Chapter 23: Management of Patients With Chest and Lower Respiratory Tract Disorders

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? a) 1 to 3 weeks b) 6 to 12 months c) 2 to 4 months d) 3 to 5 days

b) 6 to 12 months Explanation: Prophylactic isoniazid therapy must continue for 6 to 12 months at a daily dosage of 300 mg. Taking the drug for less than 6 months may not provide adequate protection against tuberculosis. pg.589

You are a clinic nurse caring for a client with acute tracheobronchitis. The client asks what may have caused the infection. Which of the following responses from the nurse would be most accurate? a) Drug ingestion b) Chemical irritation c) Direct lung damage d) Aspiration

b) Chemical irritation Explanation: Chemical irritation from noxious fumes, gases, and air contaminants can induce acute tracheobronchitis. Aspiration related to near drowning or vomiting, drug ingestion or overdose, and direct damage to the lungs are factors associated with the development of acute respiratory distress syndrome. pg.573

You are a clinic nurse caring for a client with acute bronchitis. The client asks what may have caused the infection. What may induce acute bronchitis? a) Aspiration b) Direct lung damage c) Chemical irritation d) Drug ingestion

c) Chemical irritation Explanation: Chemical irritation from noxious fumes, gases, and air contaminants induces acute bronchitis. Aspiration related to near drowning or vomiting, drug ingestion or overdose, and direct damage to the lungs are factors associated with the development of acute respiratory distress syndrome. pg.573

You are assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis? a) Negative Homan's sign b) Pain in the feet c) Pain in the calf d) Inability to dorsiflex

c) Pain in the calf Explanation: When assessing the client's potential for pulmonary emboli, the nurse tests for a positive Homan's sign. The client lies on his or her back and lifts his or her leg and his or her foot. If the client reports calf pain (positive Homan's sign) during this maneuver, he or she may have a deep vein thrombosis. pg.600

A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? a) Client teaching about the cause of TB b) Developing a list of people with whom the client has had contact c) Client teaching about the importance of TB testing d) Reviewing the risk factors for TB

b) Developing a list of people with whom the client has had contact Explanation: To lessen the spread of TB, everyone who had contact with the client must undergo a chest X-ray and TB skin test. Testing will help determine if the client infected anyone else. Teaching about the cause of TB, reviewing the risk factors, and the importance of testing are important areas to address when educating high-risk populations about TB before its development. pg.590

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: a) follow up with the physician in 2 weeks. b) turn and reposition himself every 2 hours. c) maintain fluid intake of 40 oz (1,200 ml) per day. d) continue to take antibiotics for the entire 10 days.

d) continue to take antibiotics for the entire 10 days. Explanation: The client demonstrates understanding of how to prevent relapse when he states that he must continue taking the antibiotics for the prescribed 10-day course. Although the client should keep the follow-up appointment with the physician and turn and reposition himself frequently, these interventions don't prevent relapse. The client should drink 51 to 101 oz (1,500 to 3,000 ml) per day of clear liquids. pg.583

A nurse is reviewing a client's X-ray. The X-ray shows an endotracheal (ET) tube placed 3/4? (2 cm) above the carina and reveals nodular lesions and patchy infiltrates in the upper lobe. Which interpretation of the X-ray is accurate? a) The X-ray is inconclusive. b) A disease process is present. c) The ET tube must be pulled back. d) The ET tube must be advanced.

b) A disease process is present. Explanation: This X-ray suggests tuberculosis. An ET tube that's 3/4? above the carina is at an adequate level in the trachea. There's no need to advance it or pull it back. pg.588

Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall? a) Viral pneumonia b) Mycoplasmata pneumonia c) Legionnaires' disease d) Streptococcal (pneumococcal) pneumonia

c) Legionnaires' disease Explanation: Legionnaires' disease accounts for 15% of community-acquired pneumonias. Streptococcal pneumonia demonstrates the highest occurrence in winter months. Mycoplasmal pneumonia demonstrates the highest occurrence in fall and early winter. Viral pneumonia demonstrates the greatest incidence during winter months. pg.574

A nurse recognizes that a client with tuberculosis needs further teaching when the client states: a) "I'll have to take these medications for 9 to 12 months." b) "The people I have contact with at work should be checked regularly." c) "I'll need to have scheduled laboratory tests while I'm on the medication." d) "It won't be necessary for the people I work with to take medication."

b) "The people I have contact with at work should be checked regularly." Explanation: The client requires additional teaching if he states that coworkers need to be checked regularly. Such casual contacts needn't be tested for tuberculosis. However, a person in close contact with a person who's infectious is at risk and should be checked. The client demonstrates effective teaching if he states that he'll take his medications for 9 to 12 months, that coworkers don't need medication, and that he requires laboratory tests while on medication. Coworkers not needing medications, taking the medication for 9 to 12 months, and having scheduled laboratory tests are all appropriate statements. pg.587

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? a) A client with a nasogastric tube b) A client who is receiving acetaminophen (Tylenol) for pain c) A client who ambulates in the hallway every 4 hours d) A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago

a) A client with a nasogastric tube Explanation: Nasogastric, orogastric, and endotracheal tubes increase the risk of pneumonia because of the risk of aspiration from improperly placed tubes. Frequent oral hygiene and checking tube placement help prevent aspiration and pneumonia. Although a client who smokes is at increased risk for pneumonia, the risk decreases if the client has stopped smoking. Ambulation helps prevent pneumonia. A client who receives opioids, not acetaminophen, has a risk of developing pneumonia because respiratory depression may occur. pg.577

A positive Mantoux test indicates that a client: a) has produced an immune response. b) has an active case of tuberculosis. c) will develop full-blown tuberculosis. d) is actively immune to tuberculosis.

a) has produced an immune response. Explanation: The Mantoux test is based on the antigen/antibody response and will show a positive reaction after an individual has been exposed to tuberculosis and has formed antibodies to the tuberculosis bacteria. Thus, a positive Mantoux test indicates the production of an immune response. Exposure doesn't confer immunity. A positive test doesn't confirm that a person has (or will develop) tuberculosis. pg.588

A client is admitted to the emergency department with a stab wound and is now presenting dyspnea, tachypnea, and sucking noise heard on inspiration and expiration. The nurse should care for the wound in which manner? a) Apply vented dressing. b) Apply airtight dressing. c) Apply direct pressure to the wound. d) Clean the wound and leave open to the air.

b) Apply airtight dressing. Explanation: The client has developed a pneumothorax, and the best action is to prevent further deflation of the affected lung by placing an airtight dressing over the wound. A vented dressing would be used in a tension pneumothorax, but because air is heard moving in and out, a tension pneumothorax is not indicated. Applying direct pressure is required if active bleeding is noted. pg.613

A physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which treatment? a) Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years b) Daily doses of isoniazid, 300 mg for 6 months to 1 year c) Isolation until 24 hours after antitubercular therapy begins d) Nothing, until signs of active disease arise

b) Daily doses of isoniazid, 300 mg for 6 months to 1 year Explanation: All clients exposed to persons with tuberculosis should receive prophylactic isoniazid in daily doses of 300 mg for 6 months to 1 year to avoid the deleterious effects of the latent mycobacterium. Daily oral doses of isoniazid and rifampin for 6 months to 2 years are appropriate for the client with active tuberculosis. Isolation for 2 to 4 weeks is warranted for a client with active tuberculosis. pg.589

An elderly client is diagnosed with pulmonary tuberculosis. Upset and tearful, he asks the nurse how long he must be separated from his family. Which nursing diagnosis is most appropriate for this client? a) Social isolation b) Deficient knowledge (disease process and treatment regimen) c) Impaired social interaction d) Anxiety

b) Deficient knowledge (disease process and treatment regimen) Explanation: This client is exhibiting Deficient knowledge about the disease process and treatment regimen; treatment of tuberculosis no longer requires isolation, provided the client complies with the ordered medication regimen. Although the client is upset, his question reflects sadness at the prospect of being separated from his family rather than anxiety about the disease. Because he has just been diagnosed and hasn't had a chance to demonstrate compliance, a nursing diagnosis of Social isolation isn't appropriate. A diagnosis of Impaired social interaction usually has a psychiatric or neurologic basis, not a respiratory one, such as pulmonary tuberculosis. pg.587

Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? a) Measure the patient's pulse oximetry b) Record the observation c) Report the finding to the physician immediately d) Apply a compression dressing to the area

b) Record the observation Explanation: Subcutaneous emphysema occurs after chest surgery as the air that is located within the pleural cavity is expelled through the tissue opening created by the surgical procedure. Subcutaneous emphysema is a typical postoperative finding in the patient after chest surgery. Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted. Subcutaneous emphysema results from air entering the tissue planes. pg.614

A Class 1 with regards to TB indicates a) disease that is not clinically active. b) exposure and no evidence of infection. c) no exposure and no infection. d) latent infection with no disease.

b) exposure and no evidence of infection. Explanation: Class 1 is exposure, but no evidence of infection. Class 0 is no exposure and no infection. Class 2 is a latent infection, with no disease. Class 4 is disease, but not clinically active. pg.588

When interpreting the results of a Mantoux test, the nurse explains to the patient that a reaction occurs when the intradermal injection site shows a) bruising. b) redness and induration. c) drainage. d) tissue sloughing.

b) redness and induration. Explanation: The injection site is inspected for redness and palpated for hardening. Drainage at the injection site does not indicate a reaction to the tubercle bacillus. Sloughing of tissue at the injection site does not indicate a reaction to the tubercle bacillus. Bruising of tissue at the site may occur from the injection, but does not indicate a reaction to the tubercle bacillus. pg.588

A nurse is caring for a patient diagnosed with empyema. Which of the following interventions does a nurse implement for patients with empyema? a) Institute droplet precautions. b) Do not allow visitors with respiratory infection. c) Encourage breathing exercises. d) Place suspected patients together.

c) Encourage breathing exercises. Explanation: The nurse teaches the patient with empyema to do breathing exercises as prescribed. The nurse should institute droplet precautions, isolate suspected and confirmed influenza patients in private rooms, or place suspected and confirmed patients together, and not allow visitors with symptoms of respiratory infection to visit the hospital to prevent outbreaks of influenza from occurring in health care settings. pg.595

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: a) Risk for falls. b) Ineffective breathing pattern. c) Ineffective airway clearance. d) Impaired tissue integrity.

c) Ineffective airway clearance. Explanation: Ineffective airway clearance is the priority nursing diagnosis for this client. Pneumonia involves excess secretions in the respiratory tract and inhibits air flow to the capillary bed. A client with pneumonia may not have an Ineffective breathing pattern, such as tachypnea, bradypnea, or Cheyne-Stokes respirations. Risk for falls and Impaired tissue integrity aren't priority diagnoses for this client. pg.582

A client is admitted to the health care facility with active tuberculosis (TB). The nurse should include which intervention in the care plan? a) Keeping the door to the client's room open to observe the client b) Instructing the client to wear a mask at all times c) Putting on an individually fitted mask when entering the client's room d) Wearing a gown and gloves when providing direct care

c) Putting on an individually fitted mask when entering the client's room Explanation: Because TB is transmitted by droplet nuclei from the respiratory tract, the nurse should put on a mask when entering the client's room. Occupation Safety and Health Administration standards require an individually fitted mask. Having the client wear a mask at all times would hinder sputum expectoration and respirations would make the mask moist. A nurse who doesn't anticipate contact with the client's blood or body fluids need not wear a gown or gloves when providing direct care. A client with TB should be in a room with laminar airflow, and the room's door should be shut at all times. pg.591

A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? a) Crackles b) Wheezes c) Rhonchi d) Decreased breath sounds

d) Decreased breath sounds Explanation: In pleural effusion, fluid accumulates in the pleural space, impairing transmission of normal breath sounds. Because of the acoustic mismatch, breath sounds are diminished. Crackles commonly accompany atelectasis, interstitial fibrosis, and left-sided heart failure. Rhonchi suggest secretions in the large airways. Wheezes result from narrowed airways, such as in asthma, chronic obstructive pulmonary disease, and bronchitis. pg.593

A client asks a nurse a question about the Mantoux test for tuberculosis. The nurse should base her response on the fact that the: a) area of redness is measured in 3 days and determines whether tuberculosis is present. b) test stimulates a reddened response in some clients and requires a second test in 3 months. c) presence of a wheal at the injection site in 2 days indicates active tuberculosis. d) skin test doesn't differentiate between active and dormant tuberculosis infection.

d) skin test doesn't differentiate between active and dormant tuberculosis infection. Explanation: The Mantoux test doesn't differentiate between active and dormant infections. If a positive reaction occurs, a sputum smear and culture as well as a chest X-ray are necessary to provide more information. Although the area of redness is measured in 3 days, a second test may be needed; neither test indicates that tuberculosis is active. In the Mantoux test, an induration 5 to 9 mm in diameter indicates a borderline reaction; a larger induration indicates a positive reaction. The presence of a wheal within 2 days doesn't indicate active tuberculosis. pg.588

A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is: a) 1.4 L. b) unspecified. c) 2 L. d) 3 L.

a) 1.4 L. Explanation: Clients need to keep their secretions thin by drinking 2 to 3 L of clear liquids per day. In clients with heart failure, fluid intake shouldn't exceed 1.5 L daily. pg.582

Which vitamin is usually administered with isoniazid (INH) to prevent INH-associated peripheral neuropathy? a) Vitamin E b) Vitamin D c) Vitamin C d) Vitamin B6

d) Vitamin B6 Explanation: Vitamin B6 (pyridoxine) is usually administered with INH to prevent INH-associated peripheral neuropathy. Vitamins C, D, and E are not appropriate. pg.589

A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction? a) "I'll stay in isolation for 6 weeks." b) "This disease may come back later if I am under stress." c) "I'll have to take the medication for up to a year." d) "I'll always have a positive test for tuberculosis."

a) "I'll stay in isolation for 6 weeks." Explanation: The client requires additional teaching if he states that he'll be in isolation for 6 weeks. The client needs to be in isolation for 2 weeks, not 6, while taking the tuberculosis drugs. After 2 weeks of antitubercular therapy, the client is no longer considered contagious. The client needs to receive the drugs for 9 months to a year. He'll be positive when tested and if he's sick or under some stress he could have a relapse of the disease. pg.587

Approximately what percentage of people who are initially infected with TB develop active disease? a) 10% b) 40% c) 20% d) 30%

a) 10% Explanation: Approximately 10% of people who are initially infected develop active disease. The other percentages are inaccurate. pg.587

A 23-year-old male client who has recently started working in a coal mine confides that he is concerned about his long-term health. The nurse instructs the client which of the following ways to prevent occupational lung disease? Select all that apply. a) Do not smoke or quit smoking if currently smoking. b) Wear appropriate protective equipment when around airborne irritants and dusts. c) Schedule an annual lung x-ray to monitor his health. d) Try to find another occupation as soon as possible.

a) Do not smoke or quit smoking if currently smoking. b) Wear appropriate protective equipment when around airborne irritants and dusts. Explanation: The nurse may instruct clients that the following precautions may help prevent occupational lung disease: not smoking, wearing appropriate protective equipment when around airborne irritants and dusts, scheduling lung function evaluation with spirometry as recommended, becoming educated about lung diseases, and paying attention to risk evaluation of the workplace to identify risks for lung disease. pg.605

Which of the following should a nurse encourage in patients who are at the risk of pneumococcal and influenza infections? a) Receiving vaccination b) Using prescribed opioids c) Using incentive spirometry d) Mobilizing early

a) Receiving vaccination Explanation: Identifying the patients who are at risk for pneumonia provides a means to practice preventive nursing care. The nurse encourages patients at risk of pneumococcal and influenza infections to receive vaccinations against these infections. The nurse should encourage early mobilization as indicated through agency protocol, administer prescribed opioids and sedatives as indicated, and teach or reinforce appropriate technique for incentive spirometry to prevent atelectasis. pg.574

After 48 hours, a Mantoux test is evaluated. At the site, there is a 10 mm induration. This finding would be considered: a) Significant b) Negative c) Nonreactive d) Not significant

a) Significant Explanation: An induration of 10 mm or greater is usually considered significant and reactive in people who have normal or mildly impaired immunity. Erythema without induration is not considered significant. pg.588

A client who has started therapy for drug-resistant tuberculosis demonstrates understanding of tuberculosis transmission when he says: a) "My tuberculosis isn't contagious after I take the medication for 24 hours." b) "I'll stop being contagious when I have a negative acid-fast bacilli test." c) "I'm contagious as long as I have night sweats." d) "I'm clear when my chest X-ray is negative."

b) I'll stop being contagious when I have a negative acid-fast bacilli test." Explanation: A client with drug-resistant tuberculosis isn't contagious when he's had a negative acid-fast test. A client with nonresistant tuberculosis is no longer considered contagious when he shows clinical evidence of decreased infection, such as significantly decreased coughing and fewer organisms on sputum smears. The medication may not produce negative acid-fast test results for several days. The client won't have a clear chest X-ray for several months after starting treatment. Night sweats are a sign of tuberculosis, but they don't indicate whether the client is contagious. pg.588

You are caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer? a) Pain on inspiration b) Mucopurulent sputum c) Obvious trauma d) Shortness of breath

b) Mucopurulent sputum Explanation: For a client with lung cancer, a cough productive of mucopurulent or blood-streaked sputum is a cardinal sign of lung cancer. Symptoms of fractured ribs consist primarily of severe pain on inspiration and expiration, obvious trauma, and shortness of breath. These symptoms may also be caused by other disorders but are not considered indicative of lung cancer. pg.607

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? a) Place client on bed rest. b) Offer nutritious snacks 2 times a day. c) Encourage increased fluid intake. d) Give antibiotics as ordered.

c) Encourage increased fluid intake. Explanation: The nurse places the client in semi-Fowler's position to aid breathing and increase the amount of air taken with each breath. Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate. The nurse monitors fluid intake and output, skin turgor, vital signs, and serum electrolytes. He or she administers antipyretics as indicated and ordered. Antibiotics are not given for viral pneumonia. The client's activity level is ordered by the physician, not decided by the nurse. pg.583

The nurse knows the mortality rate is high in lung cancer clients due to which factor? a) Increased exposure to industrial pollutants b) Increase in women smokers c) Few early symptoms d) Increased incidence among the elderly

c) Few early symptoms Explanation: Because lung cancer produces few early symptoms, its mortality rate is high. Lung cancer has increased in incidence due to increase in number of women smokers, growing aging population, and exposure to pollutants but not indicative of mortality rates. pg.607

A client, who is at risk for pneumonia, has been ordered influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine? a) "Getting the flu can complicate pneumonia." b) "Influenza vaccine will prevent typical pneumonias." c) "Influenza is the major cause of death in the United States." d) "Viruses, like influenza, are the most common cause of pneumonia."

d) "Viruses, like influenza, are the most common cause of pneumonia." Explanation: Influenza type A is the most common cause of pneumonia. Therefore, preventing influenza lowers the risk of pneumonia. Viral URIs can make the client more susceptible to secondary infections, but getting the flu is not a preventable action. Bacterial pneumonia is a typical pneumonia and cannot be prevented with a vaccine that is used to prevent a viral infection. Influenza is not the major cause of death in the United States. Combined influenza with pneumonia is the major cause of death in the United States. pg.573

A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true? a) A negative reaction always excludes the diagnosis of TB. b) The PPD can be read within 12 hours after the injection. c) A positive reaction indicates that the client has active tuberculosis (TB). d) A positive reaction indicates that the client has been exposed to the disease.

d) A positive reaction indicates that the client has been exposed to the disease. Explanation: A positive reaction means the client has been exposed to TB; it isn't conclusive for the presence of active disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection. In clients with positive reactions, further studies are usually done to rule out active disease. In immunosuppressed clients, a negative reaction doesn't exclude the presence of active disease. pg.588

Which of the following terms refers to lung tissue that has become more solid in nature due to a collapse of alveoli or an infectious process? a) Bronchiectasis b) Empyema c) Atelectasis d) Consolidation

d) Consolidation Explanation: Consolidation occurs during an infectious process such as pneumonia. Atelectasis refers to the collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression. Bronchiectasis refers to the chronic dilation of a bronchi or bronchi in which the dilated airway becomes saccular and a medium for chronic infection. Empyema refers to accumulation of purulent material in the pleural space. pg.578

A nurse reading a chart notes that the patient had a Mantoux skin test result with no induration and a 1-mm area of ecchymosis. How does the nurse interpret this result? a) Uncertain b) Positive c) Borderline d) Negative

d) Negative Explanation: The size of the induration determines the significance of the reaction. A reaction of 0-4 mm is not considered to be significant. A reaction of 5 mm or greater may be significant in people who are considered to be at risk. An induration of 10 mm or greater is usually considered significant in people who have normal or mildly impaired immunity. pg.588

A client diagnosed with tuberculosis (TB) is taking medication for the treatment of TB. The nurse should instruct the client that he will be safe from infecting others approximately how long after initiation of the chemotherapy regimen? a) Within 48 hours after initiation of bacteriocidal drugs b) Results vary with each client, so it is difficult to predict c) After completion of 6 months of bacteriocidal drugs d) Two to 3 weeks after initiation of bacteriocidal drugs

d) Two to 3 weeks after initiation of bacteriocidal drugs Explanation: The client needs to take the prescribed medications for approximately 2 to 3 weeks before discontinuing precautions against infecting others. Effectiveness of the drug therapy is determined by negative sputum smears obtained on three consecutive days. Although results can vary among clients, the majority respond to therapy within 2 to 3 weeks. pg.590

Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? a) Apply a compression dressing to the area. b) Record the observation. c) Measure the patient's pulse oximetry. d) Report the finding to the physician immediately.

a) Apply a compression dressing to the area. Explanation: Subcutaneous emphysema is a typical postoperative finding in the patient after chest surgery. During surgery the air within the pleural cavity is expelled through the tissue opening created by the surgical procedure. Subcutaneous emphysema is absorbed by the body spontaneously after the underlying leak is treated or halted. pg.616

A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? a) The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. b) The client exhibits bronchial breath sounds over the affected area. c) The client exhibits restlessness and confusion. d) The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher.

a) The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. Explanation: As the acute phase of bacterial pneumonia subsides, normal lung function returns and the PaO2 typically rises, reaching 85 to 100 mm Hg. A PaCO2 of 65 mm Hg or higher is above normal and indicates CO2 retention — common during the acute phase of pneumonia. Restlessness and confusion indicate hypoxia, not an improvement in the client's condition. Bronchial breath sounds over the affected area occur during the acute phase of pneumonia; later, the affected area should be clear on auscultation. pg.584

A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? a) Sore throat and abdominal pain b) Nonproductive cough and normal temperature c) Hemoptysis and dysuria d) Dyspnea and wheezing

d) Dyspnea and wheezing Explanation: In a client with bacterial pneumonia, retained secretions cause dyspnea, and respiratory tract inflammation causes wheezing. Bacterial pneumonia also produces a productive cough and fever, rather than a nonproductive cough and normal temperature. Sore throat occurs in pharyngitis, not bacterial pneumonia. Abdominal pain is characteristic of a GI disorder, unlike chest pain, which can reflect a respiratory infection such as pneumonia. Hemoptysis and dysuria aren't associated with pneumonia. pg.577

Which of the following interventions does a nurse implement for patients with empyema? a) Institute droplet precautions b) Do not allow visitors with respiratory infections c) Place suspected patients together d) Encourage breathing exercises

d) Encourage breathing exercises Explanation: The nurse instructs the patient in lung-expanding breathing exercises to restore normal respiratory function. pg.595

A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis carinii pneumonia. Which nursing diagnosis has the highest priority? a) Activity intolerance b) Impaired oral mucous membranes c) Imbalanced nutrition: Less than body requirements d) Impaired gas exchange

d) Impaired gas exchange Explanation: Although all of these nursing diagnoses are appropriate for a client with AIDS, Impaired gas exchange is the priority nursing diagnosis for a client with P. carinii pneumonia. Airway, breathing, and circulation take top priority for any client. pg.582

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? a) Flail chest b) Cardiac tamponade c) Pulmonary contusion d) Tension pneumothorax

d) Tension pneumothorax Explanation: Clamping can result in a tension pneumothorax. The other options would not occur if the chest tube was clamped during transportation. pg.614