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NSG 4100/ NSG 4100 Exam 3 v2– Latest 2026/2027 Update – Advanced Medical Surgical Nursing | Questions and | 100 out of 100 2026 / 2027 Academic Year
Exam
NSG 4100/ NSG 4100 Exam 3 v2– Latest
2026/2027 Update – Advanced Medical
Surgical Nursing | Questions and Verified
Answers | 100 out of 100
2026 / 2
...
027 Academic Year
Q: The nurse is preparing to care for a client who has returned to the nursing unit
following cardiac catheterization performed through the femoral vessel. The nurse checks
the health care provider's (HCP's) prescription and plans to allow which client position or
activity following the procedure?
1. Bed rest in high Fowler's position
2. Bed rest with bathroom privileges only
3.Bed rest with head elevation at 60 degrees
4. Bed rest with head elevation no greater than 30 degrees
4
Rationale:
After cardiac catheterization, the extremity into which the catheter was inserted is kept
straight for 4 to 6 hours. The client is maintained on bed rest for 4 to 6 hours (time for bed
rest may vary depending on the HCP's preference and on whether a vascular closure device
was used) and the client may turn from side to side. The head is elevated no more than 30
degrees (although some HCPs prefer a lower position or the flat position) until hemostasis
is adequately achieved.
Q: The nurse is assessing the functioning of a chest tube drainage system in a client who
has just returned from the recovery room following a thoracotomy with wedge resection.
Which are the expected assessment findings? Select all that apply.
1. Excessive bubbling in the water seal chamber
2. Vigorous bubbling in the suction control chamber
3. Drainage system maintained below the client's chest
4. 50 mL of drainage in the drainage collection chamber
5. Occlusive dressing in place over the chest tube insertion site
6. Fluctuation of water in the tube in the water seal chamber during inhalation and
exhalation
3, 4, 5, 6
Rationale:
The bubbling of water in the water seal chamber indicates air drainage from the client and
usually is seen when intrathoracic pressure is higher than atmospheric pressure, and may
occur during exhalation, coughing, or sneezing. Excessive bubbling in the water seal
chamber may indicate an air leak, an unexpected finding. Fluctuation of water in the tube in
the water seal chamber during inhalation and exhalation is expected. An absence of
fluctuation may indicate that the chest tube is obstructed or that the lung has reexpanded
and that no more air is leaking into the pleural space. Gentle (not vigorous) bubbling should
be noted in the suction control chamber. A total of 50 mL of drainage is not excessive in a
client returning to the nursing unit from the recovery room. Drainage that is more than 70
to 100 mL/hour is considered excessive and requires notification of the health care
provider. The chest tube insertion site is covered with an occlusive (airtight) dressing to
prevent air from entering the pleural space. Positioning the drainage system below the
client's chest allows gravity to drain the pleural space.
Q: The nurse is assisting a health care provider with the removal of a chest tube. The
nurse should instruct the client to take which action?
1. Stay very still.
2. Exhale very quickly.
3. Inhale and exhale quickly.
4. Perform the Valsalva maneuver.
4
Rationale:
When the chest tube is removed, the client is asked to perform the Valsalva maneuver (take
a deep breath, exhale, and bear down). The tube is quickly withdrawn, and an airtight
dressing is taped in place. An alternative instruction is to ask the client to take a deep
breath and hold the breath while the tube is removed.
Q: The nurse caring for a client with a pneumothorax and who has had a chest tube
inserted notes continuous gentle bubbling in the water seal chamber. What action is most
appropriate?
1. Do nothing, because this is an expected finding.
2. Check for an air leak, because the bubbling should be intermittent.
3. Increase the suction pressure so that the bubbling becomes vigorous.
4. Clamp the chest tube and notify the health care provider immediately.
2
Rationale:
Fluctuation with inspiration and expiration, not continuous bubbling, should be noted in
the water seal chamber. Intermittent bubbling may be noted if the client has a known
pneumothorax, but this should decrease as time goes on and as the pneumothorax begins to
resolve. Therefore, the nurse should check for an air leak. If a wet chest drainage system is
used, bubbling would be continuous in the suction control chamber and not intermittent. In
a dry system, there is no bubbling. Increasing the suction pressure only increases the rate of
evaporation of water in the drainage system; in addition, increasing the suction can be
harmful and is not done without a specific prescription to do so if using a wet system. Dry
systems will allow for only a certain amount of suction to be applied; an orange bellow will
appear in the suction window, indicating that the proper amount of suction has been
applied. Chest tubes should be clamped only with a health care provider's prescription.
Q: The nurse is caring for a client with lung cancer and bone metastasis. What signs and
symptoms would the nurse recognize as indications of a possible oncological emergency?
Select all that apply.
1. Facial edema in the morning
2.Weight loss of 20 lb (9 kg) in 1 month
3. Serum calcium level of 12 mg/dL (3.0 mmol/L)
4. Serum sodium level of 136 mg/dL (136 mmol/L)
5. Serum potassium level of 3.4 mg/dL (3.4 mmol/L)
6. Numbness and tingling of the lower extremities
1, 3, 6
Rationale:
Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome
of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior
vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous
system of the head resulting in facial edema is a sign of superior vena cava syndrome. A
serum calcium level of 12 mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and
tingling of the lower extremities could be a sign of spinal cord compression. Mild
hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL
(136 mmol/L) is a normal level.
Q: The nurse is assessing the respiratory status of a client who has suffered a fractured
rib. The nurse should expect to note which finding?
1. Slow, deep respirations
2. Rapid, deep respirations
3. Paradoxical respirations
4. Pain, especially with inspiration
4
Rationale:
Rib fractures result from a blunt injury or a fall. Typical signs and symptoms include pain
and tenderness localized at the fracture site that is exacerbated by inspiration and
palpation, shallow respirations, splinting or guarding the chest protectively to minimize
chest movement, and possible bruising at the fracture site. Paradoxical respirations are
seen with flail chest
Q: A client with a chest injury has suffered flail chest. The nurse assesses the client for
which most distinctive sign of flail chest?
1. Cyanosis
2.Hypotension
3. Paradoxical chest movement
4. Dyspnea, especially on exhalation
3
Flail chest results from multiple rib fractures. This results in a "floating" section of ribs.
Because this section is unattached to the rest of the bony rib cage, this segment results in
paradoxical chest movement. This means that the force of inspiration pulls the fractured
segment inward, while the rest of the chest expands. Similarly, during exhalation, the
segment balloons outward while the rest of the chest moves inward. This is a characteristic
sign of flail chest.
Q: The nurse is assessing a client with multiple trauma who is at risk for developing acute
respiratory distress syndrome. The nurse should assess for which earliest sign of acute
respiratory distress syndrome?
1. Bilateral wheezing
2. Inspiratory crackles
3. Intercostal retractions
4. Increased respiratory rate
4
The earliest detectable sign of acute respiratory distress syndrome is an increased
respiratory rate, which can begin from 1 to 96 hours after the initial insult to the body. This
is followed by increasing dyspnea, air hunger, retraction of accessory muscles, and cyanosis.
Breath sounds may be clear or consist of fine inspiratory crackles or diffuse coarse crackles.
Q: A client has experienced pulmonary embolism. The nurse should assess for which
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