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. 2: Clinical Judgment and Systems Thinking
— Prioritization & Clinical Reasoning
Question Stem: A 68-year-old patient with chronic COPD
arrives with increased dyspnea, productive cough, and
SpO₂ 88% on room air. Which nursing action should you
implement first?
A. Administer prescribed bronchodilator via nebulizer.
B. Elevate the head of the bed and apply supplemental
oxygen per protocol.
C. Obtain a chest x-ray to evaluate for pneumonia.
D. Draw arterial blood gas (ABG) to assess acid-base status.
Correct Answer: B
Rationales:
• Correct (B): Elevating the head of bed and applying oxygen
addresses immediate hypoxemia and respiratory distress,
consistent with prioritizing airway/oxygenation in clinical
judgment.
,• A: Nebulized bronchodilator is important but comes after
addressing hypoxemia; oxygen should not be delayed.
• C: Imaging is diagnostic and necessary but not the first
immediate intervention for low SpO₂.
• D: ABG provides data but does not immediately correct
hypoxemia; it can be obtained after oxygen is initiated.
Teaching Point: Treat airway and oxygenation problems
first—then gather diagnostic data.
Citation: Ignatavicius et al., 2024, Ch. 2: Prioritization &
Clinical Reasoning
2
Reference: Ch. 1: Overview of Professional Nursing
Concepts — Scope & Delegation
Question Stem: On a medical-surgical unit, which task
should the RN delegate to an experienced unlicensed
assistive personnel (UAP) for a postoperative hip
replacement patient?
A. Assess neurovascular status of the operative leg every
hour.
B. Reinforce preoperative teaching about hip precautions.
C. Assist the patient with a bedside-to-chair transfer using
a gait belt.
D. Teach the patient how to use a walker with a wide base.
, Correct Answer: C
Rationales:
• Correct (C): Assisting with transfers using a gait belt is
within UAP scope when patient is stable and the UAP is
trained; RN retains assessment and teaching
responsibilities.
• A: Neurovascular assessments require RN skill and clinical
judgement — cannot be delegated.
• B: Reinforcing preoperative teaching involves clinical
knowledge and should be done by RN.
• D: Walker training requires a skilled assessment and
teaching plan by RN or PT.
Teaching Point: Delegate routine, stable tasks to trained
UAPs; RN retains assessment and teaching.
Citation: Ignatavicius et al., 2024, Ch. 1: Scope &
Delegation
3
Reference: Ch. 3: Overview of Health Concepts —
Immunologic & Inflammatory Response
Question Stem: A patient with acute pancreatitis has a
rising hematocrit and an elevated BUN. Which
interpretation should the nurse prioritize?
A. The patient is developing internal hemorrhage.
B. The patient is becoming volume depleted and
, hemoconcentrated.
C. The patient has worsening renal failure.
D. The patient’s inflammatory response is resolving.
Correct Answer: B
Rationales:
• Correct (B): Rising hematocrit with elevated BUN in
pancreatitis suggests intravascular volume depletion and
hemoconcentration; fluid resuscitation is priority.
• A: Hemorrhage typically lowers hematocrit rather than
raises it.
• C: Elevated BUN could reflect hypovolemia rather than
primary renal failure in this context.
• D: These lab trends are not consistent with resolution—
they indicate worsening perfusion.
Teaching Point: Rising hematocrit + BUN equals potential
hypovolemia; prioritize fluid resuscitation.
Citation: Ignatavicius et al., 2024, Ch. 3: Inflammation &
Fluid Status
4
Reference: Ch. 4: Concepts of Care for Older Adults —
Delirium vs Dementia
Question Stem: An 82-year-old postop patient becomes
acutely disoriented and agitated on postoperative day 1.
Which nursing action is most appropriate first?
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. 2: Clinical Judgment and Systems Thinking
— Prioritization & Clinical Reasoning
Question Stem: A 68-year-old patient with chronic COPD
arrives with increased dyspnea, productive cough, and
SpO₂ 88% on room air. Which nursing action should you
implement first?
A. Administer prescribed bronchodilator via nebulizer.
B. Elevate the head of the bed and apply supplemental
oxygen per protocol.
C. Obtain a chest x-ray to evaluate for pneumonia.
D. Draw arterial blood gas (ABG) to assess acid-base status.
Correct Answer: B
Rationales:
• Correct (B): Elevating the head of bed and applying oxygen
addresses immediate hypoxemia and respiratory distress,
consistent with prioritizing airway/oxygenation in clinical
judgment.
,• A: Nebulized bronchodilator is important but comes after
addressing hypoxemia; oxygen should not be delayed.
• C: Imaging is diagnostic and necessary but not the first
immediate intervention for low SpO₂.
• D: ABG provides data but does not immediately correct
hypoxemia; it can be obtained after oxygen is initiated.
Teaching Point: Treat airway and oxygenation problems
first—then gather diagnostic data.
Citation: Ignatavicius et al., 2024, Ch. 2: Prioritization &
Clinical Reasoning
2
Reference: Ch. 1: Overview of Professional Nursing
Concepts — Scope & Delegation
Question Stem: On a medical-surgical unit, which task
should the RN delegate to an experienced unlicensed
assistive personnel (UAP) for a postoperative hip
replacement patient?
A. Assess neurovascular status of the operative leg every
hour.
B. Reinforce preoperative teaching about hip precautions.
C. Assist the patient with a bedside-to-chair transfer using
a gait belt.
D. Teach the patient how to use a walker with a wide base.
, Correct Answer: C
Rationales:
• Correct (C): Assisting with transfers using a gait belt is
within UAP scope when patient is stable and the UAP is
trained; RN retains assessment and teaching
responsibilities.
• A: Neurovascular assessments require RN skill and clinical
judgement — cannot be delegated.
• B: Reinforcing preoperative teaching involves clinical
knowledge and should be done by RN.
• D: Walker training requires a skilled assessment and
teaching plan by RN or PT.
Teaching Point: Delegate routine, stable tasks to trained
UAPs; RN retains assessment and teaching.
Citation: Ignatavicius et al., 2024, Ch. 1: Scope &
Delegation
3
Reference: Ch. 3: Overview of Health Concepts —
Immunologic & Inflammatory Response
Question Stem: A patient with acute pancreatitis has a
rising hematocrit and an elevated BUN. Which
interpretation should the nurse prioritize?
A. The patient is developing internal hemorrhage.
B. The patient is becoming volume depleted and
, hemoconcentrated.
C. The patient has worsening renal failure.
D. The patient’s inflammatory response is resolving.
Correct Answer: B
Rationales:
• Correct (B): Rising hematocrit with elevated BUN in
pancreatitis suggests intravascular volume depletion and
hemoconcentration; fluid resuscitation is priority.
• A: Hemorrhage typically lowers hematocrit rather than
raises it.
• C: Elevated BUN could reflect hypovolemia rather than
primary renal failure in this context.
• D: These lab trends are not consistent with resolution—
they indicate worsening perfusion.
Teaching Point: Rising hematocrit + BUN equals potential
hypovolemia; prioritize fluid resuscitation.
Citation: Ignatavicius et al., 2024, Ch. 3: Inflammation &
Fluid Status
4
Reference: Ch. 4: Concepts of Care for Older Adults —
Delirium vs Dementia
Question Stem: An 82-year-old postop patient becomes
acutely disoriented and agitated on postoperative day 1.
Which nursing action is most appropriate first?
