Ch 31 - Care of Patients with Infectious Respiratory Problems
12. A child is diagnosed with a group B streptococcus throat infection. In teaching the parents about treatment of the infection, what does the nurse instruct the parents? A. Need to complete entire course of penicillin or penicillin-like antibiotics B. Gradual return to activities until there are no physical complaints C. Purpose of a clear liquid diet until infection subsides D. Signs and symptoms of meningitis, which is a common complication
A
16. An active 45-year-old school teacher with chronic obstructive pulmonary disease (COPD) taking prednisone asks if it is necessary to get a flu shot. What is the best response by the nurse? A. "Yes, flu shots are highly recommended for patients with chronic illness and/or patients who are receiving immunotherapy." B. "No, flu shots are only recommended for patients 50 years old and older." C. "Yes, it will help minimize the risk of triggering an exacerbation of COPD." D. "No, patients who are active, not living in a nursing home, and not health care providers do not need a flu shot."
A
21. A patient with a history of frequent and recurrent episodes of tonsillitis now reports a severe sore throat with pain that radiates behind the ear and difficulty swallowing. The nurse suspects the patient may have a periotonsillar abscess. On physical assessment, which deviated structure supports the nurse's supposition? A. Uvula B. Trachea C. Tongue D. Mucous membranes
A
31. A patient is diagnosed with pneumonia. During auscultation of the lower lung fields, the nurse hears coarse crackles and identifies the patient problem of impaired oxygenation. What is the underlying physiologic condition associated with the patient's condition? A. Hypoxemia B. Hyperemia C. Hypocapnia D. Hypercapnia
A
33. A patient is admitted to the hospital with pneumonia. What does the nurse expect the chest x-ray results to reveal? A. Patchy areas of increased density B. Tension pneumothorax C. Thick secretions causing airway obstruction D. Large hyper inflated airways
A
35. The nurse is conducting an in-service for the hospital staff about practices that help prevent pneumonia among at-risk patients. Which nursing intervention is encouraged as standard practice? A. Administering vaccines to patients at risk B. Implementing isolation for debilitated patients C. Restricting foods from home in immunosuppressed patients D. Decontaminating respiratory therapy equipment weekly
A
40. A critical concern for a patient returning to the unit after a surgical procedure is related to impaired oxygenation caused by inadequate ventilation. Which arterial blood gas value and assessment finding indicates to the nurse that oxygen and incentive spirometry must be administered? A. PaO2 is 90 mmHg with crackles. B. PaO2 is 90 mmHg with wheezing. C. PCO2 is 38 mmHg with clear lung sounds. D. PCO2 is 45 mmHg with atelectasis
A
43. The nurse is providing discharge instructions about pneumonia to a patient and family. Which discharge information must the nurse be sure to include? A. Complete antibiotics as prescribed, rest, drink fluids, and minimize contact with crowds. B. Take all antibiotics as ordered, resume diet and all activities as before hospitalization. C. No restrictions regarding activities, diet, and rest because the patient is fully recovered when discharged. D. Continue antibiotics only until no further signs of pneumonia are present; avoid exposing immunosuppressed individuals.
A
44. A patient is admitted to the hospital with cough, purulent sputum production, temperature of 37.9 C, and reports of shortness of breath. Which intervention does the nurse provide first? A. Set up oxygen equipment and administer oxygen. B. Instruct the patient about the importance of keeping the oxygen delivery device on. C. Monitor the effectiveness of oxygen therapy (pulse oximetry, ABGs) as appropriate. D. Monitor the patient's anxiety related to the need for oxygen delivery.
A
46. Which complication of pneumonia creates pain that increases on inspiration because of inflammation of the parietal pleura? A. Pleuritic chest pain B. Pulmonary emboli C. Pleural effusion D. Meningitis
A
57. Which test result indicates a patient has clinically active TB? A. Induration of 12 mm and positive sputum B. Positive chest x-ray for TB C. Positive chest x-ray and clinical symptoms D. Sputum tests positive for blood
A
6. A patient reports throat soreness and dryness, throat pain, pain on swallowing (odynophagia), and difficulty swallowing. Which disorder does the nurse suspect? A. Pharyngitis B. Tonsillitis C. Rhinosinusitis D. Pneumonia
A
63. The nurse is teaching a patient about the combination drug therapy that is used in the treatment of TB. Which patient statement indicates the nurse's instruction was effective? A. "I will take three drugs: isoniazid, rifampin, and pyrazinamide, then ethambutol may be added later." B. "Combining the drugs in one pill is a convenient way for me to take all the medications." C. "The isoniazid combines with the TB bacteria. I can take the rifampin and pyrazinamide if I continue to have symptoms." D. "Combining the medications means to take the isoniazid, rifampin, and pyrazinamide all at the same time."
A
24. The nurse is giving discharge instructions to an adult patient diagnosed with the flu. The patient says, "I am generally pretty healthy, but I am concerned because my wife has several chronic health problems. What can I do to protect her from getting my flu?" What does the nurse instruct the patient to do? (Select all that apply.) A. Wash hands thoroughly after sneezing, coughing, or blowing nose. B. Avoid kissing, hugging, close face-to-face proximity, or hand-holding. C. If there is no tissue immediately available, cough or sneeze into your upper sleeve. D. Have the wife wear a respiratory filter mask until coughing stops. E. Use disposable tissues rather than cloth handkerchiefs, and immediately dispose of tissues.
A, B, C, E
65. The patient is receiving isoniazid (INH) to treat TB. Which nursing teaching points are essential when giving this drug? (Select all that apply.) A. Teach the patient not to take medications such as Maalox with this medication. B. Avoid drinking alcoholic beverages. C. Teach the patient that urine will be orange in color. D. Take a multivitamin with B complex. E. If going out in the sun, be sure to wear protective clothing and sunscreen. F. Teach women that this drug reduces the effectiveness of oral contraceptives.
A, B, D
4. A patient comes to the walk-in clinic reporting seasonal nasal congestion; sneezing; rhinorrhea; and itchy, watery eyes. The nurse identifies that the patient most likely has rhinitis and should also be assessed for sinusitis. Which manifestations does the nurse assess in a patient with rhinosinusitis? (Select all that apply.) A. Pain over the right cheek radiating to the teeth. B. Tenderness to percussion over the sinuses. C. Generalized musculoskeletal achiness. D. General facial pain when bending forward. E. Referred pain to the temple or back of the head.
A, B, D, E
47. Which conditions may cause patients to be at risk for aspiration pneumonia? (Select all that apply.) A. Continuous tube feedings B. Bronchoscopy procedure C. Magnetic resonance imaging (MRI) procedure D. Decreased level of consciousness E. Stroke F. Chest tube
A, B, D, E
48. An older adult patient often coughs and chokes while eating or trying to take medication. The patient insists that he is okay, but the nurse identifies the priority patient problem of risk for aspiration. Which nursing interventions are used to prevent aspiration pneumonia? (Select all that apply.) A. Head of bed should always be elevated during feeding. B. Monitor the patient's ability to swallow small bites. C. Give thin liquids to drink in small, frequent amounts. D. Consult a nutritionist and obtain swallowing studies E. Monitor the patient's ability to swallow saliva. F. Place the patient on NPO (nothing by mouth) status until swallowing is normal.
A, B, D, E
3. Drug therapy with first-generation antihistamines to treat sinusitis is used with caution in the older adult because of which possible side effects? (Select all that apply.) A. Reduced clearance B. Hypotension C. Confusion D. Dry mouth E. Constipation
A, C, D, E
9. Which factors can contribute to acute pharyngitis? (Select all that apply.) A. Viruses B. Coughing C. Irritants D. Bacteria E. Alcohol
A, C, D, E
13. Which patients are at risk for developing health-care acquired pneumonia? (Select all that apply.) A. Confused patient B. Patient with atrial fibrillation who is alert and oriented C. Patient with Gram-negative colonization of the mouth D. Patient with hyperthyroid disease E. Malnourished patient
A, C, E
5. To reduce the spread of colds, which teaching points must the nurse include when teaching patients? (Select all that apply.) A. Stay home from work, school, or other places where people gather. B. Seek medical attention at the first sign of an oncoming cold. C. Cover both mouth and nose when coughing or sneezing. D. Always dispose of used tissues properly. E. Thorough handwashing is essential.
A, C, E
55. Which people are at greatest risk for developing TB in the United States? (Select all that apply.) A. An alcoholic homeless man who occasionally stays in a shelter. B. A college student sharing a room in a dormitory C. A person with immune dysfunction or HIV D. A homemaker who does volunteer work at a homeless shelter E. Foreign immigrants (especially those from the Philippines and Mexico)
A, C, E
56. After several weeks of "not feeling well," a patient is seen in the provider's office for possible TB. If TB is present, which assessment findings does the nurse expect to observe? (Select all that apply.) A. Fatigue B. Weight gain C. Night sweats D. Chest soreness E. Low-grade fever
A, C, E
28. A patient is seen in the health care provider's office and is diagnosed with community-acquired pneumonia. What are the most common symptoms the patients will have? (Select all that apply.) A. Dyspnea B. Abdominal pain C. Back pain D. Hypoxemia E. Chest discomfort
A, D, E
29. Which diagnostic tests are most likely to be done for a patient suspected of having community-acquired pneumonia? (Select all that apply.) A. Sputum Gram stain B. Pulmonary function test C. Fluorescein bronchoscopy D. Peak flowmeter measurement E. Chest x-ray
A, E
17. A patient who had sinus surgery has a surgical incision under the upper lip. The nurse intervenes when a well-intentioned family member performs which action in attempting to make the patient feel better? A. Uses the bed controls to move the patient to a semi-Fowler's position B. Hands the patient a tissue to blow the nose C. Brings the patient a special custard dessert from a nearby restaurant D. Gently helps the patient with oral hygiene during morning care
B
18. The nursing is giving discharge instructions to a patient diagnosed with a viral pharyngitis. Which statement by the patient indicates the need for further teaching? A. "I should try to rest, increase my fluid intake, and get a humidifier for the house." B. "I will wait for my test results, then I can get a prescription for antibiotics." C. "Over-the-counter analgesics, like Tylenol or ibuprofen, can be used for pain." D. "I should gargle several times a day with warm salt water and use throat lozenges."
B
22. A parent calls the ED about her child who reports a severe sore throat and refuses to drink fluids or to take liquid pain medication. What is the most important question for the nurse to ask in order to determine the need to seek immediate medical attention? A. "Does the child seem to be refusing fluids and medications because of the sore throat." B. "Is the child drooling or do you hear stridor, a raspy rough sound when the child breathes?" C. "When did the symptoms start and how long have you been encouraging fluids?" D. "Is the throat red or do you see any white patches in the back of the throat?"
B
26. Which patient is at highest risk for developing pneumonia? A. Any hospitalized patient between the ages of 18 and 65 years B. 32-year-old trauma patient on a mechanical ventilator C. Disabled 54-year-old with osteoporosis; discharged to home D. Any patient who has not received the vaccine for pneumonia
B
27. Which statement best describes pneumonia? A. An infection of just the "windpipe" because the lungs are "clear" of any problems B. A serious inflammation of the bronchioles from various causes C. Only an infection of the lungs with mild to severe effects on breathing D. An inflammation resulting from lung damage caused by long-term smoking
B
41. The nurse has identified the priority patient problem of ineffective airway clearance with bronchospasm for a patient with pneumonia. The patient has no previous history of chronic respiration disorders. The nurse obtains an order for which nursing intervention? A. Increased liters of humidified oxygen via facemask B. Scheduled and PRN (as-needed) aerosol C. Handheld bronchodilator inhaler as needed D. Corticosteroid via inhaler or IV to reduce the inflammation
B
45. A patient has been treated for pneumonia and the nurse is preparing discharge instructions. The patient is capable of performing self-care and is anxious to return to his job at the construction site. Which instructions does the nurse give to this patient? A. "You are not contagious to others, so you can return to work as soon as you like." B. "You will continue to feel tired and will fatigue easily for the next several weeks." C. "Try to drink 4 quarts of water per day, especially if you are very physically active." D. "You should be able to return to work full-time in 2 weeks when your energy returns."
B
49. Which condition causes a patient to have the greatest risk for community-acquired pneumonia? A. Tube feedings B. History of tobacco use C. Poor nutritional status D. Altered mental status
B
53. A patient with human immunodeficiency virus (HIV) is admitted to the hospital with a temperature of 99.6 F, and reports of bloody sputum, night sweats, feeling of tiredness, and shortness of breath. What are these assessment findings consistent with? A. Penumocystis jiroveci pneumonia (PJP) B. Tuberculosis C. Superinfection as a result of low CD4 count D. Severe bronchitis
B
62. A patient has an HIV infection, but the TB skin test shows an induration of less than 10 mm and no clinical symptoms of TB are present. Which medication does the patient receive for a period of 12 months to prevent TB? A. Bacille Calmette-Guerin (BCG) vaccine B. Isoniazid (INH) C. Ethambutol D. Streptomycin
B
64. A patient diagnosed with TB has been receiving treatment for 3 weeks and has clinically shown improvement. The family asks the nurse if the patient is still infectious. What is the nurse's reply? A. "The patient is still infectious until the entire treatment is completed." B. "The patient is not infectious but needs to continue treatment for at least 6 months." C. "The patient is infectious until there is a negative chest x-ray." D. "The patient may or may not be infectious; a purified protein derivative test (PPD) must be done."
B
66. A patient with suspected TB is admitted to the hospital. Along with a private room, which nursing intervention is appropriate related to isolation procedures? A. Respiratory isolation and contact isolation for sputum only B. Strict respiratory isolation and use of specially designed face masks C. Respiratory isolation with surgical masks until diagnosis is confirmed D. No respiratory isolation necessary until diagnosis is confirmed
B
7. An older adult patient residing in a long-term care facility demonstrates new onset of coughing and sneezing with rhinorrhea after his grandchildren came to visit him. He denies pain or fever. Which infection control procedures does the nurse instruct the LPN to initiate in order to protect other residents? A. Initiate the use of standard precautions when caring for the patient. B. Place the patient on droplet precautions for the first 2 to 3 days. C. Use gown and gloves when entering the room and perform hand hygiene D. Instruct the patient to wash his hands after coughing or sneezing.
B
70. The nurse is making home visits to an older adult recovering from a hip fracture and identifies the priority patient problem of risk for respiratory infection. Which condition represents a factor of normal aging that would contribute to this increased risk? A. Inability to force a cough B. Decreased strength of respiratory muscles C. Increased elastic recoil of alveoli D. Increased macrophages in alveoli
B
8. The nurse is assessing an older adult who has been diagnosed with bacterial pharyngitis. Which assessment finding is typically associated with this medical diagnosis, but may not be present in the older adult patient? A. Cough and rash B. High fever and elevated white blood cell (WBC) count C. Pain with speaking or swallowing D. Erythema of tonsils with yellow exudate
B
19. A patient with COPD needs instruction in measures to prevent pneumonia. What information does the nurse include? (Select all that apply.) A. Avoid going outside. B. Clean all respiratory equipment you have at home. C. Avoid indoor pollutants such as dust and aerosols. D. Get plenty of rest and sleep daily. E. Limit alcoholic beverages to 4 to 5 per week.
B, C, D
54. Which statements about the precautions of caring for a hospitalized patient with tuberculosis (TB) are true? (Select all that apply.) A. Health care workers must wear a mask that covers the face and mouth. B. Negative airflow rooms are required for these patients. C. Health care workers must wear an N95 or high-efficiency particulate air (HEPA) mask. D. Gown and gloves are included in appropriate barrier protection. E. Strict contact precautions must be maintained.
B, C, D
51. The nurse is preparing a community information packet about "bird flu." What information does the nurse include for public dissemination? (Select all that apply.) A. In the event of an outbreak, do not eat any cooked or uncooked poultry products. B. Prepare a minimum of 2 weeks supply of food, water, and routine prescription drugs. C. Listen to public health announcements and early warning signs for disease outbreaks. D. Avoid traveling to areas where there has been a suspected outbreak of disease. E. Obtain a supply of antiviral drugs such as oseltamivir (Tamiflu). F. In the event of an outbreak, avoid going to public areas such as churches or schools.
B, C, D, F
69. Patients who are at high risk for TB would be asked which questions upon assessment? (Select all that apply.) A. "What does your diet normally consist of?" B. "Do you have an immune dysfunction or HIV?" C. "Do you use alcohol or inject recreational drugs?" D. "Where do you live in the United States?" E. "Do you work in a crowded area such as a prison or mental health facility?"
B, C, E
1. An adult patient diagnosed with rhinitis medicamentosa reports chronic nasal congestion. What does the nurse instruct the patient to do? A. Avoid exposure to older adults or immunosuppressed persons when symptoms flare. B. Damp-dust the house and clean the carpets to remove animal dander or mold. C. Discontinue the use of the current nose drops or sprays. D. Identify what triggers the hypersensitivity reaction by keeping a symptom diary.
C
10. A patient reporting a "sore throat" also has a temperature of 101.4 F, scarlatiniform rash, and a positive rapid test throat culture. This patient will most likely be treated for which type of bacterial infection? A. Staphylococus B. Penumococcus C. Streptococcus D. Epstein-Barr virus
C
15. A 35-year-old male patient with no health problems states that he had a flu shot last year and asks if it is necessary to have it again this year. What is the best response by the nurse? A. "No, because once you get a flu shot, it lasts for several years and is effective against many different viruses." B. "Yes, because the immunity against the virus wears off, increasing your chances of getting the flu." C. "Yes, because the vaccine guards against a specific virus and reduces your chances of acquiring flu and is only effective for one year." D. "No, flu shots are only for high-risk patients and you are not considered to be high risk."
C
20. The nurse is taking a history on a patient who presents with symptoms of pharyngitis: sore throat with dry sensation, pain on swallowing, and low-grade fever. The patient mentions plans to take an overseas trip. Which immunization does the nurse suggest the patient should have, if not already received, before leaving? A. Tetanus toxoid B. Hepatitis B C. Diphtheria D. Yellow fever
C
23. In a long-term care facility for older adults and immunocompromised patients, one employee and several patients have been diagnosed with influenza (flu). What does the supervising nurse do to decrease the risk of infection to other patients? A. Ask employees who have flu to stay at home for at least 24 hours. B. Place any patient with a sore throat, cough, or rhinorrhea into isolation for 1 to 2 weeks. C. Ask employees with flu symptoms to stay at home for up to 5 days after onset of symptoms. D. Recommend that all patients and employees be immediately vaccinated for flu.
C
25. The patient developed flu symptoms less than 24 hours ago. Which drug therapy does the nurse expect the health care provider to order at this time? A. Penicillin therapy B. Amantadine (Symmetrel) C. Oseltamivir (Tamiflu) D. IV steroid therapy
C
32. Which patient is least likely to be at risk for developing pneumonia? A. Patient with a 5-year history of smoking B. Renal transplant patient C. Postoperative patient with a bedside commode D. Postoperative patient with a hip replacement
C
34. What nursing intervention may help to prevent the complication of pneumonia for a surgical patient? A. Monitoring chest x-rays and WBC counts for early signs of infection B. Monitoring lung sounds every shift and encouraging fluids C. Teaching coughing, deep-breathing exercises, and use of incentive spirometry D. Encouraging hand hygiene among all caregivers, patients, and visitors
C
36. A patient hospitalized for pneumonia has the priority patient problem of ineffective airway clearance related to fatigue, chest pain, excessive secretions, and muscle weakness. What nursing intervention helps to correct this problem? 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 bronchospasm. D. Maintain semi-Fowler's position to facilitate breathing and prevent further fatigue.
C
37. A patient is admitted to the hospital for treatment of pneumonia. Which nursing assessment finding best indicates that the patient is responding to antibiotics? A. Wheezing, oxygen at 2 L/min, respiratory rate 26, no shortness of breath or chills B. Temperature 99 F, lung sounds clear, pulse oximetry on 2 L/min at 98%, cough with yellow sputum C. Cough, clear sputum, temperature 99 F, pulse oximetry at 96% on room air D. Feeling tired, respiratory rate 28 on 2 L/min of oxygen, audible breath sounds
C
42. An older adult patient asks the nurse how often one should receive the pneumococcal vaccine for pneumonia prevention. What is the nurse's best response? A. Every year when the patient is receiving the 'flu shot.' B. The standard vaccination every 3 years. C. It is usually given once, but some older adults may need a second vaccination after 5 years. D. There is no set schedule; it depends on the patient's history and risk factors.
C
50. In the event of a new severe acute respiratory syndrome (SARS) outbreak, what is the nurse's primary role? A. Immediately report new cases of SARS to the Centers for Disease Control and Prevention (CDC). B. Administer oxygen, standard antibiotics, and supportive therapies to patients. C. Prevent the spread of infection to other employees and patients. D. Initiate and strictly enforce contact isolation procedures.
C
52. A patient reports experiencing mild fatigue and a dry, harsh cough. There is a possibility of exposure to inhalation anthrax, but the patient currently reports feeling much better. What does the nurse advise the patient to do? A. Have a complete blood count to rule out the disease. B. Monitor for and immediately seek attention for respiratory symptoms. C. Consult a provider for diagnostic testing and antibiotic therapy. D. Stay at home, rest, increase fluid intake, and avoid public places.
C
59. A patient has a positive skin test result for TB. What explanation does the nurse give to the patient? A. "There is active disease, but you are not yet infectious to others." B. "There is active disease and you need immediate treatment." C. "You have been infected but this does not mean active disease is present." D. "A repeat skin test is necessary because the test could give a false-positive result."
C
67. A patient is admitted to the hospital to rule out TB. What type of mask does the nurse wear when caring for this patient? A. Surgical facemask B. Surgical facemask with eye shield C. HEPA respirator mask D. Any type of mask that covers the nose and mouth
C
68. After being discharged from the hospital, a patient is diagnosed with TB at the outpatient clinic. What is the correct procedure regarding public health policy in this case? A. Contact the infection control nurse at the hospital because the hospital is responsible for follow-up of this case. B. There are no regulations because the patient was diagnosed at the clinic and not during hospitalization. C. Contact the public health nurse so that all individuals who have come in contact with the patient can be screened. D. Have the patient sign a waiver regarding the hospital and clinic's liability for treatment.
C
14. The nurse is teaching the patient and family about care of a peritonsillar abscess at home. For what symptoms does the nurse indicate the need for the patient to go to the emergency department (ED) immediately? (Select all that apply.) A. Persistent cough B. Hoarseness C. Stridor D. Drooling E. Nausea and vomiting
C, D
11. A patient reporting soreness in the throat is diagnosed with "strep throat." To prevent complications such as rheumatic heart disease, this patient should receive which intervention? A. Humidification of the air B. Saline gargles 4 to 6 times a day C. Increased fluid intake of 3 to 4 L/day D. Oral antibiotics such as penicillin
D
2. The nurse notes that an older patient has a disorder that indicates drug therapy that the health care provider just prescribed for symptomatic relief of allergic rhinitis must be used with caution. Which disorder does the nurse report to the health care provider as a possible precaution for drug therapy? A. Sleep apnea B. Valvular heart disease C. Meniere's disease D. Urinary retention
D
30. The nurse is reviewing laboratory results for a patient who has pneumonia. Which laboratory value does the nurse expect to see for this patient? A. Decreased hemoglobin B. Increased red blood cells (RBCs) C. Decreased neutrophils D. Increased white blood cells (WBCs)
D
38. The nurse is reviewing the laboratory results for an older adult patient with pneumonia. Which laboratory value frequently seen in patients with pneumonia may not be seen in this patient? A. RBC 4.0 to 5.0 B. Hgb 12 to 16 C. Hct 36 to 48 D. WBC 12 to 18
D
39. A patient is admitted to the hospital to rule out pneumonia. Which infection control technique does the nurse maintain? A. Strict respiratory isolation and use of a specially designed face mask B. Respiratory isolation and contact isolation for sputum C. Respiratory isolation with a stock surgical mask D. Standard precautions and no respiratory isolation
D
58. After receiving the subcutaneous Mantoux skin test, a patient with no risk factors returns to the clinic in the required 48 to 72 hours for the test results. Which assessment finding indicates a positive result? A. Test area is red, warm, and tender to touch B. Induration or a hard nodule of any size at the site C. Induration/hardened area measure 5 mm or greater D. Induration/hardened area measure 10 mm or greater
D
60. A patient has been compliant with drug therapy for TB and has returned as instructed for follow-up. Which result indicates that the patient is no longer infectious/communicable? A. Negative chest x-ray B. No clinical symptoms C. Negative skin test D. Three negative sputum cultures
D
61. A patient diagnosed with TB agrees to take the medication as instructed and to complete the therapy. When does the nurse tell the patient is the best time to take the medication? A. Before breakfast B. After breakfast C. Midday D. Bedtime
D
