, Table of Contents v v
Table of Contents
v v 1
Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical Nursing
v v v v v v v v v 3
Chapter 02: Overview of Health Concepts for Medical-Surgical Nursing
v v v v v v v v v 8
Chapter 03: Common Health Problems of Older Adults
v v v v v v v 13
Chapter 04: Assessment and Care of Patients with Pain
v v v v v v v v v 20
Chapter 05: Genetic Concepts for Medical-Surgical Nursing
v v v v v v v 32
Chapter 06: Rehabilitation Concepts for Chronic and Disabling Health Problems
v v v v v v v v v 38
Chapter 07: End-of-Life Care
v v v v 44
Chapter 08: Concepts of Emergency and Trauma Nursing
v v v v v v v 50
Chapter 09: Care of Patients with Common Environmental Emergencies
v v v v v v v v 56
Chapter 10: Concepts of Emergency and Disaster Preparedness
v v v v v v v v 62
Chapter 11: Assessment and Care of Patients with Fluid and Electrolyte Imbalances
v v v v v v v v v v v 68
Chapter 12: Assessment and Care of Patients with Acid-Base Imbalances
v v v v v v v v v v 76
Chapter 13: Infusion Therapy
v v v 83
Chapter 14: Care of Preoperative Patients
v v v v v 94
Chapter 15: Care of Intraoperative Patients
v v v v v v 103
Chapter 16: Care of Postoperative Patients
v v v v v v 109
Chapter 17: Inflammation and Immunity
v v v v v 116
Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases
v v v v v v v v v v v 122
Chapter 19: Care of Patients with HIV Disease
v v v v v v v v 138
Chapter 20: Care of Patients with Hypersensitivity (Allergy) and Autoimmunity
v v v v v v v v v 147
Chapter 21: Cancer Development
v v v v 152
Chapter 22: Care of Patients with Cancer
v v v v v v 157
Chapter 23: Care of Patients with Infection
v v v v v v v 167
Chapter 24: Assessment of the Skin, Hair, and Nails
v v v v v v v v 174
Chapter 25: Care of Patients with Skin Problems
v v v v v v v v 179
Chapter 26: Care of Patients with Burns
v v v v v v v 196
Chapter 27: Assessment of the Respiratory System
v v v v v v 213
Chapter 28: Care of Patients Requiring Oxygen Therapy or Tracheostomy
v v v v v v v v v 220
Chapter 29: Care of Patients with Noninfectious Upper Respiratory Problems
v v v v v v v v v v 226
Chapter 30: Care of Patients with Noninfectious Lower Respiratory Problems
v v v v v v v v v v 233
Chapter 31: Care of Patients with Infectious Respiratory Problems
v v v v v v v v v 245
Chapter 32: Care of Critically Ill Patients with Respiratory Problems
v v v v v v v v v 256
Chapter 33: Assessment of the Cardiovascular System
v v v v v v v 269
Chapter 34: Care of Patients with Dysrhythmias
v v v v v v 278
Chapter 35: Care of Patients with Cardiac Problems
v v v v v v v v 287
Chapter 36: Care of Patients with Vascular Problems
v v v v v v v v 298
Chapter 37: Care of Patients with Shock
v v v v v v v 310
Chapter 38: Care of Patients with Acute Coronary Syndromes
v v v v v v v v 317
Chapter 39: Assessment of the Hematologic System
v v v v v v v 327
Chapter 40: Care of Patients with Hematologic Problems
v v v v v v v 331
Chapter 41: Assessment of the Nervous System
v v v v v v v 343
Chapter 42: Care of Patients with Problems of the CNS: The Brain
v v v v v v v v v v v 353
Chapter 43: Care of Patients with Problems of the CNS: The Spinal Cord
v v v v v v v v v v v v v 364
Chapter 44: Care of Patients with Problems of the Peripheral Nervous System
v v v v v v v v v v v 374
Chapter 45: Care of Critically Ill Patients with Neurologic Problems
v v v v v v v v v v 380
Chapter 46: Assessment of the Eye and Vision
v v v v v v v 394
Chapter 47: Care of Patients with Eye and Vision Problems
v v v v v v v v v 397
Chapter 48: Assessment and Care of Patients with Ear and Hearing Problems
v v v v v v v v v v v 403
Chapter 49: Assessment of the Musculoskeletal System
v v v v v v v 410
Chapter 50: Care of Patients with Musculoskeletal Problems
v v v v v v v 415
,Chapter 51: Care of Patients with Musculoskeletal Trauma
v v v v v v v 424
Chapter 52: Assessment of the Gastrointestinal System
v v v v v v v 435
Chapter 53: Care of Patients with Oral Cavity Problems
v v v v v v v v v 441
Chapter 54: Care of Patients with Esophageal Problems
v v v v v v v v 445
Chapter 55: Care of Patients with Stomach Disorders
v v v v v v v v 454
Chapter 56: Care of Patients with Noninflammatory Intestinal Disorders
v v v v v v v v 461
Chapter 57: Care of Patients with Inflammatory Intestinal Disorders
v v v v v v v v v 471
Chapter 58: Care of Patients with Liver Problems
v v v v v v v v 481
Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas
v v v v v v v v v v v v 489
Chapter 60: Care of Patients with Malnutrition: Undernutrition and Obesity
v v v v v v v v v v 497
Chapter 61: Assessment of the Endocrine System
v v v v v v v 506
Chapter 62: Care of Patients with Pituitary and Adrenal Gland Problems
v v v v v v v v v v 512
Chapter 63: Care of Patients with Problems of the Thyroid and Parathyroid Glands
v v v v v v v v v v v v 520
Chapter 64: Care of Patients with Diabetes Mellitus
v v v v v v v v 527
Chapter 65: Assessment of the Renal/Urinary System
v v v v v v 549
Chapter 66: Care of Patients with Urinary Problems
v v v v v v v v 557
Chapter 67: Care of Patients with Kidney Disorders
v v v v v v v v 568
Chapter 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease
v v v v v v v v v v v v 575
Chapter 69: Assessment of the Reproductive System
v v v v v v v 587
Chapter 70: Care of Patients with Breast Disorders
v v v v v v v 591
Chapter 71: Care of Patients with Gynecologic Problems
v v v v v v v v 598
Chapter 72: Care of Patients with Male Reproductive Problems
v v v v v v v v 605
Chapter 73: Care of Transgender Patients
v v v v v v 614
Chapter 74: Care of Patients with Sexually Transmitted Diseases
v v v v v v v v 618
, Chapter 01: Overview of Professional Nursing Concepts for Medical-
v v v v v v v v
Surgical Nursing
v v
MULTIPLE CHOICE v
1. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse best
v v v v v v v v v v v v v v v
demonstrates this concept?
v v v
a. Assesses for cultural influences affecting health care
v v v v v v
b. Ensures that all the clients basic needs are met
v v v v v v v v
c. Tells the client and family about all upcoming tests
v v v v v v v v
d. Thoroughly orients the client and family to the room v v v v v v v v
ANS: A v
Competency in client-focused care is demonstrated when the nurse focuses on communication, culture,
v v v v v v v v v v v v
respect compassion, client education, and empowerment. By assessing the effect of the clients culture on
v v v v v v v v v v v v v v v
health care, this nurse is practicing client-focused care. Providing for basic needs does not demonstrate this
v v v v v v v v v v v v v v v v
competence.
v
Simply telling the client about all upcoming tests is not providing empowering education. Orienting the client
v v v v v v v v v v v v v v v
and family to the room is an important safety measure, but not directly related to demonstrating client-
v v v v v v v v v v v v v v v v v
centered care. v
DIF: Understanding/Comprehension REF: 3
v v v
KEY: Patient-centered care| culture MSC: Integrated Process: Caring
v v v v v v v
NOT: Client Needs Category: Psychosocial Integrity
v v v v v v
2. A nurse is caring for a postoperative client on the surgical unit. The clients blood pressure was 142/76 mm
v v v v v v v v v v v v v v v v v v
Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is best?
v v v v v v v v v v v v v v v v v
a. Call the Rapid Response Team.
v v v v
b. Document and continue to monitor. v v v v
c. Notify the primary care provider. v v v v
d. Repeat blood pressure measurement in 15 minutes.
v v v v v v
ANS: A v
The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating
v v v v v v v v v v v v v v
vbefore they suffer either respiratory or cardiac arrest. Since the client has manifested a significant change, the
v v v v v v v v v v v v v v v v
nurse should call the RRT. Changes in blood pressure, mental status, heart rate, and pain are
v v v v v v v v v v v v v v v v
vparticularly significant. v
Documentation is vital, but the nurse must do more than document. The primary care provider should be
v v v v v v v v v v v v v v v v
notified, but this is not the priority over calling the RRT. The clients blood pressure should be reassessed
v v v v v v v v v v v v v v v v v v
frequently, but the priority is getting the rapid care to the client.
v v v v v v v v v v v v
DIF: Applying/Application REF: 3
v v v
KEY: Rapid Response Team (RRT)| medical emergencies
v v v v v v
MSC: Integrated Process: Communication and
v v v v v
Documentation
v
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
v v v v v v v
3. A nurse is orienting a new client and family to the inpatient unit. What information does the nurse provide to
v v v v v v v v v v v v v v v v v v v
help the client promote his or her own safety?
v v v v v v v v v
a. Encourage the client and family to be active partners. v v v v v v v v
b. Have the client monitor hand hygiene in caregivers.
v v v v v v v
c. Offer the family the opportunity to stay with the client.
v v v v v v v v v
d. Tell the client to always wear his or her armband.
v v v v v v v v v
ANS: A v
Each action could be important for the client or family to perform. However, encouraging the client
v v v v v v v v v v v v v v v
vto be active in his or her health care as a partner is the most critical. The other actions are very limited in
v v v v v v v v v v v v v v v v v v v v v v
scope and do not provide the broad protection that being active and involved does.
v v v v v v v v v v v v v v
DIF: Understanding/Comprehension REF: 3
v v v
KEY: Patient safety
v v v
Table of Contents
v v 1
Chapter 01: Overview of Professional Nursing Concepts for Medical-Surgical Nursing
v v v v v v v v v 3
Chapter 02: Overview of Health Concepts for Medical-Surgical Nursing
v v v v v v v v v 8
Chapter 03: Common Health Problems of Older Adults
v v v v v v v 13
Chapter 04: Assessment and Care of Patients with Pain
v v v v v v v v v 20
Chapter 05: Genetic Concepts for Medical-Surgical Nursing
v v v v v v v 32
Chapter 06: Rehabilitation Concepts for Chronic and Disabling Health Problems
v v v v v v v v v 38
Chapter 07: End-of-Life Care
v v v v 44
Chapter 08: Concepts of Emergency and Trauma Nursing
v v v v v v v 50
Chapter 09: Care of Patients with Common Environmental Emergencies
v v v v v v v v 56
Chapter 10: Concepts of Emergency and Disaster Preparedness
v v v v v v v v 62
Chapter 11: Assessment and Care of Patients with Fluid and Electrolyte Imbalances
v v v v v v v v v v v 68
Chapter 12: Assessment and Care of Patients with Acid-Base Imbalances
v v v v v v v v v v 76
Chapter 13: Infusion Therapy
v v v 83
Chapter 14: Care of Preoperative Patients
v v v v v 94
Chapter 15: Care of Intraoperative Patients
v v v v v v 103
Chapter 16: Care of Postoperative Patients
v v v v v v 109
Chapter 17: Inflammation and Immunity
v v v v v 116
Chapter 18: Care of Patients with Arthritis and Other Connective Tissue Diseases
v v v v v v v v v v v 122
Chapter 19: Care of Patients with HIV Disease
v v v v v v v v 138
Chapter 20: Care of Patients with Hypersensitivity (Allergy) and Autoimmunity
v v v v v v v v v 147
Chapter 21: Cancer Development
v v v v 152
Chapter 22: Care of Patients with Cancer
v v v v v v 157
Chapter 23: Care of Patients with Infection
v v v v v v v 167
Chapter 24: Assessment of the Skin, Hair, and Nails
v v v v v v v v 174
Chapter 25: Care of Patients with Skin Problems
v v v v v v v v 179
Chapter 26: Care of Patients with Burns
v v v v v v v 196
Chapter 27: Assessment of the Respiratory System
v v v v v v 213
Chapter 28: Care of Patients Requiring Oxygen Therapy or Tracheostomy
v v v v v v v v v 220
Chapter 29: Care of Patients with Noninfectious Upper Respiratory Problems
v v v v v v v v v v 226
Chapter 30: Care of Patients with Noninfectious Lower Respiratory Problems
v v v v v v v v v v 233
Chapter 31: Care of Patients with Infectious Respiratory Problems
v v v v v v v v v 245
Chapter 32: Care of Critically Ill Patients with Respiratory Problems
v v v v v v v v v 256
Chapter 33: Assessment of the Cardiovascular System
v v v v v v v 269
Chapter 34: Care of Patients with Dysrhythmias
v v v v v v 278
Chapter 35: Care of Patients with Cardiac Problems
v v v v v v v v 287
Chapter 36: Care of Patients with Vascular Problems
v v v v v v v v 298
Chapter 37: Care of Patients with Shock
v v v v v v v 310
Chapter 38: Care of Patients with Acute Coronary Syndromes
v v v v v v v v 317
Chapter 39: Assessment of the Hematologic System
v v v v v v v 327
Chapter 40: Care of Patients with Hematologic Problems
v v v v v v v 331
Chapter 41: Assessment of the Nervous System
v v v v v v v 343
Chapter 42: Care of Patients with Problems of the CNS: The Brain
v v v v v v v v v v v 353
Chapter 43: Care of Patients with Problems of the CNS: The Spinal Cord
v v v v v v v v v v v v v 364
Chapter 44: Care of Patients with Problems of the Peripheral Nervous System
v v v v v v v v v v v 374
Chapter 45: Care of Critically Ill Patients with Neurologic Problems
v v v v v v v v v v 380
Chapter 46: Assessment of the Eye and Vision
v v v v v v v 394
Chapter 47: Care of Patients with Eye and Vision Problems
v v v v v v v v v 397
Chapter 48: Assessment and Care of Patients with Ear and Hearing Problems
v v v v v v v v v v v 403
Chapter 49: Assessment of the Musculoskeletal System
v v v v v v v 410
Chapter 50: Care of Patients with Musculoskeletal Problems
v v v v v v v 415
,Chapter 51: Care of Patients with Musculoskeletal Trauma
v v v v v v v 424
Chapter 52: Assessment of the Gastrointestinal System
v v v v v v v 435
Chapter 53: Care of Patients with Oral Cavity Problems
v v v v v v v v v 441
Chapter 54: Care of Patients with Esophageal Problems
v v v v v v v v 445
Chapter 55: Care of Patients with Stomach Disorders
v v v v v v v v 454
Chapter 56: Care of Patients with Noninflammatory Intestinal Disorders
v v v v v v v v 461
Chapter 57: Care of Patients with Inflammatory Intestinal Disorders
v v v v v v v v v 471
Chapter 58: Care of Patients with Liver Problems
v v v v v v v v 481
Chapter 59: Care of Patients with Problems of the Biliary System and Pancreas
v v v v v v v v v v v v 489
Chapter 60: Care of Patients with Malnutrition: Undernutrition and Obesity
v v v v v v v v v v 497
Chapter 61: Assessment of the Endocrine System
v v v v v v v 506
Chapter 62: Care of Patients with Pituitary and Adrenal Gland Problems
v v v v v v v v v v 512
Chapter 63: Care of Patients with Problems of the Thyroid and Parathyroid Glands
v v v v v v v v v v v v 520
Chapter 64: Care of Patients with Diabetes Mellitus
v v v v v v v v 527
Chapter 65: Assessment of the Renal/Urinary System
v v v v v v 549
Chapter 66: Care of Patients with Urinary Problems
v v v v v v v v 557
Chapter 67: Care of Patients with Kidney Disorders
v v v v v v v v 568
Chapter 68: Care of Patients with Acute Kidney Injury and Chronic Kidney Disease
v v v v v v v v v v v v 575
Chapter 69: Assessment of the Reproductive System
v v v v v v v 587
Chapter 70: Care of Patients with Breast Disorders
v v v v v v v 591
Chapter 71: Care of Patients with Gynecologic Problems
v v v v v v v v 598
Chapter 72: Care of Patients with Male Reproductive Problems
v v v v v v v v 605
Chapter 73: Care of Transgender Patients
v v v v v v 614
Chapter 74: Care of Patients with Sexually Transmitted Diseases
v v v v v v v v 618
, Chapter 01: Overview of Professional Nursing Concepts for Medical-
v v v v v v v v
Surgical Nursing
v v
MULTIPLE CHOICE v
1. A nurse wishes to provide client-centered care in all interactions. Which action by the nurse best
v v v v v v v v v v v v v v v
demonstrates this concept?
v v v
a. Assesses for cultural influences affecting health care
v v v v v v
b. Ensures that all the clients basic needs are met
v v v v v v v v
c. Tells the client and family about all upcoming tests
v v v v v v v v
d. Thoroughly orients the client and family to the room v v v v v v v v
ANS: A v
Competency in client-focused care is demonstrated when the nurse focuses on communication, culture,
v v v v v v v v v v v v
respect compassion, client education, and empowerment. By assessing the effect of the clients culture on
v v v v v v v v v v v v v v v
health care, this nurse is practicing client-focused care. Providing for basic needs does not demonstrate this
v v v v v v v v v v v v v v v v
competence.
v
Simply telling the client about all upcoming tests is not providing empowering education. Orienting the client
v v v v v v v v v v v v v v v
and family to the room is an important safety measure, but not directly related to demonstrating client-
v v v v v v v v v v v v v v v v v
centered care. v
DIF: Understanding/Comprehension REF: 3
v v v
KEY: Patient-centered care| culture MSC: Integrated Process: Caring
v v v v v v v
NOT: Client Needs Category: Psychosocial Integrity
v v v v v v
2. A nurse is caring for a postoperative client on the surgical unit. The clients blood pressure was 142/76 mm
v v v v v v v v v v v v v v v v v v
Hg 30 minutes ago, and now is 88/50 mm Hg. What action by the nurse is best?
v v v v v v v v v v v v v v v v v
a. Call the Rapid Response Team.
v v v v
b. Document and continue to monitor. v v v v
c. Notify the primary care provider. v v v v
d. Repeat blood pressure measurement in 15 minutes.
v v v v v v
ANS: A v
The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating
v v v v v v v v v v v v v v
vbefore they suffer either respiratory or cardiac arrest. Since the client has manifested a significant change, the
v v v v v v v v v v v v v v v v
nurse should call the RRT. Changes in blood pressure, mental status, heart rate, and pain are
v v v v v v v v v v v v v v v v
vparticularly significant. v
Documentation is vital, but the nurse must do more than document. The primary care provider should be
v v v v v v v v v v v v v v v v
notified, but this is not the priority over calling the RRT. The clients blood pressure should be reassessed
v v v v v v v v v v v v v v v v v v
frequently, but the priority is getting the rapid care to the client.
v v v v v v v v v v v v
DIF: Applying/Application REF: 3
v v v
KEY: Rapid Response Team (RRT)| medical emergencies
v v v v v v
MSC: Integrated Process: Communication and
v v v v v
Documentation
v
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation
v v v v v v v
3. A nurse is orienting a new client and family to the inpatient unit. What information does the nurse provide to
v v v v v v v v v v v v v v v v v v v
help the client promote his or her own safety?
v v v v v v v v v
a. Encourage the client and family to be active partners. v v v v v v v v
b. Have the client monitor hand hygiene in caregivers.
v v v v v v v
c. Offer the family the opportunity to stay with the client.
v v v v v v v v v
d. Tell the client to always wear his or her armband.
v v v v v v v v v
ANS: A v
Each action could be important for the client or family to perform. However, encouraging the client
v v v v v v v v v v v v v v v
vto be active in his or her health care as a partner is the most critical. The other actions are very limited in
v v v v v v v v v v v v v v v v v v v v v v
scope and do not provide the broad protection that being active and involved does.
v v v v v v v v v v v v v v
DIF: Understanding/Comprehension REF: 3
v v v
KEY: Patient safety
v v v
