Silvestri Chapter 48 Ed#56c

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48: The Respiratory System PRACTICE QUESTIONS 1. A nurse is assisting in planning care for a client scheduled for insertion of a tracheostomy. What equipment would the nurse plan to have at the bedside when the client returns from surgery? 1. Oral airway 2. Epinephrine 3. Obturator 4. Tracheostomy tube with the next larger size Answer: 3 Rationale: A replacement tracheostomy tube of the same size and an obturator is kept at the bedside at all times in case the tracheostomy tube is dislodged. Additionally, a curved hemostat that could be used to hold the trachea open if dislodgement occurs should also be kept at the bedside. An oral airway and epinephrine would not be needed. Test-Taking Strategy: Use the process of elimination. Eliminate option 4 first because a tracheostomy tube of the next larger size would not be appropriate for the client. Next, eliminate option 2 because it is unrelated to the issue of the question. From the remaining options, recall that the airway has been altered because of the tracheostomy, so an oral airway would not be necessary. Remember that a replacement tracheostomy tube, an obturator, and a curved hemostat should be kept at the bedside of a client with a tracheostomy. Review care of the client with a tracheostomy if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Respiratory Reference: Christensen, B., & Kockrow, E. (2003). Foundations of nursing (4th ed.). St. Louis: Mosby, p. 457. 2. A nursing instructor is observing a nursing student suctioning a client through a tracheostomy tube. The nursing instructor intervenes if the student performed which incorrect action? 1. Hyperventilating the client with 100% oxygen before suctioning 2. Using sterile technique to perform the procedure 3. Applying suction during insertion of the catheter 4. Applying suction during withdrawal of the catheter Answer: 3 Rationale: The client should be hyperoxygenated with 100% oxygen prior to suctioning and if tracheal secretions are thick and not easily removed. Sterile technique is always used. Suction is not applied during insertion of the catheter, and intermittent suction and a twirling motion of the catheter are used during withdrawal. Test-Taking Strategy: Use the process of elimination and note the key words, incorrect action. These words indicate a false response question and that you need to select the incorrect action. Visualize the procedure and think about the mechanical trauma that suctioning can cause to the

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tissues. This will direct you to option 3. Review this procedure if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory Reference: Christensen, B., & Kockrow, E. (2003). Foundations of nursing (4th ed.). St. Louis: Mosby, p. 457. 3. A nurse is caring for a client with an endotracheal tube attached to a ventilator. The highpressure alarm sounds on the ventilator. The nurse prepares to perform which nursing intervention? 1. Check for a disconnection. 2. Evaluate the tube cuff for a leak. 3. Notify the respiratory therapist. 4. Suction the client. Answer: 4 Rationale: When the high-pressure alarm sounds on a ventilator, it is most likely caused by an obstruction. The obstruction can be caused by the client biting on the tube, kinking of the tubing, or mucus plugging requiring suctioning. It is also important to check the tubing for the presence of any water and determine if the client is out of rhythm with breathing with the ventilator. A disconnection or a cuff leak can result in sounding of the low-pressure alarm. The respiratory therapist would be notified if the nurse could not determine the cause of the alarm. Test-Taking Strategy: Use the process of elimination. Note the key words, high-pressure alarm, in the question. Recalling that the high-pressure alarm indicates a possible obstruction will assist in directing you to the correct option. Review nursing interventions related to care of a client on a ventilator if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1887. 4. A nurse is preparing to obtain a sputum specimen from the client. Which nursing action will facilitate obtaining the specimen? 1. Limiting fluids 2. Having the client take three deep breaths 3. Asking the client to spit into the collection container 4. Asking the client to obtain the specimen after eating Answer: 2 Rationale: To obtain a sputum specimen, the client should brush his or her teeth to reduce mouth contamination. The client should then take three breaths and cough into a sputum specimen container. The client should be encouraged to cough and not spit so sputum can be obtained. Sputum can be thinned by fluids or by a respiratory treatment, such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.

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Test-Taking Strategy: Use the process of elimination. Option 1 can be eliminated first recalling that fluids assist in loosening or thinning secretions. Eliminate option 3 because of the word “spit.” Spit is very different from saliva. Next, eliminate option 4 because of the words “after eating.” Review this procedure if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 1020. 5. A nurse is caring for a client following a bronchoscopy and biopsy. Which sign if noted in the client should be reported immediately? 1. Blood-streaked sputum 2. Dry cough 3. Hematuria 4. Stridor Answer: 4 Rationale: If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood is indicative of hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which can include cyanosis, dyspnea, stridor, hemoptysis, hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure. Test-Taking Strategy: Use the process of elimination. Eliminate option 3 first, because it is unrelated to the procedure. Next, eliminate option 2 because a dry cough may be expected. Noting that a biopsy has been performed will assist in eliminating option 1 because blood streaked sputum would be expected. Note that option 4, the correct option, relates to airway. If you had difficulty with this question, review postprocedure care following bronchoscopy with biopsy. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory References: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 297. Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 196. 6. An emergency room nurse is caring for a client who sustained a blunt injury to the chest wall. Which sign if noted in the client would indicate the presence of a pneumothorax? 1. Bradypnea 2. Shortness of breath 3. A low respiratory rate 4. The presence of a barrel chest Answer: 2 Rationale: This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed

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pneumothorax are shortness of breath and chest pain. A larger pneumothorax may present with tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. There may also be hyperresonance on the affected side. Test-Taking Strategy: Use the process of elimination. Option 4 can be eliminated because a barrel chest is a characteristic finding in a client with chronic obstructive pulmonary disease. Next, eliminate options 1 and 3 because they are similar. Review the signs of pneumothorax if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 486. 7. A nurse is checking the respiratory status of a client who has suffered a fractured rib. The nurse would expect to note which of the following? 1. Pain, especially with inspiration 2. Slow, deep respirations 3. Rapid, deep respirations 4. Paradoxical respirations Answer: 1 Rationale: Rib fractures are a common injury, especially in the older client, and result from a blunt injury or a fall. Typical signs and symptoms include pain and tenderness that is localized at the fracture site and is exacerbated by inspiration and palpation; shallow respirations; splinting or guarding the chest protectively to minimize chest movement; and possible bruising at the fracture site. Paradoxical respirations are seen with flail chest. Test-Taking Strategy: Use the process of elimination. Focusing on the anatomical location of the injury will direct you to option 1. Review the findings in rib fractures, if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, pp. 1900-1901. 8. An oxygen delivery system is prescribed for a client with chronic airflow limitation (CAL) to deliver a precise oxygen concentration. Which type of oxygen delivery system would the nurse anticipate to be prescribed? 1. Venturi mask 2. Aerosol mask 3. Face tent 4. Tracheostomy collar Answer: 1 Rationale: The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with CAL because it delivers a precise oxygen

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concentration. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but are most often used to administer high humidity. Test-Taking Strategy: Use the process of elimination and note the key words, precise oxygen concentration. Eliminate options 2, 3, and 4 because they are similar in that they are used to provide high humidity. Review these types of oxygen delivery systems if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 470-471. 9. A nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following would the nurse expect to note in evaluating this client? 1. Increased oxygen saturation with exercise 2. Hypocapnia 3. A hyperinflated chest on x-ray 4. A widened diaphragm noted on chest x-ray Answer: 3 Rationale: Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray will reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced. Test-Taking Strategy: Use the process of elimination. Eliminate option 1 because oxygen desaturation rather than saturation would occur. Next, eliminate option 2 because in the client with COPD, hypercapnia would be noted. From the remaining options, reading carefully will assist in directing you to option 3. If you are unfamiliar with the manifestations associated with COPD, review this content. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). St. Louis: Mosby, p. 662. 10. A nurse is reinforcing instructions with a hospitalized client with a diagnosis of emphysema about positions that will enhance the effectiveness of breathing during dyspneic periods. Which position will the nurse instruct the client to assume? 1. Side-lying in bed 2. Sitting in a recliner chair 3. Sitting up in bed 4. Sitting on the side of the bed, leaning on an overbed table Answer: 4 Rationale: Positions that will assist the client with breathing include sitting up and leaning on an

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overbed table, sitting up and resting with the elbows on the knees, or standing or leaning against the wall. The positions in options 1, 2, and 3 will not enhance the effectiveness of breathing. Test-Taking Strategy: Use the process of elimination. Eliminate option 1 because side-lying will not promote appropriate lung expansion. Next, eliminate options 2 and 3 because they are similar. If you had difficulty with this question, review the positions that will decrease the work of breathing in a client with emphysema. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 502. 11. A nurse is gathering data on a client with a diagnosis of tuberculosis (TB). The nurse reviews the results of which diagnostic test that will confirm this diagnosis? 1. Bronchoscopy 2. Chest x-ray 3. Sputum culture 4. Tuberculin skin test Answer: 3 Rationale: A definitive diagnosis of TB is confirmed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made on the basis of a tuberculin skin test, a sputum smear that is positive for acid fast bacteria, a chest x-ray, and histologic evidence of granulomatous disease on biopsy. Test-Taking Strategy: Use the process of elimination and note the key word, confirm, in the stem of the question. Confirmation is made by identifying Mycobacterium tuberculosis. If you had difficulty with this question, review the diagnostic procedures related to TB. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 505. 12. A nursing instructor asks a nursing student to describe the route of transmission of tuberculosis (TB). The nursing instructor determines that the student understands this route of transmission if the student states that TB is transmitted by: 1. The airborne route 2. Blood and body fluids 3. The enteric route 4. Hand to mouth Answer: 1 Rationale: Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis and spread primarily by the airborne route. Options 2, 3, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Recalling that TB is a respiratory disease will direct you to option 1. If you had difficulty with this question, review the transmission of

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this disease. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506. 13. A nurse is caring for a client with emphysema who is receiving oxygen. The nurse checks the oxygen flow rate to ensure that it does not exceed: 1. 1 L/min 2. 2 L/min 3. 6 L/min 4. 10 L/min Answer: 2 Rationale: One to 3 L/min of oxygen by nasal cannula may be required to raise the PaO2 level to 60 to 80 mm Hg. However, oxygen is used cautiously in the client with emphysema and should not exceed 2 L/min. Because of the long-standing hypercapnia that occurs in this disorder, the respiratory drive is triggered by low oxygen levels rather than by increased carbon dioxide levels, which is the case in a normal respiratory system. Test-Taking Strategy: Recalling the physiology associated with emphysema is required to answer this question. If you are unfamiliar with this disorder, review this content. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 500. 14. A nurse is instructing a client about pursed lip breathing and the client asks the nurse about its purpose. The nurse tells the client that the primary purpose of pursed lip breathing is to: 1. Promote oxygen intake. 2. Strengthen the diaphragm. 3. Strengthen the intercostal muscles. 4. Promote carbon dioxide elimination. Answer: 4 Rationale: Pursed lip breathing facilitates maximal expiration for clients with obstructive lung disease and promote carbon dioxide elimination. This type of breathing allows better expiration by increasing airway pressure, which keeps air passages open during exhalation. Options 1, 2, and 3 are not the purposes of this type of breathing. Test-Taking Strategy: Use the process of elimination. Visualize the use of this breathing technique to assist in answering correctly. Recalling the respiratory conditions in which this type of breathing is helpful will also assist in directing you to option 4. Review the purpose of this breathing technique if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance

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Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1812. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 467. 15. The low-pressure alarm sounds on the ventilator. The nurse checks the client and then attempts to determine the cause of the alarm but is unsuccessful. Which initial action will the nurse take? 1. Check the client's vital signs. 2. Ventilate the client manually. 3. Administer oxygen. 4. Start cardiopulmonary resuscitation (CPR). Answer: 2 Rationale: If an alarm is sounding at any time and the nurse cannot quickly ascertain the problem, the client is disconnected from the ventilator and a manual resuscitation device is used to support respirations until the problem can be corrected. There is no reason to begin CPR. Checking vital signs is not the initial action. Although oxygen is helpful, it will not provide ventilation to the client. Test-Taking Strategy: Use the process of elimination. Read the question carefully and note that the issue relates to adequate ventilation of the client. Focusing on this issue will direct you to option 2. If you are unfamiliar with the management of a client on a ventilator, review this content. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1885. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, pp. 472-473. 16. A nurse is caring for a client who is on strict bed rest. The nurse assists in developing a plan of care and suggests goals related to the prevention of deep vein thrombosis (DVT) and pulmonary emboli. Which nursing action would be most helpful to prevent these disorders from developing? 1. Applying a heating pad to the lower extremities 2. Active range-of-motion (ROM) exercises 3. Placing a pillow under the knees 4. Restricting fluids Answer: 2 Rationale: Persons at greatest risk for pulmonary emboli are immobilized clients. Basic preventive measures include early ambulation, leg elevation, active leg exercises, elastic stockings, and intermittent pneumatic calf compression. Keeping the client well hydrated is essential because dehydration predisposes to clotting. A pillow under the knees may cause

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venous stasis. Heat should not be applied without a physician’s prescription. Test-Taking Strategy: Use the process of elimination and knowledge regarding preventive measures related to preventing DVT and pulmonary emboli to answer this question. Basic principles related to care of the immobile client will assist in directing you to option 2. If you are unfamiliar with these basic measures, review this content. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 489. 17. A nurse has taught a client about the use of a respiratory inhaler. Which statement by the client indicates a need for further teaching? 1. “I need to remove the cap and shake the inhaler well before use.” 2. “I need to press the canister down with my finger as I breath in.” 3. “I need to inhale the mist and quickly exhale.” 4. “I need to wait 1 minute between puffs if more than one puff has been prescribed.” Answer: 3 Rationale: The client should be instructed to hold his or her breath for at least 5 to 10 seconds before exhaling the mist. Options 1, 2, and 4 are accurate instructions regarding the use of the inhaler. Test-Taking Strategy: Use the process of elimination and note the key words, need for further teaching. These words indicate a false response question and that you need to select the incorrect client statement. Visualizing this procedure will direct you to option 3. If you are unfamiliar with the client teaching points related to the use of an inhaler, review this content. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 715. 18. A nurse is assigned to care for a client following a left pneumonectomy. The nurse would avoid positioning the client: 1. On the side 2. In a semi-Fowler’s 3. In a low-Fowler’s 4. With the head of the bed elevated 40 degrees Answer: 1 Rationale: Complete lateral positioning should be avoided following pneumonectomy. Because the mediastinum is no longer held in place on both sides by lung tissue, extreme turning may cause mediastinal shift and compression of the remaining lung. Test-Taking Strategy: Use the process of elimination and note the key word, avoid. This word indicates a false response question and that you need to select the incorrect position. Eliminate options 2, 3, and 4 because they are similar. If you had difficulty with this question, review care

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of the client following pneumonectomy. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 389. 19. A female client is scheduled to have a chest x-ray. Which question is most importance to ask the client during data collection? 1. “Is there any possibility that you could be pregnant?” 2. “Are you wearing any metal chains or jewelry?” 3. “Can you hold your breath easily?” 4. “Are you able to hold your arms above your head?” Answer: 1 Rationale: The most important question to ask is about the client’s pregnancy status, because pregnant women should not be exposed to radiation. Clients are also asked to remove any chains or metal objects that could interfere with obtaining an adequate film. A chest x-ray is most often done at full inspiration, which gives optimal lung expansion. If a lateral view of the chest is ordered, the client is asked to raise the arms above the head. Most films are taken in the posterior-anterior (PA) view. Test-Taking Strategy: Note the key words, most important. Recalling the teratogenic effects of radiation on the fetus will direct you to option 1. Review this procedure if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 360. 20. A nurse is caring for a client following pulmonary angiography via catheter insertion into the left groin. The nurse monitors for an allergic reaction to the contrast medium by noting the presence of: 1. Hematoma in the left groin 2. Discomfort in the left groin 3. Respiratory distress 4. Hypothermia Answer: 3 Rationale: Signs of allergic reaction to the contrast medium include localized itching and edema, respiratory distress, stridor, and decreased blood pressure. Hypothermia is an unrelated event. Discomfort is expected. Hematoma formation is a complication of the procedure, but does not indicate an allergic reaction. Test Taking Strategy: Use the ABCs—airway, breathing, and circulation—and focus on the issue, an allergic reaction. This will direct you to option 3. Review the signs of an allergic reaction to the contrast medium if you had difficulty with this question.

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Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 929. 21. A nurse is teaching the client with chronic respiratory failure how to use a metered-dose inhaler correctly. The nurse instructs the client to: 1. Inhale through the nose. 2. Inhale quickly. 3. Take two inhalations during one breath. 4. Hold the breath after inhalation. Answer: 4 Rationale: Instructions for using a metered-dose inhaler include shake the canister, hold it rightside up, inhale slowly and evenly through the mouth, deliver one spray per breath, and hold the breath after inhalation. Test Taking Strategy: Specific knowledge regarding the use of an inhaler is required to answer this question. Visualizing this procedure will direct you to option 4. Review this procedure if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 715. 22. A nurse is caring for a client who is suspected of having lung cancer. The nurse monitors the client for which most frequent early sign of lung cancer? 1. Blood-streaked sputum 2. Cough 3. Wheezing 4. Pleuritic pain Answer: 2 Rationale: Cough is the most frequent early symptom of lung cancer, which begins as nonproductive and hacking and progresses to productive. In the smoker who already has a cough, a change in the character and frequency of the cough usually occurs. Wheezing and blood-streaked sputum are later signs. Pain is a very late sign and is usually pleuritic in nature. Test Taking Strategy: Use the process of elimination and note the key word, early. Focusing on the client’s diagnosis, lung cancer, will direct you to option 2. Review the early signs of lung cancer if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory References: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis:

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Mosby, p. 388. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 508. 23. A client who has had a radical neck dissection begins to hemorrhage at the incision site. Which action by the nurse would be contraindicated? 1. Lowering the head of the bed to a flat position 2. Applying manual pressure over the site 3. Monitoring the client’s airway 4. Calling the physician immediately Answer: 1 Rationale: If the client begins to hemorrhage from the surgical site following radical neck dissection, the nurse elevates the head of the bed to maintain airway patency and prevent aspiration. The nurse applies pressure over the bleeding site, and calls the physician immediately. Test Taking Strategy: Use the process of elimination and note the key word, contraindicated. This word indicates a false response question and that you need to select the incorrect action. Option 1 would not maintain airway patency. Review care of the client following radical neck dissection if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 366. 24. A nurse is reinforcing discharge instructions to the client with pulmonary sarcoidosis. The nurse determines that the client understands the information if the client verbalizes to report which early sign of exacerbation? 1. Fever 2. Weight loss 3. Fatigue 4. Shortness of breath Answer: 4 Rationale: Dry cough and dyspnea are typical signs and symptoms of pulmonary sarcoidosis. Others include chest pain, hemoptysis, and pneumothorax. Systemic signs and symptoms include weakness and fatigue, malaise, fever, and weight loss. Test Taking Strategy: Note the key word, early, in the stem of the question. Because sarcoidosis is a pulmonary problem, eliminate options 1 and 2 first. Choose option 4 over option 3, because the shortness of breath (and impaired ventilation) appears first, and would cause the fatigue as a secondary symptom. Review this disorder if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for

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positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1871. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 507. 25. A nurse working on a respiratory nursing unit is caring for several clients with respiratory disorders. The nurse would identify which of the following clients as being at the least risk for developing infection with tuberculosis? 1. A woman newly immigrated from Korea 2. An uninsured man who is homeless 3. An older woman admitted from a long-term care facility 4. A man who is an inspector for the United States Postal Service Answer: 4 Rationale: People at high risk for acquiring tuberculosis include immigrants from Asia, Africa, Latin America, and Oceania; medically underserved populations (ethnic minorities, homeless); those with human immunodeficiency virus or other immunosuppressive disorders; residents in group settings (long-term care, correctional facilities); and health care workers. Test-Taking Strategy: Use the process of elimination and note the key words, least risk. Begin to answer this question by eliminating options 1 and 2, because immigrants and the medically underserved are more frequently affected by this infection. From the remaining options, note that the postal inspector may or may not come in contact with many people, depending on job description. The client from the long-term care facility, however, lives in a group setting, where a large number of people share a common environment 24 hours a day. Review the risks associated with TB if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, pp. 1844-1845. Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 373. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 504. 26. A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1 mm area of ecchymosis. The nurse interprets that the result is: 1. Positive 2. Negative 3. Uncertain 4. Borderline Answer: 2 Rationale: A positive Mantoux reading has an induration measuring 15 mm or more in diameter in low-risk individuals. A small area of ecchymosis is insignificant and is probably related to injection technique. Test-Taking Strategy: To answer this question accurately, it is necessary to know that induration is necessary for a positive response. Because the client in this question has no induration, the

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result is negative. Review Mantoux skin test results if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1846. Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 766. 27. A nurse reads a client’s Mantoux skin test as positive. The nurse notes that previous tests were negative. The client becomes upset and asks the nurse what this means. The nurse’s response is based on the understanding that the client has: 1. No evidence of tuberculosis 2. Systemic tuberculosis 3. Pulmonary tuberculosis 4. Exposure to tuberculosis Answer: 4 Rationale: A client who tests positive on a Mantoux skin test has either been exposed to tuberculosis or has inactive (dormant) tuberculosis. The client must then tested by chest x-ray and sputum culture to confirm the diagnosis. Test-Taking Strategy: Use the process of elimination, eliminating options 2 and 3 first, because they are similar; both indicate the presence of TB. In selecting between options 1 and 4, review the question, noting that the Mantoux skin test is positive. From this information, it is best to eliminate option 1. Review this test if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, p. 766. 28. A nurse is caring for a client who had a Mantoux skin test implantation 48 hours ago on admission to the nursing unit and reads the result of the skin test as positive. Which action by the nurse is the priority? 1. Report the findings. 2. Call the radiology department for a chest x-ray. 3. Document the finding in the client’s record. 4. Call the employee health service department. Answer: 1 Rationale: The nurse who interprets a Mantoux test as positive notifies the physician immediately. The physician would order a chest x-ray to determine whether the client has clinically active tuberculosis (TB) or old, healed lesions. A sputum culture would be done to confirm the diagnosis of active TB. The client is placed on TB precautions prophylactically until a final diagnosis is made. The findings are documented in the client’s record but this action is not the highest priority. Calling the employee health service would be of no benefit to the client.

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Test-Taking Strategy: Use the process of elimination and note the key word, priority. Because the nurse may not order diagnostic tests, eliminate option 2 first. Similarly, option 4 can be eliminated, because calling the employee health service is of no benefit to the client. From the remaining options, notifying the physician should have a higher priority than the documentation, even though they may both be done in the same narrow time period. Review nursing interventions related to Mantoux testing if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Pagana, K., & Pagana, T. (2003). Mosby’s diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby, p. 895. 29. A nurse is caring for a client with tuberculosis who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse would incorporate which of the following as the best strategy to assist the client in coping with the disease? 1. Encourage the client to visit with the pastoral care department chaplain. 2. Ask family members if they wish a psychiatric consult. 3. Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease. 4. Allow the client to deal with the disease in an individual fashion. Answer: 3 Rationale: A primary role of the nurse in working with the client with tuberculosis is to teach the client about medication therapy. The anxious client may not absorb information optimally. The nurse continues to reinforce teaching using a variety of methods (repetition, teaching aids) and teaches the family about the medications as well. The most effective way of coping with the disease is to learn about the therapy, which will eradicate it. This gives the client a measure of power over the situation and outcome. Test-Taking Strategy: Use the process of elimination. The question asks for the best strategy for coping with anxiety about the disease and its prognosis. Options 2 and 4 are the least useful options and may be eliminated first. Option 2 does not involve the client, and option 4 gives no active assistance to the client. To choose from the remaining options, recall that TB is a controllable disease and not necessarily a fatal one. Review the psychosocial issues related to TB if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506. 30. A nurse has instructed a client diagnosed with tuberculosis (TB) about how to prevent the spread of infection after discharge. The nurse determines that the client needs further reinforcement of information if the client makes which of the following statements? 1. “It’s very important to wash my hands after I touch my mask, tissues, or body fluids.” 2. “I should cough into tissues and throw them away carefully.”

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3. “It’s important to cover my mouth if I laugh, sneeze, or cough.” 4. “I should use disposable plates, forks, and knives.” Answer: 4 Rationale: Because tuberculosis is transmitted by droplets, it cannot be carried on clothing, eating utensils, or other possessions. It is important to perform proper hand washing after contact with body substances, tissues, or face masks. The client should cover the mouth with a tissue when laughing, coughing, or sneezing, and dispose of tissues the carefully. Test-Taking Strategy: Note the key words, needs further reinforcement of information. These words indicate a false response question and that you need to select the incorrect client statement. Recall that TB is an airborne disease and that organisms cannot be carried on inanimate objects. This will direct you to option 4. Review client teaching points related to the prevention of the spread of TB if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Evaluation Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506. 31. A nurse is caring for the client diagnosed with tuberculosis (TB). Which of the following findings, if made by the nurse, would be inconsistent with the usual clinical presentation of tuberculosis? 1. Nonproductive or productive cough 2. Anorexia and weight loss 3. Chills and night sweats 4. High-grade fever Answer: 4 Rationale: The client with tuberculosis usually experiences cough (either productive or nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweating (which may occur at night), and a low-grade fever. Test-Taking Strategy: Note the key word, inconsistent. Options 1 and 2 can be eliminated first because they are symptoms that are common in the client with TB. From the remaining options, you need to know either that the client may get night sweats or that the fever is low grade. Review the clinical manifestations associated with TB if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 505. 32. A client being discharged from the hospital to home with a diagnosis of tuberculosis (TB) is worried about the possibility of infecting the family and others. The nurse determines that the client would get the most reassurance from the knowledge that: 1. The family does not need therapy, and the client will not be contagious after 1 month of medication therapy.

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2. The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of medication therapy. 3. The family will receive prophylactic therapy, and the client will not be contagious after 1 continuous week of medication therapy. 4. The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy. Answer: 4 Rationale: Family members or others who have been in close contact with a client diagnosed with TB are placed on prophylactic therapy with isoniazid (INH) for 6 to 12 months. The client is usually not contagious after taking medication for 2 to 3 consecutive weeks. However, the client must take the full course of therapy (for 6 months or longer) to prevent reinfection or drug resistant TB. Test-Taking Strategy: Use the process of elimination. Recalling that the family requires prophylactic therapy allows you to eliminate options 1 and 2. From the remaining options, it is necessary to know that the client is not contagious after 2 to 3 weeks of therapy. Review the concepts related to the prevention of the spread of TB if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Planning Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 505. 33. A client diagnosed with tuberculosis (TB) is distressed over the loss of physical stamina and fatigue. The nurse plans to tell the client that this is: 1. A short-lived problem, which should be gone within 1 week of medication therapy 2. An unexpected finding with TB, but it should resolve within about 1 month 3. Expected, and the client should very gradually increase activity as tolerated 4. Expected, and will last for at least a year Answer: 3 Rationale: The client with TB has significant fatigue and loss of physical stamina. This can be very frightening for the client. The nurse teaches the client that this will resolve as the therapy progresses, and that the client should gradually increase activity as energy levels permit. Test-Taking Strategy: Use the process of elimination. A helpful concept to remember in answering this question is that fatigue caused by respiratory problems may not resolve easily, and is an expected occurrence, because of tissue hypoxia. Knowing this, you can eliminate options 1 and 2 first. Choose between options 3 and 4 in this way: because the client has been on medication therapy for 6 to 9 months, or even up to 12 months, it is not reasonable that the fatigue would last for “at least a year.” This will direct you to option 3. Review the manifestations associated with TB if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506.

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34. A nurse is teaching a client with tuberculosis (TB) about dietary elements that should be increased in the diet. The nurse suggests that the client increase the intake of: 1. Meats and citrus fruits 2. Grains and broccoli 3. Eggs and spinach 4. Potatoes and fish Answer: 1 Rationale: The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C. Foods rich in vitamin C include citrus fruits, berries, melons, pineapple, broccoli, cabbage, green peppers, tomatoes, potatoes, chard, kale, asparagus, and turnip greens. Food sources that are rich in iron include liver and other meats, from which 10% to 30% of available iron is absorbed. Less than 10% of iron is absorbed from eggs and less than 5% is absorbed from grains and vegetables. Test-Taking Strategy: To answer correctly, you must recall that the diet in TB should be high in protein, vitamin C, and calories. Recalling which types of foods contain these various nutrients will direct you to option 1. If you had difficulty with this question, review these nutritional concepts. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506. 35. A nurse has reinforced discharge teaching with a client who was diagnosed with tuberculosis (TB) and has been on medication for 1½ weeks. The nurse determines that the client has understood the information if the client makes which statement? 1. “I need to continue medication therapy for 2 months.” 2. “I should not be contagious after 2 to 3 weeks of medication therapy.” 3. “I can’t shop at the mall for the next 6 months.” 4. “I can return to work if a sputum culture comes back negative.” Answer: 2 Rationale: The client is continued on medication therapy for 6 to 12 months, depending on the situation. The client is generally considered to be not contagious after 2 to 3 weeks of medication therapy. The client is instructed to wear a mask if there will be exposure to crowds, until the medication is effective in preventing transmission. The client is allowed to return to employment when the results of three sputum cultures are negative. Test-Taking Strategy: Use the process of elimination. Knowing that the medication therapy lasts for at least 6 months helps you eliminate option 1 first. Knowing that three sputum cultures must be negative helps you eliminate option 4 next. From the remaining options, recalling that the client is not contagious after 2 to 3 weeks of therapy helps you choose option 2. If you had difficulty with this question, review the infectious period of TB. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation

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Content Area: Adult Health/Respiratory References: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, p. 375. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 505. 36. A client with tuberculosis asks a nurse about precautions to take after discharge from the hospital to prevent infection of others. The nurse develops a response to the client’s question based on the understanding that: 1. The client should maintain enteric precautions only. 2. The disease is transmitted by droplet nuclei. 3. Clothing and sheets should be bleached after each use. 4. Deep pile carpet should be removed from the home. Answer: 2 Rationale: Tuberculosis is spread by droplet nuclei or the airborne route. The disease is not carried on objects such as clothing, eating utensils, linens, or furniture. Bleaching of clothing and linens is unnecessary, although the client and family members should use good hand washing technique. It is unnecessary to remove carpeting from the home. Test-Taking Strategy: Use the process of elimination. Knowing that TB is not carried on inanimate objects helps you eliminate options 3 and 4 first. From the remaining options, recalling that the disease is transmitted by the airborne route will direct you to option 2. If you had difficulty with this question, review the transmission mode of TB. Level of Cognitive Ability: Comprehension Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Adult Health/Respiratory Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506. 37. A nurse is preparing to give a bed bath to the immobilized client with tuberculosis (TB). The nurse should plan to wear which of the following items when performing this care? 1. Particulate respirator, gown, and gloves 2. Particulate respirator and protective eye wear 3. Surgical mask and gloves 4. Surgical mask, gown, and protective eye wear Answer: 1 Rationale: The nurse who is in contact with a client with TB should wear an individually fitted particulate respirator. The nurse would also wear gloves as per standard precautions. The nurse wears a gown whenever there is a possibility that the clothing could become contaminated, such as when giving a bed bath. Test-Taking Strategy: Use the process of elimination. Knowing that the nurse should wear a particulate respirator mask helps you eliminate options 3 and 4 first. Recalling standard precautions helps you choose option 1 over option 2. Review care of the client with TB if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment

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Integrated Process: Nursing Process/Planning Content Area: Adult Health/Respiratory References: Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby, pp. 240-241, 375. Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506. 38. A client with tuberculosis (TB), whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. The nurse replies that the client may resume employment when: 1. Three sputum cultures are negative. 2. Five sputum cultures are negative. 3. A sputum culture and a chest x-ray are negative. 4. A sputum culture and a Mantoux test are negative. Answer: 1 Rationale: The client must have sputum cultures tested every 2 to 4 weeks after initiation of antituberculosis medication therapy. The client may return to work when the results of three sputum cultures are negative, because the client is considered noninfectious at that point. The Mantoux test will not revert to negative once it is positive. The chest x-ray may or may not be negative. Test-Taking Strategy: Use the process of elimination. Knowing that a positive Mantoux test result never reverts to negative helps you eliminate option 4. To discriminate among the remaining options, it is necessary to know that three negative sputum cultures are required. If this question was difficult, review these concepts. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Adult Health/Respiratory Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1846. 39. A client with acquired immunodeficiency syndrome (AIDS) has histoplasmosis. A nurse checks the client for which of the following signs and symptoms? 1. Weight gain 2. Dyspnea 3. Hypothermia 4. Headache Answer: 2 Rationale: Histoplasmosis is an opportunistic fungal infection that can occur in the client with AIDS. The infection begins as a respiratory infection and can progress to disseminated infection. Typical signs and symptoms include fever, dyspnea, cough, and weight loss. There may be enlargement of the client's lymph nodes, liver, and spleen as well. Test-Taking Strategy: Use the process of elimination. Recalling that histoplasmosis is an infectious process helps you eliminate option 3. Because the client has AIDS as well as another infection, weight gain is an unlikely symptom and can be eliminated next. Knowing that histoplasmosis begins as a respiratory infection helps you choose dyspnea over headache as the

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correct option. Review the signs of histoplasmosis if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Ignatavicius, D., & Workman, M. (2006). Medical surgical nursing: Critical thinking for collaborative care (5th ed.). Philadelphia: W.B. Saunders, pp.1851, 2391. 40. A nurse is taking the nursing history of a client with silicosis. The nurse checks whether the client wears which of the following items during periods of exposure to silica particles? 1. Mask 2. Gown 3. Gloves 4. Eye protection Answer: 1 Rationale: Silicosis results from chronic, excessive inhalation of particles of free crystalline silica dust. The client should wear a mask to limit inhalation of this substance, which can cause restrictive lung disease after years of exposure. Options 2, 3, and 4 are not necessary. Test-Taking Strategy: Use the process of elimination. Recalling that exposure to silica dust causes the illness and that the dust is inhaled into the respiratory tract will direct you to option 1. If you had difficulty with this question, review the protective measures associated with silicosis. Level of Cognitive Ability: Analysis Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Data Collection Content Area: Adult Health/Respiratory Reference: Phipps, W., Monahan, F., Sands, J., Marek, J. & Neighbors, M. (2003). Medicalsurgical nursing: Health and illness perspectives (7th ed.). St. Louis: Mosby, p. 547. 41. The nurse is preparing a list of home care instructions for the client who has been hospitalized and treated for tuberculosis. Select the instructions that the nurse will include on the list. ____Avoid contact with other individuals, except family members, for at least 6 months. ____Activities should be resumed gradually. ____Consume a well-balanced diet and foods rich in iron, protein, and vitamin C. ____Respiratory isolation is not necessary because family members have already been exposed. ____Cover the mouth and nose when coughing or sneezing and confine used tissues to plastic bags. ____A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. ____When one sputum cultures is negative, the client is no longer considered infectious and can usually return to his or her former employment. Answers: Activities should be resumed gradually. Consume a well-balanced diet and foods rich in iron, protein, and vitamin C. Respiratory isolation is not necessary because family members have already been exposed. Cover the mouth and nose when coughing or sneezing and confine used tissues to plastic bags. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated.

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Rationale: The nurse should provide the client and family with information about tuberculosis and allay concerns about the contagious aspect of the infection. Instruct the client to follow the medication regimen exactly as prescribed and always to have a supply of the medication on hand. Advise the client of the side effects of the medication and ways of minimizing them to ensure compliance. Reassure the client that, after 2 to 3 weeks of medication therapy, it is unlikely that the client will infect anyone. Inform the client that activities should be resumed gradually and about the need for adequate nutrition and a well-balanced diet that is rich in iron, protein, and vitamin C to promote healing and prevent recurrence of infection. Inform the client and family that respiratory isolation is not necessary, because family members have already been exposed. Instruct the client about thorough hand washing and to cover the mouth and nose when coughing or sneezing and confine used tissues to plastic bags. Inform the client that a sputum culture is needed every 2 to 4 weeks once medication therapy is initiated and, when the results of three sputum cultures are negative, the client is no longer considered infectious and can usually return to his or her former employment. Test-Taking Strategy: Knowledge regarding the pathophysiology, transmission, and treatment of tuberculosis is needed to answer this question. Review home care instructions for the client with tuberculosis if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Adult Health/Respiratory Reference: Ignatavicius, D., & Workman, M. (2006). Medical surgical nursing: Critical thinking for collaborative care (5th ed.). Philadelphia: W.B. Saunders, pp. 644-645.