NURS 121L-A Medical-Surgical Nursing Practicum Clinical Assessment
2026 WCU
1. A patient who underwent a total hip replacement 24 hours ago becomes
suddenly confused and develops petechiae on the chest and axilla. What is the
nurse’s priority action?
A. Administer an anticoagulant as prescribed.
B. Prepare the patient for a STAT chest X-ray.
C. Perform a complete neurological assessment.
D. Initiate oxygen therapy and notify the rapid response team.
Answer: D
Rationale: Confusion and petechiae post-orthopedic surgery are classic signs of Fat
Embolism Syndrome (FES). Immediate oxygenation and stabilization are the priority
interventions.
2. An arterial blood gas (ABG) report shows: pH 7.31, PaCO2 50 mmHg, and
HCO3 24 mEq/L. How should the nurse interpret these results?
A. Compensated metabolic acidosis
B. Uncompensated metabolic alkalosis
C. Compensated respiratory alkalosis
D. Uncompensated respiratory acidosis
Answer: D
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3 is
normal, indicating no compensation has occurred yet.
,3. The nurse is assessing a patient with a potassium level of 6.2 mEq/L. Which
EKG change is most likely to be observed?
A. Prominent U waves
B. Tall, peaked T waves
C. ST-segment depression
D. Shortened PR interval
Answer: B
Rationale: Hyperkalemia (K+ > 5.0) typically causes tall, peaked T waves, widened QRS
complexes, and potentially cardiac arrest.
4. A patient with heart failure is receiving Digoxin. The patient reports nausea
and seeing yellow-green halos. What is the first action the nurse should take?
A. Withhold the next dose and notify the healthcare provider.
B. Check the patient’s serum Digoxin level.
C. Assess the patient’s apical pulse for 1 full minute.
D. Administer an antiemetic.
Answer: A
Rationale: Nausea and visual disturbances are classic signs of Digoxin toxicity. The dose
must be held immediately and the provider notified.
5. A nurse is caring for a patient post-thyroidectomy. The patient reports
numbness and tingling around the mouth. Which assessment should the nurse
perform next?
A. Assess for Chvostek’s sign.
B. Check the surgical dressing for hemorrhage.
C. Monitor for signs of a thyroid storm.
D. Evaluate the patient’s voice for hoarseness.
Answer: A
, Rationale: Numbness and tingling (paresthesia) suggest hypocalcemia, often caused by
accidental parathyroid gland removal during thyroidectomy. Chvostek’s sign tests for
hypocalcemic tetany.
6. Which clinical finding is most indicative of a patient entering the
compensatory stage of shock?
A. Mean arterial pressure (MAP) < 60 mmHg
B. Increased heart rate and narrowed pulse pressure
C. Lethargy and decreased responsiveness
D. Anuria and cold, mottled skin
Answer: B
Rationale: In the compensatory stage of shock, the body uses the sympathetic nervous
system to maintain cardiac output, resulting in tachycardia and vasoconstriction.
7. A patient with a spinal cord injury at T4 reports a sudden, throbbing
headache and has a blood pressure of 190/100 mmHg. What is the nurse’s
immediate priority?
A. Administer an antihypertensive medication.
B. Check the patient’s urinary catheter for kinks or obstruction.
C. Place the patient in a flat, supine position.
D. Perform a pupillary response check.
Answer: B
Rationale: These are signs of Autonomic Dysreflexia, a medical emergency. The nurse must
identify and remove the noxious stimulus (like a full bladder) and sit the patient upright.
2026 WCU
1. A patient who underwent a total hip replacement 24 hours ago becomes
suddenly confused and develops petechiae on the chest and axilla. What is the
nurse’s priority action?
A. Administer an anticoagulant as prescribed.
B. Prepare the patient for a STAT chest X-ray.
C. Perform a complete neurological assessment.
D. Initiate oxygen therapy and notify the rapid response team.
Answer: D
Rationale: Confusion and petechiae post-orthopedic surgery are classic signs of Fat
Embolism Syndrome (FES). Immediate oxygenation and stabilization are the priority
interventions.
2. An arterial blood gas (ABG) report shows: pH 7.31, PaCO2 50 mmHg, and
HCO3 24 mEq/L. How should the nurse interpret these results?
A. Compensated metabolic acidosis
B. Uncompensated metabolic alkalosis
C. Compensated respiratory alkalosis
D. Uncompensated respiratory acidosis
Answer: D
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3 is
normal, indicating no compensation has occurred yet.
,3. The nurse is assessing a patient with a potassium level of 6.2 mEq/L. Which
EKG change is most likely to be observed?
A. Prominent U waves
B. Tall, peaked T waves
C. ST-segment depression
D. Shortened PR interval
Answer: B
Rationale: Hyperkalemia (K+ > 5.0) typically causes tall, peaked T waves, widened QRS
complexes, and potentially cardiac arrest.
4. A patient with heart failure is receiving Digoxin. The patient reports nausea
and seeing yellow-green halos. What is the first action the nurse should take?
A. Withhold the next dose and notify the healthcare provider.
B. Check the patient’s serum Digoxin level.
C. Assess the patient’s apical pulse for 1 full minute.
D. Administer an antiemetic.
Answer: A
Rationale: Nausea and visual disturbances are classic signs of Digoxin toxicity. The dose
must be held immediately and the provider notified.
5. A nurse is caring for a patient post-thyroidectomy. The patient reports
numbness and tingling around the mouth. Which assessment should the nurse
perform next?
A. Assess for Chvostek’s sign.
B. Check the surgical dressing for hemorrhage.
C. Monitor for signs of a thyroid storm.
D. Evaluate the patient’s voice for hoarseness.
Answer: A
, Rationale: Numbness and tingling (paresthesia) suggest hypocalcemia, often caused by
accidental parathyroid gland removal during thyroidectomy. Chvostek’s sign tests for
hypocalcemic tetany.
6. Which clinical finding is most indicative of a patient entering the
compensatory stage of shock?
A. Mean arterial pressure (MAP) < 60 mmHg
B. Increased heart rate and narrowed pulse pressure
C. Lethargy and decreased responsiveness
D. Anuria and cold, mottled skin
Answer: B
Rationale: In the compensatory stage of shock, the body uses the sympathetic nervous
system to maintain cardiac output, resulting in tachycardia and vasoconstriction.
7. A patient with a spinal cord injury at T4 reports a sudden, throbbing
headache and has a blood pressure of 190/100 mmHg. What is the nurse’s
immediate priority?
A. Administer an antihypertensive medication.
B. Check the patient’s urinary catheter for kinks or obstruction.
C. Place the patient in a flat, supine position.
D. Perform a pupillary response check.
Answer: B
Rationale: These are signs of Autonomic Dysreflexia, a medical emergency. The nurse must
identify and remove the noxious stimulus (like a full bladder) and sit the patient upright.
