Otitis Media Answer Key

Tuberculosis 1) The nurse is preparing to assess a 90-year-old client admitted with tuberculosis. Which manifestation will the nurse most likely assess in this client? A) Night sweats B) Swollen lymph nodes C) Cough D) Hemoptysis Answer: C Explanation: A) Presenting symptoms of tuberculosis in the older adult are often vague and include coughing, weight loss, diminished appetite, and periodic fevers. Night sweats, swollen lymph nodes, and hemoptysis are not considered presenting symptoms of tuberculosis in the older adult. 2) A 15-year-old client is brought to the Emergency Department with fatigue, weight loss, a dry cough, and night sweats. The family just recently immigrated to the United States. For which potential risk should the nurse plan this client's care? A) Pneumothorax B) Pneumonia C) Renal failure D) Septicemia Answer: A Explanation: A) This client was foreign-born, a risk factor for TB, and has the classic symptoms of tuberculosis. The nurse plans frequent respiratory assessments, as this child is at risk for pneumothorax. Patients with TB are not at particular risk for pneumonia, renal failure, or septicemia. 3) The nurse in an inner city clinic is providing a health screening for a homeless man with a history of drug abuse. The client has a chronic non-productive cough. For what should the nurse expect to screen this client? A) Herpes zoster B) Sickle cell disease C) Sick sinus syndrome D) Tuberculosis Answer: D Explanation: A) The homeless client who abuses drugs is at risk for contracting tuberculosis. The nurse would expect to screen this client for TB. There is no evidence to support the need to screen the client for sickle cell disease, herpes zoster, or sick sinus syndrome. 4) The nurse is planning care for a 90-year-old client who was recently diagnosed with tuberculosis. The client lives alone in an apartment and will continue treatment at home. Which nursing diagnosis is a priority for this client? A) Ineffective Therapeutic Regimen Management B) Deficient Knowledge C) Ineffective Breathing Pattern D) Risk for Injury Answer: A Explanation: A) The treatment regimen for tuberculosis requires that the client take many medications, maintain nutrition, and be aware of potential side effects. Due to increased age and normal forgetfulness, this client is at risk for ineffective treatment in the home. The client may have a knowledge deficit but the priority is the treatment regimen. Since the client is being treated in the home, there is not much risk for ineffective breathing. The client is at risk for injury because of age, not TB. 5) An occupational health nurse is screening a new employee in a long-term care facility for tuberculosis. The employee questions why purified protein derivative (PPD) testing is done twice. Which is the most appropriate response by the nurse? A) "Different medication is used in the second PPD." B) "The treatment for TB is 6 months of medication, and we want to make sure the first results of the first PPD were accurate." C) "The first PPD was not interpreted in the correct time frame of 48-72 hours." D) "There is an increased risk for a false-negative response for people who work in long-term care facilities. The two-step is recommended to accurately screen for TB." Answer: D Explanation: A) PPD testing is done in a two-step process for people who work in long-term care facilities because of the risk of false-negative responses. Treatment for TB for 6 months is not a reason to complete the PPD twice. PPD testing is not done twice because different medication is used. Evaluating the test at the wrong interval is not the reason that the PPD is done twice for long-term care facility employees. 6) The nurse is caring for a client who is receiving multiple drugs for treatment of tuberculosis. The nurse teaches the client the rationale for the multiple-drug treatment and evaluates learning as effective when the client makes which statement? A) "Multiple drugs are necessary to develop immunity to tuberculosis." B) "Multiple drugs are necessary because I became infected from an immigrant." C) "Multiple drugs will be required as long as I am contagious." D) "Multiple drugs are necessary because of the risk of resistance." Answer: D Explanation: A) Tuberculosis bacilli are likely to develop resistance to one drug, so multiple drugs must be used. Treatment must be continued long after the client is no longer contagious. There is no indication that the client contracted TB from an immigrant. Multiple drugs are used for all cases of TB. 7) The nurse is caring for a client who has been admitted to the unit with tuberculosis. The client is placed in isolation. To protect the caregivers and other clients on the unit, which type of isolation room is most appropriate? A) Single-door room with positive air flow (Air flows out of the room.) B) Isolation room with an anteroom and negative air flow (Air flows into the room.) C) Isolation room with an anteroom and normal airflow D) Single-door room with normal airflow Answer: B Explanation: A) Patients with airborne infections such as meningococcemia, SARS, or TB are placed in an isolation room with an anteroom and negative pressure airflow. Air flows into the room and is vented in a special manner to prevent the organism from entering the rest of the unit. Positive flow rooms are used for those clients who are immunosuppressed so that microorganisms from the unit are not drawn into the room. Single-door isolation with normal airflow might be used for a client with droplet or wound infection. Single-door rooms are not equipped to have positive or negative airflow. 8) The charge nurse for a medical-surgical nursing unit has been notified that a client with tuberculosis is being transported to the unit. Which are the most appropriate actions for infection prevention in this circumstance? Select all that apply. A) Stock the client's supply cart at the beginning of each shift. B) Wear a mask and gown when caring for the client. C) Have the client wear a mask when coming from admissions. D) Perform hand hygiene only after leaving the room. Answer: B, C Explanation: A) Masks and gowns should be worn when caring for clients who do not reliably cover their mouths when coughing. When a client has an airborne disease and must go elsewhere in the hospital, the client must wear a mask. Supplies to prevent transmission of disease should be stocked at the end of the shift so that adequate supplies will be available for the next healthcare provider. Hand hygiene should be performed before and after client care. 9) A nurse is caring for a client with tuberculosis who is taking Rifampin for treatment of the disease. Of which nursing considerations should the nurse be aware regarding this medication? Select all that apply. A) Administer with meals to reduce gastrointestinal side effects. B) Record a baseline visual examination before therapy. C) Administer on an empty stomach. D) Administer by deep intramuscular injection into a large muscle mass. E) Monitor CBC, liver function studies, and renal function studies for evidence of toxicity. Answer: C, E Explanation: A) Rifampin is an oral antituberculosis medication that should be administered on an empty stomach. The nurse should monitor the CBC, liver function studies, and renal function studies. A baseline visual examination before therapy is necessary with ethambutol, another antituberculosis medication. 10) The nurse caring for a homeless client at risk for tuberculosis will include which symptoms of the disease when educating the client? Select all that apply. A) Fatigue B) Low-grade morning fever C) Productive cough that later turns to a dry, hacking cough D) Weight loss E) Night sweats Answer: A, D, E Explanation: A) Manifestations of tuberculosis often develop insidiously and are initially nonspecific. Fatigue, weight loss, diminished appetite, low-grade afternoon fever, and night sweats are common. A dry cough develops, which later becomes productive of purulent and/or blood-tinged sputum. It is often at this stage that the client first seeks medical attention. Urinary Tract Infection 1) A 26-year-old female client is admitted to the hospital with a diagnosis of kidney stones. The physician orders IV fluids, x-rays, blood work, and a Foley catheter for the client. The nurse is caring for the client 3 days after admission and takes morning vital signs of 101°F, heart rate 92, respirations 25, and blood pressure 120/80. The urinary output has decreased, and the urine is cloudy and dark amber. What should the nurse suspect is occurring with the client? A) The client has passed the kidney stones. B) The client is in acute renal failure. C) The client has developed a respiratory infection. D) The client has a probable nosocomial urinary tract infection. Answer: D Explanation: A) The client has developed a urinary tract infection that was not present upon admission. This is a healthcare-associated infection (HAI) and is likely due to poor technique when placing the Foley catheter. There is no evidence of a respiratory infections, renal failure, or the passage of kidney stones. 2) The nurse for a urology clinic is planning an in-service about urinary infections for a group of novice nurses. What should be included in the presentation? A) Men are most likely to experience descending urinary tract infections. B) Straight catheterization is the only way to evaluate for the presence of a urinary tract infection. C) Women require a shorter course of antibiotic therapy to manage a urinary tract infection than men. D) The rate of urinary tract infections is similar between men and women. Answer: C Explanation: A) Men will usually be prescribed a longer course of therapy to manage a urinary tract infection. They have a longer urethra. When they are infected with an infection to the system, it is typically more complicated than in a woman. Descending infections are less common than ascending infections of the urinary tract. A clean-catch midstream specimen is a reliable means to obtain a urine specimen to check for the presence of infection. Women have a higher rate of urinary tract infection than men. 3) The nurse is giving discharge instructions to the family of an elderly client with a history of urinary tract infection (UTI). The family asks what the early symptoms of a urinary tract infection are so that they can monitor the client. Which early symptom of a UTI should the nurse teach the family? A) Urinary urgency B) Blood in the urine C) Urinary frequency D) Alteration in cognition Answer: D Explanation: A) The early manifestations of a urinary infection differ in a senior from those seen in younger adults. Older adult clients will often be asymptomatic until there are changes in the level of consciousness. 4) A preadolescent student asks the school nurse to explain why the student keeps getting urinary tract infections. The school nurse determines that the diagnosis of Deficient Knowledge is appropriate based upon the student's response to which question? A) "When was your last UTI?" B) "How often do you shower?" C) "Do you have a family history of urinary problems?" D) "In what direction do you wipe after a bowel movement?" Answer: D Explanation: A) The most important teaching to provide females is always to wipe the perianal/genital area from front to back. E-coli are the most common micro-organisms responsible for urinary tract infections and can easily be dragged into the urethral orifice by wiping from the anus to the urethra after defecation. Females do have a shorter urethra compared with males and are more susceptible to urinary tract infections for this reason. Personal hygiene practices, such as cleansing after a bowel movement, are a priority teaching instruction to include for this client. Urinary tract infections are not associated with families or genetics. 5) The nurse has been invited to present a program at the local PTA meeting on recognizing and preventing illness in children. Which symptoms of urinary tract infections in preschool age children should the nurse include? Select all that apply. A) Urinary urgency B) Elevated blood pressure C) Dysuria D) Fever E) Headache Answer: A, C, D Explanation: A) Clinical manifestations of a urinary tract infection (UTI) in a preschool-age child include fever, urgency, and dysuria. Headache and elevated blood pressure are not clinical manifestations of a UTI for a preschool-age child. 6) The nurse is providing discharge teaching for a female client with a urinary tract infection. The client has been prescribed a 3-day course of oral trimethoprim-sulfamethoxazole (TMP-SMZ). What client statement indicates that teaching has been effective? A) "I will return within 10 days for a follow-up urine culture." B) "I will practices Kegel exercises on daily basis." C) "I will increase my intake of fluids, especially citrus juice." D) "I will only wear 100% cotton underwear." Answer: A Explanation: A) It is essential to validate eradication of infection with a follow-up culture that is negative. Doing Kegel exercises and wearing cotton underwear are both useful in prevention of future urinary tract infections, but they are not the best evaluation of effectiveness of teaching. Citrus juices will not increase acidity of urine and therefore are not recommended when a client has a UTI. 7) The physician has ordered an indwelling urinary catheter for a client with urinary retention. Which intervention, along with strict aseptic technique, will decrease the risk of infection for this procedure? A) Irrigating the catheter with sterile saline on a daily basis B) Instructing the client to void around the catheter C) Using an anesthetic lubricating gel during insertion D) Inflating the balloon while the catheter is in the urethra Answer: C Explanation: A) Unless contraindicated, the additional step of using an anesthetic lubricating gel promotes comfort and protects fragile urethral tissues from trauma, and therefore reduces risk for a catheter-associated UTI. Irrigating the catheter should not be done because it can introduce infection by allowing bacteria to enter the closed urinary drainage system. Although voiding around the catheter will decrease bladder spasms, it will not help reduce infection. The balloon is not inflated until the catheter is in the bladder, in order to prevent trauma to the urethra and therefore decrease the risk of infection. 8) The nurse in an urgent care center assesses a 40-year-old female client who has presented with a fever of 101.2°F and complaints of painful urination. What should the nurse ask to elicit further data that indicates cystitis? A) "Do you have any symptoms of menopause?" B) "How long have you had a fever, and have you had chills with this?" C) "Do you have any upper abdominal pain or cramping?" D) "What color is your urine?" Answer: D Explanation: A) The classic symptoms of cystitis include dysuria or painful urination, urinary frequency and urgency, and bloody urine or hematuria. A 40-year-old client who presents with a fever and painful urination is not experiencing symptoms of menopause. Asking about fever and chills is not specific to suspected cystitis and does not elicit information related to urinary symptoms. Pain from cystitis is typically suprapubic, not upper abdominal.