NURS 480 FINAL EXAM (MEDICAL-SURGICAL NURSING)
– VERIFIED NURSING EXAM PACK
Comprehensive Practice Examination
Total Questions: 150
SECTION 1: CRITICAL CARE & EMERGENCY NURSING (Questions 1-25)
1. A patient is brought to the emergency department with a gunshot wound to the chest. The
patient is hypotensive, tachycardic, and has distended neck veins. Breath sounds are
diminished on the left side. What is the priority nursing intervention?
A. Prepare for emergency needle decompression
B. Administer IV fluids rapidly
C. Obtain a chest x-ray
D. Insert a chest tube
Answer: A. Prepare for emergency needle decompression
Rationale: The patient is showing signs of tension pneumothorax (hypotension, tachycardia,
distended neck veins, diminished breath sounds), which is a life-threatening emergency
requiring immediate needle decompression. This is the priority intervention to relieve the
pressure in the pleural space. IV fluids, chest x-ray, and chest tube insertion are important but
secondary to immediate decompression.
2. A patient in the ICU is receiving mechanical ventilation. The high-pressure alarm sounds.
What is the first action the nurse should take?
A. Suction the patient
B. Assess the endotracheal tube for obstruction
C. Check the ventilator settings
D. Notify the respiratory therapist
Answer: B. Assess the endotracheal tube for obstruction
Rationale: A high-pressure alarm indicates increased airway resistance. The nurse should first
assess the endotracheal tube for kinking, obstruction, or mucus plugging. Suctioning may be
needed if the tube is obstructed by secretions. Ventilator settings should be checked after ruling
out patient-related causes. The respiratory therapist should be notified if the problem persists.
,3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 25 mmHg.
Which nursing intervention is most appropriate to reduce ICP?
A. Elevate the head of the bed to 30 degrees
B. Lower the head of the bed
C. Administer IV fluids rapidly
D. Increase the ventilator rate
Answer: A. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees reduces ICP by promoting venous
drainage from the head. Lowering the head of the bed would increase ICP. Rapid IV fluids may
worsen cerebral edema. Increasing ventilator rate may improve oxygenation but does not
directly lower ICP.
4. A patient is in cardiogenic shock. The nurse should anticipate which hemodynamic finding?
A. Low cardiac output and high systemic vascular resistance
B. High cardiac output and low systemic vascular resistance
C. Low cardiac output and low systemic vascular resistance
D. Normal cardiac output and high systemic vascular resistance
Answer: A. Low cardiac output and high systemic vascular resistance
Rationale: Cardiogenic shock is characterized by low cardiac output (due to pump failure) and
high systemic vascular resistance (compensatory vasoconstriction). This is in contrast to
distributive shock (sepsis) where CO is high and SVR is low. The decreased CO leads to tissue
hypoperfusion and organ dysfunction.
5. A patient with a burn injury has a total body surface area (TBSA) of 40%. The nurse should
anticipate which initial fluid resuscitation formula?
A. 2 mL/kg/%TBSA of lactated Ringer's
B. 4 mL/kg/%TBSA of lactated Ringer's
C. 2 mL/kg/%TBSA of normal saline
D. 4 mL/kg/%TBSA of normal saline
Answer: B. 4 mL/kg/%TBSA of lactated Ringer's
Rationale: The Parkland formula (4 mL/kg/%TBSA of lactated Ringer's) is used for initial fluid
resuscitation in burn patients. Half of the total fluid is given in the first 8 hours, and the
remaining half is given over the next 16 hours. Lactated Ringer's is preferred over normal saline
to prevent hyperchloremic metabolic acidosis.
,6. A patient is in cardiac arrest. The cardiac monitor shows ventricular fibrillation. What is the
priority intervention?
A. Defibrillate
B. Administer epinephrine
C. Administer amiodarone
D. Continue CPR
Answer: A. Defibrillate
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation. CPR
should be performed while preparing the defibrillator. Epinephrine and amiodarone are given
after defibrillation attempts or if the rhythm is refractory. Defibrillation is the priority
intervention to terminate the arrhythmia.
7. A patient with a pulmonary embolism is experiencing acute respiratory distress. The nurse
should anticipate which arterial blood gas (ABG) finding?
A. Hypoxemia and respiratory alkalosis
B. Hypoxemia and respiratory acidosis
C. Hyperoxemia and metabolic alkalosis
D. Normal ABG
Answer: A. Hypoxemia and respiratory alkalosis
Rationale: Pulmonary embolism causes ventilation-perfusion mismatch, leading to hypoxemia
(low PaO2). The patient hyperventilates in response to hypoxia, leading to respiratory alkalosis
(low PaCO2, high pH). As the condition worsens, respiratory acidosis may develop. ABG analysis
is essential for assessing oxygenation and ventilation status.
8. A patient with acute respiratory distress syndrome (ARDS) is receiving lung-protective
ventilation. What tidal volume is recommended?
A. 6 mL/kg
B. 8 mL/kg
C. 10 mL/kg
D. 12 mL/kg
Answer: A. 6 mL/kg
Rationale: Lung-protective ventilation in ARDS uses low tidal volumes (6 mL/kg ideal body
weight) to prevent ventilator-induced lung injury. Higher tidal volumes (10-12 mL/kg) can cause
volutrauma and worsen ARDS. The goal is to maintain adequate oxygenation with minimal lung
injury.
, 9. A patient with a head injury is exhibiting Cushing's triad. Which findings would the nurse
expect?
A. Hypertension, bradycardia, and widening pulse pressure
B. Hypotension, tachycardia, and narrowing pulse pressure
C. Hypertension, tachycardia, and widening pulse pressure
D. Hypotension, bradycardia, and widening pulse pressure
Answer: A. Hypertension, bradycardia, and widening pulse pressure
Rationale: Cushing's triad indicates increased intracranial pressure and is characterized by
hypertension, bradycardia, and widening pulse pressure (increased systolic and decreased
diastolic BP). This is a late sign of increased ICP requiring immediate intervention. The other
options do not describe Cushing's triad.
10. A patient is experiencing anaphylaxis. The nurse should administer which medication
first?
A. Epinephrine
B. Diphenhydramine
C. Albuterol
D. Corticosteroids
Answer: A. Epinephrine
Rationale: Epinephrine is the first-line medication for anaphylaxis. It acts rapidly to reverse
bronchospasm, vasodilation, and hypotension. Diphenhydramine, corticosteroids, and albuterol
are adjunctive treatments. Delayed administration of epinephrine is associated with increased
morbidity and mortality.
11. A patient with a chest tube has continuous bubbling in the water seal chamber. What
does this indicate?
A. Normal function
B. An air leak
C. A blocked tube
D. Increased drainage
Answer: B. An air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the chest tube
system. This can be caused by a loose connection, disconnection, or a leak in the patient's lung.
Intermittent bubbling is normal. A blocked tube would show no drainage or bubbling. Increased
drainage is assessed in the collection chamber.
– VERIFIED NURSING EXAM PACK
Comprehensive Practice Examination
Total Questions: 150
SECTION 1: CRITICAL CARE & EMERGENCY NURSING (Questions 1-25)
1. A patient is brought to the emergency department with a gunshot wound to the chest. The
patient is hypotensive, tachycardic, and has distended neck veins. Breath sounds are
diminished on the left side. What is the priority nursing intervention?
A. Prepare for emergency needle decompression
B. Administer IV fluids rapidly
C. Obtain a chest x-ray
D. Insert a chest tube
Answer: A. Prepare for emergency needle decompression
Rationale: The patient is showing signs of tension pneumothorax (hypotension, tachycardia,
distended neck veins, diminished breath sounds), which is a life-threatening emergency
requiring immediate needle decompression. This is the priority intervention to relieve the
pressure in the pleural space. IV fluids, chest x-ray, and chest tube insertion are important but
secondary to immediate decompression.
2. A patient in the ICU is receiving mechanical ventilation. The high-pressure alarm sounds.
What is the first action the nurse should take?
A. Suction the patient
B. Assess the endotracheal tube for obstruction
C. Check the ventilator settings
D. Notify the respiratory therapist
Answer: B. Assess the endotracheal tube for obstruction
Rationale: A high-pressure alarm indicates increased airway resistance. The nurse should first
assess the endotracheal tube for kinking, obstruction, or mucus plugging. Suctioning may be
needed if the tube is obstructed by secretions. Ventilator settings should be checked after ruling
out patient-related causes. The respiratory therapist should be notified if the problem persists.
,3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 25 mmHg.
Which nursing intervention is most appropriate to reduce ICP?
A. Elevate the head of the bed to 30 degrees
B. Lower the head of the bed
C. Administer IV fluids rapidly
D. Increase the ventilator rate
Answer: A. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees reduces ICP by promoting venous
drainage from the head. Lowering the head of the bed would increase ICP. Rapid IV fluids may
worsen cerebral edema. Increasing ventilator rate may improve oxygenation but does not
directly lower ICP.
4. A patient is in cardiogenic shock. The nurse should anticipate which hemodynamic finding?
A. Low cardiac output and high systemic vascular resistance
B. High cardiac output and low systemic vascular resistance
C. Low cardiac output and low systemic vascular resistance
D. Normal cardiac output and high systemic vascular resistance
Answer: A. Low cardiac output and high systemic vascular resistance
Rationale: Cardiogenic shock is characterized by low cardiac output (due to pump failure) and
high systemic vascular resistance (compensatory vasoconstriction). This is in contrast to
distributive shock (sepsis) where CO is high and SVR is low. The decreased CO leads to tissue
hypoperfusion and organ dysfunction.
5. A patient with a burn injury has a total body surface area (TBSA) of 40%. The nurse should
anticipate which initial fluid resuscitation formula?
A. 2 mL/kg/%TBSA of lactated Ringer's
B. 4 mL/kg/%TBSA of lactated Ringer's
C. 2 mL/kg/%TBSA of normal saline
D. 4 mL/kg/%TBSA of normal saline
Answer: B. 4 mL/kg/%TBSA of lactated Ringer's
Rationale: The Parkland formula (4 mL/kg/%TBSA of lactated Ringer's) is used for initial fluid
resuscitation in burn patients. Half of the total fluid is given in the first 8 hours, and the
remaining half is given over the next 16 hours. Lactated Ringer's is preferred over normal saline
to prevent hyperchloremic metabolic acidosis.
,6. A patient is in cardiac arrest. The cardiac monitor shows ventricular fibrillation. What is the
priority intervention?
A. Defibrillate
B. Administer epinephrine
C. Administer amiodarone
D. Continue CPR
Answer: A. Defibrillate
Rationale: Ventricular fibrillation is a shockable rhythm requiring immediate defibrillation. CPR
should be performed while preparing the defibrillator. Epinephrine and amiodarone are given
after defibrillation attempts or if the rhythm is refractory. Defibrillation is the priority
intervention to terminate the arrhythmia.
7. A patient with a pulmonary embolism is experiencing acute respiratory distress. The nurse
should anticipate which arterial blood gas (ABG) finding?
A. Hypoxemia and respiratory alkalosis
B. Hypoxemia and respiratory acidosis
C. Hyperoxemia and metabolic alkalosis
D. Normal ABG
Answer: A. Hypoxemia and respiratory alkalosis
Rationale: Pulmonary embolism causes ventilation-perfusion mismatch, leading to hypoxemia
(low PaO2). The patient hyperventilates in response to hypoxia, leading to respiratory alkalosis
(low PaCO2, high pH). As the condition worsens, respiratory acidosis may develop. ABG analysis
is essential for assessing oxygenation and ventilation status.
8. A patient with acute respiratory distress syndrome (ARDS) is receiving lung-protective
ventilation. What tidal volume is recommended?
A. 6 mL/kg
B. 8 mL/kg
C. 10 mL/kg
D. 12 mL/kg
Answer: A. 6 mL/kg
Rationale: Lung-protective ventilation in ARDS uses low tidal volumes (6 mL/kg ideal body
weight) to prevent ventilator-induced lung injury. Higher tidal volumes (10-12 mL/kg) can cause
volutrauma and worsen ARDS. The goal is to maintain adequate oxygenation with minimal lung
injury.
, 9. A patient with a head injury is exhibiting Cushing's triad. Which findings would the nurse
expect?
A. Hypertension, bradycardia, and widening pulse pressure
B. Hypotension, tachycardia, and narrowing pulse pressure
C. Hypertension, tachycardia, and widening pulse pressure
D. Hypotension, bradycardia, and widening pulse pressure
Answer: A. Hypertension, bradycardia, and widening pulse pressure
Rationale: Cushing's triad indicates increased intracranial pressure and is characterized by
hypertension, bradycardia, and widening pulse pressure (increased systolic and decreased
diastolic BP). This is a late sign of increased ICP requiring immediate intervention. The other
options do not describe Cushing's triad.
10. A patient is experiencing anaphylaxis. The nurse should administer which medication
first?
A. Epinephrine
B. Diphenhydramine
C. Albuterol
D. Corticosteroids
Answer: A. Epinephrine
Rationale: Epinephrine is the first-line medication for anaphylaxis. It acts rapidly to reverse
bronchospasm, vasodilation, and hypotension. Diphenhydramine, corticosteroids, and albuterol
are adjunctive treatments. Delayed administration of epinephrine is associated with increased
morbidity and mortality.
11. A patient with a chest tube has continuous bubbling in the water seal chamber. What
does this indicate?
A. Normal function
B. An air leak
C. A blocked tube
D. Increased drainage
Answer: B. An air leak
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the chest tube
system. This can be caused by a loose connection, disconnection, or a leak in the patient's lung.
Intermittent bubbling is normal. A blocked tube would show no drainage or bubbling. Increased
drainage is assessed in the collection chamber.
