NURS 121L-B Medical-Surgical Nursing Practicum - Week 5
Comprehensive Quiz 2026 |WCU
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen via a nasal cannula at 2 L/min. Which finding requires the most
immediate intervention by the nurse?
A. Oxygen saturation of 89% on room air
B. Anteroposterior chest diameter equal to lateral diameter
C. Presence of a productive cough with clear sputum
D. Respiratory rate of 10 breaths per minute and drowsiness
Answer: D
Rationale: In patients with COPD, a high concentration of oxygen can suppress the hypoxic
drive, leading to CO2 retention, respiratory depression, and somnolence. A respiratory rate
of 10 and drowsiness indicate potential CO2 narcosis.
2. Which arterial blood gas (ABG) result should the nurse expect for a patient
who has been vomiting for 24 hours?
A. pH 7.30, PaCO2 50, HCO3 26
B. pH 7.50, PaCO2 28, HCO3 22
C. pH 7.32, PaCO2 35, HCO3 18
D. pH 7.48, PaCO2 40, HCO3 30
Answer: D
Rationale: Vomiting results in the loss of gastric acid (HCl), which leads to metabolic
alkalosis. This is characterized by an elevated pH (>7.45) and an elevated bicarbonate level
(>26 mEq/L).
,3. A post-operative patient reports sudden onset of shortness of breath and
chest pain. The nurse notes a heart rate of 110 bpm and oxygen saturation of
88%. What is the priority nursing action?
A. Administer the prescribed PRN analgesic
B. Obtain a 12-lead ECG
C. Encourage the patient to use the incentive spirometer
D. Apply high-flow oxygen and notify the Rapid Response Team
Answer: D
Rationale: The symptoms are highly suggestive of a pulmonary embolism, a common post-
operative complication. Oxygenation and immediate escalation of care are the priorities to
prevent cardiovascular collapse.
4. The nurse is caring for a patient with a serum potassium level of 6.2 mEq/L.
Which ECG change is most consistent with this finding?
A. Prominent U waves
B. ST-segment depression
C. Prolonged QT interval
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an ECG as tall,
peaked T waves, which can progress to widened QRS complexes and cardiac arrest if
untreated.
, 5. A patient is admitted with a diagnosis of bacterial pneumonia. Which
assessment finding should the nurse report immediately to the healthcare
provider?
A. Crackles heard in the left lower lobe
B. Confusion and restlessness in an elderly patient
C. Oral temperature of 101.2 F (38.4 C)
D. Production of rust-colored sputum
Answer: B
Rationale: In elderly patients, confusion and mental status changes are often the first signs
of hypoxia or sepsis related to pneumonia and require immediate evaluation.
6. During the assessment of a patient’s peripheral IV site, the nurse notes
coolness, pallor, and swelling around the insertion site. Which action should the
nurse take first?
A. Apply a warm compress to the area
B. Slow the infusion rate to keep the vein open
C. Stop the infusion and remove the catheter
D. Flush the line with normal saline to check patency
Answer: C
Rationale: Coolness, pallor, and swelling are classic signs of IV infiltration. The first action
is to stop the infusion and remove the catheter to prevent further tissue damage.
7. A nurse is teaching a patient about using an incentive spirometer. Which
instruction is correct?
A. Exhale forcefully into the mouthpiece
B. Use the device once every 4 hours while awake
C. Inhale slowly and deeply through the mouthpiece
D. Hold your breath for 1 second after maximum inspiration
Answer: C
Comprehensive Quiz 2026 |WCU
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen via a nasal cannula at 2 L/min. Which finding requires the most
immediate intervention by the nurse?
A. Oxygen saturation of 89% on room air
B. Anteroposterior chest diameter equal to lateral diameter
C. Presence of a productive cough with clear sputum
D. Respiratory rate of 10 breaths per minute and drowsiness
Answer: D
Rationale: In patients with COPD, a high concentration of oxygen can suppress the hypoxic
drive, leading to CO2 retention, respiratory depression, and somnolence. A respiratory rate
of 10 and drowsiness indicate potential CO2 narcosis.
2. Which arterial blood gas (ABG) result should the nurse expect for a patient
who has been vomiting for 24 hours?
A. pH 7.30, PaCO2 50, HCO3 26
B. pH 7.50, PaCO2 28, HCO3 22
C. pH 7.32, PaCO2 35, HCO3 18
D. pH 7.48, PaCO2 40, HCO3 30
Answer: D
Rationale: Vomiting results in the loss of gastric acid (HCl), which leads to metabolic
alkalosis. This is characterized by an elevated pH (>7.45) and an elevated bicarbonate level
(>26 mEq/L).
,3. A post-operative patient reports sudden onset of shortness of breath and
chest pain. The nurse notes a heart rate of 110 bpm and oxygen saturation of
88%. What is the priority nursing action?
A. Administer the prescribed PRN analgesic
B. Obtain a 12-lead ECG
C. Encourage the patient to use the incentive spirometer
D. Apply high-flow oxygen and notify the Rapid Response Team
Answer: D
Rationale: The symptoms are highly suggestive of a pulmonary embolism, a common post-
operative complication. Oxygenation and immediate escalation of care are the priorities to
prevent cardiovascular collapse.
4. The nurse is caring for a patient with a serum potassium level of 6.2 mEq/L.
Which ECG change is most consistent with this finding?
A. Prominent U waves
B. ST-segment depression
C. Prolonged QT interval
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an ECG as tall,
peaked T waves, which can progress to widened QRS complexes and cardiac arrest if
untreated.
, 5. A patient is admitted with a diagnosis of bacterial pneumonia. Which
assessment finding should the nurse report immediately to the healthcare
provider?
A. Crackles heard in the left lower lobe
B. Confusion and restlessness in an elderly patient
C. Oral temperature of 101.2 F (38.4 C)
D. Production of rust-colored sputum
Answer: B
Rationale: In elderly patients, confusion and mental status changes are often the first signs
of hypoxia or sepsis related to pneumonia and require immediate evaluation.
6. During the assessment of a patient’s peripheral IV site, the nurse notes
coolness, pallor, and swelling around the insertion site. Which action should the
nurse take first?
A. Apply a warm compress to the area
B. Slow the infusion rate to keep the vein open
C. Stop the infusion and remove the catheter
D. Flush the line with normal saline to check patency
Answer: C
Rationale: Coolness, pallor, and swelling are classic signs of IV infiltration. The first action
is to stop the infusion and remove the catheter to prevent further tissue damage.
7. A nurse is teaching a patient about using an incentive spirometer. Which
instruction is correct?
A. Exhale forcefully into the mouthpiece
B. Use the device once every 4 hours while awake
C. Inhale slowly and deeply through the mouthpiece
D. Hold your breath for 1 second after maximum inspiration
Answer: C
