DeWitt Respiratory questions and answers with rated solutions

DeWitt Respiratory questions and answers with rated solutions Chapter 13: The Respiratory System Chapter 13: The Respiratory System MULTIPLE CHOICE ... 1. The nurse explains that the purpose of mucus is to: a. warm the air entering the lungs. b. trap particles and bacteria. c. protect the cilia. d. clean the sinus cavity. @ANS: B Mucus traps particles and bacteria that may be in the inspired air. DIF: Cognitive Level: Knowledge REF: 257 OBJ: 1 (theory) TOP: Mucus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. A patient with emphysema enters the emergency room with severe dyspnea; O2 saturation is 74%, pulse is 120, and respirations are 26. After positioning the patient in high Fowler's, the nurse should: a. attempt to help the patient slow her respirations. b. coach in pursed-lip breathing. c. give oxygen at 5 L/min by nasal cannula. d. reposition patient in orthopneic position. ANS: B Coaching in pursed-lip breathing will open the respiratory tree with negative pressure. Oxygen given at such a high concentration will cause an emphysemic patient to stop breathing. High Fowler's position is beneficial and easy to position with minimal equipment. DIF: Cognitive Level: Analysis REF: 272 OBJ: 2 (clinical) TOP: Oxygen Administration to Emphysemic Patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 3. The nurse explains that the mechanism that triggers rate and depth of respiration is based on: a. ease of respiration. b. alveolar pressure. c. patency of bronchi. d. blood pH. ANS: D Chemoreceptors in the brainstem and carotid arteries measure hydrogen concentration, as well as CO2 and O2, to trigger respiration rate to correct the excessive CO2. DIF: Cognitive Level: Comprehension REF: 259 OBJ: 2 (theory) TOP: Ventilation and Blood pH KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 4. The nurse uses a visual aid to show the mechanics of inhaling which correctly illustrates: a. the diaphragm moves down. b. the negative pressure of the lung converts to positive pressure. c. muscles contract, pulling the rib cage down. d. bronchi enlarge. ANS: A On inspiration, the diaphragm moves down, increasing the area of negative pressure, muscles pull the rib cage up, and the positive-pressure room air flows into the negative-pressure lungs. DIF: Cognitive Level: Comprehension REF: 259 OBJ: 2 (theory) TOP: Mechanics of Inspiration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. The nurse explains that the substance that decreases the surface tension of the alveolar walls is: a. plasma. b. surfactant. c. cilia. d. mucus. ANS: B Surfactant is the substance that reduces the surface tension of the walls of the alveoli, making gas exchange more effective. DIF: Cognitive Level: Comprehension REF: 259 OBJ: 1 (theory) TOP: Surfactant KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. Using animation, the nurse demonstrates how most of the inspired oxygen is carried to the tissues by the: a. plasma. b. lymphatic system. c. red blood cells. d. white blood cells. ANS: C The red blood cells carry 97% of the oxygen to the cells, attached to hemoglobin. DIF: Cognitive Level: Comprehension REF: 260 OBJ: 1 (theory) TOP: Oxygen Transport KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 7. The nurse points out to the student nurse that one of the patients she is caring for has an obstructive respiratory disorder. The student is correct in identifying the patient diagnosed with __________ as having an obstructive disorder. a. atelectasis b. lung cancer c. Guillain-Barré syndrome d. chronic bronchitis ANS: D Obstructive lung disease is related to the reduced ability to move air in and out of the lungs. Asthma, emphysema, and chronic bronchitis are classified as obstructive disorders. Atelectasis, lung cancer, and Guillain-Barré syndrome are restrictive disorders. DIF: Cognitive Level: Application REF: 261 OBJ: 1 (theory) TOP: Obstructive Lung Disease KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 8. When reviewing risk factors, the nurse correctly identifies which patient as having the greatest risk of throat cancer? a. The patient who drinks 4 cups of coffee per day. b. The patient who smokes 1 pack of cigarettes per week. c. The patient who drinks several carbonated drinks per day. d. The patient who drinks 4 vodka tonics per day. ANS: D The combination of alcohol and cigarettes increases the risk for throat cancer. However, the patient consuming 4 vodka drinks per day is at a higher risk than the patient smoking 1 pack of cigarettes per week. Coffee and carbonated drink consumption has not been found to increase the risk of throat cancer. DIF: Cognitive Level: Analysis REF: 262 | Elder Care Points OBJ: 2 (theory) TOP: Alcohol-Related Throat Cancer KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 9. The nurse cautions each person prior to giving the influenza immunization that they should not take it if they are allergic to: a. strawberries. b. ragweed. c. penicillin. d. eggs. ANS: D The influenza vaccine is cultured in chicken embryos, making anyone allergic to eggs probably allergic to the immunization. DIF: Cognitive Level: Application REF: 261 OBJ: 2 (theory) TOP: Influenza Immunization Allergy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 10. After auscultating a coarse low-pitched sonorous rattling in the left lower lobe, the nurse is concerned that the patient may be developing: a. an accumulation of secretions in the larger air passages. b. narrowing in the lower lobe of the lung. c. irritation in the pleurae. d. crackles in the left lower lobe. ANS: A Low-pitched sonorous wheezing sounds are caused by secretions accumulating in the larger airways. Narrowing of air passages will result in high-pitched wheezes. Irritation of pleurae will cause a pleural friction rub to be heard. Crackles are produced by air passing through moisture in the smaller airways. DIF: Cognitive Level: Application REF: 263-264 OBJ: 4 (theory) TOP: Breath Sounds KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 11. When the nurse places the diaphragm of the stethoscope over one of the main bronchi, the expected normal breath sound heard is: a. bronchovesicular. b. bronchial. c. rhonchi. d. vesicular. ANS: A Bronchovesicular sounds are moderate hollow sounds that are equal on inspiration and expiration. DIF: Cognitive Level: Comprehension REF: 264 OBJ: 4 (theory) TOP: Breath Sounds KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 12. The nurse performing tracheal suctioning of the patient with a respiratory disorder should suction no longer than _____ seconds. a. 2 to 5 b. 5 to 10 c. 10 to 15 d. 15 to 20 ANS: C The suctioning, which is done during extraction of the suction tip, should not last more than 10 to 15 seconds as it deprives the patient of oxygen. DIF: Cognitive Level: Comprehension REF: 272 OBJ: 5 (theory) TOP: Suctioning KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 13. The nurse is aware that the patient is in respiratory failure when the blood gas findings are a PaO2 of _____ mm Hg and a PaCO2 of _____ mm Hg. a. 46; 52 b. 50; 45 c. 52; 42 d. 55; 58 ANS: A Respiratory failure is defined by blood gases that have a PaO2 level below 50 mm Hg and a PaCO2 level equal to or higher than 50 mm Hg. DIF: Cognitive Level: Analysis REF: 273 OBJ: 5 (clinical) TOP: Blood Gases KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 14. The nurse assesses a patient's respirations who was recently admitted with a traumatic head injury. The nurse expects to find which type of breathing during the assessment? a. Apneustic respiration b. Cheyne-Stokes c. Kussmaul's d. Biot's ANS: D Biot's respirations are characterized by irregular periods of apnea followed by four to five breaths of identical depth. This pattern is associated with increased intracranial pressure, which is common with a traumatic head injury. Apneustic respirations are indicative of damage to the respiratory centers in the brain. Cheyne-Stokes respirations are often seen in patients in a coma resulting from a disorder affecting the central nervous system. Kussmaul's respiration is an abnormal breathing pattern often seen in patients with diabetic acidosis and coma. DIF: Cognitive Level: Application REF: 273 OBJ: 4 (theory) TOP: Biot's Respiration KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 15. After having the postoperative patient deep-breathe and cough, the nurse should offer: a. a warm drink. b. mouth care. c. oxygen by mask. d. an iced drink. ANS: B Mouth care should be offered after deep breathing and coughing to clear the mouth of unpleasant taste. DIF: Cognitive Level: Comprehension REF: 274 OBJ: 5 (theory) TOP: Mouth Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 16. A patient is admitted to the medical unit with an acute illness accompanied by a fever for the last 3 days. What will likely be the patient's respiratory response? a. Hypercarbia b. Respiratory alkalosis c. Kussmaul's respirations d. Respiratory acidosis ANS: B Respiratory alkalosis, or hypocapnia, results from the patient's respiratory rate being elevated for a prolonged period due to the persistent fever. The patient blows off too much CO2 as a result. Hypercarbia and respiratory acidosis are the same and result from disorders that cause hypoventilation. Kussmaul's respirations are an abnormal breathing pattern. DIF: Cognitive Level: Application REF: 273 OBJ: 2 (theory) TOP: Hypocapnia KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 17. The nurse is caring for a patient with COPD who has been in the hospital for several days. The patient complains of shortness of breath and asks the nurse to turn up his oxygen to compensate for his labored breathing. What is the best nursing response? a. Turn up the patient's oxygen flow by 1 liter. b. Call the physician for an order to turn up the oxygen. c. Assess the patient in an attempt to identify the cause of the shortness of breath. d. Ask the patient what he usually keeps his oxygen set on at home. ANS: C The nurse should assess the patient for possible causes of the shortness of breath before calling the physician. The nurse may be able to implement nursing interventions, or may need to contact the physician for orders based on the assessment findings. Since the COPD patient's respiratory drive is lowering levels of PO2, turning up the oxygen may take away his incentive to breathe. Asking the patient about his home oxygen is not helpful at this point. DIF: Cognitive Level: Analysis REF: 259 OBJ: 2 (clinical) TOP: Respiration Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care MULTIPLE RESPONSE ... 18. The nurse clarifies that when interstitial edema occurs in the lung tissue, ventilation is inhibited by: (Select all that apply.) a. thickened alveolar membranes. b. pus formation. c. alveoli filling with fluid. d. surfactant evaporation. e. failure of gas to diffuse across membrane. ANS: A, C, E Interstitial edema will cause problems that affect the alveoli: thickened walls and filling with fluid that obstructs gas exchange across the thickened walls. Pus formation is associated with infection. Surfactant decreases surface tension on the alveolar wall, allowing it to expand more easily with inspiration and preventing alveolar collapse on expiration. DIF: Cognitive Level: Application REF: 259 OBJ: 2 (theory) TOP: Interstitial Edema KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 19. The nurse reminds a group of retirees that age may alter the respiratory systems by: (Select all that apply.) a. weakened cough. b. kyphosis. c. increased ciliary movement. d. decrease in body fluid. e. muscle weakness. ANS: A, B, D, E Age often decreases ciliary movement. All other options are age-related changes that affect the respiratory system. DIF: Cognitive Level: Application REF: 260 OBJ: 2 (theory) TOP: Age-Related Changes That Affect Ventilation KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 20. The U.S. Public Health Service recommends influenza immunization for: (Select all that apply.) a. physicians. b. compromised infants. c. older adults. d. chronically ill people. e. nurses. ANS: A, C, D, E Compromised infants should not be immunized. Health care workers, older adults, and chronically ill individuals are at risk for contracting influenza and should be immunized. DIF: Cognitive Level: Comprehension REF: 261 OBJ: 3 (theory) TOP: Influenza Immunization KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 21. The nurse notes physical signs of labored breathing, which include: (Select all that apply.) a. grunting on expiration. b. elevating shoulders and ribs on inspiration. c. tensing neck and shoulder muscles. d. substernal retraction. e. productive cough. ANS: A, B, C, D Productive cough is not a sign of labored breathing. All other options are often seen with laboring respirations. DIF: Cognitive Level: Application REF: 262-263 OBJ: 4 (theory) TOP: Signs of Labored Breathing KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 22. The nurse explains that anorexia in the patient with a respiratory disorder may be attributed to: (Select all that apply.) a. increased sense of taste. b. bad taste in mouth. c. fear that eating will exacerbate coughing. d. fatigue. e. altered sense of smell. ANS: B, C, D, E The sense of taste is usually altered in the patient with a respiratory disorder. All of the other factors contribute to lack of appetite in the patient with a respiratory disorder. DIF: Cognitive Level: Comprehension REF: 274 OBJ: 2 (theory) TOP: Anorexia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation Chapter 14: Care of Patients with Disorders of the Upper Respiratory System Chapter 14: Care of Patients with Disorders of the Upper Respiratory System MULTIPLE CHOICE ... 1. The nurse reminds the patient that a cold is contagious for about _____ days. a. 2 b. 3 c. 4 d. 7 ANS: B The contagion period of a viral cold is about 3 days. DIF: Cognitive Level: Knowledge REF: 279 OBJ: 1 (theory) TOP: Contagion of Colds KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 2. The nurse clarifies that the antibiotic given to the patient with a cold is to: a. cure the cold. b. reduce the symptoms. c. prevent a secondary bacterial infection. d. protect the immune system. ANS: C Antibiotics are given to people with a viral cold to prevent a secondary bacterial infection. There is no cure for a cold. Antibiotics will not reduce symptoms of a cold because a cold is viral in etiology, and antibiotics will not affect the immune system response to viral infections. DIF: Cognitive Level: Application REF: 279 OBJ: 1 (theory) TOP: Antibiotics KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 3. When the patient with an upper respiratory infection states that it is difficult to chew due to pain in the upper teeth, the nurse suspects: a. abscess. b. caries. c. sinusitis. d. pharyngitis. ANS: C While an abscess or dental caries can cause tooth pain, generalized pain in the upper teeth associated with an upper respiratory infection indicates sinusitis. DIF: Cognitive Level: Comprehension REF: 279 OBJ: 1 (theory) TOP: Sinusitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 4. The 20-year-old who has laser surgery to remove the tonsils should be positioned postoperatively in the position of: a. side-lying. b. semi-Fowler's. c. prone. d. supine. ANS: B Semi-Fowler's position is the best position for the adult tonsillectomy patient to ensure adequate ventilation due to the airway being swollen and bleeding associated with the surgery. Side-lying, prone, and supine would not assist in ventilation. DIF: Cognitive Level: Application REF: 281 OBJ: 2 (theory) TOP: Positioning After Tonsillectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 5. The patient with sleep apnea complains to the nurse that he is constantly fatigued. The nurse is most accurate in telling the patient that his fatigue is related to which factor? a. Oxygen deficiency b. Waking frequently during the night c. Increased respiratory effort d. Snoring ANS: B The periods of apnea and abrupt intake of air wakens the patient frequently during the night and reduces the amount of rapid eye movement (REM) sleep. Oxygen deficiency also occurs, but is related to other symptoms of sleep apnea. Increased respiratory effort is not usually associated with sleep apnea. DIF: Cognitive Level: Application REF: 282 OBJ: 1 (theory) TOP: Sleep Apnea KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 6. The nurse is caring for a patient during the immediate postoperative period following a rhinoplasty. The nurse is most concerned with which assessment finding? a. The patient complains of being cold and chilled. b. The patient complains of nausea. c. The nurse notices the patient swallowing frequently. d. The patient has a decreased fluid intake. ANS: C Frequent swallowing indicates bleeding that is trickling down the back of the throat. Feeling cold and chilly is a common symptom with surgery and is related to anesthetic and the cool surgical environment. Nausea may be experienced by some patients due to anesthetic. Fluid intake is not a symptom. DIF: Cognitive Level: Application REF: 283 OBJ: 2 (theory) TOP: Postoperative Care: Rhinoplasty KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 7. The patient has a tracheostomy with a one-way valve box that allows the patient to: a. drink. b. eat. c. cough. d. speak. ANS: D The one-way valve directs air through the larynx and allows the patient to talk. DIF: Cognitive Level: Comprehension REF: 285-286 OBJ: 5 (theory) TOP: One-Way Valve Box KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 8. To help reduce the anxiety of a new tracheostomy patient, the nurse should: a. be efficient in giving care quickly. b. give care with minimal conversation. c. delay teaching until tracheostomy is healed. d. offer reassurance of awareness of apprehension. ANS: D Offering reassurance to a patient who cannot speak is essential. Care should be unhurried with teaching and conversation. Giving care quickly or with minimal conversation may cause further anxiety. Teaching cannot be delayed until the tracheostomy is healed. DIF: Cognitive Level: Application REF: 286 OBJ: 5 (theory) TOP: Care of a Tracheostomy Patient KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 9. The nurse is developing the care plan for a laryngectomy patient. Which patient need will be of the highest priority for the nurse to address? a. A method of pain control b. Family support c. A method of communication d. The need for long-term care ANS: C Pain control and family support are important, but the need of a method of communication is paramount for a new tracheostomy patient to allay anxiety, ensure accurate communication between the patient and the nurse, and make the patient comfortable that nursing staff are attentive. The need for long-term care may not be necessary. DIF: Cognitive Level: Application REF: 287-288 | Nursing Care Plan 14-1 OBJ: 4 (theory) TOP: Laryngectomy: Need for Communication KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity 10. The nurse instructs the laryngectomized patient that, in order to warm the inspired air during cold weather, the patient should: a. place hand over stoma. b. use scarf to cover stoma. c. wear moist dressing over stoma. d. stay in area of humidified air. ANS: B The fold of the scarf retains body heat and can warm air as the air passes through the scarf. DIF: Cognitive Level: Comprehension REF: 289 OBJ: 4 (theory) TOP: Warming Inspired Air KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 11. The nurse determines that the patient understands patient teaching regarding esophageal speech when witnessing the patient perform which activity? a. Inhaling air through the nose and forcing it down the esophagus b. Relaxing the diaphragm to allow air into the trachea and esophagus c. Coughing to express air d. Swallowing air and forcing it back up through the esophagus ANS: D Swallowing air and forcing it through the esophagus and moving the lips and tongue can produce speech. Inhaling air through the nose, relaxing the diaphragm, and coughing to express air are not methods to achieve esophageal speech. DIF: Cognitive Level: Application REF: 289 OBJ: 4 (theory) TOP: Esophageal Speech KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 12. The nurse is careful to apply suction prior to deflating the cuff on a cuffed tracheostomy in order to prevent: a. bleeding. b. excessive negative pressure. c. accidental dislodgement of the tube. d. aspiration. ANS: D By suctioning prior to deflating the cuff, the oral liquids that are trapped above the balloon cannot be aspirated. Bleeding, negative pressure, and dislodgement of the tube are not related to cuff inflation. DIF: Cognitive Level: Application REF: Skill 14-1 (on Evolve) OBJ: 5 (theory) TOP: Cuffed Tracheostomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 13. When doing routine cleaning of a double-lumen tracheostomy tube, the nurse will include which of the following actions? a. Place the patient flat on the bed. b. Reinsert the inner cannula without touching the faceplate of the tracheostomy tube. c. Rinse the inner cannula in a basin of hydrogen peroxide. d. Clean the inner cannula with a pipe cleaner. ANS: D The inner cannula is cleaned with a pipe cleaner, the patient is put in the semi-Fowler's position, and the inner cannula is rinsed in sterile saline or sterile water, rather than peroxide. DIF: Cognitive Level: Application REF: Skill 14-2 (on Evolve) OBJ: 1 (clinical) TOP: Double-Lumen Tracheostomy Tube KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 14. The nurse is caring for a patient experiencing epistaxis. What should the nurses's initial intervention be to stop the epistaxis? a. Have the patient lie back and hold ice to the nose. b. Firmly pack the nostrils with gauze. c. Press firmly on the area beneath the nose and lips. d. Have the patient sit forward and pinch the soft part of the nose. ANS: D Initial intervention is to pinch the soft part of the nose while the patient is sitting forward. DIF: Cognitive Level: Comprehension REF: 280 OBJ: 2 (clinical) TOP: Epistaxis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 15. The nurse is aware that the patient seeking antibiotic treatment for pharyngitis will only receive the desired medication if the condition is caused by: a. protozoa. b. bacteria. c. a virus. d. a previous infection. ANS: B Pharyngitis (sore throat) will be treated with an antibiotic only if the infection is deemed bacterial in etiology. Protozoa and viruses do not respond to antibiotics. A previous infection would not be enough cause for the primary care provider to prescribe an antibiotic. DIF: Cognitive Level: Comprehension REF: 280-281 OBJ: 1 (theory) TOP: Pharyngitis KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment: Management of Care 16. The nurse is assisting the physician with insertion of a new tracheostomy tube. The physician asks for the obturator. The nurse correctly hands the physician which device? a. The guide for the tracheostomy tube to be inserted b. The scalpel used to make the tracheotomy stoma c. A single-cannula tracheostomy tube d. A cuffed tracheostomy tube ANS: A The obturator is used during insertion of a tracheostomy tube as a guide to protect against scraping the sides of the trachea with the sharp edge of the tube. DIF: Cognitive Level: Comprehension REF: 285 OBJ: 5 (theory) TOP: Types of Tracheostomy Tubes KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care MULTIPLE RESPONSE ... 17. The nurse advises that, to reduce the risk of giving a cold to another, one should: (Select all that apply.) a. cover the mouth and nose when sneezing. b. wash the hands frequently. c. use saline nose sprays. d. turn the head to the crook of the arm when coughing. e. drink juices with vitamin C. ANS: A, B, D Covering the mouth and nose when sneezing and coughing as well as frequent washing of hands will reduce the risk of passing a cold to another. Using saline sprays and drinking juices with vitamin C are not helpful in containing a cold. DIF: Cognitive Level: Comprehension REF: 279 OBJ: 1 (theory) TOP: Cold Contagion KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 18. Common causative organisms for the infection causing sinusitis are: (Select all that apply.) a. pneumococci. b. Pseudomonas. c. staphylococci. d. Haemophilus influenzae. e. streptococci. ANS: A, D, E The common organisms causing sinusitis are pneumococci, Haemophilus influenzae, and streptococci. DIF: Cognitive Level: Comprehension REF: 279 OBJ: 1 (theory) TOP: Causes of Sinusitis KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 19. The nurse instructs the adult post-tonsillectomy patient to avoid: (Select all that apply.) a. citrus fluids. b. hot fluids. c. milk products. d. coughing and sneezing. e. using a straw. ANS: A, B, D, E Milk products are acceptable for post-tonsillectomy patients. Citrus fluids should be avoided until the throat has healed. Hot fluids, coughing and sneezing, and using a straw may cause bleeding. DIF: Cognitive Level: Application REF: 281 OBJ: 2 (theory) TOP: Post-tonsillectomy Instruction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 20. The nurse assesses the older adult with a family tendency of developing laryngeal cancer for: (Select all that apply.) a. history of smoking. b. alcohol abuse. c. exposure to asbestos. d. eating spicy foods. e. infection with Streptococcus bacteria. ANS: A, B, C, D Streptococcus bacteria are not considered a risk factor for laryngeal cancer; rather, infection with human papillomavirus is considered a risk factor. All other options are risk factors for laryngeal cancer. DIF: Cognitive Level: Application REF: 283 OBJ: 1 (theory) TOP: Risk Factors for Laryngeal Cancer KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 21. The nurse includes in the discharge instruction to a patient who has had a microlaryngoscopy with laser removal of polyps to: (Select all that apply.) a. be alert for massive swelling. b. return to work in 3 days. c. cough to expectorate blood. d. observe 2 days of voice rest. e. take opioids for pain. ANS: B, D Observation of voice rest for 2 days and return to work in 3 days are the basic instructions. There is minimal swelling or bleeding, and NSAIDs (not opioids) are used for pain control. DIF: Cognitive Level: Application REF: 283-284 OBJ: 4 (theory) TOP: Postoperative Care: Microlaryngoscopy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 22. The nurse setting up the environment for tracheal suction on a newly postoperative tracheostomy patient will: (Select all that apply.) a. auscultate lungs for retained secretions. b. wash hands and open sterile suction kit. c. don clean gloves and lift out catheter and connect to suction. d. don sterile gloves and prepare solutions from kit. e. perform suction with sterile supplies. ANS: A, B, D, E Sterile rather than clean gloves should be worn during the suctioning procedure. All other options are significant to perform suctioning safely and aseptically. DIF: Cognitive Level: Analysis REF: Skill 14-1 (on Evolve) OBJ: 2 (clinical) TOP: Tracheal Suction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 23. The radical neck resection removes a large amount of tissue on the same side as the lesion. The tissues removed include: (Select all that apply.) a. all muscle, lymph nodes, and soft tissue from the lower edge of the mandible to the top of the clavicle. b. all muscle, lymph nodes, and soft tissue from the top of the trapezius to the midline. c. all muscle, lymph nodes, and soft tissue from the lower edge of the eye socket to the bottom of the maxilla, including the zygomatic arch. d. part of the tongue and parotid salivary glands. e. lower lip to midline. ANS: A, B, C The radical neck resection does not ordinarily include the tongue, parotid salivary glands, or lip. DIF: Cognitive Level: Application REF: 283-284 OBJ: 2 (theory) TOP: Radical Neck Resection KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. When epistaxis has been controlled, the nurse instructs the patient to: (Select all that apply.) a. avoid sneezing. b. rest for several hours until all threat of epistaxis is gone. c. avoid rubbing the nose. d. gently remove clotted blood from the occluded nostril. e. blow the nose gently in small breaths. ANS: A, B, C The patient should not blow the nose or attempt to remove clotted blood. DIF: Cognitive Level: Application REF: 280 OBJ: 2 (clinical) TOP: Epistaxis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 25. The clinic nurse is giving discharge instructions to the mother of a 12-year-old boy who has been diagnosed with a mild cold. Which statements by the mother demonstrate knowledge of care? (Select all that apply.) a. "He will be receiving an antibiotic, correct?" b. "I will be sure he drinks plenty of apple and orange juice." c. "If he runs a fever, I will give him 2 aspirin every 4 hours until his fever comes down." d. "I will be sure he washes his hands well so he doesn't pass this on to his younger sister." e. "Since his cold just started, zinc lozenges are a good idea for him to take." ANS: B, D, E Citrus juices and zinc lozenges are helpful in limiting the duration and severity of a cold. Hand hygiene helps prevent the spread of the virus. Antibiotics are not used for colds (because colds are viral in etiology) unless a secondary infection is present or there is an increased risk for a secondary infection. Aspirin should not be given to children under age 12 due an increased risk for Reye's syndrome. DIF: Cognitive Level: Application REF: 277 | 279 OBJ: 1 (theory) TOP: Treatment and Nursing Management: Colds KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort Chapter 15: Care of Patients with Disorders of the Lower Respiratory System Chapter 15: Care of Patients with Disorders of the Lower Respiratory System MULTIPLE CHOICE ... 1. The patient with acute bronchitis asks if antibiotics will be ordered for the condition. The best response by the nurse would be: a. "Yes. Antibiotics are the best treatment option." b. "No. Antibiotics will not help a viral condition." c. "Antibiotics will be given if the sputum culture indicates your bronchitis is caused by bacteria." d. "I don't think so because antibiotics will inhibit the inflammatory response of your body to the invasion of this infection." ANS: C Bronchitis is treated symptomatically with humidification and cough medications. Antibiotics are only given if the sputum culture suggests it. DIF: Cognitive Level: Comprehension REF: 293-294 OBJ: 1 (theory) TOP: Bronchitis: Treatment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 2. The nurse is assessing the patient with influenza and notes general malaise and aching muscles, which have continued for 2 weeks. The nurse is aware that the patient may have developed which complication of influenza? a. Bronchitis b. Bacterial pneumonia c. Urinary infection d. Encephalitis ANS: B Bacterial pneumonia is a common complication of influenza and may present with atypical symptoms of only general malaise and muscle aches, making it difficult to recognize the symptoms of pneumonia. Bronchitis, urinary infections, and encephalitis are not commonly complications of influenza. DIF: Cognitive Level: Application REF: 296 OBJ: 1 (theory) TOP: Complications of Influenza: Pneumonia KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 3. The nurse explains that treatment with amantadine (Symmetrel) will: a. prevent viral pneumonia if taken regularly. b. stop viral spread of avian flu if taken at the first signs and symptoms of disease. c. lessen the severity of type A flu symptoms if taken within 48 hours of exposure. d. reduce irritation of bronchitis if taken weekly. ANS: C Amantadine (Symmetrel) is an antiviral medication that may be given within 48 hours of exposure or within 48 hours of the onset of influenza symptoms. It is not a drug that is taken regularly and will not stop the spread of the avian flu. DIF: Cognitive Level: Application REF: 295 OBJ: 1 (theory) TOP: Treatment: Amantadine KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 4. The nurse differentiates viral from bacterial pneumonia in that viral pneumonia causes: a. elevation in white count. b. consolidation of lung tissue. c. interstitial inflammation. d. copious exudate. ANS: C Viral pneumonia causes interstitial inflammation with attendant edema. White count will not be elevated, and no exudate is consolidating the lung as with bacterial pneumonia. DIF: Cognitive Level: Application REF: 296 OBJ: 1 (theory) TOP: Pneumonia: Viral KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 5. The 79-year-old patient with bacterial pneumonia becomes increasingly restless and confused. Temperature is 100° F and pulse, blood pressure, and respirations are elevated since the last assessment 6 hours ago. The initial intervention by the nurse should be to: a. take the patient off oral fluids. b. assess oxygen saturation. c. give the ordered mild sedative. d. administer an NSAID for discomfort. ANS: B Assessing the oxygen saturation will reveal the level of oxygenation. These are early signs of hypoxia in the older adult. Medications for sedation or discomfort do not address the patient's current condition. There is no indication for stopping oral fluids. DIF: Cognitive Level: Analysis REF: 297 | Clinical Cues OBJ: 2 (theory) TOP: Hypoxia KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 6. The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him. The nurse's most helpful reply is: a. "Yes. Pneumovax protects you for your lifetime." b. "No. The immunity afforded you by Pneumovax lasts only 2 years." c. "Yes, but it loses strength and may not protect you from all 23 pneumococcal organisms anymore." d. "No. A second dose is needed 6 years after the first for full immunity." ANS: D Pneumovax, an immunization that protects against 23 pneumococcal organisms, is repeated 6 years after the first dose. DIF: Cognitive Level: Application REF: 296 OBJ: 1 (theory) TOP: Pneumonia Immunization: Pneumovax KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 7. The 75-year-old resident in the nursing home who cares for 40 birds in an aviary complains of shortness of breath and fatigue and a dry cough. Based on this information, the nurse suspects the resident may be suffering from: a. coccidioidomycosis. b. histoplasmosis. c. tuberculosis. d. atypical pneumonia. ANS: B Histoplasmosis is caused by a fungus that lives in bird droppings. The symptoms are dry cough, shortness of breath, and fatigue. Coccidioidomycosis is contracted by people who engage in desert recreational activities or are working in occupations that require digging in the earth. Tuberculosis and atypical pneumonia are not supported by the resident's history and symptoms. DIF: Cognitive Level: Analysis REF: 298 OBJ: 2 (theory) TOP: Fungal Infection: Histoplasmosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 8. The 30-year-old American Indian female who is taking Rifater, a drug containing rifampin, isoniazid, and pyrazinamide, complains that she is tired of taking medicine and having to spit in a bottle all the time. She asks, "When can I stop all this and get on with my life?" The nurse's best response is that she will no longer be considered contagious when: a. the sputum culture comes back negative. b. the medication has been taken for 9 months. c. three consecutive sputum cultures are negative. d. the tuberculin skin test (TST) is no longer positive. ANS: C This drug is given to treat active tuberculosis. The active tuberculosis patient is considered noncontagious when three consecutive sputum cultures are negative. Taking the medication for a given period of time does not make the patient noncontagious. The TST will always be positive. DIF: Cognitive Level: Analysis REF: 301 OBJ: 3 (theory) TOP: Tuberculosis: Treatment KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 9. The nurse reading a tuberculin skin test (TST) on a new employee who lives in the Midwest, is 20 years old, and has no known history of contact with any persons with tuberculosis (TB) will record it as positive if the area around the injection site has an area of swelling of _____ mm _____ hours after the injection. a. 15; 48 b. 10; 72 c. 5; 48 d. 0 to 5; 72 ANS: A All TSTs are read at 48 to 72 hours after the injection. A positive reading of a TST for a person who is low risk for exposure is an area of swelling 15 mm or more. For individuals who are at high risk for TB (such as recent immigrants from countries where TB is prevalent, medically underserved groups, and the homeless), swelling of more than 10 mm is considered positive. Individuals with a history of contact with infectious TB or who are immunocompromised are considered to have a positive TST if there is more than 5 mm of swelling. DIF: Cognitive Level: Analysis REF: 299 OBJ: 3 (theory) TOP: Tuberculosis: TST KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 10. The nurse explains that a serious complication of a patient's chronic obstructive pulmonary disease (COPD) is cor pulmonale, which is exhibited by: a. distended neck veins. b. weight loss. c. confusion and disorientation. d. excessive coughing. ANS: A Cor pulmonale is exhibited by distended neck veins, enlarged right side of the heart, liver engorgement, and edema. DIF: Cognitive Level: Application REF: 304-305 OBJ: 2 (theory) TOP: COPD Complication: Cor Pulmonale KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 11. The patient with asthma is prescribed a leukotriene modifier drug, montelukast (Singulair). The nurse points out that the major advantage of this drug is it: a. has no GI side effects. b. provides bronchodilation and anti-inflammatory effects. c. controls acute asthma episodes. d. can be substituted for all other asthma remedies. ANS: B Singulair provides both bronchodilation and anti-inflammatory effects, but it has numerous GI side effects and is not effective in controlling acute asthmatic attacks. DIF: Cognitive Level: Application REF: 309 | Table 15-4 OBJ: 3 (clinical) TOP: Asthma: Treatment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 12. The patient with chronic airflow limitation (CAL) changed to the use of a simple face mask from a nasal cannula delivery system. The nasal equipment oxygen was set at 3 L/min. The nurse instructs the patient that, with the change in delivery systems, the oxygen should be _____ L/min. a. decreased to 2 b. decreased to 1 c. increased to 4 d. increased to 6 ANS: D When changing to a mask from a nasal cannula, the oxygen should be increased by approximately 100% to get the same concentration. Simple face masks deliver approximately the same range of concentration of oxygen as the nasal cannula. However, the nasal cannula flow rates range from 1 L to 6 L, delivering 24% to 44% oxygen, whereas the simple face mask delivers 35% to 50% oxygen which is achieved with flow rates from 6 L to 12 L. DIF: Cognitive Level: Analysis REF: 323 | Table 15-5 OBJ: 1 (clinical) TOP: Oxygen Delivery Systems KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 13. A patient who has had a left pneumonectomy to remove a lung cancer is returned to the unit from surgery. The nurse should position the patient in a _____ position. a. high Fowler's b. semi-Fowler's c. right side-lying d. left side-lying ANS: D Postoperative positioning after a pneumonectomy is on the operated side to prevent the threat of tension pneumothorax with mediastinal shift and leakage from the amputated bronchial stump. The physician's order should always be checked before turning the patient or raising the head of the bed. DIF: Cognitive Level: Application REF: 316 OBJ: 6 (theory) TOP: Pneumonectomy: Positioning KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 14. When caring for a patient who is on a closed-chest drainage system with chest tubes, the nurse can confirm that the system is intact and working when: a. the water level in the water-seal chamber fluctuates. b. the level of fluid in the collection chamber rises. c. there are constant bubbles in the water-seal chamber. d. the suction has been attached. ANS: A If the level of the water in the water-seal chamber rises and falls with the patient's respiration, the system is intact. Constant bubbles in the water-seal chamber indicate a leak in the system. The fluid in the collection container drains by gravity whether the closed-chest drainage system is intact or not. Suction is not significant with respect to whether the system is intact. DIF: Cognitive Level: Analysis REF: 316-317 OBJ: 6 (theory) TOP: Closed-Chest Drainage KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 15. When the nurse assesses that the level of drainage has not increased over the last 3 hours on a first-day postoperative thoracotomy patient, the nurse should initially: a. inform the charge nurse. b. rearrange tubing to correct dependent loops. c. splint the patient with a pillow and coach to cough. d. gently massage the tube toward the collection bottle. ANS: B Dependent loops can capture drainage and plug the tube, not allowing any more drainage to leave the chest. Massaging (milking) the tube can be implemented after the dependent loops have been corrected. It would not be necessary to notify the charge nurse unless there is a problem, and having the patient cough would not correct the drainage problem. DIF: Cognitive Level: Application REF: 316-317 OBJ: 6 (theory) TOP: Closed-Chest Drainage KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 16. The nurse schedules the postural drainage treatments to be done before breakfast because: a. fluids that have accumulated overnight can be expelled. b. bronchial openings are still more fully open after a night's rest. c. appetite will be stimulated for a meal after fluid is expelled. d. the empty stomach reduces gagging. ANS: A Morning postural drainage can expel the fluids collected overnight. After a postural drainage, the patient is tired and may not want to eat at all. The empty stomach prevents excessive vomiting but not gagging. DIF: Cognitive Level: Application REF: 321 OBJ: 2 (theory) TOP: Postural Drainage KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 17. The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP) mask and asks the nurse how this device will help. The nurse correctly responds with which statement? a. "The device delivers constant positive pressure to keep your airway open." b. "The device will require you to be intubated to open your airway." c. "The device delivers oxygen only when you are apneic." d. "The device delivers negative pressure to stimulate your respirations." ANS: A The CPAP mask delivers a constant positive pressure to keep the airway open. CPAP does not require intubation and does not deliver negative pressure. DIF: Cognitive Level: Application REF: 326 OBJ: 6 (theory) TOP: Continuous Positive Airway Pressure Mask KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 18. When caring for a patient with AIDS, the nurse is aware that this patient is most at risk for developing which type of pneumonia? a. Hypostatic b. Streptococcus pneumoniae c. Atypical d. Pneumocystis jiroveci ANS: D Pneumocystis jiroveci (formerly known as Pneumocystis carinii) is commonly seen in AIDS patients. Hypostatic pneumonia is related to inadequate aeration of the lungs seen frequently with immobile patients.Streptococcus pneumoniae is the most common causative organism for bacterial pneumonia in the general population. Atypical pneumonia refers to pneumonia that does not present with the typical symptoms of pneumonia. DIF: Cognitive Level: Comprehension REF: 297-298 OBJ: 1 (theory) TOP: Pneumonia KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 19. The nurse is teaching an asthma patient proper use of the peak flowmeter. The nurse determines further teaching is needed when observing which action by the patient? a. Repeating the procedure for a total of three readings b. Breathing in deeply through the mouthpiece c. Standing while performing the test d. Recording the highest reading on the peak flow sheet ANS: B Peak flow should be monitored on a daily basis to determine if the asthma patient has adequate airflow. The reading helps determine if treatment should be adjusted. The patient should stand to achieve adequate chest expansion while taking a deep breath. The patient then blows as hard and fast as possible into the device with the mouthpiece in the mouth and the lips clamped firmly around it for a tight seal. The procedure should be performed three times with the highest reading recorded. DIF: Cognitive Level: Knowledge REF: 307 | Patient Teaching OBJ: 3 (clinical) TOP: Patient Teaching: Peak Flowmeter KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance MULTIPLE RESPONSE ... 20. The nurse providing patient education states that influenza is spread by: (Select all that apply.) a. direct contact. b. indirect contact. c. vector. d. blood-borne method. e. droplets. ANS: A, B, E Influenza is not spread by vectors or the blood-borne method. DIF: Cognitive Level: Comprehension REF: 294 OBJ: 1 (theory) TOP: Influenza: Contagion KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 21. The home health nurse making an initial call on a newly diagnosed tuberculosis patient who lives at home with his wife and child would give special instruction for infection control to: (Select all that apply.) a. place contaminated tissues in sealable plastic bag. b. take prescribed drug exactly as directed. c. take airborne precautions. d. wash hands frequently. e. wear mask when in crowds. ANS: A, B, D, E As the family is already exposed, taking airborne precautions is unnecessary. DIF: Cognitive Level: Comprehension REF: 301 OBJ: 3 (theory) TOP: Tuberculosis: Prevention KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 22. The nurse is working with a pulmonary specialist and is aware that the physician will most likely recommend that a full-year preventative protocol of isoniazid (INH) be given to people who: (Select all that apply.) a. are living with a person newly diagnosed as having tuberculosis. b. have had a positive tuberculin skin test but negative chest films. c. have had a positive tuberculin skin test and are on steroids. d. have had a positive tuberculin skin test and have diabetes. e. have had a positive tuberculin skin test and have had a gastrectomy. ANS: A, B, C, D, E All options are people for whom a protocol of isoniazid should be recommended. DIF: Cognitive Level: Application REF: 301 OBJ: 3 (theory) TOP: Tuberculosis: Prevention KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 23. The signs the nurse would expect to see in a patient with advanced emphysema are: (Select all that apply.) a. productive cough. b. dyspnea. c. barrel chest. d. wheezing. e. cyanotic skin tone. ANS: A, B, C, E The emphysemic has a barrel chest and dyspnea. There is minimal coughing and mucus production until late in the disease. Wheezing usually does not occur in the emphysemic patient. Cyanosis is usually absent until late in the disease when the patient becomes hypoxic. DIF: Cognitive Level: Analysis REF: 303 OBJ: 2 (theory) TOP: Emphysema: Signs KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation 24. The home health nurse recommends to the 60-year-old patient with emphysema who is anorexic to enhance her nutrition by the practices of: (Select all that apply.) a. resting before eating. b. avoiding gas-producing food. c. eating four to six small meals rather than three large ones. d. lying down after eating. e. taking small bites and chewing slowly. ANS: A, B, C, E Lying down after meals will likely increase shortness of breath. All other options will enhance her ability to increase her nutritional state. DIF: Cognitive Level: Application REF: 304 | Nutrition Considerations OBJ: 2 (theory) TOP: Emphysema: Anorexia KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 25. The nurse explains to the patient on a mechanical ventilator that it is set on assist-control mode, which means that the machine will: (Select all that apply.) a. deliver a set tidal volume. b. deliver a set number of breaths if the patient's rate falls. c. automatically cuts off if the patient is breathing independently. d. deliver more oxygen at the end of an inspiration. e. help to correct respiratory acidosis. ANS: A, B The assist-control mode delivers a set tidal volume on every respiration and will deliver a set number of breaths per minute should the patient's rate drop. It does not cut off automatically or deliver more oxygen at the end of the inspiration, nor does it correct respiratory acidosis. DIF: Cognitive Level: Analysis REF: 325 OBJ: 2 (clinical) TOP: Mechanical Ventilation: Assist-Control Mode KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 26. The nurse is preparing a presentation highlighting the benefits of annual influenza vaccination. The nurse correctly targets which groups? (Select all that apply.) a. The parents of children 3 to 6 months of age b. Diabetics who are over 50 years old c. Pregnant women d. Home health aides e. CNAs who work in long-term care facilities ANS: B, C, D, E Children ages 6 to 59 months should receive the influenza vaccine, not children 3 to 6 months of age. The Advisory Committee on Immunization Practices also suggests that pregnant women, people over age 50, and people with certain chronic illnesses receive the vaccine. In addition, health care workers and those caring for persons in homes that are at high risk for contracting influenza should receive the vaccine. DIF: Cognitive Level: Application REF: 295 | Health Promotion OBJ: 1 (theory) TOP: Influenza Vaccination KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance