LEWIS’S MEDICAL SURGICAL NURSING
COMPREHENSIVE TEST PAPER 2026
COMPLETE SOLUTIONS
◉ A postoperative patient who has been receiving nasogastric
suction for 3 days has a serum sodium level of 125 mEq/L (125
mmol/L). Which of these prescribed therapies that the patient has
been receiving should the nurse question?
a. Infuse 5% dextrose in water at 125 ml/hr.
b. Administer IV morphine sulfate 4 mg every 2 hours PRN.
c. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for
nausea.
d. Administer 3% saline if serum sodium drops to less than 128
mEq/L. Answer: Answer: a. Infuse 5% dextrose in water at 125
ml/hr.
Because the patients gastric suction has been depleting electrolytes,
the IV solution should include electrolyte replacement. Solutions
such as lactated Ringers solution would usually be ordered for this
patient. The other orders are appropriate for a postoperative patient
with gastric suction.
,◉ A patient who has required prolonged mechanical ventilation has
the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg,
PaCO2 32 mm Hg, and HCO3 25 mEq/L. The nurse interprets these
results as:
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis Answer: Answer: d. respiratory alkalosis
The pH indicates that the patient has alkalosis and the low PaCO2
indicates a respiratory cause. The other responses are incorrect
based on the pH and the normal HCO3.
◉ The nurse notes that a patient who was admitted with diabetic
ketoacidosis has rapid, deep respirations. Which action should the
nurse take?
a. Notify the patient's health care provider.
b. Give the prescribed PRN lorazepam (Ativan).
c. Start the prescribed PRN oxygen at 2 to 4 L/min.
d. Encourage the patient to take deep, slow breaths. Answer:
Answer: a. Notify the patient's health care provider.
, The rapid, deep (Kussmaul) respirations indicate a metabolic
acidosis and the need for actions such as administration of sodium
bicarbonate, which will require a prescription by the health care
provider. Oxygen therapy is not indicated because there is no
indication that the increased respiratory rate is related to
hypoxemia. The respiratory pattern is compensatory, and the patient
will not be able to slow the respiratory rate. Ativan administration
will slow the respiratory rate and increase the level of acidosis.
◉ The home health nurse notes that an elderly patient has a low
serum protein level. The nurse will plan to assess for:
a. pallor.
b. edema.
c. confusion.
d. restlessness. Answer: Answer: b. edema.
Low serum protein levels cause a decrease in plasma oncotic
pressure and allow fluid to remain in interstitial tissues, causing
edema. Confusion, restlessness, and pallor are not associated with
low serum protein levels.
◉ A patient is receiving 3% NaCl solution for correction of
hyponatremia. During administration of the solution, the most
important assessment for the nurse to monitor is:
COMPREHENSIVE TEST PAPER 2026
COMPLETE SOLUTIONS
◉ A postoperative patient who has been receiving nasogastric
suction for 3 days has a serum sodium level of 125 mEq/L (125
mmol/L). Which of these prescribed therapies that the patient has
been receiving should the nurse question?
a. Infuse 5% dextrose in water at 125 ml/hr.
b. Administer IV morphine sulfate 4 mg every 2 hours PRN.
c. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for
nausea.
d. Administer 3% saline if serum sodium drops to less than 128
mEq/L. Answer: Answer: a. Infuse 5% dextrose in water at 125
ml/hr.
Because the patients gastric suction has been depleting electrolytes,
the IV solution should include electrolyte replacement. Solutions
such as lactated Ringers solution would usually be ordered for this
patient. The other orders are appropriate for a postoperative patient
with gastric suction.
,◉ A patient who has required prolonged mechanical ventilation has
the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg,
PaCO2 32 mm Hg, and HCO3 25 mEq/L. The nurse interprets these
results as:
a. metabolic acidosis
b. metabolic alkalosis
c. respiratory acidosis
d. respiratory alkalosis Answer: Answer: d. respiratory alkalosis
The pH indicates that the patient has alkalosis and the low PaCO2
indicates a respiratory cause. The other responses are incorrect
based on the pH and the normal HCO3.
◉ The nurse notes that a patient who was admitted with diabetic
ketoacidosis has rapid, deep respirations. Which action should the
nurse take?
a. Notify the patient's health care provider.
b. Give the prescribed PRN lorazepam (Ativan).
c. Start the prescribed PRN oxygen at 2 to 4 L/min.
d. Encourage the patient to take deep, slow breaths. Answer:
Answer: a. Notify the patient's health care provider.
, The rapid, deep (Kussmaul) respirations indicate a metabolic
acidosis and the need for actions such as administration of sodium
bicarbonate, which will require a prescription by the health care
provider. Oxygen therapy is not indicated because there is no
indication that the increased respiratory rate is related to
hypoxemia. The respiratory pattern is compensatory, and the patient
will not be able to slow the respiratory rate. Ativan administration
will slow the respiratory rate and increase the level of acidosis.
◉ The home health nurse notes that an elderly patient has a low
serum protein level. The nurse will plan to assess for:
a. pallor.
b. edema.
c. confusion.
d. restlessness. Answer: Answer: b. edema.
Low serum protein levels cause a decrease in plasma oncotic
pressure and allow fluid to remain in interstitial tissues, causing
edema. Confusion, restlessness, and pallor are not associated with
low serum protein levels.
◉ A patient is receiving 3% NaCl solution for correction of
hyponatremia. During administration of the solution, the most
important assessment for the nurse to monitor is:
