Respiratory MS2

A client who has started therapy for drug-resistant tuberculosis demonstrates understanding of tuberculosis transmission when he says: A. "I'll stop being contagious when I have a negative acid-fast bacilli test." B. "I'm contagious as long as I have night sweats. C. "I'm clear when my chest X-ray is negative." D. "My tuberculosis isn't contagious after I take the medication for 24 hours."

ANS: A "I'll stop being contagious when I have negative acid-fast bacilli test."

A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? A. "It is all right if I have a grilled cheese sandwich with American cheese." B. "It is all right if I drink a glass of red wine with my dinner." C. "It is fine if I eat sushi with a little bit of soy sauce." D. "I am going to have a tuna fish sandwich for lunch."

ANS: A "It is all right if I have a grilled cheese sandwich with American cheese."

The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? A. 6 to 12 months B. 3 to 5 months C. 3 months D. 13 to 18 months

ANS: A 6 to 12 months

A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true? A. A positive reaction indicates that the client has been exposed to the disease. B. A positive reaction indicates that the client has active tuberculosis (TB). C. A negative reaction always excludes the diagnosis of TB. D. The PPD can be read within 12 hours after the injection.

ANS: A A positive reaction indicates that the client has been exposed to the disease.

The nurse is assessing an adult client following a motor vehicle accident. The nurse observes that the client has an increased use of accessory muscles and is reporting chest pain and shortness of breath. The nurse should recognize the possibility of what condition? A. Pneumothorax B. Aspiration C. Acute bronchitis D. Cardiac ischemia

ANS: A Pneumothorax

When receiving heparin to treat a pulmonary embolus, a client passes bright red urine. What should the nurse do first? A. Prepare to administer protamine sulfate. B. Monitor the partial thromboplastin time (PTT). C. Decrease the heparin infusion rate. D. Start an IV infusion of dextrose 5% in water (D5W).

ANS: A Prepare to administer protamine sulfate.

The nurse caring for a client with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy? A. Vitamin B6 B. Vitamin C C. Vitamin D D. Vitamin E

ANS: A VItamin B6

A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals coarse crackles in the lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing A. decompensated heart failure with pulmonary edema. B. acute exacerbation of chronic obstructive pulmonary disease. C. bilateral pneumonia. D. tuberculosis.

ANS: A decompensated heart failure with pulmonary edema

The nurse is completing a physical assessment of a client's trachea. The nurse inspects and palpates the trachea for A. deviation from the midline B. evidence of muscle weakness C. color of the mucous membranes D. evidence of exudate

ANS: A deviation from the midline.

A nurse is evaluating education provided to various clients being discharged to home. The nurse assesses that client most likely to be nonadherent with treatment is the one who A. Has a duodenal ulcer and is prescribed a histamine-2 receptor blocker B. Has tuberculosis and is taking multiple antitubercular medications C. Has pneumonia and is prescribed an oral antibiotic D. Had abdominal surgery and will be changing the dressing daily

ANS: B

A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction? A. "I'll always have a positive test for tuberculosis." B. "I'll stay in isolation for 6 weeks." C. "I'll have to take the medication for up to a year." D. "This disease may come back later if I am under stress."

ANS: B "I'll stay in isolation for 6 weeks."

A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation? A. Reddened area B. 15-mm induration C. 5-mm induration D. A blister

ANS: B 15-mm induration

The nurse is assessing a client who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the client's respirations. How should the nurse best respond to this assessment finding? A. Inform the physician promptly that there is in imminent leak in the drainage system. B. Document that the chest drainage system is operating as it is intended. C. Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes D. Encourage the client to do deep breathing and coughing exercises

ANS: B Document that the chest drainage system is operating as it is intended

"A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates? A. Tension pneumothorax B. Flail Chest C. Pneumothorax D. ARDS

ANS: B Flail Chest

The nurse is caring for a client with tuberculosis. Why should the nurse always encourage a client with tuberculosis to perform active range-of-motion (ROM) exercises three times a day? A. For medication absorption B. For maintaining muscle strength C. For effective pain control D. For use as a baseline for evaluation.

ANS: B For maintaining muscle strength

A client on the medical unit is found to have pulmonary tuberculosis (TB). What is the most appropriate precaution for the staff to take to prevent transmission of this disease? A. Standard and contact precautions B. Standard and airborne precautions C. Standard precautions only D. Droplet precautions

ANS: B Standard and airborne precautions

The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? A. Flail chest B. Tension pneumothorax C. Pulmonary contusion D. Cardiac tamponade

ANS: B Tension pneumothorax

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? A. "If the test area turns red that means I have tuberculosis." B. "I will avoid contact with my family until I a done with the test." C. "Because I had a previous reaction to the test, this time I need to get a chest X-ray." D. "I will come back in 1 week to have the test read."

ANS: C "Because I had a previous reaction to the test, this time I need to get a chest X-ray."

A patient who wears contact lenses is to be place on rifampin for tuberculosis therapy. What should the nurse tell the patient? A. "Only wear your contact lenses during the day and take them out in the evening before bed." B. "There are no significant problems with wearing contact lenses." C. "You should switch to wearing your glasses while taking this medication." D. "The physician can give you eye drops to prevent any problems."

ANS: C "You should switch to wearing your glasses while taking this medication."

A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication? A. 5 to 6 mm B. 7 to 8 mm C. 0 to 4 mm D. 9 mm

ANS: C 0 to 4 mm

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH[Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? A. 1 to 3 weeks B. 2 to 4 months C. 6 to 12 months D. 3 to 5 days

ANS: C 6 to 12 months

On auscultation, which finding suggests a right pneumothorax? A. Inspiratory wheezes in the right thorax B. Bilateral pleural friction rub C. Absence of breath sounds in the right thorax D. Bilateral inspiratory and expiratory crackles.

ANS: C Absence of breath sounds in the right thorax

While caring for a patient with pneumocystis pneumonia, the nurse assesses flat, purplish lesions on the back and trunk. What does the nurse suspect these lesions indicate? A. Tuberculosis of the skin B. Seborrheic dermatitis C. Kaposi's sarcoma D. Molluscum contagiosum

ANS: C Karposi's sarcoma

When a disease infects a host, a portal of entry is needed for an organism to gain access. What has been identified as the usual portal of entry for tuberculosis? A. Integumentary system B. Gastrointestinal system C. Respiratory system D. Urinary system

ANS: C Respiratory System

A nurse is conducting an initial assessment on a client with possible tuberculosis. Which assessment finding indicates a risk factor for tuberculosis? A. The client works in a health insurance office. B. The client has never traveled outside of the country. C. The client had a liver transplant 2 years ago. D. The client sees the health care provider for a check-up yearly.

ANS: C The client had a liver transplant 2 years ago.

A client has been diagnosed with AIDS and Tuberculosis (TB). A nursing student asks the nurse why the client's skin test for TB is negative if the client's physician has diagnosed TB. The nurse's correct reply is which of the following? A. The solution used for the skin test was probably outdated. B. The skin test was improperly performed. C. The client's immune system cannot mount a response to the skin test. D. The client has only mild TB, which is not enough to cause a reaction.

ANS: C The client's immune system cannot mount a response to the skin test.

The nurse is administering a skin test for detection of exposure to tuberculosis. How would the nurse determine if the client was exposed to tuberculosis? A. The injection area will break out in a fine macular rash. B. The client will have a productive cough. C. The injection area swells if the client has developed antibodies against the antigen. D. The injection area will become painful with induration if the client has antibodies against the antigen.

ANS: C The injection area swells if the client has developed antibodies against the antigen.

Nursing students are reviewing the various infectious diseases that require transmission-based precautions. The students demonstrate understanding of the information when they identify which infectious disease as requiring airborne precautions? A. Impetigo B. Scabies C. Tuberculosis D. Rubella

ANS: C Tuberculosis

A client is placed in isolation for suspected tuberculosis. Which action should the nurse take when entering the client's room? A. Leave the door open when in the room B. Apply a face mask with an eye shield C. Wear an N95 respirator. D. Minimize verbal interactions.

ANS: C Wear an N95 respirator.

A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the patient's care plan? A. Keeping the door to the client's room open to observe the client B. Instructing the client to wear a mask at all times C. Wearing a disposable particulate respirator that fits snugly around the face D. Wearing a gown and gloves when providing direct care

ANS: C Wearing a disposable particulate respirator that fits snugly around the face

What does a positive Mantoux test indicate? A. development of full-blown tuberculosis B. an active case of tuberculosis C. production of immune response D. active immunity to tuberculosis

ANS: C production of immune response

Constant bubbling in the water seal of a chest drainage system indicates which problem? A. Increased drainage B. Tidaling C. Tension pneumothorax D. Air leak

ANS: D Air leak

The physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which of the following? A. Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years B. Isolation until 24 hours after antitubercular therapy begins C. Nothing, until signs of active disease arise D. Daily doses of isoniazid, 300 mg for 6 months to 1 year

ANS: D Daily doses of isoniazid, 300 mg for 6 months to 1 year

A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? A. Client teaching about the importance of TB testing. B. Reviewing the risk factors for TB C. Client teaching about the cause of TB D. Developing a list of people with whom the client has had contact

ANS: D Developing a list of people with whom the client has had contact

A client is admitted to the facility with a productive cough, night sweats, and a fever. Which action is most important in the initial care plan? A. Monitoring the client's fluid intake and output B. Wearing gloves during all client contact C. Assessing the client's temperature every 8 hours D. Placing the client in respiratory isolation

ANS: D Placing the client in respiratory isolation

The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? A. Cough B. Hemoptysis C. Syncope D. Tachypnea

ANS: D Tachypnea

An adult client has tested positive for tuberculosis (TB). While providing client teaching, what information should the nurse prioritize? A. The need to work closely with the occupational and physical therapists B. The fact that TB is self-limiting, but can take up to 2 years to resolve C. The fact that the disease is a lifelong, chronic condition that will affect ADLs. D. The importance of adhering closely to the prescribed medication regimen.

ANS: D The importance of adhering closely to the prescribed medication regimen.

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include: A. muffled or distant heart sounds B. tracheal deviation to the unaffected side. C. Paradoxical chest wall movement with respirations D. Diminished or absent breath sounds on the affected side

ANS: D diminished or absent breath sounds on the affected side

A client asks a nurse a question about the Mantoux test for tuberculosis. The nurse should base her response on the fact that the: A. test stimulates a reddened response in some clients and requires a second test in 3 months. B. area of redness is measured in 3 days and determines whether tuberculosis is present. C. presence of a wheal at the injection site in 2 days indicates active tuberculosis D. skin test doesn't differentiate between active and dormant tuberculosis infection.

ANS:D skin test doesn't differentiate between active and dormant tuberculosis infection.

A physician stated to the nurse that the client has fluid in the pleural spae and will need a thoracentesis. The nurse expects the physician to document this fluid as

pleural effusion