MSN Exam for Pneumonia

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1) In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:

  1. Respiratory acidosis, ateclectasis, and hypostatic pneumonia
  2. Appneustic breathing, atypical pneumonia and respiratory alkalosis
  3. Cheyne-Strokes respirations and spontaneous pneumothorax
  4. Kussmail’s respirations and hypoventilation

2) The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?

  1. Fluid volume deficit
  2. Decreased tissue perfusion.
  3. Impaired gas exchange.
  4. Risk for infection

3) A 65-year-old patient with pneumonia is receiving garamycin (Gentamicin). It would be MOST important for a nurse to monitor which of the following laboratory values in this patient?

  1. Hemoglobin and hematocrit.
  2. BUN and creatinine.
  3. Platelet count and clotting time.
  4. Sodium and potassium.

4) A client with bacterial pneumonia is admitted to the pediatric unit. What would the nurse expect the admitting assessment to reveal?

  1. High fever
  2. Nonproductive cough
  3. Rhinitis
  4. Vomiting and diarrhea

5) A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. Which of the following conditions has he most likely developed?

  1. Acute respiratory distress syndrome (ARDS).
  2. Atelectasis.
  3. Bronchitis.
  4. Pneumonia.

6) Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?

  1. Prescribe an antibiotic.
  2. Refer him urgently to the hospital.
  3. Instruct the mother to increase fluid intake.
  4. Instruct the mother to continue breastfeeding.

7) Which order can be associated with the prevention of atelectasis and pneumonia in a client with amyotrophic lateral sclerosis?

  1. Active and passive range of motion exercises twice a day
  2. Every 4 hours incentive spirometer
  3. Chest physiotherapy twice a day
  4. Repositioning every 2 hours around the clock

8) A client with pneumacystis carini pneumonia is receiving trimetrexate. The rationale for administering leucovorin calcium to a client receiving Methotrexate is to:

  1. Treat anemia.
  2. Create a synergistic effect.
  3. Increase the number of white blood cells.
  4. Reverse drug toxicity.

9) Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall?

  1. Legionnaires’ disease
  2. Streptococcal (pneumococcal) pneumonia
  3. Mycoplasma pneumonia
  4. Viral pneumonia

10) Braguda brought her 5-month old daughter in the nearest RHU because her baby sleeps most of the time, with decreased appetite, has colds and fever for more than a week. The physician diagnosed pneumonia. Based on this data given by Braguda, you can classify Braguda’s daughter to have:

  1. Pneumonia: cough and colds
  2. Severe pneumonia
  3. Very severe pneumonia
  4. Pneumonia moderate

11) A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia. What type of isolation is MOST appropriate for this client?

  1. Reverse isolation
  2. Respiratory isolation
  3. Standard precautions
  4. Contact isolation

12) The home health nurse is planning for the day’s visits. Which client should be seen first?

  1. The 78-year-old who had a gastrectomy 3 weeks ago and has a PEG tube
  2. The 5-month-old discharged 1 week ago with pneumonia who is being treated with amoxicillin liquid suspension
  3. The 50-year-old with MRSA being treated with Vancomycin via a PICC line
  4. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter

13) An elderly client with pneumonia may appear with which of the following symptoms first?

  1. Altered mental status and dehydration
  2. fever and chills
  3. Hemoptysis and dyspnea
  4. Pleuretic chest pain and cough

14) While caring for an HIV-positive patient who is hospitalized with Pneumocystis carinii pneumonia, you note that all of these drug therapies are scheduled for 10:00 AM. Which nursing action is most essential to accomplish at the scheduled time?

  1. Administer the protease inhibitor indinavir (Crixivan) 800 mg PO.
  2. Infuse pentamidine (Pentam-300) 300 mg IV over 60 minutes.
  3. Have the patient “swish and swallow” nystatin (Mycostatin) 5 mL.
  4. Apply acyclovir (Zovirax) cream to oral herpes simplex lesions.

15) Which of the following signs will indicate that a young child is suffering from severe pneumonia?

  1. Dyspnea
  2. Wheezing
  3. Fast breathing
  4. Chest indrawing

16) A client with AIDS develops bacterial pneumonia is admitted in the emergency department. The client’s arterial blood gases is drawn and the result is PaO2 80mmHg. then arterial blood gases are drawn again and the level is reduced from 80 mmHg to 65 mmHg. The nurse should;

  1. Have arterial blood gases performed again to check for accuracy.
  2. Increase the oxygen flow rate.
  3. Notify the physician.
  4. Decrease the tension of oxygen in the plasma.

17) The nurse is caring for four clients on a stepdown intensive care unit. The client at the highest risk for developing nosocomial pneumonia is the one who:

  1. has a respiratory infection
  2. is intubated and on a ventilator
  3. has pleural chest tubes
  4. is receiving feedings through a jejunostomy tube

18) You are evaluating an HIV-positive patient who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis carinii pneumonia. Which information is most important to communicate to the physician?

  1. The blood pressure decreased to 104/76 during administration.
  2. The patient is complaining of pain at the site of the infusion.
  3. The patient is not taking in an adequate amount of oral fluids.
  4. Blood glucose is 55 mg/dL after the medication administration.

19) For a 3-month old child to be classified to have Pneumonia (not severe), you would expect to find RR of:

  1. 60 bpm
  2. 40 bpm
  3. 70 bpm
  4. 50 pbm

20) Nurse Betty is assessing tactile fremitus in a client with pneumonia. For this examination, nurse Betty should use the:

  1. Fingertips
  2. Finger pads
  3. Dorsal surface of the hand
  4. Ulnar surface of the hand

21) A 20-year-old patient is being treated for pneumonia. He has a persistent cough and complains of severe pain on coughing. What could you tell him to help him reduce his discomfort?

  1. “Hold your cough as much as possible.”
  2. “Place the head of your bed flat to help with coughing.”
  3. “Restrict fluids to help decrease the amount of sputum.”
  4. “Splint your chest wall with a pillow for comfort.”

22) A male client with pneumonia develops respiratory failure and has a partial pressure of arterial oxygen of 55 mm Hg. He’s placed on mechanical ventilation with a fraction of inspired oxygen (FIO2) of 0.9. The nursing goal should be to reduce the FIO2 to no greater than:

  1. 0.21
  2. 0.35
  3. 0.5
  4. 0.7

23) Mr. Jose is admitted to the hospitalwith a diagnosis of pneumonia and COPD. The physician orders an oxygen therapy for him. The most comfortable method of delivering oxygen to Mr. Jose is by:

  1. Croupette
  2. Nasal Cannula
  3. Nasal catheter
  4. Partial rebreathing mask

24) A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?

  1. Inflamed lung tissue
  2. Sudden onset
  3. Responsiveness to penicillin.
  4. Elevated white blood cell (WBC) count

25) The priority is postoperative respiratory toilet. This client will quickly develop profound atelectasis and eventually pneumonia without adequate gas exchange. This will only be achieved with the appropriate pain management.

  1. Pallor
  2. Increased temperature
  3. Dyspnea
  4. Involuntary muscle spasms

26) A client with pneumonia is receiving supplemental oxygen, 2 L/min via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration?

  1. Apnea
  2. Anginal pain
  3. Respiratory alkalosis
  4. Metabolic acidosis

27) A male elderly client is admitted to an acute care facility with influenza. The nurse monitors the client closely for complications. What is the most common complication of influenza?

  1. Septicemia
  2. Pneumonia
  3. Meningitis
  4. Pulmonary edema

28) An 80-year-old male client is admitted to the hospital with a diagnosis of pneumonia. Nurse Oliver learns that the client lives alone and hasn’t been eating or drinking. When assessing him for dehydration, nurse Oliver would expect to find:

  1. Hypothermia
  2. Hypertension
  3. Distended neck veins
  4. Tachycardia

29) A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration?

  1. Apnea
  2. Anginal pain
  3. Respiratory alkalosis
  4. Metabolic acidosis

30) Which of the following would be an appropriate nursing diagnosis for a hospitalized client with bacterial pneumonia and shortness of breath?

  1. Ineffective cardiopulmonary tissue perfusion related to myocardial damage
  2. Risk for self-care deficit related to fatigue
  3. Deficient fluid volume related to nausea and vomiting
  4. Disturbed thought processes related to inadequate relief of chest pain
Answers and Rationales
  1. A. Respiratory acidosis, ateclectasis, and hypostatic pneumonia . Because of restricted respiratory movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions.
  2. C. Impaired gas exchange. Pneumonia, which is an infection, causes lobar consolidation thus impairing gas exchange between the alveoli and the blood. Because the patient would require adequate hydration, this makes him prone to fluid volume excess.
  3. B. BUN and creatinine. Question: Which lab values should you monitor for a patient receiving Gentamicin? Needed Info: Gentamicin: broad spectrum antibiotic. Side effects: neuromuscular blockage, ototoxic to eighth cranial nerve (tinnitus, vertigo, ataxia, nystagmus, hearing loss), nephrotoxic. Nursing responsibilities: monitor renal function, force fluids, monitor hearing acuity. Draw blood for peak levels 1 hr. after IM and 30 min
    • – 1 hr. after IV infusion, draw blood for trough just before next dose.
    • -Hemoglobin and hematocrit — can cause anemia; less common
    • -BUN and creatinine — CORRECT: nephrotoxic; will see proteinuria, oliguria, hematuria, thirst, increased BUN, decreased creatine clearance
    • -Platelet count and clotting time — do not usually change
    • -Sodium and potassium — hypokalemia infrequent problem
  4.  A. High fever . If the child has bacterial pneumonia, a high fever is usually present. Bacterial pneumonia usually presents with a productive cough, not a nonproductive cough, making answer B incorrect. Rhinitis is often seen with viral pneumonia, and vomiting and diarrhea are usually not seen with pneumonia,
  5. A. Acute respiratory distress syndrome (ARDS). Severe hypoxia after smoke inhalation typically is related to ARDS. The other choices aren’t typically associated with smoke inhalation.
  6. B. Refer him urgently to the hospital. Severe pneumonia requires urgent referral to a hospital. Other options are done for a client classified as having pneumonia.
  7. C. Chest physiotherapy twice a day. These clients have a potential for an inability to have voluntary and involuntary muscle movement or activity.Thus, active and passive range of motion exercises twice a day and every 4 hours incentive spirometer are inadequate with this problem in mind. Repositioning every 2 hours around the clock is not specific for prevention of complications associated with the lung.
  8. D. Reverse drug toxicity.
  9. A. Legionnaires’ disease . Legionnaires’ disease accounts for 15% of community-acquired pneumonias. Streptococcal pneumonia demonstrates the highest occurrence in winter months.Mycoplasma pneumonia demonstrates the highest occurrence in fall and early winter.Viral pneumonia demonstrates the greatest incidence during winter months.
  10. B. Severe pneumonia . For a child aging 2months up to 5 years old can be classified to have severe pneumonia when he have any of the following danger signs:
    • Not able to drink
    • Convulsions
    • Abnormally sleepy or difficult to wake
    • Stridor in calm child or
    • Severe under-nutrition
  11. D. Contact isolation . Contact or Body Substance Isolation (BSI) involves the use of barrier protection (e.g. gloves, mask, gown, or protective eyewear as appropriate) whenever direct contact with any body fluid is expected. When determining the type of isolation to use, one must consider the mode of transmission. The hands of personnel continues to be the principal mode of transmission for methicillin resistant staphylococcus aureus (MRSA). Because the organism is limited to the sputum in this example, precautions are taken if contact with the patient”s sputum is expected. A private room and BSI, along with good hand washing techniques, are the best defense against the spread of MRSA pneumonia.
  12. D. The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter . The client at highest risk for complications is the client with multiple sclerosis who is being treated with cortisone via the central line. The others are more stable. MRSA is methicillin-resistant staphylococcus aureus. Vancomycin is the drug of choice and is given at scheduled times to maintain blood levels of the drug.
  13. A. Altered mental status and dehydration . Fever, chills, hemoptysis, dyspnea, cough, and pleuric chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
  14. A. Administer the protease inhibitor indinavir (Crixivan) 800 mg PO. Taking antiretroviral medications such as indinavir on a rigid time schedule is essential for effective treatment of HIV infection and to avoid development of drug resistant-strains of the virus. The other medications should also be given within the time frame indicated in the hospital policy (usually within 30 minutes of the scheduled time).
  15. D. Chest indrawing . In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia.
  16. C. Notify the physician. This decrease in PaO2 indicates respiratory failure; it warrants immediate medical evaluation.
  17. B. is intubated and on a ventilator . When clients are on mechanical ventilation, the artificial airway impairs the gag and cough reflexes that help keep organisms out of the lower respiratory tract. The artificial airway also prevents the upper respiratory system from humidifying and heating air to enhance mucociliary clearance. Manipulations of the artificial airway sometimes allow secretions into the lower airways. Whit standard procedures the other choices wouldn’t be at high risk.
  18. D. Blood glucose is 55 mg/dL after the medication administration. Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. The low blood pressure suggests that the IV infusion rate may need to be slowed. The other responses indicated need for independent nursing actions (such as obtaining a new IV site and encouraging oral intake) but are not associated with pentamidine infusion.
  19. D. 50 pbm. A child can be classified to have Pneumonia (not severe) if:
    • the young infant is less than 2 months- 60 bpm or more
    •  if the child is 2 months up to less than 12 months- 50 bpm or more
    • if the child is 12 months to 4 y/o- 40 bpm or more
  20. D. Ulnar surface of the hand . The nurse uses the ulnar surface, or ball, of the hand to asses tactile fremitus, thrills, and vocal vibrations through the chest wall. The fingertips and finger pads best distinguish texture and shape. The dorsal surface best feels warmth.
  21. D. “Splint your chest wall with a pillow for comfort.” Showing this patient how to splint his chest wall will help decrease discomfort when coughing. Holding in his coughs will only increase his pain. Placing the head of the bed flat may increase the frequency of his cough and his work of breathing. Increasing fluid intake will help thin his secretions, making it easier for him to clear them.
  22. C. 0.5 . An FO2 greater than 0.5 for as little as 16 to 24 hours can be toxic and can lead to decreased gas diffusion and surfactant activity. The ideal oxygen source is room air F IO 2 0.18 to 0.21.
  23. B. Nasal Cannula. The nasal cannula is the most comfortable method of delivering oxygen because it allows the patient to talk, eat and drink.
  24. A. Inflamed lung tissue . The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Although most types of pneumonia have a sudden onset, a few (such as anaerobic bacterial pneumonia and mycoplasmal pneumonia) have an insidious onset. Antibiotic therapy is the primary treatment for most types of pneumonia; however, the antibiotic must be specific for the causative agent, which may not be responsive to penicillin. A few types of pneumonia, such as viral pneumonia, aren’t treated with antibiotics. Although pneumonia usually causes an elevated WBC count, some types, such as mycoplasmal pneumonia, don’t.
  25. C. Dyspnea. Client’s having the insertion of a central venous catheter are at risk for tension pneumothorax. Dyspnea, shortness of breath and chest pain are indications of this complication.
  26. A. Apnea . Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.
  27. B. Pneumonia . Pneumonia is the most common complication of influenza. It may be either primary influenza viral pneumonia or pneumonia secondary to a bacterial infection. Other complications of influenza include myositis, exacerbation of chronic obstructive pulmonary disease, and Reye’s syndrome. Myocarditis, pericarditis, transverse myelitis, and encephalitis are rare complications of influenza. Although septicemia may arise when any infection becomes overwhelming, it rarely results from influenza. Meningitis and pulmonary edema aren’t associated with influenza.
  28. D. Tachycardia . With an extracellular fluid or plasma volume deficit, compensatory mechanisms stimulate the heart, causing an increase in heart rate.
  29. A. Apnea . Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations don’t cause metabolic acidosis.
  30. B. Risk for self-care deficit related to fatigue 

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