Nokea
The nurse is developing a human needs statement for a patient who has a new diagnosis of heart failure. Identification of human needs statements occur with which of these activities?
- A. Collection of patient data
- B. Administering interventions
- C. Deciding on patient outcomes
- D. Documenting the patient's behavior
Correct Answer: A
Rationale: Identification of human needs occurs with the collection of patient data.
You may also like to solve these questions
Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase.
- A. Planning
- B. Evaluation
- C. Assessment
- D. Implementation
- E. Human needs statement
Correct Answer: C,E,A,D,B
Rationale: The nursing process is an ongoing process that begins with assessing and continues with human needs statement, planning, implementing, and evaluating.
The medication order reads, 'Give ondansetron 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.
- C. Contact the prescriber to clarify the route of the medication ordered.
- D. Hold the medication until the prescriber returns to make rounds.
Correct Answer: C
Rationale: 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. The intravenous and oral routes are not interchangeable. Holding the medication until the prescriber returns would mean that the patient would not receive a needed medication.
Which activity best reflects the implementation phase of the nursing 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 human needs statements regarding deficient knowledge related to the new treatment regimen
Correct Answer: A
Rationale: 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 human needs statements reflects analysis of data as part of planning.
When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient's right to refuse. Which of these are additional rights? (Select all that apply.)
- A. Right drug
- B. Right route
- C. Right dose
- D. Right diagnosis
- E. Right time
- F. Right patient
Correct Answer: A,B,C,E,F
Rationale: Additional rights of medication administration must always include the right drug, right dose, right time, right route, and right patient. The right diagnosis is incorrect.
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
Correct Answer: C
Rationale: The nurse must consider specific pharmacokinetic/pharmacodynamic drug properties that may be affected by the timing of the last meal. The patient's ability to swallow, height, and allergies are not factors to consider regarding the timing of the drug's administration.