Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
TEST BANK
Item 1
Reference: Ch. 1 — Clinical Judgment (Overview of Professional
Nursing Concepts)
Question Stem:
A 68-year-old postop hip replacement patient complains of
shortness of breath and sudden chest pain 2 hours after
surgery. Using clinical judgment and the nursing process, what
is the nurse’s priority action?
A. Administer ordered PRN morphine for pain.
B. Obtain a STAT 12-lead ECG and call the provider.
C. Reposition the patient and encourage deep breathing
exercises.
D. Document the symptoms and continue routine monitoring.
Correct Answer: B
Rationales:
B (correct): Sudden chest pain with dyspnea in the immediate
,postop period suggests a potential acute cardiac or pulmonary
event (e.g., pulmonary embolism, MI). Obtaining a STAT ECG
and notifying the provider prioritizes assessment and rapid
diagnosis per clinical judgment and safety principles.
A: Administering morphine before assessment could mask
symptoms and delay diagnosis.
C: Repositioning and breathing exercises are supportive but
insufficient when evaluating possible life-threatening
complications.
D: Passive documentation without urgent assessment fails to
protect patient safety and delays necessary interventions.
Teaching Point: Rapid assessment and notification for acute
cardiopulmonary symptoms is highest priority.
Citation: Ignatavicius et al., 2024, Ch. 1: Clinical Judgment
Item 2
Reference: Ch. 1 — Systems Thinking & Interprofessional
Collaboration
Question Stem:
The nurse notices repeated medication delays for multiple
patients during shift change due to interrupted medication-
room workflow. Which best reflects a systems-thinking
approach the nurse should take?
A. Report individual nurses who caused delays to the nurse
manager.
,B. Complete medication rounds earlier the next shift to avoid
delays.
C. Collect data on timing and interruptions and propose a
multidisciplinary workflow review.
D. Ask pharmacy to send medications earlier than scheduled.
Correct Answer: C
Rationales:
C (correct): Systems thinking focuses on processes and
interactions; collecting data and initiating a multidisciplinary
review addresses root causes and sustainable improvement.
A: Blaming individuals ignores system-level contributors and
inhibits improvement.
B: Individual workaround may temporarily reduce delays but
does not address systemic causes.
D: Asking pharmacy to send earlier is a unilateral fix that may
not address interruptions or workflow inefficiencies.
Teaching Point: Use data and team review to fix system-level
safety issues.
Citation: Ignatavicius et al., 2024, Ch. 1: Systems Thinking
Item 3
Reference: Ch. 1 — QSEN & Patient Safety Competencies
Question Stem:
Which action by a nurse best demonstrates the QSEN
, competency of evidence-based practice on a medical-surgical
unit?
A. Following longstanding unit habit for wound dressing.
B. Searching current literature and updating the dressing
protocol to reduce infections.
C. Waiting for the hospital to mandate changes before altering
practice.
D. Asking the charge nurse what the unit used to do last year.
Correct Answer: B
Rationales:
B (correct): Evidence-based practice requires integrating
current best evidence into clinical protocols to improve
outcomes—proactively updating protocols based on literature
embodies this competency.
A: Habit alone is not evidence-based.
C: Passive waiting delays improvements and patient safety
advances.
D: Historical practices may be outdated and are not substitutes
for current evidence.
Teaching Point: Update practice using current best evidence to
improve outcomes.
Citation: Ignatavicius et al., 2024, Ch. 1: QSEN Competencies /
Evidence-Based Practice
Item 4
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
TEST BANK
Item 1
Reference: Ch. 1 — Clinical Judgment (Overview of Professional
Nursing Concepts)
Question Stem:
A 68-year-old postop hip replacement patient complains of
shortness of breath and sudden chest pain 2 hours after
surgery. Using clinical judgment and the nursing process, what
is the nurse’s priority action?
A. Administer ordered PRN morphine for pain.
B. Obtain a STAT 12-lead ECG and call the provider.
C. Reposition the patient and encourage deep breathing
exercises.
D. Document the symptoms and continue routine monitoring.
Correct Answer: B
Rationales:
B (correct): Sudden chest pain with dyspnea in the immediate
,postop period suggests a potential acute cardiac or pulmonary
event (e.g., pulmonary embolism, MI). Obtaining a STAT ECG
and notifying the provider prioritizes assessment and rapid
diagnosis per clinical judgment and safety principles.
A: Administering morphine before assessment could mask
symptoms and delay diagnosis.
C: Repositioning and breathing exercises are supportive but
insufficient when evaluating possible life-threatening
complications.
D: Passive documentation without urgent assessment fails to
protect patient safety and delays necessary interventions.
Teaching Point: Rapid assessment and notification for acute
cardiopulmonary symptoms is highest priority.
Citation: Ignatavicius et al., 2024, Ch. 1: Clinical Judgment
Item 2
Reference: Ch. 1 — Systems Thinking & Interprofessional
Collaboration
Question Stem:
The nurse notices repeated medication delays for multiple
patients during shift change due to interrupted medication-
room workflow. Which best reflects a systems-thinking
approach the nurse should take?
A. Report individual nurses who caused delays to the nurse
manager.
,B. Complete medication rounds earlier the next shift to avoid
delays.
C. Collect data on timing and interruptions and propose a
multidisciplinary workflow review.
D. Ask pharmacy to send medications earlier than scheduled.
Correct Answer: C
Rationales:
C (correct): Systems thinking focuses on processes and
interactions; collecting data and initiating a multidisciplinary
review addresses root causes and sustainable improvement.
A: Blaming individuals ignores system-level contributors and
inhibits improvement.
B: Individual workaround may temporarily reduce delays but
does not address systemic causes.
D: Asking pharmacy to send earlier is a unilateral fix that may
not address interruptions or workflow inefficiencies.
Teaching Point: Use data and team review to fix system-level
safety issues.
Citation: Ignatavicius et al., 2024, Ch. 1: Systems Thinking
Item 3
Reference: Ch. 1 — QSEN & Patient Safety Competencies
Question Stem:
Which action by a nurse best demonstrates the QSEN
, competency of evidence-based practice on a medical-surgical
unit?
A. Following longstanding unit habit for wound dressing.
B. Searching current literature and updating the dressing
protocol to reduce infections.
C. Waiting for the hospital to mandate changes before altering
practice.
D. Asking the charge nurse what the unit used to do last year.
Correct Answer: B
Rationales:
B (correct): Evidence-based practice requires integrating
current best evidence into clinical protocols to improve
outcomes—proactively updating protocols based on literature
embodies this competency.
A: Habit alone is not evidence-based.
C: Passive waiting delays improvements and patient safety
advances.
D: Historical practices may be outdated and are not substitutes
for current evidence.
Teaching Point: Update practice using current best evidence to
improve outcomes.
Citation: Ignatavicius et al., 2024, Ch. 1: QSEN Competencies /
Evidence-Based Practice
Item 4
