Nokea
The nurse is caring for a patient who has just been admitted with pneumococcal pneumonia has a temperature of 38.7 C (101.7 F) with a frequent cough and symptoms of severe pleuritic chest pain. Which of the following prescribed medications should the nurse give first?
- A. Guaifenesin
- B. Acetaminophen
- C. Azithromycin
- D. Codeine phosphate
Correct Answer: C
Rationale: Early initiation of antibiotic therapy has been demonstrated to reduce mortality. The other medications also are appropriate and should be given as soon as possible, but the priority is to start antibiotic therapy.
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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.
The nurse is caring for a patient with bacterial pneumonia who has pleurisy. Which of the following actions should the nurse implement to promote airway clearance?
- A. Assist the patient to splint the chest when coughing.
- B. Educate the patient about the need for fluid restrictions.
- C. Encourage the patient to wear the nasal oxygen cannula.
- D. Instruct the patient on the pursed lip breathing technique.
Correct Answer: A
Rationale: 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.
The nurse is caring for a patient with pneumonia who has symptoms of a sharp pain 'whenever I take a deep breath.' Which of the following actions should the nurse take next?
- A. Listen to the patient's lungs.
- B. Administer the PRN morphine.
- C. Have the patient cough forcefully.
- D. Notify the patient's health care provider.
Correct Answer: A
Rationale: The patient's statement indicates that pleurisy or a pleural effusion may have developed and the nurse will need to listen for a pleural friction rub or decreased breath sounds. Assessment should occur before administration of pain medications. The patient is unlikely to be able to cough forcefully until pain medication has been administered. The nurse will want to obtain more assessment data before calling the health care provider.
The nurse is caring for a patient with primary pulmonary hypertension (PPH) who is receiving nifedipine. Which of the following findings indicate that the treatment is effective?
- A. BP is less than 140/90 mm Hg
- B. Patient reports decreased exertional dyspnea.
- C. Heart rate is between 60 and 100 beats/minute.
- D. Patient's chest x-ray indicates clear lung fields.
Correct Answer: B
Rationale: Since a major symptom of PPH is exertional dyspnea, an improvement in this symptom would indicate that the medication was effective. Nifedipine will affect BP and heart rate, but these parameters would not be used to monitor effectiveness of therapy for a patient with PPH. The chest x-ray will show clear lung fields even if the therapy is not effective.
The nurse is teaching a patient who is receiving standard multidrug therapy for tuberculosis (TB) about possible toxic effects of the antitubercular medications. Which of the following findings should the nurse instruct the patient to report to the health care provider?
- A. Yellow-tinged skin
- B. Changes in hearing
- C. Orange-coloured sputum
- D. Thickening of the fingernails
Correct Answer: A
Rationale: 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 adverse effect of rifampin and not an indication to call the health care provider.