Respiratory Lippincott quiz bank with complete solutions.

Respiratory Lippincott quiz bank with complete solutions.The Client with an Upper Respiratory Tract Infection A nurse is completing the health history for a client who has been taking Echinacea for a head cold. the client asks "why isn't this helping me feel better" which of the following responses by the nurse would be the most accurate: • there is limited information as to the effectiveness of herbal products • antibiotics are the agents needed to treat a head cold • the head cold should be gone within the month • combining herbal products with prescription antiviral medications is sure to help you there is limited information as to the effectiveness of herbal products 1. At this time, there is no strong research evidence to warrant recommendations of herbal products for management of colds; further study is needed to show evidence of therapeutic effects and indications. Antibiotics are effective against bacteria; the head cold may have a viral cause. An uncomplicated upper respiratory tract infection subsides within 2 to 3 weeks. There may be a drug-drug interaction with herbal products and prescriptions A nurse is teaching a client about taking antihistamines. Which of the following instructions should the nurse include in the teaching plan? Select all that apply. • 1. Operating machinery and driving may be dangerous while taking antihistamines. • 2. Continue taking antihistamines even if nasal infection develops. • 3. The effect of antihistamines is not felt until a day later. • 4. Do not use alcohol with antihistamines. • 5. Increase fluid intake to 2,000 mL/day. 1, 4, 5. Antihistamines have an anticholinergic action and a drying effect and reduce nasal, salivary, and lacrimal gland hypersecretion (runny nose, tearing, and itching eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during antihistamine use. The client should ensure adequate fluid intake of at least 8 glasses per day due to the drying effect of the drug. Antihistamines have 00:26 01:10 A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following statements would demonstrate to the nurse that the client understands the instructions? • 1. "I should limit the use of the inhaler to early morning and bedtime use." • 2. "It is important to not shake the canister because that can damage the spray device." • 3. "I should hold one nostril closed while I insert the spray into the other nostril." • 4. "The inhaler tip is inserted into the nostril and pointed toward the inside nostril wall." 3. When using an intranasal inhaler, it is important to close off one nostril while inhaling the spray into the other nostril to ensure the best inhalation of the spray. Use of the inhaler is not limited to mornings and bedtime. The canister should be shaken immediately before use. The inhaler tip should be inserted into the nostril and pointed toward the outside nostril wall to maximize inhalation of the medication. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: • 1. Maintain a fluid intake of 800 mL every 24 hours. • 2. Experience chills only once a day. • 3. Cough productively without chest discomfort. • 4. Experience less nasal obstruction and discharge. 4. A client recovering from an upper respiratory tract infection should report decreasing or no nasal discharge and obstruction. Daily fluid intake should be increased to more than 1 L every 24 hours to liquefy secretions. The temperature should be below 100° F (37.8° C) with no chills or diaphoresis. A productive cough with chest pain indicates a pulmonary infection, not an upper respiratory tract infection. The nurse teaches the client how to instill nose drops. Which of the following techniques is correct? • 1. The client uses sterile technique when handling the dropper. • 2. The client blows the nose gently before instilling drops. • 3. The client uses a new dropper for each instillation. • 4. The client sits in a semi-Fowler's position with the head tilted forward after administration of the drops. 2. The client should blow the nose before instilling nose drops. Instilling nose drops is a clean technique. The dropper should be cleaned after each administration, but it does not need to be changed. The client should assume a position that will allow the medication to reach the desired area; this is usually a supine position. The nurse should include which of the following instructions in the teaching plan for a client with chronic sinusitis? • 1. Avoid the use of caffeinated beverages. • 2. Perform postural drainage every day. • 3. Take hot showers twice daily. • 4. Report a temperature of 102° F (38.9° C) or higher. 3. The client with chronic sinusitis should be instructed to take hot showers in the morning and evening to promote drainage of secretions. There is no need to limit caffeine intake. Performing postural drainage will inhibit removal of secretions, not promote it. Clients should elevate the head of the bed to promote drainage. Clients should report all temperatures higher than 100.4° F (38° C), because a temperature that high can indicate infection. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? • 1. "Use your nasal decongestant spray regularly to help clear your nasal passages." • 2. "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." • 3. "It is important to increase your activity. A daily brisk walk will help promote drainage." • 4. "Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks." 4. It is important for clients with allergic rhinitis to determine the precipitating factors so that they can be avoided. Keeping a diary can help identify these triggers. Nasal decongestant sprays should not be used regularly because they can cause a rebound effect. Antibiotics are not appropriate for allergic rhinitis because an infection is not present. Increasing activity will not control the client's symptoms; in fact, walking outdoors may increase them if the client is allergic to pollen. Guaifenesin (Robitussin) 300 mg four times a day has been ordered as an expectorant. The dosage strength of the liquid is 200 mg/5 mL. How many milliliters should the nurse administer for each dose? _____________________ mL. 7.5 mL 300 mg/X = 200 mg/5 mL X = 7.5 mL. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible adverse effect of this drug? • 1. Constipation. • 2. Bradycardia. • 3. Diplopia. • 4. Restlessness. 4. Adverse effects of pseudoephedrine (Sudafed) are experienced primarily in the cardiovascular system and through sympathetic effects on the central nervous system (CNS). The most common CNS adverse effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular adverse effects include tachycardia, hypertension, palpitations, and arrhythmias. Constipation and diplopia are not adverse effects of pseudoephedrine. Tachycardia, not bradycardia, is a adverse effect of pseudoephedrine. The Client Undergoing Nasal Surgery A health care provider has just inserted nasal packing for a client with epistaxis. The client is taking ramipril (Altace) for hypertension. What should the nurse instruct the client to do? ■ 1. Use 81 mg of aspirin daily for relief of discomfort. ■ 2. Omit the next dose of ramipril (Altace). ■ 3. Remove the packing if there is difficulty swallowing. ■ 4. Avoid rigorous aerobic exercise. 4. Epistaxis, or nosebleed, is a common, sudden emergency. Commonly, no apparent explanation for the bleeding is known. With significant blood loss, systemic symptoms, such as vertigo, increased pulse, shortness of breath, decreased blood pressure, and pallor, will occur. Because aerobic exercise may increase blood pressure and increased blood pressure can cause epistaxis, the client with hypertension should avoid it. Aspirin inhibits platelet aggregation, reducing the ability of the blood to clot. The client should continue to take his antihypertension medication, ramipril (Altace). Posterior nasal packing should be left in place for 1 to 3 days. A 27-year-old female has had elective nasal surgery for a deviated septum. Which of the following would indicate thaat bleeding was occurring even if the nasal drip pad remained dry and intact? ■ 1. Nausea. ■ 2. Repeated swallowing. ■ 3. Increased respiratory rate. ■ 4. Increased pain. 2. Because of the dense nasal packing, bleeding may not be apparent through the nasal drip pad. Instead, the blood may run down the throat, causing the client to swallow frequently. The back of the throat, where the blood will be apparent, can be assessed with a flashlight. An accumulation of blood in the stomach can cause nausea and vomiting, but nausea would not be the initial indicator of bleeding. An increased respiratory rate occurs in shock but is not an early sign of bleeding in a client who has undergone nasal surgery. Increased pain warrants further assessment but is not an indicator of bleeding. A client who has undergone outpatient nasal surgery is ready for discharge and has nasal packing in place. Which of the following discharge instructions would be appropriate for the client? ■ 1. Avoid activities that elicit the Valsalva maneuver. ■ 2. Take aspirin to control nasal discomfort. ■ 3. Avoid brushing the teeth until the nasal packing is removed. ■ 4. Apply heat to the nasal area to control swelling. 1. The client should be instructed to avoid any activities that cause Valsalva's maneuver (e.g., constipation, vigorous coughing, exercise) in order to reduce bleeding and stress on suture lines. The client should not take aspirin because of its antiplatelet properties, which may cause bleeding. Oral hygiene is important to rid the mouth of old dried blood and to enhance the client's appetite. Cool compresses, not heat, should be applied to decrease swelling and control discoloration of the area. Which of the following statements should indicate to the nurse that a client has understood the discharge instructions provided after her nasal surgery? ■ 1. "I should not shower until my packing is removed." ■ 2. "I will take stool softeners and modify my diet to prevent constipation." ■ 3. "Coughing every 2 hours is important to prevent respiratory complications." ■ 4. "It is important to blow my nose each day to remove the dried secretions." 2. Constipation can cause straining during defecation, which can induce bleeding. Showering is not contraindicated. The client should take measures to prevent coughing, which can cause bleeding. The client should avoid blowing her nose for 48 hours after the packing is removed. Thereafter, she should blow her nose gently, using the open mouth technique to minimize bleeding in the surgical area. The nurse is planning to give preoperative instructions to a client who will be undergoing rhinoplasty. Which of the following instructions should be included? ■ 1. After surgery, nasal packing will be in place for 7 to 10 days. ■ 2. Normal saline nose drops will need to be administered preoperatively. ■ 3. The results of the surgery will be immediately obvious postoperatively. ■ 4. Aspirin-containing medications should not be taken for 2 weeks before surgery. 4. Aspirin-containing medications should be discontinued for 2 weeks before surgery to decrease the risk of bleeding. Nasal packing is usually removed the day after surgery. Normal saline nose drops are not routinely administered preoperatively. The results of the surgery will not be obvious immediately after surgery because of edema and ecchymosis. Which of the following assessments should be a priority immediately after nasal surgery? ■ 1. Assessing the client's pain. ■ 2. Inspecting for periorbital ecchymosis. ■ 3. Assessing respiratory status. ■ 4. Measuring intake and output. 3. Immediately after nasal surgery, ineffective breathing patterns may develop as a result of the nasal packing and nasal edema. Nasal packing may dislodge, leading to obstruction. Assessing for airway obstruction is a priority. Assessing for pain is important, but it is not as high a priority as assessment of the airways. It is too early to detect ecchymosis. Measuring intake and output is not typically a priority nursing assessment after nasal surgery. After nasal surgery, the client expresses concern about how to decrease facial pain and swelling while recovering at home. Which of the following discharge instructions would be most effective for decreasing pain and edema? ■ 1. Take analgesics every 4 hours around the clock. ■ 2. Use corticosteroid nasal spray as needed to control symptoms. ■ 3. Use a bedside humidifier while sleeping. ■ 4. Apply cold compresses to the area. 4. Applying cold compresses helps to decrease facial swelling and pain from edema. Analgesics may decrease pain, but they do not decrease edema. A corticosteroid nasal spray would not be administered postoperatively because it can impair healing. Use of a bedside humidifier promotes comfort by providing moisture for nasal mucosa, but it does not decrease edema. A client is being discharged with nasal packing in place. The nurse should instruct the client to: ■ 1. Perform frequent mouth care. ■ 2. Use normal saline nose drops daily. ■ 3. Sneeze and cough with mouth closed. ■ 4. Gargle every 4 hours with salt water. 1. Frequent mouth care is important to provide comfort and encourage eating. Mouth care promotes moist mucous membranes. Nose drops cannot be used with nasal packing in place. When sneezing and coughing, the client should do so with the mouth open to decrease the chance of dislodging the packing. Gargling should not be attempted with packing in place. Which of the following activities should the nurse teach the client to implement after the removal of nasal packing on the second postoperative day? ■ 1. Avoid cleaning the nares until swelling has subsided. ■ 2. Apply water-soluble jelly to lubricate the nares. ■ 3. Keep a nasal drip pad in place to absorb secretions. ■ 4. Use a bulb syringe to gently irrigate nares. 2. After removal of nasal packing, the client should be instructed to apply water-soluble jelly to the nares to lubricate the nares and promote comfort. Swelling gradually subsides over several weeks; the client can gently clean the nares as soon as packing is removed. A nasal drip pad is not needed after removal of packing. Irrigation with a bulb syringe may interfere with healing and introduce infection. The nurse is teaching a client how to manage a nosebleed. Which of the following instructions would be appropriate to give the client? ■ 1. "Tilt your head backward and pinch your nose." ■ 2. "Lie down flat and place an ice compress over the bridge of the nose." ■ 3. "Blow your nose gently with your neck flexed." ■ 4. "Sit down, lean forward, and pinch the soft portion of your nose." 4. The client should assume a sitting position and lean forward. Firm pressure should be applied to the soft portion of the nose for approximately 10 minutes. Tilting the head backward can cause the client to swallow blood, which can obscure the amount of bleeding and also can lead to nausea. Ice compresses may be applied, but the client should not lie flat. Blowing the nose is to be avoided because it can increase bleeding. An elderly client had posterior packing inserted to control a severe nosebleed. After insertion of the packing, the client should be closely monitored for which of the following complications? ■ 1. Vertigo. ■ 2. Bell's palsy. ■ 3. Hypoventilation. ■ 4. Loss of gag reflex. 3. Posterior packing may alter the respiratory status of the client, especially in elderly clients, causing hypoventilation. Clients should be observed carefully for changes in level of consciousness, respiratory rate, and heart rate and rhythm after the insertion of the packing. Vertigo does not occur as a result of the insertion of posterior packing. Bell's palsy, a disorder of the seventh cranial nerve, is not associated with epistaxis or nasal packing. Loss of gag reflex does not occur as a result of the insertionof posterior packing. The Client with Cancer of the Larynx Postoperative nursing management of the client following a radical neck dissection for laryngeal cancer requires: ■ 1. Complete bed rest minimizing head movement. ■ 2. Vital signs once a shift. ■ 3. Clear liquid diet started at 48 hours. ■ 4. Frequent suctioning of the laryngectomy tube. 4. The nurse must maintain patency of the airway with frequent suctioning of the laryngectomy tube that can become occluded from secretions, blood, and mucus plugs. Once the client is hemodynamically stable, getting out of bed should be encouraged to prevent postoperative complications. Vital signs should be monitored more frequently in a postoperative client. A swallow study is done at approximately 5 to 7 days after surgery, prior to starting oral intake. A client who has had a total laryngectomy appears withdrawn and depressed. He keeps the curtain drawn, refuses visitors, and indicates a desire to be left alone. Which nursing intervention would most likely be therapeutic for the client? ■ 1. Discussing his behavior with his wife to determine the cause. ■ 2. Exploring his future plans. ■ 3. Respecting his need for privacy. ■ 4. Encouraging him to express his feelings nonverbally and in writing. 4. The client has undergone body changes and permanent loss of verbal communication. He may feel isolated and insecure. The nurse can encourage him to express his feelings and use this information to develop an appropriate plan of care. Discussing the client's behavior with his wife may not reveal his feelings. Exploring future plans is not appropriate at this time because more information about the client's behavior is needed before proceeding to this level. The nurse can respect the client's need for privacy while also encouraging him to express his feelings. The nurse is suctioning a client who had a laryngectomy. What is the maximum amount of time the nurse should suction the client? ■ 1. 10 seconds. ■ 2. 15 seconds. ■ 3. 25 seconds. ■ 4. 30 seconds. 1. A client should be suctioned for no longer than 10 seconds at a time. Suctioning for longer than 10 seconds may reduce the client's oxygen level so much that he becomes hypoxic. When suctioning a tracheostomy or laryngectomy tube, the nurse should follow which of the following procedures? ■ 1. Use a sterile catheter each time the client is suctioned. ■ 2. Clean the catheter in sterile water after each use and reuse for no longer than 8 hours. ■ 3. Protect the catheter in sterile packaging between suctioning episodes. ■ 4. Use a clean catheter with each suctioning, and disinfect it in hydrogen peroxide between uses. 1. The recommended technique is to use a sterile catheter each time the client is suctioned. There is a danger of introducing organisms into the respiratory tract when strict aseptic technique is not used. Reusing a suction catheter is not consistent with aseptic technique. The nurse does not use a clean catheter when suctioning a tracheostomy or a laryngectomy; it is a sterile procedure. The client with a laryngectomy communicates to the nurse that he does not want his family to see him. He indicates that he thinks the opening in his throat is disgusting. Which of the following nursing diagnoses would be most appropriate? ■ 1. Deficient knowledge about the care of a stoma. ■ 2. Disturbed personal identity related to change in appearance. ■ 3. Disturbed body image related to neck surgery. ■ 4. Hopelessness related to irreversible changes in body functioning. 3. Disturbed body image is the most appropriate nursing diagnosis based on the client's statements at this time. Most clients are concerned about how their family members will respond to the physical changes that have occurred as a result of radical neck surgery. The nurse should allow the client to communicate any negative feelings or concerns that exist because of the surgery. Referral to a support group for laryngectomy clients may be helpful to the client and family members in coping with the changes in their lives. The client's feelings are not related to a knowledge deficit, but rather to a permanent change in physical appearance and functioning. The diagnosis of Disturbed personal identity refers to a client's inability to distinguish self from nonself. Hopelessness may be an issue for the client experiencing a body image disturbance; however, there are no data to support this diagnosis at this time. What areas of education should the nurse provide employees in a factory making products that cause respiratory irritation to reduce the risk of laryngeal cancer? Select all that apply. ■ 1. Smoking cessation concurrent with counseling. ■ 2. HEPA filter use in the home. ■ 3. Limiting alcohol use. ■ 4. Brushing teeth after every meal. ■ 5. Raising the voice to be heard over the noise in the factory. 1, 3. The primary risk factors for laryngeal cancer are smoking and alcohol abuse. Smoking cessation is most successful with a support group or counseling. Heavy drinking should be avoided since the risk increases with amount of alcohol consumption. HEPA filters help trap small particles and allergens to reduce allergy symptoms and asthma. Poor oral hygiene is not a risk factor, nor is over-using the voice. A client has had hoarseness for more than 2 weeks. The nurse should: ■ 1. Refer to a health care provider for a prescription for an antibiotic. ■ 2. Instruct the client to gargle with salt water at home. ■ 3. Assess the client for dysphagia. ■ 4. Instruct the client to take a throat analgesic. 3. Hoarseness occurring longer than 2 weeks is a warning sign of laryngeal cancer. The nurse should first assess other signs, such as a lump in the neck or throat, persistent sore throat or cough, earache, pain, and difficulty swallowing (dysphagia). Gargling with salt water may lead to increased irritation. There is no indication of infection warranting an antibiotic. An oral analgesic would provide only temporary relief of discomfort if hoarseness is accompanied by a sore throat. A client has just returned from the postanesthesia care unit after undergoing a laryngectomy. Which of the following interventions should the nurse include in the plan of care? ■ 1. Maintain the head of the bed at 30 to 40 degrees. ■ 2. Teach the client how to use esophageal speech. ■ 3. Initiate small feedings of soft foods. ■ 4. Irrigate drainage tubes as needed. 1. Immediately after surgery, the client should be maintained in a position with the head of the bed elevated 30 to 40 degrees (semi-Fowler's position) to decrease tissue edema, facilitate breathing, and decrease pain related to edema formation. Immediately postoperatively, the client should be provided alternative means of communicating, such as a communication board. As healing progresses and edema subsides, a speech therapist should work with the client to explore various voice restoration options, such as the use of a voice prosthesis, electrolarynx, artificial larynx, or esophageal speech. Food is not initiated in the immediate postoperative phase; enteral feedings are usually used to meet nutritional needs until edema subsides. Irrigation of the drainage tubes is an inappropriate action. Which of the following is an appropriate expected outcome for a client recovering from a total laryngectomy? The client will: ■ 1. Regain the ability to taste and smell food. ■ 2. Demonstrate appropriate care of the gastrostomy tube. ■ 3. Communicate feelings about body image changes. ■ 4. Demonstrate sterile suctioning technique for stoma care. 3. It is important that the client be able to communicate his or her feelings about the body image changes that have occurred as a result of surgery. Open communication helps promote adjustment. The client may not regain the ability to taste and smell food because of no longer breathing through the nose or because of radiation therapy treatments, or both. A gastrostomy tube would not typically be placed after a total laryngectomy, nor would it be necessary for the client to demonstrate sterile suctioning technique for stoma care. The client would use clean technique. Which of the following home care instructions would be appropriate for a client with a laryngectomy? ■ 1. Perform mouth care every morning and evening. ■ 2. Provide adequate humidity in the home. ■ 3. Maintain a soft, bland diet. ■ 4. Limit physical activity to shoulder and neck exercises. 2. Adequate humidity should be provided in the home to help keep secretions moist. A bedside humidifier is recommended. A high fluid intake is also important to liquefy secretions. Mouth care is important to prevent drying of mucous membranes and should be performed frequently throughout the day, especially before and after meals, to help stimulate appetite. The client may eat any food that can be chewed and swallowed comfortably. The client may resume physical activity as tolerated. The nurse has reported to the hospital to work the evening shift on a respiratory unit. The nurse's assignment consists of four clients. Prioritize in order from highest to lowest priority how the nurse would assess the clients after receiving report. 1. An 85-year-old client with bacterial pneumonia, temperature of 102.2° F (42° C), and shortness of breath. 2. A 60-year-old client with chest tubes who is 2 days postoperative following a thoracotomy for lung cancer and is requesting something for pain. 3. A 35-year-old client with suspected tuberculosis who is complaining of a cough. 4. A 56-year-old client with emphysema who has a scheduled dose of a bronchodilator due to be administered, with no report of acute respiratory distress. 1. An 85-year-old client with bacterial pneumonia, temperature of 102.2° F (42° C), and shortness of breath. 2. A 60-year-old client with chest tubes who is 2 days postoperative following a thoracotomy for lung cancer and is requesting something for pain. 4. A 56-year-old client with emphysema who has a scheduled dose of a bronchodilator due to be administered, with no report of acute respiratory distress. 3. A 35-year-old client with suspected tuberculosis who is complaining of a cough. The Client with Pneumonia A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care? ■ 1. Infection. ■ 2. Confusion. ■ 3. Ineffective coughing and deep breathing. ■ 4. Difficulty chewing solid foods. 3. In kyphosis, the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems because respiratory status deteriorates when pulmonary secretions are not adequately cleared from airways, ineffective coughing and deep breathing should receive priority attention. A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first? ■ 1. Elevate the head of the bed 30 to 45 degrees. ■ 2. Encourage the client to cough and deep breathe. ■ 3. Auscultate the lungs to detect abnormal breath sounds. ■ 4. Contact the physician. 1. Elevating the head of the bed facilitates breathing because the lungs are able to expand as the diaphragm descends. Coughing and deep breathing do not alleviate the symptoms of a pulmonary embolus, nor does lung auscultation. The physician must be kept informed of changes in a client's status, but the priority in this case is alleviating the symptoms. A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia? ■ 1. Age. ■ 2. Osteoarthritis. ■ 3. Vegetarian diet. ■ 4. Daily bathing. 1. The client's age is a predisposing factor for pneumonia; pneumonia is more common in elderly or debilitated clients. Other predisposing factors include smoking, upper respiratory tract infections, malnutrition, immunosuppression, and the presence of a chronic illness. Osteoarthritis, a nutritionally sound vegetarian diet, and frequent bathing are not predisposing factors for pneumonia. Which of the following is significant data to gather from a client who has been diagnosed with pneumonia? Select all that apply. ■ 1. Quality of breath sounds. ■ 2. Presence of bowel sounds. ■ 3. Occurrence of chest pain. ■ 4. Amount of peripheral edema. ■ 5. Color of nail beds. 1, 3, 5. 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 client with pneumonia. A client with bacterial pneumonia is to be started on I.V. antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins? ■ 1. Urinalysis. ■ 2. Sputum culture. ■ 3. Chest radiograph. ■ 4. Red blood cell count. 2. A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibiotic can be prescribed. Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test. Neither a urinalysis, a chest radiograph, nor a red blood cell count needs to be obtained before initiation of antibiotic therapy for pneumonia. When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which of the following laboratory values? ■ 1. Serum sodium. ■ 2. Serum potassium. ■ 3. Serum creatinine. ■ 4. Serum calcium. 3. It is essential to monitor serum creatinine in the client receiving an aminoglycoside antibiotic because of the potential of this type of drug to cause acute tubular necrosis. Aminoglycoside antibiotics do not affect serum sodium, potassium, or calcium levels. 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? ■ 1. Position changes every 4 hours. ■ 2. Nasotracheal suctioning to clear secretions. ■ 3. Frequent linen changes. ■ 4. Frequent offering of a bedpan. 3. Frequent linen changes are appropriate for this client because of the 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. Bed rest is prescribed for a client with pneumonia during the acute phase of the illness. The nurse should determine the effectiveness of bed rest by assessing the client's: ■ 1. Decreased cellular demand for oxygen. ■ 2. Reduced episodes of coughing. ■ 3. Diminished pain when breathing deeply. ■ 4. Ability to expectorate secretions more easily. 1. Exudate in the alveoli interferes with ventilation and the diffusion of gases in clients with pneumonia. During the acute phase of the illness, it is essential to reduce the body's need for oxygen at the cellular level; bed rest is the most effective method for doing so. Bed rest does not decrease coughing or promote clearance of secretions, and it does not reduce pain when taking deep breaths. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following? ■ 1. Decreased cardiac output. ■ 2. Pleural effusion. ■ 3. Inadequate peripheral circulation. ■ 4. Decreased oxygenation of the blood. 4. 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. Decreased cardiac output may be a comorbid condition in some clients with pneumonia; however, it is not the cause of cyanosis. Pleural effusions are a potential complication of pneumonia but are not the primary cause of decreased oxygenation. Inadequate peripheral circulation is also not the cause of the cyanosis that develops with bacterial pneumonia. A client with pneumonia is experiencing pleuritic chest pain. The nurse should assess the client for: ■ 1. A mild but constant aching in the chest. ■ 2. Severe midsternal pain. ■ 3. Moderate pain that worsens on inspiration. ■ 4. Muscle spasm pain that accompanies coughing. 3. Chest pain in pneumonia is generally caused by friction between the pleural layers. It is more severe on inspiration than on expiration, secondary to chest wall movement. Pleuritic chest pain is usually described as sharp, not mild or aching. Pleuritic chest pain is not localized to the sternum, and it is not the result of a muscle spasm. Which of the following measures would most likely be successful in reducing pleuritic chest pain in a client with pneumonia? ■ 1. Encourage the client to breathe shallowly. ■ 2. Have the client practice abdominal breathing. ■ 3. Offer the client incentive spirometry. ■ 4. Teach the client to splint the rib cage when coughing. 4. The pleuritic pain is triggered by chest movement and is particularly severe during coughing. Splinting the chest wall will help reduce the discomfort of coughing. Deep breathing is essential to prevent further atelectasis. Abdominal breathing is not as effective in decreasing pleuritic chest pain as is splinting of the rib cage. Incentive spirometry facilitates effective deep breathing but does not decrease pleuritic chest pain. The nurse administers two 325 mg aspirin every 4 hours to a client with pneumonia. The nurse should evaluate the outcome of administering the drug by assessing which of the following? Select all that apply. ■ 1. Decreased pain when breathing. ■ 2. Prolonged clotting time. ■ 3. Decreased temperature. ■ 4. Decreased respiratory rate. ■ 5. Increased ability to expectorate secretions. 1, 3. Aspirin is administered to clients with pneumonia because it is an analgesic that helps control chest discomfort and an antipyretic that helps reduce fever. Aspirin has an anticoagulant effect, but that is not the reason for prescribing it for a client with pneumonia, and the use of the drug will be short term. Aspirin does not affect the respiratory rate, and does not facilitate expectoration of secretions. Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? ■ 1. Coma. ■ 2. Apathy. ■ 3. Irritability. ■ 4. Depression. 3. 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. The client with pneumonia develops mild constipation, and the nurse administers docusate sodium (Colace) as ordered. This drug works by: ■ 1. Softening the stool. ■ 2. Lubricating the stool. ■ 3. Increasing stool bulk. ■ 4. Stimulating peristalsis. 1. Docusate sodium (Colace) is a stool softener that allows fluid and fatty substances to enter the stool and soften it. Docusate sodium does not lubricate the stool, increase stool bulk, or stimulate peristalsis. The unlicensed assistive personnel (UAP) reports to the registered nurse that a client admitted with pneumonia is very diaphoretic. The nurse reviews the following vital signs in the chart obtained by the UAP. Vital Signs Time 8 AM 10 AM 12 PM Temperature 38.3° C 38.8° C Pulse Respirations 16 18 24 BP 112/74 110/68 116/78 Spo2 93% 92% 92% The nurse should: ■ 1. Maintain complete bed rest. ■ 2. Check the urine output. ■ 3. Ask the UAP to change the linens. ■ 4. Administer a beta blocker. 2. A client with pneumonia experiencing diaphoresis is at risk for dehydration. The fluid status, intake, and output should be monitored closely. The client is febrile, causing an increase in heart rate. Fluid volume deficit may also increase the heart rate. A beta blocker is not indicated since the underlying cause of the tachycardia can be treated with acetaminophen (Tylenol) and fluid volume. Bed rest limits lung expansion and sitting up and deep breathing should be encouraged in a client with pneumonia. The blood pressure is stable enough to allow the client to get out of bed to the chair, with assistance to ensure safety. Which of the following is an expected outcome for an elderly client following treatment for bacterial pneumonia? ■ 1. A respiratory rate of 25 to 30 breaths/minute. ■ 2. The ability to perform activities of daily living without dyspnea. ■ 3. A maximum loss of 5 to 10 lb of body weight. ■ 4. Chest pain that is minimized by splinting the rib cage. 2. An expected outcome for a client recovering from pneumonia would be the ability to perform activities of daily living 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 to 10 lb 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. The Client with Tuberculosis Which of the following symptoms is common in clients with active tuberculosis? ■ 1. Weight loss. ■ 2. Increased appetite. ■ 3. Dyspnea on exertion. ■ 4. Mental status changes. 1. Tuberculosis typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats. Increased appetite is not a symptom of tuberculosis; dyspnea on exertion and change in mental status are not common symptoms of tuberculosis. A client is receiving streptomycin in the treatment regimen of tuberculosis. The nurse should assess for: ■ 1. Decreased serum creatinine. ■ 2. Difficulty swallowing. ■ 3. Hearing loss. ■ 4. I.V. infiltration. 3. Streptomycin can cause toxicity to the eighth cranial nerve, which is responsible for hearing, balance, and body position sense. Nephrotoxicity is a side effect that would be indicated with an increase in creatinine. Streptomycin is given via intramuscular injection. A client is receiving streptomycin for the treatment of tuberculosis. The nurse should assess the client for eighth cranial nerve damage by observing the client for: ■ 1. Vertigo. ■ 2. Facial paralysis. ■ 3. Impaired vision. ■ 4. Difficulty swallowing. 1. The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve (ototoxicity). Symptoms of ototoxicity include vertigo, tinnitus, hearing loss, and ataxia. Facial paralysis would result from damage to the facial nerve (VII). Impaired vision would result from damage to the optic (II), oculomotor (III), or the trochlear (IV) nerves. Difficulty swallowing would result from damage to the glossopharyngeal (IX) or the vagus (X) nerve. The nurse should teach clients that the most common route of transmitting tubercle bacilli from person to person is through contaminated: ■ 1. Dust particles. ■ 2. Droplet nuclei. ■ 3. Water. ■ 4. Eating utensils. 2. Tubercle bacilli are spread by airborne droplet nuclei. Droplet nuclei are the residue of evaporated droplets containing the bacilli, which remain suspended and are circulated in the air. Dust particles and water do not spread tubercle bacilli. Tuberculosis is not spread by eating utensils, dishes, or other fomites. What is the rationale that supports multidrug treatment for clients with tuberculosis? ■ 1. Multiple drugs potentiate the drugs' actions. ■ 2. Multiple drugs reduce undesirable drug adverse effects. ■ 3. Multiple drugs allow reduced drug dosages to be given. ■ 4. Multiple drugs reduce development of resistant strains of the bacteria. 4. Use of a combination of antituberculosis drugs slows the rate at which organisms develop drug resistance. Combination therapy also appears to be more effective than single-drug therapy. Many drugs potentiate (or inhibit) the actions of other drugs; however, this is not the rationale for using multiple drugs to treat tuberculosis. Treatment with multiple drugs does not reduce adverse effects and may expose the client to more adverse effects. Combination therapy may allow some medications (e.g., antihypertensives) to be given in reduced dosages; however, reduced dosages are not prescribed for antibiotics and antituberculosis drugs. The client with tuberculosis is to be discharged home with community health nursing follow-up. Of the following nursing interventions, which should have the highest priority? ■ 1. Offering the client emotional support. ■ 2. Teaching the client about the disease and its treatment. ■ 3. Coordinating various agency services. ■ 4. Assessing the client's environment for sanitation. 2. Ensuring that the client is well educated about tuberculosis is the highest priority. Education of the client and family is essential to help the client understand the need for completing the prescribed drug therapy to cure the disease. Offering the client emotional support, coordinating various agency services, and assessing the environment may be part of the care for the client with tuberculosis; however, these interventions are of less importance than education about the disease process and its treatment. The nurse is reading the results of a tuberculin skin test [that shows a firm, raised, area greater than 15 mm in diameter].The nurse should interpret the results as: ■ 1. Negative. ■ 2. Needing to be repeated. ■ 3. Positive. ■ 4. False. 3. The tuberculin test is positive. The test should be interpreted 2 to 3 days after administering the purified protein derivative (PPD) by measuring the size of the firm, raised area (induration). Positive responses indicate that the client may have been exposed to the tuberculosis bacteria. A negative response is indicated by the absence of a firm, raised area, or an area that is less than 5 mm in diameter. Since the test is positive, it is not necessary to redo the test. The test is positive, not false. Which of the following techniques for administering the Mantoux test is correct? ■ 1. Hold the needle and syringe almost parallel to the client's skin. ■ 2. Pinch the skin when inserting the needle. ■ 3. Aspirate before injecting the medication. ■ 4. Massage the site after injecting the medication. 1. The Mantoux test is administered via intradermal injection. The appropriate technique for an intradermal injection includes holding the needle and syringe almost parallel to the client's skin, keeping the skin slightly taut when the needle is inserted, and inserting the needle with the bevel side up. There is no need to aspirate, a technique that assesses for incorrect placement in a blood vessel, when giving an intradermal injection. The injection site is not massaged. Which of the following family members exposed to tuberculosis would be at highest risk for contracting the disease? ■ 1. 45-year-old mother. ■ 2. 17-year-old daughter. ■ 3. 8-year-old son. ■ 4. 76-year-old grandmother. 4. Elderly persons are believed to be at higher risk for contracting tuberculosis because of decreased immunocompetence. Other high-risk populations in the United States include the urban poor, clients with acquired immunodeficiency syndrome, and minority groups. The nurse is teaching a client who has been diagnosed with tuberculosis how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurse's instructions? Select all that apply. ■ 1. "I will need to dispose of my old clothing when I return home." ■ 2. "I should always cover my mouth and nose when sneezing." ■ 3. "It is important that I isolate myself from family when possible." ■ 4. "I should use paper tissues to cough in and dispose of them promptly." ■ 5. "I can use regular plates and utensils whenever I eat." 2, 4, 5. When teaching the client how to avoid the transmission of tubercle bacilli, it is important for the client to understand that the organism is transmitted by droplet infection. Therefore, covering the mouth and nose when sneezing, using paper tissues to cough in with prompt disposal, and using regular plates and utensils indicate that the client has understood the nurse's instructions about preventing the spread of airborne droplets. It is not essential to discard clothing, nor does the client need to isolate himself from family members.