A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Easy
Question Type: Multiple Choice (MCQ)
Question:
A nurse is preparing to administer a newly prescribed
medication. Before giving the first dose, the nurse reviews the
patient's allergy history, current medications, and recent
laboratory results. Which step of the Clinical Judgment
Measurement Model (CJMM) is the nurse performing?
A. Generate Solutions
B. Recognize Cues
C. Evaluate Outcomes
D. Take Action
Correct Answer: B. Recognize Cues
Rationale: Recognizing cues involves collecting and identifying
relevant patient information, including assessment findings,
allergies, laboratory values, and medication history before
making clinical decisions.
Question 2
Difficulty: Moderate
Question Type: Multiple Choice (MCQ)
,Question:
A patient prescribed an antihypertensive medication reports
dizziness when standing. The nurse determines that the
symptom is likely related to orthostatic hypotension caused by
the medication. Which CJMM step is demonstrated?
A. Recognize Cues
B. Analyze Cues
C. Take Action
D. Evaluate Outcomes
Correct Answer: B. Analyze Cues
Rationale: During analysis, the nurse interprets collected
information and identifies relationships between assessment
findings and potential medication effects.
Question 3
Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
A nurse is assessing a patient before administering digoxin.
Which findings should the nurse recognize as important cues?
Select all that apply.
, A. Apical pulse of 54 beats/minute
B. Serum potassium of 3.0 mEq/L
C. Patient reports nausea today
D. Patient prefers medication with breakfast
E. Recent complaint of blurred vision
Correct Answer: A, B, C, E
Rationale: Bradycardia, hypokalemia, nausea, and visual
disturbances may indicate increased digoxin sensitivity or
toxicity. Meal preference is not a priority clinical cue.
Question 4
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question:
A patient receiving intravenous antibiotics develops hives,
wheezing, and facial swelling shortly after the infusion begins.
Which nursing action should be performed FIRST?
A. Document the reaction
B. Slow the infusion rate
C. Stop the medication infusion immediately
D. Notify the pharmacist
Correct Answer: C. Stop the medication infusion immediately