Infectious Respiratory Problems Flashcards
A client has been diagnosed with tuberculosis (TB). What action by the nurse takes highest priority?
a. Educating the client on adherence to the treatment regimen
b. Encouraging the client to eat a well-balanced diet
c. Informing the client about follow-up sputum cultures
d. Teaching the client ways to balance rest with activity
ANS: A
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. The other options are appropriate topics to educate this client on but do not take priority.
A nurse is caring for several older clients in the hospital that the nurse identifies as being at high risk for healthcare-associated pneumonia. To reduce this risk, what activity should the nurse delegate to the unlicensed assistive personnel (UAP)?
a. Encourage between-meal snacks.
b. Monitor temperature every 4 hours.
c. Provide oral care every 4 hours.
d. Report any new onset of cough.
ANS: C
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. Monitoring temperature and reporting new cough in clients is important to detect the onset of possible pneumonia but do not prevent it.
A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective?
a. I need to take extra vitamin C while on INH.
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
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. Staining of contact lenses commonly occurs while taking rifampin (Rifadin).
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?
a. Albumin: 5.1 g/dL
b. Alanine aminotransferase (ALT): 180 U/L
c. Red blood cell (RBC) count: 5.2/mm3
d. White blood cell (WBC) count: 12,500/mm3
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.
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?
a. Ask the spouse to explain the fear of visiting in further detail.
b. Inform the spouse 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 its safe to visit.
ANS: A
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. Precautions for TB prevent transmission to all who come into contact with the client. Explaining isolation precautions and what to do when entering the room will be helpful, but this is too narrow in scope to be the best answer. Telling the spouse its safe to visit is demeaning of the spouses feelings.
A client is being discharged on long-term therapy for tuberculosis (TB). What referral by the nurse is most appropriate?
a. Community social worker for Meals on Wheels
b. Occupational therapy for job retraining
c. Physical therapy for homebound therapy services
d. Visiting Nurses for directly observed therapy
ANS: D
Directly observed therapy is often utilized for managing clients with TB in the community. Meals on Wheels, job retraining, and home therapy may or may not be appropriate.
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?
a. Arrange for immediate hospitalization.
b. Facilitate polymerase chain reaction testing.
c. Have the client produce a sputum sample.
d. Obtain two sets of blood cultures.
ANS: B
Polymerase chain reaction testing is used to diagnose pertussis, which this client is showing manifestations of. Hospitalization may or may not be needed but is not the most important action. The client may or may not be able to produce sputum, but sputum cultures for this disease must be obtained via deep suctioning. Blood cultures will be negative.
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.)
a. 22-year-old client with asthma
b. Client who had a cholecystectomy last year
c. Client with well-controlled diabetes
d. Healthy 72-year-old client
e. Client who is taking medication for hypertension
ANS: A, C, D, E
Clients over 65 years of age and any client (no matter what age) with a chronic health condition would be considered a priority for a pneumonia vaccination. Having a cholecystectomy a year ago does not qualify as a chronic health condition.
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.)
a. Blood urea nitrogen (BUN): 19 mg/dL
b. International normalized ratio (INR): 6.3
c. Prothrombin time: 35 seconds
d. Serum sodium: 130 mEq/L
e. White blood cell (WBC) count: 72,000/mm3
ANS: B, C
Rifampin can cause liver damage, evidenced by the clients high INR and prothrombin time. The BUN and WBC count are normal. The sodium level is low, but that is not related to this clients problem.
