300-Item Medical-Surgical Nursing Exam |
Lewis’s Medical-Surgical Nursing, 13th Edition
— 100% Verified
Medical-Surgical Nursing Exam (Lewis 13th ed)
1. A 78-year-old woman is admitted after a fall with a
suspected left hip fracture. Her left leg is shortened and
externally rotated. What is the nurse’s highest priority
assessment before preparing for surgery? [Ch. 63: Hip
Fracture] (Moderate)
A. Monitor pedal pulses and capillary refill in the affected limb.
(Correct)
B. Administer prescribed pain medication.
C. Elevate the foot of the bed to reduce swelling.
D. Move the patient to a chair to prevent pressure ulcers.
Rationale: In a suspected fracture with deformity, the nurse’s
priority is to assess and document neurovascular status of the
limb (pulses, sensation, movement) to detect compartment
syndrome or vascular injury. Pain management is important but
should follow ensuring adequate circulation. Elevation and
pressure-redistributing measures can be done later.
,2. Which nutrient should a patient with osteoporosis
increase to enhance calcium absorption? [Ch. 64:
Osteoporosis] (Easy)
A. Vitamin D (Correct)
B. Iron
C. Vitamin K
D. Magnesium
Rationale: Vitamin D is essential for intestinal calcium
absorption. Low vitamin D leads to poor calcium uptake and
bone loss. Iron and Vitamin K have no direct role in calcium
absorption, and while magnesium is involved in bone health,
vitamin D is the key cofactor for absorbing dietary calcium.
3. A 70-kg patient with 40% TBSA second-degree burns
requires fluid resuscitation. Using the Parkland formula (4
mL × weight × %TBSA), how much Lactated Ringer’s
should be given in the first 8 hours? [Ch. 65: Burns]
(Moderate)
A. 2,800 mL
B. 4,200 mL
C. 5,600 mL (Correct)
D. 11,200 mL
Rationale: Parkland formula = 4 mL/kg/%TBSA = 4 × 70 kg ×
40 = 11,200 mL in 24 hours. Half of this (5,600 mL) is given in
the first 8 hours. Lactated Ringer’s is the preferred solution.
4. Which nursing intervention is most effective in preventing
pressure ulcers in an immobile patient? [Ch. 67: Pressure
Ulcers] (Moderate)
,A. Massaging any reddened areas every 4 hours.
B. Providing a high-calorie, high-protein diet.
C. Turning the patient every 2 hours and using pressure-
relieving devices. (Correct)
D. Keeping the head of the bed elevated at 45 degrees at all
times.
Rationale: Regular turning (at least every 2 hours) and use of
pressure-relief surfaces are evidence-based measures to prevent
pressure injuries. (Massaging reddened areas can further damage
tissue; positioning and diet alone are insufficient without
repositioning).
5. A patient in a leg cast reports severe pain not relieved by
medication and pain on passive movement of the toes. Which
finding is an early sign of compartment syndrome? [Ch. 68:
Fracture Complications] (Difficult)
A. Absent pedal pulses.
B. Numbness and tingling in toes.
C. Pain on passive stretch of the toes. (Correct)
D. Marked swelling and hardness of the calf.
Rationale: Pain on passive stretch (e.g. pain when flexing toes)
is the most sensitive early sign of compartment syndrome【32†
】. Paresthesia and loss of pulses are late signs. Early detection
and fasciotomy are critical to prevent tissue necrosis.
6. A patient reports joint stiffness lasting over one hour each
morning and symmetrical swelling of multiple joints. Which
condition do these findings most suggest? [Ch. 64:
Rheumatoid Arthritis] (Moderate)
, A. Osteoarthritis.
B. Rheumatoid arthritis. (Correct)
C. Gout.
D. Septic arthritis.
Rationale: Prolonged morning stiffness (>1 hour) and
symmetric joint involvement are characteristic of rheumatoid
arthritis. Osteoarthritis causes brief stiffness (<30 min) that
worsens with activity. Gout typically affects one joint acutely;
septic arthritis causes acute pain and fever.
7. A patient on alendronate for osteoporosis asks how to take
the medication. The nurse should instruct: [Ch. 64:
Osteoporosis] (Moderate)
A. “Take it with food to reduce stomach upset.”
B. “Take it on an empty stomach with a full glass of water.”
(Correct)
C. “You may lie down immediately after taking the dose.”
D. “It can be taken at bedtime with a snack.”
Rationale: Alendronate (a bisphosphonate) should be taken first
thing in the morning on an empty stomach with water, and the
patient should remain upright for 30 minutes to prevent
esophagitis. Food, head-down position, or bedtime dosing
interfere with absorption and increase side effects.
8. Which feature of a skin lesion most strongly suggests
malignant melanoma? [Ch. 23: Skin Cancer] (Moderate)
A. Uniform brown color and round shape.
B. Diameter less than 6 mm.
Lewis’s Medical-Surgical Nursing, 13th Edition
— 100% Verified
Medical-Surgical Nursing Exam (Lewis 13th ed)
1. A 78-year-old woman is admitted after a fall with a
suspected left hip fracture. Her left leg is shortened and
externally rotated. What is the nurse’s highest priority
assessment before preparing for surgery? [Ch. 63: Hip
Fracture] (Moderate)
A. Monitor pedal pulses and capillary refill in the affected limb.
(Correct)
B. Administer prescribed pain medication.
C. Elevate the foot of the bed to reduce swelling.
D. Move the patient to a chair to prevent pressure ulcers.
Rationale: In a suspected fracture with deformity, the nurse’s
priority is to assess and document neurovascular status of the
limb (pulses, sensation, movement) to detect compartment
syndrome or vascular injury. Pain management is important but
should follow ensuring adequate circulation. Elevation and
pressure-redistributing measures can be done later.
,2. Which nutrient should a patient with osteoporosis
increase to enhance calcium absorption? [Ch. 64:
Osteoporosis] (Easy)
A. Vitamin D (Correct)
B. Iron
C. Vitamin K
D. Magnesium
Rationale: Vitamin D is essential for intestinal calcium
absorption. Low vitamin D leads to poor calcium uptake and
bone loss. Iron and Vitamin K have no direct role in calcium
absorption, and while magnesium is involved in bone health,
vitamin D is the key cofactor for absorbing dietary calcium.
3. A 70-kg patient with 40% TBSA second-degree burns
requires fluid resuscitation. Using the Parkland formula (4
mL × weight × %TBSA), how much Lactated Ringer’s
should be given in the first 8 hours? [Ch. 65: Burns]
(Moderate)
A. 2,800 mL
B. 4,200 mL
C. 5,600 mL (Correct)
D. 11,200 mL
Rationale: Parkland formula = 4 mL/kg/%TBSA = 4 × 70 kg ×
40 = 11,200 mL in 24 hours. Half of this (5,600 mL) is given in
the first 8 hours. Lactated Ringer’s is the preferred solution.
4. Which nursing intervention is most effective in preventing
pressure ulcers in an immobile patient? [Ch. 67: Pressure
Ulcers] (Moderate)
,A. Massaging any reddened areas every 4 hours.
B. Providing a high-calorie, high-protein diet.
C. Turning the patient every 2 hours and using pressure-
relieving devices. (Correct)
D. Keeping the head of the bed elevated at 45 degrees at all
times.
Rationale: Regular turning (at least every 2 hours) and use of
pressure-relief surfaces are evidence-based measures to prevent
pressure injuries. (Massaging reddened areas can further damage
tissue; positioning and diet alone are insufficient without
repositioning).
5. A patient in a leg cast reports severe pain not relieved by
medication and pain on passive movement of the toes. Which
finding is an early sign of compartment syndrome? [Ch. 68:
Fracture Complications] (Difficult)
A. Absent pedal pulses.
B. Numbness and tingling in toes.
C. Pain on passive stretch of the toes. (Correct)
D. Marked swelling and hardness of the calf.
Rationale: Pain on passive stretch (e.g. pain when flexing toes)
is the most sensitive early sign of compartment syndrome【32†
】. Paresthesia and loss of pulses are late signs. Early detection
and fasciotomy are critical to prevent tissue necrosis.
6. A patient reports joint stiffness lasting over one hour each
morning and symmetrical swelling of multiple joints. Which
condition do these findings most suggest? [Ch. 64:
Rheumatoid Arthritis] (Moderate)
, A. Osteoarthritis.
B. Rheumatoid arthritis. (Correct)
C. Gout.
D. Septic arthritis.
Rationale: Prolonged morning stiffness (>1 hour) and
symmetric joint involvement are characteristic of rheumatoid
arthritis. Osteoarthritis causes brief stiffness (<30 min) that
worsens with activity. Gout typically affects one joint acutely;
septic arthritis causes acute pain and fever.
7. A patient on alendronate for osteoporosis asks how to take
the medication. The nurse should instruct: [Ch. 64:
Osteoporosis] (Moderate)
A. “Take it with food to reduce stomach upset.”
B. “Take it on an empty stomach with a full glass of water.”
(Correct)
C. “You may lie down immediately after taking the dose.”
D. “It can be taken at bedtime with a snack.”
Rationale: Alendronate (a bisphosphonate) should be taken first
thing in the morning on an empty stomach with water, and the
patient should remain upright for 30 minutes to prevent
esophagitis. Food, head-down position, or bedtime dosing
interfere with absorption and increase side effects.
8. Which feature of a skin lesion most strongly suggests
malignant melanoma? [Ch. 23: Skin Cancer] (Moderate)
A. Uniform brown color and round shape.
B. Diameter less than 6 mm.
