st
, Chapter 01: Nursing Practice in Canada and Drug Therapy
Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition
st
MULTIPLE CHOICE st
1. Which is a judgement about a particular patient’s potential need or problem?
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a. A goal
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b. An assessment st
c. Subjective data st
d. A nursing diagnosis
st st
ANS: D st
Nursing diagnosis is the phase of the nursing process during which a clinical judgement is made about ho
st st st st st st st st st st st st st st st st st
w a patient responds to heath conditions and life processes or vulnerability for that response.
st st st st st st st st st st st st st st
DIF: Cognitive Level: Knowledge st st
2.
The patient is to receive oral furosemide (Lasix) every day; however, because the patient is unabl
st st st st st st st st st st st st st st st
e to swallow, he cannot take medication orally, as ordered. The nurse needs to contact the physician. Wh
st st st st st st st st st st st st st st st st st
at type of problem is this?
st st st st st
a. A “right time” problem
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b. A “right dose” problem
st st st
c. A “right route” problem
st st st
d. A “right medication” problem
st st st
ANS: C st
This is a “right route” problem: the nurse cannot assume the route and must clarify the route with the pre
st st st st st st st st st st st st st st st st st st st
scriber. This is not a “right time” problem because the ordered frequency has not changed. This is not a “r
st st st st st st st st st st st st st st st st st st st
ight dose” problem because the dose is not related to an inability to swallow. This is not a “right medicati
st st st st st st st st st st st st st st st st st st st
on” problem because the medication ordered will not change, just the route.
st st st st st st st st st st st
DIF: Cognitive Level: Application st st
,3.
The nurse has been monitoring the patient’s progress on his new drug regimen since the first dos
st st st st st st st st st st st st st st st st
e and has been documenting signs of possible adverse effects. What nursing process phase is the nurse pr
st st st st st st st st st st st st st st st st st
actising?
a. Planning
b. Evaluation
c. Implementation
d. Nursing diagnosis st
ANS: B st
Monitoring the patient’s progress is part of the evaluation phase. Planning, implementation, and nursing
st st st st st st st st st st st st st st
diagnosis are not illustrated by this example.
st st st st st st
DIF: Cognitive Level: Application st st
4.
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes mellitus. Wh
st st st st st st st st st st st st st st st st st
ich statement best illustrates an outcome criterion for this patient?
st st st st st st st st st
a. The patient will follow instructions.
st st st st
b. The patient will not experience complications.
st st st st st
c. The patient adheres to the new insulin treatment regimen.
st st st st st st st st
d. The patient demonstrates safe insulin self-administration technique.
st st st st st st
ANS: D st
Having the patient demonstrate safe insulin self-
st st st st st st
administration technique is a specific and measurable outcome criterion. Following instructions and avoi
st st st st st st st st st st st st
ding complications are not specific criteria. Adherence to the new insulin treatment regimen is not object
st st st st st st st st st st st st st st st
ive and would be difficult to measure.
st st st st st st
DIF: Cognitive Level: Application st st
5.
Which activity best reflects the implementation phase of the nursing process for the patient who
st st st st st st st st st st st st st st st
is newly diagnosed with type 1 diabetes mellitus?
st st st st st st st
a. Providing education regarding self-injection technique st st st st
b. Setting goals and outcome criteria with the patient’s input
st st st st st st st st
c. Recording a history of over-the-counter medications used at home
st st st st st st st st
, d.
Formulating nursing diagnoses regarding knowledge deficits related to the new treatment regim
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en
ANS: A st
Education is an intervention that occurs during the implementation phase. Setting goals and outcome crit
st st st st st st st st st st st st st st
eria reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating nur
st st st st st st st st st st st st st st
sing diagnoses regarding a knowledge deficit reflects analysis of data as part of the planning phase.
st st st st st st st st st st st st st st st
DIF: Cognitive Level: Analysis st st
st
6.
The nurse is working during a very busy night shift, and the health care provider has just given the
st st st st st st st st st st st st st st st st st st
nurse a medication order over the telephone, but the nurse does not recall the route. What is the best w
st st st st st st st st st st st st st st st st st st st st
ay for the nurse to avoid medication errors?
st st st st st st st
a. Recopy the order neatly on the order sheet, with the most common route indicated
st st st st st st st st st st st st st
b. Consult with the pharmacist for clarification about the most common route
st st st st st st st st st st
c. Call the health care provider to clarify the route of administration
st st st st st st st st st st
d. Withhold the drug until the health care provider visits the patient
st st st st st st st st st st
ANS: C st
If a medication order does not include the route, the nurse must ask the health care provider to clarify it.
st st st st st st st st st st st st st st st st st st st st
Never assume the route of administration.
st st st st st
DIF: Cognitive Level: Application | Cognitive Level: Analysis
st st st st st st
7. Which constitutes the traditional Five Rights of medication administration?
st st st st st st st st
a. Right drug, right route, right dose, right time, and right patient
st st st st st st st st st st
b. Right drug, the right effect, the right route, the right time, and the right patient
st st st st st st st st st st st st st st
c. Right patient, right strength, right diagnosis, right drug, and right route
st st st st st st st st st st
d. Right patient, right diagnosis, right drug, right route, and right time
st st st st st st st st st st
ANS: A st
The traditional Five Rights of medication administration were considered to be Right drug, Right route, Ri
st st st st st st st st st st st st st st st
ght dose, Right time, and Right patient. Right effect, right strength, and right diagnosis are not part of the
st st st st st st st st st st st st st st st st st st st
traditional Five Rights. st st
, Chapter 01: Nursing Practice in Canada and Drug Therapy
Sealock: Lilley’s Pharmacology for Canadian Health Care Practice, 4th Edition
st
MULTIPLE CHOICE st
1. Which is a judgement about a particular patient’s potential need or problem?
st st st st st st st st st st st
a. A goal
st
b. An assessment st
c. Subjective data st
d. A nursing diagnosis
st st
ANS: D st
Nursing diagnosis is the phase of the nursing process during which a clinical judgement is made about ho
st st st st st st st st st st st st st st st st st
w a patient responds to heath conditions and life processes or vulnerability for that response.
st st st st st st st st st st st st st st
DIF: Cognitive Level: Knowledge st st
2.
The patient is to receive oral furosemide (Lasix) every day; however, because the patient is unabl
st st st st st st st st st st st st st st st
e to swallow, he cannot take medication orally, as ordered. The nurse needs to contact the physician. Wh
st st st st st st st st st st st st st st st st st
at type of problem is this?
st st st st st
a. A “right time” problem
st st st
b. A “right dose” problem
st st st
c. A “right route” problem
st st st
d. A “right medication” problem
st st st
ANS: C st
This is a “right route” problem: the nurse cannot assume the route and must clarify the route with the pre
st st st st st st st st st st st st st st st st st st st
scriber. This is not a “right time” problem because the ordered frequency has not changed. This is not a “r
st st st st st st st st st st st st st st st st st st st
ight dose” problem because the dose is not related to an inability to swallow. This is not a “right medicati
st st st st st st st st st st st st st st st st st st st
on” problem because the medication ordered will not change, just the route.
st st st st st st st st st st st
DIF: Cognitive Level: Application st st
,3.
The nurse has been monitoring the patient’s progress on his new drug regimen since the first dos
st st st st st st st st st st st st st st st st
e and has been documenting signs of possible adverse effects. What nursing process phase is the nurse pr
st st st st st st st st st st st st st st st st st
actising?
a. Planning
b. Evaluation
c. Implementation
d. Nursing diagnosis st
ANS: B st
Monitoring the patient’s progress is part of the evaluation phase. Planning, implementation, and nursing
st st st st st st st st st st st st st st
diagnosis are not illustrated by this example.
st st st st st st
DIF: Cognitive Level: Application st st
4.
The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes mellitus. Wh
st st st st st st st st st st st st st st st st st
ich statement best illustrates an outcome criterion for this patient?
st st st st st st st st st
a. The patient will follow instructions.
st st st st
b. The patient will not experience complications.
st st st st st
c. The patient adheres to the new insulin treatment regimen.
st st st st st st st st
d. The patient demonstrates safe insulin self-administration technique.
st st st st st st
ANS: D st
Having the patient demonstrate safe insulin self-
st st st st st st
administration technique is a specific and measurable outcome criterion. Following instructions and avoi
st st st st st st st st st st st st
ding complications are not specific criteria. Adherence to the new insulin treatment regimen is not object
st st st st st st st st st st st st st st st
ive and would be difficult to measure.
st st st st st st
DIF: Cognitive Level: Application st st
5.
Which activity best reflects the implementation phase of the nursing process for the patient who
st st st st st st st st st st st st st st st
is newly diagnosed with type 1 diabetes mellitus?
st st st st st st st
a. Providing education regarding self-injection technique st st st st
b. Setting goals and outcome criteria with the patient’s input
st st st st st st st st
c. Recording a history of over-the-counter medications used at home
st st st st st st st st
, d.
Formulating nursing diagnoses regarding knowledge deficits related to the new treatment regim
st st st st st st st st st st st
en
ANS: A st
Education is an intervention that occurs during the implementation phase. Setting goals and outcome crit
st st st st st st st st st st st st st st
eria reflects the planning phase. Recording a drug history reflects the assessment phase. Formulating nur
st st st st st st st st st st st st st st
sing diagnoses regarding a knowledge deficit reflects analysis of data as part of the planning phase.
st st st st st st st st st st st st st st st
DIF: Cognitive Level: Analysis st st
st
6.
The nurse is working during a very busy night shift, and the health care provider has just given the
st st st st st st st st st st st st st st st st st st
nurse a medication order over the telephone, but the nurse does not recall the route. What is the best w
st st st st st st st st st st st st st st st st st st st st
ay for the nurse to avoid medication errors?
st st st st st st st
a. Recopy the order neatly on the order sheet, with the most common route indicated
st st st st st st st st st st st st st
b. Consult with the pharmacist for clarification about the most common route
st st st st st st st st st st
c. Call the health care provider to clarify the route of administration
st st st st st st st st st st
d. Withhold the drug until the health care provider visits the patient
st st st st st st st st st st
ANS: C st
If a medication order does not include the route, the nurse must ask the health care provider to clarify it.
st st st st st st st st st st st st st st st st st st st st
Never assume the route of administration.
st st st st st
DIF: Cognitive Level: Application | Cognitive Level: Analysis
st st st st st st
7. Which constitutes the traditional Five Rights of medication administration?
st st st st st st st st
a. Right drug, right route, right dose, right time, and right patient
st st st st st st st st st st
b. Right drug, the right effect, the right route, the right time, and the right patient
st st st st st st st st st st st st st st
c. Right patient, right strength, right diagnosis, right drug, and right route
st st st st st st st st st st
d. Right patient, right diagnosis, right drug, right route, and right time
st st st st st st st st st st
ANS: A st
The traditional Five Rights of medication administration were considered to be Right drug, Right route, Ri
st st st st st st st st st st st st st st st
ght dose, Right time, and Right patient. Right effect, right strength, and right diagnosis are not part of the
st st st st st st st st st st st st st st st st st st st
traditional Five Rights. st st
