Nokea
The nurse has completed discharge teaching for a patient who has had a lung transplant. Which of the following patient statements indicate that the teaching was effective?
- A. I will make an appointment to see the doctor every year.
- B. I will not turn the home oxygen up higher than 2 L/minute.
- C. I will not worry if I feel a little short of breath with exercise.
- D. I will call the health care provider right away if I develop a fever.
Correct Answer: D
Rationale: Low-grade fever may indicate infection or acute rejection, so the patient should notify the health care provider immediately if the temperature is elevated. Patients require frequent follow-up visits with the transplant team, annual health care provider visits would not be sufficient. Home oxygen use is not an expectation after lung transplant. Shortness of breath should be reported.
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After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which of the following actions should the nurse take next?
- A. Ask the patient whether medications have been taken as directed.
- B. Discuss the need to use some different medications to treat the TB
- C. Schedule the patient for directly observed therapy three times weekly.
- D. Educate about using a 2-drug regimen for the last 4 months of treatment.
Correct Answer: A
Rationale: The first action should be to determine whether the patient has been compliant with drug therapy because negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. Depending on whether the patient has been compliant or not, different medications or directly observed therapy may be indicated. A two-drug regimen will be used only if the sputum smears are negative for AFB.
The health care provider inserts a chest tube in a patient with a hemo-pneumothorax. When monitoring the patient after the chest tube placement, which of the following findings is of greatest concern?
- A. A large air leak in the water-seal chamber
- B. 400 mL of blood in the collection chamber
- C. Complaint of pain with each deep inspiration
- D. Subcutaneous emphysema at the insertion site
Correct Answer: B
Rationale: The large amount of blood may indicate that the patient is in danger of developing hypovolemic shock. Drainage greater than 100 mL is to be reported to the health care provider. A large air leak would be expected immediately after chest tube placement for pneumothorax. The pain should be treated but is not as urgent a concern as the possibility of continued hemorrhage. Subcutaneous emphysema should be monitored but is not unusual in a patient with pneumothorax.
The nurse is caring for a patient with right lower-lobe pneumonia who has been treated with intravenous (IV) antibiotics for 2 days. Which of the following assessment data obtained by the nurse indicates that the treatment has been effective?
- A. Bronchial breath sounds are heard at the right base.
- B. The patient coughs up small amounts of green mucus.
- C. The patient's white blood cell (WBC) count is 9 x 10^9/L.
- D. Increased tactile fremitus is palpable over the right chest.
Correct Answer: C
Rationale: The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed.
The health care provider writes a prescription for bacteriological testing for a patient who has a positive tuberculosis skin test. Which of the following actions should the nurse take?
- A. Repeat the tuberculin skin testing.
- B. Teach about the reason for the blood tests.
- C. Obtain consecutive sputum specimens from the patient for 3 days.
- D. Instruct the patient to expectorate three specimens as soon as possible.
Correct Answer: C
Rationale: Three consecutive sputum specimens are obtained on different days for bacteriological 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.
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. Which of the following information should the occupational health nurse provide to the staff nurse?
- A. Use and adverse effects of isoniazid (INH)
- B. Standard four-drug therapy for TB
- C. Need for annual repeat TB skin testing
- D. Bacille Calmette-Guerin (BCG) vaccine
Correct Answer: A
Rationale: The nurse is considered to have a latent TB infection and should be treated with INH daily for 6-9 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 used to prevent TB and is rarely used in Canada, it would not be helpful for this individual, who already has a TB infection.