Pharmacology
A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Moderate
Question Type: Multiple Choice (Clinical Judgment)
Question:
A nurse administers the first dose of an antihypertensive
medication to a hospitalized client. Thirty minutes later, the
client reports dizziness while attempting to stand. Which action
best demonstrates the Recognize Cues step of the Clinical
Judgment Management Model (CJMM)?
A. Assist the client back to bed and obtain blood pressure while
assessing symptoms.
B. Determine that the medication caused orthostatic
hypotension.
C. Develop a plan to reduce the client's fall risk.
D. Notify the health care provider and request a dosage
adjustment.
Correct Answer: A
Rationale: Recognizing cues involves collecting relevant
assessment data, such as vital signs and the client's symptoms,
before making clinical decisions.
Question 2
,Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
A nurse is collecting data before administering a scheduled dose
of digoxin. Which assessment findings represent relevant cues?
A. Apical heart rate of 54 beats/minute
B. Serum potassium level of 2.9 mEq/L
C. Client's favorite television program
D. Reports of nausea since this morning
E. Weight recorded six months ago
Correct Answer: A, B, D
Rationale: Bradycardia, hypokalemia, and nausea are clinically
significant cues that may indicate increased risk for digoxin
toxicity. Irrelevant personal information or outdated data
should not influence medication decisions.
Question 3
Difficulty: Difficult
Question Type: NGN Clinical Judgment
Question:
, A client receiving intravenous morphine becomes difficult to
arouse. Respiratory rate is 8 breaths/minute, oxygen saturation
is 88%, and pupils are pinpoint.
Which hypothesis should the nurse prioritize?
A. The client is experiencing opioid-induced respiratory
depression.
B. The client is anxious about pain control.
C. The client has developed pneumonia.
D. The client requires additional analgesia.
Correct Answer: A
Rationale: The assessment findings strongly indicate opioid
toxicity requiring immediate intervention. Airway and breathing
take priority.
Question 4
Difficulty: Moderate
Question Type: Multiple Choice
Question:
After identifying that a client is experiencing an allergic reaction
to an antibiotic, which action represents the Generate
Solutions (Planning) step?
A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Moderate
Question Type: Multiple Choice (Clinical Judgment)
Question:
A nurse administers the first dose of an antihypertensive
medication to a hospitalized client. Thirty minutes later, the
client reports dizziness while attempting to stand. Which action
best demonstrates the Recognize Cues step of the Clinical
Judgment Management Model (CJMM)?
A. Assist the client back to bed and obtain blood pressure while
assessing symptoms.
B. Determine that the medication caused orthostatic
hypotension.
C. Develop a plan to reduce the client's fall risk.
D. Notify the health care provider and request a dosage
adjustment.
Correct Answer: A
Rationale: Recognizing cues involves collecting relevant
assessment data, such as vital signs and the client's symptoms,
before making clinical decisions.
Question 2
,Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
A nurse is collecting data before administering a scheduled dose
of digoxin. Which assessment findings represent relevant cues?
A. Apical heart rate of 54 beats/minute
B. Serum potassium level of 2.9 mEq/L
C. Client's favorite television program
D. Reports of nausea since this morning
E. Weight recorded six months ago
Correct Answer: A, B, D
Rationale: Bradycardia, hypokalemia, and nausea are clinically
significant cues that may indicate increased risk for digoxin
toxicity. Irrelevant personal information or outdated data
should not influence medication decisions.
Question 3
Difficulty: Difficult
Question Type: NGN Clinical Judgment
Question:
, A client receiving intravenous morphine becomes difficult to
arouse. Respiratory rate is 8 breaths/minute, oxygen saturation
is 88%, and pupils are pinpoint.
Which hypothesis should the nurse prioritize?
A. The client is experiencing opioid-induced respiratory
depression.
B. The client is anxious about pain control.
C. The client has developed pneumonia.
D. The client requires additional analgesia.
Correct Answer: A
Rationale: The assessment findings strongly indicate opioid
toxicity requiring immediate intervention. Airway and breathing
take priority.
Question 4
Difficulty: Moderate
Question Type: Multiple Choice
Question:
After identifying that a client is experiencing an allergic reaction
to an antibiotic, which action represents the Generate
Solutions (Planning) step?
