Student Learning Guide Answer Key  1  

Student Learning Guide Answer Key

CHAPTER 1 viders from denying coverage for preexisting

conditions.
Terminology
Answers will be individual. Short Answer
1. Transition to practice is a program for newly 1. Any four of the following:
licensed nurses involving a minimum 6-month a. Stressed a clean environment.
preceptorship and ongoing support during the b. Included good nutrition in her care.
first year of nursing practice. c. Kept records and statistics to show validity
2. Nursing theory is based on relationships of her nursing practices.
among concepts and facts and not on actual d. Started nurse training schools.
knowledge. e. Felt holistic care was essential (meeting
3. Evidence-based nursing is integrating the best psychosocial as well as physical needs).
research evidence with clinical expertise and f. Nursing directed at both illness and main-
patient values to facilitate clinical decision- taining health.
making. g. Nursing should be taught by nurses.
4. Clinical practice guidelines are the product of h. Continuing education is essential for
evidence-based research, and they serve as a nurses.
way for nurses to implement evidence-based 2. a. Functional nursing—performance of a
practices. series of nursing tasks.
5. The nursing process is a systematic way to b. Team nursing—tasks were assigned to
deliver nursing care that combines art and sci- team members and the leader coordinated
ence. care.
c. Total patient care—one nurse carried out
Short Answer: Acronyms all nursing tasks for a patient.
1. The four spheres of care are: 1) disease pre- d. Primary nursing—one nurse plans and
vention and wellness, including the promo- directs care for a patient over a 24-hour
tion of physical and mental health; 2) chronic period.
disease care, including management of chronic e. Relationship-based care—emphasizes three
diseases and prevention of complications; 3) critical relationships: (1) the relationship
regenerative or restorative care, including between caregivers and the patients and
complex acute care, critical care, trauma, dis- families they serve; (2) the caregiver’s re-
ease exacerbation, and care of physiologically lationship with him- or herself; and (3) the
unstable patients; and, 4) hospice and palliative relationship among health team members.
care, including care at the end of life as well as f. Person-centered care—patient care that is
specialized care for people with serious long- respectful of the patient and responsive to
term illness. These four spheres of care are not individual preferences, needs, and values.
setting-specific; they can take place in numer- 3. Evidence-based nursing describes nursing care
ous settings with diverse populations. that uses the best research evidence coupled
2. An HMO is a type of group medical practice with the clinical expertise of the clinician, con-
where patients are enrolled for a set monthly sidering the values of the patient.
fee and then receive the services of a limited 4. Any four of the following:
network of doctors, hospitals, and other health a. Desire and capability to teach
care providers. b. Ability to listen
3. The Patient Protection and Affordable Care Act c. Belief in holistic care (attention to psycho-
has created health insurance exchanges, ex- social as well as physical care)
panded eligibility for Medicaid, allowed young d. Good therapeutic communicator
adults to remain on their parents’ insurance e. Able to collaborate with others
through age 26, and stopped insurance pro- f. Ability to delegate tasks to others

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2  Student Learning Guide Answer Key

g. Willing to give basic care to help another ing with the dietitian, physician, respiratory
(bathing, toileting) therapist, or physical therapist on the patient’s
h. Concern for the patient’s well-being plan of care; considering cost-effective ways to
i. Ability to give emotional support implement care; and applying research find-
j. Ability to advocate for the patient ings to care.
k. Ability to plan care in an organized fashion
l. Ability to efficiently implement care
STEPS TOWARD BETTER COMMUNICATION
5.
LPN/LVN Registered Nurse Completion
12-18 months of formal 2-5 years of formal 1. standards
training training 2. foster
3. sought
Trained to care for the Trained to care for the 4. controversy
well or chronically ill acutely ill as well as the 5. implement
chronically ill; teach 6. criteria
preventive health care 7. active listening
8. vigilant
6. Protect the public and define the legal scope of 9. scope
practice for nurses.
Vocabulary Exercises
Review Questions for the Next Generation 1. Assessment: test evaluation
NCLEX® Examination 2. Diagnosis: finding, conclusion drawing
1. 1 3. Outcome: removal result
2. practical 4. Implementation: carrying out making equip-
3. 2 ment
4. Lillian Wald 5. Evaluation: measurement analysis
5. 2 6. Collegiality: education relationship with
6. 2 other workers
7. 1, 2, 4
8. 3 Word Attack Skills
9. 1 1. a. He attributed his success to his attributes
10. 1, 4 of hard work and honesty.
11. nurse, patient, health care agency b. The use of the surgical implements was
12. 1 implemented with a training session.
2. c
Critical Thinking Activities
1. Definition should include caring for the sick,
promoting wellness, providing health teaching, CHAPTER 2
giving emotional support, and attending to
psychosocial concerns. Each person’s definition Terminology
will be different. 1. g
2. Make a list of the group’s ideas. Areas to 2. d
include are assessing patients, completing 3. h
data analysis/problem identification, stating 4. f
expected outcomes, planning interventions 5. j
to meet the outcomes, directly implementing 6. k
the actions, and evaluating the outcome of the 7. i
plan. Other ways could be quality improve- 8. e
ment activities on the nursing unit; attending 9. c
continuing education presentations or reading 10. a
journals; assisting students or new nurses on 11. b
the unit; maintaining an ethical manner (not
divulging confidential information); collaborat-

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 Student Learning Guide Answer Key  3  

Short Answer Completion

1. Health is a state of complete physical, men- 1. high-level wellness; Dunn
tal, and social well-being and not merely the 2. an active part
absence of disease or infirmity. 3. cultural
2. Any three of the following: 4. unique individual
a. Watching dietary intake to avoid becoming 5. biologic, psychological, social, and spiritual
overweight 6. coping mechanisms
b. Engaging in a regular exercise program 7. physiologic, safety and security; love and be-
c. Obtaining immunization against commu- longing; self-esteem; self-actualization
nicable disease 8. people cope
d. Having regular physical exams 9. coping
3. a. Consulting a physician or nurse 10. stress
b. Consulting a pharmacist 11. sympathetic nervous system; fight or flight
c. Visiting a neighborhood health clinic 12. hormones
d. Taking prescribed medicine
4. Helping people cope with adverse physiologic, Review Questions for the Next Generation
psychosocial, and spiritual responses to illness. NCLEX® Examination
5. a. Perception of the stressor 1. 1, 2, 6, 7, 8
b. Degree of health and fitness 2. 1, 2, 3, 4
c. Previous life experiences and personality 3. 4
d. Social support system available
e. Personal coping mechanisms

4.
Priority Number Maslow Category Patient Statement(s) Relating to Maslow Category
1 Physiologic “I’m hungry – when is lunch coming?” “Is it time for my pain
medication yet? My pain is 7/10 right now.”
2 Safety and Security “Thank you for answering my call light quickly.”
3 Love and Belonging “The thing I dislike most about being hospitalized is not be-
ing able to cuddle with my wife.” “I am joining the American
Association of Kidney Patients support group.”
4 Self-esteem “I did great with my dressing change, didn’t I?”
5 Self-actualization “Which composer wrote that piece playing overhead, Mozart
or Beethoven?” “Did you know that nursing process can be de-
scribed by quantum physics?”

5. 4 Critical Thinking Activities

6. 2 1. Psychosocial assessment, calling in a social
7. 1, 3 worker, calling a pastor or priest or other
8. 1 religious leader; attentive listening; exploring
concerns.
Matching 2. Fatigue makes one want to rest more. Fever
1. Sympathetic may cause one to lie down and rest and it helps
2. Sympathetic eliminate invading organisms. Coughing ex-
3. Parasympathetic pels secretions and viral debris. Malaise makes
4. Parasympathetic one slow down.
5. Sympathetic 3. Sweaty palms, rapid pulse, muscle tenseness,
6. Sympathetic anxiety, shakiness, (others).
4. a. Obtaining information to decrease fear of
the unknown.
b. Listening to concerns and fears.

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4  Student Learning Guide Answer Key

c. Enhancing healthy coping skills such as 3. Answers will depend on the individual. Ver-
providing quiet time for meditation. balization will increase expertise at pronuncia-
d. Meeting needs efficiently. tion and sentence structure.
4. Answers will depend on the individual.
STEPS TOWARD BETTER COMMUNICATION
CHAPTER 3
Completion
1. adverse
Terminology
2. hygiene
Examples will be individual.
3. nonadherent
1. Accepting responsibility for one’s actions.
4. perception
Example: A nurse accepts accountability for the
5. alters
care provided by the aide to whom a task was
6. intervene
assigned.
7. emerge
2. Communicated in confidence; secret; kept pri-
8. deviation
vate. Example: The patient’s history is confiden-
9. maladaptive
tial.
10. resolves
3. Sensible and caring behavior. Example: A pru-
dent nurse follows the correct procedure for
Vocabulary Exercises
catheterization.
1. Biologic b, f
4. There is failure to perform in a reasonable and
2. Psychosocial a, c
prudent manner. Example: A nurse fails to no-
3. Spiritual d, e
tify the charge nurse or primary care provider
when a patient with a fresh cast complains of
Word Attack Skills
pain and numbness.
5. Malpractice is negligence by a professional
Opposites
person; failure to act according to professional
1. minimum, adverse
standards of care as a reasonable and prudent
2. ignore
professional would. Example: A licensed nurse
3. clear, specific
fails to heed signs of toxic overdose of medi-
4. dynamic, active
cation and continues to administer the drug,
5. atrophy, stagnate
causing harm to the patient.
6. good luck, good fortune
6. Making remarks about a person that are untrue
7. overreact
and that damage the person’s reputation.
8. good health, feel good
Example: The nurse told a patient that another
nurse had been disciplined for taking patient’s
Communication Exercises
medications when this was not true.
Examples:
7. Physical contact that was against the person’s
1.
will or consent. Example: A feeding tube was
a. Behavior Dietary choices placed in a patient although no consent was
b. Genetics Propensity for heart given for its placement.
disease 8. Written defamation of character; untrue and
damaging words. Example: The newspaper
c. Medical care Can afford to seek
committed libel in printing untrue statements
medical care
about the doctor’s treatment of the patient.
d. Environment and Access to clean air 9. Violating the right to privacy concerning one’s
physical influences and water body and private information without the
e. Social determinants Poverty person’s consent. Example: Two unit secretaries
discuss the number of abortions a patient has
2. Examples: had.
a. Wearing seat belts and helmets for danger- 10. Oral statements that are false or that injure
ous sports another’s reputation. Example: A nurse makes a
b. Obtaining a cancer screening false statement to the effect that another nurse
c. Eating well-balanced meals

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 Student Learning Guide Answer Key  5  

forged a license card and is not entitled to be a 7. Provide evidence-based and expert-based solu-
nurse. tions to areas that have caused problems with
11. Assault is the threat of harm to an individual. patient safety.
Example: When the patient attempts to get out 8. To remain knowledgeable on this evolving is-
of bed, the nurse pushes him down and straps sue and remain objective when discussing end-
his arms to the bed rails. of-life options with patients who are exploring
12. Participating states allow nurses to be licensed medical aid in dying. The nurse must be aware
in one state and practice in any state belonging of personal values and has the right to consci-
to the compact. Example: A nurse has her pri- entiously object to participating; however, they
mary residence in Utah near the “four corners” must never abandon or refuse care and comfort
of Utah, Colorado, Arizona, and New Mexico to the patient.
(all of which are participating states). This 9. the delegating nurse
nurse can drive across the border and practice 10. The right task, the right circumstance, the right
nursing in any of these compact states without person, the right supervision, and the right
paying any additional licensure fees or applica- direction/communication.
tion.
13. Beneficence: to do good; taking positive action Review Questions for the Next Generation
to help others. Example: Cutting up the food for NCLEX® Examination
a patient with arthritis. 1. 3
14. Nonmaleficence: to avoid causing harm to 2. 1, 2, 3, 4
someone. Example: Checking the patient’s iden- 3. 1, 2
tity using two identifiers prior to beginning a 4. 3
medical treatment. 5. 1
15. Veracity: being honest and truthful. Example: 6. 3
Telling the patient that an injection may hurt 7. 1, 2, 3
temporarily. 8. 1, 2, 3
16. Fidelity: keeping promises. Example: Returning 9. 2
in 15 minutes after telling the patient that you 10. 2, 4, 5
would. 11. 4
17. Autonomy: respecting someone’s self-deter-
mination. Example: Allowing a patient to feed Ethical Situations
herself even though it takes a long time and the
These situations require synthesis and application
result is rather messy.
of knowledge.
Short Answer
Situation A
1. I Introduction
(Giving this information would be a breach of confiden-
S Situation
tiality.)
B Background
1. c
A Assessment
2. lawsuit; loss of employment
R Recommendation
R Readback
Situation B
2. (a) the risks and benefits of the proposed treat-
3. b (Eating the food is against hospital policy
ment, (b) the possible consequences of not hav-
and is unethical. It could be considered steal-
ing the procedure done, (c) alternatives to the
ing, even though the food cannot be served to
treatment, and (d) the name of the health care
another person.)
provider who will perform the procedure
3. a licensing or regulating agency
Situation C
4. Provide competent nursing care.
4. ethics (Taking medication prescribed for another is
5. Temporary suspension of loss of nursing licen-
illegal use of drugs, as well as stealing.)
sure.
5. legal
6. provide a way of judging the quality and ef-
fectiveness of patient care (and) in legal cases
determine whether a nurse acted correctly

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6  Student Learning Guide Answer Key

Situation D ity and unprofessional to post a comment such

6. a (Taking monetary gifts from patients is unethi- as that.
cal and is against agency policy. The rationale
is that if reward is involved with one patient, STEPS TOWARD BETTER COMMUNICATION
they may be treated better than another pa-
tient.) Completion
7. a (It is unethical to take money for services you 1. a. jeopardize
have personally rendered to a patient. However, b. escalate
it is acceptable for the patient to contribute to c. witness
the hospital or to a need for the unit on which d. resuscitate
the patient stayed.) 2. a. prescribed
b. pertinent
Critical Thinking Activities c. suggestive
1. This is a direct threat of false imprisonment. 3. a. scope
It is unethical, and if carried out, is illegal. b. proxy
Discuss the situation with the person who c. access
made the statement to the patient. Suggest d. means
alternatives to calm the patient and protect the e. precedent
patient’s safety. 4. a. seemingly
2. Consider stating that all patients are asked b. gravely
to express their preferences for care if certain
emergencies occur or health declines to the Vocabulary Exercise
point of inability to make one’s own decisions Ethics: the rules or standards governing the
any longer. Offer to explain the terms and rea- conduct of members of a profession. (Wording of
sons for the questions on the form. Explain the examples may vary.)
reasons why it is preferable to most people to
make their own decisions about these matters Word Attack Skills
in advance. Examples:
3. You are responsible for giving care equal to 1. The primary care provider will prescribe some
that of the licensed nurse in all areas in which medication for the infection.
you have already been trained. You may not 2. Take the written prescription to the pharmacy.
legally perform procedures that you have not
been sufficiently trained to do yet. You are Communication Exercises
obligated to tell the person in charge when you All exercises are individual. Each requires verbalization
do not have the appropriate training to do a practice.
procedure or sufficient expertise to care for a
group of patients.
4. You should first consult with your clinical in- CHAPTER 4
structor and the nurse assigned to the patient.
Discuss the situation out of hearing of the child Terminology
or parents. You could search the health record 1. b
for any other evidence of possible child abuse. 2. e
If a determination is made that the child could 3. c
be a victim of child abuse, you should report it 4. g
to the charge nurse and call the social worker 5. d
or report it directly to the authorities. Find out 6. a
what the correct protocol of the agency is in 7. f
this situation. It is your responsibility to see
that the authorities are notified. Short Answer
5. You should call your friend immediately and 1. Collaboration, input
advise her to take down the posting. Even 2. a. Define the problem clearly.
though no patient name was mentioned, it is b. Consider all possible alternatives.
both a potential breach of patient confidential-

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 Student Learning Guide Answer Key  7  

c. Consider possible outcomes for each alter- 10. Access to current documented standard pro-
native. cedures and evidence-based reference tools at
d. Predict the likelihood of each outcome oc- the bedside can contribute to improved patient
curring. outcomes and critical thinking skills. Nurses
e. Choose the alternative with best chance of can access (hard copy) procedure manuals
success and fewest undesirable outcomes. or (soft copy) electronic resources and apply
3. Rather than thinking about something at evidence-based knowledge to their nursing
random, critical thinking is directed and practice.
purposeful and requires skills such as effective
reading, effective writing, attentive listening, Concept Mapping
and effective communicating. Critical thinking Each person’s concept map will be different and individ-
involves keeping an open mind and looking at ual. It should depict the different areas of your life and
an issue from different perspectives. It requires the responsibilities you have in each of those areas.
an organized and systematic approach. To
think critically, one must be flexible, realistic, Review Questions for the Next Generation
creative, humble, honest, curious, and insight- NCLEX® Examination
ful. Clinical reasoning is critical thinking in the 1. 2, 3
clinical setting. 2. consider all possible alternative solutions to the
4. Speaking clearly and concisely, considering problem
what has been said and thinking before speak- 3. 2, 4, 7
ing, attentively listening before responding. 4. 4
5. Critical thinking skills can be improved by any 5. 1
of the following: 6. 3
a. Focusing on main ideas and relevant data 7.
while reading.
Clinical Judgment
b. Writing in an organized manner and
Nursing Process Measurement Model
expressing each thought coherently and
concisely, yet clearly. Assessment Recognize cues
c. Evaluating what has been written. Data analysis/Problem Analyze cues
d. Consciously practicing attentive listening. identification Prioritize hypotheses
e. Thinking about what to say and how to
Planning Generate solutions
state it clearly and concisely in a logical
way before beginning to speak. Implementation Take action
f. Taking time to consider a verbal response Evaluation Evaluate outcomes
before making one.
g. Acquiring the skills and attributes found in Critical Thinking Activity
the critical thinker as listed in the chapter. (Requires synthesis and application of knowledge.)
h. Practicing purposeful thinking. Priority rating What needs to be done
Clinical reasoning skills can be improved by 2 Buy books
practicing any of the above in the clinical set- 1 Get a map and find classrooms
ting; also by discussing patient care scenarios 5 Buy a parking permit
and prioritization with your clinical instructor. 4 Call for doctor’s appointment
6. Problem statements are usually prioritized 7 Take daughter to the doctor
along the lines of Maslow’s hierarchy of basic 8 Buy son’s school supplies
needs. 3 Go to first class
7. You should consider what will happen if the 6 Go to second class
task is not done on time. 9 Grocery shop
8. flexible; reprioritize or reorder
9. Studies demonstrate that nursing professional-
ism influences a nurse’s critical thinking ability. STEPS TOWARD BETTER COMMUNICATION
A positive self-concept is also linked to prob-
lem solving and critical thinking ability. Vocabulary Similarities Exercise
correct opinion

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for text and data mining, AI training, and similar technologies.
8  Student Learning Guide Answer Key

Completion 9. when patients are assigned to the nursing

1. unforeseen unit, enter the care of a home health agency, or
2. implement become residents in a long-term care facility
3. concisely 10. analyzing
4. overlapping 11. evaluate
5. input 12. physiologic needs for basic survival
6. enhance 13. cues
7. coherent 14. The patient, the family/significant other, the
8. prognosis health record, diagnostic test results, the pri-
mary care provider history and physical, and
Communication Exercises the admission note
1. Example: The man with the chest pain might be 15. a. interview
having a heart attack (myocardial infarction). b. health records review
That could be life-threatening. The boy with c. physical assessment
the cut had stopped the bleeding and could 16. Safety: at risk of falling
wait for treatment of his wound. Hygiene/grooming: needs assistance with
2. Individual answers will vary. ADLs
Example: “Marta, when you are finished with Elimination: urinary incontinence
the sphygmomanometer, I need to use it. I will Psychosocial and cultural: loss of indepen-
be in room 234 or 246. Would you please bring dence; blow to self-image from stroke
it to me as soon as you have finished taking the Education: instruction in walking with walker;
blood pressures? I would really appreciate it as medication instruction; instruction in possible
there are no wall units in those rooms.” cause of stroke and ways to prevent another
one.
Rest and activity: left-sided weakness; sched-
CHAPTER 5 uled rest to prevent fatigue; exercises to
strengthen muscles affected on left side and to
Terminology preserve muscle function on right side
1. h 17. Many of the problem statements in Box 5.4 fit
2. a here. Some of the most likely nursing diagno-
3. g ses are:
4. e a. Altered urinary function
5. f b. Altered mobility
6. c c. Chronic confusion
7. b d. Potential for injury
8. d e. Aspiration risk
9. j 18. Activity-exercise pattern
10. i 19. Focused assessment

Completion Correlation
1. needs; a variety of methods 1. Barbara Abeyta is admitted with severe ab-
2. ongoing dominal pain. Acute pain
3. signs; symptoms 2. Leonard Henry has fallen and fractured his
4. cause hip. Altered mobility related to injury as evidenced
5. (1) the patient’s problem or potential problem by x-ray showing hip fracture
(how the patient is responding); (2) the caus- 3. Joel Tomaso is admitted with burns on his
ative or related factors, which can include the chest. Altered skin integrity related to destroyed
pathophysiology; and (3) specific defining tissue
characteristics or the signs and symptoms. 4. Although recovering, Tyrone Peters suffered
6. subjective a stroke that has paralyzed his right extremi-
7. head to toe assessment ties. He is right-handed. Altered self-care ability
8. a risk, syndrome, or to promote wellness related to neurologic impairment as evidenced by
inability to move right arm or leg

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 Student Learning Guide Answer Key  9  

5. Valerie Tallchief has emphysema and becomes

Example of Clinical
very short of breath whenever she tries to
Clinical Judgment Step Judgment Step
perform a task. Altered activity tolerance related
to decreased lung capacity as evidenced by inability Take action Assign a sitter to stay
to perform tasks without becoming short of breath with patient
Offer to assist patient to
Review Questions for the Next Generation bathroom q2h
NCLEX® Examination Approach in a calm
1. Objective data are: manner
• Temperature = 100.4° F (38° C) Administer IV antibiot-
• Bed is wet. ics on time
• Oxygen saturation is 92%. Evaluate outcomes No falls this shift
• Patient refused her breakfast. No evidence of patient
2. Data that can be verified by auscultation, pal- injury
pation, percussion, or inspection
3. 3 Critical Thinking Activities
4. 4 1. Relief of pain; assistance with care; reduction of
5. 2 fear; emotional support (in order of priority)
6. 3, 4 2. Appropriate problem statements might be:
7. 3 Acute pain
8. 2 Expected outcome: Pain will be controlled by
9. 2 medication within 6 hours.
10. 1, 3 Altered self-care ability
11. Expected outcome: Hygiene needs will be met
daily.
Example of Clinical
Expected outcome: Toileting needs will be met
Clinical Judgment Step Judgment Step
whenever needed.
Recognize cues Patient is an older adult Anxiety
Patient is confused Expected outcome: Anxiety will be decreased
Patient is incontinent within 12 hours.
Patient had surgery 3 Fear
days ago Expected outcome: Fear will be relieved or
Patient has developed a reduced as pain is controlled and knowledge of
urinary tract infection what is to happen is gained.
Analyze cues Confusion could in- 3. Objective data: Cries out when tries to move
crease risk of injury left leg. Apprehensive facial expression and
Urinary tract infection body language. Bruise present on left forearm,
may increase the pa- pulse is 92, respirations are 18, winces when
tient’s sensation of the left leg is moved.
need to urinate Subjective data: Sustained a fall. States is
Patient could fall if he scared; states that leg really hurts.
attempts to get out of a. O
bed without assistance b. O
c. O
Prioritize hypotheses Fall risk d. S
Potential for injury e. O
Generate solutions Prevent patient fall f. O
Prevent patient injury g. S
h. O

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10  Student Learning Guide Answer Key

STEPS TOWARD BETTER COMMUNICATION 8. Evaluation

9. Nursing diagnosis/problem identification
Completion 10. Evaluation
1. significant other 11. Planning
2. deviate 12. Planning
3. differentiate
4. over-the-counter B.
5. pertinent 1. priorities of tasks
6. alleviate 2. change-of-shift report
7. formulate 3. a. if visitors will be coming
8. scan b. diagnostic tests that are scheduled
9. correlate c. time primary care provider may come to
10. concurrent condition see the patient
11. prosthesis d. medication administration schedules
12. infer 4. introducing microorganisms
5. planning; priorities
Word Attack Skills 6. dependent
1. rapport (n)—relation of harmony or accord 7. documentation
report (n)—account of an event or verbal sum- 8. expected outcomes
mary of patient condition and care for a shift 9. orders, and/or agency policy and procedure
2. elicit (v)—to get or bring out manual
illicit (adj)—unlawful 10. if interventions have been successful
3. affect (v)—have an influence; a change 11. family
effect (n)—the result of an action causing 12. sterile; invasive
change 13. the nurse

Sequencing
CHAPTER 6 (Requires synthesis and critical thinking.)
1. 5
Terminology 2. 7
1. d 3. 2
2. j 4. 1
3. k 5. 3
4. i 6. 4
5. b 7. 6
6. c
7. h Review Questions for the Next Generation
8. f NCLEX® Examination
9. g 1. 3 (application of prior knowledge)
10. l 2. 1 (application of prior knowledge)
11. a 3. 4 (application of prior knowledge)
12. e 4. 1
5. 2, 4, 7
Short Answer 6. 4
7. 1
A. 8. 3
(Answers require analysis and synthesis of information.) 9. 1
1. Assessment 10. 4
2. Planning 11. 1: dependent; 2: administer pain medication;
3. Implementation 3: independent; 4 (answers can be any of these):
4. Assessment massage, providing quiet music, decreasing
5. Assessment environmental stimulation
6. Assessment 12. 3
7. Nursing diagnosis/problem identification 13. 4

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 Student Learning Guide Answer Key  11  

14. 1 pation. Increase fluids and roughage to

15. 2 prevent constipation from pain medication.
Evaluate after implementation: Gather data
Critical Thinking Activities related to wound status, vital signs, pain level,
1. The priority of each task; the amount of time and knee swelling. Determine if actions are
available; the ability of the patient to assist helping patient meet the expected outcomes.
with self-care; medication times; procedures to 4. Concept map. This will vary per the individual
be done; if the patient will be off the unit for di- making the map. It should include all problem
agnostic tests; when the primary care provider statements that would be on the patient’s nurs-
might visit the patient; when visitors might be ing care plan. The appropriate interventions
expected. would be linked to each problem statement.
2. Some positive aspects are:
• improvement of nursing care
STEPS TOWARD BETTER COMMUNICATION
• see if care meets current standards of care
• determine if documentation is occurring
Completion
• determine whether care given is cost-effec-
1. deadline
tive
2. imminent
3. Case Study—the nursing care plan should
3. collaborative
contain the following points:
4. strive
Assessment data: MVA, splenectomy incision,
5. impairment
bruises on right extremities, swollen right knee;
6. adept
pain; cannot walk without pain.
7. blame
Problem Statements:
8. intervening
1. Altered skin integrity related to surgical inci-
9. clue
sion
10. sequence
2. Potential for infection related to incision and
11. incorporated
traumatic wounds
12. rationale
3. Altered mobility related to inability to walk
without pain
Abbreviations
4. Acute pain related to surgical incision and
1. short-term
traumatic wounds
2. long-term
Expected outcomes:
3. every
1. Incision will heal without signs of infection
4. 4 hours
within 2 weeks.
5. range of motion
2. Systemic infection will not occur during
6. physical therapy
next 4 weeks.
7. related to
3. Will be able to walk without pain within 6
8. urinalysis
weeks.
9. outcome-based quality improvement
4. Pain will be controlled by medication for 4
hours at a time.
5. Pain will resolve within 4 weeks.
CHAPTER 7
Nursing interventions:
1. Dressing change daily with aseptic tech-
Terminology
nique. Assess wound for signs of infection.
2. Monitor vital signs q4h; assess knee for A.
signs of infection q shift. Monitor bruises 1. d
for signs of infection. 2. c
3. Assist to BR; supervise ROM to other 3. g
extremities tid. Assist with hygiene and 4. b
grooming as needed. 5. f
4. Assess for pain q 3-4 hours. Medicate as 6. a
ordered pm. Provide distraction activities to 7. e
reduce pain. Monitor for signs of consti-

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12  Student Learning Guide Answer Key

B. Document the exact words the patient used

(Answers may be found in the textbook glossary or in a when refusing to adhere to the recom-
dictionary.) mended plan of care. Document instruc-
1. d tions given to the patient and the patient’s
2. c response to the information.
3. b j. Spell all entries correctly. Use a dictionary
4. h or electronic spell checker to check words
5. j you are unsure how to spell.
6. a k. If you suspect that a medical order or
7. m progress note is incorrect, seek clarifica-
8. i tion from the person who wrote the order
9. k or note. If you make an error when docu-
10. f menting, follow agency policy for correct-
11. g ing the error.
12. o 3. Documentation is organized by problem
13. e statement. Assessment data are documented.
14. n Implementation of the interventions noted on
15. l the nursing care plan is documented along
with the patient response. Evaluation of patient
Short Answer progress toward expected outcomes is placed
1. Any three of the following: in the nurse’s notes. Evaluation data are docu-
a. Provide a written record of the history, mented that indicate expected outcomes have
treatment, care, and response of the patient been met.
while under care. 4. a. Accuracy of what is documented.
b. Serve as evidence in a court of law. b. Brevity using abbreviations and symbols as
c. Provide data for quality improvement accepted.
studies. c. Legibility and completeness of assess-
d. Guide reimbursement of costs of care. ments, actions, and results.
2. a. Verify you are on the correct patient’s com- 5. a. It provides documentation of comprehen-
puter screen before beginning to document sive care by focusing on patients and their
in the electronic record. problems.
b. Record the initial assessment at the begin- b. It promotes the problem-solving approach
ning of the shift. to care.
c. Document using a 24-hour clock (military c. It improves continuity of care and com-
time) (if this is the format used by the munication by keeping data relevant to a
agency). problem all in one place so that it is more
d. Recognize that documentation is done only available to all who are providing care.
by the person who made the observation d. It allows easy auditing of patient health
or performed the intervention and who is records in evaluating staff performance or
legally responsible for the accuracy and quality of patient care.
quality of care. e. It requires continual evaluation and revi-
e. Record objective data after completing sion of the care plan.
each task. f. It reinforces application of the nursing
f. Never document before a task is actually process.
done.
g. Follow hospital policy for amending the Completion
record if a change needs to be made. 1. Possible answers: Centers for Medicare and
h. Identify care given by another health care Medicaid Services, the American Health In-
team member by documenting their name formation Management Association, The Joint
(e.g., “Dr. Joseph removed stitches from Commission
RLQ abdominal incision at 1815”). 2. documentation
i. Record a patient’s explanation anytime 3. expected outcomes
they refuse a medication or treatment. 4. caring directly; access
5. legal record; consent

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 Student Learning Guide Answer Key  13  

6. chronological 5. 24-hour intake and output

7. baseline condition 6. 1
8. relevant data 7. 2
9. problem statement; event 8. 1, 3, 5, 6, 8
10. flow sheets; checklists 9. 2, 4, 5
11. otherwise documented 10. 2, 3, 5
12. protocols 11. 2
13. abnormal data; trends 12. 4
14. real time 13. 2
15. computer screen visible 14. 1: provider orders; 2: demographic; 3: trended
16. legible information screen; 4: nursing care plan; 5:
17. variance diabetes care flowsheet or screen
18. behaviors
19. safety factors; continued care Critical Thinking Activities
1. Individual answers will vary: documenta-
Abbreviations tion method preference is a matter of personal
(Answers may be found in most medical dictionaries or choice. Advantages and disadvantages will
Medical-Surgical textbooks) depend on method of documentation chosen.
1. ADL 2. Assessment data: Female, age 22, accident
2. Bx victim, alert, oriented, and able to follow com-
3. ADHD mands. Pupils equal and reactive; fracture of
4. GU right femur; laceration of right wrist. Pain in
5. COPD leg and wrist.
6. CAD Problem statement: Altered mobility related to
7. CABG fracture of right femur.
8. HTN Expected outcome: Patient will regain full
9. URI mobility within 8 weeks.
10. Tx
11. LMP
STEPS TOWARD BETTER COMMUNICATION
12. TIA
13. BPH
Vocabulary Exercises
14. Sx
1. The adage was ambiguous.
15. CVP
2. The audit showed a need to reimburse the
16. PACU
patient’s money.
17. Dx
3. The rule of thumb is that the duration of the
18. CCU
office visit should adhere to the rules.
19. EKG, ECG
4. The student should jot down the acronyms that
20. SOB
she feels are noteworthy and compile a list.
21. FHR
5. The time frame required that the primary care
22. CKD
provider use brevity in talking about the off-
23. PCA
shoot in the problem.
24. MRI
25. Stat
Pronunciation and Intonation Skills
26. NPO
1. down
27. PT
2. up
28. ROM
3. up
29. UA
4. down
5. up
Review Questions for the Next Generation
6. down
NCLEX® Examination
1. 2, 3, 5
2. 3
3. 3
4. 2

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14  Student Learning Guide Answer Key

CHAPTER 8 h. Demonstrating respect

9. Current vital signs, pertinent laboratory data,
Terminology intake and output, medications received,
patient allergies. Introduction, Situation,
A. Matching Background, Assessment, Recommendation,
1. g Readback.
2. f 10. Any three of the following:
3. e a. Update the nursing care plan
4. b b. Charge out supplies
5. i c. Document nursing care
6. d d. Transmit orders
7. c e. Communicate plans for care with another
8. a department
9. h f. Request a consult from another health care
professional
B. Completion 11. Any four of the following:
1. feedback a. Do not speak too quickly.
2. body language b. Allow extra time for the older adult to
3. communication process your message and formulate a
4. person centered care response.
5. Therapeutic c. Face the person.
6. walking rounds d. If they wear a hearing aid, be certain it is in
7. active listening place and turned on.
8. Confidentiality e. If the older adult has impaired hearing on
one side, position yourself on the side with
Short Answer better hearing.
1. Nonverbal cues f. Gain their attention before beginning to
2. a. Culture speak.
b. Past experience 12. Approach the child at eye level by sitting or
c. Emotions, mood kneeling and use a calm, quiet, friendly voice;
d. Attitude, perceptions, and self-concept do not make sudden movements or gestures.
3. Answers may include responses such as: 13. Any three of the following:
a. Medications taken today a. Make sure you have the person’s attention
b. Presence of pain before you start.
c. When last bowel movement occurred b. Make the environment as relaxed and quiet
d. Allergies as possible.
e. If previously hospitalized, what year c. Assume the patient can understand what is
4. validated heard unless deafness has been diagnosed.
5. a. distance between communicators d. Speak to the patient as an adult; do not act
b. whether eye contact should be established as if they are mentally incompetent.
c. tone of voice e. Talk to the patient; do not talk to someone
d. the number of gestures used else in the room about the patient.
6. You might say, “That has to be hard for you” or f. Include the patient in group conversation
“I can only imagine how difficult this is.” and decision making as much as possible.
7. trust Face the patient, establish eye contact, and
8. The following: speak slowly and distinctly without drop-
a. Effective communication skills ping the voice level at the end of sentences;
b. Having the quality of empathy do not shout.
c. Having a desire to help g. Give directions with short phrases and
d. A nonjudgmental attitude simple terms; use gestures to enhance the
e. Expressing honesty words.
f. Displaying acceptance of the patient h. Phrase questions so that they can be an-
g. Displaying genuineness swered with a “yes” or “no,” and look for

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 Student Learning Guide Answer Key  15  

nonverbal behavior that agrees with the active listening. Telling her what helped you
patient’s answer. when you lost your dog is not a good choice
i. Give the person time to respond to ques- because it is giving advice; multitasking and
tions; processing may be slower than taking her vital signs while talking with her
usual. demonstrates a hurried approach and is not
j. Ask only one question at a time; be patient active listening.
and wait for an answer. Resist the urge to 4. 1
finish sentences or offer words. 5. 1: therapeutic, 2: nontherapeutic
k. If you need to repeat something, use the 6. 1
same words the second time. If there is still 7. 3
difficulty, phrase what was said differently. 8. 3
l. Use body language, drawings, gestures, 9. 1
and facial expressions to enhance the mes- 10. 4
sage. 11. 3
m. Allow one person to speak at a time. 12. 1, 2, 4
n. Praise all attempts to speak and downplay 13. 3
any errors. Avoid insisting that that each 14. 3
word be produced perfectly. 15. 1
o. Encourage independence and avoid being
overprotective. Matching
14. a. Speak very distinctly but do not shout. 1. i
b. Speak slowly with voice pitch at midrange. 2. h
c. Obtain the person’s attention before begin- 3. d
ning. 4. a
d. Face the person at eye level at a distance of 5. b
2.5 - 4 feet; do not chew gum or eat while 6. e
speaking to the person. 7. g
15. a. Engage with the individual in establishing 8. j
a caring relationship. 9. c
Sub-objectives: Demonstrates qualities of 10. f
empathy, Demonstrates compassionate
care, Establishes mutual respect with the Application of Communication Techniques
individual and family. (Answers are from Tables 8.1 and 8.2.)
b. Communicate effectively with individuals. 1. Nontherapeutic—defensive comment; “Tell me
Sub-objectives: Demonstrate relationship- how that made you feel.”
centered care; Consider individual beliefs, 2. Therapeutic; seeking clarification
values, and personalized information in 3. Nontherapeutic—changed the subject; “It is a
communication; Use a variety of com- very difficult time for you.”
munication modes appropriate for the 4. Therapeutic; encourages elaboration.
context; Demonstrate the ability to conduct 5. Nontherapeutic—reassuring cliché. “Umm-
sensitive or difficult conversations; Use mmm....” encourages elaboration of feelings.
evidence-based patient teaching materials, 6. Therapeutic; encouraging elaboration.
considering health literacy, vision, hear- 7. Nontherapeutic—offering advice. “What are
ing, and cultural sensitivity; Demonstrate your concerns?” Seeks information about feel-
emotional intelligence in communications. ings.
8. Therapeutic; shows attention to what is being
Review Questions for the Next Generation said and encourages patient to continue.
NCLEX® Examination 9. Nontherapeutic—using a cliché. “You’re con-
1. 2 cerned about the pain?” Explores feelings and
2. 3 opens discussion of how to handle the situa-
3. Maintaining eye contact (if appropriate); using tion of the pain.
silence when appropriate; giving cues that 10. Therapeutic; validates what patient is saying
show interest; blocking out distractions; not by reflection.
interrupting: are all behaviors that demonstrate

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16  Student Learning Guide Answer Key

Critical Thinking Activities 4. behavioral objective

1. Individual answers will vary, but possible 5. visual; auditory
answers include: Patient is scheduled for PT, 6. return demonstration
but is experiencing pain (physical therapist);
is not eating meals and doesn’t care for the Short Answer
food being served (dietitian); doesn’t like to 1. Knowledge of the disease or condition, diet,
take medication and would rather use natural activity, medication, wound care, treatment, or
remedies for minor complaints (physician); is self-care.
awakening every night about 3:00 am and can’t 2. Poor vision or hearing, impaired motor func-
go to sleep (night shift nurse). tion, low literacy, or impaired cognition. Age
2. Information to include in report: Vicodin given may interfere with the strength or dexterity for
at 8:30 am with pain relief; IV discontinued; performing certain tasks.
dressing clean and dry; wife visited; walked in 3. Pain, nausea, fatigue, sense of being over-
hall x 3; taking clear liquid diet without nau- whelmed, and multiple interruptions
sea. 4. a. printed material such as books and articles
3. Consider the culture of the other nurse. It is b. video- or audiotapes
possible that she comes from a culture where c. hands-on equipment
direct eye contact is a sign of disrespect; 5. a. Provide good lighting; a light source
however, in her nursing education she should coming over the shoulder of the patient is
have learned the importance of eye contact in excellent.
communication. It is possible she is tired or b. Provide written materials to reinforce the
distracted; it is less likely (although possible) patient education.
that she is using subtle disrespect for you as a c. Use large type, black printing on nonglare
student. In any event, you want to make sure paper for printed materials.
your verbal information is received. You might d. Be certain the patient is wearing glasses, if
briefly pause the report and in a pleasant tone needed, and that the lenses are clean.
of voice ask, “Is everything OK? I sense that e. If the patient wears a hearing aid, be cer-
your mind is somewhere else because you’re tain it is turned on and adjusted.
not making eye contact with me, and I want f. Use short sentences and speak slowly;
to be sure I tell you the important information pause frequently to allow time for mental
about the patient.” You might also ask for sug- processing.
gestions from her about how, in her opinion, g. Keep medical terms to a minimum and ex-
you might give a better ISBAR-R. plain those you do use. Use specific terms
when giving directions.
h. Ask questions at frequent intervals to
STEPS TOWARD BETTER COMMUNICATION check for comprehension.
i. Allow time for questions.
Completion j. State the most important points first, and
1. conveyed repeat them at the end of the session.
2. ambivalent
3. optimal Completion
4. discount 1. values; cultural
5. judiciously 2. small steps
6. verify 3. Play
7. lead 4. high literacy
8. strive 5. Insufficient knowledge
6. consistency
7. questions
CHAPTER 9 8. collaboratively
9. admission
Terminology 10. readiness; apply
1. visual 11. kinesthetic
2. auditory 12. processing
3. kinesthetic 13. dexterity

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 Student Learning Guide Answer Key  17  

14. knowledge base 5. 3

15. advantage 6. 1
16. consistency 7. 2, 3
17. feedback 8. 4
18. review 9. 3
19. return demonstration 10. 4
20. printed 11. 1
12. 3
Review Questions for the Next Generation 13. 3
NCLEX® Examination 14. 2
1. 1: visual; 2: auditory; 3: kinesthetic; 4: kines- 15. 2
thetic; 5: auditory 16. 4
2. 4 17. 1, 3, 5
3. 1, 3 18. 1
4. 2
19.
Potentially
Teaching Strategy Helpful Harmful Neutral
Ensure that patient’s physical needs (e.g., toileting) are
X
met before teaching session.
Ensure that hearing aids are on and working prior to
X
teaching session.
Face the patient at eye level so she can see your face as
X
you explain information.
Choose a vibrant location for teaching session to maxi-
X
mize stimulation.
Present material fairly quickly so you don’t take too
X
much of the patient’s time.
Tell the patient what has been successful for other pa-
X
tients like her.
Consult with physical therapy if the patient’s arthritis
X
might be a barrier to her learning insulin self-injection.

Critical Thinking Activities 2. high literacy

1. Use different modes for an assignment to 3. deficit
determine which seems to be the best learning 4. teaching moment
mode for you. 5. frame of reference
2. Practice using different techniques within your
best mode of learning to determine what is Vocabulary Exercises
most efficient for you. 1. Patient is a noun, and means a person treated
3. Cover the purpose of the medication, what by a health care provider.
it should do, potential side effects and their 2. Patient is an adjective and means to be calm
signs and symptoms, when and how to take and willing to take time.
the medication, and any precautions to be fol- 3. Patients is the plural form of the word patient.
lowed while taking the medication. 4. Patience is a noun meaning the ability to wait
calmly for something.
STEPS TOWARD BETTER COMMUNICATION

Completion
1. dexterity

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18  Student Learning Guide Answer Key

CHAPTER 10 f. collaborate with physicians and other

health team members
Terminology 3. a. Who is your immediate supervisor?
1. b b. From whom do you take orders?
2. d c. Who is over your supervisor?
3. a d. To whom should you report changes in pa-
4. c tient condition or signs of complications?
e. To whom do you go with concerns or com-
Completion plaints?
1. control; direction f. Who oversees scheduling your hours?
2. a mistake has been made or something is not g. What is the procedure for calling in sick?
known 4. a. Define the problem.
3. direct, concise; nonthreatening b. Look at alternative solutions.
4. interpersonal relationships c. Estimate possible outcomes for each alter-
5. accountable native.
6. Competencies d. Choose the best alternative to solve the
7. job description problem.
8. direct, concise; supportive and healthy e. Try the alternative. (If the alternative does
9. the assessment or aspects of the analysis, not work, repeat the problem-solving pro-
planning, or evaluation phases of the nursing cess.)
process; clinical judgment 5. a. Work for 1 year as a staff nurse
10. authority b. Have training or experience in nursing
11. feedback administration and supervision
12. privacy c. Have additional training or preparation in
13. feelings; empathy the specialized area to which assigned
14. prioritize 6. See Box 10.1 in the textbook or list others that
15. documentation of specific problems or errors you feel are important.
7. See Box 10.3 in the textbook for possible an-
Short Answer swers.
1. a. know the capabilities and competencies of
the person Review Questions for the Next Generation
b. understand which tasks can be legally NCLEX® Examination
delegated 1. 3
c. avoid delegating interventions that require 2. 1, 3, 5
clinical judgment 3. 2
d. provide feedback 4. 1, 3, 4, 5
2. a. coordinate personnel and make work as- 5. 2, 3
signments 6. 3
b. assist with patient care 7. 1, 2, 3
c. help resolve conflicts 8. 4
d. assist in writing policies and procedures 9. 2
e. contribute information for evaluation of 10. 1, 4, 5
APs

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 Student Learning Guide Answer Key  19  

11.
Clinical Situation Autocratic Democratic Laissez-Faire
Staff nurses need to choose what Quality Improvement
X
projects to monitor next month.
At change-of-shift it is discovered that your patient is
X
pulseless and unresponsive.
Staff nurses wish to put on an event for Nurses Week. X
There has been an increase in staff tardiness and ad-
ministration is threatening to take away the special X
perks from all staff because of the actions of a few.
The hospital is changing the vendor for IV pumps and
X
is asking for nursing input.
Patient satisfaction survey scores are down, so the
nurse manager is looking for ideas on ways to improve X
the scores.
It has been discovered in a recent survey using “secret
shoppers” (who secretly view and report hand hy-
X
giene) that hand hygiene compliance rates on the unit
are 55%.
Staff nurses wish to throw a baby shower for one of
X
their colleagues.

Critical Thinking Activities 3. b

1. Considerations would be which tasks legally 4. a
cannot be delegated, the competencies of the 5. d
AP to whom you are assigning, and facility
protocols on delegation. You might be able to Completion
assign patient baths, bed making, vital signs, 1. eye contact
daily weights, and ambulation to an AP. 2. conflict resolution
2. The time organization sheet should include a 3. laissez-faire
row for every hour of the shift and a column 4. competent
for each patient assigned. Include all tasks to 5. cost-effective
be completed, whether they are delegated or 6. reimbursement
not. Remember to include medications, am- 7. chain of command
bulation, ROM, bathing, vital signs, weights, 8. active listener
blood sugar determinations, etc. Schedule in 9. feedback
time for assessment/data collection and for 10. domain
procedures such as wound care. Remember to 11. constructive criticism
include time for patient education and time for 12. delegate
documentation. Priority items should be en-
tered into the time schedule first. For example, Vocabulary Exercises
ordered wound care and medications would
take precedence over bathing or ROM. Word Families
1. competent
2. compete
STEPS TOWARD BETTER COMMUNICATION 3. competently
Vocabulary Exercises Polite and Effective Communication
1. c 4. “LuAnn, I would like you to weigh Mr. Moore,
2. e Ms. Garcia, and Ms. Adams before breakfast

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20  Student Learning Guide Answer Key

today. Ask each patient what they were wear- 8. l

ing when they were weighed on Monday so 9. m
that our weights have a consistent basis. For 10. i
example, if Mr. Moore was wearing his slippers 11. d
and robe, weigh him with those items on; if 12. f
Ms. Garcia just had on her gown and slippers, 13. n
weigh her without her robe. Do you follow 14. g
what I mean? (LuAnn replies that she does.) 15. e
“Please be sure that the scale is balanced on
B. Completion
zero before weighing each patient. When you
1. 18 months; 6
are finished with all three weights, please write
2. conscious, subconscious, unconscious
them down on the jot board right away so that
3. Moro
they will be available when the providers make
4. energetic, eager, and curious
their rounds, which usually start by 8:30 am. If
5. morals
you have any problems, let me know. I will be
6. Intelligence
making rounds in about 10 minutes and then I
7. social
will be here at the desk. Can you relate back to
8. ideology
me the details of what I’ve asked you to do?”
9. genes
(LuAnn replies and further dialogue occurs if she
10. time-out
cannot repeat the instructions correctly.)
11. early and regular prenatal health care
12. double, triple
Abbreviations
13. cephalocaudal; head
1. electronic medication administration record
14. the family
2. assistive personnel
3. immediately
Review of Structure and Function
4. as soon as possible (not in the chapter, but
Answers are in the Overview of Structure and Function
widely used throughout the United States in
section of the chapter in the textbook.
many types of situations)
1. amniotic sac
2. It attaches during the second week and is at-
Completion
tached by the placenta.
1. assess or discern; solve
3. The eyes and ears begin to take shape during
2. competent
the fifth week.
3. jot; grid
4. The heart begins beating at about 31⁄2 weeks
4. instills or fosters
after conception.
5. The external genitalia begin to appear during
Idiomatic Phrases
the third month.
1. establish eye contact
6. By the fifth month, the fetus is 11-12 inches in
2. take precedence over
length and weighs about 1 lb.
3. track down
7. Multiple births are caused by the fertilization
of more than one ovum or division of an ovum.
8. Puberty in the female occurs between ages 9
CHAPTER 11
and 17, with 12 as the average age. In boys, it is
14 years of age.
Terminology
Identification
A. Matching
1. b
1. o
2. b
2. j
3. d
3. a
4. b
4. b
5. f
5. k
6. f
6. c
7. c
7. h
8. d

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 Student Learning Guide Answer Key  21  

9. e d. Small objects should be kept out of reach to

10. d prevent entry into the mouth and choking.
11. e e. Infant should be placed on its back for
12. f sleep.
13. b f. No infant should be left in a house or car
14. a alone.
15. b 7. major hormonal shifts; early adolescence
8. a. A chronic disease such as diabetes or heart
Short Answer disease
1. a. The conscious mind is based in reality and b. Lack of prenatal care
includes what is sensed, perceived, and c. Maternal age younger than 16, older than
thought. 35 (first pregnancy), or older than 40 (any
b. The subconscious stores thoughts, feelings, pregnancy)
and memories. These are easily brought d. Poor nutritional status of the mother
into the conscious mind. 9. Early and regular prenatal care; mother’s
c. The unconscious level is the part of the health; mother’s age; nutritional state; emo-
mind that is not accessible to one’s aware- tional stress, chemical use
ness. The unconscious mind stores memo-
ries that are usually painful, thus shielding Completion
the person from anxiety and stress. 1. more than one ovum is fertilized
2. a. Organization: we try to make sense of our 2. warm, consistent
world 3. 11
b. Adaptation: we discover new information 4. predictable
and adjust our thinking patterns 5. physical; cognitive; psychosocial
3. a. Obey rules to avoid punishment 6. 46 chromosomes
b. Conform to social standards to avoid dis- 7. 40
approval 8. nourished
c. Abide by laws and follow one’s conscience 9. 25-35
4. a. Growth occurs in orderly and predictable 10. nutrition; oxygen
ways. 11. 18 months
b. The rate of growth and development is 12. 16-20
individual. 13. 12 to 24
c. Development is lifelong. 14. 9-11
d. Development is multidimensional. 15. infancy and early childhood
e. Development is continual, but the rate of
development varies. Review Questions for the Next Generation
5. (Table 11.2; individual examples/answers will vary.) NCLEX® Examination
a. Can delay gratification due to trust. 1. 2
b. Practices new skills. 2. 4
c. Formulates a plan of action and carries it 3. 8
out. 4. bonding
d. Acquires skills of reading, mathematics, 5. 3
and social skills. 6. 1
e. Investigates and identifies alternatives 7. 2
regarding their vocational and personal 8. 1, 2, 3, 5
future. 9. 1, 2, 3
6. a. Infant should not be left alone on a surface 10. 2
without protection from falls. 11. 3
b. Infant must be restrained in a car seat in 12. 4
the back seat when the car is moving. 13. 1
c. Bath water should be tested to see that it 14. 2
is not too hot before putting infant into the 15. 1, 2, 3, 4
bath. 16. 1: attention-seeking; 2: abstract; 3: idealism

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22  Student Learning Guide Answer Key

17. Items that should be highlighted: g. Assessment for high risk behavior among
• Heart rate = 110 beats per minute adolescents.
• Body weight in 96th percentile for age 2. Review normal reflexes, growth patterns, and
• 16 deciduous teeth present milestones of physical and mental develop-
• Inability to bear weight on left leg ment. Review the importance of meeting the
• Bruising and swelling left ankle infant’s needs and what those needs are in
areas of safety, nutrition, hygiene, elimination,
Table Activity rest, and stimulation.
(See Overview of Structure and Function section in the
chapter.)
STEPS TOWARD BETTER COMMUNICATION
Physical Changes of Puberty
Completion
1. cyanotic
Male Female
2. erupt
• ICSH stimulates the • FSH stimulates the 3. resilient
testes to produce ovaries to begin 4. baby fat
testosterone. producing estrogen 5. gender stereotype
• FSH stimulates hormones. 6. growth spurt
the testes to begin • Breast development
producing sperm. occurs. Vocabulary Exercises
• Enlargement of • Hips widen. 1. a. vital/necessary/important (answers may
the reproductive • Axillary and pubic vary)
organs occurs. hair appears. b. helping/aiding/assisting (answers may
• The voice lowers in • There is growth of vary)
tone. the reproductive 2. linguistic: writing, speaking, learning foreign
• Growth of facial, organs. languages, early speech, talking with others,
pubic, and axillary • FSH stimulates enjoying word play
hair occurs. the development mathematical: science, engineering, mathemat-
• Bones thicken and of ova and ics, counting, understanding number concepts
skeletal muscles menstruation spatial: art, architecture, engineering, building
increase in size. begins. blocks, drawing
• Nocturnal musical: singing, playing instruments, enjoy-
emissions occur. ing music, singing songs, playing instruments,
moving to music
Critical Thinking Activities bodily kinesthetic: dance, gymnastics, sports,
1. a. Agencies and educational programs avail- exercise, active play, climbing, dancing, tum-
able in your community to help combat bling
teen pregnancy. interpersonal: outgoing, friendly, leadership,
b. Employers in the area who are tuned in to selling, working with people, outgoing, enjoys
the needs of adolescents and are interested playing with others, leads in games, enjoys
in their school performance. visiting
c. Books and online resources that help intrapersonal: quiet thinker, philosopher,
people figure out matches with interests/ poet, writer, psychologist, enjoys solitary play,
talents and strengths with career options; imagination, self-analytic
i.e., What Color is Your Parachute, personal-
ity tests, life planning classes, college op- Communication Exercises
tions, etc. Dialogues will be individual.
d. Drug and alcohol education programs
available in the community.
e. Assessment parameters for eating disor-
ders.
f. Signs of depression in adolescents.

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 Student Learning Guide Answer Key  23  

CHAPTER 12 c. Nurturance: Providing loving care and

guidance
Terminology d. Socialization: Interacting appropriately with
others
A. Matching e. Education: Teaching about values and the
1. d world
2. b f. Reproduction: Continuing the species
3. h g. Recreation: Having fun together
4. j h. Support: Helping and caring for each other
5. g 6. a. Families move around a lot making it hard
6. a to maintain friends.
7. i b. Only a small percentage of families live in
8. f rural areas and are self-sufficient.
9. e c. Since the 1980s, men are taking a greater
10. c role in their children’s lives..
7. Any three of the following risk factors:
B. Completion a. Both individuals younger than 20
1. Middle adulthood b. Lower economic status
2. intimacy c. Cohabitation before marriage
3. 30 d. Premarital pregnancy
4. Executive substage e. Having children from a previous marriage
5. Generativity f. Either partner having been previously
6. Stagnation divorced
7. Young children g. Knowing each other for only a short time
8. Sandwich generation before marriage
9. 65 h. One or both not finishing high school
10. 1000; 1200 i. No religious affiliation or practicing differ-
11. Below 120/80 ent faiths
j. One or both having divorced parents
Short Answer 8. a. Chemical abuse
1. a. Responsibility for members of one’s family b. Overeating
or community c. Inadequate sleep
b. Job responsibilities and coworkers d. An inactive lifestyle
c. Responsibility for oneself e. Sexual promiscuity
2. Executive substage 9. The major health problems of middle adults
3. Any of the following: include accidents, alcohol use disorder, obe-
a. Form close relationships with others sity, diabetes, heart disease, hypertension, and
b. Develop an intimate relationship with a mental illness.
significant other 10. Working crossword or Sudoku puzzles, work-
c. Maintain close family ties ing jigsaw puzzles, playing bridge, playing
4. Answers can include: Helping young people board games that require strategy, studying
and others in the community, being produc- some new subject, using computer programs
tive in the workforce, volunteering within the such as “Brain Age,” or “Lumosity,” and other
community, having leadership roles, being a activities that stimulate the mind all help main-
mentor tain mental crispness.
5. a. Physical maintenance: Providing essentials
for life
b. Protection: Creating an atmosphere for
health and safety

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24  Student Learning Guide Answer Key

Table Activity network of friends or family. Single adults are

responsible for themselves and are more likely
Physical Changes to report feelings of loneliness.

Young Adult Middle Adult Review Questions for the Next Generation
• Completion • Redistribution of NCLEX® Examination
of skeletal body weight 1. 4
development • Presbyopia 2. 1, 2, 4
• High levels • Presbycusis 3. 1, 5
of strength, • Compression of the 4. 3
endurance, and spinal column and 5. 2, 3, 4, 5
energy loss of height 6. 1, 2
• Dental maturity • Loss of muscle tone 7. 3
with eruption of and elasticity of 8. 1
wisdom teeth body tissues 9. 1
• Physical growth of • Blood pressure 10. 2
the brain continues increases 11. 4
until the mid-20s • Skin becomes less 12. Correct answers:
• Prime resilient • Ms. Lo dropped out of high school when
reproductive/ • Wrinkles appear she was pregnant with their first baby.
childbearing years • Graying of the hair • Ms. Lo’s spouse has been unemployed for
• Stress-related • Thinning of scalp 3 months.
illness emerges hair • Ms. Lo’s in-laws recently went through a
• Early disease • Decreased levels of divorce.
develops; i.e., estrogen in women • Mr. and Ms. Lo are both 19 years of age.
cancer and decline in • Ms. Lo earns minimum wage at a fast-food
testosterone in men restaurant.
13. 3
Completion
1. care about and for each other Critical Thinking Activities
2. one or two parents and children 1. Answers depend on your age and developmental
3. 29% stage. See Table 11.2.
4. 45; 55 2. Answers depend on your age and developmental
5. Decreased vaginal lubrication, emotional labil- stage.
ity, fatigue, flushing and hot flashes with heavy
sweating, headache, heart palpitations, insom- STEPS TOWARD BETTER COMMUNICATION
nia
6. garlic Completion
7. person-centered care 1. downsizing
8. interests; activities 2. family-friendly
9. friends 3. boomerang
10. middle years of life 4. menopause
11. mobility 5. volunteering
12. paid caregivers 6. family ties
13. 40%-50%, 60%-67%
14. poverty Vocabulary Exercises
15. 40 1. Quiet—boisterous (noisy) or active
16. cervical 2. Blonde—brunette (dark-headed) or dark
17. lower 3. Athletic—nonathletic, sedentary
18. loud music 4. Tall—short
19. Relationships 5. Large—small
20. may have no one to depend on when trouble
occurs if they do not have a strong support

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 Student Learning Guide Answer Key  25  

Pronunciation and Stress

-tion/-sion -ic/-ical -omy -ogy -ity
urbanization gen- pelvic economy au- biology maturity
eration question chronic biological tonomy sociology infidelity
maturation skeptical gerontology validity
tension physical flexibility
stagnation cervical obesity
promiscuity
generativity
personality
-ery -edy -istry
delivery remedy dentistry
grocery tragedy chemistry
nursery comedy
surgery

Communication Exercises 7. d
1. Group discussion will vary with team member 8. h
age and developmental stage.
This website about reporting child abuse may B. Completion
be helpful as well: [Link] 1. aging
gov/topics/responding/reporting/how/ 2. biologic
2. Group discussion will vary with team member 3. free radical
age and developmental stage. 4. activity
This online article about attraction may be 5. elder abuse
helpful: [Link] 6. life span
tionships/features/do-opposites-attract#1 7. 79.8
8. 94.7 million
Cultural Points 9. psychosocial
1. See online Parenting and Family resources on 10. 75
the Evolve website. 11. hypertension
2. The three stages of adulthood in the U.S. in- 12. Alzheimer disease
clude:
a. Young Adulthood, 18-35 years Short Answer
b. Middle Adulthood, 35-65 years 1. a. Biological clock theory: body cells break
c. Older Adulthood, 65 to death down after a specific length of time and
Discussion will vary but will likely include Schaie’s and die.
Erikson’s theories. b. Free-radical theory: cells are damaged by
toxins; free radicals are unstable.
c. Wear-and-tear theory: body cells and or-
CHAPTER 13 gans eventually wear out.
d. Immune system failure theory: system
Terminology loses its ability to protect the body.
e. Autoimmune theory: body no longer rec-
A. Matching ognizes itself and begins to attack its own
1. e cells.
2. c 2. a. Stops going to church, withdraws from
3. b bridge club.
4. g b. Takes an adult education class.
5. a
6. f

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26  Student Learning Guide Answer Key

c. Copes with failing eyesight by using the Critical Thinking Activities

bus rather than driving; adapts to the situ- 1. Consider nutrition, exercise, medications,
ation. social activities, and activities that require the
3. Answers can include any of the following: active use of the mind.
health; education; lifestyle; personality; gender 2. Safety concerns related to confusion; inability
(females live longer); genetics to maintain a checkbook and attend to financ-
4. Any one of the changes listed in Table 13.1. es; malnutrition from forgetting to eat; poor
5. Reintegrative stage. Older adults carefully hygiene; illness from forgetting medications.
select how they wish to spend their time. They
do not do things just to accommodate other
people as easily anymore. STEPS TOWARD BETTER COMMUNICATION
6. Answers may vary; possible answers include:
a. Active in the church and/or family events Completion
b. Proud of well-maintained home appear- 1. irrelevant
ance and savings for retirement 2. nest egg
7. a. An exercise program 3. myth
b. Involvement in service groups, volunteer- 4. lifestyle
ing, hobbies
c. Staying mentally active (reading, puzzles, Vocabulary Exercises
computer use, writing)
8. Any five of the items in Box 13.2. Myth versus Theory versus Fact
9. a. Resistance training 1. T Theory
b. Safety measures 2. M Myth
10. Any items from Box 13.1. 3. F Fact

Completion Communication Exercise

1. healthier Answers for stress markings (may vary):
2. diet; exercise
3. personality Nurse: “Good morning, Mr. Hernandez. How are
4. 20 to 30 you feeling?”
5. 73, 85 Mr. H.: “Pretty good for an old guy my age.”
6. frail; active
7. depression, older white man Nurse: “Now, what medications are you taking?”
8. weight training Mr. H.: “Oh, I don’t know. There are some pink
9. circulatory ones, and some red ones. There were some big
10. physical activity horse pills, too, but I stopped taking them.”
11. volunteer
12. needed Nurse: “Why? Did the doctor tell you to stop?”
13. 30 Mr. H.: “No, but they weren’t doing me any good
and they stuck in my throat.”
Review Questions for the Next Generation
NCLEX® Examination Nurse: “How do you know they weren’t doing
1. 1: autoimmune; 2: no longer recognizes itself you any good?”
2. 2 Mr. H.: “Well, I don’t feel any different when I take
3. 3 them.”
4. 1, 3
5. 1: glasses; 2: hearing aid; 3: turned on; 4: light- Nurse: “Mr. H., some medications don’t make any
ing difference in how you feel, but they are doing their
6. 4 job in your body. Your cholesterol and hyperten-
7. 2 sion pills help keep the blood vessels open to your
8. 1 heart and brain so you won’t have a stroke or heart
9. 2 attack. You don’t want your wife to have to take
10. 2 care of you if you can’t talk or feed yourself, do
you?”

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 Student Learning Guide Answer Key  27  

Mr. H.: “Oh gosh, no! Is that what will happen?” Short Answer
Nurse: “Well, the medication helps prevent those 1. See Table 14.2. Examples may include:
types of complications. If you have some side ef- a. a formalized system of belief and worship
fects, or other problems taking those pills, talk to b. one’s relationship to wholeness of the
the doctor and maybe he can change the prescrip- physical and nonphysical world, and the
tion. But you should continue taking them until meaning of one’s life
you talk to the doctor.” c. spiritual, religious
2. a. Beef, pork, shellfish, and caffeine are
Mr. H.: “Well, OK, but I sure don’t like those horse avoided; alcohol is discouraged; eggs/
pills!” dairy can be consumed in moderation.
Nurse: “You know the old saying, ‘healthy as a b. Alcohol is forbidden; beef requires special
horse.’ Maybe that’s how they stay healthy! Seri- processing according to Islamic dietary
ously, let’s see if the pills can be cut in half.” law; eggs from birds that are not birds of
prey are acceptable; certain fish are accept-
able; pork is forbidden.
CHAPTER 14 c. If Orthodox, eat only Kosher foods; do not
eat pork; meat is not to be consumed with
Terminology dairy products.
A. Matching d. Prefer vegetarian meals; alcohol is avoided;
1. e fish and dairy depend on denomination.
2. d e. Meat, fish, and shellfish are avoided by
3. g most devout; eggs/dairy are permitted but
4. l avoided at some observances.
5. b 3. Develop cultural awareness. Know yourself,
6. k examine your own values, attitudes, beliefs,
7. j and prejudices. Keep an open mind and try to
8. c look at the world through the perspectives of
9. o culturally diverse peoples. Learn all you can
10. h about other cultures.
11. i 4. Understanding that health is expressed differ-
12. f ently across cultures, and that culture influenc-
13. a es an individual’s response to health, illness,
14. m disease, and death.
15. n 5. a. communication
16. p b. view of time
17. q c. personal space
d. organization of the family and social orga-
B. Completion nizations
1. sensitivity e. nutritional practices
2. stereotype f. issues related to death and dying
3. dialects g. health care beliefs
4. culture 6. a. Culture is learned and acquired in a social
5. worldview context through the process of encultura-
6. generalization tion, which starts at birth and continues
7. emotional expression throughout life as a seamless and uncon-
8. Ethnic scious process.
9. yin; yang b. Culture is shared by a group.
10. curandero c. Culture is incorporated into individuals’
11. offering food identity.
12. personal d. Culture is dynamic and changes under the
13. kosher influence of shared experience.
Comparisons Completion
Answers are from Table 14.3. 1. cultural blindness

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28  Student Learning Guide Answer Key

2. rejected 5. a. You might inquire whether a sense of

3. religious, religion peace is being achieved.
4. has been cleansed with a non-blood solution b. Determine if prayer and spiritual readings
before transplantation are being used.
5. Koran c. Determine whether a religious leader is
6. eighth visiting.
7. vegetarian
8. anxiety Review Questions for the Next Generation
9. yin; yang NCLEX® Examination
10. cultural awareness; cultural sensitivity 1. 2
11. cultural imposition 2. 4
12. mind; a different cultural perspective 3. 3
13. cultural congruence 4. 1
14. traditions 5. 1
15. prayer 6. 1
16. temperature 7. 1: spiritual; 2: religious; 3: rituals; 4: faith
17. folk or home remedy 8. 4
18. African American, Asian American, Native 9. 1
American 10. 2, 3, 4
11. 2
Application of the Nursing Process 12. African American, Asian American, Native
1. Answers will vary—examples might include: American
a. Are there any cultural practices or tradi- 13. people with ancestors from sub-Saharan Af-
tions that are important for your care or rica; Spanish-speaking regions in the Western
recovery? Hemisphere (South America, the Caribbean,
b. Do you have any cultural or religious di- and Central America); Saudi Arabia; India;
etary preferences that we should consider? and Mediterranean countries such as Turkey,
c. Do you have any spiritual or religious Greece, and Italy
beliefs that bring you comfort or that you 14. 3
would like us to support during your care? 15. 2
d. Would you like us to involve any spiritual 16.
or community leaders, like a chaplain or a Potential Nursing Appropriate Nursing
faith group, in your care? Interventions Interventions
2. a. Decreased hope
Provide time for prayer.
b. Moral ambiguity
c. Spiritual disconnection Consult an older male author-
3. Any three of the following (or others listed in ity figure in the family when
the textbook): performing patient education.
a. States they have hope for the future. Work with the family to en-
b. Expresses comfort with relationship to God sure that food they bring in
and significant others. for the patient adheres to the
c. Identifies and employs spiritual support. treatment guidelines.
d. Develops or reestablishes spiritual prac- Ask the patient about
tices that nurture a relationship with God the need to consult
or a higher power. with a rabbi.
4. Individual answers may vary but may include Assign a female caregiver.
the following:
Offer milk with her
a. Inquire about foods normally consumed morning coffee.
within the patient’s culture to include in
the diet. Inquire whether the patient
consumes meat, and modify
b. Consult with the dietitian to provide cul-
the care plan accordingly.
turally acceptable foods.
c. Ask the family to bring in acceptable cul-
tural dishes for the patient’s meal.

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 Student Learning Guide Answer Key  29  

Critical Thinking Activities Comparisons

1. Define what your own cultural beliefs are. Ask Answers are from Table 15.1.
a peer about their cultural beliefs; list both and
compare. Short Answer
2. Outline what you feel the spiritual needs of the 1. a. social constructs created by people and
Hindu, the Buddhist, and the Muslim might cultures over time involving roles and
be; then plan what you would do to meet those behaviors
needs. b. the external anatomy present at birth
c. sex
2. Simply ask, “What are your pronouns?”
STEPS TOWARD BETTER COMMUNICATION 3. People express sexuality differently with
thoughts, feelings, and attitudes that are
Completion
largely influenced by the society in which they
1. refrain from
were raised. These thoughts, feelings, and
2. attire
attitudes can impact how a person engages in
3. prevalent
relationships, expresses intimacy, and engages
4. sustained
(or chooses not to engage) in sexual expression.
5. wealth of information
4. Answers may vary but may include examples
Word Attack Skills such as boys who are told that “boys do not cry”
Answers will be individual. Examples are: may grow to interpret the demonstration of feel-
1. PREValent, SECond, CATegorized, STEReo- ings as something unfavorable. Girls who are
types, CULture told they should be quiet and not call attention
2. atTIRE, reFRAIN, susTAIN, imPEDE, HisPAN- to themselves may grow to believe that they
ic, exTENDed, nuTRItion should not show enthusiasm or anger openly.
3. celeBRAtion, ethnoLOGical, malnuTRItion, 5. Answers may include any of the following:
ecoNOMic, recogNIZE, circumCISion, curanD- • Abuse or neglect
ERo • Anxiety or depression
4. susceptiBILity, ethnocenTRICity, evaluAtion, • Death of a loved one
interpreTAtion, egaliTARian, spirituALity • Experiencing discrimination
• Family or caregiver responsibilities
• Family changes (e.g., birth of a child,
CHAPTER 15 children leaving home)
• Financial concerns
Terminology • Grief
• Incarceration
A. Matching • Infertility
1. c • Job stressors or performance
2. f • Living through a stressful event (e.g.,
3. e natural disaster, quarantine during
4. a COVID-19 pandemic)
5. d • Moving from one location to another
6. g • Planning large events (e.g., wedding)
7. b • Relationship changes (e.g., marriage,
8. h divorce, separation)
• Relationship dynamics (e.g., arguing with
B. Completion
a partner, worried about a partner’s health)
1. gender identity
• Stress
2. sexuality
• Taking examinations
3. LGBTQIA2+
• Time pressure
4. gender
• Use of drugs or alcohol
5. sex
6. Answers may include: Cancer, hormonal
6. LGBTQ
changes (e.g., during pregnancy, following
7. sexual orientation
childbirth, breastfeeding), hypertension, hypo-
8. gender expression
gonadism, hypothyroidism, joint limitations,

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30  Student Learning Guide Answer Key

menopause, obesity, pain, polycystic ovary 2. a. Partners: Are you currently sexually active?
syndrome, premenstrual syndrome, rheuma- Who do you have sexual encounters with?
toid arthritis, type 1 or type 2 diabetes, urinary b. Practices: Which kind of sexual contact do
tract infections, vaginal or penile infections you have/had? Do you have vaginal sex?
Anal sex? Oral sex?
Completion c. Protections from STIs: Do you and your
1. perceptions, beliefs partner(s) discuss the following regarding
2. what others will think about them STIs and HIV: How to prevent? Getting
3. nonjudgmental, objective tested? Protective measures? Condom use?
4. gender roles d. Past history of STIs: Have you ever been
5. sexual orientation, gender identity tested for STIs and HIV? Have you ever
6. gender identity been diagnosed with an STI? Have any
7. healthy, unhealthy, harmful of your partners been diagnosed with an
8. unwanted pregnancy, sexually transmitted STI? Have you or any of your partners ever
infections (STIs) injected drugs?
9. society e. Pregnancy: Are you considering having
10. Daniel Quasar Progress Pride flag, the Safe children? How important is pregnancy
Zone display, and/or the Do Ask, Do Tell prevention? Are you or your partner(s)
poster using contraception? If so, which kind?
11. Sexuality Would you like to discuss ways to prevent
12. sexual health pregnancy?
3. Possible answers (individual answers may
Application of the Nursing Process vary):
1. Individual answers will vary, but some pos- Expected outcome: Patient will verbalize satis-
sible answers include: faction with sex drive and intimacy.
Open and Non-Judgmental Communication: Begin Intervention: Collect data about medications
by creating a safe and welcoming environment patient is taking, especially recent changes.
for Lyndsay to discuss their sexual orientation Intervention: Collect initial information regard-
without fear of judgment or discrimination. ing full health history.
Use inclusive language; show empathy and Intervention: Ascertain patient’s perception of
understanding. dysfunction.
Comprehensive Health Assessment: Conduct a 4. Individual answers will vary - Possible an-
thorough health assessment that includes ques- swers:
tions specific to Lyndsay’s sexual health and Outcome 1: Patient will correctly describe safe
mental health. Be mindful of any unique risks sex practices and methods for STI prevention
or concerns related to their sexual orientation. during the next health care visit.
Mental Health Support: Recognize that individu- Outcome 2: Patient will schedule and attend
als who identify as LGBTQ may face increased regular health screenings, including STI test-
stress, anxiety, or depression due to societal ing, within 3 months.
stigma or discrimination. Screen for mental Outcome 3: Patient will demonstrate the cor-
health issues and provide appropriate referrals rect use of condoms or other safe sex practices
to counseling or support groups. during a teaching session with the health care
Sexual Health Education: Provide tailored sexual provider within 1 month.
health education that addresses safe sex prac- 5. Individual answers will vary based on the
tices, prevention of STIs, and the importance of expected outcomes written.
regular health checkups.
Supportive Resources and Referrals: Connect Review Questions for the Next Generation
Lyndsay with local or online LGBTQ+ support NCLEX® Examination
groups, health care providers who specialize in 1. 3
LGBTQ+ care, and resources. 2. 1, 2, 3, 4, 5
Ongoing Care and Follow-up: Ensure that Lynd- 3. 1
say feels supported and understood. Schedule 4. 3
regular follow-ups to address any ongoing or 5. 1, 2, 4, 5
new health concerns. 6. 3, 5, 8, 9

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 Student Learning Guide Answer Key  31  

7. 1- gender identity, 2- gender expression, 3- and respect for diverse gender identities. Some
sexual orientation, 4- gender of us had direct personal connections, while
8. nonbinary others learned through professional or volun-
9. gender fluid teer roles. We realized that our backgrounds
10. influenced our comfort levels and awareness of
gender diversity.”
Potential Nursing Appropriate Nursing
Interventions Interventions
Inquire about the use of STEPS TOWARD BETTER COMMUNICATION
medications, including
over-the-counter (OTC) Completion
preparations. 1. remain open
Always refer to patient 2. engage with
as “she” because of 3. prefers to be addressed
the gender assigned at 4. gender identity
birth. 5. linger
Inquire about any
stresses at home or at
CHAPTER 16
work.
Ask the patient about Terminology
any supplements being
taken, including herbs A. Matching
and vitamins. 1. e
Ask if they would like 2. g
information about pos- 3. d
sibly reversing their 4. a
surgery. 5. f
6. c
Refer them to a prayer 7. i
group to ask God’s for- 8. j
giveness. 9. h
Provide patient educa- 10. b
tion about treatment 11. k
options recommended
by their provider. B. Completion
1. Complicated grief
Critical Thinking Activities 2. bereavement
1. Answer: Individual answers will vary - one 3. Anticipatory grieving
possible answer: 4. health care proxy
A potential challenge a nurse might face when 5. Hope
addressing the needs of LGBTQ patients is 6. Cheyne-Stokes
overcoming personal biases and lack of knowl-
edge about LGBTQ-specific health concerns. Short Answer
A possible strategy to overcome this challenge 1. The concept of brain death
is to engage in continuous education and train- 2. The specialized care provided to the dying in
ing on LGBTQ health issues and to actively small clinics, houses, long-term care facilities,
practice cultural humility and empathy in or the patient’s (or patient’s family’s) own
patient interactions. home.
2. Individual answers will vary - one possibility 3. Any three of the following:
would be something like this: a. Fear of pain
“Comparing our experiences, we noticed com- b. Fear of loneliness
mon themes of initial confusion or lack of un- c. Fear of abandonment
derstanding, followed by a growing awareness d. Fear of the unknown

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32  Student Learning Guide Answer Key

e. Fear of loss of dignity Correlation

f. Fear of loss of control Answers require use of Table 16.1 plus application and
4. Euthanasia is the act of ending another per- synthesis of knowledge.
son’s life to end suffering with or without their 1. d
consent. 2. b
5. Passive euthanasia occurs when a patient 3. e
chooses to refuse treatment that might prolong 4. a
life. Active euthanasia is administering a drug 5. d
or treatment that ends the patient’s life. 6. b
6. Medical aid in dying is distinguished from 7. c
active euthanasia. It is making available to pa- 8. e
tients the means to end their life (medications) 9. a
with the knowledge that ending their life is the 10. d
intent. With medical aid in dying, the patient
must have the mental and physical capacity, as Application of the Nursing Process
well as the physical ability, to self-administer 1. Any four of the following:
the medications orally or enterally when cer- a. What the primary care provider has said
tain criteria are met. about their condition
7. Code of Ethics for Nurses b. Desires for advance directives and life sup-
8. The right to die with dignity port
9. Any of the interventions listed in the section of c. What is hoped for from nursing care
the chapter on common problems. d. What are the specific concerns
a. Advocate for sufficient pain medication to e. Specifics regarding religious practices and
keep the patient comfortable. spiritual needs
b. Administering antiemetics. f. Methods of coping and emotional status
c. Obtaining an order for morphine to ease 2. minimizing (or invalidating)
breathing. 3. The patient, the family, and all health care pro-
d. Obtaining an order for a sedative. fessionals involved in the patient’s care.
e. Obtain a standing laxative order. 4. a. coma
f. Allowing decreased fluid intake when ap- b. absence of brain stem reflexes
propriate. c. apnea
g. Providing ice chips or hard candy to suck. 5. radiation treatment, nerve block, implanted
h. Removing unpleasant sights and eliminat- pump, or surgery
ing odors before mealtime. 6. softener; laxative
10. A durable power of attorney for health care is a 7. appealing; easily digested
legal document that appoints a person (health 8. Degree of attainment of the expected outcomes
care proxy) chosen by the patient to make
health care decisions if the patient becomes Review Questions for the Next Generation
incompetent or incapable of communication. NCLEX® Examination
11. a. opioid medications 1. 4, 6
b. decreased food and fluid intake 2. 1
c. decreased mobility 3. 1
12. Any three of the following: 4. 1: bargaining, 2: denial, 3: anger
a. Administer antiemetic medication. 5. 3
b. Provide frequent oral care. 6. 4
c. Offer small servings of home-prepared 7. 2, 3
food favorites. 8. 3
d. Eliminate unpleasant sights and odors at 9. 2
mealtime 10. 2
13. patient positioning, turning to the side or el-
evating the head Critical Thinking Activities
14. listen; talk 1. You are responsible for approaching the family
15. Any of the signs and symptoms listed in Box about organ and tissue donation. This requires
16.1.

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 Student Learning Guide Answer Key  33  

tact. Planning an approach will make you more 2. j

comfortable with this issue. 3. f
2. Hope comes in many forms. You might help 4. d
her to hope for a more pain-free day, for the 5. h
joy of seeing something beautiful like a bird or 6. i
flower outside the window, of the joy of watch- 7. l
ing children happily playing. You could plan 8. b
ways to decrease discomforts so that there is 9. g
hope for a more comfortable day. There can be 10. a
hope for a pleasant time with a loved one. 11. e
12. c
STEPS TOWARD BETTER COMMUNICATION
B. Completion
1. hand hygiene
Completion
2. normal flora
1. anticipatory
3. Virus
2. collaboratively
4. Protozoa
3. enhance
5. Rickettsia; vectors
4. grapple
6. fungi
5. proactive
7. pinworms, round worms; tapeworms (also
6. proxy
hookworm)
7. respite
8. Endotoxin
8. validating
9. health care–associated
10. pathogens
Vocabulary Exercise
11. culture, sensitivity
Examples will vary.
12. hand hygiene
13. patient care; gloves
Communication Exercises
14. they are dry
1. Answers will be individual.
15. 15
2. Example: “Ms. Rodney, I understand you
16. 1/4, artificial nails
are experiencing many problems and many
17. jewelry harbors microorganisms
discomforts. Now that you are in hospice care,
18. sharps
there are several things we can do to help you.
19. biohazard or hazardous waste
We are going to regulate your medications so
20. Creutzfeldt-Jakob’s
that you achieve pain relief, but do not become
so constipated. The new medications and in-
Short Answer
home oxygen should help with your shortness
1. a. adhere to mucosal surfaces or skin
of breath, and that in turn should help you
b. penetrate mucous membranes
relax. Our team will be just a phone call away
c. multiply once in the body
and we will be here at least three times a week.
d. secrete harmful enzymes or toxins
We will work with your family in ways to
e. resist phagocytosis
reposition you that do not cause you so much
f. bind with iron
discomfort. I have ordered a special air mat-
2. Any example from the process of infection is
tress to make your bed more comfortable and
acceptable.
to relieve pressure on those sore spots. What is
a. Causative agent: Streptococcus bacteria
your main concern for your care at this time?”
b. Reservoir: infected wound
c. Portal of exit: respiratory tract (mucous
membranes)
CHAPTER 17
d. Mode of transmission: drinking from a
contaminated glass
Terminology
e. Portal of entry: broken skin
f. Susceptible host: patient with a surgical
A. Matching
incision.
1. k

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34  Student Learning Guide Answer Key

3. Medical asepsis is the practice of reducing the 12. antitoxin; antiserum; antibodies or antitoxins
number of organisms present or reducing the developed in another person
risk of transmission of microorganisms. It is 13. Injection of vaccines or immunizing substances
carried out through hand hygiene, Standard that contain dead or inactive microorganisms
Precautions, and disinfection. Surgical asepsis or their toxins
is a way of protecting the patient from ex- 14. when there is a possibility of being splashed by
posure to living microorganisms. It involves body fluids
sterilization of all instruments and inanimate 15. an airborne pathogen; splashed body fluid
objects used in surgery, use of sterile supplies, 16. to prevent fluid from entering the eye area and
and special techniques for procedures that coming in contact with the mucosa or surface
invade the body. of the eye through splattering or aerosolization
4. a. direct personal contact with body excre- 17. a. Rinse the object with cold water.
tions or drainage such as from an infected b. Wash the object in hot soapy water.
wound c. Use a stiff bristled brush or abrasive to
b. indirect contact with contaminated in- clean equipment with grooves or narrow
animate objects (called fomites), such as spaces.
needles, drinking and eating utensils, d. Rinse the object well with moderately hot
dressings, clothing, and hospital equip- water.
ment e. Dry the object.
c. vectors such as fleas, ticks, mosquitoes, f. Always disinfect the cleaning equipment
and other insects that harbor infectious and the sink when you have finished clean-
agents and transmit infection to humans ing soiled objects
through bites and stings 18. a. Use gloves in appropriate situations.
d. droplet infection, or contamination by the b. Do not use gloves for routine tasks where
aerosol route through sneezing and cough- blood, body fluid, or microorganism con-
ing tamination is unlikely.
e. spread of infection from one part of the c. Do not “snap” gloves when removing.
body to another d. Do not use petroleum-based hand lotion
5. Exposing objects that can withstand heat and before donning gloves.
moisture to moist heat under pressure in an
autoclave Review Questions for the Next Generation
6. a. Any point from Table 17.5, as well as: NCLEX® Examination
b. poor nutrition 1. 3
c. chronic illness 2. 2, 3, 5, 6
d. poor hygiene related to immobility 3. 1
e. decreased immune function 4. 1
7. a. Genitourinary tract 5. 2
b. Gastrointestinal tract 6. 4
c. Respiratory tract 7. 1
d. Respiratory tract 8. 2
8. a. fever 9. 1
b. leukocytosis 10. 3
c. phagocytosis 11. 4
d. inflammation 12. 2
e. action of interferon 13. 3
9. interferon 14. fungi
10. a. neutralize and destroy harmful agents 15. 1, 2, 4, 5
b. limit the spread of harmful agents to other 16. 4
parts of the body 17. 2, 3, 5
c. prepare the damaged tissues for repair 18. 3
11. Naturally acquired immunity occurs when the 19. 2
body produces antibodies against a microor- 20. Steps in the correct order:
ganism. • Don head cover.
• Don gown.

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 Student Learning Guide Answer Key  35  

• Tie gown ties at back of neck and waist. Word Attack Skills
• Don mask. 1. b
• Don eyewear. 2. c
• Don clean gloves. 3. a
21. Steps in the correct order:
• Remove clean gloves. Communication Exercise
• Remove eyewear. Example: “Ms. Thierry, you must wash your hands
• Remove head cover. thoroughly after changing your dressing and
• Untie gown ties at back of neck and waist. cleansing the wound. Bacteria from the wound
• Remove gown. area can get onto your hands and then contaminate
• Remove mask. anything you touch if you don’t. The bacteria could
22. 1 be transferred from your hands to the telephone
or the coffee pot handle and the next person in the
Critical Thinking Activities house who touches the telephone or the coffee pot
1. Medical Asepsis: would have the bacteria transferred to their hands.
Handwashing to remove microorganisms The bacteria can infect them if there is a break in
Disinfection to prevent transfer of microorgan- the skin on the hands or if they then touch the eye
isms or the mouth where the bacteria can enter the body
Standard Precautions—use of barriers to pre- through the mucous membranes.” (Continue with
vent transfer of microorganisms how to handle the contaminated dressings, how to
Containment of microorganisms—plastic bag- disinfect surfaces, etc.)
ging contaminated dressings
Surgical Asepsis:
Autoclaving surgical instruments CHAPTER 18
Using only sterile items for invasive proce-
dures Terminology
Surgical scrubbing and sterile gloving 1. incubation period
Using only sterile supplies and technique for 2. malaise
dressing changes 3. prodromal
2. Be sure to discuss the first, second, and third 4. leukocytosis
line of defense. Use simple examples and com- 5. impervious
mon terminology to discuss the defenses of the 6. isolation
skin, secretions, cilia, bones, blood cells, liver 7. Transmission-based precautions
cells, GI secretions and activity, urination, fe- 8. infection prevention and control
ver, leukocytosis, phagocytosis, inflammation, 9. contact precautions
action of interferon, immune response. 10. convalescent
3. Discuss transmission of pathogens, particularly
HIV, hepatitis B and C, and need to prevent Short Answer
such transmission. Explain why different PPEs 1. Correct answer: surgical incisions with or with-
are used. out drains, implanted prosthetic devices (such
as heart valves; vascular grafts; or orthopedic
STEPS TOWARD BETTER COMMUNICATION joints, rods, and screws), patients requiring
repeated injections or venipunctures for blood
Completion tests, and those with a compromised immune
1. virulent system from factors such as chemotherapy,
2. scrupulously HIV infection, or long-term steroid use
3. impede 2. Correct answers include:
4. impermeable Perform hand hygiene before and after caring
5. render for the patient, before donning gloves, and
6. prevalent after their removal.
7. vector Perform hand hygiene and change gloves
between procedures that involve contact with

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36  Student Learning Guide Answer Key

mucous membranes, the perineal area, feces, in sealed plastic bags. Washing in a solution of
wound drainage, or other contaminated matter. hot, soapy water with chlorine bleach will kill
Help all patients on bed rest turn, deep most organisms. One set of linens is used by
breathe, and cough effectively at least every 2 the patient. Clean gloves may be used in place
hours. of sterile gloves in many instances.
Use correct aseptic technique for cleansing the 7. Place a special N-95 particulate mask on the
skin before performing an invasive procedure, patient.
such as IM injections and catheter insertion. 8. The older adult’s immune system is not as
Assess IV line sites for signs of infection at least active as the younger person’s. When an older
once per shift and each time you access the person has one infection, there is greater risk of
ports. contracting another because the body’s avail-
Ensure that devices such as urinary catheters able defenses are already working to fight the
and IVs are used only for appropriate rea- first infection.
sons and remain in the patient only as long as 9. a. Puncture wounds from contaminated
needed. needles or other sharps.
Always keep urinary catheter drainage bag b. Skin contact allowing infectious fluids to
below the level of the bladder (even when enter through damaged or broken skin.
transferring or transporting a patient). c. Mucous membrane contact where infec-
Clean residual urine off the catheter bag drain- tious fluids enter through the mucous
age tube after emptying the bag; do not let the membranes of the eyes, mouth, and nose.
tube touch the collection container or floor. 10. a. Know what is sterile.
Clean incontinent patients promptly. Carefully b. Know what is not sterile.
cleanse feces from surface of indwelling cath- c. Separate sterile from unsterile.
eters, the skin, and mucous membranes. d. Remedy contamination immediately.
Always cleanse from the urinary meatus to- 11. a. Perform hand hygiene each time before
ward the rectum (front to back). touching the patient, the catheter, the IV
3. a. Monitor diagnostic test reports related to site, IV line, or dressing. Wear clean gloves
infection. when providing care. Cleanse the spout on
b. Continually observe patients for signs of the catheter bag after emptying it. Inspect
infection. the IV site continuously throughout the
c. Implement procedures to contain microor- shift for signs of inflammation. Maintain
ganisms when infection is suspected. strict asepsis when changing the IV solu-
d. Properly handle, sterilize, or dispose of tion or the IV line. Perform the dressing
contaminated items and equipment. change using sterile technique. Do not talk
e. Utilize approved sanitation methods. while changing the dressing. Handle the
f. Recognize individuals at high risk for in- catheter gently so that it does not cause
fection and implement appropriate protec- undue irritation of the urinary meatus or
tion. bladder. Cleanse the catheter according to
4. With airborne precautions a room with nega- agency policy when bathing him.
tive air pressure is required and a respiratory b. Perform hand hygiene before approaching
device mask is essential. the patient. Use strict sterile technique for
5. Any three of the following: insertion of the catheter. Tape the catheter
a. Keep the patient stimulated with appropri- to the abdomen or leg so that there is no
ate activities. pulling on the balloon, which can cause
b. Increase sensory stimulation if signs of irritation of the bladder when the patient
sensory deprivation appear. moves. Cleanse the spout of the drainage
c. Listen to the patient’s feelings; give en- bag after emptying it. Encourage a high
couragement such as positive comments intake of fluid to keep the bladder flushed
on efforts at grooming or self-amusement. unless contraindicated.
d. Engage in conversation with the patient c. Obtain an order for a condom catheter or
about their interests or hobbies. other device to prevent urine contamina-
6. There is less exposure to heath care–acquired tion of the patient’s dressing. Keep his lin-
infection and strict surgical asepsis is not as ens clean and dry. Perform hand hygiene
necessary. Dirty supplies must be disposed of before giving care. Perform hand hygiene

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 Student Learning Guide Answer Key  37  

and change gloves after cleaning up after b. Fever and malaise

incontinence. Perform hand hygiene and c. Elevated temperature and increased white
use gloves when turning the patient. blood cell count
12. a. A sterile field is only sterile when in con- d. Positive culture results
stant view. Even when in a sterile gown, 2. Potential for infection related to open wound
the back of the gown is not considered ster- 3. Carefully planning care and gathering all
ile and would expose the field to possible needed supplies before going to the patient’s
pathogens. room; anticipating patient needs.
b. Talking over a sterile field is to be avoided 4. About the disease process, modes of transmis-
because saliva or droplets from the respira- sion, and precautions necessary to prevent
tory system may fall on the field. spread of the infection
c. Moisture will carry microorganisms from 5. An N-95 special particulate filter mask must be
the outside of the package wrapper to the worn when in the room.
items on the field. 6. a. Determining that all signs and symptoms
d. The outside of the unopened sterile pack- of the infection are gone
ages are not sterile and will contaminate b. Determining that the infection has not been
the entire sterile field if placed on it. Pack- transmitted to any other patient or a health
ages should be aseptically opened and care worker on the unit or in the hospital
their contents dropped into the sterile field
from its edge. Review Questions for the Next Generation
NCLEX® Examination
Matching 1. 3
All answers can be found in Box 18.1. 2. 1, 2, 3, 4, 5
1. a, c 3. 1
2. a, d 4. hand hygiene
3. a, c 5. 4
4. a, b 6. 1, 2, 4, 5, 6, 9
5. a, d 7. 1, 2, 4
6. a, c 8. 3
7. a, d 9. 4
8. a, b, d 10. 3
9. a, c 11. 1
10. a, c 12. 2
13. 2
Application of the Nursing Process 14. 3
1. a. Signs of wound infection 15. 3

16.
Nursing Intervention Effective Ineffective
Clean incontinent patients promptly. X
Perform hand hygiene before donning gloves and after doffing gloves. X
Assist bedbound patients to turn, cough, and deep breathe every 6
X
hours.
Use aseptic technique to cleanse the skin prior to invasive procedures. X
Keep the urinary catheter above the level of the bladder while transfer-
X
ring patient from bed to chair.
Cleanse the patient from rectum to meatus (back to front). X
Assess intravenous line sites for signs of infection at least once per shift
X
and each time you access the ports.

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38  Student Learning Guide Answer Key

Critical Thinking Activities B. Completion

1. The patient’s safety is at risk. Everyone in the 1. supine
room is responsible for pointing out breaks in 2. pivot
sterility. You must point out the contamination 3. shearing forces
to the surgeon. Think about how you would do 4. necrosis
this. 5. prone
2. Determine what activities and hobbies the pa- 6. symmetry
tient has. Work with the patient to plan activi- 7. ambulate
ties to prevent boredom and sensory depriva- 8. gait
tion. 9. logrolling
10. dangling
11. transfer (gait) belt
STEPS TOWARD BETTER COMMUNICATION
12. contracture
Completion
Short Answer
1. immunocompromised
1. Decrease back injuries
2. integrity
2. Any four of these:
3. residual
a. symmetry
4. scalding
b. an erect head centered over the body
5. sensory deprivation
c. buttocks in the same plane as the shoulders
6. enhance
with the thighs in line with the shoulders
d. weight evenly distributed over the but-
Vocabulary Exercises
tocks and thighs
1. premise; prevents spread of microorganisms/
e. knees flexed at about 90 degrees with the
infection
feet resting comfortably on the footrests or
2. affixed; identification bracelet
floor
3. onset; elevated temperature
f. arms lying comfortably in the lap or sup-
4. muster; people
ported by the chair armrests or lapboard
5. curtail; quieter
3. a. about shoulder-width apart
6. rectify
b. coordinated movements
7. enhanced; intact
c. close to your body
8. surveillance; true
d. level or height as the object to be moved
9. impervious; body fluids and water
e. push or lift
10. tiers; director of nurses
f. of the object or person to be moved
4. Any similar example to the following: (Box
Communication Exercises
19.1)
Answers will be individual. This exercise will help you
a. Use a wide base of support when transfer-
to become comfortable with patient education.
ring a patient. Keep feet about shoulder-
width apart.
b. Using the arms as levers placed beneath
CHAPTER 19
the patient and rocking back on the heels
to move the patient to the side of the bed.
Terminology
c. Lifting a box with elbows bent at sides to
keep weight of the box close to the body
A. Matching
and stabilize the center of gravity.
1. f
d. Raising the bed to waist height before
2. d
attempting to reposition the patient to
3. b
reduce back strain.
4. e
e. Pulling, using weight as a counterforce, to
5. c
reduce the workload.
6. a
f. Directly face the object or person to be
7. g
moved.

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 Student Learning Guide Answer Key  39  

5. a. Interference with circulation, which may 12. 3-5

lead to pressure injuries 13. extremity
b. Muscle cramps and possible contractures 14. The book seems lighter when held close to the
c. Muscle atrophy body.
d. Fluid collection in the lungs 15. Lower back strain
6. a. Place pillows lengthwise under the arms 16. Shoulder-width
from the axilla to the wrist, allowing the 17. muscles; the legs
hand to fall slightly over the end of the pil-
low. Place a rolled pillow on the outside of Matching
each leg to prevent external rotation. Use 1. c
a footboard or sneakers to keep the ankles 2. e
and feet in proper alignment. Place a flat, 3. a
small pillow at the curvature of the lower 4. f
spine to prevent excessive straightening of 5. d
the spine. 6. b
b. Place pillows lengthwise under each arm
to prevent undue rotation of the shoulders Application of the Nursing Process
and to support the joints of the arms. Place 1. Observe for symmetry; ensure the patient’s
a pillow beneath the knees, supporting head is erect and centered over the shoul-
above and below the joint to help prevent ders, the buttocks are in the same plane as the
the patient from slipping down in the bed. shoulders, and the thighs are aligned with the
Place a pillow lengthwise behind the back shoulders. The patient’s weight should be dis-
for comfort as indicated. tributed evenly over the buttocks and thighs.
7. Lock the wheels of the wheelchair and the bed. The knees should be flexed at about 90 degrees,
Place your arms under the patient’s axillae and with the feet resting comfortably on the floor
your hands on the scapulae. Assist to stand (or on a footstool if they do not reach the floor).
while bracing the patient’s legs with your The arms should lie comfortably in the lap or
knees. Pivot so that patient’s back is toward the be supported by the chair armrests.
bed. When patient’s legs are against the mat- 2. Altered mobility
tress, lower the body onto the bed. Reposition 3. The patient will master use of a wheelchair
for correct alignment in the bed. within one month.
8. The weight of the object or person is drawn 4. active; passive
close to the body, stabilizing your own center 5. logrolling
of gravity. 6. lock the wheels of the wheelchair
9. Prone provides an alternative for patients on 7. body mechanics
prolonged bed rest or who are immobilized. 8. a. Ambulated with assistance half of the
Spinal cord–injured patients sometimes use length of the hall.
this position. The position is generally not well b. Ambulated length of the hall with the
tolerated as it may be uncomfortable and deep walker.
breathing is difficult. One population that may
benefit from the prone position: critical care Review Questions for the Next Generation
unit patients with severe acute respiratory NCLEX® Examination
distress syndrome. However, it has been linked 1. 3
to sudden unexpected death in patients with 2. 2, 3
epilepsy. 3. Modified left lateral recumbent position
10. Have patient wear sturdy slippers, allow to 4. 3
stand before walking to decrease dizziness; 5. 1: internal rotation; 2: shoulder; 3: adduction
keep tubes and lines from tangling in legs 6. 2
or tripping patient; use gait belt or support 7. 3, 4
patient adequately; ask to keep head up and 8. 1
stand as straight as possible; do not overes- 9. 2, 3
timate the distance patient can walk without
extreme fatigue or weakness.
11. maximally stretched; flexibility of the joint

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40  Student Learning Guide Answer Key

10.
Nursing Intervention Effective Ineffective
Review the provider orders for any contraindications to passive ROM. X
Position the bed in the lowest position possible. X
Lock the wheels of the bed. X
Position the patient supine with pillow removed. X
Exercise each joint 3-5 times. X
Document any pain verbalized or limited ROM of any joint. X

Critical Thinking Activities bed so your feet can reach the floor. Let me help
1. If allowed, raise and lower the head of the bed you sit up and swing your legs over the side of the
slightly frequently to redistribute the weight bed, that’s it! Does that feel OK?”
over the sacral area. Provide a trapeze so that Mr. B.: (Waves his hand.) “Uh-uh!”
the patient can reposition and lift the buttocks
off the mattress from time to time. Nurse: “Are you dizzy? Just sit there for a minute,
2. All areas against the mattress: anterior hip, while I get your slippers on. OK. Do you feel better
lateral knees, ankles, right elbow, left ear. now?”
3. Hand and foot splints or footboard, pillows or Mr. B.: (Nods.) “Uh-huh. OK.”
sandbags of various sizes.
Nurse: “All right, if you are ready now, we will
stand up. Put your arms around my shoulders.”
STEPS TOWARD BETTER COMMUNICATION Nurse: “I’m going to help you up now; one, two,
three.”
Vocabulary Exercise
The striated muscle works to move the extremities. Mr. B.: “Uhhhh...”
Inertia for long periods tends to make the muscles Nurse: “Let’s just stand here until you are stable
atrophy. When muscles are not exercised and joints and then we will walk around the room.”
are not moved, the joints are predisposed to con-
tractures. Exercising the joints also alleviates the Mr. B.: “OK.”
pain that can occur with inactivity. Proper position- Nurse: “Stand straight now and walk.”
ing ensures that the weight of the body is dispersed
over a broad area. When performing ROM exer- Mr. B.: “Uh-huh.”
cises, it is best not to hyperflex a joint, as that may Nurse: “You are doing fine, Mr. B.”
cause injury. When transferring a patient from the
bed to a chair, a wide base of support is used so
that you do not sway while moving the patient. CHAPTER 20
Pronunciation of Difficult Terms Terminology
prognosis prog NO sis
design de SIGN A. Matching
aligned a LIGNED 1. g
magnificent mag NIF i cent 2. a
3. i
Communication Exercise 4. d
Dialogue will be individual. Here is an example: 5. j
Nurse: “Good morning, Mr. Brown. Are you ready 6. b
for your walk today?” 7. f
Mr. B.: “Uh-huh.” 8. e
9. h
Nurse: “First, I am going to raise the head of your 10. c
bed, to let you get oriented, and I will lower the

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 Student Learning Guide Answer Key  41  

11. k 4. Any five interventions from Safety Alert. Ex-

amples:
B. Completion a. Change the patient’s position at least q2h.
1. reactive hyperemia b. Keep the heels of an immobile patient off
2. diaphoresis the bed; use pressure reducing devices as
3. epidermis appropriate.
4. caries c. Avoid positioning patients directly on the
5. integumentary trochanter.
6. melanin d. Minimize skin injury caused by friction
7. maceration and shear forces by using proper position-
8. syncope ing, transferring, and turning techniques.
e. Use pressure-reducing bed and chair de-
Review of Structure and Function vices.
All answers may be found in the Overview of Structure f. Do not massage reddened skin.
and Function of the Integumentary System section in g. Wash and dry the incontinent patient
the textbook. promptly and thoroughly.
1. Melanin h. Avoid mechanical or physical injury from
2. keratin improperly fitting splints, braces, casts,
3. Sebaceous glands and prostheses.
4. Sebum I. Avoid burns caused by excessively hot or
5. Sweat glands cold applications.
6. Mucous membranes j. Provide adequate nutrition and fluid in-
7. dermis; corium take.
8. Skin 5. See Figure 20.3; requires critical thinking.
a. Wheelchair: shoulder blade, sacrum/coc-
Short Answer cyx, ischial tuberosity, posterior knee, foot
1. Any four of the following: b. Semi-Fowler: heels, sacrum/coccyx, elbow,
a. Loss of elastic fibers and adipose tissue dorsal thorax, ear, occiput
leads to wrinkles and sagging. c. Modified left lateral recumbent: side of
b. Loss of collagen fibers makes the skin more head, shoulder, ilium, perineum, trochan-
fragile and slower to heal. ter, anterior knee, malleolus
c. Decreased sebaceous gland activity causes 6. the bath
dryness and itching. 7. 1/2 to 3/4 the amount of time that pressure
d. Temperature control is altered due to loss was present to cause the redness
of density of the skin and decreased seba- 8. Any three characteristics listed.
ceous gland activity. a. Stage 1: An area of intact skin that is red,
e. The number of hair follicles decreases, deep pink, or mottled skin that does not
leading to slowed growth and thinning blanch with fingertip pressure. In people
hair. with darker skin, there may be discolor-
f. Nail growth decreases and nails thicken. ation of the surrounding skin. Warmth,
2. Major factors: (See Box 20.1) edema, and induration (an area that feels
Immobility hard) in comparison to surrounding tissue
Inactivity may be signs of a stage 1 pressure injury.
Moisture b. Stage 2: Partial-thickness skin loss with
Malnutrition exposed dermis. The wound bed is pink or
Advanced age red and moist and may appear as an intact
Altered sensory perception or ruptured blister.
Lowered mental awareness c. Stage 3: Full-thickness skin loss that looks
Friction and shear like a deep crater and may extend to the
3. Contributing factors: fascia. Subcutaneous tissue is damaged or
Dehydration necrotic. Fat is visible. Undermining and
Obesity tunneling may be present. There may be
Edema damage to the surrounding tissue.

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42  Student Learning Guide Answer Key

d. Stage 4: Full-thickness skin loss with exten- 19. Basin of water or a stoppered sink with some
sive tissue necrosis or damage to muscle, water in the bottom
bone, or supporting structures; sinus tracts 20. submerging
may be present. Infection is usually wide- 21. 18 or below
spread. The injury may appear dry and
black, with a buildup of tough, necrotic Application of the Nursing Process
tissue (eschar), or it can appear wet and 1. Answers may include any of the following:
oozing. a. personal preference
e. Unstageable pressure injury: loss of full b. self-care ability
thickness of tissue. The base of the injury c. economics
is covered by eschar (tan, brown, or black) d. sociocultural background
in the wound bed, or the base of the injury 2. Altered self-care ability
contains slough (yellow, tan, gray, green, or 3. Patient will participate in hygiene care each
brown). day.
f. Deep tissue pressure injury: localized 4. Make certain that the room is sufficiently
discolored intact skin that is maroon or warm with no drafts; the patient is adequately
purple or a blood-filled blister resulting covered with a bath blanket; skin is adequately
from damage to underlying soft tissue rinsed of soap; water is changed as it cools or
from pressure or shearing. The area may becomes too soapy; attention to perineal care is
be painful, firm, mushy, boggy, warmer, or paid unless patient can easily reach these areas;
cooler when compared to adjacent tissue. moisturizing lotion is applied immediately
9. the location of the abnormality, its color and after the bath.
size, and reaction to the blanch test 5. Skin with no evidence of redness, irritation, or
10. a. Cleanse the skin breaks in skin integrity; skin integrity is main-
b. Promote comfort tained.
c. Stimulate circulation to all areas of the
body Review Questions for the Next Generation
d. Remove waste products secreted through NCLEX® Examination
the skin 1. 3
11. Face, hands, axillae, back, and perineal area 2. 2
12. a. Cleanse 3. 2
b. Stimulate peripheral circulation 4. 3
c. Provide comfort 5. 3
13. healing 6. 1, 4
14. birth; rectal or vaginal 7. 1
15. confined to bed 8. 1
16. 4 9. constantly moist skin
17. a labeled container with normal saline or water 10. 3
18. diabetes; circulatory disease

11.
Nursing Intervention Effective Ineffective
Place patient in supine position. X
Assess patient for gag reflex. X
Turn on the suction device. X
Use suction to remove fluids and secretions while
X
providing oral care.

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 Student Learning Guide Answer Key  43  

12. 1- irritation, 2- infection, 3- morning, 4- bed- 5. poison

time, 5- six 6. bioterrorism
7. alarm fatigue
Critical Thinking Activities
1. Patients have a right to refuse any procedure. Short Answer
Inquire why the bath is refused. See if there is a 1. a. temperature
better time for bathing. b. ventilation
2. See if there is an electric razor on the unit that c. humidity
is sterile and that can be resterilized for the d. lighting
next patient. Have a family member bring his e. odor
razor from home. Inquire if it is all right to f. noise
shave him with a disposable safety razor. 2. 68°-74° F (21°-23° C)
3. safety; comfortable
4. Negative-airflow: air flows into the room;
STEPS TOWARD BETTER COMMUNICATION
positive-airflow: air flows out of the room.
5. Any of the following:
Completion
a. Reduce offensive odors by emptying and
1. exacerbation
rinsing the bedpan, bedside commode,
2. nick
urinal, and emesis basin promptly.
3. mottled
b. Change soiled linens as soon as possible.
4. don
c. Dispose of used medical items quickly;
5. débridement
refrain from putting odorous items in the
patient unit trash.
Vocabulary Exercises
d. Refrain from wearing perfumes, scented
1. e
lotions, or scented cosmetics while at work.
2. d
e. Remove old, disintegrating flowers and
3. b
stagnant water promptly.
4. c
6. Avoiding long conversations on the intercom
5. a
and limiting staff conversation in the hallway;
speak in a lowered voice.
Word Attack Skills
7. glare; soft and diffuse
1. outer, on
8. bed rest
2. skin
9. a. Use good body alignment.
3. hard
b. Maintain a wide base of support.
c. Face toward the direction of movement.
Communication Exercise
d. Bend at the knees rather than bending the
Yes, you should talk, but be sensitive to the pa-
back.
tient’s feelings. They may just want to relax and
e. Raise the bed to the proper working height.
enjoy the pleasure of having someone take care of
10. Toileting the patient on a regular schedule to
them, especially during the backrub. Talk about the
prevent the need for getting up without assis-
weather, the seasons, ask about family, or visitors,
tance.
tell something about your activities. During the
11. Staff Education: regarding the effects of de-
bath is a good time to gather further assessment
layed response to alarms; Attach a bed alarm
data, explore learning needs, and begin patient
to the call light system. Check on patients
education.
regularly and implement bedside handoffs.
Frequently (every shift) reevaluate the need for
a bed alarm. Educate the patient and family
CHAPTER 21
regarding the purpose of the alarm and use
of call light. Round on patients regularly and
Terminology
implement bedside handoffs.
1. environment
12. Always knock gently and identify yourself
2. ventilation
before entering the room. In multiple-patient
3. acute radiation sickness
rooms, close the curtain around the patient
4. humidity
for personal tasks such as using a bedpan and

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44  Student Learning Guide Answer Key

bathing. Post a sign on the door informing 28. name of the product; patient’s age, weight and
others of such tasks to discourage them from pertinent medical history; amount and timing
entering the room. of product involved; exposure route of prod-
13. Possible answers include: uct; any symptoms and/or complaints.
Hospital: 29. candy
• Identify patients correctly 30. last resort
• Improve staff communication 31. to bring in items from home that are familiar
• Use medicines safely such as photographs or mementos
• Use alarms safely 32. a sudden change in mental status or behavior
• Prevent infections 33. index and middle fingers
• Identify patient safety risks 34. an immovable part of the bed frame
• Improve health care equity 35. 2 hours; active or passive range-of-motion
• Prevent mistakes in surgery exercises
Nursing Care Center:
• Identify patients correctly Review Questions for the Next Generation
• Use medicines safely NCLEX® Examination
• Prevent infection 1. 1
• Prevent patients from falling 2. 1, 3
• Prevent bed sores 3. 2
14. Any four measures from Box 21.3. Individual judg- 4. 2
ment dictates what is most important. 5. 1, 3, 6, 8, 9
15. a. Patient with diabetes 6. 1
b. Patient with impaired circulation 7. 3
c. Patient who has paralysis 8. 2
d. Patient receiving medications that alter 9. 3
mental awareness 10. central nervous
16. any equipment that could cause a spark 11. 3
17. a. Location of fire alarms 12. 1, 4
b. Location of fire extinguishers 13. 4
c. Escape routes from the unit 14. 2
d. Your institution’s fire regulations 15. 4
18. Rescue the patient quickly. 16. 2
Activate the fire alarm system. 17. 2
Contain the fire by closing doors and windows. 18. Steps in the correct order:
Extinguish the flames or Evacuate. • Assess whether all alternatives have been
19. the release of pathogenic microorganisms into attempted prior to use of restraint or
the community to achieve political and/or supportive device
military goals • Check to see if a provider order for the
20. a. gas device has been written
b. liquid • Review agency policies and procedures
c. solid regarding the use of restraints and
21. 21 supportive devices
22. loss of consciousness, convulsions, paralysis, • Assess the skin and circulation where the
and death device is to be placed
23. time, distance, and shielding • Explain the purpose and need for the
24. nausea, vomiting, diarrhea, loss of appetite, device to patient and family
fatigue, fever, skin damage, hair loss, seizures, • Check on patient every 15-30 minutes, or
coma, and possibly death per agency policy
25. b, a, c, d, although some would say b, c, a, d. It • Release ties, change position, perform
takes experience to triage accurately. ROM of extremities every 2 hours
26. decontamination with removal of clothing and • Provide access to call light
jewelry and scrubbing down
27. who will most likely survive if they receive Critical Thinking Activities
treatment 1. Have someone sit with them.

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 Student Learning Guide Answer Key  45  

Use a bed alarm. Communication Exercises

Remind the patient where they are and why. 1. I am putting your bed rails up for your safety
Try to determine why they want to get up. so you won’t fall out.
2. A fire safety inventory is required; answer will 2. Could you please lower your voices or move
depend on what deficiencies are found. into the lounge area? Some patients are trying
3. A poison safety inspection is needed; answer to rest.
will depend on what is found. 3. We do this for her own safety. We check them
4. Instruct patient to change positions slowly. regularly to be sure she is comfortable.
Instruct patient to sit on edge of bed and 4. Be careful, the tea is hot.
dangle their feet before standing.
Instruct patient to perform dorsiflexion before Grammar Points
standing. 1. in the role of
2. because
STEPS TOWARD BETTER COMMUNICATION 3. to the same amount
4. for example
Completion
1. diffuse
2. noxious CHAPTER 22
3. frayed
4. tact Terminology
5. neat and tidy
6. glare A. Matching
7. compromise 1. f
8. prone 2. b
9. altercations 3. h
10. refrain from 4. a
5. i
Vocabulary Exercises 6. e
1. 7. d
8. j
Word Physical/Tangible Emotional/Intangible 9. c
frayed worn at the irritated, annoyed 10. g
edges
glare a strong reflected to look hard at B. Completion
light someone with anger 1. eupnea
or hatred 2. dyspnea
3. diastolic
miter tall, pointed making a corner 4. defervescence
bishop’s hat with two pieces at an 5. auscultatory gap
angle 6. basal metabolic rate (BMR)
prone lying face down likely to happen 7. metabolism
slump to slide or bend to fall or sink down 8. Kussmaul
into a low 9. the volume of blood pushed into the aorta with
position each heartbeat
stifle preventing or prevent someone Review of Structure and Function
restricting from from doing All answers for this section are in Overview of the
getting air something Structures and their Functions that Regulate the Vital
Signs in the textbook.
2. a. I hate clutter; I like to keep my work area 1. a pyrogen causes the body to conserve and
neat and tidy. manufacture heat
b. That light produces too much glare, and I
would like you to do something to diffuse
the light.

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46  Student Learning Guide Answer Key

2. the thyroid gland; epinephrine, norepineph- c. Position the manometer gauge so it can be
rine, testosterone hormones; and muscle move- seen at eye level from a distance of 1-3 feet.
ments that produce heat d. Attach the cuff over the bare arm.
3. diaphoresis e. Center the bladder of the cuff over the
4. stroke volume brachial artery.
5. sinoatrial node f. Inflate the cuff while palpating the artery,
6. vasodilation, vasoconstriction noting the level at which the pulse disap-
7. 5 liters pears. Inflate the cuff 30 mm Hg over the
8. in and out of the lungs level at which the pulse disappeared when
9. alveolar membrane auscultating the pressure.
10. the nose, pharynx, larynx, trachea, bronchi, g. Place the diaphragm of the stethoscope
lungs, diaphragm, and respiratory muscles firmly but lightly over the artery with all
11. surfactant edges of the diaphragm in contact with the
12. pons; medulla skin.
13. carotid body receptors; aortic body h. Deflate the cuff at about 2 mm Hg per sec-
14. maximum pressure exerted on the arteries dur- ond and deflate all the way to zero without
ing left ventricular contraction (systole) stopping.
15. the heart is at rest and pressure in the arteries 12. shock
is lowest 13. orthostatic or postural
16. stroke 14. count the apical pulse rate at exactly the same
17. peripheral vascular time as another nurse counts the radial pulse
18. decreases using the same watch for both of you. Subtract
19. increase the radial pulse from the apical pulse to obtain
20. metabolic rate the pulse deficit.
21. increased
Application of the Nursing Process
Short Answer 1. A temporal artery or tympanic thermometer
1. can include any of the following: time of day would be best. The tympanic thermometer
(circadian rhythm), age, metabolic rate (e.g., should be used in the ear canal pointing to-
menstrual cycle, pregnancy), environmental ward the tympanic membrane. Pull the earlobe
temperature, hormone levels, muscle move- upward gently to straighten the canal.
ment from exercise, shivering, diseases, drugs 2. The apical, rather than the radial, pulse is taken
2. 97.5°-99.5° F; 36.4°-37.5° C on children younger than 2 years. Locate the
3. 60-100 bpm apical heart sound by placing the stethoscope
4. Rhythm and volume on a point midway between the imaginary line
5. Over the radial artery, temporal artery, carotid running from the middle of the left clavicle
artery, femoral artery, popliteal artery, posterior through the left nipple in the fifth intercostal
tibial artery, and dorsalis pedis artery space.
6. Apex of the heart [fifth intercostal space (ICS) 3. If the radial pulse is irregular, tell the patient
at midclavicular line]; a full minute you are having trouble feeling the pulse and
7. a. Bradycardia take an apical pulse rate for a full minute.
b. Tachycardia 4. A large adult blood pressure cuff should be
c. Arrhythmia used with the sphygmomanometer and stetho-
8. 101.3° F, or 38.5° C scope. A normal adult cuff will not fit most
9. brain (between the cerebral hemispheres); hy- patients with this weight and will give a falsely
pothalamus high reading.
10. 120/80 5. You might place a hand on the chest and
11. Any five of the following factors helpful for measure the rise of the chest on inspiration, or
accurate BP determination: use a stethoscope on the chest to listen to the
a. Have the patient rest for at least 5 minutes breaths.
before taking the blood pressure. 6. a. Altered body temperature related to unknown
b. Position the arm at heart level and support cause
it. b. Altered breathing pattern related to impaired
respiration

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 Student Learning Guide Answer Key  47  

c. Altered cardiac output related to rapid heart Priority Setting

rate 1. 2
d. Altered peripheral tissue perfusion related to 2. 3
decreased systemic blood flow associated with 3. 1
increased vascular resistance (Other possible 4. 5
problem statements might be: Potential for 5. 4
injury related to consistently elevated blood
pressure; Insufficient knowledge regarding Review Questions for the Next Generation
disease process and therapeutic regimen) NCLEX® Examination
7. a. Temperature will return to normal with ad- 1. 2
ministration of antipyretic within 8 hours. 2. 2
b. Breathing will return to normal pattern 3. 1
with 1 hour of use of bronchodilator medi- 4. 2
cation. 5. 2, 4, 5
c. Heart rate will return to normal within 8 6. 4
hours after initiating beta blocker therapy. 7. 4
d. Blood pressure will return to normal level 8. 1
within 1 week after beginning antihyper- 9. 3
tensive therapy. 10. 1
8. a. Temperature 98.6° F (37.0° C) at 4 pm (6 11. 4
hours later) 12. between 120 and 160
b. Respirations 20, 1 hour after nebulizer 13. higher
treatment with albuterol 14. 3
c. Heart rate 94 bpm at 4 pm (8 hours after 15. 2
medication) 16. 1, 2, 3, 7, 8, 9
d. BP 136/86 mm Hg at clinic visit 1 week 17. 1
after initiating antihypertensive therapy

18.
Nursing Intervention Effective Ineffective
Have the patient resting for 5 minutes prior to starting the measure-
X
ment.
Support the arm above the level of the heart. X
Position the manometer gauge so it can be seen at eye level from a dis-
X
tance of 3-5 feet.
Place the cuff and stethoscope directly on the skin. X
Inflate the cuff while palpating the artery and note where the pulse dis-
X
appears.
Deflate the cuff; wait 10 seconds before reinflating. X
Inflate the cuff 50 mm Hg above where the pulse disappeared on palpa-
X
tion.
Allow the cuff to deflate at 5 mm Hg per second. X
When the audible sounds disappear while you are deflating, quickly
X
reinflate to double-check the last audible sound.
Document the blood pressure per agency policy. X

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48  Student Learning Guide Answer Key

Critical Thinking Activities Pronunciation Skills

1. The respiratory rate will vary when a lower
ap ne a   bra dyp ne a   ta chyp ne a  
respiratory infection is present. Causes include
eup ne a   dysp ne a
secretions in the lungs interfering with oxygen
and carbon dioxide dispersion, narrowing hy pox i a   ar rhyth mi a   tach y car di a
of bronchioles and bronchi, or obstruction of di as tol ic  a scul ta tory
airways, causing the body to increase the rate
feb rile  py rex i a   def er ves ence  
to obtain sufficient oxygen.
di a phor e sis
2. The body tries to conserve and manufacture
heat to raise the set point for core temperature. sphyg mo man om e ter
Because the person feels cold, clothes or cov-
ers are used to conserve heat and the person Communication Exercises
huddles with extremities held curled close to
the body, environmental heat may be turned Sample Dialogue B
up. Chills may occur that increase body me- Nurse: “Slip this probe under your tongue. The
tabolism, thereby increasing heat production. thermometer will beep when it is done. Turn your
3. A major examination causes some degree of arm over for me, so I can feel your pulse more
anxiety. Anxiety stimulates the sympathetic easily. (Places fingers over artery.) There it is. It is
nervous system, which in turn raises the heart regular at 76 beats per minute.”
rate.

CHAPTER 23
STEPS TOWARD BETTER COMMUNICATION
Terminology
Completion
1. abatement
A. Matching
2. alter
1. g
3. contraindicated
2. k
4. propelled
3. i
5. flared
4. b
6. simultaneously
5. c
7. distract
6. f
8. clockwise
7. e
9. blunt
8. l
10. peripheral
9. m
10. h
Vocabulary Exercises
11. j
12. d
Textbook Conversation 13. a
Blunt Short, stubby, Straightforward;
or flat not very tactful B. Completion
1. bronchovesicular
Superficial Close to the Speaking in
2. vesicular
surface generalities
3. stridor
or of nothing
4. palpation
important
5. wheeze
6. Rinne
Word Attack Skills
7. Weber
1. he mo/dy NAM ics, blood/movement =
8. ascites
movement of the blood and pressures within
9. gurgles (or low-pitched wheezes)
the body
10. olfaction
2. an te/CUB ital space, above/the elbow = sur-
face of the arm in front of the elbow

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 Student Learning Guide Answer Key  49  

Identification White patches inside the mouth or on the

1. a tongue: could be precancerous lesions
2. d Unusual bleeding or discharge: in the stool,
3. d from the vagina, in the urine
4. b Breast changes—change in size or shape of
5. e breast of nipple or change in texture of breast
6. a, b skin
7. e, a Persistent indigestion, trouble swallowing, or
8. b changes in appetite
9. a, b Persistent cough or hoarseness
10. b Unexplained night sweats

Short Answer Priority Setting

1. a. Female genitalia, pelvic exam The physical assessment should be performed from
b. Rectal exam head to toe. There can be some variation. The fol-
c. Flexible sigmoidoscopy lowing would be appropriate:
2. a. Mentation and level of consciousness (Skill 6, 5, 3, 4, 1, 7, 8, 2, 9
23.2)
b. Pupil reflexes and extraocular movements; Completion
size, equality, reaction, and accommoda- 1. fruity
tion to light 2. a hand
c. Motor movements to command, and 3. dialysis shunt; mastectomy
muscle strength 4. bell
d. Vital signs 5. mucous membranes
3. a. Health history factors 6. bilaterally
b. Current health problems 7. tibia; ankle
c. Psychosocial/cultural data 8. expected outcomes
4. a. Rest and activity 9. RNS HOPE
b. Nutritional, fluid, and electrolytes 10. head, toe
c. Safety and security 11. diagnostic tests
d. Hygiene and grooming 12. unnecessary exposure
e. Oxygenation and circulation needs 13. neurologic exam
f. Psychosocial and learning needs 14. 12
g. Elimination
5. a. Need for and timing of regular physical Application of the Nursing Process
examination 1. the patient, the family, the health record, other
b. Recommended periodic diagnostic tests health care workers involved in the patient’s
c. Need and schedule for immunizations care, and diagnostic test results
d. Warning signs of cancer 2. an individualized plan of care can be formu-
e. The necessity of regular dental examina- lated
tions 3. Any five of the following:
f. When to notify their primary care provider Frequent injuries that are referred to as from an
6. Correct answers may include any of the follow- “accident.”
ing: Dressing in clothing designed to hide bruises
Unexplained weight gain or loss of 10 pounds or scars (long sleeves in hot weather, sunglass-
or more with no reason es worn indoors).
Extreme tiredness or fatigue Rarely go out without the partner or spouse.
Abdominal pain Have limited access to money or family car.
Skin changes: A new mole or a change in an Considerable anxiety or depression.
existing mole or a lesion that does not heal Are afraid of the spouse or partner or seem
A thickening or lump under the skin extremely anxious to please that person.
Change in bowel or bladder habits, pain when Talk about their partner or spouse’s temper or
passing urine or difficulty urinating possessiveness.

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50  Student Learning Guide Answer Key

4. Correct answers may include: ages 35-70 who are overweight or have BMI
Determining the patient’s level of health and over 30; consider younger screening if patient
physiologic functioning is from a population with disproportionately
Arriving at a preliminary problem statement/ high prevalence of diabetes; bone density
nursing diagnosis associated with a health screening for women age 65 and older; annu-
problem ally starting at age 45 (or at age 40 if desired),
Confirming a diagnosis of dysfunction, disease, then every 1-2 years starting at age 55. Women
or inability to carry out activities of daily living determined to be at higher risk for breast
(ADLs) cancer should have annual mammograms and
Indicating specific body areas or systems for MRI scans. Checking stool for occult blood, sig-
additional testing or examination moidoscopy or colonoscopy starting at age 45
Evaluating the effectiveness of prescribed treat- and continuing through age 75; conventional
ment and therapy and observing for adverse (Papanicolaou [Pap] smear) or liquid-based
side effects cytology for women every 3 years, combined
Monitoring for changes in body function with HPV every 5 years, between ages 25 and
Determining whether there are any signs of 65; annual dental exam; tongue inspection
abuse every few months; baseline eye exam at age 40
5. less than 3 seconds followed by every 1-2 years after age 65 (more
6. ophthalmoscope frequently if patient has eye disease or diabe-
tes); report testicular masses or difficulties in
Review Questions for the Next Generation urination to primary care provider; report skin
NCLEX® Examination moles with abnormal pigmentation, asymme-
1. 3 try, irregular borders, or changes to primary
2. compare care provider
3. 3 3. See Skill 23.1.
4. 4
5. 1, 3
STEPS TOWARD BETTER COMMUNICATION
6. 1, 4
7. 4 Completion
8. 3 1. appraising
9. 1 2. opacity
10. 1, 2, 3, 5 3. holistic
11. Steps in the correct order: 4. ascertaining
• Perform hand hygiene, explain the 5. subsides
procedure and provide privacy 6. acronym
• Elevate the head of the bed 45-90 degrees 7. patent
• Assist patient to loosen or remove clothing 8. astute
• Auscultate over the apex of the heart using
the diaphragm of the stethoscope Vocabulary Exercises
• Auscultate over each of the four cardiac 1. abnormal
valve locations using the bell of the 2. a word made from the initials of other words
stethoscope 3. occluded
• Document the apical pulse rate and the 4. sluggish
presence of normal and abnormal cardiac
sounds Word Attack Skills
12. 1: head injury; 2: cranial; 3: seizures; 4: central Pronunciation of Difficult Terms
nervous system; 5: two A. Requires practice pronouncing the words.
B. 1. sphyg/mo/ma/nom/e/ter
Critical Thinking Activities 2. oph/thal/mo/scope
1. Auscultate the heart and lungs, including heart
valve sounds. Check all peripheral pulses and Abbreviations
compare bilaterally. 1. Point of maximal impulse
2. Annual blood pressure screening for age 40 2. Pupils equal, round, reactive to light, and ac-
and older; blood glucose screening for adults commodation

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 Student Learning Guide Answer Key  51  

3. Complete blood count 2. a. Location of call light and its operation.

4. Patient-controlled analgesia b. Location of bathroom and its call light.
5. Activities of daily living c. How to operate the television and telephone.
6. Dual-energy x-ray absorptiometry d. Explain visiting hours.
7. Extraocular movements e. Explain NPO if necessary or tell meal
times.
Communication Exercise f. Explain services available; i.e., chaplain,
A. Requires practice with a partner. social worker, etc.
B. Who can you count on when you are having a g. Explain information on the status board.
problem or an emergency? 3. a. primary and secondary diagnoses
Are you ever depressed or really feeling blue? b. current orders
Will you be able to have someone care for you c. medications (including over-the-counter
at home while you recover, or would you like medications, dietary supplements, and any
to speak with the social worker to arrange your herbal products the patient takes), noting
convalescence? dosage, route, frequency, and time of last
Will you be able to obtain your medications dose given
and dressing supplies without a problem? d. care provider names and telephone num-
What are your fears or concerns at this point in bers
time? e. brief synopsis of the hospital stay
Let’s wait and see what the pathology report 4. Any six of these answers:
and prognosis are to see if there is a further Phone number of primary care provider and
problem. time of follow-up appointment
How will you change your dressing and care Diet instructions
for your incision? Activity restrictions and exercise instructions
C. Each dialogue will be different depending on Medications and schedule for administration
your personality and knowledge level. Share Over-the-counter medications not to take while
your dialog with a peer or your instructor for on current prescriptions
comments. Instructions about bathing and hygiene
Dressing change instructions
Instructions for any new prosthesis or brace
CHAPTER 24 Signs and symptoms to report to the primary
care provider
Terminology Any requirements for follow-up laboratory
work
A. Matching 5. autopsy
1. f 6. Sent home with the family; placed within a
2. e valuables envelope, listed, sealed, and placed
3. c in safe storage according to facility protocol
4. a 7. RN; LPN/LVN
5. d 8. plan of care, health record, wristband
6. b 9. attending physician; admissions (business) of-
fice and the family or significant other
B. Completion 10. “improve staff communication”
1. discharge planner 11. discharge planner
2. emergency admission 12. nurse who signs off on the orders
3. Medicare 13. Wound care, diabetes care and patient educa-
4. TRICARE tion, IV medication administration
5. prior authorization 14. physical therapy, occupational therapy, speech
6. Managed care plans therapy, respiratory care, personal care
15. the primary care provider
Short Answer 16. listen to what the patient has to say, answer
1. make sure that all admission criteria are met questions, offer to ask the primary care provid-
and verify authorization for admission and er or supervising nurse to talk with the patient;
insurance coverage. ask the patient to sign the AMA form

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52  Student Learning Guide Answer Key

17. not pay for the treatment that has been re- 3. rectal
ceived 4. easy
18. a. Simply sit with the bereaved, listen, and 5. deep
offer quiet comfort. 6. blind
b. Offer to call the priest, minister, rabbi, or
spiritual advisor. Communication Exercise
c. Offer to make telephone calls or arrange- Each role play will be individual.
ments for someone to come and take the
significant other home if appropriate. CHAPTER 25
d. Allow the family and friends adequate
time at the bedside to say their goodbyes. Terminology
19. a. Death is from unknown causes. 1. aspiration
b. Death is at the hands of another. 2. biopsy
c. Patient has not been under the care of a 3. endoscope
physician within a specific time. 4. hematoma
5. jaundice
Review Questions for the Next Generation 6. panel
NCLEX® Examination 7. polyps
1. 2 8. smear
2. 3 9. transducer
3. 1, 3, 4, 6, 8, 9 10. tonsil
4. 4 11. liquid-based cytology (LBC)
5. 1
6. 4 Matching
7. 3 1. f
8. 4 2. c
9. 3 3. g
10. 1, 2, 4 4. b
11. 1 5. h
12. 1: AMA (against medical advice); 2: health; 3: 6. e
prescriptions; 4: hospital bill 7. i
8. d
Critical Thinking Activities 9. j
1. Answers will be individual. 10. a
2. Seek out relatives, the employer, and friends to 11. l
supply the needed information. 12. k
3. Seek the assistance of the social worker; enlist
the aid of a relative or neighbor to look in on Completion
her if she is self-sufficient. 1. diagnosis
2. noninvasive
STEPS TOWARD BETTER COMMUNICATION 3. ultrasonic waves
4. Hematology; components
Completion 5. leukocytosis; infection
1. significant other 6. prothrombin time
2. protocols 7. sedimentation
3. verified 8. 8 to 12
4. synopsis 9. Standard Precautions
5. alleviate 10. glucometer
6. devastating 11. kidney
7. lethargic 12. deteriorates
8. In general 13. pathology
14. movement
Word Attack Skills
15. nuclear medicine
1. drowsy
16. kidneys, ureters, bladder
2. active

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 Student Learning Guide Answer Key  53  

17. metal • posttest routine

18. electrical activity 2. • describe machine and sensations
19. heart; valves; coronary • need for keeping still
20. respiratory; capacity; diffusion • methods of dealing with claustrophobia
21. upper GI; barium enema • amount of time it takes
22. reaction; dye 3. Describe how ultrasound waves reflect struc-
23. GI tures.
24. colonoscopy procedures
25. endoscopic retrograde cholangiopancreatogra-
STEPS TOWARD BETTER COMMUNICATION
phy; stricture; cyst; stones
26. immediately
Completion
27. in a preservative solution
1. diagnostic
Review Questions for the Next Generation 2. titer
NCLEX® Examination 3. deteriorates
1. lithotomy 4. troubleshoot
2. 1, 2, 6, 8
3. 1 Word Attack Skills
4. 2 1. endoscope, microscope, fluoroscope, gastro-
5. 1 scope, sigmoidoscope, cystoscope, stethoscope
6. 1 2. cystoscopy, gastroscopy, proctosigmoidoscopy,
7. 2, 4, 5 sigmoidoscopy, fluoroscopy, colonoscopy
8. 1 3. arteriograph
9. 1, 3 4. angiography, ultrasonography, sonography,
10. 4 radiography, cineradiography, tomography,
11. 1: electrocardiogram; 2: treadmill (exercise) arteriography, cholangiopancreatography, elec-
stress test; 3: oximetry; 4: ventilation tests troencephalography

Application of the Nursing Process Pronunciation of Difficult Terms

1. a. Assess what the patient knows about the 1. AN gi OG ra phy
test. 2. cho LAN gi o PAN cre a TOG ra phy
b. Assess what concerns the patient has about 3. cys TOS co py
the test. 4. e LEC tro en CEPH al o gram
c. Assess for safety measures that need to be 5. gas TROS co py
implemented before or after the test. 6. my o CAR di al in FARC tion
d. Assess for allergy to medication used for 7. PAR a cen TE sis
the test or to skin preparation solutions to 8. PROC to sig moid OS co py
be used. 9. RA di o o PAQUE
2. Insufficient knowledge related to unfamiliarity with 10. RA di o IM mu no AS says
diagnostic test 11. THO ra cen TE sis
3. Patient will verbalize purpose of the test and
what will be experienced during and after the Communication Exercise
test. Practice increases pronunciation and intonation ability.
4. patient education regarding the test
5. implementing safety measures such as frequent
vital signs, forcing fluids, or other measures to CHAPTER 26
protect the patient
6. compare the result with the previous test result Terminology
Critical Thinking Activities
A. Matching
1. • what exactly is done
1. d
• purpose
2. c
• sensations patient will feel
3. g
• how long it takes
4. f
• pretest sedation

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54  Student Learning Guide Answer Key

5. h 3. plasma proteins and plasma colloid osmotic

6. a pressure
7. j 4. fluid imbalance
8. k 5. daily weight
9. i 6. a pulse rate over 100 bpm
10. e 7. neuromuscular irritability
11. l 8. tap the facial nerve about an inch in front of the
12. b earlobe

B. Completion Application of the Nursing Process

1. hypovolemia 1. Diarrhea, fatigue, nausea or anorexia, palpita-
2. hypokalemia tions, muscle weakness or paresthesias
3. hypocalcemia 2. Mucous membranes, concentrated urine, and
4. diffusion other signs
5. Osmosis 3. Fluid volume deficit
6. isotonic 4. Patient’s weight will decrease by 1.5 lb by
7. hypertonic tomorrow; pedal edema will subside before
8. edema discharge.
9. filtration 5. take in only clear liquids; take small sips of
10. active transport electrolyte solution such as Gatorade every
11. hypernatremia hour; give an antidiarrheal drug; encourage
12. hyperkalemia intake of water and other liquids; attempt to
13. hypermagnesemia determine cause of diarrhea; provide antinau-
14. hyperventilation sea medication if needed, keep the room free
15. diabetes from odors
6. weight, intake and output 24-hour total, elec-
Identification trolyte lab values, state of pedal edema, and
lung sounds
A.
1. Low—hypokalemia Review Questions for the Next Generation
2. Normal NCLEX® Examination
3. High—hypercalcemia 1. 4
4. Normal 2. 3
5. Normal 3. full, bounding pulse; weight 82 kg; blood pres-
6. Low—hyponatremia sure 190/90; inspiratory crackles to ausculta-
tion; pitting edema in feet
B. 4. 1
1. Respiratory acidosis 5. 1, 3, 4
2. Respiratory alkalosis 6. 450 mL
3. Metabolic acidosis 7. 4
4. Metabolic alkalosis 8. 1
9. 3
Short Answer 10. 4
1. a. be a vehicle for the transportation of sub- 11. 1, 2
stances to and from the cells 12. 3
b. aid heat regulation by providing perspira- 13. 1, 2, 3, 5, 6, 8
tion that evaporates 14. 3
c. assist maintenance of hydrogen ion balance 15. 1
in the body 16. 3
d. serve as a medium for the enzymatic action
of digestion Critical Thinking Activities
2. a. extracellular fluid 1. Cover kidney’s role in potassium regulation in
b. intracellular fluid the blood. Review foods containing potassium.

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 Student Learning Guide Answer Key  55  

Meats must be decreased; see Patient Educa- Mr. J.: “I think I can manage to do that.”
tion in the textbook.
Nurse: “You will also need to be certain you use
2. Present how sodium affects blood pressure. Re-
this container when you empty your bladder. Set it
fer to Patient Education Table in the textbook
aside and turn on the call light. Someone will come
and work with the patient’s food preferences to
and empty the container and record the amount of
devise an appropriate diet.
urine that was in it.”
Mr. J.: “I can’t do that myself? I hate to leave that
STEPS TOWARD BETTER COMMUNICATION
for someone else to do.”
Completion Nurse: “We really need to look at the urine when
1. considerable we measure it as well, so I’d prefer that you just let
2. compensatory us handle that task.”
3. tracking
Mr. J.: “OK, if you say so. I want to do what is
4. twitch
best.”
5. lethargic
6. buffer Nurse: “Thank you, Mr. J.”
7. ingestion

Vocabulary Exercises CHAPTER 27

1. Lung sounds: moist
2. Pulse: weak, full, bounding, thready, faint, Terminology
slow, rapid
3. Blood pressure: elevated A. Matching
4. Mucous membranes: moist, dry, sticky 1. o
5. Urine: scanty 2. k
6. Skin: moist, dry, sticky, pale 3. d
4. b
Word Attack Skills 5. j
1. shallow—deep 6. i
2. rapid—slow 7. g
3. passive—active 8. a
4. moist—dry 9. h
5. attraction—repellent 10. m
6. gain—loss 11. e
7. increase—decrease 12. n
8. deficit—excess 13. c
14. f
Communication Exercise 15. l
Dialogue written will vary among individuals.
Here is an example. B. Completion
1. complete (or high-quality) protein
Nurse: “Mr. Jones, we will be monitoring all the
2. incomplete (or low-quality) protein
fluids that you take into your body and all that are
3. complementary proteins
excreted. We do this any time a patient is receiving
4. essential
IV fluids to make certain that he is not receiving
5. nonessential
more fluid than the body can handle.”
6. Middle Eastern
Mr. J.: “So what will I have to do?” 7. kwashiorkor
8. vegan
Nurse: “You will need to write down on this sheet
9. vegetable fats
all the fluids that you drink. You can just note 1/2
10. saturated
glass water or 1 cup of coffee and I will translate
11. toxic effects
that amount into milliliters.”
12. kosher

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56  Student Learning Guide Answer Key

13. Kwashiorkor e. Religion: Food may need to be prepared in

14. glycemic index a certain way to be acceptable.
15. omega-3 fatty acids f. Culture: Appetite is usually better when
foods are familiar.
Review of Structure and Function 12. 6; double; triple
All answers are found in the Overview of Structure and 13. 4 to 6 months
Function section of the chapter. 14. sweet, non-nutritious foods
1. h 15. fast foods
2. d 16. evening; obesity (or hypertension)
3. b 17. older adults
4. a 18. 14, 1
5. e 19. 5
6. g 20. complete protein, vitamins, and minerals
7. c 21. 24.9
8. f 22. 300

Short Answer Identification

1. fruits and vegetables
2. linoleic acid, oleic acid, and linolenic acid A. Function of Vitamins
3. provide a concentrated supply of energy and All answers are in Table 27.4.
spare protein from being burned for energy 1. A
4. Cells; tissues; play a role in maintaining fluid 2. D
and acid-base balance, assist with transporta- 3. A
tion of nutrients, and are necessary for anti- 4. B3 (niacin)
body, enzyme, and hormone production, as 5. K
well as acting as a source of energy for the 6. B6
body 7. Folic acid
5. 10-15 8. E
6. 60%; complex; 4 9. C
7. metabolism; cellular 10. B12
8. breads, pasta, cereal, potatoes, and rice
9. a. Provide a quick source of energy B. Function of Minerals
b. Regulate protein and fat metabolism All answers may be found in Table 27.6. Any one an-
c. Help fight infection swer is correct.
d. Promote growth of body tissues 1. Calcium: muscle action, coagulation, building
e. High fiber intake is helpful in treating of strong bones and teeth
certain gastrointestinal disorders (e.g., con- Deficiency causes: poor bone growth, poor
stipation and hemorrhoids) and reducing blood clotting
blood cholesterol synthesis and levels 2. Chloride: maintenance of fluid and acid-base
10. 500 mL balance, activation of gastric enzymes
11. Examples will be of individual choice. Some Deficiency causes: acid-base imbalance
examples are: 3. Magnesium: build strong teeth and bones;
a. Age: Older adults may receive inadequate protein synthesis; regulation of heartbeat
nutrition because of difficulty obtaining or Deficiency causes: cardiac arrhythmia; possible
preparing food. confusion or poor memory
b. Illness: Nausea may cause inadequate 4. Phosphorus: build strong bones and teeth;
nutrient intake. maintain acid-base balance
c. Emotional status: Severe stress may cause Deficiency causes: weakness, stiff joints, an-
either anorexia or overeating and weight orexia
gain. 5. Potassium: maintain acid-base balance; trans-
d. Economic status: Inadequate funds may mission of nerve impulses; helps control
lead to a diet deficient in protein. muscle contractions; helps regulate heartbeat

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 Student Learning Guide Answer Key  57  

Deficiency causes: cardiac arrhythmia; hyper- 3. a. Patient will stabilize body weight after
tension; possible impaired growth surgery within 2 months.
6. Sodium: maintain acid-base and fluid balance b. Patient will not develop diarrhea when
Deficiency causes: hyponatremia; edema of feeding is resumed.
lower extremities 4. Any two of the following:
7. Chromium: activates enzymes; contributes to a. Weigh patient three times per week.
removal of glucose from the blood b. Ask family to bring in favorite foods to
Deficiency causes: central nervous system dys- tempt appetite.
function; weight loss; aggravation of diabetes c. Start small, bland, frequent feedings as
mellitus tolerated and slowly increase amounts.
8. Fluoride: contributes to formation of bones and d. Monitor closely for diarrhea, nausea, or
teeth; decreases cavities abdominal distention.
Deficiency causes: risk of dental caries 5. a. Weight is stabilized at 128 lbs.
9. Iodine: helps regulate metabolism; contributes b. Diarrhea minimal and stopped after 3
to healthy skin, hair, and nails days.
Deficiency causes: goiter; cretinism in children 6. Declining most of diet due to anorexia.
if mother was deficient during pregnancy Weight loss of 0.5 lb this week.
10. Iron: formation of hemoglobin Loose stools occurred after first three feedings.
Deficiency causes: iron-deficiency anemia Continues to experience nausea.
11. Zinc: immune function; protein synthesis; nor- 7. Revise the plan of care in attempt to find inter-
mal growth and sexual development; wound ventions that will assist the patient to meet the
healing expected outcomes.
Deficiency causes: depressed immune function;
poor growth; delayed sexual maturation Review Questions for the Next Generation
NCLEX® Examination
Application of the Nursing Process (Answers require synthesis and application of knowl-
1. BMI = 24 edge.)
2. Potential for altered nutrition 1. 2
2. 4

3.
Nursing Action Indicated Contraindicated
Create a pleasant mealtime environment. X
Encourage favorite sweet snacks between meals. X
Instruct patient that protein and vitamin C are essen-
X
tial to healing.
Ask family or friends to bring in favorite foods. X
Sneak in a Frappuccino from the local coffee shop. X

4. 3 13. 3
5. 2 14. 1
6. 3 15. 2, 4
7. 1 16. 2, 4, 5, 8
8. 1, 2, 5 17. 1
9. 2 18. 4
10. 1, 2, 3, 4 19. thyroid gland
11. 4
12. 3

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58  Student Learning Guide Answer Key

Critical Thinking Activities Ms. A.: Not even a little in cooking?

1. See Table 27.4 for problems of deficiency of the Nurse: Not if (10) ya want to follow doctor’s orders
various B vitamins. and keep your blood pressure down. We don’t
2. Plan choices using MyPlate along with calorie want to see you back in here again.
and fat charts for various fast foods. Consider
Jackie’s likes and dislikes. Suggest take-along Ms. A.: No offense, but I (11) don’ wanna BE back
foods such as fresh fruit and snack packs of here again.
carrots. Discuss nutrition bars. (12) I’ll jus’ hafta try ta get usta it, I guess.
3. Recommend finger foods such as high-quality
hot dog pieces or low-fat sausage pieces, Nurse: That’s the spirit. Now let me take your vital
chunks of cheese cut into fun shapes. Raw signs.
vegetable pieces may be more appealing than
cooked vegetables. Refrain from sweet foods 1. Good Morning, Ms. Andrews. How are you
as much as possible. Encourage real fruit slices today?
rather than juice drinks. Try a variety of foods. 2. they would give me
Offer small rewards such as a story if all food 3. What do you mean? What did you have?
is eaten. Feed more frequently throughout the 4. and cold oatmeal and milk. And the toast was
day. dry and cold.
4. Individual answers will indicate changes 5. That doesn’t
needed. 6. Did you call the nurse and ask for hot tea?
7. No. It wasn’t worth it. I am going home today,
anyway.
STEPS TOWARD BETTER COMMUNICATION 8. You know you are
9. supposed to
Vocabulary Exercises 10. you
1. Child rearing is comprised of feeding, clothing, 11. don’t want
nourishing, training, loving, and educating a 12. I’ll just have to try to get used to it
child.
2. Finicky eaters consume some foods sparingly.
3. The lack of green vegetables in his diet com- CHAPTER 28
promised his health.
4. Many volunteers for the Meals on Wheels pro- Terminology
gram are retired and enjoy helping their peers.
A. Completion
Communication Exercise 1. atherosclerosis
Nurse: (1) Morning, Ms. Andrews. How’re you 2. binge eating
today? 3. glycosuria
4. dysphagia
Ms. A.: I’m OK, but I wish (2) they’d gimme a bet- 5. obese
ter breakfast! 6. bulimia nervosa
Nurse: (3) Whaddaya mean? What’d you have? 7. obesity
8. parenteral
Ms. A.: Just some lukewarm watery tea, (4) and 9. PEG (percutaneous endoscopic gastrostomy)
cold oatmeal and milk—with no salt. And the toast 10. elevated at least 30 degrees
was dry and cold. 11. residue
Nurse: (5) Doesn’t sound very appetizing. I’ll speak
to dietary. Didya call the nurse and ask fer hot tea? Identification
Answers may be found in Box 28.1.
Ms. A.: (7) Naw. ‘t wasn’t worth it. I’m goin’ home 1. N (unless it is strained)
today anyway. 2. B
Nurse: That’s good news. But (8) ya’ know you’re 3. F
on a low sodium diet. That means you’re not (9) 4. B
sposed ta have salt added to your food. 5. F
6. N

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 Student Learning Guide Answer Key  59  

7. B 13. aspiration
8. B 14. x-ray examination
9. F 15. endoscopy; ambulation; feedings
10. F 16. Check the health record for the measurements.
11. B Measure the tube length from skin level to the
12. F end of the placement adapter. Compare the
measurements to the initial measurements
Short Answer right after placement. High measurement
1. a. have paralysis or immobilization of an arm indicates outward movement of tube. Notify
b. are visually impaired charge nurse and physician if dislodged.
c. have an intravenous line in their hand or 17. 240-360
arm 18. glycosuria; diarrhea
d. have severe impairments or weakness 19. Any four of the principles listed in Box 28.3.
e. problems with breathing or swallowing 20. speed up the rate to catch up on the amount
(dysphagia) that should have been infused.
2. up to 12 hours
3. nutritional; modification; psychological Application of the Nursing Process
4. a. Physical education and physical activity Any four of the following from Table 28.5.
b. Nutrition environment and services 1. a. Monitor IV site every 4 hours for signs red-
c. Health education ness, swelling, or drainage.
d. Social and emotional school climate b. Patient response: Every shift. Observe for
e. Physical environment signs of restlessness or discomfort.
f. Health services c. Monitor blood glucose levels every 6-8
g. Counseling, psychological and social ser- hours. Report abnormal levels to primary
vices care provider.
h. Employee wellness d. Assess rate of flow every 4 hours to deter-
i. Community involvement mine that solution is flowing no faster than
j. Family engagement rate ordered.
5. thiamine e. Track intake and output every shift.
6. cardiovascular disease, stroke, diabetes, hyper- f. Monitor vital signs every 4–8 hours to de-
tension, gallbladder disease, joint disease, and tect any sign of infection or complications.
some forms of cancer g. Monitor weight daily or weekly as or-
7. saturated fats, and trans-fats, and cholesterol dered.
8. fruits, vegetables, nuts, seeds, legumes, and h. Electrolytes, CBC, and BUN: Daily or as
low fat dairy products ordered. Evaluates the patient’s response.
9. secreted in normal or excessive amounts but i. Nutritional status: Ongoing. Includes
receptor sites won’t let most glucose into the weight, albumin levels, and status of
cells muscle mass.
10. a. cardiovascular disease 2. Altered nutrition related to anorexia and oral
b. hypertension lesions. Fluid volume deficit, related to frequent
c. kidney disease diarrhea. Potential for injury related to possible
d. stroke aspiration related to tube feeding.
e. blindness 3. Expected outcomes will depend on the prob-
11. 70-120 lem statements chosen. For the nursing diagno-
12. a. Maintaining high calorie intake ses in #1 above, the expected outcomes might
b. Increasing protein intake to maintain or be:
increase muscle mass a. Caloric intake will be 2500 calories per day.
c. Offering bland, soft, or puréed foods when b. Fluid intake and output will be balanced
the mouth is painful within 48 hours.
d. Adding thickening agents to liquids if c. No injury from aspiration of tube feeding
swallowing is difficult will occur while feeding tube is in place.
e. Adding seasoning to help food taste more d. The patient will tolerate food and fluids
appealing without vomiting.
f. Encouraging small, frequent meals

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60  Student Learning Guide Answer Key

e. The patient will consume at least 90% of all If persistent diarrhea occurs, notify the primary
meals. care provider.
f. The patient’s breath sounds will remain 5. Correct order is:
clear without evidence of aspiration of a. 5 Open the clamp and prime tubing.
food or fluids. b. 7 Observe the infusion for 2-3 minutes
g. The patient will gain 2 pounds by time of before leaving patient.
discharge. c. 3 Elevate the patient’s head and upper
h. The patient’s stools will be formed. body.
4. Any four of the following: d. 2 Don gloves.
Elevate the head of the bed 30-90 degrees be- e. 1 Check orders for type, amount, and
fore feeding and leave it up for 30-60 minutes flow rate of feeding.
after the feeding. f. 4 Open tubing and feeding bag and con-
Keep the head of the bed always elevated at nect to feeding pump with tubing clamp
least 30 degrees if the patient is receiving con- closed.
tinuous feeding. g. 6 Attach tubing and set the flow rate.
Assess bowel sounds at least once every 8 h. 8 Remove gloves and perform hand
hours. hygiene.
Assess abdomen for distention. 6. Evaluation statements might be:
Check the tube position (using two methods) a. Patient demonstrates no nausea or diar-
within the gastrointestinal tract before each rhea.
feeding is started or at least once each shift. b. Weight has remained the same or there is
Check for gastric residual by aspirating via the weight gain.
gastric tube before each intermittent feeding c. No evidence of muscle wasting or abnor-
or at least every 4 hours if the patient is receiv- mal serum albumin level.
ing continuous feeding. If the gastric residual
is greater than 500 mL (or per agency policy), Review Questions for the Next Generation
replace the residual, document and notify the NCLEX® Examination
RN or primary care provider, and delay the 1. 40
next feeding for 1-2 hours. 2. 2
Perform fingerstick for blood glucose every 4 3. 2
to 6 hours as ordered for hyperglycemia until 4. 3
the patient demonstrates a normal blood glu- 5. 2, 3, 5
cose level. 6. 2
If nausea occurs, stop the feeding and notify 7. 2
the primary care provider. 8. 4
Maintain an accurate intake and output record. 9. 2
Dehydration can occur because of diarrhea or 10. 3, 4, 5
the high glucose content of the formula. 11. 3

12.
Nursing Action Indicated Contraindicated
Approach patient in a nonjudgmental manner. X
Educate the patient about “carb counting.” X
Teach the patient about bad carbohydrates that need to be
X
avoided.
Assist the patient in identifying nutritious foods to include
X
in the meal plan.
Help the patient plan how to limit carbohydrates early in
X
the day and save most carbohydrates for late in the day.

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 Student Learning Guide Answer Key  61  

13. 1: complete nutrition, 2: catheter; 3: large; 4: CHAPTER 29

central; 5: shorter-term; 6: arm; 7: carbohydrate;
8: digestive Terminology

Critical Thinking Activities A. Matching

1. Consider ways to decrease cholesterol, saturat- 1. m
ed fat, trans-fat and sodium-containing foods; 2. h
no added salt at the table or in cooking. Should 3. e
include menus for several days. 4. g
2. Frequent, small meals; experiment with sea- 5. i
sonings to enhance taste. Add powdered milk 6. j
to solids such as meatloaf, mashed potatoes, 7. c
casseroles, etc. Make high-powered milkshakes 8. d
using fruits and protein powder. Add extra egg 9. k
to casseroles and dishes such as meatloaf. 10. f
3. Answers will vary. Example of possible an- 11. b
swer: 12. l
To assist an adolescent patient with type 2 13. n
diabetes in adapting their diet, focus on incor- 14. o
porating healthier versions of their favorite 15. a
foods, such as using whole grain options for
pizza or burgers. Encourage balanced meals B. Completion
with appropriate portions of proteins, healthy 1. endotracheal tube (ETT)
fats, and vegetables. Additionally, involve the 2. tracheostomy
adolescent in meal planning and preparation 3. obturator
to foster a sense of control and adherence to 4. inspiration
dietary changes. 5. hypercapnia
6. hypoxemia
7. anoxia
DEVELOPING CLINICAL JUDGMENT 8. respiratory
1. See Box 28.3.
2. See Table 28.5. Review of Structure and Function
3. See Nursing Care Plan 28.1. 1. Central nervous system
4. Reference labs from clinical text and consider 2. Cilia
patient diagnosis and medications. 3. Alveolar macrophages
4. Chemoreceptors
STEPS TOWARD BETTER COMMUNICATION 5. Mucous membranes
6. Alveolar membrane
Completion 7. Trachea
1. discrepancies 8. Upper airway passages
2. bland
3. resection Short Answer
4. binge 1. See Skill 29.2. Ask if the person can speak and
5. collaboration verify person is choking. If unable to speak and
6. trimester coughing is ineffective, stand behind the per-
7. exacerbation son and place arms around the person halfway
8. instilled between the umbilicus and the xiphoid process
with one hand forming a fist and the other
over the fist. With an upward motion, force-
fully thrust the hands into the abdomen at an
upward angle.

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62  Student Learning Guide Answer Key

2. See Table 29.4. Sequencing

a. Nasal cannula: patient can move, talk, and Sequence of correct answers: 7, 13, 3, 2, 12, 8, 6, 9,
eat while receiving oxygen. 10, 11, 14, 1, 5, 4
b. Simple face mask: allows higher delivery
of oxygen than cannula. Application of the Nursing Process
c. Partial rebreathing mask: Can deliver 1. Auscultate the patient’s lungs, measure vital
higher concentrations (40%-60%) oxygen signs, check skin and mucous membrane color,
flow. assess shortness of breath with activity, check
d. Non-rebreathing mask: Can deliver 60%- mentation.
90% oxygen in an emergency. 2. Altered gas exchange related to retained secretions
e. Venturi mask: Accurate delivery: provides in right lower lobe.
consistent Fio2 regardless of breathing pat- 3. Gas exchange will improve within 2 days.
tern. 4. Turn, cough, and deep breathe at least every 2
f. Transtracheal catheter: The flow require- hours; use incentive spirometer; ambulate fre-
ment is reduced 60%-80%, increasing the quently; increase fluid intake to thin secretions;
time that oxygen is available from the administer oxygen as ordered; monitor lung
portable source. The catheter is less visible. status and respiratory rate; provide postural
Less nasal irritation occurs. drainage if ordered.
g. Tracheostomy collar: Adds humidity to 5. Actions are effective if lungs are clear to aus-
oxygen flow for a tracheostomy. cultation and there is no shortness of breath;
h. T-bar: Adds humidity to oxygen flow for a respiratory rate is within normal limits.
tracheostomy.
3. a. Preoxygenate the patient. Review Questions for the Next Generation
b. Maintain sterility of the suction catheter NCLEX® Examination
and supplies. 1. 2-3
c. Do not apply suction while inserting the 2. 1
catheter. 3. 2, 3, 5
d. Do not suction for more than 10 seconds. 4. 4
4. Any five of the following: 5. 3
a. restlessness and irritability 6. 2
b. increasing anxiety 7. 3
c. confusion, decreased concentration 8. 3
d. tachypnea 9. 1
e. stridor 10. 2-12
f. retractions of accessory muscles 11. 2
g. cardiac arrhythmia 12. Steps in the correct order:
h. cyanosis • Auscultate the lungs to locate retained
i. does not seem right secretions.
j. combative • Position patient in semi-Fowler position
k. headache • Preoxygenate patient.
l. lethargic • Set up and check that suction equipment is
5. Making certain that the sensor is attached and correctly functioning.
functioning properly, the machine is properly • Open catheter suction kit; pour solution
set, that a trend of decreasing oxygen satura- into container.
tion is reported promptly to the primary care • Don sterile gloves (or sterile glove
provider, adjusting oxygen flow to provider on dominant hand + clean glove on
orders based on SpO2 levels, and documenting nondominant hand).
readings at intervals. • Pick up sterile catheter with gloved
6. a. To relieve an airway obstruction dominant hand.
b. To protect the airway • Insert moistened catheter into naris.
c. To facilitate suctioning • Intermittently apply suction while
d. To provide artificial ventilation withdrawing catheter.
• Rinse the catheter and tubing with solution

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 Student Learning Guide Answer Key  63  

• Auscultate the lungs; listen for noise Review of Structure and Function
indicating retained (remaining) secretions. 1. c
• Document procedure. 2. f
13. 1: air; 2: fluid; 3: pleural space; 4: sucked; 5: 3. d
chest; 6: expected; 7: constant 4. b
5. a
Critical Thinking Activities 6. e
1. Medicate for pain; assist to splint ribs to cough;
teach forced exhalation coughing. Identification
2. — When it will be done 1. Color: dark amber
— Pain medication beforehand 2. Character: slightly cloudy
— How it will feel 3. x Specific gravity: 1.008
— Need for occlusive dressing 4. pH: 6.0
3. — Monitor oxygen saturation of the blood in 5. x Glucose: 1+
noninvasive fashion 6. x Protein: 1+
— Explain mechanics of light probe 7. Ketones: 0
— Meaning of readout on screen 8. x Leukocytes: moderate
— Alarms 9. Erythrocytes: 0
— How readings are used 10. x Bilirubin: slight
11. x Pyuria: trace
STEPS TOWARD BETTER COMMUNICATION
Short Answer
1. frequency, urgency, dysuria (painful urination),
Completion
burning, malaise, foul-smelling urine, and a
1. copious
slight temperature elevation
2. brink
2. Any three of the following:
3. intertwined
a. Run water in a basin while the patient at-
4. combustion
tempts to urinate.
b. Pour warm water over the perineum while
CHAPTER 30 patient attempts to urinate.
c. Have male patient stand at the side of the
Terminology bed to urinate.
d. Have the patient blow into a straw placed
A. Matching in a glass of water while attempting to
1. e urinate.
2. f Other possible answers for question #2:
3. i e. Run water in a nearby sink so the patient
4. h hears the sound.
5. a f. Have the patient deep breathe, relax, and
6. g visualize a peaceful place with a bubbling
7. j brook. Encourage the patient to drink a
8. b cup of warm caffeinated coffee or tea.
9. c g. With an order, gently but firmly use Credé
10. d maneuver over the bladder (massage from
top of bladder to bottom by starting above
B. Completion the pubic bone and rocking the palm of the
1. commode chair hand steadily downward). This is pri-
2. micturition marily used for patients with neurogenic
3. residual urine urinary dysfunction.
4. retention h. Obtain an order for a sitz bath and have
5. urostomy the patient sit in the warm water. Encour-
6. catheterization age the patient to void while in the bath.
7. condom catheter Cleanse the perineum afterward.

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64  Student Learning Guide Answer Key

3. discard the catheter and use a sterile one to the patient has been consistently inconti-
avoid introducing bacteria into the bladder nent during the night.
4. regularly experience urinary retention or 9. label the specimen correctly with the patient’s
incontinence such as those who have a neu- name, room number, primary care provider’s
romuscular problem that prevents them from name, date, and time; place the container in a
emptying the bladder normally biohazard transport bag; transport it to the lab
5. Any three of the following: within 15 minutes of collection or refrigerate it
a. Wash out residual urine or sediment from until specimen pick-up time
the bladder.
b. Remove clots and stop oozing of blood Completion
after prostate or bladder surgery. 1. 5-10 times
c. Soothe irritated bladder tissues and pro- 2. infection
mote healing. 3. 8
d. Ensure that the lumen of the indwelling 4. 15 minutes
catheter is open and draining. 5. discard
e. Instill medication into the bladder. 6. strained
6. Cystitis and other UTIs may be avoided by: 7. 1.010 to 1.030
Increasing fluid intake to 2500-3000 mL/day. 8. get onto/sit
Avoiding citrus fruits and juice (if prone to 9. Coudé
frequent reoccurrence) because they cause 10. 1 million
alkaline urine; bacteria grow more readily in 11. dilute
alkaline urine. 12. beneath the buttocks
Always wiping the rectal area from front to 13. urinary meatus
back after a bowel movement. This is especially 14. reduce the number of urinary tract infections
important in female patients. 15. will not
For the female patient, avoiding wearing 16. Wash out residual urine/sediment from the
tight clothing and nylon pantyhose that cause bladder
continual perineal moisture; wearing cotton Remove clots and stop oozing of blood; sur-
underwear. gery
Not sitting around in a wet bathing suit for Soothe irritated bladder tissues; promote heal-
extended periods. ing
For the female patient, not using bubble bath Ensure patency of catheter; instill medication
or feminine hygiene sprays. into the bladder
For the female patient, emptying the bladder
promptly after intercourse and drinking two Application of the Nursing Process
glasses of water to flush out microorganisms 1. Is there any burning? Do you have trouble
that may have entered the bladder. initiating the stream? Is there a foul smell to
Bathing or showering daily (all sexual part- the urine? What color is the urine? How much
ners). fluid are you drinking? How often do you have
Emptying the bladder every 2-3 hours to pre- get up at night? What medications are you tak-
vent stasis and potential for bacteria to multi- ing?
ply if present. 2. *Altered urinary function
7. closed technique Disrupted sleep pattern
8. a. Determine the cause of urinary inconti- Potential for infection
nence and whether a continence program 3. Answers will vary and may include:
is appropriate. a. Urine elimination will be maintained with
b. Keep a record of actual voiding times for 3 use of catheter or drugs.
days. b. Normal urinary pattern will be reestab-
c. Establish a 2-hour voiding schedule timed lished after 2 months of drug therapy.
before the patient’s usual voiding times. 4. He is at risk for urinary tract infection because
d. Encourage the intake of 2000-3000 mL of of the altered urinary function (retention).
fluid between awakening and 6 pm. Decreasing fluid volume will increase that risk.
e. Toilet just before bedtime; do not awaken He should drink normal amounts of fluid.
for toileting except before the time when

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 Student Learning Guide Answer Key  65  

5. Palpate the bladder after he voids to determine Vocabulary Exercises

if there is still retention. Assess output and Answers will be individual. Examples are:
compare it to input to see if there is a balance. 1. The patient with the fractured hip and a uri-
Assess if voidings are becoming less frequent nary catheter was dependent on the nurse to
and of more volume. help him turn in bed.
2. The tubing leading to the urinary catheter
Review Questions for the Next Generation drainage bag should not be dependent; it
NCLEX® Examination should be kept above the level of the bag.
1. urine specific gravity 3. The preoperative order is invalid because
2. 1 the patient has had surgery. New orders are
3. 2, 3, 5 needed.
4. 1, 2, 3 4. While recovering from kidney surgery, the
5. 2 patient is considered an invalid.
6. 3, 4 5. When stasis of urine occurs regularly, the pa-
7. 2 tient is prone to urinary tract infection.
8. 4 6. After placement of the urostomy tube, the
9. 1 patient was more comfortable on his side or in
10. 2 a prone position.
11. 1
12. 2, 5, 6, 7
13. 1- Kegel; 2- abdominal; 3- breath; 4- 10 CHAPTER 31

Priority Setting Terminology

1. 2
2. 4 A. Matching
3. 3 1. k
4. 1 2. e
3. a
Critical Thinking Activities 4. c
1. Base the plan on the individual and Patient 5. j
Education in the textbook. 6. i
2. Use Health Promotion “How to Prevent Recur- 7. f
rent Cystitis” and adjust patient education to 8. g
the individual. 9. b
3. Explain dangers of urine backing up into the 10. h
kidney. Explain the functions of the kidney and 11. l
how they can be damaged. 12. d

STEPS TOWARD BETTER COMMUNICATION B. Completion

1. fecal impaction
Completion 2. borborygmi
1. bulbous 3. incontinence
2. impede 4. 45
3. stasis 5. vagal response
4. instillation 6. Valsalva maneuver
5. prone 7. ostomy
6. pucker 8. atrophy
7. patent 9. baby bottle nipple
10. periostomal
11. effluent
12. black or occult

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66  Student Learning Guide Answer Key

Review of Structure and Function b. Keeping the height of the enema bag no
1. g more than 18 inches above the rectum
2. a c. Controlling the flow of the fluid so that it
3. c doesn’t run in too fast
4. j d. Stopping the flow if the patient experiences
5. h severe cramping
6. d 8. a. stimulating the inner surface of the rectum
7. i b. forming gas that expands the rectum
8. b c. melting to lubricate the stool for easier pas-
9. f sage from the rectum
10. e
Application of the Nursing Process
Short Answer 1. obtain a history of usual bowel function, diet,
1. Any four of the following: and medications; characteristics of the stool;
a. Dehydration changes in appearance of stool or pattern of
b. Narcotic pain medication bowel movements; auscultate bowel sounds;
c. Diet lacking fiber and sufficient fluid palpate and percuss abdomen
d. Decreased exercise or immobility 2. Potential for constipation related to inactivity and
e. Hypoactive bowel narcotic pain medication
f. Injury or disease affecting abdominal 3. Patient will have normal bowel movements
muscles before discharge.
g. small serving of stewed or dried prunes 4. increase fluid intake; add fiber to the diet; give
2. a. Melena: bleeding in the stomach or small a stool softener or bulk-forming laxative; pro-
intestine vide privacy for defecation; assess abdominal
b. Occult blood: small amount of bleeding in status and bowel pattern
the intestines 5. bowel movements and appearance of stool
c. Pale white or light gray stool: blockage of (intake and output; dietary intake; and toler-
bile flow into the intestine ance of stool softener or bulk-forming laxative
d. Mucus: Irritation or inflammation of the would be assessed also)
bowel
e. Foul-smelling stool that floats in water: Review Questions for the Next Generation
high fat content in the stool NCLEX® Examination
f. Liquid stool; gastrointestinal infection or 1. modified left lateral recumbent position
toxicity causing diarrhea 2. 3
g. Hard, dry stool: lack of fluid and fiber or 3 1
lack of peristalsis 4. 4
3. a. loss of body function and change in body 5. 4
image 6. 3
b. possibility of rejection by others 7. 1, 4, 5
c. loss of physical or sexual attractiveness 8. 2
d. death from underlying disease 9. 3
4. A member of the United Ostomy Association of 10. 3
America 11. 1
5. a. Colostomy 12. Steps in the correct order:
b. Ileostomy • Assess stoma appearance, type, and
c. Kock pouch (Figure 31.6) location.
6. a. Increase dietary fiber • Gather necessary supplies.
b. Increase fluid intake • Measure the stoma with measuring device.
c. Exercise regularly • Don gloves; empty old pouch.
d. Heed the urge to defecate • Remove old pouch while stabilizing skin;
7. a. Testing the fluid temperature to be sure it discard; save the closure clip.
isn’t too hot • Gently clean stoma and skin; pat dry.
• Change gloves; prepare appliance.

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 Student Learning Guide Answer Key  67  

• Center and carefully apply the pouch CHAPTER 32

appliance.
• Gently press down on skin barrier ring. Terminology
• Attach and secure closure clip. 1. f
• Remove gloves, perform hand hygiene, 2. d
and make patient comfortable. 3. h
• Document procedure. 4. l
13. Using PCA every 2 hours; no BM since admis- 5. c
sion; hypoactive bowel sounds; IV infusing at 6. b
50 mL/hr; inadequate oral intake 7. i
8. e
Priority Setting 9. k
2, 3, 1, 4, 5 10. g
11. a
Critical Thinking Activities 12. j
1. Teach basics of how bowel works. Cover points
of bowel dietary and exercise intervention and Short Answer
the importance of paying attention to the urge 1. Biofeedback: use of a machine that measures
to defecate. Individualize the plan to accom- the degree of muscular tension to teach the
modate eating in restaurants most of the time. patient to relax particular muscles.
2. How to collect the stool—Saran WrapTM over 2. Distraction technique: patient focuses on some-
toilet bowl, paper plate, etc.; How much stool thing other than pain, such as a word or object.
to place on the test window. The concentration blocks out the pain sensa-
3. See Steps 31.2 and individualize to the patient tions.
as needed. 3. Epidural analgesia: catheter is placed in epi-
dural space and opioid analgesic is adminis-
STEPS TOWARD BETTER COMMUNICATION tered via a pump.
4. Guided imagery: patient is assisted to form
Completion pleasant mental images of another place that
1. heed takes focus off of pain sensations.
2. distention 5. Hypnosis: inducing a trance-like state using
3. triggering focusing and relaxing techniques to alter con-
4. wafer sciousness.
5. oblique 6. Meditation technique: patient concentrates on
6. commode a focal point such as a visual point, a sound,
7. scanty a repeated phrase, or on their own breathing,
which turns attention away from pain.
Word Attack Skills 7. Patient-controlled analgesia: intravenous opi-
1. Colostomy is located along the colon. oid medication administered from a pump by
2. Ileostomy is located along the ileum of the the patient.
small intestine. 8. Relaxation technique: Techniques to relax
3. Urostomy is located on the abdominal wall muscle groups that decrease muscle tension,
where the ureter is attached to discharge urine thereby reducing pain.
from the kidney. 9. Transcutaneous electrical nerve stimulation:
small electrical stimulator delivers pulses of
Communication Exercises electrical current that block the transmission of
2B. Dialogue will be individual for each student. pain sensations.
3. Dialogue with the enterostomal therapist will be 10. stimulating large-diameter nerve fibers, closing
individual. the gate.
11. a. Transduction: NSAIDs to block substances
that trigger the nociceptors.
b. Transmission: opioids to interfere with the
transmission of impulses from nociceptors.

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68  Student Learning Guide Answer Key

c. Perception: distraction or guided imagery may be prescribed to reposition the tongue or

to divert perception away from the pain. jaw at night. If a device cannot be tolerated,
d. Modulation: drugs that block neurotrans- surgical procedures can be performed to cor-
mitter uptake. rect the obstruction
12. providing distraction 25. a. Poor muscle tone, excessive tissue, or de-
13. the cerebral cortex and thalamus to open the formities such as a deviated septum
gate b. Obstructed airways related to colds or al-
14. a. nonopioid pain medications lergies
b. cyclooxygenase-2 (COX-2) inhibitors 26. a. warm water compresses
c. narcotics or opioids b. warm blankets
d. adjuvant analgesics c. Aquathermia pads
15. nerve injury d. tub and whirlpool baths
16. 14 to 17; brain maturation e. chemical self-heating packs
17. tolerance; analgesia f. heat-producing equipment
18. a. Fear 27. sudden onset, recurrent, uncontrollable brief
b. Pain episodes of sleep during hours of wakefulness
c. Stress in a well-rested person
d. Medication side effects 28. clinical evaluation, sleep logs, and sleep labora-
19. 9 to 12 tory tests
20. Non-rapid eye movement sleep (NREM) 29. a. Reducing swelling
21. a. Stage 1: a light sleep with relaxed muscles b. Calming muscle spasm
lasting only a few minutes c. Reducing pain in joints and muscles
b. Stage 2: a deeper sleep with more brain 30. a. Use a barrier between the ice pack and the
wave activity and bursts of electrical activ- skin.
ity lasting about 10-20 minutes b. Limit duration of use to 15-20 minutes at a
c. Stage 3: delta sleep with slow brain waves; time.
respirations and heart rate slow and the
body becomes immobile; lasts 20-40 min- Application of the Nursing Process
utes 1. Look for changes in his vital signs; develop
d. Stage 4: deepest stage of sleep with person a system of communication in writing or by
difficult to arouse; lasts about 30 minutes pointing to pictures. Use a pain scale by point-
e. REM sleep: brain waves become active as ing to the options and have him blink or move
if awake; dreams occur; lasts 20 minutes or his head for “yes” and “no” answers. Study his
longer body language for clues to the degree of pain.
22. a. Too much caffeine 2. Problem statements chosen will vary. Examples
b. Nicotine from smoking are:
c. Alcohol consumption can cause nocturnal Potential for injury related to potential for fat em-
awakenings bolus from fracture
d. Regular exercise promotes sleep, but not Potential for infection related to multiple trauma
too close to bedtime and intubation
e. Napping during the day may disrupt Altered mobility related to trauma and ventilation
nighttime sleep Altered self-care ability related to immobility
23. a. Environment is too noisy. 3. Expected outcomes will vary depending on
b. Room is too hot or too cold. choice of problem statement. Examples: (syn-
c. Room is has too much ambient light. thesis and application of knowledge)
24. Obstructive apnea may be treated conserva- a. Patient will not suffer injury from a fat
tively with recommendations for weight loss embolus.
and sleep aids such as support pillows. More b. Patient will not develop wound or respira-
complex cases require treatment with a contin- tory infection while immobilized.
uous positive airway pressure (CPAP) device c. Patient will not develop muscle atrophy
or a bilevel positive airway pressure (BiPAP) while immobilized.
device. The devices use a small compressor to d. Patient will resume self-care activities
maintain airflow via a mask or nasal prongs when no longer immobilized.
while the patient sleeps. A dental appliance 4. a. Administration of analgesia via PCA pump

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 Student Learning Guide Answer Key  69  

b. Use of distraction in the form of video- 3. Use progressive relaxation starting at the toes
games, apps, or TV or head and going steadily up or down the
c. Use of guided relaxation exercises or imag- body relaxing the muscles in each area. Use
ery slow, deep breaths between each set of muscle
d. Use of cold packs over injured joints relaxations.
5. Statements will vary depending on the expect-
ed outcomes written. Examples: (see Nursing
STEPS TOWARD BETTER COMMUNICATION
Care Plan 32.1)
a. Indicates PCA pump is controlling pain.
Completion
b. Did not use PCA while engaged in playing
videogame.
A.
c. Indicated guided relaxation helps decrease
1. adjuvant
pain.
2. stress
d. Indicates cold packs feel good and reduce
3. distraction
pain.
4. pantomime
5. divert
Review Questions for the Next Generation
6. enhanced
NCLEX® Examination
7. perception
1. 3
8. stoic
2. 1
9. integrative
3. 3, 4, 5
10. phantom
4. FLACC
5. 4
B.
6. 1, 2, 3, 4, 5
Examples are:
7. 2
1. During the course of the night the patient expe-
8. 3
rienced severe phantom pain.
9. 1, 2, 4
2. On occasion, over-the-counter pain medication
10. 2, 4
is effective for most patients.
11. Steps in the correct order:
3. During the course of an illness, over-the-coun-
• Check provider order to determine
ter medication may be used before seeking the
electrode placement.
help of a health care professional.
• Assemble equipment.
4. Most nurses on occasion get tired of the hours
• Identify the patient.
of shift work.
• Explain the procedure.
5. Many nurses are likely to suffer from the ef-
• Ensure TENS unit is OFF and electrodes
fects of shift work if they continuously have to
are properly connected.
work the night shift.
• Spread conductive jelly on electrode pads.
6. Patients who are on prescription medications
• Place electrode pads on patient skin; tape if
and also take over-the-counter medications are
needed.
likely to suffer from some drug interactions.
• Turn unit on.
7. Nurses do adjust to shift work to a fair degree
• Increase amplitude according to patient
rather quickly.
tolerance/response.
• Turn unit off when treatment completed;
Communication Exercises
remove electrodes.
Answers depend on individual responses.
• Assist patient in cleaning jelly off.
• Assess tolerance of procedure.
• Document procedure.
CHAPTER 33
12. 1- acute; 2- chronic; 3- nociceptive; 4- transmis-
sion
Terminology
1. Acupressure
Critical Thinking Activities
2. aromatherapy
1. Consult Patient Education in the textbook.
3. chiropractic
2. Use Table 32.2 and a drug handbook.
4. Reiki

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70  Student Learning Guide Answer Key

5. Folk medicine 10. 1, 5

6. Acupuncture
7. meridian Critical Thinking Activities
8. integrative 1. patients with sensitivity to ragweed; pregnant
patients
Short Answer 2. Chiropractic medicine is used mainly to treat
1. Psychological practices (part of “Mind and muscle and skeletal problems. It is often
Body Practices”) combined with massage, electrostimulation of
Physical practices (part of “Mind and Body muscle, and specific exercises. Back strain and
Practices”) whiplash injury are two commonly treated
Nutritional (includes nutrition and natural maladies. It is based on the belief that correct
products) spinal alignment leads to healing of muscle
2. Any four of the following: acupuncture, yoga, strains and impingement of nerves.
chiropractic, massage therapy, relaxation ther- 3. You should caution the cardiac transplant can-
apy, imagery, meditation, biofeedback, biofield didate to discuss herbs being taken with their
therapies (Qi gong, Reiki, therapeutic touch), primary care provider. Many herbs interact
hypnotherapy, music/art/dance therapy, hu- with medications used with transplant patients
mor and can even lead to organ rejection.
3. check for contraindications to the use of herbal
therapies, considering other medications the Completion
patient is taking and the total health status of 1. inherently
the patient. The patient should be directed to 2. alignment
reliable information available about the herbals 3. wafted
being considered. 4. comprised
4. a. like cures like 5. medium/conduit
b. the greater the dilution of the remedy, the
greater its potency Vocabulary Exercises
c. illness is specific to the individual 1. Alternative means to do or use one thing
instead of another. EXAMPLE: Use relaxation
Completion instead of giving a painkiller.
1. Psychological (mind) Integrative means to combine approaches.
Physical (body) EXAMPLE: Using conventional (example: pain
Meditation, art, music, yoga, Tai Chi, etc. medication) combined with alternative/com-
2. National Institute of Health’s National Center plementary treatments (example: relaxation)
for Complementary and Integrative Health for holistic care.
(NCCIH) Complementary means to do or use in addition
3. biofeedback to, to complete. EXAMPLE: Use relaxation as
4. Mindfulness, meditation well as giving a painkiller. (Note: some sources
5. Acupuncture use the terms integrative and complementary as
6. efficacy, safety, prescription medications synonyms.)
7. yoga 2. Compliment is a positive comment about
something; complimentary is a remark that
Review Questions for the Next Generation does that. EXAMPLE: That was a very good
NCLEX® Examination report you gave in class.
1. 3 Note: Complimentary can also mean free, or
2. 2, 3 without charge.
3. 1, 3, 5 3. Medium can mean a method or way of distri-
4. 2, 4 bution. EXAMPLE: Television is a medium for
5. 2 advertising.
6. heart and respiratory rates Medium can mean being in the middle. EXAM-
7. 2, 5 PLE: What size do you wear—small, medium,
8. 4 or large?
9. 1- conventional medical practice; 2- in conjunc-
tion with; 3- in place of; 4- increasing

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 Student Learning Guide Answer Key  71  

Word Attack Skills 7. therapeutic range

Bioelectromagnetic-based (13) 8. toxic effect
Bio/electro/magnet/ic-base/d
bi o e lec tro mag net ic-base d Short Answer
Contraindications (11) 1. a. stimulation or depression
Contra/indications b. replacement
Con tra in di ca tions c. Inhibition or killing of organisms or abnor-
Polarities (4) mal cells
Polar/ities d. irritation
Po lar ities 2. safe and therapeutic effect of the drugs
3. they do not comprehend how the drug works,
Communication Exercise why they are taking it, or that they need to take
it to maintain a steady blood level of the drug
Patient: I think I will skip my radiation treatments so it can work
and just eat a macrobiotic diet. My friend knows 4. the blood level of the drug increases above the
someone who did that and is doing very well. therapeutic range and unintended damage to
Nurse: You should talk to your doctor about that. normal cells occurs
He can tell you the pros and cons of each. 5. Any five of the items in the textbook under
“Considerations for the Older Adult”
Patient: What do you think about using St. John’s 6. Provide the patient and caregiver with written
wort to help my child? instructions about what to report to the prima-
Nurse: Be sure you ask the pharmacist about that ry care provider; if possible, observe the care-
when you leave your prescription. Inform the giver or patient prepare medications; verify
pharmacist of any medications your child is tak- that patient can obtain the needed medications;
ing, your child’s age, and why you wish to use St. if not, notify the provider; keep medications
John’s wort. That way the pharmacist can let you out of reach of children; check expiration dates
know whether there are any contraindications to on medications and discard; obtain feedback
giving your child that herb. that indicates the caregiver understands what
each medication is for, when it is to be given,
side effects to monitor, and adverse effects to
CHAPTER 34 report to the primary care provider; reinforce
patient education.
Terminology 7. how drugs affect cellular physiology, biology,
and their mechanism of action
A. Matching 8. never to take the drug again; each time the
1. f drug produces an allergic reaction, it will be
2. i worse and can be life-threatening
3. c 9. a. The right drug
4. a b. The right dose
5. g c. The right route
6. d d. The right time
7. b e. The right patient
8. e f. The right documentation
9. h 10. what it looks like, its intended action, possible
10. j side effects, and how to take it. Explain why
it should be taken with food or on an empty
B. Completion stomach and why it is important to take it on
1. agonist schedule
2. antagonist 11. every other day
3. drug interaction 12. check with the pharmacist and/or the prescrib-
4. pharmacokinetics ing provider
5. nursing implications 13. any high-alert drug such as IV potassium,
6. synergistic effect anticoagulants, IV cardiac drugs, opioids, and
insulin

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72  Student Learning Guide Answer Key

14. a. Staff nurse education Drug Calculations and Conversions

b. Use of “no-interruption wear” (vest or 1. 2.5 mL
sash) that a nurse wears while preparing 2. 2 capsules
medications 3. 10 mL
c. Delineation of a “no interruption zone” 4. 2 capsules
where medications are prepared 5. 0.66 mL
d. Signage placed indicating medication
preparation is in progress Application of the Nursing Process
e. Printed card with guidelines for respond- 1. “Mrs. Murano, may I see the medication vials
ing to interruptions. for those medications you are taking now? I
15. a. Obtain information on the current medi- also need to see any other drugstore medicines
cations being taken when the patient is you are using even occasionally.”
admitted to the hospital or seen in the For each drug, ask:
outpatient setting. “How long have you been taking __________?”
b. Define the types of information to be col- “Have you noticed any problems with it?”
lected in non–24-hour settings and differ- (Ask specific questions regarding very com-
ent patient circumstances (e.g., name, dose, mon side effects of the drug.)
frequency, route, purpose). “Do you remember to take each drug as you
c. Compare the information from the patient are supposed to take it? How do you remem-
with medications being ordered for the pa- ber to do that?”
tient to identify and resolve discrepancies. 2. You need to know:
d. Provide the patient with written medica- a. any drug allergies she has.
tion instructions after hospital discharge or b. how she plans to manage her drug regi-
completion of outpatient encounter. men.
e. Explain to the patient the importance of c. if any of the drugs interact.
managing medication information after d. nursing precautions and implications for
hospital discharge or completion of outpa- each drug.
tient encounter. e. usual and safe dosage range for each drug.
f. any side effects that she has suffered cur-
Identification rently or in the past from the drugs she is
Answers are from Table 34.1. taking.
1. ACE inhibitor; antihypertensive that relaxes g. whether periodic laboratory testing is
arterial vessels needed for any of the drugs she is taking.
2. Beta blocker; antihypertensive/antianginal that 3. Nonadherence with the treatment plan related to
blocks beta adrenergic receptors in vascular forgetfulness
smooth muscle 4. Patient will use a medication planner to take
3. Blocks histamine-2 receptors; inhibits hista- all prescribed doses of medication on time.
mine at H2 receptor sites, decreasing gastric 5. a. Assist Mrs. Murano to obtain a medication
secretions planner and set it up with the medications.
4. Antilipemic; inhibits HMG-COA reductase b. Make arrangements with a relative or
enzyme, reducing cholesterol synthesis friend to help her refill her medication
5. Broad-spectrum antiinfective; inhibits bacteria planner each week.
by interfering with DNA c. Verify that therapeutic action of each drug
is occurring.
Drug Knowledge d. If needed, try to set up a telephone remind-
Answers can be found in any drug handbook or pharma- er system for Mrs. Murano.
cology textbook. e. Be certain Mrs. Murano understands the
1. Diuretic, antihypertensive importance of and reason for taking each
2. 25-100 mg PO drug to increase adherence.
3. PO 6. Check the medication planner and pill vials at
4. Presence of anuria, or hypersensitivity to sul- each home visit to see that pills are indeed be-
fonamides or thiazide diuretics, renal decom- ing taken. Question Mrs. Murano about when
pensation she is taking her pills and how she is remem-
5. Take in the evening.

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 Student Learning Guide Answer Key  73  

bering to use the planner. Speak with a relative Review Questions for the Next Generation
or friend who is helping Mrs. Murano to obtain NCLEX® Examination
information about her medication adherence. 1. 3
Evaluation statements might be: 2. liver
Medication planner set up with prescribed 3. 4
medications for one week. (Wed.) Medication 4. 2
planner bins empty for Monday, Tuesday, and 5. 1
Wednesday am. States has been remember- 6. 1, 2, 3, 4
ing to take medications. Sister states that Mrs. 7. 1
Murano has been responsive to reminder calls 8. 1
and has usually taken the medications already 9. 1- brand name; 2- generic name; 3- brand
when she calls. name; 4- chemical name

10.
Nursing Intervention Effective Ineffective
Assess the medication errors, looking for patterns. X
Schedule staff inservice: reinforcing the six rights of med administra-
X
tion.
Enlist the APs on the unit to help nurses administer medications. X
Ensure all patient wristbands are in place with the correct information. X
When verifying identity of the patients, use “yes/no” questions to keep
X
the med pass on time.
Remind nurses to administer the easiest meds first and those requiring
X
special considerations (e.g., vital sign measurement) last.
Use teamwork to increase efficiency: have one nurse pour all of the
X
meds and a different nurse administer the meds.

Critical Thinking Activities STEPS TOWARD BETTER COMMUNICATION

1. Use a drug handbook or a pharmacology book
to locate the information needed to devise a pa- Completion
tient education plan. Cover action, side effects, 1. incompatible
adverse effects to report, and nursing implica- 2. adherent; tactful
tions. 3. readily
2. Review the laws governing the dispensing and 4. erroneously
prescribing of scheduled drugs. Also cover 5. categorize
potential problems when taking a drug not
prescribed by a prescribing provider (other Communication Exercises
drug interactions and effects on chronic health 1. For this exercise, have the partner choose three
conditions). drugs that the patient might be taking. Drugs
3. Health and health problems, allergies, why will vary with the scenario.
patient is receiving the drug, other drugs and 2. For this exercise, use three other drugs. Drugs
over-the-counter medications being taken, will vary with the scenario.
diagnostic tests scheduled on which the drug 3. Points to cover are:
might have an effect, side effects from previous a. what the drug is supposed to do.
doses, what patient knows about the drug and b. how to take the drug.
taking it. c. when to take the drug and whether it must
be taken with or without food.
d. possible side effects of the drug.

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74  Student Learning Guide Answer Key

e. adverse reactions to report to the primary b. antibiotic

care provider. c. antiemetic
f. what to do if a dose is forgotten. d. antiarrhythmic
g. what might happen if the medication is e. analgesic
stopped. 5. Protocol orders are used in the emergency
department, intensive care unit, labor and
delivery, and occasionally on general medical-
CHAPTER 35 surgical units. They are used for common
emergency situations.
Terminology 6. a. sublingual or buccal
b. enteric coated
A. Matching c. sustained release
1. e d. potentially carcinogenic (antineoplastic)
2. a products
3. d 7. Consider crushing or cutting the pill unless
4. f contraindicated, or ask the provider for a liquid
5. h form of the drug.
6. g 8. Nurses are legally responsible for being knowl-
7. j edgeable about each medication they admin-
8. b ister to patients: the correct dose, the route by
9. i which it should be given, desired effects, side
10. c effects, interactions with other medications,
and any contraindications. Professional respon-
B. Abbreviations sibilities also include (a) knowing which drugs
Helen Warren is being treated for asthma. Her are “high alert;” (b) calculating dosages accu-
medications are not adequately controlling her rately/have calculations checked; (c) knowing
symptoms. The doctor orders a nebulizer treatment interferences with laboratory tests; (d) know-
for her immediately (stat) to relieve her broncho- ing drug allergies; (e) knowing dosage limits;
spasm. He tells her to discontinue the antihista- (f) following the six rights; (g) documenting;
mine she has been taking as it does not seem to (h) teaching about each drug; (i) assessing for
be helping. He prescribes oral (PO) montelukast therapeutic effect.
sodium to be taken with water in the evening. He 9. To take a sip of water and swallow it; place
puts her on another metered-dose inhaler (MDI), the pill toward the back of the tongue. Have
triamcinolone acetonide and tells her to use the the person take a large sip of water, place the
new inhaler three times a day. tongue on the roof of the mouth and with the
chin tilted slightly downward, swallow; follow
Short Answer with more water.
1. To prevent medication errors and enhance
patient safety. Completion
2. a. the correct dose 1. questioned
b. the route by which it may be given 2. apothecary
c. desired effects of the medication 3. another colleague
d. potential side effects of the medication 4. skin; mucous membranes
e. interactions with other medications 5. 48-72 hours
f. any contraindications for giving this drug 6. surgery; general anesthesia
to the patient 7. immediately
3. a. the patient’s full name 8. be certain the old patch is removed and the
b. the full name of the drug skin cleansed of any remaining medication.
c. the dosage to be given The new patch is placed in a different location
d. the route of administration on the skin.
e. how often it is to be given 9. medication administration record (MAR);
f. date and time the prescription was written electronic medication administration record
g. signature of the prescriber (eMAR)
4. a. antihypertensive 10. automated dispensing machine (ADM)

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 Student Learning Guide Answer Key  75  

11. patted onto 2. 1

12. douche 3. 5
13. unwrapped, lubricated 4. 3
14. meniscus 5. 6
15. ineffective 6. 2

Application of the Nursing Process Review Questions for the Next Generation
1. Assessment: Any three of the following: NCLEX® Examination
a. Determine that the order is still valid 1. 2, 3, 5
(within date). 2. 3
b. Assess for patient allergies. 3. 2
c. Determine why the patient is receiving the 4. 1, 2, 4
drug. 5. 2, 3, 5
d. Assess for therapeutic effect of previous 6. 1, 2, 3
doses of the drug. 7. 3
e. Assess for contraindications to taking the 8. 1, 2, 3
drug. 9. Erythromycin 250 mg PO qid
f. Assess for side effects of previous doses of 10. 2
the drug. 11. The medication nurse leaves the nitroglycerin
g. Assess for drug interactions with food or at the bedside because Ms. Gavney shares it
other drugs. with her roommate; Ms. Gavney states that
h. Assess the patient’s knowledge about the she prefers the same location for nitroglycerin
drug. administration every time because it’s not
2. a. All medications will be safely administered visible under her clothing; The nurse instructs
to each patient on time. Ms. Gavney to blow her nose after receiving
b. Serious side effects of medication will be the nasal drops; The nurse vigorously rubs the
identified quickly. nitroglycerin ointment into Ms. Gavney’s skin;
c. The medications will be effective. The medication nurse unwraps the bisacodyl
d. No allergic reaction to the medication will and instructs Ms. Gavney to swallow it with a
occur. full glass of water.
e. The patient will understand why the drug 12. Steps in the correct order:
is prescribed, adhere to the medication • Obtain necessary supplies.
schedule, and report serious side effects. • Perform hand hygiene.
3. three times • Identify the patient and provide privacy.
4. Any one of the following: • Place patient in modified left lateral
a. Wound is clean and dry without inflamma- recumbent position.
tion or tenderness. • Don gloves and squeeze lubricant onto
b. Wound culture after 5 days of antibiotic paper towel.
treatment is negative. • Expose anus and insert suppository.
c. Temperature and WBC are within normal • Remove gloves and discard.
limits. • Document procedure.
d. Area of inflammation and tenderness
around wound is decreased. Critical Thinking Activities
1. Discard the medication and document that it
Priority Setting was not given and why.
It is most important to give the drugs that must 2. Verify the provider’s actual order, determine
be maintained at a therapeutic blood level as close that the pill in question is actually that medica-
to the ordered time as possible. Antiarrhythmics, tion; determine why the patient is to receive
anticonvulsants, and antianginals should always this pill, and why, if it is a continuing order, he
be given as close to the ordered time as possible. has received a different medication than this
Vitamins and minerals can usually be given within one.
an hour of the ordered time according to agency 3. Technically, the pill should be replaced by a
policy. new one. However, most nurses allow the
1. 4 patient to pick up the tablet and take it, as it is

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76  Student Learning Guide Answer Key

contaminated with the patient’s own microor- b. Select the correct site to prevent damage to
ganisms. tissues.
c. Use sterile equipment and aseptic tech-
nique to prevent infection.
STEPS TOWARD BETTER COMMUNICATION
3. lateral surfaces of the upper arm or the anterior
and lateral aspects of the thigh
Completion
4. abdominal subcutaneous sites
This is a very potent drug. The directions for using
5. insulin, heparin, allergy extract, and certain
it are ambiguous, so we had better check with the
immunizations
doctor. I don’t want to make any deviation from his
6. a. Mid-deltoid muscle
plans.
b. Ventrogluteal site
c. Vastus lateralis site in thigh
d. Rectus femoris site in the adult thigh
CHAPTER 36
7. rotate sites
8. Z-track
Terminology
9. emotional support
10. irritating
A. Matching
11. urticaria (hives), bronchiolar constriction
1. g
(wheezing, difficulty breathing), and circula-
2. n
tory collapse.
3. d
12. 25-, 27-, or 29-gauge
4. m
13. 45 degrees
5. j
14. 3 mL, 2 mL
6. b
15. filter
7. c
16. tenths
8. e
17. sterile water; sterile saline
9. h
18. allergies
10. i
19. aqueous; oil
11. k
20. needle sticks; HIV, hepatitis B, hepatitis C
12. f
21. the size of muscle mass and possible decreased
13. a
circulation in the area; a shorter needle may be
14. l
needed and you may have to hold pressure for
longer due to decreased clotting time.
B. Completion
1. intradermal
Correlation
2. anaphylactic shock
1. c
3. parenteral
2. a
4. Z-track
3. a
5. tuberculin
4. a
6. subcutaneous
5. b
7. compatibility
6. c
8. intramuscular (subcutaneous can also be cor-
7. c
rect in certain circumstances)
8. b
9. b
Short Answer
10. a
1. a. When the patient cannot take medication
by mouth
Application of the Nursing Process
b. To hasten the action of the drug
1. d, c, f, e, b, a
c. When digestive juices would counteract
2. Fluid volume deficit related to vomiting
the effects of the drug if given by the oral
3. Vomiting will be controlled by antiemetic
route
medication within 1 hour.
d. When a continuous infusion of medication
4. Any three of the following:
is necessary
a. Move him as little as possible.
2. a. Ensure that the dose is accurate.

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 Student Learning Guide Answer Key  77  

b. Apply a cool cloth to the forehead, back of given. Seek an order change to a PO medica-
neck, or under the chin. tion. Note on the MAR or eMAR that the medi-
c. Keep food and other odors out of the room. cation was not taken.
d. Decrease environmental stimuli. 3. First check—after taking the medication from
e. Give nothing by mouth. stock.
5. Statement chosen will be individual. Examples Second check—just before drawing it up, at the
include: bedside.
• States nausea has eased since injection of Third check—just after drawing it up.
medication. 4. Review which type of insulin to draw up first.
• No vomiting after injection of antiemetic. Discuss adding air to both vials first then be-
ginning drawing of insulin.
Review Questions for the Next Generation
NCLEX® Examination
STEPS TOWARD BETTER COMMUNICATION
1. 3
2. abdomen; 45-degree
Completion
3. 4
4. 1, 3, 4, 6, 7
A.
5. 2
1. aqueous
6. 2, 3, 4
2. reconstituted
7. 1, 2, 4, 5
3. beveled
8. 3
4. dexterity
9. rapidly
5. compatible
10. 1, 2, 3
6. vial
11. Steps in the correct order:
7. apprehensive
• Check the medication with the provider
8. needle stick
order.
• Choose a syringe with at least a 1.5-inch
B.
needle and second needle.
1. sloughed off, with dexterity, vial
• Perform hand hygiene.
2. apprehensive, aqueous, reconstituted
• Draw up the correct amount of medication.
3. scored, calibrated
• Change the needle.
4. hastened, induration
• Perform hand hygiene and don clean
5. beveled, were compatible
gloves.
• Position the skin with nondominant hand.
Time Clauses
• Cleanse the skin; insert needle at 90-degree
angle.
A.
• Slowly inject medication.
1. When I fell, I was walking up the stairs.
• Wait 10 seconds.
2. While he was in the hospital, Donald Moore
• Slowly withdraw needle; wipe with
learned to give himself injections.
alcohol swab.
3. When her sister arrived, Margaret Smith was
• Document, including site used and
eating.
technique.
4. After she received the injection, the patient felt
12. 1- dermal; 2- bleb; 3- subcutaneous; 4- 1; 5- 3;
better.
6- intramuscular
5. Before the nurse gave her the injection, she was
having a lot of pain.
Critical Thinking Activities
1. Discuss how to prevent a needle stick; “scoop”
B.
up the cap; take a small biohazard sharps
Answers will vary.
container with you. Use a safety needle and
syringe.
2. Waste the medication; if it is narcotic, have
someone witness the wasting and document
it on the narcotic checkout sheet. Document in
the health record that the medication was not

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78  Student Learning Guide Answer Key

CHAPTER 37 5. a. Infiltration: remove IV catheter and restart

IV in the other extremity. (Consult agency
Terminology policy for certain IV solutions or drugs.)
b. Phlebitis: remove IV catheter, notify the
A. Matching primary care provider, and apply warm,
1. h moist packs to the IV site, document.
2. g c. Speed shock: stop the infusion, run 5%
3. b dextrose in water at KVO rate, monitor
4. f vital signs closely, notify the primary care
5. i provider.
6. a d. Circulatory overload: slow infusion,
7. e elevate the head of the bed, keep patient
8. d warm, notify the primary care provider,
9. c assess for edema. Administer oxygen and
diuretic as ordered.
B. Completion e. Air embolus: place on left side and lower
1. hypertonic head of bed; inspect IV system for discon-
2. hypotonic nection or leak, notify primary care pro-
3. isotonic vider.
4. infiltrated 6. hives, itching, facial flushing, chills, back pain,
5. Macrodrop apprehension, and fever
6. microdrop; 60 7. Turn off the blood and start the saline using
7. vascular access device fresh tubing; give oxygen as needed; stay with
the patient; notify the primary care provider
Short Answer immediately. If shortness of breath occurs, start
1. Any four of the following: low-flow oxygen per agency protocol. Return
a. Supply hydration when fluids cannot be the blood component bag to the blood bank
taken orally. with the transfusion reaction form.
b. Deliver medication directly to the blood- 8. 1500-2000
stream. 9. 200
c. Quickly replenish and balance electrolytes. 10. clarity, leaks, or particulate matter
d. Supply nutrients when the patient cannot 11. needleless
absorb them from the intestinal tract or 12. movement
needs supplementation. 13. normal saline
e. Replenish blood, plasma, or blood compo- 14. a. small amounts of fluid are required
nents. b. extreme care must be used to measure
2. a. Keep IV fluid sterile. the exact amount, such as when giving IV
b. Protect the catheter site from contamina- fluids to infants, children, and older adults
tion to avoid possible infection. 15. flushed
c. Hang fluids at the correct height. 16. 1-2 hours
d. Carefully regulate the rate of flow. 17. a. Winged-tip or butterfly needles
e. Monitor intake and output when a patient b. Over-the-needle catheters
is receiving IV fluids or blood. 18. superior vena cava; atrium
f. Hang the solution that should run in first 19. high blood flow vessel
in a higher position. 20. take blood pressure
g. Assess the site frequently for signs of com- 21. placement must be confirmed by x-ray
plications. 22. non-coring, Huber
3. IV solution; 1-2 hours; complications; flow rate 23. 80-250
4. local edema, skin blanching, skin coolness, 24. 15
leakage at the puncture site, pain, and feelings 25. distal site
of tightness and sometimes numbness 26. potassium
27. a. Plan: Have a backup plan in the event of
pump failure; participate in educational
opportunities relating to the facility’s smart

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 Student Learning Guide Answer Key  79  

pump; use a secondary device to check the 4. 3

expected volume infused. 5. 2
b. Label: Clearly label tubing and pump 6. 1, 3, 4, 5
channels with the name of the medication 7. Steps in the correct order:
infusing, especially if multiple lines are • Correctly identify the patient.
running. • Scrub the cannula hub.
c. Check: Verify pump settings; have another • Flush the cannula with normal saline.
nurse double-check your settings when • Attach the piggyback tubing to the
infusing high risk medications. cannula.
d. Monitor: Carefully watch patients for signs • Set the flow rate for the piggyback
of overinfusion or underinfusion. infusion.
e. Use: Consult with superusers for addi- 8. 3
tional assistance and training; use available 9. 4
resources to prevent and respond to pump 10. blood glucose level
problems; follow the six rights of medica- 11. 1- intake & output; 2- nurse practice act; 3-
tion administration. policy; 4- IV certified
f. Report: Promptly report adverse events to
the FDA; remove equipment that is known Critical Thinking Activities
to not be working properly. 1. Pull the skin taut distal to the projected site.
Use only a 5- to 15-degree angle to approach
Application of the Nursing Process the vessel with the IV catheter. Use the small-
1. a. The correct IV solution is hanging. est-gauge catheter possible.
b. The site is patent and the solution is infus- 2. First, make certain the patient is not lying
ing. on the tubing. Next, raise the IV bag. Detach
c. The flow rate is that which is ordered. the tubing from the cannula and attempt to
d. No complications are occurring. aspirate blood from the cannula. Reposition the
2. a. The patient is not allergic to the medica- cannula by rotating it slightly. Try aspirating
tion. again. If nothing works, discontinue the can-
b. The medication is not incompatible with nula and restart the IV at another site.
the fluid that is infusing. 3. Attempt to aspirate blood. Untape the cannula
3. Potential for infection related to invasive procedure and rotate it slightly to move the opening away
4. Fluid volume deficit will not occur. from the vessel wall. Attempt to aspirate blood
5. a. 17 gtt/minute again. See if you can gently flush the cannula
b. 31 gtt/minute now. If not, discontinue the cannula and place
c. 31-32 gtt/minute a new one in a different location.
d. 21 gtt/minute
e. 20 gtt/minute
STEPS TOWARD BETTER COMMUNICATION
6. a. The IV flow
b. The rate of the infusion
Completion
c. The infusion pump
d. The insertion site
A.
e. Patient complaints
1. piggyback
f. The level of the fluid remaining in the bag
2. ascertain
7. good skin turgor, moist mucous membranes,
3. discrepancy
and adequate urine output
4. rule of thumb
8. laboratory data indicating that the blood count
5. runaway
has increased for the type of blood product
infused
B.
1. rule of thumb, criss-crosses and chevrons,
Review Questions for the Next Generation
ascertained, discrepancies
NCLEX® Examination
2. mimicked, piggyback
1. 3
3. runaway, taut
2. 2
3. 31

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80  Student Learning Guide Answer Key

Grammar Points C. Combining

1. The nurse observed the patient while checking 1. colostomy
the IV. 2. thoracotomy
2. She checked the level of fluid remaining in the 3. cholecystectomy
bag before disconnecting it. 4. orchiopexy
3. The intravenous solution was leaking out of 5. fibroma
the bag when the patient pushed the call but- 6. mammoplasty
ton.
4. Before making the subcutaneous pocket, the Short Answer
surgeon entered the subclavian vessel. 1. “time-out”
2. a. General anesthesia—major surgical proce-
dure such as a colon resection
CHAPTER 38 b. Regional anesthesia (nerve block)—obstet-
rical procedures, or pelvic or lower extrem-
Terminology ity surgery
c. Procedural or moderate (conscious)
A. Matching sedation—shorter procedures such as a
1. f dilatation and curettage or breast biopsy,
2. e although it can be used for any type of sur-
3. a gery that general anesthesia would be used
4. d for.
5. b d. Local anesthesia—minor surgical proce-
6. c dure such as skin cyst removal or pace-
7. g maker insertion
8. h 3. Any five of the factors listed in Table 38.1.
4. Allow time for voicing concerns and fears,
B. Completion make adjustments for cultural beliefs, allow
1. Collapse of the alveoli in the lungs restricting time for questions, explain what to expect pre-
air flow. operatively and postoperatively
2. Failure of forward movement of bowel con- 5. a. Laser surgery
tents after surgery b. Fiberoptic surgery
3. Clot (thrombus) that breaks off and travels c. Robotic surgery
and lodges in a blood vessel. (Solid, liquid, or 6. Check to see that the surgical consent form
gaseous mass of undissolved matter present in is signed, the Universal Protocol has been
a blood or lymphatic vessel.) completed (preprocedure verification process,
4. Extrusion of the viscera through the surgical marking the surgical site, and time out), physi-
incision resulting from wound dehiscence. cal exam, and lab work is in the health record,
5. Loss of an extensive amount of blood, which patient has been NPO for allotted time, preop-
may lead to shock; escape of blood from a rup- erative checklist is complete, allergies (includ-
tured vessel. ing latex) have been noted, patient is bathed
6. Lack of movement or of position change causes and gowned for surgery, skin preparation has
stasis of secretions, which become a breeding been completed, bladder is emptied, preopera-
ground for bacteria. tive patient education is complete, and preop-
7. Inflammation and irritation due to entry of erative medications have been given.
gastric or oropharyngeal food or fluids into 7. Anxiety related to the surgical experience and out-
tracheobronchial passages from dysfunction or come or Anxiety related to the threat to self-concept
absence of normal protective mechanisms. and threat of death
8. Stoppage of flow or movement of blood or Fear related to risk of death and loss of control due
secretions. to anesthesia
9. Inflammation of a blood vessel from the irrita- Insufficient knowledge related to postoperative care
tion of a clot (thrombus) on the vessel wall. Limited coping ability related to threat to self and
multiple stressors
8. Anxiety will be reduced by voicing concerns.

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 Student Learning Guide Answer Key  81  

Fear will be reduced by speaking with anesthe- Assists with the transfer of the patient to the
siologist. operating table and positions the patient.
Learning related to self-care will be obtained Places an electrocautery ground pad under the
through postoperative patient education. patient if electrocautery is to be used.
9. a. Patient is prepared physically and emo- Assists the anesthesia induction provider with
tionally. anesthesia.
b. Patient is able to demonstrate deep breath- May prep the patient’s skin before sterile drap-
ing, coughing, and leg exercises. ing occurs.
c. Patient is able to verbalize understanding May insert a urinary catheter.
of the procedure and expectations for the Handles labeling and disposition of specimens.
postoperative period. Coordinates activities with the radiology and
d. Patient is able to maintain fluid and elec- pathology departments.
trolyte balance throughout the postopera- Monitors urine and blood loss during surgery
tive period. and reports findings to the surgeon.
10. Any three of the following: Observes for breaks in sterile technique and
Gathers all equipment for the procedure. announces them to the team.
Prepares all sterile supplies and instruments Monitors traffic and noise within the operating
using sterile technique. room.
Gowns and gloves surgeons on entry to the Communicates information on the surgery’s
operating room. progress to family during long procedures.
Assists with sterile draping of the patient. Documents care, events, interventions, and
Maintains sterility within the sterile field dur- findings.
ing surgery. Helps transfer patient to a gurney and accom-
Hands instruments and supplies to the operat- panies patient to the recovery area, providing
ing team during surgery. report of the surgery and patient condition to
Maintains a neat instrument table. recovery nurse.
Labels and handles surgical specimens cor- 12. Vital signs are stable and the patient is awake
rectly. and able to respond to stimuli.
Maintains an accurate count of sponges,
sharps, and instruments on the sterile field; Table Activity
verifies counts with the circulating nurse be- See Table 38.5. Any one of the signs or symptoms listed
fore and after surgery. for each complication is acceptable.
Monitors for breaks in sterile technique and
points them out. Short Answer
Cleans up after the surgery is over. 1. Any five of the following:
11. Any three of the following: • Each medication to be taken, including
Coordinates care, oversees the environment, when to take it
and cares for the patient in the operating room. • The diet, any restrictions, and guidelines
Verifies that consent is signed and accurate and for fluid intake; avoiding alcohol for 24
that surgical site is marked. hours after surgery.
Greets patient and performs patient assess- • Any restrictions on activity; and
ment. instructions for use of any special
Checks health record and preoperative forms equipment, such as crutches, a splint, or a
for completeness. walker.
Sets up the operating room; adjusts lights, • Not driving or making important decisions
stools, and discard buckets; and ensures sup- for 24 hours after anesthesia
plies and diagnostic support are available. • The type of bath or shower permitted and
Gathers and checks all equipment anticipated any special needs (such as a shower chair
to be used, ensuring its safe function. or dressing cover) that may be required
Opens sterile supplies for scrub nurse. during this activity
Provides needed padding and warming or • Cleansing and dressing of the wound, and
cooling devices for the operating table. where to obtain supplies
Assists with ties of surgical team’s gowns. • Signs and symptoms to report to the
surgeon such as temperature above 100° F,

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82  Student Learning Guide Answer Key

increasing malaise, severe pain or swelling, 4. Assisting the patient to the chair safely and as
bleeding through the bandage, decreased painlessly as possible will require an assistant.
sensation below the surgical site, or severe Assistance will be needed from the nurse for
nausea and vomiting ambulation.
• When to make a follow-up appointment The nurse will need to attend to tubes and lines
with the provider (provide in writing) as the patient turns from side to side.
• All essential points of care (provide in Assistance with splinting the chest will be
writing) needed for effective coughing initially.
2. printed instructions Regular assessment of pain level should be
done to keep pain under control so the patient
Priority Setting will turn, cough, deep breathe, and move
1. 3 around.
2. 1 5. Turn, cough, deep breathe (TCDB); assessment
3. 2 of chest drainage; assessment of urine flow;
4. 5 checking IV flow rate and IV site; checking the
5. 4 dressing; assessment for pain level; ambulation
or sitting up in the chair)
Application of the Nursing Process 6. Turn, cough, and deep breathe q2h while
1. Take vital signs, check the chest tube to be awake.
certain it is not kinked and that the suction is Splint chest incision while coughing.
functioning, mark the amount of drainage in Monitor oxygen saturation level q2h.
the chamber, check the oxygen setting, check Auscultate lungs q shift.
the IV solution and flow rate, auscultate the Oxygen via cannula at ____L/min.
lungs, assess level of consciousness, assess lev- Monitor chest drainage and suction.
el of pain using a pain scale, check the urinary 7. Lung sound status, oxygen saturation level,
catheter and make certain the tubing is not amount of chest drainage, result of last chest
crimped, note the amount of drainage in the x-ray.
bag, check all areas of the chest dressing and 8. a. Oxygen saturation increased to 98%.
mark any drainage showing, check what pain b. Lungs sounds clear in all lung fields.
medication—if any—was given in the PACU c. Chest drainage ceased.
and when it was given, check what medica-
tions the patient received preoperatively and Review Questions for the Next Generation
during surgery as well. NCLEX® Examination
2. Altered gas exchange related to partially collapsed 1. 1, 4, 5
lung and anesthesia 2. 4
Pain related to surgical procedure 3. 3
Altered activity tolerance related to tubes, pain, and 4. 2
anesthesia 5. 2
Potential for injury related to decreased level of 6. 1, 3, 5
awareness 7. 3
3. Patient will have a normal oxygen saturation 8. 2
level on room air by postoperative day 3. 9. 1
Pain will be controlled by oral analgesia by 10. 30 mL
discharge. 11. 1- PACU; 2- 5; 3- 15; 4- pain; 5- nausea; 6- in-
Patient will ambulate independently before centive spirometer; 7- antiembolic stockings
discharge.

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 Student Learning Guide Answer Key  83  

12.
Nursing Intervention Effective Ineffective
Assess surgical site every 2 hours. X
Check level of orientation hourly throughout the night. X
Reinforce teaching of use of the PCA pump. X
Encourage deep breathing every 2 hours. X
Encourage fluids. X
Monitor distal pulse and capillary refill with each vital
X
signs check.

Critical Thinking Activities “The surgeon should be able to give you an

1. The correct order of priority would be: idea of what you might be facing as soon as
• Check the surgeon’s orders. you wake up after surgery.”
• Check for a signed surgical consent form. “Tell me more about your wife, Mr. Jones.
• Check that lab work is complete and in the Have you been married a very long time?”
health record. “We’ll help you learn to cope if you have to
• Have the patient shower. have a colostomy. We have specially trained
• Check to see that preoperative medications nurses who can teach you all you need to know
ordered are available on the unit. to care for yourself. It might be good to wait
• Complete the preoperative checklist. and see if you even need a colostomy before
• Have the patient empty their bladder. you start worrying about it.”
• Give preoperative medications. 2. Example: “Mr. Stevens, it is time to get you
• Document the patient’s readiness for the ready for surgery. Here are the towels and
OR. special soap for your shower. Soap your chest
• Transfer the patient to the OR. and abdomen twice. I’ll be back in 15 minutes
• Prepare the unit for the postoperative to give you the preoperative medications.”
return of the patient. “Mr. Stevens, I have your preoperative medica-
2. Possibilities include dehydration, loss of blood tion. Would you please empty your bladder
and decreased perfusion to the kidneys, hem- before I give it to you?”
orrhagic shock, kidney toxicity from anesthesia “OK, first state your name and then I need to
or drugs. check your armband to verify you are the right
3. Continue to give the patient nothing but small patient for these medications. Good, that’s cor-
ice chips that are allowed to melt in the mouth. rect. Please turn on your side, then I will give
Encourage ambulation, auscultate bowel you these two injections. You stated you are
sounds every 4 hours, ask patient to report the not allergic to any medications, is that correct?
passing of any flatus. Here is the first injection. Now I will put the
second one right here. That’s it, Mr. Stevens.
You are all ready to go to surgery. These medi-
STEPS TOWARD BETTER COMMUNICATION cations may make you a little groggy and I’m
putting up the side rails as I don’t want you to
Completion get out of bed. The orderly will be here shortly
1. allayed to transport you to surgery. I’ll be back then.”
2. sharps 3. “Mr. Jones, you must stick to a soft diet for the
3. groggy next few days. Once your bowel movements
4. grounded are normal, you can slowly go back to your
5. prior usual diet. I want you to continue to do your
foot and leg exercises at least six times a day
Communication Exercises at home. You should get plenty of rest and
1. Example: “What concerns you most about just take it easy for the next week. Do not lift
undergoing anesthesia, Mr. Jones?” anything weighing more than 5 pounds. I want
you to walk around the house twice today and

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84  Student Learning Guide Answer Key

then increase the distance and time you walk c. Heat

until you are walking around the block without d. Pain
any stiffness or problem. Take the antibiotics in e. Loss of function
this vial as the directions say. This vial is your 2. bleeding, exposed organs, exposed blood
pain medication, and you may take it every 4-6 vessels or nerves, and malignant (cancerous)
hours as you need for the discomfort. Remem- tissue
ber to drink plenty of water as this medicine 3. a. The inflammatory phase
can make you constipated. Change the dress- b. the proliferation or reconstruction phase
ing every day. Wash your hands thoroughly c. the maturation, or remodeling, phase
and remove the dressing. Cleanse the area 4. Any of the examples mentioned in the section
with the saline solution, pat it dry and apply on “Factors Affecting Wound Healing” are ac-
new gauze pads. Tape it crosswise as it is now. ceptable.
Report any redness, new pain, fever, or other a. Age—an 80-year-old with peripheral vas-
problems immediately to your surgeon. Call cular disease
tomorrow to make your follow-up appoint- b. Nutrition—the unhoused person suffering
ment with them.” from malnutrition
c. Lifestyle—the pack-a-day smoker
d. Medications—the patient with asthma who
CHAPTER 39 is on prednisone (a steroid)
e. Infection—the cancer patient who is im-
Terminology munocompromised by chemotherapy
f. Chronic illness—the patient with diabetes,
A. Completion especially with poorly controlled blood
1. approximation glucose
2. débridement 5. a decline in immune function occurs, reduced
3. adhesion liver function impairs synthesis of blood fac-
4. exudate tors, decreased lung function reduces available
5. collagen oxygen needed for synthesis of collagen, skin
6. abscess becomes fragile and easily damaged, there may
7. eschar be chronic disease present
8. necrosis 6. fall in blood pressure; rapid, thready pulse;
9. fistula increased rate of respirations; restlessness;
10. phagocytosis diaphoresis; and cold, clammy skin
11. Cellulitis 7. a piece of wide, flat rubber tubing; provide an
12. secondary intention exit for blood and fluids that accumulate from
13. sanguineous the inflammatory process so that the wound
14. serosanguineous may heal
15. fistula 8. pain, redness, warmth, exudate
16. purulent 9. place the patient supine, cover the area with
large sterile dressings or towels soaked in
B. Matching normal saline, reassure the patient, notify the
1. f surgeon, and prepare the patient for a return to
2. g surgery
3. c 10. general comfort, healing process
4. a 11. Local heat application: hot water bottle, electric
5. i pad, Aquathermia pad, disposable heat pack
6. e Moist heat application: compresses, hot packs,
7. d soaks, sitz bath
8. b 12. provides local anesthesia and decreases muscle
9. h tension
13. causing vasoconstriction and diminishing
Short Answer blood flow and fluid accumulation in the area
1. a. Edema (swelling) 14. attempting to create heat to bring up the tem-
b. Erythema (redness) perature

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 Student Learning Guide Answer Key  85  

15. older adults may have decreased sensation in Review Questions for the Next Generation
the affected part and can’t detect something NCLEX® Examination
that is too hot. The skin of older adults is much 1. 1
more fragile and may sustain a burn more eas- 2. 4
ily. 3. 4
4. 1
Completion 5. 1, 2, 5
1. Inflammation 6. 3
2. secondary 7. 4
3. tertiary 8. 1, 3, 4
4. contracture 9. 4
5. Staphylococcus aureus 10. 3
6. asepsis; wound 11. 1
7. hydrocolloid, hydrocellular, foam, or hydrogel 12. 3, 4
8. compress it; replace 13. 2
9. shiny 14. 2
10. moist 15. serosanguineous
11. Montgomery straps 16. Steps in the correct order:
12. growth factors; NPWT • Check provider orders.
13. infection • Perform hand hygiene and don clean
14. hematoma gloves.
• Remove the soiled dressing.
Application of the Nursing Process • Remove clean gloves/perform hand
1. Inspect the surgical wound for approxima- hygiene.
tion of the edges; whether sutures/staples are • Prepare the irrigation solution.
intact; degree of redness; warmth of area; pres- • Don sterile gloves.
ence of swelling, drainage, or bleeding; and • Draw up the solution to be used.
degree of pain in the area. • Gently irrigate the wound.
2. Inspect it visually, smell it, palpate the sur- • Apply the sterile dressing.
rounding area. Measure its dimensions. • Remove sterile gloves/perform hand
3. NPWT involves applying a suction device to hygiene.
a special wound dressing to institute negative • Document procedure.
pressure at the wound site, drawing the edges 17. 1- 1; 2- 2; 3- 2; 4- 3; 5- pressure; 6- drainage; 7-
together. NPWT can be useful for treating redness; 8- loose dressing
wounds that are difficult to heal.
4. Analyze the patient’s temperature trend and Critical Thinking Activities
check the blood count for WBC trend. Inquire 1. This injury is defined as unstageable. The es-
how the patient is feeling. char needs to be débrided either mechanically
5. Altered skin integrity related to traumatic loss of or enzymatically before staging and before
tissue, Infection related to loss of tissue healing will take place. Treat with prescribed
6. Answer may vary. Examples: Wound will dem- débriding agent and an absorbent dressing.
onstrate beginning stages of healing within 4 2. Sterile gloves, sterile dressings—4 x 4s, ABDs,
days. Wound will be free from infection within sterile normal saline for cleansing the skin,
7 days. sterile forceps, discard bag, tape, disposable
7. Obtain order for wound culture. clean gloves for removing the outer old dress-
Culture wound. ing
Administer antibiotics as ordered. 3. Apply a gel hot pack after checking the tem-
Cleanse and inspect wound every day. perature to make certain it is not so hot it will
Use aseptic technique for dressing change. burn. Could use moist hot packs—again check
Monitor temperature and WBCs. the temperature. For moist packs, cover with
8. Appearance of wound that indicates absence of plastic to maintain heat longer. Use for 20 min-
infection and growth of new tissue. Absence of utes 3-6 times a day.
redness, swelling, or pain in wound area. Ab-
sence of temperature elevation; normal WBC.

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86  Student Learning Guide Answer Key

STEPS TOWARD BETTER COMMUNICATION 11. hypostatic pneumonia

12. external fixator
Completion 13. internal fixator
1. hydrate
2. frayed Short Answer
3. friable 1. Prolonged immobility limits the effectiveness
4. cardinal of venous return because normal movement
5. nonadherent assists in venous return by compression of
6. shearing forces the muscles against the venous walls when
7. binder the muscles are in motion. In addition, certain
8. health care–associated patient conditions (fracture, trauma, or debili-
9. numbing tating illness) and treatments (casts, traction,
10. cessation or bedrest) can impair general circulation and
predispose the patient to pressure injury and
Vocabulary Exercise permanent loss of function.
Examples: frayed = worn—My nerves are so frayed 2. Inspect the skin distal to the injury; palpate
I yelled at her for nothing. the temperature of the skin, compare to the
Binder = notebook—Put this paper in your binder, opposite extremity. Check movement distal to
please. the injury, inquire about tingling or numbness,
Radiant = glowing—Her smile was radiant. check sensation bilaterally; palpate pulses dis-
tal to the injury and compare bilaterally. Check
Communication Exercises capillary refill and inquire about the degree, lo-
Answers will be individual. cation, and nature of pain. Remember to assess
for the 5 Ps: pain, pallor, paralysis, paresthesia,
and pulselessness.
CHAPTER 40 3. Performing active or passive ROM exercises to
maintain joint mobility and muscle integrity.
Terminology 4. The cast should be supported by pillows with
the extremity elevated above the level of the
A. Matching heart. The patient and cast should be turned
1. f periodically to promote even drying of the cast.
2. c Use the flat part of the palms to handle the cast
3. g when turning or repositioning.
4. h 5. Assume that the patient can hear you and treat
5. i them as a valuable person. Talk to the patient
6. j in a kind and caring voice. Explain what is be-
7. d ing done before and as it is done, and apolo-
8. k gize for any unavoidable pain the care may be
9. e causing. Talk to the patient about what is going
10. b on in the world. If cards or letters arrive, read
11. a them to the patient.
6. Blowing cool air under the cast with a can of
B. Completion electronic air cleaner may help decrease itch-
1. bivalve ing. Discomfort can sometimes be relieved by
2. quadriplegia directing the air of a hair dryer set on “cool”
3. isometric into the cast. Cast Comfort spray is a commer-
4. paraplegia cial product that delivers a soothing layer of
5. immobilization talc under the cast.
6. spica 7. a. Air fluidized bed: has tiny silicone beads in
7. hemiparesis an air-permeable filter sheet. Warmed air
8. hemiplegia sets the particles in motion so that they
9. boot act like a fluid, causing the patient to float.
10. trapeze bar Prevents occlusion of blood vessels and
shearing of tissues. The heat keeps the skin

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 Student Learning Guide Answer Key  87  

dry. Used for patients at high risk for skin e. Kidney stone: increase fluid intake to 3000
breakdown. mL/day
b. Low air loss mattress: air is distributed f. Skin breakdown: reposition at least every 2
through multiple cushions connected in hours, pad bony prominences when posi-
a series to provide pressure relief for the tioning, keep clean and dry.
patient. Eliminates shear and friction. g. Boredom: encourage visitors at intervals;
c. Continuous lateral rotation bed or mattress: provide diversional games and books, TV,
bed moves slowly from side to side, de- videogames, or use of laptop or tablet.
creasing the respiratory complications of 11. Provide frequent, small feedings and bedtime
immobility and promoting normal urine nourishment. Have family and friends bring in
flow. Reduces the risk for thrombosis. favorite foods. Encourage family or friends to
Reduces pressure on patient. Patient is visit and eat with the patient.
wedged into the bed. May be used with 12. more active; immobilization
spinal traction. 13. restore joint function
8. a. Foam and gel pads 14. pressure on vital nerves occluding blood ves-
b. Sheepskin pads sels in the axilla, causing temporary or perma-
c. Pulsating air pads nent damage, including paralysis
d. Water mattresses 15. swinging free; good alignment
e. Heel or elbow protectors 16. before it becomes severe
9. a. Elevate the limb and support it while ap- 17. move freely in the pulleys
plying the bandage. 18. structural problems
b. Face the patient and wrap the bandage 19. elevated above heart level
from the distal to the proximal area. 20. pin care
c. Apply even pressure by exerting equal 21. circulatory impairment; pressure injuries
tension throughout the wrapping of the 22. uneven
bandage. 23. immobilize a joint; reduce swelling; apply pres-
d. Overlap turns of the bandage equally. sure
e. Smooth the bandage, removing wrinkles, 24. palms of the hands
as you wrap it. 25. spreader bar
f. Secure the end of the bandage with self- 26. unattended
adherent portion of the bandage, a safety 27. weak; their balance
pin, or tape. (Do not use metal clips, as 28. 15–30; hip
they may come loose and land in the bed, 29. rest the body weight on the axillary bar
causing injury to the patient.) 30. overall length; the axillary bar; handgrip
g. Check the color and sensation of the part 31. freedom of movement
distal and proximal to the bandage when 32. paresthesia
finished and at frequent intervals thereaf-
ter. Application of the Nursing Process
h. Remove the bandage for bathing of the 1. Determining if the weights are swinging free,
body part; assess the skin for irritation or the ropes are moving freely, the patient is in
breaks; rewrap the bandage at least twice a proper alignment and pulled up in the bed to
day provide countertraction. Are the pin insertion
10. Any of the following interventions: sites clean and dry? Does she need pain medi-
a. Thrombus formation: encourage exercise; cation? Are her vital signs normal? Are there
increase fluids; apply elastic stockings. any signs of infection? Are there any signs of
b. Atelectasis: have patient deep breathe or complications of immobility? Are the lungs
use incentive spirometer. clear? Is intake and output normal? Is the urine
c. Constipation: increase fluid intake and clear? Are bowel sounds present? Does the
fiber intake; administer stool softener. patient have any complaints?
d. Joint contracture: perform active or pas- 2. Altered mobility related to fractured leg in traction
sive exercise; position joints in anatomical 3. Potential for injury related to pressure on nerves
alignment, splinting as needed. 4. Patient will not experience nerve damage while
cast is present.

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88  Student Learning Guide Answer Key

5. a. Coordinate visitors so they come at inter- • Knee dressing loose and not adhering on
vals rather than all at once. all sides.
b. Have family bring in materials for ac- • All side rails on Mr. Milby’s bed are down.
tivities she does at home such as knitting,
cross-stitch, etc. Critical Thinking Activities
c. Supply a jigsaw puzzle for her to work on. 1. Assess his interests and develop the program
6. Effectiveness of treatment is shown by x-ray around them if possible. Plan some activities
that shows proper healing of the fracture with for fun and some that will make him use his
no evidence of infection. Normal temperature brain.
and normal WBC would be two parameters for 2. Allow ventilation of feelings. Explain what
evaluation. you are doing each time you wrap the stump.
7. a. Performing quadricep setting exercises to Explain what will happen if the stump is not
prepare muscles for walking. cared for properly and the pain that can occur.
b. Working with PT on weight bearing in 3. Allow ventilation of feelings regarding loss of
preparation for ambulation (after traction a body function and the change in body im-
is discontinued). age. Explain what can happen if ambulation
is attempted without the walker (fractures or
Review Questions for the Next Generation head injury). Review the activities that can be
NCLEX® Examination performed independently using the walker.
1. 1, 2, 5 4. Increase fluid and fiber intake. Perform active
2. 3 and passive range of motion exercises. Admin-
3. 1 ister stool softeners.
4. 1
5. 2, 4
STEPS TOWARD BETTER COMMUNICATION
6. 1, 2, 3, 4, 5
7. 3
Completion
8. 2
1. diversionary
9. 2, 3
2. longitudinally
10. 4
3. regress
11. 2
4. disintegrate
12. pad bony prominences
5. gait
13. 4
6. debilitating
14. 2
15. 3
Vocabulary Exercises
16. Steps in the correct order:
Individual answers will vary. Examples:
• Assess patient readiness for procedure.
1. a. (Noun) Put the dirty clothes in the hamper.
• Obtain a second person to assist.
b. (Verb) An arm cast can hamper ability for
• Position the wheelchair with brakes
self-care.
locked.
2. a. (Noun) The dictate is that no children are
• Adjust bed to correct height and lock
allowed.
wheels.
b. (Verb) She would like to dictate what I do.
• Position sling correctly.
3. a. (Noun) Exams cause me a lot of stress.
• Position lift.
b. (Verb) I can’t stress the importance of prac-
• Lower sling hooks and attach.
tice enough.
• Instruct patient to fold arms over chest.
• Elevate patient using the lift mechanism.
Communication Exercise
• Roll lift away from the bed.
Each partner should ask the questions and then answer
• Lower patient slowly.
them when the other partner asks the questions.
• Position patient for comfort, provide call
light.
17. • Mr. Milby complains of “tightness” of inci-
sion when CPM machine is at maximum
flexion.
• Head of the bed is elevated 45 degrees.

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 Student Learning Guide Answer Key  89  

CHAPTER 41 ter rugs); even walkers and canes may contrib-

ute; medications (many types)
Terminology 5. risk factors, targeted nursing interventions
6. Any three of the following:
A. Matching a. assess the home environment
1. g b. perform patient and family education
2. f about fall risk factors and measures to
3. b avoid falls
4. e c. implement toileting schedule if cognitively
5. h impaired
6. d d. hip protectors
7. i e. move the older adult out of bed slowly
8. a f. appropriate footwear
9. c g. gait belt
10. j h. assistive devices (cane, walker) if needed
7. Any five of the following:
B. Completion a. impaired senses
1. menopausal hormone therapy (MHT); calcium b. multiple chronic disorders
and vitamin D; weight-bearing exercise; hor- c. impaired cognitive functioning
mone therapy d. forgetfulness
2. bladder retraining e. multiple providers prescribing
3. over-the-counter f. borrowing drugs from others
4. bladder retraining g. use of multiple pharmacies
5. fecal impaction h. miscommunication or lack of education
6. walking speed (also known as gait velocity) i. use of over-the-counter medications
8. A chronic respiratory disorder may decrease
Short Answer lung capacity or gas exchange and thereby
1. a. Impaired mobility reduce available oxygen in the blood. This in
b. Urinary incontinence turn causes fatigue with activity and decreases
c. Constipation mobility.
d. Alteration in nutrition 9. Decreased activity causes loss of muscle
e. Vision deficit strength, decreased joint mobility, loss of bone
f. Hearing deficit mass, decreased balance and coordination, and
e. Polypharmacy thereby interferes with mobility.
2. Physically, incontinence can lead to constantly 10. Any of the factors in AACN Essentials Box
wet skin and skin breakdown. It contributes (Fall Prevention) are acceptable. Individual
to the formation of pressure injuries. Psycho- priority will vary.
logically, it may cause embarrassment, social • Use bright, nonglare lighting in each room
withdrawal, depression, and low self-esteem. of the house.
3. Any of the following: • Keep eyeglasses clean.
a. decreased risk of osteoporosis • Get up from the bed or chair slowly and
b. decreased muscle wasting stand before walking.
c. decreased low back pain • Avoid tipping the head backward (extend-
d. decreased incidence of diabetes ing the neck) to obtain something from a
e. improved ability to perform activities of shelf, wash a tall window, or hang clothes,
daily living since this may cause you to lose your bal-
f. improved balance and walking endurance ance.
4. Any four of the following: Changes in the older • Use flat shoes and slippers with nonskid
adult’s posture, balance, gait, and vision; en- soles. Avoid long, loose-fitting clothing
vironmental factors, such as clutter in walking that may cause tripping or get caught on
areas, inadequate lighting or glare; improper furniture or doorknobs.
footwear, and unsafe furnishings (such as scat- • Use a night light in the bedroom and bath-
room or turn on a lamp before getting up

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90  Student Learning Guide Answer Key

at night. Wait for your eyes to adjust to the 26. entering; leaving
light before arising. 27. rearranging
• If you become dizzy, sit down immediately 28. care providers
if possible, or hold on to something solid. 29. impacted cerumen
• Avoid using scatter rugs and small bath- 30. 130 g/day
room mats that can slide. 31. safe sex
• Avoid slick, high polish on floors, and do 32. chlamydia, gonorrhea, and syphilis
not walk on wet floor surfaces.
• Use a nonskid mat in the bathtub or Table Activity
shower.
• Install a grab rail in the bath or shower and Physical Care
near the toilet. Problem Contributing Factors
• Wipe up spills immediately. Impaired Osteoporosis, falls, gout, foot
• Watch for pets underfoot. mobility problems, obesity, arthritis, cardiac
• Avoid clutter in living spaces. and respiratory disease, depression,
• Select furniture that provides stability and neurologic disorders (e.g., multiple
support, such as chairs with arms. sclerosis)
• Check walking aids routinely for worn Urinary Immobility, neurologic disorder
rubber tips and replace them as needed. incontinence (e.g., stroke), urinary tract infection,
• Avoid floor coverings with a busy pattern. urinary retention
• Install handrails on both sides of stairs. Constipation Immobility, decreased abdominal
11. gait belt musculature, insufficient fluid
12. Answers will vary and may include: and fiber in diet, hemorrhoids,
a. gardening diverticulosis, depression, nervous
b. dancing system disorders, cognitive
c. home maintenance impairment, poor dentition, pain
d. swimming medications (e.g., codeine), other
13. weight bearing; calcium and vitamin D medications (e.g., antidepressants and
14. bedroom; bathroom anticholinergics)
15. quarter Alteration in Neurologic deficit (e.g., stroke);
16. medication nutrition impaired vision; impaired
17. climbing on a ladder; standing on a chair mobility; anorexia; lack of income,
18. safety hazards transportation, or facilities; dementia;
19. head alcohol use disorder; depression;
20. cause taste alterations (e.g., cancer therapy);
21. increase fluid intake multiple medications
22. fecal impaction
Vision deficit Inadequate income for eye care,
23. sugar; fat; roughage
diabetes, arteriosclerosis, long-term
24. Answers may include any of the following:
steroid use
a. Sit the patient upright or in a high Fowler’s
Hearing Long-term exposure to loud
position
deficit noise, heredity, Ménière disease,
b. Feed small amounts to avoid aspiration.
labyrinthitis
c. Thicken fluids if recommended by the
swallowing evaluation. Polypharmacy Impaired senses, multiple chronic
d. Have the person tuck the chin when swal- disorders, impaired cognitive
lowing. functioning, forgetfulness, multiple
e. Assess the patient for adequate hydration. providers prescribing, borrowing
f. Maintain the patient upright for 45-60 min- drugs from others, use of multiple
utes after eating. pharmacies, miscommunication or
g. Provide a stress-free environment for eat- lack of education, use of over-the-
ing. counter medications
25. a. decreased peripheral vision
b. decreased night vision
c. decreased depth perception

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 Student Learning Guide Answer Key  91  

Review Questions for the Next Generation 6. engaged

NCLEX® Examination
1. 3 B.
2. 2 Coupled with the mud from the inclement weather
3. 3 we were having, cleaning up the clutter was quite
4. 2, 3, 4 a chore. Prudently, I addressed the problem by en-
5. mobility gaging help to clean up the odoriferous mess. The
6. 1 situation was enhanced by cueing my helper that it
7. 3 was imperative to finish early.
8. 1, 2, 5
9. 1, 3, 5 Communication Exercises
10. 2 Answers will vary per individual. Each exercise should
11. 3 be practiced with a peer, paying close attention to each
12. 1, 2, 3, 4, 5 other’s pronunciation.
13. 1
14. urinary incontinence
15. 1 CHAPTER 42
16. 2
17. 4 Terminology
18. 4
19. 2 A. Matching
20. 1, 3, 4, 5 1. d
21. “I am so glad I don’t have to use protection 2. h
since I can’t get pregnant.” “I don’t have to 3. c
worry because nobody in my age group has 4. a
HIV.” “At least I don’t have to worry about 5. e
sexually transmitted infections anymore!” 6. b
22. 1- nutritional deficiencies; 2- swallowing evalu- 7. f
ation, 3- upright or high Fowler; 4- small; 5- 8. g
tucked; 6- 45; 7- 60
B. Completion
Critical Thinking Activities 1. functional limitations
1. Assess the situation completely; i.e., shopping, 2. slower
food preparation, appetite, etc. Explore avail- 3. cognitive changes
able meal resources; explore family’s ability 4. STOPP Criteria List (Screening Tool of Older
to help. Assess patient’s ability to use a mi- Person’s Prescriptions)
crowave oven. Assess freezer space. Enlist the 5. psychosocial interventions and medication
help of the social worker. 6. validation
2. Assess for all safety hazards that could cause
fire or a fall. Identification
3. Explore all aids available for a visually im- 1. Delirium, depression
paired person. 2. Delirium, dementia
3. Dementia
4. Delirium
STEPS TOWARD BETTER COMMUNICATION 5. Depression
6. Depression
Completion 7. Dementia
8. Dementia, delirium
A. 9. Delirium, dementia
1. address 10. Depression, dementia
2. imperative 11. Dementia, depression
3. cueing 12. Dementia
4. clutter
5. enhance

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92  Student Learning Guide Answer Key

Short Answer b. Adequate public transportation to keep

1. Any four of the items listed in Box 42.3: older people in their own homes without
• Monitor and maintain physical well-being. having to drive
• Recognize the underlying meaning of ac- 7. Perform an assessment using a comprehensive
tions and behaviors. mental status examination using a tool such as
• Adjust the environment accordingly. the Short Portable Mental Status Questionnaire
• Use concise, direct interactions. (SPMSQ), Mini-Cog or the Mini-Mental State
• Maintain and enhance self-esteem and Examination (MMSE).
socialization. 8. patience; respond to questions
• Implement strategies to enhance orienta- 9. well-being
tion. 10. a. medication effects
• Maintain adequate nutrition. b. a new environment
2. Medication effects, a new environment, disease c. disease process
processes such as pneumonia or a urinary tract d. fluid and electrolyte imbalance
infection, fluid and electrolyte imbalance, or e. psychosocial stressors
psychosocial stressors. 11. dignity, independence, personality, and sup-
3. They are interrelated in that they have similar port system and complicate diagnosis and
risk factors associated with multiple losses. treatment of an illness
Loss of status and power, income, spouse, 12. Impaired mental status, dehydration, fatigue,
friends, health, and mobility contribute to low lighting or increased shadows, and disrup-
feelings of despair and hopelessness. The older tion in the internal body clock
adult’s outlook on life is distorted, preventing 13. all other types of nursing interventions; effec-
them from exploring acceptable solutions to tiveness
their problems. 14. Changes in lifestyle, privacy, socialization, and
4. Examples will vary and may include: family dynamics. The caregiver may experi-
a. Elder abuse: explore conflicting explana- ence physical and mental exhaustion from
tion about older person’s condition. providing round-the-clock care.
b. Household theft: obtain and verify ID of all 15. adult day services and respite care
workers entering the home. 16. a. Preclinical AD: No obvious symptoms of
c. Mail theft: use direct deposit of social secu- memory loss or confusion, measurable
rity funds and pension checks. biologic changes (biomarkers); specific
d. White collar crime: do not give information biomarkers (such as the APOE gene) may
to strangers on the phone. include brain imaging studies and protein
e. Vehicular theft: lock vehicle doors and in spinal fluid. No obvious symptoms of
never leave the keys in the car. memory loss or confusion; occurs years to
f. Purse snatching: avoid carrying valuables perhaps decades before the next stage
with you; if you must carry them, use an b. Mild cognitive impairment caused by AD:
inside pocket Mild changes in memory, reasoning, and
5. Examples (following each of the five catego- visual perception noticeable to person
ries) may vary and can include: affected, friends, and family; capable of
a. Physical: using drugs to keep older person carrying out everyday activities
docile. c. Dementia caused by AD: Memory impair-
b. Psychological: threatening physical vio- ment, behavioral symptoms, impaired
lence to control behavior. ability to function in daily life
c. Material: misuse of older person’s funds. 17. art, music, and humor
d. Neglect: not assisting with ADLs as needed 18. trust
or providing inadequate care. 19. Any three of the following:
e. Sexual: infliction of nonconsensual sexual a. ensuring the environment is safe for wan-
contact of any kind. dering
6. Any two of the issues discussed in the text. b. informing and educating others about this
Examples: problem
a. Adequate health care including the cost of c. ensuring the patient has an identification
prescriptions bracelet
d. frequently checking the patient

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 Student Learning Guide Answer Key  93  

e. observing for behaviors that trigger the 22. complaining of anorexia, sleep disturbance,
wandering lack of energy, and loss of interest and enjoy-
f. diverting his attention ment in life
g. maintaining a regular activity program 23. develop trust; be consistent and reliable; do not
20. a lifelong psychological pattern, an organic make promises you cannot keep
condition, or an adverse reaction to medication 24. depression, insomnia, mental confusion, fre-
21. Any of the strategies listed in Patient Educa- quent falls, self-neglect, uncontrollable hyper-
tion Box in the textbook. Examples: tension or diabetes, gastritis, or anemia
a. Serve one food at a time to decrease confu- 25. giving positive feedback for desired behaviors
sion. and negative feedback for undesired behaviors
b. Remind patient to open mouth, chew, and 26. distraction
swallow. 27. meticulous planning of personal affairs, giving
c. Avoid hurrying the patient to eat. away treasured possessions, sudden euphoria,
or stated death wishes
28. coma or death

Table Activity

Alzheimer Disease
Cause Loss of function of neurons in the frontal and temporal lobes of the brain.
Signs and symptoms Increasing short-term memory loss; inability to learn new things, depression,
agitation, suspiciousness, hallucinations, wandering, impaired judgment and
cognition, deteriorating speech.
Diagnosis Based on ruling out other causes for the symptoms; PET scan shows reduced lobe
activity, biologic changes (in the brain’s b-amyloid plaque); specific biomarkers
(such as the APOE gene).
Treatment Symptomatic. Drug therapy with rivastigmine, galantamine, or donepezil
improves memory, alertness, and social engagement. Memantine, another
medication, may protect nerve cells from excess stimulation from the
neurotransmitter glutamate and delay progression of symptoms. Use of memory
aids, antidepressant therapy for depression.

Review Questions for the Next Generation 17. Short Portable Mental Status Questionnaire
NCLEX® Examination (SPMSQ); Mini-Cog; Mini-Mental State Exami-
1. 2 nation (MMSE)
2. 1 18. neglect
3. 3 19. 2
4. 3 20. 3
5. 4 21. 3
6. infection 22. 1
7. 1 23. pet
8. 3 24. 1- cholinesterase; 2- acetylcholine; 3- cerebral
9. 2 cortex; 4- memory, alertness, and social engage-
10. 4 ment; 5- cure
11. 1 25. 1, 2, 3, 5, 8
12. 2, 3
13. 2 Critical Thinking Activities
14. 3 1. Intervention should include increasing social
15. 1, 3, 4, 5 contact, activities that will increase her self-
16. 3 esteem (volunteering, etc.), increase physical
activity, obtain social atmosphere for meals,

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for text and data mining, AI training, and similar technologies.
94  Student Learning Guide Answer Key

possible attendance in a grief support group, STEPS TOWARD BETTER COMMUNICATION

antidepressant medication.
2. List the signs and symptoms of elder abuse. Completion
The approach will be individual but should 1. unkempt
begin with establishing a trusting, confidential 2. Advocacy
relationship. The social worker should be con- 3. pose
sulted. 4. condescending
3. Individual answers will vary; consider means 5. implication
for older people to obtain transportation for
food and medical appointments as well as Communication Exercise
social activity. How could an inexpensive chore Dialogue will be individual.
service be provided for seniors?
4. Provide a safe, consistent environment. Stick
to routines, do not make changes if possible,
make sure patient has a name tag, provide
assistance as needed with ADLs, post clearly
labeled signs.

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for text and data mining, AI training, and similar technologies.