LEWIS MEDICAL-SURGICAL NURSING – COMPREHENSIVE QUESTIONS
AND ANSWERS | VERIFIED AND WELL-DETAILED ANSWERS | DETAILED EXPLANATIONS
AND
RATIONALES | COMPLETE EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS |
LATEST EXAM UPDATE
•
CORE DOMAINS
• Cardiovascular disorders and nursing management
• Respiratory disorders and oxygenation
• Neurologic disorders and neurologic assessment
• Gastrointestinal, hepatic, and pancreatic disorders
• Renal and urinary disorders
• Endocrine and metabolic disorders
• Hematologic, immune, and oncologic disorders
• Musculoskeletal, integumentary, and infectious disorders
• Perioperative care, fluid/electrolyte balance, and clinical decision-making
INTRODUCTION
This comprehensive assessment is designed to reinforce the knowledge and clinical reasoning
expected in adult medical-surgical nursing. The questions evaluate foundational concepts,
pathophysiology, assessment findings, diagnostic interpretation, pharmacologic and nursing
interventions, patient safety, prioritization, and clinical decision-making. Multiple-choice
questions are used to test both recognition of essential concepts and application of
knowledge to realistic patient situations. Effective preparation requires more than
memorizing isolated facts; nurses must understand relationships among disease processes,
assessment findings, treatments, complications, and patient responses. The explanations
accompanying each answer emphasize the rationale behind appropriate nursing decisions
and help distinguish closely related concepts.
SECTION ONE: QUESTIONS 1–100
Question 1. A nurse is assessing a patient with left-sided heart failure. Which assessment
finding is most consistent with pulmonary congestion?
A. Dependent peripheral edema
B. Crackles in the lung bases
C. Jugular venous distention
D. Enlarged liver
Correct Answer: B. Crackles in the lung bases
,Explanation: Left-sided heart failure causes blood to back up into the pulmonary circulation.
Increased pulmonary capillary pressure promotes fluid movement into the interstitial and
alveolar spaces, producing crackles and potentially dyspnea. Peripheral edema, jugular
venous distention, and hepatomegaly are more characteristic of systemic venous congestion
associated with right-sided heart failure.
Question 2. A patient with acute pulmonary edema is severely dyspneic and anxious. Which
intervention should the nurse implement first?
A. Place the patient in a high-Fowler position
B. Encourage oral fluids
C. Place the patient in a supine position
D. Obtain a detailed dietary history
Correct Answer: A. Place the patient in a high-Fowler position
Explanation: High-Fowler positioning promotes lung expansion and decreases venous return
to the heart, which can reduce pulmonary congestion. Immediate attention to oxygenation
and breathing takes priority over nonurgent assessment activities.
Question 3. Which assessment finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles only
B. Pink frothy sputum
C. Dependent peripheral edema
D. Severe inspiratory stridor
Correct Answer: C. Dependent peripheral edema
Explanation: Right-sided heart failure produces systemic venous congestion. Common
findings include dependent edema, jugular venous distention, hepatomegaly, ascites, and
weight gain from fluid retention.
Question 4. A patient taking digoxin reports nausea, poor appetite, and seeing yellow-green
halos around lights. What should the nurse suspect?
A. Hypoglycemia
B. Digoxin toxicity
C. Acute pulmonary edema
D. Hyperthyroidism
Correct Answer: B. Digoxin toxicity
Explanation: Gastrointestinal symptoms and visual disturbances such as yellow-green halos
are classic manifestations associated with digoxin toxicity. The nurse should withhold the
medication as appropriate according to the clinical situation and notify the healthcare
provider for further evaluation.
, Question 5. Before administering digoxin, which assessment is particularly important?
A. Respiratory rate
B. Bowel sounds
C. Apical pulse
D. Skin temperature
Correct Answer: C. Apical pulse
Explanation: Digoxin slows the heart rate and affects cardiac conduction. The apical pulse
should be assessed before administration, and the medication may need to be withheld
when the pulse is below the prescribed safety parameter.
Question 6. A patient with stable angina reports chest discomfort after walking several
blocks that resolves with rest. How should the nurse interpret this finding?
A. The pattern is consistent with stable angina
B. The patient is experiencing cardiac tamponade
C. The patient has acute pericarditis
D. The finding confirms a pulmonary embolism
Correct Answer: A. The pattern is consistent with stable angina
Explanation: Stable angina typically occurs predictably with exertion or emotional stress and
improves with rest or prescribed antianginal therapy. Unstable or new chest pain requires
urgent evaluation because it may indicate acute coronary syndrome.
Question 7. Which instruction is most appropriate for a patient prescribed sublingual
nitroglycerin?
A. Swallow the tablet with water
B. Store the medication in its original container
C. Take the medication only after chest pain lasts 30 minutes
D. Place the tablet under the tongue and allow it to dissolve
Correct Answer: D. Place the tablet under the tongue and allow it to dissolve
Explanation: Sublingual nitroglycerin is absorbed rapidly through the oral mucosa. It should
be placed under the tongue and allowed to dissolve rather than swallowed.
Question 8. A patient receiving nitroglycerin reports a headache. What is the most
appropriate interpretation?
A. The patient is developing meningitis
B. The medication has caused an expected vasodilatory effect
C. The patient is experiencing hypoglycemia
D. The medication has caused bronchoconstriction
AND ANSWERS | VERIFIED AND WELL-DETAILED ANSWERS | DETAILED EXPLANATIONS
AND
RATIONALES | COMPLETE EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS |
LATEST EXAM UPDATE
•
CORE DOMAINS
• Cardiovascular disorders and nursing management
• Respiratory disorders and oxygenation
• Neurologic disorders and neurologic assessment
• Gastrointestinal, hepatic, and pancreatic disorders
• Renal and urinary disorders
• Endocrine and metabolic disorders
• Hematologic, immune, and oncologic disorders
• Musculoskeletal, integumentary, and infectious disorders
• Perioperative care, fluid/electrolyte balance, and clinical decision-making
INTRODUCTION
This comprehensive assessment is designed to reinforce the knowledge and clinical reasoning
expected in adult medical-surgical nursing. The questions evaluate foundational concepts,
pathophysiology, assessment findings, diagnostic interpretation, pharmacologic and nursing
interventions, patient safety, prioritization, and clinical decision-making. Multiple-choice
questions are used to test both recognition of essential concepts and application of
knowledge to realistic patient situations. Effective preparation requires more than
memorizing isolated facts; nurses must understand relationships among disease processes,
assessment findings, treatments, complications, and patient responses. The explanations
accompanying each answer emphasize the rationale behind appropriate nursing decisions
and help distinguish closely related concepts.
SECTION ONE: QUESTIONS 1–100
Question 1. A nurse is assessing a patient with left-sided heart failure. Which assessment
finding is most consistent with pulmonary congestion?
A. Dependent peripheral edema
B. Crackles in the lung bases
C. Jugular venous distention
D. Enlarged liver
Correct Answer: B. Crackles in the lung bases
,Explanation: Left-sided heart failure causes blood to back up into the pulmonary circulation.
Increased pulmonary capillary pressure promotes fluid movement into the interstitial and
alveolar spaces, producing crackles and potentially dyspnea. Peripheral edema, jugular
venous distention, and hepatomegaly are more characteristic of systemic venous congestion
associated with right-sided heart failure.
Question 2. A patient with acute pulmonary edema is severely dyspneic and anxious. Which
intervention should the nurse implement first?
A. Place the patient in a high-Fowler position
B. Encourage oral fluids
C. Place the patient in a supine position
D. Obtain a detailed dietary history
Correct Answer: A. Place the patient in a high-Fowler position
Explanation: High-Fowler positioning promotes lung expansion and decreases venous return
to the heart, which can reduce pulmonary congestion. Immediate attention to oxygenation
and breathing takes priority over nonurgent assessment activities.
Question 3. Which assessment finding is most characteristic of right-sided heart failure?
A. Pulmonary crackles only
B. Pink frothy sputum
C. Dependent peripheral edema
D. Severe inspiratory stridor
Correct Answer: C. Dependent peripheral edema
Explanation: Right-sided heart failure produces systemic venous congestion. Common
findings include dependent edema, jugular venous distention, hepatomegaly, ascites, and
weight gain from fluid retention.
Question 4. A patient taking digoxin reports nausea, poor appetite, and seeing yellow-green
halos around lights. What should the nurse suspect?
A. Hypoglycemia
B. Digoxin toxicity
C. Acute pulmonary edema
D. Hyperthyroidism
Correct Answer: B. Digoxin toxicity
Explanation: Gastrointestinal symptoms and visual disturbances such as yellow-green halos
are classic manifestations associated with digoxin toxicity. The nurse should withhold the
medication as appropriate according to the clinical situation and notify the healthcare
provider for further evaluation.
, Question 5. Before administering digoxin, which assessment is particularly important?
A. Respiratory rate
B. Bowel sounds
C. Apical pulse
D. Skin temperature
Correct Answer: C. Apical pulse
Explanation: Digoxin slows the heart rate and affects cardiac conduction. The apical pulse
should be assessed before administration, and the medication may need to be withheld
when the pulse is below the prescribed safety parameter.
Question 6. A patient with stable angina reports chest discomfort after walking several
blocks that resolves with rest. How should the nurse interpret this finding?
A. The pattern is consistent with stable angina
B. The patient is experiencing cardiac tamponade
C. The patient has acute pericarditis
D. The finding confirms a pulmonary embolism
Correct Answer: A. The pattern is consistent with stable angina
Explanation: Stable angina typically occurs predictably with exertion or emotional stress and
improves with rest or prescribed antianginal therapy. Unstable or new chest pain requires
urgent evaluation because it may indicate acute coronary syndrome.
Question 7. Which instruction is most appropriate for a patient prescribed sublingual
nitroglycerin?
A. Swallow the tablet with water
B. Store the medication in its original container
C. Take the medication only after chest pain lasts 30 minutes
D. Place the tablet under the tongue and allow it to dissolve
Correct Answer: D. Place the tablet under the tongue and allow it to dissolve
Explanation: Sublingual nitroglycerin is absorbed rapidly through the oral mucosa. It should
be placed under the tongue and allowed to dissolve rather than swallowed.
Question 8. A patient receiving nitroglycerin reports a headache. What is the most
appropriate interpretation?
A. The patient is developing meningitis
B. The medication has caused an expected vasodilatory effect
C. The patient is experiencing hypoglycemia
D. The medication has caused bronchoconstriction
