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 

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 statement 

beginning “Anxiety related to anxious feelings” is incorrect because the “related to” section is 

simply a restatement of the problem “anxiety,” not a separate factor related to the response.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 7

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. “Right time”

b. “Right dose”

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. “Dose” is incorrect because the dose is not related to the time the 

medication administration is scheduled. “Route” is incorrect because the route is not affected. 

“Medication” is incorrect because the medication ordered will not change.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 11

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

3. The nurse has been monitoring the patient’s progress on a new drug regimen since the first dose 

and documenting the patient’s therapeutic response to the medication. Which phase of the 

nursing process do these actions illustrate?

a. Nursing diagnosis

Chapter 01: The Nursing Process and Drug Therapy 5

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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: pp. 13-14

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

4. 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.

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 experiencing complications” are not specific criteria. 

“Adhering to new regimen” would be difficult to measure.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 8

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

5. 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 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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: pp. 8-9

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

6. 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?

Chapter 01: The Nursing Process and Drug Therapy 6

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.

ANS: 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. 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.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 12

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

7. 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

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.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 12

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

8. The nurse is performing an assessment of a newly admitted patient. Which is an example of 

subjective data?

a. Blood pressure 158/96 mm Hg

b. Weight 255 pounds

c. The patient reports that he uses the herbal product ginkgo.

d. The patient’s laboratory work includes a complete blood count and urinalysis.

ANS: C

Subjective data include information shared through the spoken word by any reliable source, such 

as the patient. Objective data may be defined as any information gathered through the senses or 

that which is seen, heard, felt, or smelled. A patient’s blood pressure, weight, and laboratory tests 

are all examples of objective data.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 6

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

MULTIPLE RESPONSE

Chapter 01: The Nursing Process and Drug Therapy 7

1. 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

ANS: A, B, C, E, F

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.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 9

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

2. Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the 

last phase. (Select all that apply.)

a. Planning

b. Evaluation

c. Assessment

d. Implementation

e. Nursing Diagnoses

ANS: A, B, C, D, E

The nursing process is an ongoing process that begins with assessing and continues with 

diagnosing, planning, implementing, and evaluating.

DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 4

TOP: NURSING PROCESS: General

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Chapter 02: Pharmacologic Principles 8

Chapter 02: Pharmacologic Principles

MULTIPLE CHOICE

1. The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are 

absorbed into the circulation in identical amounts. Which term is used to identify this principle?

a. Bioequivalent

b. Synergistic

c. Prodrugs

d. Steady state

ANS: A

Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the 

same bioavailability; thus, they are bioequivalent. A drug’s steady state is the physiologic state in 

which the amount of drug removed via elimination is equal to the amount of drug absorbed from 

each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is 

greater than the sum of the effects of each drug given alone. A prodrug is an inactive drug 

dosage form that is converted to an active metabolite by various biochemical reactions once it is 

inside the body.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 21

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies