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Answer Key
CHAPTER 2: Cancer, pages 15-18 educating people about risk factors. Focus: Assign-
ment; QSEN: TC; Concept: Clinical Judgment
1. Ans: 1 Oral hygiene is within the scope of duties 7. Ans: 3 Further assess what the patient means by
of the UAP. It is the responsibility of the nurse to having “control over my own life and death.” This
observe response to treatments and to help the patient could be an indirect statement of suicidal intent. A
deal with loss or anxiety. The UAP can be directed to patient who believes he will be cured should also be
weigh the patient but should not be expected to know assessed for misunderstanding what the physician
when to initiate that measurement. Focus: Delega- said; however, the patient may need to use denial
tion; QSEN: TC; Concept: Clinical Judgment as a temporary defense mechanism. The patient’s
2. Ans: 4 The patient’s physical condition is currently acknowledgment that the treatments are for control
stable, but emotional needs are affecting his or her of symptoms or plans: for the immediate future
ability to receive the information required to make an suggest an understanding of what the physician
informed decision. The other diagnoses are relevant, said. Focus: Prioritization; QSEN: S; Concept:
but if the patient leaves the clinic the interventions Mood & Affect
may be delayed or ignored. Focus: Prioritization; 8. Ans: 3 The UAP can observe the amount that the
QSEN: PCC; Concept: Anxiety patient eats (or what is gone from the tray) and report
3. Ans: 1 Pancreatic cancer is more common in African- to the nurse. Assessing patterns of fatigue and skin
Americans, males, and smokers. Other associated reaction is the responsibility of the RN. The initial
factors include alcohol use, diabetes, obesity, history recommendation for exercise should come from the
of pancreatitis, exposure to organic chemicals, con- physician. Focus: Delegation; QSEN: TC; Concept:
sumption of a high-fat diet, and previous abdominal Clinical Judgment
irradiation. Focus: Prioritization; QSEN: N/A; Con- 9. Ans: 3 Paresthesia is a side effect associated with
cept: Clinical Judgment some chemotherapy drugs such as vincristine. The
4. Ans: 2, 3, 5, 6, 7 Mouthwash should not include physician can modify the dosage or discontinue the
alcohol, because it has a drying action that leaves drug. Fatigue, nausea, vomiting, and anorexia are
mucous membranes more vulnerable. Insertion of common side effects of many chemotherapy medica-
suppositories, probes, or tampons into the rectal or tions. The nurse can assist the patient by planning
vaginal cavity is not recommended. All other options for rest periods, giving antiemetics as ordered, and
are appropriate. Focus: Prioritization, knowledge; encouraging small meals containing high-protein and
QSEN: S; Concept: Clotting high-calorie foods. Focus: Prioritization; QSEN:
5. Ans: 2 Administering enemas and antibiotics is EBP; Concept: Safety
within the scope of practice of LPNs/LVNs. Al- 10. Ans: 1 WBC count is especially important, because
though some states and facilities may allow the LPN/ chemotherapy can cause decreases in WBCs, particu-
LVN to administer blood, in general, administering larly neutrophils (known as neutropenia), which leave
blood, providing preoperative teaching, and assisting the patient vulnerable to infection. The other tests
with central line insertion are the responsibilities of are important in the total management but are less
the RN. Focus: Assignment; QSEN: TC; Concept: directly specific to chemotherapy in general. Focus:
Clinical Judgment Prioritization; QSEN: S; Concept: Immunity
6. Ans: 1. Nurse practitioner, 2. Nutritionist, 3. LPN/ 11. Ans: 3 Giving medications is within the scope
LVN, 4. Nurse practitioner, 5. RN The nurse prac- of practice of the LPN/LVN. Assisting the patient
titioner is often the provider who performs the phys- in brushing and flossing should be delegated to the
ical examinations and recommends diagnostic testing. UAP. Explaining contraindications is the responsibil-
The nutritionist can give information about diet. ity of the RN. Recommendations for saliva substitutes
The LPN/LVN will know the standard seven warning should come from the physician or pharmacist.
signs and can educate through standard teaching Focus: Delegation; QSEN: TC; Concept: Clinical
programs. The RN has primary responsibility for Judgment
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Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
12. Ans: 1 Chemotherapy drugs should be given by unless specially trained, and do not interpret results
nurses who have received additional training in how of diagnostic tests for patients. LPNs/LVNs could
to safely prepare and deliver the drugs and protect reinforce standard information about screening rec-
themselves and others from exposure. The other op- ommendations. The RN should make the nursing
tions express concerns, but the general principles diagnoses, and the LPN/LVN assists in planning
of drug administration apply. Focus: Assignment; and implementing the interventions. Focus: Assign-
QSEN: S, TC; Concept: Safety ment; QSEN: TC; Concept: Clinical Judgment
13. Ans: 1, 3, 2, 4 Tumor lysis syndrome is an emer- 17. Ans: 2 Potentially life-threatening hypercalcemia
gency involving electrolyte imbalances and potential can occur in cancers with destruction of bone. Other
renal failure. A patient scheduled for surgery should laboratory values are pertinent for overall patient
be assessed and prepared for surgery. A patient with management but are less specific to bone cancers.
breakthrough pain needs assessment, and the physi- Focus: Prioritization; QSEN: S; Concept: Clinical
cian may need to be contacted for a change of dosage Judgment
or medication. Anticipatory nausea and vomiting has 18. Ans: 2, 4 Debulking of tumor and laminectomy are
a psychogenic component that requires assessment, palliative procedures. These patients can be placed in
teaching, reassurance, and administration of anti- the same room. The patient with a low neutrophil
emetics. Focus: Prioritization; QSEN: S; Concept: count and the patient who has had a bone marrow
Clinical Judgment transplantation need protective isolation. Focus:
14. Ans: 1 Back pain is an early sign of spinal cord Assignment; QSEN: S; Concept: Immunity
compression occurring in 95% of patients. The other 19. Ans: 3 The patient is not coping with the recent
symptoms are later signs. Focus: Prioritization; diagnosis of cancer and prospect of losing his leg.
QSEN: S; Concept: Clinical Judgment His decision to go hiking may be a form of denial, or
15. Ans: 2, 7, 1, 3, 6, 4, 5 Determine level of conscious- possibly a veiled suicide threat. It is also possible that
ness and responsiveness, and changes from baseline. he has decided not to have any treatment; however,
Oxygen should be administered immediately in the you need to make additional assessment about his
presence of respiratory distress or risk for decreased decision and actions and help him to discuss alterna-
oxygenation and perfusion. Pulse oximetry can be tives and consequences. The other diagnoses may also
used for continuous monitoring. Adequate pulse, apply, but if he leaves the hospital there will be no
blood pressure, and respirations are required for chance to address any other issues. Focus: Prioritiza-
cerebral perfusion. Increased temperature may signal tion; QSEN: PCC, S; Concept: Coping
infection or sepsis. Blood glucose levels should be 20. Ans: 2 Tumor lysis syndrome can result in severe
checked even if the patient is not diabetic. Severe hypo- electrolyte imbalances and potential kidney failure.
glycemia should be immediately treated per protocol. A The other laboratory values are important to monitor
patent IV line may be needed for delivery of emergency to identify general chemotherapy side effects but
drugs. Electrolyte and ammonia levels are relevant data are less pertinent to tumor lysis syndrome. Focus:
for this patient, and abnormalities in these parameters Prioritization; QSEN: EBP, S; Concept: Fluid &
may be contributing to change in mental status. (Note: Electrolyte Balance
Laboratory results [i.e., electrolytes and ammonia lev- 21. Ans: 1, 3, 4, 5 Women age 21 or over should have
Answer Key
els] may be concurrently available; however, you should annual Pap smears, regardless of sexual activity.
train yourself to systematically look at data. Look at African-American men should begin prostate-specific
electrolytes first because these are more commonly or- antigen testing at age 45. Colonoscopy and annual
dered. In some cases, you may actually have to remind fecal occult blood testing are recommended for those
the physician to order the ammonia level if the patient with average risk starting at age 50. Annual mammo-
with a hepatic disorder is having a change in mental grams are recommended for women over the age of
status.) Focus: Prioritization; QSEN: S; Concept: 40. Women age 65 or older who have normal results
Clinical Judgment on previous Pap tests may forego additional screenings
16. Ans: 1. Advanced practice nurse, MD, 2. Advanced for cervical cancer. Focus: Prioritization; QSEN: S,
practice nurse, MD, RN, 3. Advanced practice EBP; Concept: Health Promotion
nurse, RN, 4. Advanced practice nurse, MD, RN, 22. Ans: 2 Hyponatremia is a concern; therefore, fluid
5. Advanced practice nurse, MD, RN, LPN/LVN, restrictions would be ordered. Urinalysis is less perti-
6. MD Advanced practice nurses could do any of the nent; however, the nurse should monitor for changes
tasks; however, explaining results of a mammogram in urine specific gravity. The diet may need to include
may be handled by the supervising physician, especially sodium supplements. Fluid bolus is unlikely to be
if complex follow-up is needed (e.g., surgery). Physi- ordered for patients with SIADH; however, IV nor-
cians could do any of the tasks except they do not mal saline or hypertonic saline solutions may be given
make nursing diagnoses. RNs could do tasks 2, 3, 4, very cautiously. Focus: Prioritization; QSEN: EBP;
and 5 but usually do not do clinical breast examination, Concept: Fluid & Electrolyte Balance
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Prioritization Delegation and Assignment 3rd Edition LaCharity Solutions Manual
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23. Ans: 1, 2, 4, 6 Measuring vital signs and reporting needed. Asking the nurse to stay is not the best solu-
on specific parameters, practicing good hand washing, tion, because the care of the patient and the effects of
and gathering equipment are within the scope of duties the medication continue after the infusion has been
for a UAP. Assessing for symptoms of infections and completed. Looking up the side effects of the drug is
superinfections is the responsibility of the RN. Focus: okay for your own information, but you are still not
Delegation; QSEN: TC; Concept: Immunity qualified to deal with this situation. In addition,
24. Ans: 2 An LPN/LVN is versed in medication ad- knowing how to properly discontinue the infusion
ministration and able to teach patients standardized and dispose of the equipment are essential for your
information. The other options require more in-depth own safety and the safety of others. Focus: Prioritiza-
assessment, planning, and teaching, which should be tion; QSEN: S; Concept: Safety
performed by the RN. Helping patients with smoking 27. Ans: 2 If the radiation implant has obviously been
cessation is a Core Measure. Focus: Delegation; expelled (i.e., is on the bed linens), use a pair of for-
QSEN: TC; Concept: Health Promotion ceps to place the radiation source in a lead container.
25. Ans: 1 Morphine elixir is the therapy of choice The other options would be appropriate after safety
because it is thought to reduce anxiety and the subjec- of the patient and personnel are ensured. Focus:
tive sensation of air hunger. It also increases venous Prioritization, supervision; QSEN: S; Concept:
capacitance. End-of-life-care should not include Clinical Judgment
aggressive measures such as intubation or resuscita- 28. Ans: 3 You must try to find out what Nurse A is
tion. Support and comfort are always welcome, but in thinking and feeling. If you can discover the underly-
this case you should not sit quietly because there is an ing issue, there is a better chance that you can help
option that would offer some physical relief for the her (e.g., referral to counseling or in-service training).
patient. Focus: Prioritization; QSEN: EBP, PCC; You should try to avoid being too draconian with your
Concept: Palliation staff by insisting that they switch back to the original
26. Ans: 3 Explain that you are not chemotherapy assignments, or too condescending by lecturing them
certified so that the charge nurse can quickly rear- about patients’ rights. Nurses frequently can and do
range the patient assignments. You can assess the switch patients to help each other out, but the charge
patient, site, and infusion; however, you do not have nurse should always be informed prior to making
the expertise to recognize the side effects of the the switch. Focus: Assignment, supervision; QSEN:
medication or to give specialized care that may be TC, QI; Concept: Professionalism
Answer Key
QSEN Key: PCC, Patient-Centered Care; TC, Teamwork & Collaboration; EBP, Evidence-Based Practice; QI, Quality Improvement; S, Safety; I, Informatics
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Copyright © 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
After seven months of pregnancy the fœtus has all the conditions
for breathing and exercising its digestion. It may then be separated
from its mother, and change its mode of existence. Child-birth rarely,
however, happens at this period: most frequently the fœtus remains
two months longer in the uterus, and it does not pass out of this
organ till after the revolution of nine months.
Examples are related of children being born after ten full months
of gestation; but these cases are very doubtful, for it is extremely
difficult to know the exact period of conception. The legislation in
France, however, has fixed the principle, that child-birth may take
place up to the two hundred and ninety-ninth day of pregnancy.
Nothing is more curious than the mechanism by which the fœtus is
expelled; everything happens with wonderful precision; all seems to
have been foreseen, and calculated to favor its passage through the
pelvis and the genital parts.
The physical causes that determine the exit of the fœtus are the
contraction of the uterus and that of the abdominal muscles; by their
force the liquor amnii flows out, the head of the fœtus is engaged in
the pelvis, it goes through it, and soon passes out by the valve, the
folds of which disappear; these different phenomena take place in
succession, and continue a certain time; they are accompanied with
pains more or less severe; with swelling and softening of the soft
parts of the pelvis and external genital parts, and with an abundant
mucous secretion in the cavity of the vagina. All these circumstances,
each in its own way, favor the passage of the fœtus. To facilitate the
study of this action, it may be divided into several periods.
The first period of child-birth.—It is constituted by the precursory
signs. Two or three days before child-birth a flow of mucus takes
place from the vagina, the external genital parts swell and become
softer; it is the same with the ligaments that unite the bones of the
pelvis; the mouth of the womb flattens, its opening is enlarged, its
edges become thinner; slight pains, known under the name of flying
pains, are felt in the loins and abdomen.
Second period.—Pains of a peculiar kind come on; they begin in
the lumbar region, and seem to be propagated towards the womb or
the rectum; and are renewed only after intervals of a quarter or half
an hour each. Each of them is accompanied with an evident
contraction of the body of the uterus, with tension of its neck and
dilatation of the opening; the finger directed into the vagina
discovers that the envelopes of the fœtus are pushed outward, and
that there is a considerable tumor, which is called the waters; the
pains very soon become stronger, and the contraction of the uterus
more powerful; the membranes break, and a part of the liquid
escapes; the uterus contracts on itself, and is applied to the surface of
the fœtus.
Third period.—The pains and contractions of the uterus increase
considerably; they are instinctively accompanied by the contraction
of the abdominal muscles. The woman who is aware of their effect is
inclined to favour them, by making all the muscular efforts of which
she is capable: her pulse then becomes stronger and more frequent;
her face is animated, her eyes shine, her whole body is in extreme
agitation, and perspiration flows in abundance. The head descends
into the lower strait of the pelvis.
Fourth period.—After some moments of repose the pains and
expulsive contractions resume all their activity; the head presents
itself at the vulva, makes an effort to pass, and succeeds when there
happens to be a contraction sufficiently strong to produce this effect.
The head being once disengaged, the remaining parts of the body
easily follow, on account of their smaller volume. The section of the
umbilical cord is then made, and a ligature is put around it at a short
distance from the umbilicus or navel.
Fifth period.—If the midwife has not proceeded immediately to the
extraction of the placenta after the birth of the child, slight pains are
felt in a short time, the uterus contracts freely, but with force enough
to throw off the placenta and the membranes of the ovum; this
expulsion bears the name of delivery. During the twelve or fifteen
days that follow child-birth the uterus contracts by degrees upon
itself, the woman suffers abundant perspirations, her breasts are
extended by the milk that they secrete; a flow of matter, which takes
place from the vagina, called lochia, first sanguiferous, then whitish,
indicates that the organs of the woman resume, by degrees, the
disposition they had before conception.
MANAGEMENT OF LABOR.