Lewis Medical-Surgical Nursing 13th Edition Test Bank | All
Chapters | Latest Edition - 240 Questions
This exam assesses advanced understanding of perioperative nursing, encompassing preoperative assessment,
intraoperative interventions, postoperative complications, and evidence-based management across the surgical
continuum. Questions require synthesis of pathophysiology, pharmacology, and nursing standards. It contains
240 multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 12 focused sections: Perioperative Care, Fluid, Electrolyte, and
Acid-Base Imbalances, Pain Management, Cardiovascular Disorders, Respiratory Disorders, Neurologic
Disorders, Endocrine Disorders, Renal and Urinary Disorders, Gastrointestinal Disorders, Oncologic Disorders,
Musculoskeletal Disorders, Emergency and Disaster Nursing. Targeted learning outcomes include: Analyze risk
factors and implement evidence-based interventions to prevent perioperative complications.; Integrate
pharmacologic and non-pharmacologic strategies for optimal perioperative patient outcomes.; Evaluate
postoperative assessment findings to differentiate normal recovery from complications requiring immediate
intervention.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 90%. Aligned with This exam
Section 1: Perioperative Care (Questions 1-21)
1 A patient with a history of obstructive sleep apnea (OSA) is scheduled for
laparoscopic cholecystectomy. Which preoperative intervention is most
critical to reduce the risk of postoperative respiratory complications?
A) Administer a benzodiazepine for anxiety
B) Initiate continuous positive airway pressure (CPAP) therapy immediately
before surgery
C) Obtain a baseline arterial blood gas (ABG)
D) Prescribe a high dose of opioid analgesic for anticipated pain
Answer: B
Rationale: CPAP therapy reduces the risk of airway obstruction and hypoxia in
OSA patients. Benzodiazepines can worsen respiratory depression. Baseline
ABG is not routinely indicated. High-dose opioids increase respiratory
depression risk.
2 During surgery, a patient's end-tidal CO2 (ETCO2) suddenly drops from 35
to 20 mm Hg, and blood pressure decreases. Which intraoperative
complication should the nurse suspect first?
A) Malignant hyperthermia
B) Venous air embolism
C) Hypovolemia due to hemorrhage
,D) Anaphylactic reaction to anesthetic
Answer: B
Rationale: A sudden drop in ETCO2 with hypotension is classic for venous air
embolism, especially in procedures where surgical site is above heart.
Malignant hyperthermia presents with increased ETCO2, tachycardia, and
rigidity. Hypovolemia and anaphylaxis cause hypotension but not sudden
ETCO2 drop.
3 A patient on warfarin is scheduled for elective hip replacement. The surgeon
plans to bridge with enoxaparin. Which laboratory value must be assessed
before surgery to ensure safe anticoagulation management?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
C) Platelet count
D) Anti-factor Xa assay
Answer: B
Rationale: INR monitors warfarin effect; it must be "d1.5 before surgery to
minimize bleeding risk. aPTT monitors heparin, not warfarin. Platelet count is
not specific for warfarin. Anti-factor Xa monitors low molecular weight
heparin, not warfarin.
4 A patient develops postoperative ileus after bowel resection. Which nursing
intervention is most effective in promoting return of bowel function?
A) Maintain strict NPO status until passage of flatus
B) Encourage early ambulation
C) Administer a stimulant laxative
D) Insert a nasogastric tube for decompression
Answer: B
Rationale: Early ambulation stimulates peristalsis and decreases ileus duration.
NPO is standard but does not actively promote function. Laxatives may cause
cramping and are not first-line. NG tube is for severe distention, not routine
promotion.
5 In the immediate postoperative period, a patient's urine output is 20 mL over
2 hours. Which assessment finding would indicate that the oliguria is likely
prerenal rather than intrinsic renal failure?
,A) Urine sodium 15 mEq/L
B) Urine osmolality 350 mOsm/kg
C) Fractional excretion of sodium (FENa) 3%
D) Serum creatinine 2.5 mg/dL
Answer: A
Rationale: Low urine sodium (<20 mEq/L) indicates prerenal azotemia due to
renal hypoperfusion. High urine osmolality (>500) is prerenal; 350 is
indeterminate. FENa <1% is prerenal; 3% suggests intrinsic. Elevated
creatinine alone does not differentiate.
6 A patient undergoing general anesthesia receives succinylcholine for
intubation. The nurse monitors for malignant hyperthermia. Which early sign
would the nurse identify?
A) Bradycardia
B) Decreased end-tidal CO2
C) Masseter muscle rigidity
D) Hypotension
Answer: C
Rationale: Masseter muscle rigidity is an early sign of malignant hyperthermia
after succinylcholine. Tachycardia and increased ETCO2 occur later.
Bradycardia and hypotension are not typical early signs.
7 The nurse is preparing a patient for surgery who has a history of deep vein
thrombosis (DVT). Which intervention is most appropriate for venous
thromboembolism prophylaxis?
A) Apply sequential compression devices (SCDs) only
B) Administer unfractionated heparin 5000 units subcutaneously twice daily
C) Encourage leg exercises and early ambulation
D) Insert an inferior vena cava (IVC) filter preoperatively
Answer: B
Rationale: Pharmacologic prophylaxis with heparin is indicated for patients
with prior DVT. SCDs alone are insufficient. Leg exercises and ambulation are
adjunctive, not primary. IVC filter is reserved for contraindication to
anticoagulation or recurrent embolism despite therapy.
, 8 A patient develops acute postoperative pain after abdominal surgery. The
nurse administers morphine 4 mg IV. Thirty minutes later, the patient rates
pain as 7/10. What is the nurse's priority action?
A) Administer another 4 mg morphine immediately
B) Assess vital signs, sedation level, and respiratory rate
C) Change to a different opioid
D) Apply a cold pack to the incision
Answer: B
Rationale: Before re-dosing, assess for opioid side effects (respiratory
depression, sedation). Re-dosing without assessment risks overdose. Changing
opioid is premature. Cold pack may help but is not priority.
9 Which intraoperative nursing action best reduces the risk of surgical site
infection (SSI)?
A) Administer prophylactic antibiotic within 60 minutes before incision
B) Shave the surgical site the night before surgery
C) Keep the operating room temperature at 25°C (77°F)
D) Use a high-efficiency particulate air (HEPA) filter continuously
Answer: A
Rationale: Timely antibiotic administration (within 60 min before incision) is a
core SSI prevention measure. Shaving increases microabrasions and infection
risk; clipping is preferred. Warm OR temp may increase infection risk due to
perspiration. HEPA filtration is standard but not the most critical action.
10 A patient in the post-anesthesia care unit (PACU) has a heart rate of 48
bpm, blood pressure 88/50 mm Hg, and is drowsy. The nurse suspects
opioid-induced respiratory depression. Which medication should the nurse
prepare to administer?
A) Flumazenil
B) Naloxone
C) Atropine
D) Ephedrine
Answer: B
Rationale: Naloxone reverses opioid effects, including respiratory depression.
Flumazenil reverses benzodiazepines. Atropine treats bradycardia but not
cause. Ephedrine treats hypotension but not respiratory depression.
Chapters | Latest Edition - 240 Questions
This exam assesses advanced understanding of perioperative nursing, encompassing preoperative assessment,
intraoperative interventions, postoperative complications, and evidence-based management across the surgical
continuum. Questions require synthesis of pathophysiology, pharmacology, and nursing standards. It contains
240 multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Content is organized into 12 focused sections: Perioperative Care, Fluid, Electrolyte, and
Acid-Base Imbalances, Pain Management, Cardiovascular Disorders, Respiratory Disorders, Neurologic
Disorders, Endocrine Disorders, Renal and Urinary Disorders, Gastrointestinal Disorders, Oncologic Disorders,
Musculoskeletal Disorders, Emergency and Disaster Nursing. Targeted learning outcomes include: Analyze risk
factors and implement evidence-based interventions to prevent perioperative complications.; Integrate
pharmacologic and non-pharmacologic strategies for optimal perioperative patient outcomes.; Evaluate
postoperative assessment findings to differentiate normal recovery from complications requiring immediate
intervention.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 90%. Aligned with This exam
Section 1: Perioperative Care (Questions 1-21)
1 A patient with a history of obstructive sleep apnea (OSA) is scheduled for
laparoscopic cholecystectomy. Which preoperative intervention is most
critical to reduce the risk of postoperative respiratory complications?
A) Administer a benzodiazepine for anxiety
B) Initiate continuous positive airway pressure (CPAP) therapy immediately
before surgery
C) Obtain a baseline arterial blood gas (ABG)
D) Prescribe a high dose of opioid analgesic for anticipated pain
Answer: B
Rationale: CPAP therapy reduces the risk of airway obstruction and hypoxia in
OSA patients. Benzodiazepines can worsen respiratory depression. Baseline
ABG is not routinely indicated. High-dose opioids increase respiratory
depression risk.
2 During surgery, a patient's end-tidal CO2 (ETCO2) suddenly drops from 35
to 20 mm Hg, and blood pressure decreases. Which intraoperative
complication should the nurse suspect first?
A) Malignant hyperthermia
B) Venous air embolism
C) Hypovolemia due to hemorrhage
,D) Anaphylactic reaction to anesthetic
Answer: B
Rationale: A sudden drop in ETCO2 with hypotension is classic for venous air
embolism, especially in procedures where surgical site is above heart.
Malignant hyperthermia presents with increased ETCO2, tachycardia, and
rigidity. Hypovolemia and anaphylaxis cause hypotension but not sudden
ETCO2 drop.
3 A patient on warfarin is scheduled for elective hip replacement. The surgeon
plans to bridge with enoxaparin. Which laboratory value must be assessed
before surgery to ensure safe anticoagulation management?
A) Activated partial thromboplastin time (aPTT)
B) International normalized ratio (INR)
C) Platelet count
D) Anti-factor Xa assay
Answer: B
Rationale: INR monitors warfarin effect; it must be "d1.5 before surgery to
minimize bleeding risk. aPTT monitors heparin, not warfarin. Platelet count is
not specific for warfarin. Anti-factor Xa monitors low molecular weight
heparin, not warfarin.
4 A patient develops postoperative ileus after bowel resection. Which nursing
intervention is most effective in promoting return of bowel function?
A) Maintain strict NPO status until passage of flatus
B) Encourage early ambulation
C) Administer a stimulant laxative
D) Insert a nasogastric tube for decompression
Answer: B
Rationale: Early ambulation stimulates peristalsis and decreases ileus duration.
NPO is standard but does not actively promote function. Laxatives may cause
cramping and are not first-line. NG tube is for severe distention, not routine
promotion.
5 In the immediate postoperative period, a patient's urine output is 20 mL over
2 hours. Which assessment finding would indicate that the oliguria is likely
prerenal rather than intrinsic renal failure?
,A) Urine sodium 15 mEq/L
B) Urine osmolality 350 mOsm/kg
C) Fractional excretion of sodium (FENa) 3%
D) Serum creatinine 2.5 mg/dL
Answer: A
Rationale: Low urine sodium (<20 mEq/L) indicates prerenal azotemia due to
renal hypoperfusion. High urine osmolality (>500) is prerenal; 350 is
indeterminate. FENa <1% is prerenal; 3% suggests intrinsic. Elevated
creatinine alone does not differentiate.
6 A patient undergoing general anesthesia receives succinylcholine for
intubation. The nurse monitors for malignant hyperthermia. Which early sign
would the nurse identify?
A) Bradycardia
B) Decreased end-tidal CO2
C) Masseter muscle rigidity
D) Hypotension
Answer: C
Rationale: Masseter muscle rigidity is an early sign of malignant hyperthermia
after succinylcholine. Tachycardia and increased ETCO2 occur later.
Bradycardia and hypotension are not typical early signs.
7 The nurse is preparing a patient for surgery who has a history of deep vein
thrombosis (DVT). Which intervention is most appropriate for venous
thromboembolism prophylaxis?
A) Apply sequential compression devices (SCDs) only
B) Administer unfractionated heparin 5000 units subcutaneously twice daily
C) Encourage leg exercises and early ambulation
D) Insert an inferior vena cava (IVC) filter preoperatively
Answer: B
Rationale: Pharmacologic prophylaxis with heparin is indicated for patients
with prior DVT. SCDs alone are insufficient. Leg exercises and ambulation are
adjunctive, not primary. IVC filter is reserved for contraindication to
anticoagulation or recurrent embolism despite therapy.
, 8 A patient develops acute postoperative pain after abdominal surgery. The
nurse administers morphine 4 mg IV. Thirty minutes later, the patient rates
pain as 7/10. What is the nurse's priority action?
A) Administer another 4 mg morphine immediately
B) Assess vital signs, sedation level, and respiratory rate
C) Change to a different opioid
D) Apply a cold pack to the incision
Answer: B
Rationale: Before re-dosing, assess for opioid side effects (respiratory
depression, sedation). Re-dosing without assessment risks overdose. Changing
opioid is premature. Cold pack may help but is not priority.
9 Which intraoperative nursing action best reduces the risk of surgical site
infection (SSI)?
A) Administer prophylactic antibiotic within 60 minutes before incision
B) Shave the surgical site the night before surgery
C) Keep the operating room temperature at 25°C (77°F)
D) Use a high-efficiency particulate air (HEPA) filter continuously
Answer: A
Rationale: Timely antibiotic administration (within 60 min before incision) is a
core SSI prevention measure. Shaving increases microabrasions and infection
risk; clipping is preferred. Warm OR temp may increase infection risk due to
perspiration. HEPA filtration is standard but not the most critical action.
10 A patient in the post-anesthesia care unit (PACU) has a heart rate of 48
bpm, blood pressure 88/50 mm Hg, and is drowsy. The nurse suspects
opioid-induced respiratory depression. Which medication should the nurse
prepare to administer?
A) Flumazenil
B) Naloxone
C) Atropine
D) Ephedrine
Answer: B
Rationale: Naloxone reverses opioid effects, including respiratory depression.
Flumazenil reverses benzodiazepines. Atropine treats bradycardia but not
cause. Ephedrine treats hypotension but not respiratory depression.
