NURS 121L-B Module Exam 4: Medical-Surgical Nursing Practicum
2026 |WCU
1. A nurse is caring for a patient post-cholecystectomy who has a T-tube. Which
finding should the nurse report to the provider immediately?
A. 500 mL of greenish-brown drainage in the first 24 hours
B. Drainage that turns from greenish-brown to bloody
C. Occasional cramping after the T-tube is clamped for meals
D. Skin irritation around the T-tube insertion site
Answer: B
Rationale: While greenish-brown drainage is normal for bile, a change to bloody drainage
suggests internal hemorrhage and requires immediate intervention.
2. Which arterial blood gas (ABG) result is most indicative of a patient
experiencing acute respiratory failure?
A. pH 7.35, PaCO2 40 mmHg, HCO3 24 mEq/L
B. pH 7.48, PaCO2 30 mmHg, HCO3 22 mEq/L
C. pH 7.25, PaCO2 60 mmHg, SaO2 80%
D. pH 7.50, PaCO2 35 mmHg, HCO3 30 mEq/L
Answer: C
Rationale: A pH below 7.35 with a PaCO2 above 45 mmHg and low oxygen saturation
indicates respiratory acidosis and failure.
,3. A patient with chronic kidney disease (CKD) has a potassium level of 6.4
mEq/L. Which medication should the nurse anticipate administering first?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Furosemide (Lasix)
D. Regular Insulin and Dextrose
Answer: B
Rationale: Calcium gluconate does not lower potassium but is administered first to
stabilize the myocardium and prevent life-threatening dysrhythmias.
4. The nurse is assessing a patient 2 hours post-thyroidectomy. Which finding is
the highest priority?
A. Pain at the incision site
B. Hoarseness of the voice
C. Laryngeal stridor
D. Calcium level of 8.8 mg/dL
Answer: C
Rationale: Laryngeal stridor indicates airway obstruction, possibly due to edema or
tetany, and is a medical emergency.
5. During a blood transfusion, the patient reports chills, low back pain, and
nausea. What is the nurse’s first action?
A. Notify the healthcare provider
B. Stop the transfusion and disconnect the tubing
C. Check the patient’s vital signs
D. Slow the infusion rate to a KVO (keep vein open) rate
Answer: B
Rationale: These are signs of a hemolytic reaction. The nurse must stop the transfusion
immediately to prevent further exposure to the incompatible blood.
, 6. A patient with Type 1 Diabetes is found unresponsive and clammy. The nurse
should perform which action first?
A. Administer 15g of simple carbohydrates orally
B. Obtain a capillary blood glucose reading
C. Call the Rapid Response Team
D. Administer Glucagon IM or SQ per protocol
Answer: D
Rationale: If the patient is unresponsive, they cannot safely swallow oral carbohydrates.
Glucagon is the priority to treat severe hypoglycemia in an unconscious patient.
7. When assessing a patient with a chest tube, the nurse notes continuous
bubbling in the water-seal chamber. This indicates:
A. A normal finding for a patient with a pneumothorax
B. An air leak in the system
C. The lung has fully re-expanded
D. The suction pressure is too high
Answer: B
Rationale: Intermittent bubbling is normal with a pneumothorax, but continuous bubbling
in the water-seal chamber indicates a leak in the drainage system.
8. Which assessment finding in a patient with a leg cast indicates compartment
syndrome?
A. Capillary refill of 2 seconds
B. 1+ pedal pulse
C. Warm, pink toes
D. Paresthesia and intense pain unrelieved by opioids
Answer: D
Rationale: Unrelieved pain and paresthesia are early indicators of compartment
syndrome, a surgical emergency caused by increased pressure within the muscle fascia.
2026 |WCU
1. A nurse is caring for a patient post-cholecystectomy who has a T-tube. Which
finding should the nurse report to the provider immediately?
A. 500 mL of greenish-brown drainage in the first 24 hours
B. Drainage that turns from greenish-brown to bloody
C. Occasional cramping after the T-tube is clamped for meals
D. Skin irritation around the T-tube insertion site
Answer: B
Rationale: While greenish-brown drainage is normal for bile, a change to bloody drainage
suggests internal hemorrhage and requires immediate intervention.
2. Which arterial blood gas (ABG) result is most indicative of a patient
experiencing acute respiratory failure?
A. pH 7.35, PaCO2 40 mmHg, HCO3 24 mEq/L
B. pH 7.48, PaCO2 30 mmHg, HCO3 22 mEq/L
C. pH 7.25, PaCO2 60 mmHg, SaO2 80%
D. pH 7.50, PaCO2 35 mmHg, HCO3 30 mEq/L
Answer: C
Rationale: A pH below 7.35 with a PaCO2 above 45 mmHg and low oxygen saturation
indicates respiratory acidosis and failure.
,3. A patient with chronic kidney disease (CKD) has a potassium level of 6.4
mEq/L. Which medication should the nurse anticipate administering first?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Furosemide (Lasix)
D. Regular Insulin and Dextrose
Answer: B
Rationale: Calcium gluconate does not lower potassium but is administered first to
stabilize the myocardium and prevent life-threatening dysrhythmias.
4. The nurse is assessing a patient 2 hours post-thyroidectomy. Which finding is
the highest priority?
A. Pain at the incision site
B. Hoarseness of the voice
C. Laryngeal stridor
D. Calcium level of 8.8 mg/dL
Answer: C
Rationale: Laryngeal stridor indicates airway obstruction, possibly due to edema or
tetany, and is a medical emergency.
5. During a blood transfusion, the patient reports chills, low back pain, and
nausea. What is the nurse’s first action?
A. Notify the healthcare provider
B. Stop the transfusion and disconnect the tubing
C. Check the patient’s vital signs
D. Slow the infusion rate to a KVO (keep vein open) rate
Answer: B
Rationale: These are signs of a hemolytic reaction. The nurse must stop the transfusion
immediately to prevent further exposure to the incompatible blood.
, 6. A patient with Type 1 Diabetes is found unresponsive and clammy. The nurse
should perform which action first?
A. Administer 15g of simple carbohydrates orally
B. Obtain a capillary blood glucose reading
C. Call the Rapid Response Team
D. Administer Glucagon IM or SQ per protocol
Answer: D
Rationale: If the patient is unresponsive, they cannot safely swallow oral carbohydrates.
Glucagon is the priority to treat severe hypoglycemia in an unconscious patient.
7. When assessing a patient with a chest tube, the nurse notes continuous
bubbling in the water-seal chamber. This indicates:
A. A normal finding for a patient with a pneumothorax
B. An air leak in the system
C. The lung has fully re-expanded
D. The suction pressure is too high
Answer: B
Rationale: Intermittent bubbling is normal with a pneumothorax, but continuous bubbling
in the water-seal chamber indicates a leak in the drainage system.
8. Which assessment finding in a patient with a leg cast indicates compartment
syndrome?
A. Capillary refill of 2 seconds
B. 1+ pedal pulse
C. Warm, pink toes
D. Paresthesia and intense pain unrelieved by opioids
Answer: D
Rationale: Unrelieved pain and paresthesia are early indicators of compartment
syndrome, a surgical emergency caused by increased pressure within the muscle fascia.
