LEWIS’S MEDICAL SURGICAL NURSING
ACTUAL EXAM PAPER 2026 QUESTIONS
ANSWERS GRADED A+
◉ A recently admitted patient has a small cell carcinoma of the lung,
which is causing the syndrome of inappropriate antidiuretic
hormone (SIADH). The nurse will monitor carefully for:
a. increased total urinary output.
b. elevation of serum hematocrit.
c. decreased serum sodium level.
d. rapid and unexpected weight loss. Answer: Answer: c. decreased
serum sodium level.
SIADH causes water retention and a decrease in serum sodium level.
Weight loss, increased urine output, and elevated serum hematocrit
may be associated with excessive loss of water, but not with SIADH
and water retention.
◉ When the nurse is evaluating the fluid balance for a patient
admitted for hypervolemia associated with multiple draining
wounds, the most accurate assessment to include is:
a. skin turgor.
,b. daily weight.
c. presence of edema.
d. hourly urine output. Answer: Answer: b. daily weight.
Daily weight is the most easily obtained and accurate means of
assessing volume status. Skin turgor varies considerably with age.
Considerable excess fluid volume may be present before fluid moves
into the interstitial space and causes edema. Hourly urine outputs
do not take account of fluid intake or of fluid loss through insensible
loss, sweating, or loss from the gastrointestinal tract or wounds.
◉ When caring for an alert and oriented elderly patient with a
history of dehydration, the home health nurse will teach the patient
to increase fluid intake:
a. in the late evening hours.
b. if the oral mucosa feels dry.
c. when the patient feels thirsty.
d. as soon as changes in level of consciousness (LOC) occur. Answer:
Answer: b. if the oral mucosa feels dry.
An alert, elderly patient will be able to self-assess for signs of oral
dryness such as thick oral secretions or dry-appearing mucosa. The
thirst mechanism decreases with age and is not an accurate
indicator of volume depletion. Many older patients prefer to restrict
, fluids slightly in the evening to improve sleep quality. The patient
will not be likely to notice and act appropriately when changes in
LOC occur.
◉ A patient is taking potassium-wasting diuretic for treatment of
hypertension. The nurse will teach the patient to report symptoms
of adverse effects such as:
a. personality changes.
b. frequent loose stools.
c. facial muscle spasms.
d. generalized weakness. Answer: Answer: d. generalized weakness.
Generalized weakness progressing to flaccidity is a manifestation of
hypokalemia. Facial muscle spasms might occur with hypocalcemia.
Loose stools are associated with hyperkalemia. Personality changes
are not associated with electrolyte disturbances, although changes
in mental status are common manifestations with sodium excess or
deficit.
◉ Spironolactone (Aldactone), an aldosterone antagonist, is
prescribed for a patient as a diuretic. Which statement by the patient
indicates that the teaching about this medication has been effective?
a. I will try to drink at least 8 glasses of water every day.
ACTUAL EXAM PAPER 2026 QUESTIONS
ANSWERS GRADED A+
◉ A recently admitted patient has a small cell carcinoma of the lung,
which is causing the syndrome of inappropriate antidiuretic
hormone (SIADH). The nurse will monitor carefully for:
a. increased total urinary output.
b. elevation of serum hematocrit.
c. decreased serum sodium level.
d. rapid and unexpected weight loss. Answer: Answer: c. decreased
serum sodium level.
SIADH causes water retention and a decrease in serum sodium level.
Weight loss, increased urine output, and elevated serum hematocrit
may be associated with excessive loss of water, but not with SIADH
and water retention.
◉ When the nurse is evaluating the fluid balance for a patient
admitted for hypervolemia associated with multiple draining
wounds, the most accurate assessment to include is:
a. skin turgor.
,b. daily weight.
c. presence of edema.
d. hourly urine output. Answer: Answer: b. daily weight.
Daily weight is the most easily obtained and accurate means of
assessing volume status. Skin turgor varies considerably with age.
Considerable excess fluid volume may be present before fluid moves
into the interstitial space and causes edema. Hourly urine outputs
do not take account of fluid intake or of fluid loss through insensible
loss, sweating, or loss from the gastrointestinal tract or wounds.
◉ When caring for an alert and oriented elderly patient with a
history of dehydration, the home health nurse will teach the patient
to increase fluid intake:
a. in the late evening hours.
b. if the oral mucosa feels dry.
c. when the patient feels thirsty.
d. as soon as changes in level of consciousness (LOC) occur. Answer:
Answer: b. if the oral mucosa feels dry.
An alert, elderly patient will be able to self-assess for signs of oral
dryness such as thick oral secretions or dry-appearing mucosa. The
thirst mechanism decreases with age and is not an accurate
indicator of volume depletion. Many older patients prefer to restrict
, fluids slightly in the evening to improve sleep quality. The patient
will not be likely to notice and act appropriately when changes in
LOC occur.
◉ A patient is taking potassium-wasting diuretic for treatment of
hypertension. The nurse will teach the patient to report symptoms
of adverse effects such as:
a. personality changes.
b. frequent loose stools.
c. facial muscle spasms.
d. generalized weakness. Answer: Answer: d. generalized weakness.
Generalized weakness progressing to flaccidity is a manifestation of
hypokalemia. Facial muscle spasms might occur with hypocalcemia.
Loose stools are associated with hyperkalemia. Personality changes
are not associated with electrolyte disturbances, although changes
in mental status are common manifestations with sodium excess or
deficit.
◉ Spironolactone (Aldactone), an aldosterone antagonist, is
prescribed for a patient as a diuretic. Which statement by the patient
indicates that the teaching about this medication has been effective?
a. I will try to drink at least 8 glasses of water every day.
