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 72-year-old patient with a history of chronic heart failure is admitted with acute pulmonary
edema. The nurse notes the patient is anxious, diaphoretic, and has a BP of 160/90, HR 118,
and SpO2 88% on room air. Which intervention is the nurse's priority?
A. Prepare to administer IV nitroglycerin as ordered.
B. Assist the patient to a high Fowler's position and apply oxygen.
C. Obtain a 12-lead ECG.
D. Administer IV furosemide as ordered.
Answer: B. Assist the patient to a high Fowler's position and apply oxygen.
2. A patient with sepsis develops new-onset atrial fibrillation with rapid ventricular response.
The nurse is preparing to administer IV amiodarone. Which assessment finding is most
concerning and requires immediate action?
A. Blood pressure 90/60 mmHg
B. Serum potassium 3.8 mEq/L
C. QT interval 480 ms
D. Respiratory rate 20 breaths/min
Answer: C. QT interval 480 ms
3. A patient with acute pancreatitis is receiving total parenteral nutrition (TPN). The nurse
monitors for refeeding syndrome. Which laboratory value is most important to assess?
A. Serum potassium
B. Serum magnesium
C. Serum phosphorus
D. Serum glucose
Answer: C. Serum phosphorus
4. A patient with a history of heart failure and renal insufficiency presents with dyspnea, jugular
vein distention, and 2+ pitting edema. The primary healthcare provider prescribes furosemide
80 mg IV. Which parameter should the nurse monitor to assess the drug's effectiveness?
A. Serum potassium levels
B. Daily weight and urine output
C. Blood pressure and heart rate
D. Serum creatinine levels
Answer: B. Daily weight and urine output
5. A patient with acute chest pain is diagnosed with ST-elevation myocardial infarction (STEMI).
Which intervention should the nurse anticipate as the priority?
A. Administer sublingual nitroglycerin every 5 minutes for up to 3 doses.
B. Administer aspirin 324 mg chewed immediately.
C. Prepare for primary percutaneous coronary intervention (PCI) within 90 minutes of arrival.
, D. Administer IV opioids for pain relief.
Answer: C. Prepare for primary percutaneous coronary intervention (PCI) within 90 minutes of
arrival.
6. A patient with aortic stenosis is scheduled for valve replacement surgery. Preoperatively, the
nurse notes the patient has a heart rate of 52 bpm and complains of dizziness. What is the
nurse's best action?
A. Document the findings and continue with the surgical preparation.
B. Administer atropine as ordered for bradycardia.
C. Notify the healthcare provider immediately and hold the surgery preparation.
D. Elevate the patient's legs to improve cerebral perfusion.
Answer: C. Notify the healthcare provider immediately and hold the surgery preparation.
7. A patient with end-stage chronic obstructive pulmonary disease (COPD) is admitted with
increasing dyspnea and a change in mental status. Arterial blood gas (ABG) results: pH 7.28,
PaCO2 65 mmHg, HCO3- 30 mEq/L. Which interpretation is correct?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with acute exacerbation
C. Metabolic alkalosis with respiratory compensation
D. Mixed metabolic acidosis and respiratory alkalosis
Answer: B. Chronic respiratory acidosis with acute exacerbation
8. A patient has just had a chest tube inserted for a pneumothorax. The nurse notes that the
water seal chamber has continuous bubbling. What is the priority nursing action?
A. Clamp the chest tube immediately.
B. Assess the chest tube system for an air leak.
C. Notify the healthcare provider immediately.
D. Increase the suction until bubbling stops.
Answer: B. Assess the chest tube system for an air leak.
9. A patient with pulmonary embolism is receiving IV heparin. The nurse notes the activated
partial thromboplastin time (aPTT) is 120 seconds. What is the most appropriate nursing
action?
A. Administer vitamin K as ordered.
B. Stop the heparin infusion and notify the healthcare provider.
C. Continue the heparin infusion and recheck aPTT in 6 hours.
D. Administer protamine sulfate as ordered.
Answer: B. Stop the heparin infusion and notify the healthcare provider.
10. A patient with myasthenia gravis is experiencing increased muscle weakness and difficulty
swallowing. The nurse administers edrophonium, and the patient's strength improves within 2
minutes. Which condition is the patient most likely experiencing?
A. Cholinergic crisis
B. Myasthenic crisis
C. Nerve agent poisoning
D. Guillain-Barré syndrome
Answer: B. Myasthenic crisis
, 11. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 25 mmHg. Which
nursing intervention is the most appropriate to decrease ICP?
A. Administer hypertonic saline as prescribed.
B. Suction the patient every 2 hours routinely.
C. Keep the head of the bed flat to promote venous drainage.
D. Encourage the patient to cough and deep breathe.
Answer: A. Administer hypertonic saline as prescribed.
12. A patient has a new onset of aphasia and right-sided weakness. The nurse suspects a
stroke. What is the first action the nurse should take?
A. Notify the healthcare provider immediately.
B. Ensure a patent airway and assess breathing and circulation.
C. Perform a glucose check using a fingerstick.
D. Position the patient on the weak side.
Answer: B. Ensure a patent airway and assess breathing and circulation.
13. A patient with suspected acute kidney injury (AKI) has a serum creatinine that has
increased from 1.0 to 1.5 mg/dL in 24 hours and urine output of 0.4 mL/kg/hr. Which medication
should the nurse question?
A. Metformin
B. Acetaminophen
C. Amlodipine
D. Pantoprazole
Answer: A. Metformin
14. A patient with chronic kidney disease (CKD) is prescribed sodium bicarbonate for metabolic
acidosis. The nurse monitors for which complication?
A. Hypocalcemia and tetany
B. Fluid overload and hypernatremia
C. Hypokalemia and arrhythmias
D. Hypomagnesemia and muscle cramps
Answer: B. Fluid overload and hypernatremia
15. A patient with a new diagnosis of type 2 diabetes is started on metformin therapy. The nurse
includes which instruction in the teaching plan?
A. Take the medication with meals to reduce gastrointestinal upset.
B. Take the medication at bedtime to avoid daytime side effects.
C. Skip the medication if the blood glucose is less than 200 mg/dL.
D. Discontinue the medication if you develop a cough.
Answer: A. Take the medication with meals to reduce gastrointestinal upset.
16. A patient with hyperthyroidism is scheduled for a thyroidectomy. After surgery, the patient
develops a fever of 104°F, tachycardia, and confusion. The nurse identifies this as a thyroid
storm. Which order should the nurse question?
A. Propranolol 40 mg PO every 6 hours
B. Propylthiouracil 200 mg PO every 6 hours
C. Acetaminophen 650 mg PO every 4 hours as needed for fever
Advanced Medical Surgical Nursing NURS 480 Final Exam
Study Guide | Advanced Med-Surg Nursing – West Coast
University (2026)
1. A 72-year-old patient with a history of chronic heart failure is admitted with acute pulmonary
edema. The nurse notes the patient is anxious, diaphoretic, and has a BP of 160/90, HR 118,
and SpO2 88% on room air. Which intervention is the nurse's priority?
A. Prepare to administer IV nitroglycerin as ordered.
B. Assist the patient to a high Fowler's position and apply oxygen.
C. Obtain a 12-lead ECG.
D. Administer IV furosemide as ordered.
Answer: B. Assist the patient to a high Fowler's position and apply oxygen.
2. A patient with sepsis develops new-onset atrial fibrillation with rapid ventricular response.
The nurse is preparing to administer IV amiodarone. Which assessment finding is most
concerning and requires immediate action?
A. Blood pressure 90/60 mmHg
B. Serum potassium 3.8 mEq/L
C. QT interval 480 ms
D. Respiratory rate 20 breaths/min
Answer: C. QT interval 480 ms
3. A patient with acute pancreatitis is receiving total parenteral nutrition (TPN). The nurse
monitors for refeeding syndrome. Which laboratory value is most important to assess?
A. Serum potassium
B. Serum magnesium
C. Serum phosphorus
D. Serum glucose
Answer: C. Serum phosphorus
4. A patient with a history of heart failure and renal insufficiency presents with dyspnea, jugular
vein distention, and 2+ pitting edema. The primary healthcare provider prescribes furosemide
80 mg IV. Which parameter should the nurse monitor to assess the drug's effectiveness?
A. Serum potassium levels
B. Daily weight and urine output
C. Blood pressure and heart rate
D. Serum creatinine levels
Answer: B. Daily weight and urine output
5. A patient with acute chest pain is diagnosed with ST-elevation myocardial infarction (STEMI).
Which intervention should the nurse anticipate as the priority?
A. Administer sublingual nitroglycerin every 5 minutes for up to 3 doses.
B. Administer aspirin 324 mg chewed immediately.
C. Prepare for primary percutaneous coronary intervention (PCI) within 90 minutes of arrival.
, D. Administer IV opioids for pain relief.
Answer: C. Prepare for primary percutaneous coronary intervention (PCI) within 90 minutes of
arrival.
6. A patient with aortic stenosis is scheduled for valve replacement surgery. Preoperatively, the
nurse notes the patient has a heart rate of 52 bpm and complains of dizziness. What is the
nurse's best action?
A. Document the findings and continue with the surgical preparation.
B. Administer atropine as ordered for bradycardia.
C. Notify the healthcare provider immediately and hold the surgery preparation.
D. Elevate the patient's legs to improve cerebral perfusion.
Answer: C. Notify the healthcare provider immediately and hold the surgery preparation.
7. A patient with end-stage chronic obstructive pulmonary disease (COPD) is admitted with
increasing dyspnea and a change in mental status. Arterial blood gas (ABG) results: pH 7.28,
PaCO2 65 mmHg, HCO3- 30 mEq/L. Which interpretation is correct?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis with acute exacerbation
C. Metabolic alkalosis with respiratory compensation
D. Mixed metabolic acidosis and respiratory alkalosis
Answer: B. Chronic respiratory acidosis with acute exacerbation
8. A patient has just had a chest tube inserted for a pneumothorax. The nurse notes that the
water seal chamber has continuous bubbling. What is the priority nursing action?
A. Clamp the chest tube immediately.
B. Assess the chest tube system for an air leak.
C. Notify the healthcare provider immediately.
D. Increase the suction until bubbling stops.
Answer: B. Assess the chest tube system for an air leak.
9. A patient with pulmonary embolism is receiving IV heparin. The nurse notes the activated
partial thromboplastin time (aPTT) is 120 seconds. What is the most appropriate nursing
action?
A. Administer vitamin K as ordered.
B. Stop the heparin infusion and notify the healthcare provider.
C. Continue the heparin infusion and recheck aPTT in 6 hours.
D. Administer protamine sulfate as ordered.
Answer: B. Stop the heparin infusion and notify the healthcare provider.
10. A patient with myasthenia gravis is experiencing increased muscle weakness and difficulty
swallowing. The nurse administers edrophonium, and the patient's strength improves within 2
minutes. Which condition is the patient most likely experiencing?
A. Cholinergic crisis
B. Myasthenic crisis
C. Nerve agent poisoning
D. Guillain-Barré syndrome
Answer: B. Myasthenic crisis
, 11. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 25 mmHg. Which
nursing intervention is the most appropriate to decrease ICP?
A. Administer hypertonic saline as prescribed.
B. Suction the patient every 2 hours routinely.
C. Keep the head of the bed flat to promote venous drainage.
D. Encourage the patient to cough and deep breathe.
Answer: A. Administer hypertonic saline as prescribed.
12. A patient has a new onset of aphasia and right-sided weakness. The nurse suspects a
stroke. What is the first action the nurse should take?
A. Notify the healthcare provider immediately.
B. Ensure a patent airway and assess breathing and circulation.
C. Perform a glucose check using a fingerstick.
D. Position the patient on the weak side.
Answer: B. Ensure a patent airway and assess breathing and circulation.
13. A patient with suspected acute kidney injury (AKI) has a serum creatinine that has
increased from 1.0 to 1.5 mg/dL in 24 hours and urine output of 0.4 mL/kg/hr. Which medication
should the nurse question?
A. Metformin
B. Acetaminophen
C. Amlodipine
D. Pantoprazole
Answer: A. Metformin
14. A patient with chronic kidney disease (CKD) is prescribed sodium bicarbonate for metabolic
acidosis. The nurse monitors for which complication?
A. Hypocalcemia and tetany
B. Fluid overload and hypernatremia
C. Hypokalemia and arrhythmias
D. Hypomagnesemia and muscle cramps
Answer: B. Fluid overload and hypernatremia
15. A patient with a new diagnosis of type 2 diabetes is started on metformin therapy. The nurse
includes which instruction in the teaching plan?
A. Take the medication with meals to reduce gastrointestinal upset.
B. Take the medication at bedtime to avoid daytime side effects.
C. Skip the medication if the blood glucose is less than 200 mg/dL.
D. Discontinue the medication if you develop a cough.
Answer: A. Take the medication with meals to reduce gastrointestinal upset.
16. A patient with hyperthyroidism is scheduled for a thyroidectomy. After surgery, the patient
develops a fever of 104°F, tachycardia, and confusion. The nurse identifies this as a thyroid
storm. Which order should the nurse question?
A. Propranolol 40 mg PO every 6 hours
B. Propylthiouracil 200 mg PO every 6 hours
C. Acetaminophen 650 mg PO every 4 hours as needed for fever
