NH N480 Exam 1 – Advanced Medical
Surgical Nursing Examination 2026–2027 |
Comprehensive 150 -Question Practice Test
with Answers & Rationales| Free Pdf Access
Question 1
A client is receiving mechanical ventilation and has the following arterial blood gas
(ABG) results: pH 7.23, PaCO2 58 mmHg, HCO3 24 mEq/L, PaO2 68 mmHg. Which
ventilator adjustment should the nurse anticipate?
A) Decrease the FiO2 to prevent oxygen toxicity.
B) Increase the tidal volume to improve oxygenation.
C) Increase the respiratory rate to blow off CO2.
D) Initiate sedation to decrease oxygen demand.
Correct Answer: C
This ABG shows respiratory acidosis (low pH and high PaCO2). The priority is to correct
the acidosis by increasing the respiratory rate to help eliminate carbon dioxide. Increasing
the FiO2 or tidal volume addresses oxygenation, not the primary acid-base problem, and
sedation could worsen respiratory depression.
Question 2
A nurse is observing a nursing student suctioning an intubated client. Which action by
the student has the greatest potential to cause tissue damage?
,A) Applying suction when the catheter is inserted.
B) Hyperoxygenating the client after removing the suction catheter.
C) Applying intermittent suction during catheter withdrawal.
D) Assessing oxygen saturation post-suctioning.
Correct Answer: A
Suction should only be applied during catheter withdrawal, not insertion, to prevent
trauma to the airway mucosa. Applying suction during insertion can cause significant
tissue damage and hypoxemia.
Question 3
A client with a chest tube has a water-seal chamber with no fluctuations (tidaling). What
is the nurse's priority action?
A) Clamp the chest tube immediately.
B) Notify the provider immediately.
C) Assess for tube obstruction or lung re-expansion.
D) Document this as a normal finding.
Correct Answer: C
Fluctuations in the water-seal chamber indicate that the chest tube is patent and the
pleural space is communicating with the drainage system. An absence of tidaling can
mean the lung has re-expanded or the tube is obstructed. The nurse must assess the client
and the system to determine the cause. Clamping the tube without an order is unsafe.
Question 4
A client with a suspected pulmonary embolism (PE) is being assessed. Which finding
should be of the greatest concern to the nurse?
A) Pleuritic chest pain.
B) Tachypnea.
,C) Hemoptysis.
D) Hypotension.
Correct Answer: D
Hypotension in a client with a PE indicates obstructive shock from a massive embolus
causing right ventricular failure. This is a life-threatening emergency requiring immediate
intervention. While pain, tachypnea, and hemoptysis are concerning, hypotension is the
most immediate threat to survival.
Question 5
A nurse is caring for a client with severe pain who is receiving IV morphine. Which
assessment finding should be a concern for the nurse?
A) Blood pressure of 88/52 mm Hg.
B) Respiratory rate of 14 breaths per minute.
C) SpO2 of 98% on room air.
D) Reports of passing stool once in 7 days.
Correct Answer: A
Hypotension can be an adverse effect of IV morphine due to vasodilation and decreased
preload. A blood pressure of 88/52 requires assessment and possibly intervention. A
respiratory rate of 14 is adequate, and while constipation is a side effect, it is not an
immediate concern.
Question 6
The nurse is teaching a client scheduled for a coronary angiography. Which statement
should the nurse include?
A) "You should have nothing to eat or drink 2 hours prior to the procedure."
B) "You will need to keep the affected leg straight after the procedure."
C) "You will be given general anesthesia during the procedure."
D) "You should not have this procedure done if you are allergic to eggs."
, Correct Answer: B
After coronary angiography through the femoral artery, the affected leg must remain
straight to prevent bleeding or hematoma formation at the puncture site. Clients are
typically NPO for 6-8 hours before the procedure, not 2 hours.
Question 7
A client who is 3 days postoperative following coronary artery bypass grafting (CABG)
declines to perform coughing and deep breathing exercises because of incisional pain.
Which action should the nurse take?
A) Allow the client to rest and return in half an hour.
B) Document in the client's record that the client is non-adherent.
C) Inform the client that these exercises must be performed before discharge.
D) Teach the client to use a pillow to splint the incisions.
Correct Answer: D
Splinting the incisions with a pillow reduces pain during coughing and deep breathing,
encouraging compliance. This is an effective intervention to prevent postoperative
pulmonary complications.
Question 8
A nurse is reviewing the results of a troponin test for a client suspected of having a
myocardial infarction. Which statement about troponin testing is most accurate?
A) Troponin provides information about which chambers of the heart are affected.
B) Troponin provides information regarding the valvular functions of the heart.
C) Troponin levels provide the location of the myocardial infarction.
D) Troponin increases in the presence of damage to cardiac muscles.
Correct Answer: D
Surgical Nursing Examination 2026–2027 |
Comprehensive 150 -Question Practice Test
with Answers & Rationales| Free Pdf Access
Question 1
A client is receiving mechanical ventilation and has the following arterial blood gas
(ABG) results: pH 7.23, PaCO2 58 mmHg, HCO3 24 mEq/L, PaO2 68 mmHg. Which
ventilator adjustment should the nurse anticipate?
A) Decrease the FiO2 to prevent oxygen toxicity.
B) Increase the tidal volume to improve oxygenation.
C) Increase the respiratory rate to blow off CO2.
D) Initiate sedation to decrease oxygen demand.
Correct Answer: C
This ABG shows respiratory acidosis (low pH and high PaCO2). The priority is to correct
the acidosis by increasing the respiratory rate to help eliminate carbon dioxide. Increasing
the FiO2 or tidal volume addresses oxygenation, not the primary acid-base problem, and
sedation could worsen respiratory depression.
Question 2
A nurse is observing a nursing student suctioning an intubated client. Which action by
the student has the greatest potential to cause tissue damage?
,A) Applying suction when the catheter is inserted.
B) Hyperoxygenating the client after removing the suction catheter.
C) Applying intermittent suction during catheter withdrawal.
D) Assessing oxygen saturation post-suctioning.
Correct Answer: A
Suction should only be applied during catheter withdrawal, not insertion, to prevent
trauma to the airway mucosa. Applying suction during insertion can cause significant
tissue damage and hypoxemia.
Question 3
A client with a chest tube has a water-seal chamber with no fluctuations (tidaling). What
is the nurse's priority action?
A) Clamp the chest tube immediately.
B) Notify the provider immediately.
C) Assess for tube obstruction or lung re-expansion.
D) Document this as a normal finding.
Correct Answer: C
Fluctuations in the water-seal chamber indicate that the chest tube is patent and the
pleural space is communicating with the drainage system. An absence of tidaling can
mean the lung has re-expanded or the tube is obstructed. The nurse must assess the client
and the system to determine the cause. Clamping the tube without an order is unsafe.
Question 4
A client with a suspected pulmonary embolism (PE) is being assessed. Which finding
should be of the greatest concern to the nurse?
A) Pleuritic chest pain.
B) Tachypnea.
,C) Hemoptysis.
D) Hypotension.
Correct Answer: D
Hypotension in a client with a PE indicates obstructive shock from a massive embolus
causing right ventricular failure. This is a life-threatening emergency requiring immediate
intervention. While pain, tachypnea, and hemoptysis are concerning, hypotension is the
most immediate threat to survival.
Question 5
A nurse is caring for a client with severe pain who is receiving IV morphine. Which
assessment finding should be a concern for the nurse?
A) Blood pressure of 88/52 mm Hg.
B) Respiratory rate of 14 breaths per minute.
C) SpO2 of 98% on room air.
D) Reports of passing stool once in 7 days.
Correct Answer: A
Hypotension can be an adverse effect of IV morphine due to vasodilation and decreased
preload. A blood pressure of 88/52 requires assessment and possibly intervention. A
respiratory rate of 14 is adequate, and while constipation is a side effect, it is not an
immediate concern.
Question 6
The nurse is teaching a client scheduled for a coronary angiography. Which statement
should the nurse include?
A) "You should have nothing to eat or drink 2 hours prior to the procedure."
B) "You will need to keep the affected leg straight after the procedure."
C) "You will be given general anesthesia during the procedure."
D) "You should not have this procedure done if you are allergic to eggs."
, Correct Answer: B
After coronary angiography through the femoral artery, the affected leg must remain
straight to prevent bleeding or hematoma formation at the puncture site. Clients are
typically NPO for 6-8 hours before the procedure, not 2 hours.
Question 7
A client who is 3 days postoperative following coronary artery bypass grafting (CABG)
declines to perform coughing and deep breathing exercises because of incisional pain.
Which action should the nurse take?
A) Allow the client to rest and return in half an hour.
B) Document in the client's record that the client is non-adherent.
C) Inform the client that these exercises must be performed before discharge.
D) Teach the client to use a pillow to splint the incisions.
Correct Answer: D
Splinting the incisions with a pillow reduces pain during coughing and deep breathing,
encouraging compliance. This is an effective intervention to prevent postoperative
pulmonary complications.
Question 8
A nurse is reviewing the results of a troponin test for a client suspected of having a
myocardial infarction. Which statement about troponin testing is most accurate?
A) Troponin provides information about which chambers of the heart are affected.
B) Troponin provides information regarding the valvular functions of the heart.
C) Troponin levels provide the location of the myocardial infarction.
D) Troponin increases in the presence of damage to cardiac muscles.
Correct Answer: D
