Med Surg II - Chapter 31 - Care of Patients with Infectious Respiratory Problems

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. 1 "Refrain from wearing soft contact lenses." 2 "Refrain from drinking alcoholic beverages." 3 "Refrain from taking the drug on an empty stomach." 4 "Drink at least 8 ounces of water when you take the medication." 5 "Report yellowing of the skin and any darkened urine immediately."

2 "Refrain from drinking alcoholic beverages." 5 "Report yellowing of the skin and any darkened urine immediately." All the anti-tubercular drugs cause liver damage. Therefore, alcoholic beverages should not be consumed. Yellowing of the skin and darkening of the urine should be reported immediately to reduce further complications of drug therapy. Rifampin causes permanent staining of soft contact lenses. Other anti-tubercular drugs may not cause this. Isoniazid is the only anti-tubercular drug that should be administered on an empty stomach. Drinking 8 ounces of water with the medication is necessary in patients who are using only pyrazinamide.

The nurse is preparing to admit an adult patient with pertussis. Which symptom does the nurse anticipate finding in this patient? 1 Hemoptysis 2 Post-cough emesis 3 Mild cold-like symptoms 4 "Whooping" after a cough

2 Post-cough emesis Patients with pertussis will have paroxysms of coughing often followed by changes in color and/or vomiting. Adults do not usually have the characteristic whooping sound associated with coughing that children with pertussis exhibit. Hemoptysis may occur after the acute phase when changes in the respiratory mucosa occur. Mild, cold-like symptoms occur in the initial stages of pertussis and generally do not require hospitalization.

Which symptoms may be observed in an older patient with pneumonia? Select all that apply. 1 Fever 2 Cough 3 Fatigue 4 Confusion 5 Poor appetite

3 Fatigue 4 Confusion 5 Poor appetite In older patients, pneumonia may be characterized by fatigue, confusion, and poor appetite. Fever and cough are not always present in these patients.

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? 1 WBC 5,100/mm 3 2 WBC 6,500/mm 3 3 WBC 9,500/mm 3 4 WBC 12,000/mm 3

4 WBC 12,000/mm 3 An elevated white blood count is associated with bacterial infections such as pneumonia. A WBC of 12,000/mm 3 is elevated. Any WBC below 10,000/mm 3 is considered normal.

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? 1 "Be sure to complete the full course of antibiotics." 2 "Fluid should be restricted to prevent excess mucous production." 3 "Decongestants may cause rebound rhinitis and should be avoided." 4 "Facial pain that is worse when bending forward is abnormal and should be reported to your provider."

1 "Be sure to complete the full course of antibiotics." Treatment for bacterial rhinosinusitis includes the use of broad-spectrum antibiotics. Facial pain that is worse when bending forward is a common manifestation of rhinosinusitis. Decongestants are commonly prescribed for rhinosinusitis. Fluids should be increased unless the patient has other medical conditions that require fluid restriction.

What questions should the nurse ask to determine an older adult patient's risk for developing pneumonia? Select all that apply. 1 "Do you have a habit of smoking?" 2 "Do you have a history of hypertension?" 3 "Do you have any family history of lung disease?" 4 "Have you had a pneumococcal vaccination in the last 3 years?" 5 "Have you had any symptoms of influenza in the previous months?"

1 "Do you have a habit of smoking?" 4 "Have you had a pneumococcal vaccination in the last 3 years?" 5 "Have you had any symptoms of influenza in the previous months?" Smoking is a risk factor of pneumonia. A one-time pneumococcal vaccination is necessary to prevent pneumonia, or if the patient has not received the vaccination in the past 5 years, he or she is at a risk to develop pneumonia. Patients with symptoms of influenza previously may develop pneumonia if it is left untreated. Hypertension and family history of lung disease may not precipitate pneumonia.

A patient is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? 1 "You will need to have your household undergo TB testing." 2 "You will have to take these medications for at least 1 year." 3 "You are not contagious unless you stop taking your medication." 4 "Your sputum may turn a rust color as your condition gets better."

1 "You will need to have your household undergo TB testing." The people the patient has been living with have already been exposed and need to be tested. They cannot be re-exposed simply because the diagnosis has now been confirmed. The patient with active tuberculosis is contagious, even while taking medication. The length of time for treatment is 6 months. Fluid from the pulmonary capillaries and red blood cells moving into the alveoli is a result of the inflammatory process. Rust-colored sputum is an indication that the tuberculosis is getting worse.

Which patients should receive education about pneumococcal vaccines? Select all that apply. 1 An adult older than 65 2 A patient who is pregnant 3 A patient who is HIV-positive 4 A patient who has alcoholism 5 A patient with chronic lung disease

1 An adult older than 65 3 A patient who is HIV-positive 4 A patient who has alcoholism 5 A patient with chronic lung disease Patients that should receive education about a pneumococcal vaccine include patients who are older than 65, have alcoholism, are HIV-positive, or have a chronic lung disease. A patient who is pregnant does not need to receive education about pneumococcal vaccines because this is not necessarily recommended for every pregnant patient.

Which points does the nurse include when educating an older patient and family about pneumonia prevention? Select all that apply. 1 Avoiding dehydration 2 Monitoring blood pressure 3 Avoiding crowded public places 4 Decreasing exposure to air pollutants 5 Receiving an annual influenza vaccine

1 Avoiding dehydration 3 Avoiding crowded public places 4 Decreasing exposure to air pollutants 5 Receiving an annual influenza vaccine

A patient has been started on ethambutol for tuberculosis. What adverse effect requires the patient to notify the provider? 1 Changes in vision 2 Darkening of the urine 3 Yellowing appearance of skin 4 Increased bruising or bleeding

1 Changes in vision When taking ethambutol for tuberculosis, the patient should report any vision changes to the provider as the medication can cause optic neuritis. Darkening of the urine, yellowing appearance of the skin, and increased bleeding or bruising is associated with liver toxicity or failure and may be seen with isoniazid, rifampin, and pyrazinamide.

Which method is the best way to prevent outbreaks of pandemic influenza? 1 Early recognition and quarantine 2 Avoiding public gatherings at all times 3 Widespread distribution of antiviral drugs 4 Vaccinating everyone with pneumonia vaccine

1 Early recognition and quarantine The recommended approach to disease prevention consists of early recognition of new cases and implementing community and personal quarantine to reduce exposure to the virus. Public gatherings should be avoided only if a widespread outbreak has occurred in a community. No vaccine is available for pandemic influenza. The pneumonia vaccine is recommended for high-risk populations because pneumonia may be a complication of influenza. The current influenza vaccine is updated, reevaluated, and changed yearly to meet anticipated changes in the virus. When a cluster of cases is discovered in an area, the antiviral drugs oseltamivir and zanamivir should be widely distributed to help reduce the severity of the infection and to decrease mortality.

Which statement is true about community-acquired pneumonia (CAP) as compared to health care-associated pneumonia (HAP)? 1 HAPs are more likely to be resistant to some antibiotics. 2 In CAP, the fibrin and edema of inflammation stiffen the lung. 3 In CAP, capillary leak spreads the infection to areas of the lung. 4 CAPs are more difficult to treat due to their resistance to antibiotics.

1 HAPs are more likely to be resistant to some antibiotics. HAPs are more likely to be resistant to some antibiotics, most likely related to the widespread use of antibiotics in the health care environment. Pneumonias acquired in the community are less likely to be caused by organisms that have been exposed to antibiotics and developed resistance. The fibrin and edema that accompanies the inflammation with pneumonia can stiffen the lung in both CAP and HAP. As red blood cells and fibrin move into the alveoli with pneumonia, the infection spreads to other areas of the lung in both CAP and HAP.

Which groups are at greatest risk for drug-resistant Streptococcus pneumoniae? Select all that apply. 1 Individuals older than age 65 years 2 Those who have aspirated acidic stomach contents 3 People who have not received an influenza vaccine 4 People who have traveled outside the United States 5 Older adults exposed to children from a daycare environment

1 Individuals older than age 65 years 5 Older adults exposed to children from a daycare environment Individuals greater than age 65 and those exposed to children from a daycare environment are at greatest risk of drug-resistant Streptococcus pneumoniae. These factors should be part of the initial assessment of individuals presenting with symptoms of pneumonia. Although individuals who have aspirated acidic stomach contents are at risk for pneumonia, it is not as likely to be the drug-resistant Streptococcus pneumoniae variety. Since pneumonia often follows the flu, annual vaccination for influenza is important for all causative organisms. Individuals with respiratory symptoms should be queried regarding travel outside the United States; however, this is not a leading risk factor for drug-resistant Streptococcus pneumoniae.

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. 1 Left lower lobe 2 Left upper lobe 3 Right lower lobe 4 Right upper lobe 5 Right middle lobe

1 Left lower lobe 3 Right lower lobe 5 Right middle lobe Initial infection of tuberculosis (TB) is most often seen in the middle or lower lobes of the lung. The upper lobes of the lung are not the primary location of initial infection of TB.

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? 1 Mild cough 2 Severe cough 3 Bloody sputum 4 Pneumonia on chest x-ray

1 Mild cough Pertussis occurs in three distinct phases. During the first (catarrhal) phase, the patient may present with signs and symptoms of the common cold, including a mild cough. After 1 or 2 weeks, the paroxysmal phase occurs, characterized by a severe cough and bloody sputum, and potentially complicated by pneumonia. The third phase is the convalescent phase, which can last for several months.

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? 1 Moist heat packs over the affected sinuses 2 Tilting the head forward to relieve discomfort 3 Anticoagulant medications to reduce pressure 4 Frequent nose-blowing to clear sinus passages

1 Moist heat packs over the affected sinuses Moist heat packs over the sinuses can alleviate some discomfort. Decongestant medications are not indicated. Frequent nose-blowing is not recommended. Patients should be taught to avoid placing the sinuses in a dependent position.

Which actions known as the "ventilator bundle" have been shown to reduce the incidence of ventilator-associated pneumonia (VAP)? Select all that apply. 1 Oral care 2 Hand hygiene 3 Head-of-bed elevation 4 Equipment decontamination 5 Careful monitoring of oxygen levels

1 Oral care 2 Hand hygiene 3 Head-of-bed elevation Hand hygiene, oral care, and head-of-bed elevation are the three interventions known as a "ventilator bundle" aimed at reducing VAP. Diligent oral care using agents to reduce organisms and provide moisture is especially important for nurses to perform to accomplish this goal. Monitoring for hypoxia and diligent equipment decontamination are indeed important in the care of the patient with pneumonia, but not "packaged" as part of the "ventilator bundle."

Which pathological findings associated with pneumonia result in an increased respiratory rate and dyspnea? Select all that apply. 1 Pain 2 Anxiety 3 Alveolar consolidation 4 Stimulation of J receptors 5 Pulmonary capillary shunting

1 Pain 2 Anxiety 4 Stimulation of J receptors Pathological findings associated with pneumonia that result in an increased respiratory rate and dyspnea include pain, anxiety, and stimulation of the J receptors. Alveolar consolidation and pulmonary capillary shunting result in hypoxemia.

Which disorder of the lungs may feature a distinct "whooping" sound in children that may not be present in adults? 1 Pertussis 2 Tuberculosis 3 Inhalation anthrax 4 Coccidioidomycosis

1 Pertussis The distinct "whooping" sound of pertussis that is common in children at the end of a cough may not be present in adults. Tuberculosis, inhalation anthrax, and coccidioidomycosis are not associated with this "whooping" sound.

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. 1 The patient has asthma. 2 The patient has diabetes. 3 The patient is 30 years old. 4 The patient lives in a nursing home. 5 The patient is being treated for cancer.

1 The patient has asthma. 2 The patient has diabetes. 4 The patient lives in a nursing home. 5 The patient is being treated for cancer. Those patients needing the influenza vaccine include those with chronic conditions such asthma or diabetes, those living in institutions such as a nursing home, and those that are immunocompromised such as when undergoing radiation therapy or chemotherapy for cancer. Patients older than 50 years of age, not 30 years of age, are recommended for influenza vaccine.

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? 1 An hour before bedtime 2 An hour before breakfast 3 Immediately after breakfast 4 Immediately before breakfast

2 An hour before breakfast Isoniazid must be taken on an empty stomach to ensure adequate medication absorption so the best time for the patient to take this medication is an hour before breakfast. The patient would need to fast for two hours before taking the medication prior to bedtime to ensure that the stomach is empty. Taking the medication immediately before or after breakfast would not allow the stomach to be empty while the medication is absorbed.

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? 1 Have the patient repeat medication names and side effects. 2 Arrange for a health care worker to watch the patient take the medication. 3 Give the patient written instructions about how to take prescribed medications. 4 Instruct the patient about the possible consequences of nonadherence.

2 Arrange for a health care worker to watch the patient take the medication. Because this patient is unlikely to adhere to long-term treatment unless directly supervised while taking medications, the best option is to arrange for directly observed therapy (DOT). Giving a patient who is homeless and addicted to heroin written instructions on how to take prescribed medications is placing too much responsibility on the patient to follow through. Also, the question does not indicate whether the patient can read. Simply because the patient can state the names and side effects of medications does not mean that the patient understands what the medications are and why he or she needs to take them. A patient who is homeless may be more concerned with obtaining shelter and food than with properly taking his or her medication.

An older patient with pneumonia has become more confused during the initial assessment. What action should the nurse take initially? 1 Notify the Rapid Response Team. 2 Assess the patient's oxygen saturation. 3 Evaluate orientation to person, place, and time. 4 Request a nebulized bronchodilator medication.

2 Assess the patient's oxygen saturation. Patients who have altered level of consciousness are often hypoxic. The nurse should assess oxygen saturation to evaluate the possible cause if this occurs. The nurse may evaluate orientation, but the oxygen saturation is more important and should be performed initially. It is not necessary to notify the Rapid Response Team at this time. A bronchodilator medication is not indicated.

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? 1 Ordering sputum cultures 2 Beginning antibiotic therapy 3 Ordering PCR laboratory testing 4 Prescribing an antifungal agent

2 Beginning antibiotic therapy The patient's symptoms and travel history suggest inhalation anthrax in the prodromal phase. The nurse should begin antibiotic therapy. Without therapy, inhalation anthrax is fatal. Anthrax diagnosis may be confirmed with a Gram stain of blood or chest x-ray. Sputum cultures and PCR laboratory testing are appropriate for pertussis. Antifungal agents are appropriate for coccidioidomycosis, not anthrax.

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? 1 Monitor peak flow levels every 4 hours. 2 Encourage the patient to drink more fluids. 3 Request an order to switch to an oral antibiotic. 4 Reassure the patient that the infection is improving.

2 Encourage the patient to drink more fluids. Thick secretions indicate decreased hydration and the patient is at risk for airway obstruction if these secretions cannot be cleared easily; the nurse should encourage increased fluid intake. Peak flow levels are used to monitor relative airway obstruction in patients with obstructive lung disease. A decrease in secretions does not necessarily indicate improvement in the infection, especially if the secretions are thick and not easily mobilized. The patient should continue intravenous antibiotics until there is evidence that the infection is improving.

What information is important to share with a patient who is being discharged after treatment for pneumonia? Select all that apply. 1 Resume regular activities 2 Get an annual influenza immunization 3 Avoid contact with all persons with colds or influenza 4 Stop or reduce any intake of tobacco and tobacco products 5 Because you have had pneumonia, you won't need a pneumococcal vaccination

2 Get an annual influenza immunization 3 Avoid contact with all persons with colds or influenza 4 Stop or reduce any intake of tobacco and tobacco products Individuals who have had pneumonia need to be instructed to avoid contact with ill persons, stop or reduce smoking, and get an annual influenza immunization and a pneumococcal immunization as recommended by the health care provider. The patient recovering from pneumonia is advised to avoid crowded places such as malls and churches, so the patient would not be able to resume all regular activities. Pneumococcal immunizations are usually given once after age 65 and may be given 5 years after that if the patient is at high risk.

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? 1 Oseltamivir 2 Hydroxyzine 3 Phenylephrine 4 Cephalosporin

2 Hydroxyzine Hydroxyzine is a first-generation antihistamine that may cause anticholinergic effects such as constipation and dry mouth when used in older adults. Phenylephrine is a nasal decongestant that may cause rebound nasal congestion. Cephalosporin is an antibiotic used to treat bacterial infections. Oseltamivir is used in the treatment of influenza.

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? 1 Influenza A 2 Influenza B 3 Influenza C 4 Influenza AB

2 Influenza B Symptoms of influenza B may include nausea, vomiting, and diarrhea. The influenza viruses (A, B, and C) all include headache, muscle aches, fever, chills, fatigue, and weakness. Influenza is identified as A, B, or C; there is no combination or AB.

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? 1 Viral 2 Lobar 3 Bronchial 4 Bacterial

2 Lobar Lobar pneumonia manifests as consolidation in a segment or an entire lobe of the lung. Bronchopneumonia manifests as diffusely scattered patches around the bronchi. While lobar pneumonia is generally bacterial, the pattern of lung involvement does not necessarily indicate the etiology.

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? 1 Mastoiditis 2 Pneumonia 3 Rheumatic fever 4 Acute glomerulonephritis

2 Pneumonia Pneumonia symptoms include a cough, fever, chills, shortness of breath, and chest pain. Symptoms of acute glomerulonephritis include hypertension, decreased urinary output, dark urine, cough, and facial puffiness. Ear drainage and swelling is associated with mastoiditis. Rheumatic fever symptoms include red, hot, painful joints.

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? 1 Provide supplemental oxygen. 2 Request an order for a chest x-ray. 3 Monitor closely for respiratory failure. 4 Ask the provider to order a complete blood count.

2 Request an order for a chest x-ray. Patients with chronic lung disease who are malnourished are at increased risk for hospital-acquired pneumonia; a chest x-ray is necessary to diagnose this condition so that treatment can be initiated. The patient is not hypoxic and does not need supplemental oxygen at this time. There is not an indication of respiratory failure in this patient. A complete blood count will likely be ordered, but obtaining the chest x-ray is the priority for diagnostic and management purposes.

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? 1 To allow for missed doses 2 To shorten therapy by 6 months 3 To treat highly resistant cases of tuberculosis 4 To improve the patient's ability to tolerate medications

2 To shorten therapy by 6 months Combination medication shortens therapy by 6 to 12 months. Tuberculosis medications should be taken as ordered without missing a dose. Combination therapy is not related to disease resistance. Medications may be changed based upon the patient's ability to tolerate drugs.

What is the most important information for the nurse to convey to a patient who is beginning pharmacological therapy for the treatment of tuberculosis to ensure suppression of the disease? 1 "Eat a diet rich in Vitamin K." 2 "Do not drink alcoholic beverages." 3 "Take the medication exactly as prescribed." 4 "Contact the health care provider if you become ill."

3 "Take the medication exactly as prescribed." It is most important for the nurse to teach the patient to take the medication regularly, exactly as prescribed, for as long as it is prescribed to ensure adequate suppression of the disease. The patient should be instructed to eat a diet rich in Vitamins B and C. A diet rich in Vitamin K will not assist the patient in any way. Staying away from alcoholic beverages will prevent liver damage from the medications but will not ensure suppression of the disease. It is important for the patient to understand that the health care provider should be contacted in the case of illness; however, it will not ensure suppression of the disease.

Which mode of ventilation is suitable for a patient suffering from sleep apnea? 1 Flow-by ventilation 2 Assist-control ventilation 3 Bi-level positive airway ventilation 4 Synchronized intermittent mandatory ventilation

3 Bi-level positive airway ventilation Bi-level positive airway ventilation (BiPAP) provides noninvasive pressure support ventilation by nasal mask or face mask. It is most often used for patients suffering from sleep apnea. Flow-by ventilation is beneficial for patients in whom weaning from mechanical ventilation is needed. Assist-control ventilation continues to deliver a preset tidal volume, even when the patient's spontaneous breathing rate increases. Synchronized intermittent mandatory ventilation (SIMV) coordinates breathing between the ventilator and the patient and is not required in a patient with sleep apnea since continuous flow is needed.

Which are complications for a patient who splints fractured ribs? Select all that apply. 1 Increased pain 2 Increased risk of flail chest 3 Decreased breathing depth 4 Increased risk of a pneumothorax 5 Ineffective clearance of secretions

3 Decreased breathing depth 5 Ineffective clearance of secretions Complications associated with splinting fractured ribs includes decreased breathing depth and ineffective clearance of secretions. A patient splints the fracture to decrease pain. Flail chest and a pneumothorax are not risk factors of splinting fractured ribs.

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? 1 Administer levofloxacin 500 mg IV. 2 Give lorazepam as needed for agitation. 3 Draw aerobic and anaerobic blood cultures. 4 Refer to social worker for alcohol counselling.

3 Draw aerobic and anaerobic blood cultures. Obtaining aerobic and anaerobic cultures is the first action the nurse should perform and is standard procedure in a febrile patient for whom antibiotics have been requested. Levofloxacin, an antibiotic, is important to administer, but blood cultures should be drawn before antibiotics are started. Unless this patient is a danger to self or staff, giving lorazepam for agitation is not the first action; the question indicates that the patient is agitated but does not indicate whether other attempts to control agitation have been tried, such as decreasing stimulation. A referral to social work for alcohol counselling will be initiated before the time of discharge; this patient is febrile and agitated, and a referral is not the immediate concern.

Which factors are pathophysiologic bases for the clinical manifestations of pneumonia? Select all that apply. 1 A temperature greater than 38.5° C upon arising in the morning is typically present. 2 Suppression of fever with the use of acetaminophen will speed the recovery process in older adults. 3 Fluid accumulation in the receptors of the individual's respiratory system triggers the coughing mechanism. 4 Pulmonary capillary shunting and movement of red blood cells into the alveoli cause pleuritic chest discomfort. 5 Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea.

3 Fluid accumulation in the receptors of the individual's respiratory system triggers the coughing mechanism. 5 Stimulation of chemoreceptors and decreased lung compliance lead to an increased respiratory rate and dyspnea. Stimulation of chemoreceptors in the respiratory system and the increased work of breathing secondary to decreased lung compliance lead to the clinical manifestation of increased respiratory rate and dyspnea. Fluid accumulation in the receptors of the trachea, bronchi, and bronchioles cause the coughing seen with pneumonia. Pulmonary capillary shunting leads to hypoxemia. Movement of red blood cells into the alveoli causes the presence of purulent, blood-tinged, or rust-colored sputum. Fever is secondary to the release of pyrogens that cause the hypothalamus to increase body temperature; this is a normal physiologic response—suppression of or masking the fever will not speed recovery. The presence of a fever is a clinical manifestation; fever upon arising in the morning is not a pathophysiologic mechanism.

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? 1 Tonsillitis 2 Pharyngitis 3 Peritonsillar abscess 4 Retropharyngeal abscess

3 Peritonsillar abscess Pain and difficulty swallowing, swelling of the throat, and difficulty in opening the mouth are symptoms of peritonsillar abscess, a complication of acute tonsillitis. Pain and difficulty swallowing and swelling of the throat are also common symptoms of tonsillitis, pharyngitis, and retropharyngeal abscess; however, difficulty in opening the mouth is not associated with these conditions.

In which condition does the primary health care provider advocate the use of a single chest tube in a patient with chest trauma? 1 Flail chest 2 Rib fractures 3 Pneumothorax 4 Pulmonary contusion

3 Pneumothorax Chest tubes may be employed in patients with pneumothorax to facilitate the escape of air which will allow the lung to re-inflate. Humidified oxygen, pain management, and promotion of lung expansion are beneficial interventions in patients with flail chest. Pain management is the main focus of treatment in patients with rib fractures. Oxygen, intravenous fluids, and moderate Fowler's position are advocated in patients with pulmonary contusion.

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? 1 "You have most likely been exposed to TB and will need to be tested." 2 "You should receive TB prophylaxis until your provider rules out active disease." 3 "TB is spread from person to person by sharing drinking cups and eating utensils. 4 "Among people exposed to the disease, only a small percentage develop active TB."

4 "Among people exposed to the disease, only a small percentage develop active TB." With the development of acquired immunity, few of those who are exposed and initially infected actually develop active TB. The disease is spread by inhaling respiratory droplets aerosolized by coughing, sneezing, singing, laughing, and whistling. Unless there is a strong suspicion that TB is present or the patient has had a close exposure, testing is not necessary. TB drugs are given only after the disease is identified.

Which statements by the patient with rhinitis indicate ineffective learning about reducing the risk of spreading colds? Select all that apply. 1 "I will rest for 10 hours each day." 2 "I will dispose of tissues immediately after use." 3 "I will wash my hands after coughing, sneezing, and nose blowing." 4 "I will stop my cough reflex when I am in a crowded place or with the family." 5 "I will have minimal contact with people who have chronic respiratory problems."

4 "I will stop my cough reflex when I am in a crowded place or with the family." 5 "I will have minimal contact with people who have chronic respiratory problems." Trying to stop the cough reflexes when in a crowd is not recommended, because coughing promotes the removal of sputum from lungs. Since colds spread from person to person by droplets from coughing or sneezing and by direct contact, even minimal contact with people who have chronic respiratory problems should be avoided. Resting for 8 to 10 hours each day, disposing of used tissues immediately, and washing hands after coughing, sneezing, and nose blowing are interventions to reduce the risk of spreading colds.

What is the nursing priority to provide safe and effective care for the patient with pneumonia? 1 Monitoring for signs of sepsis 2 Assisting with bronchial hygiene 3 Frequently assessing breath sounds 4 Applying principles of infection control

4 Applying principles of infection control The nursing priority for providing safe and effective care for the patient with pneumonia includes applying principles of infection control, such as performing hand hygiene and implementing isolation precautions. The nursing priority for interpreting vital sign assessments includes monitoring for signs of sepsis. Assisting with bronchial hygiene is a nursing priority that will improve gas exchange in the patient with pneumonia. Frequent assessment of breath sounds is a nursing priority for respiratory assessment.

The nurse is caring for a patient with impending respiratory failure who refuses intubation and mechanical ventilation. Which method provides an alternative to mechanical ventilation? 1 Oropharyngeal airway 2 Positive end-expiratory pressure (PEEP) 3 Nonrebreathing mask with 100% oxygen 4 Bilevel positive airway pressure (BiPAP)

4 Bilevel positive airway pressure (BiPAP) BiPAP ventilation is a noninvasive method that may provide short-term ventilation without intubation. An oropharyngeal airway is used to prevent the tongue from occluding the airway or the patient from biting the endotracheal tube. A nonrebreathing mask will assist with oxygenation; however, muscle fatigue and hypoventilation may occur as causes of respiratory failure. The need for PEEP indicates a severe gas-exchange problem; this modality is "dialed in" on the mechanical ventilator.

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? 1 Ask the provider for an order for nebulized albuterol. 2 Report the patient's worsening condition to the provider. 3 Request an order for a stronger antibiotic to combat bacterial resistance. 4 Continue the current plan of care and reassess the patient periodically.

4 Continue the current plan of care and reassess the patient periodically. The cough with pneumococcal pneumonia is typically productive of purulent rusty brown or yellow mucus; white mucus production indicates resolution of the infection. It is not necessary to administer a bronchodilator or a different antibiotic. The provider does not need to be notified.

What education will be provided for the family of a patient being treated for tuberculosis convalescing at home? 1 Use airborne precautions. 2 Place used tissues in a trash can. 3 Cover your mouth and nose when sneezing. 4 Everyone must undergo tuberculosis testing.

4 Everyone must undergo tuberculosis testing. The family members living with a patient diagnosed with tuberculosis will have to undergo testing. Airborne precautions are unnecessary because the family members have already been exposed to the TB. The patient should be instructed to place used tissues in a plastic bag, and cover mouth and nose when sneezing, but this instruction is not specific to family members.

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? 1 Hospital acquired 2 Community acquired 3 Ventilator associated 4 Health care associated

4 Health care associated Health care associated pneumonia often has multidrug-resistant organisms and is seen in patients who were hospitalized for greater than 48 hours in the last 90 days, live in a nursing home or assisted-living facility, or received wound care or IV therapy in the last 30 days. This is an outpatient, and hospital-acquired pneumonia occurs greater than 48 hours after admission to the hospital. Multidrug-resistant organisms are not usually seen in community-acquired pneumonia. Ventilator-associated pneumonia is related to the presence of the endotracheal tube.

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? 1 Fever 2 Fatigue 3 Dry cough 4 Hypotension

4 Hypotension Inhalation anthrax infection has two stages: prodromal (early) and fulminant (late). Hypotension may occur in the fulminant stage of inhalation anthrax infection. Fever, fatigue, and dry cough occur in the prodromal stage of inhalation anthrax infection.

Incentive spirometry for the treatment of pneumonia has which outcome objective? 1 Reduced sputum production and increased cough 2 Reduced crackles and wheezes and improved oxygenation 3 Improved expiratory air flow and increased respiratory effort 4 Increased inspiratory muscle action and decreased atelectasis

4 Increased inspiratory muscle action and decreased atelectasis Incentive spirometry helps improve inspiratory muscle action and prevents or reverses atelectasis. It does not increase respiratory effort, reduce crackles and wheezes, or reduce sputum production.

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? 1 Mantoux test 2 Sputum culture 3 QuantiFERRON-TB Gold 4 Nucleic acid amplification test

4 Nucleic acid amplification test The nurse can anticipate an order for the nucleic acid amplification test, the most rapid and accurate way to screen for TB. Results are available in two hours. The Mantoux test is read within 48 to 72 hours. A sputum culture confirms the diagnosis but can take up to four weeks for a valid result. The QuantiFERRON-TB Gold blood test can show that a person is infected with TB but does not indicate whether the infection is latent or active.

What term describes air in the pleural space? 1 Stridor 2 Hemothorax 3 Thoracotomy 4 Pneumothorax

4 Pneumothorax Pneumothorax is air in the pleural space causing a loss of negative pressure in chest cavity, a rise in chest pressure, and a reduction in vital capacity, which can lead to a lung collapse. Stridor is a high-pitched, crowing noise during inspiration caused by laryngospasm or edema around the glottis. Hemothorax is bleeding into the chest cavity. Thoracotomy is a surgical incision into the chest wall.

The nurse is preparing a patient for discharge who has been treated for the prodromal stage of inhalation anthrax. What information is most important for the nurse to communicate to this patient? 1 Have your antibiotics refilled if you begin to feel ill. 2 It is normal for you to feel worse before you feel better. 3 Contact the health care practitioner for mild chest pain. 4 Seek medical attention immediately if you begin to feel breathless.

4 Seek medical attention immediately if you begin to feel breathless. The fulminant stage of inhalation anthrax usually begins after the patient has been feeling better for a day or so. This stage often begins with the patient experiencing breathlessness so it is important for the patient to seek help immediately if this symptom develops. A nurse should never encourage a patient to refill any medications unless it has been ordered by the health care practitioner. The patient should be given information about all of the symptoms of the fulminating stage, not given the impression that it is normal to feel worse before feeling better, so that any symptom will cause the patient to seek appropriate medical attention. Mild chest pain is expected with the prodromal stage of inhalation anthrax.