MED SURGE (LEWIS) EXAM 1 - EVOLVE Q&A – EXAM-STYLE QUESTIONS AND
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A client with a history of heart failure is admitted with acute shortness of
breath. The nurse assesses jugular venous distention, crackles in the lung bases,
and peripheral edema. Which intervention should the nurse anticipate as the
priority?
A. Administer a beta-blocker to reduce cardiac workload.
B. Place the client in a high-Fowler's position.
C. Prepare for insertion of a pulmonary artery catheter.
D. Restrict oral fluids to 1000 mL per day.
Correct Answer: B. Place the client in a high-Fowler's position.
Rationale: The priority action in acute decompensated heart failure is to position
the client to maximize ventilation and reduce venous return. High-Fowler's position
decreases preload and facilitates gas exchange, which is a rapid, independent
nursing intervention. Beta-blockers are not first-line for acute exacerbations and
can worsen acute failure. A pulmonary artery catheter may be used in severe cases
but is not the initial priority. Fluid restriction is an important long-term
management strategy but does not address the immediate breathing difficulty.**
,2. A nurse is providing discharge teaching to a client prescribed warfarin for
atrial fibrillation. Which statement by the client indicates a correct
understanding of the medication?
A. "I will need to have my blood drawn regularly to check my clotting time."
B. "I should take an aspirin with my warfarin to prevent a stroke."
C. "I can stop taking this medication if I experience any side effects."
D. "I will increase my intake of leafy green vegetables to maintain a steady level."
Correct Answer: A. "I will need to have my blood drawn regularly to check my
clotting time."
Rationale: Warfarin therapy requires regular monitoring of the International
Normalized Ratio (INR) to ensure therapeutic levels and prevent bleeding
complications. Aspirin is contraindicated with warfarin unless specifically
prescribed, as it increases bleeding risk. Clients should never abruptly stop warfarin.
Consistent intake of vitamin K-rich foods (leafy greens) is essential, but increasing
intake can affect INR and is not a way to maintain a steady level.**
3. A client with chronic obstructive pulmonary disease (COPD) has a baseline
oxygen saturation of 88% on room air. Which assessment finding would
indicate a potential complication of oxygen therapy?
A. Increased respiratory rate from 16 to 22 breaths per minute.
B. A decrease in the client's level of consciousness.
C. The client reports a mild headache.
D. The client's oxygen saturation increases to 94%.
Correct Answer: B. A decrease in the client's level of consciousness.
,Rationale: A decreased level of consciousness in a COPD client receiving oxygen
can indicate oxygen-induced hypoventilation due to the loss of hypoxic drive, which
is a life-threatening complication. While a decreased respiratory rate is also
expected, a change in mentation is a more sensitive early indicator of this condition.
An increased respiratory rate (A) may indicate respiratory distress, but hypoxia is a
more common driver in COPD. A mild headache can be a sign of hypercapnia or
hypoxia, but a change in consciousness is a more severe and specific warning
sign.**
4. A nurse is caring for a client with a chest tube to water-seal drainage for a
pneumothorax. Which finding requires immediate intervention?
A. Continuous bubbling in the water-seal chamber.
B. Intermittent bubbling in the suction-control chamber.
C. Gentle, constant bubbling in the water-seal chamber.
D. Tidaling in the water-seal chamber with respirations.
Correct Answer: A. Continuous bubbling in the water-seal chamber.
Rationale: Continuous bubbling in the water-seal chamber indicates a large air
leak, likely from the client or the system, which compromises the integrity of the
drainage system and can prevent lung re-expansion. Intermittent bubbling in the
suction-control chamber is expected. Gentle bubbling in the water-seal chamber is
not a standard description; an air leak is continuous. Tidaling in the water-seal
chamber is a normal finding indicating that the system is intact.**
, 5. A client is prescribed a low-sodium diet for the management of
hypertension. Which food choice by the client indicates a correct
understanding of the dietary teaching?
A. A sandwich with turkey, lettuce, and tomato on whole-wheat bread.
B. A cup of tomato soup with a side of crackers.
C. A serving of canned green beans and a baked potato.
D. Grilled chicken breast with steamed broccoli and a fresh orange.
Correct Answer: D. Grilled chicken breast with steamed broccoli and a fresh
orange.
Rationale: Fresh or unprocessed foods are naturally low in sodium. Grilled chicken,
steamed broccoli, and an orange are excellent choices. Processed meats (A) are
often high in sodium. Canned soups (B) are notoriously high in sodium. Canned
vegetables (C) are typically high in sodium, although rinsing can reduce it, the
question implies a standard understanding.**
6. The nurse is assessing a client who is receiving a blood transfusion. Fifteen
minutes after the initiation, the client reports back pain and chills. What is the
nurse's priority action?
A. Slow the rate of the infusion.
B. Administer prescribed acetaminophen.
C. Stop the transfusion immediately.
D. Reassure the client that this is a common reaction.
Correct Answer: C. Stop the transfusion immediately.
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | 2026/27 LATEST UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
SECTION ONE: QUESTIONS 1-50
1. A client with a history of heart failure is admitted with acute shortness of
breath. The nurse assesses jugular venous distention, crackles in the lung bases,
and peripheral edema. Which intervention should the nurse anticipate as the
priority?
A. Administer a beta-blocker to reduce cardiac workload.
B. Place the client in a high-Fowler's position.
C. Prepare for insertion of a pulmonary artery catheter.
D. Restrict oral fluids to 1000 mL per day.
Correct Answer: B. Place the client in a high-Fowler's position.
Rationale: The priority action in acute decompensated heart failure is to position
the client to maximize ventilation and reduce venous return. High-Fowler's position
decreases preload and facilitates gas exchange, which is a rapid, independent
nursing intervention. Beta-blockers are not first-line for acute exacerbations and
can worsen acute failure. A pulmonary artery catheter may be used in severe cases
but is not the initial priority. Fluid restriction is an important long-term
management strategy but does not address the immediate breathing difficulty.**
,2. A nurse is providing discharge teaching to a client prescribed warfarin for
atrial fibrillation. Which statement by the client indicates a correct
understanding of the medication?
A. "I will need to have my blood drawn regularly to check my clotting time."
B. "I should take an aspirin with my warfarin to prevent a stroke."
C. "I can stop taking this medication if I experience any side effects."
D. "I will increase my intake of leafy green vegetables to maintain a steady level."
Correct Answer: A. "I will need to have my blood drawn regularly to check my
clotting time."
Rationale: Warfarin therapy requires regular monitoring of the International
Normalized Ratio (INR) to ensure therapeutic levels and prevent bleeding
complications. Aspirin is contraindicated with warfarin unless specifically
prescribed, as it increases bleeding risk. Clients should never abruptly stop warfarin.
Consistent intake of vitamin K-rich foods (leafy greens) is essential, but increasing
intake can affect INR and is not a way to maintain a steady level.**
3. A client with chronic obstructive pulmonary disease (COPD) has a baseline
oxygen saturation of 88% on room air. Which assessment finding would
indicate a potential complication of oxygen therapy?
A. Increased respiratory rate from 16 to 22 breaths per minute.
B. A decrease in the client's level of consciousness.
C. The client reports a mild headache.
D. The client's oxygen saturation increases to 94%.
Correct Answer: B. A decrease in the client's level of consciousness.
,Rationale: A decreased level of consciousness in a COPD client receiving oxygen
can indicate oxygen-induced hypoventilation due to the loss of hypoxic drive, which
is a life-threatening complication. While a decreased respiratory rate is also
expected, a change in mentation is a more sensitive early indicator of this condition.
An increased respiratory rate (A) may indicate respiratory distress, but hypoxia is a
more common driver in COPD. A mild headache can be a sign of hypercapnia or
hypoxia, but a change in consciousness is a more severe and specific warning
sign.**
4. A nurse is caring for a client with a chest tube to water-seal drainage for a
pneumothorax. Which finding requires immediate intervention?
A. Continuous bubbling in the water-seal chamber.
B. Intermittent bubbling in the suction-control chamber.
C. Gentle, constant bubbling in the water-seal chamber.
D. Tidaling in the water-seal chamber with respirations.
Correct Answer: A. Continuous bubbling in the water-seal chamber.
Rationale: Continuous bubbling in the water-seal chamber indicates a large air
leak, likely from the client or the system, which compromises the integrity of the
drainage system and can prevent lung re-expansion. Intermittent bubbling in the
suction-control chamber is expected. Gentle bubbling in the water-seal chamber is
not a standard description; an air leak is continuous. Tidaling in the water-seal
chamber is a normal finding indicating that the system is intact.**
, 5. A client is prescribed a low-sodium diet for the management of
hypertension. Which food choice by the client indicates a correct
understanding of the dietary teaching?
A. A sandwich with turkey, lettuce, and tomato on whole-wheat bread.
B. A cup of tomato soup with a side of crackers.
C. A serving of canned green beans and a baked potato.
D. Grilled chicken breast with steamed broccoli and a fresh orange.
Correct Answer: D. Grilled chicken breast with steamed broccoli and a fresh
orange.
Rationale: Fresh or unprocessed foods are naturally low in sodium. Grilled chicken,
steamed broccoli, and an orange are excellent choices. Processed meats (A) are
often high in sodium. Canned soups (B) are notoriously high in sodium. Canned
vegetables (C) are typically high in sodium, although rinsing can reduce it, the
question implies a standard understanding.**
6. The nurse is assessing a client who is receiving a blood transfusion. Fifteen
minutes after the initiation, the client reports back pain and chills. What is the
nurse's priority action?
A. Slow the rate of the infusion.
B. Administer prescribed acetaminophen.
C. Stop the transfusion immediately.
D. Reassure the client that this is a common reaction.
Correct Answer: C. Stop the transfusion immediately.
