NURS 480 Exam 3 Advanced Medical-Surgical Nursing WCU
Question Bank (Latest 2026/2027 Edition) – 100% Correct
Questions, Answers & Detailed Rationales
Q1
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents to the emergency department with acute onset dyspnea, tachypnea, and
pleuritic chest pain. His arterial blood gas reveals pH 7.49, PaCO₂ 28 mmHg, PaO₂ 62
mmHg, and HCO₃⁻ 22 mEq/L. Which acid-base disorder is most consistent with these
findings?
A) Respiratory acidosis with metabolic compensation
B) Respiratory alkalosis
C) Metabolic alkalosis with respiratory compensation
D) Uncompensated metabolic acidosis
Answer: B
Rationales:
● A: Respiratory acidosis would present with an elevated PaCO₂ and decreased pH,
which contradicts the patient's low PaCO₂ and elevated pH.
, ● B: The elevated pH, decreased PaCO₂, and normal HCO₃⁻ are classic for acute
respiratory alkalosis, consistent with acute pulmonary embolism causing
hyperventilation.
● C: Metabolic alkalosis would demonstrate an elevated HCO₃⁻ as the primary
disturbance, not a normal bicarbonate level.
● D: Metabolic acidosis would present with a decreased pH and decreased HCO₃⁻,
neither of which is present in this ABG.
Q2
A nurse is caring for a patient who underwent a total thyroidectomy 24 hours ago. The
patient develops stridor, a high-pitched voice, and progressive neck swelling. Which
intervention is the priority?
A) Administer supplemental oxygen via nasal cannula at 4 L/min
B) Prepare for immediate tracheostomy at the bedside
C) Have the surgeon paged stat and keep emergency airway equipment ready
D) Reassure the patient and apply a cool compress to the neck
Answer: C
Rationales:
● A: Supplemental oxygen will not address the underlying airway obstruction
caused by expanding hematoma compressing the trachea.
● B: Tracheostomy is an extreme measure reserved for complete airway
obstruction and is not the first-line intervention; surgical evacuation of the
hematoma takes precedence.
, ● C: These signs indicate a postoperative hematoma causing airway compromise,
requiring immediate notification of the surgeon for emergency suture line
opening and hematoma evacuation.
● D: Reassurance and cool compresses are inappropriate as they delay critical
intervention for a life-threatening airway emergency.
Q3
A patient with end-stage renal disease on hemodialysis develops pericarditis. Which
clinical finding differentiates uremic pericarditis from other causes and indicates the
need for urgent intervention?
A) Presence of a pericardial friction rub on auscultation
B) Pulsus paradoxus greater than 10 mmHg
C) ST-segment elevation in all leads on ECG
D) Elevated erythrocyte sedimentation rate
Answer: B
Rationales:
● A: A pericardial friction rub is present in most forms of pericarditis and does not
specifically indicate tamponade or urgency.
● B: Pulsus paradoxus exceeding 10 mmHg indicates cardiac tamponade
physiology from pericardial effusion, which in uremic pericarditis may
necessitate emergency pericardiocentesis or intensive dialysis.
● C: Diffuse ST-segment elevation is characteristic of acute pericarditis generally
but does not differentiate severity or indicate hemodynamic compromise.
, ● D: An elevated ESR is a nonspecific inflammatory marker present in many
infectious and inflammatory conditions.
Q4
A 55-year-old female with cirrhosis presents with confusion, asterixis, and a flapping
tremor. Her ammonia level is elevated. Which dietary modification is most appropriate
for managing her current condition?
A) Increase protein intake to 1.5 g/kg/day to promote hepatic regeneration
B) Restrict protein to 20 g/day initially and provide lactulose
C) Initiate a high-fat, low-carbohydrate ketogenic diet
D) Eliminate all sodium from the diet to reduce ascites
Rationales:
● A: High protein intake increases ammonia production from gut bacteria,
potentially worsening hepatic encephalopathy.
● B: Temporary protein restriction combined with lactulose acidifies the colonic
contents, trapping ammonia as ammonium and promoting its excretion, which is
the cornerstone of hepatic encephalopathy management.
● C: A ketogenic diet has no established role in hepatic encephalopathy and may
stress hepatic metabolism further.
● D: While sodium restriction is important for ascites management, complete
sodium elimination is neither feasible nor indicated, and it does not address the
encephalopathy.
Question Bank (Latest 2026/2027 Edition) – 100% Correct
Questions, Answers & Detailed Rationales
Q1
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents to the emergency department with acute onset dyspnea, tachypnea, and
pleuritic chest pain. His arterial blood gas reveals pH 7.49, PaCO₂ 28 mmHg, PaO₂ 62
mmHg, and HCO₃⁻ 22 mEq/L. Which acid-base disorder is most consistent with these
findings?
A) Respiratory acidosis with metabolic compensation
B) Respiratory alkalosis
C) Metabolic alkalosis with respiratory compensation
D) Uncompensated metabolic acidosis
Answer: B
Rationales:
● A: Respiratory acidosis would present with an elevated PaCO₂ and decreased pH,
which contradicts the patient's low PaCO₂ and elevated pH.
, ● B: The elevated pH, decreased PaCO₂, and normal HCO₃⁻ are classic for acute
respiratory alkalosis, consistent with acute pulmonary embolism causing
hyperventilation.
● C: Metabolic alkalosis would demonstrate an elevated HCO₃⁻ as the primary
disturbance, not a normal bicarbonate level.
● D: Metabolic acidosis would present with a decreased pH and decreased HCO₃⁻,
neither of which is present in this ABG.
Q2
A nurse is caring for a patient who underwent a total thyroidectomy 24 hours ago. The
patient develops stridor, a high-pitched voice, and progressive neck swelling. Which
intervention is the priority?
A) Administer supplemental oxygen via nasal cannula at 4 L/min
B) Prepare for immediate tracheostomy at the bedside
C) Have the surgeon paged stat and keep emergency airway equipment ready
D) Reassure the patient and apply a cool compress to the neck
Answer: C
Rationales:
● A: Supplemental oxygen will not address the underlying airway obstruction
caused by expanding hematoma compressing the trachea.
● B: Tracheostomy is an extreme measure reserved for complete airway
obstruction and is not the first-line intervention; surgical evacuation of the
hematoma takes precedence.
, ● C: These signs indicate a postoperative hematoma causing airway compromise,
requiring immediate notification of the surgeon for emergency suture line
opening and hematoma evacuation.
● D: Reassurance and cool compresses are inappropriate as they delay critical
intervention for a life-threatening airway emergency.
Q3
A patient with end-stage renal disease on hemodialysis develops pericarditis. Which
clinical finding differentiates uremic pericarditis from other causes and indicates the
need for urgent intervention?
A) Presence of a pericardial friction rub on auscultation
B) Pulsus paradoxus greater than 10 mmHg
C) ST-segment elevation in all leads on ECG
D) Elevated erythrocyte sedimentation rate
Answer: B
Rationales:
● A: A pericardial friction rub is present in most forms of pericarditis and does not
specifically indicate tamponade or urgency.
● B: Pulsus paradoxus exceeding 10 mmHg indicates cardiac tamponade
physiology from pericardial effusion, which in uremic pericarditis may
necessitate emergency pericardiocentesis or intensive dialysis.
● C: Diffuse ST-segment elevation is characteristic of acute pericarditis generally
but does not differentiate severity or indicate hemodynamic compromise.
, ● D: An elevated ESR is a nonspecific inflammatory marker present in many
infectious and inflammatory conditions.
Q4
A 55-year-old female with cirrhosis presents with confusion, asterixis, and a flapping
tremor. Her ammonia level is elevated. Which dietary modification is most appropriate
for managing her current condition?
A) Increase protein intake to 1.5 g/kg/day to promote hepatic regeneration
B) Restrict protein to 20 g/day initially and provide lactulose
C) Initiate a high-fat, low-carbohydrate ketogenic diet
D) Eliminate all sodium from the diet to reduce ascites
Rationales:
● A: High protein intake increases ammonia production from gut bacteria,
potentially worsening hepatic encephalopathy.
● B: Temporary protein restriction combined with lactulose acidifies the colonic
contents, trapping ammonia as ammonium and promoting its excretion, which is
the cornerstone of hepatic encephalopathy management.
● C: A ketogenic diet has no established role in hepatic encephalopathy and may
stress hepatic metabolism further.
● D: While sodium restriction is important for ascites management, complete
sodium elimination is neither feasible nor indicated, and it does not address the
encephalopathy.
