NURS 121L-B Medical-Surgical Nursing Practicum Final Exam 2026
|WCU
1. A patient with a history of heart failure is admitted with a serum potassium
level of 2.8 mEq/L. Which EKG change is the nurse most likely to observe?
A. Peaked T waves
B. Widened QRS complex
C. Shortened QT interval
D. Prominent U waves
Answer: D
Rationale: Hypokalemia (potassium < 3.5 mEq/L) typically presents with prominent U
waves, ST-segment depression, and flat or inverted T waves. Peaked T waves are
associated with hyperkalemia.
2. When preparing a patient for an elective cholecystectomy, the nurse notices
the surgical consent form is not signed. The patient states, ‘I’m still not sure why
they have to remove my whole gallbladder.’ What is the nurse’s priority action?
A. Notify the surgeon that the patient needs further clarification.
B. Ask the patient to sign the form so the surgery is not delayed.
C. Explain the risks and benefits of the procedure to the patient.
D. Document that the patient refused to sign the consent form.
Answer: A
Rationale: It is the surgeon’s responsibility to provide informed consent. If the patient
expresses lack of understanding, the nurse must notify the surgeon to explain the
procedure before the consent is signed.
,3. A postoperative patient develops a sudden onset of chest pain and dyspnea.
The nurse notes a heart rate of 110 bpm and an oxygen saturation of 88% on
room air. Which condition should the nurse suspect first?
A. Pulmonary Embolism
B. Myocardial Infarction
C. Pneumonia
D. Atelectasis
Answer: A
Rationale: Sudden onset of dyspnea, tachycardia, and hypoxemia in a postoperative
patient are classic signs of a pulmonary embolism, a common complication of immobility
after surgery.
4. A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). Which acid-base
imbalance is most consistent with this condition?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: B
Rationale: DKA involves the accumulation of ketones, which are acidic, leading to a
decrease in serum pH and bicarbonate, characterizing metabolic acidosis.
5. Which clinical manifestation would the nurse expect to find in a patient with
right-sided heart failure?
A. Peripheral edema
B. Dyspnea on exertion
C. Pulmonary crackles
D. Orthopnea
Answer: A
, Rationale: Right-sided heart failure results in systemic venous congestion, leading to
peripheral edema, jugular venous distention, and hepatomegaly. Left-sided failure causes
pulmonary symptoms.
6. A patient has been prescribed Alendronate for osteoporosis. Which
instruction is vital for the nurse to include in the discharge teaching?
A. Take the medication with a full glass of milk.
B. Lie down for 30 minutes after taking the medication.
C. Take the medication first thing in the morning with water and remain upright.
D. Take the medication at bedtime to prevent nausea.
Answer: C
Rationale: Alendronate can cause severe esophageal irritation. Patients must take it with
water on an empty stomach and remain upright for at least 30 minutes to facilitate passage
into the stomach.
7. A nurse is assessing a patient with a chest tube. Which finding requires
immediate intervention?
A. Occasional bubbling in the water seal chamber during coughing.
B. Constant, vigorous bubbling in the water seal chamber.
C. Fluctuation of the water level in the water seal chamber with breathing.
D. Drainage of 50 mL of serosanguinous fluid over 4 hours.
Answer: B
Rationale: Constant bubbling in the water seal chamber indicates a large air leak in the
system or the patient’s pleural space. Intermittent bubbling with coughing is normal.
|WCU
1. A patient with a history of heart failure is admitted with a serum potassium
level of 2.8 mEq/L. Which EKG change is the nurse most likely to observe?
A. Peaked T waves
B. Widened QRS complex
C. Shortened QT interval
D. Prominent U waves
Answer: D
Rationale: Hypokalemia (potassium < 3.5 mEq/L) typically presents with prominent U
waves, ST-segment depression, and flat or inverted T waves. Peaked T waves are
associated with hyperkalemia.
2. When preparing a patient for an elective cholecystectomy, the nurse notices
the surgical consent form is not signed. The patient states, ‘I’m still not sure why
they have to remove my whole gallbladder.’ What is the nurse’s priority action?
A. Notify the surgeon that the patient needs further clarification.
B. Ask the patient to sign the form so the surgery is not delayed.
C. Explain the risks and benefits of the procedure to the patient.
D. Document that the patient refused to sign the consent form.
Answer: A
Rationale: It is the surgeon’s responsibility to provide informed consent. If the patient
expresses lack of understanding, the nurse must notify the surgeon to explain the
procedure before the consent is signed.
,3. A postoperative patient develops a sudden onset of chest pain and dyspnea.
The nurse notes a heart rate of 110 bpm and an oxygen saturation of 88% on
room air. Which condition should the nurse suspect first?
A. Pulmonary Embolism
B. Myocardial Infarction
C. Pneumonia
D. Atelectasis
Answer: A
Rationale: Sudden onset of dyspnea, tachycardia, and hypoxemia in a postoperative
patient are classic signs of a pulmonary embolism, a common complication of immobility
after surgery.
4. A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). Which acid-base
imbalance is most consistent with this condition?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: B
Rationale: DKA involves the accumulation of ketones, which are acidic, leading to a
decrease in serum pH and bicarbonate, characterizing metabolic acidosis.
5. Which clinical manifestation would the nurse expect to find in a patient with
right-sided heart failure?
A. Peripheral edema
B. Dyspnea on exertion
C. Pulmonary crackles
D. Orthopnea
Answer: A
, Rationale: Right-sided heart failure results in systemic venous congestion, leading to
peripheral edema, jugular venous distention, and hepatomegaly. Left-sided failure causes
pulmonary symptoms.
6. A patient has been prescribed Alendronate for osteoporosis. Which
instruction is vital for the nurse to include in the discharge teaching?
A. Take the medication with a full glass of milk.
B. Lie down for 30 minutes after taking the medication.
C. Take the medication first thing in the morning with water and remain upright.
D. Take the medication at bedtime to prevent nausea.
Answer: C
Rationale: Alendronate can cause severe esophageal irritation. Patients must take it with
water on an empty stomach and remain upright for at least 30 minutes to facilitate passage
into the stomach.
7. A nurse is assessing a patient with a chest tube. Which finding requires
immediate intervention?
A. Occasional bubbling in the water seal chamber during coughing.
B. Constant, vigorous bubbling in the water seal chamber.
C. Fluctuation of the water level in the water seal chamber with breathing.
D. Drainage of 50 mL of serosanguinous fluid over 4 hours.
Answer: B
Rationale: Constant bubbling in the water seal chamber indicates a large air leak in the
system or the patient’s pleural space. Intermittent bubbling with coughing is normal.
