PNEUMONIA and Tubercolosis

1. is an inflammation of the lung parenchyma cause by various microorganisms

- Pneumonia
2. a more general term that describes an inflammatory process in the lung tissue that may predispose or place the
patient at risk for microbial invasion.
- Pneumonitis
3. a more general term that describes an inflammatory process in the ung tissue that may predispose or place the
patient at risk for microbial invasion.
- Pneumococcus
4. Which system effect of pneumonia should the nurse monitor?
- Cyanosis
5. A client who is significantly immunocompromised is diagnosed with Pneumocystis jiroveci. The client states to
the nurse, "Every time I leave my house, I have worn a mask, so that I would not get sick. How did I get this?"
Which response by the nurse represents an understanding of the pathogen responsible for the diagnosis?
- "This organism could have been brought into your home by a visitor."
6. The nurse is caring for a client thought to have lobar pneumonia. Which color does the nurse anticipate the
sputum to be when obtaining a sputum sample?
- Rust-colored
7. The nurse is caring for a client diagnosed with bronchopneumonia and experiencing apnea. Which condition
should the nurse recognize as the cause of apnea?
- Respiratory muscle fatigue
8. The nurse is conducting a teaching session for new parents on the causes of viral pneumonia. Which cause
should the nurse include in the teaching? (Select all that apply.)
- Adenovirus
- Norovirus
- Cytomegalovirus (CMV)
9. A 73 y.o. female pt who lives alone is admitted to the hospital w/ dx of pneumococcal pneumonia. Which clinical
manifestation, if observed by the RN, indicates that the pt is likely to by hypoxic?
- Sudden onset of confusion
(Confusion or stupor may be the only clinical manifestation of pneumonia in an older pt.)
10. The RN cares for a 50 y.o. pt w/ pneumonia that has been unresponsive to two different antibiotics. Which task
is most important for the nurse to complete before administering a newly prescribed antibiotic?
- Obtain a sputum specimen for culture and Gram stain.
(To identify the organism.)
11. The nurse is providing a 68-year-old client with health promotion activities. Which vaccine will the nurse
recommend for the prevention of bacterial pneumonia?
- Pneumococcal vaccine
12. The nurse is caring for a pregnant woman new to the clinic. Which question will uncover whether the client has
the highest risk for developing pneumonia?
- "Does anyone smoke in the house?"
13. The nurse is preparing discharge instructions for the parents of a young child recovering from pneumonia.
Which information should the nurse provide to help prevent the reoccurrence of the disease?
- "Complete all prescribed medications."
14. The nurse caring for a client with pneumonia reviews the medical administration record and order sheet. Which
agent should the nurse expect to administer? (Select all that apply.
- Oxygen
- Mucolytic agent
 - Broad-spectrum antibiotic
15. The nurse in the emergency department is caring for a client with a temperature of 39°C (102.5°F), productive
cough, chills, shortness of breath, and malaise. Which diagnostic test should the nurse expect to prepare the
client for? (Select all that apply.)
- Chest x-ray
- Sputum culture and sensitivity
- Arterial blood gases
16. The nurse informs a client with pneumonia that a respiratory therapist is scheduled to perform chest
physiotherapy. The client asks, "What does that mean?" Which response by the nurse is best?
- "Chest physiotherapy will help move the liquid out of your lungs."
17. A client with pneumonia is prescribed 100% oxygen. Which type of oxygen delivery device should the nurse use?
- Nonrebreather mask
18. The nurse is caring for a client diagnosed with pneumonia resulting from Staphylococcus aureus. Which
classification of medication should the nurse anticipate the healthcare provider will order to eradicate the
infection?
- Cephalosporin
19. To promote airway clearance in a pt with pneumonia, what should the nurse instruct the pt to do? Select all that
apply.
- Maintain adequate fluid intake.
- Splint the chest when coughing
- Instruct pt to cough at end of exhalation
(Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The RN should
instruct pt to splint the chest while coughing. This will reduce discomfort and allow for more effective
coughing. Coughing at end of exhalation promotes efficient cough.Pt position should be upright sitting
with head slightly flexed.)
20. Which instruction should the nurse provide to a client who has pneumonia and is being discharged for home
care? (Select all that apply.)
- "Maintain adequate fluid intake."
- "Avoid smoking or exposure to secondhand smoke."
- "Limit activities and increase rest."
21. The nurse is planning the interventions for a client diagnosed with pneumococcal pneumonia. Which
intervention should provide the most improvement in the client's ventilation?
- Providing adequate pain relief
22. The nurse is caring for a client with pneumonia-related atelectasis. Which action would be most appropriate for
the nurse to implement to improve oxygen saturation?
- Instructing the client how to use the incentive spirometer
23. The nurse is evaluating the goals for a client with atypical pneumonia. Which finding indicates that an outcome
has been successfully met?
- The client has obtained uninterrupted sleep through the night.
24. Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway
clearance. Which information best supports this diagnosis?
- Weak, nonproductive cough effort
(The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The
other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing
pattern.)
25. During assessment of the chest in a patient with pneumococcal pneumonia, the nurse would expect to find
- increased tactile fremitus.
 (Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial
pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents
with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical.)
26. A patient with bacterial pneumonia has rhonchi and thick sputum. Which action will the nurse use to promote
airway clearance?
- Assist the patient to splint the chest when coughing.
(Coughing is less painful and more likely to be effective when the patient splints the chest during
coughing. Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas
exchange, but will not improve airway clearance. Pursed lip breathing is used to improve gas exchange
in patients with COPD, but will not improve airway clearance.)
27. Which statement by a patient who has been hospitalized for pneumonia indicates a good understanding of the
discharge instructions given by the nurse?
- "I will continue to do the deep breathing and coughing exercises at home."
(Patients should continue to cough and deep breathe after discharge. Fatigue for several weeks is
expected. Home oxygen therapy is not needed with successful treatment of pneumonia. The
pneumovax and influenza vaccines can be given at the same time.)
28. Which nursing action will be most effective in preventing aspiration pneumonia in patients who are at risk?
- Place patients with altered consciousness in side-lying positions.
29. A patient was admitted to the intensive care unit 48 hours ago for treatment of a gunshot wound. The patient
has recently developed a productive cough and a fever of 104.3 'F. The patient is breathing on their own and
doesn't require mechanical ventilation. On assessment, you note coarse crackles in the right lower lobe. A chest
x-ray shows infiltrates with consolidation in the right lower lobe. Based on this specific patient scenario, this is
known as what type of pneumonia?
- Hospital-acquired pneumonia
30. Which of the following patients are MOST at risk for developing pneumonia? Select-all-that-apply:
- A 42 year old male with COPD and is on continuous oxygen via nasal cannula.
- A 53 year old female recovering from abdominal surgery.
- A 8 month old with RSV (respiratory syncytial virus) infection.
31. Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:
- Coarse crackles
- Oxygen saturation less than 90%
- Elevated white blood cells
- Tachypnea
32. You're educating a patient with pneumonia on how to deep breathe by using an incentive spirometer. Which of
the following is the correct way to use this device?
- The patient inhales slowly from the device until no longer able, and then holds breath for 6 seconds and
exhales.
33. A patient is admitted with pneumonia. Sputum cultures show that the patient is infected with a gram positive
bacterium. The patient is allergic to Penicillin. Which medication would the patient most likely be prescribed?
- Macrolide
34. You are about to hang a bag of intravenous Vancomycin for a patient who has severe pneumonia. Which
statement by the patient causes you to hold the bag of Vancomycin and notify the doctor immediately?
- "I have this constant ringing in my ears."
(Vancomycin can cause ototoxicity. Roaring or ringing in the ears are a possible sign/symptom of this
adverse effect)
35. A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place the patient in
___________________ precautions and will always wear _____________________ when providing patient
care?
- airborne, respirator
36. Which statement is correct regarding mycobacterium tuberculosis?*
- It is known as being an aerobic type of bacteria.
37. You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a
possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and
tested for the disease. Select all the risk factors below that increases a patient's risk for developing
tuberculosis:*
- Long-term care resident
- Inmate
- IV drug user
- HIV
38. A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a
U.S. resident but grew-up in a foreign country. She reports that as a child she received the BCG vaccine (bacille
Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order
clarification?*
- PPD (Mantoux test)
39. You're teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What
signs and symptoms will you include in your education?*
- Night sweats
- Hemoptysis
- Chills
- Fever
- Chest pain
40. A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that:*
- The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is
provided.
41. A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the
clinic to have his PPD skin test assessed. What is considered a positive result?*
- 10 mm induration
42. The physician orders an acid-fast bacilli sputum culture smear on a patient with possible tuberculosis. How will
you collect this?*
- Collect 3 different sputum specimens on 3 different days
43. The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis
skin test. Which action will the nurse take?
- Obtain consecutive sputum specimens from the patient for 3 days.
(Three consecutive sputum specimens are obtained on different days for bacteriologic testing for M.
tuberculosis. The patient should not provide all the specimens at once. Blood cultures are not used for
tuberculosis testing. Once skin testing is positive, it is not repeated.)
44. Which information about a patient who has a recent history of tuberculosis (TB) indicates that the nurse can
discontinue airborne isolation precautions?
- Three sputum smears for acid-fast bacilli are negative.
(Negative sputum smears indicate that M. tuberculosis is not present in the sputum, and the patient
cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether
treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-
resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux
testing would not be done since it will not change even with effective treatment.)
45. The nurse recognizes that the goals of teaching regarding the transmission of pulmonary tuberculosis (TB) have
been met when the patient with TB
- covers the mouth and nose when coughing.
 (Covering the mouth and nose will help decrease airborne transmission of TB. The other actions will not
be effective in decreasing the spread of TB.)
46. Which information will the nurse include in the patient teaching plan for a patient who is receiving rifampin
(Rifadin) for treatment of tuberculosis?
- "Your urine, sweat, and tears will be orange colored."
(Orange-colored body secretions are a side effect of rifampin. The other adverse effects are associated
with other antituberculosis medications.)
47. When teaching the patient who is receiving standard multidrug therapy for tuberculosis (TB) about possible
toxic effects of the antitubercular medications, the nurse will give instructions to notify the health care provider
if the patient develops.
- yellow-tinged skin.
(Noninfectious hepatitis is a toxic effect of isoniazid (INH), rifampin, and pyrazinamide, and patients who
develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are
not expected with the four medications used for initial TB drug therapy. Orange discoloration of body
fluids is an expected side effect of rifampin and not an indication to call the health care provider.)
48. An alcoholic and homeless patient is diagnosed with active tuberculosis (TB). Which intervention by the nurse
will be most effective in ensuring adherence with the treatment regimen?
- Arranging for a daily noontime meal at a community center and giving the medication then
(Directly observed therapy is the most effective means for ensuring compliance with the treatment
regimen, and arranging a daily meal will help to ensure that the patient is available to receive the
medication. The other nursing interventions may be appropriate for some patients, but are not likely to
be as helpful with this patient.)
49. A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse
has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the
- use and side effects of isoniazid (INH).
(The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9
months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not
done for individuals who have already had a positive skin test. BCG vaccine is not used in the United
States and would not be helpful for this individual, who already has a TB infection.)
50. When caring for a patient who is hospitalized with active tuberculosis (TB), the nurse observes a family member
who is visiting the patient. The nurse will need to intervene if the family member
- puts on a surgical face mask before visiting the patient.

(A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be
used when entering the patient's room because the HEPA mask can filter out 100% of small airborne
particles.)
51.