Complete Rationales 2026-2027
Updated.
assessment - Answer first part of the nursing process that involves collecting, organizing,
validating, and documenting data starting with the initial contact with the patient, continuing
with every interaction after
-This includes gathering baseline data, subjective data, objective data, and a health history
diagnosis - Answer second part of the nursing process involving judgement by the nurse of the
patient's actual or potential health problem after assessing the data collected
-includes analyzing data, identifying health problems, risks, and strengths, and formulating
diagnostic statements
-goal is to provide the basis for the plan and remaining steps
planning - Answer third step of the nursing process where the nurse reviews the diagnosis,
establishes goals and outcomes, and sets nursing interventions that would best help the patient
and established diagnosis
-includes prioritizing problems/diagnoses, formulating goals/desired outcomes, selecting
nursing interventions, and writing nursing interventions
-goal is to establish a well-thought plan before taking action
Intervention (Implementation) - Answer fourth step of the nursing process where the nurse
uses all information gathered as well as the established plan and puts them into action to reach
the established goals and outcomes
-includes reassessing the client, determining the nurses need for assistance, implementing the
nursing interventions, supervising delegated care, and documenting nursing activities
evaluation - Answer last step of nursing process where once the plan has been put into action,
the nurse must now assess the outcomes and if the patient's health status has improved
-includes collecting data related to outcomes, comparing data with outcomes, relate nursing
actions to client goals/outcomes, drawing conclusion about problem status, and continuing,
modifying, or terminating the patient's care plan
adverse effect - Answer unintended, unfavorable, and often unpredictable drug reaction
-warrant either lowing the dosage of the drug or discontinuing the drug
indication - Answer a sign or piece of information that indicates the use of a particular
medication
, contraindication - Answer any conditions or special circumstances, such as diseases or
conditions, in which use of the drug is undesirable or for which the drug should be given with
caution
Peak drug level - Answer plasma level when the medication has reached its highest
concentration in the bloodstream
-drawn after drug is administered
trough drug level - Answer the lowest plasma concentration of a drug, and it measures the
rate at which the drug is eliminated
-drawn between the first and second dose of the drug
Pharmacokinetic phase - Answer the process of drug movement to achieve drug action
-absorption: process involving the movement of a substance from its site of administration,
across body membranes, to circulating fluids; determines the length of time it takes a drug to
produces its effect
-distribution: involves the transport of drugs throughout the body determined by the amount of
blood flow to body tissues
-metabolism: process of chemically converting a drug to a form that is usually more easily
removed from the body involving complex biochemical pathways and reactions that alter drugs,
nutrients, vitamins, and minerals; primary site is the liver
-excretion: the process by which drugs are removed from the body; primary site is the kidneys;
the rate at which medications are excreted is a primary determinant of the concentration of the
drugs in the bloodstream and tissues
SSRI mechanism of action (selective serotonin reuptake inhibitors) - Answer selectively inhibit
the reuptake of serotonin with little or no effects on other neurotransmitters in the CNS such as
norepinephrine and dopamine
-slow the reuptake of serotonin into presynaptic nerve terminals, increasing levels of serotonin
in the brain, producing excitatory reactions in the CNS
-too much can lead to serotonin syndrome (panic disorder characterized by mental status
change, hypertension, tremors, sweating hyperpyrexia, ataxia)
MAOI mechanism of action (monoamine oxidase inhibitors) - Answer inhibit the MAO enzyme
activity inside presynaptic nerve terminals, degrading norepinephrine and other
neurotransmitters, enhancing catecholamine release
-no tyramine diet
lithium - Answer -T: antimanics