 10-year-old diagnosed with bronchitis asks the nurse about treatment options. Which of the following is the best response?

"Treatment is focused on managing your child's symptoms" Bronchitis is usually a self-limiting disease that is caused by a virus. Treatment focuses on managing symptoms like fever and discomfort.

A ventilated client has developed a pneumothorax and requires a chest tube. The nurse knows that the chest tube will be inserted where?

2nd intercostal space When a client has air in the pleural space, the chest tube is placed in the 2nd intercostal space.

When assessing the respiratory rate of a 6-month-old who has been admitted with bronchitis, the nurse knows to count breath sounds for how long to ensure accuracy?

60 seconds Infants are irregular breathers so respirations should be counted for a full minute to insure accuracy.

The nurse is caring for a client who has developed a tension pneumothorax. The provider asks the nurse to gather the necessary supplies. Which of the following will the nurse obtain?

Chest tube insertion kit A tension pneumothorax requires emergent chest tube insertion, so the nurse will gather those supplies.

A nurse works in a rehabilitation facility that cares for clients of various ages and medical backgrounds. Which of the following situations would the nurse encounter as the biggest risk for aspiration?

A client who uses a mechanical ventilator Aspiration involves breathing in fluid or particles that are not meant to enter the respiratory tract. Unmanaged, aspiration can lead to pneumonia, in which an infection develops in the lungs. Certain clients are at higher risk of aspiration and illness, including those who use mechanical ventilators, those with nasogastric feeding tubes, and those who have dysphagia. In the mechanically ventilated client, there is a risk for microaspiration, even if the tube cuff is inflated properly. This client is at the greatest risk of aspiration.

A client with COPD has been admitted to the hospital for exacerbation of symptoms 7 times in the past year. Which of the following elements should be included as part of the discharge plan that can reduce instances of readmission for this client?

A provision for home health care that includes ongoing respiratory management The nurse who works with a client who has a chronic illness with repeated hospitalizations needs to determine what factors are causing the repeated illnesses and required hospitalizations. If there is something that can be changed that will improve the client's health and reduce readmission to the hospital, the nurse can initiate the process. In this case, the nurse can make arrangements for home health care that will continue to assess the client at home, or get case management involved to help with the process. If the client is having difficulties or declining health, the home health nurse can work with the client further or help the client receive assistance.

Which of the following is a common finding in an open pneumothorax?

A sucking sound on inspiration and expiration In an open pneumothorax, there is an open wound to the outside so a sucking sound is heard on inspiration and expiration.

A 28-year-old woman arrives at the hospital in active labor. The client stayed at home as long as possible because she also has pneumonia. In addition to caring for the client during her delivery, which of the following interventions would the nurse also need to apply in this situation?

Administer supplemental oxygen to the mother so that the fetus will have enough oxygen Pneumonia occurs as an infection in the lung tissue. It may lead to atelectasis and collapse of the alveoli, which can impair gas exchange. In this situation, the mother will need extra oxygen not only for herself, but also for the baby before it is born. The nurse should administer supplemental oxygen throughout the time that the mother is in labor to promote adequate oxygenation for the fetus and to prevent fetal hypoxia.

Which of the following is seen in a client with a flail chest?

Affected side goes in with inspiration and out with expiration In a flail chest, the affected side goes in with inspiration and out with expiration, due to multiple breaks on a rib bone, causing a portion of the rib to 'float'. There is usually no sucking chest wound and there can be various lung sounds heard that are nonspecific for flail chest.

A nurse who works in a long-term care facility has learned that one of the residents has developed active tuberculosis. What should the nurse do to protect the other residents?

Allow the client to remain in the nursing home but provide isolation precautions and treat the active disease A client with active tuberculosis has the potential to transmit the infection to others and is considered contagious. In a long-term care facility, the client should receive treatment for the disease and should be isolated from other residents until the potential for the spread of the infection is past, which is one to two weeks after treatment is started. Other residents should be tested for exposure to tuberculosis using the Mantoux skin test.

A client with COPD is being seen in the primary care clinic for evaluation. During the assessment, the nurse asks the client medical history questions. Which of the following would most likely reveal whether a client is behaving in a way that works against the client's treatment plan?

Asking the client about smoking habits Nurses often work in situations where potential ethical dilemmas take place. While assessing a client during an intake interview, a nurse may learn of information about the client that causes an ethical dilemma, which must be dealt with in some way. For example, a client with COPD may continue to smoke, thereby worsening the condition, even though this client could be using oxygen and prescriptions and care from the provider. In this case, the client's actions at home are contrary to the desire to receive care and help for COPD.

While caring for a client who has a chest tube, the nurse takes measures to prevent a tension pneumothorax. Which of the following interventions would the nurse most likely employ?

Avoid clamping the chest tube A client with a chest tube is at increased risk of developing a tension pneumothorax, in which air builds up in the pleural cavity and further collapses the lung. The chest tube is in place to remove air in the intrapleural space using a water seal and gentle suctioning, but complications can arise. An air leak in the chest tube system can cause air to enter the pleural space, further worsening a pneumothorax. If the tube is clamped, any air that has accumulated cannot escape from the pleural space. The nurse can avoid causing a pneumothorax in the chest tube client by not clamping the tube.

A nurse is reviewing the principles of COPD management with a client. Which of the following suggestions would most likely support the health of the client with COPD?

Avoid extremely cold temperatures A client with COPD suffers from a chronic disease that can progressively worsen, especially with poor health management. As part of health education, the nurse must teach the client important facts that will most support overall health. This includes smoking cessation, avoiding extremes in temperatures, limiting activity and alternating activity with rest periods, meeting nutritional requirements, and recognizing the signs of respiratory distress. Avoid allergens and lung irritants COPD can be exacerbated by exposure to allergens and other lung irritants. The client with COPD often sees improvement in symptoms when these irritants are avoided. Smoking cessation A client with COPD who smokes should be counseled to stop smoking completely.

A nurse is caring for a client who is admitted for pneumonia and sepsis. The nurse is reviewing orders and knows to implement which of the following prior to hanging antibiotics?

Blood culture The nurse should ensure that the blood cultures are drawn before the antibiotics are first given to ensure that the antibiotics don't affect the results of the blood culture.

The nurse is caring for a client who is in the hospital for exacerbation of emphysema symptoms. The nurse notes shortness of breath and tachypnea. Which of the following actions is most appropriate in response to this?

Check the client's arterial blood gases A client who demonstrates shortness of breath and tachypnea as a result of a chronic disease needs further monitoring and intervention to help improve their ability to breathe. In this situation, the nurse should routinely check the client's arterial blood gases, as ordered, as these test results can identify whether there is enough oxygen in the bloodstream or if carbon dioxide levels are building.

A nurse walks into a client's room and discovers that the client is in respiratory distress. The client has tracheal deviation to the right side. The nurse knows to prepare for which of the following emergent procedures?

Chest tube insertion on the left side Tracheal deviation most commonly indicates a pneumothorax. The trachea will deviate toward the side that is away from the pneumothorax. So, if the trachea is deviating to the right, then the pneumothorax is on the left. The treatment for this is a chest tube on the side of the deflated lung.

A nurse is caring for a 5-year-old child who has been diagnosed with bronchiectasis. Based on the nurse's understanding of this condition, the nurse knows to expect signs and symptoms of which of the following?

Chronic cough that produces green sputum Bronchiectasis is a lung condition that causes permanent dilation of the bronchi, resulting in breathing difficulties and pooling of sputum in the bronchial tree that can progressively worsen. The nurse should assess for signs and symptoms of a productive cough with thick or green sputum. Occasionally, the client may also cough up blood. As the disease progresses, sputum production tends to increase.

Cardiac tamponade & treatment

Collection of blood in the pericardial sac, compressing the myocardium, preventing ventricular filling Treatment: pericardiocentesis - a needle and catheter remove fluid from the pericardium, the sac around your heart.

The nurse caring for a 6-year-old with bronchitis knows which of the following symptoms are commonly associated with this diagnosis?

Dry, hacking cough that worsens at night The cough associated with bronchitis tends to be dry and gets worse at night.

A nurse is caring for a client who requires a ventilator for breathing assistance. Which of the following practices would most likely reduce the risk of the client developing ventilator-associated pneumonia?

Elevating the head of the bed Ventilator-associated pneumonia (VAP) is a potential complication of mechanical ventilation, and is a common healthcare acquired infection. Every client who is on a ventilator is at risk for developing VAP. The nurse can also help prevent development of this type of pneumonia by practicing routine hand hygiene, oral cleansing of the client, and suctioning when necessary.

A 46-year-old client was involved in a motorcycle accident and comes in to the emergency department with rib fractures and a flail chest. The provider orders to set up for treatment utilizing pneumatic stabilization. Which actions would be included as part of this treatment? Select all that apply.

Endotracheal intubation A flail chest occurs with rib fractures when three or more portions of the rib are broken, causing floating pieces of ribs in the chest cavity. Pneumatic stabilization involves stabilizing the internal lung tissue to support ventilation. This includes endotracheal intubation and mechanical ventilation with PEEP. Mechanical ventilation Mechanical ventilation would be used in this scenario. Use of PEEP with ventilation Positive end expiratory pressure is used in a client with flail chest to decrease the chance of alveoli collapsing.

A nurse is caring for a client with a chest tube after being injured in a car accident. Which action of the nurse best describes how to maintain the water seal on the tube?

Ensure that the chest tube chamber is kept upright A chest tube has more than one compartment that manages fluid and air that is removed from the client's pleural cavity. The water seal allows the air to be removed from the pleural space but prevents air and fluid from entering by acting as a one-way valve. The nurse can ensure the patency of the water seal by ensuring that the chamber is upright and by keeping 2cm of water in the water seal chamber.

The nurse suspects that a client has a diaphragmatic rupture and is in respiratory distress that is worsening. The nurse knows that which of the following additional information would confirm this suspicion?

Exacerbated symptoms when supine The diaphragmatic rupture allows abdominal organs to herniate into the thorax compressing the lungs. Respiratory compromise will increase when laying the patient supine.

The nurse is caring for a 70-year-old female with osteoporosis admitted for pneumonia. The nurse knows to implement which of the following precautions?

Fall precautions An older adult with osteoporosis is at high risk for an injury from falling due to the fragility of the client's bones.

The nurse is caring for a client that is suspected to have a flail chest injury. The nurse knows that it is best to position the client in which of the following positions?

Flail side downward to stabilize flail segments and improve ventilation This will stabilize the chest and improve ventilation in the non-injured hemothorax.

A client is admitted to the emergency room with suspected hemothorax. The nurse knows that which of the following is a possible sign of a massive hemothorax?

Flattened neck veins This would be a finding due to severe blood loss. A hemothorax is a collection of blood in the space between the chest wall and the lung.

The nurse is caring for a client with COPD. Which of the following are appropriate inhalation drugs to reduce inflammation? Select all that apply.

Fluticasone Fluticasone is an inhaled antiinflammatory drug. Dexamethasone

A nurse is caring for a client who has tuberculosis. The client is just completing a 9-month regimen of medication as part of treatment for the condition in which she responded well. Which of the following choices describes how follow-up is handled for the client who was treated successfully?

Follow-up is needed only if the client experiences symptoms of TB The standard form of treatment for tuberculosis is a 6 to 12 month regimen of medication, which is usually effective for most clients. After completing a therapeutic regimen, the client does not necessarily need routine follow-up unless he develops further symptoms of TB.

The nurse is admitting a client with pneumonia. The client's ABCs are intact. Which is the priority for this client?

Give IV antibiotics The nurse will need to obtain baseline labs as ordered by the provider. Once this is done, the first thing on the list is to initiate IV antibiotic therapy to treat the infection.

The nurse is caring for a client who has pneumonia. Which of the following are warning signs that the client may be going septic? Select all that apply.

Hypotension Hypotension is a sign of sepsis. Chills Chills indicate fever, which is a sign of infection. This can indicate sepsis. Decreased urination A septic client will demonstrate decreased urination due to hypoperfusion of the kidneys. Tachypnea A respiratory rate above 20 per minute is a sign of sepsis.

A nurse is caring for a client with a chest tube. He notes that the dressing around the client's tube insertion site is wet and there is some crepitus with mild palpation. Which actions by the nurse are most appropriate in this situation? Select all that apply.

Keep the tubing below the level of the insertion site To avoid back flow of fluid, the tubing must be kept below the insertion site. Prepare for replacement of the tube Crepitus indicates subcutaneous emphysema. The tube will need to be replaced to correct the air leak. Notify the provider to evaluate the level of suction Subcutaneous emphysema may develop in a client with a chest tube if air leaks under the skin, causing crepitus and swelling of the face and neck. The nurse should notify the physician right away and prepare to replace the tube.

The client has suffered from a chest injury. What are some nursing interventions appropriate to this situation? Select all that apply.

Monitor for shock A client with a chest injury is at high risk for hypovolemic shock and must be monitored appropriately. Provide humidified O2 This client is at risk for impaired oxygenation and the nurse will plan to support with supplemental humidified oxygen as needed. Monitor ABGs Due to the risk for impaired oxygenation and gas exchange, ABGs will need to be monitored in order to recognize potential decompensation.

A 69-year-old client has been diagnosed with aspiration pneumonia after suffering from a chronic illness. The nurse is teaching the client about how to best perform exercises for pulmonary hygiene. Which of the following should the nurse include as part of teaching?

Place your hands across your abdomen, take a deep breath, and cough A client who has pneumonia should practice pulmonary exercises that will help to improve breathing and overall lung function. Examples of pulmonary hygiene include using incentive spirometry and teaching the client to cough and deep breathe. The nurse should teaching the client to brace the abdomen with the hand for support, take a deep breath, and cough in order to clear secretions and open tiny alveoli in the lungs.

A nurse is caring for a client admitted to the emergency department. The client has just been diagnosed with a hemothorax. What is the priority nursing intervention at this time?

Prepare for chest tube insertion A hemothorax is blood (hemo) around the lungs in the chest cavity (thorax), which can cause the lung to collapse. The priority treatment is insertion of a chest tube to drain the blood and allow the lung to reinflate. Therefore the priority nursing intervention is to prepare for this by gathering supplies, positioning the client, setting up the collection chamber and suction setup, and possibly administering pain medication.

A nurse is applying an occlusive dressing over a chest wound and knows that in order for it to be properly applied, the goal for the dressing is to do which of the following?

Prevent air from entering the chest cavity when the patient inhales As the client breathes in, the occlusive dressing is pulled down to the wound preventing the entry of air.

A client arrives in the emergency room with rib fractures. The nurse and healthcare provider are reviewing the x-ray and would be most concerned about rib fractures in which of the following locations?

Right side, ribs 1 & 2 This location has the highest concern for the possibility of concurrent injuries. The significance of a first rib fracture is the association with cervical spine trauma, multiple rib fractures or life-threatening vascular injuries. Historically, fractures of ribs 1-3 have been associated with injuries of the brachial plexus and major vessels.

The nurse is caring for a client who was admitted with pneumonia 2 weeks ago. The client had been intubated and sedated for the first 48 hours. The client has a Foley catheter and a central venous catheter with fluids running at 75 ml/hr and intermittent IV antibiotics. The client also began working with PT/OT and gets up to the chair for meals. With which of the following is the nurse most concerned?

Risk for infection This client has had a Foley catheter and central venous catheter for over 2 weeks. Since the client is ambulatory and no longer on any medications that require central venous access, the central line should be discontinued as soon as possible to decrease the risk of infection.

The nurse knows that which of the following are risk factors for chronic obstructive pulmonary disease (COPD)? Select all that apply.

Smoking COPD is present when a client has chronic bronchitis and emphysema leading to obstruction of airflow. Risks include smoking, smoke exposure, air pollution, asbestos, and alpha-1 antitrypsin deficiency. Smoke exposure Smoke exposure is a risk factor for COPD. Asbestos Asbestos is a risk factor for COPD.

The nurse is caring for a client with a chest tube. While assessing the tubing, the nurse notes a clot in the tubing. What action is appropriate in order to remove the clot from the tubing?

Squeeze by sections moving from the client to the chest tube chamber Squeezing with one hand then releasing before squeezing further down is the best evidence-based way to clear a chest tube of a clot.

While caring for a client who is recovering from surgery, the nurse finds out that the client is infected with active tuberculosis. Prior to this discovery, the nurse had only been using standard precautions. Which action of the nurse is most appropriate for providing proper precautions in this situation?

Start using precautions right away by placing the client in a negative pressure room and using a respirator mask Isolation precautions are used for different types of infectious conditions to prevent the transmission of illness. A client with active TB requires airborne precautions, which include isolation in a negative-pressure room and the use of a specialized filter mask when providing care. Airborne precautions should be implemented right away, even if this nurse was unaware of the condition before.

A nurse is caring for a client who is receiving a TPN infusion. The nurse suspects that the client has developed a pneumothorax because of the placement of the central line. Which action would the nurse perform in response?

Stop the infusion and get a chest x-ray A pneumothorax is a potential complication of central catheter use, particularly when the catheter is placed in a central vein that could perforate the pleural space. The client with a pneumothorax from a central line may develop sudden shortness of breath, cyanosis and tachycardia. They may also complain of sharp pain in the chest or shoulder. The nurse should stop the infusion, notify the provider and prepare to obtain a chest x-ray if this occurs.

Which of the following is a true statement regarding tuberculosis?

TB is caused by an infection with a bacterium called Mycobacterium Tuberculosis is an infectious disease caused by mycobacterium tuberculosis that can spread easily between people who do not take appropriate precautions. M. tuberculosis is an aerobic bacterium, so it primarily affects the lungs, but can affect other organs including the brain, kidneys, joints, and liver.

The nurse is caring for a client with a chest tube. The nurse will refrain from clamping the chest tube because which of the following could happen?

Tension pneumothorax Clamping a chest tube can cause a tension pneumothorax, because it becomes a one-way valve for air to enter the pleural space, but the air cannot escape because the tube is clamped. The trachea will deviate away from the affected side in this situation, and the client will present with chest pain, dyspnea, hypoxia and hypotension.

A 60-year-old client is going through pulmonary rehabilitation for COPD. The nurse understands that an expected outcome of pulmonary rehabilitation is which of the following?

The client has an easier time performing activities of daily living Pulmonary rehabilitation is designed to help a client with lung disease to improve their ability to perform activities of daily living and overall quality of life. The program may provide education about oxygen therapy and medications, offer tips for the client to exercise more, and often provides social support.

A 68-year-old client with COPD is being seen for pulmonary rehabilitation. The nurse is instructing the client on exercise guidelines for managing the disease. Which information must the nurse include as part of exercise guidelines for this client?

The client should be monitored during exercise to address safety Part of pulmonary rehabilitation is to educate the client about guidelines for activity levels. While it is important for a client with COPD to get enough exercise, the nurse also needs to address the client's safety to prevent harm from exercise that is too intense. When starting pulmonary rehab, the client will most likely need to be monitored while exercising.

A nurse has just received report on 4 clients who all have chest tubes in place. Which client is the priority to see first?

The client with continuous bubbling in the drainage chamber Continuous bubbling in the chamber reflects an air leak, meaning there could be a hole in the tubing or it could be dislodged. This client is the priority to be seen first. Note - a client with a pneumothorax will have bubbling in the chamber during breathing, which is a normal, expected finding. But it will fluctuate with breathing, not be continuous.

A client is being admitted to the hospital from home with complications of tuberculosis. When making a room assignment, the nurse would most likely consider which of the following factors?

The hospital's isolation procedures Most client room assignments are made based on the client's condition and the availability of staff. In this situation, the client has an infectious condition and needs a specific room that has a negative pressure air system. Therefore in this case, the client's assignment is based on the hospital's isolation procedures for a client with an airborne illness.

A student nurse caring for a 6-year-old diagnosed with bronchitis asks what this means. Which of the following is the best explanation of the diagnosis related to where inflammation and infection occur?

The lower airways Bronchitis is when there is inflammation in the large airways, the trachea and bronchi, which are part of the lower airways.

A nurse must use a N95 respirator for protection against tuberculosis with a client. Which of the following considerations should be used while the nurse is utilizing this mask?

The mask must be fitted specifically for the nurse An N95 respirator is a special type of mask worn by the nurse to filter out airborne particles of microorganisms. The respirator is designed to protect the wearer against pathogens of a specific size, such as tuberculosis. It must be fitted specifically for the nurse to ensure there is a tight seal against the face. The N95 respirator is not the same as a surgical mask and the two are not interchangeable.

A nurse is working with a new staff member who has just been hired as a nurse on the surgical unit. A client has been brought in for care who has an infection with tuberculosis. The nurse instructs the new staff nurse that the client needs airborne precautions. Which is the correct action for this type of precaution that the nurse would observe in the new staff member?

The nurse wears a N95 respirator when caring for the client A person with an infectious disease who requires airborne precautions would need specialized equipment that would prevent the infectious particles from reaching the nurse. An N95 respirator is a fitted mask designed to filter the small particles of tuberculosis that would protect the nurse from being exposed to the disease. Additional actions for airborne precautions include placing the client in a private, negative airflow pressure room with the door closed except for entering and exiting, and a surgical mask for the client whenever the client leaves the room.

A nurse is caring for a client who has a chest tube after a motor vehicle accident. The provider has ordered low suction for the chest tube. Which interventions would the nurse utilize when managing suction on this chest tube? Select all that apply.

The wall suction should be set at > 80 mmHg When a wet suction control unit is used, the level of water determines the amount of suction inside the chest cavity. The wall suction should be set at >80 mmHg for a suction level of -20 mmHg. The nurse should note tidaling when the client breathes Tidaling in the water-seal chamber means that the client is breathing, and is normal. However, intermittent or continuous bubbling in the water-seal chamber means there is an air leak. The leak should be located and fixed immediately, and the provider needs to be notified if the nurse is unable to find the leak. The nurse should notify the provider if there is a sudden increase in drainage If there is a large increase in the amount of output from the chest tube, the provider must also be notified right away, because this could indicate hemorrhage.

The nurse caring for a 15-year-old with chronic bronchitis asks the client about which of the following?

Tobacco and marijuana use Chronic bronchitis in teenagers is often associated with tobacco and marijuana use.

The nurse is caring for a client whose chest x-ray shows pneumonia. The provider has placed the following orders: vancomycin IV, piperacillin/tazobactam IV, blood and sputum cultures, vitals now and every 4 hours. Which order needs to be completed first?

Vitals The order reads "vitals now", which means vital signs should be taken first. After vital signs, the nurse would draw blood cultures, then the antibiotics would be administered. It is essential to draw cultures prior to antibiotic initiation, because the antibiotics will impact culture results.