NURS 121L-B Medical-Surgical Nursing Practicum Week 13 High-Acuity
Assessment 2026 |WCU
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation with High-Level Positive End-Expiratory Pressure (PEEP).
What is the primary physiological risk associated with this setting?
A. Decreased venous return and reduced cardiac output
B. Increased alveolar collapse during expiration
C. Respiratory alkalosis due to hyperventilation
D. Systemic hypertension from sympathetic activation
Answer: A
Rationale: High PEEP increases intrathoracic pressure, which can compress the vena cava,
reducing venous return (preload) and subsequently decreasing cardiac output and blood
pressure.
2. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse identifies
which lab result as the most critical indicator of the effectiveness of the insulin
infusion?
A. Decrease in serum glucose level to 200 mg/dL
B. Absence of glucose in the urine
C. Normalization of serum potassium levels
D. Closure of the anion gap
Answer: D
Rationale: While blood glucose decreases, the resolution of metabolic acidosis (indicated
by the closing of the anion gap) is the ultimate goal in treating DKA, as it shows that ketone
production has ceased.
,3. The nurse is caring for a patient in the oliguric phase of Acute Kidney Injury
(AKI). Which dietary modification is most appropriate?
A. Increased protein and decreased carbohydrates
B. High potassium and high magnesium intake
C. Low protein, low potassium, and low sodium
D. High sodium to prevent hyponatremia
Answer: C
Rationale: During the oliguric phase, the kidneys cannot excrete nitrogenous waste,
potassium, or sodium effectively. Restricting these prevents azotemia, hyperkalemia, and
fluid overload.
4. A patient with a history of cirrhosis presents with altered mental status and
asterixis. Which medication should the nurse anticipate administering to reduce
serum ammonia levels?
A. Spironolactone
B. Propranolol
C. Rifaximin and Neomycin
D. Lactulose
Answer: D
Rationale: Lactulose is the gold standard for hepatic encephalopathy as it promotes the
excretion of ammonia through the stool by acidifying the colon.
, 5. Which assessment finding should the nurse prioritize in a patient who has just
returned from a percutaneous coronary intervention (PCI) via the femoral
artery?
A. A palpable pedal pulse in the affected extremity
B. Small amount of bruising at the insertion site
C. The patient reporting a ‘warm sensation’ in the leg
D. Development of a firm, enlarging mass at the puncture site
Answer: D
Rationale: A firm, enlarging mass suggests a hematoma or active bleed, requiring
immediate intervention (manual pressure) to prevent hemorrhage.
6. An elderly patient with Heart Failure is prescribed Digoxin. Which electrolyte
imbalance most increases the risk for Digoxin toxicity?
A. Hypermagnesemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: Hypokalemia increases the sensitivity of the cardiac muscle to Digoxin,
significantly increasing the risk of toxicity even if the Digoxin level is within the therapeutic
range.
7. A nurse is monitoring a patient with a chest tube. The nurse notes continuous
bubbling in the water seal chamber. This indicates:
A. An air leak in the system or the patient’s pleural space
B. The system is functioning normally
C. The lung has fully re-expanded
D. The suction pressure is too high
Answer: A
Assessment 2026 |WCU
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation with High-Level Positive End-Expiratory Pressure (PEEP).
What is the primary physiological risk associated with this setting?
A. Decreased venous return and reduced cardiac output
B. Increased alveolar collapse during expiration
C. Respiratory alkalosis due to hyperventilation
D. Systemic hypertension from sympathetic activation
Answer: A
Rationale: High PEEP increases intrathoracic pressure, which can compress the vena cava,
reducing venous return (preload) and subsequently decreasing cardiac output and blood
pressure.
2. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse identifies
which lab result as the most critical indicator of the effectiveness of the insulin
infusion?
A. Decrease in serum glucose level to 200 mg/dL
B. Absence of glucose in the urine
C. Normalization of serum potassium levels
D. Closure of the anion gap
Answer: D
Rationale: While blood glucose decreases, the resolution of metabolic acidosis (indicated
by the closing of the anion gap) is the ultimate goal in treating DKA, as it shows that ketone
production has ceased.
,3. The nurse is caring for a patient in the oliguric phase of Acute Kidney Injury
(AKI). Which dietary modification is most appropriate?
A. Increased protein and decreased carbohydrates
B. High potassium and high magnesium intake
C. Low protein, low potassium, and low sodium
D. High sodium to prevent hyponatremia
Answer: C
Rationale: During the oliguric phase, the kidneys cannot excrete nitrogenous waste,
potassium, or sodium effectively. Restricting these prevents azotemia, hyperkalemia, and
fluid overload.
4. A patient with a history of cirrhosis presents with altered mental status and
asterixis. Which medication should the nurse anticipate administering to reduce
serum ammonia levels?
A. Spironolactone
B. Propranolol
C. Rifaximin and Neomycin
D. Lactulose
Answer: D
Rationale: Lactulose is the gold standard for hepatic encephalopathy as it promotes the
excretion of ammonia through the stool by acidifying the colon.
, 5. Which assessment finding should the nurse prioritize in a patient who has just
returned from a percutaneous coronary intervention (PCI) via the femoral
artery?
A. A palpable pedal pulse in the affected extremity
B. Small amount of bruising at the insertion site
C. The patient reporting a ‘warm sensation’ in the leg
D. Development of a firm, enlarging mass at the puncture site
Answer: D
Rationale: A firm, enlarging mass suggests a hematoma or active bleed, requiring
immediate intervention (manual pressure) to prevent hemorrhage.
6. An elderly patient with Heart Failure is prescribed Digoxin. Which electrolyte
imbalance most increases the risk for Digoxin toxicity?
A. Hypermagnesemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: Hypokalemia increases the sensitivity of the cardiac muscle to Digoxin,
significantly increasing the risk of toxicity even if the Digoxin level is within the therapeutic
range.
7. A nurse is monitoring a patient with a chest tube. The nurse notes continuous
bubbling in the water seal chamber. This indicates:
A. An air leak in the system or the patient’s pleural space
B. The system is functioning normally
C. The lung has fully re-expanded
D. The suction pressure is too high
Answer: A
