1.

Clients with chronic illnesses are more likely to get pneumonia when
which of the following situations is present?
A Dehydration
B Group living
C Malnutrition
D Severe periodontal disease
2. Which of the following pathophysiological mechanisms that occurs
in the lung parenchyma allows pneumonia to develop?
A Atelectasis
B Bronchiectasis
C Effusion
D Inflammation
3. Which of the following organisms most commonly causes
community-acquired pneumonia in adults?
A Haemiphilus influenzae
B Klebsiella pneumoniae
C Steptococcus pneumoniae
D Staphylococcus aureus
4. An elderly client with pneumonia may appear with which of the
following symptoms first?
A Altered mental status and dehydration
B Fever and chills
C Hemoptysis and dyspnea
D Pleuritic chest pain and cough
5. When auscultating the chest of a client with pneumonia, the nurse
would expect to hear which of the following sounds over areas of
consolidation?
A Bronchial
B Bronchovestibular
C Tubular
D Vesicular
6. A diagnosis of pneumonia is typically achieved by which of the
following diagnostic tests?
A ABG analysis
B Chest x-ray
C Blood cultures
D sputum culture and sensitivity
7. A client with pneumonia develops dyspnea with a respiratory rate
of 32 breaths/minute and difficulty expelling his secretions. The nurse
auscultates his lung fields and hears bronchial sounds in the left lower
lobe. The nurse determines that the client requires which of the
following treatments first?
A Antibiotics
B Bed rest
C Oxygen
D Nutritional intake

8. A client has been treated with antibiotic therapy for right lowerlobe pneumonia for 10 days and will be discharged today. Which of the
following physical findings would lead the nurse to believe it is
appropriate to discharge this client?
A Continued dyspnea
B Fever of 102*F
C Respiratory rate of 32 breaths/minute
D Vesicular breath sounds in right base
9. The right forearm of a client who had a purified protein derivative
(PPD) test for tuberculosis is reddened and raised about 3mm where
the test was given. This PPD would be read as having which of the
following results?
A Indeterminate
B Needs to be redone
C Negative
D Positive
10. A client with primary TB infection can expect to develop which of
the following conditions?
A Active TB within 2 weeks
B Active TB within 1 month
C A fever that requires hospitalization
D A positive skin test
11. A client was infected with TB 10 years ago but never developed
the disease. Hes now being treated for cancer. The client begins to
develop signs of TB. This is known as which of the following types of
infection?
A Active infection
B Primary infection
C Superinfection
D Tertiary infection
12. A client has active TB. Which of the following symptoms will he
exhibit?
A Chest and lower back pain
B Chills, fever, night sweats, and hemoptysis
C Fever of more than 104*F and nausea
D Headache and photophobia
13. Which of the following diagnostic tests is definitive for TB?
A Chest x-ray
B Mantoux test
C Sputum culture
D Tuberculin test
14. A client with a positive Mantoux test result will be sent for a chest
x-ray. For which of the following reasons is this done?
A To confirm the diagnosis
B To determine if a repeat skin test is needed
C To determine the extent of the lesions

D To determine if this is a primary or secondary infection

15. A chest x-ray should a clients lungs to be clear. His Mantoux test
is positive, with a 10mm if induration. His previous test was negative.
These test results are possible because:
A He had TB in the past and no longer has it.
B He was successfully treated for TB, but skin tests always stay
positive.
C Hes a seroconverter, meaning the TB has gotten to his
bloodstream.
D Hes a tuberculin converter, which means he has been infected
with TB since his last skin test.
16. A client with a positive skin test for TB isnt showing signs of active
disease. To help prevent the development of active TB, the client
should be treated with isonaizid, 300mg daily, for how long?
A 10 to 14 days
B 2 to 4 weeks
C 3 to 6 months
D 9 to 12 months
17. A client with a productive cough, chills, and night sweats is
suspected of having active TB. The physician should take which of the
following actions?
A Admit him to the hospital in respiratory isolation
B Prescribe isoniazid and tell him to go home and rest
C Give a tuberculin test and tell him to come back in 48 hours and
have it read.
D Give a prescription for isoniazid, 300mg daily for 2 weeks, and
send him home.
18. A client is diagnosed with active TB and started on triple antibiotic
therapy. What signs and symptoms would the client show if therapy is
inadequate?
A Decreased shortness of breath
B Improved chest x-ray
C Nonproductive cough
D Positive acid-fast bacilli in a sputum sample after 2 months of
treatment.
19. A client diagnosed with active TB would be hospitalized primarily
for which of the following reasons?
A To evaluate his condition
B To determine his compliance
C to prevent spread of the disease
D To determine the need for antibiotic therapy.
20. A high level of oxygen exerts which of the following effects on the
lung?
A Improves oxygen uptake
B Increases carbon dioxide levels
C Stabilizes carbon dioxide levels

D Reduces amount of functional alveolar surface area

21. A 24-year-old client comes into the clinic complaining of rightsided chest pain and shortness of breath. He reports that it started
suddenly. The assessment should include which of the following
interventions?
A Auscultation of breath sounds
B Chest x-ray
C Echocardiogram
D Electrocardiogram (ECG)
22. A client with shortness of breath has decreased to absent breath
sounds on the right side, from the apex to the base. Which of the
following conditions would best explain this?
A Acute asthma
B Chronic bronchitis
C Pneumonia
D Spontaneous pneumothorax
23. Which of the following treatments would the nurse expect for a
client with a spontaneous pneumothorax?
A Antibiotics
B Bronchodilators
C Chest tube placement
D Hyperbaric chamber
24. Which of the following methods is the best way to confirm the
diagnosis of a pneumothorax?
A Auscultate breath sounds
B Have the client use an incentive spirometer
C Take a chest x-ray
D stick a needle in the area of decreased breath sounds
25. A pulse oximetry gives what type of information about the client?
A Amount of carbon dioxide in the blood
B Amount of oxygen in the blood
C Percentage of hemoglobin carrying oxygen
D Respiratory rate
26. What effect does hemoglobin amount have on oxygenation status?
A No effect
B More hemoglobin reduces the clients respiratory rate
C Low hemoglobin levels cause reduces oxygen-carrying capacity
D Low hemoglobin levels cause increased oxygen-carrying capacity.
27. Which of the following statements best explains how opening up
collapsed alveoli improves oxygenation?
A Alveoli need oxygen to live
B Alveoli have no effect on oxygenation
C Collapsed alveoli increase oxygen demand
D Gaseous exchange occurs in the alveolar membrane.

28. Continuous positive airway pressure (CPAP) can be provided

through an oxygen mask to improve oxygenation in hypoxic patients
by which of the following methods?
A The mask provides 100% oxygen to the client.
B The mask provides continuous air that the client can breathe.
C The mask provides pressurized oxygen so the client can breathe
more easily.
D The mask provides pressurized at the end of expiration to open
collapsed alveoli.
29. Which of the following best describes pleural effusion?
A The collapse of alveoli
B The collapse of bronchiole
C The fluid in the alveolar space
D The accumulation of fluid between the linings of the pleural
space.
30. If a pleural effusion develops, which of the following actions best
describes how the fluid can be removed from the pleural space and
proper lung status restored?
A Inserting a chest tube
B Performing thoracentesis
C Performing paracentesis
D Allowing the pleural effusion to drain by itself.
31. A comatose client needs a nasopharyngeal airway for suctioning.
After the airway is inserted, he gags and coughs. Which action should
the nurse take?
A Remove the airway and insert a shorter one.
B Reposition the airway.
C Leave the airway in place until the client gets used to it.
D Remove the airway and attempt suctioning without it.
32. An 87-year-old client requires long term ventilator therapy. He has
a tracheostomy in place and requires frequent suctioning. Which of the
following techniques is correct?
A Using intermittent suction while advancing the catheter.
B Using continuous suction while withdrawing the catheter.
C Using intermittent suction while withdrawing the catheter.
D Using continuous suction while advancing the catheter.
33. A clients ABG analysis reveals a pH of 7.18, PaCO2 of 72 mm Hg,
PaO2 of 77 mm Hg, and HCO3 of 24 mEq/L. What do these values
indicate?
A Metabolic acidosis
B Respiratory alkalosis
C Metabolic alkalosis
D Respiratory acidosis
34. A police officer brings in a homeless client to the ER. A chest x-ray
suggests he has TB. The physician orders an intradermal injection of 5

tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is

appropriate for this injection?
A 5/8 to 25G to 27G needle.
B 1 to 3 20G to 25G needle.
C to 3/8 26 or 27G needle.
D 1 20G needle.
35. A 76-year old client is admitted for elective knee surgery. Physical
examination reveals shallow respirations but no signs of respiratory
distress. Which of the following is a normal physiologic change related
to aging?
A Increased elastic recoil of the lungs
B Increased number of functional capillaries in the alveoli
C Decreased residual volume
D Decreased vital capacity
36. A 79-year-old client is admitted with pneumonia. Which nursing
diagnosis should take priority?
A Acute pain related to lung expansion secondary to lung infection
B Risk for imbalanced fluid volume related to increased insensible
fluid losses secondary to fever.
C Anxiety related to dyspnea and chest pain.
D Ineffective airway clearance related to retained secretions.
37. A community health nurse is conducting an educational session
with community members regarding TB. The nurse tells the group that
one of the first symptoms associated with TB is:
A A bloody, productive cough
B A cough with the expectoration of mucoid sputum
C Chest pain
D Dyspnea
38. A nurse evaluates the blood theophylline level of a client receiving
aminophylline (theophylline) by intravenous infusion. The nurse would
determine that a therapeutic blood level exists if which of the following
were noted in the laboratory report?
A 5 mcg/mL
B 15 mcg/mL
C 25 mcg/mL
D 30 mcg/mL
39. Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a
client with TB. A nurse reviews the medical record of the client. Which
of the following, if noted in the clients history, would require physician
notification?
A Heart disease
B Allergy to penicillin
C Hepatitis B
D Rheumatic fever
40. A client is experiencing confusion and tremors is admitted to a
nursing unit. An initial ABG report indicates that the PaCO2 level is 72

mm Hg, whereas the PaO2 level is 64 mm Hg. A nurse interprets that

the client is most likely experiencing:
A Carbon monoxide poisoning
B Carbon dioxide narcosis
C Respiratory alkalosis
D Metabolic acidosis
41. A client who is HIV+ has had a PPD skin test. The nurse notes a 7mm area of induration at the site of the skin test. The nurse interprets
the results as:
A Positive
B Negative
C Inconclusive
D The need for repeat testing.
42. A nurse is caring for a client diagnosed with TB. Which
assessment, if made by the nurse, would not be consistent with the
usual clinical presentation of TB and may indicate the development of
a concurrent problem?
A Nonproductive or productive cough
B Anorexia and weight loss
C Chills and night sweats
D High-grade fever
43. A nurse is teaching a client with TB about dietary elements that
should be increased in the diet. The nurse suggests that the client
increase intake of:
A Meats and citrus fruits
B Grains and broccoli
C Eggs and spinach
D Potatoes and fish
44. Which of the following would be priority assessment data to gather
from a client who has been diagnosed with pneumonia? Select all that
apply.
A Auscultation of breath sounds
B Auscultation of bowel sounds
C Presence of chest pain.
D Presence of peripheral edema
E Color of nail beds
45. A client with pneumonia has a temperature of 102.6*F (39.2*C), is
diaphoretic, and has a productive cough. The nurse should include
which of the following measures in the plan of care?
A Position changes q4h
B Nasotracheal suctioning to clear secretions
C Frequent linen changes
D Frequent offering of a bedpan.
46. The cyanosis that accompanies bacterial pneumonia is primarily
caused by which of the following?
A Decreased cardiac output

B Pleural effusion
C Inadequate peripheral circulation
D Decreased oxygenation of the blood.
47. Which of the following mental status changes may occur when a
client with pneumonia is first experiencing hypoxia?
A Coma
B Apathy
C Irritability
D Depression
48. A client with pneumonia has a temperature ranging between 101*
and 102*F and periods of diaphoresis. Based on this information, which
of the following nursing interventions would be a priority?
A Maintain complete bedrest
B Administer oxygen therapy
C Provide frequent linen changes.
D Provide fluid intake of 3 L/day
49. Which of the following would be an appropriate expected outcome
for an elderly client recovering from bacterial pneumonia?
A A respiratory rate of 25 to 30 breaths per minute
B The ability to perform ADLs without dyspnea
C A maximum loss of 5 to 10 pounds of body weight
D Chest pain that is minimized by splinting the ribcage.
50. Which of the following symptoms is common in clients with TB?
A Weight loss
B Increased appetite
C Dyspnea on exertion
D Mental status changes
51. The nurse obtains a sputum specimen from a client with suspected
TB for laboratory study. Which of the following laboratory techniques is
most commonly used to identify tubercle bacilli in sputum?
A Acid-fast staining
B Sensitivity testing
C Agglunitnation testing
D Dark-field illumination
52. Which of the following antituberculus drugs can cause damage to
the eighth cranial nerve?
A Streptomycin
B Isoniazid
C Para-aminosalicylic acid
D Ethambutol hydrochloride
53. The client experiencing eighth cranial nerve damage will most
likely report which of the following symptoms?
A Vertigo
B Facial paralysis
C Impaired vision
D Difficulty swallowing

54. Which of the following family members exposed to TB would be at

highest risk for contracting the disease?
A 45-year-old mother
B 17-year-old daughter
C 8-year-old son
D 76-year-old grandmother
55. The nurse is teaching a client who has been diagnosed with TB
how to avoid spreading the disease to family members. Which
statement(s) by the client indicate(s) that he has understood the
nurses instructions? Select all that apply.
A I will need to dispose of my old clothing when I return home.
B I should always cover my mouth and nose when sneezing.
C It is important that I isolate myself from family when possible.
D I should use paper tissues to cough in and dispose of them
properly.
E I can use regular plate and utensils whenever I eat.
56. A client has a positive reaction to the PPD test. The nurse correctly
interprets this reaction to mean that the client has:
A Active TB
B Had contact with Mycobacterium tuberculosis
C Developed a resistance to tubercle bacilli
D Developed passive immunity to TB.
57. INH treatment is associated with the development of peripheral
neuropathies. Which of the following interventions would the nurse
teach the client to help prevent this complication?
A Adhere to a low cholesterol diet
B Supplement the diet with pyridoxine (vitamin B6)
C Get extra rest
D Avoid excessive sun exposure.
58. The nurse should include which of the following instructions when
developing a teaching plan for clients receiving INH and rifampin for
treatment for TB?
A Take the medication with antacids
B Double the dosage if a drug dose is forgotten
C Increase intake of dairy products
D Limit alcohol intake
59. The public health nurse is providing follow-up care to a client with
TB who does not regularly take his medication. Which nursing action
would be most appropriate for this client?
A Ask the clients spouse to supervise the daily administration of
the medications.
B Visit the clinic weekly to ask him whether he is taking his
medications regularly.
C Notify the physician of the clients non-compliance and request a
different prescription.
D Remind the client that TB can be fatal if not taken properly.

60. The Causative agent of Tuberculosis is said to be:

A Mycobacterium Tuberculosis
B Hansens Bacilli
C Bacillus Anthracis
D Group A Beta Hemolytic Streptococcus
Answers and Rationales
1 B. Clients with chronic illnesses generally have poor immune
systems. Often, residing in group living situations increases the
chance of disease transmission.
2 D. The common feature of all type of pneumonia is an
inflammatory pulmonary response to the offending organism or
agent. Atelectasis and bronchiecrasis indicate a collapse of a
portion of the airway that doesnt occur in pneumonia. An
effusion is an accumulation of excess pleural fluid in the pleural
space, which may be a secondary response to pneumonia.
3 C. Pneumococcal or streptococcal pneumonia, caused by
streptococcus pneumoniae, is the most common cause of
community-acquired pneumonia. H. influenzae is the most
common cause of infection in children. Klebsiella species is the
most common gram-negative organism found in the hospital
setting. Staphylococcus aureus is the most common cause of
hospital-acquired pneumonia.
4 A. Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest
pain are common symptoms of pneumonia, but elderly clients
may first appear with only an altered mental status and
dehydration due to a blunted immune response.
5 A. Chest auscultation reveals bronchial breath sounds over areas
of consolidation. Bronchiovesicular are normal over midlobe lung
regions, tubular sounds are commonly heard over large airways,
and vesicular breath sounds are commonly heard in the bases of
the lung fields.
6 D. Sputum C & S is the best way to identify the organism causing
the pneumonia. Chest x-ray will show the area of lung
consolidation. ABG analysis will determine the extent of hypoxia
present due to the pneumonia, and blood cultures will help
determine if the infection is systemic.
7 C. The client is having difficulty breathing and is probably
becoming hypoxic. As an emergency measure, the nurse can
provide oxygen without waiting for a physicians order. Antibiotics
may be warranted, but this isnt a nursing decision. The client
should be maintained on bedrest if he is dyspneic to minimize his
oxygen demands, but providing additional will deal more
immediately with his problem. The client will need nutritional
support, but while dyspneic, he may be unable to spare the
energy needed to eat and at the same time maintain adequate
oxygenation.

8 D. If the client still has pneumonia, the breath sounds in the right
base will be bronchial, not the normal vesicular breath sounds. If
the client still has dyspnea, fever, and increased respiratory rate,
he should be examined by the physician before discharge
because he may have another source of infection or still have
pneumonia.
9 C. This test would be classed as negative. A 5mm raised area
would be a positive result if a client was HIV+ or had recent close
contact with someone diagnosed with TB. Indeterminate isnt a
term used to describe results of a PPD test. If the PPD is
reddened and raised 10mm or more, its considered positive
according to the CDC.
10 D. A primary TB infection occurs when the bacillus has
successfully invaded the entire body after entering through the
lungs. At this point, the bacilli are walled off and skin tests read
positive. However, all but infants and immunosuppressed people
will remain asymptomatic. The general population has a 10% risk
of developing active TB over their lifetime, in many cases
because of a break in the bodys immune defenses. The active
stage shows the classic symptoms of TB: fever, hemoptysis, and
night sweats.
11 A. Some people carry dormant TB infections that may develop
into active disease. In addition, primary sites of infection
containing TB bacilli may remain inactive for years and then
activate when the clients resistance is lowered, as when a client
is being treated for cancer. Theres no such thing as tertiary
infection, and superinfection doesnt apply in this case.
12 B. Typical signs and symptoms are chills, fever, night sweats, and
hemoptysis. Chest pain may be present from coughing, but isnt
usual. Clients with TB typically have low-grade fevers, not higher
than 102*F. Nausea, headache, and photophobia arent usual TB
symptoms.
13 C. The sputum culture for Myobacterium tuberculosis is the only
method of confirming the diagnosis. Lesions in the lung may not
be big enough to be seen on x-ray. Skin tests may be falsely
positive or falsely negative.
14 C. If the lesions are large enough, the chest x-ray will show their
presence in the lungs. Sputum culture confirms the diagnosis.
There can be false-positive and false-negative skin test results. A
chest x-ray cant determine if this is a primary or secondary
infection.
15 D. A tuberculin converters skin test will be positive, meaning he
has been exposed to an infected with TB and now has a cellmediated immune response to the skin test. The clients blood
and x-ray results may stay negative. It doesnt mean the
infection has advanced to the active stage. Because his x-ray is

negative, he should be monitored every 6 months to see if he

develops changes in his x-ray or pulmonary examination. Being a
seroconverter doesnt mean the TB has gotten into his
bloodstream; it means it can be detected by a blood test.
16 D. Because of the increased incidence of resistant strains of TB,
the disease must be treated for up to 24 months in some cases,
but treatment typically lasts for 9-12 months. Isoaizid is the most
common medication used for the treatment of TB, but other
antibiotics are added to the regimen to obtain the best results.
17 A. The client is showing s/s of active TB and, because of the
productive cough, is highly contagious. He should be admitted to
the hospital, placed in respiratory isolation, and three sputum
cultures should be obtained to confirm the diagnosis. He would
most likely be given isoniazid and two or three other
antitubercular antibiotics until the diagnosis is confirmed, then
isolation and treatment would continue if the cultures were
positive for TB. After 7 to 10 days, three more consecutive
sputum cultures will be obtained. If theyre negative, he would be
considered non-contagious and may be sent home, although hell
continue to take the antitubercular drugs for 9 to 12 months.
18 D. Continuing to have acid-fast bacilli in the sputum after 2
months indicated continued infection.
19 C. The client with active TB is highly contagious until three
consecutive sputum cultures are negative, so hes put in
respiratory isolation in the hospital.
20 D. Oxygen toxicity causes direct pulmonary trauma, reducing the
amount of alveolar surface area available for gaseous exchange,
which results in increased carbon dioxide levels and decreased
oxygen uptake.
21 A. Because the client is short of breath, listening to breath
sounds is a good idea. He may need a chest x-ray and an ECG,
but a physician must order these tests. Unless a cardiac source
for the clients pain is identified, he wont need an
echocardiogram.
22 D. A spontaneous pneumothorax occurs when the clients lung
collapses, causing an acute decrease in the amount of functional
lung used in oxygenation. The sudden collapse was the cause of
his chest pain and shortness of breath. An asthma attack would
show wheezing breath sounds, and bronchitis would have
rhonchi. Pneumonia would have bronchial breath sounds over the
area of consolidation.
23 C. The only way to reexpand the lung is to place a chest tube on
the right side so the air in the pleural space can be removed and
the lung reexpanded.
24 C. A chest x-ray will show the area of collapsed lung if
pneumothorax is present as well as the volume of air in the

pleural space. Listening to breath sounds wont confirm a

diagnosis. An IS is used to encourage deep breathing. A needle
thoracostomy is done only in an emergency and only by
someone trained to do it.
25 C. The pulse oximeter determines the percentage of hemoglobin
carrying oxygen. This doesnt ensure that the oxygen being
carried through the bloodstream is actually being taken up by the
tissue.
26 C. Hemoglobin carries oxygen to all tissues in the body. If the
hemoglobin level is low, the amount of oxygen-carrying capacity
is also low. More hemoglobin will increase oxygen-carrying
capacity and thus increase the total amount of oxygen available
in the blood. If the client has been tachypneic during exertion, or
even at rest, because oxygen demand is higher than the
available oxygen content, then an increase in hemoglobin may
decrease the respiratory rate to normal levels.
27 D. Gaseous exchange occurs in the alveolar membrane, so if the
alveoli collapse, no exchange occurs, Collapsed alveoli receive
oxygen, as well as other nutrients, from the bloodstream.
Collapsed alveoli have no effect on oxygen demand, though by
decreasing the surface area available for gas exchange, they
decrease oxygenation of the blood.
28 C. The mask provides pressurized oxygen continuously through
both inspiration and expiration. The mask can be set to deliver
any amount of oxygen needed. By providing the client with
pressurized oxygen, the client has less resistance to overcome in
taking his next breath, making it easier to breathe. Pressurized
oxygen delivered at the end of expiration is positive endexpiratory pressure (PEEP), not continuous positive airway
pressure.
29 D. The pleural fluid normally seeps continually into the pleural
space from the capillaries lining the parietal pleura and is
reabsorbed by the visceral pleural capillaries and lymphatics.
Any condition that interferes with either the secretion or
drainage of this fluid will lead to a pleural effusion.
30 B. Performing thoracentesis is used to remove excess pleural
fluid. The fluid is then analyzed to determine if its transudative
or exudative. Transudates are substances that have passed
through a membrane and usually occur in low protein states.
Exudates are substances that have escaped from blood vessels.
They contain an accumulation of cells and have a high specific
gravity and a high lactate dehydrogenase level. Exudates usually
occur in response to a malignancy, infection, or inflammatory
process. A chest tube is rarely necessary because the amount of
fluid typically isnt large enough to warrant such a measure.
Pleural effusions cant drain by themselves.

31 A. If a client gags or coughs after nasopharyngeal airway

placement, the tube may be too long. The nurse should remove
it and insert a shorter one. Simply repositioning the airway wont
solve the problem. The client wont get used to the tube because
its the wrong size. Suctioning without a nasopharyngeal airway
causes trauma to the natural airway.
32 C. Intermittent suction should be applied during catheter
withdrawal. To prevent hypoxia, suctioning shouldnt last more
than 10-seconds at a time. Suction shouldnt be applied while the
catheter is being advanced.
33 D.
34 C. Intradermal injections like those used in TN skin tests are
administered in small volumes (usually 0.5 ml or less) into the
outer skin layers to produce a local effect. A TB syringe with a
to 3/8 26G or 27G needle should be inserted about 1/8 below
the epidermis.
35 D. Reduction in VC is a normal physiologic change in the older
adult. Other normal physiologic changes include decreased
elastic recoil of the lungs, fewer functional capillaries in the
alveoli, and an increase is residual volume.
36 D. Pneumonia is an acute infection of the lung parenchyma. The
inflammatory reaction may cause an outpouring of exudate into
the alveolar spaces, leading to an ineffective airway clearance
related to retained secretions.
37 B. One of the first pulmonary symptoms includes a slight cough
with the expectoration of mucoid sputum.
38 B. The therapeutic theophylline blood level range from 10-20
mcg/mL.
39 C. Isoniazid and rafampin are contraindicated in clients with
acute liver disease or a history of hepatic injury.
40 B. Carbon dioxide narcosis is a condition that results from
extreme hypercapnia, with carbon dioxide levels in excess of 70
mm Hg. The client experiences symptoms such as confusion and
tremors, which may progress to convulsions and possible coma.
41 A. The client with HIV+ status is considered to have positive
results on PPD skin test with an area greater than 5-mm of
induration. The client with HIV is immunosuppressed, making a
smaller area of induration positive for this type of client.
42 D. The client with TB usually experiences cough (non-productive
or productive), fatigue, anorexia, weight loss, dyspnea,
hemoptysis, chest discomfort or pain, chills and sweats (which
may occur at night), and a low-grade fever.
43 A. The nurse teaches the client with TB to increase intake of
protein, iron, and vitamin C.
44 A, C, E. A respiratory assessment, which includes auscultating
breath sounds and assessing the color of the nail beds, is a

priority for clients with pneumonia. Assessing for the presence of

chest pain is also an important respiratory assessment as chest
pain can interfere with the clients ability to breathe deeply.
Auscultating bowel sounds and assessing for peripheral edema
may be appropriate assessments, but these are not priority
assessments for the patient with pneumonia.
45 C. Frequent linen changes are appropriate for this client because
of diaphoresis. Diaphoresis produces general discomfort. The
client should be kept dry to promote comfort. Position changes
need to be done every 2 hours. Nasotracheal suctioning is not
indicated with the clients productive cough. Frequent offering of
a bedpan is not indicated by the data provided in this scenario.
46 D. A client with pneumonia has less lung surface available for the
diffusion of gases because of the inflammatory pulmonary
response that creates lung exudate and results in reduced
oxygenation of the blood. The client becomes cyanotic because
blood is not adequately oxygenated in the lungs before it enters
the peripheral circulation.
47 C. Clients who are experiencing hypoxia characteristically exhibit
irritability, restlessness, or anxiety as initial mental status
changes. As the hypoxia becomes more pronounced, the client
may become confused and combative. Coma is a late clinical
manifestation of hypoxia. Apathy and depression are not
symptoms of hypoxia.
48 D. A fluid intake of at least 3 L/day should be provided to replace
any fluid loss occurring as a result the fever and diaphoresis; this
is a high-priority intervention.
49 B. An expected outcome for a client recovering from pneumonia
would be the ability to perform ADLs without experiencing
dyspnea. A respiratory rate of 25 to 30 breaths/minute indicates
the client is experiencing tachypnea, which would not be
expected on recovery. A weight loss of 5-10 pounds is
undesirable; the expected outcome would be to maintain normal
weight. A client who is recovering from pneumonia should
experience decreased or no chest pain.
50 A. TB typically produces anorexia and weight loss. Other signs
and symptoms may include fatigue, low-grade fever, and night
sweats.
51 A. The most commonly used technique to identify tubercle bacilli
is acid-fast staining. The bacilli have a waxy surface, which
makes them difficult to stain in the lab. However, once they are
stained, the stain is resistant to removal, even with acids.
Therefore, tubercle bacilli are often called acid-fast bacilli.
52 A. Streptomycin is an aminoglycoside, and eight cranial nerve
damage (ototoxicity) is a common side effect from
amintoglycodsides.

53 A. The eighth cranial nerve is the vestibulocochlear nerve, which

is responsible for hearing and equilibrium. Streptomycin can
damage this nerve.
54 D. Elderly persons are believed to be at higher risk for
contracting TB because of decreased immunocompetence. Other
high-risk populations in the US include the urban poor, AIDS, and
minority groups.
55 B, D, E.
56 B. A positive PPD test indicates that the client has been exposed
to tubercle bacilli. Exposure does not necessarily mean that
active disease exists.
57 B. INH competes with the available vitamin B6 in the body and
leaves the client at risk for development of neuropathies related
to vitamin deficiency. Supplemental vitamin B6 is routinely
prescribed.
58 D. INH and rifampin are hepatoxic drugs. Clients should be
warned to limit intake of alcohol during drug therapy. Both drugs
should be taken on an empty stomach. If antacids are needed for
GI distress, they should be taken 1 hour before or 2 hours after
these drugs are administered. Clients should not double the
dosage of these drugs because of their potential toxicity. Clients
taking INH should avoid foods that are rich in tyramine, such as
cheese and dairy products, or they may develop hypertension.
59 A. Directly observed therapy (DOT) can be implemented with
clients who are not compliant with drug therapy. In DOT, a
responsible person, who may be a family member or a health
care provider, observes the client taking the medication. Visiting
the client, changing the prescription, or threatening the client will
not ensure compliance if the client will not or cannot follow the
prescribed treatment.
A.