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Airway – Pneumonia and TB1. Clients with chronic illnesses are more likely to get

pneumonia when which of the following situations is

present?

A. Dehydration

B. Group living

C. Malnutrition

D.Severe periodontal disease

 

2.    Which of the following pathophysiological mechanisms

that occurs in the lung parenchyma allows pneumonia to

develop?

1. Atelectasis

2. Bronchiectasis

3. Effusion

4. Inflammation

 

3.    Which of the following organisms most commonly causes

community-acquired pneumonia in adults?

1. Haemiphilus influenzae

2. Klebsiella pneumoniae

3. Steptococcus pneumoniae

4. Staphylococcus aureus

 

4.    An elderly client with pneumonia may appear with which

of the following symptoms first?

1. Altered mental status and dehydration

2. Fever and chills

3. Hemoptysis and dyspnea

4. Pleuritic chest pain and cough

 

5.    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. Bronchial

2. Bronchovestibular

3. Tubular

4. Vesicular

 

6.    A diagnosis of pneumonia is typically achieved by which of

the following diagnostic tests?

1. ABG analysis

2. Chest x-ray

3. Blood cultures

4. sputum culture and sensitivity

 

7.    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. Antibiotics

2. Bed rest

3. Oxygen

4. Nutritional intake

 

8.    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. Continued dyspnea

2. Fever of 102*F

3. Respiratory rate of 32 breaths/minute

4. Vesicular breath sounds in right base

 

9.    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. Indeterminate

2. Needs to be redone

3. Negative

4. Positive

 

10.  A client with primary TB infection can expect to develop

which of the following conditions?

1. Active TB within 2 weeks

2. Active TB within 1 month

3. A fever that requires hospitalization

4. A positive skin test

 

11.  A client was infected with TB 10 years ago but never

developed the disease. He’s now being treated for cancer. The

client begins to develop signs of TB. This is known as which of

the following types of infection?

1. Active infection

2. Primary infection

3. Superinfection

4. Tertiary infection

 

12.  A client has active TB. Which of the following symptoms

will he exhibit?

1. Chest and lower back pain

2. Chills, fever, night sweats, and hemoptysis

3. Fever of more than 104*F and nausea

4. Headache and photophobia

 

13.  Which of the following diagnostic tests is definitive for TB?

1. Chest x-ray

2. Mantoux test

3. Sputum culture

4. Tuberculin test

 

14.  A client with a positive Mantoux test result will be sent for

a chest x-ray. For which of the following reasons is this done?

1. To confirm the diagnosis

2. To determine if a repeat skin test is needed

3. To determine the extent of the lesions

4. To determine if this is a primary or secondary infection

 

15.  A chest x-ray should a client’s lungs to be clear. His

Mantoux test is positive, with a 10mm if induration. His

previous test was negative. These test results are possible

because:

1. He had TB in the past and no longer has it.

2. He was successfully treated for TB, but skin tests always

stay positive.

3. He’s a “seroconverter”, meaning the TB has gotten to his

bloodstream.

4. He’s a “tuberculin converter,” which means he has been

infected with TB since his last skin test.

 

16.  A client with a positive skin test for TB isn’t showing signs

of active disease. To help prevent the development of active

TB, the client should be treated with isonaizid, 300mg daily,

for how long?

1. 10 to 14 days

2. 2 to 4 weeks

3. 3 to 6 months

4. 9 to 12 months

 

17.  A client with a productive cough, chills, and night sweats

is suspected of having active TB. The physician should take

which of the following actions?

1. Admit him to the hospital in respiratory isolation

2. Prescribe isoniazid and tell him to go home and rest

3. Give a tuberculin test and tell him to come back in 48

hours and have it read.

4. Give a prescription for isoniazid, 300mg daily for 2 weeks,

and send him home.

 

18.  A client is diagnosed with active TB and started on triple

antibiotic therapy. What signs and symptoms would the client

show if therapy is inadequate?

1. Decreased shortness of breath

2. Improved chest x-ray

3. Nonproductive cough

4. Positive acid-fast bacilli in a sputum sample after 2

months of treatment.

 

19.  A client diagnosed with active TB would be hospitalized

primarily for which of the following reasons?

1. To evaluate his condition

2. To determine his compliance

3. to prevent spread of the disease

4. To determine the need for antibiotic therapy.

 

20.  A high level of oxygen exerts which of the following effects

on the lung?

1. Improves oxygen uptake

2. Increases carbon dioxide levels

3. Stabilizes carbon dioxide levels

4. Reduces amount of functional alveolar surface area

 

21.  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. Auscultation of breath sounds

2. Chest x-ray

3. Echocardiogram

4. Electrocardiogram (ECG)

 

22.  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. Acute asthma

2. Chronic bronchitis

3. Pneumonia

4. Spontaneous pneumothorax

 

23.  Which of the following treatments would the nurse expect

for a client with a spontaneous pneumothorax?

1. Antibiotics

2. Bronchodilators

3. Chest tube placement

4. Hyperbaric chamber

 

24.  Which of the following methods is the best way to confirm

the diagnosis of a pneumothorax?

1. Auscultate breath sounds

2. Have the client use an incentive spirometer

3. Take a chest x-ray

4. stick a needle in the area of decreased breath sounds

 

25.  A pulse oximetry gives what type of information about the

client?

1. Amount of carbon dioxide in the blood

2. Amount of oxygen in the blood

3. Percentage of hemoglobin carrying oxygen

4. Respiratory rate

 

26.  What effect does hemoglobin amount have on oxygenation

status?

1. No effect

2. More hemoglobin reduces the client’s respiratory rate

3. Low hemoglobin levels cause reduces oxygen-carrying

capacity

4. Low hemoglobin levels cause increased oxygen-carrying

capacity.

 

27.  Which of the following statements best explains how

opening up collapsed alveoli improves oxygenation?

1. Alveoli need oxygen to live

2. Alveoli have no effect on oxygenation

3. Collapsed alveoli increase oxygen demand

4. Gaseous exchange occurs in the alveolar membrane.

 

28.  Continuous positive airway pressure (CPAP) can be

provided through an oxygen mask to improve oxygenation in

hypoxic patients by which of the following methods?

1. The mask provides 100% oxygen to the client.

2. The mask provides continuous air that the client can

breathe.

3. The mask provides pressurized oxygen so the client can

breathe more easily.

4. The mask provides pressurized at the end of expiration to

open collapsed alveoli.

 

29.  Which of the following best describes pleural effusion?

1. The collapse of alveoli

2. The collapse of bronchiole

3. The fluid in the alveolar space

4. The accumulation of fluid between the linings of the

pleural space.

 

30.  If a pleural effusion develops, which of the following

actions best describes how the fluid can be removed from the

pleural space and proper lung status restored?

1. Inserting a chest tube

2. Performing thoracentesis

3. Performing paracentesis

4. Allowing the pleural effusion to drain by itself.

 

31.  A comatose client needs a nasopharyngeal airway for

suctioning. After the airway is inserted, he gags and coughs.

Which action should the nurse take?

1. Remove the airway and insert a shorter one.

2. Reposition the airway.

3. Leave the airway in place until the client gets used to it.

4. Remove the airway and attempt suctioning without it.

 

32.  An 87-year-old client requires long term ventilator

therapy. He has a tracheostomy in place and requires frequent

suctioning. Which of the following techniques is correct?

1. Using intermittent suction while advancing the catheter.

2. Using continuous suction while withdrawing the catheter.

3. Using intermittent suction while withdrawing the

catheter.

4. Using continuous suction while advancing the catheter.

 

33.  A client’s ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm

Hg, PaO2 of 77 mm Hg, and HCO3- of 24 mEq/L. What do these

values indicate?

1. Metabolic acidosis

2. Respiratory alkalosis

3. Metabolic alkalosis

4. Respiratory acidosis

 

34.  A police officer brings in a homeless client to the ER. A

chest x-ray suggests he has TB. The physician orders an

intradermal injection of 5 tuberculin units/0.1 ml of tuberculin

purified derivative. Which needle is appropriate for this

injection?

1. 5/8” to ½” 25G to 27G needle.

2. 1” to 3” 20G to 25G needle.

3. ½” to 3/8” 26 or 27G needle.

4. 1” 20G needle.

 

35.  A 76-year old client is admitted for elective knee surgery.

Physical examination reveals shallow respirations but no signs

of respiratory distress. Which of the following is a normal

physiologic change related to aging?

1. Increased elastic recoil of the lungs

2. Increased number of functional capillaries in the alveoli

3. Decreased residual volume

4. Decreased vital capacity.

 

36.  A 79-year-old client is admitted with pneumonia. Which

nursing diagnosis should take priority?

1. Acute pain related to lung expansion secondary to lung

infection

2. Risk for imbalanced fluid volume related to increased

insensible fluid losses secondary to fever.

3. Anxiety related to dyspnea and chest pain.

4. Ineffective airway clearance related to retained

secretions.

 

37.  A community health nurse is conducting an educational

session with community members regarding TB. The nurse

tells the group that one of the first symptoms associated with

TB is:

1. A bloody, productive cough

2. A cough with the expectoration of mucoid sputum

3. Chest pain

4. Dyspnea

 

38.  A nurse evaluates the blood theophylline level of a client

receiving aminophylline (theophylline) by intravenous infusion.

The nurse would determine that a therapeutic blood level

exists if which of the following were noted in the laboratory

report?

1. 5 mcg/mL

2. 15 mcg/mL

3. 25 mcg/mL

4. 30 mcg/mL

 

39.  Isoniazid (INH) and rifampin (Rifadin) have been

prescribed for a client with TB. A nurse reviews the medical

record of the client. Which of the following, if noted in the

client’s history, would require physician notification?

1. Heart disease

2. Allergy to penicillin

3. Hepatitis B

4. Rheumatic fever

 

40.  A client is experiencing confusion and tremors is admitted

to a nursing unit. An initial ABG report indicates that the

PaCO2 level is 72 mm Hg, whereas the PaO2 level is 64 mm Hg. A

nurse interprets that the client is most likely experiencing:

1. Carbon monoxide poisoning

2. Carbon dioxide narcosis

3. Respiratory alkalosis

4. Metabolic acidosis

 

41.  A client who is HIV+ has had a PPD skin test. The nurse

notes a 7-mm area of induration at the site of the skin test. The

nurse interprets the results as:

1. Positive

2. Negative

3. Inconclusive

4. The need for repeat testing.

 

42.  A nurse is caring for a client diagnosed with TB. Which

assessment, if made by the nurse, would not be consistent with

the usual clinical presentation of TB and may indicate the

development of a concurrent problem?

1. Nonproductive or productive cough

2. Anorexia and weight loss

3. Chills and night sweats

4. High-grade fever

 

43.  A nurse is teaching a client with TB about dietary

elements that should be increased in the diet. The nurse

suggests that the client increase intake of:

1. Meats and citrus fruits

2. Grains and broccoli

3. Eggs and spinach

4. Potatoes and fish

 

44.  Which of the following would be priority assessment data

to gather from a client who has been diagnosed with

pneumonia? Select all that apply.

1. Auscultation of breath sounds

2. Auscultation of bowel sounds

3. Presence of chest pain.

4. Presence of peripheral edema

5. Color of nail beds

 

45.  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 q4h

2. Nasotracheal suctioning to clear secretions

3. Frequent linen changes

4. Frequent offering of a bedpan.

 

46.  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.

 

47.  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

 

48.  A client with pneumonia has a temperature ranging

between 101* and 102*F and periods of diaphoresis. Based on

this information, which of the following nursing interventions

would be a priority?

1. Maintain complete bedrest

2. Administer oxygen therapy

3. Provide frequent linen changes.

4. Provide fluid intake of 3 L/day

 

49.  Which of the following would be an appropriate expected

outcome for an elderly client recovering from bacterial

pneumonia?

1. A respiratory rate of 25 to 30 breaths per minute

2. The ability to perform ADL’s without dyspnea

3. A maximum loss of 5 to 10 pounds of body weight

4. Chest pain that is minimized by splinting the ribcage.

 

50.  Which of the following symptoms is common in clients

with TB?

1. Weight loss

2. Increased appetite

3. Dyspnea on exertion

4. Mental status changes

 

51.  The nurse obtains a sputum specimen from a client with

suspected TB for laboratory study. Which of the following

laboratory techniques is most commonly used to identify

tubercle bacilli in sputum?

1. Acid-fast staining

2. Sensitivity testing

3. Agglunitnation testing

4. Dark-field illumination

 

52.  Which of the following antituberculus drugs can cause

damage to the eighth cranial nerve?

1. Streptomycin

2. Isoniazid

3. Para-aminosalicylic acid

4. Ethambutol hydrochloride

 

53.  The client experiencing eighth cranial nerve damage will

most likely report which of the following symptoms?

1. Vertigo

2. Facial paralysis

3. Impaired vision

4. Difficulty swallowing

 

54.  Which of the following family members exposed to TB

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

 

55.  The nurse is teaching a client who has been diagnosed

with TB how to avoid spreading the disease to family members.

Which statement(s) by the client indicate(s) that he has

understood the nurses 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 properly.”

5. “I can use regular plate and utensils whenever I eat.”

 

56.  A client has a positive reaction to the PPD test. The nurse

correctly interprets this reaction to mean that the client has:

1. Active TB

2. Had contact with Mycobacterium tuberculosis

3. Developed a resistance to tubercle bacilli

4. Developed passive immunity to TB.

 

57.  INH treatment is associated with the development of

peripheral neuropathies. Which of the following interventions

would the nurse teach the client to help prevent this

complication?

1. Adhere to a low cholesterol diet

2. Supplement the diet with pyridoxine (vitamin B6)

3. Get extra rest

4. Avoid excessive sun exposure.

 

58.  The nurse should include which of the following

instructions when developing a teaching plan for clients

receiving INH and rifampin for treatment for TB?

1. Take the medication with antacids

2. Double the dosage if a drug dose is forgotten

3. Increase intake of dairy products

4. Limit alcohol intake

 

59.  The public health nurse is providing follow-up care to a

client with TB who does not regularly take his medication.

Which nursing action would be most appropriate for this

client?

1. Ask the client’s spouse to supervise the daily

administration of the medications.

2. Visit the clinic weekly to ask him whether he is taking his

medications regularly.

3. Notify the physician of the client’s non-compliance and

request a different prescription.

4. Remind the client that TB can be fatal if not taken

properly.

 

 

 

1. 2. Clients with chronic illnesses generally have poor

immune systems. Often, residing in group living situations

increases the chance of disease transmission.

2. 4. The common feature of all type of pneumonia is an

inflammatory pulmonary response to the offending

organism or agent. Atelectasis and bronchiecrasis

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.

3. 3. 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.

4. 1. 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.

5. 1. Chest auscultation reveals bronchial breath sounds

over areas of consolidation. Bronchiovesicular 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.

6. 4. 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.

7. 3. 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.

8. 4. 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.

9. 3. This test would be classed as negative. A 5mm 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.

10.  4. A primary TB infection occurs when the bacillus has

successfully invaded the entire body after entering through the

lungs. At this point, the bacilli are walled off and skin tests

read positive. However, all but infants and immunosuppressed

people will remain asymptomatic. The general population has a

10% risk of developing active TB over their lifetime, in many

cases because of a break in the body’s immune defenses. The

active stage shows the classic symptoms of TB: fever,

hemoptysis, and night sweats.

11.  1. Some people carry dormant TB infections that may

develop into active disease. In addition, primary sites of

infection containing TB bacilli may remain inactive for years

and then activate when the client’s resistance is lowered, as

when a client is being treated for cancer. There’s no such

thing as tertiary infection, and superinfection doesn’t apply in

this case.

12.  2. Typical signs and symptoms are chills, fever, night

sweats, and hemoptysis. Chest pain may be present from

coughing, but isn’t usual. Clients with TB typically have low-

grade fevers, not higher than 102*F. Nausea, headache, and

photophobia aren’t usual TB symptoms.

13.  3. The sputum culture for Myobacterium tuberculosis is

the only method of confirming the diagnosis. Lesions in the

lung may not be big enough to be seen on x-ray. Skin tests may

be falsely positive or falsely negative.

14.  3. If the lesions are large enough, the chest x-ray will

show their presence in the lungs. Sputum culture confirms the

diagnosis. There can be false-positive and false-negative skin

test results. A chest x-ray can’t determine if this is a primary

or secondary infection.

15.  4. A tuberculin converter’s skin test will be positive,

meaning he has been exposed to an infected with TB and now

has a cell-mediated immune response to the skin test. The

client’s blood and x-ray results may stay negative. It doesn’t

mean the infection has advanced to the active stage. Because

his x-ray is negative, he should be monitored every 6 months to

see if he develops changes in his x-ray or pulmonary

examination. Being a seroconverter doesn’t mean the TB has

gotten into his bloodstream; it means it can be detected by a

blood test.

16.  4. Because of the increased incidence of resistant strains

of TB, the disease must be treated for up to 24 months in some

cases, but treatment typically lasts for 9-12 months. Isoaizid is

the most common medication used for the treatment of TB, but

other antibiotics are added to the regimen to obtain the best

results.

17.  1. The client is showing s/s of active TB and, because of

the productive cough, is highly contagious. He should be

admitted to the hospital, placed in respiratory isolation, and

three sputum cultures should be obtained to confirm the

diagnosis. He would most likely be given isoniazid and two or

three other antitubercular antibiotics until the diagnosis is

confirmed, then isolation and treatment would continue if the

cultures were positive for TB. After 7 to 10 days, three more

consecutive sputum cultures will be obtained. If they’re

negative, he would be considered non-contagious and may be

sent home, although he’ll continue to take the antitubercular

drugs for 9 to 12 months.

18.  4. Continuing to have acid-fast bacilli in the sputum after 2

months indicated continued infection.

19.  3. The client with active TB is highly contagious until

three consecutive sputum cultures are negative, so he’s put in

respiratory isolation in the hospital.

20.  4. Oxygen toxicity causes direct pulmonary trauma,

reducing the amount of alveolar surface area available for

gaseous exchange, which results in increased carbon dioxide

levels and decreased oxygen uptake.

21.  1. 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.

22.  4. 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.

23.  3. The only way to reexpand the lung is to place a chest

tube on the right side so the air in the pleural space can be

removed and the lung reexpanded.

24.  3. A chest x-ray will show the area of collapsed lung if

pneumothorax is present as well as the volume of air in the

pleural space. Listening to breath sounds won’t confirm a

diagnosis. An IS is used to encourage deep breathing. A needle

thoracostomy is done only in an emergency and only by

someone trained to do it.

25.  3. The pulse oximeter determines the percentage of

hemoglobin carrying oxygen. This doesn’t ensure that the

oxygen being carried through the bloodstream is actually

being taken up by the tissue.

26.  3. Hemoglobin carries oxygen to all tissues in the body. If

the hemoglobin level is low, the amount of oxygen-carrying

capacity is also low. More hemoglobin will increase oxygen-

carrying capacity and thus increase the total amount of oxygen

available in the blood. If the client has been tachypneic during

exertion, or even at rest, because oxygen demand is higher

than the available oxygen content, then an increase in

hemoglobin may decrease the respiratory rate to normal

levels.

27.  4. Gaseous exchange occurs in the alveolar membrane, so

if the alveoli collapse, no exchange occurs, Collapsed alveoli

receive oxygen, as well as other nutrients, from the

bloodstream. Collapsed alveoli have no effect on oxygen

demand, though by decreasing the surface area available for

gas exchange, they decrease oxygenation of the blood.

28.  3. The mask provides pressurized oxygen continuously

through both inspiration and expiration. The mask can be set

to deliver any amount of oxygen needed. By providing the

client with pressurized oxygen, the client has less resistance to

overcome in taking his next breath, making it easier to

breathe. Pressurized oxygen delivered at the end of expiration

is positive end-expiratory pressure (PEEP), not continuous

positive airway pressure.

29.  4. The pleural fluid normally seeps continually into the

pleural space from the capillaries lining the parietal pleura and

is reabsorbed by the visceral pleural capillaries and

lymphatics. Any condition that interferes with either the

secretion or drainage of this fluid will lead to a pleural

effusion.

30.  2. Performing thoracentesis is used to remove excess

pleural fluid. The fluid is then analyzed to determine if it’s

transudative or exudative. Transudates are substances that

have passed through a membrane and usually occur in low

protein states. Exudates are substances that have escaped

from blood vessels. They contain an accumulation of cells and

have a high specific gravity and a high lactate dehydrogenase

level. Exudates usually occur in response to a malignancy,

infection, or inflammatory process. A chest tube is rarely

necessary because the amount of fluid typically isn’t large

enough to warrant such a measure. Pleural effusions can’t

drain by themselves.

31.  1. If a client gags or coughs after nasopharyngeal airway

placement, the tube may be too long. The nurse should remove

it and insert a shorter one. Simply repositioning the airway

won’t solve the problem. The client won’t get used to the tube

because it’s the wrong size. Suctioning without a

nasopharyngeal airway causes trauma to the natural airway.

32.  Intermittent suction should be applied during catheter

withdrawal. To prevent hypoxia, suctioning shouldn’t last more

than 10-seconds at a time. Suction shouldn’t be applied while

the catheter is being advanced.

33.  4.

34.  3. Intradermal injections like those used in TN skin tests

are administered in small volumes (usually 0.5 ml or less) into

the outer skin layers to produce a local effect. A TB syringe

with a ½” to 3/8” 26G or 27G needle should be inserted about

1/8” below the epidermis.

35.  4. Reduction in VC is a normal physiologic change in the

older adult. Other normal physiologic changes include

decreased elastic recoil of the lungs, fewer functional

capillaries in the alveoli, and an increase is residual volume.

36.  4. Pneumonia is an acute infection of the lung

parenchyma. The inflammatory reaction may cause an

outpouring of exudate into the alveolar spaces, leading to an

ineffective airway clearance related to retained secretions.

37.  2. One of the first pulmonary symptoms includes a slight

cough with the expectoration of mucoid sputum.

38.  2. The therapeutic theophylline blood level range from 10-

20 mcg/mL.

39.  3. Isoniazid and rafampin are contraindicated in clients

with acute liver disease or a history of hepatic injury.

40.  2. Carbon dioxide narcosis is a condition that results from

extreme hypercapnia, with carbon dioxide levels in excess of

70 mm Hg. The client experiences symptoms such as confusion

and tremors, which may progress to convulsions and possible

coma.

41.  1. The client with HIV+ status is considered to have

positive results on PPD skin test with an area greater than 5-

mm of induration. The client with HIV is immunosuppressed,

making a smaller area of induration positive for this type of

client.

42.  4. The client with TB usually experiences cough (non-

productive or productive), fatigue, anorexia, weight loss,

dyspnea, hemoptysis, chest discomfort or pain, chills and

sweats (which may occur at night), and a low-grade fever.

43.  1. The nurse teaches the client with TB to increase intake

of protein, iron, and vitamin C.

44.  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 patient with

pneumonia.

45.  3. Frequent linen changes are appropriate for this client

because of 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.

46.  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.

47.  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.

48.  4. A fluid intake of at least 3 L/day should be provided to

replace any fluid loss occurring as a result the fever and

diaphoresis; this is a high-priority intervention.

49.  2. An expected outcome for a client recovering from

pneumonia would be the ability to perform ADL’s 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-

10 pounds 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.

50.  1. TB typically produces anorexia and weight loss. Other

signs and symptoms may include fatigue, low-grade fever, and

night sweats.

51.  1. The most commonly used technique to identify tubercle

bacilli is acid-fast staining. The bacilli have a waxy surface,

which makes them difficult to stain in the lab. However, once

they are stained, the stain is resistant to removal, even with

acids. Therefore, tubercle bacilli are often called acid-fast

bacilli.

52.  1. Streptomycin is an aminoglycoside, and eight cranial

nerve damage (ototoxicity) is a common side effect from

amintoglycodsides.

53.  1. The eighth cranial nerve is the vestibulocochlear nerve,

which is responsible for hearing and equilibrium. Streptomycin

can damage this nerve.

54.  4. Elderly persons are believed to be at higher risk for

contracting TB because of decreased immunocompetence.

Other high-risk populations in the US include the urban poor,

AIDS, and minority groups.

55.  2, 4, 5.

56.  2. A positive PPD test indicates that the client has been

exposed to tubercle bacilli. Exposure does not necessarily

mean that active disease exists.

57.  2. INH competes with the available vitamin B6 in the body

and leaves the client at risk for development of neuropathies

related to vitamin deficiency. Supplemental vitamin B6 is

routinely prescribed.

58.  4. INH and rifampin are hepatoxic drugs. Clients should

be warned to limit intake of alcohol during drug therapy. Both

drugs should be taken on an empty stomach. If antacids are

needed for GI distress, they should be taken 1 hour before or 2

hours after these drugs are administered. Clients should not

double the dosage of these drugs because of their potential

toxicity. Clients taking INH should avoid foods that are rich in

tyramine, such as cheese and dairy products, or they may

develop hypertension.

59.  1. Directly observed therapy (DOT) can be implemented

with clients who are not compliant with drug therapy. In DOT,

a responsible person, who may be a family member or a health

care provider, observes the client taking the medication.

Visiting the client, changing the prescription, or threatening

the client will not ensure compliance if the client will not or

cannot follow the prescribed treatment.

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One Response to Airway – Pneumonia and TB

1. soliana says:

February 20, 2013 at 9:58 pm

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Pages 10 Diagnoses 4 Student   Nurses

Assessment Documentation   Examples

NCLEX   Ques

Airway – Obstruction and   Asthma

Airway – Pneumonia and   TB

Blood   Disorders

Cancer

Cardiac – MI and   HF

Cardiac   dysrhythmias

Cardiac Surgical   Patient

Coronary Artery Disease and   Hypertension

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Diabetes

Ear

Eye

Gastro

Gastro   2

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Growth and   Development

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Neuro – ICP, LOC,   meningitis

Neuro – CVA   (Stroke)

Neuro –   Seizures

Search

Nursing Process –   1

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Nutrition – 1 (not   NCLEX)

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OB/GYN –   Intrapartum

OB/GYN 2 –   Antepartum

OB/GYN 3 –   Newborn

OB/GYN 3a –   Newborn

OB/GYN 4 –   Postpartum

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Renal

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Mental Health – Mania, Anxiety, Mood, Schizo, Depression and DRUGS   notes

Mental health – Personality Disorder and   Alcohol

Neuro – Nursing   Diagnosis

ICP’s

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OBGYN –   Antepartum

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Cardiac Cardio Tutorials  0

EKG course  0

Emergency Clinical Guide  0

Fluid and Electrolytes ABG pratice test  0

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Restoring Electrolyte Imbalance  0

General Nursing Info Get CPR certification in NC  Joanne Fried – quick, good, inexpensive 0

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RN Central Careplans  0

Great A&P reference pages Fetal Circulation  and Congenital Heart Defects 0

Get Body Smart  0

Medical Physiology And Pathophysiology  quick reference on A&P 0

Neuroanatomy Tutorial 1  This guy is amazing!! 0

Video on BP regulation  another amazement from hyperhigh! 0

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NCLEX Study Guide  Wow! Check this out 0

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Increased ICP’s, herniation, etc. for indepth information about ICP, coma,

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Neuro assesssment refresher Neuro assessment refresher 0

OB/GYN links

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