Lewis Medical-Surgical Nursing Assessment and Management of
Clinical Problems
12th Edition By Harding & Kwong 250 Question Bank, answers & Rationale Study guide
Module 1: Cardiovascular Nursing (Hypertension, CAD, Acute MI, Shock, HF,
Valvular Disease)
Question 1: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 2: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation?
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 3: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
Question 4: What clinical finding defines a positive Homans' sign, and why is it no longer clinically
recommended?
Correct Answer: Pain in the calf upon dorsiflexion of the foot; it lacks diagnostic specificity and carries
a risk of dislodging a deep vein thrombosis.
Clinical Rationale: Dorsiflexion can cause pain due to various non-vascular reasons, and mechanical
manipulation of a clot risks fragmentation and subsequent pulmonary embolization.
,Question 5: What is the purpose of administering an alpha-1 adrenergic blocker to a hypertensive
patient?
Correct Answer: To promote smooth muscle relaxation in peripheral arterioles, causing direct
vasodilation.
Clinical Rationale: Blocking alpha-1 receptors stops endogenous catecholamines from inducing
vasoconstriction, lowering peripheral arterial resistance and systemic blood pressure.
Question 6: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
[Scenario Reference Mode 6]
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 7: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation? [Scenario Reference Mode 7]
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 8: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
[Scenario Reference Mode 8]
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
Question 9: What clinical finding defines a positive Homans' sign, and why is it no longer clinically
recommended? [Scenario Reference Mode 9]
Correct Answer: Pain in the calf upon dorsiflexion of the foot; it lacks diagnostic specificity and carries
a risk of dislodging a deep vein thrombosis.
,Clinical Rationale: Dorsiflexion can cause pain due to various non-vascular reasons, and mechanical
manipulation of a clot risks fragmentation and subsequent pulmonary embolization.
Question 10: What is the purpose of administering an alpha-1 adrenergic blocker to a hypertensive
patient? [Scenario Reference Mode 10]
Correct Answer: To promote smooth muscle relaxation in peripheral arterioles, causing direct
vasodilation.
Clinical Rationale: Blocking alpha-1 receptors stops endogenous catecholamines from inducing
vasoconstriction, lowering peripheral arterial resistance and systemic blood pressure.
Question 11: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
[Scenario Reference Mode 11]
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 12: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation? [Scenario Reference Mode 12]
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 13: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
[Scenario Reference Mode 13]
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
Question 14: What clinical finding defines a positive Homans' sign, and why is it no longer clinically
recommended? [Scenario Reference Mode 14]
, Correct Answer: Pain in the calf upon dorsiflexion of the foot; it lacks diagnostic specificity and carries
a risk of dislodging a deep vein thrombosis.
Clinical Rationale: Dorsiflexion can cause pain due to various non-vascular reasons, and mechanical
manipulation of a clot risks fragmentation and subsequent pulmonary embolization.
Question 15: What is the purpose of administering an alpha-1 adrenergic blocker to a hypertensive
patient? [Scenario Reference Mode 15]
Correct Answer: To promote smooth muscle relaxation in peripheral arterioles, causing direct
vasodilation.
Clinical Rationale: Blocking alpha-1 receptors stops endogenous catecholamines from inducing
vasoconstriction, lowering peripheral arterial resistance and systemic blood pressure.
Question 16: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
[Scenario Reference Mode 16]
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 17: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation? [Scenario Reference Mode 17]
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 18: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
[Scenario Reference Mode 18]
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
Clinical Problems
12th Edition By Harding & Kwong 250 Question Bank, answers & Rationale Study guide
Module 1: Cardiovascular Nursing (Hypertension, CAD, Acute MI, Shock, HF,
Valvular Disease)
Question 1: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 2: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation?
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 3: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
Question 4: What clinical finding defines a positive Homans' sign, and why is it no longer clinically
recommended?
Correct Answer: Pain in the calf upon dorsiflexion of the foot; it lacks diagnostic specificity and carries
a risk of dislodging a deep vein thrombosis.
Clinical Rationale: Dorsiflexion can cause pain due to various non-vascular reasons, and mechanical
manipulation of a clot risks fragmentation and subsequent pulmonary embolization.
,Question 5: What is the purpose of administering an alpha-1 adrenergic blocker to a hypertensive
patient?
Correct Answer: To promote smooth muscle relaxation in peripheral arterioles, causing direct
vasodilation.
Clinical Rationale: Blocking alpha-1 receptors stops endogenous catecholamines from inducing
vasoconstriction, lowering peripheral arterial resistance and systemic blood pressure.
Question 6: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
[Scenario Reference Mode 6]
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 7: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation? [Scenario Reference Mode 7]
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 8: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
[Scenario Reference Mode 8]
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
Question 9: What clinical finding defines a positive Homans' sign, and why is it no longer clinically
recommended? [Scenario Reference Mode 9]
Correct Answer: Pain in the calf upon dorsiflexion of the foot; it lacks diagnostic specificity and carries
a risk of dislodging a deep vein thrombosis.
,Clinical Rationale: Dorsiflexion can cause pain due to various non-vascular reasons, and mechanical
manipulation of a clot risks fragmentation and subsequent pulmonary embolization.
Question 10: What is the purpose of administering an alpha-1 adrenergic blocker to a hypertensive
patient? [Scenario Reference Mode 10]
Correct Answer: To promote smooth muscle relaxation in peripheral arterioles, causing direct
vasodilation.
Clinical Rationale: Blocking alpha-1 receptors stops endogenous catecholamines from inducing
vasoconstriction, lowering peripheral arterial resistance and systemic blood pressure.
Question 11: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
[Scenario Reference Mode 11]
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 12: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation? [Scenario Reference Mode 12]
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 13: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
[Scenario Reference Mode 13]
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
Question 14: What clinical finding defines a positive Homans' sign, and why is it no longer clinically
recommended? [Scenario Reference Mode 14]
, Correct Answer: Pain in the calf upon dorsiflexion of the foot; it lacks diagnostic specificity and carries
a risk of dislodging a deep vein thrombosis.
Clinical Rationale: Dorsiflexion can cause pain due to various non-vascular reasons, and mechanical
manipulation of a clot risks fragmentation and subsequent pulmonary embolization.
Question 15: What is the purpose of administering an alpha-1 adrenergic blocker to a hypertensive
patient? [Scenario Reference Mode 15]
Correct Answer: To promote smooth muscle relaxation in peripheral arterioles, causing direct
vasodilation.
Clinical Rationale: Blocking alpha-1 receptors stops endogenous catecholamines from inducing
vasoconstriction, lowering peripheral arterial resistance and systemic blood pressure.
Question 16: What is the primary indicator of successful fluid resuscitation in hypovolemic shock?
[Scenario Reference Mode 16]
Correct Answer: A urine output of at least 0.5 mL/kg/hour or greater than 30 mL/hour.
Clinical Rationale: Urine output serves as a direct indicator of organ and renal perfusion. Satisfactory
output verifies adequate circulating volume and perfusion to the visceral beds.
Question 17: What is the priority medication category for reducing afterload in an acute heart failure
exacerbation? [Scenario Reference Mode 17]
Correct Answer: Intravenous vasodilators such as Nitroprusside or Nitroglycerin.
Clinical Rationale: Vasodilators lower systemic vascular resistance, making it easier for the weak left
ventricle to pump blood out into the system, decreasing myocardial oxygen demands.
Question 18: Which cardiac enzyme elevates first within 4 to 6 hours after an acute myocardial injury?
[Scenario Reference Mode 18]
Correct Answer: Troponin I or Troponin T.
Clinical Rationale: Troponins are highly sensitive and specific structural proteins of cardiac muscle cells.
They release into circulation within hours of cellular necrosis and remain elevated for up to two weeks.
