Null Lagrangian-preserving surgeries are a generalization of the Garoufalidis and Rozansky null-moves, that these authors introduced to study the Kricker lift of the Kontsevich integral, in the setting of pairs (M,K) composed of a rational homology sphere M and a null-homologous knot K in M. They are defined as replacements of null-homologous rational homology handlebodies of M\K by other such handlebodies with identical Lagrangian. A null Lagrangian-preserving surgery induces a canonical isomorphism between the rational Alexander modules of the involved pairs, which preserves the Blanchfield form. Conversely, we prove that a fixed isomorphism between rational Alexander modules which preserves the Blanchfield form can be realized, up to multiplication by a power of t, by a finite sequence of null Lagrangian-preserving surgeries. We also prove that such classes of isomorphisms can be realized by rational S-equivalences. In the case of integral homology spheres, we prove similar realization results for a fixed isomorphism between integral Alexander modules.