Solution Manual For Foundations and Adult Health Nursing, 8th Edition

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter07:Asepsis and Infection ControlAnswer Keys-Critical Thinking QuestionsNursing Care Plan7-1:The Patient with anInfection1.Mr.R.has a peripheral IV infusing andreportsdiscomfort at the site of insertion. Whatshouldthe nursedo?The nurse should immediately assess the IV site for obviousdislodgment of the IV catheter,edema, erythema,or increased warmth orcoolness. Coolness may indicate IVinfiltration; theother signs may indicate irritation (possiblyfrom a previously administered medication or as anadverse effect of it) or infection.In general,if an IV site is obviously infiltrated, nursingjudgment is sufficient todeterminewhether to stopthe IV infusionand/or remove the infiltrated IV catheter.Warm compresses maygenerally be applied per nursingjudgment as well. (Facility policies must be verified.)Thehealth care providermust be notified sothatthe determinationcan be made regarding thenecessity to restart a newintravenous access site.2.Mr.R.has a urinary catheter connected to continuousdrainage. Hereportsburning at the siteof insertionandthe nursenotesdark, concentrated urine in the tubing. Whatshould the nurse donext?The nurse should assess the site of the catheter insertionfor any signs ofedema, erythema, orexudate. The nurseshould then take the patient’s vital signs, notingany changes in temperatureand pulse. Compare thedata obtained withpatient’s previousvital signs.??Following these nursing actions, the nurse shouldobtain urine samples for urinalysis and cultureandsensitivity (using aseptic technique), in anticipation of thehealth care provider’s orders tocome.All of the above should then be reported to thepatient’shealth care provideras promptly aspossible. The nurseshould also encouragethe patient to increase his fluidintake. Makeadditional fluids available to him, if notcontraindicated.3.The nursenoteson the sheet of laboratoryresults forMr.R.that hisWBCcountis 2800/mm3.Why is thisa concern,and whatis recommended as a precautionary measure?This indicates a severely compromised immune system,placing the patient at very high risk forinfection. Thepatient is especially susceptible to microorganisms thatnormally do not pose asignificant threat to a healthyimmune system. A healthy immune system will destroy or

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Answer Keys-Critical Thinking Questions7-2deactivate most pathogens before they can multiply intogreater numbers. If a patient isimmunocompromised,even weaker or opportunistic pathogens (herpes varicella virus or CMV)can become establishedand cause infection or disease. Oftenthis isin a more severe formbecause the patient also cannot initiate an effective immuneresponse to combat it.Mr.R.should be placed on neutropenic precautions(formerly known asreverse isolationorProtectiveIsolation). The intent of neutropenic precautions is tominimize threats to the patient’scompromised immunestatus; for instance, protecting the patient from his or herenvironment.Most facilities have specific protocols forimplementing neutropenic precautions. Thesegenerallyinvolve a private room with the door to remain closed;limiting visitors; no obviouslyinfected visitors; no freshfruit, flowers, or raw vegetables; and no open containers(juices, water,etc.) which can serve as reservoirs forenvironmental pathogens.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter08:Body Mechanics and Patient MobilityAnswer Keys-Critical Thinking QuestionsNursing Care Plan8-1:ThePatient withActivity Intolerance1. The nurse is in the process of transferring Mr.D.from hisbed to a chair using a mechanicallift. The nurse has preparedthe chair and placed it near the bed. The nurse turnsMr.D.to hisside, places the sling under Mr.D.to ensureadequate support of his head, returns Mr. D. to hisback, andslowly begins to lift Mr.D.from his bed. What has the nurseforgotten to do, and whyis it important?The nurse has forgotten to fold Mr.D.’sarms across hischest to prevent them from becominginjured during thelift.2. The patient has a trapeze bar across the bed, trochanterrolls, and a footboard. Explain therationale for each of thesedevices in maintaining proper body alignment.A trapeze bar allows the patient to use his upper body tomove around in bed. Trochanter rollsstabilize the hip jointwhen placed firmly beside it, and prevent the hip fromrolling outward. Afootboard prevents permanent, abnormalplantar flexion (footdrop) resulting from injury totheflexor muscles.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter09:Hygiene and Care of thePatient’sEnvironmentAnswer Keys-Critical Thinking QuestionsNursing Care Plan9-1:The Patient NeedingSkin Care1. Mr.P.has a poor appetite and his chemistry profile revealslow protein, low albumin, andalowanion gap (A/G)ratio. Explain whypoor nutrition predisposes the patient to impairment ofskinintegrity and poor tissue healing.Proteins,which aresynthesized by the liver, are required for tissuerepair and proper immunesystem function. The onlysource of proteins is through dietary intake. If a patient isundernourished, he will be unable to produce adequateprotein for metabolic processes,such astissue repair andhealing, and fighting infection.2. With Mr.P.’s history of diarrhea, explain the possiblecomplication that could evolve if dry,intact skindevelopsanopen lesion.It is possible that an open lesion in this anatomic regionmay become contaminated and infectedwith bacterianormally found in the intestines, notablyEscherichiacoli.This type of situation isoften difficult to treat with antibiotics.As a further consequence of Mr.P.’s poor nutritionalstatus, his immune system will beweakened and may notbe able to effectively combat pathogens, making the infectioneven moredifficult to manage.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter10:SafetyAnswer Keys-Critical Thinking QuestionsNursing Care Plan10-1:PatientSafety1.The nursewalking down the hall hears a patient calling out for help. The nurse assesses thesituation and realizes that the patient does not remember how to use the call light. What factorspossibly contribute to the patient’s inability to remember, and how should the nurse teach thepatient to use the call light?A patient’s memory and cognitive function can be affectedby a variety of factors, such asmedications, anxiety, pain,disorientation, and dementia. Sensory perceptions shouldbe assessedby the nurse as thoroughly as possible, withinformation and education being provided to patientsand family/visitors appropriate to level of comprehension.Reinforcement of information shouldbe provided asnecessary.Demonstrations of the use of equipment (in thiscase, the call light) by the nurse and returndemonstrationsby the patient may be appropriate in some situations,particularly if the patient isin new or unfamiliarsurroundings. It is also often helpful in this type ofsituation if the nursechecks the patient frequently, both toassess the patient’s status and to reassure patients that theyhave not been left alone.Patients may need to be reoriented to surroundingsfrequently, especially if mental status changesarea concern. It is often helpful for a patient with sensoryor cognitive impairment to be in aroom closeto thenurses’ station.2.The nurse enters the patient’s room to answer the call bell and sees the patient franticallypointing to the trash can next to the bed. The nurse smells smoke and sees small flames. Whatshould be done to help prevent fires, and what should the nurse do in this situation?The priority in this situation is to ensure patient safety.The nurse should call for assistance andimplement thefacility’sRACEprotocol:Rescue/Remove the patient fromthe area; initiate theAlarm process;Contain the fire (closefire doors, patient room doors, etc.);Extinguish the fire, ifrealistic; andEvacuate the other patients, if necessary.Patients and visitors should be educated about facilitysafety policies:reinforce the no smokingpolicy; andtheuse of equipment and personal items(hair dryers, electric shavers, lamps, etc.,)only if theymeet appropriate facility codes. Safety reviews are generallyconducted with facilitypersonnel to ensure awarenessof potential risks and proper safety procedures.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter16:Care of Patients Experiencing Urgent Alterations in HealthAnswer Keys-Critical Thinking QuestionsNursing Care Plan16-1:ThePatient with a Laceration1. Ms.T.’s wound was superficial.In contrast, what would be the nurse’sactions if the woundappeared to be deep or was spurtingblood?Firm, direct pressure must be applied to the area (thenurse should be wearing gloves) and thepatientmust beobservedfor signs and symptoms of shock. Thehealth care providershould benotified immediately by another nurse.2. What safety measuresare indicatedto ensure Ms.T.is notinjured again?Ms.T.may require more assistance or supervision duringmealtimes than she did previously.Forexample, shemay needherfood cutup, perhaps before the meal isserved to her (to preventembarrassment).

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter 20:Complementary and Alternative TherapiesAnswer Keys-Critical Thinking QuestionsNursing Care Plan20-1:Using Complementaryand Alternative Therapiesin Treatment1. Ms.L.complains of feeling fatigued and tense.List somenonpharmacologic methodsofbringingabout a state of physical and mental tranquilitythat may be helpful. Why might each ofthese methods be helpful for Ms.L.?Have Ms.L.try drinking some nonstimulating herbal tea,accepting atherapeutic massage, orpositioning forcomfort and relaxation.Decreasethe stimulation of the environmentbyloweringthe intensity of the lighting and listening tosoothing music or nature sounds (especially rhythmicones, such as wavesorgentle rain).2. Ms.L.turns on her light andsheis crying. She complains offeeling helpless and inadequateto assume responsibility forcaring for her children and husband when she is discharged.Whatare some therapeutic interventions that willpromote her feelings of stabilityand validation ofher anxiety?Allow and encourage Ms.L.to express her concernsand feelings. This may result in Ms.L.verbalizing morespecific concerns regarding her perceived inability to assumeher role in thefamily.Answering any questions she may have andoffering information regarding the usual healingprocessmay help to alleviate some of her anxiety.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter21:Pain Management, Comfort, Rest, and SleepAnswer Keys-Critical Thinking QuestionsNursing Care Plan21-1:ThePatient with Chronic Pain1. During the morning ADLs, Mr.J.states, “I feel so useless. Ican’t even place the urinal formyself.” What would be thenurse’smost therapeutic response?Mr.J.should be encouraged to verbalize his concerns andfrustrations. “Itsounds like this is verydifficult for you,”“You sound frustrated. Is that how you are feeling?” or“Why don’t you tellme more about how you’re feeling?”may help him to feel he can safely express himself.As part of his ongoing care, Mr.J.should also beallowed as much choice and control over hisnursing careand treatment regimen as possible,and should be givenadequate time to performthose ADLs and self-care measureshe can manage.2.What would be the most useful nursing intervention to achieve the goal of reduced pain duringMr.J.’sassistedambulation?Mr.J.should receive analgesia adequate to allow him enough relieffromhis pain to enable himgreater mobility(i.e., ambulation) without sedative effects or impairedjudgment. The analgesicshould be administered 30 minutes beforethescheduled activity ifthe drug is givenIV; 45minutes to 1hour before ifthe drug is givenorally.3. Which comfort measures could the nurse perform to ensurethat Mr.J.has several hours ofrestorative sleep?Position and reposition Mr.J.as comfortably andas frequently as possible.Providepain-reliefmeasurespreferred bythepatient, as appropriate (analgesia, relaxationtherapy) before retiringfor the night.Minimizeenvironmental stimulation.4. Mr.J.complains of his eyes burning and feeling dry andthe lights annoying him. Whatmeasuresare most likelytohelprelieve his symptoms?Keepthe patient’seyes free from irritantsandcrusting by providingwarm or cool soaks (aspatient prefers) to eyes.Reducecornealdrying by administering artificial tears.Decreaselightingwhile Mr.J.is in bed or in a chair,but be sure to performappropriatenursing assessmentsfrequentlywithregardtoMr.J.’ssafety.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter23:Specimen Collection and DiagnosticTestingAnswer Keys-Critical Thinking QuestionsNursing Care Plan23-1:Specimen Collection orDiagnostic Examination1.Thepatient has been very quiet during his morning care.When you attempt a conversation,heis obviously not interested.What is a wayfor you toinitiate a conversation to encouragehim torelate his concernsoverhis upcoming bronchoscopy?The nurse might say something such as, “You seem preoccupiedthis morning,” or “It looks likesomething is onyour mind this morning.” A statementlike or similar to thisoften openschannels of therapeutic communication withthe nurse and results in patients expressing theirconcerns.If more encouragement is needed, the nurse mightbe more direct by asking, “What has yourdoctor told youabout your test this morning?” or “What questions do youhave about your testtoday?”2.Yourpatient is scheduled for an intravenous pyelogram(IVP). Duringyourpreparation of thispatient, he remarkshe once hada reaction while eating shellfish. Whatwill you probablydonext?Shellfish, iodine, or contrast dye (as is used in manydiagnostic procedures, such as CT scans andMRIs) “reactions”can indicate sensitivity oranallergy to iodine-basedsubstances,andtheyshould be followed up with thehealth care providerimmediately.The nurse should obtain as much additional informationfrom the patient and his documentedmedicalhistory on file. Certain effects of the contrast dye mediumused are considered responsesto it (i.e., sensations ofwarmth, total body flushing, nausea) and not allergic reactions.Thehealth care providershould be notified and the patient’sdirect statements should be noted.All of these actionsshould be documented in the patient’s medical record.In some cases an alternate contrast medium willbe used during the diagnostic procedure. Insome casesthe original iodine-baseddye will still be used; the patient will receive antihistaminesas part of his preprocedure preparation to minimizethe possibility of a severe adverse reaction toit.3. The patient is obviously quite anxious about his upcomingmagnetic resonance imaging (MRI)scan. He breaks out in a cold sweat,andis breathingrapidly, and when assessing his pulse,younote tachycardia.Howwill yourespond to this patient?

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Answer Keys-Critical Thinking Questions23-2The nurse needs to ascertain exactly why this patient isso anxious, and then relieve his anxietyifpossible. This situation isvery similar to one discussed previously (please refer toCriticalThinking QuestionNo.1), and the same basic approachis indicated. Starting with statementssuch as, “Youseem worried (nervous, etc.) this morning,” often allow apatient the opportunityto express his fears and concernssafely.In addition to the nurse’s therapeutic responses, thepatientshould be asked if he would find ithelpful to asksome questions,have the nurse offer information abouthis upcoming diagnostictest,or speak with hishealth care provider.Some patients may be claustrophobic and this can beascertained when discussing the patient’s concerns.The nurse should use simple language and explanations,becausepeople exhibiting anxiety at thislevel will generallybe unable to comprehend or process detailed or largeamounts ofinformation.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter25:Loss, Grief, Dying, and DeathAnswer Keys-Critical Thinking QuestionsNursing Care Plan25-1:The PatientExperiencingComplicatedGrieving (UnresolvedGrief)1. Ms.S.is admitted to the medical unit for severe weakness,weight loss, and chronicdepression. She is reluctant to getout of bed to dress and have meals.How could the nursefacilitate progressionthrough the grieving process?Encourage and assist Ms.S.with ADLs, allowing her asmuch control as is reasonable. Thenurse needs to beaware that too many choices or too much detail can beoverwhelming for apatient who is depressed. Choicesshould be kept as simple as possible; for example, “Wouldyoulike me to help youbathenow, or would you ratherI come back in 10 minutes?”It is also important for the nurse to be especiallyconsistent in this type of situation. If “10minutes” is thetime frame offered, the nurse should make every effortto adhere to it.Inconsistency can accentuate a depressedpatient’s feeling that she is not “worth the trouble.”Ms.S.also needs to feel that she can safely expressher emotions. She should be allowed ampletime andopportunity to talk about her concerns, encouraged byaccepting, nonjudgmentalresponses fromthenurse; forexample, “You seem sad, Ms.S.How can I help you?”2. Ms.S.appears thin, with poor tissue turgor.How canthe nurse and dietitianencourageimprovement of her nutritional status?Ascertain Ms.S.’s food preferences and attempt to incorporatethem into her diet as much aspossible. Offeringfrequent, small meals and snacks may also be indicated.A larger meal mayseem overwhelming and require toomuch energy for a depressed individual. Nutritionalsupplements may also be an option.Monitor the patient’s intake and output,andrecordperiodic weights to determinewhethernutritional status is improving.3. The nursing assessment for Ms.S.revealed a flat affect, littleverbalization, and poor personalhygiene.Whichtherapeutic nursing interventionswouldhelpachieve patientgoals andexpectedoutcomes?Encourage and assist Ms.S.with ADLs,andoffer acceptablechoices to her (for example,“Would you like atubbath orashower today?”).Attempts to “cheer up” the patient should not bemade. These may be perceived by Ms.S.as thenurse’sinability to understand her feelings and attempts tominimize the significance of heremotional pain. This canresult in further withdrawal and isolation of the patient.

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Answer Keys-Critical Thinking Questions25-2Nursing Care Plan25-2:The PatientFacing Death1. Ms.B.complains of severe bone pain and nausea. Sheappears cachexic and extremely weak.What are somenursing interventionsto decrease Ms.B.’ssymptoms?Administer and assesstheeffect ofanalgesic andantinausea medications required for increasedcomfort;givesupplemental oxygen as ordered. Administer sips or drops oforal fluids (using asyringewithout a needle)todecrease some of the dehydrationsymptomsthataccompanycachexia,althoughthismay not bedesired by Ms.B. Mouth careandice chipsmay helpdecrease dehydration as well, but Ms.B.’s nausea must bemanaged first.2.Ms. B. says, “I want to go home to die. I don’t want to stay in the hospital. All I want to do isgo home and be with my family.” How can the hospice team most beneficially assist Ms. B.?EvaluateMs.B.’s situation to determine if hospice homecare services can be realisticallydelivered. This will includeassessing her home and family/support system as well.3.When the nurse enters Ms. B.’s room to begin ADLs, she notes the patient’s extreme fatigueand lethargy. What are some nursing interventions to conserve Ms. B.’s strength?Minimizeenvironmental stimulation,performonly necessary physical care and gentlerepositioning forcomfort, andassess Ms.B.’s need for analgesia (which willdecrease metabolicdemands and can therefore provide relaxation,as well).Explain all nursing actions to Ms.B.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter 26:Health Promotion and PregnancyAnswer Keys-Critical Thinking QuestionsNursing Care Plan26-1:ThePatient with a NormalPregnancy1.How should the nurse respond to Ms. P. if she expresses concern about her dietary practicesand their effect on her baby? What suggestions can the nurse give her to ensure that her diet isadequate to support the pregnancy?There is a strong correlation between maternal diet andfetal healththatcan be explained to Ms.P. Her concernfor her baby should be viewed as a positive occurrence.DetermineMs.P.’s food preferences and eatinghabitsbyasking herto keep a food diary forafew days and to bring it with her for review at her nextvisit. It is important that Ms.P.beassured that this will befor her and her baby’s benefit only. The nurse must takespecial care notto appear judgmental regarding Ms.P.’seating habits and choices.The nurse can review Ms.P.’snutritional needs duringpregnancy and suggest ways to meetthem. Shewill need basic nutritional education (theUSDA’snewMyPlateplan) withmodifications addressing her vegetarianchoices. Since she does eat fish, she can be encouragedto have at least three servings of tuna, salmon, halibut,flounder, or mackerel (not fried)a week.Advise hernot skip any meals.Additionally, peas, beans, and lentils and green leafyvegetables all also contain nutrients vital tonormal fetaldevelopment. Ms.P.should be encouraged to increasethese foods, which arestaples of the vegetarian diet. Itmay also be easier for her to tolerate small, frequent mealsratherthan the usual three meals per day.Ms.P.may find it helpful to speakwith a dietitian (a WIC referral is appropriate, if the eligibilitycriteria are met).2.Ms. P. states that she is concerned about having to reduce her activity schedule, particularlytennis, which she enjoys. She is worried she will begin to resent her baby because of the need toalter her activities. How should the nurse respond to her concerns? What suggestions should thenurse give her?The goal of exercise during pregnancy is maintenanceof fitness, but strenuous exercise shouldbe avoided.Ms.P.should be reassured that once medicallycleared by her obstetrician ormidwifeafter the birth,she will be able togradually resume her activities to her former levels.Ms.P.is also processing throughRubin’s four maternal tasks. She should be reassured thatfeelings of ambivalence are normal. Ms.P.is expressingvalid concerns and should beencouraged to continue todo so.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter 27:Labor and DeliveryAnswer Keys-Critical Thinking QuestionsNursing Care Plan27-1:ThePatient with SpontaneousRupture of Membranes1.Ms. G.’s labor is progressing normally with continuous monitoring. Suddenly the fetal heartrate drops to 90 bpm with late decelerations with each contraction. What should the nurse do?Explain the reason for these actions.Reposition the mother to prevent supine hypotension. Administer oxygen via mask to increasethe amount ofoxygen in the mother’s blood. Increase maintenance IVfluid to expand bloodvolume and make more available tothe placenta.Stop oxytocin infusion because it intensifiescontractionsand reduces placental blood flow,and administertocolytic drugs to decrease uterinecontractions.The healthcare provider should be notified aftertheseinitialsteps are taken to correct thedecelerations.2.Ms. G. and her coach have been working well together to manage her labor, using a focalpoint, breathing techniques, and guided imagery. Suddenly she becomes irritable and tells hercoach, “Don’t touch me!” Her coach is bewildered by this change in behavior. How should thenurse explain Ms. G.’s behavior to her coach? How can the nurse help the coach continue to beeffective during this time?Ms.G.’sbehavior indicatesshe is approachingtransition. During this phase of labor, the cervixdilates from 7to10 cm (full dilation) anditbecomescompletelyeffaced.Ms.G.is fatigued; shemay request medicationbut fears losing control and is obviously demonstratingirritability, allexpected during this phase.The nurse can best support the coach by explainingall of this and reassuring both Ms.G.and hercoachthat these signs indicatethat labor is progressingnormally. The coach should beencouraged to accept anynegative comments from Ms.G.to be part of this processand to try notto take them personally. The coach shouldcontinue to encourage breathing and relaxationtechniques,praise and reassure Ms.G., and maintain a positiveapproach.Even though coaches are usually reluctant to leavethe laboring woman’s side, Ms.G.’s coachshould be encouragedto take rest or snack breaks periodically to best assist Ms.G.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter 28:Care of the Mother and NewbornAnswer Keys-Critical Thinking QuestionsNursing Care Plan28-1:TheMother with a Newborn1.Even though Caleb is nursing well at each feeding, Ms. P. is anxious about her ability tosuccessfully breast-feed. She asks how she will know whether Caleb is getting enough breastmilk and whether she should supplement with formula, juice, or cereal. How should the nurseanswer her?Signs that Ms.P.is successfully breastfeeding are that herbreasts feel full before feedings andsoften afterward; the“letdown” reflex occurs;BabyC.nurses at each breast for10to15 minutes,8to10 times per day; Ms.P.hears an audibleswallow asBabyC.sucks;BabyC.demands hisfeeding andappears relaxed after feeding;BabyC.has 6to8 wet diapersper day and passesstools several times per day; andBabyC.steadily gains weight and grows in length according tostandardized growth charts.Supplementation with formula is not necessary ifthese are regular occurrences, but additionalwater canbe offered, if Ms.P.desires. Adding juices or cereals isgenerally not recommendedfor several months, but Ms.P.should check with herpediatric health care provider for specificrecommendations.2.A Gomco circumcision is performed on Caleb. After the procedure is completed, Caleb isreturned to his mother’s room. What should the nurse tell Ms. P. in response to her questionsregarding diaper changes and care of the circumcision? How should the nurse describe theexpected appearance of the circumcised penis?Petrolatum jelly or petrolatum jelly–impregnated gauzemay be applied to the end ofBabyC.’spenis to preventsticking to the diaper; the area should be checked for signsor symptoms ofbleeding, irritation, or infection (exudate,with or without odor).BabyC.’s ability to urinateshould be monitored (checking diapers and noting saturationand odor).Since during circumcision,the foreskin of the penisis removed, the head ofBabyC.’s penis willbe visible andshould appear pink. It may also appear slightly swollenfrom the recentcircumcision.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter 32:Care of the Child with a Physical and Mental or Cognitive DisorderAnswer Keys-Critical Thinking QuestionsNursing Care Plan32-1:TheChild with a Congenital HeartDisease1.You enter D.’s room and notice her mother sitting at her bedside crying. She states, “I don’tknow how I will deal with her having heart surgery.” What would be an appropriate initialresponse to D.’s mother?“You sound worried.Why don’t we talkabout yourdaughter’s surgeryand any concerns youhave?”This statement and question allowMs.B.an opportunity toexpress her feelings andconcerns.2.The mother states that D. has a very poor appetite. What two helpful suggestions may helpeducate the mother?OfferingBabyD.smaller, more frequent feedings, using a softnipple with holes large enough toprevent the baby fromtiring (sucking requires a great deal of energy expenditurein thissituation); and holding and comfortingBabyD.duringher feedings whenever possible.Offersmall, nutritious snacks several times a day.3.The mother mentions that she is concerned that D. will get an infection and become acutely ill.What are two therapeutic nursing interventions for patient teaching?Avoid crowds and people (including family members)who are ill, even with something asseemingly minoras a mildupper respiratory infection. These can be dangerous toBabyD.,whoseimmune system is already compromised. Immunizationsshould also be reviewed andupdated asage-appropriate.BabyD.’s pediatrichealth careprovider should be consulted forrecommendations.Proper handwashing should be reviewedwith Ms.B.and encouraged as well.Nursing Care Plan32-2:The Child Who AttemptsSuicide1.Upon entering S.’s room, the nurse notices that she is crying. She states, “I can’t live withoutmy mother; I want to be with her.” What is an appropriate initial response?“You’ve been going through such tough times. You soundvery sad right now.” This may givepatient S.an opportunity toexpresssafelyher feelings further.It is important not to contradictpatient S.by saying thingssuch as, “Oh, no, you’re so young.Your mother wouldn’twant that.” Statements such asthismay be perceived asminimizing theemotional pain being experienced andemphasizing feelings of low self-worth.

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Answer Keys-Critical Thinking Questions32-22.S.’s father is concerned about taking her home after discharge. What are two therapeuticnursing interventions for patient and family teaching?Patient S.should return home with specific counseling appointments,and her father needstoensure that she keepsthem. (He may also be expected to attend family sessionswith her.) PatientS.will also benefit from her father displayingreassurance and a nonjudgmental manner towardsher.PatientS.’s father also needs education regarding early warningsigns of suicidal ideation orgestures, such as isolation,disinterest in the future or activities with friends, andinsomnia. Heshould also be given information regardingmaintaining a safe environment forhis daughter, aswell ashealth careprovider and crisis hotline phone numbers.It should be remembered thatpatientS.’s father has alsosuffered a significant loss (his wife),and may need helpin coping with his own grief as well as caring for hisdaughter.3.S. begins to express interest in others and in activities in her hospital unit. What nursinginterventions would be appropriate to encourage her?It is important for the nurse to interact withpatient S.in a nonjudgmentalmanner. Positivefeedback should be givenwhenevershedisplays interest in age-appropriate activities, and thenurse should discusspatient S.’s feeling with her after attending activities.She should beencouraged to become involved in activitiesthatseem to interest her, butsheshould be reassuredif interactionsdo not initially proceed as well asshehad hoped.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter35:Care of the Patient with a Psychiatric DisorderAnswer Keys-Critical Thinking QuestionsNursing Care Plan35-1:The Patient withDepression1.Mr. W. is admitted to the psychiatric unit and placed on suicide precautions. He sits stoicallystaring out the window and does not respond to the nurse’s greeting. What safety interventionsshould the team incorporate into Mr. W.’s care to prevent his self-destruction?Mr.W.’s environment should be continuously monitoredfor safety. He may require constant(1:1or with remote access) visual supervision,or close supervision (visual check every 15minutes).Potential safety hazards (e.g., in this case, thewindow) should be evaluated for possiblyproviding Mr.W.an opportunity for a suicide attempt.Assessing Mr.W.for increasing suicide risk should beongoing, because his mental status mayfluctuate. Manypatients give some clue before exhibitingself-destructive behavior. The nurseshould be especiallyaware of Mr.W.appearing to be deep in thought or suddenlyhappy.A no-suicide contract may be appropriate at somepoint, but should be implemented cautiously.2.Mr. W. sleeps poorly, approximately 2 to 3 hours a night. What therapeutic interventionsshould be used to correct his sleep pattern disturbance?Engaging Mr.W.in activities of interest to him duringthe day, especially those involving somephysical activity(short walks, running) or concentration (card games,sanding or poundingwood, if appropriate). These activitiescan also enhance Mr.W.’s feelings ofself-worthwhen hecompletes these tasks.Other nonpharmacologic nursing interventionsinclude avoiding daytime naps, eliminatingstimulantssuch as caffeinein the evening, and keeping a journal of daily activitiesand a sleeplog. Pharmacologic interventions should onlybe implemented after considering Mr.W.’s totaltreatmentregimen (i.e., antidepressant medications).3.Mr. W. has lost 32 lb. What are some options for the staff to help him meet adequatenutritional requirements?Snacks, finger foods, or nutritional supplements may benecessary. The nurse or dietitian shouldascertain Mr.W.’s food preferences and try to incorporate them into adietary plan for him.Intake and output should be monitoreddaily until Mr.W.is able to assume responsibility formeeting his nutritional needs.

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Answer Keys-Critical Thinking Questions35-2Any attempts Mr.W.makes to improve his nutritionalstatus should be acknowledged andpositively reinforced.Since patients with depression are often unable tomake decisions assimple as what foods to choose, positivereinforcement has the added benefit of increasing Mr.W.’sself-esteem,as well as improving his nutritional status.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter36:Care of the Patient with an Addictive PersonalityAnswer Keys-Critical Thinking QuestionsNursing Care Plan36-1:The Patient Who AbusesAlcohol1.During Mr. J.’s assessment, the nurse notes that he has tremors, is agitated, and verbalizesvisual hallucinations. What therapeutic interventions are appropriate to perform to preventinjury to the patient?Mr.J.’s personal safetyis a priority. It will be difficultfor nurses to anticipatefullythe patient’sperceptions, andhe must be protected from harm while he is experiencingthese symptoms.He should be admitted to a room as close to thenurse’s station as possiblefor close monitoring.Stimuli should be reduced,including decreasing the lighting in his room. He shouldbe assessedfor impending seizure activity and placed onfacility seizure precautions. Medications notconsideredtoxic to the liver, or those necessary to decreaseMr.J.’sanxiety and increasinglyirritable neurologic status(e.g., lorazepam[Ativan]or IV barbiturates)may beindicated incertain circumstances.2.As Mr. J.’s physical condition improves, he discloses his hopelessness and lack of desire tocontinue living. What is an appropriate response by the nurse?Patient safety is the priority in this situation; a safephysical environment needs to be providedand maintainedat all times. Substance abusers oftenhavelow self-esteem and depression. AsMr.J.’s physical andmental status improve, he is becoming aware of the poorchoices he haspreviously made and their consequences.This can serve as the basis of overwhelming emotionaland psychological pain, andcanlead to suicidal ideation.Treatment facilities generally havespecific protocols forstaff to implement and follow in this potentially high-risksituation.The nurse must be aware of the patient’s increasedneed for acceptance and support during thistime, andshould reassureMr.J.thatthestaffisavailable to him.Mr.J.should also be givenopportunities and encouragementto express his concernsfurther.3.During group therapy, Mr. J. states, “Now that I am physically better, I know I will be able tostop drinking. I don’t need any help. There really isn’t anything wrong with me.” What is theappropriate staff intervention at this time?Mr.J.is exhibiting denial, which must be addressed andovercome for treatment to be effective.Staff can identifyand relate problems and difficultiesthe patienthas experiencedin his lifethatare directly related to his alcoholuse.Mr.J.should also not be allowed to rationalize thecircumstances of their occurrence; blaming others andnot accepting responsibility for one’sactions serves as anexcuse to continue both his denial and his drinking.

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Answer Keys-Critical Thinking Questions36-2It is important that the staff interactions withMr.J.occur in an accepting, nonjudgmentalmanner.Mr.J.should also be assisted and encouraged toidentify his own behaviors that have causedsome of theseproblems in his life. He needs to receive more educationabout alcoholism as adisease; the significant role denialplays in the disease process; and assistance with exploringalternate, effective ways of dealing with stressful situations.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter39:Rehabilitation NursingAnswer Keys-Critical Thinking QuestionsNursing Care Plan39-1:ThePatient with Spinal CordInjury1.Describe the stimuli or precipitating factors associated with bowel functioning ormanagement that have potential to cause autonomic dysreflexia. What are the appropriateinterventions if it does occur?Autonomic dysreflexia typically occurs in patients withinjuries above the T-6 level. It is usuallycaused by sometype of noxious stimulus below the spinal cord injuryactivating the sympatheticnervous system. This responseremains unchecked because the parasympathetic nervoussystemcannot descend past the level of injury. The goal ofintervention is to identify and relieve thecause withoutfurther increasing the sympathetic nervous systemresponse.The most common cause of autonomic dysreflexia isbladder distention, but it can also be causedby bowel impaction,among other stimuli. Multiple factors contributeto the risk for developmentofthis potentially life-threatening complicationin the patient with a spinal cord injury:immobility,slowed bowel motility, and loss of rectal sphincter tone.Insertion of a rectalsuppository (for bowel regulationand continence) may precipitate dysreflexia, as this maycauseincreased stimulation of the rectal area and causeexacerbation of symptoms. It is recommendedthat anestheticointment be applied to the rectum before manualdisimpaction or suppositoryinsertion to prevent thisfrom occurring.If autonomic dysreflexia does occur, the patient’sblood pressure should be taken immediatelyand thenmonitored every 5 minutes. (Since spinal cord injury patientsare generally hypotensive,even mildly hypertensivereadings may indicate a significant rise fromthebaseline.)The patient should be placed intheFowler positionto use the effect oforthostasis to controlbloodpressure (i.e., induce hypotension).Once the acute episode is past, a plan to preventreoccurrence should be devised with the patientandcaregivers.2.The patient has C5 quadriplegia. How is it possible to lessen the patient’s potential fordeveloping orthostatic hypotension?The patient’s quadriplegia greatly increases his risk for developmentof orthostatic hypotension,but the prevention ofit is similar to that of other patients. Patients should betaught to changeposition gradually, especially when raisingtheir heads or going fromthesupineorhorizontalpositiontothevertical(lying flat to sitting to standing)position.

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Answer Keys-Critical Thinking Questions39-2Use of elasticorantiembolism stockings will help promote venous return to the heart andprevent poolingof blood in the legs. A reclining wheelchair can also helplessen this response.3.When explaining orthostatic hypotension to a new nursing assistant, what commonlyoccurring signs and symptoms should the nurse describe, and what instructions should be givento the nursing assistant?Common signs and symptoms of orthostatic hypotensionare light-headedness,sweating(sometimes with cool orpale skin),and the patient may also complain of nausea orheadache.The patient should immediately sit or be returnedto bed and placed in the supine position. If thisis notrealistic (e.g.,the patient is ambulating out of her room) she should be supported by theunlicensed assistive personneland both should gently slide down to the floor, if necessary.

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Answer Keys-Critical Thinking Questions39-3Nursing Care Plan39-2:ThePatient with TraumaticBrain Injury1.Deficits with socialization, motivation, and sexual behaviors that occur after brain injuryresult from damage to which portion of the brain? Discuss appropriate nursing interventions fora patient with this type of injury.These types of neurologic deficits may be the result ofdamage to the cerebral cortex (whichinterprets stimuli),the temporal and limbic areas (which modify responsesto stimuli),or thehypothalamus and pituitary (whichcoordinate the motor cortex and language areas).The brain can be seen as an inhibitor of emotions. When it is not fully functional, emotionalresponses lackthis inhibition. For this reason, nurses need to ensureprovision of a safe,consistent environment for patientsrecovering from brain injury. Reinforcement of appropriatebehaviors should be provided, andredirection of thepatient demonstrating inappropriatebehaviors may alsobe necessary. Emotional support should be provided forthe patient andcaregivers.Additionally, the patient’s family should beinvolved in the plan of care. These types of outburstsandbehaviors can be highly distressing to caregivers. Educatingeveryone involved in thepatient’s care that theseoutbursts arethe result ofthe patient’s disease process will assistthem indeveloping effective coping strategies for dealingwith their loved one. This information will alsoassistthem with management of their own stress levels. Socialservice and rehabilitation referralsare also indicated to develop the most comprehensive plans ofpatientcare.2.A patient recovering from a traumatic brain injury has problems telling the difference betweenobjects that have a similar shape. What is this type of deficit, and whatnursing interventions areappropriate for a patient with this deficit?The patienthas most likely developed a form of agnosia, whichis thedisturbance and resultantdifficulty in interpretationof sensory information. A patient with agnosia maybe unable torecognize or attach meaning to familiarfaces, objects, orsymbols. This can pose significantself-caredeficits and safety risks for affected patients.Appropriate nursing interventions in this caseinclude frequent patient assessment andmonitoring forsafety and potential risks for injury, and adapting thepatient’s environmentaccordingly.Additionally, using frequent cues with repetition anddemonstration may assist the patient withdeficits (e.g., holding up a toothbrush and imitating actionsfor oral care while saying to thepatient, “It’s time to brushyour teeth now.”). This can help to reinforce the differencesbetweensimilar objects (e.g.,a toothbrush and a pencil).

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Answer Keys-Critical Thinking Questions39-43.What interventions are most appropriate to begin establishing communication with a patientwho is just emerging from coma after a brain injury?Nurses should initiate communication withthe patientbyspeaking slowly and calmlywhileassessingthe patient’sneurologicbaselinefunction. The nurse should alsoassist withhelping thepatient as much as possible withmemoryfunction, and orientthe patient to place and time.Sensory overload (including potentiallynoxious stimuli) should be avoided. Anxiety and fear areto be expected froma patientin this situation; all nursingactions should be explained tothepatientas simply as possiblebefore proceeding.The nursing focus should be on providing structureat this stage ofthe patient’s recovery. Afterinteraction withthe patient, the nurse will be better able to determine if alternatemethods ofcommunication will need to beused.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter40:Hospice CareAnswer Keys-Critical Thinking QuestionsNursing Care Plan40-1:TheHospice Patient withMetastatic Prostate Cancer1.Mr. B.’s wife complains to the hospice nurse that her husband has not had a bowel movementin 3 days. What will be included in an appropriate nursing intervention that would provide relieffor Mr. B.?Mr.B.should be receiving frequent sips of liquids toincrease his fluid intake,as well as foodshigh in fiber as tolerated. The nurseshould also obtain medical orders for a regularly (generallythree times daily) administered stool softener and a gentle laxativeif he has not had a bowelmovement after 2 days.2.The nurse notes that Mr. B. is restless and demonstrates dyspnea. She performs an oximetrycheck on Mr. B. and notes that oxygen saturation is 83%. List three nursing interventions toimprove his respiratory distress.Raise Mr.B.’sHOBtoahigh Fowler’s position astolerated; encourage deep breaths (in throughhis nose,out through his mouth); and administer oxygen via nasalcannula.Additionally, Mr.B.may be experiencing increasedpain.Position changes andnonpharmacologic pain management should be implemented. If these pain control methods arenot effective, opioidanalgesia should be administered promptly;this will decrease his oxygendemands and ease his dyspnea.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter42:Care of the Surgical PatientAnswer Keys-Critical Thinking QuestionsNursing Care Plan42-1:The Postoperative Patient1.On the second postoperative day, Mr. S. is taking shallow breaths and having difficultycomplying with coughing anddeep breathing. His temperature is 101.8°F (38.8°C), and he hasadventitious breath sounds bilaterally in the bases. List several nursing interventions to assistMr. S.The nurse should perform a full assessment of Mr. S.The assessment will need to include vitalsigns, oxygen saturation/pulse oximetry, and respiratory status.The respiratory assessment willinclude shortness of breath, retractions, use of accessory muscles, rate, rhythm, and cyanosis.The completed assessment will need to be completed to thecharge nurse and physician.Alowdose of morphine sulfate may be obtained to ease Mr. S.’sanxiety and decrease his oxygendemand. This will result in a reduction of his labored respirations. Thehealth care providermayalso order respiratory and antibiotic therapy after sputum cultures and chest x-ray films areobtained.Raising the HOBto semi-Fowler or Fowler position if possible, and ensure oxygenadministration at 2 L via nasal cannula. The nurse should also encourage deeper breathing byinstructing Mr. S.to breathe in through his nose and out through his mouth, or use his incentivespirometer if he is able (unlikely at this point).2. In his third postoperative day Mr. S.has an erythematous incision with moderate amounts ofpurulent exudate from the Penrose drain site. List the correct nursing interventions.The incision site and vital signs will be assessed by the nurse.The findings will be reported tothe health care provider.Culture of the wound exudate is indicated.The incision site should be cleansed with normal saline (or perhealth careproviderorders)several times a day. The site and dressing should be maintained as clean, dry, and intact, whichmay require dressing changes several times a day usinganaseptic technique. Drainage should bemarked on the patient’s dressing and monitored for amount, appearance, odor, and consistency.Vital signs should be monitored every 4 hours. WBC count should also be monitored. Changesin the wound status,vital signs, signs/symptoms, or WBC count should be reported to thehealthcare provider.3. What signs and symptoms would the nurse note when assessing Mr. S.for dehydrationsecondary to elevated temperature and decreased fluid intake?

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Answer Keys-Critical Thinking Questions42-2The diminished intake and elevated temperature will promote dehydration.Decreased urineoutput will be noted.Changes in urine characteristics may include dark color, strong odor,andelevations in specific gravity.Urine outputbelow 30 mL/hr must be reported.Accompanyingcomplaints may includethirst or dry mouth, dry oral mucosa.Lips may appear dry and chapped,and Mr. S.will most likely also exhibit poor skin turgor.Laboratory values most helpful in this case would be elevated BUN; unless he is developingrenal problems,the hematocritlevel may be elevated. Creatinine values will be within normallimits.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th EditionChapter43: Care of the Patient with an Integumentary DisorderAnswer Keys-Critical Thinking QuestionsNursing Care Plan43-1:The Patient with Herpes Zoster1.Ms. L. turns onher call light. She is crying and states she is in severe pain. She describes thepain as a burning,stabbing pain over her left forehead and eye. She rates her pain as a 7 on apain scale of 0 to 10. She also complains of pruritus. What would be the most appropriatenursing interventions to provide comfort and pain control for Ms. L.?Liberal application of calamine lotion may help alleviate pruritus. Be careful not to get lotioninto the eye. Ensuring administration of antiviral medication (acyclovir) on schedule is themainstay of treatment; acetaminophen, possibly with codeine orastronger analgesic, should alsobe administered on schedule for pain management. Do not exceed 400 mg of acetaminophen in24 hours. Cold compresses may also be applied to ruptured lesions.2.Ms. L. tells the nurse that a friend told her she could not visit because she has not hadchickenpox. Her friend isafraid she might “catch chickenpox” from Ms. L.’s shingles. Describethe accurate patient teaching to give in response to Ms. L.’s statements.Herpes zoster infection is the result of the reactivation of a previous varicella (chickenpox)infection, usually in adults over age 50. Although much less communicable than varicella, it ispossible for others who have not had varicella to develop it after exposure to someoneexperiencing an outbreak of herpes zoster. Visitors should be especially careful to avoid contactwith any drainage from the patient’s lesions. Meticulous handwashing should be emphasized.

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Answer Keys-Critical Thinking Questions43-2Nursing Care Plan43-2:The Patient with Systemic Lupus Erythematosus1.Ms. T. has painful, edematous joints that greatly decrease her mobility. She has 4+ pittingedema to the lower extremities secondary to the loss of protein through her kidneys. What arethe most appropriate nursing interventions to decrease Ms. T.’s pain level and to increase hermobility?Heat packs can be applied to relieve joint pain and stiffness. Regular exercise and movement astolerated should be encouraged to ensure maintenance of full range of motion andtopreventcontractures;good body alignment should be maintained at all times. Physical and occupationaltherapy referrals should be made.Steroid therapy is often prescribed for management of inflammatory symptoms during diseaseexacerbations. Ms. T.will need to be observed for her response to the corticosteroids, includingany adverse reactions to the medications.Because of her renal problems, Ms. T.will probably also require a low-protein, low-sodium diet.2.On entering the room, the nurse notes Ms. T. crying. She says that her lifestyle is severelyaltered because she isunable to be in the sun to work in her beloved garden. What nursinginterventions would be most beneficial?SLE often produces photosensitivity in patients. Ms. T.should be advised to minimize her directsun exposure and to use a sunscreen with a minimum SPF of 15 when outdoors. She should alsowear protective clothing such as a hat, long sleeves, and long pants when outdoors.Strategies toincorporate her new activity restrictionsshould be provided to Ms. T.These may includegardening at times that are not as “sunny” as well as shade gardening or possibly houseplants.Inaddition to avoiding excessive sun exposure, Ms. T should be advised to avoid tanning beds orsalons.Occupational counseling would be helpful, also. The nurse should explore other potential areasof interest with Ms. T.3.Ms. T. confides that she fears that this severe increase in her symptoms will lead to an earlydeath. What initialresponse to this statement would be of greatest assistance?Development of a therapeutic relationship is crucial in this situation. Interpersonalcommunication skills will need to be used to encourage Ms. T.to verbalize her fears andconcerns.Examples of appropriate nursing responses to this patient’s stated fears would include,“You sound very frightened about the effects of your illness. Would you like to talk about this?”and, “Would it help if we talked about treatment options?” Nursing responses such as these allowthe patient to express concerns.

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