PROCESS APPROACH, 11TH EDITION BY LINDA E. MCCUISTION
CHAPTER 1-58 NEW UPDATE
Chapter 01: The Nursing Process and Patient-Centered Care
ki ki ki ki ki ki ki
McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 11thEdition
ki ki ki ki ki ki ki k
i
MULTIPLE CHOICE ki
1. All of the following would be considered subjective data, EXCEPT:
ki ki ki ki ki ki ki ki ki
a. Patient-reported health history ki ki
b. Patient-reported signs and symptoms of their illness ki ki ki ki ki ki
c. Financial barriers reported by the patient’s caregiver. ki ki ki ki ki ki
d. Vital signs obtained from the medical record. ki ki ki ki ki ki
ANS: D. k i
Subjective data is based on what patients or family members communicate to the nurse. Pa ki ki ki ki ki ki ki ki ki ki ki ki ki ki
tient-
reported health history, signs and symptoms, and caregiver reportedfinancial barriers wo
ki ki ki ki ki ki ki ki ik ki ki
uld be considered subjective data. Vital signs obtained from themedical record would be co
ki ki ki ki ki ki ki ki ki ik ki ki ki ki
nsidered objective data. ki ki
DIF: Cognitive Level: Understanding (Comprehension) ki ki ki
TOP: Nursing Process:PlanningMSC: NCLEX: Management of Client Care
k i ki ik k i ki ki ki ki
2. The nurse is using data collected to define a set of interventions to achieve the mostdesirab
ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ik
leoutcomes. Which of the following steps is the nurse applying? ki ki ki ki ki ki ki ki ki
a. Recognizing cues (assessment) ki ki
b. Analyze cues & prioritize hypothesis (analysis) ki ki ki ki ki
c. Generate solutions (planning) ki ki
d. Take action (nursing interventions) ki ki ki
ANS: C k i
When generating solutions (planning), the nurse identifies expected outcomes and usesthe pa
ki ki ki ki ki ki ki ki ki ki ik ki
tient’s problem(s) to define a set of interventions to achieve the most desirable outcomes. Rec
ki ki ki ki ki ki ki ki ki ki ki ki ki ki
ognizing cues (assessment) involves the gathering of cues (information) from the patient abou
ki ki ki ki ki ki ki ki ki ki ki ki
t their health and lifestyle practices, which are important facts that aid the nurse in making clinic
ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki
al care decisions. Prioritizing hypothesis is used to organize and rank the patient problem(s)ide
ki ki ki ki ki ki ki ki ki ki ki ki ki
ntified. Finally, taking action involves implementation of nursing interventions to accomplish th
ki ki ki ki ki ki ki ki ki ki ki
e expected outcomes.
ki ki
DIF:
Cognitive Level: Understanding (Comprehens ki ki ki
ion)TOP: Nursing Process: NursingIntervention ki ki ki ik
MSC: NCLEX: Management of Client Care
k i ki ki ki ki
,3. A 5-year-
ki
old child with type 1 diabetes mellitus has had repeated hospitalizations for episodes ofhyper
ki ki ki ki ki ki ki ki ki ki ki ki ki
glycemia. The parents tell the nurse that they can’t keep track of everything that has to be don
ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki
e to care for their child. The nurse reviews medications, diet, and symptom management with
ki ki ki ki ki ki ki ki ki ki ki ki ki ki
the parents and draws up a daily checklist for thefamily to use. These activities are completed i
ki ki ki ki ki ki ki ki ki ik ki ki ki ki ki ki ki
nwhich step of the nursing process?
ki ki ki ki ki
a. Recognizing cues (assessment) ki ki
b. Analyze cues & prioritize hypothesis (analysis)
ki ki ki ki ki
, c. Generate solutions (planning) ki ki
d. Take action (nursing interventions) ki ki ki
ANS: D k i
Taking action through nursing interventions is where the nurse provides patient healthteachi
ki ki ki ki ki ki ki ki ki ki ki ik
ng,drug administration, patient care, and other interventions necessary to assistthe patient i
ki ki ki ki ki ki ki ki ki ik ki ki
n accomplishing expected outcomes.
ki ki ki
DIF:
Cognitive Level: Understanding (Comprehens ki ki ki
ion)TOP: Nursing Process: NursingIntervention ki ki ki ik
MSC: NCLEX: Management of Client Care
k i ki ki ki ki
4. The nurse is preparing to administer a medication and reviews the patient’s chartfor dru
ki ki ki ki ki ki ki ki ki ki ki ki ik ki
g allergies, serum creatinine, and blood urea nitrogen (BUN) levels. The nurse’s actions a
ki ki ki ki ki ki ki ki ki ki ki ki ki
rereflective of which of the following? ki ki ki ki ki
a. Recognizing cues (assessment) ki ki
b. Analyze cues & prioritize hypothesis (analysis) ki ki ki ki ki
c. Take action (nursing interventions) ki ki ki
d. Generate solutions (planning) ki ki
ANS: A k i
Recognizing cues (assessment) involves gathering subjective and objective informationabout ki ki ki ki ki ki ki ki ik ki
thepatient and the medication. Laboratory values from the patient’s chart would be considere ki ki ki ki ki ki ki ki ki ki ki ki
d collection of objective data.
ki ki ki ki
DIF: Cognitive Level: Understanding (Comprehension) ki ki ki
TOP: Nursing Process: Assessment
k i MSC: NCLEX: Management of Client Care ki ki k i ki ki ki ki
5. Which of the following would be correctly categorized as objective data?
ki ki ki ki ki ki ki ki ki ki
a. A list of herbal supplements regularly used provided by the patient.
ki ki ki ki ki ki ki ki ki ki
b. Lab values associated with the drugs the patient is taking.
ki ki ki ki ki ki ki ki ki
c. The ages and relationship of all household members to the patient.
ki ki ki ki ki ki ki ki ki ki
d. Usual dietary patterns and food intake. ki ki ki ki ki
ANS: B k i
Objective data are measured and detected by another person and would include labvalues. ki ki ki ki ki ki ki ki ki ki ki ki ik ki
Theother examples are subjective data. ki ki ki ki
DIF: Cognitive Level: Understanding (Comprehension) ki ki ki
TOP: Nursing Process: Assessment
k i MSC: NCLEX: Management of Client Care ki ki k i ki ki ki ki
6. The nurse reviews a patient’s database and learns that the patient lives alone, is forgetful, and
ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki
does not have an established routine. The patient will be sent home withthree new medicatio
ki ki ki ki ki ki ki ki ki ki ki ki ki ik ki ki
ns to be taken at different times of the day. The nurse develops a daily medication chart and e
ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki
nlistsa family member to put the patient’s pills in a pill organizer. This is an example of which el
ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki ki
ement of the nursing process? ki ki ki ki
a. Recognizing cues (assessment) ki ki
b. Analyze cues & prioritize hypothesis (analysis) ki ki ki ki ki
c. Take action (nursing interventions) ki ki ki