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 —
Interprofessional Collaboration
Stem: A 68-year-old patient recovering from hip arthroplasty
develops sudden tachycardia and hypotension on postoperative
day 2. As the RN, which immediate action best reflects
professional nursing practice and interprofessional
collaboration?
A. Call the surgeon and request an in-person evaluation.
B. Perform focused assessment, apply supplemental oxygen,
and notify rapid response team.
C. Review the patient's medication list for antihypertensives and
hold them.
D. Document the vitals and reassess in 30 minutes.
Correct Answer: B
Rationale — Correct: Performing a focused assessment and
providing immediate life-saving measures (oxygen) while
,activating the rapid response team demonstrates timely nursing
assessment, escalation, and interprofessional collaboration per
professional standards.
Rationale — Incorrect:
A. Calling the surgeon without immediate
assessment/treatment delays stabilization and misses crisis
management.
C. Reviewing meds is useful but not the first action in
hemodynamic instability — immediate stabilization required.
D. Waiting 30 minutes risks deterioration and fails to prioritize
urgent intervention.
Teaching Point: Assess and intervene immediately; escalate via
rapid response when instability occurs.
Citation: Ignatavicius et al., 2024, Ch. 1: Interprofessional
Collaboration
2
Reference: Ch. 2: Clinical Judgment and Systems Thinking —
Recognizing Cues and Prioritization
Stem: During shift report, you receive four assignments: (1) a
postoperative patient with PCA pump at 4/10 pain, (2) a
diabetic with blood glucose 56 mg/dL and sweating, (3) a
patient with controlled HTN requesting discharge teaching, (4)
an atrial fibrillation patient with HR 112 and dizziness. Which
patient should you assess first?
A. Postoperative PCA at 4/10 pain
,B. Diabetic with glucose 56 mg/dL and diaphoresis
C. HTN patient for discharge teaching
D. Atrial fibrillation patient with HR 112 and dizziness
Correct Answer: B
Rationale — Correct: Hypoglycemia (BG 56 mg/dL) with
autonomic symptoms is immediately life-threatening and
requires rapid assessment and treatment to prevent neurologic
injury.
Rationale — Incorrect:
A. Pain is important but not immediately life-threatening at this
level.
C. Discharge teaching can be delegated or scheduled after
urgent needs addressed.
D. Atrial fibrillation with HR 112 and dizziness is concerning but
less immediately life-threatening than symptomatic
hypoglycemia.
Teaching Point: Treat symptomatic hypoglycemia immediately
to prevent neuroglycopenia.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment —
Prioritization
3
Reference: Ch. 3: Overview of Health Concepts —
Hemodynamic Monitoring & Shock Recognition
Stem: A patient in the medical ICU has a central venous
pressure (CVP) of 3 mm Hg, cool extremities, and urine output
, 15 mL/hr. Which nursing intervention is the highest priority?
A. Increase the IV fluid infusion rate and notify the provider.
B. Place the patient in Trendelenburg position.
C. Administer furosemide IV push.
D. Obtain arterial blood gas (ABG).
Correct Answer: A
Rationale — Correct: Low CVP, oliguria, and cool extremities
indicate hypovolemia/shock — IV fluid resuscitation is the
priority while notifying the provider for ongoing management.
Rationale — Incorrect:
B. Trendelenburg may temporarily increase venous return but is
not first-line treatment for hypovolemia and can have
complications.
C. Furosemide would worsen hypovolemia and is
contraindicated.
D. ABG is useful diagnostically but delays immediate
resuscitation.
Teaching Point: Low CVP + poor perfusion → treat hypovolemia
with fluids promptly.
Citation: Ignatavicius et al., 2024, Ch. 3: Hemodynamics and
Shock
4
Reference: Ch. 4: Concepts of Care for Older Adults —
Polypharmacy & Falls Risk
Stem: An 82-year-old on multiple antihypertensives reports
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 —
Interprofessional Collaboration
Stem: A 68-year-old patient recovering from hip arthroplasty
develops sudden tachycardia and hypotension on postoperative
day 2. As the RN, which immediate action best reflects
professional nursing practice and interprofessional
collaboration?
A. Call the surgeon and request an in-person evaluation.
B. Perform focused assessment, apply supplemental oxygen,
and notify rapid response team.
C. Review the patient's medication list for antihypertensives and
hold them.
D. Document the vitals and reassess in 30 minutes.
Correct Answer: B
Rationale — Correct: Performing a focused assessment and
providing immediate life-saving measures (oxygen) while
,activating the rapid response team demonstrates timely nursing
assessment, escalation, and interprofessional collaboration per
professional standards.
Rationale — Incorrect:
A. Calling the surgeon without immediate
assessment/treatment delays stabilization and misses crisis
management.
C. Reviewing meds is useful but not the first action in
hemodynamic instability — immediate stabilization required.
D. Waiting 30 minutes risks deterioration and fails to prioritize
urgent intervention.
Teaching Point: Assess and intervene immediately; escalate via
rapid response when instability occurs.
Citation: Ignatavicius et al., 2024, Ch. 1: Interprofessional
Collaboration
2
Reference: Ch. 2: Clinical Judgment and Systems Thinking —
Recognizing Cues and Prioritization
Stem: During shift report, you receive four assignments: (1) a
postoperative patient with PCA pump at 4/10 pain, (2) a
diabetic with blood glucose 56 mg/dL and sweating, (3) a
patient with controlled HTN requesting discharge teaching, (4)
an atrial fibrillation patient with HR 112 and dizziness. Which
patient should you assess first?
A. Postoperative PCA at 4/10 pain
,B. Diabetic with glucose 56 mg/dL and diaphoresis
C. HTN patient for discharge teaching
D. Atrial fibrillation patient with HR 112 and dizziness
Correct Answer: B
Rationale — Correct: Hypoglycemia (BG 56 mg/dL) with
autonomic symptoms is immediately life-threatening and
requires rapid assessment and treatment to prevent neurologic
injury.
Rationale — Incorrect:
A. Pain is important but not immediately life-threatening at this
level.
C. Discharge teaching can be delegated or scheduled after
urgent needs addressed.
D. Atrial fibrillation with HR 112 and dizziness is concerning but
less immediately life-threatening than symptomatic
hypoglycemia.
Teaching Point: Treat symptomatic hypoglycemia immediately
to prevent neuroglycopenia.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment —
Prioritization
3
Reference: Ch. 3: Overview of Health Concepts —
Hemodynamic Monitoring & Shock Recognition
Stem: A patient in the medical ICU has a central venous
pressure (CVP) of 3 mm Hg, cool extremities, and urine output
, 15 mL/hr. Which nursing intervention is the highest priority?
A. Increase the IV fluid infusion rate and notify the provider.
B. Place the patient in Trendelenburg position.
C. Administer furosemide IV push.
D. Obtain arterial blood gas (ABG).
Correct Answer: A
Rationale — Correct: Low CVP, oliguria, and cool extremities
indicate hypovolemia/shock — IV fluid resuscitation is the
priority while notifying the provider for ongoing management.
Rationale — Incorrect:
B. Trendelenburg may temporarily increase venous return but is
not first-line treatment for hypovolemia and can have
complications.
C. Furosemide would worsen hypovolemia and is
contraindicated.
D. ABG is useful diagnostically but delays immediate
resuscitation.
Teaching Point: Low CVP + poor perfusion → treat hypovolemia
with fluids promptly.
Citation: Ignatavicius et al., 2024, Ch. 3: Hemodynamics and
Shock
4
Reference: Ch. 4: Concepts of Care for Older Adults —
Polypharmacy & Falls Risk
Stem: An 82-year-old on multiple antihypertensives reports
