Chapter 27 1 of 4
A nurse is caring for a pediatric patient who has experienced a cough, clear and watery sputum, headache, and muscle aches for the past two weeks. The nurse auscultates wheezes during expiration. There is no other abnormality found. The patient's parent asks why an antibiotic has not been prescribed. How should the nurse respond? 1 Explain that antibiotics are not required for the patient. 2 Advise the parent to see another health care provider for a second opinion. 3 Explain that the child needs anticancer treatment and antibiotics will not help. 4 Explain that antibiotics will be prescribed if the cough persists for two more days
Answer: 1
A patient began taking antitubercular drugs a week ago. The nurse reviews the patient's medical record and learns that the patient has a 10-year history of consuming one standard drink of alcohol three times a week. The patient states, "In the last week, my urine turned orange and I am very worried about it." How should the nurse respond? 1 Inform the patient that it is one of the side effects of the antitubercular drug rifampin. 2 Recognize that the tuberculosis may have spread to the liver and further medical consultation is required. 3 Recognize that the liver may be damaged due to alcohol, and so a liver function test should be performed. 4 Instruct the patient to stop taking antitubercular drugs immediately and consult the primary health care provider
Answer: 1
A patient reports shortness of breath one day after a cholecystectomy. On examination there is dullness on percussion on the right side of the chest, and breath sounds are also decreased in this region. The nurse recognizes that the most probable reason for the assessment findings is what? 1 Atelectasis 2 Pneumonia 3 Pneumothorax 4 Tension pneumothorax
Answer: 1
A patient with a history of epilepsy is admitted to the hospital for treatment of fever and shortness of breath. The patient is diagnosed with pneumonia. On taking history, the nurse finds that the patient had a seizure four days ago with profuse vomiting. What type of pneumonia does the patient have? 1 Aspiration pneumonia 2 Opportunistic pneumonia 3 Hospital-associated pneumonia 4 Community-acquired pneumonia
Answer: 1
The nurse cares for a patient with a diagnosis of tuberculosis. Which assessment finding best indicates that the patient has been following the prescribed treatment plan? 1 Negative sputum cultures 2 Clear breath sounds bilaterally 3 Decrease in the number of coughing episodes 4 Conversion of the Mantoux test from positive to negative
Answer: 1
The nurse cares for a patient with tuberculosis who is taking isoniazid and rifampin. About which data found in the patient's health history is the nurse most concerned? 1 Hepatitis B 2 Asthma attacks 3 Rheumatic fever 4 Allergy to penicillin
Answer: 1
The nurse collaborates with the health care team to arrange for home care for a patient with pulmonary tuberculosis (TB). Of the family members that live with the patient, who is the one at greatest risk for contracting TB? 1 A 75-year-old parent who takes prednisone 2 A 15-year-old child who has a history of asthma 3 A 50-year-old woman who is at least 20 lb overweight 4 A 25-year-old daughter who is seven months pregnant
Answer: 1
To ease pleuritic pain caused by pneumonia, what nursing interventions should be performed? 1 Instructing the patient to splint the chest when coughing 2 Offering the patient an incentive spirometer every four hours 3 Instructing the patient in how to perform abdominal breathing 4 Encouraging the patient use shallow breathing during episodes of pain
Answer: 1
When the patient with a persistent cough is diagnosed with pertussis (instead of acute bronchitis), the nurse knows that treatment will include which type of medication? 1 Antibiotic 2 Corticosteroid 3 Bronchodilator 4 Cough suppressant
Answer: 1
The nurse is caring for the patient with a pulmonary embolism. Which factor(s) are associated with a pulmonary embolism (PE)? Select all that apply. 1 Immobility 2 Pregnancy 3 Pelvic surgery 4 Herbal therapy
Answer: 1,2,3
A patient is being admitted with a diagnosis of pertussis. The nurse knows which of these are true? Select all that apply. 1 The cough may last from 6 to 10 weeks. 2 This is a highly contagious respiratory tract infection. 3 Treatment usually includes antibiotics such as macrolides. 4 Cough suppressants and antihistamines should not be used. 5 Corticosteroids and bronchodilators are very useful in reducing symptoms. 6 Lifetime immunity results from one vaccination of diphtheria, pertussis, or tetanus (DPT)
Answer: 1,2,3,4
Complications of pneumonia occur more frequently in older patients. The nurse knows that potential complications include which of these? Select all that apply. 1 Sepsis 2 Pleurisy 3 Bronchitis 4 Encephalitis 5 Pleural effusion 6 Congestive heart disease
Answer: 1,2,5
To promote airway clearance in a patient with pneumonia, what should the nurse instruct the patient to do? Select all that apply. 1 Maintain adequate fluid intake 2 Splint the chest when coughing 3 Maintain a 30-degree elevation 4 Maintain a semi-Fowler's position 5 Instruct patient to cough at end of exhalation
Answer: 1,2,5
When admitting a 45-year-old female with a diagnosis of pulmonary embolism, the nurse will assess the patient for which risk factors? Select all that apply. 1 Obesity 2 Pneumonia 3 Malignancy 4 Cigarette smoking 5 Prolonged air travel 00:00:01 Question Answer Confidence ButtonsJust a guessPretty sureNailed it
Answer: 1,3,4,5
The nurse is assessing a patient who was admitted from a nursing home with suspected tuberculosis (TB). Which of these are initial manifestations of tuberculosis? Select all that apply. 1 Anorexia 2 Dyspnea 3 Night sweats 4 Hemoptysis 5 Low-grade fever 6 Unexplained weight loss
Answer: 1,3,5,6
The nurse is preparing an education session for community planners concerning targeting resources to address increased rates of tuberculosis among community members. Which populations would the nurse include in the presentation? Select all that apply. 1 Guards and food service workers in the nearby prison 2 Elderly adults who attend activities at the local senior center 3 Young adult men accessing services at a local homeless shelter 4 Children who attend a private faith-based preschool 3 days a week 5 Middle-aged adults who live in a low-income inner-city neighborhood 6 Immigrants from Burma currently living with relatives while trying to find housing
Answer: 1,3,5,6
The nurse is caring for a patient who has a nasogastric tube. What actions should the nurse perform to prevent aspiration in this patient? Select all that apply. 1 Monitor gastric residual volumes. 2 Feed the patient in a reclined position. 3 Lower the head of the bed to 10 degrees. 4 Elevate the head of the bed 30 to 45 degrees. 5 Encourage the patient to sit upright for all meals.
Answer: 1,4,5
A 72-year-old patient is in the emergency department with a temperature of 101.4° F and a productive cough with rust-colored sputum. The nurse notifies the health care provider, understanding these findings are indicative of which condition? 1 Tuberculosis 2 Pneumonia 3 Pulmonary embolus 4 Chronic heart failure (CHF)
Answer: 2
A patient has an initial positive PPD (purified protein derivative) skin test result. A repeat PPD's result is also positive. No other signs or symptoms of tuberculosis or allergies are evident. Which medication(s) does the nurse anticipate will be prescribed? 1 Penicillin 2 Isoniazid (INH) 3 Theophylline 4 INH and an antibiotic
Answer: 2
A patient presents with a lung abscess. What treatment option would be the most appropriate? 1 Postural drainage 2 Antibiotic treatment 3 Chest physiotherapy 4 Reduction of fluid intake
Answer: 2
A patient with asthma who has undergone a total hip replacement complains on the third postoperative day of shortness of breath and slight chest pain and notes that "something is wrong." Temperature is 98.8° F, blood pressure 168/98 mm Hg, pulse 96, respirations 32, and oxygen saturation is 89% on room air. What is the priority nursing action? 1 Notify the health care provider and document the vital signs. 2 Apply oxygen and place the patient in a semi-Fowler's position. 3 Obtain an electrocardiogram (ECG) and administer albuterol nebulizers. 4 Administer the prescribed antihypertensive medication and reassess in 15 minutes
Answer: 2
After admitting a patient from home to the medical unit with a diagnosis of pneumonia, the nurse will verify that which health care provider prescriptions have been completed before administering a dose of cefuroxime to the patient? 1 Pulmonary function evaluation 2 Sputum culture and sensitivity 3 Orthostatic blood pressures (BP) 4 Serum laboratory studies prescribed for the morning
Answer: 2
The health care provider has prescribed intravenous (IV) vancomycin for a patient with pneumonia. Which action should the nurse perform first? 1 Obtain a full set of vital signs. 2 Obtain sputum cultures for sensitivity. 3 Administer the antibiotic over at least 60 minutes. 4 Draw a blood specimen to evaluate the white blood cell count
Answer: 2
The nurse is caring for a patient with a diagnosis of lung abscess. What does the nurse know is true? 1 Hemoptysis rarely occurs. 2 Purulent sputum often is dark brown. 3 Physical examination reveals hyperresonance and fremitus. 4 Clinical manifestations related to anaerobic organisms usually occur more acutely over a period of a few days.
Answer: 2
The nurse is monitoring a patient who is having a thoracentesis for recurrent pleural effusion. Which of these assessment findings would be of most concern? 1 Removal of 1000 mL of pleural fluid 2 Restlessness and sudden complaint of dyspnea 3 SpO2 reading of 96% while on 2 L/minute of oxygen 4 Patient complaint of pressure at the needle insertion site
Answer: 2
When caring for a patient with tuberculosis, what measures should the nurse instruct the patient to take to avoid the spread of infection? Select all that apply. 1 Drink plenty of water and maintain an erect posture. 2 Throw used tissues in a paper bag and dispose with the trash. 3 Carefully wash hands after handling sputum and soiled tissues. 4 Wear a standard isolation mask when outside the patient's room. 5 Cover the nose and mouth with a tissue while coughing and sneezing. 6 Get out of bed and move freely about the hospital to keep up strength
Answer: 2,3,4,5
The nurse is monitoring a patient who has pneumonia with thick secretions. The patient is having difficulty clearing the secretions. Which of these would be appropriate nursing interventions for this patient? Select all that apply. 1 Perform postural drainage every hour. 2 Encourage the patient to rest and limit activity. 3 Provide adequate hydration by encouraging fluid intake. 4 Provide analgesics as prescribed to promote patient comfort. 5 Teach the patient how to cough effectively to bring secretions to the mouth.
Answer: 2.3.5
A patient has been admitted with a suspected lung abscess. During the assessment, the nurse is aware that the most common manifestation of a lung abscess is which of these? 1 Fever 2 Vomiting 3 Purulent sputum that has a foul odor and taste 4 Increased breath sounds on auscultation over the involved segment of lung.
Answer: 3
The nurse determines that additional discharge teaching is needed for a patient with pneumonia when the patient states what? 1 "I will take all medications as prescribed." 2 "Breathing exercises may help prevent future infections." 3 "I should take antibiotics for all upper respiratory infections." 4 "I will seek medical attention if I develop a fever or productive cough."
Answer: 3
The nurse is reviewing the laboratory reports for the patient receiving cefuroxime. The nurse determines that the medication is having the intended effect by noting which laboratory result? 1 Sodium 138 mEq/L 2 Platelets 175,000 per µL 3 White blood cell count 4500/mm³ 4 Blood urea nitrogen (BUN) 8 mmol/L
Answer: 3
The patient has acute bronchitis. What is the most important factor for the nurse to consider for this patient? 1 Abnormal chest x-ray 2 Presence of tactile fremitus 3 Therapy is mainly supportive 4 Clinical assessment finding of egophony
Answer: 3
The patient with human immunodeficiency virus (HIV) has been diagnosed with Candida albicans, an opportunistic infection. The nurse knows the patient needs more teaching when the patient makes which statement? 1 "I will be given amphotericin B to treat the fungus." 2 "I got this fungus because I am immunocompromised." 3 "I need to be isolated from my family and friends so they won't get it." 4 "The effectiveness of my therapy can be monitored with fungal serology titers."
Answer: 3
Which clinical manifestation should the nurse expect to find during assessment of a patient admitted with pneumonia? 1 Hyperresonance on percussion 2 Vesicular breath sounds in all lobes 3 Increased vocal fremitus on palpation 4 Fine crackles in all lobes on auscultation
Answer: 3
The nurse is caring for a 73-year-old patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient complains of shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4° F, blood pressure 130/88, respirations 36/minute, and oxygen saturation 91% on room air. What action should the nurse take first? 1 Notify the health care provider. 2 Administer a nitroglycerin tablet sublingually. 3 Conduct a thorough assessment of the chest pain. 4 Sit the patient up in bed as tolerated and apply oxygen
Answer: 4
The nurse is caring for a patient with a diagnosis of active tuberculosis (TB). What does the nurse know is true? 1 Directly observed therapy is used only in the initial phase. 2 Drug therapy is in three phases (initial, interim, and continuation). 3 Liver function tests (LFTs) are initiated 14 days after the start of treatment. 4 Alcohol is avoided because it increases the hepatotoxicity of isoniazid (INH).
Answer: 4
The nurse would determine that levofloxacin therapy has not been effective after noting which indicator? 1 Temperature 99.7° F 2 Increased respiratory rate 3 Adventitious lung sounds 4 White blood cell count 14,000/mm 3
Answer: 4
When can airborne infection isolation for a patient with pulmonary tuberculosis (TB) be discontinued?
Answer: After three consecutive acid-fast bacillus (AFB) smears are negative
A 48-year-old patient with sudden onset of respiratory distress is scheduled for a stat ventilation-perfusion scan. What explanations should the nurse provide to the patient about the procedure? 1 Radioisotope is injected and inhaled to examine the lungs. 2 You will be sedated during the test to prevent you from moving. 3 We need to be sure there is no metal in your body before this test. 4 You will feel a sensation of chest pressure as the dye circulates through your body
Answer:1
The nurse cares for an immunocompetent patient. Which clinical manifestation is most indicative of pulmonary tuberculosis? 1 Mucopurulent sputum 2 Diarrhea and fatigue 3 Lymph node enlargement 4 Hematuria and dehydration
Answer:1
Which factor places a conscious patient at risk for pneumonia? 1 Difficulty swallowing medication 2 Lying supine for two consecutive hours 3 Effective postoperative pain management 4 Adequate cough and deep breathing exercises
Answer:1
The nurse makes a nursing diagnosis of "impaired gas exchange" for a patient with pneumonia based upon which physical assessment findings? Select all that apply. 1 SpO2 of 85% 2 PaCO2 of 65 mm Hg 3 Presence of thick yellow mucus 4 Respiratory rate 24 breaths/minute 5 Absent breath sounds in right lung lobes
Answer:1,2,5
A patient with pneumonia is being treated at home and has reported fatigue to the nurse. What instructions should the nurse include when teaching the patient about care and recovery at home? Select all that apply. 1 Get adequate rest. 2 Restrict fluid intake. 3 Avoid alcohol and smoking. 4 Resume work to build strength. 5 Take every dose of the prescribed antibiotic
Answer:1,3,5
Which nursing interventions will the nurse implement to help the patient expectorate mucus in a 72-year-old patient with bronchitis? Select all that apply. 1 Humidify the oxygen. 2 Teach pursed lip breathing. 3 Administer a cough suppressant. 4 Elevate the head of the bed to 45 degrees. 5 Increase fluid intake to 3 L per day if tolerated
Answer:1,4,5
The family of a patient with newly diagnosed tuberculosis is tested for infection with Mycobacterium tuberculosis. The patient's wife, who has a history of alcoholism, has had two negative Mantoux (PPD) tests. Both of their children have positive Mantoux results. The nurse recognizes that a course of preventive treatment with isoniazid will be required for which family member(s)? 1 The spouse only 2 Both children only 3 The spouse and the children 4 Neither the spouse nor the children
Answer:2
A 46-year-old patient who has undergone total left knee arthroplasty complains of shortness of breath and slight chest pain. Temperature is 98° F, blood pressure 140/86 mmHg, respirations 30, and oxygen saturation 92% on room air. The nurse suspects that the patient is experiencing which condition? 1 Pneumonia 2 Unstable angina 3 Pulmonary embolus 4 Chronic obstructive pulmonary disease (COPD) exacerbation
Answer:3
When the patient is diagnosed with a lung abscess, what should the nurse teach the patient? 1 Lobectomy surgery usually is needed to drain the abscess. 2 Intravenous (IV) antibiotic therapy will be used for a prolonged period of time. 3 Oral antibiotics will be used when the patient and x-ray show evidence of improvement. 4 No further culture and sensitivity tests are needed if the patient takes the medication as prescribed
Answer:3
A patient presenting with pneumonia scores 5 on the CURB-65 scale. What action should the nurse take? 1 Advise no treatment. 2 Advise treating at home. 3 Consider hospital admission. 4 Consider admission to an intensive care unit
Answer:4
A pediatric patient is diagnosed with pertussis. The cough is worse during the night and is accompanied by a loud, long, rasping, indrawn breath. Even though the child has completed a week's course of antibiotics and has received cough suppressants, the cough has worsened. The nurse determines that what is the likely reason the cough has worsened? 1 It could be a fungal infection. 2 The child may have lung cancer. 3 It could be a side effect of the antibiotics. 4 It may be due to administration of cough suppressant
Answer:4
What is the priority nursing intervention in helping a patient expectorate thick lung secretions? 1 Humidify the oxygen as able. 2 Administer cough suppressant. 3 Teach the patient to splint the affected area. 4 Increase fluid intake to 3 L/day if tolerated.
Answer:4
When planning care for a patient with pneumonia, the nurse recognizes which intervention as the highest priority? 1 Administering analgesics as needed for pain 2 Keeping the patient in a calm and quiet environment 3 Routinely checking vital signs and oxygen saturation 4 Increasing fluids to 2 to 3 L/day unless contraindicated
Answer:4
The nurse is caring for the patient with a productive cough. The nurse collects a sputum specimen for an acid-fast bacillus (AFB) smear. What collection time by the nurse is most appropriate?
6Am
A patient has just been admitted to the intensive care unit with a suspected diagnosis of pulmonary embolism (PE). The patient's condition is stable. The nurse will prepare for which intervention? 1 Oral administration of warfarin 2 Thrombolytic therapy with alteplase 3 Subcutaneous administration of enoxaparin 4 Intravenous administration of unfractionated heparin
Answer 3
A 70-year-old patient presents to the emergency department with a cough producing yellow sputum, fever, chills, and shortness of breath. On examination the nurse finds that the patient is confused, has a respiratory rate of 42/minute, and a blood pressure of 80/50 mm Hg. The nurse expects that what will be included in the patient's treatment plan? 1 Admit the patient to intensive care unit. 2 Admit the patient to a general medical-surgical unit. 3 Discharge the patient and monitor for signs of worsening infection. 4 Admit the patient for a 23-hour observation and monitor for pulmonary embolism
Answer: 1
To maintain patient safety, the nurse would question the health care provider about the prescription for prednisone if the patient also had which condition? 1 Diabetes mellitus 2 Renal insufficiency 3 Congestive heart failure 4 Systemic fungal infection
Answer: 4