Situation: A 20 year old client is being treated for pneumonia. he has persistent cough and complained severe pain on coughing.
1. Which of the following organisms most commonly causes community acquired pneumonia in adults?
a) haemophilus influenzae
b) klebsiella pnemoniae
c) streptococcus pneumoniae
d) staphylococcus aureus
2. What type of instruction could be given to help the client reduce the discomfort he is ahving?
a) hold in your cough as much as possible
b) place the head of your bed flat to help with coughing
c) restrict fluids to help decrease the amount of sputum
d) splint your chest wall with pillow for comfort
3. A diagnosis of pneumonia is typically achieved by which of the following diagnostic test?
a) ABG analysis
b) chest x-ray
c) blood cultures
d) nutritional intake
4. The client has been treated with antibiotic therapy for left lower lobe pneumonia for 10 days. Which of the following physical findings would lead the nurse to believe it is appropriate to discharge the client?
a) continued dyspnea
b) temperature of 102 F
c) respiratory rate of 32 bpm
d) vesicular breath sounds in left base
5. A nurse is caring for a client with chest-tube drainage system. The nurse notes constant bubbling in the suction control chamber. Which of the following nursing actions is most appropriate?
a) reposition the client
b) notify the physician
c) this is normal, expected finding and no action is necessary
d) turn off suction machine
6. The nurse determines that influenza vaccine must be given regularly to clients with
a) hypertension
b) diabetes mellitus
c) urinary calculi
d) chronic illness
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ANSWERS AND RATIONALE
1) C
- pneumonia is inflammation of the bronchioles and alveoli that is usually accompanied by increased interstitial or alveolar fluid. Infectious pneumonia is caused by the following microorganisms:
Microorganisms that causes Pneumonia
- Streptococcus pneumoniae - most common cause of community acquied pneumonia
- Mycoplasma pneumoniae and hemophillus influenza - are other causes of community acquired pneumonia
- Pneumocystiis carinii - affects immunocompromised individuals such as those with AIDS
- Staphylococcus aureus, kleibsiella pneumoniae, P. aeruginosa and E. coli are common caused of nosochomial pneumonia.
2) D
- Nursing care for patients with Pneumonia includes:
- pleuritic chest pain may prevent the patient from coughing and performing deep breathing exercises effectively. To minimize the patient's discomfort the nurse can teach the patient to splint the chest wall with pillow during coughing. Pleuritic chest pain is sharp localized chest pain that occurs with breathing and coughing.
- place patient in fowler's or high fowler's position to promote lung expansion and facilitate breathing.
- change position every 2 hours in patient's who have altered level of consciousness to mobilize secretions, preferably placed in side lying to prevent aspiration with the head of the bed raised to 45 degrees.
- activity intolerance may result due to impaired oxygen and carbon dioxide exchange. Schedule patient's activity after treatment and medication. Activity of the patient should be according to tolerance
- chest physiotherapy including percussion, vibration and postural drainage is performed to reduce lung consolidation and prevent atelectasis. These activities help to mobilize secretions.
- suctioning, coughing and deep breathing to clear airways
- provide liberal fluid intake of 2,500 to 3,000 ml a day to help liquefy secretions.
- Chest x-ray - is ordered to determine the extent and pattern of lung tissue involvement. On chest x-ray, areas of pneumonia appear as consolidation. On auscultation, bronchial breath sounds will be heard over consolidated areas. Presence of fluids, atelectasis and infiltrates will also be seen with x-ray.
- Sputum culture and sensitivity - not blood culture, is ordered for pneumonia to identify the infecting microorganism and determine which antibiotic would be most effective in destroying the pathogenic agent.
- ABG analysis - is ordered to assess the patient's gas exchange as areas of consolidated tissue will not be able to exchange carbon dioxide and oxygen properly with blood which could result in impaired gas exchange. The ABG is abnormal is arterial oxygen tension (PO2) is less than 80mmHg. This indicates the need to place patient under oxygen therapy.
- the major diagnostic tests used to identify the extent of the lung tissue affected by pneumonia is chest x-ray and to identify the causitive agent is sputum culture and microscopy.
4) D
- Common Manifestation of pneumonia includes fever, headache, chills, sweating, pleuritic chest pain, cough, sputum production, dyspnea, muscle pain and fatigue. On auscultation limited breath sounds crackles or rales maybe heard over the affected part of the lungs. Pleural friction rub may also be heard.
Type of Pneumonia and its Manifestations:
1. Pneumococcal pneumonia
- sudden onset of chills
- fever
- stabbing pleuritic chest pain
- dyspnea
- tachypnea
- high WBC
- consolidation on chest x-ray
- productive cough - rusty brown or blood streaked purulent sputum turns yellow and mucoid
- gradual onset with cough
- scattered crackles
- minimal dyspnea
- low grade fever
- patchy areas of consolidation on chest x-ray
- gradual onset with chills
- fever
- body malaise
- headache
- confusion
- lack of appetite
- diarrhea
- muscle and joint pain
- dyspnea
- elevated WBC
- dry cough -scant mucoid or blood tinged sputum
- sudden onset with fever
- multiple chills
- pleuritic pain
- dyspnea
- rales
- decreased breath sounds
- chest x-ray may show patcht infiltrates
- empyema
- abscesses and pneumothorax
- elevated WBC
- productive cough - purulent golden yellow or blood streaked sputum
- sudden or gradual onset with flulike symptoms
- fever
- muscle aches
- normal to slightly elevated WBC
- dyspnea
- breath sounds maybe normal or with occasional wheezing and crackles
- dry cough - with scant mucoid that turns to purulent sputum
- abrupt onset with tachypnea
- shortness of breath
- fever
- respiratory distress
- dry cough
- Rationale: constant bubbling in the suction control bottle is normal. It indicates proper functioning of the apparatus
6) D
- Rationale: clients with chronic illness have low resistance to infection. Therefore, they should receive influenza vaccine yearly
Related Topics:
- Online Nursing Practice Test about Respiratory Diseases (7-10)
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- Online Nursing Classes: NCLEX Practice Test Downloads
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