A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Easy
Question Type: Multiple Choice
Question:
A nurse is preparing to administer a newly prescribed
medication. Before giving the medication, the nurse reviews the
patient's allergies, current medications, laboratory values, and
vital signs. Which step of the Clinical Judgment Measurement
Model (CJMM) is the nurse performing?
A. Generate Solutions
B. Recognize Cues
C. Take Action
D. Evaluate Outcomes
Correct Answer: B. Recognize Cues
Rationale: Recognize Cues involves collecting and validating
relevant assessment data before making clinical decisions.
Reviewing patient information helps identify factors that may
influence safe medication administration.
Question 2
Difficulty: Moderate
Question Type: Multiple Choice
,Question:
A patient receiving an antihypertensive medication reports
dizziness when standing. Blood pressure is 88/54 mm Hg, and
heart rate is 58 beats/min. Which nursing action best
demonstrates the Analyze Cues step of the CJMM?
A. Hold the medication and notify the provider immediately.
B. Determine whether the dizziness and vital signs are related
to the medication.
C. Teach the patient to rise slowly from bed.
D. Document the assessment findings.
Correct Answer: B. Determine whether the dizziness and vital
signs are related to the medication.
Rationale: Analyze Cues requires interpreting assessment
findings to determine their clinical significance. The nurse first
identifies the likely relationship between the medication and
the patient's symptoms before selecting an intervention.
Question 3
Difficulty: Moderate
Question Type: Select All That Apply (SATA)
Question:
, A nurse is assessing a patient before administering insulin.
Which assessment findings should be recognized as important
cues?
Select all that apply.
A. Current blood glucose level
B. Meal tray availability
C. Recent potassium level
D. Patient's favorite television program
E. Level of consciousness
Correct Answer: A, B, C, E
Rationale: Blood glucose, meal availability, potassium level, and
neurologic status directly influence insulin safety. Personal
entertainment preferences are unrelated to medication
administration.
Question 4
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question:
A patient is prescribed an opioid analgesic after surgery.
Assessment findings include respiratory rate 10 breaths/min,