NURS 480: ADVANCED NURSING CONCEPTS & LEADERSHIP 2026/2027 |
100% VERIFIED EXAM QUESTIONS AND EXPLAINED ANSWERS | LATEST
CRITICAL CARE & MANAGEMENT PROTOCOLS
1. A nurse is preparing to administer digoxin to a patient with heart failure. Which
assessment finding should prompt the nurse to withhold the medication and notify
the provider?
A. Heart rate of 68 bpm
B. Heart rate of 54 bpm
C. Blood pressure of 110/70 mmHg
D. Respiratory rate of 16 breaths/min
Correct Answer: B. Digoxin is withheld when the apical pulse is below 60
bpm in adults (below 70 in children). A heart rate of 54 bpm indicates
bradycardia and potential digoxin toxicity risk.
2. A patient receiving warfarin therapy has an INR of 4.8. Which nursing
intervention is the priority?
A. Administer the next scheduled dose as ordered
B. Withhold the dose and notify the prescriber immediately
C. Encourage increased dietary intake of vitamin K
D. Apply sequential compression devices to both legs
Correct Answer: B. A therapeutic INR for most indications is 2–3. An INR of
4.8 indicates supratherapeutic anticoagulation and significant bleeding risk;
the dose must be withheld and the provider notified.
3. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypermagnesemia
, Correct Answer: C. Hypokalemia potentiates digoxin toxicity by increasing
myocardial sensitivity to the drug. The nurse should monitor potassium levels
closely in patients on digoxin.
4. A nurse is teaching a patient about metformin therapy for type 2 diabetes. Which
instruction is most important?
A. Take the medication on an empty stomach
B. Report any muscle pain or weakness immediately
C. Expect mild hypoglycemia when beginning therapy
D. Avoid all physical activity while on this medication
Correct Answer: B. Metformin carries a rare but serious risk of lactic
acidosis, which presents with muscle pain, weakness, difficulty breathing, and
GI symptoms. Patients must report these signs immediately.
5. A patient is prescribed lisinopril for hypertension. Which side effect should the
nurse instruct the patient to report to the provider?
A. Mild headache
B. Dry, persistent cough
C. Increased urination
D. Slight ankle swelling
Correct Answer: B. ACE inhibitors such as lisinopril commonly cause a
persistent dry cough due to bradykinin accumulation. This may require a
change to an ARB if intolerable.
6. A nurse is administering IV vancomycin. The patient develops flushing,
erythema, and hypotension during the infusion. What is the most likely cause?
A. Anaphylaxis
B. Red man syndrome
C. Septicemia
D. Fluid overload
Correct Answer: B. Red man syndrome is a non-immune-mediated reaction to
rapid vancomycin infusion, characterized by flushing, erythema of the face and
neck, and hypotension. Slowing the infusion rate prevents recurrence.
,7. Which medication requires the nurse to monitor for signs of serotonin syndrome
when combined with tramadol?
A. Metoprolol
B. Sertraline
C. Metformin
D. Amlodipine
Correct Answer: B. Combining tramadol (which inhibits serotonin reuptake)
with SSRIs such as sertraline increases the risk of serotonin syndrome,
presenting with agitation, hyperthermia, diaphoresis, and tremor.
8. A patient on heparin therapy develops sudden thrombocytopenia. Which
condition should the nurse suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia (HIT)
C. Idiopathic thrombocytopenic purpura
D. Aplastic anemia
Correct Answer: B. HIT is an immune-mediated adverse reaction to heparin
that paradoxically causes thrombosis. Heparin must be discontinued
immediately and an alternative anticoagulant initiated.
9. A nurse is preparing to administer morphine to a post-operative patient. Which
assessment finding is a contraindication to administration?
A. Pain rating of 7/10
B. Respiratory rate of 8 breaths/min
C. Blood pressure of 118/76 mmHg
D. Oxygen saturation of 96%
Correct Answer: B. A respiratory rate below 12 breaths/min indicates
respiratory depression, a serious opioid side effect. Morphine should be
withheld and the provider notified immediately.
10. A patient receiving furosemide should be monitored for which electrolyte
imbalance?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
, D. Hypercalcemia
Correct Answer: C. Furosemide is a loop diuretic that causes potassium
wasting at the nephron, leading to hypokalemia. The nurse should monitor
serum potassium levels and assess for muscle cramps and cardiac
dysrhythmias.
11. A patient admitted with acute myocardial infarction (MI) suddenly develops a
heart rate of 180 bpm with a regular rhythm and narrow QRS complexes. Which
dysrhythmia is most likely?
A. Ventricular fibrillation
B. Atrial flutter
C. Supraventricular tachycardia (SVT)
D. Third-degree heart block
Correct Answer: C. SVT is characterized by a sudden onset, regular narrow-
complex tachycardia at 150–250 bpm. It originates above the bundle of His and
is common in post-MI patients.
12. Which finding on an ECG is most consistent with hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. Depressed ST segment
D. Delta waves
Correct Answer: B. Hyperkalemia produces tall, peaked (tented) T waves on
ECG. As potassium levels rise further, the QRS widens and eventually a sine-
wave pattern appears, which can progress to ventricular fibrillation.
13. A patient with heart failure has a BNP of 850 pg/mL. How should the nurse
interpret this finding?
A. Normal finding in a healthy adult
B. Indicates significant cardiac stress and volume overload
C. Suggests dehydration
D. Indicates renal failure
Correct Answer: B. BNP (B-type natriuretic peptide) is released in response
to increased ventricular wall stress. Levels above 100 pg/mL suggest heart
100% VERIFIED EXAM QUESTIONS AND EXPLAINED ANSWERS | LATEST
CRITICAL CARE & MANAGEMENT PROTOCOLS
1. A nurse is preparing to administer digoxin to a patient with heart failure. Which
assessment finding should prompt the nurse to withhold the medication and notify
the provider?
A. Heart rate of 68 bpm
B. Heart rate of 54 bpm
C. Blood pressure of 110/70 mmHg
D. Respiratory rate of 16 breaths/min
Correct Answer: B. Digoxin is withheld when the apical pulse is below 60
bpm in adults (below 70 in children). A heart rate of 54 bpm indicates
bradycardia and potential digoxin toxicity risk.
2. A patient receiving warfarin therapy has an INR of 4.8. Which nursing
intervention is the priority?
A. Administer the next scheduled dose as ordered
B. Withhold the dose and notify the prescriber immediately
C. Encourage increased dietary intake of vitamin K
D. Apply sequential compression devices to both legs
Correct Answer: B. A therapeutic INR for most indications is 2–3. An INR of
4.8 indicates supratherapeutic anticoagulation and significant bleeding risk;
the dose must be withheld and the provider notified.
3. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypermagnesemia
, Correct Answer: C. Hypokalemia potentiates digoxin toxicity by increasing
myocardial sensitivity to the drug. The nurse should monitor potassium levels
closely in patients on digoxin.
4. A nurse is teaching a patient about metformin therapy for type 2 diabetes. Which
instruction is most important?
A. Take the medication on an empty stomach
B. Report any muscle pain or weakness immediately
C. Expect mild hypoglycemia when beginning therapy
D. Avoid all physical activity while on this medication
Correct Answer: B. Metformin carries a rare but serious risk of lactic
acidosis, which presents with muscle pain, weakness, difficulty breathing, and
GI symptoms. Patients must report these signs immediately.
5. A patient is prescribed lisinopril for hypertension. Which side effect should the
nurse instruct the patient to report to the provider?
A. Mild headache
B. Dry, persistent cough
C. Increased urination
D. Slight ankle swelling
Correct Answer: B. ACE inhibitors such as lisinopril commonly cause a
persistent dry cough due to bradykinin accumulation. This may require a
change to an ARB if intolerable.
6. A nurse is administering IV vancomycin. The patient develops flushing,
erythema, and hypotension during the infusion. What is the most likely cause?
A. Anaphylaxis
B. Red man syndrome
C. Septicemia
D. Fluid overload
Correct Answer: B. Red man syndrome is a non-immune-mediated reaction to
rapid vancomycin infusion, characterized by flushing, erythema of the face and
neck, and hypotension. Slowing the infusion rate prevents recurrence.
,7. Which medication requires the nurse to monitor for signs of serotonin syndrome
when combined with tramadol?
A. Metoprolol
B. Sertraline
C. Metformin
D. Amlodipine
Correct Answer: B. Combining tramadol (which inhibits serotonin reuptake)
with SSRIs such as sertraline increases the risk of serotonin syndrome,
presenting with agitation, hyperthermia, diaphoresis, and tremor.
8. A patient on heparin therapy develops sudden thrombocytopenia. Which
condition should the nurse suspect?
A. Disseminated intravascular coagulation
B. Heparin-induced thrombocytopenia (HIT)
C. Idiopathic thrombocytopenic purpura
D. Aplastic anemia
Correct Answer: B. HIT is an immune-mediated adverse reaction to heparin
that paradoxically causes thrombosis. Heparin must be discontinued
immediately and an alternative anticoagulant initiated.
9. A nurse is preparing to administer morphine to a post-operative patient. Which
assessment finding is a contraindication to administration?
A. Pain rating of 7/10
B. Respiratory rate of 8 breaths/min
C. Blood pressure of 118/76 mmHg
D. Oxygen saturation of 96%
Correct Answer: B. A respiratory rate below 12 breaths/min indicates
respiratory depression, a serious opioid side effect. Morphine should be
withheld and the provider notified immediately.
10. A patient receiving furosemide should be monitored for which electrolyte
imbalance?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
, D. Hypercalcemia
Correct Answer: C. Furosemide is a loop diuretic that causes potassium
wasting at the nephron, leading to hypokalemia. The nurse should monitor
serum potassium levels and assess for muscle cramps and cardiac
dysrhythmias.
11. A patient admitted with acute myocardial infarction (MI) suddenly develops a
heart rate of 180 bpm with a regular rhythm and narrow QRS complexes. Which
dysrhythmia is most likely?
A. Ventricular fibrillation
B. Atrial flutter
C. Supraventricular tachycardia (SVT)
D. Third-degree heart block
Correct Answer: C. SVT is characterized by a sudden onset, regular narrow-
complex tachycardia at 150–250 bpm. It originates above the bundle of His and
is common in post-MI patients.
12. Which finding on an ECG is most consistent with hyperkalemia?
A. Prolonged QT interval
B. Peaked T waves
C. Depressed ST segment
D. Delta waves
Correct Answer: B. Hyperkalemia produces tall, peaked (tented) T waves on
ECG. As potassium levels rise further, the QRS widens and eventually a sine-
wave pattern appears, which can progress to ventricular fibrillation.
13. A patient with heart failure has a BNP of 850 pg/mL. How should the nurse
interpret this finding?
A. Normal finding in a healthy adult
B. Indicates significant cardiac stress and volume overload
C. Suggests dehydration
D. Indicates renal failure
Correct Answer: B. BNP (B-type natriuretic peptide) is released in response
to increased ventricular wall stress. Levels above 100 pg/mL suggest heart
