Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type
Multiple Choice (MCQ)
Clinical Scenario
A nurse prepares to administer a newly prescribed
antihypertensive medication to a hospitalized patient. During
the assessment, the patient's blood pressure is 88/54 mm Hg,
and the patient reports dizziness when sitting upright.
Question
Which nursing action best demonstrates application of the
nursing process before administering the medication?
A. Administer the medication as prescribed.
B. Hold the medication and notify the health care provider.
C. Ask another nurse to administer the medication.
D. Document the blood pressure after giving the medication.
Correct Answer
B. Hold the medication and notify the health care provider.
Comprehensive Rationale
,Assessment is the first step of the nursing process and is
essential before medication administration. The patient's
hypotension and symptoms suggest the medication could
further reduce blood pressure, increasing the risk of syncope
and injury. The nurse should recognize these cues, withhold the
medication according to institutional policy, notify the
prescriber, and continue monitoring.
Pharmacologic reasoning:
• Antihypertensives reduce systemic blood pressure.
• Giving the medication despite symptomatic hypotension
may worsen tissue perfusion.
Medication safety:
• Assessment precedes implementation.
• Nurses must evaluate whether administration is clinically
appropriate.
Distractor Analysis
A. Incorrect.
• Ignores assessment findings.
• Safety risk: severe hypotension.
C. Incorrect.
, • Responsibility cannot be transferred because abnormal
assessment data require nursing judgment.
D. Incorrect.
• Evaluation occurs after implementation, but assessment
findings require intervention before administration.
Nursing Process Integration
Primary:
• Assessment
Other steps:
• Nursing diagnosis: Risk for ineffective tissue perfusion.
• Planning: Maintain adequate blood pressure.
• Implementation: Hold medication.
• Evaluation: Reassess blood pressure after interventions.
NCJMM
• Recognize Cues
• Analyze Cues
• Take Action
• Evaluate Outcomes
Difficulty
Easy
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type
Multiple Choice (MCQ)
Clinical Scenario
A nurse prepares to administer a newly prescribed
antihypertensive medication to a hospitalized patient. During
the assessment, the patient's blood pressure is 88/54 mm Hg,
and the patient reports dizziness when sitting upright.
Question
Which nursing action best demonstrates application of the
nursing process before administering the medication?
A. Administer the medication as prescribed.
B. Hold the medication and notify the health care provider.
C. Ask another nurse to administer the medication.
D. Document the blood pressure after giving the medication.
Correct Answer
B. Hold the medication and notify the health care provider.
Comprehensive Rationale
,Assessment is the first step of the nursing process and is
essential before medication administration. The patient's
hypotension and symptoms suggest the medication could
further reduce blood pressure, increasing the risk of syncope
and injury. The nurse should recognize these cues, withhold the
medication according to institutional policy, notify the
prescriber, and continue monitoring.
Pharmacologic reasoning:
• Antihypertensives reduce systemic blood pressure.
• Giving the medication despite symptomatic hypotension
may worsen tissue perfusion.
Medication safety:
• Assessment precedes implementation.
• Nurses must evaluate whether administration is clinically
appropriate.
Distractor Analysis
A. Incorrect.
• Ignores assessment findings.
• Safety risk: severe hypotension.
C. Incorrect.
, • Responsibility cannot be transferred because abnormal
assessment data require nursing judgment.
D. Incorrect.
• Evaluation occurs after implementation, but assessment
findings require intervention before administration.
Nursing Process Integration
Primary:
• Assessment
Other steps:
• Nursing diagnosis: Risk for ineffective tissue perfusion.
• Planning: Maintain adequate blood pressure.
• Implementation: Hold medication.
• Evaluation: Reassess blood pressure after interventions.
NCJMM
• Recognize Cues
• Analyze Cues
• Take Action
• Evaluate Outcomes
Difficulty
Easy
