Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
TEST BANK
Item 1
Reference: Ch. 1 — Section: Patient-Centered Care / QSEN
Competencies
Question Stem: A 67-year-old patient with chronic COPD tells
the nurse they prefer inhaler therapy over nebulized treatments
due to mobility limitations at home. Which nursing action best
demonstrates patient-centered care during discharge planning?
A. Explain the hospital’s standard nebulizer schedule and
document refusal.
B. Assess the patient’s home environment, resources, and
inhaler technique.
C. Schedule a home health referral without further discussion.
D. Recommend switching to systemic steroids for convenience.
Correct Answer: B
Rationale (correct): Assessing the home environment and
inhaler technique identifies barriers and personal preferences,
enabling tailored, evidence-based discharge teaching and safer
self-management. This aligns with patient-centered care and
,QSEN emphasis on individualized education.
Rationale (A): Merely explaining hospital policy and
documenting refusal ignores the patient’s context and doesn’t
promote shared decision-making.
Rationale (C): Automatic referral may be appropriate but omits
essential assessment and patient teaching needed for safe self-
care.
Rationale (D): Recommending a medication change for
convenience ignores clinical indication and shared decision-
making.
Teaching Point: Assess context and abilities first; tailor
discharge teaching to patient preferences.
Citation: Ignatavicius et al., 2024, Ch. 1: Overview of
Professional Nursing Concepts for Medical-Surgical Nursing.
evolve.elsevier.com+1
Item 2
Reference: Ch. 1 — Section: Clinical Judgment / Nursing Process
(ADPIE)
Question Stem: A postop patient develops sudden tachycardia
(HR 128) and hypotension (BP 86/48). After an initial focused
assessment, what should the nurse do first?
A. Call the health care provider to report vitals.
B. Raise the head of the bed and encourage deep breathing.
C. Assess airway, breathing, and circulation (ABCs) and apply
supplemental oxygen.
,D. Obtain a 12-lead ECG to evaluate for dysrhythmia.
Correct Answer: C
Rationale (correct): Prioritizing ABCs and stabilizing
oxygenation/perfusion is immediate—consistent with clinical
judgment and safety frameworks—before diagnostics or
notifying the provider.
Rationale (A): Reporting is important but should follow
immediate stabilization if the patient is hemodynamically
unstable.
Rationale (B): Raising head may worsen hypotension; deep
breathing alone won’t correct possible hypoperfusion.
Rationale (D): ECG is diagnostic but should not delay immediate
resuscitative actions for unstable vital signs.
Teaching Point: Prioritize immediate stabilization (ABCs) before
diagnostics or notification.
Citation: Ignatavicius et al., 2024, Ch. 1: Clinical judgment and
nursing process. evolve.elsevier.com+1
Item 3
Reference: Ch. 1 — Section: Systems Thinking / Safety &
Reporting
Question Stem: During medication reconciliation, a nurse
discovers a patient’s home opioid dose is double the hospital-
prescribed dose. Which action best reflects systems thinking
and patient safety?
A. Continue the hospital dose and document the discrepancy in
, the chart only.
B. Immediately administer the higher home dose to match
outpatient regimen.
C. Notify the prescriber, reconcile doses, and coordinate a plan
including monitoring and education.
D. Ask the patient to refuse the hospital dose and sign an AMA
form.
Correct Answer: C
Rationale (correct): Systems thinking recognizes medication
reconciliation as a safety checkpoint; notifying the prescriber
and creating a monitored plan addresses risk across care
settings.
Rationale (A): Documentation alone fails to resolve the
medication mismatch or protect the patient from under- or
overdosing.
Rationale (B): Changing doses without prescriber order risks
error and legal/safety issues.
Rationale (D): Asking for refusal/A.M.A. is inappropriate and
does not resolve the medication safety concern.
Teaching Point: Reconcile discrepancies collaboratively;
escalate and monitor when needed.
Citation: Ignatavicius et al., 2024, Ch. 1: Systems thinking and
safety. evolve.elsevier.com+1
Item 4
Reference: Ch. 1 — Section: Ethics / Professional Accountability
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
TEST BANK
Item 1
Reference: Ch. 1 — Section: Patient-Centered Care / QSEN
Competencies
Question Stem: A 67-year-old patient with chronic COPD tells
the nurse they prefer inhaler therapy over nebulized treatments
due to mobility limitations at home. Which nursing action best
demonstrates patient-centered care during discharge planning?
A. Explain the hospital’s standard nebulizer schedule and
document refusal.
B. Assess the patient’s home environment, resources, and
inhaler technique.
C. Schedule a home health referral without further discussion.
D. Recommend switching to systemic steroids for convenience.
Correct Answer: B
Rationale (correct): Assessing the home environment and
inhaler technique identifies barriers and personal preferences,
enabling tailored, evidence-based discharge teaching and safer
self-management. This aligns with patient-centered care and
,QSEN emphasis on individualized education.
Rationale (A): Merely explaining hospital policy and
documenting refusal ignores the patient’s context and doesn’t
promote shared decision-making.
Rationale (C): Automatic referral may be appropriate but omits
essential assessment and patient teaching needed for safe self-
care.
Rationale (D): Recommending a medication change for
convenience ignores clinical indication and shared decision-
making.
Teaching Point: Assess context and abilities first; tailor
discharge teaching to patient preferences.
Citation: Ignatavicius et al., 2024, Ch. 1: Overview of
Professional Nursing Concepts for Medical-Surgical Nursing.
evolve.elsevier.com+1
Item 2
Reference: Ch. 1 — Section: Clinical Judgment / Nursing Process
(ADPIE)
Question Stem: A postop patient develops sudden tachycardia
(HR 128) and hypotension (BP 86/48). After an initial focused
assessment, what should the nurse do first?
A. Call the health care provider to report vitals.
B. Raise the head of the bed and encourage deep breathing.
C. Assess airway, breathing, and circulation (ABCs) and apply
supplemental oxygen.
,D. Obtain a 12-lead ECG to evaluate for dysrhythmia.
Correct Answer: C
Rationale (correct): Prioritizing ABCs and stabilizing
oxygenation/perfusion is immediate—consistent with clinical
judgment and safety frameworks—before diagnostics or
notifying the provider.
Rationale (A): Reporting is important but should follow
immediate stabilization if the patient is hemodynamically
unstable.
Rationale (B): Raising head may worsen hypotension; deep
breathing alone won’t correct possible hypoperfusion.
Rationale (D): ECG is diagnostic but should not delay immediate
resuscitative actions for unstable vital signs.
Teaching Point: Prioritize immediate stabilization (ABCs) before
diagnostics or notification.
Citation: Ignatavicius et al., 2024, Ch. 1: Clinical judgment and
nursing process. evolve.elsevier.com+1
Item 3
Reference: Ch. 1 — Section: Systems Thinking / Safety &
Reporting
Question Stem: During medication reconciliation, a nurse
discovers a patient’s home opioid dose is double the hospital-
prescribed dose. Which action best reflects systems thinking
and patient safety?
A. Continue the hospital dose and document the discrepancy in
, the chart only.
B. Immediately administer the higher home dose to match
outpatient regimen.
C. Notify the prescriber, reconcile doses, and coordinate a plan
including monitoring and education.
D. Ask the patient to refuse the hospital dose and sign an AMA
form.
Correct Answer: C
Rationale (correct): Systems thinking recognizes medication
reconciliation as a safety checkpoint; notifying the prescriber
and creating a monitored plan addresses risk across care
settings.
Rationale (A): Documentation alone fails to resolve the
medication mismatch or protect the patient from under- or
overdosing.
Rationale (B): Changing doses without prescriber order risks
error and legal/safety issues.
Rationale (D): Asking for refusal/A.M.A. is inappropriate and
does not resolve the medication safety concern.
Teaching Point: Reconcile discrepancies collaboratively;
escalate and monitor when needed.
Citation: Ignatavicius et al., 2024, Ch. 1: Systems thinking and
safety. evolve.elsevier.com+1
Item 4
Reference: Ch. 1 — Section: Ethics / Professional Accountability
