NURS 121L-B | Medical-Surgical Nursing Practicum | Exam 3 Study
Guide 2026 |WCU
1. A patient presents with a pH of 7.25, PaCO2 of 50 mmHg, and HCO3 of 26
mEq/L. Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause, and since the HCO3 is normal, it is uncompensated respiratory acidosis.
2. Which clinical manifestation should a nurse prioritize when assessing a
patient with a potassium level of 6.2 mEq/L?
A. Increased muscle strength
B. Polyuria
C. Hypoactive bowel sounds
D. Tall, peaked T waves on ECG
Answer: D
Rationale: Hyperkalemia (K+ > 5.0) can lead to life-threatening cardiac dysrhythmias.
Peaked T waves are an early sign of potassium toxicity.
,3. A patient with left-sided heart failure is most likely to present with which of
the following symptoms?
A. Jugular venous distension
B. Crackles in the lungs
C. Peripheral edema
D. Hepatosplenomegaly
Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion and crackles.
4. Which intervention is most appropriate for a patient in the immediate
postoperative period who is experiencing evisceration?
A. Push the organs back into the abdominal cavity
B. Cover the protruding organs with sterile gauze soaked in normal saline
C. Apply a tight abdominal binder
D. Place the patient in a prone position
Answer: B
Rationale: Evisceration is a medical emergency. The nurse should cover the area with
sterile, saline-soaked dressings and notify the surgeon immediately.
5. What is the primary goal of administering a loop diuretic like Furosemide to a
patient with Chronic Kidney Disease (CKD)?
A. To increase creatinine clearance
B. To lower blood glucose levels
C. To prevent metabolic alkalosis
D. To manage fluid volume overload
Answer: D
Rationale: Diuretics are used in CKD to manage fluid retention and edema by increasing
urine output, although their efficacy decreases as GFR drops.
, 6. A patient with Type 1 Diabetes is found unconscious and clammy. What is the
priority nursing action?
A. Administer 10 units of regular insulin
B. Check the blood glucose level
C. Administer glucagon or D50W IV
D. Provide a complex carbohydrate snack
Answer: C
Rationale: If a patient is unconscious and hypoglycemia is suspected, emergency glucose
or glucagon must be given immediately; oral intake is unsafe due to aspiration risk.
7. Which lab value is most indicative of Acute Kidney Injury (AKI) in a
postoperative patient?
A. Increased Serum Creatinine
B. Decreased Serum Potassium
C. Increased Hemoglobin
D. Decreased Blood Urea Nitrogen (BUN)
Answer: A
Rationale: Serum creatinine is the most reliable indicator of kidney function. An increase
indicates a decrease in GFR and potential AKI.
8. A patient is diagnosed with Atrial Fibrillation. The nurse understands the
patient is at highest risk for which complication?
A. Ischemic Stroke
B. Cardiac Tamponade
C. Ventricular Tachycardia
D. Pneumothorax
Answer: A
Rationale: Atrial fibrillation causes blood to pool in the atria, which can lead to clot
formation. If a clot dislodges, it can travel to the brain, causing a stroke.
Guide 2026 |WCU
1. A patient presents with a pH of 7.25, PaCO2 of 50 mmHg, and HCO3 of 26
mEq/L. Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause, and since the HCO3 is normal, it is uncompensated respiratory acidosis.
2. Which clinical manifestation should a nurse prioritize when assessing a
patient with a potassium level of 6.2 mEq/L?
A. Increased muscle strength
B. Polyuria
C. Hypoactive bowel sounds
D. Tall, peaked T waves on ECG
Answer: D
Rationale: Hyperkalemia (K+ > 5.0) can lead to life-threatening cardiac dysrhythmias.
Peaked T waves are an early sign of potassium toxicity.
,3. A patient with left-sided heart failure is most likely to present with which of
the following symptoms?
A. Jugular venous distension
B. Crackles in the lungs
C. Peripheral edema
D. Hepatosplenomegaly
Answer: B
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
leading to pulmonary congestion and crackles.
4. Which intervention is most appropriate for a patient in the immediate
postoperative period who is experiencing evisceration?
A. Push the organs back into the abdominal cavity
B. Cover the protruding organs with sterile gauze soaked in normal saline
C. Apply a tight abdominal binder
D. Place the patient in a prone position
Answer: B
Rationale: Evisceration is a medical emergency. The nurse should cover the area with
sterile, saline-soaked dressings and notify the surgeon immediately.
5. What is the primary goal of administering a loop diuretic like Furosemide to a
patient with Chronic Kidney Disease (CKD)?
A. To increase creatinine clearance
B. To lower blood glucose levels
C. To prevent metabolic alkalosis
D. To manage fluid volume overload
Answer: D
Rationale: Diuretics are used in CKD to manage fluid retention and edema by increasing
urine output, although their efficacy decreases as GFR drops.
, 6. A patient with Type 1 Diabetes is found unconscious and clammy. What is the
priority nursing action?
A. Administer 10 units of regular insulin
B. Check the blood glucose level
C. Administer glucagon or D50W IV
D. Provide a complex carbohydrate snack
Answer: C
Rationale: If a patient is unconscious and hypoglycemia is suspected, emergency glucose
or glucagon must be given immediately; oral intake is unsafe due to aspiration risk.
7. Which lab value is most indicative of Acute Kidney Injury (AKI) in a
postoperative patient?
A. Increased Serum Creatinine
B. Decreased Serum Potassium
C. Increased Hemoglobin
D. Decreased Blood Urea Nitrogen (BUN)
Answer: A
Rationale: Serum creatinine is the most reliable indicator of kidney function. An increase
indicates a decrease in GFR and potential AKI.
8. A patient is diagnosed with Atrial Fibrillation. The nurse understands the
patient is at highest risk for which complication?
A. Ischemic Stroke
B. Cardiac Tamponade
C. Ventricular Tachycardia
D. Pneumothorax
Answer: A
Rationale: Atrial fibrillation causes blood to pool in the atria, which can lead to clot
formation. If a clot dislodges, it can travel to the brain, causing a stroke.
