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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.
