TestBank FOR Lewis Medical Surgical Nursing
TestBank for Lewis Medical Surgical
Nursing Practice Exam 2026 Edition 100
Advanced Questions with Answers and
Detailed Rationales
Part 1 (Questions 1–25)
Question 1
A 68-year-old patient is admitted with acute decompensated heart failure. Which assessment
finding requires immediate nursing intervention?
A. Bibasilar crackles
B. Bilateral ankle edema
C. Oxygen saturation of 84% on room air
D. Weight gain of 2 kg in 3 days
Answer: C
Rationale: An SpO₂ of 84% indicates significant hypoxemia and threatens oxygen delivery to
vital organs. Immediate oxygen therapy and further assessment are priorities. Crackles, edema,
and recent weight gain are expected findings in heart failure but are less immediately life-
threatening.
Question 2
A patient develops sudden crushing chest pain, diaphoresis, and ST-segment elevation on the
ECG. Which action has the highest priority?
A. Obtain cardiac enzyme levels.
B. Administer oxygen if indicated and notify the provider to activate the reperfusion pathway.
C. Encourage bed rest.
D. Schedule an echocardiogram.
Answer: B
Rationale: ST-segment elevation suggests an acute myocardial infarction requiring rapid
reperfusion therapy. Supporting oxygenation (when hypoxemic) and activating the reperfusion
process take precedence over additional diagnostic testing.
, TestBank FOR Lewis Medical Surgical Nursing
Question 3
Which assessment finding is most consistent with left-sided heart failure?
A. Hepatomegaly
B. Peripheral edema
C. Pulmonary crackles
D. Jugular venous distention
Answer: C
Rationale: Left ventricular failure causes pulmonary congestion, resulting in crackles, dyspnea,
orthopnea, and hypoxemia. Right-sided failure more commonly causes peripheral edema,
hepatomegaly, and jugular venous distention.
Question 4
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen. Which
assessment finding indicates improvement?
A. PaCO₂ increases.
B. Respiratory rate increases to 34/min.
C. Oxygen saturation improves from 86% to 91%.
D. The patient becomes increasingly drowsy.
Answer: C
Rationale: An increase in oxygen saturation into the patient's target range suggests improved
oxygenation. Worsening hypercapnia, tachypnea, or increasing drowsiness may indicate
deterioration.
Question 5
A nurse is caring for a patient with bacterial meningitis. Which intervention has the highest
priority?
A. Encourage fluids.
B. Institute droplet precautions promptly.
C. Administer stool softeners.
D. Restrict visitors.
, TestBank FOR Lewis Medical Surgical Nursing
Answer: B
Rationale: Bacterial meningitis is highly transmissible through respiratory droplets. Prompt
isolation helps protect others while antimicrobial therapy is initiated.
Question 6
A patient with diabetic ketoacidosis (DKA) has:
Blood glucose: 540 mg/dL
Potassium: 5.6 mEq/L
pH: 7.18
Which physician order should the nurse implement first?
A. Administer IV insulin.
B. Begin isotonic IV fluids.
C. Give sodium bicarbonate.
D. Administer potassium chloride.
Answer: B
Rationale: Fluid resuscitation restores intravascular volume and improves tissue perfusion.
Insulin is started after initial fluid replacement and assessment of potassium. Routine bicarbonate
therapy is generally not indicated unless acidosis is severe.
Question 7
Which finding is expected after effective treatment of hyperkalemia?
A. Peaked T waves
B. Narrowed QRS complex
C. Muscle weakness increases.
D. Bradycardia worsens.
Answer: B
Rationale: Resolution of hyperkalemia improves cardiac conduction, with normalization of
ECG changes such as QRS widening and peaked T waves.
, TestBank FOR Lewis Medical Surgical Nursing
Question 8
A patient with acute kidney injury has a serum potassium level of 6.7 mEq/L. Which prescribed
medication should the nurse anticipate administering immediately to stabilize the myocardium?
A. Regular insulin
B. Sodium polystyrene sulfonate
C. IV calcium gluconate
D. Furosemide
Answer: C
Rationale: IV calcium gluconate does not lower serum potassium but rapidly stabilizes cardiac
cell membranes, reducing the risk of life-threatening dysrhythmias.
Question 9
A patient reports black, tarry stools. This finding most likely indicates:
A. Hematuria
B. Upper gastrointestinal bleeding
C. Hemorrhoids
D. Diverticulitis
Answer: B
Rationale: Melena (black, tarry stool) usually results from digested blood originating from an
upper gastrointestinal source.
Question 10
Following thyroidectomy, which assessment finding requires immediate intervention?
A. Hoarse voice immediately after surgery
B. Tingling around the mouth
C. Mild incisional pain
D. Slight neck swelling
Answer: B
Rationale: Perioral tingling may indicate hypocalcemia from inadvertent injury to or removal of
the parathyroid glands and can progress to tetany or airway compromise.
TestBank for Lewis Medical Surgical
Nursing Practice Exam 2026 Edition 100
Advanced Questions with Answers and
Detailed Rationales
Part 1 (Questions 1–25)
Question 1
A 68-year-old patient is admitted with acute decompensated heart failure. Which assessment
finding requires immediate nursing intervention?
A. Bibasilar crackles
B. Bilateral ankle edema
C. Oxygen saturation of 84% on room air
D. Weight gain of 2 kg in 3 days
Answer: C
Rationale: An SpO₂ of 84% indicates significant hypoxemia and threatens oxygen delivery to
vital organs. Immediate oxygen therapy and further assessment are priorities. Crackles, edema,
and recent weight gain are expected findings in heart failure but are less immediately life-
threatening.
Question 2
A patient develops sudden crushing chest pain, diaphoresis, and ST-segment elevation on the
ECG. Which action has the highest priority?
A. Obtain cardiac enzyme levels.
B. Administer oxygen if indicated and notify the provider to activate the reperfusion pathway.
C. Encourage bed rest.
D. Schedule an echocardiogram.
Answer: B
Rationale: ST-segment elevation suggests an acute myocardial infarction requiring rapid
reperfusion therapy. Supporting oxygenation (when hypoxemic) and activating the reperfusion
process take precedence over additional diagnostic testing.
, TestBank FOR Lewis Medical Surgical Nursing
Question 3
Which assessment finding is most consistent with left-sided heart failure?
A. Hepatomegaly
B. Peripheral edema
C. Pulmonary crackles
D. Jugular venous distention
Answer: C
Rationale: Left ventricular failure causes pulmonary congestion, resulting in crackles, dyspnea,
orthopnea, and hypoxemia. Right-sided failure more commonly causes peripheral edema,
hepatomegaly, and jugular venous distention.
Question 4
A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen. Which
assessment finding indicates improvement?
A. PaCO₂ increases.
B. Respiratory rate increases to 34/min.
C. Oxygen saturation improves from 86% to 91%.
D. The patient becomes increasingly drowsy.
Answer: C
Rationale: An increase in oxygen saturation into the patient's target range suggests improved
oxygenation. Worsening hypercapnia, tachypnea, or increasing drowsiness may indicate
deterioration.
Question 5
A nurse is caring for a patient with bacterial meningitis. Which intervention has the highest
priority?
A. Encourage fluids.
B. Institute droplet precautions promptly.
C. Administer stool softeners.
D. Restrict visitors.
, TestBank FOR Lewis Medical Surgical Nursing
Answer: B
Rationale: Bacterial meningitis is highly transmissible through respiratory droplets. Prompt
isolation helps protect others while antimicrobial therapy is initiated.
Question 6
A patient with diabetic ketoacidosis (DKA) has:
Blood glucose: 540 mg/dL
Potassium: 5.6 mEq/L
pH: 7.18
Which physician order should the nurse implement first?
A. Administer IV insulin.
B. Begin isotonic IV fluids.
C. Give sodium bicarbonate.
D. Administer potassium chloride.
Answer: B
Rationale: Fluid resuscitation restores intravascular volume and improves tissue perfusion.
Insulin is started after initial fluid replacement and assessment of potassium. Routine bicarbonate
therapy is generally not indicated unless acidosis is severe.
Question 7
Which finding is expected after effective treatment of hyperkalemia?
A. Peaked T waves
B. Narrowed QRS complex
C. Muscle weakness increases.
D. Bradycardia worsens.
Answer: B
Rationale: Resolution of hyperkalemia improves cardiac conduction, with normalization of
ECG changes such as QRS widening and peaked T waves.
, TestBank FOR Lewis Medical Surgical Nursing
Question 8
A patient with acute kidney injury has a serum potassium level of 6.7 mEq/L. Which prescribed
medication should the nurse anticipate administering immediately to stabilize the myocardium?
A. Regular insulin
B. Sodium polystyrene sulfonate
C. IV calcium gluconate
D. Furosemide
Answer: C
Rationale: IV calcium gluconate does not lower serum potassium but rapidly stabilizes cardiac
cell membranes, reducing the risk of life-threatening dysrhythmias.
Question 9
A patient reports black, tarry stools. This finding most likely indicates:
A. Hematuria
B. Upper gastrointestinal bleeding
C. Hemorrhoids
D. Diverticulitis
Answer: B
Rationale: Melena (black, tarry stool) usually results from digested blood originating from an
upper gastrointestinal source.
Question 10
Following thyroidectomy, which assessment finding requires immediate intervention?
A. Hoarse voice immediately after surgery
B. Tingling around the mouth
C. Mild incisional pain
D. Slight neck swelling
Answer: B
Rationale: Perioral tingling may indicate hypocalcemia from inadvertent injury to or removal of
the parathyroid glands and can progress to tetany or airway compromise.
