Solutions Manual for Medical-Surgical Nursing 1st Edition by Bowen, Carey, Palozie, Reinholdt
ISBN: 9781711472898
OpenStax Medical-Surgical Nursing
Chapter
Chapter 1: Professional Medical-Surgical Nursing
Review Questions
1. Which action reflects The Joint Commission’s contribution to a health care organizations’ improvement initiatives?
a. setting standards for quality care, QI, and patient safety
b. excluding nurses from safety and improvement initiatives
c. focusing on emergency management and infection prevention
d. eluding the National Patient Safety Goals
[Answer: A]
2. Which component reflects a key element of PCC?
a. excluding the patient's family from the care setting
b. ignoring the patient's emotional well-being
c. customize care based on the patient's values and perspectives
d. respecting the patient's physical comfort
[Answer: C]
3. Ms. Hutto is complaining of pain (8 out of 10) in her lower back and abdomen. As the patient’s nurse, you determine her abdomen is soft but distended, with positive bowel sounds in all four quadrants. Interventions such as ambulation, position changes, warm compresses, and warm prune juice have provided no relief. This scenario highlights which component of the ISBAR communication tool?
a. situation
b. background
c. assessment
d. recommendation or request
[Answer: C]
4. What is the primary goal of an intercollaborative care team in the context of patientcentered care?
a. achieving financial targets
b. streamlining administrative processes
c. improving patient outcomes through personalized care
d. minimizing the workload for health care providers
[Answer: C]
5. A nurse is caring for a 72-year-old woman with a diagnosis of atrial fibrillation. When making his shift change report, the nurse realizes that 4 hours ago, he administered 0.5 mg of the patient’s antiarrhythmic medication instead of 5.0 mg. When the nurse realizes the error and calls the physician to report the incident, which ethical principal is described in this situation?
a. nonmaleficence
b. justice
c. autonomy
d. beneficence
[Answer: A]
6. Mr. Johnson is scheduled for an endoscopy. Despite the excruciating abdominal pain he is experiencing, Mr. Johnson refuses to have the procedure. Which ethical principal is described in this scenario?
a. beneficence
b. justice
c. autonomy
d. nonmaleficence
[Answer: C]
7. Which option is a social determinant of health?
a. medical history
b. promotion of healthy choices
c. homelessness
d. life expectancy
[Answer: C]
8. As a nurse practicing EBP, which process related to improving patient satisfaction will be most effective?
a. checking on each patient’s pain level every 4 hours
b. administering medications as close as possible to the administration times
c. making rounds on each patient hourly
d. offering a bath daily to each patient
[Answer: C]
9. Joann, a nurse in the medical-surgical unit, would like to implement a project to improve the cleanliness of patient rooms. Aside from the nurses, which group of key stakeholders should be included in the planning?
a. hospital maintenance staff
b. physical therapists and technicians
c. housekeeping staff and unlicensed assistive personnel
d. occupational therapy team
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[Answer: C]
10. A nurse manager has received an increase in patient complaints that monitor alarms are sounding for extended periods, which is disrupting their sleep and creating unnecessary anxiety. After close observation, the nurse manager realized the nurses appeared as if they did not hear the alarms while charting. What type of QI plan would be most appropriate for the nurse manager to consider for her unit?
a. a plan of correction related to nurses not promptly addressing the monitor alarms
b. a process improvement project to address alarm fatigue
c. a plan to ensure all the patients have standing orders for medications to relieve their anxiety
d. a plan to have the nurses increase the volume of the monitor alarms
[Answer: B]
11. Ms. Blanchard is presently being treated for a new diagnosis of high blood pressure. Her primary care physician has recommended that, in addition to her daily dose of medication, Ms. Blanchard should also stop smoking. This recommendation demonstrates with which level of prevention?
a. primary prevention
b. secondary prevention
c. tertiary prevention
d. intermediary prevention
[Answer: C]
12. Which statement reflects the role an agency has on the health care continuum?
a. Agencies provide a variety of in-home care, including physical and occupational therapy.
b. Government agencies exist to supplement middle-class populations.
c. All hospitals provide inpatient services at low to no cost to patients in need.
d. Subacute inpatient settings are no longer needed for sick patients.
[Answer: A]
13. Which description best defines systems-based practice in health care?
a. the focus on individual patient care, considering their immediate medical needs
b. the use of advanced medical technologies to enhance PCC and outcomes
c. recognizing the various layers of the health care system and understanding how they impact patient care
d. implementing standardized procedures in health care settings to ensure consistency in patient treatment
[Answer: C]
14. What is a nursing informaticist?
a. a nurse who is skilled at communicating complex information to patients
b. a nurse who is an expert on laws protecting patient information
c. a nurse who develops technologies that securely store and communicate information
d. a nurse who uses information and technology to improve the efficiency of health care
[Answer: D]
15. How has technology affected nursing education, particularly in sim labs?
a. by reducing the need for clinical experiences in real health care settings
b. by providing high-tech sim labs with realistic manikins for hands-on practice
c. by eliminating the importance of critical thinking skills in nursing education
d. by decreasing the need for online platforms in nursing courses
[Answer: B]
Check Your Understanding Questions
1. What are the six main competencies of Quality and Safety Education for Nurses?
[Answer: patient-centered care, teamwork and collaboration, EBP, QI, safety, and informatics]
2. Identify examples of PCC in which the nurse takes an active role.
[Answers will vary but may include
● Family members are invited to be a part of the interdisciplinary care team to participate in discussions and care decisions.
● The family and patient are provided with timely updates, ensuring the patient’s wishes (directives) are included in the plan of care.
● respecting the patient’s and family’s treatment decisions
● advocating for patients and families to promote quality care and patient safety
● aligning a patient’s care with their goals, preferences, values, cultural traditions, and socioeconomic status
● focusing care equally on physical comfort and emotional well-being]
3. Identify two different social determinants of health and explain how they can affect a person’s health.
[Answers will vary but may include the following: SODH include environmental factors such as where one was born, grew up, lived, and aged. For example, people who grow up in a wealthy community with lots of health resources will likely be healthier than people who grow up in an impoverished community with few resources. SODH also include factors that shape daily life, such as access to health care and education, economic stability, community development, social and society norms, political systems, and race and ethnicity. For example, certain racial or ethnic groups are genetically predisposed to certain diseases and thus more likely to acquire those diseases than people of other groups.]
4. What is the difference between EBP and nursing research?
[Answer: The purpose of research in nursing is to evaluate current knowledge and theories in order to formulate better nursing practices for improved patient outcomes. The purpose of EBP in nursing is to use the evidence from research to make informed decisions regarding patient care and outcomes.]
5. Identify social determinants that affect the delivery of health care.
[Answers will vary but may include income, education, job security and unemployment, working conditions, living conditions and the environment, access to food, childhood development, access to affordable housing and necessities, and access to affordable health care and quality services.]
6. In your own words, define systems-based practice.
[Answers should be a variation on this definition from the text: Systems-based practice is health care that considers the multiple systems involved in a patient’s condition and uses evidence
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about their interactions to develop a treatment plan that incorporates all the entities involved in the patient’s care.]
7. What building blocks of communication influence nursing?
[Answer: data, information, knowledge, and wisdom]
8. What is the purpose of the Health Insurance Portability and Accountability Act?
[Answer: To create national standards to protect a patient’s privacy and prevent their health information from being disclosed without their consent or knowledge.]
Reflection Questions
1. Reflect on a recent patient you may have cared for during clinicals or discussed in a recent scenario in class. What questions could you have asked to guide you through the critical thinking process?
[Answers will vary but may include
● What relevant information do I need? What does this information tell me?
● Does this information point to a specific problem? Do I need additional information?
● Have I identified the most pertinent issues?
● Have I gathered all the relevant information (e.g., signs and symptoms, laboratory values, medical history, medication history, emotional factors, mental status)?
● Are there any missing pieces of information?
● Is there any information that needs to be reported immediately or that may require immediate action?
● What is the patient’s significant risk factors? What can be done to minimize these risk factors?
● Are there any complications that need to be considered?
● What problems are the most significant? Do the patient and family recognize them?
● What are the desired outcomes? Does the patient agree with the outcomes? Which outcomes have the highest priority?
● What should be the first action in this situation?
● Which information or details are the most relevant in constructing the plan of care to achieve the goals?
● Are there any age-related factors that need to be considered and incorporated into the plan of care?
● How do the family dynamics factor into this situation, the plan of care, and the desired outcomes?
● Are there cultural factors to consider?
● Is there an ethical problem that needs to be dealt with? If so, what is the best course of action to resolve it?
● What research has been conducted in the areas that have been presented in this situation?]
2. A 35-year-old patient with a history of opiate abuse is admitted to the emergency department with multiple stab wounds. Two days after extensive surgery to repair the wounds, the patient reports severe, unrelenting pain and reports the administered pain medication (an opioid) is not diminishing the pain. Because of the patient’s history of substance abuse, some staff members do not believe the patient’s reported pain level; they
assume the patient just wants to obtain more medication. Keeping in mind the four main principles of nursing ethics, how do you address pain relief for this patient? How would you address the views of the staff members who believe the patient should not receive additional medication?
[Answers will vary but may include the following ideas. To ignore a patient’s pain is unethical; it violates the principle of beneficence. Using sharp observations skills, the nurse should determine the legitimacy of the patient’s pain. The nurse should also ask the patient to rate their pain on a scale from 0 to 10 (with 10 being the worst) before medication administrations and 30 minutes after the medication has been administered. The nurse should advocate for the patient by communicating with the physicians, the interdisciplinary team, and the oncoming nurse who will be providing care for the patient at shift change. It’s possible that the physician could decrease the strength of the dose while also increasing its frequency to determine the efficacy of the pain medication. The physician could change the medication altogether or possibly prescribe a second medication to be administered in between the times the first medication is administered. All of this should be well documented in the patient’s record by the nurses, physicians, and interdisciplinary team members.]
3. In your own words, describe what evidence-based practice is and why it is used in the nursing profession.
[Answers will vary but may include these ideas: EBP is the process of making clinical decisions based on the best available evidence from the most up-to-date research. EBP enables nurses to implement best practices in patient care. It promotes better outcomes, reduces costs, increases patient satisfaction, and maintains the relevance and currency of health care practices. Nurses involved in the delivery of care are instrumental in analyzing the current data (evidence) and refining the processes related to QIs.]
4. Why is SBP important in nursing?
[Answers will vary but may include these ideas:
● By recognizing how one functions within the system and how their actions affect each aspect of the system, nurses hold the key to unlocking effective SBP strategies.
● By having an awareness of the complexities of the system, as well as an ability to call on the other resources within the larger context and system of health care, nurses are positioned to improve the quality of patient care and the care delivery system.
● By understanding SBP, nurses are more aware of the cost of care, better understand risks and benefits, more effectively advocate for quality patient care, participate in interdisciplinary teamwork, identify system errors, and develop and implement system solutions.]
5. Describe the impact of a multidisciplinary approach to health care delivery. [Answers will vary but may include: improved patient outcomes, efficient care coordination, comprehensive treatment plans, reduced health care costs, and enhanced professional satisfaction.]
6. How has medical technology improved the delivery of health care?
[Answers will vary but may include the following ideas:
● Patient information is easily accessible by the nurse and interdisciplinary team.
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● Nursing informatics has improved communication among the interdisciplinary team, enabling nurses and providers to make informed decisions and reducing the number of delayed treatments and medical errors.
● EHRs and digital orders, made possible by technological advancements, have improved communication within interdisciplinary teams, reduced medical errors, minimized patient care delays, and contributed to overall cost-effectiveness in health care delivery]
What Should the Nurse Do?
Mary, a nursing student in her final year of training, is about to start her clinical rotation at a busy urban hospital. She is eager to apply her knowledge and skills in patient care while adhering to the competencies outlined by the QSEN. During her first day on the medicalsurgical unit, Mary encounters a patient named Mr. Johnson, a 65-year-old man admitted with a diagnosis of congestive heart failure.
1. What steps should Mary take to ensure she is adhering to the QSEN competencies in her care of Mr. Johnson?
[Answer: Mary should ensure she integrates the principles of PCC, teamwork and collaboration, EBP, QI, safety, and informatics into her nursing practice by following established protocols, communicating effectively with the health care team, using evidence-based interventions, participating in QI initiatives, prioritizing patient safety, and using technology to enhance patient care.]
2. How can Mary ensure that she effectively engages Mr. Johnson in his care to provide patient-centered care?
[Answer: To effectively engage Mr. Johnson in his care, Mary can use active listening skills, show empathy and respect, provide information in a clear and understandable manner, involve him in care decisions, and address his concerns and preferences. By fostering a therapeutic relationship with Mr. Johnson, Mary can ensure his individual needs and preferences are considered in the care plan.]
3. How can Mary empower Mr. Johnson to actively participate in his care decisions and express his treatment preferences to the health care team?
[Answer: Mary can advocate for Mr. Johnson's preferences by actively involving him in care decisions, respecting his autonomy and choices, communicating his preferences to the health care team, addressing any barriers to his preferences, and ensuring that his rights are respected throughout his hospitalization.]
Emily, a registered nurse working in a community health center, is caring for a diverse patient population. She encounters Mrs. Lopez, a patient with low income who is struggling to access affordable health care services due to financial constraints. Emily recognizes the importance of advocating for Mrs. Lopez’s needs and ensuring she receives patient-centered care despite socioeconomic challenges.
4. What SDOH might Emily consider when caring for Mrs. Lopez?
[Answer: Emily might consider the following SDOH when caring for Mrs. Lopez:
● socioeconomic status, including income level, employment status, and access to affordable health care services
● education level and health literacy, which can affect Mrs. Lopez's understanding of her health condition and ability to navigate the health care system
● housing stability and neighborhood environment, including access to safe housing, transportation, and healthy food options
● Social support networks and community resources available to Mrs. Lopez, such as local social services, community health centers, and support groups.]
5. How can Emily fulfill her role as an advocate for Mrs. Lopez in providing patient-centered care?
[Answer: Emily can fulfill her role as an advocate for Mrs. Lopez by:
● Assessing Mrs. Lopez's individual needs, preferences, and concerns regarding her health care access and addressing them collaboratively.
● Educating Mrs. Lopez about her rights as a patient, available health care resources, and options for accessing affordable care, including community health programs and financial assistance programs.
● Communicating Mrs. Lopez's health care needs and preferences to the interdisciplinary health care team and advocating for appropriate interventions and support services.
● Empowering Mrs. Lopez to actively participate in decision-making regarding her health care, promoting autonomy, dignity, and respect for her choices.]
6. How can Emily apply core principles of ethics when advocating for Mrs. Lopez’s health care needs?
[Answer: Emily can apply core principles of ethics, including beneficence, nonmaleficence, autonomy, and justice, when advocating for Mrs. Lopez's health care needs by:
● Ensuring that Mrs. Lopez receives timely and appropriate health care services that promote her well-being and address her health concerns (beneficence).
● Avoiding harm or potential risks to Mrs. Lopez by advocating for safe and evidencebased health care practices (nonmaleficence).
● Respecting Mrs. Lopez's right to make informed decisions about her health care and involving her in the decision-making process (autonomy).
● Advocating for equitable access to health care services and resources for Mrs. Lopez, regardless of her socioeconomic status, and addressing systemic barriers to health care access (justice).]
Mark is a nurse working in a community health clinic that provides preventive health care services to a diverse population. He encounters several patients with different health care needs, ranging from preventive screenings and vaccinations to chronic disease management and health education. Mark navigates various factors influencing health care delivery, including the role of health care agencies and the availability of preventive services.
7. What actions should Mark take to differentiate between the types of preventive services available in the health care system?
[Answer: To differentiate between the types of preventive services available in the health care system, Mark should
● conduct a comprehensive assessment of each patient's health status, risk factors, and health care needs to determine the appropriate preventive services.
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● educate patients about different types of preventive services, including screenings, immunizations, counseling, and health promotion activities, tailored to their individual health goals and preferences.
● collaborate with other health care professionals, such as physicians, nurse practitioners, and public health specialists, to ensure a holistic approach to preventive care delivery.
● stay updated on evidence-based guidelines and recommendations for preventive services issued by reputable health care organizations and regulatory agencies.]
8. How can Mark discuss the impact agencies have on health care systems based on his experiences in the community health clinic?
[Answer: Mark can discuss the impact agencies have on health care systems by
● identifying and describing the roles and functions of various health care agencies, such as government health departments, community clinics, nonprofit organizations, and insurance providers, in delivering health care services.
● analyzing how health care agencies influence health care delivery processes, resource allocation, funding mechanisms, and policy development within the community health system.
● explaining how collaboration and partnerships between different health care agencies contribute to enhancing access to care, improving health outcomes, and addressing health disparities among underserved populations.
● advocating for policies and initiatives that promote collaboration, coordination, and integration of services across health care agencies to optimize health care delivery and population health outcomes.]
9. What factors affecting health care delivery should Mark consider when providing care to patients in the community health clinic?
[Answer: Mark should consider various factors affecting health care delivery, including
● socioeconomic determinants of health, such as income, education, employment, housing, and access to transportation, which can affect patients' ability to seek and receive timely health care services.
● cultural and linguistic diversity among the patient population, including language barriers, health beliefs, and practices, that may influence health care-seeking behaviors and treatment adherence.
● availability and accessibility of health care resources, including health care facilities, medical equipment, medications, and specialty services, within the local community.
● health care policies, regulations, and reimbursement mechanisms that govern health care delivery, insurance coverage, and payment models, which may affect service delivery and resource allocation in the community health clinic.]
Competency-Based Assessments
1. During patient assessment, what cues might indicate that a patient’s care is not adequately patient-centered, and how would you address these cues?
[Answer: Cues may include patient dissatisfaction, nonadherence, or unmet emotional needs. Addressing these cues involves open communication, reassessment of care plans, and collaborative decision-making.]
2. If a patient expresses dissatisfaction with their care, outline the steps you would take as a nurse to address their concerns and enhance the patient-centeredness of their care.
[Answer: Actions may include active listening, acknowledging concerns, involving the patient in care decisions, and collaborating with the health care team to adjust the care plan.]
3. Explain how effective communication methods play a crucial role in the interdisciplinary health care team. Provide examples of best practices for communication that enhance collaboration among team members.
[Answer: Effective communication is vital for the success of an interdisciplinary health care team. Best practices include using clear and concise language, active listening, and using tools such as SBAR (Situation, Background, Assessment, Recommendation) to ensure accurate information transfer. For instance, a nurse effectively communicating with a physician using SBAR ensures the physician receives essential information for informed decision-making.]
4. Define critical thinking and clinical judgment in the context of health care. How do these cognitive processes impact the roles and interactions of members within an interdisciplinary health care team?
[Answer: Critical thinking involves the ability to analyze, synthesize, and evaluate information, whereas clinical judgment is the application of critical thinking in decision-making within clinical settings. In an interdisciplinary team, critical thinking enables effective problem-solving, and clinical judgment guides individual members in contributing to comprehensive patient care plans.]
5. As part of providing PCC, the nurse should determine a patient’s cognitive abilities as well as any relevant knowledge deficits or learning disabilities. You are assigned to teach an elderly patient about medications they will be taking at home. Create a plan for assessing this patient’s condition and psychosocial situation to determine how to best instruct her about her medications. Explain how you would modify your teaching plan if the patient were hard of hearing, visually impaired, or unable to read or write.
[Answers will vary but may include the following ideas:
● To determine the patient’s cognitive abilities, the nurse can first ask simple, nonmedical questions to assess the patient’s short-term memory (recall abilities). If the patient’s short-term memory appears intact, the nurse can ask questions to determine if the patient is familiar with the prescribed medications and if the patient recalls information they have already learned about the use and frequency of each medication.
● The nurse can also ask if the patient uses any kind of medication reminders, such as a family member calling to remind the patient to take their medications, or if a caregiver is present on a regular basis to assist the patient with medications.
● It's also possible that the patient uses pill boxes to stay on track with their medications. If the patient is cognitively intact, they may load their own pill boxes. If not, a family member or caregiver may conduct this task.
● An additional consideration is that the pharmacy may dispense the medications in bubble packaging that may or may not be color coded to correlate with morning, noon, afternoon, evening, and bedtime administration times.
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