Chapter 22: Respiratory Tract Infections, Neoplasms, and Childhood Disorders PATHO taken from http://thepoint.lww.com/Book/Show

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? a) "This test will evaluate whether your tumor cells will be receptive to chemotherapy treatment." b) "This procedure will evaluate every inch of your brain to see if there are any tumors there." c) "This test will tell the doctor how well your immune system is working." d) "This diagnostic procedure will let the doctor know if you have any mestastatic lesions in your body."

"This diagnostic procedure will let the doctor know if you have any mestastatic lesions in your body." Explanation: Positron emission tomography (PET) is a noninvasive alternative for identifying metastatic lesions in the mediastinum or distant sites. Persons with SCLC should also have a CT scan or MRI of the brain for detection of metastasis

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? a) "Drug therapy will continue until all symptoms of tuberculosis have stopped." b) "You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." c) "Drug therapy will continue unless a drug resistance develops." d) "You will be on multiple drug therapy for the rest of your life."

"You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." Explanation: The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period

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: a) "Do not use nasal decongestant medication; it is safer to use the oral decongestant." b) "You should not take this medication; it can cause problems." c) "Only take it when you feel you really need it." d) "If you double the recommended dosage, you will improve faster."

"You should not take this medication; it can cause problems." Explanation: Oral preparations containing decongestants may cause systemic vasoconstriction and elevation of blood pressure when given in doses large enough to relieve nasal congestion, and they should be avoided in persons with hypertension, heart disease, hyperthyroidism, diabetes mellitus, or other health problems

The neonatal ICU nurse is aware that Type II alveolar cells produce surfactant and they usually develop at how many weeks gestation? a) 19-20 weeks. b) 17-18 weeks. c) 34-38 weeks. d) 24-28 weeks.

24-28 weeks. Explanation: Type II alveolar cells begin to develop at ~24 weeks. These cells produce surfactant, a substance capable of lowering the surface tension of the air-alveoli interface. By the 28th-30th weeks, sufficient amounts of surfactant are available to prevent alveolar collapse when breathing begins

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) A 76-year-old client with cardiopulmonary disease b) A 42-year-old client with syncope c) A 24-year-old client involved in a motor vehicle accident with a concussion d) A 36-year-old client with a bowel obstruction

A 76-year-old client with cardiopulmonary disease Explanation: Viral pneumonia occurs as a complication of influenza most frequently in older adults or in people with cardiopulmonary disease. It typically develops within one day after onset of influenza and is characterized by rapid progression of fever, tachypnea, tachycardia, and hypotension.

Which of the following situations would be most deserving of a pediatrician's attention? a) A neonate is visibly flaring her nostrils on inspiration. b) A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting. c) The mother of an infant 2 days post-partum notes that her baby has intermittent periods of hyperventilation followed by slow respirations or even brief periods of apnea. d) A volunteer in the nursery notes that one of the infants, aged 2 weeks, appears unable to breath through his mouth, even when his nose is congested.

A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting. Explanation: Retraction and grunting indicate a significant increase in the work of breathing that can be indicative of respiratory distress syndrome, a situation that would require medical intervention. Periods of hyperventilation interspersed with reduced breathing rates are common during the transition to postpartum ventilation, and infants are commonly unable to mouthbreath. Nostril flaring could be a sign of dyspnea, but it can also be a compensatory mechanism that the infant uses to increase oxygen intake; this situation would not be considered as serious as an infant who has chest retractions and grunting.

A client recovered from influenza two 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) A secondary bacterial pneumonia b) Reye syndrome c) A relapse of the flu d) Tuberculosis

A secondary bacterial pneumonia Explanation: People in whom secondary bacterial pneumonia develops usually report that they were beginning to feel better when they experienced a return of fever, shaking chills, pleuritic chest pain, and productive cough. Reye syndrome is a complication, though rare, of influenza, particularly in young children who have been given aspirin as an antipyretic agent. Tuberculosis is not a complication of influenza.

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? a) Common cold b) Blocked eustachian tube c) Acute viral rhinosinusitis d) Mastoiditis

Acute viral rhinosinusitis Explanation: The symptoms of acute viral rhinosinusitis often are similar to those of the common cold and allergic rhinitis. They include facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever. The discharge from a common cold is clear and watery, ear pain is the primary symptoms with a blocked eustachian tube. Mastoiditis is swelling on one side of the neck.

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? a) Fecal-oral contact b) Body fluid transmission c) Airborne droplets d) Direct skin contact

Airborne droplets Explanation: M. tuberculosis is an airborne infection spread by minute, invisible particles, called droplet nuclei that are harbored in the respiratory secretions of people with active tuberculosis. Coughing, sneezing, and talking all create respiratory droplets. These droplets evaporate and leave organisms (droplet nuclei), which remain suspended in the air and are circulated by air currents. Thus, living under crowded and confined conditions increases the risk for spread of the disease.

The nurse is providing instructions to a client for the treatment of a common cold. The most appropriate information would be: a) Antibiotics and antihistamines b) Antipyretic medications and rest c) Antibiotics administered for 7 days d) Complete isolation and bedrest

Antipyretic medications and rest Explanation: The common cold virus does not respond to antibiotics and should be treated with antipyretic medications and rest. Bed rest is recommended, but complete isolation is not required.

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? a) Bacterial tracheitis b) Bronchopulmonary dysplasia c) Blastomycosis d) Spasmodic croup

Bronchopulmonary dysplasia Explanation: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in premature infants who were treated with long-term mechanical ventilation, mainly for RDS. The condition is considered to be present if the neonate is oxygen dependent at 36 weeks after gestation.

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? a) Radiation b) Cigarette smoke c) Air pollution d) Asbestos

Cigarette smoke Explanation: Cigarette smoking causes more than 80% of cases of lung cancer. The risk for lung cancer among cigarette smokers increases with duration of smoking and the number of cigarettes smoked per day. Cigarette smokers can benefit at any age from smoking cessation. Industrial hazards also contribute to the incidence of lung cancer. A commonly recognized hazard is exposure to asbestos. The mean risk for lung cancer is significantly greater in asbestos workers compared to the general population. In addition, tobacco smoke contributes heavily to the development of lung cancer in people exposed to asbestos.

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: a) Bronchitis b) Epiglottitis c) Tracheobronchitis d) Pneumonitis

Epiglottitis Explanation: Epigottitis typically presents with an acute onset of sore throat and fever. The child appears pale, toxic, and lethargic and assumes a distinctive position—sitting up with the mouth open and the chin thrust forward. Symptoms rapidly progress to difficulty swallowing, a muffled voice, drooling, and extreme anxiety. Moderate to severe respiratory distress is evident. The other options do not have these manifestations.

A nurse is assessing a 2-week-old infant with pulmonary edema. Which of the following symptoms indicates the infant is experiencing respiratory distress? a) Grunting during expiration b) Respiratory rate of 45 breaths/minute c) Coughing d) Frequent sneezing and hiccups

Grunting during expiration Explanation: Children with restrictive lung disorders, such as pulmonary edema or RDS, breathe at faster rates, and their respiratory excursions are shallow. Grunting is an audible noise emitted during expiration. An expiratory grunt is common as the child tries to raise the end-expiratory pressure and thus prolong the period of oxygen and carbon dioxide exchange across the alveolar-capillary membrane.

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: a) Pulling in of the soft tissue surrounding the cartilaginous and bony thorax b) Nasal obstruction and inhalation occurring through the mouth rather than the nares c) Increased turbulence of air moving through the obstructed airways d) The collapse of intrathoracic airways because of air trapping

Increased turbulence of air moving through the obstructed airways Explanation: The crowing sound of stridor occurs with the increased turbulence of air moving through the obstructed airways. Pulling in of the soft tissue surrounding the cartilaginous and bony thorax describes the mechanisms that produce inspiratory retractions. The collapse of intrathoracic airways because of air trapping describes the mechanism for the production of wheezing.

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? a) Influenza transmission occurs by inhalation of droplet nuclei. b) Influenza is transmitted by exposure to urine, blood, and body secretions. c) Influenza may be contracted by touching a surface that an infected person has touched. d) Influenza transmission occurs through contact with the skin of an infected person.

Influenza transmission occurs by inhalation of droplet nuclei. Explanation: As with many viral respiratory tract infections, influenza is more contagious than bacterial respiratory tract infections. In contrast to the rhinoviruses, transmission occurs by inhalation of droplet nuclei rather than touching contaminated objects.

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? a) Nosocomial hospital-acquired infection b) Autoimmune disease c) Community-acquired infection d) Opportunistic infection

Nosocomial hospital-acquired infection Explanation: Hospital-acquired pneumonia is defined as a lower respiratory tract infection that was not present or incubating on admission to the hospital. Hospital-acquired pneumonia is the second most common cause of hospital-acquired infection and has a mortality rate of 20% to 50%. Most hospital-acquired infections are bacterial. The organisms are those present in the hospital environment and include P. aeruginosa, S. aureus, Enterobacter species, Klebsiella species, Escherichia coli, and Serratia species. The organisms that are responsible for hospital-acquired pneumonias are different from those responsible for community-acquired pneumonias, and many of them have acquired antibiotic resistance and are more difficult to treat.

A client was admitted 3 days ago and is developing signs and symptoms of pneumonia. Select the correct documentation of the diagnosis. a) Nosocomial pneumonia b) Typical pneumonia c) Community-acquired pneumonia d) Antibiotic-resistant pneumonia

Nosocomial pneumonia Explanation: Pneumonia can be classified according to the type of organism causing the infection (typical or atypical), location of the infection—lobar pneumonia or bronchopneumonia—and setting in which it occurs—community- or nosocomial/hospital-acquired pneumonia. Community-acquired pneumonia involves infections from organisms that are present more often in the community than in the hospital or nursing home. Hospital-acquired (nosocomial) pneumonia is defined as a lower respiratory tract infection occurring 48 hours or more after admission.

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? a) Streptococcus pneumoniae b) Pseudomonas aeruginosa c) Staphylococcus aeureus d) Escherichia coli

Streptococcus pneumoniae Explanation: Streptococcus pneumoniae (pneumococcus) remains the most common cause of bacterial pneumonia. S. pneumoniae is a gram-positive diplococcus, possessing a capsule of polysaccharide. The virulence of the pneumococcus is a function of its capsule, which prevents or delays digestion by phagocytes.

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? a) "If you wake up with dried blood on your pillow, call your doctor right away." b) "When you can no longer get up or have the energy to go to work [fatigue], you should make an appointment with your physician." c) "The earliest symptoms relate to a chronic cough and shortness of breath." d) "If you start losing weight without trying and coughing up thick, yellow sputum, you should seek medical attention."

The earliest symptoms relate to a chronic cough and shortness of breath." Explanation: The earliest symptoms usually are chronic cough, shortness of breath, and wheezing because of airway irritation and obstruction. Hemoptysis (i.e., blood in the sputum) occurs when the lesion erodes into blood vessels. Later symptoms include coughing up blood, extreme fatigue, and weight loss.

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? a) The patient will have copious bloody sputum and diffuse chest pain and may lose his cough reflex. b) The patient will lack lung consolidation and will have little if any sputum production. c) The man will be hypotensive and febrile and may manifest cognitive changes. d) The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.

The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles. Explanation: The typical onset of pneumococcal pneumonia involves production of clear sputum, along with faint breath sounds and fine crackles. The patient is less likely to be hypotensive, have copious bloody sputum, or have chest pain. A lack of lung consolidation or sputum production is more closely associated with atypical pneumonias.

A client has been diagnosed with pneumococcal infection. The nurse shares with the client which statement about the spread of the disease? a) The spread is primarily by chronically ill persons who have an impaired immunity. b) Only persons showing active infection with fever and body aches is considered infectious and can spread the bacteria. c) The spread of this bacteria, especially the antibiotic-resistant strain, is largely by healthy, colonized individuals. d) This infection is spread primarily by children who do no wash their hands regularly.

The spread of this bacteria, especially the antibiotic-resistant strain, is largely by healthy, colonized individuals. Explanation: Perfectly healthy people can be colonized and carry the organism without evidence of infection. The spread of particular strains of pneumococci, particularly antibiotic-resistant strains, is largely by healthy, colonized individuals. By the time the client exhibits symptoms of infection, they have been spreading the bacteria for a few days. It is spread primarily by coughing, not by the hands of children. The chronically ill person with impaired immunity is at risk for developing the pneumonia, not spreading it.

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? a) The use of antiviral medications b) Maintaining bed rest for 7 days c) Limiting fluid intake until the fever is normal d) The use of antibiotics

The use of antibiotics Explanation: Treatment for community-acquired pneumonia involves the use of appropriate antibiotic therapy. Empiric antibiotic therapy, based on knowledge regarding an antibiotic's spectrum of action and ability to penetrate bronchopulmonary secretions, often is used for people with community-acquired pneumonia who do not require hospitalization

The nurse is educating a group of school-age students about the prevention of cold viruses and staying healthy during the school year. What should the nurse inform the students is one of the most important ways for them to avoid spreading a cold? a) Wear a mask while in public. b) When sneezing, cup your hands around your mouth and sneeze into your hands. c) Request an antibiotic from the physician when the symptoms begin. d) Wash your hands after touching surfaces prior to touching your nose or eyes.

Wash your hands after touching surfaces prior to touching your nose or eyes. Explanation: The "cold viruses" are spread rapidly from person to person. The fingers are the greatest source of spread, and the nasal mucosa, and conjunctival surface of the eyes are the most common portals for entry of the virus. Aeorsol spread of colds through coughing and sneezing is much less important than the spread through direct mucous membrane contact by fingers picking up the virus from contaminated surfaces and carrying it to the nasal membranes and eyes.

The nurse is caring for an infant admitted to the emergency department diagnosed with bronchiolitis. The nurse would assess the client for: a) Jaundiced skin and mucous membranes b) No history of upper respiratory infection c) Dehydration and drooling d) Wheezy cough and dyspnea

Wheezy cough and dyspnea Explanation: Lower airway infections produce wheezing due to bronchospasm, mucosal inflammation, and edema. Infants with acute bronchiolitis have a typical appearance, marked by breathlessness with rapid respirations, a distressing cough, and retractions of the lower ribs and sternum. Crying and feeding exaggerate these signs. Cyanosis would be present with extreme respiratory failure. The child with epiglottis (upper airway infection) assumes a distinctive position—sitting up with the mouth open and the chin thrust forward—has difficulty swallowing and exhibits drooling

A mother in premature labor asks the nurse why her doctor has prescribed corticosteroids. The nurse's response is based on the fact that: a) corticosteroids cause blood glucose levels to rise, thus preventing hypoglycemia in premature infants. b) cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. c) corticosteroids can perform anti-inflammatory acts that may prevent infections. d) cortisol administration will enhance the secretion of insulin, which is needed for surfactant production.

cortisol can accelerate maturation of type II cells and stimulate the formation of surfactant. Explanation: Surfactant synthesis is influenced by several hormones, including insulin and cortisol. Insulin tends to inhibit surfactant production. Cortisol can accelerate maturation of type II cells and formation of surfactant. These observations have led to administration of corticosteroid drugs before delivery to mothers with infants at high risk for development of RDS

The client ask the nurse how influenza is spread from person-to-person. The nurse educates her client that influenza is transmitted by: a) blood exposure. b) direct contact with secretions. c) contact with moist mucous membranes. d) inhalation of droplet nuclei.

inhalation of droplet nuclei. Explanation: Influenza transmission occurs by inhalation of droplet nuclei rather than touching contaminated objects or blood exposure

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. a) Mild fever b) Watery, clear nasal secretions c) Photosensitivity d) Nuchal rigidity e) Coughing

• Mild fever • Watery, clear nasal secretions • Coughing Explanation: The condition usually begins with a sore and scratchy throat followed by profuse and watery rhinorrhea, nasal congestion, sneezing, and coughing. Other cold symptoms include malaise, fatigue, headache, hoarseness, sinus congestion, and myalgia. Fever is a common sign in children. Photosensitivity and nuchal rigidity are signs of meningitis.

A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply. a) Substernal retractions with each breathe b) Expiratory grunting c) Bluish discoloration of the skin and mucous membranes (central cyanosis) d) Clubbed fingers e) Periorbital edema

• Substernal retractions with each breathe • Expiratory grunting • Bluish discoloration of the skin and mucous membranes (central cyanosis) Explanation: Infants with RDS present with multiple signs of respiratory distress, usually within the first 24 hours of birth. Central cyanosis is a prominent sign. Breathing becomes more difficult, and retractions occur as the infant's soft chest wall is pulled in as the diaphragm descends. Grunting sounds accompany expiration. Periorbital edema is usually associated with kidney disease in infants. Clubbed fingers occur over a long period of time (years) in clients with COPD

Which of the following clients at the clinic should be encouraged to receive the pneumococcal polysaccharide vaccine (PPSV23)? A client: Select all that apply. a) Who is school-aged and has received a liver transplant b) With a smoking history c) Who is a teenager with history of kidney disease d) Who is 65 years old with chronic asthma e) Who is a young adult with HIV-positive results

• Who is 65 years old with chronic asthma • With a smoking history Explanation: The PPSV23 vaccine consists of the 23 most common capsular serotypes that cause the most common invasive pneumococcal disease. It is recommended for all adults 65 years of age and older and for those 2 years of age and older who are at high risk for the disease. It is also recommended for adults who smoke or have asthma. The PCV13 protects against 13 types of pneumococcal bacteria. It is recommended for use in infants and young children and for all adults 50 years of age and older who have conditions that weaken the immune system such as HIV infection, organ transplantation, leukemia, lymphoma, and severe kidney disease.

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? a) "Do you smoke?" b) "Do you have cats and clean litter boxes?" c) "Do you work in construction and dig soil?" d) "Do you have a history of cancer?"

"Do you work in construction and dig soil?" Explanation: The disease resembles tuberculosis, and its mechanisms of infection are similar to those of histoplasmosis. It is most prevalent in the deserts in southwestern United States, principally in parts of California, Arizona, Nevada, New Mexico, and Texas. The C. immitis and C. posadasii organism lives in soil and can establish new sites in the soil. Events such as dust storms and digging for construction have been associated with increased incidence of the disease.