Medical-Surgical Nursing Practicum - Exam 4 Study Guide 2026 |WCU
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation with High-Level Positive End-Expiratory Pressure (PEEP).
Which assessment finding most urgently requires intervention?
A. A PaO2 of 70 mmHg with an FiO2 of 60%
B. A decrease in systolic blood pressure from 120 mmHg to 95 mmHg
C. Crackles heard at the lung bases bilaterally
D. Respiratory rate of 24 breaths per minute
Answer: B
Rationale: High PEEP can increase intrathoracic pressure, leading to decreased venous
return to the heart, which reduces cardiac output and causes hypotension.
2. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a
blood glucose of 450 mg/dL, pH 7.20, and potassium 5.8 mEq/L. What is the
physiological reason for the elevated potassium?
A. Extracellular shift of potassium in response to metabolic acidosis
B. Excessive intake of dietary potassium before admission
C. Renal failure associated with dehydration
D. Decreased insulin secretion causing potassium retention
Answer: A
Rationale: In metabolic acidosis, hydrogen ions move into the cells, forcing potassium ions
out of the cells into the bloodstream to maintain electrical neutrality, resulting in
hyperkalemia.
,3. The nurse is caring for a patient with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). Which laboratory result is most consistent with this
diagnosis?
A. Serum sodium 124 mEq/L
B. Serum osmolality 310 mOsm/kg
C. Urine specific gravity 1.002
D. Hematocrit 55%
Answer: A
Rationale: SIADH involves excessive ADH, leading to water retention and dilutional
hyponatremia; therefore, a low serum sodium level is expected.
4. A patient is diagnosed with Pheochromocytoma. Which clinical manifestation
should the nurse prioritize for immediate management?
A. Abdominal pain and constipation
B. Excessive sweating and palpitations
C. Severe headache and hypertension (BP 210/110 mmHg)
D. Weight loss and heat intolerance
Answer: C
Rationale: Pheochromocytoma causes a surge in catecholamines, which can lead to a
hypertensive crisis, placing the patient at risk for stroke or myocardial infarction.
5. A patient with Chronic Kidney Disease (CKD) has a serum potassium of 6.5
mEq/L and EKG changes showing peaked T-waves. Which medication should be
administered first to protect the heart?
A. Calcium Gluconate
B. Regular Insulin and 50% Dextrose
C. Sodium Polystyrene Sulfonate (Kayexalate)
D. Sodium Bicarbonate
Answer: A
, Rationale: Calcium gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent lethal arrhythmias in the setting of hyperkalemia.
6. Following a thyroidectomy, a patient develops tetany and a positive
Chvostek’s sign. Which medication does the nurse anticipate administering?
A. Levothyroxine
B. Potassium Chloride
C. Calcium Gluconate
D. Calcitonin
Answer: C
Rationale: Hypocalcemia can occur if the parathyroid glands are accidentally removed or
damaged during a thyroidectomy, leading to tetany. Intravenous calcium gluconate is the
treatment.
7. A patient in the oliguric phase of Acute Kidney Injury (AKI) is at greatest risk
for which acid-base imbalance?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Rationale: In AKI, the kidneys are unable to excrete metabolic acids (like hydrogen ions)
and cannot regenerate bicarbonate, leading to metabolic acidosis.
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation with High-Level Positive End-Expiratory Pressure (PEEP).
Which assessment finding most urgently requires intervention?
A. A PaO2 of 70 mmHg with an FiO2 of 60%
B. A decrease in systolic blood pressure from 120 mmHg to 95 mmHg
C. Crackles heard at the lung bases bilaterally
D. Respiratory rate of 24 breaths per minute
Answer: B
Rationale: High PEEP can increase intrathoracic pressure, leading to decreased venous
return to the heart, which reduces cardiac output and causes hypotension.
2. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a
blood glucose of 450 mg/dL, pH 7.20, and potassium 5.8 mEq/L. What is the
physiological reason for the elevated potassium?
A. Extracellular shift of potassium in response to metabolic acidosis
B. Excessive intake of dietary potassium before admission
C. Renal failure associated with dehydration
D. Decreased insulin secretion causing potassium retention
Answer: A
Rationale: In metabolic acidosis, hydrogen ions move into the cells, forcing potassium ions
out of the cells into the bloodstream to maintain electrical neutrality, resulting in
hyperkalemia.
,3. The nurse is caring for a patient with Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). Which laboratory result is most consistent with this
diagnosis?
A. Serum sodium 124 mEq/L
B. Serum osmolality 310 mOsm/kg
C. Urine specific gravity 1.002
D. Hematocrit 55%
Answer: A
Rationale: SIADH involves excessive ADH, leading to water retention and dilutional
hyponatremia; therefore, a low serum sodium level is expected.
4. A patient is diagnosed with Pheochromocytoma. Which clinical manifestation
should the nurse prioritize for immediate management?
A. Abdominal pain and constipation
B. Excessive sweating and palpitations
C. Severe headache and hypertension (BP 210/110 mmHg)
D. Weight loss and heat intolerance
Answer: C
Rationale: Pheochromocytoma causes a surge in catecholamines, which can lead to a
hypertensive crisis, placing the patient at risk for stroke or myocardial infarction.
5. A patient with Chronic Kidney Disease (CKD) has a serum potassium of 6.5
mEq/L and EKG changes showing peaked T-waves. Which medication should be
administered first to protect the heart?
A. Calcium Gluconate
B. Regular Insulin and 50% Dextrose
C. Sodium Polystyrene Sulfonate (Kayexalate)
D. Sodium Bicarbonate
Answer: A
, Rationale: Calcium gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent lethal arrhythmias in the setting of hyperkalemia.
6. Following a thyroidectomy, a patient develops tetany and a positive
Chvostek’s sign. Which medication does the nurse anticipate administering?
A. Levothyroxine
B. Potassium Chloride
C. Calcium Gluconate
D. Calcitonin
Answer: C
Rationale: Hypocalcemia can occur if the parathyroid glands are accidentally removed or
damaged during a thyroidectomy, leading to tetany. Intravenous calcium gluconate is the
treatment.
7. A patient in the oliguric phase of Acute Kidney Injury (AKI) is at greatest risk
for which acid-base imbalance?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Rationale: In AKI, the kidneys are unable to excrete metabolic acids (like hydrogen ions)
and cannot regenerate bicarbonate, leading to metabolic acidosis.
