NURS 121L-B Medical-Surgical Nursing Practicum Exam 3 2026 |WCU
1. A nurse is assessing a patient with a pH of 7.28, PaCO2 of 55 mmHg, and
HCO3 of 25 mEq/L. Which acid-base imbalance is occurring?
A. Respiratory Alkalosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis, and an elevated PaCO2 indicates a
respiratory cause. The bicarbonate is within normal limits, confirming uncompensated
respiratory acidosis.
2. A patient is 2 hours postoperative following abdominal surgery. The nurse
notes the abdominal dressing is saturated with bright red blood and the patient
is tachycardic. What is the priority action?
A. Document the findings and continue to monitor.
B. Change the dressing to a sterile dry gauze.
C. Apply a pressure dressing and notify the surgeon.
D. Check the patient’s temperature for signs of infection.
Answer: C
Rationale: Bright red blood and tachycardia suggest active hemorrhage; applying pressure
and notifying the surgeon is the priority intervention.
,3. A patient with heart failure is prescribed Digoxin. Which laboratory result
should the nurse report to the provider before administration?
A. Sodium 138 mEq/L
B. Potassium 3.2 mEq/L
C. Creatinine 1.0 mg/dL
D. Calcium 9.5 mg/dL
Answer: B
Rationale: Hypokalemia increases the risk of Digoxin toxicity. The nurse must verify
potassium levels prior to administration.
4. Which clinical manifestation is a hallmark sign of a patient experiencing
Malignant Hyperthermia during surgery?
A. Muscle flaccidity
B. Bradycardia
C. Hypothermia
D. Hypercapnia and muscle rigidity
Answer: D
Rationale: Malignant Hyperthermia is characterized by an unexplained rise in end-tidal
CO2 (hypercapnia) and generalized muscle rigidity.
5. A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). Which IV fluid
should the nurse expect to initiate first?
A. Dextrose 5% in Water
B. 0.45% Sodium Chloride
C. 0.9% Sodium Chloride
D. Dextrose 5% in 0.9% Sodium Chloride
Answer: C
Rationale: Initial management of DKA requires rapid fluid resuscitation with isotonic
saline (0.9% NaCl) to restore circulatory volume.
, 6. A patient with Chronic Obstructive Pulmonary Disease (COPD) presents with
peripheral edema and jugular venous distention. The nurse suspects which
complication?
A. Cor Pulmonale
B. Left-sided Heart Failure
C. Pneumonia
D. Pulmonary Embolism
Answer: A
Rationale: Cor pulmonale is right-sided heart failure resulting from pulmonary
hypertension, common in chronic respiratory diseases.
7. A patient is receiving a unit of packed red blood cells and reports low back
pain and chills within 15 minutes. What is the nurse’s first action?
A. Slow the infusion rate.
B. Notify the blood bank.
C. Administer diphenhydramine as ordered.
D. Stop the transfusion immediately.
Answer: D
Rationale: Low back pain and chills are signs of an acute hemolytic reaction. The
transfusion must be stopped immediately to prevent further injury.
8. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.5 mEq/L.
Which medication should the nurse anticipate giving to protect the heart?
A. Calcium Gluconate
B. Furosemide
C. Sodium Polystyrene Sulfonate
D. Regular Insulin
Answer: A
1. A nurse is assessing a patient with a pH of 7.28, PaCO2 of 55 mmHg, and
HCO3 of 25 mEq/L. Which acid-base imbalance is occurring?
A. Respiratory Alkalosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: A pH below 7.35 indicates acidosis, and an elevated PaCO2 indicates a
respiratory cause. The bicarbonate is within normal limits, confirming uncompensated
respiratory acidosis.
2. A patient is 2 hours postoperative following abdominal surgery. The nurse
notes the abdominal dressing is saturated with bright red blood and the patient
is tachycardic. What is the priority action?
A. Document the findings and continue to monitor.
B. Change the dressing to a sterile dry gauze.
C. Apply a pressure dressing and notify the surgeon.
D. Check the patient’s temperature for signs of infection.
Answer: C
Rationale: Bright red blood and tachycardia suggest active hemorrhage; applying pressure
and notifying the surgeon is the priority intervention.
,3. A patient with heart failure is prescribed Digoxin. Which laboratory result
should the nurse report to the provider before administration?
A. Sodium 138 mEq/L
B. Potassium 3.2 mEq/L
C. Creatinine 1.0 mg/dL
D. Calcium 9.5 mg/dL
Answer: B
Rationale: Hypokalemia increases the risk of Digoxin toxicity. The nurse must verify
potassium levels prior to administration.
4. Which clinical manifestation is a hallmark sign of a patient experiencing
Malignant Hyperthermia during surgery?
A. Muscle flaccidity
B. Bradycardia
C. Hypothermia
D. Hypercapnia and muscle rigidity
Answer: D
Rationale: Malignant Hyperthermia is characterized by an unexplained rise in end-tidal
CO2 (hypercapnia) and generalized muscle rigidity.
5. A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). Which IV fluid
should the nurse expect to initiate first?
A. Dextrose 5% in Water
B. 0.45% Sodium Chloride
C. 0.9% Sodium Chloride
D. Dextrose 5% in 0.9% Sodium Chloride
Answer: C
Rationale: Initial management of DKA requires rapid fluid resuscitation with isotonic
saline (0.9% NaCl) to restore circulatory volume.
, 6. A patient with Chronic Obstructive Pulmonary Disease (COPD) presents with
peripheral edema and jugular venous distention. The nurse suspects which
complication?
A. Cor Pulmonale
B. Left-sided Heart Failure
C. Pneumonia
D. Pulmonary Embolism
Answer: A
Rationale: Cor pulmonale is right-sided heart failure resulting from pulmonary
hypertension, common in chronic respiratory diseases.
7. A patient is receiving a unit of packed red blood cells and reports low back
pain and chills within 15 minutes. What is the nurse’s first action?
A. Slow the infusion rate.
B. Notify the blood bank.
C. Administer diphenhydramine as ordered.
D. Stop the transfusion immediately.
Answer: D
Rationale: Low back pain and chills are signs of an acute hemolytic reaction. The
transfusion must be stopped immediately to prevent further injury.
8. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.5 mEq/L.
Which medication should the nurse anticipate giving to protect the heart?
A. Calcium Gluconate
B. Furosemide
C. Sodium Polystyrene Sulfonate
D. Regular Insulin
Answer: A
