,Chapter 01: The Nursing Process and Drug Therapy
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Lilley: Pharmacology and the Nursing Process, 10th Edition
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MULTIPLE CHOICE fd
1. The nurse is developing a human needs statement for a patient who has a new diagnosis of h
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eart failure. Identification of human needs statements occur with which of these activities?
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a. Collection of patient data fd fd fd
b. Administering interventions fd
c. Deciding on patient outcomes fd fd fd
d. Documenting the patient‘s behavior fd fd fd
ANS: A fd
Identification of human needs occurs with the collection of patient data. fd fd fd fd fd fd fd fd fd fd
DIF:
Cognitive Level: Understanding (Comprehension) fd fd fd fd
TOP: Nursing Process: Human Needs Statement
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MSC: NCLEX: Safe and Effective Care Environment: Management of Care
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2. The patient is to receive oral guaifenesin twice a day. Today, the nurse was busy and gave the m
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edication 2 hours after the scheduled dose was due. What type of problem does this represent?
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a. ―Right time‖ fd
b. ―Right dose‖ fd
c. ―Right route‖ fd
d. ―Right medication‖ fd
ANS: A fd
―Right time‖ is correct because the medication was given more than 30 minutes after the schedule
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d dose was due. ―Dose‖ is incorrect because the dose is not related to the time the medication admi
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nistration is scheduled. ―Route‖ is incorrect because the route is not affected.
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―Medication‖ is incorrect because the medication ordered will not change. fd fd fd fd fd fd fd fd fd
DIF:
Cognitive Level: Applying (Application) fd fd fd fd
TOP: Nursing Process: Implementation
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MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
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3. The nurse has been monitoring the patient‘s progress on a new drug regimen since the first d
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ose and documenting the patient‘s therapeutic response to the medication. Which phase of th
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e nursing process do these actions illustrate?
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a. Human needs statement fd fd
b. Planning
c. Implementation
d. Evaluation
ANS: D fd
Monitoring the patient‘s progress, including the patient‘s response to the medication, is part of t
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he evaluation phase. Planning, implementation, and human needs statement are not illustrated b
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y this example.
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,DIF: f d f d Cognitive Level: Understanding (Comprehension)
fd fd fd TOP: Nursing Process: Evaluation
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, MSC: NCLEX: Safe and Effective Care Environment: Management of Care
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4. The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus.
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Which statement best illustrates an outcome criterion for this patient?
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a. The patient will follow instructions. fd fd fd fd
b. The patient will not experience complications.
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c. The patient will adhere to the new insulin treatment regimen.
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d. The patient will demonstrate correct blood glucose testing technique.
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ANS: D fd
―Demonstrating correct blood glucose testing technique‖ is a specific and measurable outco fd fd fd fd fd fd fd fd fd fd fd
me criterion. ―Following instructions‖ and ―not experiencing complications‖ are not specific c
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riteria. ―Adhering to new regimen‖ would be difficult to measure.
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DIF: Cognitive Level: Applying (Application) fd fd fd
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment: Ma
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nagement of Care fd fd
5. Which activity best reflects the implementation phase of the nursing process for the patient w
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ho is newly diagnosed with hypertension?
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a. Providing education on keeping a journal of blood pressure readings fd fd fd fd fd fd fd fd fd
b. Setting goals and outcome criteria with the patient‘s input fd fd fd fd fd fd fd fd
c. Recording a drug history regarding over-the-counter medications used at home fd fd fd fd fd fd fd fd fd
d. Formulating human needs statements regarding deficient knowledge related to the n fd fd fd fd fd fd fd fd fd fd
ew treatment regimen fd fd
ANS: A fd
Education is an intervention that occurs during the implementation phase. Setting goals and outcom
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es reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating h
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uman needs statements reflects analysis of data as part of planning.
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DIF:
Cognitive Level: Applying (Application) fd fd fd fd
TOP: Nursing Process: Implementation
f d fd fd
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
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6. The medication order reads, ―Give ondansetron 4 mg, 30 minutes before beginning chemo
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therapy to prevent nausea.‖ The nurse notes that the route is missing from the order. What is
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the nurse‘s best action?
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a. Give the medication intravenously because the patient might vomit.
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b. Give the medication orally because the tablets are available in 4-mg doses.
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c. Contact the prescriber to clarify the route of the medication ordered.fd fd fd fd fd fd fd fd fd fd
d. Hold the medication until the prescriber returns to make rounds.
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ANS: C fd
A complete medication order includes the route of administration. If a medication order does not
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include the route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes
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are not interchangeable. Holding the medication until the prescriber returns would mean that th
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e patient would not receive a needed medication.
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DIF:
Cognitive Level: Applying (Application) fd fd fd fd
TOP: Nursing Process: Implementation
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