A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Easy
Question Type: Multiple Choice
Question:
A nurse is preparing to administer a newly prescribed
medication. Which action best demonstrates the Recognize
Cues step of the Clinical Judgment Management Model
(CJMM)?
A. Administer the medication as prescribed.
B. Assess the patient's allergies, vital signs, and current
symptoms.
C. Evaluate whether the medication achieved the desired effect.
D. Develop goals for medication therapy.
Correct Answer: B
Rationale: Recognizing cues involves collecting relevant
assessment data before making clinical decisions. Reviewing
allergies, vital signs, and symptoms helps identify factors that
influence medication safety.
Question 2
Difficulty: Moderate
,Question Type: Multiple Choice
Question:
A patient receiving an antihypertensive medication reports
dizziness when standing. The nurse determines the dizziness is
likely related to orthostatic hypotension. Which CJMM step is
the nurse performing?
A. Recognize Cues
B. Analyze Cues
C. Generate Solutions
D. Evaluate Outcomes
Correct Answer: B
Rationale: Analyzing cues involves interpreting assessment
findings and determining their clinical significance. Identifying
orthostatic hypotension as the likely cause reflects data
analysis.
Question 3
Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
Before administering a medication, which assessment findings
should the nurse recognize as important clinical cues?
, A. Current allergies
B. Recent laboratory results
C. Patient's preferred television channel
D. Current medications
E. Vital signs
Correct Answer: A, B, D, E
Rationale: Allergies, laboratory values, medication history, and
vital signs are essential assessment cues that influence safe
medication administration. Television preference is unrelated to
pharmacologic care.
Question 4
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question:
A patient is prescribed insulin before breakfast. The nurse notes
a blood glucose level of 58 mg/dL, diaphoresis, and confusion.
Which action should the nurse take FIRST?
A. Administer the insulin immediately.
B. Notify the provider before assessing the patient.
C. Treat the hypoglycemia according to protocol.
D. Delay breakfast until insulin is administered.