Medical-Surgical Nursing – Ignatavicius 11th
Edition | NCLEX-Style Practice Questions and
Answers with Rationale
Section 1: Professional Nursing Practice & Clinical
Judgment
Question 1
A competent adult patient with end-stage disease refuses a blood transfusion
despite family pleas. What is the nurse's best action?
A) Administer the transfusion because it may prolong life
B) Respect the patient's decision and notify the healthcare team
C) Arrange for family members to persuade the patient
D) Ask the provider to obtain a court order to override refusal
,Correct Answer: B) Respect the patient's decision and notify the healthcare team
*Rationale: Respecting the autonomy of a competent patient is both ethical and legally
required. Administering without consent constitutes battery; coercion violates informed
consent principles .
Question 2
A patient with limited health literacy is being discharged with new medications.
Which teaching strategy is most effective?
A) Provide a lengthy written packet covering all discharge instructions
B) Use the "teach-back" method and provide simplified, prioritized instructions
C) Assume understanding because the patient nods during teaching
D) Delay discharge education until a family member is available
Correct Answer: B) Use the "teach-back" method and provide simplified, prioritized
instructions
*Rationale: Teach-back with concise, prioritized instructions and simplified materials
supports comprehension and safe transitions. Long packets overwhelm low-literacy
patients; nodding is not a reliable indicator of understanding .
Question 3
,Before administering intravenous heparin, which safety action should the nurse
perform first?
A) Begin infusion at the nurse's usual heparin rate
B) Double-check dosage and infusion pump settings with another licensed nurse
C) Ask the patient if they have ever received heparin
D) Administer a bolus without verifying anticoagulation orders
Correct Answer: B) Double-check dosage and infusion pump settings with another
licensed nurse
*Rationale: Heparin is a high-alert medication; independent double-checks and pump
verification reduce medication error risk. Using a "usual" rate without verification risks
dosing errors; administering without verification is unsafe .
Question 4
During medication reconciliation at admission, the nurse discovers the patient's
home medication list conflicts with the electronic medication administration
record (eMAR). What is the nurse's best first action?
A) Delete home meds from the record to avoid duplication
B) Contact the provider and pharmacy to verify the accurate regimen
C) Document both lists without notifying the team
D) Assume the eMAR is correct and proceed
, Correct Answer: B) Contact the provider and pharmacy to verify the accurate
regimen
*Rationale: Verifying discrepancies with the patient, provider, and pharmacy prevents
medication errors. Deleting data without verification risks omission of necessary
medications; documentation alone without verification allows potential harm .
Question 5
After a near-miss medication error, which action best reflects the nurse's role in a
nonpunitive safety culture?
A) Hide the event to protect staff from discipline
B) Complete the facility's incident report and participate in system review
C) Publicly reprimand the staff member who made the error
D) Transfer the patient to another unit to avoid scrutiny
Correct Answer: B) Complete the facility's incident report and participate in system
review
*Rationale: Nonpunitive safety culture focuses on system improvement, not individual
blame. Incident reporting and root cause analysis help design evidence-based safety
interventions .
Section 2: Delegation & Teamwork
Edition | NCLEX-Style Practice Questions and
Answers with Rationale
Section 1: Professional Nursing Practice & Clinical
Judgment
Question 1
A competent adult patient with end-stage disease refuses a blood transfusion
despite family pleas. What is the nurse's best action?
A) Administer the transfusion because it may prolong life
B) Respect the patient's decision and notify the healthcare team
C) Arrange for family members to persuade the patient
D) Ask the provider to obtain a court order to override refusal
,Correct Answer: B) Respect the patient's decision and notify the healthcare team
*Rationale: Respecting the autonomy of a competent patient is both ethical and legally
required. Administering without consent constitutes battery; coercion violates informed
consent principles .
Question 2
A patient with limited health literacy is being discharged with new medications.
Which teaching strategy is most effective?
A) Provide a lengthy written packet covering all discharge instructions
B) Use the "teach-back" method and provide simplified, prioritized instructions
C) Assume understanding because the patient nods during teaching
D) Delay discharge education until a family member is available
Correct Answer: B) Use the "teach-back" method and provide simplified, prioritized
instructions
*Rationale: Teach-back with concise, prioritized instructions and simplified materials
supports comprehension and safe transitions. Long packets overwhelm low-literacy
patients; nodding is not a reliable indicator of understanding .
Question 3
,Before administering intravenous heparin, which safety action should the nurse
perform first?
A) Begin infusion at the nurse's usual heparin rate
B) Double-check dosage and infusion pump settings with another licensed nurse
C) Ask the patient if they have ever received heparin
D) Administer a bolus without verifying anticoagulation orders
Correct Answer: B) Double-check dosage and infusion pump settings with another
licensed nurse
*Rationale: Heparin is a high-alert medication; independent double-checks and pump
verification reduce medication error risk. Using a "usual" rate without verification risks
dosing errors; administering without verification is unsafe .
Question 4
During medication reconciliation at admission, the nurse discovers the patient's
home medication list conflicts with the electronic medication administration
record (eMAR). What is the nurse's best first action?
A) Delete home meds from the record to avoid duplication
B) Contact the provider and pharmacy to verify the accurate regimen
C) Document both lists without notifying the team
D) Assume the eMAR is correct and proceed
, Correct Answer: B) Contact the provider and pharmacy to verify the accurate
regimen
*Rationale: Verifying discrepancies with the patient, provider, and pharmacy prevents
medication errors. Deleting data without verification risks omission of necessary
medications; documentation alone without verification allows potential harm .
Question 5
After a near-miss medication error, which action best reflects the nurse's role in a
nonpunitive safety culture?
A) Hide the event to protect staff from discipline
B) Complete the facility's incident report and participate in system review
C) Publicly reprimand the staff member who made the error
D) Transfer the patient to another unit to avoid scrutiny
Correct Answer: B) Complete the facility's incident report and participate in system
review
*Rationale: Nonpunitive safety culture focuses on system improvement, not individual
blame. Incident reporting and root cause analysis help design evidence-based safety
interventions .
Section 2: Delegation & Teamwork
