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NH N480 Exam 2 – Advanced Medical-Surgical
Nursing–QUESTIONS AND DETAILED SOLUTIONS
JUST RELEASED
NH N480 Exam 2 – Advanced Medical-Surgical Nursing
Practice Questions with Answers & Rationales
EXAM COVERAGE AREAS (MOST TESTED)
1. Cardiovascular Disorders – Heart failure, MI, angina, cardiac surgery, dysrhythmias, cardiac
catheterization
2. Anticoagulation & Antiplatelet Therapy – Heparin, warfarin, clopidogrel; monitoring aPTT, INR;
bleeding precautions
3. ECG Interpretation & Dysrhythmias – Atrial fibrillation, ventricular tachycardia, asystole, PEA;
cardioversion vs. defibrillation
4. Neurological Disorders – Stroke (ischemic vs. hemorrhagic), ICP management, cranial nerve
assessment
5. Fluid & Electrolyte Imbalances – Sodium, potassium, calcium, magnesium; acid-base disturbances
6. Neurocritical Care – Meningitis, spinal cord injury, autonomic dysreflexia
7. Palliative & End-of-Life Care – Goals of care, bereavement, symptom management
8. Medication Safety – Digoxin, nitroglycerin, amiodarone, adenosine, inotropic agents
9. Postoperative Care – CABG, thyroidectomy complications, preventing complications
10. Perioperative Nursing – Informed consent, preoperative assessment, herbal supplement interactions
1. A patient on warfarin has an INR of 4.5. What is the most appropriate nursing action to ensure patient
safety and prevent bleeding complications?
A) Administer the next scheduled dose as ordered by the provider
B) Hold the dose, notify the provider, and assess for signs of bleeding
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C) Administer vitamin K immediately without waiting for provider orders
D) Increase the next dose to bring the INR back into therapeutic range
Answer: B - The therapeutic INR range for most indications is 2.0–3.0. An INR of 4.5 indicates
supratherapeutic anticoagulation with increased bleeding risk. The provider should be notified, and the
dose may be held. Vitamin K may be ordered if there is active bleeding .
2. A patient with peripheral artery disease (PAD) reports leg pain that occurs with walking and resolves
with rest. What is this condition called, and what is the underlying cause of the pain?
A) Rest pain caused by venous stasis and edema formation
B) Intermittent claudication caused by ischemic muscle pain from atherosclerosis
C) Neuropathic pain caused by diabetic nerve damage in the lower extremities
D) Venous insufficiency caused by incompetent venous valves and pooling of blood
Answer: B - Intermittent claudication is ischemic muscle pain that occurs with exercise and resolves with
rest. It is a hallmark symptom of peripheral artery disease caused by atherosclerosis .
3. A patient prescribed clopidogrel after a myocardial infarction asks about potential side effects. What
is the most important warning the nurse should include in the discharge teaching for this medication?
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A) "Notify the provider if you notice black, tarry stools or any unusual bleeding."
B) "Take this medication with food to prevent stomach upset and nausea."
C) "You may stop taking this medication if you experience mild headaches."
D) "This medication will dissolve any existing blood clots in your arteries."
Answer: A - Clopidogrel is an antiplatelet medication that increases the risk of bleeding. Black, tarry
stools indicate gastrointestinal bleeding and require immediate medical attention. Clopidogrel does not
dissolve existing clots; it prevents new clot formation .
4. A patient is 2 hours post-cardiac catheterization via the femoral artery. Which assessment finding
requires immediate nursing intervention and notification of the provider?
A) Pedal pulses are palpable bilaterally with good capillary refill
B) A hematoma is developing at the femoral insertion site
C) The patient reports mild discomfort at the insertion site
D) The patient's vital signs are stable with no acute changes
Answer: B - A hematoma at the femoral insertion site indicates bleeding and requires immediate
intervention. The affected leg should be kept straight, pressure should be applied, and the provider
should be notified promptly .
NH N480 Exam 2 – Advanced Medical-Surgical
Nursing–QUESTIONS AND DETAILED SOLUTIONS
JUST RELEASED
NH N480 Exam 2 – Advanced Medical-Surgical Nursing
Practice Questions with Answers & Rationales
EXAM COVERAGE AREAS (MOST TESTED)
1. Cardiovascular Disorders – Heart failure, MI, angina, cardiac surgery, dysrhythmias, cardiac
catheterization
2. Anticoagulation & Antiplatelet Therapy – Heparin, warfarin, clopidogrel; monitoring aPTT, INR;
bleeding precautions
3. ECG Interpretation & Dysrhythmias – Atrial fibrillation, ventricular tachycardia, asystole, PEA;
cardioversion vs. defibrillation
4. Neurological Disorders – Stroke (ischemic vs. hemorrhagic), ICP management, cranial nerve
assessment
5. Fluid & Electrolyte Imbalances – Sodium, potassium, calcium, magnesium; acid-base disturbances
6. Neurocritical Care – Meningitis, spinal cord injury, autonomic dysreflexia
7. Palliative & End-of-Life Care – Goals of care, bereavement, symptom management
8. Medication Safety – Digoxin, nitroglycerin, amiodarone, adenosine, inotropic agents
9. Postoperative Care – CABG, thyroidectomy complications, preventing complications
10. Perioperative Nursing – Informed consent, preoperative assessment, herbal supplement interactions
1. A patient on warfarin has an INR of 4.5. What is the most appropriate nursing action to ensure patient
safety and prevent bleeding complications?
A) Administer the next scheduled dose as ordered by the provider
B) Hold the dose, notify the provider, and assess for signs of bleeding
, Page 2 of 29
C) Administer vitamin K immediately without waiting for provider orders
D) Increase the next dose to bring the INR back into therapeutic range
Answer: B - The therapeutic INR range for most indications is 2.0–3.0. An INR of 4.5 indicates
supratherapeutic anticoagulation with increased bleeding risk. The provider should be notified, and the
dose may be held. Vitamin K may be ordered if there is active bleeding .
2. A patient with peripheral artery disease (PAD) reports leg pain that occurs with walking and resolves
with rest. What is this condition called, and what is the underlying cause of the pain?
A) Rest pain caused by venous stasis and edema formation
B) Intermittent claudication caused by ischemic muscle pain from atherosclerosis
C) Neuropathic pain caused by diabetic nerve damage in the lower extremities
D) Venous insufficiency caused by incompetent venous valves and pooling of blood
Answer: B - Intermittent claudication is ischemic muscle pain that occurs with exercise and resolves with
rest. It is a hallmark symptom of peripheral artery disease caused by atherosclerosis .
3. A patient prescribed clopidogrel after a myocardial infarction asks about potential side effects. What
is the most important warning the nurse should include in the discharge teaching for this medication?
, Page 3 of 29
A) "Notify the provider if you notice black, tarry stools or any unusual bleeding."
B) "Take this medication with food to prevent stomach upset and nausea."
C) "You may stop taking this medication if you experience mild headaches."
D) "This medication will dissolve any existing blood clots in your arteries."
Answer: A - Clopidogrel is an antiplatelet medication that increases the risk of bleeding. Black, tarry
stools indicate gastrointestinal bleeding and require immediate medical attention. Clopidogrel does not
dissolve existing clots; it prevents new clot formation .
4. A patient is 2 hours post-cardiac catheterization via the femoral artery. Which assessment finding
requires immediate nursing intervention and notification of the provider?
A) Pedal pulses are palpable bilaterally with good capillary refill
B) A hematoma is developing at the femoral insertion site
C) The patient reports mild discomfort at the insertion site
D) The patient's vital signs are stable with no acute changes
Answer: B - A hematoma at the femoral insertion site indicates bleeding and requires immediate
intervention. The affected leg should be kept straight, pressure should be applied, and the provider
should be notified promptly .
