Kee: Pharmacology, 6th Edition

Test Bank Chapter 2: Nursing Process and Client Teaching

MULTIPLE CHOICE 1. Which of the following is the sequence of steps in the nursing process? 1. implementation, evaluation, planning, assessment 2. planning, assessment, implementation, evaluation 3. assessment, planning, implementation, evaluation 4. evaluation, implementation, assessment, planning ANS: 3

These are the steps of the nursing process. In this text, analysis is considered part of assessment
DIF: Cognitive Level: Comprehension REF: 13 MSC: CONTENT CATEGORY: Management of Care TOP: Nursing Process: All

2. The clients knowledge base about drugs used is part of which of the following? 1. plan 2. analysis 3. subjective database 4. objective database ANS: 3

Data received in the subjective realm are based on client statements. The data would reflect the clients knowledge.
DIF: Cognitive Level: Comprehension REF: 14 TOP: Nursing Process: Assessment MSC: CONTENT CATEGORY: Health Promotion and Maintenance 3. Effectiveness of health teaching and drug therapy is associated with which of the

following phases of the nursing process? 1. implementation 2. planning 3. assessment 4. evaluation

ANS: 4

The nurse would assess the effectiveness of a medication during the evaluation phase.
DIF: Cognitive Level: Comprehension Evaluation REF: 21 TOP: Nursing Process:

Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

4. During which phase of the nursing process would the nurse identify client perceptions

and expectations of the drugs effectiveness? 1. planning 2. assessment 3. evaluation 4. implementation

ANS: 2

This information is solicited during the assessment phase.

DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment Care REF: 14 MSC: CONTENT CATEGORY: Management of

5. The nurse is establishing goals for a client related to medication administration. Which of

the phases of the nursing process is characterized by goal setting? 1. planning 2. evaluation 3. implementation 4. assessment
ANS: 1

It is during planning that nursing diagnoses are prioritized and client goals and nursing strategies are developed.
DIF: Cognitive Level: Comprehension REF: 17 Planning MSC: CONTENT CATEGORY: Management of Care TOP: Nursing Process:

6. During the implementation phase of the nursing process, which of the following is the

most important nursing function? 1. client education and teaching 2. identification of financial resources 3. monitoring goal attainment 4. analysis of assessment data
ANS: 1

This is the phase for teaching; the other answers are in other steps of the nursing process.
DIF: Cognitive Level: Comprehension REF: 17 TOP: Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Management of Care 7. Which of the following is a correctly written goal? 1. The client will independently administer a prescribed dose of antibiotic by the end

of the first teaching session.

2. The client will learn to take an antibiotic correctly. 3. The client will administer a prescribed dose. 4. The client will know how to administer antibiotics.

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ANS: 1

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Client goals should include a subject, action verb, measurable and observable behaviors, and a target date.
DIF: Cognitive Level: Application REF: 17 Planning MSC: CONTENT CATEGORY: Management of Care TOP: Nursing Process:

8. Upon physical assessment, a nurse notes that a client has visual impairment. The nurse is

concerned that the clients visual changes may affect his ability to self-administer medications. Select the nursing diagnosis below that best describes this situation. 1. risk for ineffective therapeutic regimen management related to medication secondary to visual impairment 2. deficient knowledge related to medication administration 3. ineffective family therapeutic regimen management related to visual impairment 4. ineffective coping related to lack of ability to self-administer medications
ANS: 1

The nurse would need more information to determine if an actual nursing diagnosis exists. This diagnosis would best represent this problem.
DIF: Cognitive Level: Analysis REF: 16 Analysis MSC: CONTENT CATEGORY: Management of Care TOP: Nursing Process:

9. In your assessment, a client tells you that he or she has had a reaction to a medication.

Your next nursing intervention is to: 1. let the physician know that the client cannot receive the medication 2. ask the client the type of reaction experienced 3. reassure the client that the reaction will not occur again 4. note the comment in the clients chart and give the medication
ANS: 2

It is important for the nurse to know what type of reaction occurred in order to plan action.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment Care REF: 14-15 MSC: CONTENT CATEGORY: Management of

10. A nurse is caring for a client who takes a chewable medication. The client does not take

the medication because his teeth and gums have pain when chewing. The nurse establishes the following nursing diagnosis for the client: impaired dentition related to chronic gum inflammation secondary to poor dental hygiene. Which of the following nursing goals is most appropriate for the client? 1. The client will verbalize the pathophysiology of gum disease. 2. The client will demonstrate the procedure for brushing teeth. 3. The client will understand the need for dental hygiene. 4. The client will discuss the reasons dental hygiene is important.
Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

ANS: 2

An important intervention would be to teach the client how to take care of his teeth, which would alleviate the pain and allow for greater adherence to the medication regimen.
DIF: Cognitive Level: Application REF: 17 Planning MSC: CONTENT CATEGORY: Management of Care TOP: Nursing Process:

11. A nurse is teaching a client about a medication that is scheduled to be administered qid.

The client states that she does not use a watch or clock and lives without a daily routine. Which of the following would be most helpful for the client? 1. Instruct the client to take the medication each morning and evening when brushing her teeth. 2. Instruct the client to take the medication at lunch every day. 3. Provide the client with a watch to ensure she takes the medication at correct times. 4. Teach the client to take the medication with meals and at bedtime each day.
ANS: 4

For a client who is not time oriented and needs to take the medication 4 times a day, this is the only answer that is feasible.
DIF: Cognitive Level: Application REF: 19 TOP: Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Health Promotion and Maintenance 12. You are teaching a client about his medications. In his care plan, a previous nurse

indicated that the client was a visual learner. Which of the following teaching strategies would be indicated for this client? 1. pamphlets or videos about the medication 2. opportunities for practicing the administration of medication 3. a discussion about the medication 4. an audiotape describing the medication and its actions
ANS: 1

A visual learner would respond best to teaching strategies that can be seen (e.g., pamphlets or videos).
DIF: Cognitive Level: Application REF: 18 | 20 TOP: Nursing Process: Planning MSC: CONTENT CATEGORY: Health Promotion and Maintenance 13. A nurse is establishing a plan of care for a client ordered to receive antibiotic therapy.

The client does not read English but is able to understand spoken English. He is of a lower income socioeconomic group. Which of the following strategies would be most appropriate to teach this client? 1. Provide a videotape going over the information. 2. Give the client several pamphlets and ask him to go over them with his family.

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3. Provide a teaching sheet with simple words and pictures. 4. Arrange a quiet time to discuss the medication regimen with the client. ANS: 4

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This strategy takes both the clients strengths and economics into account.
DIF: Cognitive Level: Application REF: 19 Planning MSC: CONTENT CATEGORY: Management of Care TOP: Nursing Process:

14. A client with AIDS-defined disease is ordered to receive two different medications. The

primary care nurse notes that he has not been taking his medications as ordered. He states that he doesnt like the side effects of the drugs. Which of the following is an appropriate nursing diagnosis? 1. knowledge deficit related to progression of the AIDS disease 2. grieving related to diagnosis of terminal disease 3. risk for infection related to impaired immune function 4. noncompliance related to medication side effects and lack of knowledge
ANS: 4

This nursing diagnosis reflects analysis of the client data.

DIF: Cognitive Level: Analysis REF: 15-16 Analysis MSC: CONTENT CATEGORY: Management of Care TOP: Nursing Process:

Elsevier items and derived items 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.