NH N480 Exam 1 – Advanced Medical
Surgical Nursing (2026) Actual Questions
& Answers (WCU) 100% Verified | Graded
A| 2026-2027
Ace the NH N480 Exam 1 on your first try with this fully updated 2026 guide! This
comprehensive exam prep document gives you the exact questions and answers used in the
West Coast University Advanced Medical Surgical Nursing course. Covering MUST-KNOW
topics like tension pneumothorax, ARDS, mechanical ventilation, chest tube management,
arterial blood gas (ABG) interpretation, heparin therapy, and critical care medication
calculations. Includes the Group Performance Profile data for Spring II 2026! Stop wasting
hours guessing. This resource provides the key concepts, distractors, and Rationales you
need to pass with confidence. Perfect for BSN students preparing for med -surg and ICU
nursing exams. Learn to spot life-threatening conditions like flail chest and tracheal
deviation. Master fluid and electrolyte imbalances (hyponatremia, hyperkalemia). Get the
edge with actual educator questions from West Coast University. Don't risk failing – invest
in your nursing success today! Instant digital download.
,1. A nurse is caring for a mechanically ventilated patient who suddenly develops severe
respiratory distress, absent breath sounds on the right side, and tracheal deviation to
the left. What is the nurse's priority action?
a) Prepare for emergency chest tube insertion
b) Administer a nebulized bronchodilator
c) Increase the FiO2 on the ventilator
d) Reposition the endotracheal tube
Answer: a) Prepare for emergency chest tube insertion
Rationale: These findings are classic signs of a tension pneumothorax, which causes air
accumulation in the pleural space, shifting mediastinal structures (tracheal deviation)
and compressing the lung. Immediate needle decompression followed by chest tube
insertion is the life-saving priority.
2. A patient on a ventilator has a high-pressure alarm sounding. Which assessment finding
is the most likely cause?
a) Disconnected ventilator tubing
b) Kink in the endotracheal tube
c) Extubation of the patient
d) Deflated endotracheal tube cuff
Answer: b) Kink in the endotracheal tube
Rationale: A high-pressure alarm indicates increased resistance or obstruction in the
airway. Common causes include kinking of the tube, mucus plugging, or the patient
biting the tube. A disconnect or deflated cuff would trigger a low-pressure alarm.
3. A patient with acute respiratory distress syndrome (ARDS) has a PaO2 of 55 mmHg on a
FiO2 of 80%. Which intervention should the nurse anticipate to improve oxygenation?
a) Administering a bolus of normal saline
b) Placing the patient in the prone position
c) Decreasing the PEEP setting
d) Suctioning the patient every hour
Answer: b) Placing the patient in the prone position
Rationale: Prone positioning improves oxygenation in ARDS by recruiting dorsal lung
regions, improving ventilation-perfusion matching, and facilitating secretion drainage. It
is a standard intervention for refractory hypoxemia.
4. The nurse is calculating the IV infusion rate for a patient requiring Propofol at 5
mcg/kg/min. The patient weighs 75 kg. The pharmacy provides Propofol 10 mg/mL. At
what rate (mL/hr) should the nurse set the pump?
a) 2.25 mL/hr
, b) 22.5 mL/hr
c) 2.5 mL/hr
d) 225 mL/hr
Answer: b) 22.5 mL/hr
Rationale: (5 mcg x 75 kg) = 375 mcg/min. 375 mcg/min x 60 min = 22,500 mcg/hr =
22.5 mg/hr. Since the concentration is 10 mg/mL, 22.5 mg/hr ÷ 10 mg/mL = 2.25 mL/hr.
5. A patient receiving a continuous Heparin infusion develops bleeding gums and epistaxis.
Which medication should the nurse prepare to administer?
a) Vitamin K
b) Naloxone
c) Protamine sulfate
d) Flumazenil
Answer: c) Protamine sulfate
Rationale: Protamine sulfate is the specific reversal agent for Heparin. It binds to heparin
to form a stable complex, neutralizing its anticoagulant effects. Vitamin K reverses
Warfarin.
6. A client with a history of seizures is prescribed phenytoin. The nurse should monitor the
client for which common side effect?
a) Tachycardia
b) Gingival hyperplasia
c) Hyperkalemia
d) Weight loss
Answer: b) Gingival hyperplasia
Rationale: Gingival hyperplasia (overgrowth of gum tissue) is a well-known side effect of
long-term phenytoin therapy. Good oral hygiene and regular dental care are essential for
these patients.
7. The nurse is caring for a client with fluid volume deficit. Which of the following is a sign
of this condition?
a) Distended neck veins
b) Decreased urine output
c) Bounding peripheral pulses
d) Crackles in the lung bases
Answer: b) Decreased urine output
Rationale: In fluid volume deficit (hypovolemia), the kidneys conserve water, leading to
decreased urine output (oliguria). Distended neck veins, bounding pulses, and crackles
are signs of fluid volume excess.
, 8. For a mechanically ventilated client, which intervention is most important to reduce the
risk of ventilator-associated pneumonia (VAP)?
a) Suctioning the endotracheal tube every 4 hours
b) Performing oral care with chlorhexidine every 2 hours
c) Keeping the head of the bed flat at all times
d) Changing the ventilator circuit daily
Answer: b) Performing oral care with chlorhexidine every 2 hours
Rationale: Oral care with chlorhexidine reduces the bacterial load in the oropharynx,
decreasing the risk of aspiration of pathogens into the lower respiratory tract. The head
of the bed should be elevated to 30-45 degrees to prevent VAP.
9. A patient's arterial blood gas (ABG) results are: pH 7.28, PaCO2 55 mmHg, HCO3 24
mEq/L. The nurse interprets these results as:
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis
Answer: c) Respiratory acidosis
Rationale: The pH is low (acidosis) and the PaCO2 is elevated (above 45 mmHg),
indicating a respiratory cause. The HCO3 is normal, suggesting this is an acute
respiratory acidosis without renal compensation yet.
10. Which of the following clients should the nurse assess first?
a) A client with a chest tube reporting pain of 6 on a 0-10 scale
b) A client with a new tracheostomy who has bloody sputum
c) A client with a pulse oximetry reading of 89% on 2L nasal cannula
d) A client with a central line who has a fever of 101.2°F
Answer: c) A client with a pulse oximetry reading of 89% on 2L nasal cannula
Rationale: An SpO2 of 89% indicates hypoxemia and inadequate oxygenation, which is a
life-threatening priority. This client requires immediate intervention to prevent
respiratory failure.
11. The nurse is caring for a patient with a chest tube connected to a water-seal drainage
system. The nurse notes continuous bubbling in the water-seal chamber. What is the
most appropriate action?
a) Clamp the chest tube immediately
b) Assess the system for an air leak
c) Increase the suction pressure
d) Document this as a normal finding
Surgical Nursing (2026) Actual Questions
& Answers (WCU) 100% Verified | Graded
A| 2026-2027
Ace the NH N480 Exam 1 on your first try with this fully updated 2026 guide! This
comprehensive exam prep document gives you the exact questions and answers used in the
West Coast University Advanced Medical Surgical Nursing course. Covering MUST-KNOW
topics like tension pneumothorax, ARDS, mechanical ventilation, chest tube management,
arterial blood gas (ABG) interpretation, heparin therapy, and critical care medication
calculations. Includes the Group Performance Profile data for Spring II 2026! Stop wasting
hours guessing. This resource provides the key concepts, distractors, and Rationales you
need to pass with confidence. Perfect for BSN students preparing for med -surg and ICU
nursing exams. Learn to spot life-threatening conditions like flail chest and tracheal
deviation. Master fluid and electrolyte imbalances (hyponatremia, hyperkalemia). Get the
edge with actual educator questions from West Coast University. Don't risk failing – invest
in your nursing success today! Instant digital download.
,1. A nurse is caring for a mechanically ventilated patient who suddenly develops severe
respiratory distress, absent breath sounds on the right side, and tracheal deviation to
the left. What is the nurse's priority action?
a) Prepare for emergency chest tube insertion
b) Administer a nebulized bronchodilator
c) Increase the FiO2 on the ventilator
d) Reposition the endotracheal tube
Answer: a) Prepare for emergency chest tube insertion
Rationale: These findings are classic signs of a tension pneumothorax, which causes air
accumulation in the pleural space, shifting mediastinal structures (tracheal deviation)
and compressing the lung. Immediate needle decompression followed by chest tube
insertion is the life-saving priority.
2. A patient on a ventilator has a high-pressure alarm sounding. Which assessment finding
is the most likely cause?
a) Disconnected ventilator tubing
b) Kink in the endotracheal tube
c) Extubation of the patient
d) Deflated endotracheal tube cuff
Answer: b) Kink in the endotracheal tube
Rationale: A high-pressure alarm indicates increased resistance or obstruction in the
airway. Common causes include kinking of the tube, mucus plugging, or the patient
biting the tube. A disconnect or deflated cuff would trigger a low-pressure alarm.
3. A patient with acute respiratory distress syndrome (ARDS) has a PaO2 of 55 mmHg on a
FiO2 of 80%. Which intervention should the nurse anticipate to improve oxygenation?
a) Administering a bolus of normal saline
b) Placing the patient in the prone position
c) Decreasing the PEEP setting
d) Suctioning the patient every hour
Answer: b) Placing the patient in the prone position
Rationale: Prone positioning improves oxygenation in ARDS by recruiting dorsal lung
regions, improving ventilation-perfusion matching, and facilitating secretion drainage. It
is a standard intervention for refractory hypoxemia.
4. The nurse is calculating the IV infusion rate for a patient requiring Propofol at 5
mcg/kg/min. The patient weighs 75 kg. The pharmacy provides Propofol 10 mg/mL. At
what rate (mL/hr) should the nurse set the pump?
a) 2.25 mL/hr
, b) 22.5 mL/hr
c) 2.5 mL/hr
d) 225 mL/hr
Answer: b) 22.5 mL/hr
Rationale: (5 mcg x 75 kg) = 375 mcg/min. 375 mcg/min x 60 min = 22,500 mcg/hr =
22.5 mg/hr. Since the concentration is 10 mg/mL, 22.5 mg/hr ÷ 10 mg/mL = 2.25 mL/hr.
5. A patient receiving a continuous Heparin infusion develops bleeding gums and epistaxis.
Which medication should the nurse prepare to administer?
a) Vitamin K
b) Naloxone
c) Protamine sulfate
d) Flumazenil
Answer: c) Protamine sulfate
Rationale: Protamine sulfate is the specific reversal agent for Heparin. It binds to heparin
to form a stable complex, neutralizing its anticoagulant effects. Vitamin K reverses
Warfarin.
6. A client with a history of seizures is prescribed phenytoin. The nurse should monitor the
client for which common side effect?
a) Tachycardia
b) Gingival hyperplasia
c) Hyperkalemia
d) Weight loss
Answer: b) Gingival hyperplasia
Rationale: Gingival hyperplasia (overgrowth of gum tissue) is a well-known side effect of
long-term phenytoin therapy. Good oral hygiene and regular dental care are essential for
these patients.
7. The nurse is caring for a client with fluid volume deficit. Which of the following is a sign
of this condition?
a) Distended neck veins
b) Decreased urine output
c) Bounding peripheral pulses
d) Crackles in the lung bases
Answer: b) Decreased urine output
Rationale: In fluid volume deficit (hypovolemia), the kidneys conserve water, leading to
decreased urine output (oliguria). Distended neck veins, bounding pulses, and crackles
are signs of fluid volume excess.
, 8. For a mechanically ventilated client, which intervention is most important to reduce the
risk of ventilator-associated pneumonia (VAP)?
a) Suctioning the endotracheal tube every 4 hours
b) Performing oral care with chlorhexidine every 2 hours
c) Keeping the head of the bed flat at all times
d) Changing the ventilator circuit daily
Answer: b) Performing oral care with chlorhexidine every 2 hours
Rationale: Oral care with chlorhexidine reduces the bacterial load in the oropharynx,
decreasing the risk of aspiration of pathogens into the lower respiratory tract. The head
of the bed should be elevated to 30-45 degrees to prevent VAP.
9. A patient's arterial blood gas (ABG) results are: pH 7.28, PaCO2 55 mmHg, HCO3 24
mEq/L. The nurse interprets these results as:
a) Metabolic acidosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Respiratory alkalosis
Answer: c) Respiratory acidosis
Rationale: The pH is low (acidosis) and the PaCO2 is elevated (above 45 mmHg),
indicating a respiratory cause. The HCO3 is normal, suggesting this is an acute
respiratory acidosis without renal compensation yet.
10. Which of the following clients should the nurse assess first?
a) A client with a chest tube reporting pain of 6 on a 0-10 scale
b) A client with a new tracheostomy who has bloody sputum
c) A client with a pulse oximetry reading of 89% on 2L nasal cannula
d) A client with a central line who has a fever of 101.2°F
Answer: c) A client with a pulse oximetry reading of 89% on 2L nasal cannula
Rationale: An SpO2 of 89% indicates hypoxemia and inadequate oxygenation, which is a
life-threatening priority. This client requires immediate intervention to prevent
respiratory failure.
11. The nurse is caring for a patient with a chest tube connected to a water-seal drainage
system. The nurse notes continuous bubbling in the water-seal chamber. What is the
most appropriate action?
a) Clamp the chest tube immediately
b) Assess the system for an air leak
c) Increase the suction pressure
d) Document this as a normal finding
