Community-Acquired Pneumonia — NCLEX-NG Practice Quiz

NCLEX-NG formative assessment for BSN nursing students covering Community-Acquired Pneumonia (CAP) risk stratification, pathogen identification, antibiotic selection, oxygenation management, complications, prevention, and clinical judgment. Based on the Mr. Hannigan CAP case study and current IDSA/ATS guidelines.

20 questions Pass: 75% 40 min

Question 0 of 20 answered 0%

A nurse is reviewing two CAP severity scoring systems: PSI/PORT and CURB-65. Which statement best differentiates the two tools?

A PSI/PORT uses five variables and is simpler to calculate at the bedside; CURB-65 incorporates more demographic and lab data B CURB-65 uses five variables and is simpler to calculate at the bedside; PSI/PORT incorporates more demographic and lab data C Both tools use the same five variables and produce identical risk class scores D PSI/PORT is preferred in the emergency department because it requires no laboratory data

A nurse is comparing typical versus atypical CAP pathogens. Which pairing of pathogen and its key differentiating clinical feature is CORRECT?

A Streptococcus pneumoniae — 'walking pneumonia,' gradual onset, dry cough, affects young adults; treat with amoxicillin B Mycoplasma pneumoniae — rust-colored sputum, acute lobar consolidation, gram-positive diplococci on Gram stain C Legionella pneumophila — hyponatremia, GI symptoms, positive urinary antigen test; intracellular organism requiring fluoroquinolone or macrolide D Haemophilus influenzae — positive cold agglutinins, bilateral patchy infiltrates disproportionate to mild symptoms

A hospitalized patient with CAP is producing rust-colored (rusty) sputum. Which pathogen is most characteristically associated with this finding?

A Mycoplasma pneumoniae B Legionella pneumophila C Streptococcus pneumoniae D Haemophilus influenzae

A patient with CAP is about to receive their first dose of antibiotics. The nurse notes that sputum and blood cultures have not yet been collected. What is the nurse's priority action?

A Administer the antibiotic as ordered; cultures can be collected on the next blood draw B Collect sputum and blood cultures before administering the first antibiotic dose C Delay the antibiotic and notify the provider to discuss whether cultures are necessary D Skip sputum culture; blood cultures alone are sufficient before antibiotic administration

A nurse reviews empiric antibiotic orders for four different CAP patients. Match each patient scenario to the appropriate first-line IDSA/ATS regimen. Which antibiotic choice is correctly matched to its CAP severity and patient scenario?

A Healthy 28-year-old outpatient, no comorbidities → IV ceftriaxone plus IV azithromycin B 65-year-old outpatient with COPD and recent antibiotic use → amoxicillin monotherapy C Hospitalized 70-year-old on medical unit (non-ICU) → IV ceftriaxone plus azithromycin, OR respiratory fluoroquinolone monotherapy D ICU patient with severe CAP → oral levofloxacin monotherapy

A nurse questions why levofloxacin is ordered for a patient with CAP rather than ciprofloxacin. Which explanation is most accurate?

A Ciprofloxacin has superior activity against Streptococcus pneumoniae and atypical organisms compared to levofloxacin B Levofloxacin is a 'respiratory quinolone' with enhanced activity against S. pneumoniae and atypical organisms; ciprofloxacin has poor pneumococcal coverage C Levofloxacin is preferred solely because it is available in an oral formulation, while ciprofloxacin is only available intravenously D Both fluoroquinolones have identical spectra; levofloxacin is preferred for CAP solely due to once-daily dosing convenience

A patient with CAP has an SpO₂ of 89% on room air. The nurse applies 2 L/min via nasal cannula and SpO₂ rises to 91%. What is the target SpO₂ for a CAP patient without COPD, and what is the nurse's next action?

A Target SpO₂ is ≥88%; 91% is acceptable; document and continue monitoring B Target SpO₂ is ≥92%; 91% is below target; increase oxygen flow rate or upgrade delivery device C Target SpO₂ is 100%; escalate immediately to non-rebreather mask at 15 L/min D Target SpO₂ is ≥95%; discontinue nasal cannula and apply Venturi mask at 24% FiO₂

A nurse is teaching a patient with CAP how to use an incentive spirometer (IS). Which instruction best reflects correct technique, frequency, and therapeutic purpose?

A Breathe in and out rapidly through the mouthpiece 10 times per hour to mobilize secretions B Inhale slowly and deeply through the mouthpiece to raise the piston, hold at peak inhalation for 2–3 seconds, then exhale; perform 10 repetitions every 1–2 hours while awake C Exhale forcefully through the mouthpiece to push the piston upward; repeat every 4 hours D Use the IS only once in the morning; over-use can worsen dyspnea and fatigue

A patient with right-lower-lobe CAP is experiencing significant dyspnea and an SpO₂ of 90%. Which positioning strategy is most appropriate as the nurse's initial intervention?

A Lateral decubitus with the RIGHT (affected) side down to maximize blood flow to the consolidated lung B Semi-Fowler's position (HOB 30–45°) to improve diaphragm excursion and reduce work of breathing C Supine flat position to prevent orthostatic hypotension associated with fever D Immediate prone positioning, as it is the standard for all CAP patients with hypoxia

A patient with CAP develops worsening pleuritic chest pain, fever persisting despite 48 hours of appropriate antibiotics, and a new pleural effusion on chest X-ray. Which complication should the nurse suspect, and what is the priority nursing action?

A Pulmonary embolism from immobility; prepare for CT pulmonary angiography B Parapneumonic effusion progressing to empyema; notify the provider and prepare for possible thoracentesis C Spontaneous pneumothorax from vigorous coughing; prepare for emergent chest tube insertion D Drug fever from antibiotics; discontinue current antibiotic regimen immediately

A 72-year-old patient asks the nurse about pneumococcal vaccination. The patient has never received a pneumococcal vaccine. Which vaccination strategy is currently recommended by ACIP for vaccine-naive adults ≥65 years?

A PPSV23 alone is preferred for all adults age 65 and older B PCV15 followed by PPSV23 at least one year later, OR PCV20 alone as a single dose C PCV20 followed by PPSV23 four weeks later for maximum combined serotype coverage D No pneumococcal vaccine is needed if the annual influenza vaccine has been received

A nurse is providing discharge education about CAP prevention. The patient asks how the annual influenza vaccine relates to CAP prevention. What is the most accurate response?

A Influenza vaccine directly prevents all types of pneumonia, including all bacterial CAP B Influenza vaccine prevents influenza infection, which reduces the risk of secondary bacterial CAP that frequently complicates influenza C Influenza vaccine and pneumococcal vaccine cannot be given at the same visit due to interaction risk D Influenza vaccine is only recommended for patients over age 65 with underlying lung disease

A patient admitted with CAP develops worsening confusion, tachycardia (HR 118 bpm), tachypnea (RR 26 breaths/min), temperature 39.6°C, and systolic BP 94 mmHg. Which rapid bedside assessment tool should the nurse apply first to screen for sepsis?

A CURB-65 scoring tool B qSOFA (Quick Sequential Organ Failure Assessment) score C PSI/PORT Pneumonia Severity Index D Glasgow Coma Scale score alone

A nurse calculates a CURB-65 score for a 70-year-old patient with CAP. The patient is confused (new), has a BUN of 26 mg/dL (urea >7 mmol/L), respiratory rate of 32 breaths/min, and blood pressure of 86/52 mmHg. What is the CURB-65 score and recommended disposition?

A Score 3 — consider short-stay observation admission; routine antibiotics B Score 4 — hospitalization warranted; assess for ICU-level care C Score 5 — maximum possible score; hospitalization mandatory with strong ICU consideration D Score 2 — outpatient treatment with 24-hour follow-up

A patient with CAP is being evaluated for hospital discharge. Which set of clinical stability criteria must be met before discharge is appropriate per IDSA/ATS guidelines?

A Chest X-ray showing complete resolution of infiltrates and WBC returned to normal limits B Temperature ≤37.8°C, HR ≤100, RR ≤24, SBP ≥90, SpO₂ ≥90% on ≤2 L/min NC or room air, tolerating oral intake and medications C Patient subjectively feeling better with no dyspnea at rest, regardless of vital sign values D Completion of a minimum 10-day full IV antibiotic course before any oral step-down

A 22-year-old college student presents with 10 days of gradual onset dry cough, low-grade fever (38.1°C), headache, and fatigue. She reports attending classes throughout her illness. Chest X-ray shows bilateral patchy infiltrates greater than expected from her mild symptoms. Which pathogen and treatment are most appropriate?

A Streptococcus pneumoniae — treat with amoxicillin 1 g TID B Legionella pneumophila — treat with levofloxacin and send urinary antigen C Mycoplasma pneumoniae ('walking pneumonia') — treat with azithromycin or doxycycline D Klebsiella pneumoniae — treat with IV ceftriaxone plus metronidazole

A patient admitted with CAP develops hyponatremia (Na 127 mEq/L), diarrhea, and relative bradycardia (HR 58 bpm despite fever of 39.2°C). Legionella pneumophila is suspected. Which diagnostic test most rapidly confirms Legionella, and why are beta-lactam antibiotics ineffective?

A Sputum Gram stain (gram-negative rods); beta-lactams ineffective due to beta-lactamase production B Urinary antigen test (rapid, detects L. pneumophila serogroup 1); beta-lactams ineffective because Legionella is an intracellular organism C Serum cold agglutinin titer; beta-lactams ineffective because Legionella lacks a cell wall D Blood culture on standard blood agar; beta-lactams ineffective due to intrinsic drug efflux pumps

True or False: Applying a chest binder (a wide elastic wrap worn around the thorax) is an appropriate nursing intervention to relieve pleuritic chest pain in a patient recovering from CAP.

T True F False

A patient aspirates gastric contents after vomiting while being repositioned. Four hours later, the patient has mild tachypnea (RR 22), cough, and SpO₂ 93% on room air, but NO fever and NO purulent sputum. Chest X-ray shows bilateral patchy opacities in dependent lung zones. Which condition does this presentation most likely represent, and what is the appropriate management?

A Aspiration pneumonia — start immediate broad-spectrum antibiotics targeting anaerobes B Aspiration pneumonitis — supportive care with oxygen; monitor for secondary bacterial infection before initiating antibiotics C Community-acquired pneumonia — begin empiric antibiotics per IDSA guidelines immediately D Pulmonary edema from aspiration of fluid volume — administer IV furosemide 40 mg

A patient with CAP has an SpO₂ of 88% on room air. Identify two priority nursing diagnoses for this patient. (List the two most appropriate NANDA-aligned nursing diagnoses for this clinical presentation.)

Community-Acquired Pneumonia — NCLEX-NG Practice Quiz

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