Chapter 01: The Nursing Process and Drug Therapy
MULTIPLE CHOICE
1. 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 refle
...
Chapter 01: The Nursing Process and Drug Therapy
MULTIPLE CHOICE
1. 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
b. Anxiety related to new drug therapy
c. Anxiety related to anxious feelings about drug therapy, as evidenced by statements
VXch aV ³I¶P XSVeW abRXW haYiQg WR WeVW P\ bORRd VXgaUV.´
d. AQ[ieW\ UeOaWed WR QeZ dUXg WheUaS\, aV eYideQced b\ VWaWePeQWV VXch aV ³I¶P
upset about having to test my blood VXgaUV.´
ANS: D
Formulation of nursing diagnoses is usually a three-VWeS SURceVV. ³AQ[ieW\´ iV PiVViQg Whe
³UeOaWed WR´ aQd ³aV eYideQced b\´ SRUWiRQV Rf defiQiQg chaUacWeUiVWicV. ³AQ[ieW\ UeOaWed WR QeZ
dUXg WheUaS\´ iV PiVViQg Whe ³aV eYideQced b\´ portion of defining characteristics. The statement
begiQQiQg ³AQ[ieW\ UeOaWed WR aQ[iRXV feeOiQgV´ iV iQcRUUecW becaXVe Whe ³UeOaWed WR´ VecWiRQ iV
ViPSO\ a UeVWaWePeQW Rf Whe SURbOeP ³aQ[ieW\,´ QRW a VeSaUaWe facWRU UeOaWed WR Whe UeVSRQVe.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Safe and Effective Care Environment: Management of Care
2. 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. ³RighW WiPe´
b. ³RighW dRVe´
c. ³RighW URXWe´
d. ³RighW PedicaWiRQ´
ANS: A
³RighW WiPe´ iV cRUUecW becaXVe Whe PedicaWiRQ ZaV giYeQ PRUe WhaQ 30 minutes after the
VchedXOed dRVe ZaV dXe. ³DRVe´ iV iQcRUUecW becaXVe Whe dRVe iV QRW UeOaWed WR Whe WiPe Whe
PedicaWiRQ adPiQiVWUaWiRQ iV VchedXOed. ³RRXWe´ iV iQcRUUecW becaXVe Whe URXWe iV QRW affecWed.
³MedicaWiRQ´ iV iQcRUUecW becaXVe Whe PedicaWiRQ Rrdered will not change.
DIF: COGNITIVE LEVEL: Applying (Application)
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control
3. The QXUVe haV beeQ PRQiWRUiQg Whe SaWieQW¶V SURgUeVV RQ a QeZ drug regimen since the first dose
aQd dRcXPeQWiQg Whe SaWieQW¶V WheUaSeXWic UeVSRQVe WR Whe PedicaWiRQ. Which ShaVe Rf Whe
nursing process do these actions illustrate?
a. Nursing diagnosis
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Chapter 01: The Nursing Process and Drug Therapy 5
b. Planning
c. Implementation
d. Evaluation
ANS: D
Monitoring Whe SaWieQW¶V SURgUeVV, iQcOXdiQg Whe SaWieQW¶V UeVSRQVe WR Whe PedicaWiRQ, iV SaUW Rf
the evaluation phase. Planning, implementation, and nursing diagnosis are not illustrated by this
example.
DIF: COGNITIVE LEVEL: Understanding (Comprehension)
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Safe and Effective Care Environment: Management of Car
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