NUR 155 Med Surg Test 3, Exam Questions & Answers, Deeply
Explained With Rationales
A severely obese patient has undergone Roux-en-Y gastric bypass surgery. In planning
postoperative care, the nurse anticipates that the patient
A. may have severe diarrhea early in the postoperative period.
B. will not be allowed to ambulate for 1 to 2 days postoperatively.
C. will require nasogastric suction until the incision heals.
D. may have only liquids orally, and in very limited amounts, during the postoperative period. -
D. may have only liquids orally, and in very limited amounts, during the postoperative period.
Rationale:
During the immediate postoperative period, water and sugar-free clear liquids are given (30 mL
every 2 hours while the patient is awake).
You are providing care to a patient with COPD who is receiving medical treatment for
exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient
is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on
the arms and legs. Which medication ordered for this patient can cause hyperglycemia and
bruising?
A) Prednisone
B) Atrovent
C) Flagyl
D) Levaquin - A) Prednisone
Rationale:
Prednisone is a corticosteroid and can cause hyperglycemia and bruising.
(SATA) Which of the following statements are incorrect about discharge teaching that you
would provide to a patient with COPD?
1. "It is best to eat three large meals a day that are relatively low in calories
2. "Avoid going outside during extremely hot or cold days."
3. "It is important to receive the Pneumovax vaccine annually."
4. "Smoking cessation can help improve your symptoms."
A) 1,4
B) 1,3
C) 2,4
,D) 1,2,3
E) All of these
F) None - B) 1,3
Rational:
The answers are 1 and 3. The patient needs to eat high calorie and protein rich meals that are
small but frequent. The pneumovax is definitely recommended for patients with COPD but is
given every 5 years (not annually).
Clients with chronic illnesses are more likely to get pneumonia when which of the following
situations is present?
A. Dehydration
B. Group living
C. Malnutrition
D. Severe periodontal disease - B. Group living
Rationale:
Clients with chronic illnesses generally have poor immune systems. Often, residing in group
living situations increases the chance of disease transmission. Pneumonia is a fairly prevalent
disease and carries a heavy burden in all populations. A study carried out by the US Centers for
Disease Control and Prevention (CDC) aimed at estimating its burden in North America found
that CAP accounted for the eighth leading cause of mortality in the United States and the seventh
leading cause of mortality in Canada after adjusting for various gender and age differences.
- Option A: Pneumonia can also cause dehydration from fever and decreased thirst and appetite,
which may require treatment with extra fluids intravenously. Potential benefits of fluids are
replacing fluid lost because of fever or rapid breathing, treating dehydration, and reducing the
viscosity of mucus.
- Option C: Pneumonia is common in malnourished children and is frequently associated with
fatal outcomes, especially in children younger than 24 months of age. Studies consistently
reported a two- to threefold greater risk of mortality in cases with pneumonia associated with
malnutrition. Therefore, pneumonia and malnutrition are two of the biggest killers in childhood
diseases.
- Option D: Various pathogenic bacteria have been found in patients with deep periodontal
pockets. The association between periodontal
disease and pneumonia may be due to colonization by pathogenic bacteria in the periodontal
pocket, as inhalation of a pathogen is considered a risk factor for pneumonia
Which of the following organisms most commonly causes community-acquired pneumonia in
adults?
,A. Haemophilus influenzae
B. Klebsiella pneumoniae
C. Streptococcus pneumoniae
D. Staphylococcus aureus - C. Streptococcus pneumoniae
Rationale:
Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumoniae, is the most
common cause of community-acquired pneumonia. Streptococcus pneumoniae is the bacterium
that has historically been the most common pathogen to cause CAP worldwide. In the era before
antibiotics, S. pneumoniae was estimated to be the cause of 95% of all cases of pneumonia.
Currently, however, S. pneumoniae accounts for up to 15% of pneumonia cases in the United
States and 27% of cases worldwide today.
-Option A: H. influenzae is the most common cause of infection in children. Haemophilus
influenzae is a bacteria characterized as a small, facultatively anaerobic, pleomorphic, and
capnophilic gram-negative coccobacillus of the family Pasteurellaceae. It is a common cause of a
variety of invasive and non-invasive bacterial infections.
-Option B: Klebsiella species is the most common gram-negative organism found in the hospital
setting. Today, K. pneumoniae pneumonia is considered the most common cause of hospital-
acquired pneumonia in the United States, and the organism accounts for 3% to 8% of all
nosocomial bacterial infections.
-Option D: Staphylococcus aureus is the most common cause of hospital-acquired pneumonia.
Staphylococcus aureus is a major bacterial human pathogen that causes a wide variety of clinical
manifestations. Infections are common both in community-acquired as well as hospital-acquired
settings and treatment remains challenging to manage due to the emergence of multi-drug
resistant strains such as MRSA (Methicillin-Resistant Staphylococcus aureus).
An elderly client with pneumonia may appear with which of the following symptoms first?
A. Altered mental status and dehydration
B. Fever and chills
C. Hemoptysis and dyspnea
D. Pleuritic chest pain and cough - A. Altered mental status and dehydration
Rational:
Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of
pneumonia, but elderly clients may first appear with only an altered mental status and
dehydration due to a blunted immune response. A small fraction of patients may have an altered
mental status, abdominal pain, chest pain, and other systemic findings.
, - Option B: Historically, the chief complaints in case of pneumonia include systemic signs like
fever with chills, malaise, loss of appetite, and myalgia. These findings are more common in
viral pneumonia as compared to bacterial pneumonia.
- Option C: Pulmonary findings include cough with or without sputum production. Bacterial
pneumonia is associated with purulent or rarely blood-tinged sputum. Viral pneumonia is
associated with watery or occasionally mucopurulent sputum production.
- Option D: There may be an associated pleuritic chest pain with the concomitant involvement of
the pleura. Dyspnea and a diffuse heaviness of the chest are also seen occasionally. The cough
may be either non productive or productive with mucoid, purulent, or blood-tinged sputum.
A diagnosis of pneumonia is typically achieved by which of the following diagnostic tests?
A. ABG analysis
B. Chest x-ray
C. Blood cultures
D. Sputum culture and sensitivity - D. Sputum culture and sensitivity
Rational:
Sputum C & S is the best way to identify the organism causing the pneumonia. If good quality,
sputum evaluation may reveal more than 25 WBC per low-power field and less than 10
squamous epithelial cells. Some bacterial causes present with specific biochemical evidence,
such as Legionella, may present with hyponatremia and microhematuria.
- Option A: ABG analysis will determine the extent of hypoxia present due to the pneumonia. An
arterial blood gas may reveal hypoxia and respiratory acidosis. Pulse oximetry of less than 92%
indicates severe hypoxia, and elevated CRP predicts a serious infection.
- Option B: Chest x-ray will show the area of lung consolidation. Findings may vary from lobar
to interstitial infiltrate, to occasionally cavitary lesions with air-fluid levels suggestive of a more
severe disease process.
- Option C: Blood cultures will help determine if the infection is systemic. These include a series
of tests like blood culture, sputum culture and microscopy, routine blood counts, and lymphocyte
count. Special tests such as urinary antigen testing, bronchial aspirate, or induced sputum may be
used for certain pathogens.
A client with pneumonia develops dyspnea with a respiratory rate of 32 breaths/minute and
difficulty expelling his secretions. The nurse auscultates his lung fields and hears bronchial
sounds in the left lower lobe. The nurse determines that the client requires which of the
following treatments first?
A. Antibiotics
B. Bed rest
C. Oxygen
