Test Bank For Dewit’s Medical Surgical Nursing Concepts
and Practice 4th Edition By Holly Stromberg 9780323608442
Chapter 1-49 Complete Guide EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Nursing Process and Clinical Judgment
2. Care of the Older Adult and Chronic Illness
3. Fluid, Electrolyte, and Acid-Base Balance
4. Infection Prevention and Wound Healing
5. Perioperative Nursing Care
6. Pain Management and Palliative Care
7. Cardiovascular, Hematologic, and Lymphatic Disorders
8. Respiratory Disorders
9. Gastrointestinal and Nutritional Disorders
10. Endocrine and Metabolic Disorders
11. Musculoskeletal and Integumentary Disorders
12. Neurological and Sensory Disorders
,13. Renal and Urinary Disorders
14. Reproductive and Sexual Health
15. Emergency and Disaster Nursing
1. A nurse is caring for an older adult patient who has developed confusion and agitation. Which
nursing action should the nurse prioritize to ensure patient safety?
A. Administer a sedative to prevent the patient from falling.
B. Assess for physiological causes, such as UTI, dehydration, or hypoxia.
C. Use physical restraints to prevent the patient from getting out of bed.
D. Reorient the patient every 15 minutes to improve cognitive function.
CORRECT ANSWER : B
Rationale: Sudden confusion in an older adult is often a manifestation of delirium, which is
commonly secondary to an underlying physiological issue like infection. Sedatives and restraints
(A, C) can exacerbate delirium and lead to negative outcomes. Reorientation (D) is helpful but
does not identify the underlying cause.
2. A patient is being evaluated for fluid volume deficit following persistent vomiting. Which
assessment finding is the most reliable indicator of this condition?
A. Normal skin turgor
B. Increased serum osmolality
C. Urine output of 50 mL/hr
D. Decreased hematocrit
CORRECT ANSWER : B
Rationale: Increased serum osmolality indicates hemoconcentration due to a loss of free water
relative to solutes, which is characteristic of dehydration. Skin turgor (A) is unreliable in older
adults. Output (C) is within normal range, and hematocrit (D) would likely be increased due to
hemoconcentration.
3. A nurse is caring for a patient post-operatively. What is the most effective way to prevent post-
operative pneumonia?
, A. Keeping the patient NPO until bowel sounds return.
B. Encouraging the use of an incentive spirometer and early ambulation.
C. Administering prophylactic antibiotics every 4 hours.
D. Maintaining the patient in a supine position to ensure rest.
CORRECT ANSWER : B
Rationale: Atelectasis is a precursor to pneumonia; incentive spirometry and ambulation
improve lung expansion and gas exchange. NPO (A) is for GI rest, not pulmonary health.
Prophylactic antibiotics (C) are not standard. Supine positioning (D) promotes stasis of
secretions.
4. A patient with Type 2 Diabetes is prescribed metformin. The nurse should explain that the
primary purpose of this medication is to:
A. Increase insulin secretion from the pancreas.
B. Decrease glucose production by the liver.
C. Prevent the breakdown of carbohydrates in the intestine.
D. Directly replace missing insulin in the body.
CORRECT ANSWER : B
Rationale: Metformin is a biguanide that primarily works by inhibiting hepatic glucose
production and improving insulin sensitivity. Secretagogues (A) and alpha-glucosidase
inhibitors (C) have different mechanisms, and insulin (D) is required for Type 1, not metformin.
5. A patient with a chronic pressure ulcer on the sacrum is being treated with negative pressure
wound therapy. Which finding indicates the therapy is effective?
A. The presence of necrotic tissue in the wound bed.
B. Formation of healthy, pink granulation tissue.
C. Increased drainage of purulent material.
D. The surrounding skin becoming red and macerated.
CORRECT ANSWER : B
, Rationale: Granulation tissue is the vascular connective tissue that indicates healing. Necrotic
tissue (A) indicates the need for debridement. Purulent drainage (C) suggests infection.
Maceration (D) indicates improper dressing application or moisture control.
6. A nurse is assessing a patient with congestive heart failure. Which clinical finding is a hallmark
of pulmonary congestion?
A. Pitting edema of the ankles.
B. Crackles auscultated in the lung bases.
C. Distended neck veins.
D. A decrease in blood pressure.
CORRECT ANSWER : B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to fluid in the alveoli, heard as crackles. Edema (A) and JVD (C) are associated with
right-sided failure.
7. A patient is receiving a continuous heparin infusion. Which laboratory value should the nurse
monitor to evaluate the effectiveness of the treatment?
A. International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Platelet count
D. Prothrombin Time (PT)
CORRECT ANSWER : B
Rationale: Heparin is titrated based on the aPTT to achieve a therapeutic range of
anticoagulation. INR and PT (A, D) are used for warfarin. Platelets (C) are monitored for
heparin-induced thrombocytopenia.
8. A patient is admitted with suspected appendicitis. Which abdominal assessment technique should
the nurse avoid?
A. Auscultation of bowel sounds.
B. Deep palpation of the abdomen.
C. Inspection of the abdominal contour.
and Practice 4th Edition By Holly Stromberg 9780323608442
Chapter 1-49 Complete Guide EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Nursing Process and Clinical Judgment
2. Care of the Older Adult and Chronic Illness
3. Fluid, Electrolyte, and Acid-Base Balance
4. Infection Prevention and Wound Healing
5. Perioperative Nursing Care
6. Pain Management and Palliative Care
7. Cardiovascular, Hematologic, and Lymphatic Disorders
8. Respiratory Disorders
9. Gastrointestinal and Nutritional Disorders
10. Endocrine and Metabolic Disorders
11. Musculoskeletal and Integumentary Disorders
12. Neurological and Sensory Disorders
,13. Renal and Urinary Disorders
14. Reproductive and Sexual Health
15. Emergency and Disaster Nursing
1. A nurse is caring for an older adult patient who has developed confusion and agitation. Which
nursing action should the nurse prioritize to ensure patient safety?
A. Administer a sedative to prevent the patient from falling.
B. Assess for physiological causes, such as UTI, dehydration, or hypoxia.
C. Use physical restraints to prevent the patient from getting out of bed.
D. Reorient the patient every 15 minutes to improve cognitive function.
CORRECT ANSWER : B
Rationale: Sudden confusion in an older adult is often a manifestation of delirium, which is
commonly secondary to an underlying physiological issue like infection. Sedatives and restraints
(A, C) can exacerbate delirium and lead to negative outcomes. Reorientation (D) is helpful but
does not identify the underlying cause.
2. A patient is being evaluated for fluid volume deficit following persistent vomiting. Which
assessment finding is the most reliable indicator of this condition?
A. Normal skin turgor
B. Increased serum osmolality
C. Urine output of 50 mL/hr
D. Decreased hematocrit
CORRECT ANSWER : B
Rationale: Increased serum osmolality indicates hemoconcentration due to a loss of free water
relative to solutes, which is characteristic of dehydration. Skin turgor (A) is unreliable in older
adults. Output (C) is within normal range, and hematocrit (D) would likely be increased due to
hemoconcentration.
3. A nurse is caring for a patient post-operatively. What is the most effective way to prevent post-
operative pneumonia?
, A. Keeping the patient NPO until bowel sounds return.
B. Encouraging the use of an incentive spirometer and early ambulation.
C. Administering prophylactic antibiotics every 4 hours.
D. Maintaining the patient in a supine position to ensure rest.
CORRECT ANSWER : B
Rationale: Atelectasis is a precursor to pneumonia; incentive spirometry and ambulation
improve lung expansion and gas exchange. NPO (A) is for GI rest, not pulmonary health.
Prophylactic antibiotics (C) are not standard. Supine positioning (D) promotes stasis of
secretions.
4. A patient with Type 2 Diabetes is prescribed metformin. The nurse should explain that the
primary purpose of this medication is to:
A. Increase insulin secretion from the pancreas.
B. Decrease glucose production by the liver.
C. Prevent the breakdown of carbohydrates in the intestine.
D. Directly replace missing insulin in the body.
CORRECT ANSWER : B
Rationale: Metformin is a biguanide that primarily works by inhibiting hepatic glucose
production and improving insulin sensitivity. Secretagogues (A) and alpha-glucosidase
inhibitors (C) have different mechanisms, and insulin (D) is required for Type 1, not metformin.
5. A patient with a chronic pressure ulcer on the sacrum is being treated with negative pressure
wound therapy. Which finding indicates the therapy is effective?
A. The presence of necrotic tissue in the wound bed.
B. Formation of healthy, pink granulation tissue.
C. Increased drainage of purulent material.
D. The surrounding skin becoming red and macerated.
CORRECT ANSWER : B
, Rationale: Granulation tissue is the vascular connective tissue that indicates healing. Necrotic
tissue (A) indicates the need for debridement. Purulent drainage (C) suggests infection.
Maceration (D) indicates improper dressing application or moisture control.
6. A nurse is assessing a patient with congestive heart failure. Which clinical finding is a hallmark
of pulmonary congestion?
A. Pitting edema of the ankles.
B. Crackles auscultated in the lung bases.
C. Distended neck veins.
D. A decrease in blood pressure.
CORRECT ANSWER : B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to fluid in the alveoli, heard as crackles. Edema (A) and JVD (C) are associated with
right-sided failure.
7. A patient is receiving a continuous heparin infusion. Which laboratory value should the nurse
monitor to evaluate the effectiveness of the treatment?
A. International Normalized Ratio (INR)
B. Activated Partial Thromboplastin Time (aPTT)
C. Platelet count
D. Prothrombin Time (PT)
CORRECT ANSWER : B
Rationale: Heparin is titrated based on the aPTT to achieve a therapeutic range of
anticoagulation. INR and PT (A, D) are used for warfarin. Platelets (C) are monitored for
heparin-induced thrombocytopenia.
8. A patient is admitted with suspected appendicitis. Which abdominal assessment technique should
the nurse avoid?
A. Auscultation of bowel sounds.
B. Deep palpation of the abdomen.
C. Inspection of the abdominal contour.
