Study Guide for
Medical-Surgical Nursing: Assessment and Management of Clinical Problems
Contents
Section 1: Concepts in Nursing Practice
1 Professional Nursing Practice, 1
2 Health Disparities and Culturally Competent Care, 5
3 Health History and Physical Examination, 8
4 Patient and Caregiver Teaching, 11
5 Chronic Illness and Older Adults, 15
6 Complementary and Alternative Therapies, 19
7 Stress and Stress Management, 22
8 Sleep and Sleep Disorders, 26
9 Pain, 29
10 Palliative Care at End of Life, 33
11 Substance Abuse, 36
Section 2: Pathophysiologic Mechanisms of Disease
12 Inflammation and Wound Healing, 40
13 Genetics and Genomics, 44
14 Altered Immune Responses and Transplantation, 47
15 Infection and Human Immunodeficiency Virus Infection, 51
16 Cancer, 55
17 Fluid, Electrolyte, and Acid-Base Imbalances, 60
Section 3: Perioperative Care
18 Nursing Management: Preoperative Care, 66
, 19 Nursing Management: Intraoperative Care, 69
20 Nursing Management: Postoperative Care, 72
Section 4: Problems Related to Altered Sensory Input
21 Nursing Assessment: Visual and Auditory Systems, 75
22 Nursing Management: Visual and Auditory Problems, 80
23 Nursing Assessment: Integumentary System, 85
24 Nursing Management: Integumentary Problems, 88
25 Nursing Management: Burns, 92
Section 5: Problems of Oxygenation: Ventilation
26 Nursing Assessment: Respiratory System, 97
27 Nursing Management: Upper Respiratory Problems, 101
28 Nursing Management: Lower Respiratory Problems, 105
29 Nursing Management: Obstructive Pulmonary Diseases, 111
Section 6: Problems of Oxygenation: Transport
30 Nursing Assessment: Hematologic System, 117
31 Nursing Management: Hematologic Problems, 120
Section 7: Problems of Oxygenation: Perfusion
32 Nursing Assessment: Cardiovascular System, 127
33 Nursing Management: Hypertension, 134
34 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome, 138
35 Nursing Management: Heart Failure, 145
36 Nursing Management: Dysrhythmias, 149
37 Nursing Management: Inflammatory and Structural Heart Disorders, 156
38 Nursing Management: Vascular Disorders, 161
iii
iv Contents
Section 8: Problems of Ingestion, Digestion, Absorption, and Elimination
39 Nursing Assessment: Gastrointestinal System, 167
40 Nursing Management: Nutritional Problems, 171
41 Nursing Management: Obesity, 175
42 Nursing Management: Upper Gastrointestinal Problems, 179
43 Nursing Management: Lower Gastrointestinal Problems, 185
44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems, 192
Section 9: Problems of Urinary Function
45 Nursing Assessment: Urinary System, 199
46 Nursing Management: Renal and Urologic Problems, 203
47 Nursing Management: Acute Kidney Injury and Chronic Kidney Disease, 208
Section 10: Problems Related to Regulatory and Reproductive Mechanisms
48 Nursing Assessment: Endocrine System, 214
49 Nursing Management: Diabetes Mellitus, 218
50 Nursing Management: Endocrine Problems, 224
51 Nursing Assessment: Reproductive System, 229
52 Nursing Management: Breast Disorders, 234
53 Nursing Management: Sexually Transmitted Infections, 238
54 Nursing Management: Female Reproductive Problems, 241
55 Nursing Management: Male Reproductive Problems, 246
,Section 11: Problems Related to Movement and Coordination
56 Nursing Assessment: Nervous System, 250
57 Nursing Management: Acute Intracranial Problems, 256
58 Nursing Management: Stroke, 261
59 Nursing Management: Chronic Neurologic Problems, 265
60 Nursing Management: Alzheimer’s Disease, Dementia, and Delirium, 270
61 Nursing Management: Peripheral Nerve and Spinal Cord Problems, 274
62 Nursing Assessment: Musculoskeletal System, 279
63 Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery, 284
64 Nursing Management: Musculoskeletal Problems, 290
65 Nursing Management: Arthritis and Connective Tissue Diseases, 293
Section 12: Nursing Care in Critical Care Settings
66 Nursing Management: Critical Care, 298
67 Nursing Management: Shock, Systemic Inflammatory Response
Syndrome, and Multiple Organ Dysfunction Syndrome, 304
68 Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome, 309
69 Nursing Management: Emergency, Terrorism, and Disaster Nursing, 313
Answers to Worksheets, 317
CHAPTER
1
1. Using the American Nurses Association’s definition of nursing, which activities are within the
domain of nursing (select all that apply)?
a. Implementing intake and output for a patient who is vomiting
b. Establishing and implementing a stress management program for family
caregivers of patients with Alzheimer’s disease
c. Explaining the risks associated with the planned surgical procedure when a
preoperative patient inquires about risks
d. Developing and performing a study to compare the health status of older patients who
live alone with the status of older patients who live with family members
e. Identifying the effect of an investigational drug on patients’ hemoglobin levels
f. Using a biofeedback machine to teach a patient with cancer how to manage chronic pain
g. Preventing pneumonia in an immobile patient by implementing frequent turning,
coughing, and deep breathing
h. Determining and administering fluid replacement therapy needed for a patient with serious
burns
i. Testifying to legislative bodies regarding the effect of health policies on
culturally, socially, and economically diverse populations
2. A nurse who has worked on an orthopedic unit for several years is encouraged by the nurse
manager to become certified in orthopedic nursing. What will certification in nursing require
and/or provide (select all that apply)?
a. A certain amount of clinical experience
b. Successful completion of an examination
c. Membership in specialty nursing organizations
d. Professional recognition of expertise in a specialty area
e. An advanced practice role that requires graduate education
, 3. What accurately describes the health care system in which future nurses will be employed?
a. With improvements in medicine there will be fewer patients with chronic illnesses.
b. Rapidly changing technology and expanding knowledge will simplify the health care environment.
c. The Quality and Safety Education for Nurses (QSEN) project measures the ability of
nursing graduates to be prepared for the reality of practice.
d. The Joint Commission establishes National Patient Safety Goals and evidence-based
solutions for nurses to promote meeting these goals by all caring for the patient.
4. What ware wthe wsix wcompetencies wfrom wQuality wand wSafety wEducation wfor wNurses
w(QSEN) wthat ware wexpected wof wnew wnursing wgraduates?
a.
b.
c.
d.
e.
f.
1
2 Chapter w1 Professional wNursing w Practice
5. Place wthe wsteps wof wthe wevidence-based wpractice w(EBP) wprocess win worder w(0 wbeing wthe wfirst
wstep; w6 wbeing wthe wlast wstep).
wMake wrecommendations wfor wpractice wor wgenerate wdata
wAsk wa wclinical wquestion
wCritically wanalyze wthe wevidence
wFind wand wcollect wthe wevidence
wEvaluate wthe woutcomes win wthe wclinical wsetting
wCreate wa wspirit wof winquiry
wUse wevidence, wclinical wexpertise, wand wpatient wpreferences wto wdetermine wcare
6. The wfollowing wis wan wexample wof wan wevidence-based wpractice w(EBP) wclinical
wquestion. w“In wadult wseizure wpatients, w is wrestraint wor wmedication wmore weffective win
wprotecting wthem wfrom winjury wduring wa wseizure?” wWhich wword(s) win wthe wquestion
widentify(ies) wthe wC wpart wof wthe wPICOT wformat?
a. Restraint
b. Or wmedication
c. During wa wseizure
Medical-Surgical Nursing: Assessment and Management of Clinical Problems
Contents
Section 1: Concepts in Nursing Practice
1 Professional Nursing Practice, 1
2 Health Disparities and Culturally Competent Care, 5
3 Health History and Physical Examination, 8
4 Patient and Caregiver Teaching, 11
5 Chronic Illness and Older Adults, 15
6 Complementary and Alternative Therapies, 19
7 Stress and Stress Management, 22
8 Sleep and Sleep Disorders, 26
9 Pain, 29
10 Palliative Care at End of Life, 33
11 Substance Abuse, 36
Section 2: Pathophysiologic Mechanisms of Disease
12 Inflammation and Wound Healing, 40
13 Genetics and Genomics, 44
14 Altered Immune Responses and Transplantation, 47
15 Infection and Human Immunodeficiency Virus Infection, 51
16 Cancer, 55
17 Fluid, Electrolyte, and Acid-Base Imbalances, 60
Section 3: Perioperative Care
18 Nursing Management: Preoperative Care, 66
, 19 Nursing Management: Intraoperative Care, 69
20 Nursing Management: Postoperative Care, 72
Section 4: Problems Related to Altered Sensory Input
21 Nursing Assessment: Visual and Auditory Systems, 75
22 Nursing Management: Visual and Auditory Problems, 80
23 Nursing Assessment: Integumentary System, 85
24 Nursing Management: Integumentary Problems, 88
25 Nursing Management: Burns, 92
Section 5: Problems of Oxygenation: Ventilation
26 Nursing Assessment: Respiratory System, 97
27 Nursing Management: Upper Respiratory Problems, 101
28 Nursing Management: Lower Respiratory Problems, 105
29 Nursing Management: Obstructive Pulmonary Diseases, 111
Section 6: Problems of Oxygenation: Transport
30 Nursing Assessment: Hematologic System, 117
31 Nursing Management: Hematologic Problems, 120
Section 7: Problems of Oxygenation: Perfusion
32 Nursing Assessment: Cardiovascular System, 127
33 Nursing Management: Hypertension, 134
34 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome, 138
35 Nursing Management: Heart Failure, 145
36 Nursing Management: Dysrhythmias, 149
37 Nursing Management: Inflammatory and Structural Heart Disorders, 156
38 Nursing Management: Vascular Disorders, 161
iii
iv Contents
Section 8: Problems of Ingestion, Digestion, Absorption, and Elimination
39 Nursing Assessment: Gastrointestinal System, 167
40 Nursing Management: Nutritional Problems, 171
41 Nursing Management: Obesity, 175
42 Nursing Management: Upper Gastrointestinal Problems, 179
43 Nursing Management: Lower Gastrointestinal Problems, 185
44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems, 192
Section 9: Problems of Urinary Function
45 Nursing Assessment: Urinary System, 199
46 Nursing Management: Renal and Urologic Problems, 203
47 Nursing Management: Acute Kidney Injury and Chronic Kidney Disease, 208
Section 10: Problems Related to Regulatory and Reproductive Mechanisms
48 Nursing Assessment: Endocrine System, 214
49 Nursing Management: Diabetes Mellitus, 218
50 Nursing Management: Endocrine Problems, 224
51 Nursing Assessment: Reproductive System, 229
52 Nursing Management: Breast Disorders, 234
53 Nursing Management: Sexually Transmitted Infections, 238
54 Nursing Management: Female Reproductive Problems, 241
55 Nursing Management: Male Reproductive Problems, 246
,Section 11: Problems Related to Movement and Coordination
56 Nursing Assessment: Nervous System, 250
57 Nursing Management: Acute Intracranial Problems, 256
58 Nursing Management: Stroke, 261
59 Nursing Management: Chronic Neurologic Problems, 265
60 Nursing Management: Alzheimer’s Disease, Dementia, and Delirium, 270
61 Nursing Management: Peripheral Nerve and Spinal Cord Problems, 274
62 Nursing Assessment: Musculoskeletal System, 279
63 Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery, 284
64 Nursing Management: Musculoskeletal Problems, 290
65 Nursing Management: Arthritis and Connective Tissue Diseases, 293
Section 12: Nursing Care in Critical Care Settings
66 Nursing Management: Critical Care, 298
67 Nursing Management: Shock, Systemic Inflammatory Response
Syndrome, and Multiple Organ Dysfunction Syndrome, 304
68 Nursing Management: Respiratory Failure and Acute Respiratory Distress Syndrome, 309
69 Nursing Management: Emergency, Terrorism, and Disaster Nursing, 313
Answers to Worksheets, 317
CHAPTER
1
1. Using the American Nurses Association’s definition of nursing, which activities are within the
domain of nursing (select all that apply)?
a. Implementing intake and output for a patient who is vomiting
b. Establishing and implementing a stress management program for family
caregivers of patients with Alzheimer’s disease
c. Explaining the risks associated with the planned surgical procedure when a
preoperative patient inquires about risks
d. Developing and performing a study to compare the health status of older patients who
live alone with the status of older patients who live with family members
e. Identifying the effect of an investigational drug on patients’ hemoglobin levels
f. Using a biofeedback machine to teach a patient with cancer how to manage chronic pain
g. Preventing pneumonia in an immobile patient by implementing frequent turning,
coughing, and deep breathing
h. Determining and administering fluid replacement therapy needed for a patient with serious
burns
i. Testifying to legislative bodies regarding the effect of health policies on
culturally, socially, and economically diverse populations
2. A nurse who has worked on an orthopedic unit for several years is encouraged by the nurse
manager to become certified in orthopedic nursing. What will certification in nursing require
and/or provide (select all that apply)?
a. A certain amount of clinical experience
b. Successful completion of an examination
c. Membership in specialty nursing organizations
d. Professional recognition of expertise in a specialty area
e. An advanced practice role that requires graduate education
, 3. What accurately describes the health care system in which future nurses will be employed?
a. With improvements in medicine there will be fewer patients with chronic illnesses.
b. Rapidly changing technology and expanding knowledge will simplify the health care environment.
c. The Quality and Safety Education for Nurses (QSEN) project measures the ability of
nursing graduates to be prepared for the reality of practice.
d. The Joint Commission establishes National Patient Safety Goals and evidence-based
solutions for nurses to promote meeting these goals by all caring for the patient.
4. What ware wthe wsix wcompetencies wfrom wQuality wand wSafety wEducation wfor wNurses
w(QSEN) wthat ware wexpected wof wnew wnursing wgraduates?
a.
b.
c.
d.
e.
f.
1
2 Chapter w1 Professional wNursing w Practice
5. Place wthe wsteps wof wthe wevidence-based wpractice w(EBP) wprocess win worder w(0 wbeing wthe wfirst
wstep; w6 wbeing wthe wlast wstep).
wMake wrecommendations wfor wpractice wor wgenerate wdata
wAsk wa wclinical wquestion
wCritically wanalyze wthe wevidence
wFind wand wcollect wthe wevidence
wEvaluate wthe woutcomes win wthe wclinical wsetting
wCreate wa wspirit wof winquiry
wUse wevidence, wclinical wexpertise, wand wpatient wpreferences wto wdetermine wcare
6. The wfollowing wis wan wexample wof wan wevidence-based wpractice w(EBP) wclinical
wquestion. w“In wadult wseizure wpatients, w is wrestraint wor wmedication wmore weffective win
wprotecting wthem wfrom winjury wduring wa wseizure?” wWhich wword(s) win wthe wquestion
widentify(ies) wthe wC wpart wof wthe wPICOT wformat?
a. Restraint
b. Or wmedication
c. During wa wseizure
