Question 1

The emergency department (ED)manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia.What outcome demonstrates that goals for this client type have been met?

Accepted Answer

Goals for treatment of community-acquired pneumonia include initiating antibiotics prior to inpatient admission or within 6 hours of presentation to the ED.Timely collection of blood cultures,chest x-ray,and pulse oximetry are important as well but do not coincide with established goals.

Question 2

Which teaching point is most important for the client with bacterial pharyngitis?

Accepted Answer

Any client on antibiotics must be instructed to complete the entire course of antibiotics.Not completing them can lead to complications or drug-resistant strains of bacteria.The other instructions are appropriate,just not the most important.

Question 3

A client has been diagnosed with tuberculosis (TB).What action by the nurse takes highest priority?

Accepted Answer

The treatment regimen for TB ranges from 6 to 12 months,making adherence problematic for many people.The nurse should stress the absolute importance of following the treatment plan for the entire duration of prescribed therapy.The other options are appropriate topics to educate this client on but do not take priority.

Question 4

A client is in the family medicine clinic reporting a dry,sore throat.The provider asks the nurse to assess for odynophagia.What assessment technique is most appropriate?

Accepted Answer

Odynophagia is painful swallowing.The nurse should assess the client for this either by asking or by having the client attempt to drink water.It is not related to specific foods and is not assessed by palpating the jaw.Being unable to swallow saliva is not odynophagia,but it would be a serious situation.

Question 5

A client is in the family practice clinic reporting a severe cough that has lasted for 5 weeks.The client is so exhausted after coughing that work has become impossible.What action by the nurse is most appropriate?

Accepted Answer

Polymerase chain reaction testing is used to diagnose pertussis,which this client is showing manifestations of.Hospitalization may or may not be needed but is not the most important action.The client may or may not be able to produce sputum,but sputum cultures for this disease must be obtained via deep suctioning.Blood cultures will be negative.

Question 6

The charge nurse on a medical unit is preparing to admit several "clients" who have possible pandemic flu during a preparedness drill.What action by the nurse is best?

Accepted Answer

Preventing the spread of pandemic flu is equally important as caring for the clients who have it.Clients can be cohorted together in the same set of rooms on one part of the unit to use distancing to help prevent the spread of the disease.The other actions are not appropriate.

Question 7

A client is in the family practice clinic reporting a severe "cold" that started 4 days ago.On examination,the nurse notes the client also has a severe headache and muscle aches.What action by the nurse is best?

Accepted Answer

Sneezing and coughing into one's sleeve helps prevent the spread of upper respiratory infections.The client does have manifestations of the flu (influenza),but it is too late to start antiviral medications; to be effective,they must be started within 24 to 48 hours of symptom onset.The client does not need hospital admission.The client should be instructed to have a flu vaccination,but now that he or she has the flu,vaccination will have to wait until next year.

Question 8

A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is worse when bending over,tenderness across the cheeks,and postnasal discharge.What instruction will be most helpful?

Accepted Answer

This client has rhinosinusitis.Comfort measures for this condition include breathing in warm steam,hot packs,nasal saline irrigations,sleeping with the head elevated,increased fluids,and avoiding cigarette smoke.The client does not need a CT scan.

Question 9

A nurse working in a geriatric clinic sees clients with "cold" symptoms and rhinitis.Which drug would be appropriate to teach these clients to take for their symptoms?

Accepted Answer

First-generation antihistamines are not appropriate for use in the older population.These drugs include chlorpheniramine,diphenhydramine,and hydroxyzine.Fexofenadine is a second-generation antihistamine.

Question 10

A client has been admitted for suspected inhalation anthrax infection.What question by the nurse is most important?

Accepted Answer

Inhalation anthrax is rare and is an occupational hazard among people who work with animal wool,bone meal,hides,and skin,such as taxidermists and veterinarians.Inhalation anthrax seen in someone without an occupational risk is considered a bioterrorism event and must be reported to authorities immediately.The other questions are appropriate for anyone with an infection.

Question 11

A nurse has educated a client on isoniazid (INH).What statement by the client indicates teaching has been effective?

Accepted Answer

INH needs to be taken on an empty stomach,either 1 hour before or 2 hours after meals.Extra vitamin B needs to be taken while on the drug.Staining of contact lenses commonly occurs while taking rifampin (Rifadin).

Question 12

A client seen in the emergency department reports fever,fatigue,and dry cough but no other upper respiratory symptoms.A chest x-ray reveals mediastinal widening.What action by the nurse is best?

Accepted Answer

This client has manifestations of early inhalation anthrax.For treatment,after IV antibiotics are finished,oral antibiotics are continued for at least 60 days.Sputum cultures are not needed.Anthrax is not transmissible from person to person,so Standard Precautions are adequate.Directly observed therapy is often used for tuberculosis.

Question 13

A client has been taking isoniazid (INH)for tuberculosis for 3 weeks.What laboratory results need to be reported to the health care provider immediately?

Accepted Answer

INH can cause liver damage,especially if the client drinks alcohol.The ALT (one of the liver enzymes)is extremely high and needs to be reported immediately.The albumin and RBCs are normal.The WBCs are slightly high,but that would be an expected finding in a client with an infection.

Question 14

A client admitted for pneumonia has been tachypneic for several days.When the nurse starts an IV to give fluids,the client questions this action,saying "I have been drinking tons of water.How am I dehydrated?" What response by the nurse is best?

Accepted Answer

Tachypnea and mouth breathing,both seen in pneumonia,increase insensible water loss and can lead to a degree of dehydration.The other options do not give the client useful information.

Question 15

A client is being discharged on long-term therapy for tuberculosis (TB).What referral by the nurse is most appropriate?

Accepted Answer

Directly observed therapy is often utilized for managing clients with TB in the community.Meals on Wheels,job retraining,and home therapy may or may not be appropriate.

Question 16

A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia.To reduce this risk,what activity should the nurse delegate to the unlicensed assistive personnel (UAP)?

Accepted Answer

Oral colonization by gram-negative bacteria is a risk factor for healthcare-associated pneumonia.Good,frequent oral care can help prevent this from developing and is a task that can be delegated to the UAP.Encouraging good nutrition is important,but this will not prevent pneumonia.Monitoring temperature and reporting new cough in clients is important to detect the onset of possible pneumonia but do not prevent it.

Question 17

An older adult is brought to the emergency department by a family member,who reports a moderate change in mental status and mild cough.The client is afebrile.The health care provider orders a chest x-ray.The family member questions why this is needed since the manifestations seem so vague.What response by the nurse is best?

Accepted Answer

It is essential to obtain an early chest x-ray in older adults suspected of having pneumonia because symptoms are often vague.Waiting until definitive manifestations are present to obtain the x-ray leads to a costly delay in treatment.Stating that chest x-rays are always ordered does not give the family definitive information.The x-ray can be done while laboratory values are still pending,but this also does not provide specific information about the importance of a chest x-ray in this client.The client has manifestations of pneumonia,so the staff is not testing for any possible source of infection but rather is testing for a suspected disorder.

Question 18

A client is admitted with suspected pneumonia from the emergency department.The client went to the primary care provider a "few days ago" and shows the nurse the results of what the client calls "an allergy test," as shown below:

What action by the nurse takes priority?

Accepted Answer

This "allergy test" is actually a positive tuberculosis test.The client should be placed on Airborne Precautions immediately.The other options do not take priority over preventing the spread of the disease.

Question 19

A client has been hospitalized with tuberculosis (TB).The client's spouse is fearful of entering the room where the client is in isolation and refuses to visit.What action by the nurse is best?

Accepted Answer

The nurse needs to obtain further information about the spouse's specific fears so they can be addressed.This will decrease stress and permit visitation,which will be beneficial for both client and spouse.Precautions for TB prevent transmission to all who come into contact with the client.Explaining isolation precautions and what to do when entering the room will be helpful,but this is too narrow in scope to be the best answer.Telling the spouse it's safe to visit is demeaning of the spouse's feelings.

Question 20

A client has the diagnosis of "valley fever" accompanied by myalgias and arthralgias.What treatment should the nurse educate the client on?

Accepted Answer

"Valley fever," or coccidioidomycosis,is a fungal infection.Many people do not need treatment and the disease resolves on its own.However,the presence of joint and muscle pain indicates a moderate infection that needs treatment with antifungal medications.IV amphotericin is reserved for pregnant women and those with severe infection.Anti-inflammatory medications may be used to treat muscle aches and pain but are not used long term.

Quiz 31: Care of Patients with Infectious Respiratory Problems

The emergency department (ED) manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia.What outcome demonstrates that goals for this client type have been met?

Which teaching point is most important for the client with bacterial pharyngitis?

A client has been diagnosed with tuberculosis (TB) .What action by the nurse takes highest priority?

A client is in the family medicine clinic reporting a dry,sore throat.The provider asks the nurse to assess for odynophagia.What assessment technique is most appropriate?

A client is in the family practice clinic reporting a severe cough that has lasted for 5 weeks.The client is so exhausted after coughing that work has become impossible.What action by the nurse is most appropriate?

The charge nurse on a medical unit is preparing to admit several "clients" who have possible pandemic flu during a preparedness drill.What action by the nurse is best?

A client is in the family practice clinic reporting a severe "cold" that started 4 days ago.On examination,the nurse notes the client also has a severe headache and muscle aches.What action by the nurse is best?

A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is worse when bending over,tenderness across the cheeks,and postnasal discharge.What instruction will be most helpful?

A nurse working in a geriatric clinic sees clients with "cold" symptoms and rhinitis.Which drug would be appropriate to teach these clients to take for their symptoms?

A client has been admitted for suspected inhalation anthrax infection.What question by the nurse is most important?

A nurse has educated a client on isoniazid (INH) .What statement by the client indicates teaching has been effective?

A client seen in the emergency department reports fever,fatigue,and dry cough but no other upper respiratory symptoms.A chest x-ray reveals mediastinal widening.What action by the nurse is best?

A client has been taking isoniazid (INH) for tuberculosis for 3 weeks.What laboratory results need to be reported to the health care provider immediately?

A client admitted for pneumonia has been tachypneic for several days.When the nurse starts an IV to give fluids,the client questions this action,saying "I have been drinking tons of water.How am I dehydrated?" What response by the nurse is best?

A client is being discharged on long-term therapy for tuberculosis (TB) .What referral by the nurse is most appropriate?

A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia.To reduce this risk,what activity should the nurse delegate to the unlicensed assistive personnel (UAP) ?

A client is admitted with suspected pneumonia from the emergency department.The client went to the primary care provider a "few days ago" and shows the nurse the results of what the client calls "an allergy test," as shown below: What action by the nurse takes priority?

A client has been hospitalized with tuberculosis (TB) .The client's spouse is fearful of entering the room where the client is in isolation and refuses to visit.What action by the nurse is best?

A client has the diagnosis of "valley fever" accompanied by myalgias and arthralgias.What treatment should the nurse educate the client on?