• Medical-Surgical 09/15/2026
Nursing
Test Bank Lewis's Medical-Surgical Nursing
Assessment and Management of Clinical Problems,
Single Volume 12th Edition by Mariann M. Harding,
Jeffrey Kwong, Debra Hagler Chapter 1-69 | Isbn-
9780323789615
1.
The nurse reviews the electronic health record for a patient scheduled for a total hip replacement. Which
assessment data shown in the accompanying figure increase the patient's risk for respiratory failure after
surgery?
a. Older age and anemia
b. Albumin level and weight loss
P 1
, • Medical-Surgical 09/15/2026
Nursing
c. Recent arthroscopic procedure
d. Confusion and disorientation to time –
Correct Answer :ANS: B
The patient's recent weight loss and low protein stores indicate possible muscle weakness, which make it more
difficult for an older patient to recover from the effects of general anesthesia and immobility associated with the
hip surgery. The other information will also be noted by the nurse but does not place the patient at higher risk
for respiratory failure.
1. Which actions would the nurse use to reduce a patient's risk for ventilator- associated pneumonia (VAP)?
(Select all that apply.)
a. Obtain arterial blood gases daily.
b. Provide a "sedation holiday" daily.
c. Give prescribed pantoprazole (Protonix).
d. Elevate the head of the bed to at least 30 degrees.
e. Provide oral care daily with chlorhexidine (0.12%) solution. –
Correct Answer :ANS: B, C, D, E
These interventions are part of the ventilator bundle that is recommended to prevent VAP. Arterial blood gases
may be done daily but are not always necessary and do not help prevent VAP.
An older adult patient who has just arrived in the emergency department has a pulse deficit of 46 beats. Which
intervention would the nurse anticipate for this patient?
A) Cardiac catheterization
B) Hourly blood pressure checks
C) Electrocardiographic monitoring
D) Emergent synchronized cardioversion
P 2
, • Medical-Surgical 09/15/2026
Nursing
- Correct Answer :C)
Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may
be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac
catheterization, and emergent cardioversion are used for diagnosis and/or treatment of cardiovascular disorders
but would not be as helpful in determining the immediate reason for the pulse deficit.
During a physical examination of an older patient, the nurse palpates the point of maximal impulse (PMI) in the
sixth intercostal space lateral to the left midclavicular line. Which action is the most specific way for the nurse to
follow up on this finding?
A) Ask about risk factors for atherosclerosis.
B) Determine family history of heart disease.
C) Assess for symptoms of ventricular hypertrophy.
D) Auscultate carotid arteries for the presence of a bruit.
- Correct Answer :C)
The PMI should be felt at the intersection of the fifth intercostal space and left midclavicular line. A PMI found
outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy (LVH).
The other assessments are part of a general cardiac assessment but do not represent follow-up for LVH. Cardiac
enlargement is not necessarily associated with atherosclerosis or carotid artery disease.
How would the nurse listen to auscultate for S3 or S4 gallops in the mitral area?
A) Use the diaphragm of the stethoscope with the patient lying flat.
B) Use the bell of the stethoscope with the patient in the left lateral position.
C) Use the diaphragm of the stethoscope with the patient in a supine position.
D) Use the bell of the stethoscope with the patient sitting and leaning forward. - Correct Answer :B)
Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds
associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart
closer to the chest wall. The diaphragm of the stethoscope is best to use for the higher pitched sounds such as
S1 and S2.
P 3
, • Medical-Surgical 09/15/2026
Nursing
A patient is being treated for heart failure. Which laboratory test result will the nurse review to determine the
effects of the treatment?
A) Troponin
B) Homocysteine (Hcy)
C) Low-density lipoprotein (LDL)
D) B-type natriuretic peptide (BNP) - Correct Answer :D)
Levels of BNP are a marker for heart failure. The other laboratory results would assess for myocardial infarction
(troponin) or the risk for coronary artery disease (Hcy and LDL).
While doing the hospital admission assessment for a slender older adult, the nurse observes pulsation of the
abdominal aorta in the epigastric area. Which action would the nurse take?
A) Teach the patient about aneurysms.
B) Notify the hospital rapid response team.
C) Instruct the patient to remain on bed rest.
D) Document the finding in the patient record. - Correct Answer :D)
Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. The
nurse would simply document the finding in the admission assessment. Unless there are other abnormal findings
(such as a bruit, pain, or hyper/hypotension) associated with the pulsation, the other actions are not necessary.
A patient is scheduled for a cardiac catheterization with coronary angiography. What information would the
nurse provide before the procedure?
A) It will be important not to move at all during the procedure.
B) A flushed feeling is common when the contrast dye is injected.
C) Monitored anesthesia care will be provided during the procedure.
D) Arterial pressure monitoring will be needed for 24 hours after the test. - Correct Answer :B)
A sensation of warmth or flushing is common when the contrast material is injected, which can be anxiety
producing unless it has been discussed with the patient. The patient may receive a sedative drug before the
P 4
Nursing
Test Bank Lewis's Medical-Surgical Nursing
Assessment and Management of Clinical Problems,
Single Volume 12th Edition by Mariann M. Harding,
Jeffrey Kwong, Debra Hagler Chapter 1-69 | Isbn-
9780323789615
1.
The nurse reviews the electronic health record for a patient scheduled for a total hip replacement. Which
assessment data shown in the accompanying figure increase the patient's risk for respiratory failure after
surgery?
a. Older age and anemia
b. Albumin level and weight loss
P 1
, • Medical-Surgical 09/15/2026
Nursing
c. Recent arthroscopic procedure
d. Confusion and disorientation to time –
Correct Answer :ANS: B
The patient's recent weight loss and low protein stores indicate possible muscle weakness, which make it more
difficult for an older patient to recover from the effects of general anesthesia and immobility associated with the
hip surgery. The other information will also be noted by the nurse but does not place the patient at higher risk
for respiratory failure.
1. Which actions would the nurse use to reduce a patient's risk for ventilator- associated pneumonia (VAP)?
(Select all that apply.)
a. Obtain arterial blood gases daily.
b. Provide a "sedation holiday" daily.
c. Give prescribed pantoprazole (Protonix).
d. Elevate the head of the bed to at least 30 degrees.
e. Provide oral care daily with chlorhexidine (0.12%) solution. –
Correct Answer :ANS: B, C, D, E
These interventions are part of the ventilator bundle that is recommended to prevent VAP. Arterial blood gases
may be done daily but are not always necessary and do not help prevent VAP.
An older adult patient who has just arrived in the emergency department has a pulse deficit of 46 beats. Which
intervention would the nurse anticipate for this patient?
A) Cardiac catheterization
B) Hourly blood pressure checks
C) Electrocardiographic monitoring
D) Emergent synchronized cardioversion
P 2
, • Medical-Surgical 09/15/2026
Nursing
- Correct Answer :C)
Pulse deficit is a difference between simultaneously obtained apical and radial pulses. It indicates that there may
be a cardiac dysrhythmia that would best be detected with ECG monitoring. Frequent BP monitoring, cardiac
catheterization, and emergent cardioversion are used for diagnosis and/or treatment of cardiovascular disorders
but would not be as helpful in determining the immediate reason for the pulse deficit.
During a physical examination of an older patient, the nurse palpates the point of maximal impulse (PMI) in the
sixth intercostal space lateral to the left midclavicular line. Which action is the most specific way for the nurse to
follow up on this finding?
A) Ask about risk factors for atherosclerosis.
B) Determine family history of heart disease.
C) Assess for symptoms of ventricular hypertrophy.
D) Auscultate carotid arteries for the presence of a bruit.
- Correct Answer :C)
The PMI should be felt at the intersection of the fifth intercostal space and left midclavicular line. A PMI found
outside these landmarks indicates possible cardiac enlargement, such as with left ventricular hypertrophy (LVH).
The other assessments are part of a general cardiac assessment but do not represent follow-up for LVH. Cardiac
enlargement is not necessarily associated with atherosclerosis or carotid artery disease.
How would the nurse listen to auscultate for S3 or S4 gallops in the mitral area?
A) Use the diaphragm of the stethoscope with the patient lying flat.
B) Use the bell of the stethoscope with the patient in the left lateral position.
C) Use the diaphragm of the stethoscope with the patient in a supine position.
D) Use the bell of the stethoscope with the patient sitting and leaning forward. - Correct Answer :B)
Gallop rhythms generate low-pitched sounds and are most easily heard with the bell of the stethoscope. Sounds
associated with the mitral valve are accentuated by turning the patient to the left side, which brings the heart
closer to the chest wall. The diaphragm of the stethoscope is best to use for the higher pitched sounds such as
S1 and S2.
P 3
, • Medical-Surgical 09/15/2026
Nursing
A patient is being treated for heart failure. Which laboratory test result will the nurse review to determine the
effects of the treatment?
A) Troponin
B) Homocysteine (Hcy)
C) Low-density lipoprotein (LDL)
D) B-type natriuretic peptide (BNP) - Correct Answer :D)
Levels of BNP are a marker for heart failure. The other laboratory results would assess for myocardial infarction
(troponin) or the risk for coronary artery disease (Hcy and LDL).
While doing the hospital admission assessment for a slender older adult, the nurse observes pulsation of the
abdominal aorta in the epigastric area. Which action would the nurse take?
A) Teach the patient about aneurysms.
B) Notify the hospital rapid response team.
C) Instruct the patient to remain on bed rest.
D) Document the finding in the patient record. - Correct Answer :D)
Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. The
nurse would simply document the finding in the admission assessment. Unless there are other abnormal findings
(such as a bruit, pain, or hyper/hypotension) associated with the pulsation, the other actions are not necessary.
A patient is scheduled for a cardiac catheterization with coronary angiography. What information would the
nurse provide before the procedure?
A) It will be important not to move at all during the procedure.
B) A flushed feeling is common when the contrast dye is injected.
C) Monitored anesthesia care will be provided during the procedure.
D) Arterial pressure monitoring will be needed for 24 hours after the test. - Correct Answer :B)
A sensation of warmth or flushing is common when the contrast material is injected, which can be anxiety
producing unless it has been discussed with the patient. The patient may receive a sedative drug before the
P 4
