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Study Guide for Understanding Medical Surgical Nursing 6th Edition best in 2021(Handbook)

Study Guide for Understanding Medical Surgical Nursing 6th Edition best in 2021(Handbook) @MehrsysSupport @MehrsysSupport STUDENT WORKBOOK FOR UNDERSTANDING Medical Surgical Nursing FIFTH EDITION STUDENT WORKBOOK FOR UNDERSTANDING Medical Surgical Nursing FIFTH EDITION Paula D. Hopper, MSN, RN, CNE Professor of Nursing Jackson College Jackson, Michigan Linda S. Williams, MSN, RN Professor of Nursing Jackson College Jackson, Michigan F.A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2015 by F.A. Davis Company Copyright © 2015 by F.A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Lisa B. Houck Director of Content Development: Darlene D. Pedersen Content Project Manager: Elizabeth D. Hart Illustration & Design Manager: Carolyn O‘Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. ISBN 13: 978-0-8036-4069-6 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F.A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-4069-6/11 0 + $.25. Proudly sourced and uploaded by [StormRG] Kickass Torrents | TPB | ET | h33t Preface NOTE TO THE STUDENT The Student Workbook for Understanding Medical Surgical Nursing has been written and edited by the authors to accompany the fifth edition of Understanding Medical Surgical Nursing. We have included exercises that not only help you review content, but also will help you develop your critical thinking abilities. It is essential for you to be able to think critically about the content as you prepare for the NCLEX-PN. We hope you will use this resource as well as your electronic study guide and the great resources on DavisPlus. SUGGESTIONS FOR USING THE STUDY GUIDE Checklists for Learning Success are provided at the beginning of each unit. You can use these checklists to track your study of the major topics. Each chapter includes: • An exercise to help you practice chapter vocabulary items. It is important to understand the underlying vocabulary before attempting to apply the terms to understand the remainder of the information in each chapter. • Basic matching, true/false, word scramble, and other exercises to allow you to practice and understand medical-surgical nursing information. These exercises are most helpful for developing knowledge and recall of material. • Critical thinking exercises to help you practice your new knowledge in patient situations and make good clinical judgments. We feel strongly that you must learn to think critically, rather than just memorize facts. The answers we provide for the critical thinking exercises are just some of the possibilities. You will come up with additional answers of your own as your knowledge base expands. • NCLEX-PN style questions to provide practice in applying your new knowledge. Rationale for why an answer is correct or incorrect has been included to strengthen your critical thinking and test-taking abilities. • Function and Assessment chapters also include a labeling exercise to help you review basic anatomy. STUDY GUIDE ANSWERS • To students: Study Guide answers are posted on the instructor‘s DavisPlus site. Ask your instructor about accessing answers. • To instructors: Study Guide answers are posted on the instructor‘s DavisPlus site. Students do not have access to Study Guide answers. Please provide answers to students according to your needs. We hope you find this study guide useful. Happy studying! PAULA D. HOPPER AND LINDA S. WILLIAMS v Contents UNIT ONE Understanding Health Care Issues 1 1 Critical Thinking and the Nursing Process 2 2 Evidence-Based Practice 5 3 Issues in Nursing Practice 8 4 Cultural Influences on Nursing Care 12 5 Complementary and Alternative Modalities 16 UNIT TWO Understanding Health and Illness 19 6 Nursing Care of Patients With Fluid, Electrolyte, and Acid-Base Imbalances 20 7 Nursing Care of Patients Receiving Intravenous Therapy 23 8 Nursing Care of Patients With Infections 26 9 Nursing Care of Patients in Shock 30 10 Nursing Care of Patients in Pain 34 11 Nursing Care of Patients With Cancer 37 12 Nursing Care of Patients Having Surgery 40 13 Nursing Care of Patients With Emergent Conditions and Disaster/Bioterrorism Response 45 UNIT THREE Understanding Life Span Influences on Health and Illness 49 14 Developmental Considerations in the Nursing Care of Adults 50 15 Nursing Care of Older Adult Patients 53 16 Nursing Care of Patients at Home 57 17 Nursing Care of Patients at the End of Life 60 UNIT FOUR Understanding the Immune System 63 18 Immune System Function, Assessment, and Therapeutic Measures 64 19 Nursing Care of Patients With Immune Disorders 68 20 Nursing Care of Patients With HIV Disease and AIDS 74 UNIT FIVE Understanding the Cardiovascular System 77 21 Cardiovascular System Function, Assessment, and Therapeutic Measures 78 22 Nursing Care of Patients With Hypertension 82 23 Nursing Care of Patients With Valvular, Inflammatory, and Infectious Cardiac or Venous Disorders 86 24 Nursing Care of Patients With Occlusive Cardiovascular Disorders 92 25 Nursing Care of Patients With Cardiac Dysrhythmias 96 26 Nursing Care of Patients With Heart Failure 102 UNIT SIX Understanding the Hematologic and Lymphatic Systems 107 27 Hematologic and Lymphatic System Function, Assessment, and Therapeutic Measures 108 28 Nursing Care of Patients With Hematologic and Lymphatic Disorders 112 UNIT SEVEN Understanding the Respiratory System 117 29 Respiratory System Function, Assessment, and Therapeutic Measures 118 30 Nursing Care of Patients With Upper Respiratory Tract Disorders 123 31 Nursing Care of Patients With Lower Respiratory Tract Disorders 126 UNIT EIGHT Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems 131 32 Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment, and Therapeutic Measures 132 vii viii Contents 33 Nursing Care of Patients With Upper Gastrointestinal Disorders 137 34 Nursing Care of Patients With Lower Gastrointestinal Disorders 141 35 Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders 144 UNIT NINE Understanding the Urinary System 149 36 Urinary System Function, Assessment, and Therapeutic Measures 150 37 Nursing Care of Patients With Disorders of the Urinary System 154 UNIT TEN Understanding the Endocrine System 159 38 Endocrine System Function and Assessment 160 39 Nursing Care of Patients With Endocrine Disorders 163 40 Nursing Care of Patients With Disorders of the Endocrine Pancreas 167 UNIT ELEVEN Understanding the Genitourinary and Reproductive System 171 41 Genitourinary and Reproductive System Function and Assessment 172 42 Nursing Care of Women With Reproductive System Disorders 177 43 Nursing Care of Male Patients With Genitourinary Disorders 180 44 Nursing Care of Patients With Sexually Transmitted Infections 183 UNIT TWELVE Understanding the Musculoskeletal System 187 45 Musculoskeletal Function and Assessment 188 46 Nursing Care of Patients With Musculoskeletal and Connective Tissue Disorders 192 UNIT THIRTEEN Understanding the Neurologic System 197 47 Neurologic System Function, Assessment, and Therapeutic Measures 198 48 Nursing Care of Patients With Central Nervous System Disorders 203 49 Nursing Care of Patients With Cerebrovascular Disorders 207 50 Nursing Care of Patients With Peripheral Nervous System Disorders 211 UNIT FOURTEEN Understanding the Sensory System 215 51 Sensory System Function, Assessment, and Therapeutic Measures: Vision and Hearing 216 52 Nursing Care of Patients With Sensory Disorders: Vision and Hearing 221 UNIT FIFTEEN Understanding the Integumentary System 225 53 Integumentary System Function, Assessment, and Therapeutic Measures 226 54 Nursing Care of Patients With Skin Disorders 229 55 Nursing Care of Patients With Burns 232 UNIT SIXTEEN Understanding Mental Health Care 235 56 Mental Health Function, Assessment, and Therapeutic Measures 236 57 Nursing Care of Patients With Mental Health Disorders 239 unit ONE Understanding Health Care Issues CHECKLIST FOR LEARNING SUCCESS Critical Thinking ❑ Critical thinking traits ❑ Knowledge base ❑ Critical thinking skills ❑ Problem solving ❑ Role of the LPN/LVN ❑ Nursing process ❑ Data collection ❑ Documentation of data ❑ Nursing diagnosis ❑ Planning care ❑ Prioritizing care ❑ Identifying interventions ❑ Implementation ❑ Evaluation Evidence-Based Practice ❑ Evidence-based practice ❑ Use of evidence-based practice ❑ Identifying evidence ❑ Evidence-based practice process ❑ Six steps of evidencebased practice ❑ Evidence-based practice, quality and safety ❑ Quality and Safety Education for Nurses (QSEN) project ❑ Joint Commission‘s 2014 National Patient Safety Goals Issues ❑ Health care delivery ❑ Economic issues ❑ Nursing/health team ❑ Leadership in nursing practice ❑ Career opportunities ❑ Ethics and values ❑ Ethical obligations and nursing ❑ Nursing code of ethics ❑ Building blocks of ethics ❑ Ethical theories ❑ Ethical decision making ❑ Legal concepts ❑ HIPAA ❑ Nursing liability and the law Cultural Influences ❑ Cultural diversity ❑ Communication ❑ Space ❑ Time orientation ❑ Social organization ❑ Environmental control ❑ Health care providers ❑ Biological variations ❑ Death and dying ❑ Cultural groups ❑ Culturally competent care Alternative/Complementary ❑ Alternative versus complementary therapies ❑ Allopathic/Western medicine ❑ Ayurveda ❑ Chinese medicine ❑ Chiropractic ❑ Homeopathy ❑ Naturopathy ❑ American Indian medicine ❑ Osteopathy ❑ Herbal therapy ❑ Relaxation therapies ❑ Massage therapy ❑ Aquatherapy ❑ Heat and cold ❑ Safety/effectiveness ❑ Role of LPN/LVN Critical Thinking and the Nursing Process VOCABULARY Define the following terms and use them in sentences. Nursing process Definition: Sentence: Critical thinking Definition: Sentence: Assessment Definition: Sentence: Objective data Definition: Sentence: Subjective data Definition: Sentence: Nursing diagnosis Definition: Sentence: Evaluation Definition: Sentence: Vigilance Definition: Sentence: 2 1 SUBJECTIVE AND OBJECTIVE DATA Identify the following data as subjective (symptom) or objective (sign). Chapter 1 Critical Thinking and the Nursing Process 3 12. Serum potassium 3.6 mEq/L 13. Palpitations (feeling of racing heart) 14. Blood pressure 130/82 mm Hg 1. Pain 2. Shortness of breath 3. Edema (swelling) 4. Capillary refill 2 seconds 5. Nausea 6. Vomiting 7. Dizziness 8. Cyanosis 9. Numbness 10. Indigestion 11. Pale 15. White blood cell count 7000/mm3 CRITICAL THINKING Sometimes cognitive maps are used to organize thinking. Look at samples in any of the Function and Assessment chapters under Aging Changes. Some of the workbook chapters will ask you to make a cognitive map, so here is an opportunity to practice. Consider a time when you have had a headache or other discomfort. Fill in the spaces with information related to the WHAT‘S UP? questions. See Chapter 1 Answers for one patient‘sresponses. Once you have the questions answered, you could go even further and make links with possible interventions. There is no one right way to make a cognitive map—use your imagination! Choose the best answer unless directed otherwise. 1. Which one of the following is a nursing diagnosis? 1. Peptic ulcer 2. Pneumonia 3. Ineffective airway clearance 4. Myocardial infarction 2. Which one of the following is a medical diagnosis? 1. Hiatal hernia 2. Impaired mobility 3. Powerlessness 4. Anxiety 3. An LPN wishes to learn why a patient‘s lung sounds have crackles and questions the physician during morning rounds. Which critical thinking attitude is the nurse exhibiting? 1. Intellectual humility 2. Intellectual sense of justice 3. Intellectual empathy 4. Intellectual integrity REVIEW QUESTIONS—CONTENT REVIEW Patient's perception Where is it? Quality Aggravating and alleviating factors Headache Useful other data Severity Timing 4 UNIT ONE Understanding Health Care Issues 4. The LVN is caring for a patient with diabetes. In what order should the nurse carry out the nursing process? Place all steps in correct sequential order. 1. Implement plan of care 2. Assist with evaluation 3. Collect data 4. Assist with development of nursing diagnoses 5. Assist with planning of outcomes and interventions 5. Which of the following statements best defines critical thinking? 1. Orderly, goal-directed thinking 2. Clear thinking during critical situations 3. Constructive feedback about nursing actions 4. Critical evaluation of patient responses to care Choose the best answer unless directed otherwise. 6. The LPN is reviewing the nursing care plan for a patient with acute pain related to a fractured ankle. Which of the following would determine whether the care plan is effective? 1. Assessment of the patient‘s ability to walk 2. Evaluation of the patient‘s fracture on X-ray 3. Elevating the patient‘s foot on two pillows 4. Evaluation of the patient‘s pain rating on a 10-point scale. 7. A patient with a history of cardiac disease reports a feeling of tightness in the chest that radiates down the left arm. Which of the following actions by the LPN should be carried out immediately? 1. Check the patient‘s vital signs. 2. Formulate nursing diagnoses related to an acute myocardial infarction. 3. Determine the patient‘s outcome after nitroglycerin has been administered. 4. Plan interventions to reduce long-term cardiac damage. 8. The LPN is documenting patient data. Which of the following should the nurse document under objective data? 1. Denies nausea 2. Shortness of breath 3. Heart rate 72 beats per minute 4. Midsternal chest pain 9. A patient is admitted with chest pain, which has resolved. The patient states, ―I hope I can live a normal life.‖ According to Maslow‘s hierarchy of needs, which of the following levels is best reflected by this statement? 1. Physiological needs 2. Safety and security 3. Love and belonging 4. Self-esteem 10. A patient has a nursing diagnosis of impaired swallowing related to muscle weakness as evidenced by drooling, coughing, and choking. Which of the following outcomes is appropriate for this patient‘s nursing diagnosis? 1. Improved airway clearance within 8 hours as evidenced by clear lung sounds and productive cough 2. Baseline body weight maintained as evidenced by no weight loss 3. Improved muscle strength as evidenced by ability to sit up while eating 4. Improved swallowing within 48 hours as evidenced by no coughing or choking 11. The LPN is providing care for a patient with a medical diagnosis of congestive heart failure who is very short of breath. Which of the following is a nursing diagnosis that is correctly stated in the PES (problem, etiology, and signs and symptoms) format? 1. Deficient knowledge related to disease process and self-care for shortness of breath 2. Impaired gas exchange related to excess interstitial fluid as evidenced by respiratory rate of 32 per minute and patient stating he feels short of breath 3. Congestive heart failure related to decreased cardiac output as evidenced by abnormal arterial blood gasses 4. Acute dyspnea related to congestive heart failure as evidenced by swollen lower extremities and confusion. REVIEW QUESTIONS—TEST PREPARATION Evidence-Based Practice 2 VOCABULARY Define the following terms. 1. Evidence-based practice 2. Randomized controlled trials 3. Research 4. Systematic review EVIDENCE-BASED PRACTICE 1. Evidence is the of effectiveness behind nursing practice. 2. It is important for the in which the evidence will be used to be considered. 3. Evidence-based practice (EBP) is a complex but important, necessary process to facilitate care and optimal patient outcomes. 4. Evidence-based practice is used by nurses to give the best possible. 9. Patient-centered care meets the needs and preferred schedules. 10. Evidence is the core that directs safe, quality-driven, excellent patient care. CRITICAL THINKING Read the following case study and answer the questions. Nurses on a surgical unit were interested in knowing if music would reduce the preoperative anxiety of patients on their unit. 1. How are these nurses contributing to quality care? 5. Level I is the evidence and is an analysis of many controlled trials. 6. Nurses will know from measured that they are giving the best care possible. 2. What should the nurses do to begin the process? 7. Evidence-based practice is considered the standard of health care. 8. The Quality and Safety Education for Nurses (QSEN) project focuses on education that promotes the continual improvement of quality and safety in patient care. 3. What are some examples of resources that can be used to find evidence? 5 6 UNIT ONE Understanding Health Care Issues 4. The nurses found Level I research studies that showed music therapy could be beneficial in reducing anxiety. What step should the nurses take next? 5. The planned intervention was implemented, data were collected during the implementation, and now the pilot study has ended. What step should the nurses take next? Choose the best answer unless directed otherwise. 1. Which of the following is considered significant evidence to guide nursing care? 1. Research studies that are quasi-experimental 2. Cochrane Reviews 3. Nursing information from the Internet 4. The opinion of a nationally known nursing expert 2. A nurse would like to find other studies on wound care that might be relevant to how wound care is done. Which of the following would be the best for searching for nursing articles on wound care? 1. CINAHL 2. Medline 3. Cochrane Review 4. PubMed 3. A nurse on the safety committee is assigned to review the current National Patient Safety Goals. In which of these ways will the nurse find the goals? 1. Review Joanna Briggs Best Practices. 2. Review a fundamentals nursing textbook. 3. Go to . 4. Search Cochrane Reviews. 4. Which of the following best describes a randomized clinical trial (RCT)? 1. An observational study designed to collect subjective data 2. An experimental study in which multiple factors affecting the results are controlled 3. A specific design categorizing modifiable and nonmodifiable risk factors 4. Tracking of disease occurrence over a set period of time 5. Evidence-based practice most often begins with which of the following? 1. Asking how to solve a clinical problem 2. Initiating a literature search 3. Analyzing available evidence 4. Measuring baseline outcomes Choose the best answer unless directed otherwise. 6. The nurse is reviewing the patient‘s plan of care and ordered treatments. Which of the following is an independent nursing intervention? Select all that apply. 1. Giving Tylenol 650 milligrams orally every 4 hours as needed (prn) 2. Assisting patient to position of comfort 3. Giving hand massage daily 4. Initiating high-risk fall protocol 5. Placing call button within reach at all times 6. Teaching deep breathing and relaxation techniques as needed 7. A nurse on the research committee is assigned to review the best evidence on patient centered bathing. Which of the following kinds of evidence would the nurse select for Level I research? Select all that apply. 1. A Cochrane review 2. One RCT 3. Four quasi-experimental studies that show similar results 4. The opinion of a national nursing expert on the subject 5. A Joanna Briggs Best Practice Review REVIEW QUESTIONS—TEST PREPARATION REVIEW QUESTIONS—CONTENT REVIEW 8. The nurse will include which of the following in applying the process of evidence-based practice to patient centered care? Select all that apply. 1. Evaluate the change. 2. Determine current practice. 3. Ask a burning question. 4. Know how to conduct an RCT. 5. Search for the best available evidence. 6. Make it happen. 9. The nurse provides care for residents on an Alzheimer‘s unit and is working with family members of a 67-year-old patient who was recently admitted. Which of the following statements reveals the nurse‘s awareness of evidence-based reality orientation practice? 1. ―Patients on this unit are generally very sweet, so your loved one will quickly fit right in.‖ 2. ―Our dietician provides high-protein snacks twice daily to help prevent brain degeneration.‖ 3. ―You‘ll notice clocks, calendars, and the use of patient pictures in the hallways to help residents stay oriented.‖ 4. ―Alzheimer‘s is a devastating disease, so it is mandatory that family members participate in our weekly support groups.‖ Chapter 2 Evidence-Based Practice 7 10. A nurse investigating the effect of 12-hour shifts on medication errors identifies 962 articles published on the topic of 12-hour shifts in the past 5 years. Which action should the nurse take next? 1. Find out how many of the articles can be found at the institution. 2. Request all 962 articles and determine their validity. 3. Limit the request to articles published in the past 3 years. 4. Narrow the search to identify which articles discuss medication errors. Issues in Nursing Practice VOCABULARY Match the term with the appropriate definition or statement. 1. Assault 2. Battery 3. Defamation 4. False imprisonment 5. Outrage 6. Invasion of privacy and wrongful disclosure of confidential information 1. Unlawful touching of another 2. Unlawful conduct that places another in the immediate fear of unlawful touching or battery; the real threat of bodily harm 3. Unlawful restriction of a person‘s freedom 4. Extreme and outrageous conduct by a defendant relating to the care of the patient or the body of a deceased individual 5. Wrongful injury to another‘s reputation or standing in a community; may be written (libel) or spoken (slander) 6. Liability when a patient‘s privacy is invaded physically or if records are released without authority NURSING PRACTICE AND ETHICAL AND LEGAL PRINCIPLES 1. The health–illness continuum represents the potential shifting between health and poor health throughout the span. 2. Nurses must be licensed to practice to the public and maintain the of health care services. 3. is a central virtue in nursing. 4. Nursing care uses the following principles: ensuring and respect, confidentiality, respecting the patient‘s right to make care choices, and maintaining a professional relationship with the patient. 5. Effective leaders are about the management process, , positive thinkers, and use to earn the of their coworkers. VALUES CLARIFICATION Complete the following sentences. 1. The one thing I have always wanted to do is . 2. If I inherited 5 million dollars, I would . 3. As president of the United States, I would . 4. If I died today, I would like my obituary to say . 5. If I could control the world and its destiny, I would . 8 3 Complete this list of things people value with any other items you believe should be included, then rank the value you believe each item has, with 1 being the highest value. Rank Valued Item Rank Valued Item Family Professionalism Career Religion Honor Material possessions Health Recreation What have you learned about yourself by doing this exercise? What do the rankings signify? Can you identify yourself as more utilitarian or more deontological? (There are no answers to this section because this is an exercise requiring personal responses.) CRITICAL THINKING Read the following case study and answer the questions. Mrs. Reo, a 5 foot, 3 inch, 105-lb, 86-year-old retired cleaning lady, was admitted to a general medical-surgical unit in a small rural hospital. She was diagnosed 3 months ago with metastatic cancer that had spread from her liver to her lungs Chapter 3 Issues in Nursing Practice 9 perhaps sepsis. In her already weakened condition, an infection or sepsis would most likely be fatal. Betsy, who had been a licensed practical nurse for some 15 years, disagreed with the manager. Her feeling was that causing this obviously terminal patient so much pain by turning her was cruel and violated her dignity as a human being. She stated that she could not stand to hear Mrs. Reo yell anymore and refused to take care of her until some other decision was made about her nursing care. Sally, a new graduate nurse, felt that the patient should have some say in her own care and that perhaps some type of compromise could be reached about turning her, perhaps turning her less frequently or providing more pain relief medication. Monica, a registered nurse who had worked on the unit for 2 years, felt that the physician should make the decision about turning this patient, and then the nurses should follow the order. This last suggestion was met with strong negative comments by the other nurses present. They felt that patient comfort and turning were nursing measures. 1. What are the important ethical principlesin this dilemma? 2. How does the Code of Ethics apply to this situation? and bone marrow. She received chemotherapy and radiation therapy for several weeks, but the treatment was not effective. She was admitted to the hospital because she became too weak to walk or care for herself at home. The cancer returned, and the large doses of oral narcotic medications taken at home were having little effect on her pain while increasing her confusion and weakness. Her oncologist decided that further chemotherapy or radiation therapy would not be effective, and she ordered Mrs. Reo to be kept comfortable with medications. A continuous morphine intravenous (IV) drip was started to help control the pain. Even with this medication, Mrs. Reo cried 3. What are the legal issues? 4. Are there ever any situations when a nurse might legally and ethically violate a standard of care? out in pain, particularly when morning care was given, and begged the nurses not to move her. Because she was severely underweight, the skin over her bony prominences quickly became reddened and showed the beginning signs of breakdown. The hospital standards of care for immobile patients 5. What are some other possible solutions to this dilemma? What types of consequences might they have? require that they be repositioned at least every 2 hours. Mrs. Reo yelled so loudly when she was turned that the nursing staff wondered if they were really helping her or hurting her. To help decide what should be done, the nurses who gave care to Mrs. Reo called a patient care conference. The manager of the unit stated clearly that the hospital standards of care required Mrs. Reo be repositioned at least every 2 hours to prevent skin breakdown, infections, and (There are no correct answers to this section because this is an ethical exercise that has many choices to be considered for the best outcome for the patient. Discuss your options with classmates.) 10 UNIT ONE Understanding Health Care Issues Choose the best answer unless directed otherwise. 1. The ethical principle that the primary goal of health care and nursing is to do good for others is called which of the following? 1. Autonomy 2. Fidelity 3. Beneficence 4. Veracity 2. The ethical principle of nonmaleficence is defined as which of the following? 1. Health care workers avoiding harm to patients 2. Telling the truth to patients in all matters 3. Being faithful to commitments made to patients 4. The right of self-determination of patients 3. Which of the following is the term used to describe an ethical situation that arises in which there is a choice between two equally unfavorable alternatives? 1. Tort 2. Ethical antagonism 3. Contraindication 4. Ethical dilemma 4. Which of the following is the first step in the ethical decision-making process? 1. Analyze the alternatives. 2. Identify the ethical dilemma. 3. Consider the consequences of the actions. 4. Make a decision. 5. Ethical dilemmas most often involve which of the following situations? 1. A conflict of basic human rights 2. Violations of the Nurses‘ Code of Ethics 3. Nurses who do not understand the ethical code 4. Patients who wish to die 6. When applying the ethical principle of autonomy to patient care, the nurse should understand that which of the following is applicable to autonomy? 1. Autonomy is an absolute principle that has no exceptions. 2. Only patients who are awake and oriented have the right to autonomy. 3. Under certain conditions, autonomy can be limited. 4. Autonomy is the same as the principle of nonmaleficence. 7. Which of the following punishments distinguishes criminal liability from civil liability? 1. Personal liability 2. Financial recovery 3. Loss of license 4. Potential loss of freedom 8. Which of the following is an unintentional tort? 1. Negligence 2. Outrage 3. Assault 4. Privacy invasion Choose the best answer unless directed otherwise. 9. A patient with emphysema is being seen by the home health nurse. The patient is on oxygen, lives alone, and is able to perform activities of daily living, prepare meals, and do light household tasks with rest periods. The patient is unable to perform yard work, which was a favorite hobby. Which of the following would describe the patient‘s location on the health–illness continuum? 1. Near death 2. High-level wellness 3. Poor health 4. Moderate-level wellness 10. A Nurses‘ Code of Ethics states, ―The nurse safeguards the patient‘s right to privacy by judiciously protecting information of a confidential nature.‖ This statement is based on which of the following principles? 1. The right to privacy is an inalienable right of all persons. 2. The nurse–patient relationship is based on trust. 3. A breach of confidentiality may expose the nurse to liability. 4. Nurses know what is best for patients‘ health care. REVIEW QUESTIONS—TEST PREPARATION REVIEW QUESTIONS—CONTENT REVIEW 11. A patient asks the nurse what is the purpose of a new medication. The nurse responds, ―The medication will help you feel better, and not to worry about it.‖ The nurse‘s response demonstrates which of the following conditions? 1. Therapeutic communication 2. Paternalism 3. Lack of knowledge 4. Legal obligations 12. The nurse attempts to apply the standard of best interest to a patient who has had a cardiac arrest and is now unconscious. Which of the following conditions is the most important factor for the nurse to consider? 1. The patient‘s wishes as expressed before becoming unconscious 2. The family‘s wishes now that the patient can no longer communicate 3. The patient‘s chances for survival after the cardiac arrest 4. The physician‘s orders regarding future arrest situations Chapter 3 Issues in Nursing Practice 11 13. The LVN is considering whether the task of taking a blood pressure on a 78-year-old resident with hypertension can be delegated to a nursing assistant. Which of the following steps should the nurse consider in this decision-making process for delegation? Select all that apply. 1. Right task 2. Right circumstances 3. Right patient 4. Right communication 5. Right supervision 6. Right route Cultural Influences on Nursing Care VOCABULARY Match the term with the appropriate definition or statement. 1. Belief 2. Cultural awareness 3. Cultural competence 4. Ethnic 5. Ethnocentrism 6. Generalization 7. Stereotype 8. Value 9. Worldview 10. Custom 11. Cultural sensitivity 12. Assimilation 1. A usual way of acting in a given situation 2. Accepted as true, need not be proven 3. Focuses on knowledge and appreciation of history and ancestry of other cultures 4. Avoiding actions that may offend another person‘s cultural beliefs 5. Belief that ―my way is the only right way‖ 6. An assumption that needs validation 7. An opinion or belief about someone because of ethnic background 8. Belonging to a subgroup of a larger cultural group 9. Way a person perceives the world 10. The process of taking on a dominant culture‘s values, sometimes with risk of losing one‘s own cultural heritage 11. Using knowledge and skills about another culture to provide care 12. A principle or belief that has worth to an individual or group CULTURAL CHARACTERISTICS Answer the following questions. Discuss with a classmate. 1. What are some examples of primary characteristics of culture? 2. What are some examples of secondary characteristics of culture? 12 4 Chapter 4 Cultural Influences on Nursing Care 13 3. What is meant by traditional health care practitioners? 3. What significance does food have to you besides satisGive an example. fying hunger? 4. What are some characteristics of people who are primarily present oriented? Past oriented? Future oriented? 4. Are you usually on time for social events? For appointments? Why or why not? CRITICAL THINKING: IMMIGRANTS There are no correct or incorrect answers to the following questions. Share your thoughts with your classmates. 1. Are immigrants taking away from the United States, or are they adding to its richness? Give specific examples, and share your reasons for your position. (There are no answers to this section because this is an exercise requiring personal responses.) CRITICAL THINKING: BATHING Read the following case study and answer the questions. An older adult male Arab American patient refuses to be bathed by a female nurse‘s aide. He has not been bathed for 3 days, and today he really needs a bath. His family is at his bedside. 2. Identify health care difficulties that new immigrants must overcome in the United States. How might you, as a nurse, help them overcome these difficulties? 1. Why do you think he is refusing his bath? 2. What alternatives do you have? (There are no answers to this section because this is an exercise requiring personal responses.) CRITICAL THINKING: PERSONAL INSIGHTS Answer the following questions. Consider how people from other cultures might answer differently. 1. What do you personally do to prevent illness? 3. What is the best solution to the problem? 2. What home remedies do you use when you have a minor illness such as a cold or flu? Do you use overthe-counter medications to treat yourself? How might these over-the-counter medicines cause a problem with prescription medications? 14 UNIT ONE Understanding Health Care Issues Choose the best answer unless directed otherwise. 1. Patients of Eastern European Jewish heritage who are getting married should be provided information on which disorder? 1. Sickle cell anemia 2. Thalassemia 3. Lactose intolerance 4. Tay-Sachs disease 2. A patient states, ―I don‘t know why that foreign doctor needs to be here. I only want to see American doctors.‖ This is an example of which of the following principles? 1. Cultural sensitivity 2. Cultural diversity 3. Ethnocentrism 4. Acculturation 3. Hispanic Americans and American Indians generally have a (higher or lower) glucose level than whites. Choose the best answer unless directed otherwise. 4. A 26-year-old Pueblo American Indian mother arrives at the health clinic to receive treatment for a laceration on her leg. Accompanying her are her two children, who missed their immunization appointments last month because she did not have transportation. As the clinic nurse, what is the best approach to ensure that the children get their immunizations? 1. Give the immunizations today. 2. Reschedule the appointment for next month at the regular hours for the immunization clinic. 3. Reschedule the immunizations for when she returns to have her stitches removed. 4. Ask the community health nurse to go to the home to give the immunizations. 5. A Guatemalan patient died after a cardiac arrest. His wife is uncontrollably wailing and shouting ―Vaya con dios!‖ and lying on the floor shaking. What action should the nurse take? 1. Call a cardiac arrest team. 2. Immediately call for a stretcher and get her off the floor. 3. Calmly remain beside her and talk to her. 4. Call the house physician to order a tranquilizer. 6. A Laotian child is brought to the emergency department by the school nurse. She wants the child examined for the possibility of child abuse because he has several circular ecchymotic areas 2 inches in diameter on his back. What action should the intake nurse perform? 1. Call the child welfare authorities to intervene. 2. Explain to the school nurse that the bruised areas may be caused by the traditional Chinese practice of cupping. 3. Inform the child‘s mother that he is in the emergency department. 4. Report the school nurse for not getting consent from the mother to bring the child to the emergency department. 7. A 42-year-old Arab American patient has chronic renal failure. He asks the nurse where he can purchase a kidney for transplantation. Which response is best? 1. Organs cannot be purchased in the United States. 2. Explain the ethical dilemma in purchasing organs. 3. Call the unit supervisor. 4. Give him the area organ procurement telephone number. REVIEW QUESTIONS—TEST PREPARATION REVIEW QUESTIONS—CONTENT REVIEW 8. A 12-year-old child from a traditional Korean American family is newly diagnosed with diabetes mellitus. His home health nurse isto teach the patient and family diabetes care. Both parents and the child can administer his insulin and recite the signs and symptoms of hypoglycemia and hyperglycemia. They are highly educated and read and speak English well. Which is the best firststep in teaching them about nutrition therapy for diabetes? 1. Give them a food exchange list for a diabetic diet. 2. Determine whether they can calculate calories in a sample meal. 3. Assess current dietary food practices. 4. Have them make an appointment with a consulting dietitian. Chapter 4 Cultural Influences on Nursing Care 15 11. A 42-year-old African American patient is 40 pounds overweight. She admits to baking pies with lard and frying food in bacon grease, practices she does not wish to stop. To reduce fat and calories, what can the home health nurse encourage her to do? 1. Do not purchase lard. 2. Reduce the portion size when she cuts her pies. 3. Bake two separate pies, one for her and one for her family. 4. Continue baking with lard, but reduce calories she receives from other foods in her diet. 12. A 41-year-old Hispanic woman has had a mastectomy for cancer of the breast. Her physician recommends radiation therapy. She says, ―What is the use? My life is in God‘s hands anyway.‖ Which of the following 9. A 46-year-old Cuban American high school teacher has been admitted for cancer of the breast. She wants her religious counselor, a santero, to visit. Which action should the nurse take? 1. Ask the nursing supervisor to see if a visit from a santero is permitted. 2. Tell her thatsanteros are not permitted in the hospital. 3. Suggest that she see a hospital priest instead. 4. Tell her a visit is fine, but for safety reasons she should tell the nurse or physician before accepting any treatments. 10. A 62-year-old Hispanic Peruvian woman is in the operating room having bypass surgery. Eighteen family members arrive on the unit and wait in her room, which is shared by two other patients. Which is the best solution to this problem? 1. Allow two family members to wait in the room and send the rest of them to the cafeteria. 2. Send all of them to the lobby and tell them they will be notified when the patient returns to her room. 3. Allow only her husband and mother to visit. 4. Assign the patient to a private room and allow the family to wait there. responses is appropriate? 1. Agree with her, but tell her she must accept the radiation or she will die. 2. Ensure that she understands all of the implications of her decision before accepting it. 3. Keep encouraging her to think about the radiation, and ask all of the other staff to do the same. 4. Have her ask her physician to prescribe chemotherapy instead of radiation therapy. 13. A 72-year-old Iranian patient says he will not be able to take his morning antibiotic, which is scheduled every 8 hours, because he is celebrating Ramadan and has to fast from sunup to sundown. Which of the following actions should the nurse take? 1. Explain that the medicine must be taken now to maintain the blood level of the drug. 2. Rearrange his medication schedule so he can take all his medicines between sundown and sunup. 3. Omit the medicine and record his refusal on the medication administration record. 4. Ask his family to encourage him to take the medicine. Complementary and Alternative Modalities VOCABULARY Match the term with the appropriate definition or statement. 1. Alternative modality 2. Complementary modality 3. Homeopathy 4. Naturopathy 5. Ayurvedic 6. Chiropractic 1. Illness is a result of falling out of balance with nature 2. Uses nutrition, herbs, and hydrotherapy 3. Illness is a result of nerve dysfunction 4. Added to a conventional therapy 5. Unconventional therapy 6. ―Like cures like‖ COMPLEMENTARY MODALITY: GUIDED IMAGERY Describe the purpose of guided imagery. Write a teaching plan on how to do guided imagery. Try teaching it to a family member or friend. Purpose: 1. What is feverfew used for? 2. What is capsaicin used for? 3. What is St. John‘s wort used for? Teaching Plan: 4. Where can you get information about the safety of taking these herbs with heart failure or with heart failure CRITICAL THINKING medications? Read the following case study and answer the questions. Mrs. Lawless is admitted to your unit with heart failure and fluid overload. As you collect admission data, you find that she is taking feverfew, capsaicin, and St. John‘s Wort regularly in addition to her prescribed medications for heart 5. What should you tell Mrs. Lawless? failure. When you question her, she says that the salesperson at the health food store told her these herbs were safe to use with her other medications. 16 5 Chapter 5 Complementary and Alternative Modalities 17 Choose the best answer unless directed otherwise. 1. Which of the following therapies would be considered a complementary modality? 1. Using inhalers in addition to oral medications for asthma 2. Participating in a cardiac rehabilitation program after having a heart attack 3. Using echinacea instead of antibiotics for an upper respiratory infection 4. Using progressive muscle relaxation in addition to muscle relaxants for back pain 2. Which of the following therapies would be considered an alternative modality? 1. Using hydrotherapy in place of nonsteroidal antiinflammatory drugs for arthritis 2. Visiting a spiritual healer in addition to chemotherapy for cancer treatment 3. Using antibiotics and bronchodilators for acute bronchitis 4. Using aspirin for a headache 3. Which of the following terms describes traditional Western medicine? 1. Homeopathy 2. Naturopathy 3. Allopathy 4. Ayurveda 4. Which of the following herbal remedies is possibly effective against viruses and colds? 1. Echinacea 2. Feverfew 3. Chamomile 4. Ginger 5. The nurse recognizes which of the following as complementary or alternative therapies aimed at altering the body‘s energy? Select all that apply. 1. Reiki 2. Magnet therapy 3. Music therapy 4. Hydrotherapy 5. Yoga 6. Therapeutic touch Choose the best answer unless directed otherwise. 6. The nurse has provided instruction to a patient on how to use guided imagery. Which of the following statements by the patient would indicate to the nurse that further teaching is required? 1. ―I will focus on my breathing.‖ 2. ―I imagine the ocean, including the smell, the sound, and the feel of the air.‖ 3. ―I will relax all parts of my body.‖ 4. ―I will keep my eyes open until the exercise is complete.‖ 7. A patient tells a nurse that a chiropractor is going to do minor surgery to remove a small superficial lump on her neck. Which response by the nurse is best? 1. ―The lump is likely pressing against a nerve; that is why it needs to be removed.‖ 2. ―You need to question your chiropractor‘s qualifications. Chiropractors do not perform surgery.‖ 3. ―Chiropractors specialize in nerve function; removing the lump will restore normal nerve function.‖ 4. ―Surgery might not be necessary; usually a simple chiropractic adjustment will relieve pressure on a nerve.‖ REVIEW QUESTIONS—TEST PREPARATION REVIEW QUESTIONS—CONTENT REVIEW 18 UNIT ONE Understanding Health Care Issues 8. A patient admitted with chronic pain says he is interested in pursuing an alternative modality for his pain, but he is unsure how to determine whether it is safe. Which of the following responses by the nurse is best? 1. ―As long as the therapy does not include medication, it should be safe.‖ 2. ―You should talk with your primary care practitioner before trying anything new.‖ 3. ―Be careful, because many alternative therapies have dangerous side effects.‖ 4. ―Traditional analgesics are always the safest treatment for chronic pain.‖ 9. A nurse is interested in providing therapeutic touch therapy for her home care patient with severe pain. This will be her first experience with therapeutic touch. Which of the following steps is least appropriate before beginning to provide this new service? 1. Obtain permission from the patient‘s physician and home care agency. 2. Take classes on how to administer therapeutic touch. 3. Tell the patient he will be able to reduce the number of medications he takes. 4. Read current research on the use of therapeutic touch. 10. A patient is preparing to go home from the hospital after an anterior wall myocardial infarction. He has new prescriptions for isosorbide (Imdur), warfarin (Coumadin), atorvastatin (Lipitor), and aspirin. He also takes metformin (Glucophage) and glipizide (Glucotrol XL) for type 2 diabetes and takes self-prescribed ginseng daily. Which initial response by the nurse is best? 1. ―Ginseng can effectively lower blood glucose in patients with diabetes. It is a good choice for you.‖ 2. ―Ginseng is a relatively safe herbal agent. Be sure to check out a reliable website for interactions before continuing to take it at home.‖ 3. ―Ginseng, like other herbal agents, is unsafe to take with your prescribed medications.‖ 4. ―I am concerned that ginseng could interact with your prescribed medications and affect your blood glucose and your blood clotting.‖ unit TWO Understanding Health and Illness CHECKLIST FOR LEARNING SUCCESS Fluid, Electrolyte, and Acid–Base Nursing Care of Patients Receiving Nursing Care of Nursing Care of Nursing Care of Nursing Care of Patients With Emergent Conditions and Disaster/ Balance and Imbalance Intravenous (IV) Therapy Patients With Infections Nursing Care of Patients in Shock Nursing Care of Patients in Pain Patients With Cancer Patients Having Surgery Bioterrorism Response ❑ Fluid balance ❑ Indications ❑ Infectious ❑ Pathophysiology ❑ Definitions of ❑ Review of ❑ Surgery urgency/ ❑ Primary survey ❑ Dehydration ❑ Fluid excess ❑ Electrolyte balance ❑ Sodium imbalances for IV therapy ❑ Types of infusions ❑ Methods of infusion ❑ Types of Fluids process ❑ Body‘s defense mechanisms ❑ Infectious disease of shock ❑ Complications from shock ❑ Hypovolemic shock ❑ Cardiogenic pain ❑ Mechanism of pain transmission ❑ Types of pain ❑ Nonopioid normal anatomy and physiology ❑ Pathophysiology and etiology ❑ Risk factors purpose ❑ Preoperative phase ❑ Preoperative assessment/ admission ❑ Secondary survey ❑ Shock ❑ Anaphylaxis ❑ Major trauma ❑ Hypothermia ❑ Frostbite ❑ Potassium (tonicity) ❑ Community shock analgesics for cancer ❑ Nursing process: ❑ Hyperthermia imbalances ❑ Calcium imbalances ❑ Magnesium imbalances ❑ Acid–base balance ❑ Respiratory acidosis ❑ Metabolic acidosis ❑ Respiratory alkalosis ❑ Metabolic alkalosis ❑ IV access ❑ Peripheral IV therapy ❑ Venipuncture steps ❑ Nursing process ❑ Complications of IV therapy ❑ Central venous access devices ❑ Nutrition support ❑ Home IV therapy infection control ❑ Health care agency infection control ❑ Antibioticresistant infections ❑ Infectious disease interventions ❑ Nursing process ❑ Obstructive shock ❑ Distributive shock ❑ Shock therapeutic interventions ❑ Nursing process ❑ Opioid analgesics ❑ Opioid antagonists ❑ Adjuvants ❑ WHO ladder ❑ Routes for analgesic administration ❑ Nondrug therapies ❑ Nursing process ❑ Pain assessment ❑ Patient education ❑ Cancer classification ❑ Early detection/ prevention ❑ Diagnostic tests ❑ Staging and grading ❑ Surgery ❑ Radiation therapy ❑ Chemo-therapy ❑ Side effects of therapies ❑ Nursing process ❑ Hospice care ❑ Oncological emergencies ❑ Preoperative ❑ Intraoperative phase ❑ Postoperative phase ❑ Perianesthesia care unit ❑ Postoperative nursing care: ❑ Respiratory ❑ Circulatory ❑ Pain ❑ Urinary ❑ Wound care ❑ Gastrointestinal ❑ Mobility ❑ Patient discharge ❑ Home health care ❑ Poisoning and drug overdose ❑ Near-drowning ❑ Psychiatric emergencies ❑ Disaster response ❑ Bioterrorism Nursing Care of Patients With Fluid, Electrolyte, and Acid–Base Imbalances VOCABULARY Fill in the blanks with key terms from the chapter. 1. The process through which a solute moves from an area of higher to an area of lower concentration is . 2. A fluid that has the same osmolarity as blood is said to be . 3. A fluid that has a higher osmolarity than blood is said to be . 4. A decrease in blood volume is called . 5. Electrolytes in the blood that have a positive charge are called . 6. The patient with an excess of sodium in the blood has . 7. The patient with not enough potassium in the blood has . 8. The patient with not enough calcium in the blood has . 9. occurs when the serum pH falls below 7.35. 10. If the serum pH is too high, the condition is called . DEHYDRATION Circle the errors in the following paragraph and write in ELECTROLYTE IMBALANCES Match the electrolyte imbalance with its signs and symptoms. the correct information. Mrs. White is a 78-year-old woman admitted to the hospital with a diagnosis of severe dehydration. The licensed practical nurse/licensed vocational nurse (LPN/LVN) assigned to Mrs. White is asked to collect data related to fluid status. The LPN expects Mrs. White‘s blood pressure to be elevated because of the shift of fluid from tissues to her bloodstream. The nurse also finds Mrs. White‘s skin to be taut and firm and notes that the urine is copious and dark amber. The nurse asks Mrs. White if she knows where she is and what day it is because severe dehydration may cause confusion. In addition, the nurse initiates intake and output measurements because this is the most accurate way to monitor fluid balance. 1. Hyponatremia 2. Hyperkalemia 3. Hypokalemia 4. Hypercalcemia 5. Hypocalcemia 1. Osteoporosis, hyperactive reflexes 2. Muscle weakness, weak pulse 3. Muscle weakness, kidney stones 4. Fluid balance and mental status changes 5. Muscle cramps, irregular heart rate 20 6 Chapter 6 Nursing Care of Patients With Fluid, Electrolyte, and Acid–Base Imbalances 21 CRITICAL THINKING Read the following case study and answer the questions. Mr. James is an 89-year-old man admitted to your unit with worsening chronic bronchitis. On admission he is short of 3. The RN pages the physician while you return to check on the patient. What nursing interventions can help until orders are received? breath, but he is able to walk to the bathroom without difficulty. The physician orders bronchodilators, antibiotics, and an intravenous (IV) infusion of normal saline at 150 mL per hour. The next day when you return to work, you find Mr.James gasping for breath, coughing, and panicky. You quickly listen to his lungs and hear an increase in moist cracklessince yesterday. 4. How will you know when the problem has been resolved? 1. What additional data do you collect to confirm your suspicion of fluid overload? 2. You report your findings to the registered nurse (RN) and collaborate on quickly developing a nursing diagnosis of fluid overload. What factors contributed to this problem? Choose the best answer unless directed otherwise. 1. Which of the following IV solutions is hypotonic? 1. Normal saline 2. 0.45% saline 3. Ringer‘s lactate 4. 5% dextrose in normal saline 2. Which of the following hormones retains sodium in the body? 1. Antidiuretic hormone 2. Thyroid hormone 3. Aldosterone 4. Insulin 3. Which food should be avoided by the patient on a low-sodium diet? 1. Apples 2. Cheese 3. Chicken 4. Broccoli 4. Which food is recommended for the patient who must increase intake of potassium? 1. Bread 2. Egg 3. Potato 4. Cereal 5. Which is the most reliable method for monitoring fluid balance? 1. Daily intake and output 2. Daily weight 3. Vital signs 4. Skin turgor 6. An older adult patient presents to the emergency department reporting severe vomiting and diarrhea, sweating, and rapid heartbeat but has a normal temperature. In continuing the assessment of the patient, what should the nurse first suspect? 1. Hypervolemia 2. Dehydration 3. Edema 4. Hyponatremia REVIEW QUESTIONS—CONTENT REVIEW 22 UNIT TWO Understanding Health and Illness Choose the best answer unless directed otherwise. 7. Which patient is most at risk for fluid volume overload? 1. The 40-year-old with meningitis 2. The 35-year-old with kidney failure 3. The 60-year-old with psoriasis 4. The 2-year-old with influenza 8. Which patients should be monitored closely for dehydration? Select all that apply. 1. A 50-year-old with an ileostomy 2. A 19-year-old with chronic asthma 3. A 22-year-old with diabetes mellitus 4. A 45-year-old with a temperature of 102.3°F 5. A 28-year-old with a broken femur 6. A 36-year-old taking diuretic therapy 9. An older-adult nursing home resident who has always been alert and oriented is now showing signs of dehydration and has become confused. Which electrolyte imbalance is most likely involved? 1. Hyponatremia 2. Hyperkalemia 3. Hypercalcemia 4. Hypomagnesemia 10. The LPN/LVN is caring for a patient with osteoporosis who appears weak and frail. Which of the following nursing interventions is best? 1. Maintain bed rest 2. Encourage fluids 3. Ambulate with assistance 4. Provide a high-protein diet 11. A 19-year-old student develops symptoms of respiratory alkalosis related to an anxiety attack. Which nursing intervention is most appropriate? 1. Make sure his oxygen is being administered as ordered. 2. Have him breathe into a paper bag. 3. Place him in a semi-Fowler‘s position. 4. Have him do coughing and deep-breathing exercises. 12. A patient has chronic respiratory acidosis related to long-standing lung disease. Which of the following problems is the cause? 1. Hyperventilation 2. Hypoventilation 3. Loss of acid by kidneys 4. Loss of base by kidneys 13. The nurse is providing discharge instructions for a patient taking Slow-K®, an oral potassium chloride supplement. Which of the following statements by the patient indicates that more teaching is needed? Select all that apply. 1. ―I won‘t use salt substitutes that have potassium.‖ 2. ―I need to have my blood checked routinely.‖ 3. ―I should take my supplement first thing in the morning and then wait 30 minutes before eating.‖ 4. ―If the pill is too big to swallow, I can crush it.‖ 5. ―I should call the doctor if I have nausea, vomiting, or abdominal cramps.‖ 6. ―I can expect some diarrhea with this medication.‖ REVIEW QUESTIONS—TEST PREPARATION Nursing Care of Patients Receiving Intravenous Therapy VOCABULARY Match the term with the appropriate definition or statement. 1. Intravenous (IV) 2. Cannula 3. Distal 4. Infiltration 5. Peripherally inserted central catheter (PICC) 6. Hematoma 7. Phlebitis 8. Proximal 1. Inside a vein 2. Seepage of IV fluid into tissues 3. Nearest the point of attachment 4. Inflammation of a vein 5. Access device inserted into a superficial peripheral vein and advanced into the central system to the superior vena cava. 6. An IV needle or catheter with a stylet. 7. Farthest from the center or from the trunk 8. A localized collection of extravasated blood in the subcutaneous tissue, from a break in a blood vessel PERIPHERAL VEINS Label the veins that can be used for IV therapy. 23 7 24 UNIT TWO Understanding Health and Illness COMPLICATIONS OF IV THERAPY Fill in the blank with the correct complication. 1. Pain and inflammation at the IV insertion site is called . 2. Redness and exudate at the IV insertion site indicate the presence of . 3. Infiltration into tissue by an IV fluid or drug is called . 4. Dyspnea and crackles can be a sign of . 5. A cool, puffy insertion site indicates . 6. Fever, chills, and tachycardia indicate a systemic infection called . 7. Sharp pain at the IV site during infusion of a cold fluid indicates a . 8. If the patient develops cyanosis, hypotension, and loss of consciousness, the nurse should suspect . CRITICAL THINKING Read the following case study and answer the questions. Mr. Livesay is admitted with cellulitis and is receiving IV fluids by gravity drip. When you check his IV, you find it is not dripping. What data can you collect to determine the cause of the problem? What is the role of the licensed practical nurse (LPN)? When must the registered nurse (RN) be consulted? CALCULATION PRACTICE Calculate the answers to the following problems. Round each answer to the nearest whole number. 1. June has an IV of 5% dextrose in water ordered to infuse at 83 mL/hr. How many drops per minute should be set if the tubing delivers 15 drops per milliliter? 2. Frank has a piggyback antibiotic of 500 mg in 50 mL of 5% dextrose in water. The medication must infuse over 20 minutes. The tubing drip factor is 10. How many drops per minute? 3. Dave has an IV of normal saline ordered at 1 L over 12 hours. How many milliliters per hour should he receive? 4. Lucy has an order to administer 800 units of heparin per hour. The registered nurse hangs heparin 50,000 units in 500 mL of 5% dextrose in water. It will run on an electronic infusion device. How many milliliters should be administered per hour? 5. Jack has an order for 1000 mL of normal saline over 24 hours. How many drops should be administered per minute, using microdrop tubing? Choose the best answer unless directed otherwise. 1. Which vein should be used first when initiating IV therapy? 1. Jugular 2. Basilic 3. Brachiocephalic 4. Axillary 2. When preparing a site for venipuncture with chlorhexidine gluconate, how long must the area be cleaned? 1. 5 seconds 2. 10 seconds 3. 30 seconds 4. 60 seconds 3. Which of the following complications can occur if a clotted cannula is aggressively flushed? 1. A clot can enter the circulation. 2. An air embolism can enter the circulation. 3. A painful arterial spasm can occur. 4. The patient can experience speed shock. 4. Which of the following symptoms most likely indicates that an infusion is infiltrated? 1. Redness at the site 2. Pain at the site 3. Puffiness at the site 4. Exudate at the site REVIEW QUESTIONS—CONTENT REVIEW REVIEW QUESTIONS—TEST PREPARATION Chapter 7 Nursing Care of Patients Receiving Intravenous Therapy 25 5. An 87-year-old patient recovering from abdominal surgery has a continuous IV infusion to supply nutrients and antibiotics. What complication should the LPN suspect when signs and symptoms of redness, warmth, and pain at the infusion site are reported? 1. Phlebitis 2. Thrombosis 3. Hematoma 4. Infiltration Choose the best answer unless directed otherwise. 6. Which patient would benefit most from a capped IV access that is used intermittently rather than continuously? 1. The patient with pneumonia who needs fluids and antibiotics 2. The patient who has had major blood loss after a motor vehicle accident 3. The young child who is dehydrated 4. The older patient who is receiving a diuretic for fluid overload 7. The physician orders furosemide (Lasix) 40 mg IV push (IVP) STAT for a patient in acute fluid overload. Why was the IV route likely chosen? 1. Furosemide can be administered only by the IV route. 2. IVP is the route of choice for rapid action. 3. IVP dosing is more accurate. 4. IVP furosemide has fewer side effects than oral. 8. A patient has orders to receive 1 L (1000 mL) of 5% dextrose and lactated Ringer‘s solution to be infused over 8 hours. How many milliliters will be infused per hour? 1. 80 2. 100 3. 125 4. 150 9. A patient is receiving an IV piggyback antibiotic in 50 mL of 5% dextrose in water to run over 1 hour. The tubing has a drop factor of 60. How many drops per minute should be delivered? 1. 6 2. 17 3. 50 4. 100 10. The nurse is caring for a patient who is to receive IV fluids at 100 mL per hour with IV antibiotic therapy scheduled every 4 hours. Which of the following sites for the IV placement is best? 1. Large vein on the dorsal side of the patient‘s nondominant arm 2. Small vein on the surface of the patient‘s dominant hand 3. Small vein on the surface of the patient‘s nondominant hand 4. Large vein in the nondominant antecubital space Nursing Care of Patients With Infections VOCABULARY Define the following terms and use them in a sentence. Antigen Definition: Sentence: Asepsis Definition: Sentence: Bacteria Definition: Sentence: Clostridium difficile (C. diff) Definition: Sentence: Hand hygiene Definition: Sentence: Pathogens Definition: Sentence: Personal protective equipment Definition: Sentence: Phagocytosis Definition: Sentence: Sepsis Definition: Sentence: Virulence Definition: Sentence: 26 8 Viruses Chapter 8 Nursing Care of Patients With Infections 27 Definition: Sentence: PATHOGEN TRANSMISSION Match the pathogen with its mode of transmission. CRITICAL THINKING Read the following case study and answer the questions. 1. Chickenpox 2. Malaria 3. Tuberculosis 4. Rocky Mountain spotted fever 5. Meningitis 6. Pneumonia 7. Measles 8. Influenza 9. Pneumonic plague 10. Hepatitis A 1. Common vehicle 2. Droplet 3. Airborne 4. Vectorborne A 72-year-old patient is admitted to a private room with an antibiotic-resistant respir

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