lOMoARcPSD| 13728229
, lOMoARcPSD| 13728229
a. A “right time” problem
w w w
b. A “right dose” problem
w w w
c. A “right route” problem
w w w
d. A “right medication” problem
w w w
ANS: C w
This is a “right route” problem: the nurse cannot assume the route and must cla
w w w w w w w w w w w w w w
prescriber. This is not a “right time” problem because the ordered frequency has no
w w w w w w w w w w w w w w
“right dose” problem because the dose is not related to an inability to swallo
w w w w w w w w w w w w w w
medication” problem because the medication ordered will not change, just the route
w w w w w w w w w w w w
DIF: Cognitive Level: Application w w
3. The nurse has been monitoring the patient’s progress on his new drug regimen since t
w w w w w w w w w w w w w w
wbeen documenting signs of possible adverse effects. What nursing process phase is th
w w w w w w w w w w w w
a. Planning
b. Evaluation
c. Implementation
d. Nursing diagnosis w
ANS: B w
Monitoring the patient’s progress is part of the evaluation phase. Planning, implement
w w w w w w w w w w w
diagnosis are not illustrated by this example.
w w w w w w w
DIF: Cognitive Level: Application w w
4. The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes m
w w w w w w w w w w w w w w w w
wstatement best illustrates an outcome criterion for this patient?
w w w w w w w w
a. The patient will follow instructions.
w w w w
b. The patient will not experience complications.
w w w w w
c. The patient adheres to the new insulin treatment regimen.
w w w w w w w w
d. The patient demonstrates safe insulin self-administration technique.
w w w w w w
ANS: D w
Having the patient demonstrate safe insulin self-administration technique is a specific
w w w w w w w w w w w
outcome criterion. Following instructions and avoiding complications are not specific
w w w w w w w w w w w
the new insulin treatment regimen is not objective and would be difficult to measure
w w w w w w w w w w w w w w
DIF: Cognitive Level: Application w w
5. Which activity best reflects the implementation phase of the nursing process for the p
w w w w w w w w w w w w w
wdiagnosed with type 1 diabetes mellitus? w w w w w
a. Providing education regarding self-injection techniquew w w w
b. Setting goals and outcome criteria with the patient’s input
w w w w w w w w
c. Recording a history of over-the-counter medications used at home
w w w w w w w w
d. Formulating nursing diagnoses regarding knowledge deficits w w w w w
related to the new treatment regimen
w w w w w w
ANS: A w
Education is an intervention that occurs during the implementation phase. Setting goa
w w w w w w w w w w w
reflects the planning phase. Recording a drug history reflects the assessment phase. F
w w w w w w w w w w w w w
diagnoses regarding a knowledge deficit reflects analysis of data as part of the planni
w w w w w w w w w w w w w w
, lOMoARcPSD| 13728229
6. The nurse is working during a very busy night shift, and the health care provider has ju
w w w w w w w w w w w w w w w w
wmedication order over the telephone, but the nurse does not recall the route. What i
w w w w w w w w w w w w w w
wnurse to avoid medication errors?
w w w w
a. Recopy the order neatly on the order sheet, with the most common route indicate
w w w w w w w w w w w w w
b. Consult with the pharmacist for clarification about the most common route
w w w w w w w w w w
c. Call the health care provider to clarify the route of administration
w w w w w w w w w w
d. Withhold the drug until the health care provider visits the patient
w w w w w w w w w w
ANS: C w
If a medication order does not include the route, the nurse must ask the health care p
w w w w w w w w w w w w w w w w
wassume the route of administration.
w w w w
DIF: Cognitive Level: Application | Cognitive Level: Analysis
w w w w w w
7. Which constitutes the traditional Five Rights of medication administration?
w w w w w w w w
a. Right drug, right route, right dose, right time, and right patient
w w w w w w w w w w
b. Right drug, the right effect, the right route, the right time, and the right patient
w w w w w w w w w w w w w w
c. Right patient, right strength, right diagnosis, right drug, and right route
w w w w w w w w w w
d. Right patient, right diagnosis, right drug, right route, and right time
w w w w w w w w w w
ANS: A w
The traditional Five Rights of medication administration were considered to be Right d
w w w w w w w w w w w w
dose, Right time, and Right patient. Right effect, right strength, and right diagnosis ar
w w w w w w w w w w w w w w
Five Rights.
w w
DIF: Cognitive Level: Comprehension w w
8. What correctly describes the nursing process?
w w w w w
a. Diagnosing, planning, assessing, implementing, and finally evaluating
w w w w w w
b. Assessing, then diagnosing, implementing, and ending with evaluating
w w w w w w w
c. A linear direction that begins with assessing and continues
w w w w w w w w
through diagnosing, planning, and finally implementing
w w w w w w
d. An ongoing process that begins with assessing and continues with
w w w w w w w w w
diagnosing, planning, implementing, and evaluating
w w w w w
ANS: D w
The nursing process is an ongoing, flexible, adaptable, and adjustable five-step process
w w w w w w w w w w w
assessing and continues through diagnosing, planning, implementing, and finally evalu
w w w w w w w w w w
lead back to any of the other phases.
w w w w w w w w
DIF: Cognitive Level: Application w w
9. When the nurse is considering the timing of a drug dose, which is most important to a
w w w w w w w w w w w w w w w w
a. The patient’s identification
w w
b. The patient’s weight w w
c. The patient’s last meal
w w w
d. Any drug or food allergies
w w w w
ANS: C w
, lOMoARcPSD| 13728229
w shots.’” The answer “Anxiety” is missing the “related to” and “as evidenced by” porti
w w w w w w w w w w w w w
w “Anxiety related to new drug therapy” is missing the “as evidenced by” portion of def
w w w w w w w w w w w w w w
w The “related to” section in “Anxiety related to anxious feelings about drug therapy, as
w w w w w w w w w w w w w
w statements such as ‘I’m upset about having to give myself shots’” is simply a restatem
w w w w w w w w w w w w w w
w “anxiety,” not a separate factor related to the response.
w w w w w w w w
DIF: Cognitive Level: Analysis w w
OTHER
1. Place the phases of the nursing process in the correct order, starting with the first pha
w w w w w w w w w w w w w w w
a. Planning
b. Evaluation
c. Assessment
d. Implementation
e. Diagnosing
ANS:
C, E, A, D, B
w w w w
DIF: Cognitive Level: Analysis w w
, lOMoARcPSD| 13728229
a. A “right time” problem
w w w
b. A “right dose” problem
w w w
c. A “right route” problem
w w w
d. A “right medication” problem
w w w
ANS: C w
This is a “right route” problem: the nurse cannot assume the route and must cla
w w w w w w w w w w w w w w
prescriber. This is not a “right time” problem because the ordered frequency has no
w w w w w w w w w w w w w w
“right dose” problem because the dose is not related to an inability to swallo
w w w w w w w w w w w w w w
medication” problem because the medication ordered will not change, just the route
w w w w w w w w w w w w
DIF: Cognitive Level: Application w w
3. The nurse has been monitoring the patient’s progress on his new drug regimen since t
w w w w w w w w w w w w w w
wbeen documenting signs of possible adverse effects. What nursing process phase is th
w w w w w w w w w w w w
a. Planning
b. Evaluation
c. Implementation
d. Nursing diagnosis w
ANS: B w
Monitoring the patient’s progress is part of the evaluation phase. Planning, implement
w w w w w w w w w w w
diagnosis are not illustrated by this example.
w w w w w w w
DIF: Cognitive Level: Application w w
4. The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes m
w w w w w w w w w w w w w w w w
wstatement best illustrates an outcome criterion for this patient?
w w w w w w w w
a. The patient will follow instructions.
w w w w
b. The patient will not experience complications.
w w w w w
c. The patient adheres to the new insulin treatment regimen.
w w w w w w w w
d. The patient demonstrates safe insulin self-administration technique.
w w w w w w
ANS: D w
Having the patient demonstrate safe insulin self-administration technique is a specific
w w w w w w w w w w w
outcome criterion. Following instructions and avoiding complications are not specific
w w w w w w w w w w w
the new insulin treatment regimen is not objective and would be difficult to measure
w w w w w w w w w w w w w w
DIF: Cognitive Level: Application w w
5. Which activity best reflects the implementation phase of the nursing process for the p
w w w w w w w w w w w w w
wdiagnosed with type 1 diabetes mellitus? w w w w w
a. Providing education regarding self-injection techniquew w w w
b. Setting goals and outcome criteria with the patient’s input
w w w w w w w w
c. Recording a history of over-the-counter medications used at home
w w w w w w w w
d. Formulating nursing diagnoses regarding knowledge deficits w w w w w
related to the new treatment regimen
w w w w w w
ANS: A w
Education is an intervention that occurs during the implementation phase. Setting goa
w w w w w w w w w w w
reflects the planning phase. Recording a drug history reflects the assessment phase. F
w w w w w w w w w w w w w
diagnoses regarding a knowledge deficit reflects analysis of data as part of the planni
w w w w w w w w w w w w w w
, lOMoARcPSD| 13728229
6. The nurse is working during a very busy night shift, and the health care provider has ju
w w w w w w w w w w w w w w w w
wmedication order over the telephone, but the nurse does not recall the route. What i
w w w w w w w w w w w w w w
wnurse to avoid medication errors?
w w w w
a. Recopy the order neatly on the order sheet, with the most common route indicate
w w w w w w w w w w w w w
b. Consult with the pharmacist for clarification about the most common route
w w w w w w w w w w
c. Call the health care provider to clarify the route of administration
w w w w w w w w w w
d. Withhold the drug until the health care provider visits the patient
w w w w w w w w w w
ANS: C w
If a medication order does not include the route, the nurse must ask the health care p
w w w w w w w w w w w w w w w w
wassume the route of administration.
w w w w
DIF: Cognitive Level: Application | Cognitive Level: Analysis
w w w w w w
7. Which constitutes the traditional Five Rights of medication administration?
w w w w w w w w
a. Right drug, right route, right dose, right time, and right patient
w w w w w w w w w w
b. Right drug, the right effect, the right route, the right time, and the right patient
w w w w w w w w w w w w w w
c. Right patient, right strength, right diagnosis, right drug, and right route
w w w w w w w w w w
d. Right patient, right diagnosis, right drug, right route, and right time
w w w w w w w w w w
ANS: A w
The traditional Five Rights of medication administration were considered to be Right d
w w w w w w w w w w w w
dose, Right time, and Right patient. Right effect, right strength, and right diagnosis ar
w w w w w w w w w w w w w w
Five Rights.
w w
DIF: Cognitive Level: Comprehension w w
8. What correctly describes the nursing process?
w w w w w
a. Diagnosing, planning, assessing, implementing, and finally evaluating
w w w w w w
b. Assessing, then diagnosing, implementing, and ending with evaluating
w w w w w w w
c. A linear direction that begins with assessing and continues
w w w w w w w w
through diagnosing, planning, and finally implementing
w w w w w w
d. An ongoing process that begins with assessing and continues with
w w w w w w w w w
diagnosing, planning, implementing, and evaluating
w w w w w
ANS: D w
The nursing process is an ongoing, flexible, adaptable, and adjustable five-step process
w w w w w w w w w w w
assessing and continues through diagnosing, planning, implementing, and finally evalu
w w w w w w w w w w
lead back to any of the other phases.
w w w w w w w w
DIF: Cognitive Level: Application w w
9. When the nurse is considering the timing of a drug dose, which is most important to a
w w w w w w w w w w w w w w w w
a. The patient’s identification
w w
b. The patient’s weight w w
c. The patient’s last meal
w w w
d. Any drug or food allergies
w w w w
ANS: C w
, lOMoARcPSD| 13728229
w shots.’” The answer “Anxiety” is missing the “related to” and “as evidenced by” porti
w w w w w w w w w w w w w
w “Anxiety related to new drug therapy” is missing the “as evidenced by” portion of def
w w w w w w w w w w w w w w
w The “related to” section in “Anxiety related to anxious feelings about drug therapy, as
w w w w w w w w w w w w w
w statements such as ‘I’m upset about having to give myself shots’” is simply a restatem
w w w w w w w w w w w w w w
w “anxiety,” not a separate factor related to the response.
w w w w w w w w
DIF: Cognitive Level: Analysis w w
OTHER
1. Place the phases of the nursing process in the correct order, starting with the first pha
w w w w w w w w w w w w w w w
a. Planning
b. Evaluation
c. Assessment
d. Implementation
e. Diagnosing
ANS:
C, E, A, D, B
w w w w
DIF: Cognitive Level: Analysis w w
