Pneumonia
Clients with chronic illnesses are more likely to get pneumonia in which of the following situations?
A. Dehydration
B. Group living
C. Malnutrition
D. Severe periodontal disease
B. Group Living - residing in group living situations increases the chance of disease transmission. Pneumonia is a fairly prevalent disease and carries a heavy burden in all populations.
The most reliable index to determine the respiratory status of a client is to:
Correct Answer: C. Listen and feel the air movement.
To check for breathing, the nurse places her ear and cheek next to the client’s mouth and nose to listen and feel for air movement. During the inspection, the examiner should pay attention to the pattern of breathing: thoracic breathing, thoracoabdominal breathing, coastal markings, and use of accessory breathing muscles.
Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD?
Correct Answer: A. Increased anteroposterior chest diameter.
Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. In addition, coarse crackles beginning with inspiration may be heard.
Notes state that the client has a “barrel chest.” The nurse interprets that this client has which of the following forms of chronic airflow limitation?
Correct Answer: B. Emphysema
The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, which is referred to as “barrel chest.”
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?
Correct Answer: D. Spontaneous pneumothorax
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.
Which of the following organisms most commonly causes community-acquired pneumonia in adults?
Correct Answer: C. Streptococcus pneumoniae
Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most common cause of community-acquired pneumonia. Streptococcus pneumoniae is the bacterium that has historically been the most common pathogen to cause CAP worldwide. In the era before antibiotics, S. pneumoniae was estimated to be the cause of 95% of all cases of pneumonia
The client with asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack?
Correct Answer: B. Viral respiratory infections.
The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production. This leads to a significant increase in airway resistance, which is most pronounced on expiration.
The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected?
Correct Answer: D. Coarse crackles and rhonchi
Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. Crackles are usually due to airway secretions within a large airway and disappear on coughing. These crackles are scanty, gravity-independent, usually audible at the mouth, and strongly associated with severe airway obstruction.
Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination?
Correct Answer: C. A 50-year-old woman caring for a spouse with cancer.
Individuals who are household members or home care providers for high-risk individuals are high-priority targeted groups for immunization against influenza to prevent transmission to those who have a decreased capacity to deal with the disease. The wife who is caring for a husband with cancer has the highest priority of the clients described.
Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?
Correct Answer: C. Chest tube placement
The only way to re-expand 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 re-expanded.
An elderly client with pneumonia may appear with which of the following symptoms first?
Correct Answer: A. Altered mental status and dehydration
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 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?
Correct Answer: D. Administer bronchodilators.
In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, intravenous corticosteroids
A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note on assessment of this client?
C. Hyperinflated Chest on X ray
Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a flattened diaphragm as the disease is advanced.
An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings?
Correct Answer: A. It is likely that the client is developing a secondary bacterial pneumonia.
Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent cough and crackles may be indicative of a bacterial infection that is not consistent with a diagnosis of influenza.
A pulse oximetry gives what type of information about the client?
Correct Answer: C. Percentage of hemoglobin carrying oxygen.
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.
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. Which of the following treatments takes priority?
Correct Answer: C. Oxygen
The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a physician’s order.
A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?
Correct Answer: C. Corticosteroids have an anti-inflammatory effect.
Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. At a physiologic level, steroids reduce airway inflammation and mucus production and potentiate beta-agonist activity in smooth muscles and reduce beta-agonists tachyphylaxis in patients with severe asthma. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.
Which phrase is used to describe the volume of air inspired and expired with a normal breath?
Correct Answer: C. Tidal volume
Tidal volume refers to the volume of air inspired and expired with a normal breath. Tidal volume is the amount of air that moves in or out of the lungs with each respiratory cycle. It measures around 500 mL in an average healthy adult male and approximately 400 mL in a healthy female. It is a vital clinical parameter that allows for proper ventilation to take place.
When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following?
Correct Answer: A. Develop infections easily.
A client with COPD is at high risk for development of respiratory infections.
What effect does hemoglobin amount have on oxygenation status?
Correct Answer: C. Low hemoglobin levels cause reduces oxygen-carrying capacity
Hemoglobin carries oxygen to all tissues in the body. If the hemoglobin level is low, the amount of oxygen-carrying capacity is also low.
Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia?
Correct Answer: B. The ability to perform ADL’s without dyspnea
A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing action would be to:
Correct Answer: C. Administer oxygen at 2 L flow per minute.
Administer oxygen at 2 L/minute and no more, for if the client is emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function. With prolonged oxygen therapy there is an increase in blood oxygen level, which suppresses peripheral chemoreceptors; depresses ventilator drive and increase in PCO2. high blood oxygen level may also disrupt the ventilation: perfusion balance (V/Q) and cause an increase in dead space to tidal volume ratio and increase in PCO2.
A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?
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Correct Answer: C. Inhales the mist and quickly exhales.
Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client:
Correct Answer: D. Agrees to call the physician if dyspnea on exertion increases.
Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD, and therefore the physician should be notified. There are things that everyone with COPD should do to manage their disease; quitting smoking (if they smoke) is the most important. In addition, there are other non-medication treatments that can help relieve symptoms and improve quality of life.
Which of the following statements best explains how opening up collapsed alveoli improves oxygenation?
Correct Answer: D. Gaseous exchange occurs in the alveolar membrane.
Gaseous exchange occurs in the alveolar membrane, so if the alveoli collapse, no exchange occurs