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 verifies the
patient's allergies, current medications, and most recent
laboratory values. Which step of the Clinical Judgment
Measurement Model (CJMM) is the nurse performing?
A. Take Action
B. Recognize Cues
C. Generate Solutions
D. Evaluate Outcomes
Correct Answer: B. Recognize Cues
Rationale: Recognizing cues involves collecting relevant
assessment data before making clinical decisions. Reviewing
allergies, medications, and laboratory values helps identify
information necessary for safe medication administration.
Question 2
Difficulty: Moderate
,Question Type: Select All That Apply (SATA)
Question:
A nurse is caring for a patient who is prescribed an intravenous
antibiotic. Which assessment findings represent cues that
should be recognized before administering the medication?
A. History of penicillin allergy
B. Current serum creatinine level
C. Favorite television program
D. Presence of a peripheral IV site
E. Current body temperature
Correct Answer: A, B, D, E
Rationale: Allergy history, kidney function, IV access, and signs
of infection are clinically relevant cues affecting medication
administration. A patient's television preference does not
influence medication safety.
Question 3
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question:
, A patient receiving an antihypertensive medication reports
dizziness when standing. Blood pressure is 92/58 mm Hg, heart
rate is 60 beats/min, and the patient nearly falls while walking.
Which cue requires the highest priority analysis?
A. Heart rate of 60 beats/min
B. Complaint of dizziness with standing
C. Age of the patient
D. Scheduled lunch time
Correct Answer: B. Complaint of dizziness with standing
Rationale: Symptomatic hypotension places the patient at
immediate risk for falls and injury. This cue requires prompt
analysis and intervention before medication administration.
Question 4
Difficulty: Moderate
Question Type: Multiple Choice (MCQ)
Question:
After recognizing that a patient has low blood pressure before
an antihypertensive medication is due, which CJMM step
follows?
A. Evaluate Outcomes