SOLUTIONS MANUAL
** All Chapters included
** Clinical Reasoning Questions
,Table of Contents are given below
Module 1: Acid-Base Balance
Module 2: Cellular Regulation
Module 3: Comfort
Module 4: Digestion
Module 5: Elimination
Module 6: Fluids and Electrolytes
Module 7: Health, Wellness, and Illness
Module 8: Immunity
Module 9: Infection
Module 10: Inflammation
Module 11: Intracranial Regulation
Module 12: Metabolism
Module 13: Mobility
Module 14: Nutrition
Module 15: Oxygenation
Module 16: Perfusion
Module 17: Perioperative Care
Module 18: Sensory Perception
Module 19: Sexuality
Module 20: Thermoregulation
Module 21: Tissue Integrity
, MODULE 1: THE CONCEPT OF ACID–BASE BALANCE
Clinical Examples A–C
Clinical Example A
Jay James is a 24-year-old man who was rock climbing with his friends at a national park 25
miles from the nearest hospital when he suddenly lost his footing and slid 20 feet to the ground.
Mr. James was alert and oriented when his friends reached him, and he could move all
extremities quite easily. He had multiple scrapes over his anterior chest and a large gash over his
left thigh (near the groin), which was bleeding profusely. His friends made a makeshift
tourniquet, which slowed the bleeding. They immediately contacted the park ranger, who
secured a helicopter to evacuate Mr. James to the nearest hospital.
Two large-bore IVs were placed in each arm in-flight, and normal saline was administered. The
flight medic placed a 100% nonrebreathing mask on Mr. James. Mr. James became disoriented
and confused during the flight. Mr. James arrived in the emergency department (ED) 45 minutes
after the fall.
On arrival in the ED, Mr. James is lethargic but responsive to painful stimuli. He has multiple
abrasions over his chin and neck. His pulse oximetry is 99% on the nonrebreather mask, so the
ED team replaces the mask with a nasal cannula at 4 L/m. A repeat pulse oximeter reads 95%
saturation.
Vital signs are as follows: TO 37.3°C (99.1°F): HR 130 bpm; R 30/min; and BP 100/60 mmHg.
Skin is cool and clammy, nail beds are pale, and mucous membranes are dry. All pulses are
palpable but weak and thready. Lungs are clear, heart sounds regular. Output via urinary catheter
for the past hour is 20 mL.
Clinical Reasoning Questions Level I
Question 1
Which system should the nurse assess first?
Answer 1
The nursing assessment should initially focus on the cardiovascular system since the most likely
cause of the high heart rate and low blood pressure is shock related to loss of blood, which
causes compensatory high heart rate and low blood pressure related to volume loss.
Question 2
You take note that Mr. James has cool, clammy skin and a thready pulse, what is your priority
nursing intervention?
Answer 2
A priority nursing intervention is to monitor his vital signs and oxygen saturation levels.
, Clinical Reasoning Questions Level II
Question 3
What are the priority nursing interventions at this time?
Answer 3
The nursing priorities are fluid volume deficiency related to hypovolemia, and confusion related
to decreased blood flow to the brain.
Question 4
Why is Mr. James exhibiting confusion and disorientation?
Answer 4
With blood loss there is decreased blood/fluid volume and decreased circulation of oxygenation
to the brain, which leads to confusion and disorientation.
Question 5
What diagnostic tests would you expect to be ordered for Mr. James?
Answer 5
The expected diagnosis tests would be chest x-ray, CT scan, arterial blood gases, and serum labs
that include chemistry, blood count, and coagulation.
Clinical Example B
Anna Zemakis is a 49-year-old woman admitted to the hospital with severe vomiting and muscle
weakness. She fell 2 weeks ago and reports not feeling well since. Four days ago, she developed
abdominal discomfort with vomiting. The vomiting has been severe, and she has not been able to
eat or drink very much. She says she has lost a significant amount of weight. She has felt very
weak, anorexic, and lethargic. She has not had diarrhea or urinary symptoms. There is no
significant past medical history, and she reports she is not on any prescribed medications or
taking anything over-the-counter. Ms. Zemakis’s vital signs are as follows: TO 37.7°C (98.9°F):
HR 84 bpm; R 18/min; BP 90/58 mmHg (sitting), BP 110/60 mmHg (lying); pulse oximetry
98% on room air. Her lungs are clear, and her heart sounds normal. You observe she has dry
mucous membranes. Initial examination reveals slight abdominal tenderness.
Clinical Reasoning Questions Level I
Question 1
What assessment do you want to perform first on Ms. Zemakis and why?
Answer 1
ABCs are the first to assess in every patient. We will focus on C for circulation because Ms.
Zemakis is orthostatic hypotensive. Decreased fluid volume can decrease renal perfusion and
** All Chapters included
** Clinical Reasoning Questions
,Table of Contents are given below
Module 1: Acid-Base Balance
Module 2: Cellular Regulation
Module 3: Comfort
Module 4: Digestion
Module 5: Elimination
Module 6: Fluids and Electrolytes
Module 7: Health, Wellness, and Illness
Module 8: Immunity
Module 9: Infection
Module 10: Inflammation
Module 11: Intracranial Regulation
Module 12: Metabolism
Module 13: Mobility
Module 14: Nutrition
Module 15: Oxygenation
Module 16: Perfusion
Module 17: Perioperative Care
Module 18: Sensory Perception
Module 19: Sexuality
Module 20: Thermoregulation
Module 21: Tissue Integrity
, MODULE 1: THE CONCEPT OF ACID–BASE BALANCE
Clinical Examples A–C
Clinical Example A
Jay James is a 24-year-old man who was rock climbing with his friends at a national park 25
miles from the nearest hospital when he suddenly lost his footing and slid 20 feet to the ground.
Mr. James was alert and oriented when his friends reached him, and he could move all
extremities quite easily. He had multiple scrapes over his anterior chest and a large gash over his
left thigh (near the groin), which was bleeding profusely. His friends made a makeshift
tourniquet, which slowed the bleeding. They immediately contacted the park ranger, who
secured a helicopter to evacuate Mr. James to the nearest hospital.
Two large-bore IVs were placed in each arm in-flight, and normal saline was administered. The
flight medic placed a 100% nonrebreathing mask on Mr. James. Mr. James became disoriented
and confused during the flight. Mr. James arrived in the emergency department (ED) 45 minutes
after the fall.
On arrival in the ED, Mr. James is lethargic but responsive to painful stimuli. He has multiple
abrasions over his chin and neck. His pulse oximetry is 99% on the nonrebreather mask, so the
ED team replaces the mask with a nasal cannula at 4 L/m. A repeat pulse oximeter reads 95%
saturation.
Vital signs are as follows: TO 37.3°C (99.1°F): HR 130 bpm; R 30/min; and BP 100/60 mmHg.
Skin is cool and clammy, nail beds are pale, and mucous membranes are dry. All pulses are
palpable but weak and thready. Lungs are clear, heart sounds regular. Output via urinary catheter
for the past hour is 20 mL.
Clinical Reasoning Questions Level I
Question 1
Which system should the nurse assess first?
Answer 1
The nursing assessment should initially focus on the cardiovascular system since the most likely
cause of the high heart rate and low blood pressure is shock related to loss of blood, which
causes compensatory high heart rate and low blood pressure related to volume loss.
Question 2
You take note that Mr. James has cool, clammy skin and a thready pulse, what is your priority
nursing intervention?
Answer 2
A priority nursing intervention is to monitor his vital signs and oxygen saturation levels.
, Clinical Reasoning Questions Level II
Question 3
What are the priority nursing interventions at this time?
Answer 3
The nursing priorities are fluid volume deficiency related to hypovolemia, and confusion related
to decreased blood flow to the brain.
Question 4
Why is Mr. James exhibiting confusion and disorientation?
Answer 4
With blood loss there is decreased blood/fluid volume and decreased circulation of oxygenation
to the brain, which leads to confusion and disorientation.
Question 5
What diagnostic tests would you expect to be ordered for Mr. James?
Answer 5
The expected diagnosis tests would be chest x-ray, CT scan, arterial blood gases, and serum labs
that include chemistry, blood count, and coagulation.
Clinical Example B
Anna Zemakis is a 49-year-old woman admitted to the hospital with severe vomiting and muscle
weakness. She fell 2 weeks ago and reports not feeling well since. Four days ago, she developed
abdominal discomfort with vomiting. The vomiting has been severe, and she has not been able to
eat or drink very much. She says she has lost a significant amount of weight. She has felt very
weak, anorexic, and lethargic. She has not had diarrhea or urinary symptoms. There is no
significant past medical history, and she reports she is not on any prescribed medications or
taking anything over-the-counter. Ms. Zemakis’s vital signs are as follows: TO 37.7°C (98.9°F):
HR 84 bpm; R 18/min; BP 90/58 mmHg (sitting), BP 110/60 mmHg (lying); pulse oximetry
98% on room air. Her lungs are clear, and her heart sounds normal. You observe she has dry
mucous membranes. Initial examination reveals slight abdominal tenderness.
Clinical Reasoning Questions Level I
Question 1
What assessment do you want to perform first on Ms. Zemakis and why?
Answer 1
ABCs are the first to assess in every patient. We will focus on C for circulation because Ms.
Zemakis is orthostatic hypotensive. Decreased fluid volume can decrease renal perfusion and
