Medical-Surgical Nursing
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
TEST BANK
1
Reference: Ch. 1 — Clinical Judgment (Overview of Professional
Nursing Concepts for Medical-Surgical Nursing)
Question Stem: A 68-year-old postop patient becomes
confused, diaphoretic, and hypotensive 2 hours after a bowel
resection. Which nursing action should the RN perform first?
A. Call the surgeon to report the vital signs.
B. Obtain a focused set of vital signs and assess the surgical
dressing.
C. Give the PRN opioid prescribed for pain.
D. Reorient the patient, provide a blanket, and encourage deep
breathing.
Correct Answer: B
Rationale (correct): Rapid focused assessment (vitals and
surgical site) identifies potential causes (e.g., hemorrhage,
sepsis) and guides immediate interventions; assessment
precedes notification or medication. Text emphasizes
,assessment as the first step in clinical judgment and the nursing
process.
Rationale (A): Calling the surgeon is important but should
follow immediate assessment data to provide accurate
information.
Rationale (C): Administering opioids before assessing could
worsen hypotension or mask deterioration.
Rationale (D): Comfort measures may help but do not address
possible acute surgical complications causing hypotension and
diaphoresis.
Teaching Point: Immediate focused assessment directs safe,
prioritized interventions.
Citation: Ignatavicius et al., 2024, Ch. 1: Clinical Judgment.
2
Reference: Ch. 1 — Systems Thinking (Overview of Professional
Nursing Concepts)
Question Stem: The unit is planning to reduce medication-
administration errors. Which systems-level change most directly
targets latent system causes?
A. Reprimanding nurses involved in past errors.
B. Implementing bar-coded medication administration (BCMA)
integrated with the EHR.
C. Reminding nurses at shift report to double-check all meds.
D. Posting a unit policy on dose-calculation procedures.
Correct Answer: B
,Rationale (correct): BCMA integrated with EHR addresses
system design and latent causes by adding a forcing function
and standardization; systems thinking targets process-level
fixes.
Rationale (A): Individual blame doesn’t fix system
vulnerabilities and may worsen reporting culture.
Rationale (C): Reminders rely on human memory rather than
system redesign and are less reliable.
Rationale (D): Policies are necessary but alone do not change
workflow or provide technological safeguards.
Teaching Point: Systems fixes (technology/workflow) reduce
latent error more reliably than reminders.
Citation: Ignatavicius et al., 2024, Ch. 1: Systems Thinking.
3
Reference: Ch. 1 — QSEN Competencies / Teamwork &
Collaboration
Question Stem: A newly admitted patient with heart failure
needs daily weights, low-sodium education, and diuretic timing.
Which interprofessional plan best demonstrates collaborative
care?
A. Nurse educates patient; dietitian provides low-sodium meal
plan; pharmacist adjusts diuretic schedule with provider.
B. Nurse gives all education, schedules weights, and adjusts
medications per standing orders.
C. Provider meets the patient and instructs the nurse to follow
, provider preferences.
D. Case manager schedules outpatient follow-up; team
members act independently.
Correct Answer: A
Rationale (correct): Collaborative low-sodium education,
coordinated medication management, and nursing monitoring
reflect interprofessional teamwork and role clarity for best
outcomes.
Rationale (B): Nursing alone providing all functions risks gaps
and role overload; interprofessional input improves quality.
Rationale (C): Top-down orders without team coordination may
miss discipline-specific expertise.
Rationale (D): Independent actions without coordination risk
inconsistent messaging and fragmented care.
Teaching Point: Use interprofessional roles to share expertise
and ensure cohesive care.
Citation: Ignatavicius et al., 2024, Ch. 1: Teamwork and
Collaboration.
4
Reference: Ch. 1 — Ethics (Professional Concepts)
Question Stem: A competent adult patient refuses a
recommended chest CT despite the provider’s
recommendation. What is the RN’s best immediate response?
A. Explain the clinical risks of refusal and document the refusal.
B. Tell the patient the provider will be notified and insist the CT
11th Edition
• Author(s)Donna D. Ignatavicius; Cherie R. Rebar; Nicole M.
Heimgartner
TEST BANK
1
Reference: Ch. 1 — Clinical Judgment (Overview of Professional
Nursing Concepts for Medical-Surgical Nursing)
Question Stem: A 68-year-old postop patient becomes
confused, diaphoretic, and hypotensive 2 hours after a bowel
resection. Which nursing action should the RN perform first?
A. Call the surgeon to report the vital signs.
B. Obtain a focused set of vital signs and assess the surgical
dressing.
C. Give the PRN opioid prescribed for pain.
D. Reorient the patient, provide a blanket, and encourage deep
breathing.
Correct Answer: B
Rationale (correct): Rapid focused assessment (vitals and
surgical site) identifies potential causes (e.g., hemorrhage,
sepsis) and guides immediate interventions; assessment
precedes notification or medication. Text emphasizes
,assessment as the first step in clinical judgment and the nursing
process.
Rationale (A): Calling the surgeon is important but should
follow immediate assessment data to provide accurate
information.
Rationale (C): Administering opioids before assessing could
worsen hypotension or mask deterioration.
Rationale (D): Comfort measures may help but do not address
possible acute surgical complications causing hypotension and
diaphoresis.
Teaching Point: Immediate focused assessment directs safe,
prioritized interventions.
Citation: Ignatavicius et al., 2024, Ch. 1: Clinical Judgment.
2
Reference: Ch. 1 — Systems Thinking (Overview of Professional
Nursing Concepts)
Question Stem: The unit is planning to reduce medication-
administration errors. Which systems-level change most directly
targets latent system causes?
A. Reprimanding nurses involved in past errors.
B. Implementing bar-coded medication administration (BCMA)
integrated with the EHR.
C. Reminding nurses at shift report to double-check all meds.
D. Posting a unit policy on dose-calculation procedures.
Correct Answer: B
,Rationale (correct): BCMA integrated with EHR addresses
system design and latent causes by adding a forcing function
and standardization; systems thinking targets process-level
fixes.
Rationale (A): Individual blame doesn’t fix system
vulnerabilities and may worsen reporting culture.
Rationale (C): Reminders rely on human memory rather than
system redesign and are less reliable.
Rationale (D): Policies are necessary but alone do not change
workflow or provide technological safeguards.
Teaching Point: Systems fixes (technology/workflow) reduce
latent error more reliably than reminders.
Citation: Ignatavicius et al., 2024, Ch. 1: Systems Thinking.
3
Reference: Ch. 1 — QSEN Competencies / Teamwork &
Collaboration
Question Stem: A newly admitted patient with heart failure
needs daily weights, low-sodium education, and diuretic timing.
Which interprofessional plan best demonstrates collaborative
care?
A. Nurse educates patient; dietitian provides low-sodium meal
plan; pharmacist adjusts diuretic schedule with provider.
B. Nurse gives all education, schedules weights, and adjusts
medications per standing orders.
C. Provider meets the patient and instructs the nurse to follow
, provider preferences.
D. Case manager schedules outpatient follow-up; team
members act independently.
Correct Answer: A
Rationale (correct): Collaborative low-sodium education,
coordinated medication management, and nursing monitoring
reflect interprofessional teamwork and role clarity for best
outcomes.
Rationale (B): Nursing alone providing all functions risks gaps
and role overload; interprofessional input improves quality.
Rationale (C): Top-down orders without team coordination may
miss discipline-specific expertise.
Rationale (D): Independent actions without coordination risk
inconsistent messaging and fragmented care.
Teaching Point: Use interprofessional roles to share expertise
and ensure cohesive care.
Citation: Ignatavicius et al., 2024, Ch. 1: Teamwork and
Collaboration.
4
Reference: Ch. 1 — Ethics (Professional Concepts)
Question Stem: A competent adult patient refuses a
recommended chest CT despite the provider’s
recommendation. What is the RN’s best immediate response?
A. Explain the clinical risks of refusal and document the refusal.
B. Tell the patient the provider will be notified and insist the CT
