Lewis Medical-Surgical Nursing, 12th Edition
(Harding) with correct answers and
rationales updated 2026
Unit 1: Concepts in Nursing Practice (Chapters 1–5)
1. A nurse is using the nursing process to care for a patient. Which action best demonstrates the
"assessment" phase?
a) Administering a prescribed medication
b) Obtaining a health history and performing a physical examination
c) Developing a plan of care
d) Evaluating patient outcomes
Rationale: Assessment is the first step of the nursing process and involves collecting subjective and
objective data through health history, physical examination, and diagnostic tests. The other options
represent implementation, planning, and evaluation, respectively.
2. Which statement by the nurse demonstrates an understanding of evidence-based practice
(EBP)?
a) "I always follow the same routine because it has worked for years."
b) "I use my intuition to make clinical decisions."
c) "I integrate the best research evidence with my clinical expertise and patient preferences."
d) "I follow hospital policy without questioning it."
Rationale: EBP is the integration of the best available research evidence, clinical expertise, and
patient values and preferences. Intuition and tradition alone are not sufficient for EBP.
3. A patient is scheduled for surgery and asks the nurse about advance directives. Which response
is most appropriate?
a) "You don't need to worry about that now."
b) "Advance directives are only for terminally ill patients."
c) "Advance directives allow you to document your wishes for care if you become unable to make
decisions."
d) "Only your physician can complete advance directives."
Rationale: Advance directives (living will, durable power of attorney for health care) allow patients
to document their healthcare wishes. They are appropriate for all adults, not just terminally ill
patients.
4. The nurse is caring for a patient from a different cultural background. Which action
demonstrates cultural competence?
a) Assuming the patient shares the nurse's health beliefs
b) Asking the patient about health practices and beliefs
,c) Avoiding discussion of cultural differences
d) Using family members as interpreters for all communication
Rationale: Cultural competence involves assessing and respecting the patient's cultural beliefs and
practices. Using family members as interpreters is generally discouraged due to confidentiality and
accuracy concerns.
5. Which patient is at greatest risk for health disparities?
a) A middle-aged white male with insurance
b) An uninsured minority patient with limited English proficiency
c) A college-educated Asian American female
d) A retired military veteran with benefits
Rationale: Health disparities are most prevalent among racial/ethnic minorities, those with low
socioeconomic status, the uninsured, and those with limited English proficiency.
6. A nurse is teaching a patient about health promotion. Which activity is an example of primary
prevention?
a) Mammography screening
b) Immunization against influenza
c) Rehabilitation after a stroke
d) Blood pressure monitoring for hypertension
Rationale: Primary prevention aims to prevent disease before it occurs (e.g., immunizations, health
education). Screening is secondary prevention; rehabilitation is tertiary prevention.
7. The nurse is preparing to discharge a patient. Which action is most important for continuity of
care?
a) Providing written instructions only
b) Coordinating with the interprofessional team and community resources
c) Scheduling a follow-up appointment in 6 months
d) Telling the patient to call if problems arise
Rationale: Continuity of care requires coordination among the interprofessional team and
community resources to ensure seamless transition and prevent readmissions.
8. Which statement best describes the purpose of the Patient Protection and Affordable Care Act
(ACA)?
a) To eliminate private insurance
b) To increase access to health care and reduce the number of uninsured
c) To reduce Medicare benefits
d) To limit patient choices in providers
Rationale: The ACA was designed to expand health insurance coverage, improve access, and reduce
the number of uninsured Americans.
,9. A nurse is evaluating a patient's understanding of a low-sodium diet. Which statement indicates
correct understanding?
a) "I can eat canned soups as long as I drain the liquid."
b) "I will read food labels and choose items with less than 140 mg of sodium per serving."
c) "I can use soy sauce instead of table salt."
d) "I will add salt only at the table, not during cooking."
Rationale: A low-sodium diet generally limits sodium to 2–3 g/day. Reading labels and choosing low-
sodium foods is essential. Canned soups and soy sauce are high in sodium.
10. The nurse is caring for an older adult. Which physiologic change of aging is most important to
consider when administering medications?
a) Increased gastric motility
b) Decreased renal clearance
c) Increased liver function
d) Increased total body water
Rationale: Decreased renal clearance in older adults can lead to drug accumulation and toxicity.
Total body water decreases, and liver function may decline.
Unit 2: Perioperative Care (Chapters 16–19)
11. A patient is scheduled for surgery. Which preoperative assessment finding is most important
to report to the surgeon?
a) Blood pressure 130/80 mm Hg
b) History of bleeding disorder
c) Mild anxiety about surgery
d) NPO status since midnight
Rationale: A bleeding disorder increases the risk for hemorrhage during and after surgery and must
be reported. Mild anxiety and stable BP are expected.
12. The nurse is teaching a patient how to perform incentive spirometry. Which instruction is
correct?
a) "Inhale quickly and forcefully."
b) "Inhale slowly and deeply, hold your breath, then exhale slowly."
c) "Exhale into the device as hard as you can."
d) "Use the device only when you feel short of breath."
Rationale: Incentive spirometry promotes lung expansion. The patient should inhale slowly and
deeply, hold briefly, then exhale. It should be used routinely, not just when short of breath.
13. A patient is 2 hours postoperative following abdominal surgery. Which assessment finding
requires immediate intervention?
, a) Blood pressure 110/70 mm Hg
b) Respiratory rate 8 breaths/min and shallow
c) Pain level 4/10
d) Urine output 40 mL/hr
Rationale: A respiratory rate of 8 and shallow breathing may indicate opioid-induced respiratory
depression or airway obstruction, requiring immediate intervention.
14. The nurse is caring for a patient with a nasogastric tube after surgery. Which intervention is
appropriate?
a) Irrigate the tube with 50 mL of water every shift
b) Check tube placement and patency regularly
c) Clamp the tube continuously
d) Remove the tube immediately after surgery
Rationale: NG tube placement and patency should be verified regularly to prevent complications.
Irrigation volumes should follow orders, and the tube is not clamped continuously.
15. Which patient is at highest risk for malignant hyperthermia during surgery?
a) A patient with a history of asthma
b) A patient with a family history of malignant hyperthermia
c) A patient with diabetes mellitus
d) A patient with hypertension
Rationale: Malignant hyperthermia is an inherited disorder triggered by certain anesthetic agents
(e.g., succinylcholine, volatile anesthetics). Family history is a key risk factor.
16. A patient is undergoing surgery with general anesthesia. Which nursing action is priority
immediately after extubation?
a) Offering oral fluids
b) Assessing airway patency and oxygenation
c) Ambulating the patient
d) Administering pain medication
Rationale: Airway patency and oxygenation are the priority after extubation due to risk of
laryngospasm, edema, or obstruction.
17. The nurse is preparing a patient for surgery. Which lab value is most important to report?
a) Hemoglobin 13 g/dL
b) INR 3.5
c) Sodium 140 mEq/L
d) Glucose 110 mg/dL
Rationale: An INR of 3.5 indicates increased bleeding risk and may require correction before surgery.
(Harding) with correct answers and
rationales updated 2026
Unit 1: Concepts in Nursing Practice (Chapters 1–5)
1. A nurse is using the nursing process to care for a patient. Which action best demonstrates the
"assessment" phase?
a) Administering a prescribed medication
b) Obtaining a health history and performing a physical examination
c) Developing a plan of care
d) Evaluating patient outcomes
Rationale: Assessment is the first step of the nursing process and involves collecting subjective and
objective data through health history, physical examination, and diagnostic tests. The other options
represent implementation, planning, and evaluation, respectively.
2. Which statement by the nurse demonstrates an understanding of evidence-based practice
(EBP)?
a) "I always follow the same routine because it has worked for years."
b) "I use my intuition to make clinical decisions."
c) "I integrate the best research evidence with my clinical expertise and patient preferences."
d) "I follow hospital policy without questioning it."
Rationale: EBP is the integration of the best available research evidence, clinical expertise, and
patient values and preferences. Intuition and tradition alone are not sufficient for EBP.
3. A patient is scheduled for surgery and asks the nurse about advance directives. Which response
is most appropriate?
a) "You don't need to worry about that now."
b) "Advance directives are only for terminally ill patients."
c) "Advance directives allow you to document your wishes for care if you become unable to make
decisions."
d) "Only your physician can complete advance directives."
Rationale: Advance directives (living will, durable power of attorney for health care) allow patients
to document their healthcare wishes. They are appropriate for all adults, not just terminally ill
patients.
4. The nurse is caring for a patient from a different cultural background. Which action
demonstrates cultural competence?
a) Assuming the patient shares the nurse's health beliefs
b) Asking the patient about health practices and beliefs
,c) Avoiding discussion of cultural differences
d) Using family members as interpreters for all communication
Rationale: Cultural competence involves assessing and respecting the patient's cultural beliefs and
practices. Using family members as interpreters is generally discouraged due to confidentiality and
accuracy concerns.
5. Which patient is at greatest risk for health disparities?
a) A middle-aged white male with insurance
b) An uninsured minority patient with limited English proficiency
c) A college-educated Asian American female
d) A retired military veteran with benefits
Rationale: Health disparities are most prevalent among racial/ethnic minorities, those with low
socioeconomic status, the uninsured, and those with limited English proficiency.
6. A nurse is teaching a patient about health promotion. Which activity is an example of primary
prevention?
a) Mammography screening
b) Immunization against influenza
c) Rehabilitation after a stroke
d) Blood pressure monitoring for hypertension
Rationale: Primary prevention aims to prevent disease before it occurs (e.g., immunizations, health
education). Screening is secondary prevention; rehabilitation is tertiary prevention.
7. The nurse is preparing to discharge a patient. Which action is most important for continuity of
care?
a) Providing written instructions only
b) Coordinating with the interprofessional team and community resources
c) Scheduling a follow-up appointment in 6 months
d) Telling the patient to call if problems arise
Rationale: Continuity of care requires coordination among the interprofessional team and
community resources to ensure seamless transition and prevent readmissions.
8. Which statement best describes the purpose of the Patient Protection and Affordable Care Act
(ACA)?
a) To eliminate private insurance
b) To increase access to health care and reduce the number of uninsured
c) To reduce Medicare benefits
d) To limit patient choices in providers
Rationale: The ACA was designed to expand health insurance coverage, improve access, and reduce
the number of uninsured Americans.
,9. A nurse is evaluating a patient's understanding of a low-sodium diet. Which statement indicates
correct understanding?
a) "I can eat canned soups as long as I drain the liquid."
b) "I will read food labels and choose items with less than 140 mg of sodium per serving."
c) "I can use soy sauce instead of table salt."
d) "I will add salt only at the table, not during cooking."
Rationale: A low-sodium diet generally limits sodium to 2–3 g/day. Reading labels and choosing low-
sodium foods is essential. Canned soups and soy sauce are high in sodium.
10. The nurse is caring for an older adult. Which physiologic change of aging is most important to
consider when administering medications?
a) Increased gastric motility
b) Decreased renal clearance
c) Increased liver function
d) Increased total body water
Rationale: Decreased renal clearance in older adults can lead to drug accumulation and toxicity.
Total body water decreases, and liver function may decline.
Unit 2: Perioperative Care (Chapters 16–19)
11. A patient is scheduled for surgery. Which preoperative assessment finding is most important
to report to the surgeon?
a) Blood pressure 130/80 mm Hg
b) History of bleeding disorder
c) Mild anxiety about surgery
d) NPO status since midnight
Rationale: A bleeding disorder increases the risk for hemorrhage during and after surgery and must
be reported. Mild anxiety and stable BP are expected.
12. The nurse is teaching a patient how to perform incentive spirometry. Which instruction is
correct?
a) "Inhale quickly and forcefully."
b) "Inhale slowly and deeply, hold your breath, then exhale slowly."
c) "Exhale into the device as hard as you can."
d) "Use the device only when you feel short of breath."
Rationale: Incentive spirometry promotes lung expansion. The patient should inhale slowly and
deeply, hold briefly, then exhale. It should be used routinely, not just when short of breath.
13. A patient is 2 hours postoperative following abdominal surgery. Which assessment finding
requires immediate intervention?
, a) Blood pressure 110/70 mm Hg
b) Respiratory rate 8 breaths/min and shallow
c) Pain level 4/10
d) Urine output 40 mL/hr
Rationale: A respiratory rate of 8 and shallow breathing may indicate opioid-induced respiratory
depression or airway obstruction, requiring immediate intervention.
14. The nurse is caring for a patient with a nasogastric tube after surgery. Which intervention is
appropriate?
a) Irrigate the tube with 50 mL of water every shift
b) Check tube placement and patency regularly
c) Clamp the tube continuously
d) Remove the tube immediately after surgery
Rationale: NG tube placement and patency should be verified regularly to prevent complications.
Irrigation volumes should follow orders, and the tube is not clamped continuously.
15. Which patient is at highest risk for malignant hyperthermia during surgery?
a) A patient with a history of asthma
b) A patient with a family history of malignant hyperthermia
c) A patient with diabetes mellitus
d) A patient with hypertension
Rationale: Malignant hyperthermia is an inherited disorder triggered by certain anesthetic agents
(e.g., succinylcholine, volatile anesthetics). Family history is a key risk factor.
16. A patient is undergoing surgery with general anesthesia. Which nursing action is priority
immediately after extubation?
a) Offering oral fluids
b) Assessing airway patency and oxygenation
c) Ambulating the patient
d) Administering pain medication
Rationale: Airway patency and oxygenation are the priority after extubation due to risk of
laryngospasm, edema, or obstruction.
17. The nurse is preparing a patient for surgery. Which lab value is most important to report?
a) Hemoglobin 13 g/dL
b) INR 3.5
c) Sodium 140 mEq/L
d) Glucose 110 mg/dL
Rationale: An INR of 3.5 indicates increased bleeding risk and may require correction before surgery.
