PRIMEXAM.COM
,Chapter 01: The Nursing Process and Drug Therapy
f f f f f f f
Lilley: Pharmacology and the Nursing Process, 10th Edition
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MULTIPLE CHOICE f
1. The nurse is developing a human needs statement for a patient who has a new diagnosis of
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heart failure. Identification of human needs statements occur with which of these activities?
f f f f f f f f f f f f f
a. Collection of patient data f f f
b. Administering interventions f
c. Deciding on patient outcomes f f f
d. Documenting the patient‘s behavior f f f
ANS: A f
Identification of human needs occurs with the collection of patient data. f f f f f f f f f f
DIF: Cognitive Level: Understanding (Comprehension) f f f
TOP: Nursing Process: Human Needs Statement
f f f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
2. The patient is to receive oral guaifenesin twice a day. Today, the nurse was busy and gave the
f f f f f f f f f f f f f f f f f
medication 2 hours after the scheduled dose was due. What type of problem does this
f f f f f f f f f f f f f f f
represent?
f
a. ―Right time‖ f
b. ―Right dose‖ f
c. ―Right route‖ f
d. ―Right medication‖ f
ANS: A f
―Right time‖ is correct because the medication was given more than 30 minutes after the scheduled
f f f f f f f f f f f f f f f
dose was due. ―Dose‖ is incorrect because the dose is not related to the time the medication
f f f f f f f f f f f f f f f f f
administration is scheduled. ―Route‖ is incorrect because the route is not affected.
f f f f f f f f f f f f
―Medication‖ is incorrect because the medication ordered will not change. f f f f f f f f f
DIF: Cognitive Level: Applying (Application) f f f
TOP: Nursing Process: Implementation
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
f f f f f f f f f f
3. The nurse has been monitoring the patient‘s progress on a new drug regimen since the first
f f f f f f f f f f f f f f f
dose and documenting the patient‘s therapeutic response to the medication. Which phase of
f f f f f f f f f f f f f
the nursing process do these actions illustrate?
f f f f f f f
a. Human needs statement f f
b. Planning
c. Implementation
d. Evaluation
ANS: D f
Monitoring the patient‘s progress, including the patient‘s response to the medication, is part of
f f f f f f f f f f f f f
the evaluation phase. Planning, implementation, and human needs statement are not illustrated
f f f f f f f f f f f f
by this example.
f f f
DIF: f f Cognitive Level: Understanding (Comprehension) f f f TOP: Nursing Process: Evaluation f f f
PRIMEXAM.COM
, MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
4. The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus.
f f f f f f f f f f f f f f f
Which statement best illustrates an outcome criterion for this patient?
f f f f f f f f f f
a.The patient will follow instructions. f f f f
b.The patient will not experience complications.
f f f f f
c.The patient will adhere to the new insulin treatment regimen.
f f f f f f f f f
d.The patient will demonstrate correct blood glucose testing technique.
f f f f f f f f
ANS: D f
―Demonstrating correct blood glucose testing technique‖ is a specific and measurable f f f f f f f f f f
outcome criterion. ―Following instructions‖ and ―not experiencing complications‖ are not
f f f f f f f f f f
specific criteria. ―Adhering to new regimen‖ would be difficult to measure.
f f f f f f f f f f f
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning f f f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f f
5. Which activity best reflects the implementation phase of the nursing process for the patient
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who is newly diagnosed with hypertension?
f f f f f f
a.Providing education on keeping a journal of blood pressure readings f f f f f f f f f
b.Setting goals and outcome criteria with the patient‘s input f f f f f f f f
c.Recording a drug history regarding over-the-counter medications used at home f f f f f f f f f
d.Formulating human needs statements regarding deficient knowledge related to the f f f f f f f f f
new treatment regimen
f f f
ANS: A f
Education is an intervention that occurs during the implementation phase. Setting goals and
f f f f f f f f f f f f
outcomes reflects the planning phase. Recording a drug history reflects the assessment phase.
f f f f f f f f f f f f f
Formulating human needs statements reflects analysis of data as part of planning.
f f f f f f f f f f f f
DIF: Cognitive Level: Applying (Application) f f f
TOP: Nursing Process: Implementation
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
6. The medication order reads, ―Give ondansetron 4 mg, 30 minutes before beginning
f f f f f f f f f f f
chemotherapy to prevent nausea.‖ The nurse notes that the route is missing from the order.
f f f f f f f f f f f f f f f
What is the nurse‘s best action?
f f f f f f
a. Give the medication intravenously because the patient might vomit.
f f f f f f f f
b. Give the medication orally because the tablets are available in 4-mg doses.
f f f f f f f f f f f
c. Contact the prescriber to clarify the route of the medication ordered. f f f f f f f f f f
d. Hold the medication until the prescriber returns to make rounds.
f f f f f f f f f
ANS: C f
A complete medication order includes the route of administration. If a medication order does not
f f f f f f f f f f f f f f
include the route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes
f f f f f f f f f f f f f f f f f
are not interchangeable. Holding the medication until the prescriber returns would mean that
f f f f f f f f f f f f f
the patient would not receive a needed medication.
f f f f f f f f
DIF: Cognitive Level: Applying (Application) f f f
TOP: Nursing Process: Implementation
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
PRIMEXAM.COM
, 7. When the nurse considers the timing of a drug dose, which factor is appropriate to consider
f f f f f f f f f f f f f f f
when deciding when to give a drug?
f f f f f f f
a.The patient‘s ability to swallow f f f f
b.The patient‘s height f f
c.The patient‘s last meal f f f
d.The patient‘s allergies f f
ANS: C f
The nurse must consider specific pharmacokinetic/pharmacodynamic drug properties that may
f f f f f f f f f
be affected by the timing of the last meal. The patient‘s ability to swallow, height, and allergies
f f f f f f f f f f f f f f f f f
are not factors to consider regarding the timing of the drug‘s administration.
f f f f f f f f f f f f
DIF: Cognitive Level: Understanding (Comprehension) f f f
TOP: Nursing Process: Assessment
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
8. The nurse is performing an assessment of a newly admitted patient. Which is an example of
f f f f f f f f f f f f f f f
subjective data?
f f
a. Weight 155 pounds f f
b. Pulse 72 beats/minute f f
c. The patient reports that he uses the herbal product ginkgo
f f f f f f f f f
d. The patient‘s complete blood count results f f f f f
ANS: C f
Subjective data include information shared through the spoken word by any reliable source,
f f f f f f f f f f f f
such as the patient. Objective data may be defined as any information gathered through the
f f f f f f f f f f f f f f f
senses or that which is seen, heard, felt, or smelled. A patient‘s pulse, weight, and laboratory
f f f f f f f f f f f f f f f f
tests are all examples of objective data.
f f f f f f f
DIF: Cognitive Level: Understanding (Comprehension) f f f
TOP: Nursing Process: Assessment
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
MULTIPLE RESPONSE f
1. When giving medications, the nurse will follow the rights of medication administration. The
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rights include the right documentation, the right reason, the right response, and the patient‘s
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right to refuse. Which of these are additional rights? (Select all that apply.)
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a. Right drug f
b. Right route f
c. Right dose f
d. Right diagnosis f
e. Right time f
f. Right patient f
ANS: A, B, C, E, F f f f f f
Additional rights of medication administration must always include the right drug, right dose,
f f f f f f f f f f f f
right time, right route, and right patient. The right diagnosis is incorrect.
f f f f f f f f f f f f
DIF: Cognitive Level: Remembering (Knowledge) f f f
TOP: Nursing Process: Implementation
f f f f
PRIMEXAM.COM
,Chapter 01: The Nursing Process and Drug Therapy
f f f f f f f
Lilley: Pharmacology and the Nursing Process, 10th Edition
f f f f f f f
MULTIPLE CHOICE f
1. The nurse is developing a human needs statement for a patient who has a new diagnosis of
f f f f f f f f f f f f f f f f
heart failure. Identification of human needs statements occur with which of these activities?
f f f f f f f f f f f f f
a. Collection of patient data f f f
b. Administering interventions f
c. Deciding on patient outcomes f f f
d. Documenting the patient‘s behavior f f f
ANS: A f
Identification of human needs occurs with the collection of patient data. f f f f f f f f f f
DIF: Cognitive Level: Understanding (Comprehension) f f f
TOP: Nursing Process: Human Needs Statement
f f f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
2. The patient is to receive oral guaifenesin twice a day. Today, the nurse was busy and gave the
f f f f f f f f f f f f f f f f f
medication 2 hours after the scheduled dose was due. What type of problem does this
f f f f f f f f f f f f f f f
represent?
f
a. ―Right time‖ f
b. ―Right dose‖ f
c. ―Right route‖ f
d. ―Right medication‖ f
ANS: A f
―Right time‖ is correct because the medication was given more than 30 minutes after the scheduled
f f f f f f f f f f f f f f f
dose was due. ―Dose‖ is incorrect because the dose is not related to the time the medication
f f f f f f f f f f f f f f f f f
administration is scheduled. ―Route‖ is incorrect because the route is not affected.
f f f f f f f f f f f f
―Medication‖ is incorrect because the medication ordered will not change. f f f f f f f f f
DIF: Cognitive Level: Applying (Application) f f f
TOP: Nursing Process: Implementation
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
f f f f f f f f f f
3. The nurse has been monitoring the patient‘s progress on a new drug regimen since the first
f f f f f f f f f f f f f f f
dose and documenting the patient‘s therapeutic response to the medication. Which phase of
f f f f f f f f f f f f f
the nursing process do these actions illustrate?
f f f f f f f
a. Human needs statement f f
b. Planning
c. Implementation
d. Evaluation
ANS: D f
Monitoring the patient‘s progress, including the patient‘s response to the medication, is part of
f f f f f f f f f f f f f
the evaluation phase. Planning, implementation, and human needs statement are not illustrated
f f f f f f f f f f f f
by this example.
f f f
DIF: f f Cognitive Level: Understanding (Comprehension) f f f TOP: Nursing Process: Evaluation f f f
PRIMEXAM.COM
, MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
4. The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus.
f f f f f f f f f f f f f f f
Which statement best illustrates an outcome criterion for this patient?
f f f f f f f f f f
a.The patient will follow instructions. f f f f
b.The patient will not experience complications.
f f f f f
c.The patient will adhere to the new insulin treatment regimen.
f f f f f f f f f
d.The patient will demonstrate correct blood glucose testing technique.
f f f f f f f f
ANS: D f
―Demonstrating correct blood glucose testing technique‖ is a specific and measurable f f f f f f f f f f
outcome criterion. ―Following instructions‖ and ―not experiencing complications‖ are not
f f f f f f f f f f
specific criteria. ―Adhering to new regimen‖ would be difficult to measure.
f f f f f f f f f f f
DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning f f f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f f
5. Which activity best reflects the implementation phase of the nursing process for the patient
f f f f f f f f f f f f f
who is newly diagnosed with hypertension?
f f f f f f
a.Providing education on keeping a journal of blood pressure readings f f f f f f f f f
b.Setting goals and outcome criteria with the patient‘s input f f f f f f f f
c.Recording a drug history regarding over-the-counter medications used at home f f f f f f f f f
d.Formulating human needs statements regarding deficient knowledge related to the f f f f f f f f f
new treatment regimen
f f f
ANS: A f
Education is an intervention that occurs during the implementation phase. Setting goals and
f f f f f f f f f f f f
outcomes reflects the planning phase. Recording a drug history reflects the assessment phase.
f f f f f f f f f f f f f
Formulating human needs statements reflects analysis of data as part of planning.
f f f f f f f f f f f f
DIF: Cognitive Level: Applying (Application) f f f
TOP: Nursing Process: Implementation
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
6. The medication order reads, ―Give ondansetron 4 mg, 30 minutes before beginning
f f f f f f f f f f f
chemotherapy to prevent nausea.‖ The nurse notes that the route is missing from the order.
f f f f f f f f f f f f f f f
What is the nurse‘s best action?
f f f f f f
a. Give the medication intravenously because the patient might vomit.
f f f f f f f f
b. Give the medication orally because the tablets are available in 4-mg doses.
f f f f f f f f f f f
c. Contact the prescriber to clarify the route of the medication ordered. f f f f f f f f f f
d. Hold the medication until the prescriber returns to make rounds.
f f f f f f f f f
ANS: C f
A complete medication order includes the route of administration. If a medication order does not
f f f f f f f f f f f f f f
include the route, the nurse must ask the prescriber to clarify it. The intravenous and oral routes
f f f f f f f f f f f f f f f f f
are not interchangeable. Holding the medication until the prescriber returns would mean that
f f f f f f f f f f f f f
the patient would not receive a needed medication.
f f f f f f f f
DIF: Cognitive Level: Applying (Application) f f f
TOP: Nursing Process: Implementation
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
PRIMEXAM.COM
, 7. When the nurse considers the timing of a drug dose, which factor is appropriate to consider
f f f f f f f f f f f f f f f
when deciding when to give a drug?
f f f f f f f
a.The patient‘s ability to swallow f f f f
b.The patient‘s height f f
c.The patient‘s last meal f f f
d.The patient‘s allergies f f
ANS: C f
The nurse must consider specific pharmacokinetic/pharmacodynamic drug properties that may
f f f f f f f f f
be affected by the timing of the last meal. The patient‘s ability to swallow, height, and allergies
f f f f f f f f f f f f f f f f f
are not factors to consider regarding the timing of the drug‘s administration.
f f f f f f f f f f f f
DIF: Cognitive Level: Understanding (Comprehension) f f f
TOP: Nursing Process: Assessment
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
8. The nurse is performing an assessment of a newly admitted patient. Which is an example of
f f f f f f f f f f f f f f f
subjective data?
f f
a. Weight 155 pounds f f
b. Pulse 72 beats/minute f f
c. The patient reports that he uses the herbal product ginkgo
f f f f f f f f f
d. The patient‘s complete blood count results f f f f f
ANS: C f
Subjective data include information shared through the spoken word by any reliable source,
f f f f f f f f f f f f
such as the patient. Objective data may be defined as any information gathered through the
f f f f f f f f f f f f f f f
senses or that which is seen, heard, felt, or smelled. A patient‘s pulse, weight, and laboratory
f f f f f f f f f f f f f f f f
tests are all examples of objective data.
f f f f f f f
DIF: Cognitive Level: Understanding (Comprehension) f f f
TOP: Nursing Process: Assessment
f f f f
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
f f f f f f f f f
MULTIPLE RESPONSE f
1. When giving medications, the nurse will follow the rights of medication administration. The
f f f f f f f f f f f f
rights include the right documentation, the right reason, the right response, and the patient‘s
f f f f f f f f f f f f f f
right to refuse. Which of these are additional rights? (Select all that apply.)
f f f f f f f f f f f f f
a. Right drug f
b. Right route f
c. Right dose f
d. Right diagnosis f
e. Right time f
f. Right patient f
ANS: A, B, C, E, F f f f f f
Additional rights of medication administration must always include the right drug, right dose,
f f f f f f f f f f f f
right time, right route, and right patient. The right diagnosis is incorrect.
f f f f f f f f f f f f
DIF: Cognitive Level: Remembering (Knowledge) f f f
TOP: Nursing Process: Implementation
f f f f
PRIMEXAM.COM
