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: Professional Roles and Scope – Nursing
Delegation
Question stem: A registered nurse (RN) working on a med-surg
unit is delegating tasks for the upcoming shift. Which task is the
RN’s best choice to delegate to a licensed practical nurse (LPN)?
A nurse needs: frequent reinforcement of discharge teaching
about insulin administration for a newly diagnosed diabetic; a
wound dressing change for a stable patient with a clean, closed
incision; a postoperative assessment of a patient 30 minutes
after an appendectomy; or administration of the first dose of a
new IV antibiotic.
Options:
A. Reinforce discharge teaching about insulin administration.
B. Perform the wound dressing change for the stable incision.
C. Do the postoperative assessment 30 minutes after
,appendectomy.
D. Administer the first dose of a new IV antibiotic.
Correct answer: B
Rationales:
• Correct (B): LPNs are typically skilled in performing
routine, stable wound care and dressing changes; this is
within predictable, delegated tasks and allows the RN to
focus on assessments and unstable tasks.
• A (incorrect): Teaching and evaluation of learning—
especially initial education for insulin self-management—is
the RN’s responsibility because it requires assessment,
planning, and evaluation.
• C (incorrect): Immediate postoperative assessment is an
RN priority task requiring complex assessment and clinical
judgment.
• D (incorrect): Administration of the first dose of a new IV
antibiotic often requires RN medication reconciliation and
assessment for allergies and response; it is not ideal to
delegate as the first-time dose.
Teaching point: Delegate predictable, stable, technical tasks;
retain assessment and teaching responsibilities.
Citation: Ignatavicius et al., 2024, Ch. 1: Professional Roles and
Delegation
,2
Reference: Ch. 1: Legal/Ethical Concepts – Patient Rights &
Informed Consent
Question stem: A 72-year-old patient with early Alzheimer
disease is scheduled for elective hernia repair. The patient’s
daughter (healthcare proxy) gives consent, but the patient
verbally objects on arrival. Which action should the RN take
first?
A. Proceed with surgery because the daughter is the designated
proxy.
B. Ask the patient to sign a refusal of surgery form.
C. Notify the surgeon and postpone surgery until capacity is
assessed.
D. Explain to the patient that the proxy already gave consent
and continue.
Options:
A. Proceed with surgery because the daughter is the designated
proxy.
B. Ask the patient to sign a refusal form.
C. Notify the surgeon and postpone surgery until capacity is
assessed.
D. Explain to the patient that the proxy already gave consent
and continue.
Correct answer: C
Rationales:
, • Correct (C): If a patient expresses dissent, the RN must
prompt reassessment of decision-making capacity and
notify the surgeon; an expressed objection may indicate
preserved capacity and requires immediate attention.
• A (incorrect): A proxy’s consent applies when the patient
lacks capacity; expressed objection suggests capacity may
be present and overrides proxy consent until capacity is
evaluated.
• B (incorrect): Asking the patient to sign a refusal presumes
capacity without assessing it; the RN should first arrange a
capacity assessment.
• D (incorrect): Dismissing the patient’s objection violates
respect for autonomy and legal/ethical standards.
Teaching point: Always assess capacity and notify the surgeon
when a patient objects despite proxy consent.
Citation: Ignatavicius et al., 2024, Ch. 1: Ethical and Legal Issues
in Nursing
3
Reference: Ch. 2: Clinical Judgment Model – Recognizing Cues &
Prioritization
Question stem: On evening rounds a post-op patient’s
respiratory rate increases from 14 to 28 breaths/min and
oxygen saturation drops from 98% to 90% on room air. The
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: Professional Roles and Scope – Nursing
Delegation
Question stem: A registered nurse (RN) working on a med-surg
unit is delegating tasks for the upcoming shift. Which task is the
RN’s best choice to delegate to a licensed practical nurse (LPN)?
A nurse needs: frequent reinforcement of discharge teaching
about insulin administration for a newly diagnosed diabetic; a
wound dressing change for a stable patient with a clean, closed
incision; a postoperative assessment of a patient 30 minutes
after an appendectomy; or administration of the first dose of a
new IV antibiotic.
Options:
A. Reinforce discharge teaching about insulin administration.
B. Perform the wound dressing change for the stable incision.
C. Do the postoperative assessment 30 minutes after
,appendectomy.
D. Administer the first dose of a new IV antibiotic.
Correct answer: B
Rationales:
• Correct (B): LPNs are typically skilled in performing
routine, stable wound care and dressing changes; this is
within predictable, delegated tasks and allows the RN to
focus on assessments and unstable tasks.
• A (incorrect): Teaching and evaluation of learning—
especially initial education for insulin self-management—is
the RN’s responsibility because it requires assessment,
planning, and evaluation.
• C (incorrect): Immediate postoperative assessment is an
RN priority task requiring complex assessment and clinical
judgment.
• D (incorrect): Administration of the first dose of a new IV
antibiotic often requires RN medication reconciliation and
assessment for allergies and response; it is not ideal to
delegate as the first-time dose.
Teaching point: Delegate predictable, stable, technical tasks;
retain assessment and teaching responsibilities.
Citation: Ignatavicius et al., 2024, Ch. 1: Professional Roles and
Delegation
,2
Reference: Ch. 1: Legal/Ethical Concepts – Patient Rights &
Informed Consent
Question stem: A 72-year-old patient with early Alzheimer
disease is scheduled for elective hernia repair. The patient’s
daughter (healthcare proxy) gives consent, but the patient
verbally objects on arrival. Which action should the RN take
first?
A. Proceed with surgery because the daughter is the designated
proxy.
B. Ask the patient to sign a refusal of surgery form.
C. Notify the surgeon and postpone surgery until capacity is
assessed.
D. Explain to the patient that the proxy already gave consent
and continue.
Options:
A. Proceed with surgery because the daughter is the designated
proxy.
B. Ask the patient to sign a refusal form.
C. Notify the surgeon and postpone surgery until capacity is
assessed.
D. Explain to the patient that the proxy already gave consent
and continue.
Correct answer: C
Rationales:
, • Correct (C): If a patient expresses dissent, the RN must
prompt reassessment of decision-making capacity and
notify the surgeon; an expressed objection may indicate
preserved capacity and requires immediate attention.
• A (incorrect): A proxy’s consent applies when the patient
lacks capacity; expressed objection suggests capacity may
be present and overrides proxy consent until capacity is
evaluated.
• B (incorrect): Asking the patient to sign a refusal presumes
capacity without assessing it; the RN should first arrange a
capacity assessment.
• D (incorrect): Dismissing the patient’s objection violates
respect for autonomy and legal/ethical standards.
Teaching point: Always assess capacity and notify the surgeon
when a patient objects despite proxy consent.
Citation: Ignatavicius et al., 2024, Ch. 1: Ethical and Legal Issues
in Nursing
3
Reference: Ch. 2: Clinical Judgment Model – Recognizing Cues &
Prioritization
Question stem: On evening rounds a post-op patient’s
respiratory rate increases from 14 to 28 breaths/min and
oxygen saturation drops from 98% to 90% on room air. The
