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 Measurement Model
(CJMM)?
A. Administering the medication as prescribed
B. Reviewing the patient's allergies, vital signs, and current
symptoms
C. Evaluating whether the medication relieved the patient's
symptoms
D. Documenting the medication administration
Correct Answer: B
Rationale: Recognizing cues involves collecting relevant
assessment data before making clinical decisions. Reviewing
allergies, vital signs, and symptoms helps identify information
needed for safe medication administration.
Question 2
,Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
A nurse is analyzing assessment findings before administering
an antihypertensive medication. Which findings should prompt
further analysis before giving the medication? (Select all that
apply.)
A. Blood pressure 88/54 mm Hg
B. Heart rate 48 beats/min
C. Patient reports dizziness upon standing
D. Blood pressure 136/82 mm Hg
E. Patient denies medication allergies
Correct Answer: A, B, C
Rationale: Hypotension, bradycardia, and dizziness may
indicate increased risk for adverse effects from antihypertensive
medications. These findings require further analysis before
medication administration.
Question 3
Difficulty: Moderate
Question Type: Multiple Choice
, Question:
A patient scheduled to receive an intravenous antibiotic
develops a widespread rash and reports difficulty breathing
immediately before the infusion begins. What should the nurse
do first?
A. Administer the antibiotic slowly
B. Notify the healthcare provider after administering the
medication
C. Hold the medication and assess the patient's airway and
breathing
D. Document the findings and continue with the scheduled
dose
Correct Answer: C
Rationale: Airway compromise is the highest priority. The nurse
should withhold the medication and immediately assess the
patient's respiratory status before additional interventions.
Question 4
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question: