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WorksheetsExam 2 (MedSurg) Lower Respiratory Problems
Total questions: 125
Worksheet time: 1hrs 6mins
What is the most common cause of acute bronchitis?
Bacteria
Viruses
Fungi
Parasites
Which of the following is the most common symptom of acute bronchitis?
Fever
Cough
Chest pain
Headache
Acute bronchitis may last as long as ____ weeks.
3
1
6
10
SATA: Which breath sounds are associated with the diagnosis of acute bronchitis?
A) Crackles
B) Stridor
C) Bruits
D) Rhonchi
E) Wheezes
What is the goal of treatment for acute bronchitis?
Symptom relief, prevention of pneumonia, and supportive care
Immediate use of antibiotics for all cases
Surgical intervention to remove infected tissue
Long-term steroid therapy
Bordetella pertussis is a ________ bacteria that attaches to cilia and releases toxins that result in inflammation.
gram negative
gram positive
acid-fast
spore-forming
Pertussis is also known as ________ cough.
whooping
dry
chronic
smoker's
Immunity from DPT (Diphtheria, Pertussis, Tetanus) vaccine decreases over time.
True
False
Stage 1 of pertussis lasts for how many weeks?
1-2 weeks
3-4 weeks
4-6 weeks
6-8 weeks
Which stage of pertussis is characterized by paroxysms (sudden violent attacks) of cough?
Stage 2
Stage 1
Stage 3
Stage 4
The whoop sound in pertussis is from air against obstructed ______.
glottis
trachea
esophagus
bronchioles
Which diagnostic methods are used for pertussis?
H/P, nasopharyngeal cultures, PCR of nasopharyngeal secretions, serology testing
Chest X-ray, sputum analysis, urine culture, skin prick test
Blood pressure measurement, ECG, liver function tests, allergy panel
Stool examination, abdominal ultrasound, CT scan, bone marrow biopsy
Which class of antibiotics is considered the first-line treatment for pertussis?
Macrolides
Penicillins
Tetracyclines
Cephalosporins
Cough suppressants and antihistamines cause coughing in pertussis and make it worse.
True
False
What is the definition of pneumonia?
Acute infection of lung parenchyma
Chronic inflammation of the bronchi
Obstruction of the upper airway
Accumulation of fluid in the pleural space
Fill in the blank: Normal defense mechanisms of the respiratory system include air filtration, epiglottis over trachea, cough reflex, mucociliary escalator, and reflex bronchoconstriction, as well as the immune components ___, ___, and alveolar macrophages.
IgA, IgG
IgM, IgE
IgD, IgM
IgE, IgD
Fill in the blank: One way organisms reach the lungs is by ___ of normal flora from nasopharynx or oropharynx.
aspiration
diffusion
exhalation
filtration
Fill in the blank: Hematogenous spread from ___ elsewhere in the body is a way for pathogens to reach the lungs.
primary infection
secondary infection
chronic inflammation
allergic reaction
Fill in the blank: CAP (Community-acquired pneumonia) is defined as an acute infection in patients who have NOT been hospitalized or resided in long-term care facility within ___ days of onset of s/s.
14
7
30
21
What is HAP also known as?
Community-acquired pneumonia
Nosocomial pneumonia
Viral pneumonia
Aspiration pneumonia
True HAP occurs 48 hours or longer AFTER hospitalization and is NOT PRESENT at time of admission.
True
False
Ventilator-associated pneumonia (VAP) occurs more than 48 hours after _______.
endotracheal intubation
extubation
tracheostomy removal
oxygen therapy
Both HAP and VAP are associated with:
Shorter hospital stays
Increased costs
Healthier patients
Decreased mortality
When should empiric antibiotic therapy for pneumonia be started?
After definitive diagnosis
Before definitive diagnosis
Only if symptoms worsen
After discharge
Which type of pneumonia is most common and may be mild or life-threatening?
Bacterial
Viral
Mycoplasma
Aspiration
Mycoplasma pneumonia is atypical, mild, and occurs in persons less than ______ years of age.
40
20
60
10
Abnormal entry of oral or gastric material into the lower airway leads to which type of pneumonia?
Viral
Aspiration
Bacterial
Necrotizing
Primary ______ infection is most common in aspiration pneumonia.
bacterial
viral
fungal
parasitic
What is a possible complication of bacterial lung infection that often happens with CPAP?
Necrotizing Pneumonia
Aspiration Pneumonia
Opportunistic Pneumonia
Pneumocystis jiroveci pneumonia
Which organisms are common causes of necrotizing pneumonia?
A) Staphylococcus, Klebsiella, Streptococcus
B) E. coli, Pseudomonas, Legionella
C) Mycoplasma, Chlamydia, Influenza
D) Candida, Aspergillus, Histoplasma
Fill in the blank: Signs and symptoms of necrotizing pneumonia include respiratory insufficiency/failure, leukocytosis, and abnormalities on ________.
chest imaging
blood pressure monitoring
urinalysis
electrocardiogram
What is the treatment for necrotizing pneumonia?
Short-term antivirals
Long-term antibiotics
Long-term antifungals
Fixed-course of steroids
Which of the following is NOT a risk factor for opportunistic pneumonia?
Severe protein-calorie malnutrition
Immunodeficiencies
Chemotherapy
Iron-deficiency anemia
Opportunistic pneumonia can be caused by bacteria, virus, or microorganisms that do not normally cause disease.
True
False
Pneumocystis jiroveci pneumonia (PJP) is most common in which group of patients?
HIV patients
Diabetic patients
Pediatric patients
Elderly patients
Chemotherapy patients
Fill in the blank: The chest x-ray of a patient with Pneumocystis jiroveci pneumonia (PJP) shows diffuse bilateral infiltrates to massive ________.
consolidation
effusion
calcification
atelectasis
What is the FIRST LINE treatment for Pneumocystis jiroveci pneumonia (PJP)?
Nystatin, ketoconazole
Trimethoprim, sulfamethoxazole
Amphotericin B, miconazole
Fluconazole, terbinafine
Pneumocystis jiroveci pneumonia (PJP) is a fungal form of pneumonia. Therefore, it will respond to most antifungals.
True
False
Cytomegalovirus pneumonia (CMV) is caused by which virus?
Herpes virus
Influenza virus
Adenovirus
Rhinovirus
What is the most important life-threatening complication after hematopoietic stem cell transplants?
CMV pneumonia
Necrotizing pneumonia
Aspiration pneumonia
Mycoplasma pneumonia
What is the treatment for Cytomegalovirus pneumonia (CMV)?
Antivirals and high dose immunoglobulin
Antibiotics and corticosteroids
Antifungals and bronchodilators
Supportive care only
Atelectasis is defined as:
Absence of gas or air in one or more areas of the lung
Inflammation of the pleura
Accumulation of fluid in the alveoli
Constriction of the bronchial tubes
SATA: Atelectasis may present with which severe symptoms?
Extreme SOB
Intense headache with dizziness
Skin rash and itching
Frequent urination
Pleuritic chest pain
SATA: Consolidation in the lungs means alveoli become filled with what?
Water
Pleural Fluid
Debris
Mucus
Blood
Consolidation is typical with which type of pneumonia?
Viral
Bacterial
Fungal
Aspiration
Consolidation can obstruct airflow, impair gas exchange, and cause significant respiratory insufficiency.
True
False
Which of the following is NOT a manifestation of pneumonia?
Cough
Green, yellow, or rust colored sputum
Fever
Hypertension
Geriatric patients with pneumonia may present with which symptoms?
Confusion, stupor, hyperthermia, diaphoresis, anorexia, fatigue, myalgias, headache
Chest pain, hematuria, jaundice, pruritus
Polyuria, polydipsia, weight gain, insomnia
Rash, joint swelling, visual disturbances, tinnitus
What physical exam finding is described in pneumonia?
Fine or coarse crackles over affected region
Hyperresonance over affected region
Absent breath sounds over unaffected region
Wheezing only on expiration
SATA: Which physical exam findings are associated with consolidation in pneumonia?
Bronchial breath sounds
Dullness to percussion
Fine crackles
Egophony
Increased fremitus
What physical exam finding is associated with pleural effusion in pneumonia?
Dullness to percussion over affected area
Hyperresonance to percussion over affected area
Increased tactile fremitus over affected area
Bronchial breath sounds over affected area
Which of the following is NOT a risk factor for MDR pathogens in pneumonia?
A) Old age
B) Immunosuppression
C) Short-term antibiotic use
D) Prolonged mechanical ventilation
Why are antibiotic susceptibility tests vital in pneumonia treatment?
To determine the most effective antibiotic for MDR pathogens
To identify the type of pneumonia virus
To measure lung capacity
To check for allergic reactions to antibiotics
MDR pathogens increase mortality from pneumonia.
True
False
What is pleurisy?
Inflammation of pleura
Inflammation of pericardium
Inflammation of alveoli
Inflammation of bronchi
What is pleural effusion?
Liquid in pleural space
Air in pleural space
Solid mass in pleural space
Gas in pleural space
What is bacteremia?
Bacterial infection in the blood
Bacterial infection in the lung parenchyma
Bacterial infection in the urine
Bacterial infection in the pleural fluid
What happens in pneumothorax related to pneumonia?
Lungs collapse from air in the pleural space
Lungs fill with fluid from the pleural space
Lungs expand due to excess oxygen
Lungs become inflamed due to bacteria
What is the leading cause of death in severe pneumonia?
ARF: ineffective O2 and CO2 exchange
Septic shock: overwhelming infection
Pulmonary embolism: blood clot in lungs
Cardiac arrhythmia: irregular heartbeat
Sepsis in pneumonia occurs when bacteria in alveoli enter the bloodstream. What can this lead to?
Shock and MODS
Pulmonary embolism
Asthma exacerbation
Chronic bronchitis
SATA: Which diagnostic tests are ideally performed before antibiotics are started in pneumonia?
Sputum gram stain
Blood cultures
ESWL
Sputum cultures
IVP
Fill in the blank: Response to pneumonia therapy generally occurs within ____ to ____ hours.
48 to 72
12 to 24
96 to 120
6 to 12
Fill in the blank: Abnormal physical findings in pneumonia can last over a _____, even after treatment.
week
day
month
hour
There is a current definitive treatment for viral pneumonia.
True
False
Fill in the blank: Supportive care for viral pneumonia generally resolves in ____ to ____ days.
3-4
7-10
1-2
10-14
Fill in the blank: Nutrition therapy for pneumonia includes small, frequent, _____ calorie, nutritious meals.
HIGH
LOW
MEDIUM
ZERO
Fill in the blank: In respiratory objective data, the use of ________ muscles is a sign of distress.
accessory
skeletal
smooth
cardiac
Decreased LOC is a major risk factor for which type of pneumonia?
Viral pneumonia
Aspiration pneumonia
Necrotizing pneumonia
Mycoplasma pneumonia
Pneumocystis jiroveci pneumonia can spread to organs other than the lungs.
True
False
How often should pneumonia patients receive CHG oral care?
Once per day
Twice per day
Once per week
Every other day shift
Tuberculosis only affects the lungs.
True
False
What is the leading cause of mortality in HIV patients?
Tuberculosis
Necrotizing pneumonia
Aspiration pneumonia
Pneumocystis jiroveci pneumonia
Tuberculosis is a gram-______, ______ bacteria.
positive, anaerobic
negative, anaerobic
positive, aerobic
negative, aerobic
Mycobacteria tuberculosis is an acid-fast bacillus.
True
False
A patient with active tuberculosis would be placed on _______ precautions.
universal
contact
droplet
airborne
How long can droplets of TB be suspended in the air?
seconds to minutes
minutes to hours
hours to days
days to weeks
Tuberculosis is most commonly spread by touching, kissing, and sharing food utensils.
True
False
Once inhaled, where will the droplets of TB lodge?
esophagus and trachea
superior vena cava and aorta
mucous membranes and epiglottis
bronchioles and alveoli
The hallmark diagnostic finding of TB is the:
Goblin lesion
Ghon lesion
Ghrelin lesion
Goober lesion
What is a Ghon lesion?
a calcified TB granuloma
a serous fluid mass of TB droplets
ischemic dead tissue destroyed by TB
a precursor to imminent pneumothorax caused by TB
A Ghon lesion is the immune system's attempt at a defense mechanism against TB.
True
False
What percentage of persons with dormant TB will develop active TB?
50-60%
15-20%
5-10%
1-2%
SATA: Select all of the qualities of M. tuberculosis.
aerophilic
aerophobic
can spread via the bloodstream
can spread via the lymphatic system
can grow in other organs besides the lungs
Multi-drug resistant TB or MDR-TB, is resistant to two first-line treatments of TB therapy, which are:
penicillin and keflex
ceftriaxone and nystatin
isoniazid and rifampin
riboflavin and cefepime
Extremely drug-resistant TB, or XDR-TB, is resistant to any ______ and at least __ second-line drug(s).
cephalosporin, 2
macrolide, 4
fluoroquinolone, 1
penicillin, 3
Most people have an effective immune response when exposed to primary TB droplets.
True
False
A patient with reactivated TB is considered infectious if the site of TB infection is:
esophageal or renal
laryngeal or pulmonary
pulmonary or cardiovascular
laryngeal or integumentary
Persons with latent TB can have a _____ skin test but be asymptomatic.
positive
negative
Persons with latent TB can still transmit the disease.
True
False
What is the characteristic INITIAL clinical manifestation of active TB infection?
Dry cough that becomes productive
Productive cough that becomes dry
dyspnea that becomes hemoptysis
hemoptysis that becomes dsypnea
SATA: Which patients are less likely to have a fever with an active TB infection?
HIV patients
geriatric patients
pediatric patients
COPD patients
asthma patients
What may be the ONLY sign of TB infection in older adults?
Fever
Cough
Congestion
Confusion
Miliary TB is when ____ numbers of TB bacterium spread via the bloodstream to ______.
small, lung parenchyma
large, the pleural space
large, distant organs
small, the cerebellum
Miliary TB is often fatal if untreated.
True
False
SATA: Select the following manifestations of severe miliary TB.
lymphadenopathy
hepatomegaly
splenomegaly
cor pulmonale
adrenalomegaly
Pleural TB can cause:
emphysema
empyema
empanada
epytripsy
Pleural TB, which is a ______ form of TB, is characterized by ______ pleural effusion.
pulmonary, bilateral
pulmonary, unilateral
extrapulmonary, bilateral
extrapulmonary, unilateral
How long should the RN wait after administering a TB skin test to observe for induration?
4-8 hours
6-12 hours
12-24 hours
48-72 hours
SATA: Select all of the qualities of an induration from a TB skin test.
palpable
raised
hardened
swollen
redness
What does an induration indicate following a TB skin test?
production of antibodies following TB exposure
latent TB infection
active TB infection
imminent miliary TB infection
How many mm in diameter for an induration constitutes as a positive TST for LOW risk individuals?
5 mm
10 mm
15 mm
8 mm
How many mm in diameter for an induration constitutes as a positive TST for HIGH risk individuals?
5 mm
10 mm
15 mm
8 mm
How many mm in diameter for an induration constitutes as a positive TST for IMMUNOCOMPROMISED risk individuals (i.e. HIV patients)?
5 mm
10 mm
15 mm
8 mm
Initial TB screening is usually done as a two step (two injection) test. What does a positive result on the FIRST test indicate?
give second injection STAT to confirm positive TB diagnosis
further evaluation for active TB disease
no change, false positives are common with TSTs
give second injection in 1-3 weeks to determine positive TB diagnosis
What is the ONLY way latent TB can be diagnosed?
QuantiFERON Gold TB Test
Ruling out active TB
T-SPOT TB Test
Mantoux TB Test
A diagnosis of active TB can be made solely by a chest x-ray.
True
False
What is the gold standard of bacteriologic TB studies?
Blood culture
Sputum culture
Urine culture
Epithelial culture
When collecting the 3 sputum specimens required for a TB sputum culture, the RN should make sure one of the specimens is obtained:
right before the patient goes to sleep
right when the patient wakes up
in the middle of the night
right before the patient eats dinner
What is the initial test done on a sputum specimen when TB is suspected?
stained and smeared for AFB
ran through a PCR machine
dipstick color change interpretation
methylene blue staining
A definitive diagnosis of TB can be made when a sputum culture shows mycobacterial growth. This can take:
up to 2 days
up to 10 days
up to 6 weeks
up to 12 weeks
up to 2 months
If a patient's sputum culture is positive for TB, they are infectious for __ weeks after exhibiting signs and symptoms.
5
10
4
2
What are the two phases of drug treatment for ACTIVE TB?
slow, fast
intensive, continuation
strong, weak
infective, non-infective
SATA: Select all of the drugs used for first-line treatment of active TB.
Fluconazole
Isoniazid
Ethambutol
Rifampin
Pyrazinamide
SATA: Why would a patient with TB NOT be given pyrazinamide?
patient also is pregnant
patient also has myocarditis
patient also has nephritis
patient also has hepatitis
patient also has bronchiolitis
The second stage of active TB treatment is composed of only two drugs, which are:
pyrazinamide and ethambutol
rifampin and ethambutol
rifampin and isoniazid
isoniazid and pyrazinamide
Which lab test should be monitored closely while a patient receives drug treatment for TB, due to their side effects?
White blood cells
Creatinine
Liver function tests
Red blood cells
The drug regimen for MDR-TB is more intensive than standard active TB treatment. The initial phase is composed of at least __ different drugs.
4
10
15
5
SATA: Select all of the medications used for initial, intensive treatment of MDR-TB.
1-2 first line drugs (isoniazid, rifampin, etc.)
a fluoroquinolone
an injectable antibiotic
1 or more second-line drug
an antifungal agent
Continuation drug therapy for MDR-TB is composed of ____ different drugs, and must be continued for ______ months.
3, 6-12
4, 18-24
5, 24-48
4, 48-72
Initial treatment of MDR-TB should go on for at least ___ months after a negative sputum test finally occurs.
2
12
6
24
What is a major factor in the development of MDR-TB and TB treatment failure?
Nephrotoxicity
Non-adherence
Cardiomyopathy
Renal failure
The standard treatment plan for latent TB infection is nine months of _____ therapy, which can be adapted into a six month modality if adherence is an issue.
rifampin
ethambutol
isoniazid
pyrazimadine
The BCG vaccine for TB can result in false positive TSTs.
True
False
TB is a reportable disease. Public health authorities may use patient information to identify carriers and potential community risk.
True
False
Which lobes of the lung are most commonly affected by lung abscesses?
upper anterior lobes
upper posterior lobes
lower anterior lobes
lower posterior lobes
