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NURS 3000 Midterm Exam Questions And Verified Detailed Answers
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NURS 3000 Midterm Exam Questions AndVerified Detailed Answers
The risk for aspiration is decreased when a client with a decreased level of
consciousness is placed in a side-lying or upright position. Frequent turning prevents
pooling of secretions in immobilized clients but will not decrease the risk for aspiration
in clients at risk. Monitoring of parameters such as breath sounds and oxygen saturation
will help detect pneumonia in immuno-compromised clients, but it will not decrease the
risk for aspiration. Continuous subglottic suction is indicated for intubated clients, not
for all clients receiving enteral feedings.
The nurse is caring for the client with right lower-lobe pneumonia who has received 2
days of IV antibiotics. The nurse obtains the following assessment data. Which data
indicate the antibiotic therapy has been effective?
a. Bronchial breath sounds are heard at the right base.
b. The client expectorates small amounts of green sputa.
c. The client's WBC count is 9 x 109 /L.
d. Decreased tactile fremitus is palpable over the right chest. - ANSWER ANS: C
The normal WBC count suggests that the antibiotics have been effective. All of the other
data indicate that the treatment should be changed.
The health care provider orders a prescription for bacteriological testing for a client
who has a positive tuberculosis skin test. Which of the following actions should the
nurse perform?. Retest the tuberculin skin testing. Provide information about the
purpose of the blood tests. Collect consecutive sputum specimens over a 3-day period
from the client.
d. Instruct the client to expectorate three specimens as soon as possible. - ANSWER
ANS: C
Three consecutive sputum specimens are collected on separate days for bacteriologic
,examination for M. tuberculosis. The client should not collect all the specimens at the
same time. Blood cultures are not used to test for tuberculosis. Skin testing is not
repeated after positive results have been obtained.
A client has a recent history of tuberculosis. Which of the following indicates that the
nurse can stop airborne isolation precautions?
a. Chest x-ray shows no upper lobe infiltrates.
b. TB medications have been taken for 6 months.
c. Mantoux testing shows an induration of 10 mm.
d. Three sputum smears for acid-fast bacilli are negative. - ANSWER ANS: D
Negative sputum smears mean that M. tuberculosis is not in the sputum and it is not
possible for the client to spread the bacteria through the air. Chest x-rays are not a valid
way to confirm successful treatment of this infection. The diseases multidrug-resistant
forms may not be treated after 6 months of medication, though 6 months is required to
take all the medications. It would not be appropriate to repeat the Mantoux testing as it
will not change even with effective treatment of the disease.
A nurse is educating a client diagnosed with pulmonary tuberculosis about the
transmission of TB. Which of the following client teaching behaviors related to the
spread of TB are appropriate? a. Demonstrates correct use of a nebulizer. b. Washes
dishes and personal items after each use. c. Covers the mouth and nose when
coughing. d. Calls the public health department daily. - ANSWER ANS: C
This will help decrease the airborne transmission of TB. The other actions will not be
effective in decreasing the spread of TB.
Which of the following information should the nurse include in the teaching plan for a
client who is receiving rifampin for treatment of tuberculosis?
a. "Your urine, sweat, and tears will be orange coloured."
b. "Read a newspaper daily to check for changes in vision."
c. "Take vitamin B6 daily to prevent peripheral nerve damage."
d. "Call the health care provider if you notice any hearing loss." - ANSWER ANS: A
,Orange-coloured body secretions are an adverse effect of rifampin. The other adverse
effects are associated with other antituberculosis medications.
The nurse is teaching a client who is taking standard multidrug therapy for TB about
possible toxic effects of the antitubercular medications. Which of the following findings
should the nurse instruct the client to report to the health care provider?
a. Yellow-tinged skin
b. Changes in hearing
c. Orange-coloured sputum
d. Thickening of the fingernails - ANSWER ANS: A
INH, rifampin, and pyrazinamide have noninfectious hepatitis as a toxic effect, and
clients who develop hepatotoxicity will require medications other than these. Changes
in hearing and thickening of the nails are not expected adverse effects of any one of the
four medications used for initial TB drug therapy. An expected adverse effect of
rifampin, not an adverse effect that requires notification of the health care provider, is
orange discoloration of body fluids.
The nurse is caring for clients with active tuberculosis (TB) who abuse alcohol and/or
are homeless. Which of the following interventions by the nurse will best facilitate
compliance with a treatment regimen? a. Instructing the client regarding the long-range
effects of TB on the client's health b. Providing the client with written instructions
regarding how to take the medications
c. Informing the client that there is a high risk for infecting others unless treatment is
followed
d. Arranging for a daily noontime meal at a community centre and giving the medication
then - ANSWER ANS: D
Of the options provided, direct observation of therapy is the most effective way to
ensure the client's adherence to the treatment regimen, and arranging a daily meal will
help ensure that the client is present to receive the medication. The remaining nursing
interventions may be effective and appropriate for some clients, but are less likely to be
so with this client.
, After 2 months of TB therapy with a standard four-drug regimen, a client is still showing
positive sputum smears for AFB. Which of the following is the nurse's next action? a. Ask
whether the client has taken medications as prescribed. b. Explain that it will be
necessary to try some different medications to treat the TB.
c. Schedule the client for directly observed therapy three times weekly.
d. Instruct on the use of a 2-drug regimen for the last 4 months of treatment - ANSWER
ANS: A
The first course of action would be to see if the client has been compliant with drug
therapy, as one would expect negative sputum smears after appropriate intake of
medications in case of a susceptible TB bacillus. Further course of action regarding
medications or directly observed therapy is indicated based on compliance. Two-drug
regime will be continued only if the sputum smears are negative for AFB.
A staff nurse has a positive tuberculosis (TB) skin test with 16-mm induration. The chest
radiograph is negative and the nurse is asymptomatic for TB. Which of the following
should the occupational health nurse communicate to the staff nurse?
a. Use and side effects of isoniazid (INH)
b. Standard four-drug therapy for TB
c. Need for annual repeat TB skin testing
d. Bacille Calmette-Guérin (BCG) vaccine ANSWER ANS: A
The nurse has latent TB infection and INH treatment daily for 6-9 months is indicated.
Four-drug therapy would be appropriate if the nurse had active TB in her lungs. Skin
testing is not done on clients who have already had a positive skin test. BCG vaccine is a
prevention method and is rarely used in Canada; this would serve no purpose for this
individual who already has a TB infection.
The nurse is caring for a client who is hospitalized with active TB and the nurse
observes a family member who is visiting the client. Which of the following actions by
the visitor should cause the nurse to intervene? a. Washes hands before entering the
client's room b. Hands the client a tissue from the box at the bedside
c. Wears a surgical face mask before client room entry
d. Prepares "fast-food" restaurant food for the client - ANSWER ANS: C
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