Advanced Medical-Surgical Nursing Practice Exam 7 2026
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient with ARDS is being treated with mechanical ventilation using PEEP.
What is the primary purpose of adding PEEP to the ventilator settings?
A. To prevent alveolar collapse and improve oxygenation
B. To decrease the risk of barotrauma
C. To increase the fraction of inspired oxygen (FiO2)
D. To reduce the patient’s work of breathing
Answer: A
Rationale: Positive End-Expiratory Pressure (PEEP) keeps the alveoli open at the end of
expiration, preventing collapse and increasing the surface area for gas exchange, which
improves oxygenation.
2. A client is admitted with suspected Acute Myocardial Infarction. Which
cardiac biomarker is most specific for myocardial injury?
A. Creatine Kinase (CK-MB)
B. Troponin I
C. Myoglobin
D. Lactate Dehydrogenase (LDH)
Answer: B
Rationale: Troponin I and T are highly specific to cardiac muscle and remain elevated
longer than other markers, making them the gold standard for diagnosing MI.
,3. A nurse is caring for a patient in the oliguric phase of Acute Kidney Injury.
Which electrolyte imbalance is the nurse most likely to observe?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hypophosphatemia
Answer: C
Rationale: In the oliguric phase of AKI, the kidneys cannot excrete potassium, leading to
hyperkalemia, which can cause life-threatening arrhythmias.
4. Which assessment finding is most indicative of Cardiac Tamponade?
A. Bounding peripheral pulses
B. Increased urinary output
C. Muffled heart sounds and JVD
D. Flattened neck veins
Answer: C
Rationale: Beck’s triad for cardiac tamponade includes muffled heart sounds, jugular
venous distention (JVD), and hypotension.
5. A patient with liver cirrhosis has developed hepatic encephalopathy. Which
medication should the nurse expect to administer to reduce ammonia levels?
A. Spironolactone
B. Furosemide
C. Lactulose
D. Propranolol
Answer: C
Rationale: Lactulose promotes the excretion of ammonia through the stool, which helps
improve the neurological status of patients with hepatic encephalopathy.
, 6. What is the immediate priority intervention for a patient experiencing
Autonomic Dysreflexia?
A. Administering a bolus of IV fluids
B. Checking for a fecal impaction
C. Placing the patient in a high-Fowler’s position
D. Applying a cooling blanket
Answer: C
Rationale: Sitting the patient upright (high-Fowler’s) helps lower blood pressure through
orthostatic changes and is the first priority in managing autonomic dysreflexia.
7. A patient with a chest tube has continuous bubbling in the water-seal
chamber. What does this suggest?
A. There is an air leak in the system
B. The lung has fully re-expanded
C. Normal functioning during expiration
D. The suction is set too high
Answer: A
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak, either
from the patient’s pleural space or within the drainage tubing/system.
8. Which arterial blood gas (ABG) result is consistent with a patient in Diabetic
Ketoacidosis (DKA)?
A. pH 7.30, PaCO2 30, HCO3 16
B. pH 7.48, PaCO2 32, HCO3 22
C. pH 7.32, PaCO2 48, HCO3 28
D. pH 7.50, PaCO2 45, HCO3 32
Answer: A
Rationale: DKA results in metabolic acidosis with respiratory compensation (Kussmaul
breathing), characterized by a low pH, low HCO3, and low PaCO2.
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient with ARDS is being treated with mechanical ventilation using PEEP.
What is the primary purpose of adding PEEP to the ventilator settings?
A. To prevent alveolar collapse and improve oxygenation
B. To decrease the risk of barotrauma
C. To increase the fraction of inspired oxygen (FiO2)
D. To reduce the patient’s work of breathing
Answer: A
Rationale: Positive End-Expiratory Pressure (PEEP) keeps the alveoli open at the end of
expiration, preventing collapse and increasing the surface area for gas exchange, which
improves oxygenation.
2. A client is admitted with suspected Acute Myocardial Infarction. Which
cardiac biomarker is most specific for myocardial injury?
A. Creatine Kinase (CK-MB)
B. Troponin I
C. Myoglobin
D. Lactate Dehydrogenase (LDH)
Answer: B
Rationale: Troponin I and T are highly specific to cardiac muscle and remain elevated
longer than other markers, making them the gold standard for diagnosing MI.
,3. A nurse is caring for a patient in the oliguric phase of Acute Kidney Injury.
Which electrolyte imbalance is the nurse most likely to observe?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hypophosphatemia
Answer: C
Rationale: In the oliguric phase of AKI, the kidneys cannot excrete potassium, leading to
hyperkalemia, which can cause life-threatening arrhythmias.
4. Which assessment finding is most indicative of Cardiac Tamponade?
A. Bounding peripheral pulses
B. Increased urinary output
C. Muffled heart sounds and JVD
D. Flattened neck veins
Answer: C
Rationale: Beck’s triad for cardiac tamponade includes muffled heart sounds, jugular
venous distention (JVD), and hypotension.
5. A patient with liver cirrhosis has developed hepatic encephalopathy. Which
medication should the nurse expect to administer to reduce ammonia levels?
A. Spironolactone
B. Furosemide
C. Lactulose
D. Propranolol
Answer: C
Rationale: Lactulose promotes the excretion of ammonia through the stool, which helps
improve the neurological status of patients with hepatic encephalopathy.
, 6. What is the immediate priority intervention for a patient experiencing
Autonomic Dysreflexia?
A. Administering a bolus of IV fluids
B. Checking for a fecal impaction
C. Placing the patient in a high-Fowler’s position
D. Applying a cooling blanket
Answer: C
Rationale: Sitting the patient upright (high-Fowler’s) helps lower blood pressure through
orthostatic changes and is the first priority in managing autonomic dysreflexia.
7. A patient with a chest tube has continuous bubbling in the water-seal
chamber. What does this suggest?
A. There is an air leak in the system
B. The lung has fully re-expanded
C. Normal functioning during expiration
D. The suction is set too high
Answer: A
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak, either
from the patient’s pleural space or within the drainage tubing/system.
8. Which arterial blood gas (ABG) result is consistent with a patient in Diabetic
Ketoacidosis (DKA)?
A. pH 7.30, PaCO2 30, HCO3 16
B. pH 7.48, PaCO2 32, HCO3 22
C. pH 7.32, PaCO2 48, HCO3 28
D. pH 7.50, PaCO2 45, HCO3 32
Answer: A
Rationale: DKA results in metabolic acidosis with respiratory compensation (Kussmaul
breathing), characterized by a low pH, low HCO3, and low PaCO2.
