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OpenStax Medical-Surgical Nursing Instructor Answer Guide
OpenStax Medical-Surgical Nursing
Instructor Answer Guide
Chapter 1: Professional Medical-Surgical Nursing.......................................................................... 3
Chapter 2: Culturally Competent Care.......................................................................................... 13
Chapter 3: Health Promotion and Patient Education ................................................................... 19
Chapter 4: Clinical Judgment in the Nursing Process ................................................................... 31
Chapter 5: Ethical Decision Making .............................................................................................. 37
Chapter 6: Comprehensive Health Assessment and Physical Examination ................................. 44
Chapter 7: Pain Assessment and Management ............................................................................ 49
Chapter 8: Stress and Stress-Related Disorders ........................................................................... 53
Chapter 9: Management of Chronic Illness .................................................................................. 62
Chapter 10: Fluid, Electrolyte, and Acid-Base Imbalances ........................................................... 67
Chapter 11: Gas Exchange, Airway Management and Respiratory System Disorders ................. 72
Chapter 12: Cardiovascular System .............................................................................................. 82
Chapter 13: Musculoskeletal System............................................................................................ 90
Chapter 14: Integumentary System .............................................................................................. 96
Chapter 15: Cerebrovascular System.......................................................................................... 102
Chapter 16: Hematopoietic Disorders and Regulation ............................................................... 106
Chapter 17: Nervous System and Chronic Diseases of the Nervous System ............................. 114
Chapter 18: Sensory Organs ....................................................................................................... 120
Chapter 19: Gastrointestinal System and Gastrointestinal Disorders ........................................ 125
Chapter 20: Genitourinary and Reproductive Systems .............................................................. 134
Chapter 21: Endocrine System and Endocrine System Disorders .............................................. 142
Chapter 22: Infection and Infectious Diseases ........................................................................... 147
Chapter 23: Shock and Sepsis ..................................................................................................... 154
Chapter 24: Management of Patients with Allergic Disorders ................................................... 162
Chapter 25: Preoperative Care ................................................................................................... 168
Chapter 26: Intraoperative Care ................................................................................................. 172
Chapter 27: Postoperative Care .................................................................................................. 179
Chapter 28: Inflammation and Healing....................................................................................... 184
2
For more free, peer-reviewed, openly licensed resources visit OpenStax.org.
9/25/2024
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Chapter 29: Immune Response................................................................................................... 192
Chapter 30: Genetics .................................................................................................................. 198
Chapter 31: Cancer ..................................................................................................................... 203
Chapter 32: Palliative Care.......................................................................................................... 206
Chapter 33: Emergency Care ...................................................................................................... 212
Chapter 34: Disaster and Recovery............................................................................................. 220
Chapter 35: Critical Care ............................................................................................................. 224
Chapter 36: Home Health Nursing and Rehabilitation ............................................................... 231
Chapter 37: Trends in Healthcare Technology ........................................................................... 233
Chapter 38: Unfolding Case Study and NCLEX Prep ................................................................... 239
Chapter 1: Professional Medical-Surgical Nursing
Review Questions
1. Which action reflects The Joint Commission’s contribution to a health care organizations’
improvement initiatives?
a. setting standards for quality care, QI, and patient safety
b. excluding nurses from safety and improvement initiatives
c. focusing on emergency management and infection prevention
d. eluding the National Patient Safety Goals
[Answer: A]
2. Which component reflects a key element of PCC?
a. excluding the patient's family from the care setting
b. ignoring the patient's emotional well-being
c. customize care based on the patient's values and perspectives
d. respecting the patient's physical comfort
[Answer: C]
3. Ms. Hutto is complaining of pain (8 out of 10) in her lower back and abdomen. As the
patient’s nurse, you determine her abdomen is soft but distended, with positive bowel
sounds in all four quadrants. Interventions such as ambulation, position changes, warm
compresses, and warm prune juice have provided no relief. This scenario highlights which
component of the ISBAR communication tool?
a. situation
b. background
c. assessment
d. recommendation or request
[Answer: C]
4. What is the primary goal of an intercollaborative care team in the context of patient-
centered care?
a. achieving financial targets
3
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OpenStax Medical-Surgical Nursing Instructor Answer Guide
b. streamlining administrative processes
c. improving patient outcomes through personalized care
d. minimizing the workload for health care providers
[Answer: C]
5. A nurse is caring for a 72-year-old woman with a diagnosis of atrial fibrillation. When
making his shift change report, the nurse realizes that 4 hours ago, he administered 0.5 mg
of the patient’s antiarrhythmic medication instead of 5.0 mg. When the nurse realizes the
error and calls the physician to report the incident, which ethical principal is described in
this situation?
a. nonmaleficence
b. justice
c. autonomy
d. beneficence
[Answer: A]
6. Mr. Johnson is scheduled for an endoscopy. Despite the excruciating abdominal pain he is
experiencing, Mr. Johnson refuses to have the procedure. Which ethical principal is
described in this scenario?
a. beneficence
b. justice
c. autonomy
d. nonmaleficence
[Answer: C]
7. Which option is a social determinant of health?
a. medical history
b. promotion of healthy choices
c. homelessness
d. life expectancy
[Answer: C]
8. As a nurse practicing EBP, which process related to improving patient satisfaction will be
most effective?
a. checking on each patient’s pain level every 4 hours
b. administering medications as close as possible to the administration times
c. making rounds on each patient hourly
d. offering a bath daily to each patient
[Answer: C]
9. Joann, a nurse in the medical-surgical unit, would like to implement a project to improve
the cleanliness of patient rooms. Aside from the nurses, which group of key stakeholders
should be included in the planning?
a. hospital maintenance staff
b. physical therapists and technicians
c. housekeeping staff and unlicensed assistive personnel
d. occupational therapy team
4
For more free, peer-reviewed, openly licensed resources visit OpenStax.org.
9/25/2024
!!!!!!!!!!!!!!~~~~~~~~~~~~~Medical-Surgical_Nursing_IAG.docx!!!!!!!!!!!!!!!!!!!$$$$$$$$$
4/8/2026, 3:53:49 PM!!!!!!!!!!!!!!!!!! Medical-Surgical_Nursing_IAG.docx@@@@@@@@
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[Answer: C]
10. A nurse manager has received an increase in patient complaints that monitor alarms are
sounding for extended periods, which is disrupting their sleep and creating unnecessary
anxiety. After close observation, the nurse manager realized the nurses appeared as if they
did not hear the alarms while charting. What type of QI plan would be most appropriate for
the nurse manager to consider for her unit?
a. a plan of correction related to nurses not promptly addressing the monitor alarms
b. a process improvement project to address alarm fatigue
c. a plan to ensure all the patients have standing orders for medications to relieve their
anxiety
d. a plan to have the nurses increase the volume of the monitor alarms
[Answer: B]
11. Ms. Blanchard is presently being treated for a new diagnosis of high blood pressure. Her
primary care physician has recommended that, in addition to her daily dose of medication,
Ms. Blanchard should also stop smoking. This recommendation demonstrates with which
level of prevention?
a. primary prevention
b. secondary prevention
c. tertiary prevention
d. intermediary prevention
[Answer: C]
12. Which statement reflects the role an agency has on the health care continuum?
a. Agencies provide a variety of in-home care, including physical and occupational therapy.
b. Government agencies exist to supplement middle-class populations.
c. All hospitals provide inpatient services at low to no cost to patients in need.
d. Subacute inpatient settings are no longer needed for sick patients.
[Answer: A]
13. Which description best defines systems-based practice in health care?
a. the focus on individual patient care, considering their immediate medical needs
b. the use of advanced medical technologies to enhance PCC and outcomes
c. recognizing the various layers of the health care system and understanding how they
impact patient care
d. implementing standardized procedures in health care settings to ensure consistency in
patient treatment
[Answer: C]
14. What is a nursing informaticist?
a. a nurse who is skilled at communicating complex information to patients
b. a nurse who is an expert on laws protecting patient information
c. a nurse who develops technologies that securely store and communicate information
d. a nurse who uses information and technology to improve the efficiency of health care
[Answer: D]
15. How has technology affected nursing education, particularly in sim labs?
a. by reducing the need for clinical experiences in real health care settings
b. by providing high-tech sim labs with realistic manikins for hands-on practice
5
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OpenStax Medical-Surgical Nursing Instructor Answer Guide
c. by eliminating the importance of critical thinking skills in nursing education
d. by decreasing the need for online platforms in nursing courses
[Answer: B]
Check Your Understanding Questions
1. What are the six main competencies of Quality and Safety Education for Nurses?
[Answer: patient-centered care, teamwork and collaboration, EBP, QI, safety, and informatics]
2. Identify examples of PCC in which the nurse takes an active role.
[Answers will vary but may include
● Family members are invited to be a part of the interdisciplinary care team to participate
in discussions and care decisions.
● The family and patient are provided with timely updates, ensuring the patient’s wishes
(directives) are included in the plan of care.
● respecting the patient’s and family’s treatment decisions
● advocating for patients and families to promote quality care and patient safety
● aligning a patient’s care with their goals, preferences, values, cultural traditions, and
socioeconomic status
● focusing care equally on physical comfort and emotional well-being]
3. Identify two different social determinants of health and explain how they can affect a
person’s health.
[Answers will vary but may include the following: SODH include environmental factors such as
where one was born, grew up, lived, and aged. For example, people who grow up in a wealthy
community with lots of health resources will likely be healthier than people who grow up in an
impoverished community with few resources. SODH also include factors that shape daily life,
such as access to health care and education, economic stability, community development,
social and society norms, political systems, and race and ethnicity. For example, certain racial or
ethnic groups are genetically predisposed to certain diseases and thus more likely to acquire
those diseases than people of other groups.]
4. What is the difference between EBP and nursing research?
[Answer: The purpose of research in nursing is to evaluate current knowledge and theories in
order to formulate better nursing practices for improved patient outcomes. The purpose of EBP
in nursing is to use the evidence from research to make informed decisions regarding patient
care and outcomes.]
5. Identify social determinants that affect the delivery of health care.
[Answers will vary but may include income, education, job security and unemployment,
working conditions, living conditions and the environment, access to food, childhood
development, access to affordable housing and necessities, and access to affordable health
care and quality services.]
6. In your own words, define systems-based practice.
[Answers should be a variation on this definition from the text: Systems-based practice is health
care that considers the multiple systems involved in a patient’s condition and uses evidence
6
For more free, peer-reviewed, openly licensed resources visit OpenStax.org.
9/25/2024
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OpenStax Medical-Surgical Nursing Instructor Answer Guide
OpenStax Medical-Surgical Nursing
Instructor Answer Guide
Chapter 1: Professional Medical-Surgical Nursing.......................................................................... 3
Chapter 2: Culturally Competent Care.......................................................................................... 13
Chapter 3: Health Promotion and Patient Education ................................................................... 19
Chapter 4: Clinical Judgment in the Nursing Process ................................................................... 31
Chapter 5: Ethical Decision Making .............................................................................................. 37
Chapter 6: Comprehensive Health Assessment and Physical Examination ................................. 44
Chapter 7: Pain Assessment and Management ............................................................................ 49
Chapter 8: Stress and Stress-Related Disorders ........................................................................... 53
Chapter 9: Management of Chronic Illness .................................................................................. 62
Chapter 10: Fluid, Electrolyte, and Acid-Base Imbalances ........................................................... 67
Chapter 11: Gas Exchange, Airway Management and Respiratory System Disorders ................. 72
Chapter 12: Cardiovascular System .............................................................................................. 82
Chapter 13: Musculoskeletal System............................................................................................ 90
Chapter 14: Integumentary System .............................................................................................. 96
Chapter 15: Cerebrovascular System.......................................................................................... 102
Chapter 16: Hematopoietic Disorders and Regulation ............................................................... 106
Chapter 17: Nervous System and Chronic Diseases of the Nervous System ............................. 114
Chapter 18: Sensory Organs ....................................................................................................... 120
Chapter 19: Gastrointestinal System and Gastrointestinal Disorders ........................................ 125
Chapter 20: Genitourinary and Reproductive Systems .............................................................. 134
Chapter 21: Endocrine System and Endocrine System Disorders .............................................. 142
Chapter 22: Infection and Infectious Diseases ........................................................................... 147
Chapter 23: Shock and Sepsis ..................................................................................................... 154
Chapter 24: Management of Patients with Allergic Disorders ................................................... 162
Chapter 25: Preoperative Care ................................................................................................... 168
Chapter 26: Intraoperative Care ................................................................................................. 172
Chapter 27: Postoperative Care .................................................................................................. 179
Chapter 28: Inflammation and Healing....................................................................................... 184
2
For more free, peer-reviewed, openly licensed resources visit OpenStax.org.
9/25/2024
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Chapter 29: Immune Response................................................................................................... 192
Chapter 30: Genetics .................................................................................................................. 198
Chapter 31: Cancer ..................................................................................................................... 203
Chapter 32: Palliative Care.......................................................................................................... 206
Chapter 33: Emergency Care ...................................................................................................... 212
Chapter 34: Disaster and Recovery............................................................................................. 220
Chapter 35: Critical Care ............................................................................................................. 224
Chapter 36: Home Health Nursing and Rehabilitation ............................................................... 231
Chapter 37: Trends in Healthcare Technology ........................................................................... 233
Chapter 38: Unfolding Case Study and NCLEX Prep ................................................................... 239
Chapter 1: Professional Medical-Surgical Nursing
Review Questions
1. Which action reflects The Joint Commission’s contribution to a health care organizations’
improvement initiatives?
a. setting standards for quality care, QI, and patient safety
b. excluding nurses from safety and improvement initiatives
c. focusing on emergency management and infection prevention
d. eluding the National Patient Safety Goals
[Answer: A]
2. Which component reflects a key element of PCC?
a. excluding the patient's family from the care setting
b. ignoring the patient's emotional well-being
c. customize care based on the patient's values and perspectives
d. respecting the patient's physical comfort
[Answer: C]
3. Ms. Hutto is complaining of pain (8 out of 10) in her lower back and abdomen. As the
patient’s nurse, you determine her abdomen is soft but distended, with positive bowel
sounds in all four quadrants. Interventions such as ambulation, position changes, warm
compresses, and warm prune juice have provided no relief. This scenario highlights which
component of the ISBAR communication tool?
a. situation
b. background
c. assessment
d. recommendation or request
[Answer: C]
4. What is the primary goal of an intercollaborative care team in the context of patient-
centered care?
a. achieving financial targets
3
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OpenStax Medical-Surgical Nursing Instructor Answer Guide
b. streamlining administrative processes
c. improving patient outcomes through personalized care
d. minimizing the workload for health care providers
[Answer: C]
5. A nurse is caring for a 72-year-old woman with a diagnosis of atrial fibrillation. When
making his shift change report, the nurse realizes that 4 hours ago, he administered 0.5 mg
of the patient’s antiarrhythmic medication instead of 5.0 mg. When the nurse realizes the
error and calls the physician to report the incident, which ethical principal is described in
this situation?
a. nonmaleficence
b. justice
c. autonomy
d. beneficence
[Answer: A]
6. Mr. Johnson is scheduled for an endoscopy. Despite the excruciating abdominal pain he is
experiencing, Mr. Johnson refuses to have the procedure. Which ethical principal is
described in this scenario?
a. beneficence
b. justice
c. autonomy
d. nonmaleficence
[Answer: C]
7. Which option is a social determinant of health?
a. medical history
b. promotion of healthy choices
c. homelessness
d. life expectancy
[Answer: C]
8. As a nurse practicing EBP, which process related to improving patient satisfaction will be
most effective?
a. checking on each patient’s pain level every 4 hours
b. administering medications as close as possible to the administration times
c. making rounds on each patient hourly
d. offering a bath daily to each patient
[Answer: C]
9. Joann, a nurse in the medical-surgical unit, would like to implement a project to improve
the cleanliness of patient rooms. Aside from the nurses, which group of key stakeholders
should be included in the planning?
a. hospital maintenance staff
b. physical therapists and technicians
c. housekeeping staff and unlicensed assistive personnel
d. occupational therapy team
4
For more free, peer-reviewed, openly licensed resources visit OpenStax.org.
9/25/2024
!!!!!!!!!!!!!!~~~~~~~~~~~~~Medical-Surgical_Nursing_IAG.docx!!!!!!!!!!!!!!!!!!!$$$$$$$$$
4/8/2026, 3:53:49 PM!!!!!!!!!!!!!!!!!! Medical-Surgical_Nursing_IAG.docx@@@@@@@@
,Medical-Surgical_Nursing_IAG.docx!!!!!!!!!!!!!!@@@@@@@@@@$$$$$$$$$!!!!!!!!!!!!@@@
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Medical-Surgical_Nursing_IAG.docx!!!!!!!!!!!!!!!!!!!!!@@@@@@@@@@@@@@@@$###########
[Answer: C]
10. A nurse manager has received an increase in patient complaints that monitor alarms are
sounding for extended periods, which is disrupting their sleep and creating unnecessary
anxiety. After close observation, the nurse manager realized the nurses appeared as if they
did not hear the alarms while charting. What type of QI plan would be most appropriate for
the nurse manager to consider for her unit?
a. a plan of correction related to nurses not promptly addressing the monitor alarms
b. a process improvement project to address alarm fatigue
c. a plan to ensure all the patients have standing orders for medications to relieve their
anxiety
d. a plan to have the nurses increase the volume of the monitor alarms
[Answer: B]
11. Ms. Blanchard is presently being treated for a new diagnosis of high blood pressure. Her
primary care physician has recommended that, in addition to her daily dose of medication,
Ms. Blanchard should also stop smoking. This recommendation demonstrates with which
level of prevention?
a. primary prevention
b. secondary prevention
c. tertiary prevention
d. intermediary prevention
[Answer: C]
12. Which statement reflects the role an agency has on the health care continuum?
a. Agencies provide a variety of in-home care, including physical and occupational therapy.
b. Government agencies exist to supplement middle-class populations.
c. All hospitals provide inpatient services at low to no cost to patients in need.
d. Subacute inpatient settings are no longer needed for sick patients.
[Answer: A]
13. Which description best defines systems-based practice in health care?
a. the focus on individual patient care, considering their immediate medical needs
b. the use of advanced medical technologies to enhance PCC and outcomes
c. recognizing the various layers of the health care system and understanding how they
impact patient care
d. implementing standardized procedures in health care settings to ensure consistency in
patient treatment
[Answer: C]
14. What is a nursing informaticist?
a. a nurse who is skilled at communicating complex information to patients
b. a nurse who is an expert on laws protecting patient information
c. a nurse who develops technologies that securely store and communicate information
d. a nurse who uses information and technology to improve the efficiency of health care
[Answer: D]
15. How has technology affected nursing education, particularly in sim labs?
a. by reducing the need for clinical experiences in real health care settings
b. by providing high-tech sim labs with realistic manikins for hands-on practice
5
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OpenStax Medical-Surgical Nursing Instructor Answer Guide
c. by eliminating the importance of critical thinking skills in nursing education
d. by decreasing the need for online platforms in nursing courses
[Answer: B]
Check Your Understanding Questions
1. What are the six main competencies of Quality and Safety Education for Nurses?
[Answer: patient-centered care, teamwork and collaboration, EBP, QI, safety, and informatics]
2. Identify examples of PCC in which the nurse takes an active role.
[Answers will vary but may include
● Family members are invited to be a part of the interdisciplinary care team to participate
in discussions and care decisions.
● The family and patient are provided with timely updates, ensuring the patient’s wishes
(directives) are included in the plan of care.
● respecting the patient’s and family’s treatment decisions
● advocating for patients and families to promote quality care and patient safety
● aligning a patient’s care with their goals, preferences, values, cultural traditions, and
socioeconomic status
● focusing care equally on physical comfort and emotional well-being]
3. Identify two different social determinants of health and explain how they can affect a
person’s health.
[Answers will vary but may include the following: SODH include environmental factors such as
where one was born, grew up, lived, and aged. For example, people who grow up in a wealthy
community with lots of health resources will likely be healthier than people who grow up in an
impoverished community with few resources. SODH also include factors that shape daily life,
such as access to health care and education, economic stability, community development,
social and society norms, political systems, and race and ethnicity. For example, certain racial or
ethnic groups are genetically predisposed to certain diseases and thus more likely to acquire
those diseases than people of other groups.]
4. What is the difference between EBP and nursing research?
[Answer: The purpose of research in nursing is to evaluate current knowledge and theories in
order to formulate better nursing practices for improved patient outcomes. The purpose of EBP
in nursing is to use the evidence from research to make informed decisions regarding patient
care and outcomes.]
5. Identify social determinants that affect the delivery of health care.
[Answers will vary but may include income, education, job security and unemployment,
working conditions, living conditions and the environment, access to food, childhood
development, access to affordable housing and necessities, and access to affordable health
care and quality services.]
6. In your own words, define systems-based practice.
[Answers should be a variation on this definition from the text: Systems-based practice is health
care that considers the multiple systems involved in a patient’s condition and uses evidence
6
For more free, peer-reviewed, openly licensed resources visit OpenStax.org.
9/25/2024
!!!!!!!!!!!!!!~~~~~~~~~~~~~Medical-Surgical_Nursing_IAG.docx!!!!!!!!!!!!!!!!!!!$$$$$$$$$
4/8/2026, 3:53:49 PM!!!!!!!!!!!!!!!!!! Medical-Surgical_Nursing_IAG.docx@@@@@@@@
