Test 3: Breakdown of test questions
Please note this is not an all-inclusive list of test items
Test 3 is not cumulative. However, some concepts will from the early modules will be applied on this test (e.g.
patient teaching principles and postoperative care).
Test 3 has 50 questions. Most items are multiple choice, but a few items may be multiple answer (select all that
apply).
The time limit is 75 minutes.
Partial credit is not awarded for select all that apply/multiple response items.
o Note: “Select all that apply”/multiple response questions may have 2 or more correct answers. It is
possible for all of the options to be correct for these types of questions.
Generic names and pharmacotherapeutic class will be provided for medications
Unit 10 Pulmonary: 18 questions
Pneumonia
o What is it: Acute infection of the lung parenchyma caused by virus, bacteria or an atypical organism
All pneumonia starts as an inflammatory response
On an x-ray: the alveoli are filled with thick mucous and is noted as consolidation
o Clinical manifestations
Sudden onset of fever
Shaking chills
SOB
Cough productive of purulent sputum
Pleuritic chest pain (pain with deep breathing or coughing)
Adventitious breath sounds
Non-Specific:
Headaches, muscle ache, diaphoresis, anorexia (loss of appetite)
Signs and symptoms:
Accessory muscle use
Tachypnea
Leaning forward
Gasping
Nasal flaring
OLDER ADULTS:
Change in level of consciousness or orientation
o WHAT IS IMPORTANT TO ASSESS: asses oxygen (O2 Saturation)
o Diagnostic findings:
CBC: elevated WBC
ABG
At first: normal or decreased PaO2: mild respiratory alkalosis
Then: decreased PaO2: respiratory acidosis
Positive sputum
Abnormal chest x-ray
,o Priorities for nursing care
Collect a sample first
If they cannot produce sputum let the provider know but still start antibiotic
START antibiotic ASAP
The earlier initiated the better to decrease serious illness or death
Oxygen for hypoxemia
NC
Watch O2 closely
Fluid intake @ least 3L per day
Caloric intake @ least 1500 per day
o Implementation
At risk patients
Elevate HOB 30 to 45 degrees for patients with feeding tubes
Aspiration precautions
Turn and reposition patient
o Do not let them stay supine
Encourage coughing
Specimen collection
Respiratory assessment, pulse ox
O2 therapy
Hydrate
o Medications (general principles—antibiotics, expectorants, antipyretics, pain)
Need to rest to promote recovery
Antibiotics
Take full course of meds
Do not stop taking if they feel better
Analgesic for chest pain
Can take Tylenol
Antipyretics
Considered fever if above 101.5
Acetaminophen is not the first action
Expectorants
Robitussin (no extra things in it) to help liquify the sputum to help excrete it
Follow-up with chest x-ray in 6-8 weeks to evaluate
, Tuberculosis
o What is it: infectious disease caused by Mycobacterium tuberculosis that’s spreads via airborne droplets
Replicates slowly and spreads via lymphatic system
Latent TB
screen testing (secondary prevention) or blood testing, generally do not have any
symptoms
Not transmissible but they can’t still develop full TB
Classifications:
0 = no TB exposure (never exposed)
1 = TB exposure, NO infection
o Negative test
2 = Latent TB, no disease
o Positive skin test but NO infection, no x-ray findings
3 = TB, clinically active
o Positive test with x-ray evidence
4 = TB, but not clinically active (has history of it)
5 = TB suspect (briefly)
Clinical Manifestations:
Early stages are free of symptoms
Can see
o Fatigue, malaise, anorexia, weight loss, night sweats
Acute symptoms = generalized flu symptoms
o Interpretation of tuberculin skin testing
Intradermal admin of tuberculin
The test is read and inspected 48-72 hours later
Positive reactions
> 5 mm—immunocompromised patients, people with close personal contact to infected
person (positive reaction)
> 10 mm—recent immigrants from areas with increased TB incidence, IV drug users,
residents or employees of prisons, SNFs, homeless shelters
> 15 mm—no known risk factors
When it becomes positive = it is an immune response because they already have it (they
will always be positive)
Measures the indurated area (feels hard)
o Palpate to the hard area and measure that
Two-step testing for individuals who will be tested periodically (only done ONCE)
Skin test assess for immune response
o Adherence to therapy
Hospitalization not necessary for most patients (outpatients)
Drug therapy used to prevent or treat active disease (treatment lasts several months)
Active disease
Four drugs are used in initial phase for maximum effectiveness.
o (Isoniazid, rifampin, pyrazinamide, and ethambutol)
Treatment is aggressive to combat resistant strains of TB.
Liver function should be monitored (advised not to drink alcohol at ALL)
o Medications can cause inflammation to the liver
Directly observed therapy (DOT)
Noncompliance is major factor in multidrug resistance and treatment failures.
Requires watching patient swallow drugs
Preferred to ensure adherence
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