West Coast University NURS 480 /NURS480 Final Exam
Advanced Medical Surgical Nursing NURS 480 Final Exam
Study Guide | Advanced Med-Surg Nursing – West Coast
University (2026)
1. A 68-year-old patient with a history of heart failure is admitted with acute pulmonary edema.
After IV furosemide and nitroglycerin infusion, the patient's blood pressure drops to 82/50 mm
Hg and the heart rate rises to 118 bpm. Which action is the priority?
A. Administer a bolus of isotonic crystalloid to restore perfusion.
B. Obtain a stat electrocardiogram to rule out acute coronary syndrome.
C. Decrease or stop the nitroglycerin infusion and reassess hemodynamics.
D. Prepare for emergent intubation due to respiratory fatigue.
Answer: C. Decrease or stop the nitroglycerin infusion and reassess hemodynamics.
2. A 72-year-old patient with chronic kidney disease (stage 4) is admitted with sepsis. The
provider orders vancomycin 25 mg/kg IV. The patient's current weight is 70 kg, and serum
creatinine is 3.2 mg/dL. What is the nurse's most appropriate action?
A. Administer the full dose as ordered because the loading dose is based on weight and not renal function.
B. Consult pharmacy to adjust the dose and interval based on the patient's renal function.
C. Hold the dose until blood cultures are reported.
D. Administer the dose with a slow infusion and monitor for red man syndrome.
Answer: B. Consult pharmacy to adjust the dose and interval based on the patient's renal
function.
3. A 45-year-old patient with a severe traumatic brain injury (GCS 7) has an intraventricular
catheter. The nurse notes a sudden rise in intracranial pressure (ICP) to 32 mm Hg. Which
intervention should the nurse perform first?
A. Notify the neurosurgeon immediately.
B. Check the cerebrospinal fluid (CSF) drainage system and ensure it is set to drain at the prescribed
pressure.
C. Elevate the head of the bed to 30 degrees and ensure the neck is in a neutral position.
D. Administer a prescribed dose of mannitol if ordered.
Answer: B. Check the cerebrospinal fluid (CSF) drainage system and ensure it is set to drain at
the prescribed pressure.
4. A 58-year-old patient with type 2 diabetes is admitted with unstable angina. The cardiac
catheterization reveals a 90% lesion in the left anterior descending artery. Which medication
should the nurse question if prescribed concurrently with metformin?
A. Nitroglycerin
B. Furosemide
C. Iodinated contrast media
D. Heparin
Answer: C. Iodinated contrast media
5. A 72-year-old patient with atrial fibrillation is on warfarin. The nurse notes an INR of 6.5, and
,the patient has minor gum bleeding. The patient is not hemodynamically unstable. Which
intervention should the nurse anticipate?
A. Administer protamine sulfate IV bolus.
B. Administer vitamin K orally or subcutaneously and monitor INR.
C. Administer a dose of fresh frozen plasma immediately.
D. Administer four units of activated prothrombin complex concentrate.
Answer: B. Administer vitamin K orally or subcutaneously and monitor INR.
6. A 34-year-old asthmatic patient is admitted with acute exacerbation. The provider orders a
continuous albuterol nebulizer. The nurse notices the patient's heart rate is 150 bpm, and the
patient complains of tremor and palpitations. What is the nurse's best action?
A. Stop the nebulizer immediately and prepare to start a nonselective beta-blocker.
B. Continue the nebulizer, and reassure the patient that these are expected side effects.
C. Assess the patient's lung sounds and oxygen saturation, and notify the provider of potential systemic
beta-agonist toxicity.
D. Reduce the albuterol dose by half without notifying the provider.
Answer: C. Assess the patient's lung sounds and oxygen saturation, and notify the provider of
potential systemic beta-agonist toxicity.
7. A patient in the ICU is receiving a norepinephrine infusion at 15 mcg/min for septic shock.
The nurse notes that the patient's blood pressure is now 100/60 mm Hg but the patient is
tachycardic and has cool, clammy skin. Which assessment finding would be most concerning
for inadequate tissue perfusion?
A. Urine output of 0.5 mL/kg/hr over the last 2 hours.
B. Central venous oxygen saturation (ScvO2) of 65%.
C. Lactate level of 4.2 mmol/L.
D. Capillary refill time of 3 seconds.
Answer: C. Lactate level of 4.2 mmol/L.
8. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation with a tidal volume of 6 mL/kg ideal body weight. The plateau pressure is 32 cm
H2O, and the PaO2/FiO2 ratio is 120. Which intervention should the nurse anticipate?
A. Increase the tidal volume to 8 mL/kg to improve oxygenation.
B. Administer a neuromuscular blocking agent and prone positioning.
C. Decrease the positive end-expiratory pressure (PEEP) to minimize barotrauma.
D. Switch the ventilator to pressure-controlled mode with a pressure limit of 40 cm H2O.
Answer: B. Administer a neuromuscular blocking agent and prone positioning.
9. Which assessment finding in a post-operative patient at 4 hours after a total hip replacement
is most indicative of developing rhabdomyolysis?
A. Deep vein thrombosis (DVT) in the affected leg with a positive Homan's sign.
B. Dark brown urine and serum creatine kinase of 32,000 U/L.
C. Wound drainage that is sanguineous and 100 mL in 4 hours.
D. A temperature of 38.5°C (101.3°F) and rigors.
Answer: B. Dark brown urine and serum creatine kinase of 32,000 U/L.
10. A nurse is caring for a patient with a new colostomy. The patient expresses concern about
, odor during sexual activity. Which response is most therapeutic?
A. Reassure the patient that odor is minimal and will not be noticeable.
B. Instruct the patient to avoid eating foods that cause gas prior to intimacy.
C. Acknowledge the concern and suggest ways to manage odor, such as using an odor-proof pouch and
emptying the colostomy before intimacy.
D. Tell the patient to talk to their provider about getting a pouch that can be removed for sexual activity.
Answer: C. Acknowledge the concern and suggest ways to manage odor, such as using an
odor-proof pouch and emptying the colostomy before intimacy.
11. A 65-year-old patient with sepsis is in the ICU. The nurse reviews the medication
administration record and notes that the patient is on an insulin drip. Which condition would
necessitate a decrease in the insulin infusion rate?
A. The patient's blood glucose is 250 mg/dL with a trend downward.
B. The patient is receiving continuous renal replacement therapy (CRRT).
C. The patient's temperature has increased from 38°C to 40°C.
D. The patient is receiving norepinephrine, which increases insulin resistance.
Answer: A. The patient's blood glucose is 250 mg/dL with a trend downward.
12. A patient with a history of coronary artery disease is prescribed sildenafil (Viagra) for
erectile dysfunction. Which medication should the nurse warn the patient to avoid?
A. Aspirin
B. Lisinopril
C. Isosorbide mononitrate
D. Atorvastatin
Answer: C. Isosorbide mononitrate
13. In a patient with diabetic ketoacidosis (DKA), which electrolyte replacement is most critical
to prevent life-threatening arrhythmias?
A. Potassium chloride
B. Sodium bicarbonate
C. Magnesium sulfate
D. Calcium gluconate
Answer: A. Potassium chloride
14. The nurse is evaluating the effectiveness of IV pantoprazole in a patient with a
gastrointestinal bleed. Which assessment indicates the medication is working?
A. Absence of hematochezia for 8 hours.
B. Gastric pH is 5 or above.
C. Hemoglobin is stable at 8.2 g/dL.
D. The patient reports less abdominal pain.
Answer: B. Gastric pH is 5 or above.
15. A patient with a new ileostomy has output of 1200 mL over the past 12 hours. Which
assessment is most concerning?
A. Serum sodium of 134 mEq/L.
B. Urine output of 30 mL/hr.
C. Weight loss of 0.5 kg since yesterday.
Advanced Medical Surgical Nursing NURS 480 Final Exam
Study Guide | Advanced Med-Surg Nursing – West Coast
University (2026)
1. A 68-year-old patient with a history of heart failure is admitted with acute pulmonary edema.
After IV furosemide and nitroglycerin infusion, the patient's blood pressure drops to 82/50 mm
Hg and the heart rate rises to 118 bpm. Which action is the priority?
A. Administer a bolus of isotonic crystalloid to restore perfusion.
B. Obtain a stat electrocardiogram to rule out acute coronary syndrome.
C. Decrease or stop the nitroglycerin infusion and reassess hemodynamics.
D. Prepare for emergent intubation due to respiratory fatigue.
Answer: C. Decrease or stop the nitroglycerin infusion and reassess hemodynamics.
2. A 72-year-old patient with chronic kidney disease (stage 4) is admitted with sepsis. The
provider orders vancomycin 25 mg/kg IV. The patient's current weight is 70 kg, and serum
creatinine is 3.2 mg/dL. What is the nurse's most appropriate action?
A. Administer the full dose as ordered because the loading dose is based on weight and not renal function.
B. Consult pharmacy to adjust the dose and interval based on the patient's renal function.
C. Hold the dose until blood cultures are reported.
D. Administer the dose with a slow infusion and monitor for red man syndrome.
Answer: B. Consult pharmacy to adjust the dose and interval based on the patient's renal
function.
3. A 45-year-old patient with a severe traumatic brain injury (GCS 7) has an intraventricular
catheter. The nurse notes a sudden rise in intracranial pressure (ICP) to 32 mm Hg. Which
intervention should the nurse perform first?
A. Notify the neurosurgeon immediately.
B. Check the cerebrospinal fluid (CSF) drainage system and ensure it is set to drain at the prescribed
pressure.
C. Elevate the head of the bed to 30 degrees and ensure the neck is in a neutral position.
D. Administer a prescribed dose of mannitol if ordered.
Answer: B. Check the cerebrospinal fluid (CSF) drainage system and ensure it is set to drain at
the prescribed pressure.
4. A 58-year-old patient with type 2 diabetes is admitted with unstable angina. The cardiac
catheterization reveals a 90% lesion in the left anterior descending artery. Which medication
should the nurse question if prescribed concurrently with metformin?
A. Nitroglycerin
B. Furosemide
C. Iodinated contrast media
D. Heparin
Answer: C. Iodinated contrast media
5. A 72-year-old patient with atrial fibrillation is on warfarin. The nurse notes an INR of 6.5, and
,the patient has minor gum bleeding. The patient is not hemodynamically unstable. Which
intervention should the nurse anticipate?
A. Administer protamine sulfate IV bolus.
B. Administer vitamin K orally or subcutaneously and monitor INR.
C. Administer a dose of fresh frozen plasma immediately.
D. Administer four units of activated prothrombin complex concentrate.
Answer: B. Administer vitamin K orally or subcutaneously and monitor INR.
6. A 34-year-old asthmatic patient is admitted with acute exacerbation. The provider orders a
continuous albuterol nebulizer. The nurse notices the patient's heart rate is 150 bpm, and the
patient complains of tremor and palpitations. What is the nurse's best action?
A. Stop the nebulizer immediately and prepare to start a nonselective beta-blocker.
B. Continue the nebulizer, and reassure the patient that these are expected side effects.
C. Assess the patient's lung sounds and oxygen saturation, and notify the provider of potential systemic
beta-agonist toxicity.
D. Reduce the albuterol dose by half without notifying the provider.
Answer: C. Assess the patient's lung sounds and oxygen saturation, and notify the provider of
potential systemic beta-agonist toxicity.
7. A patient in the ICU is receiving a norepinephrine infusion at 15 mcg/min for septic shock.
The nurse notes that the patient's blood pressure is now 100/60 mm Hg but the patient is
tachycardic and has cool, clammy skin. Which assessment finding would be most concerning
for inadequate tissue perfusion?
A. Urine output of 0.5 mL/kg/hr over the last 2 hours.
B. Central venous oxygen saturation (ScvO2) of 65%.
C. Lactate level of 4.2 mmol/L.
D. Capillary refill time of 3 seconds.
Answer: C. Lactate level of 4.2 mmol/L.
8. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled
ventilation with a tidal volume of 6 mL/kg ideal body weight. The plateau pressure is 32 cm
H2O, and the PaO2/FiO2 ratio is 120. Which intervention should the nurse anticipate?
A. Increase the tidal volume to 8 mL/kg to improve oxygenation.
B. Administer a neuromuscular blocking agent and prone positioning.
C. Decrease the positive end-expiratory pressure (PEEP) to minimize barotrauma.
D. Switch the ventilator to pressure-controlled mode with a pressure limit of 40 cm H2O.
Answer: B. Administer a neuromuscular blocking agent and prone positioning.
9. Which assessment finding in a post-operative patient at 4 hours after a total hip replacement
is most indicative of developing rhabdomyolysis?
A. Deep vein thrombosis (DVT) in the affected leg with a positive Homan's sign.
B. Dark brown urine and serum creatine kinase of 32,000 U/L.
C. Wound drainage that is sanguineous and 100 mL in 4 hours.
D. A temperature of 38.5°C (101.3°F) and rigors.
Answer: B. Dark brown urine and serum creatine kinase of 32,000 U/L.
10. A nurse is caring for a patient with a new colostomy. The patient expresses concern about
, odor during sexual activity. Which response is most therapeutic?
A. Reassure the patient that odor is minimal and will not be noticeable.
B. Instruct the patient to avoid eating foods that cause gas prior to intimacy.
C. Acknowledge the concern and suggest ways to manage odor, such as using an odor-proof pouch and
emptying the colostomy before intimacy.
D. Tell the patient to talk to their provider about getting a pouch that can be removed for sexual activity.
Answer: C. Acknowledge the concern and suggest ways to manage odor, such as using an
odor-proof pouch and emptying the colostomy before intimacy.
11. A 65-year-old patient with sepsis is in the ICU. The nurse reviews the medication
administration record and notes that the patient is on an insulin drip. Which condition would
necessitate a decrease in the insulin infusion rate?
A. The patient's blood glucose is 250 mg/dL with a trend downward.
B. The patient is receiving continuous renal replacement therapy (CRRT).
C. The patient's temperature has increased from 38°C to 40°C.
D. The patient is receiving norepinephrine, which increases insulin resistance.
Answer: A. The patient's blood glucose is 250 mg/dL with a trend downward.
12. A patient with a history of coronary artery disease is prescribed sildenafil (Viagra) for
erectile dysfunction. Which medication should the nurse warn the patient to avoid?
A. Aspirin
B. Lisinopril
C. Isosorbide mononitrate
D. Atorvastatin
Answer: C. Isosorbide mononitrate
13. In a patient with diabetic ketoacidosis (DKA), which electrolyte replacement is most critical
to prevent life-threatening arrhythmias?
A. Potassium chloride
B. Sodium bicarbonate
C. Magnesium sulfate
D. Calcium gluconate
Answer: A. Potassium chloride
14. The nurse is evaluating the effectiveness of IV pantoprazole in a patient with a
gastrointestinal bleed. Which assessment indicates the medication is working?
A. Absence of hematochezia for 8 hours.
B. Gastric pH is 5 or above.
C. Hemoglobin is stable at 8.2 g/dL.
D. The patient reports less abdominal pain.
Answer: B. Gastric pH is 5 or above.
15. A patient with a new ileostomy has output of 1200 mL over the past 12 hours. Which
assessment is most concerning?
A. Serum sodium of 134 mEq/L.
B. Urine output of 30 mL/hr.
C. Weight loss of 0.5 kg since yesterday.
