Page 1 of 96
NH N480 EXAM 1 – ADVANCED MEDICAL SURGICAL NURSING
EXAM QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
NH N480 EXAM 1 – ADVANCED MEDICAL SURGICAL NURSING
MOSTLY TESTED AREAS
1. Advanced respiratory assessment, oxygenation, ventilation, and arterial blood gas
interpretation
2. Mechanical ventilation, airway management, suctioning, and ventilator complications
3. Chest tubes, pneumothorax, hemothorax, pleural effusion, and thoracic emergencies
4. Acute respiratory distress syndrome, pulmonary embolism, and critical respiratory
failure
5. Cardiovascular emergencies, acute coronary syndromes, dysrhythmias, and
hemodynamic monitoring
6. Shock states, sepsis, systemic inflammatory response, perfusion, and emergency
stabilization
7. Renal and fluid-electrolyte disorders requiring advanced medical-surgical nursing care
8. Neurologic emergencies, altered mental status, intracranial pressure, and spinal
emergencies
9. Endocrine emergencies, medication safety, pharmacology, nutrition, and critical-care
interventions
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10. Prioritization, delegation, clinical judgment, patient safety, emergency response, and
dosage calculations
QUESTIONS
1. A client with acute respiratory distress develops increasing work of breathing despite
supplemental oxygen. Which assessment finding requires the nurse's immediate attention?
A. Respiratory rate of 22/minute
B. Mild anxiety about hospitalization
C. ✓ Increasing somnolence with decreasing respiratory effort
D. Oxygen saturation of 94% while receiving oxygen
Rationale: Increasing somnolence and declining respiratory effort can indicate worsening
hypoxemia, hypercapnia, and impending respiratory failure.
2. A client with a large pneumothorax suddenly develops hypotension, severe dyspnea, and
tracheal deviation. Which complication should the nurse suspect?
A. Pleural effusion
B. ✓ Tension pneumothorax
C. Stable atelectasis
D. Pulmonary fibrosis
Rationale: Hypotension, severe respiratory compromise, and tracheal deviation are classic signs
of tension pneumothorax requiring immediate intervention.
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3. A nurse assesses a client with a chest tube connected to a water-seal drainage system. Which
finding most strongly suggests an air leak?
A. Tidaling with respirations
B. Small amount of serous drainage
C. Mild insertion-site discomfort
D. ✓ Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber may indicate an air leak in the
system or from the patient.
4. A client recovering from a pneumothorax has a chest tube in place. Which finding suggests
that the affected lung has re-expanded?
A. Continuous bubbling in the water seal
B. Increasing subcutaneous emphysema
C. ✓ Absence of expected tidaling as the lung re-expands
D. Sudden increase in bright-red drainage
Rationale: Tidaling may diminish or stop when the lung re-expands, although the entire clinical
picture should be assessed.
5. A client with pleural effusion reports worsening shortness of breath while lying flat. Which
intervention should the nurse implement first?
A. Place the client supine
B. Encourage vigorous exercise
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C. Restrict all oral fluids
D. ✓ Position the client in high-Fowler's position
Rationale: Upright positioning promotes maximal lung expansion and can reduce the work of
breathing.
6. A mechanically ventilated client becomes suddenly restless and oxygen saturation falls from
96% to 82%. What should the nurse do first?
A. Increase the sedation infusion
B. ✓ Assess the airway, tubing, and ventilator connections immediately
C. Wait for the next scheduled arterial blood gas
D. Administer a prescribed oral anxiolytic
Rationale: Sudden deterioration in a ventilated client requires immediate assessment for airway
obstruction, disconnection, tube displacement, or equipment malfunction.
7. A client with acute respiratory distress syndrome remains severely hypoxemic despite high
inspired oxygen concentrations. Which intervention may improve oxygenation?
A. Place the client flat
B. Increase tidal volume substantially
C. ✓ Anticipate prone positioning
D. Discontinue positive end-expiratory pressure
Rationale: Prone positioning can improve ventilation-perfusion matching and oxygenation in
severe ARDS.
NH N480 EXAM 1 – ADVANCED MEDICAL SURGICAL NURSING
EXAM QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
NH N480 EXAM 1 – ADVANCED MEDICAL SURGICAL NURSING
MOSTLY TESTED AREAS
1. Advanced respiratory assessment, oxygenation, ventilation, and arterial blood gas
interpretation
2. Mechanical ventilation, airway management, suctioning, and ventilator complications
3. Chest tubes, pneumothorax, hemothorax, pleural effusion, and thoracic emergencies
4. Acute respiratory distress syndrome, pulmonary embolism, and critical respiratory
failure
5. Cardiovascular emergencies, acute coronary syndromes, dysrhythmias, and
hemodynamic monitoring
6. Shock states, sepsis, systemic inflammatory response, perfusion, and emergency
stabilization
7. Renal and fluid-electrolyte disorders requiring advanced medical-surgical nursing care
8. Neurologic emergencies, altered mental status, intracranial pressure, and spinal
emergencies
9. Endocrine emergencies, medication safety, pharmacology, nutrition, and critical-care
interventions
, Page 2 of 96
10. Prioritization, delegation, clinical judgment, patient safety, emergency response, and
dosage calculations
QUESTIONS
1. A client with acute respiratory distress develops increasing work of breathing despite
supplemental oxygen. Which assessment finding requires the nurse's immediate attention?
A. Respiratory rate of 22/minute
B. Mild anxiety about hospitalization
C. ✓ Increasing somnolence with decreasing respiratory effort
D. Oxygen saturation of 94% while receiving oxygen
Rationale: Increasing somnolence and declining respiratory effort can indicate worsening
hypoxemia, hypercapnia, and impending respiratory failure.
2. A client with a large pneumothorax suddenly develops hypotension, severe dyspnea, and
tracheal deviation. Which complication should the nurse suspect?
A. Pleural effusion
B. ✓ Tension pneumothorax
C. Stable atelectasis
D. Pulmonary fibrosis
Rationale: Hypotension, severe respiratory compromise, and tracheal deviation are classic signs
of tension pneumothorax requiring immediate intervention.
, Page 3 of 96
3. A nurse assesses a client with a chest tube connected to a water-seal drainage system. Which
finding most strongly suggests an air leak?
A. Tidaling with respirations
B. Small amount of serous drainage
C. Mild insertion-site discomfort
D. ✓ Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber may indicate an air leak in the
system or from the patient.
4. A client recovering from a pneumothorax has a chest tube in place. Which finding suggests
that the affected lung has re-expanded?
A. Continuous bubbling in the water seal
B. Increasing subcutaneous emphysema
C. ✓ Absence of expected tidaling as the lung re-expands
D. Sudden increase in bright-red drainage
Rationale: Tidaling may diminish or stop when the lung re-expands, although the entire clinical
picture should be assessed.
5. A client with pleural effusion reports worsening shortness of breath while lying flat. Which
intervention should the nurse implement first?
A. Place the client supine
B. Encourage vigorous exercise
, Page 4 of 96
C. Restrict all oral fluids
D. ✓ Position the client in high-Fowler's position
Rationale: Upright positioning promotes maximal lung expansion and can reduce the work of
breathing.
6. A mechanically ventilated client becomes suddenly restless and oxygen saturation falls from
96% to 82%. What should the nurse do first?
A. Increase the sedation infusion
B. ✓ Assess the airway, tubing, and ventilator connections immediately
C. Wait for the next scheduled arterial blood gas
D. Administer a prescribed oral anxiolytic
Rationale: Sudden deterioration in a ventilated client requires immediate assessment for airway
obstruction, disconnection, tube displacement, or equipment malfunction.
7. A client with acute respiratory distress syndrome remains severely hypoxemic despite high
inspired oxygen concentrations. Which intervention may improve oxygenation?
A. Place the client flat
B. Increase tidal volume substantially
C. ✓ Anticipate prone positioning
D. Discontinue positive end-expiratory pressure
Rationale: Prone positioning can improve ventilation-perfusion matching and oxygenation in
severe ARDS.
