Pneumonia (13 Questions)

1. M. Jacques Tremblay, 68 years old, presents to the Emergency Department accompanied by his wife. He reports that he has been feeling progressively worse over the last 3 days. M. Tremblay appears fatigued and flushed. Upon assessment, the nurse notes that he has a productive cough with rust-colored sputum, sharp chest pain when he takes a deep breath, and he is confused about the day of the week. His vital signs show a temperature of 39.1°C and a respiratory rate of 28.

Medical Orders:
*Chest X-ray.
*CBC and Electrolytes.
*Blood cultures x 2.
*Sputum culture.

Question:
Which assessment finding is the most significant indicator of severe pneumonia in an elderly patient? *

The fever of 39.1°C.

The rust-colored sputum.

The new onset of confusion.

The pleuritic chest pain.

2. Mme. Ginette Roy, 82 years old, is a resident in a long-term care facility who recently suffered a stroke with residual dysphagia. The nurse enters the room to feed her lunch and finds Mme. Roy coughing weakly after sipping water. The nurse observes that her voice sounds "wet" and gurgly. Two days later, Mme. Roy develops a fever and crackles in her right upper lobe.

Medical Orders:
*Keep NPO.
*Start IV antibiotics.
*Consult Speech Therapy.

Question:
What is the most likely cause of this pneumonia? *

Viral transmission from a visitor.

Aspiration of secretions due to dysphagia.

Immobility causing stasis of secretions.

A side effect of her stroke medication.

3. M. Pierre Gagnon, 55 years old, is admitted with a diagnosis of bacterial pneumonia. He is febrile and short of breath. The nurse receives the admission orders at 10:00.

Medical Orders:
*Oxygen 2 L/min via nasal cannula.
*Blood cultures x 2 sets.
*Sputum culture.
*Ceftriaxone 1 g IV daily.
*Azithromycin 500 mg IV daily

Question:
What is the correct sequence of nursing actions? *

Administer the antibiotics immediately, then collect the cultures.

Collect the blood and sputum cultures first, then administer the antibiotics without delay.

Wait for the culture results to come back (24 hours) before starting antibiotics.

Administer the Tylenol for fever, then collect cultures, then give antibiotics.

4. Mme. Claire Bouchard, 60 years old, has pneumonia and a weak cough. She tells the nurse, "I can feel the phlegm stuck in my chest, but I can't get it up." On auscultation, the nurse hears coarse crackles and rhonchi throughout the lung fields. Her SpO2 is 92%.

Medical Orders:
*Encourage fluids 2-3 L/day.
*Ambulate as tolerated.

Question:
Which intervention is most effective to help the patient clear secretions? *

Advise the patient to suppress the cough to conserve energy.

Place the patient in a supine position.

Encourage hydration (2-3 L/day) to liquefy secretions.

Administer a cough suppressant (antitussive) medication.

5. M. Robert Fortin, 45 years old, is suspected of having tuberculosis or fungal pneumonia. The physician orders a sputum specimen for analysis. M. Fortin asks when is the best time to do this.

Medical Orders:
*Sputum for C&S and Gram stain.

Question:
What instruction should the nurse provide? *

"Collect the sample right after you eat lunch."

"Spit into the cup immediately after using mouthwash."

"Collect the sample just before you go to sleep."

"We will collect the sample first thing in the morning, after you rinse your mouth with water but before you eat."

6. Mme. Sophie Lemieux, 70 years old, is being discharged after a 5-day admission for pneumococcal pneumonia. She has a history of COPD. The nurse is reviewing preventative health measures.

Medical Orders:
*Discharge home.
*Pneumococcal Vaccine (Pneumovax 23) if not previously received.

Question:
Mme. Lemieux asks, "Why do I need a shot if I just had pneumonia? Aren't I immune now?" What is the nurse’s response? *

"You are right; you do not need the vaccine now."

"This vaccine is actually for the flu, not pneumonia."

"You need it because your immune system is now permanently damaged."

"There are many different strains of pneumonia bacteria; this vaccine protects you against 23 common types to prevent future infections."

7. M. Sylvain Cote, 35 years old, is recovering from pneumonia but complains of sharp, "stabbing" chest pain every time he coughs or takes a deep breath. He is holding his chest rigidly (splinting) and taking very shallow breaths.

Medical Orders:
*Ibuprofen 400 mg PO q6h PRN.
*Incentive Spirometry.

Question:
What is the nurse’s explanation for this pain, and what is the goal of management? *

"This is Angina; we need to treat your heart."

"This is muscle strain; you should stop coughing."

"This is Pleurisy; we must control the pain so you can breathe deeply and prevent lung collapse."

"This is gastric reflux from the antibiotics."

8. M. Michel Desjardins, 50 years old, is being discharged with a prescription for oral antibiotics. He tells the nurse, "I hate taking pills. As soon as my fever is gone, I'm stopping them."

Medical Orders:
*Amoxicillin 500 mg PO TID x 7 days.

Question:
What is the priority nursing teaching? *

"That is fine, as long as you feel better."

"You can stop them early if you get diarrhea."

"Save the leftover pills for the next time you get sick."

"You must complete the entire course of antibiotics, even if you feel better, to prevent the bacteria from becoming resistant and the infection returning."

9. Mme. Valérie Turcotte, 78 years old, has been treated for bacterial pneumonia for 48 hours. The nurse enters the room to assess her progress. Upon assessment, the nurse notes that Mme. Turcotte is sitting up in the chair eating breakfast. Her skin is pink and warm. Vital signs show T 37.2°C, RR 18, and SpO2 96% on room air.

Medical Orders:
*Continue current therapy.
*Wean oxygen as tolerated.

Question:
Which clinical finding best indicates that the treatment is effective? *

The patient is eating breakfast.

The white blood cell count is 12.0 (high normal).

The patient requests to go home.

The SpO2 is 96% on room air and respiratory rate has normalized.

10. M. André Lemieux, 60 years old, is intubated in the ICU following a cardiac arrest. The nurse is implementing the "VAP Bundle" to prevent Ventilator-Associated Pneumonia.

Medical Orders:
*Mechanical Ventilation.
*Enteral feeding via NG tube.

Question:
Which intervention is a critical component of the VAP prevention bundle? *

Keep the patient supine (flat) at all times.

Perform oral care with saline once a day.

Maintain the Head of Bed elevated at 30-45 degrees and perform frequent oral care with Chlorhexidine.

Change the ventilator tubing circuit every 24 hours.

11. M. Claude Gagnon, 72 years old, is admitted with severe pneumonia and sepsis.

Timeline of Events:
10:00: Admission orders received.
10:15: The nurse collects blood and sputum cultures as ordered.
10:30: The nurse prepares to hang the first dose of IV antibiotics (Piperacillin-Tazobactam).
10:35: The lab calls to say the preliminary culture results will not be available for 24 hours.

Question:
Should the nurse administer the antibiotics now, or wait for the results? *

Wait for the culture results to ensure the antibiotic is effective against the specific bacteria.

Administer the antibiotics immediately because the cultures have already been collected.

Hold the dose and contact the physician for a narrower spectrum antibiotic.

Administer half the dose now and the rest when results are confirmed.

12.1 M. Jean-Paul Cote, 84 years old, is brought to the ED by his son. The son states, "My dad is usually sharp as a tack, but since yesterday he doesn't know where he is, he's talking nonsense, and he's very agitated."

Assessment:
*Neuro: Confused, disoriented to time/place (Delirium).
*Resp: RR 28, SpO2 88% RA, coarse crackles in Right Lower Lobe.
*Vitals: Temp 38.5°C, HR 110, BP 100/60.
*Urine: Clear, no signs of UTI.

Question:
Based on the assessment, what is the primary physiological cause of the patient’s delirium? *

Early onset Dementia (Alzheimer's).

Dehydration.

Stroke.

Hypoxia and infection secondary to Pneumonia.

12.2 His son appears very distressed and asks the nurse, "Is my dad going to be like this forever? Has he lost his mind?"

Question:
What is the most appropriate nursing response? *

"Unfortunately, at his age, confusion like this is usually permanent."

"We will need to consult a neurologist to see if he has dementia."

"This confusion is a temporary condition called delirium caused by the pneumonia; as we treat the infection and his oxygen levels improve, his mental status should return to normal."

"He will likely need to be placed in a long-term care home after this."