Pneumonia and Sepsis Flashcards
Which of the following is a key factor in the etiology of pneumonia?
1.Increased neutrophil and macrophage activation
2.Sterile airway distal to the larynx
3.Enhanced function of defense mechanisms
4.Aspiration of inert substances
Correct Answer: 4. Aspiration of inert substances
Rationale: Pneumonia can occur when defense mechanisms are overwhelmed, such as through the aspiration of substances, including inert ones, into the airway. Increased neutrophil and macrophage activation and enhanced function of defense mechanisms would typically help prevent pneumonia. The airway distal to the larynx is normally sterile but can become contaminated, leading to pneumonia.
A patient is admitted with community-acquired pneumonia (CAP). Which of the following statements is true regarding CAP?
A) It occurs more than 48 hours after hospital admission.
B) The causative organism is identified in most cases.
C) It is more common in winter and in patients with COPD.
D) It is most commonly caused by aspiration of stomach contents.
Answer: C) It is more common in winter and in patients with COPD.
Rationale:
CAP is an infection acquired outside the hospital or within the first 48 hours of hospitalization. It is more common in winter and in individuals with risk factors such as COPD, smoking, and recent antibiotic use. The causative organism is only identified in about 50% of cases. Hospital-acquired pneumonia (HAP), not CAP, occurs after 48 hours of admission. Aspiration pneumonia occurs due to inhalation of stomach contents.
A nurse is caring for a patient with pneumonia. Which assessment finding would be most concerning?
A) Increased fremitus and crackles on auscultation.
B) A productive cough with purulent sputum.
C) A sudden drop in blood pressure and confusion.
D) Fever and pleuritic chest pain.
Answer: C) A sudden drop in blood pressure and confusion.
Rationale:
A sudden drop in blood pressure and confusion could indicate sepsis, a life-threatening complication of pneumonia. Increased fremitus and crackles, productive cough with purulent sputum, and fever with pleuritic chest pain are expected findings in pneumonia but are not immediately life-threatening.
Which of the following nursing interventions is most appropriate to prevent complications in a hospitalized patient with pneumonia?
A) Encourage deep breathing and coughing exercises.
B) Administer broad-spectrum antibiotics only when fever is present.
C) Limit fluid intake to prevent pulmonary congestion.
D) Position the patient in a supine position to reduce discomfort.
Answer: A) Encourage deep breathing and coughing exercises.
Rationale:
Deep breathing and coughing help clear secretions, prevent atelectasis, and improve oxygenation. Antibiotics should be given as prescribed, regardless of fever. Fluid intake should not be limited unless contraindicated, as hydration helps loosen secretions. A semi-Fowler’s or upright position is preferred to improve lung expansion.
A patient with sepsis is being managed with the 1-hour sepsis bundle. Which intervention should be completed first?
A) Administer broad-spectrum antibiotics.
B) Measure the serum lactate level.
C) Obtain blood cultures.
D) Start vasopressors for hypotension.
Answer: B) Measure the serum lactate level.
Rationale:
The first step in the 1-hour sepsis bundle is measuring lactate levels, as elevated lactate indicates poor tissue perfusion. Blood cultures should be obtained before administering antibiotics, but lactate measurement helps assess the severity of shock. Vasopressors are started only if hypotension persists after fluid resuscitation.
A patient with septic shock has been receiving aggressive IV fluid resuscitation but remains hypotensive. What is the next best action?
A) Administer norepinephrine.
B) Increase the IV fluid rate.
C) Administer a diuretic to remove excess fluids.
D) Encourage oral fluid intake.
Answer: A) Administer norepinephrine.
Rationale:
If hypotension persists despite fluid resuscitation, vasopressors like norepinephrine should be given to maintain a MAP of at least 65 mmHg. Increasing IV fluids further can lead to fluid overload. Diuretics and oral fluids are not appropriate in this situation.
A nurse is assessing a patient with pneumonia. Which of the following is an early clinical manifestation?
A) Cyanosis and bradypnea
B) Sudden onset of fever and chills
C) Peripheral edema and weight gain
D) Decreased urine output and hypotension
Answer: B) Sudden onset of fever and chills.
Rationale:
Early symptoms of pneumonia include fever, chills, productive cough, and pleuritic chest pain. Cyanosis and bradypnea indicate severe hypoxia. Peripheral edema and weight gain are more common in heart failure. Decreased urine output and hypotension suggest sepsis, a possible complication of pneumonia.
A nurse is teaching a group of older adults about pneumonia prevention. Which statement requires further teaching?
A) “I should get the pneumococcal vaccine if I have chronic illnesses.”
B) “Washing my hands frequently can help prevent pneumonia.”
C) “I don’t need the influenza vaccine since I already got the pneumonia vaccine.”
D) “If I develop a cough and fever, I should see my healthcare provider.”
Answer: C) “I don’t need the influenza vaccine since I already got the pneumonia vaccine.”
Rationale:
Both the pneumococcal and influenza vaccines are recommended for older adults and those with chronic illnesses. Influenza can lead to secondary bacterial pneumonia, making both vaccines essential. Hand hygiene and seeking medical attention for symptoms are appropriate preventive measures.
A nurse suspects sepsis in a patient with pneumonia. Which clinical finding supports this suspicion?
A) Respiratory rate of 10 breaths per minute
B) Blood pressure of 86/48 mmHg despite fluid resuscitation
C) Urine output of 50 mL/hour
D) Blood glucose level of 80 mg/dL (4.4 mmol/L)
Answer: B) Blood pressure of 86/48 mmHg despite fluid resuscitation.
Rationale:
Septic shock is characterized by persistent hypotension despite fluid resuscitation. A respiratory rate of 10 is not a typical sign of sepsis (tachypnea is more common). Urine output of 50 mL/hour is within normal range. Hyperglycemia, not normal glucose levels, is often seen in sepsis.
A patient is at risk for aspiration pneumonia. Which nursing intervention is most appropriate?
A) Encourage the patient to drink fluids rapidly.
B) Place the patient in a supine position during meals.
C) Ensure the head of the bed is elevated at least 30 degrees.
D) Avoid suctioning the patient to prevent airway irritation.
Answer: C) Ensure the head of the bed is elevated at least 30 degrees.
Rationale:
Keeping the head of the bed elevated reduces the risk of aspiration. Drinking fluids too quickly may increase aspiration risk. The patient should not be in a supine position while eating. Suctioning is necessary for patients with secretion buildup to prevent aspiration.
Which of the following is a priority nursing intervention for a patient with sepsis?
A) Administering a bronchodilator
B) Applying oxygen and monitoring SpO₂
C) Encouraging early ambulation
D) Delaying antibiotic therapy until cultures result
Answer: B) Applying oxygen and monitoring SpO₂.
Rationale:
Sepsis can lead to hypoxia, so oxygen therapy and monitoring oxygen saturation are crucial. Bronchodilators are not the first-line treatment unless indicated for another condition (e.g., COPD). Early ambulation is important but not the priority in an unstable septic patient. Antibiotics should be given promptly waiting for cultures delays treatment and worsens outcomes.
A patient with pneumonia has dullness to percussion and increased fremitus on assessment. What do these findings indicate?
A) Pneumothorax
B) Pulmonary edema
C) Pleural effusion
D) Lung consolidation
Answer: D) Lung consolidation.
Rationale:
Dullness to percussion and increased fremitus suggest lung consolidation, a hallmark of pneumonia. Pneumothorax causes hyperresonance, while pleural effusion presents with decreased fremitus. Pulmonary edema typically presents with crackles rather than dullness.
A nurse is evaluating a patient’s response to pneumonia treatment. Which of the following indicates improvement?
A) SpO₂ increases from 88% to 95% on room air.
B) Blood cultures remain positive for bacteria.
C) The patient continues to have pleuritic chest pain.
D) Crackles are still present throughout lung fields.
Answer: A) SpO₂ increases from 88% to 95% on room air.
Rationale:
Improvement in oxygen saturation suggests better gas exchange and resolution of pneumonia. Persistent bacteremia indicates ongoing infection. Chest pain may linger but should improve with treatment. Persistent crackles suggest incomplete resolution.
A patient with pneumonia is experiencing pleuritic chest pain. Which intervention can best help alleviate this discomfort?
A) Encourage deep breathing and coughing.
B) Position the patient on the unaffected side.
C) Apply a warm compress to the chest.
D) Limit fluid intake.
Answer: B) Position the patient on the unaffected side.
Rationale:
Lying on the unaffected side can reduce pleuritic pain by limiting lung expansion on the affected side. Deep breathing and coughing are important but may increase discomfort. Warm compresses may provide some relief but are not the best intervention. Limiting fluids is not recommended unless indicated for another condition.
Which laboratory finding is most concerning in a patient with septic shock?
A) White blood cell count of 12,000/mm³
B) Lactate level of 5.2 mmol/L
C) Hemoglobin of 13 g/dL
D) Serum potassium of 4.0 mEq/L
Answer: B) Lactate level of 5.2 mmol/L.
Rationale:
A lactate level > 4 mmol/L indicates poor tissue perfusion and is a marker of severe sepsis. A WBC count of 12,000 is mildly elevated but not as concerning. Hemoglobin and potassium levels are within normal range.
A nurse is educating a patient on preventing pneumonia. Which statement by the patient indicates understanding?
A) “I should avoid getting the flu vaccine if I have had pneumonia before.”
B) “Handwashing is an effective way to prevent pneumonia.”
C) “I will stop taking antibiotics once I feel better.”
D) “Smoking has no effect on pneumonia risk.”
Answer: B) “Handwashing is an effective way to prevent pneumonia.”
Rationale:
Handwashing reduces the spread of respiratory infections, including pneumonia. The flu vaccine is recommended as viral infections can lead to secondary bacterial pneumonia. Completing the full course of antibiotics is crucial to prevent resistance. Smoking increases pneumonia risk.
A nurse is caring for a patient with pneumonia who suddenly develops pleuritic chest pain and absent breath sounds on one side. What is the nurse’s priority action?
A) Administer prescribed pain medication.
B) Notify the healthcare provider immediately.
C) Encourage deep breathing and coughing.
D) Increase the patient’s fluid intake.
Answer: B) Notify the healthcare provider immediately.
Rationale:
Absent breath sounds and pleuritic chest pain suggest a possible pneumothorax, which is a medical emergency. The healthcare provider should be notified immediately. Pain medication can be given, but it does not address the underlying issue. Deep breathing and coughing are important for pneumonia management but are not appropriate in this case. Increasing fluid intake does not resolve the problem.
A patient with sepsis has a blood pressure of 80/40 mmHg despite receiving 30 mL/kg of IV fluids. Which intervention should the nurse anticipate?
A) Administration of norepinephrine.
B) Discontinuation of IV fluids.
C) Increasing the patient’s oral fluid intake.
D) Positioning the patient in high Fowler’s position.
Answer: A) Administration of norepinephrine.
Rationale:
Persistent hypotension despite fluid resuscitation indicates septic shock. Vasopressors, such as norepinephrine, are required to maintain adequate blood pressure and tissue perfusion. IV fluids should not be discontinued, but additional fluid may not be enough. Oral fluids are not appropriate in this scenario. High Fowler’s position can help with breathing but does not address hypotension.
Which of the following findings in a patient with pneumonia suggests the development of a lung abscess?
A) Persistent fever and foul-smelling sputum.
B) Wheezing and stridor.
C) Bradycardia and hypotension.
D) Dry cough and normal lung sounds.
Answer: A) Persistent fever and foul-smelling sputum.
Rationale:
A lung abscess is a complication of pneumonia that presents with persistent fever, foul-smelling sputum, and possible hemoptysis. Wheezing and stridor are more common in airway obstruction. Bradycardia and hypotension suggest shock but are not specific to a lung abscess. A dry cough and normal lung sounds are not characteristic of this condition.
A patient is being discharged after recovering from pneumonia. Which statement by the patient indicates a need for further teaching?
A) “I will take all my antibiotics, even if I start feeling better.”
B) “I should get my flu and pneumonia vaccines to prevent future infections.”
C) “I can stop deep breathing exercises once my symptoms improve.”
D) “I will increase my fluid intake to help clear secretions.”
Answer: C) “I can stop deep breathing exercises once my symptoms improve.”
Rationale:
Deep breathing exercises help clear secretions and prevent complications such as atelectasis. The patient should continue these exercises even after symptoms improve. Completing antibiotics, getting vaccinated, and maintaining hydration are appropriate actions.
A nurse is assessing a patient at risk for sepsis. Which early sign should the nurse identify?
A) Decreased urine output.
B) Hypotension unresponsive to fluids.
C) Warm, flushed skin with a fever.
D) Cold, clammy skin with cyanosis.
Answer: C) Warm, flushed skin with a fever.
Rationale:
In early sepsis, the patient may have warm, flushed skin due to vasodilation and fever. As sepsis progresses to shock, signs such as hypotension, decreased urine output, and cold, clammy skin occur.
A patient with pneumonia develops confusion and restlessness. Which action should the nurse take first?
A) Assess oxygen saturation.
B) Administer a sedative.
C) Request a psychiatric consultation.
D) Perform a neurological assessment.
Answer: A) Assess oxygen saturation.
Rationale:
Confusion and restlessness in a patient with pneumonia may indicate hypoxia. Oxygen saturation should be checked first, and supplemental oxygen provided if needed. Sedatives and psychiatric evaluation are not the priority. A neurological assessment is important but should be done after addressing potential hypoxia.
A nurse is monitoring a patient with septic shock. Which assessment finding indicates worsening shock?
A) Increased urine output.
B) Decreasing blood pressure and weak pulses.
C) Warm, flushed skin.
D) Respiratory rate of 16 breaths per minute.
Answer: B) Decreasing blood pressure and weak pulses.
Rationale:
As septic shock worsens, blood pressure drops, and pulses become weak due to poor perfusion. Increased urine output would be an improvement. Warm, flushed skin occurs in early sepsis, while respiratory distress typically worsens rather than stabilizing.
Which nursing action is most important when caring for a patient with pneumonia receiving IV antibiotics?
A) Encouraging the patient to ambulate frequently.
B) Monitoring for signs of allergic reaction.
C) Limiting oral fluid intake to prevent fluid overload.
D) Discontinuing oxygen therapy when the patient’s condition improves.
Answer: B) Monitoring for signs of allergic reaction.
Rationale:
IV antibiotics can cause allergic reactions, so the nurse must monitor for rash, itching, or anaphylaxis. Ambulation is beneficial but is not the priority. Fluid intake should be encouraged unless contraindicated. Oxygen therapy should be discontinued only under a provider’s guidance.
A nurse is reviewing the plan of care for a patient with septic shock. Which intervention should be implemented first?
A) Administering IV fluids.
B) Administering vasopressors.
C) Obtaining blood cultures.
D) Administering broad-spectrum antibiotics.
Answer: A) Administering IV fluids.
Rationale:
Initial management of septic shock includes fluid resuscitation to improve perfusion. Blood cultures should be obtained before starting antibiotics, and vasopressors are used only if fluids do not restore blood pressure.
A patient with pneumonia is experiencing thick secretions and difficulty clearing them. What is the best nursing intervention?
A) Encourage the patient to drink at least 2-3 liters of fluids per day.
B) Limit fluid intake to prevent fluid retention.
C) Place the patient in the Trendelenburg position.
D) Administer a diuretic as prescribed.
Answer: A) Encourage the patient to drink at least 2-3 liters of fluids per day.
Rationale:
Adequate hydration helps thin secretions, making them easier to clear. Fluid restriction is not necessary unless contraindicated. The Trendelenburg position is not recommended for pneumonia. Diuretics are used for fluid overload, not secretion clearance.
