WEST COAST UNIVERSITY NURS 480 EXAM 1 –
SPRING II SECTION 1M ADVANCED MEDICAL
SURGICAL NURSING: PROMOTING WELLNESS IN
THE CRITICALLY ILL | ATI NURSING LATEST
UPDATED ACTUAL FINAL EXAM WITH COMPLETE
WELL ELABORATED AND MOST TESTED REAL
EXAM PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS CERTIFIED ANSWER KEY 2026-2027 Q&A FINAL
EXAM UPDATED VERSION ALREADY GRADED A+
(BRAND NEW)
Question 1
A nurse is caring for a client who has a chest tube in place to a closed chest
drainage system. Which of the following findings should indicate to the nurse that
the client's lung has re-expanded?
A. Oxygen saturation of 95%
B. No reports of pleuritic chest pain
C. Occasional bubbling in the water-seal chamber
D. No fluctuations in the water seal chamber
Correct Answer: D
Rationale: Absence of fluctuation (tidaling) in the water seal chamber indicates
that the lung has re-expanded and there is no longer an air leak or pressure
differential between the pleural space and the drainage system. Fluctuations are
expected while the lung is still re-expanding.
,Question 2
A nurse is caring for a client who has a new chest tube in place to closed-chest
water-seal drainage and suction. The nurse should observe the client for which of
the following indications of a problem in the drainage system?
A. Occasional bubbling in the water-seal chamber
B. Fluctuations in the fluid level in the water-seal chamber
C. Constant bubbling in the suction-control chamber
D. Continuous bubbling in the water-seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in
the system, which is a problem that requires investigation. Occasional bubbling is
normal with exhalation or coughing. Fluctuations are expected. Constant bubbling
in the suction-control chamber is normal when suction is applied.
Question 3
A nurse is caring for a client who has just had a bronchoscopy. Which of the
following is an appropriate nursing action?
A. Irrigate the client's throat every 4 hours
B. Have the client refrain from talking for 24 hours
C. Suction the client's oropharynx frequently
D. Withhold food and liquids until the client's gag reflex returns
Correct Answer: D
Rationale: After bronchoscopy, the client's gag reflex is suppressed due to local
anesthesia. Food and fluids should be withheld until the gag reflex returns to
prevent aspiration.
Question 4
The nurse participating in a client care conference with other health team
members is discussing a client with acute respiratory distress syndrome (ARDS).
The physician states that because of fluid in the alveoli, surfactant production is
falling. The nurse understands that the consequence of insufficient surfactant is:
,A. Atelectasis and viral infection
B. Bronchoconstriction and stridor
C. Decreased ciliary action and retained secretions
D. Collapse of alveoli and decreased compliance
Correct Answer: D
Rationale: Surfactant reduces surface tension in the alveoli, preventing collapse.
Insufficient surfactant leads to alveolar collapse (atelectasis) and decreased lung
compliance.
Question 5
A nurse is monitoring a client who has two chest tubes inserted for a right-sided
pneumothorax. The client complains of chest burning. Which of the following is
an appropriate nursing action?
A. Increase the client's wall suction
B. Strip the client's chest tube
C. Clamp the client's chest tube
D. Reposition the client
Correct Answer: D
Rationale: Chest burning with chest tubes is often due to the tube irritating the
pleural space. Repositioning the client can relieve this discomfort. Increasing
suction, stripping, or clamping the tube could cause injury or complications.
Question 6
The nurse assesses a client with dyspnea, decreased breath sounds, tracheal
deviation, and pulse oximetry reading of 86%. What is the nurse's interpretation
of these findings?
A. Flail chest
B. Pulmonary contusion
C. Acute respiratory distress syndrome
D. Tension pneumothorax
, Correct Answer: D
Rationale: Tracheal deviation, decreased breath sounds on the affected side,
dyspnea, and hypoxia are classic signs of tension pneumothorax. This is a life-
threatening emergency requiring immediate needle decompression.
Question 7
The nurse observes the nursing student suctioning the client. Which intervention
on the student nurse's part has the greatest potential to cause tissue damage?
A. Hyperoxygenating the client after removing the suction catheter
B. Applying intermittent suction
C. Oxygen saturation post-suctioning of 93%
D. Applying suction when the catheter is inserted
Correct Answer: D
Rationale: Applying suction during catheter insertion can cause trauma to the
mucosal tissue. Suction should only be applied during catheter withdrawal.
Question 8
A client has the following arterial blood gas values: pH 7.52, PaO2 50 mm Hg,
PaCO2 28 mm Hg, HCO3 24 mEq/L. Based upon the client's PaO2, which of the
following conclusions would be accurate?
A. The oxygen level is low but poses no risk for the client
B. The client's PaO2 level is within normal range
C. The client requires oxygen therapy with very low oxygen concentrations
D. The client is severely hypoxic
Correct Answer: D
Rationale: Normal PaO2 is 80-100 mm Hg. A PaO2 of 50 mm Hg indicates severe
hypoxemia. This client also has respiratory alkalosis (high pH, low PaCO2).
Question 9
The nurse notes thick, white secretions in the endotracheal tube (ET) of a patient
SPRING II SECTION 1M ADVANCED MEDICAL
SURGICAL NURSING: PROMOTING WELLNESS IN
THE CRITICALLY ILL | ATI NURSING LATEST
UPDATED ACTUAL FINAL EXAM WITH COMPLETE
WELL ELABORATED AND MOST TESTED REAL
EXAM PRACTICE QUESTIONS AND 100% CORRECT
VERIFIED ANSWERS WITH DETAILED RATIONALES
PLUS CERTIFIED ANSWER KEY 2026-2027 Q&A FINAL
EXAM UPDATED VERSION ALREADY GRADED A+
(BRAND NEW)
Question 1
A nurse is caring for a client who has a chest tube in place to a closed chest
drainage system. Which of the following findings should indicate to the nurse that
the client's lung has re-expanded?
A. Oxygen saturation of 95%
B. No reports of pleuritic chest pain
C. Occasional bubbling in the water-seal chamber
D. No fluctuations in the water seal chamber
Correct Answer: D
Rationale: Absence of fluctuation (tidaling) in the water seal chamber indicates
that the lung has re-expanded and there is no longer an air leak or pressure
differential between the pleural space and the drainage system. Fluctuations are
expected while the lung is still re-expanding.
,Question 2
A nurse is caring for a client who has a new chest tube in place to closed-chest
water-seal drainage and suction. The nurse should observe the client for which of
the following indications of a problem in the drainage system?
A. Occasional bubbling in the water-seal chamber
B. Fluctuations in the fluid level in the water-seal chamber
C. Constant bubbling in the suction-control chamber
D. Continuous bubbling in the water-seal chamber
Correct Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in
the system, which is a problem that requires investigation. Occasional bubbling is
normal with exhalation or coughing. Fluctuations are expected. Constant bubbling
in the suction-control chamber is normal when suction is applied.
Question 3
A nurse is caring for a client who has just had a bronchoscopy. Which of the
following is an appropriate nursing action?
A. Irrigate the client's throat every 4 hours
B. Have the client refrain from talking for 24 hours
C. Suction the client's oropharynx frequently
D. Withhold food and liquids until the client's gag reflex returns
Correct Answer: D
Rationale: After bronchoscopy, the client's gag reflex is suppressed due to local
anesthesia. Food and fluids should be withheld until the gag reflex returns to
prevent aspiration.
Question 4
The nurse participating in a client care conference with other health team
members is discussing a client with acute respiratory distress syndrome (ARDS).
The physician states that because of fluid in the alveoli, surfactant production is
falling. The nurse understands that the consequence of insufficient surfactant is:
,A. Atelectasis and viral infection
B. Bronchoconstriction and stridor
C. Decreased ciliary action and retained secretions
D. Collapse of alveoli and decreased compliance
Correct Answer: D
Rationale: Surfactant reduces surface tension in the alveoli, preventing collapse.
Insufficient surfactant leads to alveolar collapse (atelectasis) and decreased lung
compliance.
Question 5
A nurse is monitoring a client who has two chest tubes inserted for a right-sided
pneumothorax. The client complains of chest burning. Which of the following is
an appropriate nursing action?
A. Increase the client's wall suction
B. Strip the client's chest tube
C. Clamp the client's chest tube
D. Reposition the client
Correct Answer: D
Rationale: Chest burning with chest tubes is often due to the tube irritating the
pleural space. Repositioning the client can relieve this discomfort. Increasing
suction, stripping, or clamping the tube could cause injury or complications.
Question 6
The nurse assesses a client with dyspnea, decreased breath sounds, tracheal
deviation, and pulse oximetry reading of 86%. What is the nurse's interpretation
of these findings?
A. Flail chest
B. Pulmonary contusion
C. Acute respiratory distress syndrome
D. Tension pneumothorax
, Correct Answer: D
Rationale: Tracheal deviation, decreased breath sounds on the affected side,
dyspnea, and hypoxia are classic signs of tension pneumothorax. This is a life-
threatening emergency requiring immediate needle decompression.
Question 7
The nurse observes the nursing student suctioning the client. Which intervention
on the student nurse's part has the greatest potential to cause tissue damage?
A. Hyperoxygenating the client after removing the suction catheter
B. Applying intermittent suction
C. Oxygen saturation post-suctioning of 93%
D. Applying suction when the catheter is inserted
Correct Answer: D
Rationale: Applying suction during catheter insertion can cause trauma to the
mucosal tissue. Suction should only be applied during catheter withdrawal.
Question 8
A client has the following arterial blood gas values: pH 7.52, PaO2 50 mm Hg,
PaCO2 28 mm Hg, HCO3 24 mEq/L. Based upon the client's PaO2, which of the
following conclusions would be accurate?
A. The oxygen level is low but poses no risk for the client
B. The client's PaO2 level is within normal range
C. The client requires oxygen therapy with very low oxygen concentrations
D. The client is severely hypoxic
Correct Answer: D
Rationale: Normal PaO2 is 80-100 mm Hg. A PaO2 of 50 mm Hg indicates severe
hypoxemia. This client also has respiratory alkalosis (high pH, low PaCO2).
Question 9
The nurse notes thick, white secretions in the endotracheal tube (ET) of a patient
