PNA, Influenza, TB, COVID - Practice Questions
Development of which symptoms indicates to the nurse that a 48-year-old client with seasonal influenza may actually have COVID-19? a) Chest tightness and SpO2 of 86% b) productive cough with yellow-colored sputum c) anorexia and weight loss d) intermittent fever and sweating
A
Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis? a. Weak, nonproductive cough effort b. Large amounts of greenish sputum c. Respiratory rate of 28 breaths/minute d. Resting pulse oximetry (SpO2) of 85%
A
The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect? a. Increased tactile fremitus b. Dry, nonproductive cough c. Hyperresonance to percussion d. A grating sound on auscultation
A
When caring for a patient who is hospitalized with active tuberculosis (TB), the nurse observes a student nurse who is assigned to take care of a patient. Which action, if performed by the student nurse, would require an intervention by the nurse? a. The patient is offered a tissue from the box at the bedside. b. A surgical face mask is applied before visiting the patient. c. A snack is brought to the patient from the unit refrigerator. d. Hand washing is performed before entering the patient's room
B
Which complication of seasonal influenza will the nurse suspect in a 78-year-old client whose temperature remains elevated and now how new-onset confusion? a) TB b) PNA c) emphysema d) heart failure
B
A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? a. Purpose of antibiotic therapy b. Ways to limit oral fluid intake c. Appropriate use of cough suppressants d. Safety concerns with home oxygen therapy
C
A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the health care provider? a. The Mantoux test had an induration of 7 mm. b. The chest-x-ray showed infiltrates in the lower lobes. c. The patient is being treated with antiretrovirals for HIV infection. d. The patient has a cough that is productive of blood-tinged mucus
C
An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust. Which action, if recommended by the nurse, will be most helpful in reducing the incidence of lung disease? a. Treat workers with pulmonary fibrosis. b. Teach about symptoms of lung disease. c. Require the use of protective equipment. d. Monitor workers for coughing and wheezing
C
The med-surge unit has one negative airflow room. Which of these 4 clients who have just arrived on the unit should the charge nurse admit to this room? a) client with bacterial PNA and a cough productive of green sputum b) client with neutropenia and PNA caused by candida albicans c) client with possible H5N1 influenza who currently has epistaxis d) client with right empyema who has a chest tube and a fever of 103.2 F
C
The nurse on a med-surge unit is caring for an adult client who has T2DM and is now admitted for PNA. The nurse must ensure the Joint Commission's National Client Safety Goals for this client are met and therefore follows up on which of these? a) Hemoglobin A1C b) Culture and sensitivity report c) evaluating PNA vaccine status d) ensuring education to cough into the upper sleeve
C
The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung. Which information should the nurse include about the patient's postoperative care? a. Positioning on the right side b. Bed rest for the first 24 hours c. Frequent use of an incentive spirometer d. Chest tube placement with continuous drainage
C
The spouse of a 78-year-old client who was discharged to home 1 day ago after hospitalization for seasonal influenza calls to report the fever has returned and is now 103.4°F (39.7°C). What is the nurse's primary concern for this client? A. The client may not be taking the prescribed antiviral drug correctly B. A second strain of influenza is likely C. Pneumonia may be present D. The client may be dehydrated
C
Which assessment finding in an older client with PNA will the nurse report immediately to the primary health care provider? a) productive cough and normal temperature b) flushed cheeks and increased respiratory rate c) hypotension and rapid, weak pulse d) SpO2 of 86% and confusion
C
Which order or prescription will the nurse perform first for a client admitted with pneumonia who is febrile and also agitated as a result of alcohol intoxication? a) Assessing the need for an immediate dose of lorazepam b) Requesting a referral to a social worker for alcohol counseling c) Drawing blood for aerobic and anaerobic blood cultures d) Administering intravenous antibiotics
C
Which symptom will the nurse expect as typical in an 82-year-old client with PNA? a) high fever b) profound bradycardia c) acute confusion d) coughing spasms
C
A patient is admitted with active tuberculosis (TB). The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented? a. Chest x-ray shows no upper lobe infiltrates. b. TB medications have been taken for 6 months. c. Mantoux testing shows an induration of 10 mm. d. Three sputum smears for acid-fast bacilli are negative
D
A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of severe pleuritic chest pain. Which prescribed medication should the nurse give first? a. Codeine b. Guaifenesin (Robitussin) c. Acetaminophen (Tylenol) d. Piperacillin/tazobactam (Zosyn)
D
Which client will the nurse recognize as being at right for bacterial sinusitis? a) a 45-year-old with multiple dental caries and infected gums b) a 25-year-old with seasonal pollen allergies c) a 65-year-old who has a poor gag reflex after a stroke d) a 35-year-old with a 20-pack-year smoking hx who now vapes
A
The nurse in the community health clinic is planning education related to TB. Which of these groups will the nurse target? SATA. a) breast cancer survivors b) Those in local prison. c) homeless adults d) recent immigrants to the USA
B, C, D
An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? a. Arrange for a friend to administer the medication on schedule. b. Give the patient written instructions about how to take the medications. c. Teach the patient about the high risk for infecting others unless treatment is followed. d. Arrange for a daily noon meal at a community center where the drug will be administered
D
The nurse is caring for a client with severe acute respiratory syndrome (SARS). What is the most important infection control precaution that the nurse takes when preparing to suction this client? a) Keeping the door to the client's room closed b) performing oral care after suctioning the oropharynx c) washing hands and donning gloves prior to the procedure d) wearing a disposable particulate mask respirator
D
Which action will the nurse take to ensure that a client who requires drug therapy for multi-drug resistant TB and also is addicted to heroin adheres to the treatment regimen? a) arranging for a health care worker to directly observe the client take the drugs b) giving the client written instructions about how and when to take the drugs c) instructing the client about the consequences of not taking the drugs d) having the client repeat the drug names and side effects
A
Which condition indicates to the nurse that the treatment plan for a client with streptococcal pneumonia is effective? a) client has been afebrile for 48 hours b) oxygen saturation ranges between 90% and 92% on room air c) WBC is 16,000 d) bronchial breath sounds present in lung periphery
A
Which is the priority action for the nurse to take first after applying oxygen when caring for an older client admitted with symptoms of possible seasonal influenza accompanied by vomiting and high fever? a) Starting an IV line to begin hydration therapy b) administering IM influenza vaccination c) asking the client when symptoms began d) placing the client in a negative pressure room
A
Which factors or conditions will the nurse identify as increasing the risk for clients to develop aspiration PNA? (SATA) a) continuous nasogastric tube feedings b) bronchoscopy procedure c) decreased LOC d) magnetic resonance imaging procedure e) stroke f) chest tube
A, B, C, E
Which adults will the nurse identify as having a higher risk for active tuberculosis? (Select all that apply.) a) Those who were treated previously for active tuberculosis b) Kidney transplant recipients c) Homeless adults d) Those who have received bacille Calmette-Guérin (BCG) vaccine e) Those in the local prison f) Recent immigrants to the United States
A, B, C, E, F
The nurse is providing education for a client who is taking isoniazid, rifampin, and ethambutol for TB. Which of these points does the nurse include in the plan of care? SATA. a) Take a supplement containing B vitamins b) Avoid alcohol containing beverages c) Have kidney function tests monthly d) report changes in vision to the health care provider e) Notify the health care provider for red-orange urine
A, B, D
The nurse notes new onset confusion in an older patient who is normally alert and oriented. In which order should the nurse take the following actions? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain the oxygen saturation. b. Check the patient's pulse rate. c. Document the change in status. d. Notify the health care provider
A, B, D, C
A client who has been taking the four first-line drugs for TB treatment for a month reports all of the following changes. Which changes would cause the nurse to collaborate quickly with the health care provider? SATA. a) blurry vision b) constipation c) difficulty sleeping d) nausea when drinking beer e) red-tinged urine f) sunburn with minimal sun exposure g) yellowing of sclera
A, G
What is the most important personal infection control measure that the nurse will take when suctioning a client with COVID-19 or any other pandemic influenza? a) performing oral care before, as well as after, suctioning the oropharynx b) wearing a disposable particulate mask (N95) respirator with face shield or goggles c) washing hands and donning gloves prior to the procedure d) keeping the door to the client room closed
B
What is the nurse's first priority action to prevent harm when an 82-year-old client with PNA has become increasingly confused with an SpO2 change from 91% 1 hour ago to 88% now, and a respiratory rate that has increased from 26 to 32 breaths/min? a) increasing the flow rate of the IV piggy-back antibiotic b) increasing the oxygen flow rate by 2L and reassessing in 5 minutes c) assisting the client to a more upright position d) reporting the change in status to the client's primary health care provider
B
Which action to prevent harm is the highest priority for the nurse to include when teaching a client with TB about the prescribed first-line drug therapy regimen? a) be sure to drink at least 2L of fluids daily b) take these drugs daily exactly as prescribed c) expect a change in urine color d) wear sunscreen and protective clothing when you are out doors
B
Which action will the nurse take first when caring for a client with PNA who has ineffective airway clearance related to fatigue, chest pain, excessive secretions, and muscle weakness? a) administer oxygen to prevent hypoxemia and atelectasis b) administer the prescribed bronchodilator therapy to decrease bronchospasms c) encourage oral fluids to greater than 3000mL/day to ensure adequate hydration d) maintain semi-fowlers position to facilitate breathing and prevent further fatigue
B
A client who has recently relocated to the USA from Vietnam comes to the ED with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? a) contact the HCP for TB medications b) perform a TB skin test c) place a respiratory mask on the client d) test all family members for TB
C
A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days. Which assessment data obtained by the nurse indicates that the treatment has been effective? a. Bronchial breath sounds are heard at the right base. b. The patient coughs up small amounts of green mucus. c. The patient's white blood cell (WBC) count is 9000/µL. d. Increased tactile fremitus is palpable over the right chest.
C
Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse? a. Standard four-drug therapy for TB b. Need for annual repeat TB skin testing c. Use and side effects of isoniazid (INH) d. Bacille Calmette-Guérin (BCG) vaccine
C
The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test. Which action should the nurse take? a. Teach about the reason for the blood tests. b. Schedule an appointment for a chest x-ray. c. Teach about the need to get sputum specimens for 2 to 3 consecutive days. d. Instruct the patient to expectorate three specimens as soon as possible
C
A client with 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? a) Combination medication therapy is effective in eliminating cough and fever b) combination medication therapy improves adherence c) combination medication therapy has fewer side effects, particularly liver damage. d) the use of multiple medications destroys organisms quickly and reduces the development of drug resistant organisms
D
A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patient's health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Elevate the head of the bed to a semi-Fowler's position.
D
A patient with pneumonia has a fever of 101.4° F (38.6° C), a nonproductive cough, and an oxygen saturation of 88%. The patient complains of weakness, fatigue, and needs assistance to get out of bed. Which nursing diagnosis should the nurse assign as the highest priority? a. Hyperthermia related to infectious illness b. Impaired transfer ability related to weakness c. Ineffective airway clearance related to thick secretions d. Impaired gas exchange related to respiratory congestion
D
The clinic nurse has taught a client about influenza infection control. Which client statement indicates the need for further teaching? a) "Handwashing is the best way to prevent transmission." b) "I should avoid kissing and shaking hands" c) "It is best to cough and sneeze into my upper sleeve" d) "The intranasal vaccine can be given to everybody in the family"
D
The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test? a. "Is there any family history of TB?" b. "How long have you lived in the United States?" c. "Do you take any over-the-counter (OTC) medications?" d. "Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?"
D
The nurse noticed a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do? a) ensures that the client is wearing a mask b) informs the visitor that the client cannot receive visitors at this time c) provides a particulate air respirator to the visitor d) provides the visitor with a surgical mask
D
The nurse supervises unlicensed assistive personnel (UAP) who are providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by UAP is observed? a. UAP splint the patient's chest during coughing. b. UAP assist the patient to ambulate to the bathroom. c. UAP help the patient to a bedside chair for meals. d. UAP lower the head of the patient's bed to 15 degrees
D
An adult resident with a C6 spinal cord injury who resides in a LTC facility develops new onset of confusion, agitation, and shouting, "Get out of here! You're trying to kill me!" Which action will the nurse take first? a) Check the resident's oxygen saturation b) Do a complete neurologic assessment c) Administer the prescribed PRN lorazepam d) Perform a mini-mental status exam
A
An older patient is receiving standard multidrug therapy for tuberculosis (TB). The nurse should notify the health care provider if the patient exhibits which finding? a. Yellow-tinged skin b. Orange-colored sputum c. Thickening of the fingernails d. Difficulty hearing high-pitched voices
A
The clinic nurse teaches a patient with a 42 pack-year history of cigarette smoking about lung disease. Which information will be most important for the nurse to include? a. Options for smoking cessation b. Reasons for annual sputum cytology testing c. Erlotinib (Tarceva) therapy to prevent tumor risk d. Computed tomography (CT) screening for lung cancer
A
The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Review hemoglobin and hematocrit values
A
The nurse has just reviewed report on a group of clients. Which client is the nurse's priority? a) a 45-year-old with peritonsillar abscess who can no longer swallow b) a 65-year-old with rhinosinusitis and a fever of 102 F c) a 25-year-old who had endoscopic sinus surgery 8 hours ago d) a 55-year-old with TB who is standard first line therapy
A
A 70-year-old client has a complicated medical hx, including COPD. Which client statement indicates the need for further teaching about prevention of complications? a) "I am here to receive the yearly PNA shot again." b) "I am here to get my yearly flu shot again." c) "I should avoid large gatherings during cold and flu season." d) "I should cough into my upper sleeve instead of my hand"
A
A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (based on 0 to 10 scale) "whenever I take a deep breath." Which action will the nurse take next? a. Auscultate breath sounds. b. Administer the PRN morphine. c. Have the patient cough forcefully. d. Notify the patient's health care provider.
A
A patient with bacterial pneumonia has rhonchi and thick sputum. What is the nurse's most appropriate action to promote airway clearance? a. Assist the patient to splint the chest when coughing. b. Teach the patient about the need for fluid restrictions. c. Encourage the patient to wear the nasal oxygen cannula. d. Instruct the patient on the pursed lip breathing technique.
A
The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions? a. "I will call the doctor if I still feel tired after a week." b. "I will continue to do the deep breathing and coughing exercises at home." c. "I will schedule two appointments for the pneumonia and influenza vaccines." d. "I'll cancel my chest x-ray appointment if I'm feeling better in a couple weeks."
B
The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement, if made by the patient, indicates that teaching was effective? a. "I will avoid being outdoors whenever possible." b. "My husband will be sleeping in the guest bedroom." c. "I will take the bus instead of driving to visit my friends." d. "I will keep the windows closed at home to contain the germs."
B
The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first? a. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath c. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes d. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° C)
B
A client is being discharged home with active TB. Which information does the nurse include in the discharge teaching plans? a) "You will not spread the disease unless you stop taking your medication." b) "You will not pose an increased risk of disease to the people you have been living with" c) You will have to take these medications for at least 1 year" d) Your sputum may turn a rust color as your condition gets better"
B
A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? a. Chest x-ray via stretcher b. Blood cultures from two sites c. Ciprofloxacin (Cipro) 400 mg IV d. Acetaminophen (Tylenol) rectal suppository
B
After 2 months of tuberculosis (TB) treatment with isoniazid (INH), rifampin (Rifadin), pyrazinamide (PZA), and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next? a. Teach about treatment for drug-resistant TB treatment. b. Ask the patient whether medications have been taken as directed. c. Schedule the patient for directly observed therapy three times weekly. d. Discuss with the health care provider the need for the patient to use an injectable antibiotic.
B
An experienced nurse instructs a new nurse about how to care for a patient with dyspnea caused by a pulmonary fungal infection. Which action by the new nurse indicates a need for further teaching? a. Listening to the patient's lung sounds several times during the shift b. Placing the patient on droplet precautions and in a private hospital room c. Increasing the oxygen flow rate to keep the oxygen saturation above 90% d. Monitoring patient serology results to identify the specific infecting organism
B
An older client presents to the ED with a 2-day hx of cough, pain, wheezing, and dyspnea. The medical record states the client has not received the pneumococcal vaccine. While collaborating with the interprofessional team, which one of these medications does the nurse anticipate the HCP will recommend as the priority? a) corticosteroid b) Beta-Agonist c) Pneumococcal Vaccine d) Antibiotics
B
The community health nurse is collaborating with the local health department on containment of an anticipated pandemic influenza outbreak. The nurse advises the health department that the best method to prevent outbreaks of pandemic influenza is which of these? a) Avoid public gatherings at all times b) early recognition and quarantine of affected persons c) vaccinating community members with PNA vaccine d) widespread distribution of antiviral drugs
B
The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective? a. Turn and reposition immobile patients at least every 2 hours. b. Place patients with altered consciousness in side-lying positions. c. Monitor for respiratory symptoms in patients who are immunosuppressed. d. Insert nasogastric tube for feedings for patients with swallowing problems.
B
