Nokea
Which of the following actions by the occupational health nurse at a manufacturing plant where there is potential exposure to inhaled dust is most helpful in reducing incidence of lung disease?
- A. Teach about symptoms of lung disease.
- B. Treat workers who inhale dust particles
- C. Monitor workers for shortness of breath
- D. Require the use of protective equipment
Correct Answer: D
Rationale: Prevention of lung disease requires the use of appropriate protective equipment such as masks. The other actions will help in recognition or early treatment of lung disease, but will not be effective in prevention of lung damage.
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Which of the following information about a patient who has a recent history of tuberculosis (TB) indicates that the nurse can discontinue airborne isolation precautions?
- A. Chest x-ray shows no upper lobe infiltrates.
- B. TB medications have been taken for 6 months.
- C. Mantoux testing shows an induration of 10 mm.
- D. Three sputum smears for acid-fast bacilli are negative.
Correct Answer: D
Rationale: 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.
The nurse is performing tuberculosis (TB) screening in a clinic that has many patients who have immigrated to Canada. Before doing a TB skin test on a patient, which of the following questions is most important for the nurse to ask?
- A. Is there any family history of TB?
- B. Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?
- C. How long have you lived in the Canada?
- D. Do you take any over-the-counter (OTC) medications?
Correct Answer: B
Rationale: Patients who have received the BCG vaccine will have a positive Mantoux test. Another method for screening (such as a chest x-ray) will need to be used in determining whether the patient has a TB infection. The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing.
The nurse is caring for patients with active tuberculosis (TB) who misuse alcohol and/or are homeless. Which of the following interventions by the nurse will be most effective in ensuring adherence with the treatment regimen?
- A. Educating the patient about the long-term impact of TB on health
- B. Giving the patient written instructions about how to take the medications
- C. Teaching the patient about the high risk for infecting others unless treatment is followed
- D. Arranging for a daily noontime meal at a community centre and giving the medication then
Correct Answer: D
Rationale: 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.
To determine the effectiveness of prescribed therapies for a patient with cor pulmonale and right-sided heart failure, which of the following assessments should the nurse make?
- A. Lung sounds
- B. Heart sounds
- C. Blood pressure
- D. Peripheral edema
Correct Answer: D
Rationale: Cor pulmonale is right ventricular failure caused by pulmonary hypertension, so clinical manifestations of right ventricular failure such as peripheral edema, jugular vein distension, and right upper-quadrant abdominal tenderness would be expected. Abnormalities in lung sounds, blood pressure, or heart sounds are not caused by cor pulmonale.
After the nurse has received change-of-shift report about the following four patients, which patient should be assessed first?
- A. A 7-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes
- B. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled
- C. A 46-year-old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath
- D. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 37.9 C (100.2 F)
Correct Answer: C
Rationale: Sudden onset shortness of breath in a patient with a deep vein thrombosis suggests a pulmonary embolism and requires immediate assessment and actions such as oxygen administration. The other patients also should be assessed as soon as possible, but there is no indication that they may need immediate action to prevent clinical deterioration.