Lewis Medical Surgical Nursing | Exam Preparation Workbook 2026/2027
LEWIS MEDICAL SURGICAL NURSING
ALL CHAPTERS 2026/2027
Exam Preparation Workbook | Comprehensive Q&A
Instructions: This workbook contains 610 exam-style questions with correct answers and rationales. Correct
answers appear in bold cyan blue. Questions are organized by body system/domain aligned with the Lewis
Medical-Surgical Nursing textbook.
Domain Distribution
Domain Questions Count
Cardiovascular System Q1–Q50 50
Respiratory System Q51–Q100 50
Neurological System Q101–Q150 50
Endocrine System Q151–Q195 45
Gastrointestinal System Q196–Q240 45
Renal/Urinary System Q241–Q280 40
Musculoskeletal System Q281–Q315 35
Integumentary System Q316–Q340 25
Hematologic System Q341–Q370 30
Immunologic System Q371–Q400 30
Perioperative Nursing Q401–Q430 30
Fluid, Electrolyte & Acid-Base Balance Q431–Q470 40
Pain Management Q471–Q500 30
Oncologic Nursing Q501–Q530 30
Palliative & End-of-Life Care Q531–Q545 15
Emergency & Disaster Nursing Q546–Q570 25
Gerontologic Nursing Q571–Q585 15
Multisystem Disorders Q586–Q610 25
TOTAL Q1–Q610 610
Cardiovascular System
Q1. A patient with stable angina reports chest pain that occurs with exertion and is relieved by rest. The
nurse explains that this type of angina is caused by which mechanism?
A) Coronary artery spasm B) Fixed atherosclerotic C) Complete occlusion of D) Coronary artery
at rest plaque causing increased a coronary artery by dissection
oxygen demand during thrombus
exertion
Correct Answer: B
1
, Lewis Medical Surgical Nursing | Exam Preparation Workbook 2026/2027
Rationale: Stable angina is caused by a fixed atherosclerotic plaque that partially occludes a coronary artery.
During exertion, myocardial oxygen demand increases, but the narrowed artery cannot deliver enough blood flow,
resulting in chest pain that is relieved by rest. Variant (Prinzmetal’s) angina is caused by coronary artery spasm.
Q2. A patient presents to the emergency department with substernal chest pain, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. The nurse recognizes this pattern as
indicating an acute myocardial infarction in which area?
A) Anterior wall B) Lateral wall C) Inferior wall D) Posterior wall
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction. These
leads look at the inferior surface of the heart. Anterior wall MI shows ST elevation in V1–V4, lateral wall MI shows
changes in I, aVL, V5, and V6, and posterior wall MI shows ST depression in V1–V3.
Q3. The nurse is caring for a patient suspected of having an acute coronary syndrome. Which laboratory
marker is the most specific and sensitive for myocardial infarction?
A) Creatine kinase-MB B) Myoglobin C) C-reactive protein D) Cardiac troponin I or T
(CK-MB) (CRP)
Correct Answer: D
Rationale: Cardiac troponin I and T are the most specific and sensitive biomarkers for myocardial infarction.
Troponin levels rise within 3–4 hours after injury, peak at 12–24 hours, and can remain elevated for up to 7–10
days. CK-MB was previously used but is less specific. Myoglobin rises early but is not cardiac-specific.
Q4. A patient is admitted with an acute STEMI. Which of the following medications should the nurse
administer as the initial pharmacologic therapy? Select the priority intervention.
A) Metoprolol (Lopressor) B) Aspirin 325 mg chewed C) Atorvastatin (Lipitor) D) Clopidogrel (Plavix)
Correct Answer: B
Rationale: Aspirin 325 mg chewed is the first medication administered for a suspected acute MI. Aspirin
irreversibly inhibits platelet aggregation, reducing thrombus growth. It is part of the MONA protocol (Morphine,
Oxygen, Nitroglycerin, Aspirin), though oxygen is now only given if SpO2 is below 94% per current guidelines.
Q5. A patient with chest pain has elevated cardiac troponin levels but no ST-segment elevation on ECG. T-
wave inversions are noted in leads V1 through V4. The nurse understands this patient is experiencing which
type of acute coronary syndrome?
A) NSTEMI B) Stable angina C) STEMI D) Prinzmetal’s angina
Correct Answer: A
Rationale: NSTEMI (non–ST-segment elevation myocardial infarction) is characterized by elevated cardiac
biomarkers (troponin) without ST-segment elevation on ECG. The ECG may show ST-segment depression, T-wave
inversions, or nonspecific changes. NSTEMI indicates partial or intermittent occlusion of a coronary artery rather
than complete occlusion.
Q6. Which clinical manifestation is most characteristic of left-sided heart failure?
A) Jugular venous B) Hepatomegaly and C) Crackles in the lungs, D) Weight gain and
distention and dependent ascites dyspnea, and orthopnea nocturia
edema
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to the backup of blood from the left atrium
into the pulmonary vasculature. This leads to crackles (rales) in the lungs, dyspnea, orthopnea (difficulty breathing
when lying flat), and paroxysmal nocturnal dyspnea. Right-sided heart failure causes systemic venous congestion.
2
, Lewis Medical Surgical Nursing | Exam Preparation Workbook 2026/2027
Q7. A patient with right-sided heart failure is most likely to exhibit which clinical finding?
A) Jugular venous B) Pink, frothy sputum C) Dry, nonproductive D) Bilateral crackles on
distention and bilateral cough auscultation
ankle edema
Correct Answer: A
Rationale: Right-sided heart failure results in systemic venous congestion, leading to jugular venous distention
(JVD), peripheral edema (especially in the ankles and pretibial area), hepatomegaly, ascites, and weight gain.
Pulmonary symptoms such as crackles and frothy sputum are associated with left-sided heart failure.
Q8. A patient reports no limitation of physical activity and no symptoms of heart failure with ordinary
activity. The nurse classifies this patient under which NYHA functional class?
A) Class I B) Class II C) Class III D) Class IV
Correct Answer: A
Rationale: NYHA Class I indicates no limitation of physical activity and no symptoms with ordinary activity. Class
II is slight limitation with comfort at rest but symptoms with ordinary activity. Class III is marked limitation with
comfort only at rest. Class IV is inability to carry on any activity with symptoms at rest.
Q9. A patient with suspected heart failure has a B-type natriuretic peptide (BNP) level of 850 pg/mL. The
nurse interprets this result as:
A) Normal, ruling out B) Mildly elevated, C) Significantly elevated, D) Indicative of acute
heart failure suggesting possible early consistent with heart kidney injury
heart failure failure
Correct Answer: C
Rationale: BNP is released from the ventricles in response to volume overload and wall stretch. A BNP level less
than 100 pg/mL makes heart failure unlikely. Levels of 100–300 pg/mL suggest mild heart failure, 300–700 pg/mL
suggest moderate heart failure, and levels above 700 pg/mL suggest severe heart failure.
Q10. A patient with heart failure is prescribed furosemide (Lasix) 40 mg IV. Which laboratory value should
the nurse monitor most closely as a potential adverse effect of this medication?
A) Serum sodium and B) Serum calcium and C) Hemoglobin and D) Serum albumin and
potassium levels magnesium levels hematocrit total protein
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes excretion of sodium, potassium, and water. Hypokalemia is
the most significant adverse effect and can lead to cardiac dysrhythmias. The nurse should monitor serum
electrolytes, especially potassium, and assess for signs of hypokalemia such as muscle weakness and arrhythmias.
Q11. A patient with heart failure is started on lisinopril (an ACE inhibitor). The nurse teaches the patient to
report which side effect that may indicate a need to discontinue the medication?
A) Mild, dry cough B) Persistent dry, hacking C) Increased urine output D) Mild dizziness when
cough standing up quickly
Correct Answer: B
Rationale: ACE inhibitors cause accumulation of bradykinin, which can produce a persistent dry, hacking cough
in up to 20% of patients. While mild dizziness (orthostatic hypotension) and increased urination are expected
effects, a persistent cough that interferes with quality of life may require switching to an ARB.
Q12. A patient taking digoxin (Lanoxin) for heart failure reports nausea, vomiting, and visual disturbances
including yellow-tinged vision. The nurse should suspect which condition?
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, Lewis Medical Surgical Nursing | Exam Preparation Workbook 2026/2027
A) Worsening heart failure B) Electrolyte imbalance C) Digoxin toxicity D) Allergic reaction to
from diuretics digoxin
Correct Answer: C
Rationale: Nausea, vomiting, anorexia, and visual disturbances (blurred vision, yellow or green halos around
objects) are classic signs of digoxin toxicity. Other signs include cardiac dysrhythmias, particularly bradycardia
and premature ventricular contractions. The nurse should hold the dose and check serum digoxin and potassium
levels.
Q13. A patient with heart failure is instructed to follow a 2-gram sodium diet. Which food choice by the
patient indicates a need for further teaching?
A) Fresh chicken breast B) Baked potato with fresh C) Fresh fruit salad with D) Canned chicken noodle
with steamed broccoli herbs unsalted nuts soup and saltine crackers
Correct Answer: D
Rationale: Canned soups and saltine crackers are very high in sodium. One can of chicken noodle soup can
contain 800–1,000 mg of sodium, and saltine crackers also contribute significant sodium. Patients on a 2-gram
sodium restriction should avoid processed, canned, and prepackaged foods and choose fresh, unprocessed foods.
Q14. The nurse teaches a patient with heart failure to perform daily weights at home. Which instruction is
most important for the patient to follow?
A) Weigh yourself only B) Weigh yourself at C) Weigh yourself once a D) Weigh yourself in the
when you feel short of different times each day week and report any gain morning after voiding,
breath for accuracy of 5 lbs (2.3 kg) or more wearing the same clothing,
and report a gain of 2 lbs
(0.9 kg) or more in one
day
Correct Answer: D
Rationale: Daily weights are the most reliable indicator of fluid retention in heart failure. The patient should
weigh at the same time each morning, after voiding, wearing the same clothing, using the same scale. A weight
gain of 2–3 lbs (1–1.5 kg) in one day or 5 lbs (2.3 kg) in one week should be reported to the provider.
Q15. A patient with atrial fibrillation has an irregularly irregular pulse with a rate of 156 bpm. Which
medication does the nurse anticipate administering to rate-control this rhythm?
A) Diltiazem (Cardizem) B) Atropine sulfate C) Epinephrine D) Digoxin only
or metoprolol (Lopressor)
Correct Answer: A
Rationale: Rate control in atrial fibrillation is typically achieved with beta-blockers (e.g., metoprolol), non-
dihydropyridine calcium channel blockers (e.g., diltiazem), or digoxin. For acute rate control in hemodynamically
stable patients, IV diltiazem or metoprolol are first-line agents. Atropine is used for bradycardia, not tachycardia.
Q16. A patient with new-onset atrial fibrillation is being evaluated for stroke risk. Which assessment tool is
used to estimate the annual stroke risk and guide anticoagulation therapy?
A) Glasgow Coma Scale B) APGAR score C) SOFA score D) CHA2DS2-VASc score
Correct Answer: D
Rationale: The CHA2DS2-VASc score assesses stroke risk in patients with nonvalvular atrial fibrillation. Points
are assigned for Congestive heart failure, Hypertension, Age ≥75 (2 points), Diabetes, Stroke/TIA history (2
points), Vascular disease, Age 65–74, and Sex category (female). A score of 2 or higher in men or 3 or higher in
women warrants anticoagulation.
4
LEWIS MEDICAL SURGICAL NURSING
ALL CHAPTERS 2026/2027
Exam Preparation Workbook | Comprehensive Q&A
Instructions: This workbook contains 610 exam-style questions with correct answers and rationales. Correct
answers appear in bold cyan blue. Questions are organized by body system/domain aligned with the Lewis
Medical-Surgical Nursing textbook.
Domain Distribution
Domain Questions Count
Cardiovascular System Q1–Q50 50
Respiratory System Q51–Q100 50
Neurological System Q101–Q150 50
Endocrine System Q151–Q195 45
Gastrointestinal System Q196–Q240 45
Renal/Urinary System Q241–Q280 40
Musculoskeletal System Q281–Q315 35
Integumentary System Q316–Q340 25
Hematologic System Q341–Q370 30
Immunologic System Q371–Q400 30
Perioperative Nursing Q401–Q430 30
Fluid, Electrolyte & Acid-Base Balance Q431–Q470 40
Pain Management Q471–Q500 30
Oncologic Nursing Q501–Q530 30
Palliative & End-of-Life Care Q531–Q545 15
Emergency & Disaster Nursing Q546–Q570 25
Gerontologic Nursing Q571–Q585 15
Multisystem Disorders Q586–Q610 25
TOTAL Q1–Q610 610
Cardiovascular System
Q1. A patient with stable angina reports chest pain that occurs with exertion and is relieved by rest. The
nurse explains that this type of angina is caused by which mechanism?
A) Coronary artery spasm B) Fixed atherosclerotic C) Complete occlusion of D) Coronary artery
at rest plaque causing increased a coronary artery by dissection
oxygen demand during thrombus
exertion
Correct Answer: B
1
, Lewis Medical Surgical Nursing | Exam Preparation Workbook 2026/2027
Rationale: Stable angina is caused by a fixed atherosclerotic plaque that partially occludes a coronary artery.
During exertion, myocardial oxygen demand increases, but the narrowed artery cannot deliver enough blood flow,
resulting in chest pain that is relieved by rest. Variant (Prinzmetal’s) angina is caused by coronary artery spasm.
Q2. A patient presents to the emergency department with substernal chest pain, diaphoresis, and nausea. The
12-lead ECG shows ST-segment elevation in leads II, III, and aVF. The nurse recognizes this pattern as
indicating an acute myocardial infarction in which area?
A) Anterior wall B) Lateral wall C) Inferior wall D) Posterior wall
Correct Answer: C
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial infarction. These
leads look at the inferior surface of the heart. Anterior wall MI shows ST elevation in V1–V4, lateral wall MI shows
changes in I, aVL, V5, and V6, and posterior wall MI shows ST depression in V1–V3.
Q3. The nurse is caring for a patient suspected of having an acute coronary syndrome. Which laboratory
marker is the most specific and sensitive for myocardial infarction?
A) Creatine kinase-MB B) Myoglobin C) C-reactive protein D) Cardiac troponin I or T
(CK-MB) (CRP)
Correct Answer: D
Rationale: Cardiac troponin I and T are the most specific and sensitive biomarkers for myocardial infarction.
Troponin levels rise within 3–4 hours after injury, peak at 12–24 hours, and can remain elevated for up to 7–10
days. CK-MB was previously used but is less specific. Myoglobin rises early but is not cardiac-specific.
Q4. A patient is admitted with an acute STEMI. Which of the following medications should the nurse
administer as the initial pharmacologic therapy? Select the priority intervention.
A) Metoprolol (Lopressor) B) Aspirin 325 mg chewed C) Atorvastatin (Lipitor) D) Clopidogrel (Plavix)
Correct Answer: B
Rationale: Aspirin 325 mg chewed is the first medication administered for a suspected acute MI. Aspirin
irreversibly inhibits platelet aggregation, reducing thrombus growth. It is part of the MONA protocol (Morphine,
Oxygen, Nitroglycerin, Aspirin), though oxygen is now only given if SpO2 is below 94% per current guidelines.
Q5. A patient with chest pain has elevated cardiac troponin levels but no ST-segment elevation on ECG. T-
wave inversions are noted in leads V1 through V4. The nurse understands this patient is experiencing which
type of acute coronary syndrome?
A) NSTEMI B) Stable angina C) STEMI D) Prinzmetal’s angina
Correct Answer: A
Rationale: NSTEMI (non–ST-segment elevation myocardial infarction) is characterized by elevated cardiac
biomarkers (troponin) without ST-segment elevation on ECG. The ECG may show ST-segment depression, T-wave
inversions, or nonspecific changes. NSTEMI indicates partial or intermittent occlusion of a coronary artery rather
than complete occlusion.
Q6. Which clinical manifestation is most characteristic of left-sided heart failure?
A) Jugular venous B) Hepatomegaly and C) Crackles in the lungs, D) Weight gain and
distention and dependent ascites dyspnea, and orthopnea nocturia
edema
Correct Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion due to the backup of blood from the left atrium
into the pulmonary vasculature. This leads to crackles (rales) in the lungs, dyspnea, orthopnea (difficulty breathing
when lying flat), and paroxysmal nocturnal dyspnea. Right-sided heart failure causes systemic venous congestion.
2
, Lewis Medical Surgical Nursing | Exam Preparation Workbook 2026/2027
Q7. A patient with right-sided heart failure is most likely to exhibit which clinical finding?
A) Jugular venous B) Pink, frothy sputum C) Dry, nonproductive D) Bilateral crackles on
distention and bilateral cough auscultation
ankle edema
Correct Answer: A
Rationale: Right-sided heart failure results in systemic venous congestion, leading to jugular venous distention
(JVD), peripheral edema (especially in the ankles and pretibial area), hepatomegaly, ascites, and weight gain.
Pulmonary symptoms such as crackles and frothy sputum are associated with left-sided heart failure.
Q8. A patient reports no limitation of physical activity and no symptoms of heart failure with ordinary
activity. The nurse classifies this patient under which NYHA functional class?
A) Class I B) Class II C) Class III D) Class IV
Correct Answer: A
Rationale: NYHA Class I indicates no limitation of physical activity and no symptoms with ordinary activity. Class
II is slight limitation with comfort at rest but symptoms with ordinary activity. Class III is marked limitation with
comfort only at rest. Class IV is inability to carry on any activity with symptoms at rest.
Q9. A patient with suspected heart failure has a B-type natriuretic peptide (BNP) level of 850 pg/mL. The
nurse interprets this result as:
A) Normal, ruling out B) Mildly elevated, C) Significantly elevated, D) Indicative of acute
heart failure suggesting possible early consistent with heart kidney injury
heart failure failure
Correct Answer: C
Rationale: BNP is released from the ventricles in response to volume overload and wall stretch. A BNP level less
than 100 pg/mL makes heart failure unlikely. Levels of 100–300 pg/mL suggest mild heart failure, 300–700 pg/mL
suggest moderate heart failure, and levels above 700 pg/mL suggest severe heart failure.
Q10. A patient with heart failure is prescribed furosemide (Lasix) 40 mg IV. Which laboratory value should
the nurse monitor most closely as a potential adverse effect of this medication?
A) Serum sodium and B) Serum calcium and C) Hemoglobin and D) Serum albumin and
potassium levels magnesium levels hematocrit total protein
Correct Answer: A
Rationale: Furosemide is a loop diuretic that causes excretion of sodium, potassium, and water. Hypokalemia is
the most significant adverse effect and can lead to cardiac dysrhythmias. The nurse should monitor serum
electrolytes, especially potassium, and assess for signs of hypokalemia such as muscle weakness and arrhythmias.
Q11. A patient with heart failure is started on lisinopril (an ACE inhibitor). The nurse teaches the patient to
report which side effect that may indicate a need to discontinue the medication?
A) Mild, dry cough B) Persistent dry, hacking C) Increased urine output D) Mild dizziness when
cough standing up quickly
Correct Answer: B
Rationale: ACE inhibitors cause accumulation of bradykinin, which can produce a persistent dry, hacking cough
in up to 20% of patients. While mild dizziness (orthostatic hypotension) and increased urination are expected
effects, a persistent cough that interferes with quality of life may require switching to an ARB.
Q12. A patient taking digoxin (Lanoxin) for heart failure reports nausea, vomiting, and visual disturbances
including yellow-tinged vision. The nurse should suspect which condition?
3
, Lewis Medical Surgical Nursing | Exam Preparation Workbook 2026/2027
A) Worsening heart failure B) Electrolyte imbalance C) Digoxin toxicity D) Allergic reaction to
from diuretics digoxin
Correct Answer: C
Rationale: Nausea, vomiting, anorexia, and visual disturbances (blurred vision, yellow or green halos around
objects) are classic signs of digoxin toxicity. Other signs include cardiac dysrhythmias, particularly bradycardia
and premature ventricular contractions. The nurse should hold the dose and check serum digoxin and potassium
levels.
Q13. A patient with heart failure is instructed to follow a 2-gram sodium diet. Which food choice by the
patient indicates a need for further teaching?
A) Fresh chicken breast B) Baked potato with fresh C) Fresh fruit salad with D) Canned chicken noodle
with steamed broccoli herbs unsalted nuts soup and saltine crackers
Correct Answer: D
Rationale: Canned soups and saltine crackers are very high in sodium. One can of chicken noodle soup can
contain 800–1,000 mg of sodium, and saltine crackers also contribute significant sodium. Patients on a 2-gram
sodium restriction should avoid processed, canned, and prepackaged foods and choose fresh, unprocessed foods.
Q14. The nurse teaches a patient with heart failure to perform daily weights at home. Which instruction is
most important for the patient to follow?
A) Weigh yourself only B) Weigh yourself at C) Weigh yourself once a D) Weigh yourself in the
when you feel short of different times each day week and report any gain morning after voiding,
breath for accuracy of 5 lbs (2.3 kg) or more wearing the same clothing,
and report a gain of 2 lbs
(0.9 kg) or more in one
day
Correct Answer: D
Rationale: Daily weights are the most reliable indicator of fluid retention in heart failure. The patient should
weigh at the same time each morning, after voiding, wearing the same clothing, using the same scale. A weight
gain of 2–3 lbs (1–1.5 kg) in one day or 5 lbs (2.3 kg) in one week should be reported to the provider.
Q15. A patient with atrial fibrillation has an irregularly irregular pulse with a rate of 156 bpm. Which
medication does the nurse anticipate administering to rate-control this rhythm?
A) Diltiazem (Cardizem) B) Atropine sulfate C) Epinephrine D) Digoxin only
or metoprolol (Lopressor)
Correct Answer: A
Rationale: Rate control in atrial fibrillation is typically achieved with beta-blockers (e.g., metoprolol), non-
dihydropyridine calcium channel blockers (e.g., diltiazem), or digoxin. For acute rate control in hemodynamically
stable patients, IV diltiazem or metoprolol are first-line agents. Atropine is used for bradycardia, not tachycardia.
Q16. A patient with new-onset atrial fibrillation is being evaluated for stroke risk. Which assessment tool is
used to estimate the annual stroke risk and guide anticoagulation therapy?
A) Glasgow Coma Scale B) APGAR score C) SOFA score D) CHA2DS2-VASc score
Correct Answer: D
Rationale: The CHA2DS2-VASc score assesses stroke risk in patients with nonvalvular atrial fibrillation. Points
are assigned for Congestive heart failure, Hypertension, Age ≥75 (2 points), Diabetes, Stroke/TIA history (2
points), Vascular disease, Age 65–74, and Sex category (female). A score of 2 or higher in men or 3 or higher in
women warrants anticoagulation.
4
