1. Jeanne is a 48-year-old with dissociative identity disorder who was admitted to the crisis unit for a short-term stay after a suicide threat. On the unit, she has repeated the statement that she will kill herself to get rid of “all the others,” meaning her alters.
a. How do you think that staff reacts to working with patients such as Jeanne?
b. What do you believe needs to be done to protect Jeanne?
2. John, a 24-year-old, returned from the Iraq War last month. Since then he has become increasingly irritable, isolated, and depressed. His wife says he does not want to go anywhere and won’t leave his home for days at a time. In the interview with the nurse at the clinic, he indicates that he feels helpless and anxious and jumpy.
a. Identify priorities in providing care for this patient.
b. What type of medication would you anticipate being ordered for John?
Chapter 17:
1. A patient with suspected somatic symptom disorder has been admitted to the medical-surgical unit after an episode of chest pain with possible electrocardiographic changes. While on the unit, she frequently complains of palpitations, asks the nurse to check her vital signs, and begs staff to stay with her. Some nurses take her pulse and blood pressure when she asks. Others evade her requests. Most of the staff tries to avoid spending time with her.
a. Consider why staff wish to avoid her. How would you feel as a nurse in this situation?
b. Design interventions to cope with the patient’s behaviors. Give rationales for your interventions.
Chapter 18
1. Logan, a 19-year-old male model, has experienced a rapid decrease in weight over the past 4 months after his agent told him he would have to lose some weight or lose a coveted account. Logan is 6 feet 2 inches tall and weighs 132 pounds, down from his usual 176 pounds. He is brought to the emergency department with a pulse of 40 beats per minute and severe arrhythmias. His laboratory workup reveals severe hypokalemia. He has become extremely depressed, saying, “I’m too fat… I don’t want anything to eat… If I gain weight, my life will be ruined. There is nothing to live for if I can’t model.” Logan’s parents are startled and confused, and his best friend is worried and feels powerless to help Logan. “I tell Logan he needs to eat or he will die… I tell him he is a skeleton, but he refuses to listen to me. I don’t know what to do.”
a. Which physical and psychiatric criteria suggest that Logan should be immediately hospitalized?
b. What are some of the questions you would eventually ask Logan when evaluating his biopsychosocial functioning?
c. What are your feelings toward someone with anorexia? Can you make a distinction between your thoughts and feelings toward women with anorexia and toward men with anorexia?
d. What are some things you could do for Logan’s parents and friend in terms of offering them information, support, and referrals? Identify specific referrals.
e. Identify at least five criteria that, if met, would indicate that Logan was improving.
Chapter 19:
1- Anthony is a 46-year-old who complains of waking frequently at night. Consequently, he is tired all day and knows that he has not been functioning as well as he should. Whenever he can manage it, he goes out to his car at lunchtime to take a 60-minute nap, because he has fallen asleep at his desk and been given a disciplinary warning. He is drinking 2 to 3 cups of coffee in the afternoon so that he does not feel sleepy while driving home.
a. What questions would you ask to determine if Anthony might have a sleep disorder?
b. What recommendations will you make to improve his sleep hygiene?
c. What instructions and education should you give this patient regarding personal and community safety?
2. Your patient, Vivian, has been using temazepam (Restoril) for several years to treat insomnia. She has been reading that long-term use of hypnotics is not healthy or productive and wants to quit taking them. However, she is focused on needing 9 hours of sleep each night and is extremely worried about what will happen when she discontinues the temazepam.
a. What instructions would you provide to Vivian regarding stimulus control, sleep restriction, and cognitive restructuring of her sleep complaint?
b. Identify alternative pharmacological therapies.
Chapter 20:
1. As a nurse on an adolescent psychiatric-mental health nursing unit, you often encounter teenagers who are misinformed about growth and development, as well as sexuality. What information would you include in a series of teaching sessions that would help these adolescents acquire a greater understanding of the developmental changes they are going through?
2. To understand your own beliefs, answer these questions:
a. Are you comfortable with your own sexuality? With that of others?
b. Are you judgmental?
c. Could you be helpful to someone who has a sexual disorder?
d. What factors have influenced your beliefs and values regarding sexuality?
e. What do you think is the impact of sexually explicit television, music videos, and movies on your sexual attitudes, values, and beliefs?
Chapter 21:
1. Jacob is a 14-year-old adolescent who has been diagnosed with conduct disorder.
a. Explain to one of your classmates his probable behaviors in terms of (1) aggression toward others, (2) destruction of property, (3) deceitfulness, and (4) violation of rules.
b. What are the outcomes for this disorder?
c. List at least seven ways you could support Jacob’s parents. What are some community referrals you could give them in your own locale?
2. Mallory is a 17-year-old female being admitted to the adolescent psychiatric unit after several weeks of impulsive behaviors such as extensive cutting and running away from home.
a. Put the following areas of assessment in order of priority and provide the rationale for your choices:
1. Suicide risk
2. Current coping skills
3. Skin integrity/risk for infection
4. Childhood development
5. Current family relationships
b. Identify at least three appropriate nursing diagnoses for Mallory based on the previously provided information.
c. Name three nursing interventions to support the nursing diagnosis of ineffective coping.
Chapter 22:
1. Write a paragraph describing your possible reactions to a drug-dependent patient to whom you are assigned.
a. Would your response be different depending on the substance (e.g., alcohol versus heroin or marijuana versus cocaine)? Give reasons for your answers.
b. Would your response be different if the substance-dependent person were a professional colleague? How?
2. Rosetta Seymour is a 15-year-old who has started using heroin nasally.
a. Briefly discuss the trend in heroin use among teenagers.
b. When Ms. Seymour asks you why she needs to take more and more to get “high,” how would you explain to her the concept of tolerance?
c. If she had just taken heroin, what would you find on assessment of physical and behavioral-psychological signs and symptoms?
d. If she came into the emergency department with an overdose of heroin, what would be the emergency care? What might be effective long-term care?
Chapter 23:
1. Mrs. Kendel is an 82-year-old woman who has Alzheimer’s disease. She lives with her husband, who has been trying to care for her in their home. Mrs. Kendel is having trouble dressing. She has put her blouse on backward and sometimes puts her bra on over her blouse. She often forgets where things are. She makes an effort to cook but has recently attempted to “put out” the electric burners of the stove with pitchers of water. Once in a while, she cannot find the bathroom in time, often mistaking it for a closet. At times, she cries because she is aware that she is losing her sense of her place in the world. She and her husband have always been close loving companions, and he wants to keep her at home as long as possible.
a. Assist Mr. Kendel by writing out a list of suggestions that he can try at home that might help facilitate (a) communication, (b) activities of daily living, and (c) maintenance of a safe home environment.
b. Identify at least three interventions appropriate to this situation for each of the areas previously cited.
c. Identify resources available for maintaining Mrs. Kendel in her home for as long as possible. Provide the name of a self-help group that you would urge Mr. Kendel to join.
Chapter 24:

1. Cherie is brought to the emergency department after slashing her wrist with a razor. She has previously been in the emergency department for drug overdose and has a history of addictions. Cherie can be sarcastic, belittling, and aggressive to those who try to care for her. When the psychiatric triage nurse comes in to see her, Cherie is initially adoring and compliant, telling him, “You are the best nurse I’ve ever had, and I truly want to change.” But when he refuses to support her request for diazepam (Valium) and meperidine (Demerol) for “pain,” she yells at him, “You are a stupid excuse for a nurse. I want to see the doctor immediately.” Cherie has borderline personality disorder.
a. What defense mechanism is Cherie using?
b. How could the nurse handle this situation while setting limits and demonstrating concern?

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Assignment :
BIMI Case Study and Instructions.
Assignment Instructions:
After reading Brief Integrated Motivational Intervention (BIMI), use the following case study to complete a BIMI. Use the provided worksheets required to complete a BIMI with a volunteer you find to roleplay as “Keira”. If you cannot find a volunteer, you can roleplay “Keira” yourself.
You are an addictions counselor working at SUNDANCE RESIDENTIAL MENTAL HEALTH AND ADDICTIONS RECOVERY CENTRE. You are often asked to meet with clients who enter the facility due to a mental health crisis. At times some of these clients have substance abuse issues, but they have not entered the treatment center due to these issues. This is the case with Keira Keys.
KEIRA KEYS is a 27- year – old female who has entered the Sundance Mental Health & Addictions Recovery Centre. Keira came to the Centre after several days in the hospital after a serious suicide attempt. This was Keira’s 3rd attempt at suicide in the past 2 years.
Keira has been at the Sundance Recovery Centre for 2 weeks now and has been actively participating in therapy. Keira has disclosed to her therapist that prior to being hospitalized she had been drinking hard and using cocaine a lot more than usual. Keira has also indicated to her therapist that she is feeling very tired of her life. She has lost many of her old friends due to her lifestyle and while still in contact with her family, they are threatening to disown her.
The therapist had some details to pass on to you regarding some background information on Keira as well as some information about Keira’s substance use.
Keira lived in a very chaotic home with her parents and 3 siblings.Keira was the oldest and was expected to help look after her siblings from a very young age, while both her parents worked. Keira did not have a good relationship with her parents as she felt like she was their babysitter, not their daughter. Keira’s mom was very critical of Keira and her father was typically very quiet and would often go spend his free time in the garage ‘fixing things’. Keira learned later that her father went to the garage to drink. Keira never considered her father an alcoholic as he never appeared drunk and went to work every day. At the age of 17 Keira developed a relationship with a boy from school. Her new boyfriend expected Keira to spend time with him and so Keira began to rebel against her babysitting duties. Her parents weren’t happy and Keira left home before her 18th birthday. She lived with her boyfriend’s family for a few months until that relationship ended. Since that time, Keira has been struggling to support herself, but she does have her own basement apartment. She works in bars as a waitress and her tips, which is around $60.00 per night, help to keep her afloat. Due to her work environment, Keira stays for drinks with her peers after the bar closes every night. Keira has anywhere from 3 to 6 drinks depending on when the manager closes up. Keira never has to pay for drinks at the bar as the manager lets them drink for free. A year ago, she went to a party with a friend from work and she tried cocaine for her first time. For quite some time, Keira only used cocaine at parties when it was offered to her. However, over the past 3 months Keira has started buying her own. Keira is finding now that she is using her ‘tip’ money to buy cocaine, and she has less money for her living expenses. Last month, Keira was not able to make rent and her landlord threatened to evict her. It was after this news that Keira attempted to take her life by trying to overdose on alcohol and prescription meds (the therapist does not know where Keira got these). Lucky for Keira, a friend from work came by Keira’s apartment and found Keira.
The therapist has asked Keira if she would be willing to speak with you about substance use and Keira has agreed, although is not thrilled with the idea. She states she is willing to have a quick meeting with you, but she is not willing to go into another type of counseling or therapy session. BIMI Case Study and Instructions You see this as a good opportunity to use Brief Integrated Motivational Intervention with Keira and set up a time to sit down with her.
Below is a short guideline for you to follow. Please ensure you read your book for the complete information on how to complete a BIMI.
Step 1: Engagement and Brief Assessment (Chapter 2)
Session 1
Purpose: Build relationship and open environment in which substance use can be discussed. Complete worksheets: •
BIMI Brief Assessment Sheet •
AUDIT and/or SDS •
PHQ-9 •
GAD-7 •
You are at your first meeting with Keira. During this meeting you are building trust and a relationship. In a conversational style you must complete the Worksheet: BIMI Brief Assessment. Depending on Keira’s answers, there will be other questionnaires to complete with her. You must choose which worksheets to complete. As an example, if Keira is not misusing alcohol, then you would not complete an AUDIT. •
This first session may be a bit longer than the recommended 15 to 30 minutes due to the need to complete the questionnaires with your client.
Session 2
Purpose: Provide client with feedback from Session 1. Answer client questions, provide educational information to take away.
Complete worksheet *(before you meet with Kiera again): BIMI Assessment Feedback-Your Results
• To properly complete this worksheet, you will need to do some research. Be sure that any research and stats are CANADIAN.
• Be prepared to answer any questions the client may have in relation to their substance misuse and how it affects their specific mental health issues.
• During this session you will go over the results of the Feedback with your client and discuss how your client feels about the information you have presented.
Step 2: Making Decisions About Change (Chapter 3)
(Will take more than one session)
Purpose: Help client begin to consider benefits and costs associated with use.
Complete (your choice) Worksheet 1 or 2: What I enjoy about using/What keeps me using? Complete Worksheet 3: How does my use sometimes affect me?
• Complete Worksheet 1 or 2(these are the same worksheets but in different format): What I enjoy about Using/ What keeps me using?
• After discussing Worksheet 1/2; move on to Worksheet #3: How does my use sometimes affect me?
Step 3: Change Plans and Social Support (Chapter 4)
(Will take more than 1 session)
Purpose: Help build client confidence that change is possible. Identify small achievable substance related or personal goal.
Complete Worksheet 4: Taking steps toward my goals.
BIMI Case Study and Instructions
• Help client identify who is their circle of healthy supports.
• Discuss with client their personal goals. Then complete Worksheet 4: Taking steps toward my goals. You may need to use a larger sheet to complete worksheet 4. Assist your client in identifying things that might get in the way of success. Then work with your client to come up with strategies to deal with those possible setbacks should they occur.
Work Sheets
Image transcription text
BIMI-Brief Assessment Sheet Crack Cocaine
|Legal Illicit Alcohol Cannabis Cocaine
Powder | Highs | Heroin Method… Show more
Image transcription text
Crack Cocaine | Lego Illicit Alcohol Cannabis
Cocaine Powder Highs | Heroin Methodone |
Amphetamine Other What route… Show more
Image transcription text
Questions 1 2 3 4 Score 1 How often do you
have a drink Never Monthly 2-4 2-3 4+ times
containing alcohol? or less times… Show more
Image transcription text
SDS Tell your client: “Please think of
your use of during a recent period of
usingwhen you answer these qu… Show more
Image transcription text
MOODPHQ- 9 Name Date Over the lost 2
weeks, how often have you been Not Several
More Nearly bothered by any of … Show more
Image transcription text
GAD-7 Over the last 2 weeks, how often have
you been Not At Several More than Nearly
bothered by the following proble… Show more
Image transcription text
BIMI ASSESSMENT FEEDBACK-YOUR
RESULTS VENTION Diagnosis: Substance of
choice: Part 1 ALCOHOL DRUG… Show more
Image transcription text
Worksheet 1: What Do I Enjoy About Using or
What Keeps Me Using? What I enjoy about
using _(insert name of substanc… Show more
Image transcription text
Difficulties my use may be causing? 1. 2. 3. 4.
When I look over my list I feel Looking at it,
does it make me think differently… Show more
Image transcription text
Worksheet 2: What I Enjoy About Using or
What Keeps Me Using (Table) insert name of
substance] WORKSHEETS AND… Show more
Image transcription text
– Worksheet 3: How Does My Use Sometimes
Affect Me? MyTRIGGERS The EFFECT on me
What I THINK Later_qu’ Straight … Show more
Image transcription text
Worksheet 4: Taking Steps Toward My Goal
Now Goal Step 1: Step 2: Step 3: Step 4:
WORKSHEETS AND HANDOUT… Show more

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AUDIO CASE STUDY
Listen to the audio case study available on Davis Edge and then answer the following questions.
Grace and Enteral Feedings
1. What care for feeding tubes and enteral tube-feeding systems was used to prevent complications?

2. How was placement of the feeding tube verified?

3. What positioning was used during the feedings?

4. What is done for pneumonia prevention during the feedings?

FUNCTIONS OF THE GASTROINTESTINAL SYSTEM
Fill in the blanks with the appropriate parts of the gastrointestinal (GI) system.
1. The lower _______ sphincter prevents backup of stomach contents into the esophagus.
2. The _______ valve prevents backup of fecal material from the large intestine into the small intestine.
3. The _______ sphincter prevents backup of duodenal contents into the stomach.
4. The absorption of most of the end products of digestion occurs in the _______ intestine.
5. The digestion of protein begins in the _______.
6. Water and the vitamins produced by the normal flora are absorbed in the _______ intestine.
7. The _______ intestine is the site of action of bile and pancreatic enzymes.
8. The passageway for food into the stomach from the mouth is the _______.
9. Voluntary control of defecation is provided by the _______ anal sphincter.
10. The watery secretion that permits taste and swallowing is produced by the _______ glands.
11. The process of mechanical digestion is accomplished by the _______ and _______ in the mouth.
12. The structures in the small intestine that contain capillaries and lacteals for absorption are the _______.
13. The part of the colon that contracts in the defecation reflex is the _______.
14. The digestive function of the liver is the production of _______ by the hepatocytes.
VOCABULARY
Unscramble the letters to identify the word described by the definition.
1. Flexible or rigid device consisting of a tube and optical system for observing the inside of a hollow organ or cavity _______ donscepeo
2. Gurgling and clicking heard over the abdomen caused by air and fluid movement from peristaltic action that can be classified as normal, hypoactive, hyperactive, or absent _______ wlebo onudss
3. Examination of the colon with an endoscope _______ locnooscypo
4. Feeding via a tube placed in the stomach _______ gvaaeg
5. Immovable accumulation of feces in the bowels _______ mipcaitno
6. Blood not visible in feces _______ ccoltu
7. Device consisting of a fluorescent screen that makes the shadows of objects interposed between the tube and the screen visible _______ ulfroocspeo
8. Fatty stools _______ estaotrhrae
9. A test performed to measure secretions of hydrochloric acid and pepsin in the stomach. _______ stgairc naayliss
10. Examination of the stomach and abdominal cavity by use of an endoscope. _______ stgarsopcoy
LABORATORY TESTS
Match the test with its definition.
1. _____ Stool for fat (lipids)
2. _____ Stool cultures
3. _____ Stool for occult blood
4. _____ Carcinoembryonic antigen
5. _____ Stool for ova and parasites
1. Levels may indicate colorectal or other cancer.
2. Testing stool for blood that is not visible to the eye.
3. Testing stool for intestinal infections caused by parasites.
4. Testing stool for the presence of pathogenic organisms in the GI tract.
5. Testing stool for excessive amounts of fat.
BOWEL PREPARATION
Circle the eight errors in the following paragraph, and insert the correct information.
A stomach preparation is required for several procedures that visualize the lower bowel. This preparation is important for effective test results. An incomplete bowel preparation may prevent the test from being done or cause the need for it to be repeated. This can result in the patient’s early discharge and cost savings. The patient usually receives a soft diet 24 hours before the test. A laxative may be given. Enemas may be given once. Young or debilitated patients should be carefully monitored during the administration of multiple enemas, which can fatigue the patient and increase electrolytes. In patients with bleeding or constipation, the bowel preparation may not be ordered by the health care provider.
PANCREAS
Identify the pancreatic enzyme by its function.
1. Digests polypeptides to short chains of amino acids.

2. Digests emulsified fats to fatty acids and glycerol.

3. Digests starch to maltose.

LIVER
Fill in the blanks with the appropriate words.
1. Liver or gallbladder disease may cause pale or _____ -colored stools.
2. Liver disease may cause _____ disorders.
3. A liver scan records the amount of _____ material taken up by the liver to form a composite “picture” of the liver.
4. After a liver biopsy, the patient lies on the right side for the first _____ hours.
5. After a liver biopsy, nursing care focuses on monitoring for _____.
CRITICAL THINKING
Read the following case study and answer the questions.
Mrs. Davis is a 41-year-old schoolteacher who is admitted to your unit with esophageal cancer. Her health care provider orders enteral nutrition through her gastrostomy tube.
1. Before beginning the feeding, what action should you take for patient-centered care?
2. How will you verify the correct placement of the gastrostomy tube?
3. How should the patient be positioned during the feedings? Why?
4. What actions should you take to set up the feeding safely?
5. Why should a controller pump be used for a continuous feeding?
6. What action can you take to prevent patient dehydration? What health care team member should you consult for this?
7. Describe tube flushing. What are two benefits of tube flushing?

REVIEW QUESTIONS—CONTENT REVIEW
Choose the best answer unless directed otherwise.
1. Which of the following structures are connected by the ileocecal valve?
1. Duodenum to the stomach
2. Colon to the small intestine
3. Stomach to the esophagus
4. Ileum to the jejunum
2. Mechanical digestion in the stomach is accomplished by which of the following structures?
1. Mucosa
2. Smooth muscle layers
3. Striated muscle layers
4. Gastric glands
3. Gastric juice contributes to the digestion of which of the following types of nutrients?
1. Proteins
2. Fats
3. Starch
4. The enzymes of the small intestine contribute to the digestion of which of the following types of nutrients?
1. Starch
2. Fats
3. Disaccharides
5. Which of the following structures carries bile and pancreatic juices to the duodenum?
1. Pancreatic duct
2. Cystic duct
3. Hepatic duct
4. Common bile duct
6. Which of the following is a function of the liver?
1. Synthesis of plasma proteins
2. Elimination of carbohydrates
3. Concentration of bile
4. Secretion of cholecystokinin
7. Which of the following diagnostic procedures on stool specimens must the nurse collect using sterile technique?
1. Stool for ova and parasites
2. Stool for occult blood
3. Stool for culture
4. Stool for lipids
8. Which of the following colors would the nurse recognize as an expected finding for the patient’s stools immediately after a barium enema?
1. Brown
2. Black
3. Green
4. White
REVIEW QUESTIONS—TEST PREPARATION
Choose the best answer unless directed otherwise.
9. The nurse evaluates the patient as understanding the primary reason that food and fluids are held until the gag reflex returns after an esophagogastroduodenoscopy procedure if the patient states which of these?
1. “To rest the vocal cords.”
2. “To prevent aspiration.”
3. “To keep the throat dry.”
4. “To prevent vomiting.”
10. What action should the nurse take prior to initiating an enteral feeding using a newly inserted nasogastric feeding tube?
1. Auscultate bowel sounds.
2. Flush the feeding tube.
3. Review chest x-ray results.
4. Review abdominal x-ray results.
11. The nurse auscultates the patient’s abdomen and finds it to be silent. The nurse would document the bowel sounds findings as which of these?
1. Absent
2. Hyperactive
3. Hypoactive
4. Normal
12. When teaching patients about diagnostic procedures, the nurse would include food and fluid restrictions prior to the test for which of these? Select all that apply.
1. Barium swallow
2. Flat plate of the abdomen
3. Esophagogastroduodenoscopy
4. Magnetic resonance imaging
5. Endoscopic retrograde cholangiopancreatography
6. Barium enema
13. The nurse would evaluate the patient as understanding teaching if the patient replied that which of the following can occur following a barium swallow? Select all that apply.
1. Dysphagia
2. Constipation
3. Diarrhea
4. Pain
5. White stool
14. What actions can the nurse take to ensure patient safety when providing an enteral feeding? Select all that apply.
1. Use adequate room lighting.
2. Trace all lines back to their origins.
3. Check connections during patient handoff.
4. Reconnect a patient’s tubing to assist another nurse.
5. Route all tubes in the same direction.
6. Do not interfere with equipment safety features.

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Learning checkpoint one
1. What are the aims of palliative care?
2. What are the principles of palliative care?
3. What are the needs of people accessing palliative care services?
4. What are the philosophies of palliative care?
5. When should palliative care service be accessed by a person?
6. What does holistic care mean?
7. Why is communication important between all members of the palliative care team?
8. What people comprise the palliative care team?
9. What is the differences between curative and palliative approaches to care?
Martha Case Study
Martha always appears distant and withdrawn on the infrequent visits to her husband Stephen, who is dying. The palliative care team wants to involve Martha by encouraging her to visit more often and to assist with his care. Martha feels there is an expectation placed upon her. She explains the situation to Jo, the palliative care worker, because she trusts her. ‘I know I may seem uncaring but I’m exhausted from looking after him 24 hours a day at home. I just can’t do it anymore. I haven’t been close with Stephen for many years and I find it such a relief to have some life of my own at last. I appreciate all the care you are giving him.’
Martha feels supported by her husband’s care team and Jo respects that this is how Martha is feeling. When this explanation is conveyed to other members of the palliative care team, it reinforces the importance of communicating with family members.
Questions:
1. How does communication assist in the care planning approach in this example?
2. Where should the personal support worker document this information?
Learning checkpoint two:
1. What communication strategies can be utilized by the support worker to demonstrate an empowerment approach of people accessing palliative care service?
2. What communication strategies can be utilized by the support worker to demonstrate support?
3. What legal and ethical considerations regarding human rights need to be upheld in palliative care? Give two examples of rights people held by who access palliative care services.
4. Why should a personal care worker support religious practices for a person accessing palliative care services?
5. Provide two ways a personal support worker a person’s spiritual needs
6. Why is it important for the personal support worker to obtain information regarding the culture of a person accessing palliative care services?
Narla case study:
Narla is an Aboriginal woman at the terminal stage of her illness. She has progressed to a semi-conscious state while waiting for her family to arrive from an outback community 900 kilometres away. When her family arrive, they are upset as they are unable to communicate with Narla due to her condition. Communication is very important to them at this time. The nurse on duty makes an assessment that Narla is in pain and requires more morphine to relieve the pain. Casey, the palliative care worker, informs the nurse that she doesn’t think that Narla’s restlessness is due to pain but is instead because she wants to communicate with her family and is finding it difficult to do so.
Narla’s family, together with Casey, decide to reduce the dosage of morphine to see if this would allow Narla to communicate with her family. Casey informs the treating doctor of the family’s decision and the dosage is reduced. Narla is then able to sit up, eat a small meal and share stories with her family. She dies the next day.
Questions:
1. Why is it important to use non-judgemental approach to ensure the person’s lifestyle, social, spiritual and cultural needs are supported and documented in the care plan?
2. Provide an example of a legal and ethical consideration regarding work role boundaries, responsibilities and limitations.
Learning checkpoint three
1. What is an advance care directive?
2. What information might advance care directives include?
3. Explain the term dignity of risk in relation to caring for people accessing care service.
4. Explain the legal and ethical considerations regarding privacy.
5. Explain the legal and ethical considerations regarding confidentiality and disclosure.
6. Explain the legal and ethical concepts of the term duty of care.
7. Explain the responsibility of a personal care worker in upholding the rights of an individual to choose the location of their death.
Doris Case Study
Doris lives at home with her older husband who has Alzheimer’s disease. They have a son who has an intellectual disability and is cared for in a hostel. Her eldest son lives in another state. Doris has a history of severe cardiac disease and one day she requires surgery. Following the surgery and after a long, complicated admission to the intensive care unit she is transferred to a long-term ventilation unit for a slow-weaning process. Each day, Doris finds it increasingly difficult to wean from the ventilator. Although her condition appears to be improving, she is weak and reluctant to be removed from the ventilator. Cara, the palliative care worker, speaks to Doris about her feelings, beliefs, values and goals in life. Doris clearly understands the condition of her heart and is clear about her wishes if her heart ever stops. She firmly says that she does not want to be resuscitated. As the conversation continues, she explains what is important to her at this time. She wants:
to be allowed thick drinks
to be always kept clean
to not have to wean off the ventilator anymore or be treated for any more acute episodes
to receive pain medication when she requires it
to be cremated.
Cara knows that Doris is the most appropriate person to make her own decisions. Doris also tells Cara that under no circumstances should her husband be bothered by having to make any decisions, as he also has a bad heart and she wants the medical team to make all decisions for her. A conference is called to discuss the impact of the wishes Doris has expressed about her treatment. As a result, she completes the statement of choices, to reflect her decisions, in the advance care directives in her care plan. Doris is grateful for the opportunity to express her wishes and she dies peacefully three days later with her family and carers by her side.
Questions:
1. Describe the changing needs that Doris communicates to cara. Where should this information be documented?
2. Who should Cara report Dori’s decisions to?
Learning checkpoint four:
1. List and explain two common misconceptions regarding pain- relieving medication.
2. Who should the personal support worker report to when they observe a person they are supporting is in pair?
3. What actions should the personal support worker take if a person accessing refuses food?
4. If a person who is at the end of their life is unable to take fluids orally, what care strategies should be implemented?
Katie Case Study
Katie is in the final stages of her life. She has returned home and is being looked after by her family. Family members have been actively involved in all aspects of Katie’s care and understand the approach being taken by the palliative care team.
Katie’s granddaughter Molly is a registered nurse and acts as the communication link between the palliative care team and the family. Molly participates in care plan discussions about her grandmother and informs the family of changes to Katie’s care.
At the latest meeting, Molly expresses her father’s concern that Katie seems to be experiencing severe pain as she regularly moans and appears restless. Molly’s father is concerned that increasing the morphine will hasten Katie’s death. The care nurse, Val, agrees that the family needs additional information about Katie’s condition and reassures the family that, although Katie’s condition is deteriorating, the care team regularly monitor and review pain and symptom management.
Val advises the family that she will perform a comprehensive pain assessment, and discuss the outcome with Katie’s doctor. As a result, Katie’s doctor prescribes the appropriate medication to help reduce her pain. At the next assessment, Katie’s pain has reduced from severe to mild and she has become more interactive with family members and the care team.
Questions:
1. List three care strategies that the personal care worker implement Katie to assist in managing her pain.
2. Explain three evaluations the personal care worker can undertake to assess the effectiveness of pain and comfort interventions.
Learning checkpoint five:
1. Identify two common signs of grief a person their family or carer might exhibit on diagnosis of a life threatening or life limiting illness.
2. Identify and explain the five stages of grief.
3. What actions can a personal support worker take to support a person’s culture when providing end of life care?
4. List four care strategies a personal care worker can undertake to promote dignity ofr the person after death.
5. It is important to regularly check the care plan for any changes to the care delivery for a person accessing palliative care services. List two things that a person might change.
6. What does a supportive environment mean for people accessing palliative care services?
7. Identify two care strategies to support the family/carer after death has occured .
Rhonda Case Study
Rhonda is a care worker in an aged care facility. Penny, a client, is admitted there after being discharged from hospital. An assessment prior to her discharge identified the following end-of-life symptoms:
Loss of appetite
Weight loss
Profound weakness
Changes in breathing patterns
Hypertension
Mental anguish
Blood pooling along the skin
Day-to-day deterioration
Penny is also bed-bound and over the coming weeks her condition deteriorates rapidly. She appears agitated and restless and begins to talk about her mother, who died many years before. Rhonda contacts the local hospital’s palliative care service for support.
Two days later, on one of her care rounds, Rhonda finds that Penny is no longer responsive. Her breathing is irregular and, as Rhonda is watching, Penny lapses into unconsciousness. Penny’s body temperature also appears cooler than the previous day. Rhonda immediately notifies Gemma, her team leader.
Gemma then informs the care nurse on duty and Penny’s doctor. The nurse confirms that Penny is falling into a coma. Gemma asks Rhonda to sit with Penny, hold her hand and talk to her until she passes away. Gemma notifies Penny’s family who live in the country and tells Rhonda she has done a good job. ‘I don’t know if it was any help but she seemed calmer while I was there,’ Rhonda says.
Questions:
1. List three signs of imminent death that Rhonda might have observed when caring for penny.
2. Who should Rhonda report these signs to?
Learning checkpoint six:
1. List and explain two areas that organisational policies and procedures cover to manage emotional responses and ethical issues a personal care worker may experience.
2. Identify two reactions a palliative care worker may have after death of a person .
3. Explain what bereavement care includes.
Sophie Case Study
Joan is in palliative care and her support worker is Sophie. Joan’s condition deteriorates and her daughter Marilyn becomes increasingly anxious about her mother’s impending death. Marilyn constantly asks Sophie if Joan is experiencing any pain and is worried as her mother is unable to take more than a few spoonfuls of soft food and sips of fluid. Marilyn stays at the facility with her mother for the last two days of Joan’s life and is not sleeping or eating a great deal herself. Sophie becomes concerned for Marilyn and reports these concerns to the supervisor. The supervisor organises the pastoral care team worker to spend time with Marilyn and Marilyn reports that she finds comfort in these visits.
Questions:
1. Identify an emotional issue or concern that Sophie is experiencing in caring for Joan.
2. Identify two self care strategies the Sophie can implement to address the emotional impact of providing support.

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Joe works in a community centre where Susannah attends English language classes. She has three children who attend a play group at the centre. Joe has noticed that Susannah has bruises on her face and arms and that two of the children have bruises on the backs of their legs.
Joe is concerned about Susannah and her children. He is finding it hard to sleep at night and is staying back at the community centre after his shift finishes so that he can spend a few minutes talking to Susannah. He has offered to drive her home and to pick her and the children up in the morning. Joe has also approached a police officer who is a friend of his and told him about his concerns. He has given the police officer Susannah’s address and asked him to drive past her house and check on her welfare.
question 1-4
1.Identify where Joe can find information about his legal responsibilities in relation to child protection and to domestic and family violence (DFV), and describe the specific information he needs in order to manage this situation. (Approx. 75 words).
2.Describe the specific information Joe should check to identify the scope of his legal responsibilities. (Approx. 50 words that you can present in a bullet point list if you wish).
3.Describe three ways that Joe has breached his work role boundaries as well as the legal and ethical requirements of his role. (Approx. 65 words that you can present in a bullet point list if you wish).
4.How should Joe address his concerns while working within the boundaries of his professional role, legal requirements and his organisation’s policies and procedures? Suggest at least four ways Joe can address his concerns in your answer. (Approx. 75 words that you can present in a bullet point list if you wish).
Susannah’s husband Andrew has found out that Joe has been offering lifts to Susannah and the children. He has made a formal complaint to Joe’s supervisor, Betsy. He has threatened to stop his wife and children attending the centre if Joe continues to work with Susannah and has requested a female worker to support his family.
Susannah has requested a female support worker, saying she would feel more comfortable and says her husband will allow her to continue attending the centre if she has a female support worker.
Jenny is appointed as Susannah’s support worker. Susannah asks for some information about Domestic Family Violence (DFV) services in the local area. She has also asked if she can come to Jenny’s house if she feels unsafe in her own home at any time. Jenny has explained that she cannot offer Susannah accommodation in her house, but she can refer her to a women’s refuge service if Susannah needs this. Jenny feels very strongly about DFV issues and when she was younger she was in a violent relationship herself.
question 5-9
5.escribe four things Betsy should do when responding to the complaint. (Approx. 85 words that you can present in a bullet point list if you wish).
6.Describe two ways Jenny can ensure she obtains legal, valid informed consent from Susannah. (Approx. 25 words that you can present in a bullet point list if you wish).
7.What is Jenny’s responsibility regarding mandatory reporting requirements? (Approx. 25 words).
8. Access and review the Australian Community Work Practice Guidelines (Links to an external site.).
For Indicators 1.5, 3.4, 4.1 and 6.3 explain how Jenny has or can ensure she is upholding the practice guidelines in relation to the services.
9.What rights does Susannah have in this situation? Identify at least three rights that Susannah has in your answer. (Approx. 15 words that you can present in a bullet point list if you wish).
Mary is a resident in a refuge for women and children. Her husband has threatened her life and the life of her son and she has been granted a violence restraining order. Her 10-year-old son, Frederick, is very angry about being separated from his father.
Frederick approaches Beryl, a new part-time refuge worker. He confides in her how much he misses his father and how desperately he wants to see him, or even just talk to him. He persuades Beryl to let him use the phone in the office to contact his father. Beryl agrees as long as she remains in the office with him. Frederick blurts out the address of the refuge before Beryl can stop him. She realises she will be in trouble from her supervisor, so she doesn’t say anything to her.
Later that night Frederick’s father arrives at the refuge and attempts to break in. When Frederick’s father is questioned by the police, he tells them that Beryl let Frederick call him and tell him the address. Beryl faces a severe reprimand from her supervisor.
question 10-12
10. Describe one way that Beryl breached organisational procedures after the incident occurred. (Approx. 15 words).
11. When Frederick approached Beryl to ask to use the phone, what was the potential breach that Beryl should have identified? (Approx. 15 words).
12.Because Beryl did not identify the potential breach, what actual breaches occurred? Identify two breaches in your answer. (Approx. 40 words).
Alice works in a women’s refuge. She has strong religious beliefs and is a supporter of the right to life movement. Imogen has been living at the refuge and is 10 weeks pregnant. She has decided that she wants a termination.
Alice has been asked by her manager to accompany Imogen to an appointment at a women’s health centre to discuss her options. The refuge has a policy that supports self-determination and empowerment, and uses person-centred approaches to service provision.
Alice’s job role description requires her to provide emotional and practical support and to encourage people to make decisions and take control of their own lives. Alice plans to take Imogen to a pregnancy counselling service which is run by an anti-abortion organisation before taking her to the women’s health centre.
Imogen has told Jasmine, one of the other refuge support workers, that Alice is going to take her to the anti-abortion pregnancy counselling service. She says that she is worried they will persuade her to change her mind about having a termination. She also says Alice has been leaving anti-abortion literature in her room and has also asked her to attend a religious service with her. Alice has also suggested referring Imogen for counselling. As there is a long waiting list for subsidised counselling services, Alice has offered to refer Imogen to her cousin, who is in private practice as a psychologist.
question 13-18
13.As a support worker, list at least two sources of information Alice should use to ensure she upholds her ethical responsibilities to Imogen in her work role. (Approx. 10 words).
14.Describe two professional ethical responsibilities Alice must uphold within the scope of her role. (Approx. 30 words that you can present in a bullet point list if you wish).
15.Identify two sources of information about legal and ethical policy frameworks Alice could refer to. (Approx. 30 words).
16.In working with Imogen, describe one way Alice can ensure non-judgmental service provision in spite of her conflicting personal values and attitudes. (Approx. 35 words)
17.Provide one action that indicates that Alice is behaving unethically and one way that Jasmine could respond to Alice’s unethical conduct. (Approx. 50 words).
18.Describe the conflict of interest in this situation and provide one way that Alice should manage it. (Approx. 70 words).
John works in a residential group home for adults with physical disability. The routine includes a weekly group outing for the residents. All residents must attend, as staffing levels do not provide for staff to remain at the group home to supervise residents who do not participate in the group outing.
Not all residents get their first choice of outing and John tries to make this a bit fairer by allowing residents to take it in turns to choose the outing each week, but residents are not happy with this.
John has discovered that the low levels of staffing in the group home have come about because the manager agreed to share his allocation of staff with another group home which is supervised by his fiancée.
John is aware that this is an ethical issue which impacts on service and practice standards.
question 19-21
19.What are two indicators John can use to identify work practices need to be improved? (Approx. 25 words).
20.Describe how John should go about developing a new policy regarding the activities. (Approx. 45 words).
21.What actions could John take to engage the residents in the review of the current activity process? List and describe three things he could do in your answer. (Approx. 15 words).

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1. Miss Smith, a 40-year-old female with insulin-dependent diabetes mellitus, who is familiar with her disease but does not take care of herself, is currently admitted with an infected plantar ulcer and had a transmetatarsal amputation. She is discharged home on IV antibiotics via a peripherally inserted central catheter (PICC), with home care follow-up. (3 points)
What potential complications would the home care nurse be alert for?
What documentation needs to be addressed at every visit?
What patient education needs to be reinforced at home?
2. An order is received to convert a patient’s continuous IV infusion to a saline lock. The patient is complaining of pain at the IV site and has a new order for Demerol 25 mg IV push. (3 points)
What equipment must be gathered?
What are the priorities of nursing care?
What nursing interventions must be implemented?
3. List three different assessments that should be done before IV medication administration. (1 point)
4. List three different types of drug incompatibilities and an example of each different type. (2 points)
5. How quickly does IV medication go throughout the body? ______ minutes (1 point)
6. What does SAS stand for? What does SASH stand for? (1 point)
7. Mrs. Eggenson developed a MRSA incisional infection after a left hip arthroplasty. The culture revealed the bacteria was sensitive to vancomycin and the client began vancomycin IV therapy. Today the client’s BUN is 13 mg/dL and Creatinine is 0.8 mg/dL, I&O is balanced. A peak and trough for vancomycin has been ordered for the third dose. The third dose of vancomycin is to be given on the nurse’s shift. The nurse should do which of the following? (1 point)
8. Hold the dose of vancomycin and notify the physician of the BUN and creatinine levels
Draw a trough 30 minutes prior to the dose and draw a peak 60 minutes after infusion
Give the dose of vancomycin as ordered and have the peak and trough drawn with the other evening labs
Draw a peak 60 minutes prior to the dose and draw a trough 30 minutes after infusion
Discontinue the medication because the client no longer requires antibiotic therapy
9. The nurse is assessing the peripheral IV site of a client receiving doxorubicin (Adriamycin) IV infusion. The nurse suspects extravasation has occurred. After stopping the infusion and disconnecting the IV tubing, what should the nurse do next? (1 point)
Apply a cold compress to the IV site
Elevate the affect extremity
Attempt to aspirate the residual drug
Apply a hot compress to the IV site
Contact the physician
10. The nurse is starting cefazolin therapy (Ancef) IV following a physician’s order. The nurse notes that the client has an allergy to PCN. The client states he becomes short of breath and itchy after receiving penicillin. What should the nurse do? Give rationale for your answer. (1 point)
11. Central line placement needs to be verified by what means, before the line may be used? (1 point)
12. Name 5 purposes of central lines. (1 point)
13. What are four symptoms of an air embolism? (1 point)
14. When administering central line flushes, what size syringe must be used and why? (1 point)
15. When accessing port-a-caths, you should use a ______________ needle. Why? (1 point)
16. The nurse is caring for a client who is receiving IV fluids though a peripherally inserted central catheter (PICC). Which of the following nursing actions will decrease the risk of infection? (1 point)
Administer acetaminophen before dressing changes
Maintain sterile technique during all phases of PICC line care
Talk to the physician about ordering antibiotics
Assess vital signs every 4 hour
17. Mr. Phil needs chemotherapy and is having a central venous access device (CVAD) placed. He also has heparin-induced thrombocytopenia (HIT). What specific type or brand of CVAD would best minimize the risk of HIT-related complications? Give rationale for your answer. (2 points)
18. Liz, a 33-year-old client who was is a motor vehicle accident, is being treated for injuries in the ICU. She has a central venous pressure (CVP) line in place. The nurse recognizes that CVP measurement reflects information about which of the following? (1 point)
Pressure in the right atrium
Pressure in the left ventricle
Pressure in the pulmonary artery
19. What is a normal CVP measurement? What could an elevated measurement indicate? What could a decreased measurement indicate? (3 points)
20. What factors could increase a client’s risk for infection with a multi-lumen catheter? (1 point)
21. A 24-year-old male is admitted to the hospital with a diagnosis of acute lymphoblastic leukemia (ALL). His labs are WBC 31.7 thousand/mm3, Hgb 10.1 g/dL, Hct 29%, and platelets 16 thousand/mm3. He is scheduled to receive the initial induction combination chemotherapy by IV and I.T. (intrathecal) routes. He will be receiving doxorubicin, vincristine, and cyclophosphamide IVP, methotrexate I.T., and prednisone P.O. A triple lumen central venous tunneled catheter (CVTC) is inserted to facilitate chemotherapy and blood product infusions. (4 points)
What nursing care should be implemented for the tunneled catheter and the intrathecal catheter?
What nursing care should be implemented due to the meds the client will be receiving? Give at least 10 nursing interventions.
22. The nurse is administering doxorubicin (Adriamycin) IV push to Jenn, a client with breast cancer. Which of the following should the nurse explain is to be expected during therapy with this drug? (1 point)
Red colored urine
Discoloration of teeth
Permanent alopecia
Burning at the IV site
23. Always maintain ___________ pressure when flushing a central line. (1 point)
24. Gene, an RN, is caring for a client receiving TPN through a single lumen percutaneous central catheter in the acute care setting. Select all that are not proper care measures for this client. (1 point)
A mask is placed on the client when the CVAD dressing is changed.
The client is weighed every 2 weeks.
A filter is used when infusing the TPN.
The client’s CVL dressing is changed daily.
Lab samples are obtained from the CVAD.
Blood glucose levels should be monitored frequently
25. List 10 nursing interventions that are needed when caring for a client on TPN. (1 point)
26. Describe what equipment is needed for TPN infusion. (1 point)
27. Mrs. Sterling is a 55-year-old admitted with GI bleed. The physician ordered the client to receive 2 units of PRBCs for a Hgb of 6.9 g/dL. The nurse begins the infusion of the first unit at 100 ml/hr. Fifteen minutes after the start of the infusion, the client complains of feeling short of breath, having lumbar pain, and being chilled. Which of the following should the nurse do first? (1 point)
Obtain VS and notify the physician of a potential reaction
Slow the infusion to 50 ml/hr. and reassess in 15 minutes
Administer Benadryl 25 mg IV STAT
Stop the infusion and run normal saline to keep vein open
Administer a PRN pain medication, give the client a warm blanket, and apply oxygen at 2 LPM
28. The nurse is talking with Candice, a young adult client, about an ordered blood transfusion. The client does not understand the risk involved with the procedure. Which of the following statements is the best example of therapeutic communication? (1 point)
“There are many alternatives to blood transfusions like iron supplements or IV fluids.”
“I will have Susie, another nurse, come in and witness signing of the consent form.”
“The physician can explain the benefits and risks of a blood transfusion. I will contact her so that any questions you have can be discussed before you sign the consent form.”
“Don’t worry about having a transfusion. They are very common and no one I’ve ever taken care of has had a problem with it.”
29. ____________ is the collection, storage, and delivery of a recipient’s own blood. (1/2 point)
30. For an adult, blood should be transfused through a ____________ gauge needle. (1/2 point)
31. The nurse is educating Mrs. Rom, a 60-year-old client who will soon have a total knee replacement, about autologous blood donation. Which of the following statement made by the client shows that the education was successful? (1 point)
“I cannot get a reaction from my own blood.”
“I will not need a transfusion after this type of surgery.”
“I cannot donate blood for myself because I am too old.”
“I can donate my own blood several weeks before my surgery in case I need to have a transfusion after surgery.”
32. Name 5 signs/symptoms of a hemolytic reaction. Then list one nursing intervention to provide relieve each sign/symptom. (1 point)
33. Name four types of candidates for parenteral nutrition therapy. (1 point)
34. How long can PPN/TPN hang before it must be discarded? (1 point)
35. Mr. Simmons is a client receiving total parenteral nutrition (TPN) through a central line into the right subclavian vein. The nurse notices a small amount of cloudy fluid leaking from around the central line dressing. What is the most important nursing action? (1 point)
Send a culture of the fluid to the lab
Change the dressing using sterile technique
Place the client’s head lower than his feet
Check the client’s chart to see if the client is currently receiving antibiotics
Obtain a central line repair kit
Give rationale for your answer:
36. Match the blood components with their purpose. (1 point)
Whole blood_____ 1. Thrombocytopenia
Red blood cells _____ 2. Coagulation deficiencies
Fresh frozen plasma_____ 3. Major hemorrhage or autologous transfusion
Platelets_____ 4. Low protein levels due to liver failure, shock, blood loss
Albumin_____ 5. DIC, hyperfibrinogenemia, or replace Factor VIII
Cryoprecipitate_____ 6. Anemia, blood loss
37. After receiving shift report, the RN should see which of the following clients first? (1 point)
Melody, a 16-year-old client in sickle cell crisis with continuous IV fluids with an infiltrated IV
Carl, a 62-year-old client who is waiting for central line placement for IV antibiotics
Bernice, a 59-year-old client with leukemia who is receiving a transfusion of packed RBCs
Sally, a 47-year-old client who had a bowel resection and is receiving TPN at 100 ml/hr., and whose last blood glucose was 97
Give rationale for your answer:
38. Name four side effects noted from epidural/intrathecal medications and one nursing action used for the treatment for each side effect. (1 point)
39. The nurse needs to administer doxorubicin (Adriamycin) IV to a client. The nurse is assessing the client’s arms to determine where to perform venipuncture. Which of the following veins is the best choice to start the IV? (1 point)
The distal forearm
The wrist
The non-dominant antecubital fossa
The vein that was used for venipuncture within the last 24 hours
40. Justin, a 20-year-old client with leukemia, has consented to a blood transfusion against the wishes of his family, who are Jehovah’s Witnesses. Which of the following ethical principles supports this decision? (1 point)
Justice
Beneficence
Confidentiality
Fidelity
Non-maleficence
Autonomy

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Simulation Perfusion
Course: NUR ____2025_____ Concept/Exemplar: ___Heart Failure/Chronic renal insufficiency Hours: 1.5
Scenario Identify the Top 3 client areas for the nurse to assess.
An 89-year-old female client is admitted to a telemetry unit with a diagnosis of heart failure exacerbation. She reports a medical history of osteoarthritis, chronic renal insufficiency, and coronary artery disease including a myocardial infarction and coronary artery bypass surgery 22 years ago. She is alert and her daughter is at her bedside. The nurse’s initial client assessment findings include:
Oriented to person only, follows simple commands
Clear speech
Sinus tachycardia
Respirations of 26 breaths/min
Oxygen saturation of 90% on room air
Breathing labored with use of accessory muscles
Productive cough with pink frothy sputum
Crepitus in bilateral knee joints
Enlarged body nodes on hands
Hemoglobin = 12.4 g/dL
Hematocrit = 39%
White blood cell count = 12,ooo mm3
Next GEN NCLEX: What matters most? Noticing, Tanner’s Clinical Judgement model
Indicate which nursing action listed on the far left column is appropriate for each potential heart failure complication. Note that not all actions will be used, but there is only one appropriate action for each complication and they can be used only once.
Nursing Action Potential Heart Failure Complication Appropriate Nursing Action for each potential heart failure complication
Reduce sodium intake to 1g daily.
Acute pulmonary edema
Administer oxygen therapy
Fatigue
Weight the client each morning on the same scale
Hypokalemia
Administer furosemide 20 mg IV push.
Cardiac dysrhythmia
Encourage the client to drink at least 3L of fluid daily
Hypoxemia
Teach the client pursed-lip breathing techniques.
Administer potassium supplements
Monitor electrocardiogram, oxygen saturation, and serum electrolyte levels.
Reposition every 2 hours while in bed.
Consult a cardiac rehabilitation specialist.
Example:
Complication
Example:
Appropriate actions for complication: #3
Complete a Medication template for each of the following medications: (1) Potassium PO, (2) Furosemide IV push
Case Study Progress
The 80-year-old client will be discharged today and will move in with her daughter until she feels well enough to go home alone. Which of the following discharge instructions will the nurse provide the client and her daughter? Select all that apply
“Weight yourself each day at the same time on the same scale to monitor for fluid retention”
Contact your primary health care provider if you experience cold symptoms lasting more than 3 days.”
Exertion can cause another episode of heart failure, so help your mother by assisting her with daily activities.”
Notify your primary health care provider if you experience shortness of breath or chest pain while resting.”
“Do not use table salt, avoid salty foods, and read labels on all food items to ensure your diet is low in sodium.”
“Do not take metoprolol if your heart rate is less than 60 beats per minute.”
“Heart failure is a chronic condition, so you don’t need to be alarmed when you experience heart palpitations.”
Case Study Progress
The client was discharged 2 weeks ago and is with her daughter for her follow up primary health care provider visit. For each assessment finding, use an X to indicate whether the interventions are Effective (helped to meet expected outcomes), Ineffective (did not help to meet expected outcomes), or Unrelated (not related to the expected outcomes).
Assessment finding Effective Ineffective Unrelated
States that she has had no shortness of breath since hospital discharge
Has 2+ pitting edema in both ankles and feet
Blood pressure of 134.76 mm Hg
Has had no chest pain since hospital discharge
Reports feeling like she has more energy now when compared with before her hospital stay
Has new onset fungal skin infection
Simulation Perfusion
Course: NUR ____2025_____ Concept/Exemplar: ___Heart Failure/Aortic stenosis _ Hours: 1.5
Scenario Identify the Top 3 client areas for the nurse to assess.
A 72-year-old male client is admitted to a telemetry unit after a fall at home. The clients is experiencing severe weakness in his lower extremities and states, “I got out of bed at 0430 this morning, my legs gave out on my way to the bathroom, and I was unable to get up.” Emergency medical services transported the client to the hospital. Past medical history provided by the client includes high cholesterol, aortic valve stenosis, and residual lower extremity muscle pain and weakness secondary to poliomyelitis as a child. He saw his cardiologist and had an echocardiogram completed 3 weeks ago. He also received his influenza and pneumococcal vaccines this year. The client is married and has two adult children. He lives in a single-story home, ambulates with a cane, and completes ADLs independently. His echocardiogram reports moderate heart failure with an ejection fraction (EF) of 38%. The client’s wife provides a list of his current medications, but the list is not complete. Choose the most likely options for the information missing from the paragraph by selecting from the lists of options provided.
Next GEN NCLEX: What matters most? Noticing, Tanner’s Clinical Judgement model
Medication Dose, Route, Frequency Drug Class Indication
aspirin 1 Salicylate Prevention of platelet aggregation
Atorvastatin 20 mg orally once a day Statin 2
3 12.5 mg orally twice a day Beta-adrenergic blocker Management of hypertension and heart failure
Ibuprofen 400 mg orally every 6-8 hr as needed Nonsteroidal anti-inflammatory drug 4
5 0.125 mg orally once a day Cardiac glycoside Increase myocardial contractile force
lisinopril 2.5 mg orally once a day 6 Management of heart failure
Options for 1 Options for 2 Options for 3
0.25 mg orally twice a day Management of angina carvedilol
81 mg orally every 4-5 hr as needed for pain Treatment of bronchospasm hydrochlorothiazide
200 mg subcutaneously every 8 hours Management of heart failure furosemide
325 mg orally once a day Management of hyperlipidemia nesiritide
1000 mg transdermal patch every 2 days Prevention of pulmonary hypertension verapamil
Options for 4 Option for 5 Option for 6
Treatment for decreased cardiac output enalapril Aldosterone antagonist
Prevention of dyspnea spironolactone Angiotensin-converting enzyme inhibitor
Management of extremity pain digoxin Calcium channel blocker
Treatment of pyrexia losartan Histamine blocker
Prevention of tachycardia metroprolol Thiazide diuretic
Case Study Progress
After completing the medication reconciliation with the patient’s wife, the nurse completed the initial assessment. The nurse’s findings include:
Alert and oriented
Blurred vision
Reports lower extremity stiffness; Ambulates with crutches
Sinus rhythm with preventricular contractions (PVCs); Cardiac murmur
Reports dyspnea on exertion; Bilateral basilar crackles
Blood urea nitrogen (BUN) = 11 mg/dL and Creatinine kinases 1200 U/L
Potassium 5.3 mg/dL
Circle or place a check mark next to the assessment findings that require follow-up by the nurse.
Case Study Progress
The provider arrives to the telemetry unit to discuss the diagnosis and plan with the patient and wife. The client is diagnosed with rhabdomyolysis. Prescriptions to place a large-bore intravenous catheter and administer normal saline 0.9% at 125 mL/hr are received. Choose the most likely options for the information missing from the paragraph by selecting from the lists of options provided.
When caring for a client who has left ventricular dysfunction, the nurse assesses for _____1_____ related to inadequate cerebral perfusion, _____2______ related to inadequate myocardium perfusion, and _____3______
related to inadequate renal perfusion. The nurse monitors a client who has heart failure closely for complications of pulmonary congestion when administering intravenous fluids. Manifestations of pulmonary congestion include _____4_____, _____5_____, and _____6_____. If the client experiences acute pulmonary edema, the nurse would place the client in a sitting position and administer _____7_____ and _____8_____.
Options for 1, 2, and 3 Options for 4, 5, and 6 Options for 7 and 8
Confusion Crackles Albuterol nebulizer
Chest pain Dyspnea chest percussion
nausea Fatigue Lorazepam orally
oliguria Jugular vein distention Morphine intravenous push
orthopnea Stridor Nitroglycerin sublingual
pallor Tachypnea Supplemental oxygen
polyuria Weight gain Furosemide intravenous push

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1. Answer the following:
a. What are eponyms and acronyms? From which languages are a majority of medical terms derived?

B. A beginning student encounters a word she doesn’t know: rhabdomyolysis. How can this student determine the meaning of the word?

C. A student is wondering why it is necessary to learn the roots, suffixes, and prefixes of medical terms when she can simply memorize the actual medical terms. The student comments that learning all the word components is a waste of time. Explain why it is important to learn word components?

2. Part 1 – select the best answer and highlight answers in yellow:
1. A medical term formed from the first letters of a word in a set phrase is
an acronym.
from modern language.
an eponym.
composed of word parts.

2. The medical term hepatitis is
composed of word parts.
an acronym.
from modern language.
an eponym.

3. A word root is
attached at the beginning of a word.
the core of the word.
used to ease pronunciation.
attached at the end of a word.

4. A suffix is
attached at the beginning of a word.
the core of the word.
used to ease pronunciation.
attached at the end of a word.

5. In the medical term sub/hepat/ic the word part -ic is a
combining vowel.
combining form.
prefix.
suffix.
6. In the medical term sub/hepat/ic the word part sub- is a
combining vowel.
combining form.
prefix.
suffix.
7. Which of the following is analyzed correctly?
intra/ven/ous
int/rav/enous
intra/veno/us
intra/ve/nous
8. If the suffix -ous means pertaining to, then the medical term intra/ven/ous means
within a vein.
pertaining to within a vein.
disease within a vein.
enlargement within a vein.

Define the Four Word Parts and Combining Form
Prefix
combining vowel
suffix
root word
combining form
Using the words above, write the corresponding word part next to its definition.
1. ___________________________ word root with combining vowel attached
2. ___________________________ usually an “o”
3. ___________________________ the core of the medical term
4. ___________________________ attached at the beginning of a word root
5.____________________________ attached at the end of a word root

Identify the Four Word Parts and Combining Form
Identify correct answer.
1. In the medical term oste/o/pathy, meaning disease of the bone, oste/o is a
The following are word parts and
their definitions that can be used.

Combining Forms Definitions
cyt/o………………………… cell
leuk/o… ……………………. white
my/o………………………… muscle
dermat/o…………………… . skin

Suffixes Definitions
-itis………………… ………… inflammation
-pathy…………………………. disease
-oid……………………………. resembling
-logy…………………………….study of
prefix.
suffix.
word root.
combining form.

2. In the medical term oste/o/pathy, /o/ is a
prefix.
suffix.
combining vowel.
combining form.

3. In the medical term arthr/itis, meaning inflammation of a joint, -itis is a
prefix.
suffix.
combining vowel.
combining form.
4. In the medical term arthr/itis, arthr is a
combining vowel.
suffix.
word root.
combining form..
5. In the medical term intra/ven/ous, meaning pertaining to within a vein, intra- is a
prefix.
suffix.
combining vowel.
combining form.

Analyzing and Defining Medical Terms
Analyze and define the following terms.
1. cytology ____________________________________________________________
2. dermatitis ___________________________________________________________
3. dermatology _________________________________________________________
4. cytoid ______________________________________________________________
5. myopathy ___________________________________________________________

The following are word parts and
their definitions that can be used
with Exercises 3, 4 and 5.
Combining Forms Definitions
cyt/o………………………… cell
leuk/o… ……………………. white
my/o………………………… muscle
dermat/o…………………… . skin
Suffixes Definitions
-itis………………… ………… inflammation
-pathy…………………………. disease
-oid……………………………. resembling
-logy…………………………….study of

Chapter 2 Assignment
Read Chapter 2 and complete the exercises in the textbook as you read to prepare you to take the quiz and to the following homework.
1. Answer the following:
A 38-year-old woman has vaginal spotting and goes to see a gynecologist. She has a history of cervical hyperplasia and is afraid she is having an exacerbation of the condition. After receiving pap smear results, her doctor tells her that the pathology results revealed severe dysplasia. The doctor says the condition diagnosed is carcinoma in situ, but she is unsure of the cause. The patient says, “I don’t understand what all of these words mean.” How could this be explained?

2. – select the best answer and highlight answers in yellow.
1. The cell could best be described as
the basic unit of all living things.
gel-like fluid.
regions within the chromosome.
two or more like kinds of tissue.

2. The meaning of the combining form leuk/o is
red.
yellow.
white.
blue.

3. The prefix hypo- means
after.
new.
below.
before.

4. The suffix -ology means
resembling.
disease.
cell.
study of.

5. The term that means cancerous tumor is
chloroma.
sarcoma.
carcinoma.
adenocarcinoma.

6. The meaning of the medical term pathology is
study of disease.
study of tissue.
study of tumors.
study of medicine.

7. The medical term that means originating in the body is
systemic.
visceral.
pathogenic.
somatogenic.
8. The meaning of the medical term metastasis is
absence of disease.
not malignant.
excessive development.
beyond control.

9. Which of the following abbreviations is a treatment for cancer?
RBC
Dx
chemo
ca

10. The patient will be treated for cancer in which hospital department?
oncologist
oncology
histology
pathologist

Anatomical Structures
Highlight the correct letter corresponding to the term(s) described.
A group of organs that work together to perform complex body functions is a
cell.
tissue.
system.
gene.

2. The boundary of the cell is formed by the
DNA.
Tissue.
cytoplasm.
cell membrane.

3. The tissue composed of cells that have the ability to contract, usually producing movement, is
muscle tissue.
nervous tissue.
epithelial tissue.
connective tissue.

4. The cavity that contains the brain is the
thoracic cavity.
cranial cavity.
spinal cavity.
pelvic cavity.

5. The urinary bladder is located in the
spinal cavity.
thoracic cavity.
abdominal cavity.
pelvic cavity.

Word Parts

A. Match combining forms with their definitions.
_______ 1. nucleus a. eti/o
_______ 2. gland b. iatr/o
_______ 3. cause (of disease) c. chlor/o
_______ 4. smooth d. kary/o
_______ 5. fiber e. gno/o
_______ 6. physician, medicine (treatment) f. chrom/o
_______ 7. knowledge g. aden/o
_______ 8. green h. fibr/o
_______ 9. color i. rhabd/o
_______ 10. rod-shaped, striated j. lei/o

B. Match word parts with their definitions.
_______ 1. before a. -sis
_______ 2. through, complete b. -plasia
_______ 3. difficult, labored, painful, abnormal c. pro-
_______ 4. state of d. -genesis
_______ 5. abnormal condition e. -stasis
_______ 6. condition of formation, development, growth f. -osis
_______ 7. origin, cause g. -gen
_______ 8. substance or agent that produces or causes h. -plasm
_______ 9. a growth, a substance, a formation i. dia-
_______ 10. control, stop, standing j. dys-

Build Medical Terms

Fill in the blanks with the correct word parts to complete the sentence.
A tumor composed of epithelium is an epitheli________.
A malignant black tumor is a _______carcin_______.
The term for producing cancer is carcino________.
A red blood cell is an ________cyte.
The study of tissue is called ________ology.
Incomplete development (of an organ or tissue) is called hypo________.
________oid is the term for resembling fat.
A white blood cell is a ________cyte.
The term for a new growth is ________plasm.
10. ________ic means pertaining to a body system.
11. Originating in the body is called ________genic.
12. Resembling a nerve is neur________.
13. ________al is the term meaning pertaining to the internal organs.
14. ________oma is a tumor composed of connective tissue.
15. Cell substance is called cyto________.

True/False
Mark each statement T (true) or F (false). If the statement is false, rewrite it to make it true.
___________ 1. Histology means the study of tissue.
___________ 2. The study of causes of diseases is pathology.
___________ 3. Prognosis means identifying a disease.
___________ 4. Neoplasm means new disease.
___________ 5. Something caused by injury is termed iatrogenic.
___________ 6. An increase in the number of red blood cells is called erythrocyte.
___________ 7. Cyanosis is the abnormal condition of blue skin color.
___________ 8. Something producing disease is called carcinogenic.
___________ 9. Visceral means pertaining to the body as a whole.
___________ 10. Lipoid means resembling epithelium.

Abbreviations
Write the letter of the abbreviation next to the medical term it abbreviates.
_____ 1. white blood cell a. chemo
_____ 2. chemotherapy b. Px
_____ 3. radiation therapy c. WBC
_____ 4. red blood cell d. Dx
_____ 5. prognosis e. RBC
_____ 6. diagnosis f. mets
_____ 7. metastasis g. XRT

Spelling
Correct any misspelled terms by writing them correctly in the space at the right.
1. epithelioma ______________________________________________________
2. carsinogen ______________________________________________________
3. cyanoses ______________________________________________________
4. cytology ______________________________________________________
5. erithrocytosis ______________________________________________________
6. luecocytosis ______________________________________________________
7. metestasis ______________________________________________________
8. somatoplasm ______________________________________________________
9. vesceral ______________________________________________________
10. zanthosis ______________________________________________________

Medical Dictionary
Use your medical dictionary to find terms that begin with the following word parts and combining forms. Write the medical term and its definition in the spaces provided.
1. hist/o New medical term: ________________________
Definition: ___________________________________________________
____________________________________________________________
2. my/o New medical term: ________________________
Definition: ___________________________________________________
____________________________________________________________
3. lei/o New medical term: ________________________
Definition: ___________________________________________________
____________________________________________________________
4. hyper- New medical term: ________________________
Definition: ___________________________________________________
____________________________________________________________
5. dys- New medical term: ________________________
Definition: ___________________________________________________
____________________________________________________________

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1. In the table below complete the personal development plan, setting goals and personal objectives that will enable you to improve on your own work practice / nursing career.
You can review the following example[1] to assist with this task
Personal Development Plan
Strengths Areas for further development
Opportunities What is stopping you
Setting Goals – discuss a minimum of three (3)
What do I want to learn?
What do I have to do?
What support and resources do I need?
How will I measure success?
Target date for review
Personal objectives
Short term goals (next 12 months)
Medium term goals (next 1 – 3 yrs.)
2. Discuss how you can measure the progress of this plan and the importance of measuring the progress. (Word Count Range: 50-100 words, reference)
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3. Once you have completed your personal development plan, undertake a self-evaluation of the plan by discussing it with a colleague you work with or one of your peers, then answer the following question.
Write a short self-evaluation of your personal development plan including any feedback you have received from your discussion of this plan with others (Word Count Range: 100-150 words)
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4a. Identify a time when you received feedback from an employer, peer or facilitator on vocational placement and discuss how the conversation went – show a 2-way open conversation about feedback, explain if the feedback was descriptive or evaluative and give a rationale (Word Count Range: 100-150 words, reference)
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4b. Now that you have discussed your personal plan, obtained feedback and completed a self-evaluation, outline at least two (2) areas that you feel could be improved upon. (Word Count Range: 50-100 words)
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5. Provide a short reflection on the feedback you have actively sought and received so far from your clinical placements, either from your facilitators or staff where you did placement. (Word Count Range: 50-100)
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6. Outline two (2) ways that you can regularly participate in the review processes at a place of employment that will show your commitment to upgrading your skills and knowledge (Word Count Range: 50-100 words, reference)
(Please note that this can relate to any employment that you are currently in or have been in)
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7. As you progress as a nurse there will be many opportunities to enhance your learning development. Outline three (3) ways you can seek specialist advice or further training (Word Count Range: 50-100 words, reference)
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[1] https://www.managers.org.uk/~/media/Files/Checklists/Personal-Development-Plan-Example-Guide.pdf

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During active labor, there is a gush of clear fluid and the fetal heart rate drops to 100 bpm. A vaginal examination reveals a loop of umbilical cord in the vagina. The nurse places the client in which position?
A) Trendelenburg
B) Lithotomy
C) Hands and knees
D) Left-side lying
2. A client at 8 weeks’ gestation comes to the clinic with vaginal bleeding and cramps. An ultrasound examination shows the cervix is dilated. What is the client experiencing?
A) Inevitable abortion
B) Threatened abortion
C) Missed abortion
D) Complete abortion
3. The nurses assesses a neonate born at 36 weeks’ gestation. The neonate is grunting, has nasal flaring, and subcostal retractions. Respiratory rate is 82 breaths/min, and on auscultations there are crackles in the lungs. What is the nurse’s assessment of the neonate’s condition?
A) Transient tachypnea
B) Surfactant deficiency
C) Persistent pulmonary hypertension
D) Apnea
4. A client at 38 weeks’ gestation is admitted to labor and delivery with vaginal bleeding after sustaining abdominal trauma. Which laboratory values are a priority in determining the plan of care for this client? Select all that apply.
A) Fibrinogen
B) Fibrin degradation products
C) Prothrombin time
D) Red blood cell count
E) Bleeding time
5. Why are newborns born to diabetic mothers prone to hypoglycemia?
A) Excess subcutaneous fat reduces blood flow to the tissues
B) Increased metabolic stress due to the stress on mother’s body
C) Elevated insulin production metabolized glucose faster
D) Liver is immature and cannot convert glycogen to glucose
6. A new mother is alarmed because her newborn has lost 10 ounces in weight since being born 2 days ago. She believes that she has been breastfeeding properly. Which information would the nurse include as a likely cause of this phenomenon? Select all that apply.
A) Absence of salt- and fluid-retaining maternal hormones
B) The infant’s voiding and passing stool
C) Low calorie content of colostrum
D) A congenital digestive disorder
E) An increase in fetal metabolism
F) Failure of mother to bond with newborn
7. A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?
A) 6 months
B) 3 months
C) 9 months
D) 12 months
8. A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?
A) Schedule induction of labor today.
B) Allow her to continue without plans for delivery.
C) Schedule cesarean delivery at 39 weeks.
D) Prepare for assessment of fetal lung maturity.
9. The nurse determines that a fetal nonstress test is nonreactive for over 20 minutes. The nurse interprets this result as suggesting which situation? Select all that apply.
A) The patient is sleeping.
B) The patient is hypoglycemic.
C) The patient is using an illicit drug.
D) The patient is exercising too much.
E) The patient is smoking while pregnant.
10. A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?
A) Twin-to-twin transfusion syndrome (TTTS)
B) HELLP syndrome
C) TORCH syndrome
D) ABO incompatibility
11. A patient in labor and delivery has just been diagnosed with pre-eclampsia. Which signs and symptom should the nurse prioritize when assessing this client? Select all that apply.
A) BP 140/90 mm Hg
B) slow reflexes
C) glucose in urine
D) edema of face
E) headache
12. A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?
A. Painless red vaginal bleeding
B. Increasing abdominal pain with a nonrelaxed uterus
C. Abdominal pain with scant red vaginal bleeding
D. Intermittent abdominal pain following passage of bloody mucus
13. A nurse is caring for a newborn immediately following birth. After assuring a patent airway, what is the priority nursing action?
A. Administer vitamin K.
B. Dry the skin.
C. Administer eye prophylaxis.
D. Place an identification bracelet.
14. A nurse in a prenatal clinic is caring for a client who is at 7 weeks of gestation. The client reports urinary frequency and asks if this will continue until delivery. Which of the following responses should the nurse make?
A. “It’s a minor inconvenience, which you should ignore.”
B. “In most cases it only lasts until the 12th week, but it will continue if you have poor bladder tone.”
C. “There is no way to predict how long it will last in each individual client.”
D. “It occurs during the first trimester and near the end of the pregnancy.”
15. A nurse is caring for a client who just delivered a newborn. Following the delivery, which nursing action should be done first to care for the newborn?
A. Clear the respiratory tract.
B. Dry the infant off and cover the head.
C. Stimulate the infant to cry.
D. Cut the umbilical cord.
16. A nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines the umbilical cord. Which of the following vessels should the nurse expect to observe in the umbilical cord?
A. Two veins and one artery
B. One artery and one vein
C. Two arteries and one vein
D. Two arteries and two veins
17. A nurse in a prenatal clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?
A. Rapid decline in human chorionic gonadotropin (hCG) levels
B. Profuse, clear vaginal discharge
C. Irregular fetal heart rate
D. Excessive uterine enlargement
18. A nurse is caring for a new mother who is concerned that her newborn’s eyes cross. Which of the following statements is a therapeutic response by the nurse?
A. “I will call your primary care provider to report your concerns.”
B. “I will take your baby to the nursery for further examination.”
C. “This occurs because newborns lack muscle control to regulate eye movement.”
D. “This is a concern, but strabismus is easily treated with patching.”
19. A nurse is caring for a client who is having a nonstress test performed. The fetal heart rate (FHR) is 130 to 150/min, but there has been no fetal movement for 15 min. Which of the following actions should the nurse perform?
A. Immediately report the situation to the client’s provider and prepare the client for induction of labor.
B. Encourage the client to walk around without the monitoring unit for 10 min, then resume monitoring.
C. Offer the client a snack of orange juice and crackers.
D. Turn the client onto her left side.
20. A nurse on a labor unit is admitting a client who reports painful contractions. The nurse determines that the contractions have a duration of 1 min and a frequency of 3 min. The nurse obtains the following vital signs: fetal heart rate 130/min, maternal heart rate 128/min and maternal blood pressure 92/54 mm Hg. Which of the following is the priority action for the nurse to take?
A. Notify the provider of the findings.
B. Position the client with one hip elevated.
C. Ask the client if she needs pain medication.
D. Have the client void.
21. A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is “not
really sure if she is in labor or not.” Which of the following should the nurse recognize as a sign of true labor?
A. Rupture of the membranes
B. Changes in the cervix
C. Station of the presenting part
D. Pattern of contractions
22. A nurse is caring for a client who is at 40 weeks of gestation and is in labor. The client’s ultrasound examination indicates that the fetus is small for gestational age (SGA). Which of the following interventions should be included in the newborn’s plan of care?
A. Observe for meconium in respiratory secretions.
B. Monitor for hyperglycemia.
C. Identify manifestations of anemia.
D. Monitor for hyperthermia.
23. A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has a neural tube defect, which of the following information should the nurse include in the teaching?
A. Limit alcohol consumption.
B. Increase intake of iron-rich foods.
C. Consume foods fortified with folic acid.’
D. Avoid foods containing aspartame.
24. A nurse in the ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage (D&C) following a spontaneous miscarriage. Which of the following should be included in the teaching?
A. Vaginal intercourse can be resumed after 2 weeks.
B. Products of conception will be present in vaginal bleeding.
C. Increased intake of zinc-rich foods is recommended.
D. Aspirin may be taken for cramps.
25. A nurse is preparing to assess a newborn who is postmature. Which of the following findings should the nurse expect? (Select all that apply.)
A. Cracked, peeling skin
B. Positive Moro reflex
C. Short, soft fingernails
D. Abundant lanugo
E. Vernix in the folds and creases
26. A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first?
A. Cover the cord with a sterile, moist saline dressing.
B. Prepare the client for an immediate birth.
C. Place the client in knee-chest position.
D. Insert a gloved hand into the vagina to relieve pressure on the cord.

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