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
1
Reference: Ch. 1: Professional Roles and Scope of Practice —
Delegation and Accountability
Question Stem: A newly licensed RN is preparing assignments
for an inpatient medical–surgical unit. Which task is most
appropriate for the RN to delegate to an experienced LPN/LVN
for a stable post-op patient?
A. Initial comprehensive assessment on admission
B. Administration of scheduled oral acetaminophen and
documentation of pain score
C. Teaching the patient how to manage new insulin injections
D. Developing the patient’s individualized discharge plan
,Correct Answer: B
Rationale (correct): Delegation to an LPN/LVN may include
administering routine oral medications and documenting
responses for a stable patient; this matches scope-of-practice
tasks while the RN retains overall accountability.
Rationale (A): Initial comprehensive assessments are within the
RN’s scope and should not be delegated.
Rationale (C): Teaching complex skills (new insulin regimen)
requires RN assessment and teaching skills and is not
appropriate to delegate.
Rationale (D): Discharge planning requires RN clinical judgment
and interprofessional coordination; it should not be delegated.
Teaching Point: Delegate routine, stable tasks; retain
assessments, teaching, and planning.
Citation: Ignatavicius, Rebar, & Heimgartner, 2024, Ch. 1:
Delegation and Accountability
2
Reference: Ch. 2: Clinical Judgment and Systems Thinking —
Recognizing Cues and Prioritization
Question Stem: During morning rounds, a nurse notes a patient
with COPD has increased work of breathing, a respiratory rate
of 28/min, SpO₂ 88% on room air, and agitation. What is the
nurse’s best next action?
A. Offer the patient a glass of water and reposition to sitting
,upright
B. Apply supplemental oxygen per protocol, reassess breath
sounds, and notify the provider
C. Encourage the patient to perform pursed-lip breathing and
document findings
D. Administer PRN albuterol via metered-dose inhaler and chart
response
Correct Answer: B
Rationale (correct): Hypoxemia (SpO₂ 88%) and increased work
of breathing require immediate oxygenation and reassessment;
notifying the provider aligns with escalation of care and safety.
Rationale (A): Repositioning may help but alone is inadequate
for treating hypoxemia and respiratory distress.
Rationale (C): Pursed-lip breathing is useful but is insufficient
when SpO₂ is 88% and the patient is agitated.
Rationale (D): Bronchodilator may be appropriate but should
follow initial stabilization with oxygen and reassessment, and
may require provider order depending on setting.
Teaching Point: Treat hypoxemia immediately—oxygen first,
then reassess and escalate.
Citation: Ignatavicius et al., 2024, Ch. 2: Recognizing Cues and
Making Decisions
3
, Reference: Ch. 3: Health Concepts — Risk Factors and
Prevention (Cardiovascular)
Question Stem: A 58-year-old patient with type 2 diabetes and
LDL 160 mg/dL asks what modifiable risk factor will most
reduce cardiovascular risk. Which response by the nurse is
best?
A. “Stopping cigarette smoking will significantly reduce your
cardiovascular risk.”
B. “Reducing your HDL cholesterol is the most important
change.”
C. “Only genetic factors determine cardiovascular risk; lifestyle
changes won’t help much.”
D. “Taking aspirin daily is the single most important step you
can take.”
Correct Answer: A
Rationale (correct): Smoking cessation is a major modifiable
cardiovascular risk factor and substantially reduces morbidity
and mortality, especially in patients with diabetes and
hyperlipidemia.
Rationale (B): Lowering HDL is not beneficial; raising HDL or
improving overall lipid profile is desirable.
Rationale (C): Lifestyle modifications (smoking cessation, lipid
control, glycemic control) meaningfully reduce cardiovascular
risk—this statement is incorrect.
Rationale (D): Aspirin may be appropriate in select patients but
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
1
Reference: Ch. 1: Professional Roles and Scope of Practice —
Delegation and Accountability
Question Stem: A newly licensed RN is preparing assignments
for an inpatient medical–surgical unit. Which task is most
appropriate for the RN to delegate to an experienced LPN/LVN
for a stable post-op patient?
A. Initial comprehensive assessment on admission
B. Administration of scheduled oral acetaminophen and
documentation of pain score
C. Teaching the patient how to manage new insulin injections
D. Developing the patient’s individualized discharge plan
,Correct Answer: B
Rationale (correct): Delegation to an LPN/LVN may include
administering routine oral medications and documenting
responses for a stable patient; this matches scope-of-practice
tasks while the RN retains overall accountability.
Rationale (A): Initial comprehensive assessments are within the
RN’s scope and should not be delegated.
Rationale (C): Teaching complex skills (new insulin regimen)
requires RN assessment and teaching skills and is not
appropriate to delegate.
Rationale (D): Discharge planning requires RN clinical judgment
and interprofessional coordination; it should not be delegated.
Teaching Point: Delegate routine, stable tasks; retain
assessments, teaching, and planning.
Citation: Ignatavicius, Rebar, & Heimgartner, 2024, Ch. 1:
Delegation and Accountability
2
Reference: Ch. 2: Clinical Judgment and Systems Thinking —
Recognizing Cues and Prioritization
Question Stem: During morning rounds, a nurse notes a patient
with COPD has increased work of breathing, a respiratory rate
of 28/min, SpO₂ 88% on room air, and agitation. What is the
nurse’s best next action?
A. Offer the patient a glass of water and reposition to sitting
,upright
B. Apply supplemental oxygen per protocol, reassess breath
sounds, and notify the provider
C. Encourage the patient to perform pursed-lip breathing and
document findings
D. Administer PRN albuterol via metered-dose inhaler and chart
response
Correct Answer: B
Rationale (correct): Hypoxemia (SpO₂ 88%) and increased work
of breathing require immediate oxygenation and reassessment;
notifying the provider aligns with escalation of care and safety.
Rationale (A): Repositioning may help but alone is inadequate
for treating hypoxemia and respiratory distress.
Rationale (C): Pursed-lip breathing is useful but is insufficient
when SpO₂ is 88% and the patient is agitated.
Rationale (D): Bronchodilator may be appropriate but should
follow initial stabilization with oxygen and reassessment, and
may require provider order depending on setting.
Teaching Point: Treat hypoxemia immediately—oxygen first,
then reassess and escalate.
Citation: Ignatavicius et al., 2024, Ch. 2: Recognizing Cues and
Making Decisions
3
, Reference: Ch. 3: Health Concepts — Risk Factors and
Prevention (Cardiovascular)
Question Stem: A 58-year-old patient with type 2 diabetes and
LDL 160 mg/dL asks what modifiable risk factor will most
reduce cardiovascular risk. Which response by the nurse is
best?
A. “Stopping cigarette smoking will significantly reduce your
cardiovascular risk.”
B. “Reducing your HDL cholesterol is the most important
change.”
C. “Only genetic factors determine cardiovascular risk; lifestyle
changes won’t help much.”
D. “Taking aspirin daily is the single most important step you
can take.”
Correct Answer: A
Rationale (correct): Smoking cessation is a major modifiable
cardiovascular risk factor and substantially reduces morbidity
and mortality, especially in patients with diabetes and
hyperlipidemia.
Rationale (B): Lowering HDL is not beneficial; raising HDL or
improving overall lipid profile is desirable.
Rationale (C): Lifestyle modifications (smoking cessation, lipid
control, glycemic control) meaningfully reduce cardiovascular
risk—this statement is incorrect.
Rationale (D): Aspirin may be appropriate in select patients but
