,NH N480 EXAM 1
Advanced Medical-Surgical Nursing
Original Practice Questions with Answers & Rationales
QUESTION 1
A nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding may indicate that the client's lung has re-expanded?
A. Continuous bubbling in the water-seal chamber
B. Persistent bright-red drainage
C. Absence of tidaling in the water-seal chamber
D. Sudden severe dyspnea
Answer: C. Absence of tidaling in the water-seal chamber
Rationale: Tidaling may decrease or stop when the lung has fully re-expanded. Continuous
bubbling may instead indicate an air leak, depending on the drainage system and clinical
situation. Current NH N480 Exam 1 listings specifically identify chest-tube assessment and
interpretation as exam topics.
QUESTION 2
A client suddenly develops severe dyspnea, absent breath sounds on one side, hypotension, and
tracheal deviation. Which condition should the nurse suspect?
A. Tension pneumothorax
B. Simple atelectasis
C. Pleural effusion
D. Stable pneumonia
Answer: A. Tension pneumothorax
Rationale: Severe respiratory distress accompanied by unilateral absent breath sounds,
hypotension, and tracheal deviation is highly concerning for tension pneumothorax, an
emergency requiring immediate intervention.
QUESTION 3
,A client with a chest tube accidentally disconnects the tubing from the drainage system. What
should the nurse do first?
A. Clamp the chest tube for 30 minutes
B. Reconnect the tubing using sterile technique according to facility protocol
C. Remove the chest tube
D. Place the client flat
Answer: B. Reconnect the tubing using sterile technique according to facility protocol
Rationale: Maintaining a closed drainage system is essential. The nurse should promptly restore
the system according to institutional protocol and assess the client's respiratory status.
QUESTION 4
Which finding is most concerning in a client with a chest tube?
A. Small amount of expected drainage
B. Mild discomfort at the insertion site
C. Sudden increase in respiratory distress
D. Intermittent tidaling
Answer: C. Sudden increase in respiratory distress
Rationale: New or worsening respiratory distress can indicate complications such as recurrent
pneumothorax, tube obstruction, or another acute respiratory problem and requires immediate
assessment.
QUESTION 5
A client with a large pleural effusion reports worsening dyspnea. Which position should the
nurse use initially?
A. High-Fowler's
B. Flat supine
C. Trendelenburg
D. Prone
Answer: A. High-Fowler's
Rationale: Elevating the head of the bed can improve lung expansion and reduce the work of
breathing.
, QUESTION 6
A mechanically ventilated client receiving propofol is calm but easily aroused by verbal
stimulation. Which interpretation is most appropriate?
A. The client necessarily has excessive sedation
B. The client is demonstrating an appropriate level of sedation if this matches the prescribed
target
C. Propofol has completely failed
D. The client should automatically receive a higher dose
Answer: B. The client is demonstrating an appropriate level of sedation if this matches the
prescribed target
Rationale: Sedation should be titrated to a prescribed target using a validated sedation
assessment. The goal is generally adequate comfort and ventilator synchrony without
unnecessary deep sedation.
QUESTION 7
Which assessment finding in a mechanically ventilated client requires immediate attention?
A. Oxygen saturation within the prescribed target
B. Stable respiratory rate
C. Sudden high-pressure ventilator alarm with worsening distress
D. Patient resting comfortably
Answer: C. Sudden high-pressure ventilator alarm with worsening distress
Rationale: A high-pressure alarm combined with clinical deterioration can indicate airway
obstruction, secretions, bronchospasm, decreased lung compliance, or another acute problem.
QUESTION 8
A nurse is caring for a client receiving positive-pressure mechanical ventilation. Which
complication is associated with excessive airway pressure?
A. Barotrauma
B. Hypoglycemia
Advanced Medical-Surgical Nursing
Original Practice Questions with Answers & Rationales
QUESTION 1
A nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding may indicate that the client's lung has re-expanded?
A. Continuous bubbling in the water-seal chamber
B. Persistent bright-red drainage
C. Absence of tidaling in the water-seal chamber
D. Sudden severe dyspnea
Answer: C. Absence of tidaling in the water-seal chamber
Rationale: Tidaling may decrease or stop when the lung has fully re-expanded. Continuous
bubbling may instead indicate an air leak, depending on the drainage system and clinical
situation. Current NH N480 Exam 1 listings specifically identify chest-tube assessment and
interpretation as exam topics.
QUESTION 2
A client suddenly develops severe dyspnea, absent breath sounds on one side, hypotension, and
tracheal deviation. Which condition should the nurse suspect?
A. Tension pneumothorax
B. Simple atelectasis
C. Pleural effusion
D. Stable pneumonia
Answer: A. Tension pneumothorax
Rationale: Severe respiratory distress accompanied by unilateral absent breath sounds,
hypotension, and tracheal deviation is highly concerning for tension pneumothorax, an
emergency requiring immediate intervention.
QUESTION 3
,A client with a chest tube accidentally disconnects the tubing from the drainage system. What
should the nurse do first?
A. Clamp the chest tube for 30 minutes
B. Reconnect the tubing using sterile technique according to facility protocol
C. Remove the chest tube
D. Place the client flat
Answer: B. Reconnect the tubing using sterile technique according to facility protocol
Rationale: Maintaining a closed drainage system is essential. The nurse should promptly restore
the system according to institutional protocol and assess the client's respiratory status.
QUESTION 4
Which finding is most concerning in a client with a chest tube?
A. Small amount of expected drainage
B. Mild discomfort at the insertion site
C. Sudden increase in respiratory distress
D. Intermittent tidaling
Answer: C. Sudden increase in respiratory distress
Rationale: New or worsening respiratory distress can indicate complications such as recurrent
pneumothorax, tube obstruction, or another acute respiratory problem and requires immediate
assessment.
QUESTION 5
A client with a large pleural effusion reports worsening dyspnea. Which position should the
nurse use initially?
A. High-Fowler's
B. Flat supine
C. Trendelenburg
D. Prone
Answer: A. High-Fowler's
Rationale: Elevating the head of the bed can improve lung expansion and reduce the work of
breathing.
, QUESTION 6
A mechanically ventilated client receiving propofol is calm but easily aroused by verbal
stimulation. Which interpretation is most appropriate?
A. The client necessarily has excessive sedation
B. The client is demonstrating an appropriate level of sedation if this matches the prescribed
target
C. Propofol has completely failed
D. The client should automatically receive a higher dose
Answer: B. The client is demonstrating an appropriate level of sedation if this matches the
prescribed target
Rationale: Sedation should be titrated to a prescribed target using a validated sedation
assessment. The goal is generally adequate comfort and ventilator synchrony without
unnecessary deep sedation.
QUESTION 7
Which assessment finding in a mechanically ventilated client requires immediate attention?
A. Oxygen saturation within the prescribed target
B. Stable respiratory rate
C. Sudden high-pressure ventilator alarm with worsening distress
D. Patient resting comfortably
Answer: C. Sudden high-pressure ventilator alarm with worsening distress
Rationale: A high-pressure alarm combined with clinical deterioration can indicate airway
obstruction, secretions, bronchospasm, decreased lung compliance, or another acute problem.
QUESTION 8
A nurse is caring for a client receiving positive-pressure mechanical ventilation. Which
complication is associated with excessive airway pressure?
A. Barotrauma
B. Hypoglycemia
