Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition
Chapter 07: Asepsis and Infection Control
Answer Keys - Critical Thinking Questions
Nursing Care Plan 7-1: The Patient with an Infection
1. Mr. R. has a peripheral IV infusing and reports discomfort at the site of insertion. What
should the nurse do?
The nurse should immediately assess the IV site for obvious dislodgment of the IV catheter,
edema, erythema, or increased warmth or coolness. Coolness may indicate IV infiltration; the
other signs may indicate irritation (possibly from a previously administered medication or as an
adverse effect of it) or infection.
In general, if an IV site is obviously infiltrated, nursing judgment is sufficient to determine
whether to stop the IV infusion and/or remove the infiltrated IV catheter. Warm compresses may
generally be applied per nursing judgment as well. (Facility policies must be verified.)
The health care provider must be notified so that the determination can be made regarding the
necessity to restart a new intravenous access site.
2. Mr. R. has a urinary catheter connected to continuous drainage. He reports burning at the site
of insertion and the nurse notes dark, concentrated urine in the tubing. What should the nurse do
next?
The nurse should assess the site of the catheter insertion for any signs of edema, erythema, or
exudate. The nurse should then take the patient’s vital signs, noting any changes in temperature
and pulse. Compare the data obtained with patient’s previous vital signs.?
Following these nursing actions, the nurse should obtain urine samples for urinalysis and culture
and sensitivity (using aseptic technique), in anticipation of the health care provider’s orders to
come.
All of the above should then be reported to the patient’s health care provider as promptly as
possible. The nurse should also encourage the patient to increase his fluid intake. Make
additional fluids available to him, if not contraindicated.
3. The nurse notes on the sheet of laboratory results for Mr. R. that his WBC count is 524. Why is
this a concern, and what is recommended as a precautionary measure?
This indicates a severely compromised immune system, placing the patient at very high risk for
infection. The patient is especially susceptible to microorganisms that normally do not pose a
significant threat to a healthy immune system. A healthy immune system will destroy or

Answer Keys - Critical Thinking Questions 7-2
deactivate most pathogens before they can multiply into greater numbers. If a patient is
immunocompromised, even weaker or opportunistic pathogens (herpes varicella virus or CMV)
can become established and cause infection or disease. Often this is in a more severe form
because the patient also cannot initiate an effective immune response to combat it.
Mr. R. should be placed on neutropenic precautions (formerly known as reverse isolation or
Protective Isolation). The intent of neutropenic precautions is to minimize threats to the patient’s
compromised immune status; for instance, protecting the patient from his or her environment.
Most facilities have specific protocols for implementing neutropenic precautions. These
generally involve a private room with the door to remain closed; limiting visitors; no obviously
infected visitors; no fresh fruit, flowers, or raw vegetables; and no open containers (juices, water,
etc.) which can serve as reservoirs for environmental pathogens.

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition
Chapter 8: Body Mechanics and Patient Mobility
Answer Keys - Critical Thinking Questions
Nursing Care Plan 8-1: The Patient with Activity Intolerance
1. The nurse is in the process of transferring Mr. D. from his bed to a chair using a mechanical
lift. The nurse has prepared the chair and placed it near the bed. The nurse turns Mr. D. to his
side, places the sling under Mr. D. to ensure adequate support of his head, returns Mr. D. to his
back, and slowly begins to lift Mr. D. from his bed. What has the nurse forgotten to do, and why
is it important?
The nurse has forgotten to fold Mr. D.’s arms across his chest to prevent them from becoming
injured during the lift.
2. The patient has a trapeze bar across the bed, trochanter rolls, and a footboard. Explain the
rationale for each of these devices in maintaining proper body alignment.
A trapeze bar allows the patient to use his upper body to move around in bed. Trochanter rolls
stabilize the hip joint when placed firmly beside it, and prevent the hip from rolling outward. A
footboard prevents permanent, abnormal plantar flexion (footdrop) resulting from injury to the
flexor muscles.

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition
Chapter 9: Hygiene and Care of the Patient’s Environment
Answer Keys - Critical Thinking Questions
Nursing Care Plan 9-1: The Patient Needing Skin Care
1. Mr. P. has a poor appetite and his chemistry profile reveals low protein, low albumin, and a
low anion gap (A/G) ratio. Explain why poor nutrition predisposes the patient to impairment of
skin integrity and poor tissue healing.
Proteins, which are synthesized by the liver, are required for tissue repair and proper immune
system function. The only source of proteins is through dietary intake. If a patient is
undernourished, he will be unable to produce adequate protein for metabolic processes, such as
tissue repair and healing, and fighting infection.
2. With Mr. P.’s history of diarrhea, explain the possible complication that could evolve if dry,
intact skin develops an open lesion.
It is possible that an open lesion in this anatomic region may become contaminated and infected
with bacteria normally found in the intestines, notably Escherichia coli. This type of situation is
often difficult to treat with antibiotics.
As a further consequence of Mr. P.’s poor nutritional status, his immune system will be
weakened and may not be able to effectively combat pathogens, making the infection even more
difficult to manage.

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Answer Keys - Critical Thinking Questions 15-2
The nurse needs to ascertain exactly why this patient is so anxious, and then relieve his anxiety if
possible. This situation is very similar to one discussed previously (please refer to Critical
Thinking Question No. 1), and the same basic approach is indicated. Starting with statements
such as, “You seem worried (nervous, etc.) this morning,” often allow a patient the opportunity
to express his fears and concerns safely.
In addition to the nurse’s therapeutic responses, the patient should be asked if he would find it
helpful to ask some questions, have the nurse offer information about his upcoming diagnostic
test, or speak with his health care provider. Some patients may be claustrophobic and this can be
ascertained when discussing the patient’s concerns.
The nurse should use simple language and explanations, because people exhibiting anxiety at this
level will generally be unable to comprehend or process detailed or large amounts of
information.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition
Chapter 16: Care of Patients Experiencing Urgent Alterations in Health
Answer Keys - Critical Thinking Questions
Nursing Care Plan 16-1: The Patient with a Laceration
1. Ms. T.’s wound was superficial. In contrast, what would be the nurse’s actions if the wound
appeared to be deep or was spurting blood?
Firm, direct pressure must be applied to the area (the nurse should be wearing gloves) and the
patient must be observed for signs and symptoms of shock. The health care provider should be
notified immediately by another nurse.
2. What safety measures are indicated to ensure Ms. T. is not injured again?

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Foundations And Adult Health Nursing, 7th Edition Solution Manual

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