Case Study, Chapter 34, Management of Patients With Hematologic Neoplasms 1. John King, 60 years of age, is a male patient who is admitted with the diagnosis of multiple myeloma. He presents with a spinal fracture of the fifth lumbar vertebrae. The patient is scheduled for a vertebroplasty of the spinal fracture. The patient is to remain on bed rest and should be log rolled. Osteolytic lesions are seen in x-rays of the skull, vertebrae, and ribs. The patient has hypercalcemia. The patient’s uric acid level is elevated. The patient has orders for zoledronic acid (Zometa), thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin, ibuprofen, and Vicodin. (Learning Objective 5) a.  What nursing management should the nurse provide the patient? Explain the indication and action of the various medications ordered to treat the patient’s symptoms. 2. Susan Clare, age 38, is admitted to the medical oncology unit with acute myeloid leukemia (AML). She has many areas of ecchymosis and petechiae on her skin, as well as generalized pallor. She states she has lost 15 pounds in the last 2 months, and often has a low-grade fever. On physical assessment, you find her liver and spleen to be enlarged on palpation. (Learning Objective 3) a.  What laboratory results would you anticipate due to her ecchymosis and petechia? Why would it be important to inspect her gums and teeth? a.  Why is her liver enlarged? Case Study, Chapter 37, Management of Patients With HIV Infection and AIDS 1. The nurse is planning to provide education on HIV infection transmission and prevention strategies at a local senior center. (Learning Objectives 1 and 4) a.  What should the nurse include in the session considering the needs of the older population? 2. Sallie Jefferies, 28-year-old patient, is at the obstetric clinic for a pregnancy visit. The physician informs the patient that her HIV screen test is positive. The patient has no evidence of AIDS. The nurse provides patient education regarding what HIV is and what the clinical management entails. (Learning Objective 5) a. What clinical management is recommended for the patient during the pregnancy to help decrease the risk of transmitting HIV to the unborn child? The patient asks the nurse how zidovudine (Retrovir) will help her unborn child from getting HIV. How should the nurse respond? What explanation about Retrovir should the nurse provide? The patient asks the nurse if it will be safe to breast-feed her infant after the delivery. The nurse should provide what explanation? a.  The patient asks the nurse what testing schedule for the HIV antibody is needed after her baby is born. How should the nurse respond? Case Study, Chapter 31, Assessment and Management of Patients With Hypertension 1. Joan Smith, 55 years of age, is a female patient who presents to the intensive care unit with the diagnosis of intracranial hemorrhage. The patient stopped taking her antihypertensives suddenly because of the cost of .

1. Case Study, Chapter 34, Management of Patients With
Hematologic Neoplasms
1. John King, 60 years of age, is a male patient who is admitted
with the diagnosis of multiple myeloma. He presents with a
spinal fracture of the fifth lumbar vertebrae. The patient is
scheduled for a vertebroplasty of the spinal fracture. The patient
is to remain on bed rest and should be log rolled. Osteolytic
lesions are seen in x-rays of the skull, vertebrae, and ribs. The
patient has hypercalcemia. The patient’s uric acid level is
elevated. The patient has orders for zoledronic acid (Zometa),
thalidomide (Thalomid), allopurinol (Zyloprim), calcitonin,
ibuprofen, and Vicodin. (Learning Objective 5)
a. What nursing management should the nurse provide the
patient?
Explain the indication and action of the various medications
ordered to treat the patient’s symptoms.
2. Susan Clare, age 38, is admitted to the medical oncology unit
with acute myeloid leukemia (AML). She has many areas of
ecchymosis and petechiae on her skin, as well as generalized
pallor. She states she has lost 15 pounds in the last 2 months,
and often has a low-grade fever. On physical assessment, you
find her liver and spleen to be enlarged on palpation. (Learning
Objective 3)
a. What laboratory results would you anticipate due to her
ecchymosis and petechia?
Why would it be important to inspect her gums and teeth?

2. a. Why is her liver enlarged?
Case Study, Chapter 37, Management of Patients With HIV
Infection and AIDS
1. The nurse is planning to provide education on HIV infection
transmission and prevention strategies at a local senior center.
(Learning Objectives 1 and 4)
a. What should the nurse include in the session considering the
needs of the older population?
2. Sallie Jefferies, 28-year-old patient, is at the obstetric clinic
for a pregnancy visit. The physician informs the patient that her
HIV screen test is positive. The patient has no evidence of
AIDS. The nurse provides patient education regarding what HIV
is and what the clinical management entails. (Learning
Objective 5)
a. What clinical management is recommended for the patient
during the pregnancy to help decrease the risk of transmitting
HIV to the unborn child?
The patient asks the nurse how zidovudine (Retrovir) will help
her unborn child from getting HIV. How should the nurse
respond?
What explanation about Retrovir should the nurse provide?
The patient asks the nurse if it will be safe to breast-feed her
infant after the delivery. The nurse should provide what
explanation?

3. a. The patient asks the nurse what testing schedule for the HIV
antibody is needed after her baby is born. How should the nurse
respond?
Case Study, Chapter 31, Assessment and Management of
Patients With Hypertension
1. Joan Smith, 55 years of age, is a female patient who presents
to the intensive care unit with the diagnosis of intracranial
hemorrhage. The patient stopped taking her antihypertensives
suddenly because of the cost of the medications and she
recently lost her job to outsourcing. The patient is slightly
drowsy and complains of a headache and blurred vision. The
patient’s blood pressure is 220/130 mm Hg upon presentation.
(Learning Objective 6)
a. According to the definitions set by the Seventh Report of the
Joint National Committee on Prevention, Detection, Evaluation
and Treatment of High Blood Pressure (JNC 7), which type of
hypertensive crisis is the patient currently experiencing?
Describe the treatment goals for handling the hypertensive
crisis and apply the goals to the case study. Determine the
current mean arterial pressure (MAP) and the goals for
treatment.
The physician orders nicardipine hydrochloride (Cardene) 25
mg/250 mL, NS for peripheral IV starting at 2.5 mg/hr, and
titrate by 2.5 mg/hr every 15 minutes to reach the goal for the
first hour, which is to achieve 25% reduction of the initial
MAP.

4. Call the physician if the dosing range of 15 mg/hr has been
reached and the MAP is still not at target goal for the first hour
of treatment, or up to four dose increases.
Lower the BP within 6 hours to 160/100 mm Hg.
Adjust the IV rate so that the IV fluids plus the nicardipine IV
drip are equal to 100 mL/hr, in total. Call the physician if the
IV fluids must go above 100 mL/hr to provide the nicardipine.
c. Explain what rate to set initially for both the nicardipine drip
and the NS maintenance fluids.
d. Explain the process of titrating the nicardipine drip for the
first hour to achieve the final MAP goal of 25% reduction of the
original MAP.
2. The community health nurse is preparing a program about
hypertension for a local community center. The focus of the
program is on the reduction of risk factors and compliance for
those who have been diagnosed with high blood pressure. The
target population includes older adults. (Learning Objectives 1
to 4)
a. The nurse focuses on primary hypertension because it
accounts for 90% to 95% of hypertension in the United States.
What risk factors does the nurse include for this population?
b. The nurse prepares to discuss the changes in how the JNC 7
defines hypertension. What ranges and descriptions should the
nurse include?
c. Because this is a gerontologic audience, the nurse needs to
review why blood pressure increases with age. Explain how the

5. structural and functional changes of aging contribute to higher
blood pressure in the older adult.
a. What information does the nurse include about lifestyle
modifications that may decrease risk of hypertension (or
complications associated with diagnosed hypertension)?
Case Study, Chapter 23, Management of Patients With Chest
and Lower Respiratory Tract Disorders
1. Harry Smith, 70 years of age, is a male patient who is
admitted to the medical-surgical unit with acute community-
acquired pneumonia. He was diagnosed with paraseptal
emphysema 3 years ago. The patient smoked cigarettes one pack
per day for 55 years and quit 3 years ago. The patient has a
history of hypertension, and diabetes controlled with oral
diabetic agents. The patient presents with confusion as to time
and place. The family stated that this is a new change for the
patient. The admission vital signs are as follows: blood pressure
90/50 mm Hg, heart rate 101 bpm, respiratory rate 28
breaths/min, and temperature 101.5°F. The pulse oximeter on
room air is 85%. The CBC is as follows: WBC 12,500, platelets
350,000, HCT 30%, and Hgb 10 g/dL. ABGs on room air are pH
7.30, PaO2 55, PaCO250, HCO3 25. Chest x-ray results reveal
right lower lobe consolidation, presence of apical bullae,
flattened diaphragm, and a small pleural effusion in the right
lower lobe. Lung auscultation reveals severely diminished
breath sounds in the right lower lobe and absence of breath
sounds at the base. The breath sounds in the rest of the lungs
are slightly decreased. The patient complains of fatigue and
shortness of breath and cannot finish a short sentence before the
respiratory rate increases above the baseline and his nail beds
and lips turn a bluish tinge and the pulse oximetry decreases to
82%. The patient is diaphoretic and is using accessory muscles.
The patient coughs weakly, but he does not raise any sputum.
(Learning Objective 3)

6. a. What nursing assessment findings support the diagnosis of
pneumonia?
What diagnostic findings support the diagnosis of pneumonia?
What NANDA nursing diagnoses should the nurse formulate for
the patient?
What goals should the nurse develop for the patient?
What overall interventions should the nurse provide?
2. Marie Perez, a 53-year-old patient, is day 1 after a gastric
bypass. She complains of shortness of breath; her respiratory
rate is 30 breaths/min, heart rate is 110 bpm, pulse oximetry
89% on room air, temperature is 100°F, and her blood pressure
is 90/50 mm Hg. She complains of feeling anxious and having
stabbing chest pain which gets worse with inspiration. She
complains that she feels like she is going to pass out or possibly
die.
(Learning Objective 7)
a. What could possibly be going on with the patient and what
measures should the nurse provide immediately?
What risk factors does the patient have for a pulmonary
embolus?
What measures are appropriate to manage a pulmonary
embolism?

7. What measures are appropriate to help the patient in this case
study prevent the reoccurrence of a pulmonary embolism?
Case Study, Chapter 29, Management of Patients With
Complications From Heart Disease
1. George Brown, 72 years of age, is a male patient who is
admitted with the diagnosis of acute pulmonary edema
secondary to acute left ventricular heart failure. The patient has
a history of coronary artery disease that has been treated
medically. The patient is anxious, pale, cold, clammy, and
dyspneic. The vital signs are: blood pressure 88/50 mm Hg,
heart rate 110 bpm, respiratory rate 32 breaths/min, and
temperature 97°F. There are bubbling crackles and wheezing
throughout the lung fields and the patient is raising frothy
blood-tinged clear sputum. The patient’s admission weight is
100 kg.
a. What first actions should the nurse take and what are the
rationales for these actions?
The physician ordered furosemide (Lasix) 40 mg IVP STAT.
What are the actions of furosemide that will help the patient?
What nursing actions should be implemented when
administering a diuretic?
2. Carl Edwards is a 75-year-old man with congestive heart
failure. Having sustained three myocardial infarctions in the last
10 years, he has decreased left ventricular function. Mr.
Edwards takes Digoxin, Capoten, Coreg, and Lasix for
management of this disease. Today he presents to the emergency

8. department with fatigue, generalized weakness, and feelings of
“skipping” heartbeats. Upon arrival, he is placed on the cardiac
monitor, his vital signs are assessed, and an IV is inserted. He
currently denies chest pain, but is experiencing some shortness
of breath, and is placed on 2 L of oxygen via nasal cannula.
a. Which of his medications might be contributing to his
symptoms of generalized weakness and heart irregularities?
For what clinical manifestations should you assess to correlate
to his left-sided heart failure?
How do his medications treat his congestive heart failure?
How does the hypokalemia affect the effects of Digitalis?
Case Study, Chapter 39, Assessment and Management of
Patients With Rheumatic Disorders
1. Ellie Long, a 55-year-old patient, presents to the pain clinic
with the diagnosis of fibromyalgia syndrome. The nurse at the
clinic obtains a history and physical assessment of the patient.
(Learning Objective 2)
a. On what areas should the nurse concentrate when
interviewing the patient during the history process?
On what areas should the nurse concentrate when assessing the
patient?
What diagnostic tests are used with fibromyalgia syndrome?

9. 2. Julie Walker, a 22-year-old patient, is newly diagnosed with
systemic lupus erythematosus (SLE). She presented with
extreme fatigue; muscle and joint aching and swelling; a
butterfly-shaped, flat, red rash across the bridge of the nose;
patchy alopecia; a low-grade fever; and loss of appetite. Further
workup revealed a positive antinuclear antibodies (ANA) titer,
anemia, leucopenia, and mild thrombocytopenia. She has an
abnormal lipid profile, proteinuria, and hypertension. The liver
and renal profiles are within normal range. The physician
ordered over-the-counter ibuprofen as needed for joint
discomfort, but not to exceed 1,200 mg/day;
hydroxychloroquine sulfate (Plaquenil) before meals at the same
time each day; and prednisone in tapering doses over the next
month. The physician also started the patient on lisinopril, an
ACE inhibitor for the hypertension and a statin for the elevated
lipids. The clinic nurse is asked by the physician to provide
patient and family education. (Learning Objective 5)
a. What teaching-plan topics should the nurse provide for the
patient?
HOW TO WRITE: YOU ARE TO CREATE A PICTURE OF
YOUR PATIENT
These are topics for you to consider documenting as applies to
your client.
General appearance:
Affect/behaviour/anxiety
Level of hygiene
Body position

10. Patient mobility
Speech pattern and articulation
This is not a specific step. Evaluating the skin, hair, and nails is
an ongoing element of a full body assessment as you work
through steps 3-9.
2. Skin, hair, and nails:
Inspect for lesions, bruising, and rashes.
Palpate skin for temperature, moisture, and texture.
Inspect for pressure areas.
Inspect skin for edema.
Inspect scalp for lesions and hair and scalp for presence of lice
and/or nits.
Inspect nails for consistency, colour, and capillary refill.
Head and neck:
Inspect eyes for drainage.
Inspect eyes for pupillary reaction to light.
Inspect mouth, tongue, and teeth for moisture, colour, dentures.

11. Inspect for facial symmetry.
4. Chest:
Inspect:
Expansion/retraction of chest wall/work of breathing and/or
accessory muscle use
Jugular distension
Auscultate:
For breath sounds anteriorly and posteriorly
Apices and bases for any adventitious sounds
Apical heart rate/rhythm
Palpate:
For symmetrical lung expansion
Breasts

12. Abdomen/GI:
Inspect:
Abdomen for distension, asymmetry
Auscultate:
Bowel sounds (RLQ)
Palpate:
Four quadrants for pain and bladder/bowel distension (light
palpation only)
Check urine output for frequency, colour, odour.
Determine frequency and type of bowel movements.
Genitourinary:
Check urine output for frequency, colour, odour.
Female: vaginal discharge

13. Male: circumcision, discharge
Musculoskeletal:
Check if full or partial weight-bearing.
Determine gait/balance.
Determine need for and use of assistive devices.
Inspect:
Arms and legs for pain, deformity, edema, pressure areas,
bruises
Compare bilaterally
Palpate:
Radial pulses
Pedal pulses: dorsalis pedis and posterior tibial
CWMS and capillary refill (hands and feet)
Assess handgrip strength and equality.
Assess dorsiflex and plantarflex feet against resistance (note
strength and equality).

14. Back area (turn patient to side or ask to sit up or lean forward):
Inspect back and spine.
Inspect coccyx/buttocks.
Tubes, drains, dressings, and IVs:
Inspect for drainage, position, and function.
Assess wounds for unusual drainage.
Sample format for documentation:
General Status
Vital signs
Head, Ears, Eyes, Nose, Throat
Neck
Respiratory
Cardiac
Abdomen/GI
GU

15. Pulses
Extremities
Skin
Neurological
NURSING CARE PLAN RUBRIC
Include the case study in your document.
Do not write the NCP using a grid format… use an essay
format/ bullet point using the numbers of this rubric.
All NCP will be graded according to the following rubric.
1) Definition of the medical diagnosis
__________10
etiology/pathophysiology
2) Common signs and symptoms ___________5
3) Potential complications ___________5
4) Head to toe physical assessment you are to write one….use
the data in the case if there is none you create it as if this was
your patient.
____________10
5) Diagnostic and lab studies ___________5

16. normal values
expected abnormalities
6)
ALL
NANDA Nursing diagnoses __________10
www.deanza.edu/faculty/hrycykcatherine/NANDA_2015-
2017_list__November_2014.pdf
7) Develop
3
NANDA priority nursing diagnoses __________10
8) State a patient plan/goal for each of the
__________10
priority nursing diagnosis
9) Write interventions for each of
__________10
priority nursing diagnosis
10) Write scientific rationales for you you
___________5
interventions
11) Write evaluation of your interventions
__________10
or make changes
12) List of typical medications __________10

17. category
usual dosage
side effects
patient teaching