Exam Test Bank for Lewis’s Medical-Surgical Nursing:
Assessment and Management of Clinical Problems, 12th
Edition (Harding et al., 2024)
1. A postoperative patient receiving morphine PCA reports respiratory rate 8/min and
somnolence. The nurse’s first action is to:
A. Call the primary provider for naloxone order
B. Encourage deep breathing and coughing
C. Stop the PCA pump and stimulate the patient verbally and physically
D. Administer oxygen by nasal cannula at 2 L/min
Answer: C
Rationale: Immediate safety — stop opioid infusion and stimulate; assess
airway/respirations. Naloxone or oxygen may follow based on assessment and orders.
2. A patient with diabetic ketoacidosis (DKA) has K+ 5.6 mEq/L on admission. Which
statement is correct for nursing care?
A. Start insulin infusion and monitor K+ closely because serum K+ will drop as insulin
shifts K+ intracellularly
B. Give oral potassium immediately to prevent hypokalemia
C. Restrict fluids to avoid worsening hyperkalemia
D. Hold insulin until K+ is <4.0 mEq/L
Answer: A
Rationale: Insulin lowers serum K+; monitor and replace potassium as needed. Giving
K+ immediately without replacement needs is not appropriate.
3. A patient with heart failure has BNP elevated. Which is a correct interpretation?
A. BNP levels decrease with worsening heart failure
B. Elevated BNP suggests increased ventricular stretch and heart failure severity
,C. BNP is specific for left-sided valvular disease only
D. BNP is unaffected by renal function
Answer: B
Rationale: BNP rises with ventricular stretch (volume/pressure overload); useful for HF
assessment though affected by other factors.
4. Which finding warrants immediate intervention for a patient with a central venous
catheter?
A. Clear, yellow drainage at insertion site
B. 2 cm of catheter visible at exit site
C. Sudden onset of dyspnea and chest pain during infusion
D. Dressing change due in 48 hours
Answer: C
Rationale: Sudden dyspnea/chest pain may indicate air embolism, thrombus, or
pneumothorax — urgent assessment required.
5. A client with COPD has a PaO2 of 60 mm Hg and receives oxygen via nasal cannula
at 2 L/min. The nurse should:
A. Increase oxygen to 6 L/min immediately
B. Continue current oxygen and monitor respiratory status
C. Remove oxygen because hypoxemia stimulates breathing in COPD
D. Switch to room air and notify provider
Answer: B
Rationale: PaO2 60 mm Hg is borderline; 2 L/min is reasonable; monitor closely. Avoid
high-flow increases without assessment.
,6. Which lab indicates risk for bleeding and may require attention before surgery?
A. Hgb 14 g/dL
B. INR 2.8
C. Platelets 250,000/µL
D. Na+ 138 mEq/L
Answer: B
Rationale: INR >2.0 indicates prolonged coagulation — risk for bleeding; may need
correction pre-op.
7. A patient on heparin infusion has an aPTT significantly above the therapeutic range
and oozing from IV sites. The nurse should:
A. Continue infusion and recheck aPTT in 6 hours
B. Stop infusion and notify provider immediately
C. Administer vitamin K IV
D. Encourage ambulation to decrease bleeding
Answer: B
Rationale: Excess anticoagulation with active bleeding — stop heparin and notify
provider; protamine may be needed (not vitamin K).
8. Priority action for a patient with acute myocardial infarction reporting chest pain and
ST elevation:
A. Give scheduled ibuprofen for inflammation
B. Administer sublingual nitroglycerin and 325 mg aspirin unless contraindicated
C. Apply heat pack to chest to relieve pain
D. Delay medications until ECG repeats in 30 minutes
Answer: B
, Rationale: Aspirin and nitroglycerin are immediate interventions unless contraindicated;
prompt reperfusion protocols follow.
9. A patient receives packed RBCs. Which sign indicates a hemolytic transfusion
reaction?
A. Mild itching without rash
B. Sudden flank pain, hematuria, fever, hypotension
C. Gradual improvement in Hgb
D. Slight rise in temperature after 24 hours
Answer: B
Rationale: Hemolytic reaction: fever, flank pain, hematuria, hypotension — stop
transfusion immediately.
10. A patient with acute pancreatitis is NPO and on IV fluids. Which lab pattern is
commonly expected?
A. Elevated amylase and lipase, hypocalcemia
B. Low amylase, normal lipase, hypercalcemia
C. Normal enzymes, hypernatremia
D. Increased hemoglobin and platelets only
Answer: A
Rationale: Pancreatitis → elevated pancreatic enzymes and possible hypocalcemia
from fat saponification.
11. Best nursing intervention to prevent pressure injury in an immobile patient:
A. Turn every 8 hours
B. Keep head of bed elevated 90° at all times
Assessment and Management of Clinical Problems, 12th
Edition (Harding et al., 2024)
1. A postoperative patient receiving morphine PCA reports respiratory rate 8/min and
somnolence. The nurse’s first action is to:
A. Call the primary provider for naloxone order
B. Encourage deep breathing and coughing
C. Stop the PCA pump and stimulate the patient verbally and physically
D. Administer oxygen by nasal cannula at 2 L/min
Answer: C
Rationale: Immediate safety — stop opioid infusion and stimulate; assess
airway/respirations. Naloxone or oxygen may follow based on assessment and orders.
2. A patient with diabetic ketoacidosis (DKA) has K+ 5.6 mEq/L on admission. Which
statement is correct for nursing care?
A. Start insulin infusion and monitor K+ closely because serum K+ will drop as insulin
shifts K+ intracellularly
B. Give oral potassium immediately to prevent hypokalemia
C. Restrict fluids to avoid worsening hyperkalemia
D. Hold insulin until K+ is <4.0 mEq/L
Answer: A
Rationale: Insulin lowers serum K+; monitor and replace potassium as needed. Giving
K+ immediately without replacement needs is not appropriate.
3. A patient with heart failure has BNP elevated. Which is a correct interpretation?
A. BNP levels decrease with worsening heart failure
B. Elevated BNP suggests increased ventricular stretch and heart failure severity
,C. BNP is specific for left-sided valvular disease only
D. BNP is unaffected by renal function
Answer: B
Rationale: BNP rises with ventricular stretch (volume/pressure overload); useful for HF
assessment though affected by other factors.
4. Which finding warrants immediate intervention for a patient with a central venous
catheter?
A. Clear, yellow drainage at insertion site
B. 2 cm of catheter visible at exit site
C. Sudden onset of dyspnea and chest pain during infusion
D. Dressing change due in 48 hours
Answer: C
Rationale: Sudden dyspnea/chest pain may indicate air embolism, thrombus, or
pneumothorax — urgent assessment required.
5. A client with COPD has a PaO2 of 60 mm Hg and receives oxygen via nasal cannula
at 2 L/min. The nurse should:
A. Increase oxygen to 6 L/min immediately
B. Continue current oxygen and monitor respiratory status
C. Remove oxygen because hypoxemia stimulates breathing in COPD
D. Switch to room air and notify provider
Answer: B
Rationale: PaO2 60 mm Hg is borderline; 2 L/min is reasonable; monitor closely. Avoid
high-flow increases without assessment.
,6. Which lab indicates risk for bleeding and may require attention before surgery?
A. Hgb 14 g/dL
B. INR 2.8
C. Platelets 250,000/µL
D. Na+ 138 mEq/L
Answer: B
Rationale: INR >2.0 indicates prolonged coagulation — risk for bleeding; may need
correction pre-op.
7. A patient on heparin infusion has an aPTT significantly above the therapeutic range
and oozing from IV sites. The nurse should:
A. Continue infusion and recheck aPTT in 6 hours
B. Stop infusion and notify provider immediately
C. Administer vitamin K IV
D. Encourage ambulation to decrease bleeding
Answer: B
Rationale: Excess anticoagulation with active bleeding — stop heparin and notify
provider; protamine may be needed (not vitamin K).
8. Priority action for a patient with acute myocardial infarction reporting chest pain and
ST elevation:
A. Give scheduled ibuprofen for inflammation
B. Administer sublingual nitroglycerin and 325 mg aspirin unless contraindicated
C. Apply heat pack to chest to relieve pain
D. Delay medications until ECG repeats in 30 minutes
Answer: B
, Rationale: Aspirin and nitroglycerin are immediate interventions unless contraindicated;
prompt reperfusion protocols follow.
9. A patient receives packed RBCs. Which sign indicates a hemolytic transfusion
reaction?
A. Mild itching without rash
B. Sudden flank pain, hematuria, fever, hypotension
C. Gradual improvement in Hgb
D. Slight rise in temperature after 24 hours
Answer: B
Rationale: Hemolytic reaction: fever, flank pain, hematuria, hypotension — stop
transfusion immediately.
10. A patient with acute pancreatitis is NPO and on IV fluids. Which lab pattern is
commonly expected?
A. Elevated amylase and lipase, hypocalcemia
B. Low amylase, normal lipase, hypercalcemia
C. Normal enzymes, hypernatremia
D. Increased hemoglobin and platelets only
Answer: A
Rationale: Pancreatitis → elevated pancreatic enzymes and possible hypocalcemia
from fat saponification.
11. Best nursing intervention to prevent pressure injury in an immobile patient:
A. Turn every 8 hours
B. Keep head of bed elevated 90° at all times
