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. 2: Clinical Judgment and Systems Thinking —
Clinical Judgment in Nursing Practice
Question Stem: A 68-year-old postoperative patient is
hypotensive and confused 2 hours after an open colectomy. The
nurse notes decreased urine output and cool extremities.
Which action should the nurse take first?
A. Increase the IV infusion rate per existing order.
B. Perform a focused assessment of surgical site and drains.
C. Notify the surgeon about the patient's condition.
D. Elevate the patient's legs and reassess vital signs.
Correct Answer: D
Rationales:
• Correct (D): Elevating the legs (modified Trendelenburg)
and reassessing vitals is an immediate, evidence-based
, circulatory support intervention while simultaneously
evaluating for hypovolemia or distributive causes; it’s an
appropriate first action in clinical judgment to restore
perfusion.
• A: Increasing IV rate may be appropriate if hypovolemia is
confirmed, but doing so without reassessing
hemodynamics and verifying access/orders risks error.
• B: Assessing the surgical site is important but does not
immediately address hypotension and signs of poor
perfusion.
• C: Notifying the surgeon is necessary after stabilizing and
gathering data; immediate bedside actions take priority.
Teaching Point: Immediate bedside interventions to
support perfusion precede notifications.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment
and Systems Thinking
2
Reference: Ch. 1: Overview of Professional Nursing Concepts —
Role of the Medical-Surgical Nurse
Question Stem: A nurse is asked to delegate stable post-op
dressing changes to an experienced LPN/LVN. Which task
component indicates safe delegation?
A. LPN will triage and admit new emergency patients.
B. LPN will evaluate wound healing and change the plan of care.
,C. LPN will change the wound dressing and report abnormal
findings.
D. LPN will perform an independent discharge education
session.
Correct Answer: C
Rationales:
• Correct (C): Delegation of dressing changes to an LPN/LVN
who is competent and reporting abnormalities is
appropriate; the RN retains responsibility for assessment
and planning.
• A: Triage and admission of emergency patients require RN
assessment and critical thinking; inappropriate to delegate.
• B: Evaluating healing and changing the plan of care are
assessment and planning functions that remain RN
responsibilities.
• D: Independent discharge education—especially with
complex content—requires RN responsibility and teach-
back verification.
Teaching Point: Delegate tasks within team members'
competence; RN retains assessment and evaluation duties.
Citation: Ignatavicius et al., 2024, Ch. 1: Professional Roles
and Delegation
3
, Reference: Ch. 3: Overview of Health Concepts — Health
Promotion and Risk Reduction
Question Stem: A 52-year-old with stage 2 chronic kidney
disease asks how to reduce further renal decline. Which
intervention should the nurse prioritize in teaching?
A. Limiting protein intake to zero.
B. Strict sodium restriction and blood pressure control.
C. Eliminating all potassium-containing foods.
D. Discontinuing all prescribed medications.
Correct Answer: B
Rationales:
• Correct (B): Controlling blood pressure and limiting sodium
are evidence-based interventions to slow CKD progression
and reduce cardiovascular risk; these are priority
modifiable factors.
• A: Zero protein is inappropriate and can cause
malnutrition; protein intake should be individualized.
• C: Potassium restrictions are not universally required in
stage 2 CKD unless labs indicate hyperkalemia.
• D: Discontinuing prescribed meds is unsafe; medication
review is needed but not blanket discontinuation.
Teaching Point: BP control and sodium reduction are key
to slowing CKD progression.
Citation: Ignatavicius et al., 2024, Ch. 3: Health Promotion
and Risk Reduction
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. 2: Clinical Judgment and Systems Thinking —
Clinical Judgment in Nursing Practice
Question Stem: A 68-year-old postoperative patient is
hypotensive and confused 2 hours after an open colectomy. The
nurse notes decreased urine output and cool extremities.
Which action should the nurse take first?
A. Increase the IV infusion rate per existing order.
B. Perform a focused assessment of surgical site and drains.
C. Notify the surgeon about the patient's condition.
D. Elevate the patient's legs and reassess vital signs.
Correct Answer: D
Rationales:
• Correct (D): Elevating the legs (modified Trendelenburg)
and reassessing vitals is an immediate, evidence-based
, circulatory support intervention while simultaneously
evaluating for hypovolemia or distributive causes; it’s an
appropriate first action in clinical judgment to restore
perfusion.
• A: Increasing IV rate may be appropriate if hypovolemia is
confirmed, but doing so without reassessing
hemodynamics and verifying access/orders risks error.
• B: Assessing the surgical site is important but does not
immediately address hypotension and signs of poor
perfusion.
• C: Notifying the surgeon is necessary after stabilizing and
gathering data; immediate bedside actions take priority.
Teaching Point: Immediate bedside interventions to
support perfusion precede notifications.
Citation: Ignatavicius et al., 2024, Ch. 2: Clinical Judgment
and Systems Thinking
2
Reference: Ch. 1: Overview of Professional Nursing Concepts —
Role of the Medical-Surgical Nurse
Question Stem: A nurse is asked to delegate stable post-op
dressing changes to an experienced LPN/LVN. Which task
component indicates safe delegation?
A. LPN will triage and admit new emergency patients.
B. LPN will evaluate wound healing and change the plan of care.
,C. LPN will change the wound dressing and report abnormal
findings.
D. LPN will perform an independent discharge education
session.
Correct Answer: C
Rationales:
• Correct (C): Delegation of dressing changes to an LPN/LVN
who is competent and reporting abnormalities is
appropriate; the RN retains responsibility for assessment
and planning.
• A: Triage and admission of emergency patients require RN
assessment and critical thinking; inappropriate to delegate.
• B: Evaluating healing and changing the plan of care are
assessment and planning functions that remain RN
responsibilities.
• D: Independent discharge education—especially with
complex content—requires RN responsibility and teach-
back verification.
Teaching Point: Delegate tasks within team members'
competence; RN retains assessment and evaluation duties.
Citation: Ignatavicius et al., 2024, Ch. 1: Professional Roles
and Delegation
3
, Reference: Ch. 3: Overview of Health Concepts — Health
Promotion and Risk Reduction
Question Stem: A 52-year-old with stage 2 chronic kidney
disease asks how to reduce further renal decline. Which
intervention should the nurse prioritize in teaching?
A. Limiting protein intake to zero.
B. Strict sodium restriction and blood pressure control.
C. Eliminating all potassium-containing foods.
D. Discontinuing all prescribed medications.
Correct Answer: B
Rationales:
• Correct (B): Controlling blood pressure and limiting sodium
are evidence-based interventions to slow CKD progression
and reduce cardiovascular risk; these are priority
modifiable factors.
• A: Zero protein is inappropriate and can cause
malnutrition; protein intake should be individualized.
• C: Potassium restrictions are not universally required in
stage 2 CKD unless labs indicate hyperkalemia.
• D: Discontinuing prescribed meds is unsafe; medication
review is needed but not blanket discontinuation.
Teaching Point: BP control and sodium reduction are key
to slowing CKD progression.
Citation: Ignatavicius et al., 2024, Ch. 3: Health Promotion
and Risk Reduction
