Chapter 31- Quiz #5 & Lecture Material

The nurse is providing teaching to a patient who has been diagnosed with bacterial rhinosinusitis. Which instruction does the nurse include when teaching this patient about his diagnosis? A. "Be sure to complete the full course of antibiotics." B. "Fluid should be restricted to prevent excess mucous production." C. "Decongestants may cause rebound rhinitis and should be avoided." D. "Facial pain that is worse when bending forward is abnormal and should be reported to your provider."

A. "Be sure to complete the full course of antibiotics."

A patient is about to begin drug therapy for the treatment of tuberculosis (TB). What information is most important for the nurse to give to this patient prior to the start of therapy? A. "Do not drink alcohol." B. "Eat foods high in carbohydrates." C. "Take medications in the morning." D. "Limit ingestion of orange or grapefruit juice."

A. "Do not drink alcohol."

What questions should the nurse ask to determine an older adult patient's risk for developing pneumonia? Select all that apply. A. "Do you have a habit of smoking?" B. "Do you have a history of hypertension?" C. "Do you have any family history of lung disease?" D. "Have you had a pneumococcal vaccination in the last 3 years?" E. "Have you had any symptoms of influenza in the previous months?"

A. "Do you have a habit of smoking?" D. "Have you had a pneumococcal vaccination in the last 3 years?" E. "Have you had any symptoms of influenza in the previous months?"

The nurse is counseling a patient whose parent has just been diagnosed with tuberculosis (TB). The patient tells the nurse that the parent was exposed several years ago, but developed symptoms only recently. What does the nurse tell this patient about the risk of contracting the disease? A. "People are infectious to others only when symptoms are present." B. "As soon as drug therapy is initiated, your parent will not be contagious." C. "Since you have had prolonged contact with your parent, you are most likely infected." D. "You will need to begin treatment for TB since you have been exposed to your parent."

A. "People are infectious to others only when symptoms are present."

An adult has been diagnosed as having pulmonary tuberculosis. What direction should the nurse provide before the patient is started on isoniazid (INH) therapy? Select all that apply. A. "Take a daily multivitamin." B. "Avoid alcoholic beverages." C. "Do not wear contact lenses." D. "It is important to use contraceptives." E. "Know the signs and symptoms of gout."

A. "Take a daily multivitamin." B. "Avoid alcoholic beverages."

A nurse is providing discharge instructions for a patient with active tuberculosis (TB) who has been prescribed isoniazid. What information about medication administration does the nurse include when providing discharge instructions? A. "Take the drug on an empty stomach." B. "Take the drug with food for better absorption." C. "Take an antacid with the drug for better absorption." D. "Take the drug with a full glass of water and increase your water intake."

A. "Take the drug on an empty stomach."

A 75-year-old patient tells the nurse he is not planning to receive a "flu shot" this year because the shot makes him sick. What is the nurse's best response? A. "The injectable flu vaccine is not a live virus and cannot cause influenza." B. "If you had a 'flu shot' last year, you should still have immunity to influenza." C. "If the shot makes you sick, your provider can order an antiviral medication." D. "The virus in the injection is attenuated, meaning it can cause mild symptoms."

A. "The injectable flu vaccine is not a live virus and cannot cause influenza."

A patient with active tuberculosis is ordered to take isoniazid (INH), pyrazinamide (PZA), and rifampin (RIF) and asks the nurse why it is necessary to take three antibiotics. What is the nurse's best answer? A. "Three antibiotics help prevent bacterial drug resistance." B. "You will have fewer drug side effects with multidrug therapy." C. "The dose of each drug can be reduced with multidrug therapy." D. "Taking three drugs has a synergistic effect in eradicating the organism."

A. "Three antibiotics help prevent bacterial drug resistance."

A nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). The patient's 52-year-old caregiver asks the nurse if she should receive an annual influenza vaccination. What is the nurse's best response? A. "Yes, you should receive the influenza vaccination by injection and should receive it every year." B. "Yes, as long as you are healthy you can receive the intranasal spray influenza vaccine every year." C. "No, as long as the patient has received the influenza vaccination by injection, you do not need it every year." D. "No, as long as you are healthy you do not have an increased risk of spreading or becoming infected with influenza."

A. "Yes, you should receive the influenza vaccination by injection and should receive it every year."

The nurse has been instructed to administer tuberculosis (TB) medication to a patient who has been noncompliant by directly observed therapy. Which statement by the nurse will assist the patient in understanding this therapy? A. "You must swallow your pills in front of me." B. "It is necessary for you to call me right after you take your medications." C. "I will check your pill bottles every day to make sure you are taking your medications." D. "I will meet you at the pharmacy to make sure you are picking up the correct prescriptions."

A. "You must swallow your pills in front of me."

A patient is being admitted for pneumonia. The sputum culture is positive for streptococcus, and the patient asks about the length of the treatment. What is the best answer the nurse can give? A. "You will be treated for 5 to 7 days." B. "You must be afebrile for 24 hours." C. "You will complete 6 days of therapy." D. "You will require antibiotics for 7 to 10 days."

A. "You will be treated for 5 to 7 days."

A patient tells the nurse that after 3 weeks of multidrug therapy to treat tuberculosis (TB), the symptoms seem to have resolved. What does the nurse tell this patient? A. "You will need to continue therapy for at least 6 months." B. "Directly observed therapy will be necessary in your case." C. "If a TB skin test is negative, you may stop taking the drugs." D. "The provider may reduce the number of drugs you are taking."

A. "You will need to continue therapy for at least 6 months."

A patient is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? A. "You will need to have your household undergo TB testing." B. "You will have to take these medications for at least 1 year." C. "You are not contagious unless you stop taking your medication." D. "Your sputum may turn a rust color as your condition gets better."

A. "You will need to have your household undergo TB testing."

The nurse is providing health education to an older adult patient to prevent pneumonia. Which statements made by the patient demonstrate a need for further teaching? Select all that apply. A. "I will refrain from smoking." B. "I will refrain from drinking nonalcoholic fluids." C. "I will refrain from exposure to indoor pollutants." D. "I will refrain from going to public areas during flu season." E. "I will refrain from obtaining the pneumococcal vaccination."

B. "I will refrain from drinking nonalcoholic fluids." E. "I will refrain from obtaining the pneumococcal vaccination."

The nurse is instructing a patient with tuberculosis about combination drug therapy. What are common instructions that the patient should follow for all the anti-tubercular drugs? Select all that apply. A. "Refrain from wearing soft contact lenses." B. "Refrain from drinking alcoholic beverages." C. "Refrain from taking the drug on an empty stomach." D. "Drink at least 8 ounces of water when you take the medication." E. "Report yellowing of the skin and any darkened urine immediately."

B. "Refrain from drinking alcoholic beverages." E. "Report yellowing of the skin and any darkened urine immediately."

A patient who has acute viral rhinitis cares for an older family member who is susceptible to respiratory infections. Which action does the nurse suggest to this patient to help prevent the spread of infection? A. "Get an influenza vaccine immediately." B. "Thoroughly wash hands after touching the face." C. "Complete the full course of antibiotic medication." D. "Wear a mask while providing care to the family member."

B. "Thoroughly wash hands after touching the face."

The nurse is caring for a patient who has just been diagnosed with pulmonary tuberculosis and will be discharged with a prescription for isoniazid 300 mg orally each day. At what time should the nurse teach this patient to take this medication? A. An hour before bedtime B. An hour before breakfast C. Immediately after breakfast D. Immediately before breakfast

B. An hour before breakfast

The community health nurse is planning tuberculosis treatment for a patient who is homeless and heroin-addicted. Which action will be most effective in ensuring that the patient completes treatment? A. Have the patient repeat medication names and side effects. B. Arrange for a health care worker to watch the patient take the medication. C. Give the patient written instructions about how to take prescribed medications. D. Instruct the patient about the possible consequences of nonadherence.

B. Arrange for a health care worker to watch the patient take the medication.

Stroke patients are at high risk for pneumonia related to what condition? A. Helminths B. Aspiration C. Inhalation D. Mycoplasmas

B. Aspiration

An older patient with pneumonia has become more confused during the initial assessment. What action should the nurse take initially? A. Notify the Rapid Response Team. B. Assess the patient's oxygen saturation. C. Evaluate orientation to person, place, and time. D. Request a nebulized bronchodilator medication.

B. Assess the patient's oxygen saturation.

The nurse is teaching a patient newly diagnosed with tuberculosis (TB) about the medication and treatment regimen for this disease. What information does the nurse include when teaching this patient? A. Most people can be effectively treated with one or two medications. B. Avoid alcohol while taking the medications unless the provider says otherwise. C. Do not participate in even nonstrenuous exercise while taking these medications. D. Have the skin test repeated periodically to evaluate the drug therapy's effectiveness.

B. Avoid alcohol while taking the medications unless the provider says otherwise.

What recommendations will the nurse make for a patient and his or her family about the prevention of pneumonia? Select all that apply. A. Get plenty of exercise. B. Avoid indoor pollutants. C. Eat a healthy, balanced diet. D. Drink at least 1 L of fluid a day. E. Avoid crowded areas during flu season and holidays.

B. Avoid indoor pollutants. C. Eat a healthy, balanced diet. E. Avoid crowded areas during flu season and holidays.

The nurse is caring for a patient with low-grade fever, fatigue, mild chest pain, and a dry cough. The patient does not have a sore throat or rhinitis. When asked about travel history, the patient tells the nurse about a recent trip to volunteer at a livestock farm. What is the nurse's priority action? A. Ordering sputum cultures B. Beginning antibiotic therapy C. Ordering PCR laboratory testing D. Prescribing an antifungal agent

B. Beginning antibiotic therapy

A patient with pneumonia is producing a smaller volume of thicker secretions than the day before. The patient is receiving intravenous antibiotics. What action does the nurse take? A. Monitor peak flow levels every 4 hours. B. Encourage the patient to drink more fluids. C. Request an order to switch to an oral antibiotic. D. Reassure the patient that the infection is improving.

B. Encourage the patient to drink more fluids.

What information is important to share with a patient who is being discharged after treatment for pneumonia? Select all that apply. A. Resume regular activities B. Get an annual influenza immunization C. Avoid contact with all persons with colds or influenza D. Stop or reduce any intake of tobacco and tobacco products E. Because you have had pneumonia, you won't need a pneumococcal vaccination

B. Get an annual influenza immunization C. Avoid contact with all persons with colds or influenza D. Stop or reduce any intake of tobacco and tobacco products

A 76-year-old patient who is recovering from influenza A reports severe dry mouth and constipation. After reviewing the patient's medication list, the nurse suspects the patient is experiencing the anticholinergic effect of which medication? A. Oseltamivir B. Hydroxyzine C. Phenylephrine D. Cephalosporin

B. Hydroxyzine

A febrile patient presents to the emergency department with a headache, chills, fatigue, nausea, vomiting, and diarrhea. What illness does the nurse suspects that the patient has? A. Influenza A B. Influenza B C. Influenza C D. Influenza AB

B. Influenza B

The nurse performs follow-up care for a group of patients who have previously had tuberculosis. Which patients are most at risk for developing secondary tuberculosis (TB)? Select all that apply. A. A 34-year-old with HIV infection B. A 55-year-old who recently had abdominal surgery C. A 14-year-old who is recovering from a broken femur D. A 75-year-old who is recovering from a hip replacement E. A 7-year-old who is undergoing chemotherapy for leukemia

A. A 34-year-old with HIV infection D. A 75-year-old who is recovering from a hip replacement E. A 7-year-old who is undergoing chemotherapy for leukemia

A clinic nurse notes that large numbers of clients present with flulike symptoms. Which recommendations should the nurse include in the plan of care for these clients? Select all that apply. A. Get plenty of rest. B. Increase intake of liquids. C. Take antipyretics for fever. D. Get a flu shot immediately. E. Eat fruits and vegetables high in vitamin C.

A. Get plenty of rest. B. Increase intake of liquids. C. Take antipyretics for fever. E. Eat fruits and vegetables high in vitamin C.

Which statement is true about community-acquired pneumonia (CAP) as compared to health care-associated pneumonia (HAP)? A. HAPs are more likely to be resistant to some antibiotics. B. In CAP, the fibrin and edema of inflammation stiffen the lung. C. In CAP, capillary leak spreads the infection to areas of the lung. D. CAPs are more difficult to treat due to their resistance to antibiotics.

A. HAPs are more likely to be resistant to some antibiotics.

A patient reports pain over the cheek radiating to the teeth and fever, swelling, fatigue, ear pressure, referred pain to the temple, and general facial pain that is worse when bending forward. Upon assessment, the nurse finds erythema and tenderness to percussion over the sinuses. Which medications does the nurse anticipate will be beneficial for the patient? Select all that apply. A. Ibuprofen B. Amoxicillin C. Phenylephrine D. Diphenhydramine E. Chlorpheniramine

A. Ibuprofen B. Amoxicillin C. Phenylephrine

An older adult patient was diagnosed with influenza 1 week ago. What direction should the nurse include in the teaching plan for the patient? Select all that apply. A. Increase fluid intake. B. Increase daily caloric intake. C. Humidity can worsen symptoms. D. Avoid the use of diphenhydramine. E. Use appropriate hand-washing techniques.

A. Increase fluid intake. D. Avoid the use of diphenhydramine. E. Use appropriate hand-washing techniques.

Which groups are at greatest risk for drug-resistant Streptococcus pneumoniae? Select all that apply. A. Individuals older than age 65 years B. Those who have aspirated acidic stomach contents C. People who have not received an influenza vaccine D. People who have traveled outside the United States E. Older adults exposed to children from a daycare environment

A. Individuals older than age 65 years E. Older adults exposed to children from a daycare environment

Which statements about pulmonary tuberculosis (TB) are correct? Select all that apply. A. Infected people are not infectious to others until manifestations of the disease occur. B. Mycobacterium tuberculosis is transmitted from person to person via the airborne route. C. An asymptomatic period of up to years or decades can follow the time of primary infection. D. Foreign immigrants, especially from Mexico, the Philippines, and Vietnam, are at greatest risk. E. Anergy is not a problem with the use of a TB skin test once a person presents with symptoms.

A. Infected people are not infectious to others until manifestations of the disease occur. B. Mycobacterium tuberculosis is transmitted from person to person via the airborne route. C. An asymptomatic period of up to years or decades can follow the time of primary infection. D. Foreign immigrants, especially from Mexico, the Philippines, and Vietnam, are at greatest risk.

A nurse is caring for a patient who is orally intubated and mechanically ventilated. The nurse understands that this patient is at an increased risk for developing ventilator associated pneumonia. When planning care for this patient, what pathophysiological concepts regarding an artificial airway does the nurse recognize as a contributing factor to the development of this condition? Select all that apply. A. It bypasses the protective airway mechanisms B. It alters and decreases the body's immune response C. It prevents adequate gas exchange at the cellular level D. It causes a hyperactive reaction of the mucociliary clearance E. It allows aspiration of secretions from the oropharynx and stomach

A. It bypasses the protective airway mechanisms E. It allows aspiration of secretions from the oropharynx and stomach

A patient with suspected initial infection of tuberculosis (TB) is admitted to the respiratory intensive care unit (ICU). The nurse caring for the patient reviews the patient's recent chest x-ray. Where on the patient's chest x-ray will the nurse most likely find evidence of the patient's infection? Select all that apply. A. Left lower lobe B. Left upper lobe C. Right lower lobe D. Right upper lobe E. Right middle lobe

A. Left lower lobe C. Right lower lobe E. Right middle lobe

What signs and symptoms does the nurse anticipate to find in a patient diagnosed with tuberculosis? Select all that apply. A. Lethargy B. Dyspnea C. Weight gain D. Night sweats E. Low-grade fever

A. Lethargy D. Night sweats E. Low-grade fever

The nurse is caring for a pediatric patient with pertussis who is currently in the catarrhal phase of the illness. What manifestations will the nurse most likely find on assessment of this patient? A. Mild cough B. Severe cough C. Bloody sputum D. Pneumonia on chest x-ray

A. Mild cough

A patient taking antibiotics to treat rhinosinusitis reports facial pain over the affected sinuses. Which comfort measure does the nurse suggest in addition to the antibiotic therapy? A. Moist heat packs over the affected sinuses B. Tilting the head forward to relieve discomfort C. Anticoagulant medications to reduce pressure D. Frequent nose-blowing to clear sinus passages

A. Moist heat packs over the affected sinuses

A patient returns to the provider's office three weeks after being diagnosed with pneumonia. The nurse notes that the patient reports fatigue, weakness, and cough. The patient is concerned the pneumonia is returning. What is the best action the nurse should take? A. Arrange for the patient to be readmitted to the hospital. B. Assess for patient noncompliance to treatment regimen. C. Assure the patient that recovery from pneumonia is a long process. D. Arrange for the patient to receive another treatment of anti-infective medications.

C. Assure the patient that recovery from pneumonia is a long process.

A patient is admitted with cough, fever, sore throat, progressive shortness of breath, diarrhea, and vomiting that developed after returning from a business trip overseas. The nurse suspects which illness is the likely cause of the patient's symptoms? A. Pneumonia B. Viral influenza C. Avian influenza D. Tuberculosis exposure

C. Avian influenza

The nurse is reviewing the influenza criteria to see if a newly admitted patient meets vaccination requirements. Which findings would lead the nurse to recommend that the patient receive the vaccine? Select all that apply. A. The patient has asthma. B. The patient has diabetes. C. The patient is 30 years old. D. The patient lives in a nursing home. E. The patient is being treated for cancer.

A. The patient has asthma. B. The patient has diabetes. D. The patient lives in a nursing home. E. The patient is being treated for cancer.

A patient taking ethambutol for tuberculosis is receiving discharge teaching from the nurse. What is the most important sign or symptom of a serious adverse reaction to this medication that the nurse should teach this patient? A. Fatigue B. Anorexia C. Changes in vision D. Aching of the feet

C. Changes in vision

An older adult resident in a long-term care facility becomes confused and agitated, telling the nurse "Get out of here! You're going to kill me!" Which action should the nurse take first? A. Give the prescribed PRN lorazepam. B. Do a complete neurologic assessment. C. Check the resident's oxygen saturation. D. Notify the resident's primary care provider.

C. Check the resident's oxygen saturation.

The nurse understands that which of the following is the most common manifestation of pneumonia in the older adult patient? A. Fever B. Cough C. Confusion D. Weakness

C. Confusion

he nurse is caring for a patient who comes to the clinic because of a cough. What symptom of the cough will lead the nurse to believe that the health care practitioner will order testing for pertussis? A. The patient reports that the cough has lasted more than 3 weeks. B. The patient states that sometimes it seems like he is wheezing when he coughs. C. The patient states that the cough is caused by a "tickle" in the back of the throat. D. The patient says that the cough is productive with green and yellow colored sputum.

A. The patient reports that the cough has lasted more than 3 weeks.

A patient with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The patient is febrile and agitated. Which health care provider order should the nurse implement first? A. Administer levofloxacin 500 mg IV. B. Give lorazepam as needed for agitation. C. Draw aerobic and anaerobic blood cultures. D. Refer to social worker for alcohol counselling.

C. Draw aerobic and anaerobic blood cultures.

A patient is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The patient calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes? A. Rifampin B. Isoniazid C. Ethambutol D. Pyrazinamide

C. Ethambutol

Which symptoms may be observed in an older patient with pneumonia? Select all that apply. A. Fever B. Cough C. Fatigue D. Confusion E. Poor appetite

C. Fatigue D. Confusion E. Poor appetite

The nurse is performing health assessments at an ambulatory walk-in clinic. Which patients would the nurse consider at risk for tuberculosis? Select all that apply. A. The patient who abuses alcohol B. The patient who has congestive heart failure C. The patient who recently emigrated from Spain D. The patient who doesn't have a permanent residence E. The patient recently released from a corrective facility

A. The patient who abuses alcohol D. The patient who doesn't have a permanent residence E. The patient recently released from a corrective facility

A patient has been diagnosed with community-acquired pneumonia (CAP). What risk-factors are associated with CAP? Select all that apply. A. Use of tobacco B. Recent aspiration C. History of chronic lung disease D. Pneumococcal vaccine more than 5 years ago E. Presence of gram-negative colonization of the mouth and throat

A. Use of tobacco D. Pneumococcal vaccine more than 5 years ago

Which nursing interventions are focused on preventing the spread of severe acute respiratory syndrome (SARS) caused by coronaviruses? Select all that apply. A. Using strict airborne isolation techniques B. Handwashing before and after all patient care C. Disinfecting contaminated surfaces and equipment D. Using Contact Precautions with people suspected to have SARS E. Reporting the occurrence to the Centers for Disease Control and Prevention (CDC)

A. Using strict airborne isolation techniques B. Handwashing before and after all patient care C. Disinfecting contaminated surfaces and equipment D. Using Contact Precautions with people suspected to have SARS

A patient with a recent history of a mild respiratory infection is admitted to the hospital after a sudden onset of breathlessness. The patient has a temperature of 104°F, is diaphoretic and dyspneic, and the nurse observes stridor and cyanosis. A chest x-ray reveals mediastinal widening. The nurse anticipates an order for administering which antibiotics for this patient? A. Vancomycin and rifampin B. Amoxicillin and doxycycline C. Doxycycline and ciprofloxacin D. Ciprofloxacin and clindamycin

D. Ciprofloxacin and clindamycin

Which disorder of the lungs is caused by a fungus? A. Pertussis B. Tuberculosis C. Inhalation anthrax D. Coccidioidomycosis

D. Coccidioidomycosis

The nurse is preparing a patient for discharge who has undergone percutaneous needle aspiration of a peritonsillar abscess. Which is most important to teach the patient about follow-up care? A. Using warm saline gargles and irrigations B, Taking pain medications every 4 to 6 hours C. Completing the antibiotic medication regimen D. Contacting the provider if the throat feels more swollen

D. Contacting the provider if the throat feels more swollen

A patient with pneumococcal pneumonia is being treated with intravenous antibiotics. On the fifth day of treatment, the nurse notes a productive cough with white mucus. Which action should the nurse take? A. Ask the provider for an order for nebulized albuterol. B. Report the patient's worsening condition to the provider. C. Request an order for a stronger antibiotic to combat bacterial resistance. D. Continue the current plan of care and reassess the patient periodically.

D. Continue the current plan of care and reassess the patient periodically.

The nurse is counseling a young woman about drug therapy with isoniazid and rifampin to treat tuberculosis. Before developing the teaching plan, what must the nurse assess for first? A. History of gout B. Color blindness C. Susceptibility to sunburn D. Contraceptive methods used

D. Contraceptive methods used

The nurse is caring for a patient who has had abdominal surgery. Which action should the nurse take to help prevent pulmonary infection in this patient? A. Provide adequate analgesia. B. Give intravenous antibiotics. C. Administer low-molecular-weight heparin. D. Encourage regular use of an incentive spirometer.

D. Encourage regular use of an incentive spirometer.

What education will be provided for the family of a patient being treated for tuberculosis convalescing at home? A. Use airborne precautions. B. Place used tissues in a trash can. C. Cover your mouth and nose when sneezing. D. Everyone must undergo tuberculosis testing.

D. Everyone must undergo tuberculosis testing.

Which virus is a strain of the bird flu? A. H1N7 B. H1N1 C. H1N5 D. H5N1

D. H5N1

The nurse is reviewing the cultures of an outpatient cancer patient with pneumonia. The nurse notes that the sputum has multidrug-resistant organisms. Based on this finding, the nurse concludes that the patient is most likely infected with what type of pneumonia? A. Hospital acquired B. Community acquired C. Ventilator associated D. Health care associated

D. Health care associated

An older patient has a persistent cough with hemoptysis and has a known exposure to tuberculosis. A tuberculin skin test reveals a reaction of 5 mm. The nurse documents that this test result indicates which condition? A. Latent tuberculosis B. Immunity to tuberculosis C. Reduced immune function D. Human immunodeficiency disease

D. Human immunodeficiency disease

A community health nurse is preparing a community education class on bioterrorism and the use of inhalation anthrax. When preparing to discuss the manifestations of the fulminant stage of the infection, what manifestation does the nurse include in the teaching? A. Fever B. Fatigue C. Dry cough D. Hypotension

D. Hypotension

Incentive spirometry for the treatment of pneumonia has which outcome objective? A. Reduced sputum production and increased cough B. Reduced crackles and wheezes and improved oxygenation C. Improved expiratory air flow and increased respiratory effort D. Increased inspiratory muscle action and decreased atelectasis

D. Increased inspiratory muscle action and decreased atelectasis

A patient is admitted to the hospital with a streptococcal peritonsillar abscess following incomplete treatment with an oral antibiotic. The nurse notes that the patient is experiencing stridor. Which action should the nurse take next? A. Provide clear, cool oral liquids to help soothe the throat. B. Elevate the head of the bed to at least a 30-degree angle. C. Contact the provider to request an order for a steroid medication. D. Notify the Rapid Response Team to assist with airway management.

D. Notify the Rapid Response Team to assist with airway management.

A patient admitted to the medical surgical unit is suspected of having tuberculosis (TB). Which rapid screening for TB does the nurse anticipate to be ordered by the health care provider? A. Mantoux test B. Sputum culture C. QuantiFERRON-TB Gold D. Nucleic acid amplification test

D. Nucleic acid amplification test

The nursing instructor is preparing to teach a group of nursing students about treatment of patients infected during a pandemic outbreak of the H5N1 or "avian influenza." What should the nurse include in the teaching plan? A. Oseltamivir vaccination is a two-step process. B. Everyone should be vaccinated with Vepacel annually. C. Once patients receive the initial dose of Vepacel, immunity follows. D. Oseltamivir and zanamivir may reduce the mortality of the infection.

D. Oseltamivir and zanamivir may reduce the mortality of the infection.

The medical-surgical unit has one negative airflow room. Which of these four newly arrived patients should the charge nurse admit to this room? A. Patient with neutropenia and pneumonia caused by Candida albicans B. Patient with bacterial pneumonia and a cough productive of green sputum C. Patient with right empyema who has a chest tube and a fever of 103.2° F D. Patient with possible pulmonary tuberculosis who currently has hemoptysis

D. Patient with possible pulmonary tuberculosis who currently has hemoptysis

The nurse is performing an admission assessment on a 90-year-old patient and notes confusion with poor orientation to person, place, and time. The patient's daughter tells the nurse that this isn't normal. Which initial action should the nurse take? A. Contact the provider to request an order for an intravenous antibiotic. B. Notify the provider and request orders for serum electrolytes and kidney function tests. C. Reassure the daughter that confusion is common in older patients who are admitted to the hospital. D. Perform a detailed respiratory assessment including lung sounds, pulse oximetry, and temperature.

D. Perform a detailed respiratory assessment including lung sounds, pulse oximetry, and temperature.

Community health nurses are tasked with providing education on the prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority? A. Politicians B. Hospital staff C. Homeless people D. Prison staff and inmates

D. Prison staff and inmates

A patient is experiencing hypotension, fever, chills, night sweats, and weight loss. Upon assessment, the nurse notes a displaced PMI. The nurse knows this collection of symptoms are associated most closely with which condition? A. Influenza B. Pneumonia C. Tuberculosis D. Pulmonary empyema

D. Pulmonary empyema

A patient with pneumonia develops increased fever, chills, and night sweats. The nurse auscultates decreased breath sounds in the right lung and observes decreased chest wall movement in that area. The nurse reports these findings to the provider and suspects which secondary infection has likely developed? A. Tuberculosis B. Lung abscess C. Fungal infection D. Pulmonary empyema

D. Pulmonary empyema

A client's baseline vital signs are as follows: temperature 98.8°F (37.1°C) oral, pulse 74 beats/min, respirations 18 breaths/min, and blood pressure 124/76 mm Hg. The client's temperature suddenly spikes to 103°F (39.4°C). Which corresponding respiratory rate should the nurse anticipate in this client as part of the body's response to the change in status? A. Respiratory rate of 12 breaths/min B. Respiratory rate of 16 breaths/min C. Respiratory rate of 18 breaths/min D. Respiratory rate of 22 breaths/min

D. Respiratory rate of 22 breaths/min

Which viral agent is responsible for the most common community-acquired pneumonia? A. Adenovirus B. Rhinovirus C. Parainfluenza virus D. Respiratory syncytial virus

D. Respiratory syncytial virus

A patient with nasal congestion, fever, and cough has been using over-the-counter medications for a week without improvement. The patient exhibits tenderness to percussion over the sinuses and referred pain to the back of the head. These findings may indicate which condition? A. Rhinitis B. Tonsilitis C. Pharyngitis D. Rhinosinusitis

D. Rhinosinusitis

A previously infected patient with a dormant tuberculosis (TB) infection has experienced a reactivation of the disease. Which was likely a factor in this occurrence? A. Fracture of a rib 1 week ago B. Allergy testing 6 months ago C. Pneumonia vaccine 2 months ago D. Taking prednisone for the past 3 weeks

D. Taking prednisone for the past 3 weeks

Which method is the best way to prevent outbreaks of pandemic influenza? A. Early recognition and quarantine B. Avoiding public gatherings at all times C. Widespread distribution of antiviral drugs D. Vaccinating everyone with pneumonia vaccine

D. Vaccinating everyone with pneumonia vaccine

Upon assessment of a patient with chest pain, the nurse finds unequal chest expansion, crackles with diminished breath sounds, tachypnea, and a fever. Which laboratory data finding would lead the nurse to believe the patient has pneumonia? A. WBC 5,100/mm 3 B. WBC 6,500/mm 3 C. WBC 9,500/mm 3 D. WBC 12,000/mm 3

D. WBC 12,000/mm 3

The nurse is caring for a patient with severe acute respiratory syndrome (SARS). What is the most important precaution the nurse should take when preparing to suction this patient in order to prevent contracting the infection? A. Performing oral care after suctioning the oropharynx B. Keeping the head of the bed elevated 30 to 45 degrees C. Washing hands and donning gloves prior to the procedure D. Wearing a disposable particulate mask respirator and protective eyewear

D. Wearing a disposable particulate mask respirator and protective eyewear

What are the actions needed to be taken if a chest tube becomes disconnected?

DO NOT CLAMP! Immediately place the end of the tube in a container of sterile saline or water until a new drainage system can be connected

A patient is tested for seasonal influenza and their results come back as positive. Which precautions will they be placed on?

DROPLET (mask) and after being placed on precautions, the patient will be prescribed antiviral agents in order to stop the progression (lessoning of signs & symptoms) and shorten the duration; additional treatment will include rest, fluids, antihistamines (for drainage), and gargling with saline

A patient diagnoses with Pandemic Influenza will be placed on strict isolation precautions at the hospital. What does this mean when they are discharged and go home?

educate patients on early recognition, community & person quarantine once recognized, and keeping antiviral drugs "on hand" to have enough medicine to at least shorten the duration for patients

Management of Pneumonia: Laboratory Assessment (Serum BUN)

elevated status will indicate dehydration

Two hours later, the patient has a weak cough, crackles in both lower lobes, and an SaO2 reading of 90% by pulse oximetry. What interventions should be implemented by the nurse at this time?

encourage coughing & deep breathing every two hours, incentive spirometer use every hour while awake, consumption of 3 L of fluid per day, monitoring intake & output, and administration of a bronchodilator if ordered (patient has developed problems with her airway)

Hydration Status

essential for patients experiencing a fever as 300-400 mL of fluid is lost daily already by the lungs through evaporation; hydration will thin mucous trapped in the bronchioles & alveoli to facilitate expectoration

Pulmonary Tuberculosis

highly communicable, caused by Mycobacterium tuberculosis, transmitted via aerosolization (AIRBORNE PRECAUTIONS), may be secondary or primary, and patients are at an increased risk secondary to an HIV infection; individuals at risk include those in frequent contact with someone who's infected, immunocompromised individuals, residents of long-term care facilities of a group home, the homeless, lower SES, alcoholics, IV drug users, and foreign immigrants

Community-Based Care of Pneumonia

home care management, teaching for self-management, healthcare resources, prevention, immunization of appropriate individuals; teaching will be based upon the patient's prescribed medications, oxygenation, energy conservation with activities, and weakness & cough which may last for several weeks (does the patient smoke or have financial issues which are preventing access to a vaccination = reference to social services or local health department)

TB Interventions

implementations of maintaining airways & fluids, combination drug therapy with strict adherence, rest, management of nausea, appropriate isolation, and a negative sputum culture (indicates that a patient is NO longer infectious)

Positive TB Skin Test

in a healthy individual, exhibited by an induration 10mm or greater in diameter 72 hours after the skin test (may hold true for people who have received a bacillus Clamette-Guerin BCG vaccine which then requires an initial chest radiograph); healthy history with signs & symptoms form may be filled out annually until signs & symptoms arise, so then another radiograph may be required (CXR require on new employment and then every five years following)

Ventilator-Associated Pneumonia (VAP)

incidences are currently increasing (especially with mechanically ventilated ET tubes), but "ventilar bundles" help reduce the incidence through the use of hand hygiene, oral care (about every two hours), elevating the head of the bed (ex. 30^0 to prevent aspiration & further pneumonia development), maintain asepsis, perform suctioning as needed, and provide DVT prophylaxis (ex. TED hose, lovenox, anticoagulants)

Management of Pneumonia

includes acute care management, avoid airway obstruction, increased secretion, delivery of oxygen therapy, assisting patient with bronchial hygiene, incentive spirometry, cough & deep breathe, push fluids (2 L/day BEFORE the patient eats), monitor intake & output, medications, core measures, prevention of sepsis, intervention outcomes, O2 saturation AT LEAST 95% of the patient's normal range, absence of cyanosis, and A&O (tie NEURO to respiratory status)

Pneumonia History & Physical Assessment

includes age, residing environment, diet & exercise, flushed cheeks, bright eyes, anxiousness, rust-colored sputum/hemoptysis (indicative of blood), auscultated crackles due to too much fluid, hypotensiveness, orthostatic changes or syncope (puts the patient at fall risk so we teach them to dangle their feet off the bed), breathing pattern, respiratory rate, productive v. non-productive cough, sputum considerations, fatigue, dyspnea, anxiousness due to breathing difficulty, fever, chills, myalgia (ex. severe chest muscle weakness), headache, and crackles

Pulmonary Tuberculosis: Airborne Precautions

includes an N-95 respiratory mask, negative airflow pressure, and remember that patients are NOT contagious until they become symptomatic

Anti-Pneumonia Medications

includes bronchodilators, IV steroids, and expectorants

Community-Based Care of TB

includes home-care management, self-management, and healthcare resources; patient will give sputum samples every 2-4 weeks to determine if they're still contagious (MUST HAVE THREE NEGATIVES), diet to help with nausea (iron/protein & fresh produce), reassure the patient that fatigue will improve with medication adherence, and provide support groups for smoking cessation & alcoholism

Patients with Infectious Respiratory Problems: Influenza (Seasonal) Manifestations

includes horrible appearance, 24 hour contagious period before & five days after, and others dependent on influenza type Influenza A = respiratory Influenza B = N/V/D (GI component)

TB Interventions: Drug Therapy (Liver Toxicity Signs & Symptoms)

includes impacted liver enzymes and jaundice which is known as yellowing of the clear, skin, and concentrated urine

Pulmonary Tuberculosis Assessment: Physical Assessment

includes observation of bronchial breath sounds, crackles, dullness with percussion (typically done by a respiratory therapist), and partial obstruction from enlarged lymph nodes which may cause wheezing

Pulmonary Tuberculosis Manifestations

includes progressive fatigue, lethargy, nausea, anorexia, unintended weight loss, hemoptysis, low-grade fever, chills, night sweats, and dyspnea which may last from weeks to months; particularly night sweats as a significant indicator

Pneumonia History & Physical Assessment (focused)

includes work environment, diet, presence of an NG tube, swallowing problems, past respiratory illness, and equipment cleaning regimen with the existence of a chronic respiratory illness (what puts patient most at risk); observe patient for severe chest muscle weakness which makes us consider respiratory failure and to be alert for hypoventilation (ventilate inadequately)

When a patient's body is under stress, what happens to their glucose levels?

increase (hyperglycemia)

TB Medication: Isoniazid (INH)

increases phenytoin/dilantin levels

CDC TB Guidelines

indicate that the Quanti-Feron-TB Gold test, a new blood test, is more reliable than skin testing OR nucleic acid amplification (NAA) testing may be recommended when a client has signs & symptoms of TB

Patients at HIGH Risk for Pneumonia

individuals may include those with an altered LOC, brain injury, depressed or absent gag reflexes, aspiration susceptibility toward oropharyngeal secretions (ex. alcoholics & anesthetized individuals), drug OD, stroke victims, and those who are immunocompromised

Pneumonia

inflammation triggered by infectious organisms or inhaled irritants and may either be nosocomial, hospital acquired, healthcare associated (ex. post-op patients), ventilator associated, or community-acquired (most common infectious pneumonia as it's what we generally see); has a large magnitude of patients affected & associated deaths which makes prevention with vaccination a national safety goal for patients aged 19-65+ depending on health status

Pulmonary Tuberculosis Assessment

make sure to involve patient history, physical assessment, clinical manifestations, and compliance

Patients with Infectious Respiratory Problems: Influenza

may either be seasonal or pandemic

Management of Pneumonia: Imaging & Diagnostic Assessment

may include a chest x-ray, pulse oximeter, transtracheal aspiration, and bronchoscopy

Patients with Infectious Respiratory Problems: Influenza (Pandemic)

occurs when animal & bird viruses mutate and become infectious to humans (ex. H1N1 = swine flu), requires STRICT ISOLATION precautions, and patients will be prescribed antiviral drugs (ex. Tamiflu & Relenza) with supportive care which is the SAME AS SEASONAL INFLUENZA; pandemic defined as a disease which has the potential to spread globally due to lack of immunity = new viral contact

TB Interventions: Rifampin Drug Therapy

patient may develop a reddish-orange urine or coloring in sweat too which is NORMAL, patients will also be instructed to use alternative forms of contraception as this medication decreases the effectiveness of birth control

What is an important consideration for patients who have the highest risk for Seasonal Influenza?

patients at risk for contracting seasonal influenza need to be educated on getting the flu shot because of their high risk rate, about 500,000 deaths were reported last year due to PNEUMONIA COMPLICATIONS from the flu; educate patients to use tissues, cover their mouth, dispose of tissues, hand hygiene, to stay at home (provide work excuses), and all other recommendations to avoid contraction/spread of disease

We recommend the influenza vaccination, especially for susceptible patients. However, we do NOT want to give patients with which condition a shot?

patients which currently have a fever

Seasonal Influenza Vaccinations

recommended for high risk patients (expect if fever present), nasal is NO longer proven to be effective, and a rapid onset requires doctor's appointment ASAP to achieve the 24-48 hour range of treatment

TB Medication: Rifampin

reduces the effectiveness of oral contraceptives so patient should use alternative birth control methods during treatment and body fluids develop an orange tinge (also stains soft contact lenses)

Pneumonia History & Physical Assessment: Geriatric Considerations

remember that confusion is often the first sign of a pneumonia infection, making it important to rule out infectious processes as it could also be a UTI

Productive cough and comfort can be facilitated by which positioning?

semi or high-Fowler's which will lessen the pressure on the diaphragm by abdominal organs

You interpreted a patient experiencing inadequate gas exchange and oxygenation as a result of a respiratory infection. How should you respond?

significant actions include the administering oxygen, assisting the patient to an upright position (arms resting on table or armrests), prioritizing & pacing activities to prevent fatigue, administering prescribed IV/oral/inhaled drugs, ensuring respiratory therapy treatments are administered, re-assessing respiratory status after respiratory therapy treatment, and ensuring a fluid intake of AT LEAST 2 L per day (unless otherwise contradicted); observe patient for evidence of improved gas exchange & oxygenation and think about what patient teaching focus could help reduce the occurrence of a respiratory infection in the future

"Pneumonia with Consolidations"

solidification which take away airspace

Removal of Cancerous Tumors

some tumors are so large they fill up the entire lobe of a lung which causes large spaces left when removed, chest tubes are NOT usually used with these clients because the mediastinal cavity needs to fill up with fluid to prevent the shift of remaining chest organs into the new empty space

Influenza Isolation Precautions

strict droplet precautions (makes it AIRBORNE) which includes an N-95, contact precautions if the patient is draining body fluids, and patients ARE ABLE TO BE COHORTED together depending on sharing a "like-diagnosis"

TB Interventions: Isoniazid (INH) Drug Therapy

taken on an empty stomach one hour before or two hours after a meal and also depletes Vitamin B (need a replacement or supplement)

Which complication of a bronchoscopy or thoracentesis is characterized by a tracheal deviation and is a medical emergency?

tension pneumothorax

Which patients are MOST at risk for Seasonal Influenza?

the elderly (ex. 50+), chronic illness, immunocompromised, immunosuppressed, exposure to crowded/populated areas, dormitories, tight places, cancer patients prescribed steroids, and even healthcare providers who are giving care to these patients which is why we need precautions to protect ourselves (DROPLET)

What are the actions needed to be taken if a chest tube is accidentally dislodged from the client?

the nurse should cover the tube with a dry or Vaseline sterile dressing taped on three sides; if an air leak is noted, tape the dressing on three sides ONLY to allow air to escape & prevent the possible formation of a tension pneumothorax AND THEN we can notify the healthcare provider

DRUG ALERT on Nicotine Replacement Patches

these patients need to be educated on removing the patient BEFORE they start to smoke again if they do, as they are at a higher risk for MI & stroke

Why can gastric distention become a problem in patient with COPD?

this condition elevates the diaphragm and inhibits full lung expansion

TB Patient Education

very important as drug therapy is usually long term (> six months), essential that the client takes their medications as prescribed, and skipping doses or prematurely terminating drug therapy can result in a public health hazard; teach combination drug therapy to increase compliance as resistance WILL develop more slowly if several anti-TB drugs are implemented within the regimen

TB Medication: Ethambutol

vision check before starting therapy and monthly after, patients may have to take this drug for 1-2 years

What instructions do we provide a patient with when they are not diagnosed with influenza, but have symptoms?

we recommend these patients to avoid NON-ESSENTIAL public activities along with providing interventions & support such as oxygenation, bronchodilators, antibiotics if bacterial pneumonia develops, and fluid replacement; patients recommended to avoid non-essential activities will need a two week supply of food, water, OTC maintenance drugs, and even a battery-powdered radio; patient needs to know what to do when they recognize signs & symptoms and we inquire them too if they've had recent travels within the past 10 days

Patients with Infectious Respiratory Problems: Empyema

when pneumonia infection extends into the pleural cavity including the development of pus, this puts patients at risk for SEPSIS

Management of Pneumonia: Laboratory Assessment

will include a gram stain, culture (ensures antibiotic specificity), and sensitivity of sputum as well as a CBC (WBC evaluated count or eosinophil with organisms in the bloodstream), ABGs (ex. baseline PaO2 & PaCO2, serum BUN, electrolytes, and lactate level which will indicate sepsis

Chest Tube Fluid Tidaling/Fluctuations

will occur if there's no external suction, fluctuations are a good indicator that the system is intact (moves upward with each inspiration & downward with each expiration)

What should you do to INTERPRET a patient experiencing inadequate gas exchange and oxygenation as a result of a respiratory infection?

1. Perform & Interpret a Physical Assessment; vital signs, oxygen saturation through pulse oximetry, auscultation of lung fields, accuracy of pulse oximetry readings, cognitive status, present & characteristic of any sputum production, and the ability of the patient to cough & clear their airways. 2. Perform & Interpret Laboratory Values; elevated WBC count and arterial blood gas values = pH lower than 7.35, HCO-3 at or below 24 mEq/L, PaCO2 at or below 45 mmHg, PaO2 below 90 mmHg, and serum lactate levels above 8 mg/dL

What are the two indicators for fluid status?

1. Pulse Rate & Quality 2. Urine Output

Following a bioterrorism attack with anthrax, the emergency department nurse checks the medication room for ample supply of which medications? Select all that apply. A. Rifampin B. Gentamicin C. Amoxicillin D. Vancomycin E. Doxycycline F. Ciprofloxacin

A. Rifampin C. Amoxicillin D. Vancomycin E. Doxycycline F. Ciprofloxacin

When widely distributed during a pandemic flu, which drugs reduce the severity of infection and mortality rate? Select all that apply. A. Vepacel B. Zanamivir C. Oseltamivir D. Ethambutol E. Pyrazinamide

B. Zanamivir C. Oseltamivir

Which patient is most at risk for the development of either community- or hospital-acquired pneumonia? A. An 8-month-old born at 32 weeks gestation B. A 59-year-old who works in the textile industry C. A 14-year-old who developed type 1 diabetes at age 9 D. A 76-year-old who has limited mobility because of osteoarthritis

D. A 76-year-old who has limited mobility because of osteoarthritis

The nurse is caring for a pregnant patient who has a coccidioidomycosis fungal infection, which is also known as "valley fever." What medication would most likely be ordered for this patient? A. Amoxicillin IV B. Fluconazole PO C. Ketoconazole PO D. Amphotericin B IV

D. Amphotericin B IV

A patient presents with pain and difficulty swallowing, swelling in the throat, difficulty in opening the mouth, and a history of tonsillectomy performed 20 days ago. What should be the order of the treatment? 1. Antibiotic therapy 2. Incision and drainage 3. Additional antibiotic therapy 4. Intravenous (IV) opioids and IV steroids 5. Percutaneous needle aspiration and drainage of the abscess 6. Hospitalization, if the patient is showing slow response to the drugs

5. Percutaneous needle aspiration and drainage of the abscess 1. Antibiotic therapy 4. Intravenous (IV) opioids and IV steroids 6. Hospitalization, if the patient is showing slow response to the drugs 2. Incision and drainage 3. Additional antibiotic therapy

What is the nursing priority to provide safe and effective care for the patient with pneumonia? A. Monitoring for signs of sepsis B. Assisting with bronchial hygiene C. Frequently assessing breath sounds D. Applying principles of infection control

D. Applying principles of infection control

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. A. Activities should be resumed gradually. B. Avoid contact with other individuals, except family members, for at least 6 months. C. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. D. Respiratory isolation is not necessary because family members already have been exposed. E. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. F. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.

A. Activities should be resumed gradually. C. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. D. Respiratory isolation is not necessary because family members already have been exposed. E. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.

An older patient is diagnosed with pneumonia. To assist with comfort during the admission interview, what does the nurse do? A. Allows the patient to rest at frequent intervals B. Gets the interview completed as quickly as possible C. Places the patient in the bed immediately after arrival D. Performs the physical assessment quickly and efficiently

A. Allows the patient to rest at frequent intervals

Which statements about anthrax infection are correct? Select all that apply. A. Although rarely occurring naturally, inhalation anthrax is nearly 100% fatal without treatment. B. Toxins produced by the organisms in the lungs create massive edema, suppressing neutrophil action. C. Dyspnea, diaphoresis, and sudden onset of breathlessness are common in late stages of the diseases. D. Early on it is commonly accompanied by upper respiratory manifestations of sore throat or rhinitis. E. As macrophages in the lungs engulf the anthrax spores, the organism leaves its capsule and replicates.

A. Although rarely occurring naturally, inhalation anthrax is nearly 100% fatal without treatment. B. Toxins produced by the organisms in the lungs create massive edema, suppressing neutrophil action. C. Dyspnea, diaphoresis, and sudden onset of breathlessness are common in late stages of the diseases. E. As macrophages in the lungs engulf the anthrax spores, the organism leaves its capsule and replicates.

Which patients should receive education about pneumococcal vaccines? Select all that apply. A. An adult older than 65 B. A patient who is pregnant C. A patient who is HIV-positive D. A patient who has alcoholism E. A patient with chronic lung disease

A. An adult older than 65 C. A patient who is HIV-positive D. A patient who has alcoholism E. A patient with chronic lung disease

A female patient presents to the ambulatory clinic with complaints of a cough. Which other signs or symptoms, if present, would cause the nurse to begin wearing an N-95 mask and place the patient in an isolated environment? Select all that apply. A. Anorexia B. Blood-streaked sputum C. Menstrual irregularities D. Sharp chest pain when coughing E. Nighttime oral temperature greater than 101°F

A. Anorexia B. Blood-streaked sputum C. Menstrual irregularities

The nurse is reviewing home care instructions for a patient diagnosed with acute viral rhinitis. Which medication order does the nurse question? A. Antibiotic B. Antipyretic C. Decongestant D. Antihistamine

A. Antibiotic

Which points does the nurse include when educating an older patient and family about pneumonia prevention? Select all that apply. A. Avoiding dehydration B. Monitoring blood pressure C. Avoiding crowded public places D. Decreasing exposure to air pollutants E. Receiving an annual influenza vaccine

A. Avoiding dehydration C. Avoiding crowded public places D. Decreasing exposure to air pollutants E. Receiving an annual influenza vaccine

A patient has an endotracheal tube in place for mechanical ventilation. Which nursing action is most important to prevent infection in this patient? A. Brushing the patient's teeth every 12 hours B. Assessing oxygen saturation every 4 hours C. Turning the patient from side to side every 2 hours D. Suctioning the endotracheal (ET) tube every 6 hours

A. Brushing the patient's teeth every 12 hours

A patient has been started on ethambutol for tuberculosis. What adverse effect requires the patient to notify the provider? A. Changes in vision B. Darkening of the urine C. Yellowing appearance of skin D. Increased bruising or bleeding

A. Changes in vision

The nurse is caring for a patient who received bacille Calmette-Guérin (BCG) vaccine 2 years ago while living in another country. This patient is exhibiting signs and symptoms of tuberculosis. What methods does the nurse expect to be used to effectively evaluate this patient? Select all that apply. A. Chest x-ray B. Mantoux test C. Sputum culture D. Needle biopsy of lung E. QuantiFERON-TB Gold test

A. Chest x-ray E. QuantiFERON-TB Gold test

A patient with pneumonia has difficulty clearing secretions in his airway, which are quite thick. Which nursing intervention does the nurse include in this patient's plan of care? A. Encourage an intake of 2 liters of fluid per day. B. Help the patient to ambulate several times daily. C. Give intravenous antibiotics as ordered by the provider. D. Administer pain medications on schedule to provide comfort.

A. Encourage an intake of 2 liters of fluid per day.

Which nursing interventions are critical in caring for individuals with influenza? Select all that apply. A. Encouraging the patient to rest and increase fluid intake B. Supporting the patient and preventing the spread of the disease C. Avoiding the use of oxygen as it has limited benefit and will be more likely to cause toxicity D. Placing the patient in protective isolation until the patient's immune system fully recovers E. Monitoring pulse rate and quality and urine output during rehydration in a patient with diarrhea

A. Encouraging the patient to rest and increase fluid intake B. Supporting the patient and preventing the spread of the disease E. Monitoring pulse rate and quality and urine output during rehydration in a patient with diarrhea

The nurse suspects that a patient is in the prodromal stage of inhalation anthrax. Which assessment findings support the nurse's suspicion? Select all that apply. A. Fever B. Fatigue C. Mild chest pain D. Upper respiratory infection E. Sudden onset of breathlessness

A. Fever B. Fatigue C. Mild chest pain

The nurse has decided to immediately place a patient in respiratory isolation because the patient is exhibiting which signs/symptoms of the prodromal (early) stage of inhalation anthrax? Select all that apply. A. Fever B. Diaphoresis C. Mild chest pain D. Pleural effusion E. Mediastinal "widening" (chest x-ray)

A. Fever C. Mild chest pain E. Mediastinal "widening" (chest x-ray)

A patient with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? Select all that apply. A. Multiple drug regimens destroy organisms as quickly as possible. B. Combination drug therapy is effective in preventing transmission. C. Combination drug therapy is the most effective method of treating TB. D. The use of multiple drugs reduces the emergence of drug-resistant organisms. E. Combination drug therapy will decrease the length of required treatment to 2 months

A. Multiple drug regimens destroy organisms as quickly as possible. B. Combination drug therapy is effective in preventing transmission. C. Combination drug therapy is the most effective method of treating TB. D. The use of multiple drugs reduces the emergence of drug-resistant organisms.

Which assessment findings does the nurse anticipate for the patient suspected of having pneumonia? Select all that apply. A. Myalgia B. Dyspnea C. Bradypnea D. Bradycardia E. Hemoptysis

A. Myalgia B. Dyspnea E. Hemoptysis

A patient who has begun standard multidrug treatment for tuberculosis (TB) reports orange-tinged sputum and urine. The nurse tells the patient that this symptom represents which response to the treatment regimen? A. Normal drug side effects of rifampin B. Hemolysis and a potential for anemia C. Drug resistance with spread of infection D. Hepatotoxicity caused by drinking alcohol

A. Normal drug side effects of rifampin

Which actions known as the "ventilator bundle" have been shown to reduce the incidence of ventilator-associated pneumonia (VAP)? Select all that apply. A. Oral care B. Hand hygiene C. Head-of-bed elevation D. Equipment decontamination E. Careful monitoring of oxygen levels

A. Oral care B. Hand hygiene C. Head-of-bed elevation

Which pathological findings associated with pneumonia result in an increased respiratory rate and dyspnea? Select all that apply. A. Pain B. Anxiety C. Alveolar consolidation D. Stimulation of J receptors E. Pulmonary capillary shunting

A. Pain B. Anxiety D. Stimulation of J receptors

What is a key difference between seasonal influenza and pandemic influenza? A. Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans. B. Seasonal influenza is caused by viral infections; pandemic influenza is more likely to be bacterial in nature. C. People over the age of 50 who have chronic illness should be vaccinated yearly to decrease the risk of pandemic influenza. D. Humans have a natural resistance to viral infections found in animals and birds and do not require immunization against pandemic influenza.

A. Pandemic influenza has the potential to spread globally because of its highly infectious nature in humans.

Which disorder of the lungs may feature a distinct "whooping" sound in children that may not be present in adults? A. Pertussis B. Tuberculosis C. Inhalation anthrax D. Coccidioidomycosis

A. Pertussis

A patient is admitted to the emergency department (ED) with a possible diagnosis of avian influenza ("bird flu"). Which of these actions included in the hospital protocol for avian influenza should the nurse take first? A. Place the patient in a negative air pressure room. B. Ensure that ED staff members receive oseltamivir. C. Start an IV line and administer rehydration therapy. D. Obtain specimens for the H5 polymerase chain reaction test

A. Place the patient in a negative air pressure room.

A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse should assess the client for which signs and symptoms associated with this problem? A. Pleural pain and fever B. Decreased respiratory rate C. Diaphoresis during the day D. Hyperresonant breath sounds over the left thorax

A. Pleural pain and fever

Which may be the most common feature of pneumonia and lung abscesses? A. Pleuritic chest pain B. Rust-colored sputum C. Foul-smelling sputum D. Mucopurulent sputum

A. Pleuritic chest pain

A nurse is caring for a patient with community-acquired pneumonia. The patient's oxygen saturation is 88% on room air. The patient is writhing in pain and cries out, "It hurts so bad to take a deep breath. I can't even cough it hurts so bad." Understanding the patient's condition, what is the nurse's priority intervention for this patient? A. Provide the patient with supplemental oxygen B. Encourage the patient to deep breathe and cough C. Administer the ordered opioid analgesic medication D. Instruct the patient on splinting the chest when breathing

A. Provide the patient with supplemental oxygen

The nurse notices a visitor walking into the room of a patient on airborne isolation with no protective gear. What does the nurse do? A. Provides a mask to the visitor B. Ensures that the patient is wearing a mask C. Provides a particulate air respirator to the visitor D. Tells the visitor that the patient cannot receive visitors at this time

A. Provides a mask to the visitor

A patient who is taking isoniazid and rifampin to treat tuberculosis reports reddish-orange urine. Which action should the nurse take? A. Reassure the patient that this is an expected drug side effect. B. Encourage the patient to increase fluids to 2 L or more per day. C. Request an order to change the isoniazid to another anti-tubercular drug. D. Notify the provider and request an order for a complete blood count and creatinine clearance.

A. Reassure the patient that this is an expected drug side effect.

The nurse is discussing pneumonia prevention techniques with a group of adults older than age 60. What information should this nurse tell this group? Select all that apply. A. Receive an annual influenza vaccination. B. Drink approximately 1 liter of fluid each day. C. Avoid interacting with individuals who smoke. D. Attempt to get 6 to 8 hours of sleep every night. E. Receive an annual pneumococcal pneumonia vaccination

A. Receive an annual influenza vaccination. C. Avoid interacting with individuals who smoke. D. Attempt to get 6 to 8 hours of sleep every night.

Which upper respiratory infection is often triggered by a hypersensitivity reaction to airborne allergens? A. Rhinitis B. Sinusitis C. Tonsillitis D. Pharyngitis

A. Rhinitis

The nurse is instructing a nursing student on how to prevent pneumonia in an older adult who is receiving mechanical ventilation. Which statement by the student indicates a need for further teaching? A. "I will suction subglottic secretions every 2 hours and as needed." B. "I will provide meticulous oral care every 24 hours and as needed." C. "I should not wear hand jewelry while providing care to this patient." D. "I should keep the head of the bed elevated at least 30 degrees at all times."

B. "I will provide meticulous oral care every 24 hours and as needed."

The nurse is providing health education to a patient regarding ways to prevent influenza. Which statement made by the patient shows effective learning? A. "I will refrain from taking drugs for at least 2 weeks." B. "I will refrain from attending public meetings if I feel I am getting sick." C. "I will refrain from giving non-perishable food for at least 2 weeks to all the family members." D. "I will refrain from paying attention to public health announcements for disease outbreaks."

B. "I will refrain from attending public meetings if I feel I am getting sick."

Patients with Infectious Respiratory Problems: Influenza (Seasonal)

defined as a highly contagious & acute viral respiratory infection, complications of pneumonia can lead to death, vaccination is advisable, and antiviral agents may be effective if started within 24-48 hours of symptom onset; symptoms are a rapid onset of severe headache, muscle ache, fever, chills, fatigue, weakness, and/or anorexia

A nurse is caring for a patient who appears cachectic and pale but appears in no acute distress. The patient tells the nurse that he has had a chronic cough for months and produces a large amount of foul-smelling sputum. He also states that he occasionally suffers from a stabbing pain when taking a deep breath. When reviewing the patient's history, the nurse notes that the patient has a recent history of influenza. Breath sounds reveal decreased sound with rhonchi to the right lower lobe and percussion to the right lower lobe is dull. What procedure does the nurse anticipate preparing for? A. Administration of a bronchodilator B. Insertion of a thoracentesis needle and drainage C. Intubation and initiation of mechanical ventilation D. Placement of a nasogastric tube and tube feedings

B. Insertion of a thoracentesis needle and drainage

An older adult patient presents with a persistent cough, fever, night sweats, and mucopurulent sputum. What should be the first line drug therapies used in treatment? Select all that apply. A. Rifampin (RIF) 700 mg orally daily B. Isoniazid (INH) 300 mg orally daily C. Pyrazinamide 2500 mg twice a week D. Pyrazinamide (PZA) 1500 mg orally daily E. Ethambutol (EMB) 3000 mg twice a week

B. Isoniazid (INH) 300 mg orally daily D. Pyrazinamide (PZA) 1500 mg orally daily E. Ethambutol (EMB) 3000 mg twice a week

A patient who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the patient? A. Metronidazole, acyclovir, flunisolide, rifampin B. Isoniazid, rifampin, pyrazinamide (PZA), ethambutol C. Prednisone, guaifenesin, ketorolac, pyrazinamide (PZA) D. Salmeterol, cromolyn sodium, dexamethasone, isoniazid

B. Isoniazid, rifampin, pyrazinamide (PZA), ethambutol

An older patient presents to the emergency department (ED) with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The patient never had a pneumococcal vaccine. The patient's chest x-ray shows density in both bases. The patient has wheezing upon auscultation of both lungs. Would a bronchodilator be beneficial for this patient? A. It would not be beneficial for this patient. B. It would help decrease the bronchospasm. C. It would decrease the patient's pain on inspiration. D. It would clear up the density in the bases of the patient's lungs.

B. It would help decrease the bronchospasm.

A nurse is caring for a patient with coccidioidomycosis who has recently migrated from Mexico. When planning care for this patient, what manifestation noted on assessment does the nurse recognize as a sign of more severe coccidioidomycosis infection? A. Cough B. Joint pain C. Chest pain D. Night sweats

B. Joint pain

The radiology report of a patient who has had a chest x-ray shows consolidation in a segment of the patient's left lung. This is typical of which type of pneumonia? A. Viral B. Lobar C. Bronchial D. Bacterial

B. Lobar

What consideration is important for the nurse to remember when managing the care of a patient with hospital-acquired pneumonia? A. Provide suctioning as needed. B. Monitor for early signs of sepsis. C. Provide stress ulcer prophylaxis. D. Elevate the head of the bed at least 30 degrees.

B. Monitor for early signs of sepsis.

Which of these patients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit? A. Patient with group A beta-hemolytic streptococcal pharyngitis who has stridor B. Patient with pulmonary tuberculosis who is receiving multiple medications C. Patient with sinusitis who has just arrived after having endoscopic sinus surgery D. Patient with tonsillitis who has a thick-sounding voice and difficulty swallowing

B. Patient with pulmonary tuberculosis who is receiving multiple medications

A patient reports severe coughing for the last few weeks. The patient reports coughing long and hard with vomiting. What disease does the nurse suspect that this patient may have? A. Anthrax B. Pertussis C. Pneumonia D. Coccidioidomycosis

B. Pertussis

A patient with a recent diagnosis of bacterial pharyngitis caused by group A streptococcal infection calls the health care provider stating his has developed a cough, fever, chills, shortness of breath, and severe chest pain. Which complication does the nurse suspect? A. Mastoiditis B. Pneumonia C. Rheumatic fever D. Acute glomerulonephritis

B. Pneumonia

The nurse is preparing to admit an adult patient with pertussis. Which symptom does the nurse anticipate finding in this patient? A. Hemoptysis B. Post-cough emesis C. Mild cold-like symptoms D. "Whooping" after a cough

B. Post-cough emesis

A patient admitted to the hospital with an exacerbation of chronic obstructive pulmonary disease (COPD) and chronic malnutrition develops a cough, a temperature of 39°C, an oxygen saturation of 94%, and crackles in both lungs. Which action would the nurse take first? A. Provide supplemental oxygen. B. Request an order for a chest x-ray. C. Monitor closely for respiratory failure. D. Ask the provider to order a complete blood count.

B. Request an order for a chest x-ray.

The nurse is caring for a patient who was admitted with pneumonia. Which position assumed by the patient leads the nurse to suspect that the patient is developing hypoxia? A. Side-lying B. Sitting in the tripod position C. Prone with the head of the bed at 30° angle D. Supine with the head of the bed at 45° angle

B. Sitting in tripod position

A patient reports experiencing chest pain, headache, and cough with sputum production, fever, and dyspnea. What does the nurse anticipate upon assessment? Select all that apply. A. Sore throat B. Tachycardia C. Nasal drainage D. Crackles upon auscultation E. Diminished chest expansion

B. Tachycardia D. Crackles upon auscultation E. Diminished chest expansion

A patient comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first? A. Chest x-ray B. Throat culture C. Tuberculosis (TB) skin test D. Complete blood count (CBC)

B. Throat culture

A patient with pulmonary tuberculosis is being started on combination therapy. What does the nurse explain to the patient as the purpose of combination therapy? A. To allow for missed doses B. To shorten therapy by 6 months C. To treat highly resistant cases of tuberculosis D. To improve the patient's ability to tolerate medications

B. To shorten therapy by 6 months

SECONDARY Pulmonary Tuberculosis

defined as re-activation of the disease when previously infected through a dormant/re-activation cycle

A family member of a patient who has been diagnosed with severe acute respiratory syndrome (SARS) asks the nurse why the patient is not receiving an antibiotic. How does the nurse respond to this family member? A. "The organism that causes SARS is resistant to all antibiotics." B. "I will notify the provider to see if an antibiotic can be ordered." C. "Antibiotics are not effective because SARS is caused by a virus." D. "Antibiotics are usually given when the disease becomes more severe."

C. "Antibiotics are not effective because SARS is caused by a virus."

A clinic nurse is providing teaching for a patient who has been diagnosed with a peritonsillar abscess. What does the nurse include in this patient's teaching? A. "Gargling with warm saline may make discomfort worse." B. "Take the prescribed antibiotics until the swelling subsides." C. "Go to the emergency department if drooling or stridor occur." D. "A tonsillectomy will be necessary when the acute infection is past."

C. "Go to the emergency department if drooling or stridor occur."

A nurse is diagnosed with seasonal influenza, and on the second day of treatment with oseltamivir, she asks the supervising nurse when she may return to work on a hospital unit. What does the supervising nurse tell her? A. "You will need to remain off work for 2 weeks or longer." B. "After initiation of antiviral therapy, you are no longer contagious." C. "If you are feeling well and afebrile in 5 days, you may return to work." D. "When you have a negative influenza test, you will be cleared for work."

C. "If you are feeling well and afebrile in 5 days, you may return to work."

What is the most important information for the nurse to convey to a patient who is beginning pharmacological therapy for the of treatment tuberculosis to ensure suppression of the disease? A. "Eat a diet rich in Vitamin K." B. "Do not drink alcoholic beverages." C. "Take the medication exactly as prescribed." D. "Contact the health care provider if you become ill."

C. "Take the medication exactly as prescribed."

A patient is being treated with ciprofloxacin 500 mg PO twice daily due to possible exposure to inhalation anthrax. What is the nurse's best answer when the patient asks how long this medication must be taken? A. "You will need to take the medication for 10 days." B. "You will need to take the medication for at least a year." C. "You will need to take the medication for about 2 months." D. "You will need to take the medication for at least 6 months."

C. "You will need to take the medication for about 2 months."

The nurse is teaching a patient about isoniazid (INH) and rifampin (RIF) drug therapy for tuberculosis (TB). The nurse instructs that while on these medications, the patient should avoid consuming which food? A. Eggs B. Dairy C. Alcohol D. Red meat

C. Alcohol

Management of Pneumonia: Imaging & Diagnostic Assessment (Chest X-Ray)

determines areas of increased density and is an important early diagnostic tool for older adults

Patients with Infectious Respiratory Problems

diagnoses may be seen as rhinitis, sinusitis, pharyngitis, tonsillitis, INFLUENZA, PNEUMONIA, MERS, TUBERCULOSIS (TB), lung abscess, inhalation anthrax, and empyema

Which factors are pathophysiologic bases for the clinical manifestations of pneumonia? Select all that apply. A. A temperature greater than 38.5° C upon arising in the morning is typically present. B. Suppression of fever with the use of acetaminophen will speed the recovery process in older adults. C. Fluid accumulation in the receptors of the individual's respiratory system triggers the coughing mechanism. D. Pulmonary capillary shunting and movement of red blood cells into the alveoli cause pleuritic chest discomfort. E. Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea.

C. Fluid accumulation in the receptors of the individual's respiratory system triggers the coughing mechanism. E. Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea.

A newly admitted patient with pneumonia has an oral temperature of 102°F, an oxygen saturation of 93%, diminished breath sounds bilaterally, and the patient is unable to cough effectively. The nurse has received orders for oxygen therapy, intravenous antibiotics, antipyretic medication, and sputum specimen collection. What should be the nurse's first action? A. Provide humidified oxygen. B. Obtain the sputum specimen. C. Give the intravenous antibiotic. D. Administer the antipyretic medication.

C. Give the intravenous antibiotic.

Which combination of personal protective equipment does the nurse wear when caring for a patient with severe acute respiratory syndrome (SARS)? A. Gloves, gown, mask B. Gloves, mask, goggles C. Gloves, gown, goggles, mask D. Gloves, gown, head cover, goggles

C. Gloves, gown, goggles, mask

In a patient with pneumonia, what is the most important nursing intervention? A. Preventing sepsis B. Decreasing anxiety C. Managing hypoxemia D. Teaching safe oxygen management

C. Managing hypoxemia

A public health nurse is providing education to a community about preparation for a possible influenza epidemic leading to a worldwide pandemic. What does the nurse instruct community members to do upon learning that an influenza outbreak has occurred? A. Attend meetings to learn how to manage the outbreak. B. Take antiviral medications to prevent developing symptoms. C. Obtain a vaccine if not already vaccinated against influenza. D. Stock their homes with a 2-week supply of food and medicine.

C. Obtain a vaccine if not already vaccinated against influenza.

What could be the possible diagnosis for a patient who presents with pain in the throat, difficulty swallowing, swelling in the throat, and difficulty in opening the mouth? A. Tonsillitis B. Pharyngitis C. Peritonsillar abscess D. Retropharyngeal abscess

C. Peritonsillar abscess

A patient who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, bloody sputum, night sweats, and a low-grade fever. What is the nurse's first action? A. Perform a TB skin test B. Test all family members for TB C. Place a respiratory mask on the patient D. Contact the health care provider for tuberculosis (TB) medications

C. Place a respiratory mask on the patient

The nurse in the long-term care facility is concerned about the health status of an 80-year-old resident. What early symptom would alert the nurse that this patient is developing pneumonia? A. Vomiting B. Productive cough C. Recent onset of confusion D. Oral temperature of 101.1°F

C. Recent onset of confusion

A patient is admitted with a diagnosis of avian influenza (H5N1). For which symptoms specific to avian influenza does the nurse assess the patient? A. Cough, sore throat, and fever B. Fever, sore throat, and nasal drainage C. Shortness of breath, diarrhea, and bleeding D. Shortness of breath, fever, and nasal drainage

C. Shortness of breath, diarrhea, and bleeding

A patient has recently been released from prison and has just tested positive for tuberculosis (TB). What teaching points does the community health nurse want to stress for this patient regarding medications? Select all that apply. A. These medications may cause kidney failure. B. These medications must be taken for 2 years. C. The medications may cause nausea. The patient should take them at bedtime. D. The patient is generally not contagious after 2 to 3 consecutive weeks of treatment. E Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance.

C. The medications may cause nausea. The patient should take them at bedtime. E Not taking the medication could lead to an infection that is difficult to treat or to total drug resistance.

While performing an assessment of a patient, the nurse notes that the patient has progressive fatigue, anorexia, weight loss, irregular menses, and a low-grade fever. Which condition does the nurse suspect in the patient? A. Pharyngitis B. Pneumonia C. Tuberculosis D. Rhinosinusitis

C. Tuberculosis

A patient with a history of pain and difficulty swallowing ignored the symptoms and later developed neck swelling, muffled voice, and bad breath. What could the original symptoms have been? A. Untreated rhinitis B. Untreated sinusitis C. Untreated tonsillitis D. Untreated pharyngitis

C. Untreated tonsillitis

A patient with pneumonia has a cough productive of thick green mucus, is in bed with the head of bed elevated to 30 degrees, and has an oxygen saturation of 94% with 3 L/min of oxygen via nasal cannula. The nurse notes that the patient is anxious and tense. Which is the priority nursing action for this patient? A. Increasing the oxygen flow to 4 L/min B. Placing the patient in an upright position C. Using a calm, slow approach with the patient D. Telling the patient to relax and take deep breaths

C. Using a calm, slow approach with the patient

A healthy patient expresses worries about developing tuberculosis (TB) after spending time at a family reunion and learning later that a family member is being treated for the disease. What does the nurse tell this patient? A. "You have most likely been exposed to TB and will need to be tested." B. "You should receive TB prophylaxis until your provider rules out active disease." C. "TB is spread from person to person by sharing drinking cups and eating utensils. D. "Among people exposed to the disease, only a small percentage develop active TB."

D. "Among people exposed to the disease, only a small percentage develop active TB."

A patient with recurrent tonsillitis is admitted to the hospital with a peritonsillar abscess. The patient asks the nurse if surgery will be necessary. How does the nurse respond? A. "You will most likely have a surgical tonsillectomy." B. "Surgery will be delayed until the infection has been treated." C. "The provider will drain the abscess and give you antibiotics." D. "Antibiotics are usually an effective treatment for this disease."

D. "Antibiotics are usually an effective treatment for this disease."

Which statements by the patient with rhinitis indicate ineffective learning about reducing the risk of spreading colds? Select all that apply. A. "I will rest for 10 hours each day." B. "I will dispose of tissues immediately after use." C. "I will wash my hands after coughing, sneezing, and nose blowing." D. "I will stop my cough reflex when I am in a crowded place or with the family." E. "I will have minimal contact with people who have chronic respiratory problems."

D. "I will stop my cough reflex when I am in a crowded place or with the family." E. "I will have minimal contact with people who have chronic respiratory problems."

A co-worker tells the nurse that she will not get the flu shot because she believes it is better to develop her own immunity to the flu. What does the nurse tell this co-worker? A. "Getting the flu shot causes you to have influenza symptoms." B. "Since you are healthy, you will probably only have a mild case of the flu." C. "If you are exposed to influenza, you can take an antiviral medication." D. "You are putting your patients at increased risk for serious respiratory illness."

D. "You are putting your patients at increased risk for serious respiratory illness."

A young adult patient refuses an influenza vaccine, saying, "I'm healthy and won't get that sick if I get the flu." Which is the best response by the nurse? A. "If you get the flu, you can always take an antiviral medication." B. "Not getting the vaccine increases the chances of a worldwide pandemic." C. "If a flu pandemic begins, you should get the vaccine immediately." D. "You may spread the disease to people who are more at risk for severe symptoms."

D. "You may spread the disease to people who are more at risk for severe symptoms."

Based on the clinical data provided below, which age is most likely for this patient with pneumonia? A. 10 years B. 30 years C. 50 years D. 70 years

D. 70 years

Pulmonary Tuberculosis Assessment: History

Has the patient traveled recently? What is the patient's country of origin? Has the patient ever had a positive TB test? Has the patient been around anyone symptomatic or diagnosed (even family members at home)? Consider residential risk factors and the fact that a BCG vaccination appears positive for TB if given within the past 10 years (only given in other countries)

Pulmonary Tuberculosis Assessment: Assessing Diagnostic Testing

Sputum & CXR: sputum smear for acid-fast bacillus (2-4 weeks to culture), sputum culture M. tuberculosis (1-4 weeks), NAA test = TWO HOUR RESULTS and CXR can ONLY show healed & active lesions Blood: QuantiFERON-TB Gold & T-SPOT, determines if the patient has TB but can't tell us if it's latent or active Skin: tuberculin Mantoux test PPD given intradermally in the forearm (72 hour results) & tests positive if induration > 10 mm in diameter = positive for exposure OR presence of dormant disease (72 hours due to previous false positives)

TB Interventions: Ethambutol Drug Therapy

differing side effects include visual changes and kidney damage

Cerebral Hypoxia

early signs include irritability & restlessness as the client's brain is NOT receiving enough oxygen

TB Interventions: Drug Therapy

combination or singular drug therapy may includes Isoniazid (INH), Rifampin, Pyrazinamide (PZA), and Ethambutol (EMB) which can last six months to two years; medications can be hepatotoxic so patients should be education to NOT drink alcohol throughout the treatment period, know signs & symptoms of liver toxicity, take medications at night or when eating a rich diet (protein/iron/vitamins) to prevent nausea, or even prescribe an anti-emetic to help assist with compliance

PPD Skin Test

a positive reaction does NOT mean that active disease is present, but DOES indicate EXPOSURE to active or dormant TB; patients with symptoms should be managed right away as if they have the condition (we want to prevent any kind of exposure to healthcare workers)

Management of Pneumonia: Imaging & Diagnostic Assessment (Bronchoscopy)

along with a bronchoscopy, important to watch for the complication of a pneumothorax (characterized by DIMINISHED lung sounds)

Management of Pneumonia: Imaging & Diagnostic Assessment (Thoracentesis)

along with a bronchoscopy, important to watch for the complication of a pneumothorax (characterized by DIMINISHED lung sounds)

Pneumonia

also affects infants under two years of age as their immune systems are still developing

What two cultures do we run before starting a patient on antibiotics?

blood AND sputum cultures

Management of Pneumonia: Core Measures

blood cultures performed before antibiotics are prescribed, and then are changed throughout treatment

What are the actions needed to be taken if the fluid in a chest tube ceases to fluctuate?

check for kind tubing or accumulation of fluid in the tubing, change the client's position (expanding lung tissue may be occluding the opening), and continuous/excessive bubbling will be indicative of an air leak when it is connected to suction

Pulmonary Tuberculosis Assessment: Compliance

consider if the patient is able to comply to their treatment regimen before if NOT, they will develop drug resistant organisms; requires direct-observation therapy where medication administration is directly observed by a healthcare provider