NURS 121L-B Medical-Surgical Nursing Practicum - Exam 1 2026 |WCU
1. A patient who is 1 day postoperative after a total hip arthroplasty complains
of sudden onset shortness of breath and chest pain. What is the nurse’s priority
action?
A. Encourage the patient to use the incentive spirometer.
B. Administer the prescribed PRN dose of morphine for chest pain.
C. Perform a focused respiratory assessment and check oxygen saturation.
D. Assist the patient to perform ankle pump exercises.
Answer: C
Rationale: Sudden shortness of breath and chest pain postoperatively are hallmarks of
pulmonary embolism. Assessment is the priority before intervention.
2. When evaluating a patient with a potassium level of 6.2 mEq/L, which EKG
change is the nurse most likely to observe?
A. Prominent U waves
B. ST-segment depression
C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Rationale: Hyperkalemia typically causes tall, peaked T waves and widened QRS
complexes; U waves and ST depression are associated with hypokalemia.
,3. A nurse is caring for a patient with an IV infusion of 0.45% normal saline. This
solution is classified as:
A. Isotonic
B. Hypertonic
C. Hypotonic
D. Colloid
Answer: C
Rationale: 0.45% sodium chloride has a lower osmolarity than plasma, making it a
hypotonic solution which shifts fluid into cells.
4. Which clinical manifestation is a late sign of hypoxia in a patient with
respiratory distress?
A. Tachycardia
B. Restlessness
C. Cyanosis
D. Hypertension
Answer: C
Rationale: Restlessness and tachycardia are early signs of hypoxia, whereas cyanosis is a
late and critical indicator of severe oxygen deprivation.
5. A patient with Type 1 Diabetes Mellitus is found unconscious and clammy.
The bedside glucose is 42 mg/dL. What is the immediate nursing action?
A. Administer 15g of oral glucose gel.
B. Provide 4 ounces of orange juice.
C. Administer 1mg of Glucagon IM or SQ.
D. Re-check the blood glucose level in 15 minutes.
Answer: C
Rationale: Since the patient is unconscious, oral intake is contraindicated due to aspiration
risk; Glucagon or IV Dextrose is required for emergency treatment.
, 6. While assessing a postoperative abdominal wound, the nurse notes the
protrusion of internal organs. What is the first intervention?
A. Push the organs back into the abdominal cavity gently.
B. Apply a dry sterile dressing tightly.
C. Cover the wound with sterile dressings moistened with sterile normal saline.
D. Call the surgeon immediately before performing any local care.
Answer: C
Rationale: This is evisceration. The priority is to keep the organs moist and sterile with
saline-soaked dressings while awaiting surgical intervention.
7. A patient is diagnosed with Right-Sided Heart Failure. Which assessment
finding is most consistent with this diagnosis?
A. Peripheral edema and JVD
B. Dyspnea on exertion
C. Pulmonary crackles
D. Orthopnea
Answer: A
Rationale: Right-sided heart failure causes systemic venous congestion leading to jugular
venous distention (JVD) and peripheral edema; others are left-sided symptoms.
8. What is the primary purpose of the ‘Time Out’ procedure in the operating
room?
A. To verify the correct patient, site, and procedure.
B. To allow the anesthesia to take full effect.
C. To ensure all surgical instruments are sterilized.
D. To document the start time of the surgery for billing.
Answer: A
Rationale: The Universal Protocol ‘Time Out’ is a safety measure to prevent wrong-site,
wrong-procedure, and wrong-person surgery.
1. A patient who is 1 day postoperative after a total hip arthroplasty complains
of sudden onset shortness of breath and chest pain. What is the nurse’s priority
action?
A. Encourage the patient to use the incentive spirometer.
B. Administer the prescribed PRN dose of morphine for chest pain.
C. Perform a focused respiratory assessment and check oxygen saturation.
D. Assist the patient to perform ankle pump exercises.
Answer: C
Rationale: Sudden shortness of breath and chest pain postoperatively are hallmarks of
pulmonary embolism. Assessment is the priority before intervention.
2. When evaluating a patient with a potassium level of 6.2 mEq/L, which EKG
change is the nurse most likely to observe?
A. Prominent U waves
B. ST-segment depression
C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Rationale: Hyperkalemia typically causes tall, peaked T waves and widened QRS
complexes; U waves and ST depression are associated with hypokalemia.
,3. A nurse is caring for a patient with an IV infusion of 0.45% normal saline. This
solution is classified as:
A. Isotonic
B. Hypertonic
C. Hypotonic
D. Colloid
Answer: C
Rationale: 0.45% sodium chloride has a lower osmolarity than plasma, making it a
hypotonic solution which shifts fluid into cells.
4. Which clinical manifestation is a late sign of hypoxia in a patient with
respiratory distress?
A. Tachycardia
B. Restlessness
C. Cyanosis
D. Hypertension
Answer: C
Rationale: Restlessness and tachycardia are early signs of hypoxia, whereas cyanosis is a
late and critical indicator of severe oxygen deprivation.
5. A patient with Type 1 Diabetes Mellitus is found unconscious and clammy.
The bedside glucose is 42 mg/dL. What is the immediate nursing action?
A. Administer 15g of oral glucose gel.
B. Provide 4 ounces of orange juice.
C. Administer 1mg of Glucagon IM or SQ.
D. Re-check the blood glucose level in 15 minutes.
Answer: C
Rationale: Since the patient is unconscious, oral intake is contraindicated due to aspiration
risk; Glucagon or IV Dextrose is required for emergency treatment.
, 6. While assessing a postoperative abdominal wound, the nurse notes the
protrusion of internal organs. What is the first intervention?
A. Push the organs back into the abdominal cavity gently.
B. Apply a dry sterile dressing tightly.
C. Cover the wound with sterile dressings moistened with sterile normal saline.
D. Call the surgeon immediately before performing any local care.
Answer: C
Rationale: This is evisceration. The priority is to keep the organs moist and sterile with
saline-soaked dressings while awaiting surgical intervention.
7. A patient is diagnosed with Right-Sided Heart Failure. Which assessment
finding is most consistent with this diagnosis?
A. Peripheral edema and JVD
B. Dyspnea on exertion
C. Pulmonary crackles
D. Orthopnea
Answer: A
Rationale: Right-sided heart failure causes systemic venous congestion leading to jugular
venous distention (JVD) and peripheral edema; others are left-sided symptoms.
8. What is the primary purpose of the ‘Time Out’ procedure in the operating
room?
A. To verify the correct patient, site, and procedure.
B. To allow the anesthesia to take full effect.
C. To ensure all surgical instruments are sterilized.
D. To document the start time of the surgery for billing.
Answer: A
Rationale: The Universal Protocol ‘Time Out’ is a safety measure to prevent wrong-site,
wrong-procedure, and wrong-person surgery.
