NURS 121L-B Medical-Surgical Nursing Practicum Exam 4 2026 |WCU
1. A patient in the ICU is being treated for septic shock. Despite aggressive fluid
resuscitation of 30 mL/kg, the mean arterial pressure (MAP) remains at 55
mmHg. What is the priority nursing intervention?
A. Administer a bolus of 5% Dextrose in Water
B. Begin a dobutamine drip to increase contractility
C. Initiate a norepinephrine infusion
D. Prepare for emergent hemodialysis
Answer: C
Rationale: In septic shock, if fluid resuscitation is insufficient to maintain a MAP ≥ 65
mmHg, vasopressors (norepinephrine as first-line) are indicated to maintain organ
perfusion.
2. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22
mmHg and a MAP of 70 mmHg. Calculate the Cerebral Perfusion Pressure (CPP)
and determine the clinical significance.
A. CPP is 92 mmHg; this is within normal limits
B. CPP is 48 mmHg; this indicates inadequate brain perfusion
C. CPP is 1540 mmHg; this indicates extreme hypertension
D. CPP is 70 mmHg; this is the optimal target for TBI
Answer: B
Rationale: CPP = MAP - ICP. 70 - 22 = 48 mmHg. Normal CPP is 60-100 mmHg. A CPP < 50
mmHg is associated with ischemia and neuronal death.
,3. A patient with a full-thickness burn over 40% of their body is in the emergent
phase. The nurse notes a heart rate of 120 bpm, BP 88/50 mmHg, and urine
output of 15 mL/hour. Which action is most appropriate?
A. Decrease the IV fluid rate to prevent heart failure
B. Increase the rate of Lactated Ringer’s infusion
C. Administer a loop diuretic to increase urine output
D. Prepare for immediate escharotomy
Answer: B
Rationale: Low urine output and hypotension in the emergent phase of a burn indicate
hypovolemia. The Parkland formula provides a guideline, but fluid titration is based on
maintaining a urine output of 0.5-1 mL/kg/hr.
4. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The
ventilator is set to provide Positive End-Expiratory Pressure (PEEP). What is the
primary purpose of PEEP in this patient?
A. To increase functional residual capacity and open collapsed alveoli
B. To prevent barotrauma by limiting peak inspiratory pressure
C. To decrease the work of breathing by providing pressure support
D. To normalize the pH by increasing the respiratory rate
Answer: A
Rationale: PEEP prevents alveolar collapse at the end of expiration, increasing the surface
area for gas exchange and improving oxygenation in ARDS patients who suffer from
refractory hypoxemia.
, 5. A patient with Acute Kidney Injury (AKI) has a serum potassium level of 6.8
mEq/L. The ECG shows peaked T waves. Which medication should the nurse
expect to administer first to protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Regular Insulin and D50
D. Calcium Gluconate
Answer: D
Rationale: Calcium Gluconate does not lower potassium, but it antagonizes the membrane
effect of hyperkalemia on the heart, stabilizing the myocardium to prevent lethal
arrhythmias.
6. When assessing a patient with a T6 spinal cord injury, the nurse notes a
sudden onset of severe headache, BP 210/110 mmHg, and bradycardia. What is
the nurse’s immediate priority?
A. Administer an antihypertensive medication
B. Check for bladder distention or fecal impaction
C. Place the patient in a supine position
D. Assess the patient’s pupils and GCS
Answer: B
Rationale: These are classic signs of Autonomic Dysreflexia. The priority is to sit the
patient up and then identify/remove the noxious stimulus, most commonly a full bladder
or bowel.
1. A patient in the ICU is being treated for septic shock. Despite aggressive fluid
resuscitation of 30 mL/kg, the mean arterial pressure (MAP) remains at 55
mmHg. What is the priority nursing intervention?
A. Administer a bolus of 5% Dextrose in Water
B. Begin a dobutamine drip to increase contractility
C. Initiate a norepinephrine infusion
D. Prepare for emergent hemodialysis
Answer: C
Rationale: In septic shock, if fluid resuscitation is insufficient to maintain a MAP ≥ 65
mmHg, vasopressors (norepinephrine as first-line) are indicated to maintain organ
perfusion.
2. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22
mmHg and a MAP of 70 mmHg. Calculate the Cerebral Perfusion Pressure (CPP)
and determine the clinical significance.
A. CPP is 92 mmHg; this is within normal limits
B. CPP is 48 mmHg; this indicates inadequate brain perfusion
C. CPP is 1540 mmHg; this indicates extreme hypertension
D. CPP is 70 mmHg; this is the optimal target for TBI
Answer: B
Rationale: CPP = MAP - ICP. 70 - 22 = 48 mmHg. Normal CPP is 60-100 mmHg. A CPP < 50
mmHg is associated with ischemia and neuronal death.
,3. A patient with a full-thickness burn over 40% of their body is in the emergent
phase. The nurse notes a heart rate of 120 bpm, BP 88/50 mmHg, and urine
output of 15 mL/hour. Which action is most appropriate?
A. Decrease the IV fluid rate to prevent heart failure
B. Increase the rate of Lactated Ringer’s infusion
C. Administer a loop diuretic to increase urine output
D. Prepare for immediate escharotomy
Answer: B
Rationale: Low urine output and hypotension in the emergent phase of a burn indicate
hypovolemia. The Parkland formula provides a guideline, but fluid titration is based on
maintaining a urine output of 0.5-1 mL/kg/hr.
4. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The
ventilator is set to provide Positive End-Expiratory Pressure (PEEP). What is the
primary purpose of PEEP in this patient?
A. To increase functional residual capacity and open collapsed alveoli
B. To prevent barotrauma by limiting peak inspiratory pressure
C. To decrease the work of breathing by providing pressure support
D. To normalize the pH by increasing the respiratory rate
Answer: A
Rationale: PEEP prevents alveolar collapse at the end of expiration, increasing the surface
area for gas exchange and improving oxygenation in ARDS patients who suffer from
refractory hypoxemia.
, 5. A patient with Acute Kidney Injury (AKI) has a serum potassium level of 6.8
mEq/L. The ECG shows peaked T waves. Which medication should the nurse
expect to administer first to protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Regular Insulin and D50
D. Calcium Gluconate
Answer: D
Rationale: Calcium Gluconate does not lower potassium, but it antagonizes the membrane
effect of hyperkalemia on the heart, stabilizing the myocardium to prevent lethal
arrhythmias.
6. When assessing a patient with a T6 spinal cord injury, the nurse notes a
sudden onset of severe headache, BP 210/110 mmHg, and bradycardia. What is
the nurse’s immediate priority?
A. Administer an antihypertensive medication
B. Check for bladder distention or fecal impaction
C. Place the patient in a supine position
D. Assess the patient’s pupils and GCS
Answer: B
Rationale: These are classic signs of Autonomic Dysreflexia. The priority is to sit the
patient up and then identify/remove the noxious stimulus, most commonly a full bladder
or bowel.
