NURS 121L-B Medical-Surgical Nursing Practicum Exam 4 2026 |WCU
1. A patient’s arterial blood gas results are: pH 7.31, PaCO2 50 mm Hg, and
HCO3 24 mEq/L. Which condition does the nurse suspect?
A. Metabolic Alkalosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis, and an elevated PaCO2 indicates a
respiratory cause, as the bicarbonate is within normal limits.
2. Which EKG finding is most indicative of hyperkalemia in a patient with renal
failure?
A. U waves
B. Prolonged QT interval
C. Peaked T waves
D. ST segment depression
Answer: C
Rationale: Tall, peaked T waves are a classic early sign of high potassium levels, which can
lead to cardiac arrest if not treated.
,3. A patient with Chronic Kidney Disease (CKD) should be instructed to limit
intake of which mineral to prevent osteodystrophy?
A. Calcium
B. Phosphorus
C. Iron
D. Magnesium
Answer: B
Rationale: Phosphorus retention in CKD leads to bone disease by pulling calcium from the
bones; patients need phosphate binders and low-phosphorus diets.
4. Which clinical manifestation is unique to Diabetic Ketoacidosis (DKA)
compared to Hyperosmolar Hyperglycemic State (HHS)?
A. Polyuria
B. Kussmaul respirations
C. Blood glucose > 600 mg/dL
D. Severe Dehydration
Answer: B
Rationale: DKA involves metabolic acidosis and ketosis, leading to compensatory deep,
rapid Kussmaul breathing to blow off CO2.
5. To prevent Dumping Syndrome following a subtotal gastrectomy, the nurse
should teach the patient to:
A. Drink large amounts of liquids with meals.
B. Eat high-carbohydrate meals.
C. Lie down for 30 minutes after eating.
D. Eat three large meals per day.
Answer: C
Rationale: Reclining or lying down after eating slows the movement of food into the
jejunum, reducing dumping symptoms.
, 6. On the Glasgow Coma Scale (GCS), what total score is the standard threshold
indicating a patient is in a comatose state?
A. 15
B. 8 or less
C. 12
D. 3 or less
Answer: B
Rationale: A GCS score of 8 or less typically indicates severe brain injury and that the
patient is in a coma.
7. An AIDS patient with a CD4+ T-cell count of 150 cells/mm3 is at the highest
risk for which opportunistic infection?
A. Pneumocystis jirovecii pneumonia
B. Seasonal influenza
C. Streptococcal pharyngitis
D. Tinea pedis
Answer: A
Rationale: Pneumocystis jirovecii pneumonia (PJP) is a major opportunistic infection that
occurs when CD4 counts drop below 200.
8. What is the priority medication to administer during a Malignant
Hyperthermia crisis in the operating room?
A. Atropine
B. Epinephrine
C. Dantrolene sodium
D. Succinylcholine
Answer: C
Rationale: Dantrolene is the only specific pharmacological treatment that reverses the
skeletal muscle hypermetabolism in Malignant Hyperthermia.
1. A patient’s arterial blood gas results are: pH 7.31, PaCO2 50 mm Hg, and
HCO3 24 mEq/L. Which condition does the nurse suspect?
A. Metabolic Alkalosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis, and an elevated PaCO2 indicates a
respiratory cause, as the bicarbonate is within normal limits.
2. Which EKG finding is most indicative of hyperkalemia in a patient with renal
failure?
A. U waves
B. Prolonged QT interval
C. Peaked T waves
D. ST segment depression
Answer: C
Rationale: Tall, peaked T waves are a classic early sign of high potassium levels, which can
lead to cardiac arrest if not treated.
,3. A patient with Chronic Kidney Disease (CKD) should be instructed to limit
intake of which mineral to prevent osteodystrophy?
A. Calcium
B. Phosphorus
C. Iron
D. Magnesium
Answer: B
Rationale: Phosphorus retention in CKD leads to bone disease by pulling calcium from the
bones; patients need phosphate binders and low-phosphorus diets.
4. Which clinical manifestation is unique to Diabetic Ketoacidosis (DKA)
compared to Hyperosmolar Hyperglycemic State (HHS)?
A. Polyuria
B. Kussmaul respirations
C. Blood glucose > 600 mg/dL
D. Severe Dehydration
Answer: B
Rationale: DKA involves metabolic acidosis and ketosis, leading to compensatory deep,
rapid Kussmaul breathing to blow off CO2.
5. To prevent Dumping Syndrome following a subtotal gastrectomy, the nurse
should teach the patient to:
A. Drink large amounts of liquids with meals.
B. Eat high-carbohydrate meals.
C. Lie down for 30 minutes after eating.
D. Eat three large meals per day.
Answer: C
Rationale: Reclining or lying down after eating slows the movement of food into the
jejunum, reducing dumping symptoms.
, 6. On the Glasgow Coma Scale (GCS), what total score is the standard threshold
indicating a patient is in a comatose state?
A. 15
B. 8 or less
C. 12
D. 3 or less
Answer: B
Rationale: A GCS score of 8 or less typically indicates severe brain injury and that the
patient is in a coma.
7. An AIDS patient with a CD4+ T-cell count of 150 cells/mm3 is at the highest
risk for which opportunistic infection?
A. Pneumocystis jirovecii pneumonia
B. Seasonal influenza
C. Streptococcal pharyngitis
D. Tinea pedis
Answer: A
Rationale: Pneumocystis jirovecii pneumonia (PJP) is a major opportunistic infection that
occurs when CD4 counts drop below 200.
8. What is the priority medication to administer during a Malignant
Hyperthermia crisis in the operating room?
A. Atropine
B. Epinephrine
C. Dantrolene sodium
D. Succinylcholine
Answer: C
Rationale: Dantrolene is the only specific pharmacological treatment that reverses the
skeletal muscle hypermetabolism in Malignant Hyperthermia.
