Chp33 Care of Pt w/infectious Resp Problems – Flashcards

A. "Yes, if your grandchildren are up to date on their immunizations, they will be protected against your cold." B. "Yes, you were only contagious for the first 24 hours after you began having manifestations of a cold and are now no longer contagious." C. "No, the usual period for being able to spread a cold is during the first 2 or 3 days after you start having manifestations." D. "No, you will be considered contagious until all manifestations of the cold have been gone for at least 24 hours." ANS: C The cold virus is easily spread from one person to another through nasal secretions, eye secretions, and droplets from sneezing or coughing. The person with a cold is considered to be most contagious during the early part of the illness, especially for the first 2 to 3 days.

A. 25-year-old man with a latex allergy B. 45-year-old woman with hypertension C. 32-year-old woman who is taking oral contraceptives D. 65-year-old man who has had type 1 diabetes mellitus for 20 years ANS: B Most decongestants work by increasing blood vessel constriction. This action increases peripheral vascular resistance and blood pressure. The client who already has hypertension may develop dangerously high blood pressure when taking a decongestant.

A. Ophthalmoscopic examination of the eye B. Blood pressure in both arms C. Sputum specimen D. Urinalysis ANS: D Persistent streptococcal infection from no treatment or inadequate treatment commonly causes the complication of glomerular nephritis. A follow-up urinalysis after a streptococcal infection may show increased protein and the presence of blood, both of which are early manifestations of glomerular nephritis and indicate a need for more antibiotic therapy.

A. "Wash your hands after blowing your nose or sneezing." B. "Use a dishwasher or boiling water to clean all dishes and utensils you have used." C. "Have the other members of your family wear masks until all cold manifestations have subsided." D. "Humidify the air in your home with a humidifier or by running hot shower water to produce steam." ANS: A Cold viruses are shed in nasal and bronchial secretions. Handwashing after events that place viruses on the hands reduces the risk that the viruses will be spread directly or indirectly to others. Dishes need only to be washed in hot, sudsy water. The mouth has more protective mechanisms to prevent viral infection than do either the nose or the conjunctiva of the eye. Masks worn by others have not been proven effective in preventing the spread of colds and may give family members a false sense of security. Humidifying the air promotes comfort but does not inhibit viral spread.

A. Asthma B. Hypotension C. Kidney stones D. Urinary retention ANS: D Antihistamines are often composed of anticholinergic drugs. In older adult clients, these medications can cause or worsen urinary retention.

A. "I have been taking two aspirins every 6 hours for this headache." B. "My nose doesn't stay open even though I'm using nasal spray every hour." C. "I have been taking a lot of vitamin C this year to keep from getting so many colds." D. "The only way I can get to sleep with this nasal congestion is by taking an over-the-counter antihistamine at night." ANS: B Excessive use of nose drops or nasal spray, especially those with a 12-hour duration of action, causes a severe rebound nasal congestion

A. "Drink 10 or more glasses of liquid each day." B. "Do not keep your mouth closed while sneezing." C. "Avoid bending over or putting your head in a dependent position." D. "Take the antibiotic for the entire time it is prescribed, not just until you feel better." ANS: A Increasing the fluid intake is thought to thin the drainage in the sinuses, making them easier to drain.

A. "Drink at least 8 glasses of water each day." B. "Sleep in a semisitting position for the first 2 weeks." C. "Use a stool softener as prescribed to prevent constipation." D. "Change the mustache dressing whenever it becomes wet or soiled." ANS: C The client needs to avoid any activity that stimulates the Valsalva reflex and increases pressure within the surgical area. Such activities include bending over, straining to have a bowel movement, vomiting, and coughing. Using a stool softener to prevent having to strain will help prevent bleeding from the surgical site.

A. Fever of 101o F B. Difficulty swallowing C. Swollen lymph nodes D. Erythema of the pharynx ANS: A Viral pharyngitis causes little or no fever. Bacterial pharyngitis usually causes fevers over 100o F. The presence of a cough, difficulty swallowing, lymph node enlargement, and erythema of the pharynx are common to both viral and bacterial pharyngitis.

ANS: C The mouth and throat normally harbor many nonpathogenic microorganisms. The purpose of a throat culture is to ensure that the specimen contains only organisms from the infected areas of the tonsils and throat.

A. Fatigue related to malaise and fever B. Acute Pain related to local inflammation C. Risk for Ineffective Breathing Pattern related to airway obstruction D. Risk for Imbalanced Nutrition: Less than Body Requirements related to pain and difficulty swallowing ANS: C The epiglottis is an elastic structure that has a hingelike action. The epiglottis opens during breathing and coughing. It folds over and closes the entrance to the larynx during swallowing to prevent aspiration. When the epiglottis is swollen during infection or inflammation, it can completely obstruct the airway.

A. "If you notice an enlarged lymph node on the same side of your neck as the abscess, call the doctor." B. "Stay home from work or school until your temperature has been normal for 24 hours." C. "You may gargle with warm water that has a teaspoon of salt in it as often as you like." D. "Take the antibiotic for the entire time it is prescribed, not just until you feel better." ANS: D Untreated or ineffectively treated peritonsillar abscesses can extend throughout the pharyngeal area, causing swelling that may jeopardize the client's airway.

A. Amoxicillin (Amoxil) B. Erythromycin (E-Mycin) C. Cephalexin (Keflex) D. Tetracycline (Sumycin) ANS: B Cephalosporins have the same chemical structure as penicillin and most people who are allergic to penicillin will also have an allergy to the cephalosporins. Tetracyclines are not usually effective enough against streptococcal species. Erythromycin is usually just as effective as penicillin but has many more gastrointestinal side effects.

A. "I knew I would get laryngitis this time because I cheered for hours at the ball game." B. "At the first hint of laryngitis, I whisper instead of talking in my regular voice." C. "I suck on throat lozenges to keep my mouth and throat from getting so dry." D. "When laryngitis starts, I quit smoking until all symptoms are gone." ANS: B Whispering places an added strain on the larynx and can cause or worsen laryngitis. Total voice rest rather than whispering is recommended. If the client must speak, urge him or her to use a normal voice intensity.

A. "If you got a flu shot last year, you need to make sure that you get the new shot exactly 1 year later." B. "You should get a flu shot early in the fall so that you make enough antibodies before the flu season arrives." C. "Since we don't know if the flu will come this year, you should wait until an outbreak of flu in our area is reported." D. "Because flu shots are good for five years at a time, if you got a flu shot last year you do not need to get another one this year." ANS: B People over age 50 and those with chronic disease should be vaccinated against the flu each year early in the fall. The major flu season is late fall and winter. It takes 3 to 8 weeks to develop enough antibodies from the flu shot to be able to protect against the flu after exposure. If a client waits until the flu season hits to get the flu shot, he or she may be exposed to the flu before sufficient antibodies have been developed. Flu shots appear to be effective for only one flu season, depending on the specific virus causing the flu each year

A. Preventing the virus from entering respiratory cells B. Boosting the client's immune system C. Inhibiting the virus from multiplying D. Directly killing the virus ANS: A Oseltamivir prevents viral spread in the respiratory tract by inhibiting a viral enzyme (neuraminidase) that allows the virus to penetrate respiratory cells. This drug can prevent infection if taken soon after exposure and shortens the duration of influenza A or B if taken within 24 to 48 hours after the onset of manifestations.

A. Pulse oximetry reading of 92% B. Shallow respirations of 32 per minute C. Percussion is dull in the left lower lobe D. Wheezes are audible over the right and left bronchi ANS: C Dull percussion indicates consolidation, a hallmark of pneumonia. The other manifestations are expected findings in a client with chronic bronchitis.

A. The 40-year-old first-grade teacher B. The 60-year-old smoker who is also an alcoholic C. The 75-year-old with exercise-induced wheezing D. The 35-year-old aerobics instructor who skips meals and eats only vegetables ANS: B Although age is a factor in the development of community-acquired pneumonia, other lifestyle and exposure factors increase the risk more than age. Two conditions that heavily predispose to the development of pneumonia are cigarette smoking and alcoholism. Cigarette smoking interferes with the ciliary function of removal of invasive materials. Alcoholism usually results in imbalanced nutrition as well as decreased immune function.

A. The 60-year-old client receiving mechanical ventilation B. The 40-year-old client receiving antibiotics for a surgical wound infection C. The 60-year-old client in traction for a fractured femur who also has a cold D. The 40-year-old client with type 2 diabetes who has a 50 pack-year smoking history ANS: A Mechanical ventilation in a hospitalized client is a high risk for the development of nosocomial pneumonia. The endotracheal tube or the tracheostomy tube provides direct access of hospital flora to the respiratory tract. Such pneumonia is termed ventilation-acquired pneumonia (VAP).

A. Cap off the Lukens tube, lower attachment to the suction catheter, upper attachment to the suction source B. Cap off the Lukens tube, lower attachment to the suction source, upper attachment to the suction catheter C. Cap on the Lukens tube, lower attachment to the suction catheter, upper attachment to the suction source D. Cap on the Lukens tube, lower attachment to the suction source, upper attachment to the suction catheter ANS: C The cap must be on the Lukens tube or there will not be sufficient suction generated to move the sputum into the tube. The sputum is heavier than air. If the suction catheter were higher than the suction source, the sputum would be sucked out of the tube through the lower suction source tube. With the suction source attached higher on the tube than the suction catheter, any sputum entering the tube falls to the bottom of the tube.

A. pH 7.35, HCO3- 22 mEq/L, PCO2 45 mm Hg, PO2 86 mm Hg B. pH 7.30, HCO3- 22 mEq/L, PCO2 60 mm Hg, PO2 92 mm Hg C. pH 7.32, HCO3- 17 mEq/L, PCO2 25 mm Hg, PO2 98 mm Hg D. pH 7.30, HCO3- 28 mEq/L, PCO2 65 mm Hg, PO2 75 mm Hg ANS: A The gas exchange affected by pneumonia is oxygen. Excess carbon dioxide retention is not usually a problem but hypoxemia is present. The pH is at the low range of normal and bicarbonate is neither synthesized nor excreted as a compensatory mechanism

A. Deficient Fluid Volume B. Disturbed Sleep Pattern C. Ineffective Airway Clearance D. Potential for Pleural Effusion ANS: C All the listed nursing diagnoses and collaborative problems are important and serious. The one with the greatest priority is Ineffective Airway Clearance, because it is the most life threatening as an actual problem.

A. The 40-year-old registered nurse who works full-time as a scrub nurse in an ambulatory surgical center B. The 70-year-old woman living with her 4-year-old grandson who attends day care 3 days per week C. The 50-year-old woman with seasonal asthma who lives with three teenage children D. The 60-year-old welder who smokes three packs of cigarettes per day. ANS: B The biggest risk factors for developing DRSP (drug resistant Streptococcus pneumonia) are being an older adult and being exposed to small children who spend significant amounts of time in a day care environment

A. Incentive spirometry 5 to 10 breaths per session every hour while awake B. Chest physiotherapy every 4 hours while awake C. Positioning the client on the unaffected side D. Oxygen at 45 L/minute by nasal cannula ANS: A Chest physiotherapy and positioning on the unaffected side have minimal if any benefit in assisting with airway clearance. Oxygen therapy does not contribute to airway clearance. Incentive spirometry facilitates deep breathing and stimulates coughing, both of which help clear the airways.

A. "You are right. A major risk factor for getting pneumonia is infection with influenza." B. "That's great. Now you are fully protected against infectious respiratory problems for this year." C. "The flu shot protects you against some viruses that cause influenza but does not protect you against bacteria that cause pneumonia. You need both types of shots." D. "Although you have some protection, it would still be best to get the pneumococcal vaccination so you would be less like to be a carrier and infect other people." ANS: C Although influenza can lead to pneumonia, and preventing influenza with a "flu shot" reduces the risk for a secondary pneumonia, bacterial pneumonia can be acquired without influenza as a precipitating event and can be life threatening

A. The client does not have a cough. B. Urine output is 900 mL for the day. C. Pulse oximetry shows an oxygen saturation of 90%. D. Tactile fremitus is increased over the affected lung fields. ANS: C Older clients may not have a cough, even with severe pneumonia. Increased tactile fremitus indicates greater consolidation and is associated with pneumonia, not its resolution. During full-blown pneumonia, clients have severely decreased oxygen saturation. Although 90% is at the low end of normal, it is greater than expected for pneumonia.

A. "Abruptly discontinuing this patch can cause high blood pressure." B. "Abruptly discontinuing this patch can cause nausea and vomiting." C. "Smoking while using this patch increases the risk for pneumonia." D. "Smoking while using this patch increases the risk for a heart attack." ANS: D Nicotine constricts blood vessels, increases mean arterial pressure, and increases afterload. Smoking while using a nicotine patch increases afterload to such an extent that the myocardium must work harder (with the coronary arteries constricted) and may cause a myocardial infarction

A. Monitor urine output every shift. B. Perform neuro checks every 2 hours. C. Examine the stool and vomitus for the presence of blood. D. Monitor the complete white blood cell count and differential daily. ANS: A Amikacin is an aminoglycoside antibiotic and is nephrotoxic. Urine output should be monitored for decreased volume, which could indicate renal insufficiency. At the first sign of renal insufficiency, the drug dosage should be decreased or this class of antibiotics discontinued

A. The 30-year-old nurse providing direct care to clients with SARS B. The 50-year-old farmer working directly with cows and pigs C. The 60-year-old client with type 2 diabetes mellitus and renal insufficiency D. The 70-year-old client residing in an assisted living environment ANS: A At the present time, the most significant risk factor for contracting SARS is being in close direct contact with an infected person. Nurses and family caregivers of clients with SARS meet these criteria and must use precautions to prevent infecting themselves and others with the causative organism.

A. Airborne precautions B. Droplet precautions C. Airborne precautions and contact precautions D. Droplet precautions and contact precautions ANS: C The virus is easily spread by airborne droplets from infected people through sneezing, coughing, and talking. It can contaminate surfaces and objects, although it does not survive on nonliving surfaces for long periods. People at greatest risk for SARS are those who are in close direct contact with an infected person. The portals of entry for infection with the virus are the mucous membranes of the eyes, nose, and mouth. Airborne precautions are more stringent than droplet precautions.

A. Positive PPD test B. The presence of calcified lesions on chest x-ray C. The presence of M. tuberculosis in a sputum culture D. The combined clinical manifestations of weight loss, night sweats, fever, and cough productive of mucopurulent bloody sputum ANS: C While all the above findings suggest active tuberculosis, only the presence of M. tuberculosis in the sputum culture confirms it

A. "When your PPD test is negative." B. "When your chest x-ray shows resolution of the lesions." C. "When you have been on the medication at least 6 weeks." D. "When you have three negative sputum cultures in a row." ANS: D When results of three sputum cultures are negative, the client is considered to be noninfectious (but still requires treatment with medication), can return to work, and can resume other social interactions without infection precautions.

A. Use standard precautions alone because the client does not have tuberculosis. B. Use standard precautions and airborne precautions because the client has tuberculosis. C. Use standard precautions and airborne precautions until a chest x-ray shows the client does not have tuberculosis. D. Use airborne precautions alone because the client is taking penicillin therapy for another respiratory infection. ANS: C When clients are very old or have severe immunodeficiency, their PPD tests may be negative, even when active tuberculosis is present, because they have too few immune system cells and cell products to mount an immune response to the test. Therefore, airborne precautions should be used with any older client who presents with clinical manifestations of tuberculosis until other tests rule out tuberculosis.

A. 7 to 10 days B. 6 weeks C. 6 months D. 2 years ANS: C The client who has nondrug-resistant tuberculosis must remain on the prescribed medications for at least 6 months. The organism that causes TB, Mycobacterium tuberculosis, is slow- growing and resistant to standard antibiotics.

A. Document the report as the only action. B. Obtain a specimen for culture. C. Test the urine for occult blood. D. Notify the physician. ANS: A Rifampin normally turns urine orange color. No action is needed

A. Institute airborne infection precautions immediately. B. Document the observation as the only action. C. Retest the client on the opposite arm. D. Re-examine the test site at 72 hours. ANS: D An area of induration (not just redness) measuring 10 mm or more in diameter 48 to 72 hours after injection indicates exposure to and infection with TB. Recent studies indicate that a reading after 72 hours rather than after just 48 hours is more accurate. The incidence of false-negative readings is greater at 48 hours.

A. Wheezing on exhalation on the side with the broken ribs B. Absence of fremitus at and below the site of injury C. Crepitus of the skin around the site of injury D. Absence of gastric motility ANS: B Absent fremitus on palpation is associated with fluid in the lung or in the pleural space

A. Airborne precautions B. Droplet precautions C. Contact precautions D. No additional precautions ANS: D Inhalation anthrax is not spread by person-to-person contact. The infected person does not pose an infection hazard to others and no additional precautions beyond standard precautions are needed.

A. Increasing CNS activity leading to seizures B. Absence of upper respiratory manifestations C. Slow, spreading subcutaneous hemorrhage D. Rapid loss of 10% to 20% of total body weight ANS: B Unlike many respiratory infections, inhalation anthrax is only a deep infection and does not stimulate any of the usual upper respiratory clinical manifestations such as headache, sore throat, or rhinitis.

A. "If you have no manifestations, you may stop the drug now." B. "You will need to take this drug for at least one month to be sure you don't spread the disease to others." C. "You need to take this drug for at least 60 days because the organism is first encapsulated, and it may take up to 8 weeks for manifestations to appear." D. "You will need to be on prophylactic antibiotic therapy for the rest of your life to keep the organism from breaking free from its capsule and multiplying." ANS: C This organism first forms a spore, an encapsulated organism that is inactive. At this stage, even when in the body, antibiotics are not effective in penetrating the spore. When many spores are inhaled into the deep parts of the lungs, macrophages engulf them. Once inside the macrophage, the organism leaves its capsule and replicates. The process of leaving the capsule and replicating can be slow and it is at this point that drug therapy is most effective. The active bacteria produce several toxins that they release into the infected tissues and the blood.