LEWIS FINAL STUDY GUIDE 2026 SOLVED
QUESTIONS PREMIUM REVIEW
◉ A client admitted to the hospital with chest pain and a history of
type 2 diabetes mellitus is scheduled for cardiac catheterization.
Which medication would need to be withheld for 24 hours before
the procedure and for 48 hours after the procedure?
1.Regular insulin
2.Glipizide (Glucotrol)
3.Repaglinide (Prandin)
4.Metformin (Glucophage). Answer: 4.
Metformin (Glucophage) needs to be withheld 24 hours before and
for 48 hours after cardiac catheterization because of the injection of
contrast medium during the procedure. If the contrast medium
affects kidney function, with metformin in the system, the client
would be at increased risk for lactic acidosis. The medications in the
remaining options do not need to be withheld 24 hours before and
48 hours after cardiac catheterization.
◉ A client in sinus bradycardia, with a heart rate of 45 beats/minute,
complains of dizziness and has a blood pressure of 82/60 mm Hg.
Which prescription should the nurse anticipate will be prescribed?
,1.Defibrillate the client.
2.Administer digoxin (Lanoxin).
3.Continue to monitor the client.
4.Prepare for transcutaneous pacing.. Answer: 4.
Hypotension and dizziness are signs of decreased cardiac output.
Transcutaneous pacing provides a temporary measure to increase
the heart rate and thus perfusion in the symptomatic client.
Defibrillation is used for treatment of pulseless ventricular
tachycardia and ventricular fibrillation. Digoxin will further
decrease the client's heart rate. Continuing to monitor the client
delays necessary intervention.
◉ The nurse in a medical unit is caring for a client with heart failure.
The client suddenly develops extreme dyspnea, tachycardia, and
lung crackles and the nurse suspects pulmonary edema. The nurse
immediately asks another nurse to contact the health care provider
and prepares to implement which priority interventions? Select all
that apply.
1.Administering oxygen
2.Inserting a Foley catheter
3.Administering furosemide (Lasix)
4.Administering morphine sulfate intravenously
5.Transporting the client to the coronary care unit
,6.Placing the client in a low Fowler's side-lying position. Answer:
1,2,3,4
Pulmonary edema is a life-threatening event that can result from
severe heart failure. In pulmonary edema, the left ventricle fails to
eject sufficient blood, and pressure increases in the lungs because of
the accumulated blood. Oxygen is always prescribed, and the client
is placed in a high Fowler's position to ease the work of breathing.
Furosemide, a rapid-acting diuretic, will eliminate accumulated
fluid. A Foley catheter is inserted to measure output accurately.
Intravenously administered morphine sulfate reduces venous return
(preload), decreases anxiety, and also reduces the work of breathing.
Transporting the client to the coronary care unit is not a priority
intervention. In fact, this may not be necessary at all if the client's
response to treatment is successful.
◉ A client with myocardial infarction suddenly becomes tachycardic,
shows signs of air hunger, and begins coughing frothy, pink-tinged
sputum. Which finding would the nurse anticipate when
auscultating the client's breath sounds?
1.Stridor
2.Crackles
3.Scattered rhonchi
4.Diminished breath sounds. Answer: 2.
Pulmonary edema is characterized by extreme breathlessness,
dyspnea, air hunger, and the production of frothy, pink-tinged
, sputum. Auscultation of the lungs reveals crackles. Rhonchi and
diminished breath sounds are not associated with pulmonary
edema. Stridor is a crowing sound associated with laryngospasm or
edema of the upper airway.
◉ A client with myocardial infarction is developing cardiogenic
shock. Because of the risk of myocardial ischemia, what condition
should the nurse carefully assess the client for?
1.Bradycardia
2.Ventricular dysrhythmias
3.Rising diastolic blood pressure
4.Falling central venous pressure. Answer: 2.
Classic signs of cardiogenic shock as they relate to myocardial
ischemia include low blood pressure and tachycardia. The central
venous pressure would rise as the backward effects of the severe left
ventricular failure became apparent. Dysrhythmias commonly occur
as a result of decreased oxygenation and severe damage to greater
than 40% of the myocardium.
◉ A client who had cardiac surgery 24 hours ago has had a urine
output averaging 20 mL/hour for 2 hours. The client received a
single bolus of 500 mL of intravenous fluid. Urine output for the
subsequent hour was 25 mL. Daily laboratory results indicate that
the blood urea nitrogen level is 45 mg/dL and the serum creatinine
QUESTIONS PREMIUM REVIEW
◉ A client admitted to the hospital with chest pain and a history of
type 2 diabetes mellitus is scheduled for cardiac catheterization.
Which medication would need to be withheld for 24 hours before
the procedure and for 48 hours after the procedure?
1.Regular insulin
2.Glipizide (Glucotrol)
3.Repaglinide (Prandin)
4.Metformin (Glucophage). Answer: 4.
Metformin (Glucophage) needs to be withheld 24 hours before and
for 48 hours after cardiac catheterization because of the injection of
contrast medium during the procedure. If the contrast medium
affects kidney function, with metformin in the system, the client
would be at increased risk for lactic acidosis. The medications in the
remaining options do not need to be withheld 24 hours before and
48 hours after cardiac catheterization.
◉ A client in sinus bradycardia, with a heart rate of 45 beats/minute,
complains of dizziness and has a blood pressure of 82/60 mm Hg.
Which prescription should the nurse anticipate will be prescribed?
,1.Defibrillate the client.
2.Administer digoxin (Lanoxin).
3.Continue to monitor the client.
4.Prepare for transcutaneous pacing.. Answer: 4.
Hypotension and dizziness are signs of decreased cardiac output.
Transcutaneous pacing provides a temporary measure to increase
the heart rate and thus perfusion in the symptomatic client.
Defibrillation is used for treatment of pulseless ventricular
tachycardia and ventricular fibrillation. Digoxin will further
decrease the client's heart rate. Continuing to monitor the client
delays necessary intervention.
◉ The nurse in a medical unit is caring for a client with heart failure.
The client suddenly develops extreme dyspnea, tachycardia, and
lung crackles and the nurse suspects pulmonary edema. The nurse
immediately asks another nurse to contact the health care provider
and prepares to implement which priority interventions? Select all
that apply.
1.Administering oxygen
2.Inserting a Foley catheter
3.Administering furosemide (Lasix)
4.Administering morphine sulfate intravenously
5.Transporting the client to the coronary care unit
,6.Placing the client in a low Fowler's side-lying position. Answer:
1,2,3,4
Pulmonary edema is a life-threatening event that can result from
severe heart failure. In pulmonary edema, the left ventricle fails to
eject sufficient blood, and pressure increases in the lungs because of
the accumulated blood. Oxygen is always prescribed, and the client
is placed in a high Fowler's position to ease the work of breathing.
Furosemide, a rapid-acting diuretic, will eliminate accumulated
fluid. A Foley catheter is inserted to measure output accurately.
Intravenously administered morphine sulfate reduces venous return
(preload), decreases anxiety, and also reduces the work of breathing.
Transporting the client to the coronary care unit is not a priority
intervention. In fact, this may not be necessary at all if the client's
response to treatment is successful.
◉ A client with myocardial infarction suddenly becomes tachycardic,
shows signs of air hunger, and begins coughing frothy, pink-tinged
sputum. Which finding would the nurse anticipate when
auscultating the client's breath sounds?
1.Stridor
2.Crackles
3.Scattered rhonchi
4.Diminished breath sounds. Answer: 2.
Pulmonary edema is characterized by extreme breathlessness,
dyspnea, air hunger, and the production of frothy, pink-tinged
, sputum. Auscultation of the lungs reveals crackles. Rhonchi and
diminished breath sounds are not associated with pulmonary
edema. Stridor is a crowing sound associated with laryngospasm or
edema of the upper airway.
◉ A client with myocardial infarction is developing cardiogenic
shock. Because of the risk of myocardial ischemia, what condition
should the nurse carefully assess the client for?
1.Bradycardia
2.Ventricular dysrhythmias
3.Rising diastolic blood pressure
4.Falling central venous pressure. Answer: 2.
Classic signs of cardiogenic shock as they relate to myocardial
ischemia include low blood pressure and tachycardia. The central
venous pressure would rise as the backward effects of the severe left
ventricular failure became apparent. Dysrhythmias commonly occur
as a result of decreased oxygenation and severe damage to greater
than 40% of the myocardium.
◉ A client who had cardiac surgery 24 hours ago has had a urine
output averaging 20 mL/hour for 2 hours. The client received a
single bolus of 500 mL of intravenous fluid. Urine output for the
subsequent hour was 25 mL. Daily laboratory results indicate that
the blood urea nitrogen level is 45 mg/dL and the serum creatinine
