NURS 121L-B | Medical-Surgical Nursing Practicum | Exam 1 Study
Guide (2026 Update) WCU
1. A patient with chronic kidney disease presents with a serum potassium level
of 6.8 mEq/L. Which of the following ECG changes is the most urgent indicator
for immediate intervention?
A. Widened QRS complex
B. Prominent U waves
C. ST-segment depression
D. Inverted T waves
Answer: A
Rationale: Hyperkalemia (K+ > 5.0) causes peaked T waves initially, but a widened QRS
complex indicates life-threatening cardiac instability and potential progression to
ventricular fibrillation.
2. Following a thyroidectomy, a patient complains of tingling in the fingertips
and around the mouth. Which assessment should the nurse perform first?
A. Monitor for respiratory distress
B. Check the surgical dressing for hemorrhage
C. Assess for Chvostek’s sign
D. Measure the patient’s blood pressure
Answer: C
Rationale: Hypocalcemia can occur if parathyroid glands are accidentally removed or
damaged during a thyroidectomy. Tingling is an early sign; Chvostek’s sign (facial
twitching) confirms neuromuscular irritability.
,3. An elderly patient is admitted with a diagnosis of dehydration. Which
physiological change associated with aging increases this patient’s risk?
A. Decreased glomerular filtration rate
B. Increased thirst mechanism
C. Increased total body water content
D. Decreased lean muscle mass
Answer: A
Rationale: Aging reduces renal function (GFR) and the ability to concentrate urine.
Additionally, the thirst mechanism is often blunted in older adults, and total body water
decreases with age.
4. A patient’s ABG results are: pH 7.28, PaCO2 50 mmHg, HCO3 24 mEq/L. How
should the nurse interpret these findings?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Uncompensated Metabolic Alkalosis
D. Partially Compensated Respiratory Acidosis
Answer: B
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), matching
the acidosis (respiratory). Since the HCO3 is normal, no compensation has occurred.
5. During the intraoperative phase, a patient develops tachycardia, rigid jaw
muscles, and a rapidly rising temperature. Which medication must be readily
available?
A. Atropine sulfate
B. Naloxone
C. Dantrolene sodium
D. Epinephrine
Answer: C
, Rationale: These are classic signs of Malignant Hyperthermia, a life-threatening anesthetic
complication. Dantrolene is the primary skeletal muscle relaxant used to treat it.
6. A patient who is 2 days post-op from abdominal surgery reports a ‘popping’
sensation after coughing. The nurse observes loops of bowel protruding through
the incision. What is the priority action?
A. Gently push the bowel back into the abdominal cavity
B. Apply a sterile, saline-soaked dressing to the site
C. Instruct the patient to perform the Valsalva maneuver
D. Place the patient in a high-Fowler’s position
Answer: B
Rationale: This is an evisceration. The nurse should cover the organs with sterile saline-
soaked dressings to prevent drying/necrosis, keep the patient supine with knees flexed,
and call the surgeon immediately.
7. Which assessment finding in a patient with a sodium level of 155 mEq/L
requires the most immediate notification of the healthcare provider?
A. Dry mucous membranes
B. New onset of confusion and agitation
C. Intense thirst
D. Increased urine specific gravity
Answer: B
Rationale: Hypernatremia causes cellular dehydration, particularly in the brain.
Neurological changes like confusion or seizures indicate a serious shift that requires
controlled correction to prevent cerebral edema.
Guide (2026 Update) WCU
1. A patient with chronic kidney disease presents with a serum potassium level
of 6.8 mEq/L. Which of the following ECG changes is the most urgent indicator
for immediate intervention?
A. Widened QRS complex
B. Prominent U waves
C. ST-segment depression
D. Inverted T waves
Answer: A
Rationale: Hyperkalemia (K+ > 5.0) causes peaked T waves initially, but a widened QRS
complex indicates life-threatening cardiac instability and potential progression to
ventricular fibrillation.
2. Following a thyroidectomy, a patient complains of tingling in the fingertips
and around the mouth. Which assessment should the nurse perform first?
A. Monitor for respiratory distress
B. Check the surgical dressing for hemorrhage
C. Assess for Chvostek’s sign
D. Measure the patient’s blood pressure
Answer: C
Rationale: Hypocalcemia can occur if parathyroid glands are accidentally removed or
damaged during a thyroidectomy. Tingling is an early sign; Chvostek’s sign (facial
twitching) confirms neuromuscular irritability.
,3. An elderly patient is admitted with a diagnosis of dehydration. Which
physiological change associated with aging increases this patient’s risk?
A. Decreased glomerular filtration rate
B. Increased thirst mechanism
C. Increased total body water content
D. Decreased lean muscle mass
Answer: A
Rationale: Aging reduces renal function (GFR) and the ability to concentrate urine.
Additionally, the thirst mechanism is often blunted in older adults, and total body water
decreases with age.
4. A patient’s ABG results are: pH 7.28, PaCO2 50 mmHg, HCO3 24 mEq/L. How
should the nurse interpret these findings?
A. Compensated Metabolic Acidosis
B. Uncompensated Respiratory Acidosis
C. Uncompensated Metabolic Alkalosis
D. Partially Compensated Respiratory Acidosis
Answer: B
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), matching
the acidosis (respiratory). Since the HCO3 is normal, no compensation has occurred.
5. During the intraoperative phase, a patient develops tachycardia, rigid jaw
muscles, and a rapidly rising temperature. Which medication must be readily
available?
A. Atropine sulfate
B. Naloxone
C. Dantrolene sodium
D. Epinephrine
Answer: C
, Rationale: These are classic signs of Malignant Hyperthermia, a life-threatening anesthetic
complication. Dantrolene is the primary skeletal muscle relaxant used to treat it.
6. A patient who is 2 days post-op from abdominal surgery reports a ‘popping’
sensation after coughing. The nurse observes loops of bowel protruding through
the incision. What is the priority action?
A. Gently push the bowel back into the abdominal cavity
B. Apply a sterile, saline-soaked dressing to the site
C. Instruct the patient to perform the Valsalva maneuver
D. Place the patient in a high-Fowler’s position
Answer: B
Rationale: This is an evisceration. The nurse should cover the organs with sterile saline-
soaked dressings to prevent drying/necrosis, keep the patient supine with knees flexed,
and call the surgeon immediately.
7. Which assessment finding in a patient with a sodium level of 155 mEq/L
requires the most immediate notification of the healthcare provider?
A. Dry mucous membranes
B. New onset of confusion and agitation
C. Intense thirst
D. Increased urine specific gravity
Answer: B
Rationale: Hypernatremia causes cellular dehydration, particularly in the brain.
Neurological changes like confusion or seizures indicate a serious shift that requires
controlled correction to prevent cerebral edema.
