West Coast University NURS 480 (West
Coast University) Advanced Medical-Surgical
Nursing Final Exam Review | Comprehensive
Practice Questions & Study Guide
(2025/2026 Update)
WEST COAST UNIVERSITY — NURS 480
Advanced Medical-Surgical Nursing Final Exam Review
Comprehensive Practice Questions & Study Guide (2025/2026 Update)
• This study guide contains 200 high-yield practice questions covering all major
Advanced Med-Surg topics — use it by attempting each question independently
before revealing the correct answer and EXPERT RATIONALE below it.
• Each question features five answer options (A–E), a bolded correct answer with
EXPERT RATIONALE, designed to mirror the critical-thinking style of your actual
final exam.
SECTION 1: CARDIOVASCULAR SYSTEM
1. A patient with heart failure has a BNP level of 850 pg/mL. Which nursing
intervention is the PRIORITY?
A. Encourage oral fluid intake to maintain hydration
B. Place the patient in Trendelenburg position
C. Administer a bolus of normal saline IV
D. Prepare the patient for immediate surgery
E. Administer prescribed diuretics and monitor urine output
Correct Answer: E. Administer prescribed diuretics and monitor urine output
, EXPERT RATIONALE: An elevated BNP indicates significant cardiac stress and
fluid overload. The priority intervention is administering diuretics to reduce preload
and monitoring output to assess effectiveness.
2. A nurse is caring for a patient on a heparin drip for deep vein thrombosis.
The aPTT result is 120 seconds. What is the MOST appropriate action?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Continue the current infusion rate without changes
C. Hold the heparin infusion and notify the provider
D. Administer protamine sulfate immediately
E. Switch the patient to oral warfarin right away
Correct Answer: C. Hold the heparin infusion and notify the provider
EXPERT RATIONALE: The therapeutic aPTT range for heparin is 60–100
seconds. An aPTT of 120 seconds indicates supratherapeutic anticoagulation and
bleeding risk; the infusion should be held and the provider notified.
3. A patient presents with crushing chest pain radiating to the left arm,
diaphoresis, and nausea. The 12-lead ECG shows ST elevation in leads II, III,
and aVF. Which artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Left main coronary artery
D. Right marginal artery
E. Right coronary artery
Correct Answer: E. Right coronary artery
, EXPERT RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior
wall MI, which is most commonly caused by occlusion of the right coronary artery
(RCA).
4. A nurse is preparing to administer digoxin to a patient with atrial
fibrillation. Which assessment finding requires the nurse to HOLD the
medication?
A. Blood pressure of 138/86 mmHg
B. Respiratory rate of 18 breaths/min
C. Apical pulse of 54 beats per minute
D. Serum sodium of 138 mEq/L
E. Temperature of 37.2°C
Correct Answer: C. Apical pulse of 54 beats per minute
EXPERT RATIONALE: Digoxin should be held if the apical pulse is below 60 bpm,
as it slows conduction through the AV node and can cause life-threatening
bradycardia.
5. Which electrolyte imbalance MOST increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypermagnesemia
C. Hypokalemia
D. Hypercalcemia
E. Hyperphosphatemia
Correct Answer: C. Hypokalemia
EXPERT RATIONALE: Low potassium levels potentiate digoxin toxicity by
increasing digoxin binding to myocardial cells, increasing the risk of dysrhythmias.
, 6. A patient in cardiogenic shock is hypotensive with a BP of 78/50 mmHg.
Which medication should the nurse anticipate administering FIRST?
A. Furosemide IV push
B. Metoprolol IV
C. Norepinephrine infusion
D. Nitroglycerin infusion
E. Diltiazem IV
Correct Answer: C. Norepinephrine infusion
EXPERT RATIONALE: Norepinephrine is the vasopressor of choice for
cardiogenic shock to restore adequate perfusion pressure. Diuretics and
vasodilators would worsen hypotension.
7. A patient with hypertension is started on lisinopril. Which side effect
should the nurse PRIORITIZE in patient education?
A. Peripheral edema
B. Bradycardia
C. Hyperglycemia
D. Dry persistent cough
E. Increased urine output
Correct Answer: D. Dry persistent cough
EXPERT RATIONALE: ACE inhibitors like lisinopril commonly cause a dry,
persistent cough due to bradykinin accumulation. Patients should be educated to
report this and may need to be switched to an ARB.
Coast University) Advanced Medical-Surgical
Nursing Final Exam Review | Comprehensive
Practice Questions & Study Guide
(2025/2026 Update)
WEST COAST UNIVERSITY — NURS 480
Advanced Medical-Surgical Nursing Final Exam Review
Comprehensive Practice Questions & Study Guide (2025/2026 Update)
• This study guide contains 200 high-yield practice questions covering all major
Advanced Med-Surg topics — use it by attempting each question independently
before revealing the correct answer and EXPERT RATIONALE below it.
• Each question features five answer options (A–E), a bolded correct answer with
EXPERT RATIONALE, designed to mirror the critical-thinking style of your actual
final exam.
SECTION 1: CARDIOVASCULAR SYSTEM
1. A patient with heart failure has a BNP level of 850 pg/mL. Which nursing
intervention is the PRIORITY?
A. Encourage oral fluid intake to maintain hydration
B. Place the patient in Trendelenburg position
C. Administer a bolus of normal saline IV
D. Prepare the patient for immediate surgery
E. Administer prescribed diuretics and monitor urine output
Correct Answer: E. Administer prescribed diuretics and monitor urine output
, EXPERT RATIONALE: An elevated BNP indicates significant cardiac stress and
fluid overload. The priority intervention is administering diuretics to reduce preload
and monitoring output to assess effectiveness.
2. A nurse is caring for a patient on a heparin drip for deep vein thrombosis.
The aPTT result is 120 seconds. What is the MOST appropriate action?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Continue the current infusion rate without changes
C. Hold the heparin infusion and notify the provider
D. Administer protamine sulfate immediately
E. Switch the patient to oral warfarin right away
Correct Answer: C. Hold the heparin infusion and notify the provider
EXPERT RATIONALE: The therapeutic aPTT range for heparin is 60–100
seconds. An aPTT of 120 seconds indicates supratherapeutic anticoagulation and
bleeding risk; the infusion should be held and the provider notified.
3. A patient presents with crushing chest pain radiating to the left arm,
diaphoresis, and nausea. The 12-lead ECG shows ST elevation in leads II, III,
and aVF. Which artery is MOST likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Left main coronary artery
D. Right marginal artery
E. Right coronary artery
Correct Answer: E. Right coronary artery
, EXPERT RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior
wall MI, which is most commonly caused by occlusion of the right coronary artery
(RCA).
4. A nurse is preparing to administer digoxin to a patient with atrial
fibrillation. Which assessment finding requires the nurse to HOLD the
medication?
A. Blood pressure of 138/86 mmHg
B. Respiratory rate of 18 breaths/min
C. Apical pulse of 54 beats per minute
D. Serum sodium of 138 mEq/L
E. Temperature of 37.2°C
Correct Answer: C. Apical pulse of 54 beats per minute
EXPERT RATIONALE: Digoxin should be held if the apical pulse is below 60 bpm,
as it slows conduction through the AV node and can cause life-threatening
bradycardia.
5. Which electrolyte imbalance MOST increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypermagnesemia
C. Hypokalemia
D. Hypercalcemia
E. Hyperphosphatemia
Correct Answer: C. Hypokalemia
EXPERT RATIONALE: Low potassium levels potentiate digoxin toxicity by
increasing digoxin binding to myocardial cells, increasing the risk of dysrhythmias.
, 6. A patient in cardiogenic shock is hypotensive with a BP of 78/50 mmHg.
Which medication should the nurse anticipate administering FIRST?
A. Furosemide IV push
B. Metoprolol IV
C. Norepinephrine infusion
D. Nitroglycerin infusion
E. Diltiazem IV
Correct Answer: C. Norepinephrine infusion
EXPERT RATIONALE: Norepinephrine is the vasopressor of choice for
cardiogenic shock to restore adequate perfusion pressure. Diuretics and
vasodilators would worsen hypotension.
7. A patient with hypertension is started on lisinopril. Which side effect
should the nurse PRIORITIZE in patient education?
A. Peripheral edema
B. Bradycardia
C. Hyperglycemia
D. Dry persistent cough
E. Increased urine output
Correct Answer: D. Dry persistent cough
EXPERT RATIONALE: ACE inhibitors like lisinopril commonly cause a dry,
persistent cough due to bradykinin accumulation. Patients should be educated to
report this and may need to be switched to an ARB.
