Nokea
Which statement made by the client indicates the nurse's discharge teaching is effective for the client diagnosed with COPD?
- A. I need to get an influenza vaccine each year, even when there is a shortage.
- B. I need to get a vaccine for pneumonia each year with my influenza shot.
- C. If I reduce my cigarettes to six (6) a day, I won't have difficulty breathing.
- D. I need to restrict my drinking liquids to keep from having so much phlegm.
Correct Answer: A
Rationale: Annual flu vaccines (A) reduce COPD exacerbation risk, even in shortages. Pneumonia vaccines (B) are not yearly, smoking reduction (C) is insufficient, and fluid restriction (D) is incorrect.
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A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that:
- A. The patient will need to immediately be placed in droplet precautions and started on a medication regime.
- B. The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is provided.
- C. The patient will need an IGRA test to help differentiate between a latent tuberculosis infection versus an active tuberculosis infection.
- D. The patient will need to repeat the skin test in 48-72 hours to confirm the results.
Correct Answer: B
Rationale: A positive PPD result does NOT necessarily mean the patient has an active infection of TB. The patient will need a chest x-ray and sputum culture to determine if mycobacterium tuberculosis is present and then treatment will be based on those results. The IGRA test does NOT differentiate between LTBI or an active TB infection. Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB.
A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication?
- A. The patient should use the medications every 2 hours for acute episodes of shortness of breath.
- B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort.
- C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later.
- D. The patient should use the medications at the same exact time, regardless of the order.
Correct Answer: B
Rationale: Spiriva (anticholinergic) should be used first to open airways, followed by Pulmicort (corticosteroid) 5 minutes later to reduce inflammation. Every 2 hours is incorrect for maintenance drugs, and order matters (C, D).
An adult is being treated with isoniazid (INH) and streptomycin for active tuberculosis. He is also receiving pyridoxine (vitamin B6). Why is this medication prescribed for him?
- A. Pyridoxine is bacteriostatic against Mycobacterium tuberculosis.
- B. To enhance his general nutritional status
- C. To prevent side effects of INH
- D. Pyridoxine acts to increase the effects of streptomycin.
Correct Answer: C
Rationale: Pyridoxine is prescribed to prevent INH-induced peripheral neuritis by supporting nerve function.
A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification?
- A. PPD (Mantoux test)
- B. Chest X-ray
- C. QuantiFERON-TB Gold (QFT)
- D. Sputum culture
Correct Answer: A
Rationale: The BCG vaccine can cause false-positive PPD (Mantoux) test results, making it unreliable in patients with a BCG history. The nurse should clarify this order, as an IGRA test (e.g., QuantiFERON-TB Gold) or other diagnostics are preferred.
The client diagnosed with a pulmonary embolus is in the intensive care department. Which assessment data warrant immediate intervention from the nurse?
- A. The client's ABGs are pH 7.36, Pao2 95, Paco2 38, Hco3 24.
- B. The client's telemetry exhibits occasional premature ventricular contractions (PVCs).
- C. The client's pulse oximeter reading is 90%.
- D. The client's urinary output for the 12-hour shift is 800 mL.
Correct Answer: C
Rationale: SpO2 90% (C) indicates hypoxia in PE, requiring immediate oxygen adjustment. Normal ABGs (A), occasional PVCs (B), and urine output (D) are less urgent.