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A client has been admitted for suspected inhalation anthrax infection. What question by the nurse is most important?
- A. Are any family members also ill?
- B. Have you traveled recently?
- C. How long have you been ill?
- D. What is your occupation?
Correct Answer: D
Rationale: Inhalation anthrax is rare and is an occupational hazard among people who work with animal wool, bone meal, hides, and such, such as tanners and veterinarians. Inhalation anthrax in someone without an occupational risk is considered a bioterrorism event and must be reported to authorities immediately.
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A client is in the family practice clinic reporting a severe cough that has lasted for 5 weeks. The client is so exhausted after coughing that work has become impossible. What action by the nurse is most appropriate?
- A. Arrange for immediate hospitalization.
- B. Facilitate polymerase chain reaction testing.
- C. Have the client produce a sputum sample.
- D. Obtain two sets of blood cultures.
Correct Answer: B
Rationale: Polymerase chain reaction testing is used to diagnose pertussis, which this client is showing manifestations of. This is the most appropriate action to confirm the diagnosis.
The emergency department (ED) manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia. What outcome demonstrates that goals for this client type have been met?
- A. Antibiotics started before admission.
- B. Blood cultures obtained within 20 minutes.
- C. Chest x-ray was obtained within 30 minutes.
- D. Pulse oximetry obtained on all clients.
Correct Answer: A
Rationale: Goals for treatment of community-acquired pneumonia include initiating antibiotics prior to inpatient admission or within 6 hours of presentation to the ED. This is a key indicator of effective treatment.
A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately?
- A. Albumin: 5.1 g/dL.
- B. Alanine aminotransferase (ALT): 180 U/L.
- C. Red blood cell (RBC) count: 5.2 million/mm³.
- D. White blood cell (WBC) count: 12,500/mm³.
Correct Answer: B
Rationale: INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of the liver enzymes) is extremely high and needs to be reported immediately, as it indicates potential liver toxicity.
A client seen in the emergency department reports fever, fatigue, and dry cough but no other upper respiratory symptoms. A chest x-ray reveals mediastinal widening. What action by the nurse is best?
- A. Collect a sputum sample for culture by deep suctioning.
- B. Instruct the client that antibiotics will be needed for 60 days.
- C. Place the client on Airborne Precautions immediately.
- D. Tell the client that directly observed therapy is needed.
Correct Answer: B
Rationale: This client has manifestations of early inhalation anthrax. For treatment, after IV antibiotics are finished, oral antibiotics are continued for at least 60 days, making this the best action.
A nurse has educated a client on isoniazid (INH). What statement by the client indicates teaching has been effective?
- A. I need to take extra vitamin C while on INH.
- B. I should take this medicine with milk or juice.
- C. I should take this medication on an empty stomach.
- D. My contact lenses will be permanently stained.
Correct Answer: C
Rationale: INH needs to be taken on an empty stomach, either 1 hour before or 2 hours after meals. This statement indicates the client understands the correct administration of the medication.