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The Client with Pneumonia
32. A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia?
1. Age.
The client's age is a predisposing factor for pneumonia; pneumonia is more common in elderly or debilitated clients.
Other predisposing factors include smoking, upper respiratory tract infections, malnutrition, immunosuppression, and the presence of a chronic illness.
2. Osteoarthritis.
3. Vegetarian diet.
4. Daily bathing.
Osteoarthritis, a nutritionally sound vegetarian diet, and frequent bathing are not predisposing factors for pneumonia.
33. 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.
5. Color of nail beds.
A respiratory assessment, which includes auscultating breath sounds
and assessing the color of the nail beds, is a priority for clients with pneumonia.
3. Presence of chest pain.
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.
2. Auscultation of bowel sounds.
4. Presence of peripheral edema.
Auscultating bowel sounds and assessing for peripheral edema
may be appropriate assessments,
but these are not priority assessments for the patient with pneumonia.
34. A client with bacterial pneumonia is to be started on intravenous antibiotics.
Which of the following diagnostic tests must be completed before antibiotic therapy begins?
2. Sputum culture.
A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibiotic can be prescribed. Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test.
1. Urinalysis.
3. Chest radiograph.
4. Red blood cell count.
Neither a urinalysis, a chest radiograph, nor a red blood cell count needs to be obtained before initiation of antibiotic therapy for pneumonia.
35. When caring for the client who is receiving an amino glycoside antibiotic, the nurse monitors which of the following laboratory values?
1. Serum sodium.
2. Serum potassium.
4. Serum calcium.
Aminoglycoside antibiotics
do not affect serum sodium, potassium, or calcium levels.
3. Serum creatinine.
It is essential to monitor serum creatinine in the client receiving an amino glycoside antibiotic because of the potential of these drugs to cause acute tubular necrosis.
36. 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 every 4 hours.
Position changes need to be done every 2 hours.
2. Nasotracheal suctioning to clear secretions.
Nasotracheal suctioning is not indicated with the client's productive cough.
3. Frequent linen changes.
Frequent linen changes are appropriate for this client
because of the diaphoresis. Diaphoresis produces general discomfort.
The client should be kept dry to promote comfort.
4. Frequent offering of a bedpan.
Frequent offering of a bedpan is not indicated by the data provided in this scenario.
37. Bed rest is prescribed for a client with pneumonia during the acute phase of the illness. Bed rest serves which of the following purposes?
1. It reduces the cellular demand for oxygen.
Exudate in the alveoli interferes with ventilation and the diffusion of gases in clients with pneumonia. During the acute phase of the illness, it is essential to reduce the body's need for oxygen at the cellular level; bed rest is the most effective method for doing so.
2. It decreases the episodes of coughing.
Bed rest does not decrease coughing or promote clearance of secretions,
3. It promotes safety.
it does not necessarily provide a safe environment.
4. It promotes clearance of secretions.
38. The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
1. Decreased cardiac output.
Decreased cardiac output may be a comorbid condition in some clients with pneumonia; however, it is not the cause of cyanosis.
2. Pleural effusion.
Pleural effusions are a potential complication of pneumonia
but are not the primary cause of decreased oxygenation.
3. Inadequate peripheral circulation.
Inadequate peripheral circulation is also not the cause of the cyanosis
that develops with bacterial pneumonia.
4. Decreased oxygenation of the blood.
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.
39. A client with pneumonia is experiencing pleuritic chest pain.
Which of the following describes pleuritic chest pain?
1. A mild but constant aching in the chest.
Pleuritic chest pain is usually described as sharp, not mild or aching.
2. Severe midsternal pain.
Pleuritic chest pain is not localized to the sternum
3. Moderate pain that worsens on inspiration.
Chest pain in pneumonia is generally caused by friction between the pleural layers. It is more severe on inspiration than on expiration, secondary to chest wall movement.
4. Muscle spasm pain that accompanies coughing.
It is not the result of a muscle spasm.
40. Which of the following measures would most likely be successful in reducing pleuritic chest pain in a client with pneumonia?
1. Encourage the client to breathe shallowly.
Deep breathing is essential to prevent further atelectasis.
2. Have the client practice abdominal breathing.
Abdominal breathing is not as effective in decreasing pleuritic chest pain
as is splinting of the rib cage.
3. Offer the client incentive spirometry.
Incentive spirometry facilitates effective deep breathing
but does not decrease pleuritic chest pain.
4. Teach the client to splint the rib cage when coughing.
The pleuritic pain is triggered by chest movement
and is particularly severe during coughing.
Splinting the chest wall will help reduce the discomfort of coughing.
41. Aspirin is administered to clients with pneumonia because of its antipyretic and
1. analgesic effects.
Aspirin is administered to clients with pneumonia because it is an analgesic that helps control chest discomfort and an antipyretic that helps reduce fever.
It is also an anti-inflammatory agent that reduces inflammation.
2. anticoagulant effects.
Aspirin has an anticoagulant effect,
but that is not the reason for prescribing it for a client with pneumonia.
3. adrenergic effects.
4. antihistamine effects.
Aspirin does not have adrenergic or antihistamine effects,
and drugs with adrenergic or antihistamine effects
are not used for the treatment of pneumonia.
42. Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
3. Irritability.
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.
1. Coma.
Coma is a late clinical manifestation of hypoxia.
2. Apathy.
4. Depression.
Apathy and depression are not symptoms of hypoxia.
43. The client with pneumonia develops mild constipation, and the nurse administers docusate sodium (Colace) as ordered. This drug works by
1. softening the stool.
Docusate sodium is a stool softener that allows fluid and fatty substances
to enter the stool and soften it
2. lubricating the stool.
3. increasing stool bulk.
4. stimulating peristalsis.
It does not lubricate the stool, increase stool bulk, or stimulate peristalsis.
44. A client with pneumonia has a temperature ranging between 101 ° and 102°F (38.3° and 38.50C) and periods of diaphoresis. Based on this information, which of the following nursing interventions would be a priority?
1. Maintain complete bed rest.
Although clients with pneumonia may be prescribed bed rest,
complete bed rest is not necessary solely because of the elevated temperature.
2. Administer oxygen therapy.
Administration of oxygen therapy also
is not indicated for the purposes of treating the fever.
3. Provide frequent linen changes.
Frequent linen changes are an appropriate intervention,
but it is not of the highest priority among the options given.
4. Provide fluid intake of 3 L/ day.
A fluid intake of at least 3 L/day should be provided to replace any fluid loss occurring as a result of the fever and diaphoresis; this is a high-priority intervention.
45. 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/minute.
It indicates the client is experiencing tachypnea,
which would not be expected on recovery.
2. The ability to perform activities of daily living without dyspnea.
An expected outcome for a client recovering from pneumonia would be the ability to perform activities of daily living without experiencing dyspnea.
3. A maximum loss of 5 to 10 pounds of body weight.
A weight loss of 5 to 10 pounds is undesirable;
the expected outcome would be to maintain normal weight.
4. Chest pain that is minimized by splinting the ribcage.
A client who is recovering from pneumonia
should experience decreased or no chest pain.
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