NURS 121L-B Medical-Surgical Nursing Practicum Exam 2 2026 |WCU
1. A client with an acute exacerbation of COPD has a pH of 7.31, PaCO2 of 55
mmHg, and HCO3 of 25 mEq/L. How should the nurse interpret these ABG
results?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Answer: B
Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 mmHg (respiratory
origin). The normal HCO3 indicates no compensation has occurred yet.
2. The nurse is caring for a client with heart failure receiving Digoxin. Which
clinical finding should the nurse identify as a priority sign of toxicity?
A. Increased urine output
B. Yellow-tinged vision
C. Tachycardia
D. Hyperkalemia
Answer: B
Rationale: Visual disturbances such as yellow halos or blurred vision, along with nausea
and bradycardia, are classic signs of digoxin toxicity.
,3. Following a total hip arthroplasty, the nurse should position the client’s
affected extremity in which manner to prevent dislocation?
A. Adduction
B. Internal rotation
C. Flexion greater than 90 degrees
D. Abduction
Answer: D
Rationale: Abduction using an abduction pillow prevents the prosthesis from dislocating
out of the acetabulum.
4. A nurse is monitoring a client with a chest tube. The nurse notes continuous
bubbling in the water-seal chamber. What is the priority action?
A. Document this as a normal finding
B. Clamp the tube immediately and call the provider
C. Increase the suction pressure
D. Check the system for an air leak
Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system. Tidaling is normal; continuous bubbling is not.
5. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which of the following
breathing patterns should the nurse expect to observe?
A. Bradypnea
B. Cheyne-Stokes respirations
C. Biot’s respirations
D. Kussmaul respirations
Answer: D
Rationale: Kussmaul respirations are deep, rapid breaths that represent the body’s
attempt to blow off CO2 to compensate for metabolic acidosis.
, 6. Which assessment finding is the most sensitive indicator of a client’s
neurological status changing?
A. Pupillary reaction to light
B. Level of consciousness
C. Motor strength in extremities
D. Vital signs
Answer: B
Rationale: Changes in the level of consciousness (LOC) are usually the first sign of
neurological deterioration.
7. A nurse is preparing to administer Lispro insulin. When should the nurse
ensure the client’s meal is available?
A. 30 to 60 minutes after administration
B. Within 15 minutes of administration
C. 2 hours after administration
D. Immediately before the next scheduled snack
Answer: B
Rationale: Lispro is a rapid-acting insulin with an onset of 15 minutes. The meal must be
present to prevent hypoglycemia.
8. A client has a potassium level of 6.2 mEq/L. Which medication should the
nurse anticipate administering?
A. Spironolactone
B. Potassium chloride
C. Sodium polystyrene sulfonate
D. Furosemide
Answer: C
Rationale: Sodium polystyrene sulfonate (Kayexalate) helps remove excess potassium
from the body via the GI tract.
1. A client with an acute exacerbation of COPD has a pH of 7.31, PaCO2 of 55
mmHg, and HCO3 of 25 mEq/L. How should the nurse interpret these ABG
results?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Answer: B
Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 mmHg (respiratory
origin). The normal HCO3 indicates no compensation has occurred yet.
2. The nurse is caring for a client with heart failure receiving Digoxin. Which
clinical finding should the nurse identify as a priority sign of toxicity?
A. Increased urine output
B. Yellow-tinged vision
C. Tachycardia
D. Hyperkalemia
Answer: B
Rationale: Visual disturbances such as yellow halos or blurred vision, along with nausea
and bradycardia, are classic signs of digoxin toxicity.
,3. Following a total hip arthroplasty, the nurse should position the client’s
affected extremity in which manner to prevent dislocation?
A. Adduction
B. Internal rotation
C. Flexion greater than 90 degrees
D. Abduction
Answer: D
Rationale: Abduction using an abduction pillow prevents the prosthesis from dislocating
out of the acetabulum.
4. A nurse is monitoring a client with a chest tube. The nurse notes continuous
bubbling in the water-seal chamber. What is the priority action?
A. Document this as a normal finding
B. Clamp the tube immediately and call the provider
C. Increase the suction pressure
D. Check the system for an air leak
Answer: D
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak in the
system. Tidaling is normal; continuous bubbling is not.
5. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which of the following
breathing patterns should the nurse expect to observe?
A. Bradypnea
B. Cheyne-Stokes respirations
C. Biot’s respirations
D. Kussmaul respirations
Answer: D
Rationale: Kussmaul respirations are deep, rapid breaths that represent the body’s
attempt to blow off CO2 to compensate for metabolic acidosis.
, 6. Which assessment finding is the most sensitive indicator of a client’s
neurological status changing?
A. Pupillary reaction to light
B. Level of consciousness
C. Motor strength in extremities
D. Vital signs
Answer: B
Rationale: Changes in the level of consciousness (LOC) are usually the first sign of
neurological deterioration.
7. A nurse is preparing to administer Lispro insulin. When should the nurse
ensure the client’s meal is available?
A. 30 to 60 minutes after administration
B. Within 15 minutes of administration
C. 2 hours after administration
D. Immediately before the next scheduled snack
Answer: B
Rationale: Lispro is a rapid-acting insulin with an onset of 15 minutes. The meal must be
present to prevent hypoglycemia.
8. A client has a potassium level of 6.2 mEq/L. Which medication should the
nurse anticipate administering?
A. Spironolactone
B. Potassium chloride
C. Sodium polystyrene sulfonate
D. Furosemide
Answer: C
Rationale: Sodium polystyrene sulfonate (Kayexalate) helps remove excess potassium
from the body via the GI tract.
