1. Suzanne Jones, 76-year-old patient with COPD is admitted to the.docx

1. Suzanne Jones, 76-year-old patient with COPD is admitted to
the ICU. Mrs. Jones is placed on mechanical ventilation to
assist with her breathing. After 2 days on the ventilator, Mrs.
Jones is extubated and then transferred to a medical-surgical
unit. The medication regimen is adjusted during the
hospitalization. Mrs. Jones is discharged home after 6 days. She
and her family are pleased with the care she receive in the
hospital. (Learning Objectives 3 and 6)
a. Describe the quality performance tools that may be used to
demonstrate that the care and treatment rendered are both cost-
efficient and of high quality.
b. Describe the quality performance tools that may be used to
demonstrate that the nursing care utilized is evidence-based
care and high quality, resulting in patient satisfaction and good
patient outcomes.
2. The registered nurse working in the cardiac care clinic is
tasked with implementing quality improvement measures. To
educate the clinic staff, the nurse plans an in-service program to
introduce concepts of quality improvement and evidence-based
practice. Additionally, the role of the case manager will be
included in the presentation. The nurse plans on using care of
the patient with Congestive Heart Failure as a template, and
prepares sample clinical pathways, care maps, and
multidisciplinary action plans. (Learning Objective 3)
a. Describe how clinical pathways are used to coordinate care of
caseloads of patients.
b. What is the role of the case manager in evaluating a patient’s
progress?
c. What are examples of evidence-based practice tools used for
planning patient care?
. Mr. Jones, who is 74 years of age, is being discharged home

after having a right knee replacement. The discharge orders
from the orthopedic surgeon include: continuous passive motion
(CPM) at the current setting of 0-degrees extension worn when
walking with crutches (nonweight-bearing postdischarge day 1,
and may begin weight-bearing postdischarge day 2); and home
nurse visits, as needed. Physical therapy should begin the day
after discharge at an orthopedic center. The orders will be faxed
to the center. The following medications with prescriptions
attached include: Lovenox (enoxaparin) 70 mg subcutaneously
once daily for 7 days, Vicodin (hydrocodone bitartrate) 10 mg
every 4 hours PRN, and Colace (docusate sodium) 100 mg every
day. The patient is to follow up with the orthopedic surgeon in 3
weeks. His daughter plans to stay with him for several weeks to
assist him with meals and household chores, and take him to
physical therapy and the orthopedic surgeon for follow-up. Mr.
Jones has three other children who live in other states. He is a
widower and attends a local church. (Learning Objective 4)
a. What preparations should the nurse make in advance before
attaining necessary community resources and referrals before
the patient is discharged?
1. What necessary community resources and referrals will the
patient need?
2. Mrs. Johnson, a 67-year-old female patient, has recently been
discharged from the hospital following an admission for COPD.
She has a past medical history of a colon resection related to
acute diverticulitis. She developed a surgical wound infection
that requires daily wet to dry wound packing and IV Zosyn.
Mrs. Johnson was discharged with home oxygen. To manage her
care at home, home care visits were ordered. (Learning
Objective 5)

a. What would be involved in setting up the first home care
visit?
1. Describe the nursing assessments and management that would
occur during the visit.
1. Mrs. Elle, 80 years of age, is a female patient who is
diagnosed with end-stage cancer of the small intestine. She is
currently receiving comfort measures only in hospice. She has
gangrene of her right foot and has a history of diabetes
controlled with oral agents. She is confused and the physician
has determined that she is unable to make her own informed
decisions. The hospice nurse, not realizing that the weekly order
for CBC and renal profile had been discontinued, obtained the
labs and sent them to the nearby laboratory for processing. The
abnormal lab results obtained later that day revealed that the
patient needed a blood transfusion. The hospice nurse updated
the patient’s medical power of attorney who was distressed at
the report. The patient’s wishes were to die peacefully and to
not have to undergo an amputation of her right foot. But if the
patient receives the blood transfusion, she may live long enough
to need the amputation. The patient’s physician had previously
informed the medical power of attorney that the patient would
most likely not be able to survive the amputation. The patient’s
medical power of attorney had made the request to cease all labs
so that the patient would receive comfort measures until she
died. The patient has no complaint of shortness of breath or
discomfort. (Learning Objective 4)
a. What ethical dilemma exists?
1. Who are the stakeholders and what gains or losses do each
have?

1. What strategies should the hospice nurse take to resolve the
ethical dilemma?
2. The nurse receives a 12-year-old girl from the operating room
after an emergent appendectomy due to ruptured appendix.
Upon arrival to the postanesthesia care unit, the patient is
drowsy, but arousable to voice; she was extubated in the
operating room and is receiving oxygen by facemask at 40%.
She has two peripheral IVs in her left arm that are infusing
Lactated Ringers solution at 100 mL/hr. A nasogastric tube is
attached to low constant suction, and a small amount of aspirate
is noted. She has a urinary catheter that is draining clear,
yellow urine. Her abdominal dressing is dry and intact. Upon
arousal, she complains of abdominal pain. (Learning Objective
5)
a. What NANDA-approved nursing diagnoses may be relevant to
this patient?
1. Once the nursing diagnoses are determined, what steps does
the nurse take to complete the Planning Phase of the Nursing
Process?
1. What is the difference between nursing diagnoses and
collaborative problems?
Case Study, Chapter 4, Health Education and Health Promotion
1. Mr. Smith, a 57-year-old patient, presents at a health fair
asking questions about the age-appropriate health maintenance
and promotion considerations he should be concerned about. He
stated that he only goes to his physician when he is sick and the
last time he saw his physician was 2 years ago when he had a
sinus infection. (Learning Objectives 7 to 9)

a. What further assessment does the nurse need to make before
designing a teaching plan?
1. What topics does the nurse need to include for Mr. Smith
based on current medical recommendations?
1. Design a teaching plan that covers the topics.
2. The community health nurse is planning a health promotion
workshop for a high school PTSO (Parent-Teacher-Student
Organization). The choice of topics was suggested by the high
school’s registered nurse who has observed a gradual increase
in student obesity. The two nurses have collaborated to develop
this workshop to provide parents, students, and teachers with
information about the importance of health promotion.
(Learning Objectives 6, 8, and 9)
a. Describe the importance of a focus on health promotion.
1. According to the health promotion model developed by
Becker (1993), what four variables influence the selection and
use of health promotion behaviors?
1. Describe four components of health promotion.
Case Study, Chapter 5, Adult Health and Nutritional Assessment
1. Mrs. Jones, a 40-year-old female patient, is presenting for a
history and physical. The nurse gathers a family history from
the patient. She shares that her mother died at 70 years of age of
colon cancer and had adult onset diabetes controlled with oral

agents, hypercholesterolemia, and hypertension. She had a
stroke before passing away. Her father died at 67 years of age
from a stroke. He had a long history of alcoholism and smoked
two packs per day of cigarettes for 50 years. He had
hypertension, hypercholesterolemia, and two heart attacks; the
first heart attack was at 30 years of age and the second at 52
years of age. He had adult onset diabetes controlled with oral
agents since 50 years of age. He had renal stenosis that was
unsuccessfully treated with a renal angioplasty and he
developed end-stage renal failure requiring hemodialysis. Mrs.
Jones has two brothers. One brother developed hypertension,
hypercholesterolemia, and adult onset diabetes controlled with
oral agents at 50 years of age. The second brother has no health
problems. The maternal grandmother died at 88 years of age of
a stroke and had hypertension. The maternal grandfather died at
70 years of age of a massive heart attack and had a history of
hypertension. The paternal grandmother died at 80 years of age
of a heart attack. The paternal grandfather died at 50 years of
age from bleeding esophageal varices related to long-standing
alcoholism. The patient shares that her mother’s first cousin,
George, died at 52 years of age of Hodgkin lymphoma. She has
another first cousin Mabel, 72 years of age, who is alive but has
had cancer of the colon and had a recent stroke, and has a
history of hypertension, hypercholesterolemia, and adult onset
diabetes controlled with diet. Her mother’s sister, who is 68
years of age, is alive and has a history of hypertension and
hypercholesterolemia. Her mother’s brother died at 68 years of
age of renal cancer and had a history of hypertension,
hypercholesterolemia, and adult onset diabetes controlled with
oral agents. He also had a heart attack at 45 years of age and a
coronary artery bypass graft operation of three vessels at 55
years of age. He smoked cigarettes for 50 years. The patient’s
father was an only child and her father’s family all lived to be
over 80 years of age. (Learning Objective 5)

a. What genetic-related diseases do the patient’s first-order
relatives have?
1. What genetic-related diseases do the patient’s second-order
relatives have?
1. Optional: Draw a genogram of the patient’s family’s health
history using the example in the textbook (see Fig. 5-2) as a
guide.
2. The registered nurse prepares to conduct a nutritional
assessment on Mrs. Varner, a 52-year-old Caucasian female who
describes herself as “overweight most of my adult life.” The
client states that her health is good. She works part time as a
receptionist and volunteers about 10 hours per week in her
church. The nurse obtains Mrs. Varner’s height as 64 inches and
her weight as 165 pounds. (Learning Objective 8)
a. What is the rationale for computing body mass index? What
is Mrs. Varner’s BMI?
1. Calculate her ideal body weight. What is your assessment of
her BMI and weight?
1. Based on Mrs. Varner’s BMI and weight, the nurse measures
her waist circumference. Describe the proper procedure for this
assessment.
1. Mrs. Varner’s waist circumference is 38 inches. What is your
assessment?
1. What laboratory values would the nurse review to evaluate
Mrs. Varner’s protein levels?

Case Study, Chapter 6, Individual and Family Homeostasis,
Stress, and Adaptation
1. Mr. Smith, a 52-year old patient, is admitted to the coronary
care unit with the diagnosis of acute inferior myocardial
infarction. The patient has a history of smoking two packs per
day of cigarettes for 35 years, and he drinks a six-pack of beer
on weekend nights, but does not drink the rest of the week. He
is the sole financial support for his family. He is a consultant
for a company and is out of town during week days. Over the
past year, Mr. Smith has gained 20 pounds. He is 5 foot 6
inches, weighing 200 pounds. His diet consists mostly of fast
food. He rarely exercises. His wife cares for their three teenage
children. The eldest son, 17 years of age, totaled the family car
when drinking and driving 2 days ago and he is in the local
children’s hospital in the intensive care unit in critical
condition. Mr. Smith developed chest pain and slumped over in
his chair during an argument with his wife about their teenage
daughter, who is 15 years of age and wanted to get birth control
pills. The wife is in the waiting room while the nurses settle Mr.
Smith into his room. The youngest son, 13 years of age, is at a
friend’s house. The teenage daughter is staying at the bedside of
the critically ill eldest son. The wife blames her eldest son for
her husband’s heart attack and told the emergency department
nurse that she does not care to see her son at all. (Learning
Objectives 6, 10, and 11)
a. What maladaptive responses to stress may have contributed to
Mr. Smith’s development of an illness?
1. Based on the case study, what family assessment data may be
used to determine coping strategies being currently used by the
family in crisis?

1. What nursing interventions should be used to promote
effective coping for the patient and his family?
2. Mary Turner stepped on a nail 5 days ago and sustained a
puncture about 1 inch deep. She immediately cleaned the area
with soap and water and hydrogen peroxide, and applied triple
antibiotic ointment to the site. Today she comes to the clinic
with complaints of increased pain and swelling in her foot. On
assessment, the nurse notes that the puncture site is red and
edematous, and has a moderate amount of yellowish drainage.
(Learning Objective 9)
a. Describe the sequence of events that caused the local
inflammation seen in Mary’s foot.
1. What is the role of histamine and kinins in the inflammatory
process?
1. Which of the five cardinal signs of inflammation does Mary
exhibit?
1. Because Mary’s injury occurred 5 days ago, the nurse should
assess for what systemic effects?
Case Study, Chapter 7, Overview of Transcultural Nursing
1. Mrs. Perez, 32 years of age, is a Hispanic patient who is
admitted for early stage cancer of the uterus. The surgeon stated
that in order to treat Mrs. Perez’s cancer successfully, the
uterus will need to be removed surgically through a procedure
called a simple hysterectomy leaving the ovaries, fallopian
tubes, and vagina. The surgeon requests that the nurse make
arrangements for an interpreter, so they can both use the
interpreter’s services. The patient only speaks Spanish, but her

mother and one of the patient’s sisters are bilingual. They are
currently visiting the patient. Her husband is also visiting and
he only speaks Spanish. The patient’s two children are with her
sister Maria. The family stated they are devout Catholics and
request to see a priest while in the hospital. Today is Ash
Wednesday. (Learning Objective 4)
a. Which interpreter is the most appropriate choice to
communicate with Mrs. Perez and why?
1. After critically analyzing the cultural influences, what
nursing actions are appropriate for the patient?
2. The nurse manager of an ambulatory care clinic has noted an
increased number of visits by patients from different countries
and cultures, including patients from Mexico and other Latin
American countries. Concerned about meeting the needs of this
culturally diverse population, the nurse manager convenes a
staff meeting to discuss this change in patient demographics,
and to query the staff about any learning needs they have
related to the care of these patients. (Learning Objective 3)
a. What strategy to avoid stereotyping clients from other
cultures should the nurse include in this meeting?
1. Identify culturally sensitive issues to be discussed in the staff
meeting.
1. One technician on the staff complains that some patients
never make eye contact, and this makes it difficult for him to
complete his work. How should the nurse respond?
Case Study, Chapter 8, Overview of Genetics and Genomics in
Nursing

1. A patient who is 38 years of age is diagnosed with autosomal
dominant polycystic kidney disease, a hereditary disease that
results in fluid-filled cysts occupying space in the kidneys. The
cysts can interfere with the function of the kidney and may
burst and cause bleeding inside the kidney. The patient with
polycystic kidney disease may or may not have a berry
aneurysm of a blood vessel in the brain that could lead to
bleeding and death, cysts on the ovaries, and a mitral valve
prolapse (in females) that can lead to dysrhythmias (irregular
heart rhythms), or diverticula (outpouching of the bowel) that
are susceptible to infection and inflammation and may lead to
gastrointestinal bleeding. The patient is susceptible to retaining
fluid in the abdomen so the abdomen is large to constipation,
and to hypertension. There is no cure for the disease. The
patient receives supportive care for the various symptoms or
complications the patient may have. (Learning Objectives 1 to
3)
a. When explaining to the patient and family about polycystic
kidney disease, the nurse should explain what characteristics
about an autosomal dominant genetic disease?
1. How does variable expression of genetic characteristics play
a role in the course of polycystic kidney disease and how can
the nurse further predict the level of the disease?
1. Identify the roles of the nurse in integrating genetics in the
nursing care provided for the patient.
2. Mr. Wayne is a 38-year-old man with a significant family
history of elevated cholesterol levels. His father died at age 42
from a massive heart attack secondary to elevated cholesterol

and triglycerides, and two of his older siblings are currently
taking medications to lower their cholesterol levels. Mr. Wayne
makes an appointment to discuss his risk for
hypercholesterolemia. The nurse recognizes that Mr. Wayne is
at risk for familial hypercholesterolemia because this is an
autosomal dominant inherited condition. (Learning Objective 2)
a. Describe the pattern of autosomal dominant inheritance.
1. Mr. Wayne asks what chance his children have of developing
familial hypercholesterolemia. How should the nurse respond?
1. Explain the phenomenon of penetrance observed in autosomal
dominant inheritance.
Case Study, Chapter 9, Chronic Illness and Disability
1. Mr. Edwards is 20-year-old male patient who is admitted for
treatment of recurring pyelonephritis (kidney infection) and
surgical treatment of a urinary stricture, which has decreased
the urinary stream. Mr. Edwards has paraplegia; he is paralyzed
from the waist down secondary to an automobile accident when
he was 16. He came by ambulance to the hospital, leaving his
wheelchair and wheelchair pressure-relieving cushion at home.
According to the nursing history, the patient is a nonsmoker and
he does not drink alcohol or take any illegal drugs. (Learning
Objective 5)
a. What nursing considerations should be made for Mr. Edwards
related to his disability?
1. What health promotion and prevention education does Mr.
Edwards need?

2. Ms. Fulton is a 38-year-old mother who was recently
diagnosed with myasthenia gravis, a chronic disease of the
neuromuscular system. Management of this disease process
requires strict adherence to a medication regimen. The disease
also affects ADLs for the patient and her family. Additionally,
because myasthenia gravis is characterized by exacerbations
that may require hospitalizations, Ms. Fulton has had to resign
from her position as president of a marketing firm. She has
remained as an employee of the same company, but now serves
as a consultant with more flexible work hours. (Learning
Objective 3)
a. In discussing management of her chronic disease, the nurse
focuses on what types of strategies?
1. Describe supportive nursing care that may be helpful to Ms.
Fulton.
Case Study, Chapter 10, Principles and Practices of
Rehabilitation
1. Mrs. Adams, 72 years of age, is admitted to the rehab unit
with the diagnosis of stroke. The stroke affected the limbic area
in the brain, which has caused the patient to have emotional
labiality (her mood changes rapidly because she misinterprets
situations). As a result of the emotional labiality, she sometimes
refuses to be repositioned or to participate in physical or
occupational therapy. She sometimes also refuses to eat and
drink. The patient’s right side is paralyzed and flaccid. She has
no feeling on her right side. She has reddened areas on her
coccyx and both heels at least 1 cm in diameter that do not go
away with repositioning. She is incontinent of urine and stool.
She has problems with communication called global aphasia
(difficulties understanding speech and the written word and

difficulties with speaking and writing). She is 5 feet tall and
weighs 178 pounds. She has a tendency to develop skin tears
because her skin is thin, and she has several bandages on her
arms. The family states they are concerned because the staff on
the previous medical-surgical unit would drag their mother up
in bed when she slid down. The staff would chart when their
mother refused to be repositioned and then would not reposition
her for hours. (Learning Objectives 2 and 4)
a. Explain the pathophysiology of the risk factors that
predispose Mrs. Adams to developing pressure ulcers?
1. What nursing measures need to be instituted for Mrs. Adams
based on the information presented in the case study?
2. You are assigned to care for David Ramsey, a 22-year-old
male patient who sustained a back injury secondary to being
thrown from a motorcycle. He did not damage the spinal cord,
but the computed tomography revealed a compression fracture
at L-2 (lumbar area). David complains of severe lower back
pain with numbness and tingling in the lower extremities. You
identify the following nursing diagnosis: Impaired Physical
Mobility.
a. What assessments are indicated based on this nursing
diagnosis?
1. List other major nursing diagnoses based on David’s clinical
presentation.
Case Study, Chapter 11, Health Care of the Older Adult

1. The nurse working at the senior center notices Mrs. Jones, a
78-year-old, crying. The nurse approaches Mrs. Jones and asks
if she needs help. Mrs. Jones states “I am so embarrassed. I had
another accident and my pants are all wet. It’s like I’m a baby. I
never should have come to the senior center.” (Learning
Objectives 3 and 4)
a. What factors may be contributing to the urinary
incontinence?
1. How should the nurse respond to Mrs. Jones?
2. The nurse is completing the admission assessment for a
patient scheduled for cataract surgery in the outpatient center.
Because the patient is over the age of 70 and has several
chronic conditions, including hypertension and congestive heart
failure, the nurse focuses on completing a thorough medication
history. (Learning Objective 4)
a. What questions should the nurse include in the medication
history?
1. The patient states that she stopped taking one of her
medications due to cost, since her health insurance would not
reimburse for the medication. What are other reasons that older
adults may be noncompliant with ordered medications?
1. How does aging affect drug absorption, metabolism,
distribution, and excretion?
Case Study, Chapter 12, Pain Management

1. Mr. Will, a 67-year-old patient, is postoperative day 2 after a
coronary artery bypass graft operation to revascularize his
coronary arteries that were significantly blocked. He has a
midline incision of his chest and a 7-inch incision on the inner
aspect of his right thigh where a saphenous vein graft was
harvested and used to vascularize the blocked coronary artery.
The surgeon ordered Oxycodone 5 mg every 4 hours PRN for
moderate pain and Oxycodone 10 mg every 4 hours PRN for
severe pain. (Learning Objectives 7 and 8)
a. Considering the patient’s age, what medication administration
considerations should the nurse incorporate into the pain
management plan and why?
1. What measures should the nurse provide the patient to
prevent adverse effects of analgesic agents from occurring?
1. What nonpharmacologic pain management methods should
the nurse teach to Mr. Will to assist with pain management?
2. Mr. Rogers is 2 days postoperative of a thoracotomy for
removal of a malignant mass in his left chest. His pain is being
managed via an epidural catheter with morphine (an opioid
analgesic). As the nurse assumes care of Mr. Rogers, he is alert
and fully oriented, and states that his current pain is 2 on a 1-to-
10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning
Objective 6)
a. What are benefits of epidural versus systemic administration
of opioids?
1. The nurse monitors Mr. Rogers’ respiratory status and vital

signs every 2 hours. What is the rationale for these frequent
assessments?
1. The nurse monitors Mr. Rogers for what other complications
of epidural analgesia?
1. Mr. Rogers complains of a severe headache. What should the
nurse do?
1. Mr. Rogers’ epidural morphine and decreased mobility
increase his chances of constipation. What interventions should
be included in his plan of care to minimize constipation?
Case Study, Chapter 13, Fluid and Electrolytes: Balance and
Disturbance
1. Mrs. Dean is 75-year-old woman admitted to the hospital for
a small bowel obstruction. Her medical history includes
hypertension. Mrs. Dean is NPO. She has a nasogastric (NG)
tube to low continuous suction. She has an IV of 0.9% NS at 83
mL/hr. Current medications include furosemide 20 mg daily and
hydromorphone 0.2 mg every 4 hours, as needed for pain. The
morning electrolytes reveal serum potassium of 3.2 mEq/L.
a. What are possible causes of a low potassium level?
1. What action should the nurse take in relation to the serum
potassium level?
1. What clinical manifestations might the nurse assess in Mrs.
Dean?

2. Conrad Jackson is a 28-year-old man who presents to the
emergency department with severe fatigue and dehydration
secondary to a 4-day history of vomiting. During the interview,
he describes attending a family reunion and states that perhaps
he “ate something bad.” Upon admission his vital signs are a
temperature of 102.7°F, heart rate of 116 bpm, respiratory rate
of 18 breaths/min, and blood pressure of 86/54 mm Hg. The
nurse also notes the patient has dry mucous membranes and
tenting of skin. The physician orders an IV to be started with
0.45% normal saline, and orders a serum electrolytes and an
arterial blood gas. (Learning Objective 7)
The following results are returned from the laboratory:
Sodium (Na+) 150
Potassium (K+) 5.5
Chloride (Cl¯) 110
BUN 42
Creatinine 0.8
Glucose 86
pH 7.32
PaCO2 35
HCO3¯ 20
PaO2 90
O2 Sat 98%
a. What is your interpretation of this arterial blood gas sample?
1. Explain the high potassium in this patient.
1. Calculate the patient’s anion gap:
1. What is the interpretation of this anion gap?
Case Study, Chapter 14, Shock and Multiple Organ Dysfunction
Syndrome

1. Adam Smith, 77 years of age, is a male patient who was
admitted from a nursing home to the intensive care unit with
septic shock secondary to urosepsis. The patient has a Foley
catheter in place from the nursing home with cloudy greenish,
yellow-colored urine with sediments. The nurse removes the
catheter after obtaining a urine culture and replaces it with a
condom catheter attached to a drainage bag since the patient has
a history of urinary and bowel incontinence. The patient is
confused, afebrile, and hypotensive with a blood pressure of
82/44 mm Hg. His respiratory rate is 28 breaths/min and the
pulse oximeter reading is at 88% room air, so the physician
ordered 2 to 4 L of oxygen per nasal cannula titrated to keep
SaO2 greater than 90%. The patient responded to 2 L of oxygen
per nasal cannula with a SaO2 of 92%. The patient has diarrhea.
His blood glucose level is elevated at 160 mg/dL. The white
blood count is 15,000 and the C-reactive protein, a marker for
inflammation, is elevated. The patient is being treated with
broad-spectrum antibiotics and norepinephrine (Levophed)
beginning at 2 mcg/min and titrated to keep systolic blood
pressure greater than 100 mm Hg. A subclavian triple lumen
catheter was inserted and verified by chest x-ray for correct
placement. An arterial line was placed in the right radial artery
to closely monitor the patient’s blood pressure during the usage
of the vasopressor therapy. (Learning Objectives 6 and 7)
a. What predisposed the patient to develop septic shock?
1. What potential findings would suggest that the patient’s
septic shock is worsening from the point of admission?
1. The norepinephrine concentration is 16 mg in 250 mL of
normal saline (NS). Explain how the nurse should administer
the medication. What nursing implications are related to the

usage of a vasoactive medication?
1. Explain why the effectiveness of a vasoactive medication
decreases as the septic shock worsens. What treatment should
the nurse anticipate to be obtained to help the patient?
1. Explain the importance for nutritional support for this patient
and which type of nutritional support should be provided?
2. Carlos Adams was involved in a motor vehicle accident and
suffered blunt trauma to his abdomen. Upon presentation to the
emergency department, his vital signs are as follows:
temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20
breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is
firm, with bruising around the umbilicus. He is alert and
oriented, but complains of dizziness when changing positions.
The patient is admitted for management of suspected
hypovolemic shock.
The following orders are written for the patient:
Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line
Obtain complete blood count, serum electrolytes
Oxygen at 2 L/min via nasal cannula
Type and cross for 4 units of blood
Flat plate of the abdomen STAT
(Learning Objectives 1, 4, and5)
a. Describe the pathophysiologic sequence of events seen with
hypovolemic shock.
1. What are the major goals of medical management in this
patient?

1. What is the rationale for placing two large-bore IVs?
1. What are advantages of using 0.9% NS in this patient?
1. What is the rationale for placing the patient in a modified
Trendelenburg position?
ase Study, Chapter 15, Oncology: Nursing Management in
Cancer Care
1. Emanuel Jones, 60 years of age, is male patient diagnosed
with small cell carcinoma. He underwent surgery in the past to
remove the left lower lobe of his lung. He is receiving
chemotherapy. Two weeks before a round of chemotherapy, a
complete blood count with differential, and a renal and
metabolic profile are obtained for the patient. The patient
presents to the oncology clinic for chemotherapy with a
temperature of 101°F. Further assessment reveals decreased
breath sounds in the right base of the right lung, and a
productive cough expectorating green colored mucus. The
patient is short of breath and has a pulse oximetry reading that
is SaO2 of 85% on room air. The patient has a history of benign
prostate hypertrophy (BPH) and has complaints of urinary
frequency and burning upon urination. The patient is admitted
to the oncology unit in the hospital. The oncologist orders the
following: blood, sputum, and urine cultures; and a chest x-ray.
An x-ray of the kidneys, ureters, bladder (KUB) is ordered. An
arterial blood gas (ABG) on room air, CBC with differential,
and renal and metabolic profile are ordered. Oxygen is ordered
to begin with nasal cannula at 2 L/min and titrate to keep
SaO2 greater than 90%. A broad-spectrum antibiotic,
levofloxacin 500 mg in 100 mL of NS is ordered to be
administered IV over 60 minutes once daily. (Learning
Objective 8)

a. After examining the physician orders, in what sequence
should the nurse provide the care to the patient admitted to the
hospital? Give the rationale for the sequence chosen.
1. On what areas should the nurse focus the assessment to detect
potential complications for Mr. Jones?
1. What patient education does Mr. Jones need from the nurse to
help prevent the reoccurrence of an infection and to get
treatment for an infection promptly?
2. The oncology clinical nurse specialist (CNS) is asked to
develop a staff development program for registered nurses who
will be administering chemotherapeutic agents. Because the
nurses will be administering a variety of chemotherapeutic
drugs to oncology patients, the CNS plans on presenting an
overview of agents, classifications, and special precautions
related to the safe handling and administration of these drugs.
(Learning Objectives 6 and 8)
a. What does the CNS describe as the goals of chemotherapy?
1. How should the CNS respond to the following question:
“Why do patients require rounds of chemotherapeutic drugs,
including different drugs and varying intervals?”
1. In teaching about the administration of chemotherapeutic
agents, what signs of extravasation should the nurse include?
1. What clinical manifestations of myelosuppression, secondary
to chemotherapy administration, should the CNS include in this
program?
Case Study, Chapter 16, End-of-Life Care

1. Joe Clark, 79 years of age, is a male patient who is receiving
hospice care for his terminal illnesses that include lung cancer
and chronic obstructive pulmonary disease (COPD). He
developed bilateral pleural effusion (fluid that accumulates in
the pleural space of each lung), which has compromised his
lung expansion. He states that he is short of breath and feels
anxious that the next breath will be his last. The patient is
admitted to the hospital for a thoracentesis (an invasive
procedure used to drain the fluid from the pleural space so the
lung can expand). The thoracentesis is being used as a palliative
measure to relieve the discomfort he is experiencing. Low dose
morphine is ordered to provide relief from dyspnea or
discomfort. The patient is prescribed Proventil (albuterol)
inhaler 2 puffs per day, as needed, and Flovent (fluticasone
propionate) inhaler 2 puffs twice a day. The patient has 2 L/min
of oxygen ordered per nasal cannula as needed for comfort.
a. What nursing measures should the nurse use to manage the
patient’s dyspnea?
1. The patient complains that he has no appetite and struggles to
eat and breathe. What nursing measures should the nurse
implement to manage this physiologic response to the terminal
illnesses?
2. Ms. Williams underwent a lobectomy for lung cancer 6
months ago, followed by treatment with radiation therapy and
chemotherapy. On her most recent visit to the oncologist, she is
told that despite the treatments, there is evidence of metastatic
disease in her spine. The physician explains that there are no
further treatment options, and refers Ms. Rogers to Hospice for

continuing care. (Learning Objective 4)
a. What are the underlying principles of hospice?
1. To be eligible for Medicare and Medicaid Hospice benefits,
what information needs to be provided by Ms. Williams’
physician?
1. Ms. Williams has severe back pain and is concerned whether
the hospice will assist with her pain management.
Case Study, Chapter 17,Preoperative Nursing Management
1. Joan Arnold, 67 years of age, is a female patient who
underwent a coronary angiogram that diagnosed severe coronary
artery disease in three of her coronary arteries, the left anterior
descending, the left circumflex, and the right coronary artery.
She is scheduled for a coronary artery bypass graft operation
tomorrow. The nurse provides patient education for Mrs. Arnold
and her husband, which includes watching a hospital video on
the operation, the intensive care environment, what to expect
after the surgery, the recovery period, and cardiac
rehabilitation. The video also covered the importance of
coughing and deep breathing, using an incentive spirometer,
splinting, early ambulation, pain medication, and how to
position oneself safely. The video stressed the importance of
not rolling onto the side that the chest tube may be in place
postoperatively. The video also discussed the preoperative
preparation. The nurse also provided a booklet on the subject
material. The nurse had a session with the patient and her
husband to assess their understanding and to answer any
questions they may have had. (Learning Objectives 6 to 8)

a. What specific preoperative nursing measures should the nurse
review with the patient to help decrease the risk for
postoperative complications?
1. Explain the role of the nurse when implementing the
immediate preoperative preparation the day before surgery and
the morning of the surgery?
2. The nurse in a gynecology clinic is completing preoperative
teaching for a patient scheduled for an abdominal hysterectomy
next week. The patient states that she is currently taking 325 mg
of aspirin daily for chronic joint pain, along with a
multivitamin. The patient has type 2 diabetes; she closely
monitors her blood glucose levels. Currently, she is taking an
oral hypoglycemic agent. The nurse advises her to ask the
anesthesiologist whether she should take this medication the
morning of surgery. (Learning Objectives 2 and 4)
a. The nurse instructs the patient to stop taking the aspirin.
What is the rationale for this action?
1. Why is it important to assess the patient for use of herbal
products prior to surgery?
c.The patient asks how surgery could affect her blood glucose;
how should the nurse respond?
Case Study, Chapter 18,Intraoperative Nursing Management
1. Pearl Richards, 69 years of age, is a female patient who is in
the operating room for a repair of an abdominal aortic
aneurysm. The patient has a history of hypertension controlled
with medications, osteoporosis, chronic obstructive pulmonary

disease, and has smoked two packs of cigarettes per day for 40
years. (Learning Objectives 2, 6, and 9)
a. What nursing interventions are instituted to reduce the
surgical risk factors related to the patient’s age?
1. Explain the role of the nurse in providing patient safety
measures during the intraoperative period.
2. Mr. Bond is a 32-year-old Caucasian man who plays
professional football. He was admitted for repair of a rotator
cuff injury sustained in a game. In excellent shape, Mr. Bond
has a muscular build and his body fat is 18%. Mr. Bond is
transferred to the operating room, and the anesthesiologist
begins to administer general anesthesia. During the induction of
anesthesia, Mr. Bond develops tachycardia and dysrhythmias.
His condition continues to deteriorate and he becomes severely
hypotensive and exhibits decreased cardiac output. The
anesthesiologist states that Mr. Bond is developing malignant
hyperthermia. (Learning Objective 5)
a. What risk factor does Mr. Bond have for malignant
hyperthermia?
1. What clinical manifestations of malignant hyperthermia does
Mr. Bond demonstrate?
1. Based on the patient’s condition, the surgical procedure is
stopped and 100% oxygen is started. Additionally, a muscle
relaxant and sodium bicarbonate are administered. What are the
rationales for these medications?
Case Study, Chapter 19, Postoperative Nursing Management

1. Rita Schmidt, 74 years of age, is a female patient who was
admitted to the surgical unit after undergoing removal of a
section of the colon for colorectal cancer. The patient does not
have a colostomy. The patient has several small abdominal
incisions and a clear dressing over each site. The incisions are
well approximated and the staples are dry and intact. There is a
Jackson-Pratt drain intact with minimal serous sanguineous
drainage present. The patient has a Salem sump tube connected
to low continuous wall suction that is draining a small amount
of brown liquid. The patient has no bowel sounds. The Foley
catheter has a small amount of dark amber-colored urine
without sediments. The patient has sequential compression
device (SCD) in place. The nurse performs an assessment and
notes that the patient’s breath sounds are decreased bilaterally
in the bases and the patient has inspiratory crackles. The
patient’s cardiac assessment is within normal limits. The patient
is receiving O2 at 2 L per nasal cannula with a pulse oximetry
reading of 95%. The vital signs include: blood pressure, 100/50
mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and
the patient is afebrile. The patient is confused as to place and
time. (Learning Objectives 4 and 7)
a. Explain the assessment parameters used to provide clues to
detect postoperative problems early and the interventions
needed.
1. What gerontological postoperative considerations should the
nurse make?
2. Mr. John Smith is admitted to the hospital for surgical
incision and drainage (I&D) of an abscess on his right calf,
which resulted from a farm machinery accident. The right calf

has an area 3 cm × 2.5 cm, which is red, warm and hard to
touch, and edematous. (Learning Objective 5)
a. Explain the wound healing process according to the phase of
Mr. Smith’s wound?
1. The surgeon orders for wet-to-dry sterile saline dressing
twice a day with iodoform gauze to the wound, covered with the
wet-to-dry dressing. Explain how to perform this dressing
change.

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