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