Test 3
Clients with chronic illnesses are more likely to get pneumonia when which of the following
situations is present?
1. Dehydration
2. Group living
3. Malnutrition
4. Severe periodontal disease - 2. Group living
Clients with chronic illnesses generally have poor immune systems. Often, residing in group living
situations increases the chance of disease transmission.
Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows
pneumonia to develop?
1. Inflammation
2. Bronchiectasis
3. Atelectasis
4. Effusion - 1. Inflammation
The common feature of all type of pneumonia is an inflammatory pulmonary response to the
offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the
airway that doesn't occur in pneumonia. An effusion is an accumulation of excess pleural fluid in the
pleural space, which may be a secondary response to pneumonia.
Which of the following organisms most commonly causes community-acquired pneumonia in
adults?
1. Klebsiella pneumoniae
2. Staphylococcus aureus
3. Steptococcus pneumoniae
4. Haemiphilus influenzae - 3. Steptococcus pneumoniae
Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most
common cause of community-acquired pneumonia. H. influenzae is the most common cause of
infection in children. Klebsiella species is the most common gram-negative organism found in the
hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.
,An elderly client with pneumonia may appear with which of the following symptoms first?
1. Hemoptysis and dyspnea
2. Pleuritic chest pain and cough
3. Altered mental status and dehydration
4. Fever and chills - 3. 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.
When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of
the following sounds over areas of consolidation?
1. Bronchovestibular
2. Vesicular
3. Bronchial
4. Tubular - 3. Bronchial
Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchovesicular are
normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and
vesicular breath sounds are commonly heard in the bases of the lung fields.
A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
1. Blood cultures
2. Chest x-ray
3. ABG analysis
4. Sputum culture and sensitivity - 4. Sputum culture and sensitivity
Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show
the area of lung consolidation. ABG analysis will determine the extent of hypoxia present due to the
pneumonia, and blood cultures will help determine if the infection is systemic.
A client with pneumonia develops dyspnea with a respiratory rate of 32 breaths/minute and
difficulty expelling his secretions. The nurse auscultates his lung fields and hears bronchial sounds in
,the left lower lobe. The nurse determines that the client requires which of the following treatments
first?
1. Bed rest
2. Oxygen
3. Antibiotics
4. Nutritional intake - 2. 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 physicians order. Antibiotics may be
warranted, but this isn't a nursing decision. The client should be maintained on bedrest if he is
dyspneic to minimize his oxygen demands, but providing additional will deal more immediately with
his problem. The client will need nutritional support, but while dyspneic, he may be unable to spare
the energy needed to eat and at the same time maintain adequate oxygenation.
A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and will
be discharged today. Which of the following physical findings would lead the nurse to believe it is
appropriate to discharge this client?
1. Fever of 102*F
2. Vesicular breath sounds in right base
3. Continued dyspnea
4. Respiratory rate of 32 breaths/minute - 2. Vesicular breath sounds in right base
If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal
vesicular breath sounds. If the client still has dyspnea, fever, and increased respiratory rate, he
should be examined by the physician before discharge because he may have another source of
infection or still have pneumonia.
The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is
reddened and raised about 3mm where the test was given. This PPD would be read as having which
of the following results?
1. Needs to be redone
2. Positive
3. Indeterminate
4. Negative - 4. Negative
, This test would be classed as negative. A 5 mm raised area would be a positive result if a client was
HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn't a term used
to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it's considered
positive according to the CDC.
A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of
breath. He reports that it started suddenly. The assessment should include which of the following
interventions?
1. Echocardiogram
2. Electrocardiogram (ECG)
3. Chest x-ray
4. Auscultation of breath sounds - 4. Auscultation of breath sounds
Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest
x-ray and an ECG, but a physician must order these tests. Unless a cardiac source for the client's pain
is identified, he won't need an echocardiogram.
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?
1. Spontaneous pneumothorax
2. Acute asthma
3. Pneumonia
4. Chronic bronchitis - 1. 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. An asthma attack would show wheezing breath sounds, and bronchitis
would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation.
Which of the following treatments would the nurse expect for a client with a spontaneous
pneumothorax?
1. Chest tube placement
2. Antibiotics
3. Hyperbaric chamber
4. Bronchodilators - 1. Chest tube placement
Clients with chronic illnesses are more likely to get pneumonia when which of the following
situations is present?
1. Dehydration
2. Group living
3. Malnutrition
4. Severe periodontal disease - 2. Group living
Clients with chronic illnesses generally have poor immune systems. Often, residing in group living
situations increases the chance of disease transmission.
Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows
pneumonia to develop?
1. Inflammation
2. Bronchiectasis
3. Atelectasis
4. Effusion - 1. Inflammation
The common feature of all type of pneumonia is an inflammatory pulmonary response to the
offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the
airway that doesn't occur in pneumonia. An effusion is an accumulation of excess pleural fluid in the
pleural space, which may be a secondary response to pneumonia.
Which of the following organisms most commonly causes community-acquired pneumonia in
adults?
1. Klebsiella pneumoniae
2. Staphylococcus aureus
3. Steptococcus pneumoniae
4. Haemiphilus influenzae - 3. Steptococcus pneumoniae
Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most
common cause of community-acquired pneumonia. H. influenzae is the most common cause of
infection in children. Klebsiella species is the most common gram-negative organism found in the
hospital setting. Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.
,An elderly client with pneumonia may appear with which of the following symptoms first?
1. Hemoptysis and dyspnea
2. Pleuritic chest pain and cough
3. Altered mental status and dehydration
4. Fever and chills - 3. 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.
When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of
the following sounds over areas of consolidation?
1. Bronchovestibular
2. Vesicular
3. Bronchial
4. Tubular - 3. Bronchial
Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchovesicular are
normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and
vesicular breath sounds are commonly heard in the bases of the lung fields.
A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
1. Blood cultures
2. Chest x-ray
3. ABG analysis
4. Sputum culture and sensitivity - 4. Sputum culture and sensitivity
Sputum C & S is the best way to identify the organism causing the pneumonia. Chest x-ray will show
the area of lung consolidation. ABG analysis will determine the extent of hypoxia present due to the
pneumonia, and blood cultures will help determine if the infection is systemic.
A client with pneumonia develops dyspnea with a respiratory rate of 32 breaths/minute and
difficulty expelling his secretions. The nurse auscultates his lung fields and hears bronchial sounds in
,the left lower lobe. The nurse determines that the client requires which of the following treatments
first?
1. Bed rest
2. Oxygen
3. Antibiotics
4. Nutritional intake - 2. 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 physicians order. Antibiotics may be
warranted, but this isn't a nursing decision. The client should be maintained on bedrest if he is
dyspneic to minimize his oxygen demands, but providing additional will deal more immediately with
his problem. The client will need nutritional support, but while dyspneic, he may be unable to spare
the energy needed to eat and at the same time maintain adequate oxygenation.
A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and will
be discharged today. Which of the following physical findings would lead the nurse to believe it is
appropriate to discharge this client?
1. Fever of 102*F
2. Vesicular breath sounds in right base
3. Continued dyspnea
4. Respiratory rate of 32 breaths/minute - 2. Vesicular breath sounds in right base
If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal
vesicular breath sounds. If the client still has dyspnea, fever, and increased respiratory rate, he
should be examined by the physician before discharge because he may have another source of
infection or still have pneumonia.
The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is
reddened and raised about 3mm where the test was given. This PPD would be read as having which
of the following results?
1. Needs to be redone
2. Positive
3. Indeterminate
4. Negative - 4. Negative
, This test would be classed as negative. A 5 mm raised area would be a positive result if a client was
HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn't a term used
to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it's considered
positive according to the CDC.
A 24-year-old client comes into the clinic complaining of right-sided chest pain and shortness of
breath. He reports that it started suddenly. The assessment should include which of the following
interventions?
1. Echocardiogram
2. Electrocardiogram (ECG)
3. Chest x-ray
4. Auscultation of breath sounds - 4. Auscultation of breath sounds
Because the client is short of breath, listening to breath sounds is a good idea. He may need a chest
x-ray and an ECG, but a physician must order these tests. Unless a cardiac source for the client's pain
is identified, he won't need an echocardiogram.
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?
1. Spontaneous pneumothorax
2. Acute asthma
3. Pneumonia
4. Chronic bronchitis - 1. 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. An asthma attack would show wheezing breath sounds, and bronchitis
would have rhonchi. Pneumonia would have bronchial breath sounds over the area of consolidation.
Which of the following treatments would the nurse expect for a client with a spontaneous
pneumothorax?
1. Chest tube placement
2. Antibiotics
3. Hyperbaric chamber
4. Bronchodilators - 1. Chest tube placement
