EAQ Respiratory Q's
A patient is hospitalized with symptoms of tuberculosis (TB). The nurse recognizes that at least one of the sputum specimens for acid-fast bacilli (AFB) needs to be obtained at which time of the day?
6am Rationale: Culture is the gold standard for diagnosing TB. Three consecutive sputum specimens are needed, each collected at 8- to 24-hour intervals, with at least one early-morning specimen. The initial test involves a microscopic examination of stained sputum smears for AFB. Early morning (6 a.m.) is the ideal time to collect sputum specimens for an AFB smear because secretions collect during the night. The times of 12 noon, 6 p.m., and 9 p.m. are not ideal times to collect the specimen because the amount of secretions for the specimen may not be optimal. p. 512
A patient presents with a pneumonia score of 5 on the Expanded CURB-65 scale. Which action does the nurse take?
Consider admission to an intensive care unit Rationale: The Expanded CURB-65 scale may be used as a supplement to clinical judgment to determine the severity of pneumonia and if patients need to be hospitalized. A patient score of 5 on the scale means the perceived risk is high and that placement in the intensive care unit is warranted. If the patient has symptoms of pneumonia, advising no treatment is not appropriate. Treatment in an outpatient setting is advised when the scores are 0 to 2 on the scale. Hospital admission is advised when the scores are 3 to 4 on the scale.
The nurse provides education for a patient with human immunodeficiency virus (HIV) who is diagnosed with an infection of the lungs caused by Candida albicans. Which statement made by the patient indicates the need for further teaching? "I will be given amphotericin B to treat the fungus." "I contracted this fungus because I am immunocompromised." "I need to be isolated from my family and friends so that they won't get the infection." "The effectiveness of my therapy can be monitored with fungal serology titers."
"I need to be isolated from my family and friends so that they won't get the infection." Rationale: C. albicans is an organism that causes a fungal infection. Pulmonary fungal infections are acquired by inhaling spores. They are not transmitted from person to person. The patient does not have to be placed in isolation. Because the patient is immunocompromised (because of HIV), the patient is likely to have a serious infection, so the treatment will likely include IV amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers. pg. 515
The nurse is caring for a patient with pneumonia and expects which interventions to be included in the treatment plan?
- Monitor pt. response to treatment - Provide adequate hydration by encouraging fluid intake - Provide postural drainage and chest percussion Rationale: Essential nursing care for patients with pneumonia includes monitoring physical assessment parameters, providing treatment, and monitoring the patient's response to treatment. Prompt collection of specimens and initiation of antibiotics are critical. O 2 therapy, hydration, nutritional support, breathing exercises, early ambulation, and therapeutic positioning are part of nursing care. Working with respiratory therapy to monitor the patient's condition and with physical therapy for postural drainage and chest percussion is essential. The nurse should turn and reposition patients at least every two hours to promote adequate lung expansion and the mobilization of secretions. There is not enough information to support the use of around-the-clock analgesic administration.
While obtaining a health history for a patient with suspected tuberculosis (TB), the nurse expects which early signs or symptoms of the disease? Select all that apply. Select all that apply Anorexia Fatigue Dizziness Night sweats Chest tightness
Anorexia Fatigue Night sweats Rationale:Symptoms of pulmonary TB usually do not develop until 2 to 3 weeks after infection or reactivation. The primary manifestation is an initial dry cough that often becomes productive with mucoid or mucopurulent sputum. Active TB disease may initially present with constitutional symptoms (e.g., fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats). Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late sign. Dizziness and chest tightness are not symptoms associated with TB. p. 510
A patient is hospitalized with a diagnosis of pneumonia. When reviewing the patient's history, the nurse finds that the patient experienced a seizure with profuse vomiting four days prior to the hospital admission. Which type of pneumonia does the nurse suspect? Aspiration pneumonia Opportunistic pneumonia Hospital-associated pneumonia Community-acquired pneumonia
Aspiration pneumonia Rationale: it results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Conditions that increase the risk for aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric (NG) tubes with or without enteral feeding. The aspirated material (food, water, vomitus, oropharyngeal secretions) triggers an inflammatory response. The history of the patient does not suggest any exposure to pneumonia in the community. The patient has never been in the hospital; therefore hospital-associated pneumonia is highly unlikely. The patient does not have a history of HIV, intake of immunosuppressive drugs, corticosteroids, or any disorders leading to immunosuppression; therefore opportunistic pneumonia did not occur in this patient.
A patient reports shortness of breath one day after a cholecystectomy. The nurse assesses the right lung sounds and notes dullness to percussion and decreased breath sounds. Which is the most probable reason for the assessment findings?
Atelectasis Rationale: its is a lung condition characterized by collapsed, airless alveoli. There may be decreased or absent breath sounds and dullness to percussion over the affected area. The most common cause of atelectasis is obstruction of the small airways with secretions. This is common in bedridden patients and in postoperative abdominal and chest surgery patients. Pneumonia can have similar findings, but it is highly unlikely to occur one day after surgery. In both pneumothorax and tension pneumothorax, the affected area is hyperresonant. p. 531
The nurse is assessing a patient who is hospitalized with suspected tuberculosis (TB) and expects which initial manifestations? Select all that apply. Dry cough that becomes productive Dyspnea Malaise Hemoptysis Low-grade fever Unexplained weight loss
Dry cough that becomes productive Malaise Low-grade fever Unexplained weight loss Rationale: Symptoms of pulmonary TB usually do not develop until 2 to 3 weeks after infection or reactivation. The primary manifestation is an initial dry cough that often becomes productive with mucoid or mucopurulent sputum. Active TB disease may initially present with constitutional symptoms (e.g., fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats). Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late sign.
A patient who is being treated at home for pneumonia reports fatigue to the home health nurse. Which instructions does the nurse provide for the patient? Select all that apply. Get adequate rest. Restrict fluid intake. Avoid alcohol and smoking. Resume work to build strength. Take every dose of the prescribed antibiotic.
Get adequate rest. Avoid alcohol and smoking. Take every dose of the prescribed antibiotic.
The treatment plan for a patient with tuberculosis includes isoniazid and rifampin. Which data found in the patient's health history cause the nurse to question the medication prescriptions? Hepatitis Asthma attacks Rheumatic fever Allergy to penicillin
Hepatitis Rationale Isoniazid (INH) and rifampin are tuberculosis medications that are metabolized in the liver and are extremely toxic. Hepatotoxicity is a common side effect. A history of asthma, rheumatic fever, or allergy to penicillin is not a contraindication to the administration of INH and rifampin.
When planning care for a patient with pneumonia, the nurse recognizes that which is a high-priority intervention? Waiting until the patient is afebrile for 72 to 96 hours before stopping treatment Administering a bronchodilator every four hours Turning and repositioning the patient at least once per hour Increasing fluids to at least 6 to 10 glasses/day, unless contraindicated
Increasing fluids to at least 6 to 10 glasses/day, unless contraindicated Rationale: Rationale Hydration is important in the supportive treatment of pneumonia to prevent dehydration and to thin and loosen secretions. The nurse should tell the patient to drink plenty of liquids (at least 6 to 10 glasses/day, unless contraindicated). The patient should be afebrile for 48 to 72 hours before stopping treatment. Although cough suppressants, mucolytics, bronchodilators, and corticosteroids are often prescribed as adjunctive therapy, the use of these drugs is debatable. The nurse should turn and reposition patients at least every two hours to promote adequate lung expansion and mobilization of secretions.
A patient with a 10-year history of regular (three beers per week) alcohol consumption began taking rifampin to treat tuberculosis (TB). During a follow-up visit one week after starting the medication, the patient tells the nurse, "In the last week, my urine turned orange, and I am very worried about it." How does the nurse respond? Inform the patient that it is one of the side effects of the medication. Recognize that the TB may have spread to the liver; further medical consultation is required. Recognize that the liver may be damaged from alcohol consumption; a liver function test should be performed. Instruct the patient to stop taking the medication immediately and consult the health care provider.
Inform the patient that it is one of the side effects of the medication.
The nurse provides education for a group of nursing students about acute bronchitis and includes which information? Typically, there are infiltrates seen on the chest x-ray. If symptoms last longer than two weeks, patients are advised to see their health care provider (HCP). Therapy is mainly supportive. Egophony may be auscultated.
Therapy is mainly supported Rationale: Acute bronchitis is usually self-limiting, and the treatment for acute bronchitis is supportive. Chest x-rays will differentiate acute bronchitis from pneumonia. With bronchitis, no consolidation or infiltrates will be seen on an x-ray as there is with pneumonia. If patients with acute bronchitis develop a fever, have difficulty breathing, or have symptoms last longer than four weeks, they should see their HCP. Because there is no consolidation, egophony would not be auscultated. Egophony is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis. It is caused by the enhanced transmission of high-frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out. p. 503
A patient received antibiotic treatment for bacterial pneumonia. The nurse determines that the levofloxacin therapy has not been effective after noting which indicator?
WBC count over 16,000/μL Rationale: The normal white blood cell (WBC) count is 5000 to 10,000/mm 3. The presence of leukocytosis (WBC count >15,000/μL) indicates that the infection persists despite treatment with an antibiotic. Lung sounds and respiratory rate are not indicators of the efficacy of antibiotic treatment. A low-grade fever also may signify that the infection is persisting; however, the WBC count is the most reliable indicator of active infection. p. 506
A patient's initial purified protein derivative (PPD) skin test result is positive. A repeat skin test is also positive. No signs or symptoms of tuberculosis or allergies are evident. Which medication therapy does the nurse anticipate will be prescribed? Penicillin Isoniazid (INH) Theophylline INH plus an antibiotic
isoniazid (INH)