Solution Manual For Foundations and Adult Health Nursing, 8th Edition
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th 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 2800/mm3.
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
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 2800/mm3.
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
Cooper and Gosnell: Foundations and Adult Health Nursing, 8th 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 2800/mm3.
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
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 2800/mm3.
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.
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.
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.
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, 8th Edition
Chapter 08: 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.
Chapter 08: 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.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 09: 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.
Chapter 09: 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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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 10: Safety
Answer Keys - Critical Thinking Questions
Nursing Care Plan 10-1: Patient Safety
1. The nurse walking down the hall hears a patient calling out for help. The nurse assesses the
situation and realizes that the patient does not remember how to use the call light. What factors
possibly contribute to the patient’s inability to remember, and how should the nurse teach the
patient to use the call light?
A patient’s memory and cognitive function can be affected by a variety of factors, such as
medications, anxiety, pain, disorientation, and dementia. Sensory perceptions should be assessed
by the nurse as thoroughly as possible, with information and education being provided to patients
and family/visitors appropriate to level of comprehension. Reinforcement of information should
be provided as necessary.
Demonstrations of the use of equipment (in this case, the call light) by the nurse and return
demonstrations by the patient may be appropriate in some situations, particularly if the patient is
in new or unfamiliar surroundings. It is also often helpful in this type of situation if the nurse
checks the patient frequently, both to assess the patient’s status and to reassure patients that they
have not been left alone.
Patients may need to be reoriented to surroundings frequently, especially if mental status changes
are a concern. It is often helpful for a patient with sensory or cognitive impairment to be in a
room close to the nurses’ station.
2. The nurse enters the patient’s room to answer the call bell and sees the patient frantically
pointing to the trash can next to the bed. The nurse smells smoke and sees small flames. What
should be done to help prevent fires, and what should the nurse do in this situation?
The priority in this situation is to ensure patient safety. The nurse should call for assistance and
implement the facility’s RACE protocol: Rescue/Remove the patient from the area; initiate the
Alarm process; Contain the fire (close fire doors, patient room doors, etc.); Extinguish the fire, if
realistic; and Evacuate the other patients, if necessary.
Patients and visitors should be educated about facility safety policies: reinforce the no smoking
policy; and the use of equipment and personal items (hair dryers, electric shavers, lamps, etc.,)
only if they meet appropriate facility codes. Safety reviews are generally conducted with facility
personnel to ensure awareness of potential risks and proper safety procedures.
Chapter 10: Safety
Answer Keys - Critical Thinking Questions
Nursing Care Plan 10-1: Patient Safety
1. The nurse walking down the hall hears a patient calling out for help. The nurse assesses the
situation and realizes that the patient does not remember how to use the call light. What factors
possibly contribute to the patient’s inability to remember, and how should the nurse teach the
patient to use the call light?
A patient’s memory and cognitive function can be affected by a variety of factors, such as
medications, anxiety, pain, disorientation, and dementia. Sensory perceptions should be assessed
by the nurse as thoroughly as possible, with information and education being provided to patients
and family/visitors appropriate to level of comprehension. Reinforcement of information should
be provided as necessary.
Demonstrations of the use of equipment (in this case, the call light) by the nurse and return
demonstrations by the patient may be appropriate in some situations, particularly if the patient is
in new or unfamiliar surroundings. It is also often helpful in this type of situation if the nurse
checks the patient frequently, both to assess the patient’s status and to reassure patients that they
have not been left alone.
Patients may need to be reoriented to surroundings frequently, especially if mental status changes
are a concern. It is often helpful for a patient with sensory or cognitive impairment to be in a
room close to the nurses’ station.
2. The nurse enters the patient’s room to answer the call bell and sees the patient frantically
pointing to the trash can next to the bed. The nurse smells smoke and sees small flames. What
should be done to help prevent fires, and what should the nurse do in this situation?
The priority in this situation is to ensure patient safety. The nurse should call for assistance and
implement the facility’s RACE protocol: Rescue/Remove the patient from the area; initiate the
Alarm process; Contain the fire (close fire doors, patient room doors, etc.); Extinguish the fire, if
realistic; and Evacuate the other patients, if necessary.
Patients and visitors should be educated about facility safety policies: reinforce the no smoking
policy; and the use of equipment and personal items (hair dryers, electric shavers, lamps, etc.,)
only if they meet appropriate facility codes. Safety reviews are generally conducted with facility
personnel to ensure awareness of potential risks and proper safety procedures.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th 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?
Ms. T. may require more assistance or supervision during mealtimes than she did previously. For
example, she may need her food cut up, perhaps before the meal is served to her (to prevent
embarrassment).
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?
Ms. T. may require more assistance or supervision during mealtimes than she did previously. For
example, she may need her food cut up, perhaps before the meal is served to her (to prevent
embarrassment).
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 20: Complementary and Alternative Therapies
Answer Keys - Critical Thinking Questions
Nursing Care Plan 20-1: Using Complementary and Alternative Therapies in Treatment
1. Ms. L. complains of feeling fatigued and tense. List some nonpharmacologic methods of
bringing about a state of physical and mental tranquility that may be helpful. Why might each of
these methods be helpful for Ms. L.?
Have Ms. L. try drinking some nonstimulating herbal tea, accepting a therapeutic massage, or
positioning for comfort and relaxation. Decrease the stimulation of the environment by lowering
the intensity of the lighting and listening to soothing music or nature sounds (especially rhythmic
ones, such as waves or gentle rain).
2. Ms. L. turns on her light and she is crying. She complains of feeling helpless and inadequate
to assume responsibility for caring for her children and husband when she is discharged. What
are some therapeutic interventions that will promote her feelings of stability and validation of
her anxiety?
Allow and encourage Ms. L. to express her concerns and feelings. This may result in Ms. L.
verbalizing more specific concerns regarding her perceived inability to assume her role in the
family.
Answering any questions she may have and offering information regarding the usual healing
process may help to alleviate some of her anxiety.
Chapter 20: Complementary and Alternative Therapies
Answer Keys - Critical Thinking Questions
Nursing Care Plan 20-1: Using Complementary and Alternative Therapies in Treatment
1. Ms. L. complains of feeling fatigued and tense. List some nonpharmacologic methods of
bringing about a state of physical and mental tranquility that may be helpful. Why might each of
these methods be helpful for Ms. L.?
Have Ms. L. try drinking some nonstimulating herbal tea, accepting a therapeutic massage, or
positioning for comfort and relaxation. Decrease the stimulation of the environment by lowering
the intensity of the lighting and listening to soothing music or nature sounds (especially rhythmic
ones, such as waves or gentle rain).
2. Ms. L. turns on her light and she is crying. She complains of feeling helpless and inadequate
to assume responsibility for caring for her children and husband when she is discharged. What
are some therapeutic interventions that will promote her feelings of stability and validation of
her anxiety?
Allow and encourage Ms. L. to express her concerns and feelings. This may result in Ms. L.
verbalizing more specific concerns regarding her perceived inability to assume her role in the
family.
Answering any questions she may have and offering information regarding the usual healing
process may help to alleviate some of her anxiety.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 21: Pain Management, Comfort, Rest, and Sleep
Answer Keys - Critical Thinking Questions
Nursing Care Plan 21-1: The Patient with Chronic Pain
1. During the morning ADLs, Mr. J. states, “I feel so useless. I can’t even place the urinal for
myself.” What would be the nurse’s most therapeutic response?
Mr. J. should be encouraged to verbalize his concerns and frustrations. “It sounds like this is very
difficult for you,” “You sound frustrated. Is that how you are feeling?” or “Why don’t you tell
me more about how you’re feeling?” may help him to feel he can safely express himself.
As part of his ongoing care, Mr. J. should also be allowed as much choice and control over his
nursing care and treatment regimen as possible, and should be given adequate time to perform
those ADLs and self-care measures he can manage.
2. What would be the most useful nursing intervention to achieve the goal of reduced pain during
Mr. J.’s assisted ambulation?
Mr. J. should receive analgesia adequate to allow him enough relief from his pain to enable him
greater mobility (i.e., ambulation) without sedative effects or impaired judgment. The analgesic
should be administered 30 minutes before the scheduled activity if the drug is given IV; 45
minutes to 1 hour before if the drug is given orally.
3. Which comfort measures could the nurse perform to ensure that Mr. J. has several hours of
restorative sleep?
Position and reposition Mr. J. as comfortably and as frequently as possible. Provide pain-relief
measures preferred by the patient, as appropriate (analgesia, relaxation therapy) before retiring
for the night. Minimize environmental stimulation.
4. Mr. J. complains of his eyes burning and feeling dry and the lights annoying him. What
measures are most likely to help relieve his symptoms?
Keep the patient’s eyes free from irritants and crusting by providing warm or cool soaks (as
patient prefers) to eyes. Reduce corneal drying by administering artificial tears. Decrease lighting
while Mr. J. is in bed or in a chair, but be sure to perform appropriate nursing assessments
frequently with regard to Mr. J.’s safety.
Chapter 21: Pain Management, Comfort, Rest, and Sleep
Answer Keys - Critical Thinking Questions
Nursing Care Plan 21-1: The Patient with Chronic Pain
1. During the morning ADLs, Mr. J. states, “I feel so useless. I can’t even place the urinal for
myself.” What would be the nurse’s most therapeutic response?
Mr. J. should be encouraged to verbalize his concerns and frustrations. “It sounds like this is very
difficult for you,” “You sound frustrated. Is that how you are feeling?” or “Why don’t you tell
me more about how you’re feeling?” may help him to feel he can safely express himself.
As part of his ongoing care, Mr. J. should also be allowed as much choice and control over his
nursing care and treatment regimen as possible, and should be given adequate time to perform
those ADLs and self-care measures he can manage.
2. What would be the most useful nursing intervention to achieve the goal of reduced pain during
Mr. J.’s assisted ambulation?
Mr. J. should receive analgesia adequate to allow him enough relief from his pain to enable him
greater mobility (i.e., ambulation) without sedative effects or impaired judgment. The analgesic
should be administered 30 minutes before the scheduled activity if the drug is given IV; 45
minutes to 1 hour before if the drug is given orally.
3. Which comfort measures could the nurse perform to ensure that Mr. J. has several hours of
restorative sleep?
Position and reposition Mr. J. as comfortably and as frequently as possible. Provide pain-relief
measures preferred by the patient, as appropriate (analgesia, relaxation therapy) before retiring
for the night. Minimize environmental stimulation.
4. Mr. J. complains of his eyes burning and feeling dry and the lights annoying him. What
measures are most likely to help relieve his symptoms?
Keep the patient’s eyes free from irritants and crusting by providing warm or cool soaks (as
patient prefers) to eyes. Reduce corneal drying by administering artificial tears. Decrease lighting
while Mr. J. is in bed or in a chair, but be sure to perform appropriate nursing assessments
frequently with regard to Mr. J.’s safety.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 23: Specimen Collection and Diagnostic Testing
Answer Keys - Critical Thinking Questions
Nursing Care Plan 23-1: Specimen Collection or Diagnostic Examination
1. The patient has been very quiet during his morning care. When you attempt a conversation, he
is obviously not interested. What is a way for you to initiate a conversation to encourage him to
relate his concerns over his upcoming bronchoscopy?
The nurse might say something such as, “You seem preoccupied this morning,” or “It looks like
something is on your mind this morning.” A statement like or similar to this often opens
channels of therapeutic communication with the nurse and results in patients expressing their
concerns.
If more encouragement is needed, the nurse might be more direct by asking, “What has your
doctor told you about your test this morning?” or “What questions do you have about your test
today?”
2. Your patient is scheduled for an intravenous pyelogram (IVP). During your preparation of this
patient, he remarks he once had a reaction while eating shellfish. What will you probably do
next?
Shellfish, iodine, or contrast dye (as is used in many diagnostic procedures, such as CT scans and
MRIs) “reactions” can indicate sensitivity or an allergy to iodine-based substances, and they
should be followed up with the health care provider immediately.
The nurse should obtain as much additional information from the patient and his documented
medical history on file. Certain effects of the contrast dye medium used are considered responses
to it (i.e., sensations of warmth, total body flushing, nausea) and not allergic reactions.
The health care provider should be notified and the patient’s direct statements should be noted.
All of these actions should be documented in the patient’s medical record.
In some cases an alternate contrast medium will be used during the diagnostic procedure. In
some cases the original iodine-based dye will still be used; the patient will receive antihistamines
as part of his preprocedure preparation to minimize the possibility of a severe adverse reaction to
it.
3. The patient is obviously quite anxious about his upcoming magnetic resonance imaging (MRI)
scan. He breaks out in a cold sweat, and is breathing rapidly, and when assessing his pulse, you
note tachycardia. How will you respond to this patient?
Chapter 23: Specimen Collection and Diagnostic Testing
Answer Keys - Critical Thinking Questions
Nursing Care Plan 23-1: Specimen Collection or Diagnostic Examination
1. The patient has been very quiet during his morning care. When you attempt a conversation, he
is obviously not interested. What is a way for you to initiate a conversation to encourage him to
relate his concerns over his upcoming bronchoscopy?
The nurse might say something such as, “You seem preoccupied this morning,” or “It looks like
something is on your mind this morning.” A statement like or similar to this often opens
channels of therapeutic communication with the nurse and results in patients expressing their
concerns.
If more encouragement is needed, the nurse might be more direct by asking, “What has your
doctor told you about your test this morning?” or “What questions do you have about your test
today?”
2. Your patient is scheduled for an intravenous pyelogram (IVP). During your preparation of this
patient, he remarks he once had a reaction while eating shellfish. What will you probably do
next?
Shellfish, iodine, or contrast dye (as is used in many diagnostic procedures, such as CT scans and
MRIs) “reactions” can indicate sensitivity or an allergy to iodine-based substances, and they
should be followed up with the health care provider immediately.
The nurse should obtain as much additional information from the patient and his documented
medical history on file. Certain effects of the contrast dye medium used are considered responses
to it (i.e., sensations of warmth, total body flushing, nausea) and not allergic reactions.
The health care provider should be notified and the patient’s direct statements should be noted.
All of these actions should be documented in the patient’s medical record.
In some cases an alternate contrast medium will be used during the diagnostic procedure. In
some cases the original iodine-based dye will still be used; the patient will receive antihistamines
as part of his preprocedure preparation to minimize the possibility of a severe adverse reaction to
it.
3. The patient is obviously quite anxious about his upcoming magnetic resonance imaging (MRI)
scan. He breaks out in a cold sweat, and is breathing rapidly, and when assessing his pulse, you
note tachycardia. How will you respond to this patient?
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Answer Keys - Critical Thinking Questions 23-2
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.
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, 8th Edition
Chapter 25: Loss, Grief, Dying, and Death
Answer Keys - Critical Thinking Questions
Nursing Care Plan 25-1: The Patient Experiencing Complicated Grieving (Unresolved
Grief)
1. Ms. S. is admitted to the medical unit for severe weakness, weight loss, and chronic
depression. She is reluctant to get out of bed to dress and have meals. How could the nurse
facilitate progression through the grieving process?
Encourage and assist Ms. S. with ADLs, allowing her as much control as is reasonable. The
nurse needs to be aware that too many choices or too much detail can be overwhelming for a
patient who is depressed. Choices should be kept as simple as possible; for example, “Would you
like me to help you bathe now, or would you rather I come back in 10 minutes?”
It is also important for the nurse to be especially consistent in this type of situation. If “10
minutes” is the time frame offered, the nurse should make every effort to adhere to it.
Inconsistency can accentuate a depressed patient’s feeling that she is not “worth the trouble.”
Ms. S. also needs to feel that she can safely express her emotions. She should be allowed ample
time and opportunity to talk about her concerns, encouraged by accepting, nonjudgmental
responses from the nurse; for example, “You seem sad, Ms. S. How can I help you?”
2. Ms. S. appears thin, with poor tissue turgor. How can the nurse and dietitian encourage
improvement of her nutritional status?
Ascertain Ms. S.’s food preferences and attempt to incorporate them into her diet as much as
possible. Offering frequent, small meals and snacks may also be indicated. A larger meal may
seem overwhelming and require too much energy for a depressed individual. Nutritional
supplements may also be an option.
Monitor the patient’s intake and output, and record periodic weights to determine whether
nutritional status is improving.
3. The nursing assessment for Ms. S. revealed a flat affect, little verbalization, and poor personal
hygiene. Which therapeutic nursing interventions would help achieve patient goals and expected
outcomes?
Encourage and assist Ms. S. with ADLs, and offer acceptable choices to her (for example,
“Would you like a tub bath or a shower today?”).
Attempts to “cheer up” the patient should not be made. These may be perceived by Ms. S. as the
nurse’s inability to understand her feelings and attempts to minimize the significance of her
emotional pain. This can result in further withdrawal and isolation of the patient.
Chapter 25: Loss, Grief, Dying, and Death
Answer Keys - Critical Thinking Questions
Nursing Care Plan 25-1: The Patient Experiencing Complicated Grieving (Unresolved
Grief)
1. Ms. S. is admitted to the medical unit for severe weakness, weight loss, and chronic
depression. She is reluctant to get out of bed to dress and have meals. How could the nurse
facilitate progression through the grieving process?
Encourage and assist Ms. S. with ADLs, allowing her as much control as is reasonable. The
nurse needs to be aware that too many choices or too much detail can be overwhelming for a
patient who is depressed. Choices should be kept as simple as possible; for example, “Would you
like me to help you bathe now, or would you rather I come back in 10 minutes?”
It is also important for the nurse to be especially consistent in this type of situation. If “10
minutes” is the time frame offered, the nurse should make every effort to adhere to it.
Inconsistency can accentuate a depressed patient’s feeling that she is not “worth the trouble.”
Ms. S. also needs to feel that she can safely express her emotions. She should be allowed ample
time and opportunity to talk about her concerns, encouraged by accepting, nonjudgmental
responses from the nurse; for example, “You seem sad, Ms. S. How can I help you?”
2. Ms. S. appears thin, with poor tissue turgor. How can the nurse and dietitian encourage
improvement of her nutritional status?
Ascertain Ms. S.’s food preferences and attempt to incorporate them into her diet as much as
possible. Offering frequent, small meals and snacks may also be indicated. A larger meal may
seem overwhelming and require too much energy for a depressed individual. Nutritional
supplements may also be an option.
Monitor the patient’s intake and output, and record periodic weights to determine whether
nutritional status is improving.
3. The nursing assessment for Ms. S. revealed a flat affect, little verbalization, and poor personal
hygiene. Which therapeutic nursing interventions would help achieve patient goals and expected
outcomes?
Encourage and assist Ms. S. with ADLs, and offer acceptable choices to her (for example,
“Would you like a tub bath or a shower today?”).
Attempts to “cheer up” the patient should not be made. These may be perceived by Ms. S. as the
nurse’s inability to understand her feelings and attempts to minimize the significance of her
emotional pain. This can result in further withdrawal and isolation of the patient.
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Answer Keys - Critical Thinking Questions 25-2
Nursing Care Plan 25-2: The Patient Facing Death
1. Ms. B. complains of severe bone pain and nausea. She appears cachexic and extremely weak.
What are some nursing interventions to decrease Ms. B.’s symptoms?
Administer and assess the effect of analgesic and antinausea medications required for increased
comfort; give supplemental oxygen as ordered. Administer sips or drops of oral fluids (using a
syringe without a needle) to decrease some of the dehydration symptoms that accompany
cachexia, although this may not be desired by Ms. B. Mouth care and ice chips may help
decrease dehydration as well, but Ms. B.’s nausea must be managed first.
2. Ms. B. says, “I want to go home to die. I don’t want to stay in the hospital. All I want to do is
go home and be with my family.” How can the hospice team most beneficially assist Ms. B.?
Evaluate Ms. B.’s situation to determine if hospice home care services can be realistically
delivered. This will include assessing her home and family/support system as well.
3. When the nurse enters Ms. B.’s room to begin ADLs, she notes the patient’s extreme fatigue
and lethargy. What are some nursing interventions to conserve Ms. B.’s strength?
Minimize environmental stimulation, perform only necessary physical care and gentle
repositioning for comfort, and assess Ms. B.’s need for analgesia (which will decrease metabolic
demands and can therefore provide relaxation, as well). Explain all nursing actions to Ms. B.
Nursing Care Plan 25-2: The Patient Facing Death
1. Ms. B. complains of severe bone pain and nausea. She appears cachexic and extremely weak.
What are some nursing interventions to decrease Ms. B.’s symptoms?
Administer and assess the effect of analgesic and antinausea medications required for increased
comfort; give supplemental oxygen as ordered. Administer sips or drops of oral fluids (using a
syringe without a needle) to decrease some of the dehydration symptoms that accompany
cachexia, although this may not be desired by Ms. B. Mouth care and ice chips may help
decrease dehydration as well, but Ms. B.’s nausea must be managed first.
2. Ms. B. says, “I want to go home to die. I don’t want to stay in the hospital. All I want to do is
go home and be with my family.” How can the hospice team most beneficially assist Ms. B.?
Evaluate Ms. B.’s situation to determine if hospice home care services can be realistically
delivered. This will include assessing her home and family/support system as well.
3. When the nurse enters Ms. B.’s room to begin ADLs, she notes the patient’s extreme fatigue
and lethargy. What are some nursing interventions to conserve Ms. B.’s strength?
Minimize environmental stimulation, perform only necessary physical care and gentle
repositioning for comfort, and assess Ms. B.’s need for analgesia (which will decrease metabolic
demands and can therefore provide relaxation, as well). Explain all nursing actions to Ms. B.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 26: Health Promotion and Pregnancy
Answer Keys - Critical Thinking Questions
Nursing Care Plan 26-1: The Patient with a Normal Pregnancy
1. How should the nurse respond to Ms. P. if she expresses concern about her dietary practices
and their effect on her baby? What suggestions can the nurse give her to ensure that her diet is
adequate to support the pregnancy?
There is a strong correlation between maternal diet and fetal health that can be explained to Ms.
P. Her concern for her baby should be viewed as a positive occurrence.
Determine Ms. P.’s food preferences and eating habits by asking her to keep a food diary for a
few days and to bring it with her for review at her next visit. It is important that Ms. P. be
assured that this will be for her and her baby’s benefit only. The nurse must take special care not
to appear judgmental regarding Ms. P.’s eating habits and choices.
The nurse can review Ms. P.’s nutritional needs during pregnancy and suggest ways to meet
them. She will need basic nutritional education (the USDA’s new MyPlate plan) with
modifications addressing her vegetarian choices. Since she does eat fish, she can be encouraged
to have at least three servings of tuna, salmon, halibut, flounder, or mackerel (not fried) a week.
Advise her not skip any meals.
Additionally, peas, beans, and lentils and green leafy vegetables all also contain nutrients vital to
normal fetal development. Ms. P. should be encouraged to increase these foods, which are
staples of the vegetarian diet. It may also be easier for her to tolerate small, frequent meals rather
than the usual three meals per day.
Ms. P. may find it helpful to speak with a dietitian (a WIC referral is appropriate, if the eligibility
criteria are met).
2. Ms. P. states that she is concerned about having to reduce her activity schedule, particularly
tennis, which she enjoys. She is worried she will begin to resent her baby because of the need to
alter her activities. How should the nurse respond to her concerns? What suggestions should the
nurse give her?
The goal of exercise during pregnancy is maintenance of fitness, but strenuous exercise should
be avoided. Ms. P. should be reassured that once medically cleared by her obstetrician or
midwife after the birth, she will be able to gradually resume her activities to her former levels.
Ms. P. is also processing through Rubin’s four maternal tasks. She should be reassured that
feelings of ambivalence are normal. Ms. P. is expressing valid concerns and should be
encouraged to continue to do so.
Chapter 26: Health Promotion and Pregnancy
Answer Keys - Critical Thinking Questions
Nursing Care Plan 26-1: The Patient with a Normal Pregnancy
1. How should the nurse respond to Ms. P. if she expresses concern about her dietary practices
and their effect on her baby? What suggestions can the nurse give her to ensure that her diet is
adequate to support the pregnancy?
There is a strong correlation between maternal diet and fetal health that can be explained to Ms.
P. Her concern for her baby should be viewed as a positive occurrence.
Determine Ms. P.’s food preferences and eating habits by asking her to keep a food diary for a
few days and to bring it with her for review at her next visit. It is important that Ms. P. be
assured that this will be for her and her baby’s benefit only. The nurse must take special care not
to appear judgmental regarding Ms. P.’s eating habits and choices.
The nurse can review Ms. P.’s nutritional needs during pregnancy and suggest ways to meet
them. She will need basic nutritional education (the USDA’s new MyPlate plan) with
modifications addressing her vegetarian choices. Since she does eat fish, she can be encouraged
to have at least three servings of tuna, salmon, halibut, flounder, or mackerel (not fried) a week.
Advise her not skip any meals.
Additionally, peas, beans, and lentils and green leafy vegetables all also contain nutrients vital to
normal fetal development. Ms. P. should be encouraged to increase these foods, which are
staples of the vegetarian diet. It may also be easier for her to tolerate small, frequent meals rather
than the usual three meals per day.
Ms. P. may find it helpful to speak with a dietitian (a WIC referral is appropriate, if the eligibility
criteria are met).
2. Ms. P. states that she is concerned about having to reduce her activity schedule, particularly
tennis, which she enjoys. She is worried she will begin to resent her baby because of the need to
alter her activities. How should the nurse respond to her concerns? What suggestions should the
nurse give her?
The goal of exercise during pregnancy is maintenance of fitness, but strenuous exercise should
be avoided. Ms. P. should be reassured that once medically cleared by her obstetrician or
midwife after the birth, she will be able to gradually resume her activities to her former levels.
Ms. P. is also processing through Rubin’s four maternal tasks. She should be reassured that
feelings of ambivalence are normal. Ms. P. is expressing valid concerns and should be
encouraged to continue to do so.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 27: Labor and Delivery
Answer Keys - Critical Thinking Questions
Nursing Care Plan 27-1: The Patient with Spontaneous Rupture of Membranes
1. Ms. G.’s labor is progressing normally with continuous monitoring. Suddenly the fetal heart
rate drops to 90 bpm with late decelerations with each contraction. What should the nurse do?
Explain the reason for these actions.
Reposition the mother to prevent supine hypotension. Administer oxygen via mask to increase
the amount of oxygen in the mother’s blood. Increase maintenance IV fluid to expand blood
volume and make more available to the placenta. Stop oxytocin infusion because it intensifies
contractions and reduces placental blood flow, and administer tocolytic drugs to decrease uterine
contractions.
The health care provider should be notified after these initial steps are taken to correct the
decelerations.
2. Ms. G. and her coach have been working well together to manage her labor, using a focal
point, breathing techniques, and guided imagery. Suddenly she becomes irritable and tells her
coach, “Don’t touch me!” Her coach is bewildered by this change in behavior. How should the
nurse explain Ms. G.’s behavior to her coach? How can the nurse help the coach continue to be
effective during this time?
Ms. G.’s behavior indicates she is approaching transition. During this phase of labor, the cervix
dilates from 7 to 10 cm (full dilation) and it becomes completely effaced. Ms. G. is fatigued; she
may request medication but fears losing control and is obviously demonstrating irritability, all
expected during this phase.
The nurse can best support the coach by explaining all of this and reassuring both Ms. G. and her
coach that these signs indicate that labor is progressing normally. The coach should be
encouraged to accept any negative comments from Ms. G. to be part of this process and to try not
to take them personally. The coach should continue to encourage breathing and relaxation
techniques, praise and reassure Ms. G., and maintain a positive approach.
Even though coaches are usually reluctant to leave the laboring woman’s side, Ms. G.’s coach
should be encouraged to take rest or snack breaks periodically to best assist Ms. G.
Chapter 27: Labor and Delivery
Answer Keys - Critical Thinking Questions
Nursing Care Plan 27-1: The Patient with Spontaneous Rupture of Membranes
1. Ms. G.’s labor is progressing normally with continuous monitoring. Suddenly the fetal heart
rate drops to 90 bpm with late decelerations with each contraction. What should the nurse do?
Explain the reason for these actions.
Reposition the mother to prevent supine hypotension. Administer oxygen via mask to increase
the amount of oxygen in the mother’s blood. Increase maintenance IV fluid to expand blood
volume and make more available to the placenta. Stop oxytocin infusion because it intensifies
contractions and reduces placental blood flow, and administer tocolytic drugs to decrease uterine
contractions.
The health care provider should be notified after these initial steps are taken to correct the
decelerations.
2. Ms. G. and her coach have been working well together to manage her labor, using a focal
point, breathing techniques, and guided imagery. Suddenly she becomes irritable and tells her
coach, “Don’t touch me!” Her coach is bewildered by this change in behavior. How should the
nurse explain Ms. G.’s behavior to her coach? How can the nurse help the coach continue to be
effective during this time?
Ms. G.’s behavior indicates she is approaching transition. During this phase of labor, the cervix
dilates from 7 to 10 cm (full dilation) and it becomes completely effaced. Ms. G. is fatigued; she
may request medication but fears losing control and is obviously demonstrating irritability, all
expected during this phase.
The nurse can best support the coach by explaining all of this and reassuring both Ms. G. and her
coach that these signs indicate that labor is progressing normally. The coach should be
encouraged to accept any negative comments from Ms. G. to be part of this process and to try not
to take them personally. The coach should continue to encourage breathing and relaxation
techniques, praise and reassure Ms. G., and maintain a positive approach.
Even though coaches are usually reluctant to leave the laboring woman’s side, Ms. G.’s coach
should be encouraged to take rest or snack breaks periodically to best assist Ms. G.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 28: Care of the Mother and Newborn
Answer Keys - Critical Thinking Questions
Nursing Care Plan 28-1: The Mother with a Newborn
1. Even though Caleb is nursing well at each feeding, Ms. P. is anxious about her ability to
successfully breast-feed. She asks how she will know whether Caleb is getting enough breast
milk and whether she should supplement with formula, juice, or cereal. How should the nurse
answer her?
Signs that Ms. P. is successfully breastfeeding are that her breasts feel full before feedings and
soften afterward; the “letdown” reflex occurs; Baby C. nurses at each breast for 10 to 15 minutes,
8 to 10 times per day; Ms. P. hears an audible swallow as Baby C. sucks; Baby C. demands his
feeding and appears relaxed after feeding; Baby C. has 6 to 8 wet diapers per day and passes
stools several times per day; and Baby C. steadily gains weight and grows in length according to
standardized growth charts.
Supplementation with formula is not necessary if these are regular occurrences, but additional
water can be offered, if Ms. P. desires. Adding juices or cereals is generally not recommended
for several months, but Ms. P. should check with her pediatric health care provider for specific
recommendations.
2. A Gomco circumcision is performed on Caleb. After the procedure is completed, Caleb is
returned to his mother’s room. What should the nurse tell Ms. P. in response to her questions
regarding diaper changes and care of the circumcision? How should the nurse describe the
expected appearance of the circumcised penis?
Petrolatum jelly or petrolatum jelly–impregnated gauze may be applied to the end of Baby C.’s
penis to prevent sticking to the diaper; the area should be checked for signs or symptoms of
bleeding, irritation, or infection (exudate, with or without odor). Baby C.’s ability to urinate
should be monitored (checking diapers and noting saturation and odor).
Since during circumcision, the foreskin of the penis is removed, the head of Baby C.’s penis will
be visible and should appear pink. It may also appear slightly swollen from the recent
circumcision.
Chapter 28: Care of the Mother and Newborn
Answer Keys - Critical Thinking Questions
Nursing Care Plan 28-1: The Mother with a Newborn
1. Even though Caleb is nursing well at each feeding, Ms. P. is anxious about her ability to
successfully breast-feed. She asks how she will know whether Caleb is getting enough breast
milk and whether she should supplement with formula, juice, or cereal. How should the nurse
answer her?
Signs that Ms. P. is successfully breastfeeding are that her breasts feel full before feedings and
soften afterward; the “letdown” reflex occurs; Baby C. nurses at each breast for 10 to 15 minutes,
8 to 10 times per day; Ms. P. hears an audible swallow as Baby C. sucks; Baby C. demands his
feeding and appears relaxed after feeding; Baby C. has 6 to 8 wet diapers per day and passes
stools several times per day; and Baby C. steadily gains weight and grows in length according to
standardized growth charts.
Supplementation with formula is not necessary if these are regular occurrences, but additional
water can be offered, if Ms. P. desires. Adding juices or cereals is generally not recommended
for several months, but Ms. P. should check with her pediatric health care provider for specific
recommendations.
2. A Gomco circumcision is performed on Caleb. After the procedure is completed, Caleb is
returned to his mother’s room. What should the nurse tell Ms. P. in response to her questions
regarding diaper changes and care of the circumcision? How should the nurse describe the
expected appearance of the circumcised penis?
Petrolatum jelly or petrolatum jelly–impregnated gauze may be applied to the end of Baby C.’s
penis to prevent sticking to the diaper; the area should be checked for signs or symptoms of
bleeding, irritation, or infection (exudate, with or without odor). Baby C.’s ability to urinate
should be monitored (checking diapers and noting saturation and odor).
Since during circumcision, the foreskin of the penis is removed, the head of Baby C.’s penis will
be visible and should appear pink. It may also appear slightly swollen from the recent
circumcision.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 32: Care of the Child with a Physical and Mental or Cognitive Disorder
Answer Keys - Critical Thinking Questions
Nursing Care Plan 32-1: The Child with a Congenital Heart Disease
1. You enter D.’s room and notice her mother sitting at her bedside crying. She states, “I don’t
know how I will deal with her having heart surgery.” What would be an appropriate initial
response to D.’s mother?
“You sound worried. Why don’t we talk about your daughter’s surgery and any concerns you
have?” This statement and question allow Ms. B. an opportunity to express her feelings and
concerns.
2. The mother states that D. has a very poor appetite. What two helpful suggestions may help
educate the mother?
Offering Baby D. smaller, more frequent feedings, using a soft nipple with holes large enough to
prevent the baby from tiring (sucking requires a great deal of energy expenditure in this
situation); and holding and comforting Baby D. during her feedings whenever possible. Offer
small, nutritious snacks several times a day.
3. The mother mentions that she is concerned that D. will get an infection and become acutely ill.
What are two therapeutic nursing interventions for patient teaching?
Avoid crowds and people (including family members) who are ill, even with something as
seemingly minor as a mild upper respiratory infection. These can be dangerous to Baby D.,
whose immune system is already compromised. Immunizations should also be reviewed and
updated as age-appropriate. Baby D.’s pediatric health care provider should be consulted for
recommendations. Proper handwashing should be reviewed with Ms. B. and encouraged as well.
Nursing Care Plan 32-2: The Child Who Attempts Suicide
1. Upon entering S.’s room, the nurse notices that she is crying. She states, “I can’t live without
my mother; I want to be with her.” What is an appropriate initial response?
“You’ve been going through such tough times. You sound very sad right now.” This may give
patient S. an opportunity to express safely her feelings further.
It is important not to contradict patient S. by saying things such as, “Oh, no, you’re so young.
Your mother wouldn’t want that.” Statements such as this may be perceived as minimizing the
emotional pain being experienced and emphasizing feelings of low self-worth.
Chapter 32: Care of the Child with a Physical and Mental or Cognitive Disorder
Answer Keys - Critical Thinking Questions
Nursing Care Plan 32-1: The Child with a Congenital Heart Disease
1. You enter D.’s room and notice her mother sitting at her bedside crying. She states, “I don’t
know how I will deal with her having heart surgery.” What would be an appropriate initial
response to D.’s mother?
“You sound worried. Why don’t we talk about your daughter’s surgery and any concerns you
have?” This statement and question allow Ms. B. an opportunity to express her feelings and
concerns.
2. The mother states that D. has a very poor appetite. What two helpful suggestions may help
educate the mother?
Offering Baby D. smaller, more frequent feedings, using a soft nipple with holes large enough to
prevent the baby from tiring (sucking requires a great deal of energy expenditure in this
situation); and holding and comforting Baby D. during her feedings whenever possible. Offer
small, nutritious snacks several times a day.
3. The mother mentions that she is concerned that D. will get an infection and become acutely ill.
What are two therapeutic nursing interventions for patient teaching?
Avoid crowds and people (including family members) who are ill, even with something as
seemingly minor as a mild upper respiratory infection. These can be dangerous to Baby D.,
whose immune system is already compromised. Immunizations should also be reviewed and
updated as age-appropriate. Baby D.’s pediatric health care provider should be consulted for
recommendations. Proper handwashing should be reviewed with Ms. B. and encouraged as well.
Nursing Care Plan 32-2: The Child Who Attempts Suicide
1. Upon entering S.’s room, the nurse notices that she is crying. She states, “I can’t live without
my mother; I want to be with her.” What is an appropriate initial response?
“You’ve been going through such tough times. You sound very sad right now.” This may give
patient S. an opportunity to express safely her feelings further.
It is important not to contradict patient S. by saying things such as, “Oh, no, you’re so young.
Your mother wouldn’t want that.” Statements such as this may be perceived as minimizing the
emotional pain being experienced and emphasizing feelings of low self-worth.
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Answer Keys - Critical Thinking Questions 32-2
2. S.’s father is concerned about taking her home after discharge. What are two therapeutic
nursing interventions for patient and family teaching?
Patient S. should return home with specific counseling appointments, and her father needs to
ensure that she keeps them. (He may also be expected to attend family sessions with her.) Patient
S. will also benefit from her father displaying reassurance and a nonjudgmental manner towards
her. Patient S.’s father also needs education regarding early warning signs of suicidal ideation or
gestures, such as isolation, disinterest in the future or activities with friends, and insomnia. He
should also be given information regarding maintaining a safe environment for his daughter, as
well as health care provider and crisis hotline phone numbers.
It should be remembered that patient S.’s father has also suffered a significant loss (his wife),
and may need help in coping with his own grief as well as caring for his daughter.
3. S. begins to express interest in others and in activities in her hospital unit. What nursing
interventions would be appropriate to encourage her?
It is important for the nurse to interact with patient S. in a nonjudgmental manner. Positive
feedback should be given whenever she displays interest in age-appropriate activities, and the
nurse should discuss patient S.’s feeling with her after attending activities. She should be
encouraged to become involved in activities that seem to interest her, but she should be reassured
if interactions do not initially proceed as well as she had hoped.
2. S.’s father is concerned about taking her home after discharge. What are two therapeutic
nursing interventions for patient and family teaching?
Patient S. should return home with specific counseling appointments, and her father needs to
ensure that she keeps them. (He may also be expected to attend family sessions with her.) Patient
S. will also benefit from her father displaying reassurance and a nonjudgmental manner towards
her. Patient S.’s father also needs education regarding early warning signs of suicidal ideation or
gestures, such as isolation, disinterest in the future or activities with friends, and insomnia. He
should also be given information regarding maintaining a safe environment for his daughter, as
well as health care provider and crisis hotline phone numbers.
It should be remembered that patient S.’s father has also suffered a significant loss (his wife),
and may need help in coping with his own grief as well as caring for his daughter.
3. S. begins to express interest in others and in activities in her hospital unit. What nursing
interventions would be appropriate to encourage her?
It is important for the nurse to interact with patient S. in a nonjudgmental manner. Positive
feedback should be given whenever she displays interest in age-appropriate activities, and the
nurse should discuss patient S.’s feeling with her after attending activities. She should be
encouraged to become involved in activities that seem to interest her, but she should be reassured
if interactions do not initially proceed as well as she had hoped.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 35: Care of the Patient with a Psychiatric Disorder
Answer Keys - Critical Thinking Questions
Nursing Care Plan 35-1: The Patient with Depression
1. Mr. W. is admitted to the psychiatric unit and placed on suicide precautions. He sits stoically
staring out the window and does not respond to the nurse’s greeting. What safety interventions
should the team incorporate into Mr. W.’s care to prevent his self-destruction?
Mr. W.’s environment should be continuously monitored for safety. He may require constant
(1:1 or with remote access) visual supervision, or close supervision (visual check every 15
minutes).
Potential safety hazards (e.g., in this case, the window) should be evaluated for possibly
providing Mr. W. an opportunity for a suicide attempt.
Assessing Mr. W. for increasing suicide risk should be ongoing, because his mental status may
fluctuate. Many patients give some clue before exhibiting self-destructive behavior. The nurse
should be especially aware of Mr. W. appearing to be deep in thought or suddenly happy.
A no-suicide contract may be appropriate at some point, but should be implemented cautiously.
2. Mr. W. sleeps poorly, approximately 2 to 3 hours a night. What therapeutic interventions
should be used to correct his sleep pattern disturbance?
Engaging Mr. W. in activities of interest to him during the day, especially those involving some
physical activity (short walks, running) or concentration (card games, sanding or pounding
wood, if appropriate). These activities can also enhance Mr. W.’s feelings of self-worth when he
completes these tasks.
Other nonpharmacologic nursing interventions include avoiding daytime naps, eliminating
stimulants such as caffeine in the evening, and keeping a journal of daily activities and a sleep
log. Pharmacologic interventions should only be implemented after considering Mr. W.’s total
treatment regimen (i.e., antidepressant medications).
3. Mr. W. has lost 32 lb. What are some options for the staff to help him meet adequate
nutritional requirements?
Snacks, finger foods, or nutritional supplements may be necessary. The nurse or dietitian should
ascertain Mr. W.’s food preferences and try to incorporate them into a dietary plan for him.
Intake and output should be monitored daily until Mr. W. is able to assume responsibility for
meeting his nutritional needs.
Chapter 35: Care of the Patient with a Psychiatric Disorder
Answer Keys - Critical Thinking Questions
Nursing Care Plan 35-1: The Patient with Depression
1. Mr. W. is admitted to the psychiatric unit and placed on suicide precautions. He sits stoically
staring out the window and does not respond to the nurse’s greeting. What safety interventions
should the team incorporate into Mr. W.’s care to prevent his self-destruction?
Mr. W.’s environment should be continuously monitored for safety. He may require constant
(1:1 or with remote access) visual supervision, or close supervision (visual check every 15
minutes).
Potential safety hazards (e.g., in this case, the window) should be evaluated for possibly
providing Mr. W. an opportunity for a suicide attempt.
Assessing Mr. W. for increasing suicide risk should be ongoing, because his mental status may
fluctuate. Many patients give some clue before exhibiting self-destructive behavior. The nurse
should be especially aware of Mr. W. appearing to be deep in thought or suddenly happy.
A no-suicide contract may be appropriate at some point, but should be implemented cautiously.
2. Mr. W. sleeps poorly, approximately 2 to 3 hours a night. What therapeutic interventions
should be used to correct his sleep pattern disturbance?
Engaging Mr. W. in activities of interest to him during the day, especially those involving some
physical activity (short walks, running) or concentration (card games, sanding or pounding
wood, if appropriate). These activities can also enhance Mr. W.’s feelings of self-worth when he
completes these tasks.
Other nonpharmacologic nursing interventions include avoiding daytime naps, eliminating
stimulants such as caffeine in the evening, and keeping a journal of daily activities and a sleep
log. Pharmacologic interventions should only be implemented after considering Mr. W.’s total
treatment regimen (i.e., antidepressant medications).
3. Mr. W. has lost 32 lb. What are some options for the staff to help him meet adequate
nutritional requirements?
Snacks, finger foods, or nutritional supplements may be necessary. The nurse or dietitian should
ascertain Mr. W.’s food preferences and try to incorporate them into a dietary plan for him.
Intake and output should be monitored daily until Mr. W. is able to assume responsibility for
meeting his nutritional needs.
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Answer Keys - Critical Thinking Questions 35-2
Any attempts Mr. W. makes to improve his nutritional status should be acknowledged and
positively reinforced. Since patients with depression are often unable to make decisions as
simple as what foods to choose, positive reinforcement has the added benefit of increasing Mr.
W.’s self-esteem, as well as improving his nutritional status.
Any attempts Mr. W. makes to improve his nutritional status should be acknowledged and
positively reinforced. Since patients with depression are often unable to make decisions as
simple as what foods to choose, positive reinforcement has the added benefit of increasing Mr.
W.’s self-esteem, as well as improving his nutritional status.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 36: Care of the Patient with an Addictive Personality
Answer Keys - Critical Thinking Questions
Nursing Care Plan 36-1: The Patient Who Abuses Alcohol
1. During Mr. J.’s assessment, the nurse notes that he has tremors, is agitated, and verbalizes
visual hallucinations. What therapeutic interventions are appropriate to perform to prevent
injury to the patient?
Mr. J.’s personal safety is a priority. It will be difficult for nurses to anticipate fully the patient’s
perceptions, and he must be protected from harm while he is experiencing these symptoms.
He should be admitted to a room as close to the nurse’s station as possible for close monitoring.
Stimuli should be reduced, including decreasing the lighting in his room. He should be assessed
for impending seizure activity and placed on facility seizure precautions. Medications not
considered toxic to the liver, or those necessary to decrease Mr. J.’s anxiety and increasingly
irritable neurologic status (e.g., lorazepam [Ativan] or IV barbiturates) may be indicated in
certain circumstances.
2. As Mr. J.’s physical condition improves, he discloses his hopelessness and lack of desire to
continue living. What is an appropriate response by the nurse?
Patient safety is the priority in this situation; a safe physical environment needs to be provided
and maintained at all times. Substance abusers often have low self-esteem and depression. As
Mr. J.’s physical and mental status improve, he is becoming aware of the poor choices he has
previously made and their consequences. This can serve as the basis of overwhelming emotional
and psychological pain, and can lead to suicidal ideation. Treatment facilities generally have
specific protocols for staff to implement and follow in this potentially high-risk situation.
The nurse must be aware of the patient’s increased need for acceptance and support during this
time, and should reassure Mr. J. that the staff is available to him. Mr. J. should also be given
opportunities and encouragement to express his concerns further.
3. During group therapy, Mr. J. states, “Now that I am physically better, I know I will be able to
stop drinking. I don’t need any help. There really isn’t anything wrong with me.” What is the
appropriate staff intervention at this time?
Mr. J. is exhibiting denial, which must be addressed and overcome for treatment to be effective.
Staff can identify and relate problems and difficulties the patient has experienced in his life that
are directly related to his alcohol use. Mr. J. should also not be allowed to rationalize the
circumstances of their occurrence; blaming others and not accepting responsibility for one’s
actions serves as an excuse to continue both his denial and his drinking.
Chapter 36: Care of the Patient with an Addictive Personality
Answer Keys - Critical Thinking Questions
Nursing Care Plan 36-1: The Patient Who Abuses Alcohol
1. During Mr. J.’s assessment, the nurse notes that he has tremors, is agitated, and verbalizes
visual hallucinations. What therapeutic interventions are appropriate to perform to prevent
injury to the patient?
Mr. J.’s personal safety is a priority. It will be difficult for nurses to anticipate fully the patient’s
perceptions, and he must be protected from harm while he is experiencing these symptoms.
He should be admitted to a room as close to the nurse’s station as possible for close monitoring.
Stimuli should be reduced, including decreasing the lighting in his room. He should be assessed
for impending seizure activity and placed on facility seizure precautions. Medications not
considered toxic to the liver, or those necessary to decrease Mr. J.’s anxiety and increasingly
irritable neurologic status (e.g., lorazepam [Ativan] or IV barbiturates) may be indicated in
certain circumstances.
2. As Mr. J.’s physical condition improves, he discloses his hopelessness and lack of desire to
continue living. What is an appropriate response by the nurse?
Patient safety is the priority in this situation; a safe physical environment needs to be provided
and maintained at all times. Substance abusers often have low self-esteem and depression. As
Mr. J.’s physical and mental status improve, he is becoming aware of the poor choices he has
previously made and their consequences. This can serve as the basis of overwhelming emotional
and psychological pain, and can lead to suicidal ideation. Treatment facilities generally have
specific protocols for staff to implement and follow in this potentially high-risk situation.
The nurse must be aware of the patient’s increased need for acceptance and support during this
time, and should reassure Mr. J. that the staff is available to him. Mr. J. should also be given
opportunities and encouragement to express his concerns further.
3. During group therapy, Mr. J. states, “Now that I am physically better, I know I will be able to
stop drinking. I don’t need any help. There really isn’t anything wrong with me.” What is the
appropriate staff intervention at this time?
Mr. J. is exhibiting denial, which must be addressed and overcome for treatment to be effective.
Staff can identify and relate problems and difficulties the patient has experienced in his life that
are directly related to his alcohol use. Mr. J. should also not be allowed to rationalize the
circumstances of their occurrence; blaming others and not accepting responsibility for one’s
actions serves as an excuse to continue both his denial and his drinking.
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Answer Keys - Critical Thinking Questions 36-2
It is important that the staff interactions with Mr. J. occur in an accepting, nonjudgmental
manner.
Mr. J. should also be assisted and encouraged to identify his own behaviors that have caused
some of these problems in his life. He needs to receive more education about alcoholism as a
disease; the significant role denial plays in the disease process; and assistance with exploring
alternate, effective ways of dealing with stressful situations.
It is important that the staff interactions with Mr. J. occur in an accepting, nonjudgmental
manner.
Mr. J. should also be assisted and encouraged to identify his own behaviors that have caused
some of these problems in his life. He needs to receive more education about alcoholism as a
disease; the significant role denial plays in the disease process; and assistance with exploring
alternate, effective ways of dealing with stressful situations.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 39: Rehabilitation Nursing
Answer Keys - Critical Thinking Questions
Nursing Care Plan 39-1: The Patient with Spinal Cord Injury
1. Describe the stimuli or precipitating factors associated with bowel functioning or
management that have potential to cause autonomic dysreflexia. What are the appropriate
interventions if it does occur?
Autonomic dysreflexia typically occurs in patients with injuries above the T-6 level. It is usually
caused by some type of noxious stimulus below the spinal cord injury activating the sympathetic
nervous system. This response remains unchecked because the parasympathetic nervous system
cannot descend past the level of injury. The goal of intervention is to identify and relieve the
cause without further increasing the sympathetic nervous system response.
The most common cause of autonomic dysreflexia is bladder distention, but it can also be caused
by bowel impaction, among other stimuli. Multiple factors contribute to the risk for development
of this potentially life-threatening complication in the patient with a spinal cord injury:
immobility, slowed bowel motility, and loss of rectal sphincter tone. Insertion of a rectal
suppository (for bowel regulation and continence) may precipitate dysreflexia, as this may cause
increased stimulation of the rectal area and cause exacerbation of symptoms. It is recommended
that anesthetic ointment be applied to the rectum before manual disimpaction or suppository
insertion to prevent this from occurring.
If autonomic dysreflexia does occur, the patient’s blood pressure should be taken immediately
and then monitored every 5 minutes. (Since spinal cord injury patients are generally hypotensive,
even mildly hypertensive readings may indicate a significant rise from the baseline.)
The patient should be placed in the Fowler position to use the effect of orthostasis to control
blood pressure (i.e., induce hypotension).
Once the acute episode is past, a plan to prevent reoccurrence should be devised with the patient
and caregivers.
2. The patient has C5 quadriplegia. How is it possible to lessen the patient’s potential for
developing orthostatic hypotension?
The patient’s quadriplegia greatly increases his risk for development of orthostatic hypotension,
but the prevention of it is similar to that of other patients. Patients should be taught to change
position gradually, especially when raising their heads or going from the supine or horizontal
position to the vertical (lying flat to sitting to standing) position.
Chapter 39: Rehabilitation Nursing
Answer Keys - Critical Thinking Questions
Nursing Care Plan 39-1: The Patient with Spinal Cord Injury
1. Describe the stimuli or precipitating factors associated with bowel functioning or
management that have potential to cause autonomic dysreflexia. What are the appropriate
interventions if it does occur?
Autonomic dysreflexia typically occurs in patients with injuries above the T-6 level. It is usually
caused by some type of noxious stimulus below the spinal cord injury activating the sympathetic
nervous system. This response remains unchecked because the parasympathetic nervous system
cannot descend past the level of injury. The goal of intervention is to identify and relieve the
cause without further increasing the sympathetic nervous system response.
The most common cause of autonomic dysreflexia is bladder distention, but it can also be caused
by bowel impaction, among other stimuli. Multiple factors contribute to the risk for development
of this potentially life-threatening complication in the patient with a spinal cord injury:
immobility, slowed bowel motility, and loss of rectal sphincter tone. Insertion of a rectal
suppository (for bowel regulation and continence) may precipitate dysreflexia, as this may cause
increased stimulation of the rectal area and cause exacerbation of symptoms. It is recommended
that anesthetic ointment be applied to the rectum before manual disimpaction or suppository
insertion to prevent this from occurring.
If autonomic dysreflexia does occur, the patient’s blood pressure should be taken immediately
and then monitored every 5 minutes. (Since spinal cord injury patients are generally hypotensive,
even mildly hypertensive readings may indicate a significant rise from the baseline.)
The patient should be placed in the Fowler position to use the effect of orthostasis to control
blood pressure (i.e., induce hypotension).
Once the acute episode is past, a plan to prevent reoccurrence should be devised with the patient
and caregivers.
2. The patient has C5 quadriplegia. How is it possible to lessen the patient’s potential for
developing orthostatic hypotension?
The patient’s quadriplegia greatly increases his risk for development of orthostatic hypotension,
but the prevention of it is similar to that of other patients. Patients should be taught to change
position gradually, especially when raising their heads or going from the supine or horizontal
position to the vertical (lying flat to sitting to standing) position.
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Answer Keys - Critical Thinking Questions 39-2
Use of elastic or antiembolism stockings will help promote venous return to the heart and
prevent pooling of blood in the legs. A reclining wheelchair can also help lessen this response.
3. When explaining orthostatic hypotension to a new nursing assistant, what commonly
occurring signs and symptoms should the nurse describe, and what instructions should be given
to the nursing assistant?
Common signs and symptoms of orthostatic hypotension are light-headedness, sweating
(sometimes with cool or pale skin), and the patient may also complain of nausea or headache.
The patient should immediately sit or be returned to bed and placed in the supine position. If this
is not realistic (e.g., the patient is ambulating out of her room) she should be supported by the
unlicensed assistive personnel and both should gently slide down to the floor, if necessary.
Use of elastic or antiembolism stockings will help promote venous return to the heart and
prevent pooling of blood in the legs. A reclining wheelchair can also help lessen this response.
3. When explaining orthostatic hypotension to a new nursing assistant, what commonly
occurring signs and symptoms should the nurse describe, and what instructions should be given
to the nursing assistant?
Common signs and symptoms of orthostatic hypotension are light-headedness, sweating
(sometimes with cool or pale skin), and the patient may also complain of nausea or headache.
The patient should immediately sit or be returned to bed and placed in the supine position. If this
is not realistic (e.g., the patient is ambulating out of her room) she should be supported by the
unlicensed assistive personnel and both should gently slide down to the floor, if necessary.
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Answer Keys - Critical Thinking Questions 39-3
Nursing Care Plan 39-2: The Patient with Traumatic Brain Injury
1. Deficits with socialization, motivation, and sexual behaviors that occur after brain injury
result from damage to which portion of the brain? Discuss appropriate nursing interventions for
a patient with this type of injury.
These types of neurologic deficits may be the result of damage to the cerebral cortex (which
interprets stimuli), the temporal and limbic areas (which modify responses to stimuli), or the
hypothalamus and pituitary (which coordinate the motor cortex and language areas).
The brain can be seen as an inhibitor of emotions. When it is not fully functional, emotional
responses lack this inhibition. For this reason, nurses need to ensure provision of a safe,
consistent environment for patients recovering from brain injury. Reinforcement of appropriate
behaviors should be provided, and redirection of the patient demonstrating inappropriate
behaviors may also be necessary. Emotional support should be provided for the patient and
caregivers.
Additionally, the patient’s family should be involved in the plan of care. These types of outbursts
and behaviors can be highly distressing to caregivers. Educating everyone involved in the
patient’s care that these outbursts are the result of the patient’s disease process will assist them in
developing effective coping strategies for dealing with their loved one. This information will also
assist them with management of their own stress levels. Social service and rehabilitation referrals
are also indicated to develop the most comprehensive plans of patient care.
2. A patient recovering from a traumatic brain injury has problems telling the difference between
objects that have a similar shape. What is this type of deficit, and what nursing interventions are
appropriate for a patient with this deficit?
The patient has most likely developed a form of agnosia, which is the disturbance and resultant
difficulty in interpretation of sensory information. A patient with agnosia may be unable to
recognize or attach meaning to familiar faces, objects, or symbols. This can pose significant self-
care deficits and safety risks for affected patients.
Appropriate nursing interventions in this case include frequent patient assessment and
monitoring for safety and potential risks for injury, and adapting the patient’s environment
accordingly.
Additionally, using frequent cues with repetition and demonstration may assist the patient with
deficits (e.g., holding up a toothbrush and imitating actions for oral care while saying to the
patient, “It’s time to brush your teeth now.”). This can help to reinforce the differences between
similar objects (e.g., a toothbrush and a pencil).
Nursing Care Plan 39-2: The Patient with Traumatic Brain Injury
1. Deficits with socialization, motivation, and sexual behaviors that occur after brain injury
result from damage to which portion of the brain? Discuss appropriate nursing interventions for
a patient with this type of injury.
These types of neurologic deficits may be the result of damage to the cerebral cortex (which
interprets stimuli), the temporal and limbic areas (which modify responses to stimuli), or the
hypothalamus and pituitary (which coordinate the motor cortex and language areas).
The brain can be seen as an inhibitor of emotions. When it is not fully functional, emotional
responses lack this inhibition. For this reason, nurses need to ensure provision of a safe,
consistent environment for patients recovering from brain injury. Reinforcement of appropriate
behaviors should be provided, and redirection of the patient demonstrating inappropriate
behaviors may also be necessary. Emotional support should be provided for the patient and
caregivers.
Additionally, the patient’s family should be involved in the plan of care. These types of outbursts
and behaviors can be highly distressing to caregivers. Educating everyone involved in the
patient’s care that these outbursts are the result of the patient’s disease process will assist them in
developing effective coping strategies for dealing with their loved one. This information will also
assist them with management of their own stress levels. Social service and rehabilitation referrals
are also indicated to develop the most comprehensive plans of patient care.
2. A patient recovering from a traumatic brain injury has problems telling the difference between
objects that have a similar shape. What is this type of deficit, and what nursing interventions are
appropriate for a patient with this deficit?
The patient has most likely developed a form of agnosia, which is the disturbance and resultant
difficulty in interpretation of sensory information. A patient with agnosia may be unable to
recognize or attach meaning to familiar faces, objects, or symbols. This can pose significant self-
care deficits and safety risks for affected patients.
Appropriate nursing interventions in this case include frequent patient assessment and
monitoring for safety and potential risks for injury, and adapting the patient’s environment
accordingly.
Additionally, using frequent cues with repetition and demonstration may assist the patient with
deficits (e.g., holding up a toothbrush and imitating actions for oral care while saying to the
patient, “It’s time to brush your teeth now.”). This can help to reinforce the differences between
similar objects (e.g., a toothbrush and a pencil).
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Answer Keys - Critical Thinking Questions 39-4
3. What interventions are most appropriate to begin establishing communication with a patient
who is just emerging from coma after a brain injury?
Nurses should initiate communication with the patient by speaking slowly and calmly while
assessing the patient’s neurologic baseline function. The nurse should also assist with helping the
patient as much as possible with memory function, and orient the patient to place and time.
Sensory overload (including potentially noxious stimuli) should be avoided. Anxiety and fear are
to be expected from a patient in this situation; all nursing actions should be explained to the
patient as simply as possible before proceeding.
The nursing focus should be on providing structure at this stage of the patient’s recovery. After
interaction with the patient, the nurse will be better able to determine if alternate methods of
communication will need to be used.
3. What interventions are most appropriate to begin establishing communication with a patient
who is just emerging from coma after a brain injury?
Nurses should initiate communication with the patient by speaking slowly and calmly while
assessing the patient’s neurologic baseline function. The nurse should also assist with helping the
patient as much as possible with memory function, and orient the patient to place and time.
Sensory overload (including potentially noxious stimuli) should be avoided. Anxiety and fear are
to be expected from a patient in this situation; all nursing actions should be explained to the
patient as simply as possible before proceeding.
The nursing focus should be on providing structure at this stage of the patient’s recovery. After
interaction with the patient, the nurse will be better able to determine if alternate methods of
communication will need to be used.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 40: Hospice Care
Answer Keys - Critical Thinking Questions
Nursing Care Plan 40-1: The Hospice Patient with Metastatic Prostate Cancer
1. Mr. B.’s wife complains to the hospice nurse that her husband has not had a bowel movement
in 3 days. What will be included in an appropriate nursing intervention that would provide relief
for Mr. B.?
Mr. B. should be receiving frequent sips of liquids to increase his fluid intake, as well as foods
high in fiber as tolerated. The nurse should also obtain medical orders for a regularly (generally
three times daily) administered stool softener and a gentle laxative if he has not had a bowel
movement after 2 days.
2. The nurse notes that Mr. B. is restless and demonstrates dyspnea. She performs an oximetry
check on Mr. B. and notes that oxygen saturation is 83%. List three nursing interventions to
improve his respiratory distress.
Raise Mr. B.’s HOB to a high Fowler’s position as tolerated; encourage deep breaths (in through
his nose, out through his mouth); and administer oxygen via nasal cannula.
Additionally, Mr. B. may be experiencing increased pain. Position changes and
nonpharmacologic pain management should be implemented. If these pain control methods are
not effective, opioid analgesia should be administered promptly; this will decrease his oxygen
demands and ease his dyspnea.
Chapter 40: Hospice Care
Answer Keys - Critical Thinking Questions
Nursing Care Plan 40-1: The Hospice Patient with Metastatic Prostate Cancer
1. Mr. B.’s wife complains to the hospice nurse that her husband has not had a bowel movement
in 3 days. What will be included in an appropriate nursing intervention that would provide relief
for Mr. B.?
Mr. B. should be receiving frequent sips of liquids to increase his fluid intake, as well as foods
high in fiber as tolerated. The nurse should also obtain medical orders for a regularly (generally
three times daily) administered stool softener and a gentle laxative if he has not had a bowel
movement after 2 days.
2. The nurse notes that Mr. B. is restless and demonstrates dyspnea. She performs an oximetry
check on Mr. B. and notes that oxygen saturation is 83%. List three nursing interventions to
improve his respiratory distress.
Raise Mr. B.’s HOB to a high Fowler’s position as tolerated; encourage deep breaths (in through
his nose, out through his mouth); and administer oxygen via nasal cannula.
Additionally, Mr. B. may be experiencing increased pain. Position changes and
nonpharmacologic pain management should be implemented. If these pain control methods are
not effective, opioid analgesia should be administered promptly; this will decrease his oxygen
demands and ease his dyspnea.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 42: Care of the Surgical Patient
Answer Keys - Critical Thinking Questions
Nursing Care Plan 42-1: The Postoperative Patient
1. On the second postoperative day, Mr. S. is taking shallow breaths and having difficulty
complying with coughing and deep breathing. His temperature is 101.8°F (38.8°C), and he has
adventitious breath sounds bilaterally in the bases. List several nursing interventions to assist
Mr. S.
The nurse should perform a full assessment of Mr. S. The assessment will need to include vital
signs, oxygen saturation/pulse oximetry, and respiratory status. The respiratory assessment will
include shortness of breath, retractions, use of accessory muscles, rate, rhythm, and cyanosis.
The completed assessment will need to be completed to the charge nurse and physician. A low
dose of morphine sulfate may be obtained to ease Mr. S.’s anxiety and decrease his oxygen
demand. This will result in a reduction of his labored respirations. The health care provider may
also order respiratory and antibiotic therapy after sputum cultures and chest x-ray films are
obtained.
Raising the HOB to semi-Fowler or Fowler position if possible, and ensure oxygen
administration at 2 L via nasal cannula. The nurse should also encourage deeper breathing by
instructing Mr. S. to breathe in through his nose and out through his mouth, or use his incentive
spirometer if he is able (unlikely at this point).
2. In his third postoperative day Mr. S. has an erythematous incision with moderate amounts of
purulent exudate from the Penrose drain site. List the correct nursing interventions.
The incision site and vital signs will be assessed by the nurse. The findings will be reported to
the health care provider. Culture of the wound exudate is indicated.
The incision site should be cleansed with normal saline (or per health care provider orders)
several times a day. The site and dressing should be maintained as clean, dry, and intact, which
may require dressing changes several times a day using an aseptic technique. Drainage should be
marked on the patient’s dressing and monitored for amount, appearance, odor, and consistency.
Vital signs should be monitored every 4 hours. WBC count should also be monitored. Changes
in the wound status, vital signs, signs/symptoms, or WBC count should be reported to the health
care provider.
3. What signs and symptoms would the nurse note when assessing Mr. S. for dehydration
secondary to elevated temperature and decreased fluid intake?
Chapter 42: Care of the Surgical Patient
Answer Keys - Critical Thinking Questions
Nursing Care Plan 42-1: The Postoperative Patient
1. On the second postoperative day, Mr. S. is taking shallow breaths and having difficulty
complying with coughing and deep breathing. His temperature is 101.8°F (38.8°C), and he has
adventitious breath sounds bilaterally in the bases. List several nursing interventions to assist
Mr. S.
The nurse should perform a full assessment of Mr. S. The assessment will need to include vital
signs, oxygen saturation/pulse oximetry, and respiratory status. The respiratory assessment will
include shortness of breath, retractions, use of accessory muscles, rate, rhythm, and cyanosis.
The completed assessment will need to be completed to the charge nurse and physician. A low
dose of morphine sulfate may be obtained to ease Mr. S.’s anxiety and decrease his oxygen
demand. This will result in a reduction of his labored respirations. The health care provider may
also order respiratory and antibiotic therapy after sputum cultures and chest x-ray films are
obtained.
Raising the HOB to semi-Fowler or Fowler position if possible, and ensure oxygen
administration at 2 L via nasal cannula. The nurse should also encourage deeper breathing by
instructing Mr. S. to breathe in through his nose and out through his mouth, or use his incentive
spirometer if he is able (unlikely at this point).
2. In his third postoperative day Mr. S. has an erythematous incision with moderate amounts of
purulent exudate from the Penrose drain site. List the correct nursing interventions.
The incision site and vital signs will be assessed by the nurse. The findings will be reported to
the health care provider. Culture of the wound exudate is indicated.
The incision site should be cleansed with normal saline (or per health care provider orders)
several times a day. The site and dressing should be maintained as clean, dry, and intact, which
may require dressing changes several times a day using an aseptic technique. Drainage should be
marked on the patient’s dressing and monitored for amount, appearance, odor, and consistency.
Vital signs should be monitored every 4 hours. WBC count should also be monitored. Changes
in the wound status, vital signs, signs/symptoms, or WBC count should be reported to the health
care provider.
3. What signs and symptoms would the nurse note when assessing Mr. S. for dehydration
secondary to elevated temperature and decreased fluid intake?
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Answer Keys - Critical Thinking Questions 42-2
The diminished intake and elevated temperature will promote dehydration. Decreased urine
output will be noted. Changes in urine characteristics may include dark color, strong odor, and
elevations in specific gravity. Urine output below 30 mL/hr must be reported. Accompanying
complaints may include thirst or dry mouth, dry oral mucosa. Lips may appear dry and chapped,
and Mr. S. will most likely also exhibit poor skin turgor.
Laboratory values most helpful in this case would be elevated BUN; unless he is developing
renal problems, the hematocrit level may be elevated. Creatinine values will be within normal
limits.
The diminished intake and elevated temperature will promote dehydration. Decreased urine
output will be noted. Changes in urine characteristics may include dark color, strong odor, and
elevations in specific gravity. Urine output below 30 mL/hr must be reported. Accompanying
complaints may include thirst or dry mouth, dry oral mucosa. Lips may appear dry and chapped,
and Mr. S. will most likely also exhibit poor skin turgor.
Laboratory values most helpful in this case would be elevated BUN; unless he is developing
renal problems, the hematocrit level may be elevated. Creatinine values will be within normal
limits.
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Cooper and Gosnell: Foundations and Adult Health Nursing, 8th Edition
Chapter 43: Care of the Patient with an Integumentary Disorder
Answer Keys - Critical Thinking Questions
Nursing Care Plan 43-1: The Patient with Herpes Zoster
1. Ms. L. turns on her call light. She is crying and states she is in severe pain. She describes the
pain as a burning, stabbing pain over her left forehead and eye. She rates her pain as a 7 on a
pain scale of 0 to 10. She also complains of pruritus. What would be the most appropriate
nursing interventions to provide comfort and pain control for Ms. L.?
Liberal application of calamine lotion may help alleviate pruritus. Be careful not to get lotion
into the eye. Ensuring administration of antiviral medication (acyclovir) on schedule is the
mainstay of treatment; acetaminophen, possibly with codeine or a stronger analgesic, should also
be administered on schedule for pain management. Do not exceed 400 mg of acetaminophen in
24 hours. Cold compresses may also be applied to ruptured lesions.
2. Ms. L. tells the nurse that a friend told her she could not visit because she has not had
chickenpox. Her friend is afraid she might “catch chickenpox” from Ms. L.’s shingles. Describe
the accurate patient teaching to give in response to Ms. L.’s statements.
Herpes zoster infection is the result of the reactivation of a previous varicella (chickenpox)
infection, usually in adults over age 50. Although much less communicable than varicella, it is
possible for others who have not had varicella to develop it after exposure to someone
experiencing an outbreak of herpes zoster. Visitors should be especially careful to avoid contact
with any drainage from the patient’s lesions. Meticulous handwashing should be emphasized.
Chapter 43: Care of the Patient with an Integumentary Disorder
Answer Keys - Critical Thinking Questions
Nursing Care Plan 43-1: The Patient with Herpes Zoster
1. Ms. L. turns on her call light. She is crying and states she is in severe pain. She describes the
pain as a burning, stabbing pain over her left forehead and eye. She rates her pain as a 7 on a
pain scale of 0 to 10. She also complains of pruritus. What would be the most appropriate
nursing interventions to provide comfort and pain control for Ms. L.?
Liberal application of calamine lotion may help alleviate pruritus. Be careful not to get lotion
into the eye. Ensuring administration of antiviral medication (acyclovir) on schedule is the
mainstay of treatment; acetaminophen, possibly with codeine or a stronger analgesic, should also
be administered on schedule for pain management. Do not exceed 400 mg of acetaminophen in
24 hours. Cold compresses may also be applied to ruptured lesions.
2. Ms. L. tells the nurse that a friend told her she could not visit because she has not had
chickenpox. Her friend is afraid she might “catch chickenpox” from Ms. L.’s shingles. Describe
the accurate patient teaching to give in response to Ms. L.’s statements.
Herpes zoster infection is the result of the reactivation of a previous varicella (chickenpox)
infection, usually in adults over age 50. Although much less communicable than varicella, it is
possible for others who have not had varicella to develop it after exposure to someone
experiencing an outbreak of herpes zoster. Visitors should be especially careful to avoid contact
with any drainage from the patient’s lesions. Meticulous handwashing should be emphasized.
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Answer Keys - Critical Thinking Questions 43-2
Nursing Care Plan 43-2: The Patient with Systemic Lupus Erythematosus
1. Ms. T. has painful, edematous joints that greatly decrease her mobility. She has 4+ pitting
edema to the lower extremities secondary to the loss of protein through her kidneys. What are
the most appropriate nursing interventions to decrease Ms. T.’s pain level and to increase her
mobility?
Heat packs can be applied to relieve joint pain and stiffness. Regular exercise and movement as
tolerated should be encouraged to ensure maintenance of full range of motion and to prevent
contractures; good body alignment should be maintained at all times. Physical and occupational
therapy referrals should be made.
Steroid therapy is often prescribed for management of inflammatory symptoms during disease
exacerbations. Ms. T. will need to be observed for her response to the corticosteroids, including
any adverse reactions to the medications.
Because of her renal problems, Ms. T. will probably also require a low-protein, low-sodium diet.
2. On entering the room, the nurse notes Ms. T. crying. She says that her lifestyle is severely
altered because she is unable to be in the sun to work in her beloved garden. What nursing
interventions would be most beneficial?
SLE often produces photosensitivity in patients. Ms. T. should be advised to minimize her direct
sun exposure and to use a sunscreen with a minimum SPF of 15 when outdoors. She should also
wear protective clothing such as a hat, long sleeves, and long pants when outdoors. Strategies to
incorporate her new activity restrictions should be provided to Ms. T. These may include
gardening at times that are not as “sunny” as well as shade gardening or possibly houseplants. In
addition to avoiding excessive sun exposure, Ms. T should be advised to avoid tanning beds or
salons.
Occupational counseling would be helpful, also. The nurse should explore other potential areas
of interest with Ms. T.
3. Ms. T. confides that she fears that this severe increase in her symptoms will lead to an early
death. What initial response to this statement would be of greatest assistance?
Development of a therapeutic relationship is crucial in this situation. Interpersonal
communication skills will need to be used to encourage Ms. T. to verbalize her fears and
concerns.
Examples of appropriate nursing responses to this patient’s stated fears would include,
“You sound very frightened about the effects of your illness. Would you like to talk about this?”
and, “Would it help if we talked about treatment options?” Nursing responses such as these allow
the patient to express concerns.
Nursing Care Plan 43-2: The Patient with Systemic Lupus Erythematosus
1. Ms. T. has painful, edematous joints that greatly decrease her mobility. She has 4+ pitting
edema to the lower extremities secondary to the loss of protein through her kidneys. What are
the most appropriate nursing interventions to decrease Ms. T.’s pain level and to increase her
mobility?
Heat packs can be applied to relieve joint pain and stiffness. Regular exercise and movement as
tolerated should be encouraged to ensure maintenance of full range of motion and to prevent
contractures; good body alignment should be maintained at all times. Physical and occupational
therapy referrals should be made.
Steroid therapy is often prescribed for management of inflammatory symptoms during disease
exacerbations. Ms. T. will need to be observed for her response to the corticosteroids, including
any adverse reactions to the medications.
Because of her renal problems, Ms. T. will probably also require a low-protein, low-sodium diet.
2. On entering the room, the nurse notes Ms. T. crying. She says that her lifestyle is severely
altered because she is unable to be in the sun to work in her beloved garden. What nursing
interventions would be most beneficial?
SLE often produces photosensitivity in patients. Ms. T. should be advised to minimize her direct
sun exposure and to use a sunscreen with a minimum SPF of 15 when outdoors. She should also
wear protective clothing such as a hat, long sleeves, and long pants when outdoors. Strategies to
incorporate her new activity restrictions should be provided to Ms. T. These may include
gardening at times that are not as “sunny” as well as shade gardening or possibly houseplants. In
addition to avoiding excessive sun exposure, Ms. T should be advised to avoid tanning beds or
salons.
Occupational counseling would be helpful, also. The nurse should explore other potential areas
of interest with Ms. T.
3. Ms. T. confides that she fears that this severe increase in her symptoms will lead to an early
death. What initial response to this statement would be of greatest assistance?
Development of a therapeutic relationship is crucial in this situation. Interpersonal
communication skills will need to be used to encourage Ms. T. to verbalize her fears and
concerns.
Examples of appropriate nursing responses to this patient’s stated fears would include,
“You sound very frightened about the effects of your illness. Would you like to talk about this?”
and, “Would it help if we talked about treatment options?” Nursing responses such as these allow
the patient to express concerns.
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Nursing