Chapter 31: Care of Patients with Infectious Respiratory Problems

Question 1

A nurse working in a geriatric clinic sees clients with cold symptoms and rhinitis. Which drug would be appropriate to teach these clients to take for their symptoms?

Answer 1

Fexofenadine (Allegra)

First-generation antihistamines are not appropriate for use in the older population. These drugs include
chlorpheniramine, iphenhydramine, and hydroxyzine. Fexofenadine is a second-generation antihistamine.

Question 2

A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is
worse when bending over, tenderness across the cheeks, and postnasal discharge. What instruction will be most
helpful?

Answer 2

Try warm, moist heat packs on your face

This client has rhinosinusitis. Comfort measures for this condition include breathing in warm steam, hot packs, nasal saline irrigations, sleeping with the head elevated, increased fluids, and avoiding cigarette smoke.

Question 3

Which teaching point is most important for the client with bacterial pharyngitis/peritonsillar abscess?

Answer 3

Take all antibiotics as directed.

Any client on antibiotics must be instructed to complete the entire course of antibiotics. Not completing them can lead to complications or drug-resistant strains of bacteria.

Question 4

A client is in the family practice clinic reporting a severe cold that started 4 days ago. On examination, the nurse notes the client also has a severe headache and muscle aches. What action by the nurse is best?

Answer 4

Teach the client to sneeze in the upper sleeve.

Sneezing and coughing into ones sleeve helps prevent the spread of upper respiratory infections. The client does have manifestations of the flu (influenza), but it is too late to start antiviral medications; to be effective, they must be started within 24 to 48 hours of symptom onset.

Question 5

The charge nurse on a medical unit is preparing to admit several clients who have possible pandemic flu during a preparedness drill. What action by the nurse is best?

Answer 5

Cohort the clients in the same area of the unit.

Preventing the spread of pandemic flu is equally important as caring for the clients who have it. Clients can be cohorted together in the same set of rooms on one part of the unit to use distancing to help prevent the spread of the disease.

Question 6

A client admitted for pneumonia has been tachypneic for several days. When the nurse starts an IV to give
fluids, the client questions this action, saying I have been drinking tons of water. How am I dehydrated? What response by the nurse is best?

Answer 6

Breathing so quickly can be dehydrating

Tachypnea and mouth breathing, both seen in pneumonia, increase insensible water loss and can lead to a degree of dehydration

Question 7

An older adult is brought to the emergency department by a family member, who reports a moderate change in mental status and mild cough. The client is afebrile. The health care provider orders a chest x-ray. The family member questions why this is needed since the manifestations seem so vague. What response by the nurse is best?

Answer 7

Older people often have vague symptoms, so an x-ray is essential

It is essential to obtain an early chest x-ray in older adults suspected of having pneumonia because symptoms are often vague. Waiting until definitive manifestations are present to obtain the x-ray leads to a costly delay in
treatment.

Question 8

A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority?

Answer 8

Educating the client on adherence to the treatment regimen

The treatment regimen for TB ranges from 6 to 12 months, making adherence problematic for many people. The nurse should stress the absolute importance of following the treatment plan for the entire duration of prescribed therapy.

Question 9

A client has been admitted for suspected inhalation anthrax infection. What question by the
nurse is most important?

Answer 9

What is your occupation?

Inhalation anthrax is rare and is an occupational hazard among people who work with animal wool, bone meal, hides, and skin, such as taxidermists and veterinarians. Inhalation anthrax seen in someone without an occupational risk is considered a bioterrorism event and must be reported to authorities immediately.

Question 10

A nurse is caring for/rounding on several older clients in the hospital that the nurse identifies as being at high risk for
healthcare-associated(ventilator-associated) pneumonia. To reduce this risk, what activity should the nurse delegate to the unlicensed assistive personnel (UAP)?

Answer 10

Provide oral care every 4 hours.

Oral colonization by gram-negative bacteria is a risk factor for healthcare-associated pneumonia. Good, frequent oral care can help prevent this from developing and is a task that can be delegated to the UAP. Encouraging good nutrition is important, but this will not prevent pneumonia

Question 11

A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective?

Answer 11

I will take this medication on an empty stomach.

INH 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.

Question 12

A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately?

Answer 12

Alanine aminotransferase (ALT): 180 U/L

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.

Question 13

The emergency department (ED) manager is reviewing client charts to determine how well the staff
performs when treating clients with community-acquired pneumonia. What outcome demonstrates that goals for this client type have been met?

Answer 13

Antibiotics started before admission

Goals for treatment of community-acquired pneumonia include initiating antibiotics prior to inpatient
admission or within 6 hours of presentation to the ED

Question 14

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?

Answer 14

Inform the client that antibiotics will be needed for 60 days.

This client has manifestations of early inhalation anthrax. For treatment, after IV antibiotics are finished, oral antibiotics are continued for at least 60 days.

Question 15

A client has been hospitalized with tuberculosis (TB). The clients spouse is fearful of entering the room where the client is in isolation and refuses to visit. What action by the nurse is best?

Answer 15

Ask the spouse to explain the fear of visiting in further detail.

The nurse needs to obtain further information about the spouses specific fears so they can be addressed. This will decrease stress and permit visitation, which will be beneficial for both client and spouse.

Question 16

A client is being discharged on long-term therapy for tuberculosis (TB). What referral by the nurse is most appropriate?

Answer 16

Visiting Nurses for directly observed therapy

Directly observed therapy is often utilized for managing clients with TB in the community.

Question 17

A client is in the family practice clinic reporting a severe cough that has lasted for 5 weeks. The client is so exhausted after coughing that work has become impossible. What action by the nurse is most appropriate?

Answer 17

Facilitate polymerase chain reaction
testing.

Polymerase chain reaction testing is used to diagnose pertussis, which this client is showing manifestations of.

Question 18

A client has the diagnosis of valley fever accompanied by myalgias and arthralgias. What treatment should
the nurse educate the client on?

Answer 18

Oral fluconazole (Diflucan)

Valley fever, or coccidioidomycosis, is a fungal infection. Many people do not need treatment and the disease resolves on its own. However, the presence of joint and muscle pain indicates a moderate infection that needs treatment with antifungal medications

Question 19

A client is in the family medicine clinic reporting a dry, sore throat. The provider asks the nurse to assess for odynophagia. What assessment technique is most appropriate?

Answer 19

Assess the client for pain when swallowing

Odynophagia is painful swallowing. The nurse should assess the client for this either by asking or by having
the client attempt to drink water.

Question 20

A client is admitted with suspected pneumonia from the emergency department. The client went to the primary care provider a few days ago and shows the nurse the results of what the client calls an allergy test, as shown below:

What action by the nurse takes priority?

Answer 20

Immediately place the client on Airborne Precautions.

This allergy test is actually a positive tuberculosis test. The client should be placed on Airborne Precautions immediately.

Question 21

A nurse admits a client from the emergency department. Client data are listed below:

History:
70 years of age
History of diabetes
On insulin twice a day
Reports new-onset dyspnea and productive cough

Physical Assessment:
Crackles and rhonchi heard throughout the lungs
Dullness to percussion LLL
Afebrile
Oriented to person only

Laboratory Values
WBC: 5,200/mm3
PaO2 on room air 65 mm Hg

What action by the nurse is the priority?

Answer 21

Administer oxygen at 4 liters per nasal cannula.

Question 22

A nurse is providing pneumonia vaccinations in a community setting. Due to limited finances, the event organizers must limit giving the vaccination to priority groups. What clients would be considered a priority when administering the pneumonia vaccination? (Select all that apply.)

Answer 22

22-year-old client with asthma
Client with well-controlled diabetes
Healthy 72-year-old client
Client who is taking medication for
hypertension

Question 23

A client in the emergency department is taking rifampin (Rifadin) for tuberculosis. The client reports yellowing of the sclera and skin and bleeding after minor trauma. What laboratory results correlate to this condition? (Select all that apply.)

Answer 23

International normalized ratio (INR): 6.3

Prothrombin time: 35 seconds

Question 24

A client has been diagnosed with an empyema. What interventions should the nurse anticipate providing to this client? (Select all that apply.)

Answer 24

Assisting with chest tube insertion
Facilitating pleural fluid sampling
Performing frequent respiratory assessment
Providing antipyretics as needed

Question 25

A nurse working in a geriatric clinic sees clients with “cold” symptoms and rhinitis. The primary health care provider (PHCP) often leaves a prescription for diphenhydramine. What action by the nurse is best?

Answer 25

Consult with the PHCP about the medication.

First-generation antihistamines are not appropriate for use in the older population. These
drugs include chlorpheniramine, diphenhydramine, and hydroxyzine. The nurse would consult
with the PHCP and request a different medication.

Question 26

A hospital nurse is participating in a drill during which many “clients” with inhalation anthrax
are being admitted. What drugs would the nurse anticipate administering? (Select all that
apply.)

Answer 26

Vancomycin
Ciprofloxacin
Doxycycline

Question 27

A client has been diagnosed with an empyema. What interventions would the nurse anticipate providing to this client? (Select all that apply.)

Answer 27

Assisting with chest tube insertion
Facilitating pleural fluid sampling
Performing frequent respiratory assessment
Providing antipyretics as needed

Question 28

The emergency department nurse is participating in a bioterrorism drill in which several “clients” are suspected to have inhalation anthrax. Which “clients” would the nurse see as the priorities? (Select all that apply.)

Answer 28

Stridor
Oxygen saturation of 91%
Diaphoresis

Question 29

A client is taking ethambutol for tuberculosis. What instructions does the nurse provide the
client regarding this drug? (Select all that apply.)

Answer 29

Contact the primary health care provider if preexisting gout becomes worse.
Report any changes in vision immediately to the health care provider.
You will take this medication along with some others for 8 weeks.
Take this medicine with a full glass of water.

Question 30

The nurse is learning about endemic pulmonary diseases. Which diseases are matched with
correct information? (Select all that apply.)

Answer 30

Hanta virus: found in urine, droppings, and saliva of infected rodents.
Histoplasmosis: sources include soil containing bird and bat droppings.
Coccidioidomycosis: found in the southwest and far west of the United States