NURS 480 EXAM 1 PRACTICE BANK:
ADVANCED MED-SURG & CRITICAL CARE
NURSING (150 Q&AS WITH RATIONALES)
2026 UPDATED
Ace your Advanced Med-Surg Exam 1 with this ultimate Question Practice Bank! Designed
specifically for high-yield critical care curricula, this guide features realistic downward-formatted
MCQs covering ABG analysis, ARDS protocols, mechanical ventilator troubleshooting, chest tubes,
hemodynamic line management, and shock profiles. Complete with comprehensive, clear
Rationales for every single answer, this study tool guarantees you master core concepts and pass
on your first try!
,NURS 480 Exam 1 Practice Questions
Question 1
Topic: Arterial Blood Gas Interpretation
A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory distress. The arterial blood gas (ABG) results are: pH 7.25, PaCO2 65 mm Hg, HCO3
28 mEq/L, and PaO2 55 mm Hg. How should the nurse interpret this acid-base imbalance?
• A. Uncompensated metabolic acidosis
• B. Partially compensated respiratory acidosis with hypoxemia
• C. Fully compensated respiratory acidosis
• D. Uncompensated respiratory alkalosis
Correct Answer: B. Partially compensated respiratory acidosis with hypoxemia
Rationale: The pH is low (7.25), indicating acidosis. The PaCO2 is high (65 mm Hg), which
matches the acidosis and points to a respiratory cause. The HCO3 is elevated (28 mEq/L),
showing that the kidneys have begun to retain bicarbonate to compensate, but the pH is not yet
back to normal. The low PaO2 (55 mm Hg) indicates hypoxemia.
Question 2
Topic: ARDS Pathophysiology
The nurse is caring for a patient who developed acute respiratory distress syndrome (ARDS)
secondary to severe pancreatitis. What is the primary underlying pathological change that
triggers the onset of ARDS?
• A. Overproduction of surfactant leading to airway obstruction
• B. Damage to the alveolar-capillary membrane caused by systemic inflammation
• C. Decreased pulmonary vascular resistance and hypovolemia
• D. Chronic remodeling of the bronchial smooth muscle tissue
Correct Answer: B. Damage to the alveolar-capillary membrane caused by systemic
inflammation
Rationale: ARDS is characterized by systemic inflammatory processes that compromise the
structural integrity of the alveolar-capillary membrane. This leads to increased permeability,
fluid extravasation into the alveoli, surfactant inactivation, and severe non-cardiogenic
pulmonary edema.
,Question 3
Topic: Mechanical Ventilation Settings
A patient with ARDS is placed on mechanical ventilation. The healthcare provider orders low
tidal volume ventilation (4–6 mL/kg). What is the primary clinical objective of utilizing low tidal
volumes in this patient population?
• A. To maximize carbon dioxide clearance and resolve hypercapnia
• B. To prevent ventilator-induced lung injury (VILI) and volutrauma
• C. To decrease the patient’s intrinsic respiratory rate
• D. To minimize the need for positive end-expiratory pressure (PEEP)
Correct Answer: B. To prevent ventilator-induced lung injury (VILI) and volutrauma
Rationale: ARDS causes lungs to become stiff, non-compliant, and patchy ("baby lung"). Normal
tidal volumes can overdistend and rupture the remaining functional alveoli. Low tidal volume
ventilation protects fragile lung units from stretching and mechanical trauma.
Question 4
Topic: Ventilator Alarm Troubleshooting
A patient’s mechanical ventilator suddenly sounds a high-pressure alarm. Upon entering the
room, the nurse notes that the patient is coughing vigorously and attempting to bite down on
the endotracheal (ET) tube. What should be the nurse's first intervention?
• A. Increase the high-pressure alarm limit on the machine
• B. Disconnect the patient and manually ventilate with a bag-valve mask
• C. Suction the airway, place an oral bite block if needed, and assess sedation needs
• D. Immediately deflate the endotracheal tube cuff
Correct Answer: C. Suction the airway, place an oral bite block if needed, and assess sedation
needs
Rationale: High-pressure alarms indicate increased airway resistance. Common, easily
reversible bedside causes include patient coughing, secretions blocking the tube, or the patient
biting the tube. Clearing secretions and stabilizing the airway physically or pharma cologically
are the priority actions.
, Question 5
Topic: Ventilator Alarm Troubleshooting
The low-pressure alarm on a patient's ventilator begins sounding. The nurse observes that the
patient is in respiratory distress and the tubing has completely detached from the tracheostomy
hub. What is the immediate priority action?
• A. Call the respiratory therapist to replace the circuit lines
• B. Reconnect the ventilator tubing immediately to the patient’s airway
• C. Silence the alarm and obtain a portable pulse oximeter
• D. Document the event and monitor the patient's breathing rate
Correct Answer: B. Reconnect the ventilator tubing immediately to the patient’s airway
Rationale: A low-pressure alarm means a severe drop in baseline circuit pressure, usually
caused by a total disconnection or a massive leak. The nurse must immediately reconnect the
circuit to restore life-sustaining ventilation and oxygenation.
Question 6
Topic: Tension Pneumothorax Signs
A mechanically ventilated patient with high positive end-expiratory pressure (PEEP) settings
experiences a sudden drop in blood pressure, tachycardia, and a drop in oxygen saturation.
Physical assessment reveals absent breath sounds on the left side and tracheal deviation to the
right. What life-threatening condition does this present?
• A. Cardiac tamponade
• B. Acute pulmonary embolism
• C. Tension pneumothorax
• D. Bilateral pleural effusion
Correct Answer: C. Tension pneumothorax
Rationale: High PEEP levels put patients at risk for barotrauma and alveolar rupture. A tension
pneumothorax traps air in the pleural space, collapsing the affected lung (causing absent breath
sounds) and shifting mediastinal structures away from the affected side (causing tracheal
deviation), which compresses the vena cava and drops blood pressure.
ADVANCED MED-SURG & CRITICAL CARE
NURSING (150 Q&AS WITH RATIONALES)
2026 UPDATED
Ace your Advanced Med-Surg Exam 1 with this ultimate Question Practice Bank! Designed
specifically for high-yield critical care curricula, this guide features realistic downward-formatted
MCQs covering ABG analysis, ARDS protocols, mechanical ventilator troubleshooting, chest tubes,
hemodynamic line management, and shock profiles. Complete with comprehensive, clear
Rationales for every single answer, this study tool guarantees you master core concepts and pass
on your first try!
,NURS 480 Exam 1 Practice Questions
Question 1
Topic: Arterial Blood Gas Interpretation
A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute
respiratory distress. The arterial blood gas (ABG) results are: pH 7.25, PaCO2 65 mm Hg, HCO3
28 mEq/L, and PaO2 55 mm Hg. How should the nurse interpret this acid-base imbalance?
• A. Uncompensated metabolic acidosis
• B. Partially compensated respiratory acidosis with hypoxemia
• C. Fully compensated respiratory acidosis
• D. Uncompensated respiratory alkalosis
Correct Answer: B. Partially compensated respiratory acidosis with hypoxemia
Rationale: The pH is low (7.25), indicating acidosis. The PaCO2 is high (65 mm Hg), which
matches the acidosis and points to a respiratory cause. The HCO3 is elevated (28 mEq/L),
showing that the kidneys have begun to retain bicarbonate to compensate, but the pH is not yet
back to normal. The low PaO2 (55 mm Hg) indicates hypoxemia.
Question 2
Topic: ARDS Pathophysiology
The nurse is caring for a patient who developed acute respiratory distress syndrome (ARDS)
secondary to severe pancreatitis. What is the primary underlying pathological change that
triggers the onset of ARDS?
• A. Overproduction of surfactant leading to airway obstruction
• B. Damage to the alveolar-capillary membrane caused by systemic inflammation
• C. Decreased pulmonary vascular resistance and hypovolemia
• D. Chronic remodeling of the bronchial smooth muscle tissue
Correct Answer: B. Damage to the alveolar-capillary membrane caused by systemic
inflammation
Rationale: ARDS is characterized by systemic inflammatory processes that compromise the
structural integrity of the alveolar-capillary membrane. This leads to increased permeability,
fluid extravasation into the alveoli, surfactant inactivation, and severe non-cardiogenic
pulmonary edema.
,Question 3
Topic: Mechanical Ventilation Settings
A patient with ARDS is placed on mechanical ventilation. The healthcare provider orders low
tidal volume ventilation (4–6 mL/kg). What is the primary clinical objective of utilizing low tidal
volumes in this patient population?
• A. To maximize carbon dioxide clearance and resolve hypercapnia
• B. To prevent ventilator-induced lung injury (VILI) and volutrauma
• C. To decrease the patient’s intrinsic respiratory rate
• D. To minimize the need for positive end-expiratory pressure (PEEP)
Correct Answer: B. To prevent ventilator-induced lung injury (VILI) and volutrauma
Rationale: ARDS causes lungs to become stiff, non-compliant, and patchy ("baby lung"). Normal
tidal volumes can overdistend and rupture the remaining functional alveoli. Low tidal volume
ventilation protects fragile lung units from stretching and mechanical trauma.
Question 4
Topic: Ventilator Alarm Troubleshooting
A patient’s mechanical ventilator suddenly sounds a high-pressure alarm. Upon entering the
room, the nurse notes that the patient is coughing vigorously and attempting to bite down on
the endotracheal (ET) tube. What should be the nurse's first intervention?
• A. Increase the high-pressure alarm limit on the machine
• B. Disconnect the patient and manually ventilate with a bag-valve mask
• C. Suction the airway, place an oral bite block if needed, and assess sedation needs
• D. Immediately deflate the endotracheal tube cuff
Correct Answer: C. Suction the airway, place an oral bite block if needed, and assess sedation
needs
Rationale: High-pressure alarms indicate increased airway resistance. Common, easily
reversible bedside causes include patient coughing, secretions blocking the tube, or the patient
biting the tube. Clearing secretions and stabilizing the airway physically or pharma cologically
are the priority actions.
, Question 5
Topic: Ventilator Alarm Troubleshooting
The low-pressure alarm on a patient's ventilator begins sounding. The nurse observes that the
patient is in respiratory distress and the tubing has completely detached from the tracheostomy
hub. What is the immediate priority action?
• A. Call the respiratory therapist to replace the circuit lines
• B. Reconnect the ventilator tubing immediately to the patient’s airway
• C. Silence the alarm and obtain a portable pulse oximeter
• D. Document the event and monitor the patient's breathing rate
Correct Answer: B. Reconnect the ventilator tubing immediately to the patient’s airway
Rationale: A low-pressure alarm means a severe drop in baseline circuit pressure, usually
caused by a total disconnection or a massive leak. The nurse must immediately reconnect the
circuit to restore life-sustaining ventilation and oxygenation.
Question 6
Topic: Tension Pneumothorax Signs
A mechanically ventilated patient with high positive end-expiratory pressure (PEEP) settings
experiences a sudden drop in blood pressure, tachycardia, and a drop in oxygen saturation.
Physical assessment reveals absent breath sounds on the left side and tracheal deviation to the
right. What life-threatening condition does this present?
• A. Cardiac tamponade
• B. Acute pulmonary embolism
• C. Tension pneumothorax
• D. Bilateral pleural effusion
Correct Answer: C. Tension pneumothorax
Rationale: High PEEP levels put patients at risk for barotrauma and alveolar rupture. A tension
pneumothorax traps air in the pleural space, collapsing the affected lung (causing absent breath
sounds) and shifting mediastinal structures away from the affected side (causing tracheal
deviation), which compresses the vena cava and drops blood pressure.
