LEWIS MEDICAL SURGICAL NURSING 12TH
EDITION BY JEFFREY KWONG FINAL
PAPER 2026 COMPLETE SOLUTIONS AND
CORRECT ANSWERS GRADED A+
⩥ Which antilipemic medications should the nurse question for a patient
who has cirrhosis of the liver? (Select all that apply.)
Niacin
Cholestyramine
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Atorvastatin (Lipitor). Answer: Niacin
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Atorvastatin (Lipitor)
Rationale:
Ezetimibe (Zetia) should not be used by patients with liver impairment.
Adverse effects of atorvastatin (Lipitor), a statin drug, include liver
damage and myopathy. Liver enzymes must be monitored frequently,
and the medication stopped if these enzymes increase. Niacin's side
effects subside with time, although decreased liver function may occur
with high doses. Cholestyramine is safe for long-term use.
,⩥ Which patient is at greatest risk for sudden cardiac death (SCD)?
A 52-yr-old black man with left ventricular failure
A 62-yr-old obese man with diabetes and high cholesterol
A 42-yr-old white woman with hypertension and dyslipidemia
A 72-yr-old Native American woman with a family history of heart
disease. Answer: A 52-yr-old black man with left ventricular failure
Rationale:
Patients with left ventricular dysfunction (ejection fraction less than
30%) and ventricular dysrhythmias after myocardial infarction are at
greatest risk for SCD. Other risk factors for SCD include: (1) male
gender (especially blacks), (2) family history of premature
atherosclerosis, (3) tobacco use, (4) diabetes, (5) high cholesterol levels,
(6) hypertension, and (7) cardiomyopathy.
⩥ A patient experienced sudden cardiac death (SCD) and survived.
Which treatment should the nurse expect to be implemented to prevent
an SCD recurrence at home?
External cardiac pacemaker
An electrophysiologic study (EPS)
Medications to prevent dysrhythmias
Implantable cardioverter-defibrillator (ICD). Answer: Implantable
cardioverter-defibrillator (ICD)
,Rationale:
An ICD is the most common approach to preventing recurrence of SCD.
An external pacemaker may be used in the hospital but will not be used
for the patient living daily life at home. An EPS may be done to
determine if a recurrence is likely and determine the most effective
medication treatment. Medications to prevent dysrhythmias are used but
are not the best prevention of SCD.
⩥ Which person would the nurse identify as having the highest risk for
coronary artery disease (CAD)?
A 60-yr-old man with low homocysteine levels
A 45-yr-old man with a high-stress job who is depressed
A 54-yr-old woman vegetarian with increased high-density lipoprotein
(HDL) levels
A 62-yr-old woman who has a sedentary lifestyle and body mass index
(BMI) of 23 kg/m2. Answer: A 45-yr-old man with a high-stress job who
is depressed
Rationale:
The 45-yr-old depressed man with a high-stress job is at the highest risk
for CAD. Depression and stressful states can contribute to the
development of CAD. Elevated HDL levels and low homocysteine
levels help to prevent CAD. Although a sedentary lifestyle is a risk
factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient
with two risk factors is at greatest risk for developing CAD.
, ⩥ The nurse recognizes additional teaching is needed when the patient
prescribed a low-sodium, low-fat cardiac diet selects which food?
Baked flounder
Angel food cake
Canned chicken noodle soup
Baked potato with margarine. Answer: Canned chicken noodle soup
Rationale:
Canned soups are very high in sodium content. Patients need to be
taught to read food labels for sodium and fat content.
⩥ A patient has received a bolus dose and an infusion of alteplase
(Activase) for an ST-segment elevation myocardial infarction (STEMI).
Which patient assessment would determine the effectiveness of the
medication?
Presence of chest pain
Blood in the urine or stool
Tachycardia with hypotension
Decreased level of consciousness. Answer: Presence of chest pain
Rationale:
Alteplase is a fibrinolytic agent that is administered to patients who have
had a STEMI. If the medication is effective, the patient's chest pain will
EDITION BY JEFFREY KWONG FINAL
PAPER 2026 COMPLETE SOLUTIONS AND
CORRECT ANSWERS GRADED A+
⩥ Which antilipemic medications should the nurse question for a patient
who has cirrhosis of the liver? (Select all that apply.)
Niacin
Cholestyramine
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Atorvastatin (Lipitor). Answer: Niacin
Ezetimibe (Zetia)
Gemfibrozil (Lopid)
Atorvastatin (Lipitor)
Rationale:
Ezetimibe (Zetia) should not be used by patients with liver impairment.
Adverse effects of atorvastatin (Lipitor), a statin drug, include liver
damage and myopathy. Liver enzymes must be monitored frequently,
and the medication stopped if these enzymes increase. Niacin's side
effects subside with time, although decreased liver function may occur
with high doses. Cholestyramine is safe for long-term use.
,⩥ Which patient is at greatest risk for sudden cardiac death (SCD)?
A 52-yr-old black man with left ventricular failure
A 62-yr-old obese man with diabetes and high cholesterol
A 42-yr-old white woman with hypertension and dyslipidemia
A 72-yr-old Native American woman with a family history of heart
disease. Answer: A 52-yr-old black man with left ventricular failure
Rationale:
Patients with left ventricular dysfunction (ejection fraction less than
30%) and ventricular dysrhythmias after myocardial infarction are at
greatest risk for SCD. Other risk factors for SCD include: (1) male
gender (especially blacks), (2) family history of premature
atherosclerosis, (3) tobacco use, (4) diabetes, (5) high cholesterol levels,
(6) hypertension, and (7) cardiomyopathy.
⩥ A patient experienced sudden cardiac death (SCD) and survived.
Which treatment should the nurse expect to be implemented to prevent
an SCD recurrence at home?
External cardiac pacemaker
An electrophysiologic study (EPS)
Medications to prevent dysrhythmias
Implantable cardioverter-defibrillator (ICD). Answer: Implantable
cardioverter-defibrillator (ICD)
,Rationale:
An ICD is the most common approach to preventing recurrence of SCD.
An external pacemaker may be used in the hospital but will not be used
for the patient living daily life at home. An EPS may be done to
determine if a recurrence is likely and determine the most effective
medication treatment. Medications to prevent dysrhythmias are used but
are not the best prevention of SCD.
⩥ Which person would the nurse identify as having the highest risk for
coronary artery disease (CAD)?
A 60-yr-old man with low homocysteine levels
A 45-yr-old man with a high-stress job who is depressed
A 54-yr-old woman vegetarian with increased high-density lipoprotein
(HDL) levels
A 62-yr-old woman who has a sedentary lifestyle and body mass index
(BMI) of 23 kg/m2. Answer: A 45-yr-old man with a high-stress job who
is depressed
Rationale:
The 45-yr-old depressed man with a high-stress job is at the highest risk
for CAD. Depression and stressful states can contribute to the
development of CAD. Elevated HDL levels and low homocysteine
levels help to prevent CAD. Although a sedentary lifestyle is a risk
factor, a BMI of 23 kg/m2 depicts normal weight, and thus the patient
with two risk factors is at greatest risk for developing CAD.
, ⩥ The nurse recognizes additional teaching is needed when the patient
prescribed a low-sodium, low-fat cardiac diet selects which food?
Baked flounder
Angel food cake
Canned chicken noodle soup
Baked potato with margarine. Answer: Canned chicken noodle soup
Rationale:
Canned soups are very high in sodium content. Patients need to be
taught to read food labels for sodium and fat content.
⩥ A patient has received a bolus dose and an infusion of alteplase
(Activase) for an ST-segment elevation myocardial infarction (STEMI).
Which patient assessment would determine the effectiveness of the
medication?
Presence of chest pain
Blood in the urine or stool
Tachycardia with hypotension
Decreased level of consciousness. Answer: Presence of chest pain
Rationale:
Alteplase is a fibrinolytic agent that is administered to patients who have
had a STEMI. If the medication is effective, the patient's chest pain will
