NURS 121L-A Medical-Surgical Nursing Exam 3 Study Guide 2026
|WCU
1. A patient with left-sided heart failure is experiencing increasing dyspnea and
crackles in the lung bases. Which pathophysiological mechanism explains these
symptoms?
A. Systemic venous congestion leading to peripheral edema
B. Increased pulmonary capillary hydrostatic pressure causing fluid shift into alveoli
C. Decreased oncotic pressure due to liver dysfunction
D. Right ventricular hypertrophy causing backflow into the vena cava
Answer: B
Rationale: In left-sided heart failure, the left ventricle fails to pump effectively, leading to
increased pressure in the left atrium and pulmonary veins, which increases pulmonary
capillary hydrostatic pressure and forces fluid into the interstitial spaces and alveoli.
2. Which clinical manifestation should the nurse monitor for in a patient with
suspected Digoxin toxicity?
A. Tachycardia and hypertension
B. Hyperkalemia and increased urinary output
C. Visual disturbances, such as seeing yellow-green halos
D. Constipation and dry mouth
Answer: C
Rationale: Digoxin toxicity commonly presents with gastrointestinal upset (anorexia,
nausea) and neurological/visual changes, specifically yellow-green halos around lights or
blurred vision.
,3. A patient’s ABG results are: pH 7.30, PaCO2 52 mmHg, HCO3 24 mEq/L. How
should the nurse interpret these findings?
A. Compensated Metabolic Acidosis
B. Partially Compensated Metabolic Alkalosis
C. Uncompensated Respiratory Acidosis
D. Uncompensated Respiratory Alkalosis
Answer: C
Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 (respiratory). Since
the HCO3 is within the normal range (22-26), no compensation has occurred yet.
4. In a patient with Chronic Obstructive Pulmonary Disease (COPD), what is the
primary drive for breathing?
A. High serum CO2 levels
B. High serum pH levels
C. Low serum oxygen levels (hypoxic drive)
D. Low serum bicarbonate levels
Answer: C
Rationale: In chronic CO2 retainers like COPD patients, the central chemoreceptors
become insensitive to high CO2, making low oxygen levels the primary stimulus for
respiration.
5. Which nursing intervention is most critical for a patient diagnosed with
Diabetic Ketoacidosis (DKA)?
A. Intravenous fluid resuscitation with 0.9% Normal Saline
B. Administration of rapid-acting insulin via subcutaneous injection
C. Providing a high-carbohydrate snack to prevent hypoglycemia
D. Administering oral hypoglycemic agents
Answer: A
, Rationale: Fluid resuscitation is the first priority in DKA to treat dehydration and restore
perfusion before or concurrent with insulin therapy.
6. A patient with Hyperthyroidism (Grave’s Disease) is at risk for Thyroid Storm.
Which symptom indicates this medical emergency?
A. Hyperthermia and extreme tachycardia
B. Bradycardia and lethargy
C. Weight gain and cold intolerance
D. Hypotension and bradypnea
Answer: A
Rationale: Thyroid storm is a life-threatening state of hypermetabolism characterized by
high fever (hyperthermia), tachycardia, and agitated delirium.
7. Which laboratory value is the most sensitive indicator of renal function in a
patient with Chronic Kidney Disease (CKD)?
A. Blood Urea Nitrogen (BUN)
B. Glomerular Filtration Rate (GFR)
C. Serum Potassium
D. Serum Sodium
Answer: B
Rationale: GFR is considered the best overall index of kidney function because it reflects
the volume of fluid filtered through the kidneys per minute.
8. The nurse is caring for a patient post-thyroidectomy. Which assessment
finding requires immediate intervention?
A. Laryngeal stridor
B. Sore throat when swallowing
C. Hoarseness when speaking
D. Incisional pain
Answer: A
|WCU
1. A patient with left-sided heart failure is experiencing increasing dyspnea and
crackles in the lung bases. Which pathophysiological mechanism explains these
symptoms?
A. Systemic venous congestion leading to peripheral edema
B. Increased pulmonary capillary hydrostatic pressure causing fluid shift into alveoli
C. Decreased oncotic pressure due to liver dysfunction
D. Right ventricular hypertrophy causing backflow into the vena cava
Answer: B
Rationale: In left-sided heart failure, the left ventricle fails to pump effectively, leading to
increased pressure in the left atrium and pulmonary veins, which increases pulmonary
capillary hydrostatic pressure and forces fluid into the interstitial spaces and alveoli.
2. Which clinical manifestation should the nurse monitor for in a patient with
suspected Digoxin toxicity?
A. Tachycardia and hypertension
B. Hyperkalemia and increased urinary output
C. Visual disturbances, such as seeing yellow-green halos
D. Constipation and dry mouth
Answer: C
Rationale: Digoxin toxicity commonly presents with gastrointestinal upset (anorexia,
nausea) and neurological/visual changes, specifically yellow-green halos around lights or
blurred vision.
,3. A patient’s ABG results are: pH 7.30, PaCO2 52 mmHg, HCO3 24 mEq/L. How
should the nurse interpret these findings?
A. Compensated Metabolic Acidosis
B. Partially Compensated Metabolic Alkalosis
C. Uncompensated Respiratory Acidosis
D. Uncompensated Respiratory Alkalosis
Answer: C
Rationale: The pH is below 7.35 (acidosis) and the PaCO2 is above 45 (respiratory). Since
the HCO3 is within the normal range (22-26), no compensation has occurred yet.
4. In a patient with Chronic Obstructive Pulmonary Disease (COPD), what is the
primary drive for breathing?
A. High serum CO2 levels
B. High serum pH levels
C. Low serum oxygen levels (hypoxic drive)
D. Low serum bicarbonate levels
Answer: C
Rationale: In chronic CO2 retainers like COPD patients, the central chemoreceptors
become insensitive to high CO2, making low oxygen levels the primary stimulus for
respiration.
5. Which nursing intervention is most critical for a patient diagnosed with
Diabetic Ketoacidosis (DKA)?
A. Intravenous fluid resuscitation with 0.9% Normal Saline
B. Administration of rapid-acting insulin via subcutaneous injection
C. Providing a high-carbohydrate snack to prevent hypoglycemia
D. Administering oral hypoglycemic agents
Answer: A
, Rationale: Fluid resuscitation is the first priority in DKA to treat dehydration and restore
perfusion before or concurrent with insulin therapy.
6. A patient with Hyperthyroidism (Grave’s Disease) is at risk for Thyroid Storm.
Which symptom indicates this medical emergency?
A. Hyperthermia and extreme tachycardia
B. Bradycardia and lethargy
C. Weight gain and cold intolerance
D. Hypotension and bradypnea
Answer: A
Rationale: Thyroid storm is a life-threatening state of hypermetabolism characterized by
high fever (hyperthermia), tachycardia, and agitated delirium.
7. Which laboratory value is the most sensitive indicator of renal function in a
patient with Chronic Kidney Disease (CKD)?
A. Blood Urea Nitrogen (BUN)
B. Glomerular Filtration Rate (GFR)
C. Serum Potassium
D. Serum Sodium
Answer: B
Rationale: GFR is considered the best overall index of kidney function because it reflects
the volume of fluid filtered through the kidneys per minute.
8. The nurse is caring for a patient post-thyroidectomy. Which assessment
finding requires immediate intervention?
A. Laryngeal stridor
B. Sore throat when swallowing
C. Hoarseness when speaking
D. Incisional pain
Answer: A
