Download; Solution Manual for Foundations and Adult Health Nursing, 8th Ed, Cooper, Gosnel. All Chapters 1-57. Answer Key 1 CHAPTER 1—THE EVOLUTION OF NURSING Matching 1. b 2. d 3. e 4. a 5. f 6. h 7. c 8. g 9. j 10. i Short Answer 11. The National League for Nursing (NLN) established educational standards and criteria and is involved in the voluntary accreditation of nursing programs. 12. The purposes of NAPNES and NFLPN are to: Set standards for practical/vocational nursing programs. Promote and protect practical/vocational nursing. Educate and inform the general public about practical/vocational nursing. 13. LPN/LVNs function to provide specific services to patients under the direct supervision of a licensed physician, dentist, or registered nurse; assists individuals, sick or well, in the performance of those activities contributing to health, to their recovery, and to gain independence as rapidly as possible or to have a peaceful death. The LPN/LVN is educated to be a responsible member of a health care team, performing basic therapeutic, rehabilitative, and preventive care to assigned patients. LPN/ LVNs are continuing to provide care in all types of settings, with the majority employed in long-term care settings. Fill-in-the-Blank Sentences 14. state board of nursing 15. National Council of State Boards of Nursing 16. Patient’s Bill of Rights Multiple Choice 17. Answer 2: One of the primary problems of the early nineteenth century hospitals was poor hygienic practices. Hospitals were dirty and overcrowded and care was mostly given by untrained persons. 18. Answer 4: The population is aging rapidly and there is an increased need for nursing services for this growing segment of the population. 19. Answer 3: “Nightingale Nurses” improved patient care and advanced the practice of nursing through good hygiene, sanitation, patient observation, accurate recordkeeping, nutritional improvement, and the introduction and use of new equipment. 20. Answer 1: The four major concepts are nurse, patient, health, and environment. 21. Answer 4: Poverty, homelessness, and unemployment are factors in increased risk for health problems. 22. Answer 2: Physiologic needs, such as eating and oxygenation, are the first priority according to Maslow. 23. Answer 4: Adolescence is time when love and belonging to a peer group are very important. Being part of a team is the best way to help him meet this need. 24. Answer 1, 3, 5: Patient can participate in smoking cessation; stress, weight, and alcohol intake reduction; and control over own body and health. Giving information about technology, new medications, and costs may be of interest to the patient, but these topics are less useful in helping the patient take an active role in her own health. 25. Answer 4: While the UAP or unit secretary can direct visitors, extreme caution should be used in giving out patient information. (Note to student: Even acknowledging that a patient has been admitted to the hospital can be viewed as a violation of confidentiality.) Taking vital signs is acceptable; however, the pharmacist generally restocks medications. Validating and interpreting are nursing responsibilities. 26. Answer 2: Economic use of time and materials is the best way to contain costs for individualCopyright © 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. Answer Key 2 patients. Malpractice insurance does not help to contain costs. While it is appropriate to question the health care provider about safety issues, it is not appropriate to question use of diagnostic testing. Diagnosis is an extremely complicated process, which requires an extensive depth of knowledge about pathology. Referring patients to another clinic just shifts the financial burden to another part of the health care system. 27. Answer 1: Orem’s theory is based on helping the patient to attain self-care. Nightingale’s theory uses manipulation of the environment (i.e., patient’s pillows). Benner and Wrubel demonstrate caring by assisting the patient to cope. Parse’s theory encourages the patient to participate in the health experience. 28. Answer 1, 2, 3, 4, 6: Under the terms of this document, patients are assured that they can expect high-quality hospital care, a clean and safe environment, involvement in their care and the decision-making process, protection of privacy, help when leaving the hospital, and help with billing concerns. Patients cannot always expect to get a private room with all amenities. 29. Answer 3: Health care workers are entitled to respect from patients and also expect patients to be responsible for their own behavior. 30. Answer 3: LPN/LVNs never function independently without the supervision of an RN or health care provider. Critical Thinking Activities 31. Wellness Highest level of optimal health Illness Diminished or impaired state of health X This patient has some health problems and some changes in her life, but she has a relatively high level of wellness. Her blood pressure is under control and she has adapted to a major change (retirement), by taking on a new challenge of volunteering. Her positive outlook on life allows her to find joy in the prospect of sharing time with a new generation. 32. a. Originally, the white pleated cap and the apron signified respectability, cleanliness, and servitude. Caps gradually became symbolic of office and achievement and were celebrated with capping ceremonies. Uniforms became more informal and nurses complained that caps interfered with care, caused hair loss, took too much time for washing and starching, and were a source of bacteria. Health care facilities and nursing schools typically have dress codes for style of uniform and/or color. Staff are generally required to wear nametags and identification badges. Many nurses do not approve of mandatory dress codes. They argue that other health care professionals do not depend on uniforms for their authority. b. It is likely that as a nursing student and a soon-to-be nurse that looking professional is important to you. You may feel anxious to be rid of your current student uniform for a variety of reasons. Freedom of choice, unattractive style, and not being marked as a student are frequent reasons cited by students. From patients’ point of view, they feel more comfortable and confident when they are easily able to distinguish nurses from other staff members. Recent studies also suggest that patients believe that nurses who wear white are better nurses than those who do not wear white. 33. a. This patient has complex physical problems and he has some lifestyle, social, and financial issues that need extra attention. Registered nurse (RN)—provides direct patient care in the hospital and an RN from a home health agency could also be involved in the care of this patient. LPN/LVN—works under the supervision of the RN in providing patient care. Physician—provides diagnosis and prescription of treatment and medications. Social worker—provides counseling and referral to community resources. Physical therapist—offers exercises and will assist this patient in learning techniques for safe ambulation, bending, and lifting. Dietitian—provides nutritional counseling. Respiratory therapist—supervises oxygen administration and performs pulmonary assessments. Technologist—will obtain and analyze specimens and perform other diagnostic procedures. Pharmacist—prepares the medication in the hospital. The community pharmacist can help this patient monitor his home medications.Copyright © 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. Answer Key 3 (Note to student: Some hospitals will also have a financial counselor to assist the patient in understanding the hospital bill and to make arrangements in paying outof-pocket costs.) b. For primary prevention, the nurse would encourage wellness activities and preemptive screening programs such colonoscopy or glucose screening. For secondary prevention, to reduce the impact of the chronic respiratory disease, the nurse would encourage smoking cessation and weight loss. For tertiary prevention, the nurse would get a referral for home health assistance, including physical therapy, which will improve quality of life and reduce further loss of function. CHAPTER 2—LEGAL AND ETHICAL ASPECTS OF NURSING Matching 1. e 2. d 3. b 4. h 5. f 6. a 7. c 8. j 9. g 10. i True or False 11. True 12. True 13. False. Duty refers to the established relationship between the patient and the nurse. 14. False. Assault is an intentional threat to cause bodily harm to another; does not have to include actual bodily contact. The nurse would be charged with battery, which is the unlawful touching of another person without consent. 15. True Multiple Choice 16. Answer 4: The student has initiated the nursepatient relationship and therefore has the duty to act. All students are CPR-certified so the student has to perform the duty in a reasonable and prudent manner as would other nursing students. All of the other options are also likely to be necessary. (Note to student: Discuss this situation with your clinical instructor for advice about visiting patients during the preclinical preparation time.) 17. Answer 4: A poor nurse-patient relationship increases the likelihood that the patient will seek legal action and harm has to occur in order for liability to be established. The family of the elderly patient could seek damages, but that is less likely if they understand that the nurse and facility will try their best to prevent falls, but are unable to physically restrain patients for the purpose of preventing falls. The angry patient may report the nurse to the supervisor, but if no harm is sustained then any legal action against the nurse will not be successful. The family who complained at 3:00 am may also be very angry. The nurse’s decision to wait must be based on comprehensive assessment of the patient to ascertain that there is nothing to warrant calling at 3:00 am. Careful documentation is necessary. Making an incident report in all of these situations would be a good idea. 18. Answer 1, 2, 3, 4, 6: The UAP’s personal health records are confidential and unrelated to the patient’s case. 19. Answer 2: Early discharge and high levels of patient acuity require excellent discharge teaching so patients can perform self-care and self-monitoring and are therefore less likely to suffer harm. Being able to take a limited number of high-acuity patients would be ideal, but high acuity is the current trend. Having malpractice coverage is good if litigation occurs; however, insurance payouts may actually be contributing to the problem. Ensuring accountability of others is not possible. 20. Answer 1: Assess knowledge and readiness to perform. Barriers may include knowledge deficit or feelings of anxiety or self-doubt. Going with her and observing performance and pulling her file would be appropriate after assessment. Forcing someone to do a task that is beyond their ability and understanding is inappropriate supervision and the nurse would be liable for the UAP’s errors. 21. Answer 2: Locate the RN in charge so that the blood can be started. Health care providers can supervise nurses and they know the potential adverse reactions of blood products; however, they are generally less familiar with the policies and procedures related to the actual administration.Copyright © 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. Answer Key 4 22. Answer 1, 2, 3, 4: Do not include any information that identifies the patient. Information such as the room number or the health care provider’s name may seem harmless, but including those details could lead to speculation about patient’s identity. A clinical report must include information such as vital signs and medical condition. If in doubt, the clinical instructor should be consulted. 23. Answer 1: Patients must be at least 18 years old to give consent. If under 18, the exceptions are marriage; court-approved emancipation; self-supporting and living apart from parents; military service; or for STIs, alcohol or drug abuse, sexual assault, or family planning. 24. Answer 3: Policies about giving patient information over the phone will vary. For example, some facilities may not allow acknowledging that the patient is or is not there. Other facilities require that the patient have a list of people who are allowed to call for information. Another variation is that selected callers are given a phone code to reach the patient. The nurse should be familiar with hospital policy, because the policies are designed to specifically comply with HIPAA. 25. Answer 3: Alert the health care provider so the child can be examined for occult injury. The other options may also be used to investigate the possibility of child abuse. 26. Answer 3: Call for help first, because the health care team is not prepared to face armed assailants. Trying to reassure patients in the immediate area would be the second step. Stifle the impulse to run out and help. If the emergency staff is killed or injured, this makes the situation worse. Locking doors in an emergency department is likely to be impractical and create additional safety problems. 27. Answer 1: Being competent and compassionate are the best defenses. Knowing the legal definition may be helpful, but definitions are abstractions and the nurse’s day is full of real-world events. Obtaining malpractice insurance is likely to make the nurse feel better, but it does not decrease the chances of getting sued. Validating nursing actions with another is always beneficial, but this is not a realistic option for minute-to-minute care. 28. Answer 2: The nurse is assessing the wound during the dressing change and documentation should reflect the nurse’s attention to the standard of care. Documenting the type of dressing may be necessary for continuity of care and also for reimbursement. The other options are incorrect. 29. Answer 4: Disciplinary defense insurance includes attorney; wage loss reimbursement; travel, food, and lodging expenses; and legal fees when the nurse has to go before the board of nursing for disciplinary action. The other types of insurance are for malpractice protection. 30. Answer a. 4, b. 3, c. 2, d. 5, e. 1: The nurse hopes for dismissal of charges. The letter of reprimand may be formal or informal. Probation with stipulations means that the nurse can continue to work, but under conditions as determined by the board (e.g., monitored). Suspension with stipulations means that the nurse cannot continue to work, but there are conditions that must be fulfilled. Revocation of license is loss of licensure. 31. Answer 1: First, assess the patient’s feelings by encouraging expression. The patient may not understand the advance directives or may have issues that were triggered by the discussion. The other options are also necessary. 32. Answer 2: The patient’s living will is the best protection, because it reflects the patient’s wishes. Policies and procedures and the Joint Commission may contain general guidance about giving excellent care to patients, but will not offer any specific help in this situation. The Patient Self-Determination Act supports the use of living wills to define the individual’s choices about care and treatment. 33. Answer 4: The nurse, the 13-year old girl, and the mother all have very strong feelings about this emotional situation. First, the nurse must control her own responses. The other options are likely to be necessary, but this will be a difficult process and other health care team members, such as a social worker, family counselor, spiritual advisor, legal counsel, or obstetrician are likely to be involved. 34. Answer 1, 2, 3, 5: If the nurse observes another nurse being rude toward a patient, the ethical thing to do would be to follow up so that patients are respected. Texting should not be used as an additional method of passing gossip among staff. The other options demonstrate ethical professional behavior. 35. Answer 3: The supervisor should be presented with the facts. Theft is unethical and elderly residents are in an especially vulnerable position; thus the Nurse B is not giving goodCopyright © 2015, 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. All rights reserved. Answer Key 5 care. Talking to the residents or families will be part of the investigation that is conducted by the supervisor. The supervisor could recommend that both nurses seek assistance for values clarification. Critical Thinking Activities 36. a. In regard to informed consent for a surgical or diagnostic procedure, the nurse may be responsible for witnessing that the patient is signing the consent and is aware of the treatment, risks, alternatives, and consequences of accepting or rejecting care. The nurse should be careful not to discuss with the patient the elements of disclosure that the health care provider is required to make, such as the risks or benefits involved with the treatment or procedure. b. The nurse should go back to the charge nurse and clarify how nurses are getting informed consent signed. It is possible that health care providers are explaining the procedures and the nurses are later assessing the patients’ understanding and then contacting the provider if the patient has additional questions or needs clarification; however, this is not the best situation. Ideally, the nurse should accompany the provider during the explanation and the form should be signed at that time. The nurse could ask the charge nurse to obtain the informed consent and then further discuss this process with a supervisor, because the nurses in this facility are at great risk for practicing outside scope of practice and could be liable if the patient suffers harm from the procedure. 37. a. Further assessment is needed to determine the underlying motivation for the action of these two nurses. It appears that Nurse A is reluctant to care for “those kinds of people” and the code specifies that the nurse should provide care without discrimination. Assessment of Nurse A’s behavior may reveal that she lacks the confidence or skills to care for AIDS patients; thus additional training is needed. Possibly the death of a close friend from AIDS may have created an emotional barrier and thus she may need grief counseling. Nurse B is attempting to help Nurse A, which is a laudable action; however, in order to maintain a high degree of personal and professional behavior, which is also part of the code of ethics, Nurse B should talk to Nurse A about the comment, rather than ignoring it. b. Nurse B should initiate the process of values clarification, either by herself or with assistance from a counselor or supervisor.