NUR 201: Foundations of Medical-Surgical Nursing
(Ignatavicius Eleventh Edition) Prep with Detailed
Rationales
Course Code: NUR 201
Course Name: Foundations of Medical-Surgical Nursing (Ignatavicius Eleventh
Edition)
Topic: Core Competencies, Patient Safety, and Care of the Older Adult
Academic Year: 2026/2027
1. A nurse is evaluating a postoperative client on a busy surgical unit whose
blood pressure has acutely dropped from 142/76 mm Hg to 88/50 mm Hg
within the last 30 minutes. Which action must the nurse execute
immediately?
A. Repeat the blood pressure assessment in 15 minutes to confirm the trend.
B. Activate the Rapid Response Team (RRT).
C. Notify the primary health care provider and await new prescriptions.
D. Place the client in a high-Fowler's position and document the findings.
CORRECT ANSWER: B. Activate the Rapid Response Team (RRT) [1]
RATIONALE: This client is showing explicit clinical signs of acute
hemodynamic instability, which indicates early shock or severe postoperative
hemorrhage. The Rapid Response Team (RRT) is an interprofessional team of
critical care experts designed to intervene before a client experiences a full
cardiopulmonary arrest. Waiting 15 minutes to repeat the blood pressure (Choice
A) or waiting for a callback from a primary healthcare provider (Choice C) delays
critical, life-saving rescue interventions. High-Fowler's position (Choice D)
decreases venous return and would further worsen severe hypotension.
2. A client with an acute opioid overdose is brought to the emergency
department unconscious by a roommate. Simultaneously, the nurse is
assigned three other clients. Which client must the nurse assess first for
severe gas exchange abnormalities?
A. An asthmatic client who is currently being prepared for discharge after
bronchodilator therapy.
, B. A client involved in a motor vehicle crash who has a confirmed broken
femur.
C. A client with a history of COPD who presents after being bitten by a dog.
D. The unconscious client brought in following an opioid overdose.
CORRECT ANSWER: D. The unconscious client brought in following an
opioid overdose [1]
RATIONALE: Opioids are potent central nervous system depressants that
directly suppress the respiratory drive in the brainstem. An unconscious client
following an opioid overdose is at immediate, life-threatening risk for severe
hypoventilation, respiratory arrest, and catastrophic gas exchange abnormalities.
Under the ABC (Airway, Breathing, Circulation) framework, this client is the
absolute priority. The asthmatic client (Choice A) is stable enough for discharge.
The client with a broken femur (Choice B) is a circulation and musculoskeletal
priority but is not actively losing their airway. The COPD client (Choice C) has a
chronic respiratory disease but their acute reason for seeking care is a localized dog
bite.
3. An 88-year-old client who is 3 days post-hemorrhagic stroke is being
monitored on a medical-surgical unit. When planning care, the nurse
identifies this client as the highest priority for which of the following
focused assessments?
A. Periodic screening for localized cellular regulation deficits.
B. Continuous monitoring for potential impaired cognition.
C. Immediate collection of an arterial blood gas to check for metabolic
alkalosis.
D. Screening for environmental allergies and immediate dietary restrictions.
CORRECT ANSWER: B. Continuous monitoring for potential impaired
cognition [1]
RATIONALE: Advanced age (88 years old) combined with an acute
hemorrhagic stroke puts this client at extreme risk for impaired cognition,
delirium, and structural neurological decline. Delirium and cognitive changes can
indicate secondary bleeding, increased intracranial pressure, or metabolic
imbalances. While cellular regulation (Choice A) is a broad concept, it is not the
most urgent threat. Stroke does not directly induce metabolic alkalosis (Choice C).
Environmental allergy screening (Choice D) is completely non-urgent compared to
neurocognitive changes.
, 4. A nurse is reviewing the laboratory results of a client experiencing severe
protein-calorie malnutrition. Which laboratory biomarker must the nurse
prioritize as the most sensitive, acute indicator of the client’s current
nutritional status?
A. Serum Albumin.
B. Serum Prealbumin.
C. Prothrombin Time (PT).
D. Serum Sodium.
CORRECT ANSWER: B. Serum Prealbumin [1]
RATIONALE: Prealbumin has a very short half-life of approximately 2 days,
making it a highly sensitive and reliable indicator of acute dietary changes and
current nutritional status. In contrast, serum albumin (Choice A) has a longer
half-life of roughly 20 days, meaning it reflects long-term chronic nutritional status
rather than rapid, acute changes. Prothrombin time (Choice C) evaluates blood
clotting functionality and liver synthesis of clotting factors. Serum sodium (Choice
D) is an electrolyte value reflecting fluid volume balance rather than specific
protein-energy malnutrition.
5. A new graduate nurse expresses hesitation about participating in a new
hospital-wide quality improvement (QI) project, citing a lack of clinical
experience. What response by the preceptor is most accurate and
encouraging?
A. "All staff nurses are required to participate in quality improvement
projects to pass their annual evaluations here." [1]
B. "Even being new, you can implement activities designed to improve
care." [1]
C. "It's easy to identify what indicators would be used to measure quality on
an advanced research committee." [1]
D. "You should ask to be immediately assigned to the formal research and
quality committee." [1]
CORRECT ANSWER: B. "Even being new, you can implement activities
designed to improve care." [1]
RATIONALE: According to core professional nursing competencies like
Quality and Safety Education for Nurses (QSEN), every practicing professional
nurse must engage in quality improvement (QI) to optimize patient outcomes.
New graduate nurses possess valuable frontline perspectives and can actively
, participate in data collection, auditing, and executing bedside quality initiatives.
Telling the nurse it is mandatory for evaluations (Choice A) is punitive and ignores
the educational rationale. Suggesting they immediately join formal research
committees (Choice C and Choice D) jumps past basic bedside QI competencies.
6. A preceptor is working with a newly hired professional nurse on a medical-
surgical floor. The preceptor emphasizes that which of the following core
concepts serves as the absolute priority in professional nursing practice?
A. Attending comprehensively to holistic client needs.
B. Ensuring client safety.
C. Making zero medication errors during a shift.
D. Providing highly individualized, client-focused care.
CORRECT ANSWER: B. Ensuring client safety [1]
RATIONALE: While holistic care, patient-centered interventions, and
minimizing medication errors are all fundamental pillars of professional nursing
practice, ensuring client safety stands as the ultimate, foundational priority over
all other nursing actions. If a client’s environment or care delivery is unsafe,
therapeutic outcomes cannot be achieved. Holistic care (Choice A) and client-
focused care (Choice D) are dependent on a safe environment. Avoiding
medication errors (Choice C) is a sub-component of the broader imperative of
client safety.
7. A nurse is conducting an orientation to the medical-surgical unit for a newly
admitted client and their family. Which instruction by the nurse best
empowers the client to promote their own safety?
A. Encourage the client and family to be active partners in their care.
[1]
B. Have the client constantly monitor hand hygiene compliance in all
caregivers.
C. Offer the family the unrestricted opportunity to stay overnight with the
client.
D. Tell the client to always wear their identification armband throughout the
stay.
CORRECT ANSWER: A. Encourage the client and family to be active
partners in their care. [1]
RATIONALE: Patient safety is maximized when clients and families act as
(Ignatavicius Eleventh Edition) Prep with Detailed
Rationales
Course Code: NUR 201
Course Name: Foundations of Medical-Surgical Nursing (Ignatavicius Eleventh
Edition)
Topic: Core Competencies, Patient Safety, and Care of the Older Adult
Academic Year: 2026/2027
1. A nurse is evaluating a postoperative client on a busy surgical unit whose
blood pressure has acutely dropped from 142/76 mm Hg to 88/50 mm Hg
within the last 30 minutes. Which action must the nurse execute
immediately?
A. Repeat the blood pressure assessment in 15 minutes to confirm the trend.
B. Activate the Rapid Response Team (RRT).
C. Notify the primary health care provider and await new prescriptions.
D. Place the client in a high-Fowler's position and document the findings.
CORRECT ANSWER: B. Activate the Rapid Response Team (RRT) [1]
RATIONALE: This client is showing explicit clinical signs of acute
hemodynamic instability, which indicates early shock or severe postoperative
hemorrhage. The Rapid Response Team (RRT) is an interprofessional team of
critical care experts designed to intervene before a client experiences a full
cardiopulmonary arrest. Waiting 15 minutes to repeat the blood pressure (Choice
A) or waiting for a callback from a primary healthcare provider (Choice C) delays
critical, life-saving rescue interventions. High-Fowler's position (Choice D)
decreases venous return and would further worsen severe hypotension.
2. A client with an acute opioid overdose is brought to the emergency
department unconscious by a roommate. Simultaneously, the nurse is
assigned three other clients. Which client must the nurse assess first for
severe gas exchange abnormalities?
A. An asthmatic client who is currently being prepared for discharge after
bronchodilator therapy.
, B. A client involved in a motor vehicle crash who has a confirmed broken
femur.
C. A client with a history of COPD who presents after being bitten by a dog.
D. The unconscious client brought in following an opioid overdose.
CORRECT ANSWER: D. The unconscious client brought in following an
opioid overdose [1]
RATIONALE: Opioids are potent central nervous system depressants that
directly suppress the respiratory drive in the brainstem. An unconscious client
following an opioid overdose is at immediate, life-threatening risk for severe
hypoventilation, respiratory arrest, and catastrophic gas exchange abnormalities.
Under the ABC (Airway, Breathing, Circulation) framework, this client is the
absolute priority. The asthmatic client (Choice A) is stable enough for discharge.
The client with a broken femur (Choice B) is a circulation and musculoskeletal
priority but is not actively losing their airway. The COPD client (Choice C) has a
chronic respiratory disease but their acute reason for seeking care is a localized dog
bite.
3. An 88-year-old client who is 3 days post-hemorrhagic stroke is being
monitored on a medical-surgical unit. When planning care, the nurse
identifies this client as the highest priority for which of the following
focused assessments?
A. Periodic screening for localized cellular regulation deficits.
B. Continuous monitoring for potential impaired cognition.
C. Immediate collection of an arterial blood gas to check for metabolic
alkalosis.
D. Screening for environmental allergies and immediate dietary restrictions.
CORRECT ANSWER: B. Continuous monitoring for potential impaired
cognition [1]
RATIONALE: Advanced age (88 years old) combined with an acute
hemorrhagic stroke puts this client at extreme risk for impaired cognition,
delirium, and structural neurological decline. Delirium and cognitive changes can
indicate secondary bleeding, increased intracranial pressure, or metabolic
imbalances. While cellular regulation (Choice A) is a broad concept, it is not the
most urgent threat. Stroke does not directly induce metabolic alkalosis (Choice C).
Environmental allergy screening (Choice D) is completely non-urgent compared to
neurocognitive changes.
, 4. A nurse is reviewing the laboratory results of a client experiencing severe
protein-calorie malnutrition. Which laboratory biomarker must the nurse
prioritize as the most sensitive, acute indicator of the client’s current
nutritional status?
A. Serum Albumin.
B. Serum Prealbumin.
C. Prothrombin Time (PT).
D. Serum Sodium.
CORRECT ANSWER: B. Serum Prealbumin [1]
RATIONALE: Prealbumin has a very short half-life of approximately 2 days,
making it a highly sensitive and reliable indicator of acute dietary changes and
current nutritional status. In contrast, serum albumin (Choice A) has a longer
half-life of roughly 20 days, meaning it reflects long-term chronic nutritional status
rather than rapid, acute changes. Prothrombin time (Choice C) evaluates blood
clotting functionality and liver synthesis of clotting factors. Serum sodium (Choice
D) is an electrolyte value reflecting fluid volume balance rather than specific
protein-energy malnutrition.
5. A new graduate nurse expresses hesitation about participating in a new
hospital-wide quality improvement (QI) project, citing a lack of clinical
experience. What response by the preceptor is most accurate and
encouraging?
A. "All staff nurses are required to participate in quality improvement
projects to pass their annual evaluations here." [1]
B. "Even being new, you can implement activities designed to improve
care." [1]
C. "It's easy to identify what indicators would be used to measure quality on
an advanced research committee." [1]
D. "You should ask to be immediately assigned to the formal research and
quality committee." [1]
CORRECT ANSWER: B. "Even being new, you can implement activities
designed to improve care." [1]
RATIONALE: According to core professional nursing competencies like
Quality and Safety Education for Nurses (QSEN), every practicing professional
nurse must engage in quality improvement (QI) to optimize patient outcomes.
New graduate nurses possess valuable frontline perspectives and can actively
, participate in data collection, auditing, and executing bedside quality initiatives.
Telling the nurse it is mandatory for evaluations (Choice A) is punitive and ignores
the educational rationale. Suggesting they immediately join formal research
committees (Choice C and Choice D) jumps past basic bedside QI competencies.
6. A preceptor is working with a newly hired professional nurse on a medical-
surgical floor. The preceptor emphasizes that which of the following core
concepts serves as the absolute priority in professional nursing practice?
A. Attending comprehensively to holistic client needs.
B. Ensuring client safety.
C. Making zero medication errors during a shift.
D. Providing highly individualized, client-focused care.
CORRECT ANSWER: B. Ensuring client safety [1]
RATIONALE: While holistic care, patient-centered interventions, and
minimizing medication errors are all fundamental pillars of professional nursing
practice, ensuring client safety stands as the ultimate, foundational priority over
all other nursing actions. If a client’s environment or care delivery is unsafe,
therapeutic outcomes cannot be achieved. Holistic care (Choice A) and client-
focused care (Choice D) are dependent on a safe environment. Avoiding
medication errors (Choice C) is a sub-component of the broader imperative of
client safety.
7. A nurse is conducting an orientation to the medical-surgical unit for a newly
admitted client and their family. Which instruction by the nurse best
empowers the client to promote their own safety?
A. Encourage the client and family to be active partners in their care.
[1]
B. Have the client constantly monitor hand hygiene compliance in all
caregivers.
C. Offer the family the unrestricted opportunity to stay overnight with the
client.
D. Tell the client to always wear their identification armband throughout the
stay.
CORRECT ANSWER: A. Encourage the client and family to be active
partners in their care. [1]
RATIONALE: Patient safety is maximized when clients and families act as
