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Lower Respiratory ProblemsMedical Surgical Nursing

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Question Answer
T/F Antibiotic therapy for pneumonia is usually started in a hospitalized patient before blood cultures, sputum cultures or gram stains are interpreted.
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True, initiation of antibiotics should not be delayed to maximize effectiveness
T/F Prompt treatment of bacterial and mycoplasma pneumonia almost always cures the patient.
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True, improvements are seen within 48-72 hours, in abnormal cases in up to a week
_________ and ________ antiviral drugs are approved to treat Type A influenza and should be administered within 48 hours of onset.
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Amantadine (Symmetrel) and Rimantadine (Flumadine)
The neuroaminidase inhibitors ________ and __________ are active against influenza A and B. If a patient is treated early for influenza, secondary pneumonia is unlikely.
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Zanamivir (Relenza) and Oseltamivir (Tamiflu)
T/F Pneumococcal vaccines and influenza vaccines can be given on the same day as long as a different arm is used for each injection.
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True
T/F Most cases of community acquired pneumonia don't require hospitalization.
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True
Fluid intake of at least _____ L a day is important in the supportive treatment of pneumonia.
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3
If symptoms of a URI persists longer than ______ days, a patient should see a medical professional.
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7
What non-medical interventions can a nurse perform to prevent pneumonia in patients with altered levels of consciousness?
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Place them in side-lying, semirecumbent or upright positions, turn and reposition them every 2 hours
Which position is best for a patient with VAP or for those that are intubated?
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Semirecumbent (45 degrees)
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What preventative measure can be taken to prevent VAP in patients that are intubated?
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Continuous aspiration of subglottic secretions above the tracheal cuff using an endotracheal tube, and placing them in a semirecumbent position (30-45 degrees), especially during feeding
T/F Sputum from pneumonia can be pink, rusty, white, yellow, green, or purulent.
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True
How should a patient with unilateral lung disease and pneumonia be positioned to provide stable oxygenation status?
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With the best performing lung down (lateral position)
How should a patient with bilateral lung disease and pneumonia be positioned to provide stable oxygenation status?
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With the right lung down
When is percussion and postural positioning recommended for a patient with pneumonia?
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Only if an Xray shows evidence of mucous plugging and lobar collapse, or if the client is producing more than 30mL of sputum a day
How long should a patient who has had pneumonia continue incentive spirometry or deep breathing exercises after hospital discharge?
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6-8 weeks
Aside from the lungs, what other structures can TB infect?
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The larynx, kidneys, bones, adrenal glands, lymph nodes, and meninges
What three countries account for the most cases of TB?
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Africa, Asia and the Soviet Union (former)
What are the major factors that have contributed to the resurgence of TB?
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-High rates of TB among HIV infected patients -MDR strains of TB
When a strain of TB develops resistance to _________ & ________, it is considered multi-drug resistant (MDR).
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Isoniazid and Rifampin
What are considered risk factors for TB?
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-homelessness -inner city resident -foreign born -older adult -institutionalization (prison, LTC facility, etc.) -injection drug user -persons living in poverty -people with poor access to health care -immunosuppression of any kind
  
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