Nokea
Which of the following prescriptions should the nurse implement first for a patient who has just been admitted with probable bacterial pneumonia and sepsis?
- A. Administer Aspirin suppository.
- B. Send to radiology for chest x-ray.
- C. Give ciprofloxacin 400 mg IV.
- D. Obtain blood cultures from two sites.
Correct Answer: D
Rationale: Initiating antibiotic therapy rapidly is essential, but it is important that the cultures be obtained before antibiotic administration. The chest radiograph and Aspirin administration can be done last.
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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.
The nurse is caring for a patient who is hospitalized with active tuberculosis (TB) and the nurse observes a family member who is visiting the patient. Which of the following actions by the visitor should cause the nurse to intervene?
- A. Washes hands before entering the patient's room
- B. Hands the patient a tissue from the box at the bedside
- C. Puts on a surgical face mask before visiting the patient
- D. Brings food from a 'fast-food' restaurant to the patient
Correct Answer: C
Rationale: An N95 mask, rather than a standard surgical mask, should be used when entering the patient's room because the HEPA mask can filter out 100% of small airborne particles. Handwashing before visiting the patient is not necessary, but there is no reason for the nurse to stop the family member from doing this. Because anorexia and weight loss are frequent problems in patients with TB, bringing food from outside the hospital is appropriate. The family member should wash the hands after handling a tissue that the patient has used, but no precautions are necessary when giving the patient an unused tissue.
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 stage I non-small cell lung cancer who is scheduled for a lobectomy. The patient tells the nurse, 'I would rather have radiation than surgery.' Which of the following responses by the nurse is best?
- A. Are you afraid that the surgery will be very painful?
- B. Did you have bad experiences with previous surgeries?
- C. Surgery is the treatment of choice for stage I lung cancer.
- D. Tell me what you know about the various treatments available.
Correct Answer: D
Rationale: More assessment of the patient's concerns about surgery is indicated. An open-ended response will elicit the most information from the patient. The answer beginning, 'Surgery is the treatment of choice' is accurate, but it discourages the patient from sharing concerns about surgery. The remaining two answers indicate that the nurse has jumped to conclusions about the patient's reasons for not wanting surgery.
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.