Chapter 30 - Respiratory Tract Infections, Neoplasms, and Childhood Disorders Question Bank

As part of a public health initiative, a nurse is teaching a group of older adults about ways to promote and maintain their health. Recognizing that the common cold is a frequent source of ailment, the nurse is addressing this health problem. Which of the following teaching points about the common cold is most accurate?

A) "You shouldn't be taking antibiotics for a cold until your doctor has confirmed exactly which bug is causing your cold."

B) "It's important to both cover your mouth when you cough or sneeze and encourage others to do so, since most colds are spread by inhaling the germs."

C) "Scientists don't yet know exactly what virus causes the cold, and there is not likely to be a vaccine until this is known."

D) "Use caution when choosing over-the-counter drugs for your cold; most people do best with rest and antifever medications."

D

Feedback: The efficacy of over-the-counter cold remedies is minimal, and all have a risk of unwanted side effects; rest and antipyretics are normally sufficient since cold viruses are normally self-limiting. No cold-causing virus will respond to antibiotics, and most colds are spread by the fingers. There is no one specific virus that causes the common cold, and numerous different viruses cause similar symptoms.

Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?

A) A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F

B) A woman presenting with malaise, lethargy, and copious nasal secretions

C) A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F

D) A woman complaining of generalized aches and who has a hoarse voice and reddened, painful upper airways

A

Feedback: Fever and facial pain are more commonly associated with rhinosinusitis rather than the common cold. The other noted symptoms are indicative of the common cold rather than rhinosinusitis

A child with rhinosinusitis should be monitored for complications. Which of the following assessment findings would alert the nurse that a complication is developing?

A) Purulent nasal discharge

B) Temperature of 100.8°F

C) Periorbital edema

D) Complaints of headache

C

Feedback: Expected s/s of acute viral rhinosinusitis include facial pain, headache, purulent nasal discharge, decreased sense of smell, and fever. Complications can lead to intracranial and orbital wall problems. Facial swelling over the involved sinus, abnormal extraocular movements, protrusion of the eyeball, periorbital edema, or changes in mental status may indicate intracranial complications.

A family physician is performing patient teaching about the influenza virus with each patient who has come to the clinic to receive that year's vaccine. Which of the following statements by the patient best reflects an accurate understanding of the flu virus?

A) "I could come down with viral or bacterial pneumonia as a result of a bad flu bug."

B) "I know my vaccination is especially important since there aren't any drugs that can treat the flu once I get sick with it."

C) "The emphasis on bundling up, staying warm, and drinking lots of fluids is outdated and actually ineffective."

D) "Like all vaccines, it is ideal if everyone in a population gets immunized against the flu."

A

Feedback: Viral and bacterial pneumonia are known sequelae of influenza. Antiviral drugs do exist for the flu, and the efficacy of staying warm and increasing fluid consumption have been demonstrated. The flu vaccine is recommended for higher risk individuals, and guidelines do not indicate the need for all individuals to be vaccinated.

A pneumonia that occurs 48 hours or more after admission to the hospital is considered

A) community-acquired pneumonia.

B) hospital-acquired pneumonia.

C) viral pneumonia.

D) immunocompromised pneumonia.

B

Feedback: Hospital-acquired pneumonia is defined as a lower respiratory tract infection that was not present or incubating on admission to the hospital. Usually, infections occurring 48 hours or more after admission are considered hospital acquired. Community-acquired pneumonia is diagnosed within 48 hours after admission. Most hospital-acquired pneumonia is bacterial.

A nurse is providing care for an older, previously healthy adult male who has been diagnosed today with pneumococcal pneumonia. Which of the following signs and symptoms is the nurse most likely to encounter?

A) The man will be hypotensive and febrile and may manifest cognitive changes.

B) The patient will have a cough producing clear sputum, and he will have faint breath sounds and fine crackles.

C) The patient will have copious bloody sputum and diffuse chest pain and may lose his cough reflex.

D) The patient will lack lung consolidation and will have little, if any, sputum production.

B

Feedback: The typical onset of pneumococcal pneumonia involves production of clear sputum, along with faint breath sounds and fine crackles. The patient is less likely to be hypotensive, have copious bloody sputum, or have chest pain. A lack of lung consolidation or sputum production is more closely associated with atypical pneumonias.

A client with a newborn infant is also the caregiver for her 75-year-old mother, who lives with them and who has diabetes. The client requests pneumonia vaccinations for her entire household. Which vaccine is most likely to be effective for the baby?

A) Since the baby's immune system is mature at birth, regular vaccine is appropriate.

B) There is no effective vaccine for newborn infants.

C) The 23-valent vaccine will be effective.

D) No vaccine is necessary for the baby if the nursing mother is immunized

B

Feedback: S. pneumoniae capsular polysaccharides would be especially appropriate for the client and her diabetic, elderly mother but is not effective in the immune system of anyone younger than 2 years old. Fortunately, a newer, 7-valent vaccine was designed to protect infants as young as 7 months. However, because their immune system is immature, the antibody response to most flu shots is poor or inconsistent in children younger than 2 years of age.

A 66-year-old male presents to the emergency room accompanied by his wife who claims that he has been acting confused. The man is complaining of a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 102.8°F, and his blood work indicates his sodium level at 126 mEq/L (normal 135 to 145 mEq/L). Based on this assessment, the nurse suspects the patient has

A) bronchopneumonia.

B) Mycoplasma pneumonia.

C) Legionella pneumonia.

D) pneumococcal pneumonia.

C

Feedback: Confusion, dry cough, diarrhea, and hyponatremia are associated with Legionnaire disease and less so with bronchopneumonia, Mycoplasma pneumonia, or pneumococcal pneumonia

A health educator is performing a health promotion workshop with the staff of a large, urban homeless shelter, and a component of the teaching centers around tuberculosis. One of the staff members comments, "Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment?

A) "Many people do manage to fight off the infection, but you're right: they can still spread it by coughing or sneezing."

B) "If someone has been previously exposed to tuberculosis, they are particularly infectious because they are often unaware of the disease."

C) "Actually, people who have the latent form of the disease won't be sick and can't spread it either."

D) "There isn't any real risk of them spreading it, but we would like to vaccinate everyone who's had any contact with it in the past."

C

Feedback: Contact with M. tuberculosis without the development of progressive primary tuberculosis results in a latent infection that is not communicable. Vaccination is not a common intervention in the United States.

When educating a student who lives in a crowded apartment and diagnosed with tuberculosis, the college school nurse will emphasize,

A) "Once your fever goes away, you can stop taking the streptomycin injection."

B) "If isoniazid makes you nauseous, we can substitute something milder."

C) "To destroy this bacterium, you must strictly adhere to a long-term drug regimen."

D) "You will have to wear an N95 mask while on campus at all times."

C

Feedback: Success of chemotherapy for prophylaxis and treatment of tuberculosis depends on strict adherence to a lengthy drug regimen that includes isoniazid (INH), rifampin, ethambutol, pyrazinamide, and streptomycin (or some combination of these).

Around 3 weeks after razing an old chicken house, a 71-year-old retired farmer has developed a fever, nausea, and vomiting. After ruling out more common health problems, his care provider eventually made a diagnosis of histoplasmosis. Which of the following processes is most likely taking place?

A) Toxin production by Histoplasma capsulatum is triggering an immune response.

B) Antibody production against the offending fungi is delayed by the patient's age and the virulence of the organism.

C) Spore inhalation initiates an autoimmune response that produces the associated symptoms.

D) Macrophages are able to remove the offending fungi from the bloodstream but can't destroy them.

D

Feedback: Disseminated histoplasmosis results from the inability of macrophages of the reticuloendothelial system to destroy the fungi. Fungi do not produce toxins, and antibody production and autoimmune responses are not involved in the pathophysiology of this fungal infection.

A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her physician most appropriately respond to her?

A) "I'm sure this is very hard news to hear, but be aware that with aggressive treatment, your chances of beating this are quite good."

B) "This is very difficult to hear, I'm sure, and we have to observe to see if it spreads because that often happens."

C) "I'm very sorry to have to give you this news; I'd like to talk to you about surgical options, however."

D) "This is a difficult diagnosis to receive, but there is a chance that the cancer may go into remission."

B

Feedback: Metastases are common with SCLC. Survival rates are very low; surgical options do not exist; and remission is very unlikely.

A patient with small cell lung cancer (SCLC) has developed a paraneoplastic syndrome called Cushing syndrome. Based on this new complication, the nurse will likely assess which of the following clinical manifestations of Cushing syndrome?

A) Weight gain, moon face, buffalo hump, and purple striae on the abdomen

B) Bilateral edema in the arms, swollen face, and protruding eyes

C) Severe bone/joint pain, nausea/vomiting, and polyuria

D) Tetany, new-onset seizure activity, emotional lability, and extrapyramidal symptoms

A

Feedback: SCLS is associated with several types of paraneoplastic syndromes, including Cushing's. Answer choice B refers to superior vena cava syndrome; answer choice C refers to hypercalcemia; and answer choice D refers to tumor lysis syndrome. All of these are complications that can occur with cancer and treatment of cancer.

A 77-year-old lifetime smoker has been diagnosed with a tumor in his lung at the site of an old tubercle scarring site, located in a peripheral area of his bronchiolar tissue. What is this client's most likely diagnosis?

A) Squamous cell carcinoma

B) Small cell lung cancer

C) Large cell carcinoma

D) Adenocarcinoma

D

Feedback: Adenocarcinoma is associated with the periphery of the lungs, often at the site of scarring, and can occur in alveolar or bronchiolar tissue. Squamous cell carcinoma, small cell lung cancer, and large cell carcinoma are less commonly associated with these traits.

The neonatal ICU nurse is aware that type II alveolar cells produce surfactant, and they usually develop at how many weeks of gestation?

A) 17 to 18 weeks

B) 19 to 20 weeks

C) 24 to 28 weeks

D) 34 to 38 weeks

C

Feedback: Type II alveolar cells begin to develop at approximately 24 weeks. These cells produce surfactant, a substance capable of lowering the surface tension of the air–alveoli interface. By the 28th to 30th week, sufficient amounts of surfactant are available to prevent alveolar collapse when breathing begins.

Which of the following phenomena is most likely occurring during a child's alveolar stage of lung development?

A) Terminal alveolar sacs are developing, and surfactant production is beginning.

B) A single capillary network exists, and the lungs are capable of respiration.

C) The conducting airways are formed, but respiration is not yet possible.

D) Primitive alveoli are formed, and the bronchi and bronchioles become much larger.

B

Feedback: During the alveolar stage of lung development from late fetal to early childhood, a single capillary network appears, and the lungs are ready to perform respiration. The development of alveolar sacs and production of surfactant are associated with the saccular period, and formation of the conducting airways occurs during the pseudoglandular period. Formation of primitive alveoli takes place during the canalicular period.

Which of the following situations would be most deserving of a pediatrician's attention?

A) The mother of an infant 2 days postpartum notes that her baby has intermittent periods of hyperventilation followed by slow respirations or even brief periods of apnea.

B) A volunteer in the nursery notes that one of the infants, aged 2 weeks, appears unable to breathe through his mouth, even when his nose is congested.

C) A neonate is visibly flaring her nostrils on inspiration.

D) A midwife notes that a newborn infant's chest is retracting on inspiration and that the child is grunting.

D

Feedback: Retraction and grunting indicate a significant increase in the work of breathing that can be indicative of respiratory distress syndrome, a situation that would require medical intervention. Periods of hyperventilation interspersed with reduced breathing rates are common during the transition to postpartum ventilation, and infants are commonly unable to mouth breathe. Nostril flaring could be a sign of dyspnea, but it can also be a compensatory mechanism that the infant uses to increase oxygen intake; this situation would not be considered as serious as an infant who has chest retractions and grunting

A premature infant on mechanical ventilation has developed bronchopulmonary dysplasia (BPD) and is showing signs and symptoms of hypoxemia, low lung compliance, and respiratory distress. Which of the following is the most likely contributor to the infant's present health problem?

A) High-inspired oxygen concentration and injury from positive-pressure ventilation

B) Failure to administer corticosteroids to the infant in utero

C) Insufficient surfactant production and insufficient surfactant therapy

D) Insufficient supplemental oxygen therapy

A

Feedback: Retraction and grunting indicate a significant increase in the work of breathing that can be indicative of respiratory distress syndrome, a situation that would require medical intervention. Periods of hyperventilation interspersed with reduced breathing rates are common during the transition to postpartum ventilation, and infants are commonly unable to mouth breathe. Nostril flaring could be a sign of dyspnea, but it can also be a compensatory mechanism that the infant uses to increase oxygen intake; this situation would not be considered as serious as an infant who has chest retractions and grunting

A 3-year-old boy has developed croup following a winter cold. His care provider would recognize that which of the following microorganisms and treatments is most likely to be effective?

A) Respiratory syncytial virus treated with intubation

B) Parainfluenza virus treated with a mist tent and oxygen therapy

C) Haemophilus influenza treated with appropriate antibiotics

D) Staphylococcus aureus treated with bronchodilators and mist tent

B

Feedback: The majority of croup cases are caused by parainfluenza viruses, and common treatment modalities are humidified air or mist tents as well as supplementary oxygen. Respiratory syncytial virus accounts for some croup diagnoses, but intubation is not normally required. Haemophilus influenza is responsible for epiglottitis, while Staphylococcus aureus is not commonly responsible for croup.

The nurse caring for a male child with respiratory problems is concerned he may be developing respiratory failure. Upon assessment, the nurse knows that which of the following are clinical manifestations of respiratory failure? Select all that apply.

A) Severe accessory muscle retractions

B) Nasal flaring

C) Grunting on expiration

D) Inspiratory wheezes heard

E) Swollen glottis

A B C