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 — Delegation
and Accountability
Question Stem: A charge nurse assigns a newly licensed RN
(NLRN) to care for a stable post-op patient and delegates
medication administration for a different patient to an
experienced LPN. Which action by the charge nurse best
demonstrates appropriate delegation?
A. Assigning the NLRN to administer IV push narcotics
independently.
B. Asking the LPN to perform a focused bedside assessment and
document findings.
C. Instructing the NLRN to perform initial admission assessment
for a new unstable patient.
D. Assigning the LPN to titrate a complex vasoactive infusion per
protocol.
Correct Answer: B
Rationale (Correct): Delegation must match the competence of
,the delegatee; experienced LPNs can perform focused
assessments and document within their scope when allowed.
This preserves safety and accountability.
Rationale (Incorrect):
A. IV push narcotics require independent RN judgment and are
not appropriate for an unassessed novice RN.
C. Initial assessment of an unstable patient requires critical
clinical judgment beyond a newly licensed RN's expected
independence.
D. Titration of vasoactive agents requires advanced assessment
and RN judgment; inappropriate to delegate to LPN.
Teaching Point: Delegate only tasks within the delegatee’s
competence and facility policy.
Citation: Ignatavicius et al., 2024, Ch. 1: Delegation and
Accountability
Item 2
Reference: Ch. 1: Communication — SBAR and Documentation
Standards
Question Stem: During shift report, a nurse must use SBAR to
convey a patient’s condition change: the patient has new-onset
confusion and hypotension. What is the most appropriate
“Recommendation” statement to include?
A. “I think the patient is fine; please check later.”
B. “Recommend immediate assessment, STAT labs, and provider
notification for potential sepsis.”
,C. “Recommend we discharge the patient home when stable.”
D. “I recommend documenting and watching overnight.”
Correct Answer: B
Rationale (Correct): SBAR’s Recommendation should state the
needed action; new confusion and hypotension are urgent and
may indicate sepsis—requesting immediate assessment, labs,
and provider notification is appropriate.
Rationale (Incorrect):
A. Vague and dismissive; fails to state actionable
recommendation.
C. Discharge recommendation is unsafe given acute changes.
D. Watchful waiting delays essential evaluation for possible life-
threatening causes.
Teaching Point: Recommendations must be specific and action-
oriented for safe escalation.
Citation: Ignatavicius et al., 2024, Ch. 1: Communication and
SBAR
Item 3 (Application/Analysis)
Reference: Ch. 2: Clinical Judgment — Clinical Judgment
Measurement Model (CJMM)
Question Stem: A post-op patient reports increasing pain
despite scheduled analgesics and shows guarding. Using clinical
judgment steps, which action should the nurse perform first?
A. Document the pain score and continue scheduled analgesics.
B. Reassess pain characteristics, vital signs, surgical site, and
, recent analgesic timing.
C. Call the surgeon to report pain immediately without further
assessment.
D. Offer a high-protein snack to distract from pain.
Correct Answer: B
Rationale (Correct): The CJMM starts with recognizing and
interpreting cues; reassessment to gather data (character, site,
vitals, medication timing) is the appropriate first action before
interventions or reporting.
Rationale (Incorrect):
A. Documentation alone misses essential reassessment and
may delay appropriate care.
C. Contacting the surgeon without a focused assessment can
lead to incomplete information and poor decision-making.
D. A snack is not an evidence-based initial response to
escalating post-op pain.
Teaching Point: Always reassess and gather data before
planning and communicating clinical actions.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment
Item 4 (Application/Analysis)
Reference: Ch. 2: Systems Thinking — Error Reduction and Root
Cause Analysis
Question Stem: After several medication errors on a unit, the
nurse manager convenes an interprofessional meeting focused
on system redesign. Which manager action best reflects
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 — Delegation
and Accountability
Question Stem: A charge nurse assigns a newly licensed RN
(NLRN) to care for a stable post-op patient and delegates
medication administration for a different patient to an
experienced LPN. Which action by the charge nurse best
demonstrates appropriate delegation?
A. Assigning the NLRN to administer IV push narcotics
independently.
B. Asking the LPN to perform a focused bedside assessment and
document findings.
C. Instructing the NLRN to perform initial admission assessment
for a new unstable patient.
D. Assigning the LPN to titrate a complex vasoactive infusion per
protocol.
Correct Answer: B
Rationale (Correct): Delegation must match the competence of
,the delegatee; experienced LPNs can perform focused
assessments and document within their scope when allowed.
This preserves safety and accountability.
Rationale (Incorrect):
A. IV push narcotics require independent RN judgment and are
not appropriate for an unassessed novice RN.
C. Initial assessment of an unstable patient requires critical
clinical judgment beyond a newly licensed RN's expected
independence.
D. Titration of vasoactive agents requires advanced assessment
and RN judgment; inappropriate to delegate to LPN.
Teaching Point: Delegate only tasks within the delegatee’s
competence and facility policy.
Citation: Ignatavicius et al., 2024, Ch. 1: Delegation and
Accountability
Item 2
Reference: Ch. 1: Communication — SBAR and Documentation
Standards
Question Stem: During shift report, a nurse must use SBAR to
convey a patient’s condition change: the patient has new-onset
confusion and hypotension. What is the most appropriate
“Recommendation” statement to include?
A. “I think the patient is fine; please check later.”
B. “Recommend immediate assessment, STAT labs, and provider
notification for potential sepsis.”
,C. “Recommend we discharge the patient home when stable.”
D. “I recommend documenting and watching overnight.”
Correct Answer: B
Rationale (Correct): SBAR’s Recommendation should state the
needed action; new confusion and hypotension are urgent and
may indicate sepsis—requesting immediate assessment, labs,
and provider notification is appropriate.
Rationale (Incorrect):
A. Vague and dismissive; fails to state actionable
recommendation.
C. Discharge recommendation is unsafe given acute changes.
D. Watchful waiting delays essential evaluation for possible life-
threatening causes.
Teaching Point: Recommendations must be specific and action-
oriented for safe escalation.
Citation: Ignatavicius et al., 2024, Ch. 1: Communication and
SBAR
Item 3 (Application/Analysis)
Reference: Ch. 2: Clinical Judgment — Clinical Judgment
Measurement Model (CJMM)
Question Stem: A post-op patient reports increasing pain
despite scheduled analgesics and shows guarding. Using clinical
judgment steps, which action should the nurse perform first?
A. Document the pain score and continue scheduled analgesics.
B. Reassess pain characteristics, vital signs, surgical site, and
, recent analgesic timing.
C. Call the surgeon to report pain immediately without further
assessment.
D. Offer a high-protein snack to distract from pain.
Correct Answer: B
Rationale (Correct): The CJMM starts with recognizing and
interpreting cues; reassessment to gather data (character, site,
vitals, medication timing) is the appropriate first action before
interventions or reporting.
Rationale (Incorrect):
A. Documentation alone misses essential reassessment and
may delay appropriate care.
C. Contacting the surgeon without a focused assessment can
lead to incomplete information and poor decision-making.
D. A snack is not an evidence-based initial response to
escalating post-op pain.
Teaching Point: Always reassess and gather data before
planning and communicating clinical actions.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment
Item 4 (Application/Analysis)
Reference: Ch. 2: Systems Thinking — Error Reduction and Root
Cause Analysis
Question Stem: After several medication errors on a unit, the
nurse manager convenes an interprofessional meeting focused
on system redesign. Which manager action best reflects
