Brunner & Suddarth's Textbook of
Medical-Surgical Nursing
16th Edition
• Author(s)Janice L. Hinkle; Kerry H.
Cheever; Kristen J. Overbaugh; Carolyn
E. Bradley
ISBN: 9781975221133
Question 1:
Question Type: MCQ
Question Stem:
A registered nurse administers a prescribed IV antibiotic and
then notices that the client’s allergy bracelet identifies a
documented severe allergy to that medication class. Which
action best reflects professional accountability?
Options:
,A. Document the finding in the chart and continue to monitor
the client closely.
B. Report the medication error to the provider and complete an
incident report.
C. Ask the nursing assistant to recheck the allergy list in the
electronic record.
D. Wait until the next dose is due to clarify the allergy history
with the client.
Correct Answer:
B
Rationale for A:
Documenting the finding is necessary, but it is not enough
when a potentially harmful medication has already been given.
The nurse must take action to protect the client, notify the
provider, and follow the facility’s error-reporting process.
Rationale for B:
This is the best response because professional accountability
requires immediate recognition of the error, prompt
communication to the provider, and completion of an incident
report according to policy. The priority is client safety, early
intervention, and accurate reporting so the error can be
managed and systems can be improved.
Rationale for C:
A nursing assistant is not the appropriate person to validate a
medication allergy concern after an error has occurred. The RN
,is responsible for assessment, escalation, and clinical decision-
making related to medication safety.
Rationale for D:
Delaying clarification places the client at unnecessary risk. The
nurse must act immediately because the allergy issue is time-
sensitive and may require assessment for adverse reaction or
treatment.
Key Takeaway:
Professional accountability means acting immediately to
protect the client and report unsafe care.
Question 2:
Question Type: MCQ
Question Stem:
Which task is appropriate for the nurse to delegate to an
unlicensed assistive personnel (UAP)?
Options:
A. Teach a client how to use an incentive spirometer.
B. Obtain a set of routine vital signs on a stable client.
C. Assess a new client complaining of chest pain.
D. Evaluate whether a pain medication has been effective.
Correct Answer:
B
Rationale for A:
Teaching requires nursing knowledge, evaluation of
, understanding, and the ability to modify instruction based on
learning needs. This is not appropriate for delegation to UAP.
Rationale for B:
Obtaining routine vital signs for a stable client is an appropriate
task for UAP because it is routine, predictable, and does not
require nursing judgment. The RN remains responsible for
interpreting abnormal findings.
Rationale for C:
A client reporting chest pain requires immediate nursing
assessment and clinical judgment. Delegating this task could
delay recognition of a potentially life-threatening condition.
Rationale for D:
Evaluating the effectiveness of pain medication requires
assessment and decision-making by an RN. UAPs can report
observations, but they cannot determine treatment
effectiveness.
Key Takeaway:
Delegate routine, predictable tasks; keep assessment, teaching,
and evaluation with the RN.
Question 3:
Question Type: MCQ
Question Stem:
A client scheduled for surgery says, “I am not sure I understand
what procedure I agreed to.” What is the nurse’s best action?
Medical-Surgical Nursing
16th Edition
• Author(s)Janice L. Hinkle; Kerry H.
Cheever; Kristen J. Overbaugh; Carolyn
E. Bradley
ISBN: 9781975221133
Question 1:
Question Type: MCQ
Question Stem:
A registered nurse administers a prescribed IV antibiotic and
then notices that the client’s allergy bracelet identifies a
documented severe allergy to that medication class. Which
action best reflects professional accountability?
Options:
,A. Document the finding in the chart and continue to monitor
the client closely.
B. Report the medication error to the provider and complete an
incident report.
C. Ask the nursing assistant to recheck the allergy list in the
electronic record.
D. Wait until the next dose is due to clarify the allergy history
with the client.
Correct Answer:
B
Rationale for A:
Documenting the finding is necessary, but it is not enough
when a potentially harmful medication has already been given.
The nurse must take action to protect the client, notify the
provider, and follow the facility’s error-reporting process.
Rationale for B:
This is the best response because professional accountability
requires immediate recognition of the error, prompt
communication to the provider, and completion of an incident
report according to policy. The priority is client safety, early
intervention, and accurate reporting so the error can be
managed and systems can be improved.
Rationale for C:
A nursing assistant is not the appropriate person to validate a
medication allergy concern after an error has occurred. The RN
,is responsible for assessment, escalation, and clinical decision-
making related to medication safety.
Rationale for D:
Delaying clarification places the client at unnecessary risk. The
nurse must act immediately because the allergy issue is time-
sensitive and may require assessment for adverse reaction or
treatment.
Key Takeaway:
Professional accountability means acting immediately to
protect the client and report unsafe care.
Question 2:
Question Type: MCQ
Question Stem:
Which task is appropriate for the nurse to delegate to an
unlicensed assistive personnel (UAP)?
Options:
A. Teach a client how to use an incentive spirometer.
B. Obtain a set of routine vital signs on a stable client.
C. Assess a new client complaining of chest pain.
D. Evaluate whether a pain medication has been effective.
Correct Answer:
B
Rationale for A:
Teaching requires nursing knowledge, evaluation of
, understanding, and the ability to modify instruction based on
learning needs. This is not appropriate for delegation to UAP.
Rationale for B:
Obtaining routine vital signs for a stable client is an appropriate
task for UAP because it is routine, predictable, and does not
require nursing judgment. The RN remains responsible for
interpreting abnormal findings.
Rationale for C:
A client reporting chest pain requires immediate nursing
assessment and clinical judgment. Delegating this task could
delay recognition of a potentially life-threatening condition.
Rationale for D:
Evaluating the effectiveness of pain medication requires
assessment and decision-making by an RN. UAPs can report
observations, but they cannot determine treatment
effectiveness.
Key Takeaway:
Delegate routine, predictable tasks; keep assessment, teaching,
and evaluation with the RN.
Question 3:
Question Type: MCQ
Question Stem:
A client scheduled for surgery says, “I am not sure I understand
what procedure I agreed to.” What is the nurse’s best action?
