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“2025 Lewis’s Medical-Surgical Nursing NGN
Test Bank | Verified A+ Questions & Answers |
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Question 1 – Heart Failure Exacerbation (NGN, Med-Surg)
A 68-year-old client with chronic systolic heart failure (HFrEF) and
hypertension is admitted to the medical-surgical unit with progressive
shortness of breath, fatigue, and bilateral leg swelling. The client is
dyspneic at rest, has fine crackles in both lung bases, and 2+ pitting
edema in both lower extremities.
Vital signs:
BP 164/92 mmHg
HR 116 bpm
RR 28/min
SpO₂ 86% on room air
Labs: BNP 1,420 pg/mL (normal <100), K⁺ 3.1 mEq/L, Na⁺ 138 mEq/L.
Current medications: IV furosemide 40 mg BID, lisinopril 10 mg daily,
metoprolol 50 mg BID.
The client states:
"I took my water pill this morning, but my swelling and breathing feel
worse. I feel so weak."
Which nursing interventions are the highest priority at this time?
(Select 2 that apply)
, 2
A. Place the client in high Fowler’s position and apply 2 L/min oxygen
B. Administer the next IV dose of furosemide immediately
C. Call the provider to report hypokalemia before giving additional diuretics
D. Place the client in Trendelenburg position to improve cerebral perfusion
E. Restrict oral fluids to 500 mL/24 hr to prevent further fluid overload
✅ Correct Answers: A and C
Rationale:
A. Elevating HOB and applying oxygen immediately improves gas
exchange and relieves dyspnea in pulmonary congestion.
C. Hypokalemia must be corrected before additional loop diuretics
because it increases the risk for life-threatening arrhythmias.
B. Giving furosemide before correcting K⁺ can worsen hypokalemia
and arrhythmias.
D. Trendelenburg worsens pulmonary congestion and is
contraindicated.
E. Fluid restriction may be implemented later but is not the
immediate priority.
Question 2 – Diabetic Ketoacidosis (DKA, NGN, Endocrine)
A 23-year-old client with type 1 diabetes mellitus presents to the
emergency department with nausea, vomiting, abdominal pain, and
polyuria for 2 days. The client reports missing multiple insulin doses. On
assessment:
Dry mucous membranes, Kussmaul respirations, fruity odor to
breath
BP 88/54 mmHg, HR 130 bpm, RR 34/min, Temp 100.4°F (38°C)
Capillary glucose 510 mg/dL
, 3
Labs: Na⁺ 130 mEq/L, K⁺ 5.8 mEq/L, pH 7.12, HCO₃ 9 mEq/L,
positive serum ketones
Provider orders:
0.9% NS 1 L/hr IV
IV regular insulin continuous infusion
Cardiac monitoring
Which nursing actions are priority before initiating insulin therapy?
(Select 2 that apply)
A. Begin IV fluid resuscitation with 0.9% NS at 1 L/hr
B. Administer IV insulin immediately to reduce blood glucose
C. Place the client on continuous cardiac monitoring
D. Prepare IV potassium replacement for administration
E. Insert a nasogastric tube to decompress the stomach
✅ Correct Answers: A and C
Rationale:
A. Restoring intravascular volume is the first priority to prevent
shock and improve perfusion.
C. Hyperkalemia and acidosis increase the risk for lethal
arrhythmias, so cardiac monitoring is essential before insulin
therapy.
B. Insulin should not be started before initial fluid resuscitation; rapid
glucose drop without fluids may cause vascular collapse.
D. Potassium replacement may be required once insulin shifts K⁺ into
cells, but not before insulin is started.
E. NG decompression is unnecessary unless vomiting is severe or
ileus develops.
Question 3 – Pulmonary Embolism (Respiratory, NGN)
, 4
A 56-year-old post-operative client (hip replacement 3 days ago) suddenly
develops acute shortness of breath and chest pain. The client is anxious,
diaphoretic, and tachypneic.
Vital signs:
BP 90/58 mmHg
HR 132 bpm
RR 36/min
SpO₂ 82% on 6 L NC
Physical exam: jugular venous distention, clear lungs bilaterally, and
tachycardia.
The client has a history of obesity, hypertension, and deep vein
thrombosis (DVT).
Which nursing interventions are most critical at this time? (Select 2 that
apply)
A. Administer high-flow oxygen via non-rebreather mask
B. Prepare to administer subcutaneous heparin 5,000 units
C. Notify the rapid response team or provider immediately
D. Place the client in Trendelenburg position
E. Encourage the client to ambulate to improve perfusion
✅ Correct Answers: A and C
Rationale:
A. High-flow oxygen corrects hypoxemia and is the first priority in a
suspected PE.
C. Acute deterioration with hypotension and hypoxia requires rapid
response activation for advanced interventions (thrombolytics or
ICU transfer).
“2025 Lewis’s Medical-Surgical Nursing NGN
Test Bank | Verified A+ Questions & Answers |
Pass NCLEX Guaranteed”
Question 1 – Heart Failure Exacerbation (NGN, Med-Surg)
A 68-year-old client with chronic systolic heart failure (HFrEF) and
hypertension is admitted to the medical-surgical unit with progressive
shortness of breath, fatigue, and bilateral leg swelling. The client is
dyspneic at rest, has fine crackles in both lung bases, and 2+ pitting
edema in both lower extremities.
Vital signs:
BP 164/92 mmHg
HR 116 bpm
RR 28/min
SpO₂ 86% on room air
Labs: BNP 1,420 pg/mL (normal <100), K⁺ 3.1 mEq/L, Na⁺ 138 mEq/L.
Current medications: IV furosemide 40 mg BID, lisinopril 10 mg daily,
metoprolol 50 mg BID.
The client states:
"I took my water pill this morning, but my swelling and breathing feel
worse. I feel so weak."
Which nursing interventions are the highest priority at this time?
(Select 2 that apply)
, 2
A. Place the client in high Fowler’s position and apply 2 L/min oxygen
B. Administer the next IV dose of furosemide immediately
C. Call the provider to report hypokalemia before giving additional diuretics
D. Place the client in Trendelenburg position to improve cerebral perfusion
E. Restrict oral fluids to 500 mL/24 hr to prevent further fluid overload
✅ Correct Answers: A and C
Rationale:
A. Elevating HOB and applying oxygen immediately improves gas
exchange and relieves dyspnea in pulmonary congestion.
C. Hypokalemia must be corrected before additional loop diuretics
because it increases the risk for life-threatening arrhythmias.
B. Giving furosemide before correcting K⁺ can worsen hypokalemia
and arrhythmias.
D. Trendelenburg worsens pulmonary congestion and is
contraindicated.
E. Fluid restriction may be implemented later but is not the
immediate priority.
Question 2 – Diabetic Ketoacidosis (DKA, NGN, Endocrine)
A 23-year-old client with type 1 diabetes mellitus presents to the
emergency department with nausea, vomiting, abdominal pain, and
polyuria for 2 days. The client reports missing multiple insulin doses. On
assessment:
Dry mucous membranes, Kussmaul respirations, fruity odor to
breath
BP 88/54 mmHg, HR 130 bpm, RR 34/min, Temp 100.4°F (38°C)
Capillary glucose 510 mg/dL
, 3
Labs: Na⁺ 130 mEq/L, K⁺ 5.8 mEq/L, pH 7.12, HCO₃ 9 mEq/L,
positive serum ketones
Provider orders:
0.9% NS 1 L/hr IV
IV regular insulin continuous infusion
Cardiac monitoring
Which nursing actions are priority before initiating insulin therapy?
(Select 2 that apply)
A. Begin IV fluid resuscitation with 0.9% NS at 1 L/hr
B. Administer IV insulin immediately to reduce blood glucose
C. Place the client on continuous cardiac monitoring
D. Prepare IV potassium replacement for administration
E. Insert a nasogastric tube to decompress the stomach
✅ Correct Answers: A and C
Rationale:
A. Restoring intravascular volume is the first priority to prevent
shock and improve perfusion.
C. Hyperkalemia and acidosis increase the risk for lethal
arrhythmias, so cardiac monitoring is essential before insulin
therapy.
B. Insulin should not be started before initial fluid resuscitation; rapid
glucose drop without fluids may cause vascular collapse.
D. Potassium replacement may be required once insulin shifts K⁺ into
cells, but not before insulin is started.
E. NG decompression is unnecessary unless vomiting is severe or
ileus develops.
Question 3 – Pulmonary Embolism (Respiratory, NGN)
, 4
A 56-year-old post-operative client (hip replacement 3 days ago) suddenly
develops acute shortness of breath and chest pain. The client is anxious,
diaphoretic, and tachypneic.
Vital signs:
BP 90/58 mmHg
HR 132 bpm
RR 36/min
SpO₂ 82% on 6 L NC
Physical exam: jugular venous distention, clear lungs bilaterally, and
tachycardia.
The client has a history of obesity, hypertension, and deep vein
thrombosis (DVT).
Which nursing interventions are most critical at this time? (Select 2 that
apply)
A. Administer high-flow oxygen via non-rebreather mask
B. Prepare to administer subcutaneous heparin 5,000 units
C. Notify the rapid response team or provider immediately
D. Place the client in Trendelenburg position
E. Encourage the client to ambulate to improve perfusion
✅ Correct Answers: A and C
Rationale:
A. High-flow oxygen corrects hypoxemia and is the first priority in a
suspected PE.
C. Acute deterioration with hypotension and hypoxia requires rapid
response activation for advanced interventions (thrombolytics or
ICU transfer).
