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MSN Exam for Pneumonia and Tuberculosis (PM)
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Question 1
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:
A
Metabolic acidosis
B
Carbon monoxide poisoning
C
Respiratory alkalosis
D
Carbon dioxide narcosis
Question 1 Explanation:
Carbon dioxide narcosis is a condition that results from extreme hypercapnia, with carbon dioxide levels in excess of 70 mm Hg. The client experiences symptoms such as confusion and tremors, which may progress to convulsions and possible coma.
Question 2
Which of the following symptoms is common in clients with TB?
A
Mental status changes
B
Weight loss
C
Increased appetite
D
Dyspnea on exertion
Question 2 Explanation:
TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats.
Question 3
Which of the following family members exposed to TB would be at highest risk for contracting the disease?
A
8-year-old son
B
17-year-old daughter
C
76-year-old grandmother
D
45-year-old mother
Question 3 Explanation:
Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups.
Question 4
A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
A
sputum culture and sensitivity
B
Blood cultures
C
Chest x-ray
D
ABG analysis
Question 4 Explanation:
Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show the area of lung consolidation. ABG analysis will determine the extent of hypoxia present due to the pneumonia, and blood cultures will help determine if the infection is systemic.
Question 5
The Causative agent of Tuberculosis is said to be:
A
Hansen’s Bacilli
B
Mycobacterium Tuberculosis
C
Bacillus Anthracis
D
Group A Beta Hemolytic Streptococcus
Question 6
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?
A
Visit the clinic weekly to ask him whether he is taking his medications regularly.
B
Remind the client that TB can be fatal if not taken properly.
C
Ask the client’s spouse to supervise the daily administration of the medications.
D
Notify the physician of the client’s non-compliance and request a different prescription.
Question 6 Explanation:
Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.
Question 7
Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?
A
Bronchodilators
B
Hyperbaric chamber
C
Chest tube placement
D
Antibiotics
Question 7 Explanation:
The only way to reexpand the lung is to place a chest tube on the right side so the air in the pleural space can be removed and the lung reexpanded.
Question 8
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?
A
Sensitivity testing
B
Agglunitnation testing
C
Dark-field illumination
D
Acid-fast staining
Question 8 Explanation:
The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.
Question 9
A high level of oxygen exerts which of the following effects on the lung?
A
Improves oxygen uptake
B
Stabilizes carbon dioxide levels
C
Increases carbon dioxide levels
D
Reduces amount of functional alveolar surface area
Question 9 Explanation:
Oxygen toxicity causes direct pulmonary trauma, reducing the amount of alveolar surface area available for gaseous exchange, which results in increased carbon dioxide levels and decreased oxygen uptake.
Question 10
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?
A
Frequent offering of a bedpan.
B
Nasotracheal suctioning to clear secretions
C
Frequent linen changes
D
Position changes q4h
Question 10 Explanation:
Frequent linen changes are appropriate for this client because of diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario.
Question 11
A pulse oximetry gives what type of information about the client?
A
Amount of oxygen in the blood
B
Amount of carbon dioxide in the blood
C
Respiratory rate
D
Percentage of hemoglobin carrying oxygen
Question 11 Explanation:
The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn’t ensure that the oxygen being carried through the bloodstream is actually being taken up by the tissue.
Question 12
Which of the following best describes pleural effusion?
A
The collapse of bronchiole
B
The accumulation of fluid between the linings of the pleural space.
C
The fluid in the alveolar space
D
The collapse of alveoli
Question 12 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 13
The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
A
Decreased oxygenation of the blood.
B
Decreased cardiac output
C
Pleural effusion
D
Inadequate peripheral circulation
Question 13 Explanation:
A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation.
Question 14
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?
A
Decreased residual volume
B
Increased number of functional capillaries in the alveoli
C
Increased elastic recoil of the lungs
D
Decreased vital capacity
Question 14 Explanation:
Reduction in VC is a normal physiologic change in the older adult. Other normal physiologic changes include decreased elastic recoil of the lungs, fewer functional capillaries in the alveoli, and an increase is residual volume.
Question 15
A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?
A
Acute pain related to lung expansion secondary to lung infection
B
Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever.
C
Ineffective airway clearance related to retained secretions.
D
Anxiety related to dyspnea and chest pain.
Question 15 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 16
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?
A
Give a prescription for isoniazid, 300mg daily for 2 weeks, and send him home.
B
Prescribe isoniazid and tell him to go home and rest
C
Admit him to the hospital in respiratory isolation
D
Give a tuberculin test and tell him to come back in 48 hours and have it read.
Question 16 Explanation:
The client is showing s/s of active TB and, because of the 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 17
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:
A
Eggs and spinach
B
Grains and broccoli
C
Potatoes and fish
D
Meats and citrus fruits
Question 17 Explanation:
The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.
Question 18
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?
A
½” to 3/8” 26 or 27G needle.
B
5/8” to ½” 25G to 27G needle.
C
1” 20G needle.
D
1” to 3” 20G to 25G needle.
Question 18 Explanation:
Intradermal injections like those used in TN skin tests are administered in small volumes (usually 0.5 ml or less) into the outer skin layers to produce a 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 19
A client with primary TB infection can expect to develop which of the following conditions?
A
Active TB within 2 weeks
B
A positive skin test
C
Active TB within 1 month
D
A fever that requires hospitalization
Question 19 Explanation:
A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime, in many 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 20
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?
A
Provide fluid intake of 3 L/day
B
Provide frequent linen changes.
C
Maintain complete bedrest
D
Administer oxygen therapy
Question 20 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 21
An elderly client with pneumonia may appear with which of the following symptoms first?
A
Pleuritic chest pain and cough
B
Fever and chills
C
Hemoptysis and dyspnea
D
Altered mental status and dehydration
Question 21 Explanation:
Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
Question 22
Which of the following organisms most commonly causes community-acquired pneumonia in adults?
A
Haemiphilus influenzae
B
Klebsiella pneumoniae
C
Steptococcus pneumoniae
D
Staphylococcus aureus
Question 22 Explanation:
Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most common cause of community-acquired pneumonia. H. influenzae is the most common cause of infection in children. Klebsiella species is the most common gram-negative organism found in the hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.
Question 23
A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has:
A
Had contact with Mycobacterium tuberculosis
B
Active TB
C
Developed a resistance to tubercle bacilli
D
Developed passive immunity to TB.
Question 23 Explanation:
A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.
Question 24
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?
A
To determine the extent of the lesions
B
To determine if this is a primary or secondary infection
C
To confirm the diagnosis
D
To determine if a repeat skin test is needed
Question 24 Explanation:
If the lesions are large enough, the chest x-ray will show their presence in the lungs. Sputum culture confirms the diagnosis. There can be false-positive and false-negative skin test results. A chest x-ray can’t determine if this is a primary or secondary infection.
Question 25
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
A bloody, productive cough
B
Dyspnea
C
Chest pain
D
A cough with the expectoration of mucoid sputum
Question 25 Explanation:
One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum.
Question 26
Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
A
stick a needle in the area of decreased breath sounds
B
Take a chest x-ray
C
Have the client use an incentive spirometer
D
Auscultate breath sounds
Question 26 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 27
Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?
A
Gaseous exchange occurs in the alveolar membrane.
B
Alveoli need oxygen to live
C
Alveoli have no effect on oxygenation
D
Collapsed alveoli increase oxygen demand
Question 27 Explanation:
Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs, Collapsed alveoli receive oxygen, as well as other nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen demand, though by decreasing the surface area available for gas exchange, they decrease oxygenation of the blood.
Question 28
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?
A
Decreased shortness of breath
B
Positive acid-fast bacilli in a sputum sample after 2 months of treatment.
C
Nonproductive cough
D
Improved chest x-ray
Question 28 Explanation:
Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.
Question 29
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?
A
Superinfection
B
Primary infection
C
Tertiary infection
D
Active infection
Question 29 Explanation:
Some people carry dormant TB infections that may develop into active disease. In addition, primary sites of infection containing TB bacilli may remain inactive for years and then activate when the client’s resistance is lowered, as when a client is being treated for cancer. There’s no such thing as tertiary infection, and superinfection doesn’t apply in this case.
Question 30
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?
A
Chills and night sweats
B
High-grade fever
C
Nonproductive or productive cough
D
Anorexia and weight loss
Question 30 Explanation:
The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.
Question 31
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:
A
He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test.
B
He had TB in the past and no longer has it.
C
He was successfully treated for TB, but skin tests always stay positive.
D
He’s a “seroconverter”, meaning the TB has gotten to his bloodstream.
Question 31 Explanation:
A tuberculin converter’s skin test will be positive, meaning he has been exposed to an infected with TB and now has a cell-mediated immune response to the skin test. The client’s blood and x-ray results may stay negative. It doesn’t mean the infection has advanced to the active stage. Because his x-ray is negative, he should be monitored every 6 months to see if he develops changes in his x-ray or pulmonary examination. Being a seroconverter doesn’t mean the TB has gotten into his bloodstream; it means it can be detected by a blood test.
Question 32
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 isonaizid, 300mg daily, for how long?
A
9 to 12 months
B
10 to 14 days
C
2 to 4 weeks
D
3 to 6 months
Question 32 Explanation:
Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoaizid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.
Question 33
Which of the following diagnostic tests is definitive for TB?
A
Mantoux test
B
Sputum culture
C
Chest x-ray
D
Tuberculin test
Question 33 Explanation:
The sputum culture for Myobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung may not be big enough to be seen on x-ray. Skin tests may be falsely positive or falsely negative.
Question 34
Which of the following antituberculus drugs can cause damage to the eighth cranial nerve?
A
Isoniazid
B
Para-aminosalicylic acid
C
Ethambutol hydrochloride
D
Streptomycin
Question 34 Explanation:
Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity) is a common side effect from amintoglycodsides.
Question 35
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?
A
Supplement the diet with pyridoxine (vitamin B6)
B
Avoid excessive sun exposure.
C
Get extra rest
D
Adhere to a low cholesterol diet
Question 35 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 36
What effect does hemoglobin amount have on oxygenation status?
A
No effect
B
More hemoglobin reduces the client’s respiratory rate
C
Low hemoglobin levels cause reduces oxygen-carrying capacity
D
Low hemoglobin levels cause increased oxygen-carrying capacity.
Question 36 Explanation:
Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying capacity is also low. More hemoglobin will increase oxygen-carrying capacity and thus increase the total amount of oxygen available in the blood. If the client has been tachypneic during exertion, or even at rest, because oxygen demand is higher than the available oxygen content, then an increase in hemoglobin may decrease the respiratory rate to normal levels.
Question 37
Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia?
A
A respiratory rate of 25 to 30 breaths per minute
B
Chest pain that is minimized by splinting the ribcage.
C
The ability to perform ADL’s without dyspnea
D
A maximum loss of 5 to 10 pounds of body weight
Question 37 Explanation:
An expected outcome for a client recovering from pneumonia would be the ability to perform ADL’s without experiencing dyspnea. A respiratory rate of 25 to 30 breaths/minute indicates the client is experiencing tachypnea, which would not be expected on recovery. A weight loss of 5-10 pounds is undesirable; the expected outcome would be to maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.
Question 38
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?
A
Allergy to penicillin
B
Rheumatic fever
C
Hepatitis B
D
Heart disease
Question 38 Explanation:
Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.
Question 39
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?
A
Acute asthma
B
Chronic bronchitis
C
Spontaneous pneumothorax
D
Pneumonia
Question 39 Explanation:
A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of functional lung used in 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 40
Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic patients by which of the following methods?
A
The mask provides 100% oxygen to the client.
B
The mask provides continuous air that the client can breathe.
C
The mask provides pressurized at the end of expiration to open collapsed alveoli.
D
The mask provides pressurized oxygen so the client can breathe more easily.
Question 40 Explanation:
The mask provides pressurized oxygen continuously through both inspiration and expiration. The mask can be set to deliver any amount of oxygen needed. By providing the client with pressurized oxygen, the client has less resistance to overcome in taking his next breath, making it easier to breathe. Pressurized oxygen delivered at the end of expiration is positive end-expiratory pressure (PEEP), not continuous positive airway pressure.
Question 41
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?
A
Positive
B
Needs to be redone
C
Negative
D
Indeterminate
Question 41 Explanation:
This test would be classed as negative. A 5mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn’t a term used to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it’s considered positive according to the CDC.
Question 42
The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms?
A
Difficulty swallowing
B
Vertigo
C
Facial paralysis
D
Impaired vision
Question 42 Explanation:
The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve.
Question 43
The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB?
A
Increase intake of dairy products
B
Limit alcohol intake
C
Double the dosage if a drug dose is forgotten
D
Take the medication with antacids
Question 43 Explanation:
INH and rifampin are hepatoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.
Question 44
Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is present?
A
Malnutrition
B
Severe periodontal disease
C
Dehydration
D
Group living
Question 44 Explanation:
Clients with chronic illnesses generally have poor immune systems. Often, residing in group living situations increases the chance of disease transmission.
Question 45
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?
A
Metabolic acidosis
B
Respiratory acidosis
C
Respiratory alkalosis
D
Metabolic alkalosis
Question 46
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?
A
Chest x-ray
B
Auscultation of breath sounds
C
Echocardiogram
D
Electrocardiogram (ECG)
Question 46 Explanation:
Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest x-ray and an ECG, but a physician must order these tests. Unless a cardiac source for the client’s pain is identified, he won’t need an echocardiogram.
Question 47
Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia? Select all that apply.
A
Presence of peripheral edema
B
Color of nail beds
C
Auscultation of breath sounds
D
Auscultation of bowel sounds
E
Presence of chest pain.
Question 47 Explanation:
A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client’s ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the patient with pneumonia.
Question 48
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?
A
Antibiotics
B
Nutritional intake
C
Oxygen
D
Bed rest
Question 48 Explanation:
The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a 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 49
Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
A
Coma
B
Apathy
C
Irritability
D
Depression
Question 49 Explanation:
Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness, or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.
Question 50
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?
A
15 mcg/mL
B
25 mcg/mL
C
30 mcg/mL
D
5 mcg/mL
Question 50 Explanation:
The therapeutic theophylline blood level range from 10-20 mcg/mL.
Question 51
The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a 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.
A
Respiratory rate of 32 breaths/minute
B
Continued dyspnea
C
Fever of 102ºF
D
Vesicular breath sounds in right base
Question 51 Explanation:
If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal vesicular breath sounds. If the client still has dyspnea, fever, and increased respiratory rate, he should be examined by the physician before discharge because he may have another source of infection or still have pneumonia.
Question 52
A client has active TB. Which of the following symptoms will he exhibit?
A
Fever of more than 104ºF and nausea
B
Chest and lower back pain
C
Headache and photophobia
D
Chills, fever, night sweats, and hemoptysis
Question 52 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 53
When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation?
A
Vesicular
B
Tubular
C
Bronchovestibular
D
Bronchial
Question 53 Explanation:
Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchiovesicular are normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly heard in the bases of the lung fields.
Question 54
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:
A
Positive
B
Inconclusive
C
The need for repeat testing.
D
Negative
Question 54 Explanation:
The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client.
Question 55
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?
A
Using continuous suction while advancing the catheter.
B
Using intermittent suction while withdrawing the catheter.
C
Using continuous suction while withdrawing the catheter.
D
Using intermittent suction while advancing the catheter.
Question 55 Explanation:
Intermittent suction should be applied during catheter withdrawal. To prevent hypoxia, suctioning shouldn’t last more than 10-seconds at a time. Suction shouldn’t be applied while the catheter is being advanced.
Question 56
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.
A
“It is important that I isolate myself from family when possible.”
B
“I should use paper tissues to cough in and dispose of them properly.”
C
“I should always cover my mouth and nose when sneezing.”
D
“I can use regular plate and utensils whenever I eat.”
E
“I will need to dispose of my old clothing when I return home.”
Question 57
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?
A
Performing paracentesis
B
Inserting a chest tube
C
Performing thoracentesis
D
Allowing the pleural effusion to drain by itself.
Question 57 Explanation:
Performing thoracentesis is used to remove excess pleural fluid. The fluid is then analyzed to determine if it’s transudative or exudative. Transudates are substances that have passed through a membrane and usually occur in low protein states. Exudates are substances that have escaped from blood vessels. They contain an accumulation of cells and have a high specific gravity and a high lactate dehydrogenase level. Exudates usually occur in response to a malignancy, infection, or inflammatory process. A chest tube is rarely necessary because the amount of fluid typically isn’t large enough to warrant such a measure. Pleural effusions can’t drain by themselves.
Question 58
A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and coughs. Which action should the nurse take?
A
Remove the airway and attempt suctioning without it.
B
Leave the airway in place until the client gets used to it.
C
Remove the airway and insert a shorter one.
D
Reposition the airway.
Question 58 Explanation:
If a client gags or coughs after nasopharyngeal airway placement, the tube may be too long. The nurse should remove it and insert a shorter one. Simply repositioning the airway won’t solve the problem. The client won’t get used to the tube because it’s the wrong size. Suctioning without a nasopharyngeal airway causes trauma to the natural airway.
Question 59
A client diagnosed with active TB would be hospitalized primarily for which of the following reasons?
A
To determine the need for antibiotic therapy.
B
To determine his compliance
C
To evaluate his condition
D
to prevent spread of the disease
Question 59 Explanation:
The client with active TB is highly contagious until three consecutive sputum cultures are negative, so he’s put in respiratory isolation in the hospital.
Question 60
Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop?
A
Bronchiectasis
B
Atelectasis
C
Inflammation
D
Effusion
Question 60 Explanation:
The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiecrasis 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.
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MSN Exam for Pneumonia and Tuberculosis (EM)
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Question 1
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?
A
5/8” to ½” 25G to 27G needle.
B
½” to 3/8” 26 or 27G needle.
C
1” to 3” 20G to 25G needle.
D
1” 20G needle.
Question 1 Explanation:
Intradermal injections like those used in TN skin tests are administered in small volumes (usually 0.5 ml or less) into the outer skin layers to produce a 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 2
Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?
A
Alveoli have no effect on oxygenation
B
Alveoli need oxygen to live
C
Gaseous exchange occurs in the alveolar membrane.
D
Collapsed alveoli increase oxygen demand
Question 2 Explanation:
Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs, Collapsed alveoli receive oxygen, as well as other nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen demand, though by decreasing the surface area available for gas exchange, they decrease oxygenation of the blood.
Question 3
The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a 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.
A
Respiratory rate of 32 breaths/minute
B
Vesicular breath sounds in right base
C
Continued dyspnea
D
Fever of 102ºF
Question 3 Explanation:
If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal vesicular breath sounds. If the client still has dyspnea, fever, and increased respiratory rate, he should be examined by the physician before discharge because he may have another source of infection or still have pneumonia.
Question 4
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.
A
“I should use paper tissues to cough in and dispose of them properly.”
B
“I can use regular plate and utensils whenever I eat.”
C
“I will need to dispose of my old clothing when I return home.”
D
“It is important that I isolate myself from family when possible.”
E
“I should always cover my mouth and nose when sneezing.”
Question 5
A high level of oxygen exerts which of the following effects on the lung?
A
Reduces amount of functional alveolar surface area
B
Increases carbon dioxide levels
C
Stabilizes carbon dioxide levels
D
Improves oxygen uptake
Question 5 Explanation:
Oxygen toxicity causes direct pulmonary trauma, reducing the amount of alveolar surface area available for gaseous exchange, which results in increased carbon dioxide levels and decreased oxygen uptake.
Question 6
A client with primary TB infection can expect to develop which of the following conditions?
A
Active TB within 2 weeks
B
Active TB within 1 month
C
A positive skin test
D
A fever that requires hospitalization
Question 6 Explanation:
A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime, in many 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 7
A client diagnosed with active TB would be hospitalized primarily for which of the following reasons?
A
To evaluate his condition
B
To determine his compliance
C
to prevent spread of the disease
D
To determine the need for antibiotic therapy.
Question 7 Explanation:
The client with active TB is highly contagious until three consecutive sputum cultures are negative, so he’s put in respiratory isolation in the hospital.
Question 8
Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?
A
Antibiotics
B
Chest tube placement
C
Bronchodilators
D
Hyperbaric chamber
Question 8 Explanation:
The only way to reexpand the lung is to place a chest tube on the right side so the air in the pleural space can be removed and the lung reexpanded.
Question 9
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?
A
Electrocardiogram (ECG)
B
Echocardiogram
C
Chest x-ray
D
Auscultation of breath sounds
Question 9 Explanation:
Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest x-ray and an ECG, but a physician must order these tests. Unless a cardiac source for the client’s pain is identified, he won’t need an echocardiogram.
Question 10
Which of the following symptoms is common in clients with TB?
A
Weight loss
B
Increased appetite
C
Dyspnea on exertion
D
Mental status changes
Question 10 Explanation:
TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats.
Question 11
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?
A
Increased elastic recoil of the lungs
B
Decreased vital capacity
C
Decreased residual volume
D
Increased number of functional capillaries in the alveoli
Question 11 Explanation:
Reduction in VC is a normal physiologic change in the older adult. Other normal physiologic changes include decreased elastic recoil of the lungs, fewer functional capillaries in the alveoli, and an increase is residual volume.
Question 12
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:
A
Respiratory alkalosis
B
Carbon monoxide poisoning
C
Carbon dioxide narcosis
D
Metabolic acidosis
Question 12 Explanation:
Carbon dioxide narcosis is a condition that results from extreme hypercapnia, with carbon dioxide levels in excess of 70 mm Hg. The client experiences symptoms such as confusion and tremors, which may progress to convulsions and possible coma.
Question 13
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
A bloody, productive cough
B
Dyspnea
C
Chest pain
D
A cough with the expectoration of mucoid sputum
Question 13 Explanation:
One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum.
Question 14
Which of the following best describes pleural effusion?
A
The collapse of alveoli
B
The accumulation of fluid between the linings of the pleural space.
C
The collapse of bronchiole
D
The fluid in the alveolar space
Question 14 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 15
Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic patients by which of the following methods?
A
The mask provides pressurized oxygen so the client can breathe more easily.
B
The mask provides continuous air that the client can breathe.
C
The mask provides 100% oxygen to the client.
D
The mask provides pressurized at the end of expiration to open collapsed alveoli.
Question 15 Explanation:
The mask provides pressurized oxygen continuously through both inspiration and expiration. The mask can be set to deliver any amount of oxygen needed. By providing the client with pressurized oxygen, the client has less resistance to overcome in taking his next breath, making it easier to breathe. Pressurized oxygen delivered at the end of expiration is positive end-expiratory pressure (PEEP), not continuous positive airway pressure.
Question 16
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?
A
Pneumonia
B
Spontaneous pneumothorax
C
Acute asthma
D
Chronic bronchitis
Question 16 Explanation:
A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of functional lung used in 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 17
The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms?
A
Difficulty swallowing
B
Facial paralysis
C
Vertigo
D
Impaired vision
Question 17 Explanation:
The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve.
Question 18
A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has:
A
Had contact with Mycobacterium tuberculosis
B
Active TB
C
Developed a resistance to tubercle bacilli
D
Developed passive immunity to TB.
Question 18 Explanation:
A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.
Question 19
Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop?
A
Inflammation
B
Effusion
C
Atelectasis
D
Bronchiectasis
Question 19 Explanation:
The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiecrasis 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 20
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:
A
Eggs and spinach
B
Potatoes and fish
C
Grains and broccoli
D
Meats and citrus fruits
Question 20 Explanation:
The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.
Question 21
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?
A
Supplement the diet with pyridoxine (vitamin B6)
B
Get extra rest
C
Adhere to a low cholesterol diet
D
Avoid excessive sun exposure.
Question 21 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 22
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 isonaizid, 300mg daily, for how long?
A
3 to 6 months
B
10 to 14 days
C
2 to 4 weeks
D
9 to 12 months
Question 22 Explanation:
Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoaizid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.
Question 23
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?
A
Frequent linen changes
B
Nasotracheal suctioning to clear secretions
C
Position changes q4h
D
Frequent offering of a bedpan.
Question 23 Explanation:
Frequent linen changes are appropriate for this client because of diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario.
Question 24
A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
A
Blood cultures
B
ABG analysis
C
sputum culture and sensitivity
D
Chest x-ray
Question 24 Explanation:
Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show the area of lung consolidation. ABG analysis will determine the extent of hypoxia present due to the pneumonia, and blood cultures will help determine if the infection is systemic.
Question 25
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?
A
Antibiotics
B
Bed rest
C
Oxygen
D
Nutritional intake
Question 25 Explanation:
The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a 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 26
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?
A
Performing thoracentesis
B
Performing paracentesis
C
Allowing the pleural effusion to drain by itself.
D
Inserting a chest tube
Question 26 Explanation:
Performing thoracentesis is used to remove excess pleural fluid. The fluid is then analyzed to determine if it’s transudative or exudative. Transudates are substances that have passed through a membrane and usually occur in low protein states. Exudates are substances that have escaped from blood vessels. They contain an accumulation of cells and have a high specific gravity and a high lactate dehydrogenase level. Exudates usually occur in response to a malignancy, infection, or inflammatory process. A chest tube is rarely necessary because the amount of fluid typically isn’t large enough to warrant such a measure. Pleural effusions can’t drain by themselves.
Question 27
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?
A
To determine the extent of the lesions
B
To confirm the diagnosis
C
To determine if a repeat skin test is needed
D
To determine if this is a primary or secondary infection
Question 27 Explanation:
If the lesions are large enough, the chest x-ray will show their presence in the lungs. Sputum culture confirms the diagnosis. There can be false-positive and false-negative skin test results. A chest x-ray can’t determine if this is a primary or secondary infection.
Question 28
Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia? Select all that apply.
A
Auscultation of bowel sounds
B
Color of nail beds
C
Presence of peripheral edema
D
Auscultation of breath sounds
E
Presence of chest pain.
Question 28 Explanation:
A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client’s ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the patient with pneumonia.
Question 29
Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
A
Irritability
B
Coma
C
Apathy
D
Depression
Question 29 Explanation:
Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness, or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.
Question 30
When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation?
A
Bronchovestibular
B
Vesicular
C
Bronchial
D
Tubular
Question 30 Explanation:
Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchiovesicular are normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly heard in the bases of the lung fields.
Question 31
The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
A
Pleural effusion
B
Decreased oxygenation of the blood.
C
Decreased cardiac output
D
Inadequate peripheral circulation
Question 31 Explanation:
A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation.
Question 32
Which of the following diagnostic tests is definitive for TB?
A
Chest x-ray
B
Sputum culture
C
Mantoux test
D
Tuberculin test
Question 32 Explanation:
The sputum culture for Myobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung may not be big enough to be seen on x-ray. Skin tests may be falsely positive or falsely negative.
Question 33
Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
A
Have the client use an incentive spirometer
B
stick a needle in the area of decreased breath sounds
C
Take a chest x-ray
D
Auscultate breath sounds
Question 33 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 34
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?
A
Admit him to the hospital in respiratory isolation
B
Give a tuberculin test and tell him to come back in 48 hours and have it read.
C
Prescribe isoniazid and tell him to go home and rest
D
Give a prescription for isoniazid, 300mg daily for 2 weeks, and send him home.
Question 34 Explanation:
The client is showing s/s of active TB and, because of the 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 35
What effect does hemoglobin amount have on oxygenation status?
A
More hemoglobin reduces the client’s respiratory rate
B
No effect
C
Low hemoglobin levels cause increased oxygen-carrying capacity.
D
Low hemoglobin levels cause reduces oxygen-carrying capacity
Question 35 Explanation:
Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying capacity is also low. More hemoglobin will increase oxygen-carrying capacity and thus increase the total amount of oxygen available in the blood. If the client has been tachypneic during exertion, or even at rest, because oxygen demand is higher than the available oxygen content, then an increase in hemoglobin may decrease the respiratory rate to normal levels.
Question 36
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?
A
Metabolic alkalosis
B
Respiratory acidosis
C
Respiratory alkalosis
D
Metabolic acidosis
Question 37
A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and coughs. Which action should the nurse take?
A
Remove the airway and attempt suctioning without it.
B
Reposition the airway.
C
Leave the airway in place until the client gets used to it.
D
Remove the airway and insert a shorter one.
Question 37 Explanation:
If a client gags or coughs after nasopharyngeal airway placement, the tube may be too long. The nurse should remove it and insert a shorter one. Simply repositioning the airway won’t solve the problem. The client won’t get used to the tube because it’s the wrong size. Suctioning without a nasopharyngeal airway causes trauma to the natural airway.
Question 38
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?
A
Acid-fast staining
B
Agglunitnation testing
C
Sensitivity testing
D
Dark-field illumination
Question 38 Explanation:
The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.
Question 39
The Causative agent of Tuberculosis is said to be:
A
Mycobacterium Tuberculosis
B
Bacillus Anthracis
C
Hansen’s Bacilli
D
Group A Beta Hemolytic Streptococcus
Question 40
A pulse oximetry gives what type of information about the client?
A
Percentage of hemoglobin carrying oxygen
B
Respiratory rate
C
Amount of carbon dioxide in the blood
D
Amount of oxygen in the blood
Question 40 Explanation:
The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn’t ensure that the oxygen being carried through the bloodstream is actually being taken up by the tissue.
Question 41
Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is present?
A
Dehydration
B
Group living
C
Severe periodontal disease
D
Malnutrition
Question 41 Explanation:
Clients with chronic illnesses generally have poor immune systems. Often, residing in group living situations increases the chance of disease transmission.
Question 42
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?
A
Using intermittent suction while withdrawing the catheter.
B
Using continuous suction while advancing the catheter.
C
Using intermittent suction while advancing the catheter.
D
Using continuous suction while withdrawing the catheter.
Question 42 Explanation:
Intermittent suction should be applied during catheter withdrawal. To prevent hypoxia, suctioning shouldn’t last more than 10-seconds at a time. Suction shouldn’t be applied while the catheter is being advanced.
Question 43
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?
A
Ask the client’s spouse to supervise the daily administration of the medications.
B
Visit the clinic weekly to ask him whether he is taking his medications regularly.
C
Remind the client that TB can be fatal if not taken properly.
D
Notify the physician of the client’s non-compliance and request a different prescription.
Question 43 Explanation:
Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.
Question 44
A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?
A
Ineffective airway clearance related to retained secretions.
B
Acute pain related to lung expansion secondary to lung infection
C
Anxiety related to dyspnea and chest pain.
D
Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever.
Question 44 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 45
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?
A
Nonproductive cough
B
Positive acid-fast bacilli in a sputum sample after 2 months of treatment.
C
Improved chest x-ray
D
Decreased shortness of breath
Question 45 Explanation:
Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.
Question 46
Which of the following organisms most commonly causes community-acquired pneumonia in adults?
A
Klebsiella pneumoniae
B
Haemiphilus influenzae
C
Steptococcus pneumoniae
D
Staphylococcus aureus
Question 46 Explanation:
Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most common cause of community-acquired pneumonia. H. influenzae is the most common cause of infection in children. Klebsiella species is the most common gram-negative organism found in the hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.
Question 47
An elderly client with pneumonia may appear with which of the following symptoms first?
A
Pleuritic chest pain and cough
B
Hemoptysis and dyspnea
C
Altered mental status and dehydration
D
Fever and chills
Question 47 Explanation:
Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
Question 48
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:
A
He’s a “seroconverter”, meaning the TB has gotten to his bloodstream.
B
He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test.
C
He had TB in the past and no longer has it.
D
He was successfully treated for TB, but skin tests always stay positive.
Question 48 Explanation:
A tuberculin converter’s skin test will be positive, meaning he has been exposed to an infected with TB and now has a cell-mediated immune response to the skin test. The client’s blood and x-ray results may stay negative. It doesn’t mean the infection has advanced to the active stage. Because his x-ray is negative, he should be monitored every 6 months to see if he develops changes in his x-ray or pulmonary examination. Being a seroconverter doesn’t mean the TB has gotten into his bloodstream; it means it can be detected by a blood test.
Question 49
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?
A
Anorexia and weight loss
B
Nonproductive or productive cough
C
High-grade fever
D
Chills and night sweats
Question 49 Explanation:
The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.
Question 50
A client has active TB. Which of the following symptoms will he exhibit?
A
Chills, fever, night sweats, and hemoptysis
B
Fever of more than 104ºF and nausea
C
Headache and photophobia
D
Chest and lower back pain
Question 50 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 51
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?
A
Primary infection
B
Tertiary infection
C
Active infection
D
Superinfection
Question 51 Explanation:
Some people carry dormant TB infections that may develop into active disease. In addition, primary sites of infection containing TB bacilli may remain inactive for years and then activate when the client’s resistance is lowered, as when a client is being treated for cancer. There’s no such thing as tertiary infection, and superinfection doesn’t apply in this case.
Question 52
Which of the following antituberculus drugs can cause damage to the eighth cranial nerve?
A
Isoniazid
B
Streptomycin
C
Ethambutol hydrochloride
D
Para-aminosalicylic acid
Question 52 Explanation:
Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity) is a common side effect from amintoglycodsides.
Question 53
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?
A
Needs to be redone
B
Indeterminate
C
Positive
D
Negative
Question 53 Explanation:
This test would be classed as negative. A 5mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn’t a term used to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it’s considered positive according to the CDC.
Question 54
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:
A
Inconclusive
B
The need for repeat testing.
C
Positive
D
Negative
Question 54 Explanation:
The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client.
Question 55
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?
A
Provide frequent linen changes.
B
Administer oxygen therapy
C
Maintain complete bedrest
D
Provide fluid intake of 3 L/day
Question 55 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 56
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?
A
15 mcg/mL
B
5 mcg/mL
C
25 mcg/mL
D
30 mcg/mL
Question 56 Explanation:
The therapeutic theophylline blood level range from 10-20 mcg/mL.
Question 57
Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia?
A
A respiratory rate of 25 to 30 breaths per minute
B
A maximum loss of 5 to 10 pounds of body weight
C
Chest pain that is minimized by splinting the ribcage.
D
The ability to perform ADL’s without dyspnea
Question 57 Explanation:
An expected outcome for a client recovering from pneumonia would be the ability to perform ADL’s without experiencing dyspnea. A respiratory rate of 25 to 30 breaths/minute indicates the client is experiencing tachypnea, which would not be expected on recovery. A weight loss of 5-10 pounds is undesirable; the expected outcome would be to maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.
Question 58
The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB?
A
Increase intake of dairy products
B
Limit alcohol intake
C
Double the dosage if a drug dose is forgotten
D
Take the medication with antacids
Question 58 Explanation:
INH and rifampin are hepatoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.
Question 59
Which of the following family members exposed to TB would be at highest risk for contracting the disease?
A
17-year-old daughter
B
8-year-old son
C
76-year-old grandmother
D
45-year-old mother
Question 59 Explanation:
Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups.
Question 60
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?
A
Allergy to penicillin
B
Rheumatic fever
C
Hepatitis B
D
Heart disease
Question 60 Explanation:
Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.
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1. Clients with chronic illnesses are more likely to get pneumonia when which of the following situations is present?
Dehydration
Group living
Malnutrition
Severe periodontal disease
2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop?
Atelectasis
Bronchiectasis
Effusion
Inflammation
3. Which of the following organisms most commonly causes community-acquired pneumonia in adults?
Haemiphilus influenzae
Klebsiella pneumoniae
Steptococcus pneumoniae
Staphylococcus aureus
4. An elderly client with pneumonia may appear with which of the following symptoms first?
Altered mental status and dehydration
Fever and chills
Hemoptysis and dyspnea
Pleuritic chest pain and cough
5. When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation?
Bronchial
Bronchovestibular
Tubular
Vesicular
6. A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
ABG analysis
Chest x-ray
Blood cultures
sputum culture and sensitivity
7. 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?
Antibiotics
Bed rest
Oxygen
Nutritional intake
8. 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?
Continued dyspnea
Fever of 102*F
Respiratory rate of 32 breaths/minute
Vesicular breath sounds in right base
9. 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?
Indeterminate
Needs to be redone
Negative
Positive
10. A client with primary TB infection can expect to develop which of the following conditions?
Active TB within 2 weeks
Active TB within 1 month
A fever that requires hospitalization
A positive skin test
11. 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?
Active infection
Primary infection
Superinfection
Tertiary infection
12. A client has active TB. Which of the following symptoms will he exhibit?
Chest and lower back pain
Chills, fever, night sweats, and hemoptysis
Fever of more than 104*F and nausea
Headache and photophobia
13. Which of the following diagnostic tests is definitive for TB?
Chest x-ray
Mantoux test
Sputum culture
Tuberculin test
14. 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 confirm the diagnosis
To determine if a repeat skin test is needed
To determine the extent of the lesions
To determine if this is a primary or secondary infection
15. 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 had TB in the past and no longer has it.
He was successfully treated for TB, but skin tests always stay positive.
He’s a “seroconverter”, meaning the TB has gotten to his bloodstream.
He’s a “tuberculin converter,” which means he has been infected with TB since his last skin test.
16. 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 isonaizid, 300mg daily, for how long?
10 to 14 days
2 to 4 weeks
3 to 6 months
9 to 12 months
17. 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?
Admit him to the hospital in respiratory isolation
Prescribe isoniazid and tell him to go home and rest
Give a tuberculin test and tell him to come back in 48 hours and have it read.
Give a prescription for isoniazid, 300mg daily for 2 weeks, and send him home.
18. 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?
Decreased shortness of breath
Improved chest x-ray
Nonproductive cough
Positive acid-fast bacilli in a sputum sample after 2 months of treatment.
19. A client diagnosed with active TB would be hospitalized primarily for which of the following reasons?
To evaluate his condition
To determine his compliance
to prevent spread of the disease
To determine the need for antibiotic therapy.
20. A high level of oxygen exerts which of the following effects on the lung?
Improves oxygen uptake
Increases carbon dioxide levels
Stabilizes carbon dioxide levels
Reduces amount of functional alveolar surface area
21. 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?
Auscultation of breath sounds
Chest x-ray
Echocardiogram
Electrocardiogram (ECG)
22. 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?
Acute asthma
Chronic bronchitis
Pneumonia
Spontaneous pneumothorax
23. Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?
Antibiotics
Bronchodilators
Chest tube placement
Hyperbaric chamber
24. Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
Auscultate breath sounds
Have the client use an incentive spirometer
Take a chest x-ray
stick a needle in the area of decreased breath sounds
25. A pulse oximetry gives what type of information about the client?
Amount of carbon dioxide in the blood
Amount of oxygen in the blood
Percentage of hemoglobin carrying oxygen
Respiratory rate
26. What effect does hemoglobin amount have on oxygenation status?
No effect
More hemoglobin reduces the client’s respiratory rate
Low hemoglobin levels cause reduces oxygen-carrying capacity
Low hemoglobin levels cause increased oxygen-carrying capacity.
27. Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?
Alveoli need oxygen to live
Alveoli have no effect on oxygenation
Collapsed alveoli increase oxygen demand
Gaseous exchange occurs in the alveolar membrane.
28. 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 100% oxygen to the client.
The mask provides continuous air that the client can breathe.
The mask provides pressurized oxygen so the client can breathe more easily.
The mask provides pressurized at the end of expiration to open collapsed alveoli.
29. Which of the following best describes pleural effusion?
The collapse of alveoli
The collapse of bronchiole
The fluid in the alveolar space
The accumulation of fluid between the linings of the pleural space.
30. 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?
Inserting a chest tube
Performing thoracentesis
Performing paracentesis
Allowing the pleural effusion to drain by itself.
31. A comatose client needs a nasopharyngeal airway for suctioning. After the airway is inserted, he gags and coughs. Which action should the nurse take?
Remove the airway and insert a shorter one.
Reposition the airway.
Leave the airway in place until the client gets used to it.
Remove the airway and attempt suctioning without it.
32. 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 intermittent suction while advancing the catheter.
Using continuous suction while withdrawing the catheter.
Using intermittent suction while withdrawing the catheter.
Using continuous suction while advancing the catheter.
33. 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?
Metabolic acidosis
Respiratory alkalosis
Metabolic alkalosis
Respiratory acidosis
34. 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?
5/8” to ½” 25G to 27G needle.
1” to 3” 20G to 25G needle.
½” to 3/8” 26 or 27G needle.
1” 20G needle.
35. 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 elastic recoil of the lungs
Increased number of functional capillaries in the alveoli
Decreased residual volume
Decreased vital capacity
36. A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?
Acute pain related to lung expansion secondary to lung infection
Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever.
Anxiety related to dyspnea and chest pain.
Ineffective airway clearance related to retained secretions.
37. 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 bloody, productive cough
A cough with the expectoration of mucoid sputum
Chest pain
Dyspnea
38. 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?
5 mcg/mL
15 mcg/mL
25 mcg/mL
30 mcg/mL
39. 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?
Heart disease
Allergy to penicillin
Hepatitis B
Rheumatic fever
40. 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 monoxide poisoning
Carbon dioxide narcosis
Respiratory alkalosis
Metabolic acidosis
41. 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:
Positive
Negative
Inconclusive
The need for repeat testing.
42. 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?
Nonproductive or productive cough
Anorexia and weight loss
Chills and night sweats
High-grade fever
43. 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:
Meats and citrus fruits
Grains and broccoli
Eggs and spinach
Potatoes and fish
44. 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 breath sounds
Auscultation of bowel sounds
Presence of chest pain.
Presence of peripheral edema
Color of nail beds
45. 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?
Position changes q4h
Nasotracheal suctioning to clear secretions
Frequent linen changes
Frequent offering of a bedpan.
46. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
Decreased cardiac output
Pleural effusion
Inadequate peripheral circulation
Decreased oxygenation of the blood.
47. Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
Coma
Apathy
Irritability
Depression
48. 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?
Maintain complete bedrest
Administer oxygen therapy
Provide frequent linen changes.
Provide fluid intake of 3 L/day
49. Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia?
A respiratory rate of 25 to 30 breaths per minute
The ability to perform ADL’s without dyspnea
A maximum loss of 5 to 10 pounds of body weight
Chest pain that is minimized by splinting the ribcage.
50. Which of the following symptoms is common in clients with TB?
Weight loss
Increased appetite
Dyspnea on exertion
Mental status changes
51. 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?
Acid-fast staining
Sensitivity testing
Agglunitnation testing
Dark-field illumination
52. Which of the following antituberculus drugs can cause damage to the eighth cranial nerve?
Streptomycin
Isoniazid
Para-aminosalicylic acid
Ethambutol hydrochloride
53. The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms?
Vertigo
Facial paralysis
Impaired vision
Difficulty swallowing
54. Which of the following family members exposed to TB would be at highest risk for contracting the disease?
45-year-old mother
17-year-old daughter
8-year-old son
76-year-old grandmother
55. 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 will need to dispose of my old clothing when I return home.”
“I should always cover my mouth and nose when sneezing.”
“It is important that I isolate myself from family when possible.”
“I should use paper tissues to cough in and dispose of them properly.”
“I can use regular plate and utensils whenever I eat.”
56. A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has:
Active TB
Had contact with Mycobacterium tuberculosis
Developed a resistance to tubercle bacilli
Developed passive immunity to TB.
57. 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?
Adhere to a low cholesterol diet
Supplement the diet with pyridoxine (vitamin B6)
Get extra rest
Avoid excessive sun exposure.
58. The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB?
Take the medication with antacids
Double the dosage if a drug dose is forgotten
Increase intake of dairy products
Limit alcohol intake
59. 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?
Ask the client’s spouse to supervise the daily administration of the medications.
Visit the clinic weekly to ask him whether he is taking his medications regularly.
Notify the physician of the client’s non-compliance and request a different prescription.
Remind the client that TB can be fatal if not taken properly.
60. The Causative agent of Tuberculosis is said to be:
Mycobacterium Tuberculosis
Hansen’s Bacilli
Bacillus Anthracis
Group A Beta Hemolytic Streptococcus
Answers and Rationales
B. Clients with chronic illnesses generally have poor immune systems. Often, residing in group living situations increases the chance of disease transmission.
D. The common feature of all type of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiecrasis 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.
C. Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most common cause of community-acquired pneumonia. H. influenzae is the most common cause of infection in children. Klebsiella species is the most common gram-negative organism found in the hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.
A. Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
A. Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchiovesicular are normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly heard in the bases of the lung fields.
D. Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show the area of lung consolidation. ABG analysis will determine the extent of hypoxia present due to the pneumonia, and blood cultures will help determine if the infection is systemic.
C. The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a 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.
D. If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal vesicular breath sounds. If the client still has dyspnea, fever, and increased respiratory rate, he should be examined by the physician before discharge because he may have another source of infection or still have pneumonia.
C. This test would be classed as negative. A 5mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn’t a term used to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it’s considered positive according to the CDC.
D. A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime, in many 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.
A. Some people carry dormant TB infections that may develop into active disease. In addition, primary sites of infection containing TB bacilli may remain inactive for years and then activate when the client’s resistance is lowered, as when a client is being treated for cancer. There’s no such thing as tertiary infection, and superinfection doesn’t apply in this case.
B. 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.
C. The sputum culture for Myobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung may not be big enough to be seen on x-ray. Skin tests may be falsely positive or falsely negative.
C. If the lesions are large enough, the chest x-ray will show their presence in the lungs. Sputum culture confirms the diagnosis. There can be false-positive and false-negative skin test results. A chest x-ray can’t determine if this is a primary or secondary infection.
D. A tuberculin converter’s skin test will be positive, meaning he has been exposed to an infected with TB and now has a cell-mediated immune response to the skin test. The client’s blood and x-ray results may stay negative. It doesn’t mean the infection has advanced to the active stage. Because his x-ray is negative, he should be monitored every 6 months to see if he develops changes in his x-ray or pulmonary examination. Being a seroconverter doesn’t mean the TB has gotten into his bloodstream; it means it can be detected by a blood test.
D. Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoaizid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.
A. The client is showing s/s of active TB and, because of the 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.
D. Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.
C. The client with active TB is highly contagious until three consecutive sputum cultures are negative, so he’s put in respiratory isolation in the hospital.
D. Oxygen toxicity causes direct pulmonary trauma, reducing the amount of alveolar surface area available for gaseous exchange, which results in increased carbon dioxide levels and decreased oxygen uptake.
A. Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest x-ray and an ECG, but a physician must order these tests. Unless a cardiac source for the client’s pain is identified, he won’t need an echocardiogram.
D. A spontaneous pneumothorax occurs when the client’s lung collapses, causing an acute decrease in the amount of functional lung used in 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.
C. The only way to reexpand the lung is to place a chest tube on the right side so the air in the pleural space can be removed and the lung reexpanded.
C. 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.
C. The pulse oximeter determines the percentage of hemoglobin carrying oxygen. This doesn’t ensure that the oxygen being carried through the bloodstream is actually being taken up by the tissue.
C. Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying capacity is also low. More hemoglobin will increase oxygen-carrying capacity and thus increase the total amount of oxygen available in the blood. If the client has been tachypneic during exertion, or even at rest, because oxygen demand is higher than the available oxygen content, then an increase in hemoglobin may decrease the respiratory rate to normal levels.
D. Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs, Collapsed alveoli receive oxygen, as well as other nutrients, from the bloodstream. Collapsed alveoli have no effect on oxygen demand, though by decreasing the surface area available for gas exchange, they decrease oxygenation of the blood.
C. The mask provides pressurized oxygen continuously through both inspiration and expiration. The mask can be set to deliver any amount of oxygen needed. By providing the client with pressurized oxygen, the client has less resistance to overcome in taking his next breath, making it easier to breathe. Pressurized oxygen delivered at the end of expiration is positive end-expiratory pressure (PEEP), not continuous positive airway pressure.
D. 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.
B. Performing thoracentesis is used to remove excess pleural fluid. The fluid is then analyzed to determine if it’s transudative or exudative. Transudates are substances that have passed through a membrane and usually occur in low protein states. Exudates are substances that have escaped from blood vessels. They contain an accumulation of cells and have a high specific gravity and a high lactate dehydrogenase level. Exudates usually occur in response to a malignancy, infection, or inflammatory process. A chest tube is rarely necessary because the amount of fluid typically isn’t large enough to warrant such a measure. Pleural effusions can’t drain by themselves.
A. If a client gags or coughs after nasopharyngeal airway placement, the tube may be too long. The nurse should remove it and insert a shorter one. Simply repositioning the airway won’t solve the problem. The client won’t get used to the tube because it’s the wrong size. Suctioning without a nasopharyngeal airway causes trauma to the natural airway.
C. Intermittent suction should be applied during catheter withdrawal. To prevent hypoxia, suctioning shouldn’t last more than 10-seconds at a time. Suction shouldn’t be applied while the catheter is being advanced.
D.
C. Intradermal injections like those used in TN skin tests are administered in small volumes (usually 0.5 ml or less) into the outer skin layers to produce a local effect. A TB syringe with a ½” to 3/8” 26G or 27G needle should be inserted about 1/8” below the epidermis.
D. Reduction in VC is a normal physiologic change in the older adult. Other normal physiologic changes include decreased elastic recoil of the lungs, fewer functional capillaries in the alveoli, and an increase is residual volume.
D. 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.
B. One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum.
B. The therapeutic theophylline blood level range from 10-20 mcg/mL.
C. Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.
B. Carbon dioxide narcosis is a condition that results from extreme hypercapnia, with carbon dioxide levels in excess of 70 mm Hg. The client experiences symptoms such as confusion and tremors, which may progress to convulsions and possible coma.
A. The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client.
D. The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.
A. The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.
A, C, E. A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client’s ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the patient with pneumonia.
C. Frequent linen changes are appropriate for this client because of diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario.
D. A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation.
C. Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness, or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.
D. 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.
B. An expected outcome for a client recovering from pneumonia would be the ability to perform ADL’s without experiencing dyspnea. A respiratory rate of 25 to 30 breaths/minute indicates the client is experiencing tachypnea, which would not be expected on recovery. A weight loss of 5-10 pounds is undesirable; the expected outcome would be to maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.
A. TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats.
A. The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.
A. Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity) is a common side effect from amintoglycodsides.
A. The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve.
D. Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups.
B, D, E.
B. A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.
B. 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.
D. INH and rifampin are hepatoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.
A. Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.