Contents
1. Health Care Delivery and Nursing Practice 1
2. Community-Based Nursing Practice 8
3. Critical Thinking, Ethical Decision Making,
and the
... [Show More] Nursing Process 12
4. Health Education and Health Promotion 21
5. Adult Health and Nutritional Assessment 26
6. Homeostasis, Stress, and Adaptation 31
7. Individual and Family Considerations
Related to Illness 40
8. Perspectives in Transcultural Nursing 45
9. Genetics and Genomics Perspectives in
Nursing 49
10. Chronic Illness and Disability 53
11. Principles and Practices of Rehabilitation 57
12. Health Care of the Older Adult 63
13. Pain Management 68
14. Fluid and Electrolytes: Balance and
Disturbance 73
15. Shock and Multiple Organ Dysfunction
Syndrome 85
16. Oncology: Nursing Management in
Cancer Care 93
17. End-of-Life Care 101
18. Preoperative Concepts and
Nursing Management 104
19. Intraoperative Nursing Management 109
20. Postoperative Nursing Management 114
21. Assessment of Respiratory Function 120
22. Management of Patients With Upper
Respiratory Tract Disorders 127
23. Management of Patients With Chest and
Lower Respiratory Tract Disorders 134
24. Management of Patients With Chronic
Pulmonary Disease 143
25. Respiratory Care Modalities 149
26. Assessment of Cardiovascular Function 158
27. Management of Patients With
Dysrhythmias and Conduction Problems 165
28. Management of Patients With Coronary
Vascular Disorders 173
29. Management of Patients With Structural,
Infectious, and Inflammatory Cardiac
Disorders 181
30. Management of Patients With
Complications From Heart Disease 187
31. Assessment and Management of
Patients With Vascular Disorders and
Problems of Peripheral Circulation 194
32. Assessment and Management of
Patients With Hypertension 200
33. Assessment and Management of
Patients With Hematologic Disorders 204
34. Assessment of Digestive and
Gastrointestinal Function 212
35. Management of Patients With Oral and
Esophageal Disorders 218
36. Gastrointestinal Intubation and Special
Nutritional Modalities 224
37. Management of Patients With Gastric
and Duodenal Disorders 230
38. Management of Patients With Intestinal
and Rectal Disorders 236
39. Assessment and Management of
Patients With Hepatic Disorders 243
40. Assessment and Management of
Patients With Biliary Disorders 250
41. Assessment and Management of
Patients With Diabetes Mellitus 254
42. Assessment and Management of
Patients With Endocrine Disorders 263
43. Assessment of Renal and Urinary Tract
Function 271
44. Management of Patients With Renal
Disorders 274
45. Management of Patients With Urinary
Disorders 281
46. Assessment and Management of Female
Physiologic Processes 285
47. Management of Patients With Female
Reproductive Disorders 291
48. Assessment and Management of
Patients With Breast Disorders 297
49. Assessment and Management of
Problems Related to Male
Reproductive Processes 303
50. Assessment of Immune Function 308
51. Management of Patients With
Immunodeficiency 312
52. Management of Patients With HIV
Infection and AIDS 315
53. Assessment and Management of
Patients With Allergic Disorders 320
54. Assessment and Management of
Patients With Rheumatic Disorders 324
55. Assessment of Integumentary Function 330
56. Management of Patients With
Dermatologic Problems 334
57. Management of Patients With Burn Injury 341
58. Assessment and Management of Patients
With Eye and Vision Disorders 347
viii Contents
59. Assessment and Management of Patients
With Hearing and Balance Disorders 353
60. Assessment of Neurologic Function 358
61. Management of Patients With Neurologic
Dysfunction 363
62. Management of Patients With
Cerebrovascular Disorders 368
63. Management of Patients With Neurologic
Trauma 372
64. Management of Patients With Neurologic
Infections, Autoimmune Disorders, and
Neuropathies 376
65. Management of Patients With Oncologic
or Degenerative Neurologic Disorders 380
66. Assessment of Musculoskeletal Function 384
67. Musculoskeletal Care Modalities 388
68. Management of Patients With
Musculoskeletal Disorders 394
69. Management of Patients With
Musculoskeletal Trauma 398
70. Management of Patients With Infectious
Diseases 404
71. Emergency Nursing 409
72. Terrorism, Mass Casualty, and Disaster
Nursing 414
Answer Key 417
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins. 1
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
I. Interpretation, Completion, and Comparison
MULTIPLE CHOICE
Read each question carefully. Circle your answer.
1. The definition of nursing has evolved over time. According to the Social Policy Statement (2003) of the
American Nurses Association (ANA), registered nurses can and should:
CHAPTER 1
Health Care Delivery
and Nursing Practice
a. diagnose human responses to illness.
b. promote optimum levels of wellness.
c. prevent illness and maintain health.
d. do all of the above.
2. An underlying focus in any definition of nursing is the registered nurse’s responsibility to:
a. appraise and enhance an individual’s healthseeking
perspective.
b. coordinate a patient’s total health management
with all disciplines.
c. diagnose acute pathology.
d. treat acute clinical reactions to chronic illness.
3. A Jewish patient who adheres to the dietary laws of his faith is in traction and confined to bed. He needs
assistance with his evening meal of chicken, rice, beans, a roll, and a carton of milk. Choose the nursing
approach that is most representative of promoting wellness.
a. Nurse “A” removes items from the overbed
table to make room for the dinner tray.
b. Nurse “B” pushes the overbed table toward
the bed so that it will be within the patient’s
reach when the dinner tray arrives.
c. Nurse “C” asks a family member to assist the
patient with the tray and the overbed table
while the nurse straightens the area in an
attempt to provide a pleasant atmosphere for
eating.
d. Nurse “D” prepares the environment and the
overbed table and inspects the contents of the
dinner tray. The nurse asks the patient whether
he would like to make any substitutions in the
foods and fluids he has received.
4. Using the concept of the wellness–illness continuum, a nursing care plan for a chronically ill patient
would outline steps to:
a. educate the patient about every possible
complication associated with the specific
illness.
b. encourage positive health characteristics
within the limits of the specific illness.
c. limit all activities because of the progressive
deterioration associated with all chronic
illnesses.
d. recommend activity beyond the scope of
tolerance to prevent early deterioration.
10. Common features that characterize managed care include all of the following except:
2 CHAPTER 1 ■ Health Care Delivery and Nursing Practice
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
5. To be responsive to the changing health care needs of our society, registered nurses will need to:
a. focus their care on the traditional diseaseoriented
approach to patient care, because
hospitalized patients today are more acutely
ill than they were 10 years ago.
b. learn how to delegate discharge planning to
ancillary personnel so that registered nurses
can spend their time managing the “high
tech” equipment needed for patient care.
c. place increasing emphasis on wellness, health
promotion, and self-care, because the majority
of Americans today suffer from chronic
debilitative illness.
d. stress the curative aspects of illness, especially
the acute, infectious disease processes.
6. Continuous quality improvement (CQI) was mandated in health care organizations in 1992. This system
focuses on all of the following processes except:
a. analyzing similar clinical situations.
b. assessing the impact of financial decisions on
patient care delivery.
c. examining processes that affect patient care.
d. reviewing medication errors for individual
patients.
7. Quality assurance programs created in the 1980s required that hospitals be accountable for all of the
following except:
a. appropriateness of care related to established
standards.
b. cost of services.
c. staff–patient ratios for nursing care.
d. quality delivery of services.
8. The primary focus of the nurse advocacy role in managing a clinical pathway is:
a. continuity of care.
b. cost-containment practices.
c. effective utilization of services.
d. a patient’s progress toward desired outcomes.
9. Nursing practice in the home and community requires competence and experience in the techniques of:
a. decision making.
b. health teaching.
c. physical assessment.
d. all of the above.
a. fixed-price reimbursement.
b. mandatory precertification.
c. preferred provider choice.
d. prenegotiated payment rates.
SHORT ANSWER
Read each statement carefully. Write your response in the space provided.
1. List four phenomena frequently identified by the American Nurses Association (ANA) in 2003 as the
focus of nursing care and research. An example is given:
Pain and discomfort (Example)
__________________________________________________, __________________, ______________, and ________________.
2. List six significant changes (socioeconomic, political, scientific, and technological) that have evolved over
the last hundred years that have influenced where nurses practice.
_____________________________, and __________________________________________________________
_____________________________, and __________________________________________________________
_____________________________, and __________________________________________________________
3. List four major health care concerns that practitioners are facing today with the shift from acute to
chronic illnesses: ___________________________, __________________________,
_____________________________, and ____________________.
4. Choose four health and illness problems and write a human response to each that would require nursing
intervention. An example is provided.
Health and Illness Problems Human Response Requiring Nursing Intervention
Fractured right arm (Example) Self-care limitations (Example)
1. __________________________ __________________________________________
2. __________________________ __________________________________________
3. __________________________ __________________________________________
4. __________________________ __________________________________________
5. According to Hood and Leddy (2007), wellness involves proactively working toward physical, psychological,
and spiritual well-being. Four major concepts supporting wellness are:
________________________________, ________________________________,
________________________________, and _________________________________.
6. List Maslow’s hierarchy of needs, and give an example for each need. The first need is provided as
an example.
Need Example
Physiologic (Example) Food and water (Example)
_________________________________ __________________________________________
_________________________________ __________________________________________
_________________________________ __________________________________________
_________________________________ __________________________________________
_________________________________ __________________________________________
_________________________________ __________________________________________
_________________________________ __________________________________________
7. Health promotion efforts today target negative lifestyle behaviors. List six examples.
__________________________________ __________________________________________
__________________________________ __________________________________________
__________________________________ __________________________________________
8. Three infectious diseases that presently seem to be on the rise are: __________________________,
____________________________, and _________________________.
9. List four comorbidities that are associated with the major health concern of obesity: ______________,
_________________, _________________, and ____________________.
CHAPTER 1 ■ Health Care Delivery and Nursing Practice 3
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
10. Define the term evidence-based practice (EBP).
_________________________________________________________________________________________________________
11. Define the term clinical pathway as it relates to the concept of managed care.
_________________________________________________________________________________________________________
12. In addition to clinical pathways, there are four other EBP tools a nurse can use. They are:
____________________, ______________________, ______________________, and ____________________.
13. Explain when “care mapping” may be more beneficial than “clinical pathways” for managing care.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
14. List five common features of managed care: ____________________, ________________________,
____________________, ____________________, and _____________________________.
15. List the purpose and goals of case management.
_________________________________________________________________________________________________________
16. List four categories of advanced practice nurses: ________________, _______________, ________________,
and _______________________.
II. Critical Thinking Questions and Exercises
DISCUSSION AND ANALYSIS
Discuss the following topics with your classmates.
1. Review the clinical pathway for acute ischemic stroke that is presented in Appendix B. Discuss the range of
assessments, expected outcomes, nursing diagnoses, and treatment modalities listed in the chart.
2. Discuss the primary differences between community-based nursing and community-oriented/public health
nursing.
3. Discuss the current and future role of the advanced practice nurse (APN).
SUPPORTING ARGUMENTS
Read the paragraph below. Fill in the space provided with the best response.
Many recent changes in health care have significantly affected nursing care delivery and nursing education,
including the aging population, increased cultural diversity, changing patterns of disease, the rising cost of
health care, and federally legislated health care reform. Choose one factor that you believe has had the most
impact on nursing care in the last 5 years, and support your argument with data.
The most important factor is:
________________________________________________________________________________________________
Supporting argument:
________________________________________________________________________________________________
4 CHAPTER 1 ■ Health Care Delivery and Nursing Practice
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
RECOGNIZING CONTRADICTIONS
Rewrite each statement correctly. Underline the key concepts.
1. The majority of health problems in the United States today are of an infectious and acute nature.
______________________________________________________________________________________________
2. A person with a chronic illness can never attain a high level of wellness, because part of his or her health
potential will never be reached.
_____________________________________________________________________________________________.
3. It is predicted that by the year 2030, people older than 65 years of age in the United States will constitute
about 35% of the total population; racial and minority groups could approach 60% of the population.
_____________________________________________________________________________________________
4. Those individuals with infectious diseases are the largest group of health care consumers in the United States.
_____________________________________________________________________________________________
5. The largest group of health care consumers in the United States is children and the middle-aged.
_____________________________________________________________________________________________
6. Home health care nursing is a major component of public health nursing.
_____________________________________________________________________________________________
EXAMINING ASSOCIATIONS
Answer the following.
1. Examine the progression of Maslow’s hierarchy of needs in Figure 1-1. Consider one or more recent clinical
situations where the patient’s physical symptoms prevented him or her from attending to higher level needs.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
2. Using Figure 1-2 in the text, examine and explain the expected behaviors among the physician, patient,
nurse, and ancillary personnel in the collaborative practice model.
_____________________________________________________________________________________________
3. Compare the two most common models of nursing care delivery in practice today: primary nursing and
patient-focused or patient-centered care.
_____________________________________________________________________________________________
CHAPTER 1 ■ Health Care Delivery and Nursing Practice 5
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
6 CHAPTER 1 ■ Health Care Delivery and Nursing Practice
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
FIGURE 1-1. This scheme of Maslow’s hierarchy of human needs shows how a person
moves from fulfillment of basic needs to higher levels of needs, with the ultimate goal
being integrated human functioning and health.
FIGURE 1-2.
2. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) mandated in 1992 that
health care organizations move toward implementation of CQI. A cause-and-effect diagram can illustrate
potential causes of a process so that the cause can be examined and corrected and patient care improved.
Complete the following diagram.
CLINICAL SITUATIONS
Complete the following flow charts.
1. Continuous quality improvement (CQI) mandates the standardization of processes that are implemented
and improved on a continuous basis. Complete the blank lines on the flow chart for the process of radial
pulse assessment.
CHAPTER 1 ■ Health Care Delivery and Nursing Practice 7
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
8 Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
I. Interpretation, Completion, and Comparison
MULTIPLE CHOICE
Read each question carefully. Circle your answer.
1. The shift in health care delivery from acute care to community-based care is primarily the result of:
CHAPTER 2
Community-Based
Nursing Practice
a. alternative health care delivery systems.
b. changes in federal legislation.
c. tighter insurance regulations.
d. the interfacing of all three conditions.
2. Choose an alternative health care delivery system that has dramatically reduced patient-care days in acute
care settings.
a. Health Maintenance Organizations.
b. Managed Health Care Systems.
c. Preferred Provider Organizations.
d. Each of the three is equally significant.
3. The most frequent users of home health services are:
a. children with chronic, debilitating disorders.
b. newborns who are sent home with apnea
monitors.
c. the frail and elderly who need skilled care.
d. young adults on prolonged intravenous
therapy.
4. Discharge planning from the hospital to home care begins when the:
5. Nurses working in elementary schools are trained to deal with one of the most frequent health care
problems:
a. discharge order is written.
b. nurse receives the physician’s order for
discharge.
a. eating disorders.
b. emotional problems.
c. infections.
d. drug abuse.
6. Nurses working with high school students are prepared to deal with the common health care
problem of:
a. influenza.
b. cancer.
c. alcohol and drug abuse.
d. pneumonia.
c. physician notifies the insurance company.
d. patient is admitted to the hospital.
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
CHAPTER 2 ■ Community-Based Nursing Practice 9
SHORT ANSWER
Read each statement carefully. Write your response in the space provided.
1. Name three chronic conditions that are increasing in prevalence and causing an increased need for
community health services: _______________________, ________________________, and
_______________________.
2. List four factors that have affected the shift of health care delivery from inpatient to outpatient settings:
_________________________________, ___________________, ___________________, and _________________________.
3. List specific skills a nurse will need to function in community-based care.
____________________________________________________________________________________
4. Community-based nursing practice focuses on three primary goals: __________________________,
______________________, and _________________________.
5. List the four primary concepts supporting community-based nursing care: _________________________,
___________________, ___________________, and ______________________________.
6. List several examples of “skilled” nursing services provided by home care.
____________________________________________________________________________________________
7. The first step in preparing for a home visit is for the nurse to:
____________________________________________________________________________________________
8. Explain the purpose of the initial home visit.
____________________________________________________________________________________________
____________________________________________________________________________________________
9. List the range of nursing responsibilities within ambulatory health care settings.
____________________________________________________________________________________________
____________________________________________________________________________________________
10. The homeless have high rates of health care problems such as:
____________________________________________________________________________________________
II. Critical Thinking Questions and Exercises
DISCUSSION AND ANALYSIS
Discuss the following topics with your classmates.
1. Distinguish among primary, secondary, and tertiary levels of preventive care and cite a clinical case
example for each level.
2. Discuss one of the major financial incentives for discharging patients from acute care facilities prior to full
recovery.
Copyright © 2010 Wolters Kluwer Health/Lippincott Williams & Wilkins.
Study Guide for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 12th edition.
10 CHAPTER 2 ■ Community-Based Nursing Practice
3. Explain the concept of “telehealth” and its implications for nursing care. Refer to the book, Community
and Public Health Nursing, by M. Stanhope and S. Lancaster, 2008, St. Louis, Mosby.
CLINICAL SITUATIONS
CASE STUDY: Assessing the Need for a Home Visit
Read the following case study and assess the patients’ need for a home visit.
Mrs. Flynn is an 85-year-old lady who suffered a stroke on December 28. She was admitted to the emergency
department and suffered another stroke on December 30. The left occipital area and the cerebellum were
affected resulting in the loss of 50% of vision (right half of each eye) and loss of balance. After 2 weeks in the
hospital and 10 days in a rehabilitation treatment center, Mrs. Flynn will be discharged to her one-floor home
where she lives alone. Her son and daughter both live an hour away. She is capable of walking with a walker.
Before the stroke, Mrs. Flynn was independent, an active member of several citizen groups, and participated
in water walking at the YMCA three times a week. Her driver’s license was revoked. Using Chart 2-2 in the
text, complete the outline to assess Mrs. Flynn’s need for a home visit. Create your own answers to several of
the questions so you can complete the assessment.
Current Health Status
1. How well is the patient progressing?
2. How serious are the present signs and symptoms?
3. Has the patient shown signs of progressing as expected, or does it seem that recovery will be delayed?
Home Environment
1. Are worrisome safety factors apparent?
2. Are family or friends available to provide care, or is the patient alone?
Level of Self-Care Ability
1. Is the patient capable of self-care?
2. What is the patient’s level of independence?
3. Is the patient ambulatory or bedridden?
4. Does the patient have sufficient energy or is she frail and easily fatigued?
Level of Nursing Care Needed
1. What level of nursing care does the patient require?
2. Does the care require basic skills or more complex interventions?
Prognosis
1. What is the expectation for recovery in this particular instance?
2. What are the chances that complications may develop if nursing care is not [Show Less]