Pneumonia Assessment and Treatment Guidelines

Questions and Answers

Which topic should the nurse plan to include in the teaching plan for a patient with acute bronchitis?

Ways to limit oral fluid intake

Safety concerns with home oxygen therapy

Purpose of antibiotic therapy

Appropriate use of cough suppressants (correct)

Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting?

Providing supportive care to patients diagnosed with pertussis

Teaching patients about the need for adult pertussis immunizations (correct)

Teaching family members about the need for careful hand washing

Encouraging patients to complete the prescribed course of antibiotics

Which action by the new nurse indicates a need for further teaching while caring for a patient with dyspnea caused by a pulmonary fungal infection?

Increasing the oxygen flow rate to keep the oxygen saturation above 90%

Placing the patient on droplet precautions and in a private hospital room (correct)

Monitoring patient serology results to identify the specific infecting organism

Listening to the patient's lung sounds several times during the shift

Which intervention will the nurse include in the plan of care for a patient diagnosed with a lung abscess?

Teach about the need for prolonged antibiotic therapy after discharge from the hospital Signup and view all the answers

Which statement made by the patient after discharge teaching for two fractured ribs indicates that teaching has been effective?

I will use the incentive spirometer every hour or two during the day. Signup and view all the answers

Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP) for a patient with a right-sided chest tube after a right lower lobectomy?

Document the amount of drainage every eight hours Signup and view all the answers

After change-of-shift report, which patient should the nurse assess first?

64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion Signup and view all the answers

Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia?

Blood urea nitrogen (BUN) level Signup and view all the answers

Order the actions the nurse should take for a patient with new onset confusion.

Obtain the oxygen saturation = A Check the patient's pulse rate = B Notify the health care provider = D Document the change in status = C Signup and view all the answers

Following assessment of a patient with pneumonia, which assessment data best supports the nursing diagnosis of ineffective airway clearance?

Weak, nonproductive cough effort Signup and view all the answers

Which finding would the nurse expect when assessing the chest of a patient with pneumococcal pneumonia?

Increased tactile fremitus Signup and view all the answers

What is the nurse's most appropriate action to promote airway clearance for a patient with bacterial pneumonia who has rhonchi and thick sputum?

Assist the patient to splint the chest when coughing. Signup and view all the answers

Which statement, if made by the patient after discharge for pneumonia, indicates a good understanding of the instructions?

I will continue to do the deep breathing and coughing exercises at home. Signup and view all the answers

Which nursing action will be most effective in preventing aspiration in a high-risk patient?

Place patients with altered consciousness in side-lying positions. Signup and view all the answers

Which assessment data indicates that the IV antibiotic treatment for a patient with right lower-lobe pneumonia has been effective?

The patient's white blood cell (WBC) count is 9000/µL. Signup and view all the answers

Which action should the nurse take for a patient who has a positive tuberculosis skin test and is ordered for bacteriologic testing?

Teach about the need to get sputum specimens for 2 to 3 consecutive days. Signup and view all the answers

The nurse should question a health care provider's order to discontinue airborne precautions for a patient with active tuberculosis unless which finding is documented?

Three sputum smears for acid-fast bacilli are negative. Signup and view all the answers

Which statement, if made by the patient about the transmission of pulmonary tuberculosis (TB), indicates that teaching was effective?

My husband will be sleeping in the guest bedroom. Signup and view all the answers

What is the best response by the nurse to a patient taking rifampin (Rifadin) who reports orange-discolored urine and tears?

Explain that orange-discolored urine and tears are normal while taking this medication. Signup and view all the answers

Which finding should the nurse notify the health care provider about for an older patient receiving standard multidrug therapy for tuberculosis (TB)?

Yellow-tinged skin. Signup and view all the answers

Which intervention will be most effective in ensuring adherence to the treatment regimen for an alcoholic and homeless patient diagnosed with active tuberculosis (TB)?

Arrange for a daily noon meal at a community center where the drug will be administered. Signup and view all the answers

After 2 months of tuberculosis treatment, what action should the nurse take if a patient continues to have positive sputum smears for acid-fast bacilli (AFB)?

Ask the patient whether medications have been taken as directed. Signup and view all the answers

An occupational health nurse should plan to teach a staff nurse who has a 16-mm induration TB skin test and negative chest x-ray about which information?

Use and side effects of isoniazid (INH). Signup and view all the answers

Which action performed by a student nurse while caring for a patient hospitalized with active tuberculosis (TB) would require intervention by the nurse?

A surgical face mask is applied before visiting the patient. Signup and view all the answers

Which action, if recommended by the occupational health nurse working at a manufacturing plant with potential inhaled dust exposure, will be most helpful in reducing the incidence of lung disease?

Require the use of protective equipment. Signup and view all the answers

Which information will be most important for the nurse to include when teaching a patient with a 42 pack-year history of cigarette smoking about lung disease?

Options for smoking cessation. Signup and view all the answers

What is the most appropriate response by the nurse to a patient who prefers chemotherapy over scheduled lobectomy for stage I non-small cell lung cancer?

Tell me what you know about the various treatments available. Signup and view all the answers

Which action is best for the nurse to take after a patient who underwent thoracotomy complains of incisional pain and has decreased left-sided breath sounds?

Set up the patient-controlled analgesia (PCA) and administer the loading dose of morphine. Signup and view all the answers

What should the nurse do when a patient with newly diagnosed lung cancer expresses doubts about living until their next birthday?

Can you tell me what it is that makes you think you will die so soon? Signup and view all the answers

The nurse is most concerned if which assessment finding is observed?

400 mL of blood in the collection chamber Signup and view all the answers

A patient experiences a chest wall contusion. The emergency department nurse would be most concerned if which finding is observed?

Paradoxic chest movement Signup and view all the answers

When assessing a patient who has just arrived after an automobile accident, the nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient?

Insertion of a chest tube with a chest drainage system Signup and view all the answers

A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is most appropriate?

Take no further action with the collection device. Signup and view all the answers

The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung. Which information should the nurse include about the patient's postoperative care?

Frequent use of an incentive spirometer Signup and view all the answers

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies?

Observe for distended neck veins. Signup and view all the answers

A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia). Which assessment would best indicate to the nurse that the patient's condition is improving?

Patient reports decreased exertional dyspnea. Signup and view all the answers

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure?

Position the patient sitting upright on the edge of the bed and leaning forward. Signup and view all the answers

The nurse completes discharge teaching for a patient who has had a lung transplant. The nurse evaluates that the teaching has been effective if the patient makes which statement?

I will call the health care provider right away if I develop a fever. Signup and view all the answers

A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first?

Blood cultures from two sites Signup and view all the answers

The nurse cares for a patient who has just had a thoracentesis. Which assessment information obtained by the nurse is a priority to communicate to the health care provider?

Oxygen saturation is 88%. Signup and view all the answers

A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6° F. Which prescribed medication should the nurse give first?

Piperacillin/tazobactam (Zosyn) Signup and view all the answers

A patient is diagnosed with both HIV and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the health care provider?

The patient is being treated with antiretrovirals for HIV infection. Signup and view all the answers

A patient with pneumonia has a fever of 101.4° F, a nonproductive cough, and an oxygen saturation of 88%. Which nursing diagnosis should the nurse assign as the highest priority?

Impaired gas exchange related to respiratory congestion Signup and view all the answers

The nurse supervises UAP providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by UAP is observed?

UAP lower the head of the patient's bed to 15 degrees. Signup and view all the answers

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. Which action should the nurse take first?

Elevate the head of the bed to a semi-Fowler's position. Signup and view all the answers

The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first?

A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath. Signup and view all the answers

The nurse is performing TB skin tests. Which question is most important for the nurse to ask before the skin test?

Have you received the bacille Calmette-Guérin (BCG) vaccine for TB? Signup and view all the answers

A patient is admitted to the emergency department with an open stab wound to the left chest. What is the first action that the nurse should take?

Tape a nonporous dressing on three sides over the chest wound. Signup and view all the answers

The nurse notes that a patient has incisional pain after a thoracotomy. Which action should the nurse take first?

Medicate the patient with prescribed morphine. Signup and view all the answers

The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH) who is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action by the nurse?

The patient's central IV line is disconnected. Signup and view all the answers

A patient who was admitted the previous day with pneumonia complains of sharp pain of 7 (based on 0 to 10 scale) whenever taking a deep breath. Which action will the nurse take next?

Auscultate breath sounds. Signup and view all the answers

Study Notes

Assessment of Pneumonia

Ineffective airway clearance often indicated by weak, nonproductive cough.
Bacterial pneumonia presents with increased tactile fremitus, especially if there's pulmonary consolidation.

Airway Clearance Interventions

Coughing effectively improved by chest splinting during episodes.
Fluid intake encouraged to help thin thick sputum in pneumonia.

Discharge Instructions for Pneumonia

Continue deep breathing and coughing exercises post-discharge.
Follow-up chest X-ray necessary in 6-8 weeks to evaluate resolution.

Aspiration Precautions

Patients with altered consciousness should be positioned side-lying to reduce aspiration risk.

Treatment Effectiveness Indicators

Normal white blood cell count post-antibiotic treatment indicates effectiveness.
Persistent abnormal respiratory symptoms suggest need for treatment reassessment.

Tuberculosis Testing

Sputum specimens for tuberculosis should be collected over 2-3 consecutive days for accurate testing.
Negative sputum smears required before discontinuing airborne precautions for TB patients.

TB Patient Education

Ensure home ventilation and isolate the infected individual to minimize transmission risk.
Orange discoloration of urine and tears normal with rifampin treatment.

Managing TB in High-Risk Patients

Directly observed therapy recommended for patients who may struggle with medication adherence.
Compliance assessment is critical when treatment shows no improvement after 2 months.

Occupational Health and Lung Disease Prevention

Use of protective equipment essential in environments with inhalation hazards to prevent lung disease.

Lung Cancer Awareness

Smoking cessation is the key intervention for patients with a significant smoking history.

Patient Communication and Concerns

Open-ended questions help assess patients' feelings and concerns regarding their diagnosis and treatment options effectively.

Chest Tube Monitoring

Significant blood drainage post-thoracotomy raises concern for potential hypovolemic shock.
Abnormal chest movement may indicate severe respiratory compromise, necessitating immediate evaluation.### Chest Tube Insertion and Management
A right-sided pneumothorax or hemothorax requires intervention with chest tube drainage.
Continuous bubbling in the suction-control chamber indicates proper connection to suction and is expected; it does not suggest an air leak.
Postoperative care for pneumonectomy includes frequent use of an incentive spirometer to prevent atelectasis.

Cor Pulmonale and Right-Sided Heart Failure

Key assessments to evaluate therapy effectiveness include observing for distended neck veins due to right ventricular failure.
Cor pulmonale symptoms include jugular venous distention and peripheral edema, not crackles which are more indicative of left-sided heart failure.

Idiopathic Pulmonary Arterial Hypertension (IPAH) Management

Improvement in exertional dyspnea signifies effective treatment with medications like nifedipine.
Blood pressure and heart rate changes are secondary measures for assessing IPAH therapy.

Thoracentesis Preparation

Position the patient sitting upright and leaning forward to facilitate fluid drainage during thoracentesis.
No sedation is typically required; usually only small volumes of pleural fluid are removed to prevent complications.

Lung Transplant Postoperative Care

Patients should immediately report fever as it may indicate infection or acute rejection.
Regular follow-ups with the transplant team are crucial for monitoring health post-surgery.

Pneumonia Management

Obtain blood cultures from two sites before initiating antibiotic therapy to identify the causative bacteria.
Oxygen saturation of 88% post-thoracentesis is critical and warrants immediate communication with the healthcare provider.

Cough and Pain Management in Pneumonia

First action after thoracentesis is to address pain with medication, as pain can hinder deep breathing and coughing.
Enhanced assessment is necessary in the presence of new or worsening symptoms such as pleuritic pain.

Tuberculosis and HIV Co-Infection

Understanding drug interactions between HIV medications and TB treatments is vital for patient safety.
Patients with a history of the BCG vaccine will yield a positive TB skin test, leading to alternative diagnostic approaches.

Urgency of Nursing Diagnoses

Impaired gas exchange is prioritized in patients with low oxygen saturation levels, indicating a risk of hypoxia.
Interventions for pneumonia patients include ensuring proper positioning to promote ventilation.

Preventing Pertussis Spread

Adult immunizations against pertussis are crucial to reduce community outbreaks.
Hand hygiene is important, but not the most effective method compared to vaccination.

Managing Patients with Lung Abscesses

Long-term antibiotic therapy is often necessary for effective treatment of lung abscesses.
Professional monitoring of respiratory patterns and sputum characteristics is imperative for managing lung conditions.

Fractured Ribs Post-Care

The use of an incentive spirometer hourly or bi-hourly during the day helps prevent atelectasis and pneumonia following rib injuries.
Avoiding rib binders is advisable as they can inhibit effective breathing.### Atelectasis Risks
Use of a rib binder and shallow breathing after thoracic procedures can contribute to the development of atelectasis.
Taking pain medications exclusively at night may inhibit effective deep breathing, increasing the risk of lung complications.

Chest Tube Nursing Actions

Documenting drainage amounts every eight hours can be delegated to unlicensed assistive personnel (UAP).
Obtaining drainage samples for culture and assessing pain levels require the skills of licensed nursing personnel.
Checking the water-seal chamber fluid level is also within the licensed nurse's responsibilities.

Patient Assessment Priorities

A patient with tracheal deviation after a subclavian catheter insertion requires immediate assessment due to the risk of tension pneumothorax, a critical condition.
Other patients, such as those with cor pulmonale, lung transplant fever, or pleural effusion, also need timely assessments but are not in as dire a situation.

CURB-65 Factors

CURB-65 scoring for pneumonia includes considering age, blood pressure, respiratory rate, oxygen saturation, and presence of confusion.
Blood urea nitrogen (BUN) levels also influence the score; elevated BUN indicates potential severity.

Approach to New Onset Confusion

When encountering new confusion in an older patient, assess oxygen saturation first to evaluate respiratory status.
Follow with checking the pulse rate to assess circulation.
Notify the healthcare provider of the change in condition after assessments.
Document all findings and nursing actions performed for proper medical records.

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Description

This quiz evaluates your understanding of pneumonia assessment, airway clearance interventions, and discharge instructions. It includes crucial information on aspiration precautions and treatment effectiveness indicators. Test your knowledge on key aspects of pneumonia management and follow-up care.