Chapter 28: Concepts of Care for Patients
with Infectious Respiratory Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. The emergency department (ED) manager is reviewing client charts to determine how
well the staff perform when treating clients with community-acquired pneumonia.
What outcome demonstrates that goals for this client type have been met?
a. Antibiotics started before admission.
b. Blood cultures obtained within 20 minutes.
c. Chest x-ray obtained within 30 minutes.
d. Pulse oximetry obtained on all clients.
ANS: A
Goals for treatment of community-acquired pneumonia include initiating antibiotics
prior to inclient admission or within 6 hours of presentation to the ED. Timely
collection of blood cultures, chest x-ray, and pulse oximetry are important as well but
do not coincide with established goals.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Assessment
KEY: Infection, Pneumonia MSC: Client Needs Category:
Safe and Effective Care Environment: Management of Care
2. A nurse has educated a client on isoniazid. What statement by the client indicates that
teaching has been effective?
a. “I need to take extra vitamin C while on isoniazid.”
b. “I should take this medicine with milk or juice.”
, c. “I will take this medication on an empty stomach.”
d. “My contact lenses will be permanently stained.”
ANS: C
Isoniazid needs to be taken on an empty stomach, either 1 hour before or 2 hours after
meals. Extra vitamin B needs to be taken while on the drug. Staining of contact lenses
commonly occurs while taking rifampin.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Evaluation
KEY: Tuberculosis, Medications, Health teaching MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
3. A client has been taking isoniazid for tuberculosis for 3 weeks. What laboratory
results need to be reported to the primary health care provider immediately?
a. Albumin: 5.1 g/dL (7.4 mcmol/L)
b. Alanine aminotransferase (ALT): 180 U/L
c. Red blood cell (RBC) count: 5.2/million/µL (5.2 1012/L)
d. White blood cell (WBC) count: 12,500/mm3 (12.5 109/L)
ANS: B
INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of
the liver enzymes) is extremely high and needs to be reported immediately. The
albumin and RBCs are normal. The WBCs are slightly high, but that would be an
expected finding in a client with an infection.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Analysis
KEY: Tuberculosis, Medication side effects MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
, 4. A client seen in the emergency department reports fever, fatigue, and dry cough but no
other upper respiratory symptoms. A chest x-ray reveals mediastinal widening. What
action by the nurse is best?
a. Collect a sputum sample for culture by deep suctioning.
b. Inform the client that oral antibiotics will be needed for 60 days.
c. Place the client on Airborne Precautions immediately.
d. Tell the client that directly observed therapy is needed.
ANS: B
This client has signs and symptoms of early inhalation anthrax. For treatment, after IV
antibiotics are finished, oral antibiotics are continued for at least 60 days. Sputum
cultures are not needed. Anthrax is not transmissible from person to person, so
Standard Precautions are adequate. Directly observed therapy is often used for
tuberculosis.
DIF: Applying TOP: Integrated Process: Teaching/Learning KEY:
Anthrax, Antibiotics MSC: Client Needs Category: Physiological Integrity:
Physiological Adaptation
5. A client has been hospitalized with tuberculosis (TB). The client’s spouse is fearful of
entering the room where the client is in isolation and refuses to visit. What action by
the nurse is best?
a. Ask the spouse to explain the fear of visiting in further detail.
b. Inform the spouse that the precautions are meant to keep other clients safe.
c. Show the spouse how to follow the Isolation Precautions to avoid illness.
d. Tell the spouse that he or she has already been exposed, so it’s safe to visit.
ANS: A
The nurse needs to obtain further information about the spouse’s specific fears so they
can be addressed. This will decrease stress and permit visitation, which will be
beneficial for both client and spouse. Precautions for TB prevent transmission to all
who come into contact with the client. Explaining Isolation Precautions and what to
with Infectious Respiratory Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. The emergency department (ED) manager is reviewing client charts to determine how
well the staff perform when treating clients with community-acquired pneumonia.
What outcome demonstrates that goals for this client type have been met?
a. Antibiotics started before admission.
b. Blood cultures obtained within 20 minutes.
c. Chest x-ray obtained within 30 minutes.
d. Pulse oximetry obtained on all clients.
ANS: A
Goals for treatment of community-acquired pneumonia include initiating antibiotics
prior to inclient admission or within 6 hours of presentation to the ED. Timely
collection of blood cultures, chest x-ray, and pulse oximetry are important as well but
do not coincide with established goals.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Assessment
KEY: Infection, Pneumonia MSC: Client Needs Category:
Safe and Effective Care Environment: Management of Care
2. A nurse has educated a client on isoniazid. What statement by the client indicates that
teaching has been effective?
a. “I need to take extra vitamin C while on isoniazid.”
b. “I should take this medicine with milk or juice.”
, c. “I will take this medication on an empty stomach.”
d. “My contact lenses will be permanently stained.”
ANS: C
Isoniazid needs to be taken on an empty stomach, either 1 hour before or 2 hours after
meals. Extra vitamin B needs to be taken while on the drug. Staining of contact lenses
commonly occurs while taking rifampin.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Evaluation
KEY: Tuberculosis, Medications, Health teaching MSC: Client
Needs Category: Physiological Integrity: Pharmacological and Parenteral
Therapies
3. A client has been taking isoniazid for tuberculosis for 3 weeks. What laboratory
results need to be reported to the primary health care provider immediately?
a. Albumin: 5.1 g/dL (7.4 mcmol/L)
b. Alanine aminotransferase (ALT): 180 U/L
c. Red blood cell (RBC) count: 5.2/million/µL (5.2 1012/L)
d. White blood cell (WBC) count: 12,500/mm3 (12.5 109/L)
ANS: B
INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of
the liver enzymes) is extremely high and needs to be reported immediately. The
albumin and RBCs are normal. The WBCs are slightly high, but that would be an
expected finding in a client with an infection.
DIF: Analyzing TOP: Integrated Process: Nursing Process: Analysis
KEY: Tuberculosis, Medication side effects MSC: Client
Needs Category: Physiological Integrity: Reduction of Risk Potential
, 4. A client seen in the emergency department reports fever, fatigue, and dry cough but no
other upper respiratory symptoms. A chest x-ray reveals mediastinal widening. What
action by the nurse is best?
a. Collect a sputum sample for culture by deep suctioning.
b. Inform the client that oral antibiotics will be needed for 60 days.
c. Place the client on Airborne Precautions immediately.
d. Tell the client that directly observed therapy is needed.
ANS: B
This client has signs and symptoms of early inhalation anthrax. For treatment, after IV
antibiotics are finished, oral antibiotics are continued for at least 60 days. Sputum
cultures are not needed. Anthrax is not transmissible from person to person, so
Standard Precautions are adequate. Directly observed therapy is often used for
tuberculosis.
DIF: Applying TOP: Integrated Process: Teaching/Learning KEY:
Anthrax, Antibiotics MSC: Client Needs Category: Physiological Integrity:
Physiological Adaptation
5. A client has been hospitalized with tuberculosis (TB). The client’s spouse is fearful of
entering the room where the client is in isolation and refuses to visit. What action by
the nurse is best?
a. Ask the spouse to explain the fear of visiting in further detail.
b. Inform the spouse that the precautions are meant to keep other clients safe.
c. Show the spouse how to follow the Isolation Precautions to avoid illness.
d. Tell the spouse that he or she has already been exposed, so it’s safe to visit.
ANS: A
The nurse needs to obtain further information about the spouse’s specific fears so they
can be addressed. This will decrease stress and permit visitation, which will be
beneficial for both client and spouse. Precautions for TB prevent transmission to all
who come into contact with the client. Explaining Isolation Precautions and what to
