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NUR 206 Exam 1 Questions and Answers (100%
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The nurse is writing a nursing diagnosis for a plan of care for a patient
who has been newly diagnosed with type 2 diabetes. Which statement
reflects the correct format for a nursing diagnosis?
A) Anxiety
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B) Anxiety related to new drug therapy
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C) Anxiety related to anxious feelings about drug therapy, as evidenced
by statements such as "I'm upset about having to test my blood sugars."
D) Anxiety related to new drug therapy, as evidenced by statements
such as "I'm upset about having to test my blood sugars." Ans: D
Formulation of nursing diagnoses is usually a three-step process. "Anxiety"
is missing the "related to" and "as evidenced by" portions of defining
characteristics. "Anxiety related to new drug therapy" is missing the "as
evidenced by" portion of defining characteristics.
The patient is to receive oral guaifenesin (Mucinex) twice a day. Today,
the nurse was busy and gave the medication 2 hours after the
scheduled dose was due. What type of problem does this represent?
A) "Right time"
B) "Right dose"
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C) "Right route"
D) "Right medication" Ans: A
"Right time" is correct because the medication was given more than 30
minutes after the scheduled dose was due.
The nurse has been monitoring the patient's progress on a new drug
regimen since the first dose and documenting the patient's therapeutic
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response to the medication. Which phase of the nursing process do
these actions illustrate?
a. Nursing diagnosis
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b. Planning
c. Implementation
d. Evaluation Ans: D
Monitoring the patient's progress, including the patient's response to the
medication, is part of the evaluation phase. Planning, implementation,
and nursing diagnosis are not illustrated by this example.
The nurse is assigned to a patient who is newly diagnosed with type 1
diabetes mellitus. Which statement best illustrates an outcome criterion
for this patient?
a. The patient will follow instructions.
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b. The patient will not experience complications.
c. The patient will adhere to the new insulin treatment regimen.
d. The patient will demonstrate correct blood glucose testing technique.
Ans: D
"Demonstrating correct blood glucose testing technique" is a specific
and measurable outcome criterion. "Following instructions" and "not
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experiencing complications" are not specific criteria. "Adhering to new
regimen" would be difficult to measure.
Which activity best reflects the implementation phase of the nursing
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process for the patient who is newly diagnosed with hypertension?
a. Providing education on keeping a journal of blood pressure readings
b. Setting goals and outcome criteria with the patient's input
c. Recording a drug history regarding over-the-counter medications
used at home
d. Formulating nursing diagnoses regarding deficient knowledge related
to the new treatment regimen Ans: A
Education is an intervention that occurs during the implementation
phase. Setting goals and outcomes reflects the planning phase.
Recording a drug history reflects the assessment phase. Formulating
nursing diagnoses reflects analysis of data as part of planning.
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The medication order reads, "Give ondansetron (Zofran) 4 mg, 30
minutes before beginning chemotherapy to prevent nausea." The nurse
notes that the route is missing from the order. What is the nurse's best
action?
a. Give the medication intravenously because the patient might vomit.
b. Give the medication orally because the tablets are available in 4-mg
doses.
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c. Contact the prescriber to clarify the route of the medication ordered.
d. Hold the medication until the prescriber returns to make rounds. Ans:
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C
A complete medication order includes the route of administration. If a
medication order does not include the route, the nurse must ask the
prescriber to clarify it
When the nurse considers the timing of a drug dose, which factor is
appropriate to consider when deciding when to give a drug?
a. The patient's ability to swallow
b. The patient's height
c. The patient's last meal
d. The patient's allergies Ans: C