ch23 Questions with Answers
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?
3 to 5 days
1 to 3 weeks
6 to 12 months
2 to 4 months - correct answers6-12 months
Prophylactic isoniazid therapy must continue for 6 to 12 months at a daily dosage of 300 mg. Taking the
drug for less than 6 months may not provide adequate protection against tuberculosis.
A nurse is caring for a client with chest trauma. Which nursing diagnosis takes the highest priority?
Ineffective tissue perfusion (cardiopulmonary)
Impaired gas exchange
Anxiety
Decreased cardiac output - correct answersImpaired gas exchange
For a client with chest trauma, a diagnosis of Impaired gas exchange takes priority because adequate gas
exchange is essential for survival. Although the other nursing diagnoses — Anxiety, Decreased cardiac
output, and Ineffective tissue perfusion (cardiopulmonary) — are possible for this client, they are lower
priorities than Impaired gas exchange.
A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest
bacterial pneumonia?
Dyspnea and wheezing
Nonproductive cough and normal temperature
Hemoptysis and dysuria
Sore throat and abdominal pain - correct answersDyspnea and wheezing
, In a client with bacterial pneumonia, retained secretions cause dyspnea, and respiratory tract
inflammation causes wheezing. Bacterial pneumonia also produces a productive cough and fever, rather
than a nonproductive cough and normal temperature. Sore throat occurs in pharyngitis, not bacterial
pneumonia. Abdominal pain is characteristic of a GI disorder, unlike chest pain, which can reflect a
respiratory infection such as pneumonia. Hemoptysis and dysuria aren't associated with pneumonia.
When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving
which set of problems?
Hypotension, hyperoxemia, and hypercapnia
Hyperoxemia, hypocapnia, and hyperventilation
Hypercapnia, hypoventilation, and hypoxemia
Hyperventilation, hypertension, and hypocapnia - correct answershypercapnia, hypoventilation, and
hypoxemia
The cardinal physiologic abnormalities of acute respiratory failure are hypercapnia, hypoventilation, and
hypoxemia. The nurse should focus on resolving these problems.
A client asks a nurse a question about the Mantoux test for tuberculosis. The nurse should base her
response on the fact that the:
area of redness is measured in 3 days and determines whether tuberculosis is present.
test stimulates a reddened response in some clients and requires a second test in 3 months.
skin test doesn't differentiate between active and dormant tuberculosis infection.
presence of a wheal at the injection site in 2 days indicates active tuberculosis. - correct answersskin
test doesn't differentiate between active and dormant tuberculosis infection.
The Mantoux test doesn't differentiate between active and dormant infections. If a positive reaction
occurs, a sputum smear and culture as well as a chest X-ray are necessary to provide more information.
Although the area of redness is measured in 3 days, a second test may be needed; neither test indicates
that tuberculosis is active. In the Mantoux test, an induration 5 to 9 mm in diameter indicates a
borderline reaction; a larger induration indicates a positive reaction. The presence of a wheal within 2
days doesn't indicate active tuberculosis.