LEWIS'S MEDICAL-SURGICAL NURSING
IN CANADA, 5TH EDITION LATEST
UPDATE 2026
Section 1: Cardiovascular Disorders
1. A patient with heart failure is prescribed furosemide. Which
assessment finding is most important to report to the healthcare
provider?
a) Weight loss of 1 kg in 24 hours
b) Serum potassium 3.2 mEq/L
c) Blood pressure 110/70 mmHg
d) Urine output 40 mL/hour
Answer: b) Serum potassium 3.2 mEq/L
Rationale: Hypokalemia (normal 3.5–5.0) increases risk of
dysrhythmias, especially with digoxin use. Weight loss of 1 kg/day is
expected; BP and urine output are acceptable.
2. A patient with angina reports chest pain unrelieved by
nitroglycerin after 3 doses. What should the nurse do first?
a) Administer aspirin 160 mg
b) Repeat nitroglycerin in 10 minutes
,c) Activate emergency response system
d) Apply oxygen at 2 L/min
Answer: c) Activate emergency response system
Rationale: Unrelieved chest pain with nitroglycerin suggests possible
myocardial infarction; emergency care is priority. Aspirin and O2 are
important but follow activation.
3. Post-cardiac catheterization, the patient’s groin site shows a
growing hematoma. What is the priority action?
a) Apply manual pressure 1 inch above the site
b) Mark the hematoma borders and reassess in 15 minutes
c) Elevate the head of bed to 45 degrees
d) Encourage leg movement to promote circulation
Answer: a) Apply manual pressure 1 inch above the site
Rationale: Growing hematoma indicates possible arterial bleed; direct
pressure above the puncture site controls bleeding. Elevation or
movement may worsen bleeding.
Section 2: Respiratory Disorders
4. A patient with COPD has an oxygen saturation of 88% on room
air. The nurse should first:
a) Increase oxygen to 4 L/min via nasal cannula
b) Encourage pursed-lip breathing
c) Obtain an arterial blood gas
d) Position patient in high Fowler’s
,Answer: b) Encourage pursed-lip breathing
Rationale: Pursed-lip breathing improves gas exchange and reduces
air trapping. High O2 can suppress hypoxic drive; ABG may be needed
but not first action.
5. Which finding in a patient with pneumonia indicates a need for
immediate intervention?
a) Temperature 38.9°C
b) Productive cough with green sputum
c) Respiratory rate 32 breaths/min and confused
d) Crackles in left lower lobe
Answer: c) Respiratory rate 32 breaths/min and confused
Rationale: Tachypnea and confusion suggest hypoxemia or sepsis;
requires urgent assessment and possibly O2 or ventilation.
Section 3: Renal and Urinary Disorders
6. A patient on hemodialysis reports severe headache, nausea, and
blurred vision. What complication should the nurse suspect?
a) Disequilibrium syndrome
b) Air embolism
c) Hepatitis B infection
d) Hemolysis
Answer: a) Disequilibrium syndrome
Rationale: Rapid removal of urea causes cerebral edema; symptoms
, include headache, nausea, vision changes. Common early in dialysis or
after missed treatments.
7. Post-renal transplant, which lab finding suggests acute
rejection?
a) Serum creatinine 150 µmol/L (baseline 90)
b) Blood glucose 11 mmol/L
c) Hemoglobin 105 g/L
d) Urine output 2000 mL/day
Answer: a) Serum creatinine 150 µmol/L (baseline 90)
Rationale: Rising creatinine indicates kidney dysfunction; acute
rejection is a primary concern post-transplant.
Section 4: Neurological Disorders
8. A patient with a right-sided stroke has difficulty dressing the
left arm. Which term describes this deficit?
a) Aphasia
b) Apraxia
c) Agnosia
d) Hemianopsia
Answer: b) Apraxia
Rationale: Apraxia = inability to perform learned motor tasks despite
intact motor function. Agnosia = inability to recognize objects;
hemianopsia = visual field loss.
IN CANADA, 5TH EDITION LATEST
UPDATE 2026
Section 1: Cardiovascular Disorders
1. A patient with heart failure is prescribed furosemide. Which
assessment finding is most important to report to the healthcare
provider?
a) Weight loss of 1 kg in 24 hours
b) Serum potassium 3.2 mEq/L
c) Blood pressure 110/70 mmHg
d) Urine output 40 mL/hour
Answer: b) Serum potassium 3.2 mEq/L
Rationale: Hypokalemia (normal 3.5–5.0) increases risk of
dysrhythmias, especially with digoxin use. Weight loss of 1 kg/day is
expected; BP and urine output are acceptable.
2. A patient with angina reports chest pain unrelieved by
nitroglycerin after 3 doses. What should the nurse do first?
a) Administer aspirin 160 mg
b) Repeat nitroglycerin in 10 minutes
,c) Activate emergency response system
d) Apply oxygen at 2 L/min
Answer: c) Activate emergency response system
Rationale: Unrelieved chest pain with nitroglycerin suggests possible
myocardial infarction; emergency care is priority. Aspirin and O2 are
important but follow activation.
3. Post-cardiac catheterization, the patient’s groin site shows a
growing hematoma. What is the priority action?
a) Apply manual pressure 1 inch above the site
b) Mark the hematoma borders and reassess in 15 minutes
c) Elevate the head of bed to 45 degrees
d) Encourage leg movement to promote circulation
Answer: a) Apply manual pressure 1 inch above the site
Rationale: Growing hematoma indicates possible arterial bleed; direct
pressure above the puncture site controls bleeding. Elevation or
movement may worsen bleeding.
Section 2: Respiratory Disorders
4. A patient with COPD has an oxygen saturation of 88% on room
air. The nurse should first:
a) Increase oxygen to 4 L/min via nasal cannula
b) Encourage pursed-lip breathing
c) Obtain an arterial blood gas
d) Position patient in high Fowler’s
,Answer: b) Encourage pursed-lip breathing
Rationale: Pursed-lip breathing improves gas exchange and reduces
air trapping. High O2 can suppress hypoxic drive; ABG may be needed
but not first action.
5. Which finding in a patient with pneumonia indicates a need for
immediate intervention?
a) Temperature 38.9°C
b) Productive cough with green sputum
c) Respiratory rate 32 breaths/min and confused
d) Crackles in left lower lobe
Answer: c) Respiratory rate 32 breaths/min and confused
Rationale: Tachypnea and confusion suggest hypoxemia or sepsis;
requires urgent assessment and possibly O2 or ventilation.
Section 3: Renal and Urinary Disorders
6. A patient on hemodialysis reports severe headache, nausea, and
blurred vision. What complication should the nurse suspect?
a) Disequilibrium syndrome
b) Air embolism
c) Hepatitis B infection
d) Hemolysis
Answer: a) Disequilibrium syndrome
Rationale: Rapid removal of urea causes cerebral edema; symptoms
, include headache, nausea, vision changes. Common early in dialysis or
after missed treatments.
7. Post-renal transplant, which lab finding suggests acute
rejection?
a) Serum creatinine 150 µmol/L (baseline 90)
b) Blood glucose 11 mmol/L
c) Hemoglobin 105 g/L
d) Urine output 2000 mL/day
Answer: a) Serum creatinine 150 µmol/L (baseline 90)
Rationale: Rising creatinine indicates kidney dysfunction; acute
rejection is a primary concern post-transplant.
Section 4: Neurological Disorders
8. A patient with a right-sided stroke has difficulty dressing the
left arm. Which term describes this deficit?
a) Aphasia
b) Apraxia
c) Agnosia
d) Hemianopsia
Answer: b) Apraxia
Rationale: Apraxia = inability to perform learned motor tasks despite
intact motor function. Agnosia = inability to recognize objects;
hemianopsia = visual field loss.
