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 of Medical-
Surgical Nursing (Overview)
Question Stem: A nurse on a medical-surgical unit is precepting
a newly licensed nurse who asks whether they must always
follow a physician’s order even if it seems unsafe. Which
response best reflects the nurse’s professional responsibility?
Options:
A. “Yes — follow the order and document any concerns so the
provider can review later.”
B. “You should follow the order but report safety concerns to
the unit manager only.”
C. “If you believe the order is unsafe, clarify with the provider
and escalate per policy.”
D. “Refuse the order and discharge responsibility to the
provider immediately.”
Correct Answer: C
,Rationales — Correct: C — Nurses have a professional and
ethical duty to question or clarify orders that appear unsafe,
using clinical judgment and organizational escalation processes
to protect patients.
Incorrect A: Following without clarification risks patient harm;
documentation alone is insufficient.
Incorrect B: Reporting only to manager delays immediate
clarification with prescriber and risks patient safety.
Incorrect D: Refusing without attempt to clarify and provide
safe alternatives is not appropriate delegation of responsibility.
Teaching Point: Clarify unsafe orders promptly; escalate per
policy to protect the patient.
Citation: Ignatavicius, Rebar, & Heimgartner, 2024, Ch. 1:
Professional Roles and Scope.
2
Reference: Ch. 2: Clinical Judgment — Recognizing Cues and
Prioritizing Care
Question Stem: A client postoperative 12 hours after
laparoscopic cholecystectomy reports increasing abdominal
pain, pulse 118, BP 92/58, and diminished urine output. Which
action should the nurse take first?
Options:
A. Administer PRN opioid analgesic per orders.
B. Notify the surgeon immediately about vital sign changes.
C. Assess abdominal incision and dressing for bleeding.
,D. Encourage the client to ambulate to improve circulation.
Correct Answer: C
Rationales — Correct: C — Assessing the incision/dressing is the
priority to identify the source of hypotension/tachycardia (e.g.,
bleeding), which directly explains the deterioration. Assessment
precedes notification or medication.
Incorrect A: Giving analgesic may mask worsening signs and
delay identification of bleeding.
Incorrect B: Notification is important but should be preceded by
focused assessment findings to report.
Incorrect D: Ambulation could worsen blood loss or
hemodynamic instability.
Teaching Point: Always assess for causes of physiologic changes
before treatments.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment and
Prioritization.
3
Reference: Ch. 3: Health Concepts — Fluid, Electrolyte, and
Acid–Base Balance (Pathophysiology & Management)
Question Stem: A client with heart failure is admitted with
progressive dyspnea and 3+ pitting edema. The provider
prescribes IV furosemide 40 mg. Which nursing assessment
most important before administering the dose?
Options:
A. Check serum potassium level.
, B. Assess peripheral pulses.
C. Verify the client’s allergies.
D. Measure orthostatic vital signs.
Correct Answer: A
Rationales — Correct: A — Loop diuretics cause potassium loss
and can precipitate dysrhythmias in hypokalemia; baseline
serum potassium should be reviewed before administration.
Incorrect B: Peripheral pulses are useful overall but not the
highest priority before loop diuretic.
Incorrect C: Allergy check is always done, but allergies to
furosemide are rare; electrolyte status is more immediately
relevant.
Incorrect D: Orthostatic vitals are important but assessing
electrolyte labs is higher priority to prevent arrhythmias.
Teaching Point: Verify electrolytes before loop diuretics to
prevent dysrhythmias.
Citation: Ignatavicius et al., 2024, Ch. 3: Fluid and Electrolyte
Balance.
4
Reference: Ch. 4: Care of Older Adults — Assessment and
Prevention of Delirium and Falls
Question Stem: An 82-year-old admitted with community-
acquired pneumonia becomes acutely confused overnight.
Which action should the nurse take first?
Options:
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 of Medical-
Surgical Nursing (Overview)
Question Stem: A nurse on a medical-surgical unit is precepting
a newly licensed nurse who asks whether they must always
follow a physician’s order even if it seems unsafe. Which
response best reflects the nurse’s professional responsibility?
Options:
A. “Yes — follow the order and document any concerns so the
provider can review later.”
B. “You should follow the order but report safety concerns to
the unit manager only.”
C. “If you believe the order is unsafe, clarify with the provider
and escalate per policy.”
D. “Refuse the order and discharge responsibility to the
provider immediately.”
Correct Answer: C
,Rationales — Correct: C — Nurses have a professional and
ethical duty to question or clarify orders that appear unsafe,
using clinical judgment and organizational escalation processes
to protect patients.
Incorrect A: Following without clarification risks patient harm;
documentation alone is insufficient.
Incorrect B: Reporting only to manager delays immediate
clarification with prescriber and risks patient safety.
Incorrect D: Refusing without attempt to clarify and provide
safe alternatives is not appropriate delegation of responsibility.
Teaching Point: Clarify unsafe orders promptly; escalate per
policy to protect the patient.
Citation: Ignatavicius, Rebar, & Heimgartner, 2024, Ch. 1:
Professional Roles and Scope.
2
Reference: Ch. 2: Clinical Judgment — Recognizing Cues and
Prioritizing Care
Question Stem: A client postoperative 12 hours after
laparoscopic cholecystectomy reports increasing abdominal
pain, pulse 118, BP 92/58, and diminished urine output. Which
action should the nurse take first?
Options:
A. Administer PRN opioid analgesic per orders.
B. Notify the surgeon immediately about vital sign changes.
C. Assess abdominal incision and dressing for bleeding.
,D. Encourage the client to ambulate to improve circulation.
Correct Answer: C
Rationales — Correct: C — Assessing the incision/dressing is the
priority to identify the source of hypotension/tachycardia (e.g.,
bleeding), which directly explains the deterioration. Assessment
precedes notification or medication.
Incorrect A: Giving analgesic may mask worsening signs and
delay identification of bleeding.
Incorrect B: Notification is important but should be preceded by
focused assessment findings to report.
Incorrect D: Ambulation could worsen blood loss or
hemodynamic instability.
Teaching Point: Always assess for causes of physiologic changes
before treatments.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment and
Prioritization.
3
Reference: Ch. 3: Health Concepts — Fluid, Electrolyte, and
Acid–Base Balance (Pathophysiology & Management)
Question Stem: A client with heart failure is admitted with
progressive dyspnea and 3+ pitting edema. The provider
prescribes IV furosemide 40 mg. Which nursing assessment
most important before administering the dose?
Options:
A. Check serum potassium level.
, B. Assess peripheral pulses.
C. Verify the client’s allergies.
D. Measure orthostatic vital signs.
Correct Answer: A
Rationales — Correct: A — Loop diuretics cause potassium loss
and can precipitate dysrhythmias in hypokalemia; baseline
serum potassium should be reviewed before administration.
Incorrect B: Peripheral pulses are useful overall but not the
highest priority before loop diuretic.
Incorrect C: Allergy check is always done, but allergies to
furosemide are rare; electrolyte status is more immediately
relevant.
Incorrect D: Orthostatic vitals are important but assessing
electrolyte labs is higher priority to prevent arrhythmias.
Teaching Point: Verify electrolytes before loop diuretics to
prevent dysrhythmias.
Citation: Ignatavicius et al., 2024, Ch. 3: Fluid and Electrolyte
Balance.
4
Reference: Ch. 4: Care of Older Adults — Assessment and
Prevention of Delirium and Falls
Question Stem: An 82-year-old admitted with community-
acquired pneumonia becomes acutely confused overnight.
Which action should the nurse take first?
Options:
