OHSU NRS 212 Acute Exam 2 Answered
what are most acute bronchial infections caused by ?
viruses
Is the presence of green sputum a reliable indicator of bacterial infection?
No
What is the primary symptom of acute bronchitis ?
cough
[lasts up to 3 weeks]
Define hospital acquired pneumonia
begins 48 hours or longer after admission to a hospital and was not present at the time of admission.
Define Community-acquired pneumonia (CAP)
onset in the community or during the first 2 days of hospitalization.
What are the three ways pneumonia reaches the lungs ?
1. Aspiration
2. Inhalation
3. Hematogenous spread
What often occurs as a result of community acquired pneumonia?
Necrotizing pneumonia
[characterized by liquification]
What is the most common form of pneumonia in patients with HIV ?
P. jiroveci
What is the pathophysiology of pneumonia ?
the inflammatory response is triggered in the lungs due to infection which causes edema in the lungs
what type of pneumonia occurs in certain patients with altered immune responses who are highly
susceptible to respiratory infections.
Opportunistic pneumonia
describe primary TB
Bacteria is inhaled and patient is contagious
,describe secondary TB
TB bacilli are not active and there is no risk of transmission to others
what workshup should a suspect TB patient receive ?
1. chest x ray
2. sputum culture
The nurse is performing a respiratory assessment. Which finding best supports the nursing diagnosis
of ineffective airway clearance?
a.Basilar crackles
b.Oxygen saturation of 85%
c.Presence of greenish sputum
d. Respiratory rate of 28 breaths/min
Basilar crackles
[The presence of adventitious breath sounds indicates that there is accumulation of secretions in the
lower airways]
The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which
clinical manifestation should the nurse expect to find?
a) Hyperresonance on percussion
b) Vesicular breath sounds in all lobes
c) Increased vocal fremitus on palpation
d) Fine crackles in all lobes on auscultation
Increased vocal fremitus on palpation
[typical physical examination finding for a patient with pneumonia is increased vocal fremitus on
palpation]
The nurse is caring for a patient with ineffective airway clearance. What is the priority nursing action
to assist this patient expectorate thick lung secretions?
a)Humidify the oxygen as able.
b)Administer cough suppressant q4hr.
c)Teach patient to splint the affected area.
d)Increase fluid intake to 3 L/day if tolerated.
Increase fluid intake to 3 L/day if tolerated
[the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the
patient can expectorate them more easily]
,During discharge teaching for an older adult patient with chronic obstructive pulmonary disease
(COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive?
a)Pneumococcal
b)Staphylococcus aureus
c)Haemophilus influenzae
d)Bacille-Calmette-Guérin (BCG)
Pneumococcal
[The pneumococcal vaccine is important for patients with a history of heart or lung disease,
recovering from a severe illness, age 65 years or older, or living in a long-term care facility]
The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has been
effective when the patient makes which statement about measures to prevent a relapse?
a)"I will seek immediate medical treatment for any upper respiratory infections."
b)"I should continue to do deep breathing and coughing exercises for at least 12 weeks."
c)"I will increase my food intake to 2400 calories a day to keep my immune system well."
d)"I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution.
“I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia’s resolution
[The follow-up chest x-ray examination will be done in 6 to 8 weeks to evaluate pneumonia resolution. A
patient should seek medical treatment for upper respiratory infections that persist for more than 7
days]
what are pulmonary fungal infections caused by ?
inhalation of spores
Do patients with pulmonary fungal infections need to be on isolation?
No.
[Since these infections are not transmitted from person to person, the patient does not have to be
placed in isolation]
What is the mainstay treatment for pulmonary fungal infections ?
Amphotericin B
What is the most effective noninvasive evaluating for lung cancer ?
CT scan
[biopsy for true diagnosis]
what is the treatment of choice in non-small cell lung cancers?
surgical resection
, what type of pneumothorax occurs due to the rupture of small blebs on the surface of the lungs ?
spontaneous pneumothorax
what is the timeframe for delirium development ?
2-3 days
what is the main contributing factor to delirium ?
impairment of cerebral oxidative metabolism
What is the leading risk factor for delirium ?
Dementia
What type of breathing is assoc. with Metabolic Acidosis?
hyperventilation
[kussmaul]
how many sputum specimens are needed to test for pulmonary TB?
three consecutive tests
How is TB definitively diagnosed?
tubercle bacilli musty be present in sputum culture
[can take up to 8 weeks]
Who is most likely to have received the Bacillile-Calmette-Guerin (BCG) vaccine for TB?
infants in parts of the world with a high prevalence of TB
What is the Bacillile-Calmette-Guerin (BCG) vaccine?
an attenuated strain of Mycobacterium bovis
Is the Bacillile-Calmette-Guerin (BCG) vaccine routine in the US?
No
[only for at risk health care workers]
What are the precautions for TB in the hospital?
airborne precautions with negative pressure room
[providers wear HEPA masks into room]
How often should a patient with pneumonia be turned?
every 2 hours to facilitate mobilization of secretions
To prevent aspiration in pneumonia, how high should the HOB be raised?
what are most acute bronchial infections caused by ?
viruses
Is the presence of green sputum a reliable indicator of bacterial infection?
No
What is the primary symptom of acute bronchitis ?
cough
[lasts up to 3 weeks]
Define hospital acquired pneumonia
begins 48 hours or longer after admission to a hospital and was not present at the time of admission.
Define Community-acquired pneumonia (CAP)
onset in the community or during the first 2 days of hospitalization.
What are the three ways pneumonia reaches the lungs ?
1. Aspiration
2. Inhalation
3. Hematogenous spread
What often occurs as a result of community acquired pneumonia?
Necrotizing pneumonia
[characterized by liquification]
What is the most common form of pneumonia in patients with HIV ?
P. jiroveci
What is the pathophysiology of pneumonia ?
the inflammatory response is triggered in the lungs due to infection which causes edema in the lungs
what type of pneumonia occurs in certain patients with altered immune responses who are highly
susceptible to respiratory infections.
Opportunistic pneumonia
describe primary TB
Bacteria is inhaled and patient is contagious
,describe secondary TB
TB bacilli are not active and there is no risk of transmission to others
what workshup should a suspect TB patient receive ?
1. chest x ray
2. sputum culture
The nurse is performing a respiratory assessment. Which finding best supports the nursing diagnosis
of ineffective airway clearance?
a.Basilar crackles
b.Oxygen saturation of 85%
c.Presence of greenish sputum
d. Respiratory rate of 28 breaths/min
Basilar crackles
[The presence of adventitious breath sounds indicates that there is accumulation of secretions in the
lower airways]
The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which
clinical manifestation should the nurse expect to find?
a) Hyperresonance on percussion
b) Vesicular breath sounds in all lobes
c) Increased vocal fremitus on palpation
d) Fine crackles in all lobes on auscultation
Increased vocal fremitus on palpation
[typical physical examination finding for a patient with pneumonia is increased vocal fremitus on
palpation]
The nurse is caring for a patient with ineffective airway clearance. What is the priority nursing action
to assist this patient expectorate thick lung secretions?
a)Humidify the oxygen as able.
b)Administer cough suppressant q4hr.
c)Teach patient to splint the affected area.
d)Increase fluid intake to 3 L/day if tolerated.
Increase fluid intake to 3 L/day if tolerated
[the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the
patient can expectorate them more easily]
,During discharge teaching for an older adult patient with chronic obstructive pulmonary disease
(COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive?
a)Pneumococcal
b)Staphylococcus aureus
c)Haemophilus influenzae
d)Bacille-Calmette-Guérin (BCG)
Pneumococcal
[The pneumococcal vaccine is important for patients with a history of heart or lung disease,
recovering from a severe illness, age 65 years or older, or living in a long-term care facility]
The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has been
effective when the patient makes which statement about measures to prevent a relapse?
a)"I will seek immediate medical treatment for any upper respiratory infections."
b)"I should continue to do deep breathing and coughing exercises for at least 12 weeks."
c)"I will increase my food intake to 2400 calories a day to keep my immune system well."
d)"I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution.
“I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia’s resolution
[The follow-up chest x-ray examination will be done in 6 to 8 weeks to evaluate pneumonia resolution. A
patient should seek medical treatment for upper respiratory infections that persist for more than 7
days]
what are pulmonary fungal infections caused by ?
inhalation of spores
Do patients with pulmonary fungal infections need to be on isolation?
No.
[Since these infections are not transmitted from person to person, the patient does not have to be
placed in isolation]
What is the mainstay treatment for pulmonary fungal infections ?
Amphotericin B
What is the most effective noninvasive evaluating for lung cancer ?
CT scan
[biopsy for true diagnosis]
what is the treatment of choice in non-small cell lung cancers?
surgical resection
, what type of pneumothorax occurs due to the rupture of small blebs on the surface of the lungs ?
spontaneous pneumothorax
what is the timeframe for delirium development ?
2-3 days
what is the main contributing factor to delirium ?
impairment of cerebral oxidative metabolism
What is the leading risk factor for delirium ?
Dementia
What type of breathing is assoc. with Metabolic Acidosis?
hyperventilation
[kussmaul]
how many sputum specimens are needed to test for pulmonary TB?
three consecutive tests
How is TB definitively diagnosed?
tubercle bacilli musty be present in sputum culture
[can take up to 8 weeks]
Who is most likely to have received the Bacillile-Calmette-Guerin (BCG) vaccine for TB?
infants in parts of the world with a high prevalence of TB
What is the Bacillile-Calmette-Guerin (BCG) vaccine?
an attenuated strain of Mycobacterium bovis
Is the Bacillile-Calmette-Guerin (BCG) vaccine routine in the US?
No
[only for at risk health care workers]
What are the precautions for TB in the hospital?
airborne precautions with negative pressure room
[providers wear HEPA masks into room]
How often should a patient with pneumonia be turned?
every 2 hours to facilitate mobilization of secretions
To prevent aspiration in pneumonia, how high should the HOB be raised?
