Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole
M. Heimgartner
PRACTICE QUESTIONS, DETAILED RATIONALES AND CLINICAL JUDGEMENT
Chapter 1: Overview of Professional Nursing Concepts for Medical-Surgical Nursing
Question 1
A medical-surgical nurse is caring for four patients. Which action best demonstrates patient-
centered care?
A. Completing all scheduled nursing tasks before responding to a patient's concern
B. Asking the patient about preferences and incorporating those preferences into the plan of
care
C. Using the same discharge instructions for all patients with the same diagnosis
D. Asking the patient's family to make routine care decisions without consulting the patient
Correct Answer: B
Detailed Rationale:
Patient-centered care involves recognizing the patient as an individual and incorporating the
patient's values, preferences, needs, and goals into care. Asking about preferences and
integrating them into the plan of care demonstrates respect for patient autonomy and
,individualized care. Standardized routines can support safe care, but they should not replace
individualized planning.
Why the Other Options Are Incorrect:
A: Completing tasks before addressing a patient's concern places workflow ahead of the
patient's needs.
B: This is correct because it directly incorporates the patient's preferences into care planning.
C: Identical diagnoses do not mean patients have identical needs, values, abilities, or
preferences.
D: Family involvement may be appropriate, but the patient should remain central to decisions
when able to participate.
Clinical Judgment Focus: Recognize Cues
Cognitive Level: Application
Question 2
The nurse receives handoff information from another nurse and identifies that a medication
administration time was omitted from the report. What is the nurse's best action?
A. Assume the medication was given because the patient has no symptoms
B. Ask another staff member whether the medication was administered
C. Review the medication administration record and verify the medication status
D. Administer the medication immediately to avoid delaying treatment
Correct Answer: C
Detailed Rationale:
Safe nursing practice requires verification of incomplete or uncertain information before taking
action. Reviewing the medication administration record provides objective information about
,whether the medication was administered. Assuming administration or giving an additional
dose without verification can create a medication-safety risk.
Why the Other Options Are Incorrect:
A: Absence of symptoms does not confirm medication administration.
B: Another staff member may not have reliable or complete information.
C: Correct. Objective documentation should be reviewed before medication administration
when the status is uncertain.
D: Administering the medication without verification could result in a duplicate dose.
Clinical Judgment Focus: Analyze Cues
Cognitive Level: Analysis
Question 3
Which nursing action best demonstrates the Quality and Safety Education for Nurses (QSEN)
teamwork and collaboration competency?
A. Completing another nurse's assignment without informing the nurse
B. Communicating relevant patient changes promptly to the interprofessional team
C. Limiting communication to physicians because they make treatment decisions
D. Waiting until the end of the shift to discuss nonroutine patient findings
Correct Answer: B
Detailed Rationale:
Teamwork and collaboration require effective communication and coordination among
members of the healthcare team to support safe, high-quality patient care. Prompt
communication of relevant changes allows the team to respond appropriately and reduces the
risk of fragmented care.
,Why the Other Options Are Incorrect:
A: Completing another nurse's assignment without communication can create confusion and
accountability problems.
B: Correct. Timely communication supports coordinated and safe care.
C: Medical-surgical care involves multiple healthcare professionals, not physicians alone.
D: Delaying important communication can increase the risk of harm.
Clinical Judgment Focus: Generate Solutions
Cognitive Level: Understanding
Question 4 — Select All That Apply
Which nursing actions demonstrate evidence-based practice?
A. Using current evidence when selecting nursing interventions
B. Combining evidence with clinical expertise and patient preferences
C. Continuing a practice solely because it has always been performed on the unit
D. Evaluating whether available evidence applies to the patient's situation
E. Selecting an intervention only because it is preferred by another staff member
Correct Answer: A, B, D
Detailed Rationale:
Evidence-based practice involves integrating the best available evidence with clinical expertise
and the patient's preferences, needs, and circumstances. Nurses should determine whether
evidence is applicable to the specific clinical situation rather than automatically continuing
traditional practices.
Why the Other Options Are Incorrect:
A: Correct. Current evidence is a foundation of evidence-based practice.
,B: Correct. Evidence-based practice integrates evidence, clinical expertise, and patient
considerations.
C: Tradition alone is not sufficient evidence for practice.
D: Correct. Evidence must be evaluated for relevance and applicability.
E: Another person's preference does not substitute for evidence and clinical reasoning.
Clinical Judgment Focus: Analyze Cues
Cognitive Level: Evaluation
Question 5
A nurse notices that medication errors on a medical-surgical unit have increased during shift
changes. Which action best reflects quality improvement?
A. Identifying patterns in the errors and evaluating the handoff process for improvement
opportunities
B. Reporting individual nurses for every error without examining the system
C. Telling staff members to be more careful during medication administration
D. Stopping medication administration during shift change
Correct Answer: A
Detailed Rationale:
Quality improvement focuses on identifying patterns, analyzing processes, and implementing
changes to improve outcomes. If errors cluster around shift changes, the handoff process should
be examined to identify contributing factors and opportunities for system improvement. Quality
improvement is not limited to assigning blame to individuals.
Why the Other Options Are Incorrect:
A: Correct. Examining patterns and processes is consistent with quality improvement.
,B: Focusing only on individual blame does not address system contributors.
C: A general instruction to "be more careful" does not identify or correct an underlying process
problem.
D: Stopping medication administration is not a practical system-level improvement.
Clinical Judgment Focus: Analyze Cues
Cognitive Level: Analysis
Question 6
The nurse enters information into the electronic health record and notices that the patient's
documented allergy conflicts with the medication prescribed. What should the nurse do first?
A. Administer the medication because the prescription was already entered
B. Delete the allergy entry from the electronic record
C. Verify the allergy information and address the discrepancy before administration
D. Ask the patient to decide whether the medication should be given
Correct Answer: C
Detailed Rationale:
Informatics supports safe patient care by making clinically important information available to
healthcare professionals. A conflict between allergy information and a medication prescription
requires verification and resolution before administration. The nurse should not independently
delete important clinical information or shift the medication decision to the patient.
Why the Other Options Are Incorrect:
A: A prescription does not eliminate the need for medication-safety verification.
B: Removing potentially accurate allergy information could create serious safety risks.
,C: Correct. The discrepancy should be verified and resolved before the medication is
administered.
D: The patient provides important information but should not be expected to make the clinical
safety determination independently.
Clinical Judgment Focus: Recognize Cues
Cognitive Level: Analysis
Question 7
A patient tells the nurse, "I do not understand why I need this treatment, and I do not want it."
What should the nurse do first?
A. Tell the patient that the treatment is required
B. Ask the patient about the concern and determine what information is needed
C. Contact the family and ask them to persuade the patient
D. Document refusal and leave the room
Correct Answer: B
Detailed Rationale:
Respect for autonomy and patient-centered care require the nurse to understand the patient's
concerns and support informed decision-making. The nurse should assess the patient's
understanding, questions, and concerns before proceeding. The patient's refusal should not
automatically be treated as noncompliance.
Why the Other Options Are Incorrect:
A: Telling the patient that treatment is required does not support autonomy.
B: Correct. Exploring concerns and information needs supports informed participation.
C: Family involvement should not replace communication with the patient.
,D: Documentation is important, but the nurse should first address the patient's expressed
concern appropriately.
Clinical Judgment Focus: Recognize Cues
Cognitive Level: Application
Question 8 — Prioritization
The nurse begins a shift and receives four reports. Which patient should the nurse assess first?
A. A patient requesting clarification about the day's scheduled activities
B. A patient asking whether a family member can visit
C. A patient with a new change in condition that was not present during the previous
assessment
D. A patient requesting assistance with a routine hygiene activity
Correct Answer: C
Detailed Rationale:
A new change in condition may indicate deterioration and requires prompt assessment. Clinical
judgment begins with recognizing changes from baseline and determining whether the change
represents an immediate threat. Routine requests can be addressed after potentially unstable
findings are assessed.
Why the Other Options Are Incorrect:
A: Clarification is important but is not more urgent than a new clinical change.
B: Visiting arrangements are not the priority over a possible deterioration.
C: Correct. A new change from baseline requires prompt assessment.
D: Hygiene is important but is not the highest priority in the presence of a potential acute
change.
,Clinical Judgment Focus: Recognize Cues; Prioritize Hypotheses
Cognitive Level: Analysis
Question 9
A nurse is preparing discharge teaching for a patient who has limited familiarity with medical
terminology. Which approach best supports health equity and patient-centered care?
A. Provide complex written instructions so the patient has complete information
B. Use understandable language and confirm the patient's understanding
C. Ask a family member to explain the instructions later
D. Provide the same education materials used for all patients
Correct Answer: B
Detailed Rationale:
Health equity requires attention to barriers that may affect a patient's ability to understand and
use health information. Clear communication and confirmation of understanding help ensure
that the patient can meaningfully participate in care. Education should be adapted to individual
needs rather than delivered identically to every patient.
Why the Other Options Are Incorrect:
A: Complex terminology may increase misunderstanding.
B: Correct. Clear communication and verification of understanding promote equitable, patient-
centered care.
C: Family members may support learning when appropriate, but they should not automatically
replace direct patient education.
D: Standard materials may be useful but should be adapted when they do not meet the
patient's needs.
, Clinical Judgment Focus: Generate Solutions
Cognitive Level: Application
Question 10
Which action by the nurse best demonstrates clinical judgment?
A. Following the care plan without reassessing the patient
B. Completing all tasks in the order they appear on the assignment sheet
C. Recognizing a meaningful change in patient findings and determining the most likely priority
problem
D. Waiting for another healthcare professional to identify the clinical problem
Correct Answer: C
Detailed Rationale:
Clinical judgment involves recognizing relevant information, interpreting its significance,
prioritizing the most likely problem, and selecting appropriate actions. Nursing care requires
ongoing interpretation rather than simply completing predetermined tasks.
Why the Other Options Are Incorrect:
A: Care plans must be evaluated against the patient's current condition.
B: Task order does not necessarily reflect clinical priority.
C: Correct. Recognizing and interpreting changes and prioritizing problems are central to clinical
judgment.
D: Nurses have an independent responsibility to recognize and respond to patient changes
within their role.
Clinical Judgment Focus: Recognize Cues; Analyze Cues; Prioritize Hypotheses
Cognitive Level: Application
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole
M. Heimgartner
PRACTICE QUESTIONS, DETAILED RATIONALES AND CLINICAL JUDGEMENT
Chapter 1: Overview of Professional Nursing Concepts for Medical-Surgical Nursing
Question 1
A medical-surgical nurse is caring for four patients. Which action best demonstrates patient-
centered care?
A. Completing all scheduled nursing tasks before responding to a patient's concern
B. Asking the patient about preferences and incorporating those preferences into the plan of
care
C. Using the same discharge instructions for all patients with the same diagnosis
D. Asking the patient's family to make routine care decisions without consulting the patient
Correct Answer: B
Detailed Rationale:
Patient-centered care involves recognizing the patient as an individual and incorporating the
patient's values, preferences, needs, and goals into care. Asking about preferences and
integrating them into the plan of care demonstrates respect for patient autonomy and
,individualized care. Standardized routines can support safe care, but they should not replace
individualized planning.
Why the Other Options Are Incorrect:
A: Completing tasks before addressing a patient's concern places workflow ahead of the
patient's needs.
B: This is correct because it directly incorporates the patient's preferences into care planning.
C: Identical diagnoses do not mean patients have identical needs, values, abilities, or
preferences.
D: Family involvement may be appropriate, but the patient should remain central to decisions
when able to participate.
Clinical Judgment Focus: Recognize Cues
Cognitive Level: Application
Question 2
The nurse receives handoff information from another nurse and identifies that a medication
administration time was omitted from the report. What is the nurse's best action?
A. Assume the medication was given because the patient has no symptoms
B. Ask another staff member whether the medication was administered
C. Review the medication administration record and verify the medication status
D. Administer the medication immediately to avoid delaying treatment
Correct Answer: C
Detailed Rationale:
Safe nursing practice requires verification of incomplete or uncertain information before taking
action. Reviewing the medication administration record provides objective information about
,whether the medication was administered. Assuming administration or giving an additional
dose without verification can create a medication-safety risk.
Why the Other Options Are Incorrect:
A: Absence of symptoms does not confirm medication administration.
B: Another staff member may not have reliable or complete information.
C: Correct. Objective documentation should be reviewed before medication administration
when the status is uncertain.
D: Administering the medication without verification could result in a duplicate dose.
Clinical Judgment Focus: Analyze Cues
Cognitive Level: Analysis
Question 3
Which nursing action best demonstrates the Quality and Safety Education for Nurses (QSEN)
teamwork and collaboration competency?
A. Completing another nurse's assignment without informing the nurse
B. Communicating relevant patient changes promptly to the interprofessional team
C. Limiting communication to physicians because they make treatment decisions
D. Waiting until the end of the shift to discuss nonroutine patient findings
Correct Answer: B
Detailed Rationale:
Teamwork and collaboration require effective communication and coordination among
members of the healthcare team to support safe, high-quality patient care. Prompt
communication of relevant changes allows the team to respond appropriately and reduces the
risk of fragmented care.
,Why the Other Options Are Incorrect:
A: Completing another nurse's assignment without communication can create confusion and
accountability problems.
B: Correct. Timely communication supports coordinated and safe care.
C: Medical-surgical care involves multiple healthcare professionals, not physicians alone.
D: Delaying important communication can increase the risk of harm.
Clinical Judgment Focus: Generate Solutions
Cognitive Level: Understanding
Question 4 — Select All That Apply
Which nursing actions demonstrate evidence-based practice?
A. Using current evidence when selecting nursing interventions
B. Combining evidence with clinical expertise and patient preferences
C. Continuing a practice solely because it has always been performed on the unit
D. Evaluating whether available evidence applies to the patient's situation
E. Selecting an intervention only because it is preferred by another staff member
Correct Answer: A, B, D
Detailed Rationale:
Evidence-based practice involves integrating the best available evidence with clinical expertise
and the patient's preferences, needs, and circumstances. Nurses should determine whether
evidence is applicable to the specific clinical situation rather than automatically continuing
traditional practices.
Why the Other Options Are Incorrect:
A: Correct. Current evidence is a foundation of evidence-based practice.
,B: Correct. Evidence-based practice integrates evidence, clinical expertise, and patient
considerations.
C: Tradition alone is not sufficient evidence for practice.
D: Correct. Evidence must be evaluated for relevance and applicability.
E: Another person's preference does not substitute for evidence and clinical reasoning.
Clinical Judgment Focus: Analyze Cues
Cognitive Level: Evaluation
Question 5
A nurse notices that medication errors on a medical-surgical unit have increased during shift
changes. Which action best reflects quality improvement?
A. Identifying patterns in the errors and evaluating the handoff process for improvement
opportunities
B. Reporting individual nurses for every error without examining the system
C. Telling staff members to be more careful during medication administration
D. Stopping medication administration during shift change
Correct Answer: A
Detailed Rationale:
Quality improvement focuses on identifying patterns, analyzing processes, and implementing
changes to improve outcomes. If errors cluster around shift changes, the handoff process should
be examined to identify contributing factors and opportunities for system improvement. Quality
improvement is not limited to assigning blame to individuals.
Why the Other Options Are Incorrect:
A: Correct. Examining patterns and processes is consistent with quality improvement.
,B: Focusing only on individual blame does not address system contributors.
C: A general instruction to "be more careful" does not identify or correct an underlying process
problem.
D: Stopping medication administration is not a practical system-level improvement.
Clinical Judgment Focus: Analyze Cues
Cognitive Level: Analysis
Question 6
The nurse enters information into the electronic health record and notices that the patient's
documented allergy conflicts with the medication prescribed. What should the nurse do first?
A. Administer the medication because the prescription was already entered
B. Delete the allergy entry from the electronic record
C. Verify the allergy information and address the discrepancy before administration
D. Ask the patient to decide whether the medication should be given
Correct Answer: C
Detailed Rationale:
Informatics supports safe patient care by making clinically important information available to
healthcare professionals. A conflict between allergy information and a medication prescription
requires verification and resolution before administration. The nurse should not independently
delete important clinical information or shift the medication decision to the patient.
Why the Other Options Are Incorrect:
A: A prescription does not eliminate the need for medication-safety verification.
B: Removing potentially accurate allergy information could create serious safety risks.
,C: Correct. The discrepancy should be verified and resolved before the medication is
administered.
D: The patient provides important information but should not be expected to make the clinical
safety determination independently.
Clinical Judgment Focus: Recognize Cues
Cognitive Level: Analysis
Question 7
A patient tells the nurse, "I do not understand why I need this treatment, and I do not want it."
What should the nurse do first?
A. Tell the patient that the treatment is required
B. Ask the patient about the concern and determine what information is needed
C. Contact the family and ask them to persuade the patient
D. Document refusal and leave the room
Correct Answer: B
Detailed Rationale:
Respect for autonomy and patient-centered care require the nurse to understand the patient's
concerns and support informed decision-making. The nurse should assess the patient's
understanding, questions, and concerns before proceeding. The patient's refusal should not
automatically be treated as noncompliance.
Why the Other Options Are Incorrect:
A: Telling the patient that treatment is required does not support autonomy.
B: Correct. Exploring concerns and information needs supports informed participation.
C: Family involvement should not replace communication with the patient.
,D: Documentation is important, but the nurse should first address the patient's expressed
concern appropriately.
Clinical Judgment Focus: Recognize Cues
Cognitive Level: Application
Question 8 — Prioritization
The nurse begins a shift and receives four reports. Which patient should the nurse assess first?
A. A patient requesting clarification about the day's scheduled activities
B. A patient asking whether a family member can visit
C. A patient with a new change in condition that was not present during the previous
assessment
D. A patient requesting assistance with a routine hygiene activity
Correct Answer: C
Detailed Rationale:
A new change in condition may indicate deterioration and requires prompt assessment. Clinical
judgment begins with recognizing changes from baseline and determining whether the change
represents an immediate threat. Routine requests can be addressed after potentially unstable
findings are assessed.
Why the Other Options Are Incorrect:
A: Clarification is important but is not more urgent than a new clinical change.
B: Visiting arrangements are not the priority over a possible deterioration.
C: Correct. A new change from baseline requires prompt assessment.
D: Hygiene is important but is not the highest priority in the presence of a potential acute
change.
,Clinical Judgment Focus: Recognize Cues; Prioritize Hypotheses
Cognitive Level: Analysis
Question 9
A nurse is preparing discharge teaching for a patient who has limited familiarity with medical
terminology. Which approach best supports health equity and patient-centered care?
A. Provide complex written instructions so the patient has complete information
B. Use understandable language and confirm the patient's understanding
C. Ask a family member to explain the instructions later
D. Provide the same education materials used for all patients
Correct Answer: B
Detailed Rationale:
Health equity requires attention to barriers that may affect a patient's ability to understand and
use health information. Clear communication and confirmation of understanding help ensure
that the patient can meaningfully participate in care. Education should be adapted to individual
needs rather than delivered identically to every patient.
Why the Other Options Are Incorrect:
A: Complex terminology may increase misunderstanding.
B: Correct. Clear communication and verification of understanding promote equitable, patient-
centered care.
C: Family members may support learning when appropriate, but they should not automatically
replace direct patient education.
D: Standard materials may be useful but should be adapted when they do not meet the
patient's needs.
, Clinical Judgment Focus: Generate Solutions
Cognitive Level: Application
Question 10
Which action by the nurse best demonstrates clinical judgment?
A. Following the care plan without reassessing the patient
B. Completing all tasks in the order they appear on the assignment sheet
C. Recognizing a meaningful change in patient findings and determining the most likely priority
problem
D. Waiting for another healthcare professional to identify the clinical problem
Correct Answer: C
Detailed Rationale:
Clinical judgment involves recognizing relevant information, interpreting its significance,
prioritizing the most likely problem, and selecting appropriate actions. Nursing care requires
ongoing interpretation rather than simply completing predetermined tasks.
Why the Other Options Are Incorrect:
A: Care plans must be evaluated against the patient's current condition.
B: Task order does not necessarily reflect clinical priority.
C: Correct. Recognizing and interpreting changes and prioritizing problems are central to clinical
judgment.
D: Nurses have an independent responsibility to recognize and respond to patient changes
within their role.
Clinical Judgment Focus: Recognize Cues; Analyze Cues; Prioritize Hypotheses
Cognitive Level: Application
