Pneumonia
A 67-year-old patient is admitted with a high fever, cough with purulent sputum, and difficulty breathing. The healthcare provider suspects bacterial pneumonia. A chest X-ray and sputum culture are ordered. The nurse should anticipate that the provider will confirm the diagnosis based on the presence of consolidation or infiltrates in the _____.
Lungs
Rationale:
Chest X-rays are used to diagnose pneumonia by detecting consolidation or infiltrates in the lung tissue. These findings are indicative of infection or inflammation in the lungs, which are characteristic of pneumonia.
Which of the following symptoms are commonly associated with acute sinusitis? (Select all that apply)
A) Severe frontal headache
B) Thick yellow or green nasal discharge
C) Nasal congestion and facial pressure
D) A cough that worsens at night
E) Painless swelling of the neck
A) Severe frontal headache
B) Thick yellow or green nasal discharge
C) Nasal congestion and facial pressure
D) A cough that worsens at night
Rationale:
Common symptoms of acute sinusitis include a headache (especially in the frontal sinus region), thick nasal discharge that may be yellow or green, nasal congestion, facial pressure, and a persistent cough that is worse at night. Painless swelling of the neck is not a typical symptom of sinusitis and may indicate a different condition.
Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder?
A. Circumoral cyanosis
B. Increased forced expiratory volume
C. Inspiratory and expiratory wheezing
D. Normal breath sounds
C. Inspiratory and expiratory wheezing
A patient with a persistent cough, weight loss, and night sweats undergoes a tuberculin skin test (TST), which returns positive. The next step in diagnosing tuberculosis (TB) is to obtain a _____, which will confirm the presence of Mycobacterium tuberculosis.
Sputum culture
Rationale:
A sputum culture is the gold standard for diagnosing tuberculosis. The culture will confirm the presence of Mycobacterium tuberculosis, which is essential for both diagnosis and determining appropriate treatment.
Which of the following are risk factors for developing Chronic Obstructive Pulmonary Disease (COPD)? (Select all that apply)
A) Smoking
B) Exposure to occupational dust and chemicals
C) A history of frequent respiratory infections during childhood
D) Age younger than 40
E) Genetic predisposition, such as alpha-1 antitrypsin deficiency
Answer:
A) Smoking
B) Exposure to occupational dust and chemicals
C) A history of frequent respiratory infections during childhood
E) Genetic predisposition, such as alpha-1 antitrypsin deficiency
Rationale:
The main risk factor for COPD is smoking. Occupational exposure to dust and chemicals also increases the risk. A history of respiratory infections, particularly in childhood, can predispose individuals to COPD later in life. Alpha-1 antitrypsin deficiency is a rare genetic condition that can lead to early development of COPD. Age younger than 40 is not typically a risk factor unless there is a genetic predisposition.
Which of the following factors increase the risk of developing pneumonia in a patient? (Select all that apply)
A) Advanced age (over 65 years old)
B) Smoking history
C) Use of proton pump inhibitors (PPIs)
D) Active asthma with a history of frequent exacerbations
E) Recent surgery and prolonged bed rest
A) Advanced age (over 65 years old)
B) Smoking history
C) Use of proton pump inhibitors (PPIs)
D) Active asthma with a history of frequent exacerbations
E) Recent surgery and prolonged bed rest
Rationale:
All of these are risk factors for pneumonia. Advanced age weakens the immune system, smoking damages the respiratory system, PPIs can increase the risk of aspiration, active asthma can lead to lung inflammation, and recent surgery with prolonged immobility increases vulnerability to infections, including pneumonia.
A patient presents with facial pain, pressure, nasal congestion, and a purulent nasal discharge for the past 10 days. The healthcare provider diagnoses acute sinusitis. The diagnosis is typically confirmed based on the patient's clinical presentation and may be supported by findings on a(n) _____, which can show sinus opacity or fluid levels.
X-ray
Rationale:
X-rays or CT scans are commonly used to confirm the diagnosis of sinusitis, especially in chronic cases or when symptoms persist beyond 10 days. These imaging studies can show fluid levels or opacity in the sinuses, which are indicative of infection or inflammation.
A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away?
A. Beta-adrenergic blockers
B. Bronchodilators
C. Inhaled steroids
D. Oral steroids
B. Bronchodilators
A 45-year-old patient is diagnosed with active tuberculosis (TB) and begins a course of multidrug therapy, including isoniazid, rifampin, pyrazinamide, and ethambutol. The nurse educates the patient about the importance of medication adherence. Which of the following points should the nurse include in the teaching plan?
A) "You must complete the full course of antibiotics, even if you start feeling better, to prevent drug resistance."
B) "You will need to wear a mask only when in public places for the next few weeks."
C) "You should stop taking the medications if you experience red urine or discoloration of your skin."
D) "It’s okay to drink alcohol in moderation while on these medications as long as you’re not feeling ill."
A) "You must complete the full course of antibiotics, even if you start feeling better, to prevent drug resistance."
Rationale:
Adherence to the full course of TB medication is critical to ensure the infection is fully eradicated and to prevent the development of drug-resistant strains of Mycobacterium tuberculosis. The other options are incorrect: TB requires strict precautions (including wearing a mask) until it is no longer contagious, and alcohol should be avoided due to the potential for liver toxicity with TB medications.
A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance?
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
1. Respiratory acidosis
Which of the following symptoms are common in a patient with pneumonia? (Select all that apply)
A) Productive cough with green or yellow sputum
B) Tachypnea (rapid breathing)
C) Pleural chest pain
D) Bradycardia (slow heart rate)
E) Cyanosis (bluish skin color)
A) Productive cough with green or yellow sputum
B) Tachypnea (rapid breathing)
C) Pleural chest pain
E) Cyanosis (bluish skin color)
Rationale:
Common symptoms of pneumonia include a productive cough (often with green or yellow sputum), tachypnea, pleuritic chest pain (sharp pain that worsens with deep breathing or coughing), and cyanosis (indicating impaired oxygenation). Bradycardia is not typically associated with pneumonia; in fact, tachycardia (increased heart rate) is often present due to fever and respiratory distress.
If left untreated, acute sinusitis can lead to a serious complication, known as a(n) _____, which involves the spread of infection to the surrounding bone or tissues and may require surgical intervention.
Osteomyelitis
Rationale:
Osteomyelitis is a serious complication of sinusitis, where the infection spreads to the bone (often the frontal bone). This can lead to more severe symptoms and may require surgical drainage or debridement, along with long-term antibiotics to treat the infection effectively.
A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first?
A. Take a full medication history.
B. Give a bronchodilator by nebulizer.
C. Apply a cardiac monitor to the client.
D. Provide emotional support to the client.
B. Give a bronchodilator by nebulizer.
Which of the following are common symptoms of active tuberculosis (TB)? (Select all that apply)
A) Persistent cough lasting more than 3 weeks
B) Night sweats and unexplained weight loss
C) Chest pain or discomfort while breathing
D) Painful urination and blood in the urine
E) Fever and chills
A) Persistent cough lasting more than 3 weeks
B) Night sweats and unexplained weight loss
C) Chest pain or discomfort while breathing
E) Fever and chills
Rationale:
Common symptoms of active TB include a persistent cough, night sweats, unexplained weight loss, chest pain, and fever/chills. Painful urination and blood in the urine are not symptoms of TB and would suggest another condition.
One of the most common complications of advanced COPD is _____, which is characterized by an abnormal accumulation of fluid in the alveoli, leading to impaired gas exchange and respiratory failure.
Pulmonary edema
Rationale:
Pulmonary edema is a common complication of advanced COPD, especially in the setting of right-sided heart failure (cor pulmonale), where fluid backs up into the lungs, impairing gas exchange. This can lead to further respiratory distress and is a serious complication of COPD.
A patient with pneumonia is at risk for developing a serious complication known as a(n) _____, which is an accumulation of pus in the pleural space, often requiring drainage.
Empyema
Rationale:
Empyema is a serious complication of pneumonia where infected fluid accumulates in the pleural space. This condition requires drainage and antibiotic treatment to resolve the infection.
Which of the following are risk factors for developing sinusitis? (Select all that apply)
A) Allergies
B) Recent upper respiratory infection (URI)
C) Smoking
D) Use of nasal decongestant sprays for more than 3 days
E) A history of asthma or chronic respiratory conditions
A) Allergies
B) Recent upper respiratory infection (URI)
C) Smoking
D) Use of nasal decongestant sprays for more than 3 days
E) A history of asthma or chronic respiratory conditions
Rationale:
All of these factors contribute to the development of sinusitis. Allergies can cause inflammation in the sinuses, increasing the risk of infection. Recent upper respiratory infections, smoking, overuse of nasal decongestants (which can lead to rebound congestion), and chronic respiratory conditions (such as asthma) all increase the risk of sinusitis by compromising the sinuses' ability to drain effectively.
Which of the following symptoms are commonly observed in a patient experiencing an asthma attack? (Select all that apply)
A) Wheezing
B) Shortness of breath
C) Chest tightness
D) Productive cough with green sputum
E) Increased respiratory rate
A) Wheezing
B) Shortness of breath
C) Chest tightness
E) Increased respiratory rate
Rationale:
Wheezing, shortness of breath, chest tightness, and an increased respiratory rate are classic symptoms of an asthma attack due to bronchoconstriction and inflammation. A productive cough with green sputum is more indicative of a respiratory infection, not an asthma attack.
Tuberculosis is primarily transmitted through the air via _____ particles when an individual with active TB coughs, sneezes, or speaks, and these particles are inhaled by others.
Aerosol
Rationale:
TB is transmitted through the air via aerosolized droplets when an infected person with active TB expels the bacteria by coughing, sneezing, or speaking. These tiny particles can remain suspended in the air and be inhaled by individuals nearby.
A 72-year-old patient with COPD presents to the emergency department with increased shortness of breath, wheezing, and a change in sputum color, which is now greenish. The patient also reports a fever of 101°F. The healthcare provider diagnoses a COPD exacerbation likely due to a respiratory infection. The nurse should prioritize which of the following actions?
A) Administer oxygen therapy to maintain oxygen saturation between 88-92%.
B) Teach the patient how to perform pursed-lip breathing to reduce air trapping.
C) Prepare the patient for intubation and mechanical ventilation.
D) Encourage the patient to increase fluid intake to thin the sputum.
A) Administer oxygen therapy to maintain oxygen saturation between 88-92%.
Rationale:
During a COPD exacerbation, maintaining oxygen saturation between 88-92% is recommended to avoid hypercapnia (high carbon dioxide levels). Oxygen therapy should be carefully administered to avoid worsening respiratory acidosis. Pursed-lip breathing is beneficial for improving ventilation but is not the immediate priority in this acute setting. Intubation is only required if respiratory failure occurs, and increasing fluid intake helps with sputum clearance but is secondary to addressing the oxygenation needs.
A 52-year-old patient presents to the clinic with a cough, fever, chills, pleuritic chest pain, and difficulty breathing for the past 3 days. The patient has a history of smoking and occasional alcohol use. Upon examination, the nurse auscultates crackles in the lower lobes of the lungs. A chest X-ray reveals consolidation. The healthcare provider diagnoses community-acquired pneumonia (CAP). What is the most appropriate nursing intervention to prioritize for this patient?
A) Administer antibiotics as prescribed, and monitor vital signs for signs of sepsis.
B) Encourage the patient to rest and drink fluids to stay hydrated.
C) Administer a corticosteroid to reduce lung inflammation.
D) Prepare the patient for a CT scan to rule out pulmonary embolism.
A) Administer antibiotics as prescribed, and monitor vital signs for signs of sepsis.
Rationale:
Antibiotics are the cornerstone of treatment for community-acquired pneumonia, and early administration improves outcomes. Monitoring for signs of sepsis, such as fever, increased heart rate, and low blood pressure, is also essential to prevent complications. Rest and hydration are supportive measures, but antibiotics and monitoring for complications are the priorities.
A 32-year-old patient presents to the clinic with complaints of sinus pressure, headache, and yellowish nasal discharge for the past week. The patient also reports a mild fever and malaise. On examination, the nurse notes tenderness over the maxillary sinuses. The healthcare provider diagnoses acute sinusitis and prescribes an antibiotic. Which of the following actions is the nurse's priority in managing this patient?
A) Advise the patient to rest, drink plenty of fluids, and use a humidifier to relieve congestion.
B) Teach the patient about the importance of taking the prescribed antibiotics for the full duration, even if symptoms improve.
C) Encourage the patient to use nasal decongestant sprays to clear nasal passages.
D) Instruct the patient to apply warm compresses to the affected sinuses and follow up in 24 hours for further evaluation.
B) Teach the patient about the importance of taking the prescribed antibiotics for the full duration, even if symptoms improve.
Rationale:
Completing the prescribed course of antibiotics is crucial to prevent the infection from recurring or worsening. While supportive measures like rest, hydration, and warm compresses are helpful, ensuring proper antibiotic adherence is the priority to resolve the infection.
A 15-year-old patient with asthma presents to the emergency department with severe wheezing, chest tightness, and difficulty speaking in full sentences. The patient has been using their albuterol inhaler every 2 hours, but the symptoms are not improving. The healthcare provider orders nebulized albuterol and oral steroids. What is the nurse’s priority action for this patient?
A) Administer the prescribed nebulized albuterol and prepare for possible intubation.
B) Instruct the patient to use their inhaler every 15 minutes until symptoms subside.
C) Assess the patient’s oxygen saturation and prepare to administer oxygen if needed.
D) Encourage the patient to perform controlled breathing exercises to reduce anxiety.
A) Administer the prescribed nebulized albuterol and prepare for possible intubation.
Rationale:
For a patient experiencing severe asthma exacerbation that is not responding to the inhaler, nebulized albuterol is the appropriate treatment to open the airways. If symptoms persist, intubation may be necessary to ensure adequate oxygenation. Continuous monitoring and oxygen therapy may also be needed.
Which of the following are risk factors for developing tuberculosis (TB)? (Select all that apply)
A) Close contact with a person with active TB
B) A weakened immune system due to HIV
C) Living in a non-urban area with low population density
D) Smoking and a history of chronic respiratory disease
E) Recent travel to countries with a high incidence of TB
A) Close contact with a person with active TB
B) A weakened immune system due to HIV
D) Smoking and a history of chronic respiratory disease
E) Recent travel to countries with a high incidence of TB
Rationale:
TB is more likely to develop in individuals who are immunocompromised (e.g., due to HIV), those who are in close contact with someone with active TB, those who smoke, and those who have a history of chronic respiratory diseases. Traveling to countries with high TB prevalence also increases risk. Living in a non-urban area with low population density is not typically a risk factor for TB.
Client arrives in Emergency Department with worsening shortness of breath over the past week, strong productive cough with green-tinged sputum, and fatigue. Client has a history of chronic obstructive pulmonary disease -emphysema; has been using their “relief” inhaler at home with no relief of symptoms. Client lives independently at home and states they smoke approximately 1 pack of cigarettes per day. Ambulatory, alert and oriented x 4. Has coarse crackles auscultated in bilateral lower lung fields with a barrel chest appearance, using accessory muscles, expiratory wheeze on auscultation. Client states they have “less room” to take a deep breath. Clubbing noted in all digits bilaterally. What orders should the nurse expect? (Select All That Apply)
1. Administer O2 via a high-flow oxygen face mask
2. Place client in a high-fowlers position
3. Encourage client to use incentive spirometer
4. Administer ondansetron
5. Administer bromide and albuterol
6. Administer methylprednisolone