LEWIS’S MEDICAL-SURGICAL NURSING: ASSESSMENT AND
MANAGEMENT OF CLINICAL PROBLEMS | COMPLETE TESTBANK
|2026 | (By Mariann M. Harding, Jeffrey Kwong & Debra
Hagler) ISBN9780323825184
,1. A patient with chronic heart failure is receiving intravenous
furosemide. Which assessment finding indicates that the medication is
having the desired therapeutic effect?
A. Increased jugular venous pressure
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased serum potassium levels
Correct Answer: B
Expansion: Furosemide is a loop diuretic that promotes sodium and
water excretion, reducing fluid volume overload. The desired
therapeutic effect is evidenced by decreased peripheral edema,
decreased jugular venous pressure, and reduced pulmonary congestion.
Increased blood pressure would not be a direct effect; in fact, blood
pressure may decrease. Decreased potassium is an adverse effect, not a
therapeutic goal.
2. A patient with acute pancreatitis reports severe abdominal pain
that radiates to the back and is relieved by leaning forward. Which
nursing intervention should be prioritized?
A. Administer oral fluids to prevent dehydration
B. Place the patient in a supine position for comfort
C. Maintain NPO status and provide pain management
D. Apply a heating pad to the abdomen
Correct Answer: C
Expansion: In acute pancreatitis, pancreatic enzymes are activated
within the pancreas, causing autodigestion and severe pain.
Maintaining NPO status decreases pancreatic stimulation, and
adequate analgesia is essential. The pain is typically worsened by lying
,supine and relieved by leaning forward. Oral fluids would stimulate
pancreatic secretion, and heat application could increase inflammation.
3. A patient with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing pH 7.32, PaCO₂ 58 mm Hg,
HCO₃⁻ 30 mEq/L. Which interpretation is most accurate?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Expansion: The ABG shows acidosis (pH < 7.35) with elevated PaCO₂
(respiratory component). The HCO₃⁻ is elevated above normal (22-26
mEq/L), indicating renal compensation. Since the pH remains abnormal,
compensation is partial, not complete. In fully compensated respiratory
acidosis, the pH would return to normal range despite abnormal PaCO₂
and HCO₃⁻.
4. A patient with end-stage renal disease is scheduled for
hemodialysis. Which laboratory value should the nurse report to the
healthcare provider before the procedure?
A. Serum potassium 5.2 mEq/L
B. Hemoglobin 11.0 g/dL
C. Serum sodium 136 mEq/L
D. Serum phosphate 4.5 mg/dL
Correct Answer: A
Expansion: Serum potassium of 5.2 mEq/L indicates hyperkalemia,
, which is a common finding in renal failure but requires monitoring.
However, all other values listed are within or near normal ranges. If the
potassium were significantly higher (> 6.0 mEq/L) with ECG changes, it
would be critical. For this question, the nurse should report any
abnormality that may require intervention before dialysis, such as
hyperkalemia with ECG changes, but 5.2 mEq/L is generally acceptable
for dialysis. All options are relatively normal except potassium which is
slightly elevated.
5. A patient experiencing a severe asthma exacerbation has a peak
expiratory flow rate (PEFR) of 40% of personal best. Which
intervention should the nurse implement first?
A. Administer oral corticosteroids
B. Initiate inhaled beta-2 agonist therapy
C. Apply supplemental oxygen at 2 L/min via nasal cannula
D. Prepare for intubation and mechanical ventilation
Correct Answer: B
Expansion: In acute asthma exacerbation, the priority is to reverse
bronchospasm with rapid-onset inhaled beta-2 agonists (e.g., albuterol).
Oxygen should be administered simultaneously to maintain SpO₂ ≥ 90%.
Oral corticosteroids are important but have a delayed onset. Intubation
is reserved for impending respiratory failure when other measures fail. A
PEFR < 50% of personal best indicates a severe exacerbation requiring
immediate bronchodilator therapy.
6. A patient with a traumatic brain injury has an intracranial pressure
(ICP) of 22 mm Hg. Which nursing intervention is most appropriate?
MANAGEMENT OF CLINICAL PROBLEMS | COMPLETE TESTBANK
|2026 | (By Mariann M. Harding, Jeffrey Kwong & Debra
Hagler) ISBN9780323825184
,1. A patient with chronic heart failure is receiving intravenous
furosemide. Which assessment finding indicates that the medication is
having the desired therapeutic effect?
A. Increased jugular venous pressure
B. Decreased peripheral edema
C. Increased blood pressure
D. Decreased serum potassium levels
Correct Answer: B
Expansion: Furosemide is a loop diuretic that promotes sodium and
water excretion, reducing fluid volume overload. The desired
therapeutic effect is evidenced by decreased peripheral edema,
decreased jugular venous pressure, and reduced pulmonary congestion.
Increased blood pressure would not be a direct effect; in fact, blood
pressure may decrease. Decreased potassium is an adverse effect, not a
therapeutic goal.
2. A patient with acute pancreatitis reports severe abdominal pain
that radiates to the back and is relieved by leaning forward. Which
nursing intervention should be prioritized?
A. Administer oral fluids to prevent dehydration
B. Place the patient in a supine position for comfort
C. Maintain NPO status and provide pain management
D. Apply a heating pad to the abdomen
Correct Answer: C
Expansion: In acute pancreatitis, pancreatic enzymes are activated
within the pancreas, causing autodigestion and severe pain.
Maintaining NPO status decreases pancreatic stimulation, and
adequate analgesia is essential. The pain is typically worsened by lying
,supine and relieved by leaning forward. Oral fluids would stimulate
pancreatic secretion, and heat application could increase inflammation.
3. A patient with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing pH 7.32, PaCO₂ 58 mm Hg,
HCO₃⁻ 30 mEq/L. Which interpretation is most accurate?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Metabolic alkalosis with respiratory compensation
Correct Answer: B
Expansion: The ABG shows acidosis (pH < 7.35) with elevated PaCO₂
(respiratory component). The HCO₃⁻ is elevated above normal (22-26
mEq/L), indicating renal compensation. Since the pH remains abnormal,
compensation is partial, not complete. In fully compensated respiratory
acidosis, the pH would return to normal range despite abnormal PaCO₂
and HCO₃⁻.
4. A patient with end-stage renal disease is scheduled for
hemodialysis. Which laboratory value should the nurse report to the
healthcare provider before the procedure?
A. Serum potassium 5.2 mEq/L
B. Hemoglobin 11.0 g/dL
C. Serum sodium 136 mEq/L
D. Serum phosphate 4.5 mg/dL
Correct Answer: A
Expansion: Serum potassium of 5.2 mEq/L indicates hyperkalemia,
, which is a common finding in renal failure but requires monitoring.
However, all other values listed are within or near normal ranges. If the
potassium were significantly higher (> 6.0 mEq/L) with ECG changes, it
would be critical. For this question, the nurse should report any
abnormality that may require intervention before dialysis, such as
hyperkalemia with ECG changes, but 5.2 mEq/L is generally acceptable
for dialysis. All options are relatively normal except potassium which is
slightly elevated.
5. A patient experiencing a severe asthma exacerbation has a peak
expiratory flow rate (PEFR) of 40% of personal best. Which
intervention should the nurse implement first?
A. Administer oral corticosteroids
B. Initiate inhaled beta-2 agonist therapy
C. Apply supplemental oxygen at 2 L/min via nasal cannula
D. Prepare for intubation and mechanical ventilation
Correct Answer: B
Expansion: In acute asthma exacerbation, the priority is to reverse
bronchospasm with rapid-onset inhaled beta-2 agonists (e.g., albuterol).
Oxygen should be administered simultaneously to maintain SpO₂ ≥ 90%.
Oral corticosteroids are important but have a delayed onset. Intubation
is reserved for impending respiratory failure when other measures fail. A
PEFR < 50% of personal best indicates a severe exacerbation requiring
immediate bronchodilator therapy.
6. A patient with a traumatic brain injury has an intracranial pressure
(ICP) of 22 mm Hg. Which nursing intervention is most appropriate?
