NURS 121L-A Medical-Surgical Nursing Practicum Comprehensive Final
Exam 2026 |WCU
1. A patient with chronic kidney disease (CKD) presents with a potassium level
of 6.8 mEq/L. Which electrocardiogram finding should the nurse prioritize for
immediate intervention?
A. Prominent U waves
B. Prolonged PR interval
C. Shortened QT interval
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an EKG as tall,
peaked T waves. If left untreated, it can progress to widened QRS complexes and cardiac
arrest.
2. Following a subtotal thyroidectomy, the patient reports numbness and
tingling in the fingers and around the mouth. Which action should the nurse
take first?
A. Assess for Chvostek’s sign
B. Check the patient’s serum calcium level
C. Administer a dose of levothyroxine
D. Encourage the patient to cough and deep breathe
Answer: A
Rationale: Hypocalcemia is a potential complication of thyroid surgery if the parathyroid
glands are damaged. Chvostek’s sign (facial twitching) is a physical assessment for
neuromuscular irritability indicating low calcium.
,3. An arterial blood gas (ABG) result shows pH 7.28, PaCO2 55 mmHg, and HCO3
24 mEq/L. How should the nurse interpret this result?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg with a normal
bicarbonate (HCO3) indicates that the acidosis is respiratory in origin.
4. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which IV fluid should
the nurse expect to administer first?
A. D5W (5% Dextrose in water)
B. 0.45% Normal Saline
C. D5 1/2 Normal Saline
D. 0.9% Normal Saline
Answer: D
Rationale: The initial priority in DKA is volume rehydration. 0.9% Normal Saline (isotonic)
is used first to restore circulatory volume before switching to hypotonic or glucose-
containing fluids.
5. Which assessment finding is the most sensitive early indicator of increased
intracranial pressure (ICP) in a patient with a head injury?
A. Widening pulse pressure
B. Cheyne-Stokes respirations
C. Fixed and dilated pupils
D. Change in level of consciousness
Answer: D
, Rationale: Alterations in level of consciousness (LOC), such as restlessness or lethargy, are
the earliest and most sensitive indicators of rising ICP.
6. A patient with a history of heart failure reports a weight gain of 3 lbs in 24
hours. Which nursing intervention is most appropriate?
A. Decrease the frequency of vital signs
B. Request a prescription for a high-sodium diet
C. Auscultate lung sounds for crackles
D. Restrict fluids to 500 mL per day
Answer: C
Rationale: Sudden weight gain in heart failure suggests fluid volume overload. The nurse
must assess for pulmonary edema (crackles) immediately.
7. In the care of a patient with a newly created arteriovenous (AV) fistula for
hemodialysis, which action should the nurse avoid?
A. Measuring blood pressure on the affected arm
B. Auscultating for a bruit
C. Palpating for a thrill
D. Elevating the arm post-operatively
Answer: A
Rationale: Blood pressure measurements, IV insertions, and venipunctures should never
be performed on the arm with an AV fistula to prevent occlusion or damage.
Exam 2026 |WCU
1. A patient with chronic kidney disease (CKD) presents with a potassium level
of 6.8 mEq/L. Which electrocardiogram finding should the nurse prioritize for
immediate intervention?
A. Prominent U waves
B. Prolonged PR interval
C. Shortened QT interval
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an EKG as tall,
peaked T waves. If left untreated, it can progress to widened QRS complexes and cardiac
arrest.
2. Following a subtotal thyroidectomy, the patient reports numbness and
tingling in the fingers and around the mouth. Which action should the nurse
take first?
A. Assess for Chvostek’s sign
B. Check the patient’s serum calcium level
C. Administer a dose of levothyroxine
D. Encourage the patient to cough and deep breathe
Answer: A
Rationale: Hypocalcemia is a potential complication of thyroid surgery if the parathyroid
glands are damaged. Chvostek’s sign (facial twitching) is a physical assessment for
neuromuscular irritability indicating low calcium.
,3. An arterial blood gas (ABG) result shows pH 7.28, PaCO2 55 mmHg, and HCO3
24 mEq/L. How should the nurse interpret this result?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg with a normal
bicarbonate (HCO3) indicates that the acidosis is respiratory in origin.
4. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which IV fluid should
the nurse expect to administer first?
A. D5W (5% Dextrose in water)
B. 0.45% Normal Saline
C. D5 1/2 Normal Saline
D. 0.9% Normal Saline
Answer: D
Rationale: The initial priority in DKA is volume rehydration. 0.9% Normal Saline (isotonic)
is used first to restore circulatory volume before switching to hypotonic or glucose-
containing fluids.
5. Which assessment finding is the most sensitive early indicator of increased
intracranial pressure (ICP) in a patient with a head injury?
A. Widening pulse pressure
B. Cheyne-Stokes respirations
C. Fixed and dilated pupils
D. Change in level of consciousness
Answer: D
, Rationale: Alterations in level of consciousness (LOC), such as restlessness or lethargy, are
the earliest and most sensitive indicators of rising ICP.
6. A patient with a history of heart failure reports a weight gain of 3 lbs in 24
hours. Which nursing intervention is most appropriate?
A. Decrease the frequency of vital signs
B. Request a prescription for a high-sodium diet
C. Auscultate lung sounds for crackles
D. Restrict fluids to 500 mL per day
Answer: C
Rationale: Sudden weight gain in heart failure suggests fluid volume overload. The nurse
must assess for pulmonary edema (crackles) immediately.
7. In the care of a patient with a newly created arteriovenous (AV) fistula for
hemodialysis, which action should the nurse avoid?
A. Measuring blood pressure on the affected arm
B. Auscultating for a bruit
C. Palpating for a thrill
D. Elevating the arm post-operatively
Answer: A
Rationale: Blood pressure measurements, IV insertions, and venipunctures should never
be performed on the arm with an AV fistula to prevent occlusion or damage.
