Ch.22 PrepU
A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be:
"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."
The nurse is performing a health history for a male client who is having a series of diagnostic test to determine the presence of squamous cell carcinoma. What question would be most beneficial for the nurse to ask that would correlate with this suspicion?
"Do you have a history of smoking, and if so, how much?"
A client from Texas is suspected of being infected with coccidioidomycosis and has been admitted to the hospital with fever, cough, pleuritic chest pain, and skin lesions. When performing a health history, which question would be most valuable to assist with diagnosis?
"Do you work in construction and dig soil?"
Diagnostic testing has resulted in a diagnosis of small cell lung cancer in an older adult client. When exploring the etiology of the client's disease, what assessment question is most relevant?
"Have you ever been a smoker?"
A family physician is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by the patient best reflects an accurate understanding of the flu virus?
"I could come down with viral or bacterial pneumonia as a result of a bad flu bug."
While educating a smoking cessation class, a client asks the nurse, "If I can still get lung cancer, what should I be looking for?" Which response by the nurse is best?
"The earliest symptoms relate to a chronic cough and shortness of breath."
A client tells the nurse he was diagnosed with a sinus infection about 7 days ago. He is now experiencing facial swelling and has also had periods of confusion. His family told him he is not remembering things. The best response by the nurse would be:
"This can be a complication of the infection; we need to let the health care provider know."
A client, newly diagnosed with lung cancer, asks the nurse why the health care provider has ordered a positron emission tomography (PET) scan. Which response by the nurse is best?
"This diagnostic procedure will let the doctor know if you have any mestastatic lesions in your body."
A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her physician most appropriately respond to her?
"This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens."
When educating a student who lives in a crowded apartment and diagnosed with tuberculosis, the college school nurse will emphasize:
"To destroy this bacterium, you must strictly adhere to a long-term drug regimen."
As part of a public health initiative, a nurse is teaching a group of older adults about ways to promote and maintain their health. Recognizing that the common cold is a frequent source of ailment, the nurse is addressing this health problem. Which of the following teaching points about the common cold is most accurate?
"Use caution when choosing over the counter drugs for your cold; most people do best with rest and anti-fever medications."
A client diagnosis with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. Which of the following is the best response?
"You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated."
A client with a history of hypertension and diabetes mellitus has developed a cold and tells the nurse he purchased an OTC (over-the-counter) nasal decongestant. The most important information for the nurse to provide would be:
"You should not take this medication; it can cause problems."
A health educator is performing a health-promotion workshop with the staff of a large, urban homeless shelter, and a component of the teaching centers around tuberculosis. One of the staff members comments, "Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment?
"actually, people who have the latent form of the disease won't be sick and can't spread it either."
The neonatal ICU nurse is aware that Type II alveolar cells produce surfactant and they usually develop at how many weeks gestation?
24-28 weeks.
A pregnant client has experienced episodes of premature labor and is concerned about her unborn child's lung development. The client asks the nurse when the fetus begins to produce sufficient surfactant. The best response would be:
27 weeks
At an influenza vaccination clinic, a nurse is screening clients who are requesting the vaccine. The nurse determines that which of the following clients is unable to receive the vaccine?
A 20-year-old healthy female reporting an allergy to eggs
The nurse is assigned to care for four clients on a medical floor. Which client is most at risk for viral pneumonia after influenza?
A 76-year-old client with cardiopulmonary disease
Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?
A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F
Which of the following situations would be most deserving of a pediatrician's attention?
A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.
Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development?
A single-capillary network exists and the lungs are capable of respiration.
Which of the following is/are a lower airway disease? (Select all that apply.)
Acute bronchiolitis Asthma
An adult comes to the urgent care clinic reporting facial pain, headache, and copious amounts of thick purulent nasal discharge. Based on these symptoms, the nurse practitioner suspects the client is experiencing which condition?
Acute viral rhinosinusitis
A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercule scarring site, located in a peripheral area of his bronchiolar tissue. What is this client's most likely diagnosis?
Adenocarcinoma
A client has developed community-acquired pneumonia and is being treated at home. What does the nurse recognize are the methods in the diagnosis of community-acquired pneumonia? Select all that apply.
Age Coexisting health problems Severity of illness
A prison inmate contracted tuberculosis during a recent outbreak. The nurse caring for these inmates correctly identifies which of the following as the mode of transmit for this disease?
Airborne droplets
The infection control nurse at a large hospital has instituted a new education campaign aimed at reducing the incidence of hospital-acquired pneumonia (HAP). The nurse should identify which client as being particularly susceptible to hospital-acquired pneumonia?
An intubated client who is ventilator dependent following a traumatic head injury
A client diagnosed with influenza asks the nurse what treatment he can do to feel better. The nurses' response should include: Select all that apply.
Analgesics Cough medicine Antiviral medication Rest
The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be:
Antipyretic medications and rest
A client has been diagnosed with sinusitis. The nurses anticipate that the client may present with head pain that increases with:
Bending forward, coughing, or sneezing
An infant born 10 weeks premature was placed on mechanical ventilation. Eight weeks later a nursing assessment reveals a barrel chest, tachycardia, rapid and shallow breathing, hypoxemia, hypercapnia, and poor weight gain. Based on this assessment which of the following is the most likely diagnosis?
Bronchopulmonary dysplasia
An infant who was born prematurely and developed respiratory distress syndrome was placed on mechanical ventilation for several weeks. What condition should the nurse monitor the infant for related to the long-term ventilatory support?
Bronchopulmonary dysplasia
In which period of fetal lung development does type II alveolar cells begin to produce surfactant?
Canalicular
Tuberculosis is a highly destructive disease because the tubercle bacillus activates a tissue hypersensitivity to the tubercular antigens. What does the destructive nature of tuberculosis cause in a previously unexposed immunocompetent person?
Caseating necrosis and cavitation
A middle-aged client with a 30-year history of smoking was diagnosed with lung cancer. A health history revealed previous exposure to air pollution, asbestos, and radiation. Which of the following most likely had the greatest impact on development of the lung cancer?
Cigarette smoke
A 23-year-old woman goes to the drugstore to buy a medication to ease the symptoms of her cold. Her friends have told her to buy a medication with an antihistamine in it to help dry up her runny nose and make it easier to breathe. The woman talks with the pharmacist, who has known her many years. The pharmacist recommends that this young woman not buy a cold medication with a decongestant in it. Why would he do that?
Client has a history of hyperthyroidism
A 3-year-old boy has been diagnosed with croup (acute laryngotracheobronchitis). The nurse anticipates the plan of care to include:
Cool, humidified air to relieve airway spasms
Which classification of medications used to self treat the common cold should be avoided by those with a history of hypertension?
Decongestants
An expectant mother is 23 weeks into her pregnancy when she goes into labour. Regarding fetal lung development, what is of greatest concern to the attending medical team?
Development of type II alveolar cells
A client is preparing to travel for business and has developed the common cold. The client informs the nurse that she will be flying and does not want to give it to anyone else. When should the nurse inform the client is the most highly contagious period?
During the first 3 days after the onset of symptoms
The school nurse is providing education to parents of school-age children during flu season. What should the nurse teach about the importance of early diagnosis of influenza?
Early diagnosis can reduce the inappropriate use of antibiotics
When developing the plan of care for a child with respiratory distress, what nursing intervention can the nurse provide that will facilitate respiratory movements and avoid airway compression?
Elevate the head of the bed
A parent calls 911 and states her child is having trouble breathing. The child is rushed to the emergency department. Upon assessment, the child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. The parent states that the child just developed a sore throat and fever today. The health care provider determines that the child is experiencing:
Epiglottitis
Which diagnosis places a child at the greatest risk for airway obstruction?
Epiglottitis
A client's chest x-ray and pathology report identify a granulomatous lesion that contains the tubercle bacilli. The health care provider would interpret this as:
Ghon focus
A nurse is assessing a 2-week-old infant with pulmonary edema. Which of the following symptoms indicates the infant is experiencing respiratory distress?
Grunting during expiration
The community health nurse is developing a program to decrease the amount of pulmonary tuberculosis that has recently risen in her area. Which populations at risk will the nurse target? Select all that apply.
HIV-infected people Foreign-born people from countries with a high incidence of tuberculosis Residents of high-risk congregate settings
A client has been diagnosed with an advanced tumor that has invaded the mediastinum. The client would most likely manifest:
Hoarseness and difficulty swallowing
A pneumonia that occurs 48 hours or more after admission to the hospital is considered:
Hospital-acquired pneumonia.
What is the underlying cause of respiratory failure in a child with bronchiolitis?
Impaired gas exchange
A child has developed respiratory stridor and is displaying a crowing sound. The parents ask the nurse what is causing this sound. The best response would be:
Increased turbulence of air moving through the obstructed airways
The nurse is assessing a client who states he felt fine all day and then within five minutes, began to feel extremely weak and tired and began having a fever. What do these symptoms indicate that the client may be experiencing?
Influenza
A client asks the nurse if it is possible to contract influenza by being exposed to wound secretions. On what knowledge should the nurse base her response to the client?
Influenza transmission occurs by inhalation of droplet nuclei.
Influenza A subtype H5N1 (avian flu) has been documented in poultry in both East and Southeast Asian Countries. This form of avian flu is highly contagious from bird to bird but rarely is passed from human to human. There is a large amount of concern that the H5N1 strain might mutate, making it easier to be passed from human to human, carrying with it a high mortality rate. What is the main concern if the H5N1 strain does mutate?
Initiation of a pandemic
A 66-year-old male presents the emergency room accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F and his blood work indicates his sodium level at 126 mEq/L (normal 135-145 mEq/L). Based on this assessment, the nurse suspects the patient has:
Legionella pneumonia.
A 66-year-old man presents in the emergency room accompanied by his wife, who claims that he has been acting confused. The man reports a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 39.3°C, and his blood work indicates his sodium level is at 126 mmol/l (normal is 135 to 145 mmol/l). What will be the assessing physician's most likely suspicion?
Legionnaire disease
Around three weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea and vomiting. After ruling out more common health problems, his care provider eventually made a diagnosis of histoplasmosis. Which of the following processes is most likely taking place?
Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them.
Elderly people are very susceptible to pneumonia in all its varieties. The symptoms the elderly exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are elderly people with pneumonia less likely to experience than people with pneumonia in other age groups?
Marked elevation in temperature
A client diagnosed with rhinosinusitis asks the nurse what type of nonpharmacologic measures can be used to reduce the nasal stuffiness that occurs with the disorder. What suggestion can the nurse give to the client? Select all that apply.
Mist humidification Nasal irrigation Saline nasal spray
The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on?
Mycobacterium tuberculosis
A client hospitalized for 72 hours has developed symptoms of a lower respiratory tract infection. Sputum cultures reveal S. aureus as the infectious organism. The nurse explains to the client that which of the following is the most likely cause of this infection?
Nosocomial hospital-acquired infection
A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis.
Nosocomial pneumonia
A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which of the following microorganisms and treatments are most likely to be related and effective, respectively?
Parainfluenza virus, treated with a mist tent and oxygen therapy.
A child with rhinosinusitis should be monitored for complications. Which of the following assessment findings would alert the nurse that a complication is developing?
Periorbital edema
A nurse is assessing a 1-year-old child diagnosed with croup. Which of the following manifestations would most likely be present?
Respiratory stridor and barking cough
The nurse is performing an assessment for a client who is suspected of having chronic histoplasmosis. What clinical manifestations reported by the client are consistent with this diagnosis? Select all that apply.
Productive cough Night sweats Weight loss
The nurse is caring for a client who has a positive tuberculin test and a negative chest x-ray. The most appropriate treatment for the client would be:
Prophylactic treatment with isoniazid
A 3-year-old child has been admitted to the pediatric unit for the treatment of croup. The nurse should include which action in the child's plan of care?
Providing cool, moist air for the child to breathe
Community-acquired pneumonia can be categorized according to several indexes. What are these indexes? (Select all that apply.)
Radiologic findings Age Presence of coexisting disease
Premature infants who are treated with mechanical ventilation, mostly for respiratory distress syndrome, are at risk for developing bronchopulmonary dysplasia (BPD), a chronic lung disease. What are the signs and symptoms of BPD?
Rapid and shallow breathing and chest retractions
The early stages of influenza pass by as if the infection were any other viral infection. What is the distinguishing feature of an influenza viral infection that makes it different from other viral infections?
Rapid onset of profound malaise
A client diagnosed with the common cold has been taking an over-the-counter antihistamine for the control of symptoms. What should the client be aware may occur if the drugs are used too frequently over too many days?
Rebound symptoms
The nurse is educating the client with a cold about the use of over-the-counter decongestants. What expected outcome does the nurse anticipate with the use of this medication?
Reduction of nasal swelling
The nurse caring for a male child with respiratory problems is concerned he may be developing respiratory failure. Upon assessment, the nurse knows that which of the following are clinical manifestations of respiratory failure? Select all that apply.
Severe accessory muscle retractions Nasal flaring Grunting on expiration
When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis?
Sputum or bronchial cultures
A 65-year-old man has just been diagnosed with hypercalcemia with a chronic cough and hemoptysis. The physician suspects cancer. Which cancer is most likely?
Squamous cell carcinoma
An immunocompromised host is open to pneumonia from all types of organisms. There is, however, a correlation between specific types of immunologic deficits and specific invading organisms. What organism is most likely to cause pneumonia in an immunocompromised host with neutropenia and impaired granulocyte function?
Staphylococcus aureus
A client has developed bacterial pneumonia and is admitted to the hospital. The nurse obtains sputum cultures upon admission. What bacteria does the nurse anticipate finding when the results are complete?
Streptococcus pneumoniae
Which description of the onset of symptoms is most characteristic of epiglottitis?
Suddenly onset
A social worker is counselling the family of an 85-year-old woman who has just been diagnosed with non-small cell lung cancer. What concerns should she convey to the family regarding the unintended effects of treating the disease?
Surgical treatment may have the consequence of weakening the client.
Non-small cell lung cancers (NSCLCs) mimic small cell lung cancers (SCLCs) through their abilities to do what?
Synthesize bioactive products and produce paraneoplstic syndromes
A client presents to the physician's office with a chronic cough, shortness of breath, and wheezing that has gotten progressively worse, with recent episodes of hemoptysis. Diagnostic tests reveal a lung mass. Based on these symptoms, the nurse is anticipates which of the following has occurred?
The lesion has eroded blood vessels in the lungs.
A client had a tuberculin skin test (TST) performed as part of her immigration process and is surprised that the results are positive. How should the nurse best interpret this result?
The client was exposed to the tubercle bacillus at an indefinite point in the past.
A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. What medication education will the nurse provide to the client?
The client will need education about the administration of INH and the importance of taking it as prescribed.
An infant born prematurely is in the neonatal intensive care unit (NICU) for observation and to ensure hemodynamic stability when the nurse observes the infant beginning to have nasal flaring. What does the nurse understand that this may indicate?
The infant is using nasal flaring to take in more air.
An 8-month-old infant has been brought to the emergency department in respiratory distress. When obtaining the infant's history of present illness from his parents, which finding is most suggestive of acute bronchiolitis?
The parents describe a "bad cold" for several days that has become much more severe. The infant's parents state that crying and feeding make the symptoms worse.
A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which of the following signs and symptoms is the nurse most likely to encounter?
The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.
Which statements regarding childhood respiratory tract infection are true? Select all that apply.
The size of the child has an impact on the seriousness of the symptoms. Impaired airflow and obstructions are common outcomes of these infections. Each exposure to a new pathogen results in an infection. An immature immune system is the usual trigger for such infections.
Select the statement that best describes pneumococcal infection.
The spread of some strains of pneumococci is through healthy colonized individuals.
A client has been diagnosed with pneumococcal infection. The nurse shares with the client which statement about the spread of the disease?
The spread of this bacteria, especially the antibiotic-resistant strain, is largely by healthy, colonized individuals.
A client arrives in the clinic with a cough, fever, and chest discomfort and is diagnosed with community-acquired pneumonia. What education does the nurse anticipate providing prior to discharging the client from the clinic?
The use of antibiotics
A client has just been admitted with a chronic cough, shortness of breath, and wheezing. The irritation of his airway is severe enough to produce hemoptysis and diffuse pain in the chest area. He is diagnosed with large cell carcinoma. What is causing the symptoms that are listed?
Tumour invasion of the mediastinum
A client is admitted to the hospital suspected to have Legionnaire disease after a cruise. What type of specimen should the nurse collect that is a rapid test to detect the antigens of L. pneumophila?
Urine specimen
A nurse is caring for a child with an airway obstruction. It is most important for the nurse to avoid:
Using a tongue depressor to assess the child's tonsils
A parent brings a child into the urgent care clinic. The practitioner suspects the child has a "cold" based on which clinical manifestations? Select all that apply.
Watery, clear nasal secretions Coughing Mild fever
A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that:
cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant.
The client ask the nurse how influenza is spread from person-to-person. The nurse educates her client that influenza is transmitted by:
inhalation of droplet nuclei.
A client comes to an urgent care center. The nurse notes that the client has a fever of 103.2 F (39.5 C), pleuritic pain with each breath, and enlarged lymph nodes in the neck and axilla area. The client also has a productive cough. The nurse should consider tuberculosis if the client's history includes:
intravenous drug abuse and living on the streets.
A client arrives at the clinic stating he is having "terrible headaches." What questions would be appropriate for the nurse to ask that may indicate the headaches are related to sinusitis? Select all that apply.
• "Does bending forward exaggerate the headache?" • "When you sneeze, does it make the headache worse?" • "Does your neck feel stiff along with the headache?"
A client with a history of chronic obstructive pulmonary disease (COPD) has developed influenza. Which statements about possible treatments is accurate for this client. Select all that apply.
• At the onset of influenza-like symptoms, the client is eligible to begin antiviral medications within the first 36 hours. • The antiviral drug of choice is oral oseltamivir.
All of the following clients are exhibiting manifestations of a common cold. At the pharmacy, the pharmacist should advise which clients to avoid decongestant drugs from over-the-counter? Client with a history of: Select all that apply.
• Cardiac disease • Hypertension
While administering influenza vaccines for the general public, the nurse will advise which clients to avoid taking the flu shot? Select all that apply.
• Client with allergy to eggs • Client with Guillain-Barre syndrome
Which assessment findings concern the presence of respiratory distress in an infant? Select all that apply.
• Grunting • Respiratory rate of 95 breaths/minute • Sternal retraction • Central cyanosis
The neonatal ICU nurse is assessing a client with severe bronchopulmonary dysplasia (BPD). The nurse knows that this client will likely exhibit which clinical manifestations? Select all that apply.
• Rapid, shallow breathing • Chest retractions with accessory muscle use • Clubbing of the fingers
A child is having symptoms of spasmodic croup again after a previous admission to the hospital for the same diagnosis. What care does the parent provide at home that demonstrates understanding of the education received by the nurse at the hospital? Select all that apply.
• The parent brings the child into the bathroom where a warm shower is running to provide humidification. • The parent takes a child outside in the cool air. • The parent turns on the cold water room humidifier in the child's room.
The nurse is caring for an adult client diagnosed with acute rhinosinusitis. The nurse anticipates that the client will more than likely receive prescriptions for which medications? Select all that apply.
• Topical alpha-adrenergic decongestant • Guaifenesin • Intranasal corticosteroid
