NURS 121L-B Introduction to Medical-Surgical Nursing Practicum Final
Exam 2026 |WCU
1. A postoperative patient develops a sudden onset of shortness of breath and
chest pain. Which of the following is the priority nursing action?
A. Elevate the head of the bed and apply oxygen
B. Obtain an arterial blood gas (ABG) sample
C. Administer the prescribed PRN analgesic
D. Perform a comprehensive head-to-toe assessment
Answer: A
Rationale: Immediate priority is airway and breathing. Elevating the head of the bed
facilitates lung expansion, and oxygen addresses potential hypoxia while awaiting further
diagnostics for pulmonary embolism or atelectasis.
2. The nurse is preparing to administer regular insulin and NPH insulin in the
same syringe. What is the correct procedure?
A. Draw up the NPH insulin first, then the regular insulin
B. Draw each into separate syringes and then combine them
C. Inject air into the regular vial first, then air into the NPH vial
D. Draw up the regular insulin first, then the NPH insulin
Answer: D
Rationale: To prevent contaminating the short-acting (clear) insulin with the long-acting
(cloudy) insulin, the clear (regular) should be drawn first after injecting air into both vials
(NPH first, then regular).
,3. Which clinical manifestation would the nurse expect to find in a patient with
fluid volume deficit?
A. Orthostatic hypotension and increased heart rate
B. Decreased urine specific gravity and hypertension
C. Distended neck veins and bounding pulse
D. Peripheral edema and crackles in the lungs
Answer: A
Rationale: Fluid volume deficit leads to decreased circulating volume, causing a drop in
blood pressure (especially when changing positions) and a compensatory increase in heart
rate to maintain cardiac output.
4. A patient with a history of COPD is receiving oxygen at 2L/min via nasal
cannula. The nurse notes the patient’s SpO2 is 89%. What is the most
appropriate action?
A. Increase the oxygen flow to 6L/min immediately
B. Change the delivery device to a non-rebreather mask
C. Continue to monitor as this is an expected range for COPD
D. Encourage the patient to take rapid, shallow breaths
Answer: C
Rationale: For many patients with COPD, a target SpO2 range of 88% to 92% is acceptable.
Providing too much oxygen can suppress their hypoxic drive to breathe.
5. Which laboratory value is the most sensitive indicator of nutritional status in
a patient with a chronic wound?
A. Serum albumin
B. Total white blood cell count
C. Prealbumin
D. Hemoglobin level
Answer: C
, Rationale: Prealbumin has a half-life of 2 days, making it a much more sensitive indicator
of current nutritional status and protein synthesis than albumin, which has a half-life of 20
days.
6. When performing a sterile dressing change, the nurse drops a sterile gauze
pad onto the edge of the sterile field. What should the nurse do?
A. Discard the gauze and continue with the procedure
B. Consider the entire sterile field contaminated and start over
C. Pick up the gauze with sterile forceps and use it
D. Use the gauze if only the corner touched the edge
Answer: A
Rationale: The 1-inch border of a sterile field is considered contaminated. Any item
touching that border must be discarded. If the rest of the field remains untouched, the
nurse may continue.
7. A patient is 24 hours postoperative following abdominal surgery and has not
yet voided. The nurse’s first action should be to:
A. Notify the surgeon immediately
B. Increase the rate of IV fluids
C. Insert an indwelling urinary catheter
D. Perform a bladder scan
Answer: D
Rationale: A bladder scan is a non-invasive assessment tool to determine the amount of
urine in the bladder and distinguish between urinary retention and lack of production.
Exam 2026 |WCU
1. A postoperative patient develops a sudden onset of shortness of breath and
chest pain. Which of the following is the priority nursing action?
A. Elevate the head of the bed and apply oxygen
B. Obtain an arterial blood gas (ABG) sample
C. Administer the prescribed PRN analgesic
D. Perform a comprehensive head-to-toe assessment
Answer: A
Rationale: Immediate priority is airway and breathing. Elevating the head of the bed
facilitates lung expansion, and oxygen addresses potential hypoxia while awaiting further
diagnostics for pulmonary embolism or atelectasis.
2. The nurse is preparing to administer regular insulin and NPH insulin in the
same syringe. What is the correct procedure?
A. Draw up the NPH insulin first, then the regular insulin
B. Draw each into separate syringes and then combine them
C. Inject air into the regular vial first, then air into the NPH vial
D. Draw up the regular insulin first, then the NPH insulin
Answer: D
Rationale: To prevent contaminating the short-acting (clear) insulin with the long-acting
(cloudy) insulin, the clear (regular) should be drawn first after injecting air into both vials
(NPH first, then regular).
,3. Which clinical manifestation would the nurse expect to find in a patient with
fluid volume deficit?
A. Orthostatic hypotension and increased heart rate
B. Decreased urine specific gravity and hypertension
C. Distended neck veins and bounding pulse
D. Peripheral edema and crackles in the lungs
Answer: A
Rationale: Fluid volume deficit leads to decreased circulating volume, causing a drop in
blood pressure (especially when changing positions) and a compensatory increase in heart
rate to maintain cardiac output.
4. A patient with a history of COPD is receiving oxygen at 2L/min via nasal
cannula. The nurse notes the patient’s SpO2 is 89%. What is the most
appropriate action?
A. Increase the oxygen flow to 6L/min immediately
B. Change the delivery device to a non-rebreather mask
C. Continue to monitor as this is an expected range for COPD
D. Encourage the patient to take rapid, shallow breaths
Answer: C
Rationale: For many patients with COPD, a target SpO2 range of 88% to 92% is acceptable.
Providing too much oxygen can suppress their hypoxic drive to breathe.
5. Which laboratory value is the most sensitive indicator of nutritional status in
a patient with a chronic wound?
A. Serum albumin
B. Total white blood cell count
C. Prealbumin
D. Hemoglobin level
Answer: C
, Rationale: Prealbumin has a half-life of 2 days, making it a much more sensitive indicator
of current nutritional status and protein synthesis than albumin, which has a half-life of 20
days.
6. When performing a sterile dressing change, the nurse drops a sterile gauze
pad onto the edge of the sterile field. What should the nurse do?
A. Discard the gauze and continue with the procedure
B. Consider the entire sterile field contaminated and start over
C. Pick up the gauze with sterile forceps and use it
D. Use the gauze if only the corner touched the edge
Answer: A
Rationale: The 1-inch border of a sterile field is considered contaminated. Any item
touching that border must be discarded. If the rest of the field remains untouched, the
nurse may continue.
7. A patient is 24 hours postoperative following abdominal surgery and has not
yet voided. The nurse’s first action should be to:
A. Notify the surgeon immediately
B. Increase the rate of IV fluids
C. Insert an indwelling urinary catheter
D. Perform a bladder scan
Answer: D
Rationale: A bladder scan is a non-invasive assessment tool to determine the amount of
urine in the bladder and distinguish between urinary retention and lack of production.
