,West Coast NURS 480 Exam 3 | Advanced Medical-
Surgical Nursing (2026) Q&A
1. A client is admitted with hypovolemic shock following a motor vehicle accident.
Which assessment finding should the nurse expect?
A) Warm, flushed skin
B) Tachycardia and hypotension
C) Bradycardia and hypertension
D) Distended jugular veins
Correct Answer: B) Tachycardia and hypotension
Rationale: Hypovolemic shock results from significant blood or fluid loss, leading to
decreased intravascular volume. Compensatory mechanisms include tachycardia to
maintain cardiac output and hypotension due to reduced preload. Warm, flushed
skin is seen in septic shock, and distended jugular veins are seen in cardiogenic
shock.
2. A client with an acute myocardial infarction has ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Correct Answer: B) Right coronary artery
,Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, typically due to occlusion of the right coronary artery. The left anterior
descending artery supplies the anterior wall, and the left circumflex artery supplies
the lateral wall.
3. A client with heart failure has a BNP level of 1,500 pg/mL. What does this finding
indicate?
A) Normal cardiac function
B) Worsening heart failure
C) Improved heart failure
D) Pulmonary embolism
Correct Answer: B) Worsening heart failure
Rationale: BNP is released when ventricular pressure increases due to stretching of
the myocardium. Elevated BNP levels indicate worsening heart failure and guide
treatment decisions. Normal BNP is typically less than 100 pg/mL.
4. A client with a pulmonary embolism is started on a heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic effectiveness?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Correct Answer: C) Activated partial thromboplastin time (aPTT)
, Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal of 1.5 to
2.5 times the control value. PT/INR monitors warfarin therapy. Platelet count is
monitored for heparin-induced thrombocytopenia.
5. A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with a PEEP of 15 cm H₂O. The nurse notes a sudden drop in blood
pressure and absent breath sounds on the right side. Which complication should the
nurse suspect?
A) Pulmonary embolism
B) Tension pneumothorax
C) Atelectasis
D) Pulmonary edema
Correct Answer: B) Tension pneumothorax
Rationale: High PEEP levels increase the risk of barotrauma, which can lead to a
tension pneumothorax. Sudden hypotension and unilateral absent breath sounds are
classic signs requiring immediate intervention.
6. A client with severe sepsis has a lactate level of 4.2 mmol/L. What does this finding
indicate?
A) Adequate tissue perfusion
B) Anaerobic metabolism and tissue hypoperfusion
C) Normal metabolic function
D) Improved response to fluids
Correct Answer: B) Anaerobic metabolism and tissue hypoperfusion
Surgical Nursing (2026) Q&A
1. A client is admitted with hypovolemic shock following a motor vehicle accident.
Which assessment finding should the nurse expect?
A) Warm, flushed skin
B) Tachycardia and hypotension
C) Bradycardia and hypertension
D) Distended jugular veins
Correct Answer: B) Tachycardia and hypotension
Rationale: Hypovolemic shock results from significant blood or fluid loss, leading to
decreased intravascular volume. Compensatory mechanisms include tachycardia to
maintain cardiac output and hypotension due to reduced preload. Warm, flushed
skin is seen in septic shock, and distended jugular veins are seen in cardiogenic
shock.
2. A client with an acute myocardial infarction has ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
Correct Answer: B) Right coronary artery
,Rationale: ST elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, typically due to occlusion of the right coronary artery. The left anterior
descending artery supplies the anterior wall, and the left circumflex artery supplies
the lateral wall.
3. A client with heart failure has a BNP level of 1,500 pg/mL. What does this finding
indicate?
A) Normal cardiac function
B) Worsening heart failure
C) Improved heart failure
D) Pulmonary embolism
Correct Answer: B) Worsening heart failure
Rationale: BNP is released when ventricular pressure increases due to stretching of
the myocardium. Elevated BNP levels indicate worsening heart failure and guide
treatment decisions. Normal BNP is typically less than 100 pg/mL.
4. A client with a pulmonary embolism is started on a heparin infusion. Which
laboratory value should the nurse monitor to evaluate therapeutic effectiveness?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count
Correct Answer: C) Activated partial thromboplastin time (aPTT)
, Rationale: Heparin therapy is monitored using aPTT, with a therapeutic goal of 1.5 to
2.5 times the control value. PT/INR monitors warfarin therapy. Platelet count is
monitored for heparin-induced thrombocytopenia.
5. A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with a PEEP of 15 cm H₂O. The nurse notes a sudden drop in blood
pressure and absent breath sounds on the right side. Which complication should the
nurse suspect?
A) Pulmonary embolism
B) Tension pneumothorax
C) Atelectasis
D) Pulmonary edema
Correct Answer: B) Tension pneumothorax
Rationale: High PEEP levels increase the risk of barotrauma, which can lead to a
tension pneumothorax. Sudden hypotension and unilateral absent breath sounds are
classic signs requiring immediate intervention.
6. A client with severe sepsis has a lactate level of 4.2 mmol/L. What does this finding
indicate?
A) Adequate tissue perfusion
B) Anaerobic metabolism and tissue hypoperfusion
C) Normal metabolic function
D) Improved response to fluids
Correct Answer: B) Anaerobic metabolism and tissue hypoperfusion
