A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Moderate
Question Type: Multiple Choice (MCQ)
Question:
A nurse is preparing to administer a newly prescribed
medication. Before giving the medication, the nurse reviews the
patient's allergy history, current laboratory results, and vital
signs. Which step of the Clinical Judgment Measurement Model
(CJMM) is the nurse demonstrating?
A. Analyze Cues
B. Recognize Cues
C. Generate Solutions
D. Evaluate Outcomes
Correct Answer: B. Recognize Cues
Rationale: Recognize Cues involves collecting and identifying
relevant assessment data before making clinical decisions.
Reviewing allergies, laboratory values, and vital signs helps
identify information that may affect medication safety.
Question 2
Difficulty: Moderate
,Question Type: Multiple Choice (MCQ)
Question:
A patient receiving an intravenous antibiotic develops a
widespread rash and wheezing shortly after the infusion begins.
The nurse determines the patient is experiencing an allergic
reaction requiring immediate intervention. Which CJMM step is
demonstrated when the nurse interprets the assessment
findings?
A. Recognize Cues
B. Analyze Cues
C. Generate Solutions
D. Evaluate Outcomes
Correct Answer: B. Analyze Cues
Rationale: Analyze Cues involves interpreting collected
information to determine its clinical significance. The nurse
recognizes that the combination of rash and wheezing suggests
an acute hypersensitivity reaction.
Question 3
Difficulty: Moderate
Question Type: Select All That Apply (SATA)
, Question:
A nurse is preparing to administer digoxin to a patient with
heart failure. Which assessments should be completed before
administering the medication?
Select all that apply.
A. Apical heart rate
B. Serum potassium level
C. Oxygen saturation only
D. Current medication list
E. Presence of nausea or visual disturbances
Correct Answers: A, B, D, E
Rationale: Digoxin administration requires assessment of heart
rate, electrolyte status, concurrent medications, and signs of
toxicity. Oxygen saturation alone is insufficient to determine
medication safety.
Question 4
Difficulty: Difficult
Question Type: NGN Clinical Judgment
Question: