Pharmacology
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 caring for a client who develops a generalized rash
and shortness of breath within minutes of receiving a new
intravenous antibiotic. According to the Clinical Judgment
Measurement Model (CJMM), which action best reflects the
Recognize Cues step?
A. Administer epinephrine as prescribed.
B. Identify the rash, wheezing, and dyspnea as significant
findings.
C. Evaluate whether the client's breathing improved after
treatment.
D. Determine that the client is experiencing an anaphylactic
reaction.
Correct Answer: B
Rationale: Recognizing cues involves identifying relevant
assessment findings. Interpreting the findings as anaphylaxis
occurs during analysis, while treatment and evaluation occur
later in the clinical judgment process.
Question 2
,Difficulty: Moderate
Question Type: Multiple Choice (MCQ)
Question:
A client receiving an opioid analgesic becomes difficult to
arouse, with a respiratory rate of 8 breaths/minute and oxygen
saturation of 87%. Which nursing action represents the Analyze
Cues step?
A. Notify the provider immediately.
B. Conclude that the client's symptoms are most likely caused
by opioid-induced respiratory depression.
C. Administer supplemental oxygen.
D. Reassess respiratory status after treatment.
Correct Answer: B
Rationale: Analyzing cues requires interpreting assessment
findings to determine the likely clinical problem. The remaining
options represent intervention or evaluation.
Question 3
Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
A nurse is preparing to administer a medication. Which actions
, demonstrate appropriate cue recognition before
administration?
A. Reviewing the client's allergies.
B. Checking current laboratory values.
C. Verifying the medication order.
D. Evaluating therapeutic effectiveness after administration.
E. Assessing current vital signs.
Correct Answers: A, B, C, E
Rationale: Reviewing allergies, laboratory values, medication
orders, and vital signs are assessment activities that identify
important cues before medication administration. Evaluating
effectiveness occurs after intervention.
Question 4
Difficulty: Difficult
Question Type: NGN Clinical Judgment
Question:
A client with heart failure receives a prescribed diuretic. The
nurse notes blood pressure of 88/54 mm Hg, dizziness upon
standing, potassium level of 2.9 mEq/L, and urine output of
1800 mL over the past 8 hours.
Which finding should the nurse prioritize?
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 caring for a client who develops a generalized rash
and shortness of breath within minutes of receiving a new
intravenous antibiotic. According to the Clinical Judgment
Measurement Model (CJMM), which action best reflects the
Recognize Cues step?
A. Administer epinephrine as prescribed.
B. Identify the rash, wheezing, and dyspnea as significant
findings.
C. Evaluate whether the client's breathing improved after
treatment.
D. Determine that the client is experiencing an anaphylactic
reaction.
Correct Answer: B
Rationale: Recognizing cues involves identifying relevant
assessment findings. Interpreting the findings as anaphylaxis
occurs during analysis, while treatment and evaluation occur
later in the clinical judgment process.
Question 2
,Difficulty: Moderate
Question Type: Multiple Choice (MCQ)
Question:
A client receiving an opioid analgesic becomes difficult to
arouse, with a respiratory rate of 8 breaths/minute and oxygen
saturation of 87%. Which nursing action represents the Analyze
Cues step?
A. Notify the provider immediately.
B. Conclude that the client's symptoms are most likely caused
by opioid-induced respiratory depression.
C. Administer supplemental oxygen.
D. Reassess respiratory status after treatment.
Correct Answer: B
Rationale: Analyzing cues requires interpreting assessment
findings to determine the likely clinical problem. The remaining
options represent intervention or evaluation.
Question 3
Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
A nurse is preparing to administer a medication. Which actions
, demonstrate appropriate cue recognition before
administration?
A. Reviewing the client's allergies.
B. Checking current laboratory values.
C. Verifying the medication order.
D. Evaluating therapeutic effectiveness after administration.
E. Assessing current vital signs.
Correct Answers: A, B, C, E
Rationale: Reviewing allergies, laboratory values, medication
orders, and vital signs are assessment activities that identify
important cues before medication administration. Evaluating
effectiveness occurs after intervention.
Question 4
Difficulty: Difficult
Question Type: NGN Clinical Judgment
Question:
A client with heart failure receives a prescribed diuretic. The
nurse notes blood pressure of 88/54 mm Hg, dizziness upon
standing, potassium level of 2.9 mEq/L, and urine output of
1800 mL over the past 8 hours.
Which finding should the nurse prioritize?
