Chapter 30 PREP U
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."
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?"
A college student has developed a cold. Which statement shows that the student has an accurate understanding of the upper respiratory infection?
"I suppose I should have been washing my hands more in the past few days."
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."
When educating a college student who lives in a crowded apartment and was recently diagnosed with tuberculosis, the school nurse will emphasize which treatment plan?
"To destroy this bacterium, you must strictly adhere to a long-term drug regimen of several medications."
A client diagnosed with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response?
"You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated."
At an influenza vaccination clinic, a 70-year-old client asks the nurse if the vaccine is the same one given to the client's 35-year-old child 3 weeks ago. Which information will the nurse provide?
"Your vaccine is a stronger formulation than your adult child would have received."
A client is suspected to be infected with Histoplasma capsulatum. Which is the average incubation period for this infection to cause symptoms?
1 to 4 weeks
The nurse is assessing several clients in an outpatient clinic. Which client is most likely to have chronic histoplasmosis?
A 52-year old male with chronic obstructive lung disease who smokes
Which client who presented to a walk-in medical clinic is most likely to be diagnosed with rhinosinusitis rather than a common cold?
A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F (38.2°C)
Which situation 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.
A client recovered from influenza 2 days ago and informs the nurse that she is feeling better but now has a fever, chills, pain when breathing, and a productive cough. What complication does the nurse anticipate the client will be treated for?
A secondary bacterial pneumonia
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
Which individual should have priority for receiving a seasonal influenza vaccination?
An older adult resident of a long-term care facility
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
While administering influenza vaccines for the general public, the nurse will advise which clients to avoid taking the influenza shot? Select all that apply.
Client who has a fever with possible strep throat Client with anaphylactic hypersensitivity to eggs Client with Guillain-Barré syndrome
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 labor. Regarding fetal lung development, what is of greatest concern to the attending medical team?
Development of type II alveolar cells
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 acute respiratory infection in children poses the greatest threat of severe hypoxia caused by inflammatory edema?
Epiglottitis
Which diagnosis places a child at the greatest risk for airway obstruction?
Epiglottitis
Which respiratory infection in children is associated with the poorest outcomes?
Epiglottitis
In assessing the infant's respiratory system, which finding confirms to the nurse that the infant is having trouble breathing?
Expiratory grunting
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
What is the underlying cause of respiratory failure in a child with bronchiolitis?
Impaired gas exchange
The nurse is assessing a client who states he felt fine all day and then, within 5 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 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 mEq/L (126 mmol/L). The normal level is 135-145 mEq/L (135 to 145 mmol/L). What will be the assessing physician's most likely suspicion?
Legionnaire disease
Older adults are very susceptible to pneumonia in all its varieties. The symptoms that older adults exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are older adults 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
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 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
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
A client with an 80-pack-year history of tobacco smoking has presented to the clinic complaining of "bronchitis" cough for the past 5 months, weight loss, and shortness of breath. Today, this client "got scared" when he coughed up blood in his sputum. The health care provider is concerned this client may have which possible diagnosis?
Small cell lung cancer due to smoking history
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
A 6-month-old infant has been hospitalized with acute bronchiolitis. Which treatment should be prioritized in the infant's care?
Supplementary oxygen therapy
A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply.
Surgery to remove tumor Radiation therapy Chemotherapy
The nurse is caring for a client with small cell lung cancer (SCLC) and known mediastinal lymph node involvement. What new assessment finding should the nurse prioritize as evidence the client requires emergent intervention?
Swelling of the neck and face
A parent of a toddler is concerned about possible side effects of influenza immunizations. What will the nurse teach the parent regarding the influenza vaccine?
The Centers for Disease Control and Prevention recommends that all people 6 months of age and older should receive the annual influenza vaccine.
A child is diagnosed with a restrictive lung disease and is assessed by the nurse to have a rapid and shallow respiratory effort, and the nurse hears an audible expiratory grunt. What does the nurse understand the grunt signifies in this child?
The child is trying to raise the functional residual capacity by closing the glottis at the end of expiration.
A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which sign/symptom is the nurse most likely to encounter?
The client will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.
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 anticipates which of the following has occurred?
The lesion has eroded blood vessels in the lungs.
A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?
The nurse is likely asymptomatic.
Select the statement that is most accurate in terms of colonization and 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 with a newborn infant is also the caregiver for her 75-year-old mother, who lives with them and who has diabetes. The client requests pneumonia vaccinations for her entire household. Which vaccine is most likely to be effective for the baby?
There is no effective vaccine for newborn infants.
The nurse is caring for a group of infants with bronchiolitis. Which infant should the nurse prioritize as requiring immediate intervention? The infant who:
has diminishing wheezing and cyanosis.
A client with coccidioidomycosis has developed a severe headache with neck stiffness, has a fever, and states feeling very ill. Which complication does the nurse prioritize investigating, because it is the most common cause of death from coccidioidomycosis?
meningitis
A client is diagnosed with pneumococcal community-acquired pneumonia. Which education does the nurse provide the client?
use of antibiotics
A parent brings a child into the urgent care clinic. The health care provider suspects the child has a "common cold" based on which clinical manifestation(s)? Select all that apply.
watery, clear nasal secretions coughing mild fever
