Evolve Med Surg (Lewis) Exam 1 - Evolve Q&A
(Latest Update 2026) UPDATE!! (Recent exam)
Fully Solved & updated 2026 MOSTLY TESTED
(2026
A patient who is lethargic and exhibits deep, rapid respirations has
the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm
Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse
interpret these results?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
Answer A
The pH and HCO3 indicate that the patient has a metabolic acidosis.
The ABGs are inconsistent with the other responses.
A patient who has been receiving diuretic therapy is admitted to the
emergency department with a serum potassium level of 3.0 mEq/L.
The nurse should alert the health care provider immediately that the
patient is on which medication?
a. Oral digoxin (Lanoxin) 0.25 mg daily
b. Ibuprofen (Motrin) 400 mg every 6 hours
c. Metoprolol (Lopressor) 12.5 mg orally daily
d. Lantus insulin 24 U subcutaneously every evening
Answer A
Hypokalemia increases the risk for digoxin toxicity, which can cause
serious dysrhythmias. The nurse will also need to do more
assessment regarding the other medications, but they are not of as
much concern with the potassium level.
,The nurse is caring for a patient who has a calcium level of 12.1
mg/dL. Which nursing action should the nurse include on the care
plan?
a. Maintain the patient on bed rest.
b. Auscultate lung sounds every 4 hours.
c. Monitor for Trousseau's and Chvostek's signs.
d. Encourage fluid intake up to 4000 mL every day.
Answer D
To decrease the risk for renal calculi, the patient should have a fluid
intake of 3000 to 4000 mL daily. Ambulation helps decrease the loss
of calcium from bone and is encouraged in patients with
hypercalcemia. Trousseau's and Chvostek's signs are monitored
when there is a possibility of hypocalcemia. There is no indication
that the patient needs frequent assessment of lung sounds, although
these would be assessed every shift
When caring for a patient with renal failure on a low phosphate diet,
the nurse will inform unlicensed assistive personnel (UAP) to
remove which food from the patient's food tray?
a. Grape juice
b. Milk carton
c. Mixed green salad
d. Fried chicken breast
Answer B
Foods high in phosphate include milk and other dairy products, so
these are restricted on low-phosphate diets. Green, leafy
vegetables; high-fat foods; and fruits/juices are not high in
phosphate and are not restricted.
,A nurse in the outpatient clinic is caring for a patient who has a
magnesium level of 1.3 mg/dL. Which assessment would be most
important for the nurse to make?
a. Daily alcohol intake
b. Intake of dietary protein
c. Multivitamin/mineral use
d. Use of over-the-counter (OTC) laxatives
Answer A
Hypomagnesemia is associated with alcoholism. Protein intake
would not have a significant effect on magnesium level. OTC
laxatives (such as milk of magnesia) and use of multivitamin/mineral
supplements would tend to increase magnesium levels
A patient has a parenteral nutrition infusion of 25% dextrose. A
student nurse asks the nurse why a peripherally inserted central
catheter was inserted. Which response by the nurse is most
appropriate?
a. "There is a decreased risk for infection when 25% dextrose is
infused through a central line."
b. "The prescribed infusion can be given much more rapidly when
the patient has a central line."
c. "The 25% dextrose is hypertonic and will be more rapidly diluted
when given through a central line."
d. "The required blood glucose monitoring is more accurate when
samples are obtained from a central line."
Answer C
The 25% dextrose solution is hypertonic. Shrinkage of red blood
cells can occur when solutions with dextrose concentrations greater
than 10% are administered IV. Blood glucose testing is not more
accurate when samples are obtained from a central line. The
infection risk is higher with a central catheter than with peripheral IV
lines. Hypertonic or concentrated IV solutions are not given rapidly.
, The nurse is caring for a patient who has a central venous access
device (CVAD). Which action by the nurse is appropriate?
a. Avoid using friction when cleaning around the CVAD insertion
site.
b. Use the push-pause method to flush the CVAD after giving
medications.
c. Obtain an order from the health care provider to change CVAD
dressing.
d. Position the patient's face toward the CVAD during injection cap
changes.
Answer B
The push-pause enhances the removal of debris from the CVAD
lumen and decreases the risk for clotting. To decrease infection risk,
friction should be used when cleaning the CVAD insertion site. The
dressing should be changed whenever it becomes damp, loose, or
visibly soiled. The patient should turn away from the CVAD during
cap changes.
(Latest Update 2026) UPDATE!! (Recent exam)
Fully Solved & updated 2026 MOSTLY TESTED
(2026
A patient who is lethargic and exhibits deep, rapid respirations has
the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm
Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse
interpret these results?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
Answer A
The pH and HCO3 indicate that the patient has a metabolic acidosis.
The ABGs are inconsistent with the other responses.
A patient who has been receiving diuretic therapy is admitted to the
emergency department with a serum potassium level of 3.0 mEq/L.
The nurse should alert the health care provider immediately that the
patient is on which medication?
a. Oral digoxin (Lanoxin) 0.25 mg daily
b. Ibuprofen (Motrin) 400 mg every 6 hours
c. Metoprolol (Lopressor) 12.5 mg orally daily
d. Lantus insulin 24 U subcutaneously every evening
Answer A
Hypokalemia increases the risk for digoxin toxicity, which can cause
serious dysrhythmias. The nurse will also need to do more
assessment regarding the other medications, but they are not of as
much concern with the potassium level.
,The nurse is caring for a patient who has a calcium level of 12.1
mg/dL. Which nursing action should the nurse include on the care
plan?
a. Maintain the patient on bed rest.
b. Auscultate lung sounds every 4 hours.
c. Monitor for Trousseau's and Chvostek's signs.
d. Encourage fluid intake up to 4000 mL every day.
Answer D
To decrease the risk for renal calculi, the patient should have a fluid
intake of 3000 to 4000 mL daily. Ambulation helps decrease the loss
of calcium from bone and is encouraged in patients with
hypercalcemia. Trousseau's and Chvostek's signs are monitored
when there is a possibility of hypocalcemia. There is no indication
that the patient needs frequent assessment of lung sounds, although
these would be assessed every shift
When caring for a patient with renal failure on a low phosphate diet,
the nurse will inform unlicensed assistive personnel (UAP) to
remove which food from the patient's food tray?
a. Grape juice
b. Milk carton
c. Mixed green salad
d. Fried chicken breast
Answer B
Foods high in phosphate include milk and other dairy products, so
these are restricted on low-phosphate diets. Green, leafy
vegetables; high-fat foods; and fruits/juices are not high in
phosphate and are not restricted.
,A nurse in the outpatient clinic is caring for a patient who has a
magnesium level of 1.3 mg/dL. Which assessment would be most
important for the nurse to make?
a. Daily alcohol intake
b. Intake of dietary protein
c. Multivitamin/mineral use
d. Use of over-the-counter (OTC) laxatives
Answer A
Hypomagnesemia is associated with alcoholism. Protein intake
would not have a significant effect on magnesium level. OTC
laxatives (such as milk of magnesia) and use of multivitamin/mineral
supplements would tend to increase magnesium levels
A patient has a parenteral nutrition infusion of 25% dextrose. A
student nurse asks the nurse why a peripherally inserted central
catheter was inserted. Which response by the nurse is most
appropriate?
a. "There is a decreased risk for infection when 25% dextrose is
infused through a central line."
b. "The prescribed infusion can be given much more rapidly when
the patient has a central line."
c. "The 25% dextrose is hypertonic and will be more rapidly diluted
when given through a central line."
d. "The required blood glucose monitoring is more accurate when
samples are obtained from a central line."
Answer C
The 25% dextrose solution is hypertonic. Shrinkage of red blood
cells can occur when solutions with dextrose concentrations greater
than 10% are administered IV. Blood glucose testing is not more
accurate when samples are obtained from a central line. The
infection risk is higher with a central catheter than with peripheral IV
lines. Hypertonic or concentrated IV solutions are not given rapidly.
, The nurse is caring for a patient who has a central venous access
device (CVAD). Which action by the nurse is appropriate?
a. Avoid using friction when cleaning around the CVAD insertion
site.
b. Use the push-pause method to flush the CVAD after giving
medications.
c. Obtain an order from the health care provider to change CVAD
dressing.
d. Position the patient's face toward the CVAD during injection cap
changes.
Answer B
The push-pause enhances the removal of debris from the CVAD
lumen and decreases the risk for clotting. To decrease infection risk,
friction should be used when cleaning the CVAD insertion site. The
dressing should be changed whenever it becomes damp, loose, or
visibly soiled. The patient should turn away from the CVAD during
cap changes.
