NURS MISC PNEUMONIA AND TUBERCULOSIS QUIZ - Ana G. Mendez University System

NURS MISC PNEUMONIA AND TUBERCULOSIS QUIZ Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is present? Group living Severe periodontal disease Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop? Bronchiectasis Inflammation Question 2 Explanation: The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the airway that doesn’t occur in pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia. Question 3 CORRECT Which of the following organisms most commonly causes community- acquired pneumonia in adults? Klebsiella pneumoniae Staphylococcus aureus An elderly client with pneumonia may appear with which of the following symptoms first? Fever and chills Pleuritic chest pain and cough When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation? Bronchovesicular Vesicular A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests? Chest x-ray Sputum culture and sensitivity A client with pneumonia develops dyspnea with a respiratory rate of 32 breaths/minute and difficulty expelling his secretions. The nurse auscultates his lung fields and hears bronchial sounds in the left lower lobe. The nurse determines that the client requires which of the following treatments first? Bed rest Nutritional intake physicians order. Antibiotics may be warranted, but this isn’t a nursing decision. The client should be maintained on bedrest if he is dyspneic to minimize his oxygen demands, but providing additional will deal more immediately with his problem. The client will need nutritional support, but while dyspneic, he may be unable to spare the energy needed to eat and at the same time maintain adequate oxygenation. Question 8 CORRECT A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and will be discharged today. Which of the following physical findings would lead the nurse to believe it is appropriate to discharge this client? Fever of 102*F Vesicular breath sounds in right base The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and raised about 3mm where the test was given. This PPD would be read as having which of the following results? Needs to be redone Positive A client with primary TB infection can expect to develop which of the following conditions? Active TB within 1 month A positive skin test cases because of a break in the body’s immune defenses. The active stage shows the classic symptoms of TB: fever, hemoptysis, and night sweats. Question 11 WRONG A client was infected with TB 10 years ago but never developed the disease. He’s now being treated for cancer. The client begins to develop signs of TB. This is known as which of the following types of infection? Primary infection Tertiary infection A client has active TB. Which of the following symptoms will he exhibit? Chills, fever, night sweats, and hemoptysis Headache and photophobia Question 12 Explanation: Typical signs and symptoms are chills, fever, night sweats, and hemoptysis. Chest pain may be present from coughing, but isn’t usual. Clients with TB typically have low-grade fevers, not higher than 102*F. Nausea, headache, and photophobia aren’t usual TB symptoms. Question 13 CORRECT Which of the following diagnostic tests is definitive for TB? Mantoux test Tuberculin test A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the following reasons is this done? To determine if a repeat skin test is needed To determine if this is a primary or secondary infection A chest x-ray should a client’s lungs to be clear. His Mantoux test is positive, with a 10mm if induration. His previous test was negative. These test results are possible because: He was successfully treated for TB, but skin tests always stay positive He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test A client with a positive skin test for TB isn’t showing signs of active disease. To help prevent the development of active TB, the client should be treated with isoniazid, 300 mg daily, for how long? 2 to 4 weeks 9 to 12 months A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions? Prescribe isoniazid and tell him to go home and rest Give a prescription for isoniazid, 300 mg daily for 2 weeks, and send him home Question 17 Explanation: The client is showing s/s of active TB and because of a productive cough is highly contagious. He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. He would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed, then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be obtained. If they’re negative, he would be considered non-contagious and may be sent home, although he’ll continue to take the antitubercular drugs for 9 to 12 months. Question 18 CORRECT A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and symptoms would the client show if therapy is inadequate? Improved chest x-ray Positive acid-fast bacilli in a sputum sample after 2 months of treatment A client diagnosed with active TB would be hospitalized primarily for which of the following reasons? To determine his compliance To determine the need for antibiotic therapy A high level of oxygen exerts which of the following effects on the lung? Increases carbon dioxide levels Reduces amount of functional alveolar surface area A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of breath. He reports that it started suddenly. The assessment should include which of the following interventions? Chest x-ray Electrocardiogram (ECG) A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this? Chronic bronchitis Spontaneous pneumothorax oxygenation. The sudden collapse was the cause of his chest pain and shortness of breath. An asthma attack would show wheezing breath sounds, and bronchitis would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation. Question 23 CORRECT Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax? Bronchodilators Hyperbaric chamber Which of the following methods is the best way to confirm the diagnosis of a pneumothorax? Have the client use an incentive spirometer Stick a needle in the area of decreased breath sounds Question 24 Explanation: A chest x-ray will show the area of collapsed lung if pneumothorax is present as well as the volume of air in the pleural space. Listening to breath sounds won’t confirm a diagnosis. An IS is used to encourage deep breathing. A needle thoracostomy is done only in an emergency and only by someone trained to do it. Question 25 CORRECT A pulse oximetry gives what type of information about the client? Amount of oxygen in the blood Respiratory rate What effect does hemoglobin amount have on oxygenation status? More hemoglobin reduces the client’s respiratory rate Low hemoglobin levels cause increased oxygen-carrying capacity. Which of the following statements best explains how opening up collapsed alveoli improves oxygenation? Alveoli have no effect on oxygenation Gaseous exchange occurs in the alveolar membrane Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic patients by which of the following methods? The mask provides continuous air that the client can breathe The mask provides pressurized at the end of expiration to open collapsed alveoli Which of the following best describes pleural effusion? The collapse of bronchiole The accumulation of fluid between the linings of the pleural space Question 29 Explanation: The pleural fluid normally seeps continually into the pleural space from the capillaries lining the parietal pleura and is reabsorbed by the visceral pleural capillaries and lymphatics. Any condition that interferes with either the secretion or drainage of this fluid will lead to a pleural effusion. Question 30 WRONG If a pleural effusion develops, which of the following actions best describes how the fluid can be removed from the pleural space and proper lung status restored? Performing thoracentesis Allowing the pleural effusion to drain by itself A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and coughs. Which action should the nurse take? Reposition the airway Remove the airway and attempt suctioning without it An 87-year-old client requires long-term ventilator therapy. He has a tracheostomy in place and requires frequent suctioning. Which of the following techniques is correct? Using continuous suction while withdrawing the catheter Using continuous suction while advancing the catheter A client’s ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg, PaO2 of 77 mm Hg, and HCO3- of 24 mEq/L. What do these values indicate? Respiratory alkalosis Respiratory acidosis A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate for this injection? 1” to 3” 20G to 25G needle. 1” 20G needle. local effect. A TB syringe with a ½” to 3/8” 26G or 27G needle should be inserted about 1/8” below the epidermis. Question 35 CORRECT A 76-year old client is admitted for elective knee surgery. Physical examination reveals shallow respirations but no signs of respiratory distress. Which of the following is a normal physiologic change related to aging? Increased number of functional capillaries in the alveoli Decreased vital capacity A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority? Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever Ineffective airway clearance related to retained secretions Question 36 Explanation: Pneumonia is an acute infection of the lung parenchyma. The inflammatory reaction may cause an outpouring of exudate into the alveolar spaces, leading to an ineffective airway clearance related to retained secretions. Question 37 CORRECT A community health nurse is conducting an educational session with community members regarding TB. The nurse tells the group that one of the first symptoms associated with TB is: A cough with the expectoration of mucoid sputum Dyspnea A nurse evaluates the blood theophylline level of a client receiving aminophylline (theophylline) by intravenous infusion. The nurse would determine that a therapeutic blood level exists if which of the following were noted in the laboratory report? 15 mcg/mL 30 mcg/mL Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the client. Which of the following, if noted in the client’s history, would require physician notification? Allergy to penicillin Rheumatic fever A client is experiencing confusion and tremors is admitted to a nursing unit. An initial ABG report indicates that the PaCO2 level is 72 mm Hg, whereas the PaO2 level is 64 mm Hg. A nurse interprets that the client is most likely experiencing: Carbon dioxide narcosis Metabolic acidosis A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin test. The nurse interprets the results as: Negative The need for repeat testing A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not be consistent with the usual clinical presentation of TB and may indicate the development of a concurrent problem? Anorexia and weight loss High-grade fever A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The nurse suggests that the client increase intake of: Grains and broccoli Potatoes and fish Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia? Select all that apply. Auscultation of bowel sounds Presence of peripheral edema A client with pneumonia has a temperature of 102.6*F (39.2*C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care? Nasotracheal suctioning to clear secretions Frequent offering of a bedpan The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following? Pleural effusion Decreased oxygenation of the blood Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? Apathy Depression A client with pneumonia has a temperature ranging between 101* and 102*F and periods of diaphoresis. Based on this information, which of the following nursing interventions would be a priority? Administer oxygen therapy Provide fluid intake of 3 L/day Question 48 Explanation: A fluid intake of at least 3 L/day should be provided to replace any fluid loss occurring as a result the fever and diaphoresis; this is a high-priority intervention. Question 49 CORRECT Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia? The ability to perform ADL’s without dyspnea Chest pain that is minimized by splinting the ribcage. Which of the following symptoms is common in clients with TB? Increased appetite Mental status changes The nurse obtains a sputum specimen from a client with suspected TB for laboratory study. Which of the following laboratory techniques is most commonly used to identify tubercle bacilli in sputum? Sensitivity testing Dark-field illumination Which of the following antituberculous drugs can cause damage to the eighth cranial nerve? Isoniazid Ethambutol hydrochloride The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms? Facial paralysis Difficulty swallowing Which of the following family members exposed to TB would be at highest risk for contracting the disease? 17-year-old daughter 76-year-old grandmother The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all that apply. “I should always cover my mouth and nose when sneezing.” “I should use paper tissues to cough in and dispose of them properly.” A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has: Had contact with Mycobacterium tuberculosis Developed passive immunity to TB INH treatment is associated with the development of peripheral neuropathies. Which of the following interventions would the nurse teach the client to help prevent this complication? Supplement the diet with pyridoxine (vitamin B6) Avoid excessive sun exposure Question 57 Explanation: INH competes with the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed. Question 58 CORRECT The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB? Double the dosage if a drug dose is forgotten Limit alcohol intake The public health nurse is providing follow-up care to a client with TB who does not regularly take his medication. Which nursing action would be most appropriate for this client? Visit the clinic weekly to ask him whether he is taking his medications regularly. Remind the client that TB can be fatal if not taken properly. The Causative agent of Tuberculosis is said to be: Hansen’s Bacilli Group A Beta Hemolytic Streptococcus