Airway Pneumonia and TB 1.

. 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? A. B. C. D. Atelectasis Bronchiectasis Effusion Inflammation

3. An elderly client with pneumonia may appear with which of the following symptoms first? A. B. C. D. Altered mental status and dehydration Fever and chills Hemoptysis and dyspnea Pleuritic chest pain and cough

4. When auscultating the chest of a client with pneumonia, the nurse would expect to hear which of the following sounds over areas of consolidation? A. B. C. D. Bronchial Bronchovestibular Tubular Vesicular

5. A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests? A. B. C. D. ABG analysis Chest x-ray Blood cultures sputum culture and sensitivity

6. 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?

A. B. C. D.

Antibiotics Bed rest Oxygen Nutritional intake

7. 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? A. B. C. D. Continued dyspnea Fever of 102*F Respiratory rate of 32 breaths/minute Vesicular breath sounds in right base

8. A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority? A. B. C. D. Acute pain related to lung expansion secondary to lung infection Risk for imbalanced fluid volume related to increased insensible fluid losses secondary to fever. Anxiety related to dyspnea and chest pain. Ineffective airway clearance related to retained secretions.

9. Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia? Select all that apply. A. B. C. D. E. Auscultation of breath sounds Auscultation of bowel sounds Presence of chest pain. Presence of peripheral edema Color of nail beds

10. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following? A. B. C. D. Decreased cardiac output Pleural effusion Inadequate peripheral circulation Decreased oxygenation of the blood.

11. Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? A. Coma

B. Apathy C. Irritability D. Depression E. 12. Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia? A. B. C. D. A respiratory rate of 25 to 30 breaths per minute The ability to perform ADLs without dyspnea A maximum loss of 5 to 10 pounds of body weight Chest pain that is minimized by splinting the ribcage.

13. Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute? A. Arterial blood gas (ABG) and breath sounds B. Level of consciousness and a pulse oximetry value. C. Breath sounds and reflexes D. Pulse oximetry value and heart sounds 14. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? A. B. C. D. Limiting fluids Having the client take 3 deep breaths. Asking the client to spit into the collection container. Asking the client to obtain the specimen after eating.

15. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician? A. B. C. D. Blood-streaked sputum Dry cough Hematuria Bronchospasm

16. The most reliable index to determine the respiratory status of a client is to: A. B. C. D. Observe the chest rising and falling Observe the skin and mucous membrane color. Listen and feel the air movement. Determine the presence of a femoral pulse.

17. Auscultation of a clients lungs reveals crackles in the left posterior base. The nursing intervention is to: A. Repeat auscultation after asking the client to deep breathe and cough. B. Instruct the client to limit fluid intake to less than 2000 ml/day.

C. Inspect the clients ankles and sacrum for the presence of edema D. Place the client on bedrest in a semi-Fowlers position.

1.

B. Clients with chronic illnesses generally have poor immune systems. Often, residing in group living situations increases the chance of disease transmission. 2. D. 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 doesnt 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.

A. 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. 4. A. 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. 5. D. 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. 6. C. 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 isnt 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. 7. D. 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. 8. D. 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. 9. A,C,E... 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 clients 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. 10. D. 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. 11. C. 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. 12. B. An expected outcome for a client recovering from pneumonia would be the ability to perform ADLs 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.

13. 2. First, the nurse should attempt to rouse the client because this should increase the clients respiratory rate. If available, a spot pulse oximetry check should be done and breath sounds should be checked. The physician should be notified immediately if of the findings. Hell probably order ABG analysis to determine specific carbon dioxide and oxygen levels, which will indicate the effectiveness of ventilation. Reflexes and heart sounds will be part of the more extensive examination done after these initial actions are completed. 14. 2. To obtain a sputum specimen, the client should rinse the mouth to prevent contamination, breathe deeply, and then cough unto a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning. 15. 4. If a biopsy was performed during a bronchoscopy, blood streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure. 16. 3. To check for breathing, the nurse places her ear and cheek next to the clients mouth and nose to listen and feel for air movement. The chest rising and falling (1) is not conclusive of a patent airway. Observing skin color (2) is not an accurate assessment of respiratory status, nor is checking the femoral pulse. 17. 1. Although crackles often indicate fluid in the alveoli, they may also be related to hypoventilation and will clear after a deep breath or a cough. It is, therefore, premature to impose fluid (2) or activity (4) restrictions (which Margaret would totally do if Dani werent there to smack her). Inspection for edema (3) would be appropriate after reauscultation.