LEWIS’S MEDICAL SURGICAL NURSING
CERTIFICATION EVALUATION 2026 TESTED
QUESTIONS SOLVED
◉ When developing a community health program to decrease the
incidence of rheumatic fever, which action would be most important
for the community health nurse to include?
a. Vaccinate high-risk groups in the community with streptococcal
vaccine.
b. Teach community members to seek treatment for streptococcal
pharyngitis.
c. Teach about the importance of monitoring temperature when sore
throats occur.
d. Teach about prophylactic antibiotics to those with a family history
of rheumatic fever. Answer: ANS: B
The incidence of rheumatic fever is decreased by treatment of
streptococcal infections with antibiotics. Family history is not a risk
factor for rheumatic fever. There is no immunization that is effective
in decreasing the incidence of rheumatic fever. Teaching about
monitoring temperature will not decrease the incidence of
rheumatic fever.
◉ When caring for a patient with mitral valve stenosis, it is most
important that the nurse assess for:
,a. diastolic murmur.
b. peripheral edema.
c. right upper quadrant tenderness.
d. complaints of shortness of breath. Answer: ANS: d
The pressure gradient changes in mitral stenosis lead to fluid
backup into the lungs, resulting in hypoxemia and dyspnea. The
other findings also may be associated with mitral valve disease but
are not indicators of possible hypoxemia.
◉ A 21-year-old woman is scheduled for percutaneous transluminal
balloon valvuloplasty to treat mitral stenosis. When explaining the
advantage of valvuloplasty instead of valve replacement to the
patient, which information will the nurse include?
a. Biologic replacement valves require the use of
immunosuppressive drugs.
b. Mechanical mitral valves require replacement approximately
every 5 years.
c. Lifelong anticoagulant therapy is needed after mechanical valve
replacement.
d. Ongoing cardiac care by a health care provider is unnecessary
after valvuloplasty. Answer: ANS: c
, Long-term anticoagulation therapy is needed after mechanical valve
replacement, and this would restrict decisions about career and
childbearing in this patient. Mechanical valves are durable and last
longer than biologic valves. All valve repair procedures are palliative,
not curative, and require lifelong health care. Biologic valves do not
activate the immune system, and immunosuppressive therapy is not
needed.
◉ While caring for a 23-year-old patient with mitral valve prolapse
(MVP) without valvular regurgitation, the nurse determines that
discharge teaching has been effective when the patient states that it
will be necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. take an aspirin a day to prevent clots from forming on the valve.
d. avoid use of over-the-counter (OTC) medications that contain
stimulant drugs. Answer: ANS: D
Use of stimulant medications should be avoided by patients with
MVP because these may exacerbate symptoms. Daily aspirin and
restricted physical activity are not needed by patients with mild
MVP. Antibiotic prophylaxis is needed for patients with MVP with
regurgitation but will not be necessary for this patient.
◉ While caring for a patient with aortic stenosis, the nurse identifies
a nursing diagnosis of acute pain related to decreased coronary
CERTIFICATION EVALUATION 2026 TESTED
QUESTIONS SOLVED
◉ When developing a community health program to decrease the
incidence of rheumatic fever, which action would be most important
for the community health nurse to include?
a. Vaccinate high-risk groups in the community with streptococcal
vaccine.
b. Teach community members to seek treatment for streptococcal
pharyngitis.
c. Teach about the importance of monitoring temperature when sore
throats occur.
d. Teach about prophylactic antibiotics to those with a family history
of rheumatic fever. Answer: ANS: B
The incidence of rheumatic fever is decreased by treatment of
streptococcal infections with antibiotics. Family history is not a risk
factor for rheumatic fever. There is no immunization that is effective
in decreasing the incidence of rheumatic fever. Teaching about
monitoring temperature will not decrease the incidence of
rheumatic fever.
◉ When caring for a patient with mitral valve stenosis, it is most
important that the nurse assess for:
,a. diastolic murmur.
b. peripheral edema.
c. right upper quadrant tenderness.
d. complaints of shortness of breath. Answer: ANS: d
The pressure gradient changes in mitral stenosis lead to fluid
backup into the lungs, resulting in hypoxemia and dyspnea. The
other findings also may be associated with mitral valve disease but
are not indicators of possible hypoxemia.
◉ A 21-year-old woman is scheduled for percutaneous transluminal
balloon valvuloplasty to treat mitral stenosis. When explaining the
advantage of valvuloplasty instead of valve replacement to the
patient, which information will the nurse include?
a. Biologic replacement valves require the use of
immunosuppressive drugs.
b. Mechanical mitral valves require replacement approximately
every 5 years.
c. Lifelong anticoagulant therapy is needed after mechanical valve
replacement.
d. Ongoing cardiac care by a health care provider is unnecessary
after valvuloplasty. Answer: ANS: c
, Long-term anticoagulation therapy is needed after mechanical valve
replacement, and this would restrict decisions about career and
childbearing in this patient. Mechanical valves are durable and last
longer than biologic valves. All valve repair procedures are palliative,
not curative, and require lifelong health care. Biologic valves do not
activate the immune system, and immunosuppressive therapy is not
needed.
◉ While caring for a 23-year-old patient with mitral valve prolapse
(MVP) without valvular regurgitation, the nurse determines that
discharge teaching has been effective when the patient states that it
will be necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. take an aspirin a day to prevent clots from forming on the valve.
d. avoid use of over-the-counter (OTC) medications that contain
stimulant drugs. Answer: ANS: D
Use of stimulant medications should be avoided by patients with
MVP because these may exacerbate symptoms. Daily aspirin and
restricted physical activity are not needed by patients with mild
MVP. Antibiotic prophylaxis is needed for patients with MVP with
regurgitation but will not be necessary for this patient.
◉ While caring for a patient with aortic stenosis, the nurse identifies
a nursing diagnosis of acute pain related to decreased coronary
