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 medication, the nurse reviews the
patient's allergies, current vital signs, and recent laboratory
values. Which step of the Clinical Judgment Measurement
Model (CJMM) is the nurse demonstrating?
A. Generate Solutions
B. Recognize Cues
C. Take Action
D. Evaluate Outcomes
Correct Answer: B. Recognize Cues
Rationale: Recognizing cues involves collecting relevant patient
information through assessment, including allergies, vital signs,
laboratory results, and medication history before making clinical
decisions.
Question 2
Difficulty: Moderate
Question Type: Multiple Choice (MCQ)
,Question:
A patient receiving an antihypertensive medication reports
dizziness when standing. The nurse determines the symptoms
are likely related to orthostatic hypotension caused by the
medication. Which CJMM step is illustrated?
A. Analyze Cues
B. Evaluate Outcomes
C. Take Action
D. Generate Solutions
Correct Answer: A. Analyze Cues
Rationale: Analyzing cues requires interpreting assessment
findings and connecting them to possible causes, such as
recognizing that dizziness is likely medication-related.
Question 3
Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
A nurse is assessing a patient before administering insulin.
Which findings are examples of cues that should be recognized
before medication administration?
, A. Current blood glucose level
B. Time of the patient's last meal
C. Presence of diaphoresis
D. Patient's favorite food
E. Recent potassium level
Correct Answer: A, B, C, E
Rationale: Blood glucose, meal timing, symptoms of
hypoglycemia, and potassium levels are clinically relevant
assessment cues before insulin administration. Food
preferences are not immediate safety cues.
Question 4
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question:
A nurse assesses a patient who is prescribed an opioid
analgesic. Assessment findings include respiratory rate of 8
breaths/min, oxygen saturation of 90%, and excessive
drowsiness.
Which finding should the nurse prioritize?
A. Oxygen saturation of 90%
B. Respiratory rate of 8 breaths/min