Exemplar 9.5: Pneumonia

Question 1 of 8

1

You have an 18-year-old male patient that has just been confirmed to have a case of acute bacterial pneumonia, caused by streptococcus pneumoniae. The doctor tells him what's wrong, and writes him a prescription for penicillin G. You go in, hand the boy the prescription, and he confides in you that he doesn't quite understand what pneumonia is and why he needs the medication. Select all the correct and appropriate information you can give to this patient.

(2 of these are right)

Select one or more of the following:

"You can spread this disease by coughing, sneezing, or talking."
"You are having a hard time breathing because the body's response to the invading bacteria is impairing your ability to move air into the lungs, get oxygen into your body, and maintain clear airways."
"The organism that caused your case of pneumonia, streptococcus pneumoniae, is generally acquired in a hospital."
"The most typical pattern for your type of pneumonia is bronchopneumonia, meaning that the secretions from your disease will primarily remain in your bronchi."

Explanation

Question 2 of 8

1

What would you hear in your 18-year-old acute pneumococcal pneumonia patient's lungs when you auscultate? What would you see in your patient and what would the patient report to you? (4 of these are right).

Select one or more of the following:

Upon auscultation, the patient has limited breath sounds. Fine crackles could be heard in the inferior lobe of the right lung during inspiration. The patient appears to have mild dyspnea, but no accessory muscle usage could be noted.
The patient brought up large amounts of rust-colored sputum when he coughed into a tissue. The patient reported to the RN that his sputum has looked like that for approximately 24 hours.
The patient reported to the RN that he has a sharp pain in his chest whenever he breathes in or coughs.
The patient reported to the RN that he woke up yesterday with fever and chills. His temperature taken in the doctor's office was 102 degrees Fahrenheit, oral.
The patient reported to the RN that he's had a cough with minimal amounts of sputum production for the past week.
The patient reported to the RN that he has had a headache, fatigue, and aching muscles for the past week. His temperature taken in the doctor's office was 100.1 degrees Fahrenheit, oral,
The patient reported to the RN that he has chills, diminished appetite, diarrhea, and muscle and joint pain.
The patient is presenting with severe dyspnea, tachypenia, and cyanosis. Intercostal retractions can be noted.

Explanation

Question 3 of 8

1

Fill the blank spaces to complete the text.

Fill in the blanks with the correct pattern of lung involvement for that description.

-: Early on in infectious process, bacteria spread throughout the affected lobe. Red blood cells and neutrophils, damaged epithelial cells, and fibrin accumulate in alveoli and bronchioles, causing consolidation of lung tissue. Purulent exudate forms. The process is resolved as the enzymes destroy the exudate and residual debris is coughed out.

-: Spread of pathogen to lungs from bloodstream causes formation of inflammatory lesions. Primarily seen in the severely immunocompromised, so damage to pleural tissue may be significant.

-: Primarily involves the alveolar walls and connective tissue supporting the bronchial tree. Involvement may be patchy or diffuse. Alveoli typically don't contain significant exudate, but rich hyaline membranes may line the alveoli.

-: Usually involves dependent portions of lung tissue, characterized by patchy consolidation. Exudate usually remains in bronhi and bronchioles. Less edema and congestion of alveoli can be noted.

Explanation

Question 4 of 8

1

Select the patient that would NOT be at risk of getting pneumonia?

Select one of the following:

A 22 year old female on prednisone following a kidney transplant.
A healthy 70 year old female.
A 15 year old male that lives with 2 parents who smoke in the house.
A 40 year old male with diabetes mellitus.
A 50 year old alcoholic female.
A 20 year old taking eskalith and valproic acid.

Explanation

Question 5 of 8

1

Drag and drop the correct causative organism for the antibiotics given.

❌: Penicillin G & amoxicillin

❌: Doxycycline

❌: 3rd generation cephalosporins; metronidazole.

❌: 2nd and 3rd generation cephalosporins, doxycycline, azithromycin, TMP-SMZ

❌: Erythromycin, doxycycline.

❌: Penicillinase-resistant penicillin; vancomycin for methicillin-resistant organism.

❌: TMP-SMZ, pentamidine + prednisone

❌: Macrolide + rifampin; fluroquinolone

Drag and drop to complete the text.

Streptococcus pneumoniae

Chlamydia pneumoniae

Klebsiella pneumoniae

Haemophilus influenzae

Mycoplasma pneumoniae

Staphylococcus aureus

Pneumocystis jiroveci

Legionella pneumophila

Explanation

Question 6 of 8

1

Drag and drop the correct lab test with each description/

❌: Determines the extent and pattern of lung involvement. Fluid, infiltrates, consolidated lung tissue, and atelectasis appear as densities on the film.

❌: Provides a more detailed image of pulmonary tissue. May be used when the chest X-ray doesn't prove to be diagnostic.

❌: Used to evaluate gas exchange. Respiratory secretions, pleuritic pain, and alveolar inflammation can all impair gas exchange,

❌: Rapidly identifies infecting organism as Gram-positive or Gram-negative so proper antibiotic therapy can be used.

❌: Identifies the infecting organism using sputum from secretions in the lower respiratory tract. The most appropriate antibiotic therapy can then be chosen.

❌: Shows elevated white blood cell with a left shift in response to the infectious process.

❌: May be done to get a sputum specimen or remove secretions from bronchial tree.

❌: Blood tests to detect antibodies to respiratory pathogens. May be used when both blood and sputum cultures are negative.

❌: Measures arterial oxygen saturation so gas exchange can be continuously monitored.

Drag and drop to complete the text.

Chest X-ray

Doppler ultrasound

Computed tomograpy

Positron emission tomography

Arterial blood gas

Sputum Gram stain

Sputum culture and sensitivity

Complete blood count with differential

Complete blood count w/out differential

Fiberoptic bronchoscopy

Serology testing

Pulse oximetry

Explanation

Question 7 of 8

1

Which of the following medications is NOT used for treatment of pneumonia?

Select one of the following:

Sympathomimetic bronchodilators, such as albuterol sulfate and metaproterenol
Methylxanthines, such as theophylline and aminophylline
Acetylcysteine
Potassium iodide
Guaifenesin
Symbicort

Explanation

Question 8 of 8

1

You have a 65 year old female patient with COPD, with both emphysema and bronchitis, that has been diagnosed with a staphylococcus aureus pneumonia infection. The patient is on a nasal cannula running 3 L of oxygen per minute, but she seems to still have severe dyspnea, with visible cyanosis in her lips. The RN checked the patency of the patient's tubing, and saw that the tubing was completely patent. The patient reports pleuritic pain with each breath. She is running a fever of 102.5, oral, and appears to have chills.

What would be some proper interventions for this patient? (6 of these are right).

Select one or more of the following:

Assess vital signs, breath sounds, SaO2, and skin color once every 8 hours
Assess the patient's cough and the amount, color, consistency, and possible odor of sputum. Immediately report large amounts of foul-smelling sputum to provider.
Place the patient in Fowler or high-Fowler position and encourage position changes.
Get a referral to respiratory therapy & assist with pulmonary hygiene measures whenever necessary.
Administer 350 mg of acetaminophen every 12 hours and teach the patient splinting techniques to do between doses.
Take vitals after showering.
Give the patient small, frequent, well-balanced meals, and encourage a fluid intake of at least 2,500-3,000 mL a day.
Assist the client to cough, deep breathe, use assistive devices, and slow abdominal breathing.

	Created by Olivia McRitchie about 6 years ago

NCLEX Nursing (Medical-Surgical) Quiz on Exemplar 9.5: Pneumonia, created by Olivia McRitchie on 19/09/2018.

Exemplar 9.5: Pneumonia

Exemplar 9.5: Pneumonia

Question 1 of 8

Select one or more of the following:

Explanation

Question 2 of 8

What would you hear in your 18-year-old acute pneumococcal pneumonia patient's lungs when you auscultate? What would you see in your patient and what would the patient report to you? (4 of these are right).

Select one or more of the following:

Explanation

Question 3 of 8

Fill the blank spaces to complete the text.

Explanation

Question 4 of 8

Select the patient that would NOT be at risk of getting pneumonia?

Select one of the following:

Explanation

Question 5 of 8

Drag and drop to complete the text.

Explanation

Question 6 of 8

Drag and drop to complete the text.

Explanation

Question 7 of 8

Which of the following medications is NOT used for treatment of pneumonia?

Select one of the following:

Explanation

Question 8 of 8

Select one or more of the following:

Explanation