Medical-Surgical Nursing: Concepts for Interprofessional
Collaborative Care (11th Ed.) — Unit I (Ch. 1–9).
Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
Reference: Ch. 1: Overview of Professional Nursing Concepts —
Clinical Judgment & QSEN Safety Competencies
Question Stem: During handoff report, a postop patient’s
record notes "history of DVT" but no current anticoagulant is
listed. Based on clinical judgment and patient-centered safety
principles, what should the nurse do first?
A. Call the surgeon to request a standing anticoagulation order.
B. Reconcile the medication list and verify prior anticoagulation
history with the patient and chart.
C. Apply sequential compression devices and document that
mechanical prophylaxis is in place.
D. Ask the charge nurse to transfer the patient to a unit with
anticoagulation expertise.
Correct Answer: B
Rationales:
, • Correct (B): Medication reconciliation is the priority to
clarify discrepancies and prevent omission errors; it uses
assessment and systems thinking to inform subsequent
interventions.
• A: Prematurely calling the surgeon without accurate
reconciliation may lead to inappropriate orders; first
confirm the facts.
• C: Applying SCDs is appropriate safety action but should
follow verification—reconciliation may reveal current
pharmacologic prophylaxis is present/needed.
• D: Transfer is unnecessary and delays immediate
reconciliation and interventions.
Teaching Point: Always reconcile medications first to resolve
discrepancies and guide safe care.
Citation: Ignatavicius, Rebar, & Heimgartner, 2024, Ch. 1:
Clinical Judgment & QSEN Safety. evolve.elsevier.com
2
Reference: Ch. 2: Clinical Judgment and Systems Thinking —
Recognizing Cues & Hypothesis Generation
Question Stem: A 68-year-old with COPD has new agitation,
rising respiratory rate, and SpO₂ 89% on 2 L nasal cannula.
Which action best reflects proper cue recognition and
hypothesis generation?
A. Increase oxygen to 6 L via nasal cannula.
,B. Perform focused assessment (breath sounds, work of
breathing) and notify the provider with data.
C. Administer a PRN anxiolytic to reduce agitation and
respiratory demand.
D. Encourage deep breathing and incentive spirometry every
hour.
Correct Answer: B
Rationales:
• Correct (B): Focused assessment collects objective cues
(breath sounds, accessory muscle use) necessary to
generate accurate hypotheses (e.g., exacerbation, hypoxia)
and supports timely communication.
• A: Increasing oxygen without assessment risks CO₂
retention in some COPD patients; requires provider order
after assessment.
• C: Treating agitation without assessing respiratory cause
may mask hypoxia; anxiolytics can depress respirations.
• D: Incentive spirometry is for atelectasis prevention and
not immediately helpful for acute hypoxia and agitation.
Teaching Point: Assess first — collect cues before interventions
or provider notification.
Citation: Ignatavicius et al., 2024, Ch. 2: Recognizing Cues and
Hypothesis Generation. evolve.elsevier.com
, 3
Reference: Ch. 3: Overview of Health Concepts — Determinants
of Health & Health Promotion
Question Stem: A nurse is planning discharge teaching for a
patient with new diagnosis of Type 2 diabetes. Which approach
best applies systems thinking and addresses health
determinants?
A. Provide a standardized diabetes pamphlet and schedule a
primary-care follow-up.
B. Teach dietary carbohydrate counting and request the
dietitian consult prior to discharge.
C. Assess the patient’s food access, health literacy, and support,
then tailor referrals and teaching.
D. Refer the patient to online diabetes education modules and
prescribe metformin.
Correct Answer: C
Rationales:
• Correct (C): Systems thinking includes social determinants
(food access, literacy, support); tailored interventions and
referrals improve adherence and outcomes.
• A: Pamphlets and follow-up are helpful but may not
address barriers like food insecurity or literacy.
• B: Dietitian referral is useful but incomplete without
assessing social determinants.
Collaborative Care (11th Ed.) — Unit I (Ch. 1–9).
Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
Reference: Ch. 1: Overview of Professional Nursing Concepts —
Clinical Judgment & QSEN Safety Competencies
Question Stem: During handoff report, a postop patient’s
record notes "history of DVT" but no current anticoagulant is
listed. Based on clinical judgment and patient-centered safety
principles, what should the nurse do first?
A. Call the surgeon to request a standing anticoagulation order.
B. Reconcile the medication list and verify prior anticoagulation
history with the patient and chart.
C. Apply sequential compression devices and document that
mechanical prophylaxis is in place.
D. Ask the charge nurse to transfer the patient to a unit with
anticoagulation expertise.
Correct Answer: B
Rationales:
, • Correct (B): Medication reconciliation is the priority to
clarify discrepancies and prevent omission errors; it uses
assessment and systems thinking to inform subsequent
interventions.
• A: Prematurely calling the surgeon without accurate
reconciliation may lead to inappropriate orders; first
confirm the facts.
• C: Applying SCDs is appropriate safety action but should
follow verification—reconciliation may reveal current
pharmacologic prophylaxis is present/needed.
• D: Transfer is unnecessary and delays immediate
reconciliation and interventions.
Teaching Point: Always reconcile medications first to resolve
discrepancies and guide safe care.
Citation: Ignatavicius, Rebar, & Heimgartner, 2024, Ch. 1:
Clinical Judgment & QSEN Safety. evolve.elsevier.com
2
Reference: Ch. 2: Clinical Judgment and Systems Thinking —
Recognizing Cues & Hypothesis Generation
Question Stem: A 68-year-old with COPD has new agitation,
rising respiratory rate, and SpO₂ 89% on 2 L nasal cannula.
Which action best reflects proper cue recognition and
hypothesis generation?
A. Increase oxygen to 6 L via nasal cannula.
,B. Perform focused assessment (breath sounds, work of
breathing) and notify the provider with data.
C. Administer a PRN anxiolytic to reduce agitation and
respiratory demand.
D. Encourage deep breathing and incentive spirometry every
hour.
Correct Answer: B
Rationales:
• Correct (B): Focused assessment collects objective cues
(breath sounds, accessory muscle use) necessary to
generate accurate hypotheses (e.g., exacerbation, hypoxia)
and supports timely communication.
• A: Increasing oxygen without assessment risks CO₂
retention in some COPD patients; requires provider order
after assessment.
• C: Treating agitation without assessing respiratory cause
may mask hypoxia; anxiolytics can depress respirations.
• D: Incentive spirometry is for atelectasis prevention and
not immediately helpful for acute hypoxia and agitation.
Teaching Point: Assess first — collect cues before interventions
or provider notification.
Citation: Ignatavicius et al., 2024, Ch. 2: Recognizing Cues and
Hypothesis Generation. evolve.elsevier.com
, 3
Reference: Ch. 3: Overview of Health Concepts — Determinants
of Health & Health Promotion
Question Stem: A nurse is planning discharge teaching for a
patient with new diagnosis of Type 2 diabetes. Which approach
best applies systems thinking and addresses health
determinants?
A. Provide a standardized diabetes pamphlet and schedule a
primary-care follow-up.
B. Teach dietary carbohydrate counting and request the
dietitian consult prior to discharge.
C. Assess the patient’s food access, health literacy, and support,
then tailor referrals and teaching.
D. Refer the patient to online diabetes education modules and
prescribe metformin.
Correct Answer: C
Rationales:
• Correct (C): Systems thinking includes social determinants
(food access, literacy, support); tailored interventions and
referrals improve adherence and outcomes.
• A: Pamphlets and follow-up are helpful but may not
address barriers like food insecurity or literacy.
• B: Dietitian referral is useful but incomplete without
assessing social determinants.
