WCU ADVANCED MEDICAL-SURGICAL
NURSING FINAL EXAM 2026/2027 | 150
VERIFIED QUESTIONS & ANSWERS
WITH RATIONALES | WEST COAST
UNIVERSITY NURS 480 STUDY GUIDE |
INSTANT DOWNLOAD
1. A patient presents with sudden substernal chest pain radiating to the left
arm, diaphoresis, and nausea. The 12-lead EKG shows ST-segment elevation in
leads V1-V4. Which intervention is the priority?
A. Administer sublingual nitroglycerin
B. Obtain cardiac enzymes
C. Prepare for emergent percutaneous coronary intervention (PCI)
D. Administer morphine sulfate
Correct Answer: C. Rationale: ST-segment elevation in V1-V4 indicates an anterior wall
STEMI. The priority is reperfusion therapy—PCI is preferred if it can be performed
within 90 minutes of arrival. PCI is the gold standard for restoring coronary blood flow
and limiting myocardial damage. Nitroglycerin, morphine, and cardiac enzymes are
important but do not take precedence over emergent reperfusion.
2. A patient with an acute MI is receiving oxygen therapy. The nurse
understands that oxygen should be administered to maintain SpO₂ at:
A. ≥ 85%
B. ≥ 90%
C. ≥ 92%
D. ≥ 95%
Correct Answer: C. Rationale: Current guidelines recommend supplemental oxygen for
patients with MI who have SpO₂ < 90% or respiratory distress. The target SpO₂ is ≥
92%. Routine oxygen administration in all MI patients is no longer recommended as it
may cause vasoconstriction and reduce coronary blood flow.
3. The nurse is assessing a patient 6 hours post-cardiac catheterization via the
femoral artery. Which finding requires immediate intervention?
A. Pedal pulses palpable bilaterally
B. Small hematoma at the insertion site
C. Bleeding at the puncture site with a drop in blood pressure
D. Patient reports mild discomfort at the site
,Correct Answer: C. Rationale: Bleeding at the femoral access site with hemodynamic
compromise (drop in BP) suggests retroperitoneal bleeding or hematoma formation,
which can be life-threatening. Immediate pressure, notification of the provider, and
fluid resuscitation are required. Small hematoma and mild discomfort are expected
findings.
4. A patient with aortic dissection is prescribed a beta-blocker. The primary
goal of this medication is to:
A. Increase cardiac output
B. Decrease heart rate and blood pressure to reduce shear stress
C. Promote vasodilation of coronary arteries
D. Prevent clot formation
Correct Answer: B. Rationale: Beta-blockers reduce heart rate and blood pressure,
decreasing the shear stress (dP/dt) on the aortic wall, which is critical to prevent
extension or rupture of the dissection. Vasodilators alone can cause reflex tachycardia
and increase shear stress.
5. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Tall, peaked T waves
C. ST-segment depression
D. U waves
Correct Answer: B. Rationale: Hyperkalemia causes tall, peaked, narrow-based T waves.
As potassium rises further, the QRS widens and the P wave may flatten. Prolonged QT
and U waves are associated with hypokalemia.
6. A patient in the ICU has a central venous pressure (CVP) of 2 mmHg. The
nurse interprets this as:
A. Hypervolemia
B. Hypovolemia
C. Normal volume status
D. Right heart failure
Correct Answer: B. Rationale: Normal CVP is 2–8 mmHg. A CVP of 2 mmHg indicates
low right ventricular preload, consistent with hypovolemia (e.g., dehydration,
hemorrhage). Elevated CVP (>8 mmHg) suggests hypervolemia or right heart failure.
7. The nurse is preparing to administer digoxin to a patient with heart failure.
Which assessment finding would cause the nurse to withhold the dose?
A. Heart rate 88 bpm
B. Potassium level 3.0 mEq/L
C. Blood pressure 110/70 mmHg
D. Digoxin level 0.8 ng/mL
Correct Answer: B. Rationale: Hypokalemia (K⁺ < 3.5 mEq/L) increases the risk of
,digoxin toxicity. The nurse should hold the digoxin and notify the provider. Therapeutic
digoxin level is 0.5–2.0 ng/mL; 0.8 is therapeutic. HR 88 and BP 110/70 are acceptable.
8. A patient is admitted with a diagnosis of heart failure exacerbation. Which
assessment finding indicates fluid overload?
A. Flat neck veins
B. Weight loss of 1 kg in 2 days
C. Bibasilar crackles and JVD
D. Dry mucous membranes
Correct Answer: C. Rationale: Bibasilar crackles and jugular venous distention (JVD) are
classic signs of fluid overload in left and right heart failure, respectively. Flat neck veins
and dry mucous membranes suggest dehydration.
9. The nurse is teaching a patient about nitroglycerin. Which statement by the
patient indicates a need for further teaching?
A. "I will call 911 if the pain is not relieved after 5 minutes."
B. "I will take up to 3 tablets, 5 minutes apart."
C. "I will take the tablet with a glass of water."
D. "I will sit or lie down when taking the medication."
Correct Answer: C. Rationale: Sublingual nitroglycerin should be allowed to dissolve
under the tongue, not swallowed with water, as this bypasses the rapid mucosal
absorption. The other statements are correct: up to 3 tablets 5 minutes apart, call 911 if
unrelieved, and sit or lie down to prevent syncope.
10. A 68-year-old patient with a history of heart failure is admitted with acute
pulmonary edema. After IV furosemide and nitroglycerin infusion, the patient's
blood pressure drops to 82/50 mm Hg and the heart rate rises to 118 bpm.
Which action is the priority?
A. Administer a bolus of isotonic crystalloid to restore perfusion.
B. Obtain a stat electrocardiogram to rule out acute coronary syndrome.
C. Decrease or stop the nitroglycerin infusion and reassess hemodynamics.
D. Prepare for emergent intubation due to respiratory fatigue.
Correct Answer: C. Rationale: Nitroglycerin is a vasodilator that can cause hypotension.
In a patient with acute pulmonary edema who becomes hypotensive after nitroglycerin,
the priority is to decrease or stop the infusion and reassess hemodynamics. Fluid bolus
may worsen pulmonary edema.
11. A 72-year-old patient with chronic kidney disease (stage 4) is admitted with
sepsis. The provider orders vancomycin 25 mg/kg IV. The patient's current
weight is 70 kg, and serum creatinine is 3.2 mg/dL. What is the nurse's most
appropriate action?
A. Administer the full dose as ordered because the loading dose is based on weight
and not renal function.
B. Consult pharmacy to adjust the dose and interval based on the patient's renal
, function.
C. Hold the dose until blood cultures are reported.
D. Administer the dose with a slow infusion and monitor for red man syndrome.
Correct Answer: B. Rationale: Vancomycin is renally excreted. In a patient with CKD
stage 4 (serum creatinine 3.2 mg/dL), the dose and interval must be adjusted to
prevent nephrotoxicity. The nurse should consult pharmacy for renal dosing.
12. A 45-year-old patient with a severe traumatic brain injury (GCS 7) has an
intraventricular catheter. The nurse notes a sudden rise in intracranial pressure
(ICP) to 32 mm Hg. Which intervention should the nurse perform first?
A. Notify the neurosurgeon immediately.
B. Check the cerebrospinal fluid (CSF) drainage system and ensure it is set to drain at
the prescribed pressure.
C. Elevate the head of the bed to 30 degrees and ensure the neck is in a neutral
position.
D. Administer a prescribed dose of mannitol if ordered.
Correct Answer: B. Rationale: The first action is to ensure the CSF drainage system is
functioning and set to the prescribed pressure. This can rapidly reduce ICP. Notifying
the surgeon, positioning, and mannitol are also important but follow this initial check.
13. A 58-year-old patient with type 2 diabetes is admitted with unstable angina.
The cardiac catheterization reveals a 90% lesion in the left anterior descending
artery. Which medication should the nurse question if prescribed concurrently
with metformin?
A. Nitroglycerin
B. Furosemide
C. Iodinated contrast media
D. Heparin
Correct Answer: C. Rationale: Iodinated contrast media can precipitate acute kidney
injury, and metformin increases the risk of lactic acidosis in the setting of renal
impairment. Metformin should be withheld before and after contrast administration.
14. A 72-year-old patient with atrial fibrillation is on warfarin. The nurse notes
an INR of 6.5, and the patient has minor gum bleeding. The patient is not
hemodynamically unstable. Which intervention should the nurse anticipate?
A. Administer protamine sulfate IV bolus.
B. Administer vitamin K orally or subcutaneously and monitor INR.
C. Administer a dose of fresh frozen plasma immediately.
D. Administer four units of activated prothrombin complex concentrate.
Correct Answer: B. Rationale: For an INR of 6.5 with minor bleeding and no
hemodynamic instability, vitamin K (phytonadione) is administered orally or
subcutaneously, and INR is monitored. Protamine sulfate reverses heparin, not
warfarin. FFP or PCC is reserved for major bleeding or emergent reversal.
NURSING FINAL EXAM 2026/2027 | 150
VERIFIED QUESTIONS & ANSWERS
WITH RATIONALES | WEST COAST
UNIVERSITY NURS 480 STUDY GUIDE |
INSTANT DOWNLOAD
1. A patient presents with sudden substernal chest pain radiating to the left
arm, diaphoresis, and nausea. The 12-lead EKG shows ST-segment elevation in
leads V1-V4. Which intervention is the priority?
A. Administer sublingual nitroglycerin
B. Obtain cardiac enzymes
C. Prepare for emergent percutaneous coronary intervention (PCI)
D. Administer morphine sulfate
Correct Answer: C. Rationale: ST-segment elevation in V1-V4 indicates an anterior wall
STEMI. The priority is reperfusion therapy—PCI is preferred if it can be performed
within 90 minutes of arrival. PCI is the gold standard for restoring coronary blood flow
and limiting myocardial damage. Nitroglycerin, morphine, and cardiac enzymes are
important but do not take precedence over emergent reperfusion.
2. A patient with an acute MI is receiving oxygen therapy. The nurse
understands that oxygen should be administered to maintain SpO₂ at:
A. ≥ 85%
B. ≥ 90%
C. ≥ 92%
D. ≥ 95%
Correct Answer: C. Rationale: Current guidelines recommend supplemental oxygen for
patients with MI who have SpO₂ < 90% or respiratory distress. The target SpO₂ is ≥
92%. Routine oxygen administration in all MI patients is no longer recommended as it
may cause vasoconstriction and reduce coronary blood flow.
3. The nurse is assessing a patient 6 hours post-cardiac catheterization via the
femoral artery. Which finding requires immediate intervention?
A. Pedal pulses palpable bilaterally
B. Small hematoma at the insertion site
C. Bleeding at the puncture site with a drop in blood pressure
D. Patient reports mild discomfort at the site
,Correct Answer: C. Rationale: Bleeding at the femoral access site with hemodynamic
compromise (drop in BP) suggests retroperitoneal bleeding or hematoma formation,
which can be life-threatening. Immediate pressure, notification of the provider, and
fluid resuscitation are required. Small hematoma and mild discomfort are expected
findings.
4. A patient with aortic dissection is prescribed a beta-blocker. The primary
goal of this medication is to:
A. Increase cardiac output
B. Decrease heart rate and blood pressure to reduce shear stress
C. Promote vasodilation of coronary arteries
D. Prevent clot formation
Correct Answer: B. Rationale: Beta-blockers reduce heart rate and blood pressure,
decreasing the shear stress (dP/dt) on the aortic wall, which is critical to prevent
extension or rupture of the dissection. Vasodilators alone can cause reflex tachycardia
and increase shear stress.
5. Which ECG finding is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Tall, peaked T waves
C. ST-segment depression
D. U waves
Correct Answer: B. Rationale: Hyperkalemia causes tall, peaked, narrow-based T waves.
As potassium rises further, the QRS widens and the P wave may flatten. Prolonged QT
and U waves are associated with hypokalemia.
6. A patient in the ICU has a central venous pressure (CVP) of 2 mmHg. The
nurse interprets this as:
A. Hypervolemia
B. Hypovolemia
C. Normal volume status
D. Right heart failure
Correct Answer: B. Rationale: Normal CVP is 2–8 mmHg. A CVP of 2 mmHg indicates
low right ventricular preload, consistent with hypovolemia (e.g., dehydration,
hemorrhage). Elevated CVP (>8 mmHg) suggests hypervolemia or right heart failure.
7. The nurse is preparing to administer digoxin to a patient with heart failure.
Which assessment finding would cause the nurse to withhold the dose?
A. Heart rate 88 bpm
B. Potassium level 3.0 mEq/L
C. Blood pressure 110/70 mmHg
D. Digoxin level 0.8 ng/mL
Correct Answer: B. Rationale: Hypokalemia (K⁺ < 3.5 mEq/L) increases the risk of
,digoxin toxicity. The nurse should hold the digoxin and notify the provider. Therapeutic
digoxin level is 0.5–2.0 ng/mL; 0.8 is therapeutic. HR 88 and BP 110/70 are acceptable.
8. A patient is admitted with a diagnosis of heart failure exacerbation. Which
assessment finding indicates fluid overload?
A. Flat neck veins
B. Weight loss of 1 kg in 2 days
C. Bibasilar crackles and JVD
D. Dry mucous membranes
Correct Answer: C. Rationale: Bibasilar crackles and jugular venous distention (JVD) are
classic signs of fluid overload in left and right heart failure, respectively. Flat neck veins
and dry mucous membranes suggest dehydration.
9. The nurse is teaching a patient about nitroglycerin. Which statement by the
patient indicates a need for further teaching?
A. "I will call 911 if the pain is not relieved after 5 minutes."
B. "I will take up to 3 tablets, 5 minutes apart."
C. "I will take the tablet with a glass of water."
D. "I will sit or lie down when taking the medication."
Correct Answer: C. Rationale: Sublingual nitroglycerin should be allowed to dissolve
under the tongue, not swallowed with water, as this bypasses the rapid mucosal
absorption. The other statements are correct: up to 3 tablets 5 minutes apart, call 911 if
unrelieved, and sit or lie down to prevent syncope.
10. A 68-year-old patient with a history of heart failure is admitted with acute
pulmonary edema. After IV furosemide and nitroglycerin infusion, the patient's
blood pressure drops to 82/50 mm Hg and the heart rate rises to 118 bpm.
Which action is the priority?
A. Administer a bolus of isotonic crystalloid to restore perfusion.
B. Obtain a stat electrocardiogram to rule out acute coronary syndrome.
C. Decrease or stop the nitroglycerin infusion and reassess hemodynamics.
D. Prepare for emergent intubation due to respiratory fatigue.
Correct Answer: C. Rationale: Nitroglycerin is a vasodilator that can cause hypotension.
In a patient with acute pulmonary edema who becomes hypotensive after nitroglycerin,
the priority is to decrease or stop the infusion and reassess hemodynamics. Fluid bolus
may worsen pulmonary edema.
11. A 72-year-old patient with chronic kidney disease (stage 4) is admitted with
sepsis. The provider orders vancomycin 25 mg/kg IV. The patient's current
weight is 70 kg, and serum creatinine is 3.2 mg/dL. What is the nurse's most
appropriate action?
A. Administer the full dose as ordered because the loading dose is based on weight
and not renal function.
B. Consult pharmacy to adjust the dose and interval based on the patient's renal
, function.
C. Hold the dose until blood cultures are reported.
D. Administer the dose with a slow infusion and monitor for red man syndrome.
Correct Answer: B. Rationale: Vancomycin is renally excreted. In a patient with CKD
stage 4 (serum creatinine 3.2 mg/dL), the dose and interval must be adjusted to
prevent nephrotoxicity. The nurse should consult pharmacy for renal dosing.
12. A 45-year-old patient with a severe traumatic brain injury (GCS 7) has an
intraventricular catheter. The nurse notes a sudden rise in intracranial pressure
(ICP) to 32 mm Hg. Which intervention should the nurse perform first?
A. Notify the neurosurgeon immediately.
B. Check the cerebrospinal fluid (CSF) drainage system and ensure it is set to drain at
the prescribed pressure.
C. Elevate the head of the bed to 30 degrees and ensure the neck is in a neutral
position.
D. Administer a prescribed dose of mannitol if ordered.
Correct Answer: B. Rationale: The first action is to ensure the CSF drainage system is
functioning and set to the prescribed pressure. This can rapidly reduce ICP. Notifying
the surgeon, positioning, and mannitol are also important but follow this initial check.
13. A 58-year-old patient with type 2 diabetes is admitted with unstable angina.
The cardiac catheterization reveals a 90% lesion in the left anterior descending
artery. Which medication should the nurse question if prescribed concurrently
with metformin?
A. Nitroglycerin
B. Furosemide
C. Iodinated contrast media
D. Heparin
Correct Answer: C. Rationale: Iodinated contrast media can precipitate acute kidney
injury, and metformin increases the risk of lactic acidosis in the setting of renal
impairment. Metformin should be withheld before and after contrast administration.
14. A 72-year-old patient with atrial fibrillation is on warfarin. The nurse notes
an INR of 6.5, and the patient has minor gum bleeding. The patient is not
hemodynamically unstable. Which intervention should the nurse anticipate?
A. Administer protamine sulfate IV bolus.
B. Administer vitamin K orally or subcutaneously and monitor INR.
C. Administer a dose of fresh frozen plasma immediately.
D. Administer four units of activated prothrombin complex concentrate.
Correct Answer: B. Rationale: For an INR of 6.5 with minor bleeding and no
hemodynamic instability, vitamin K (phytonadione) is administered orally or
subcutaneously, and INR is monitored. Protamine sulfate reverses heparin, not
warfarin. FFP or PCC is reserved for major bleeding or emergent reversal.
