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A recent loss of consciousness. Loss of consciousness is not a common presenting symptom of CAP. This finding typically suggests a neurological or cardiovascular event rather than an initial manifestation of pneumonia. Assessing for syncope or fainting is important in differential diagnosis, but it does not reliably indicate community-acquired pneumonia in older adults.

An abrupt onset of fever and chills. Fever and chills are classic signs of pneumonia in younger adults, but older adults often have a blunted febrile response due to decreased thermoregulation and immune system changes. Relying on fever as the primary symptom may delay diagnosis in elderly clients. This emphasizes the need to consider atypical presentations such as confusion or functional decline.

A gradual onset of headache and sore throat. Headache and sore throat develop slowly and are more characteristic of viral upper respiratory infections, not bacterial CAP. These symptoms do not typically indicate pneumonia, especially in older adults, and should not be used alone to guide diagnosis. Emphasis should be placed on identifying respiratory symptoms, cognitive changes, and other risk factors for infection.

The severity of symptoms. Severity alone guides decisions regarding hospitalization or level of care, but it does not identify the causative pathogen. Treatment decisions require knowledge of likely organisms, not just symptom intensity. Relying solely on symptom severity could result in inappropriate antibiotic selection.

The presence of characteristic leukocytes. Leukocytosis indicates an inflammatory response but does not identify the specific microorganism causing pneumonia. White blood cell counts can be elevated in viral infections, bacterial infections, or other inflammatory states, making them insufficient to guide empiric therapy. Using leukocyte counts alone could lead to incorrect treatment.

Gram stains and cultures of sputum specimens. Gram stains and cultures are useful for confirming the pathogen and adjusting therapy but are not typically available immediately. Empiric treatment must begin promptly to reduce morbidity and mortality, before culture results are returned. Cultures primarily guide modification of therapy rather than initial antibiotic selection.

Obtain a sputum culture. Sputum cultures are important for identifying the causative organism and guiding antibiotic therapy but are not the immediate priority in a potentially unstable client. Delaying assessment of vital signs and oxygenation could risk deterioration if hypoxia or sepsis is present. Cultures can be obtained after stabilization.

Obtain a complete history from the client. History is valuable for understanding symptom onset, risk factors, and comorbidities, but acute confusion and pleuritic pain indicate a possible medical emergency. Immediate assessment of vital signs and oxygenation takes precedence to ensure patient safety.

Provide a pneumococcal vaccination. Vaccination is a preventive measure, not an acute treatment. Administering a vaccine does not address the client’s current symptoms of potential pneumonia and hypoxia. It is inappropriate as a priority action in the context of acute illness.

Return to work after another day of rest. Returning to work too early risks worsening fatigue, prolonging illness, and transmitting the virus to others. The client should remain home until fully recovered and fever-free to prevent complications and community spread. Advising an early return does not align with evidence-based infection control practices.

Use over-the-counter antihistamines. Antihistamines are not effective against influenza virus and do not reduce fever, myalgia, or respiratory symptoms. Their use may provide minor relief for rhinorrhea or sneezing but is not a primary treatment strategy for influenza. Relying on antihistamines alone does not address dehydration, fatigue, or systemic symptoms.

Make an appointment to get the flu shot. Vaccination is preventive and is most effective before influenza infection occurs. Post-infection vaccination does not treat current illness, and the client will not gain immediate benefit. Advising a flu shot after symptoms have already started is not clinically useful for managing active influenza.

Complete the first of three samples to be collected. Multiple sputum samples may be recommended in some cases, but the primary purpose is to identify the pathogen, not merely to collect multiple specimens. Focusing on the number of samples does not explain why the test is clinically important for treatment planning.

Differentiate between pneumonia and atelectasis. Imaging studies, such as chest x-ray or CT scan, are more useful for distinguishing pneumonia from atelectasis. Sputum cultures do not provide information about lung tissue collapse; their role is microbiologic rather than diagnostic of lung structure.

Encourage expectoration of secretions. Although expectoration may help clear mucus from the airways, this is a supportive measure and not the primary purpose of sputum collection. The clinical goal of the sample is identification of the causative pathogen for targeted therapy.

Weight loss, night sweats, persistent diarrhea, and hypothermia. These signs are more characteristic of chronic HIV infection or opportunistic gastrointestinal infections, not PCP. While immunocompromised clients may experience these systemic symptoms, they are not the primary manifestations of pulmonary infection caused by PCP.

Dysphagia, yellow-white plaques in the mouth, and sore throat. These are hallmarks of oral candidiasis, another opportunistic infection common in AIDS patients. Although clients with PCP may have concurrent infections, oral thrush is not a defining feature of PCP.

Lung crackles, chest pain, and small, painless purple-blue skin lesions. Purple-blue skin lesions are indicative of Kaposi sarcoma, and lung crackles or chest pain may occur in bacterial pneumonia or other lung pathologies. These findings are not specific to PCP, which primarily causes diffuse alveolar involvement with minimal adventitious lung sounds initially.

Avoiding antipyretics because of liver toxicity. Antipyretics such as acetaminophen are commonly used to reduce fever and improve comfort; avoiding them unnecessarily can lead to increased metabolic demand and dehydration. Standard doses are safe in clients without significant liver disease.

Including antiviral medication, such as amantadine (Symmetrel®). Antivirals are not indicated for bacterial pneumonia, which is the most common cause of community-acquired pneumonia requiring hospitalization. Their use would not address the current infection and may delay appropriate therapy.

Obtaining a physical therapy consult for increasing activity. While mobilization is beneficial in general, initiating physical therapy is not a priority intervention for acute pneumonia; focus should first be on stabilizing respiratory function and supporting hydration.

Decreased residual volume. Residual volume actually tends to increase with aging due to loss of elastic recoil, not decrease. Changes in residual volume alone do not directly impair airway clearance or cough effectiveness, so this is less likely to prompt a nursing diagnosis of pneumonia risk.

Increased vital capacity. Vital capacity decreases, rather than increases, with age because of reduced lung elasticity and thoracic expansion. An increased vital capacity is not consistent with typical age-related changes and would not indicate increased pneumonia risk.

Increased PaO₂. Arterial oxygen tension (PaO₂) generally decreases with age due to less efficient gas exchange. An increased PaO₂ is not expected in older adults and would not suggest impaired respiratory defense mechanisms.

Lung sounds were clear upon auscultation. Clear lung sounds indicate no abnormal airway or alveolar findings. In this case, the presence of a grating sound and respiratory pain clearly indicates abnormal findings, so documenting “clear” would be inaccurate and could delay treatment.

Fine crackles were heard upon auscultation. Fine crackles are brief, high-pitched sounds produced by the sudden opening of small airways or alveoli, often associated with fluid accumulation or atelectasis. Crackles do not produce grating sounds and are not typically associated with pleuritic pain, making this an inappropriate documentation choice.

Wheezing was heard upon auscultation. Wheezing is a continuous, high-pitched musical sound caused by narrowed airways, often from bronchospasm or obstruction. Wheezing does not have the coarse, grating quality described and is not associated with pleuritic pain, so it does not match this client’s presentation.

Mild allergic rhinitis. Allergic rhinitis is an immune-mediated reaction to allergens and is not a complication of influenza infection. It does not arise from viral-induced epithelial damage or bacterial colonization, making it unrelated to the client’s current viral illness.

Chronic obstructive pulmonary disease (COPD) unrelated to infection. While COPD may predispose clients to worse influenza outcomes, COPD itself is a chronic condition, not a complication caused by influenza. Exacerbations may occur, but they are not synonymous with secondary bacterial infection.

Hepatitis. Influenza primarily affects the respiratory tract, and viral infection does not directly cause hepatitis. Liver involvement is uncommon and would not be a routine complication to monitor for bacterial coinfection.

Fever and body aches. These systemic symptoms are characteristic of viral infections, such as influenza or common cold, rather than allergies. Allergic rhinitis does not typically provoke fever, myalgia, or systemic malaise. Documenting these findings would suggest a viral or bacterial cause rather than an allergic one.

Thick, yellow-green nasal discharge. Purulent nasal discharge usually indicates bacterial infection rather than an allergic response. Allergic rhinitis is associated with thin, watery secretions, not colored, thick mucus. Persistent thick discharge should prompt evaluation for sinusitis or other infectious etiologies.

Sore throat and mild fatigue. Mild pharyngeal irritation and fatigue are common in viral infections but are not distinguishing features of allergic rhinitis. Allergic rhinitis is primarily localized to the upper airway and eyes, with minimal systemic symptoms.

Typical viral influenza progression. Influenza alone usually presents with fever, myalgia, headache, dry cough, and malaise that gradually improve over 3–5 days. The onset of purulent sputum and pleuritic pain is not typical for uncomplicated viral influenza. Mistaking bacterial superinfection for normal viral progression could delay necessary antibiotic therapy.

Allergic rhinitis complication. Allergic rhinitis presents with clear rhinorrhea, sneezing, nasal congestion, and itchy eyes but does not cause high fever, purulent sputum, or pleuritic chest pain. These symptoms are inconsistent with allergic processes and indicate a pulmonary infection instead.

Unrelated asthma exacerbation. Asthma exacerbations may cause wheezing, dyspnea, and cough but are not typically associated with high fever, purulent sputum, or pleuritic chest pain. The temporal relationship with influenza infection and the purulent nature of the sputum strongly suggest secondary bacterial pneumonia rather than asthma.