Pharmacology
A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question:
A nurse is caring for a client who received an antihypertensive
medication 30 minutes ago. The client reports dizziness when
standing and appears pale. Which action demonstrates the
nurse correctly applying the “Recognize Cues” step of the
Clinical Judgment Management Model (CJMM)?
A. Administering a rapid IV fluid bolus
B. Documenting that the medication was effective
C. Identifying dizziness and pallor as possible signs of
hypotension
D. Teaching the client about medication adherence
Correct Answer: C
Rationale:
Recognizing cues involves identifying relevant clinical signs and
symptoms. Dizziness and pallor after an antihypertensive
medication may indicate hypotension. The other actions occur
during intervention or evaluation phases.
Question 2
,Difficulty: Moderate
Question Type: Multiple Choice
Question:
A nurse reviews laboratory results before administering digoxin.
Which finding requires immediate analysis before medication
administration?
A. Potassium level of 2.9 mEq/L
B. Sodium level of 140 mEq/L
C. Hemoglobin of 13 g/dL
D. Platelet count of 250,000/mm³
Correct Answer: A
Rationale:
Hypokalemia increases the risk for digoxin toxicity and requires
immediate analysis before administration. The remaining
findings are within expected ranges and are less clinically
urgent.
Question 3
Difficulty: Difficult
Question Type: SATA
Question:
, A nurse is caring for a client receiving opioid analgesics after
surgery. Which findings should the nurse identify as priority
cues requiring immediate follow-up? Select all that apply.
A. Respiratory rate of 8/min
B. Oxygen saturation of 88%
C. Pain rating of 3/10
D. Difficult arousal from sleep
E. Blood pressure of 128/76 mm Hg
Correct Answer:
A, B, D
Rationale:
Respiratory depression is a serious adverse effect of opioids. A
low respiratory rate, decreased oxygen saturation, and difficult
arousal indicate potential opioid toxicity requiring rapid
intervention.
Question 4
Difficulty: Moderate
Question Type: Prioritization
Question:
A nurse receives report on four clients. Which client should the
nurse assess first?
A Patient-Centered Nursing
Process Approach
11th Edition
• Author(s)Linda McCuistion
TEST BANK
,Question 1
Difficulty: Moderate
Question Type: NGN Clinical Judgment
Question:
A nurse is caring for a client who received an antihypertensive
medication 30 minutes ago. The client reports dizziness when
standing and appears pale. Which action demonstrates the
nurse correctly applying the “Recognize Cues” step of the
Clinical Judgment Management Model (CJMM)?
A. Administering a rapid IV fluid bolus
B. Documenting that the medication was effective
C. Identifying dizziness and pallor as possible signs of
hypotension
D. Teaching the client about medication adherence
Correct Answer: C
Rationale:
Recognizing cues involves identifying relevant clinical signs and
symptoms. Dizziness and pallor after an antihypertensive
medication may indicate hypotension. The other actions occur
during intervention or evaluation phases.
Question 2
,Difficulty: Moderate
Question Type: Multiple Choice
Question:
A nurse reviews laboratory results before administering digoxin.
Which finding requires immediate analysis before medication
administration?
A. Potassium level of 2.9 mEq/L
B. Sodium level of 140 mEq/L
C. Hemoglobin of 13 g/dL
D. Platelet count of 250,000/mm³
Correct Answer: A
Rationale:
Hypokalemia increases the risk for digoxin toxicity and requires
immediate analysis before administration. The remaining
findings are within expected ranges and are less clinically
urgent.
Question 3
Difficulty: Difficult
Question Type: SATA
Question:
, A nurse is caring for a client receiving opioid analgesics after
surgery. Which findings should the nurse identify as priority
cues requiring immediate follow-up? Select all that apply.
A. Respiratory rate of 8/min
B. Oxygen saturation of 88%
C. Pain rating of 3/10
D. Difficult arousal from sleep
E. Blood pressure of 128/76 mm Hg
Correct Answer:
A, B, D
Rationale:
Respiratory depression is a serious adverse effect of opioids. A
low respiratory rate, decreased oxygen saturation, and difficult
arousal indicate potential opioid toxicity requiring rapid
intervention.
Question 4
Difficulty: Moderate
Question Type: Prioritization
Question:
A nurse receives report on four clients. Which client should the
nurse assess first?
