Lilley:jPharmacologyjandjthejNursingjProcess,j10thjEdition
MULTIPLEjCHOICE
1. Thejnursejisjdevelopingjajhumanjneedsjstatementjforjajpatientjwhojhasjajnewjdiagnosisjofjhea
rtjfailure.jIdentificationjofjhumanjneedsjstatementsjoccurjwithjwhichjofjthesejactivities?
a. Collectionjofjpatientjdata
b. Administeringjinterventions
c. Decidingjonjpatientjoutcomes
d. Documentingjthejpatient‘sjbehavior
ANS:j A
Identificationjofjhumanjneedsjoccursjwithjthejcollectionjofjpatientjdata.
DIF:
CognitivejLevel:jUnderstandingj(Comprehension)j
TOP:j NursingjProcess:jHumanjNeedsjStatement
MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jManagementjofjCare
2. Thejpatientjisjtojreceivejoraljguaifenesinjtwicejajday.jToday,jthejnursejwasjbusyjandjgavejthejme
dicationj2jhoursjafterjthejscheduledjdosejwasjdue.jWhatjtypejofjproblemjdoesjthisjrepresent?
a. ―Rightj time‖
b. ―Rightj dose‖
c. ―Rightj route‖
d. ―Rightj medication‖
ANS:j A
―Rightjtime‖jisjcorrectjbecausejthejmedicationjwasjgivenjmorejthanj30jminutesjafterjthejscheduledj
dosejwasjdue.j―Dose‖jisjincorrectjbecausejthejdosejisjnotjrelatedjtojthejtimejthejmedicationjadminist
rationjisjscheduled.j―Route‖jisjincorrectjbecausejthejroutejisjnotjaffected.
―Medication‖jisjincorrectjbecausejthejmedicationjorderedjwilljnotjchange.
DIF:
CognitivejLevel:jApplyingj(Application)j
TOP:j NursingjProcess:jImplementation
MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jSafetyjandjInfectionjControl
3. Thejnursejhasjbeenjmonitoringjthejpatient‘sjprogressjonjajnewjdrugjregimenjsincejthejfirstjdos
ejandjdocumentingjthejpatient‘sjtherapeuticjresponsejtojthejmedication.jWhichjphasejofjthejnu
rsingjprocessjdojthesejactionsjillustrate?
a. Humanjneedsjstatement
b. Planning
c. Implementation
d. Evaluation
ANS:j D
Monitoringjthejpatient‘sjprogress,jincludingjthejpatient‘sjresponsejtojthejmedication,jisjpartjofjth
ejevaluationjphase.jPlanning,jimplementation,jandjhumanjneedsjstatementjarejnotjillustratedjbyjt
hisjexample.
DIF:j j CognitivejLevel:jUnderstandingj(Comprehension) TOP:j NursingjProcess:jEvaluation
, MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jManagementjofjCare
4. Thejnursejisjassignedjtojajpatientjwhojisjnewlyjdiagnosedjwithjtypej1jdiabetesjmellitus.jW
hichjstatementjbestjillustratesjanjoutcomejcriterionjforjthisjpatient?
a. Thejpatientjwilljfollowjinstructions.
b. Thejpatientjwilljnotjexperiencejcomplications.
c. Thejpatientjwilljadherejtojthejnewjinsulinjtreatmentjregimen.
d. Thejpatientjwilljdemonstratejcorrectjbloodjglucosejtestingjtechnique.
ANS:j D
―Demonstratingjcorrectjbloodjglucosejtestingjtechnique‖jisjajspecificjandjmeasurablejoutco
mejcriterion.j―Followingjinstructions‖jandj―notjexperiencingjcomplications‖jarejnotjspecificjc
riteria.j―Adheringjtojnewjregimen‖jwouldjbejdifficultjtojmeasure.
DIF: CognitivejLevel:jApplyingj(Application)
TOP:j NursingjProcess:jPlanningjMSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jMana
gementjofjCare
5. Whichjactivityjbestjreflectsjthejimplementationjphasejofjthejnursingjprocessjforjthejpatientjw
hojisjnewlyjdiagnosedjwithjhypertension?
a. Providingjeducationjonjkeepingjajjournaljofjbloodjpressurejreadings
b. Settingjgoalsjandjoutcomejcriteriajwithjthejpatient‘sjinput
c. Recordingjajdrugjhistoryjregardingjover-the-counterjmedicationsjusedjatjhome
d. Formulatingjhumanjneedsjstatementsjregardingjdeficientjknowledgejrelatedjtojthejn
ewjtreatmentjregimen
ANS:j A
Educationjisjanjinterventionjthatjoccursjduringjthejimplementationjphase.jSettingjgoalsjandjoutcome
sjreflectsjthejplanningjphase.jRecordingjajdrugjhistoryjreflectsjthejassessmentjphase.jFormulatingjhu
manjneedsjstatementsjreflectsjanalysisjofjdatajasjpartjofjplanning.
DIF:
CognitivejLevel:jApplyingj(Application)j
TOP:j NursingjProcess:jImplementation
MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jManagementjofjCare
6. Thejmedicationjorderjreads,j―Givejondansetronj4jmg,j30jminutesjbeforejbeginningjchemot
herapyjtojpreventjnausea.‖jThejnursejnotesjthatjthejroutejisjmissingjfromjthejorder.jWhatjisjth
ejnurse‘sjbestjaction?
a. Givejthejmedicationjintravenouslyjbecausejthejpatientjmightjvomit.
b. Givejthejmedicationjorallyjbecausejthejtabletsjarejavailablejinj4-mgjdoses.
c. Contactjthejprescriberjtojclarifyjthejroutejofjthejmedicationjordered.
d. Holdjthejmedicationjuntiljthejprescriberjreturnsjtojmakejrounds.
ANS:j C
Ajcompletejmedicationjorderjincludesjthejroutejofjadministration.jIfjajmedicationjorderjdoesjnotji
ncludejthejroute,jthejnursejmustjaskjthejprescriberjtojclarifyjit.jThejintravenousjandjoraljroutesjar
ejnotjinterchangeable.jHoldingjthejmedicationjuntiljthejprescriberjreturnsjwouldjmeanjthatjthejp
atientjwouldjnotjreceivejajneededjmedication.
DIF:
CognitivejLevel:jApplyingj(Application)j
TOP:j NursingjProcess:jImplementation
MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jManagementjofjCare
, 7. Whenjthejnursejconsidersjthejtimingjofjajdrugjdose,jwhichjfactorjisjappropriatejtojconsiderjwh
enjdecidingjwhenjtojgivejajdrug?
a. Thejpatient‘sjabilityjtojswallow
b. Thejpatient‘sjheight
c. Thejpatient‘sjlastjmeal
d. Thejpatient‘sjallergies
ANS:j C
Thejnursejmustjconsiderjspecificjpharmacokinetic/pharmacodynamicjdrugjpropertiesjthatjmayjb
ejaffectedjbyjthejtimingjofjthejlastjmeal.jThejpatient‘sjabilityjtojswallow,jheight,jandjallergiesjare
jnotjfactorsjtojconsiderjregardingjthejtimingjofjthejdrug‘sjadministration.
DIF:
CognitivejLevel:jUnderstandingj(Comprehension)j
TOP:j NursingjProcess:jAssessment
MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jManagementjofjCare
8. Thejnursejisjperformingjanjassessmentjofjajnewlyjadmittedjpatient.jWhichjisjanjexamplejofjsu
bjectivejdata?
a. Weightj155jpounds
b. Pulsej72jbeats/minute
c. Thejpatientjreportsjthatjhejusesjthejherbaljproductj ginkgo
d. Thejpatient‘sjcompletejbloodjcountjresults
ANS:j C
Subjectivejdatajincludejinformationjsharedjthroughjthejspokenjwordjbyjanyjreliablejsource,jsuch
jasjthejpatient.jObjectivejdatajmayjbejdefinedjasjanyjinformationjgatheredjthroughjthejsensesjorjt
hatjwhichjisjseen,jheard,jfelt,jorjsmelled.jAjpatient‘sjpulse,jweight,jandjlaboratoryjtestsjarejalljexa
mplesjofjobjectivejdata.
DIF:
CognitivejLevel:jUnderstandingj(Comprehension)j
TOP:j NursingjProcess:jAssessment
MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jManagementjofjCare
MULTIPLEjRESPONSE
1. Whenjgivingjmedications,jthejnursejwilljfollowjthejrightsjofjmedicationjadministration.jThejri
ghtsjincludejthejrightjdocumentation,jthejrightjreason,jthejrightjresponse,jandjthejpatient‘sjrigh
tjtojrefuse.jWhichjofjthesejarejadditionaljrights?j(Selectjalljthatjapply.)
a. Rightjdrug
b. Rightjroute
c. Rightjdose
d. Rightjdiagnosis
e. Rightjtime
f. Rightjpatient
ANS:j A,jB,jC,jE,jF
Additionaljrightsjofjmedicationjadministrationjmustjalwaysjincludejthejrightjdrug,jrightjdose,jrig
htjtime,jrightjroute,jandjrightjpatient.jThejrightjdiagnosisjisjincorrect.
DIF:
CognitivejLevel:jRememberingj(Knowledge)j
TOP:j NursingjProcess:jImplementation
, MSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jSafetyjandjInfectionjControl
OTHER
1. Placejthejphasesjofjthejnursingjprocessjinjthejcorrectjorder,jwithj1jasjthejfirstjphasejandj5jasjthejl
astjphase.
a. Planning
b. Evaluation
c. Assessment
d. Implementation
e. Humanjneedsjstatement
ANS:
C,jE,jA,jD,jB
Thejnursingjprocessjisjanjongoingjprocessjthatjbeginsjwithjassessingjandjcontinuesjwithjhuma
njneedsjstatement,jplanning,jimplementing,jandjevaluating.
DIF: CognitivejLevel:jApplyingj(Application)
TOP:j NursingjProcess:jGeneraljMSC:j NCLEX:jSafejandjEffectivejCarejEnvironment:jMana
gementjofjCare