NURS 121L-A Medical-Surgical Nursing Practicum Exam 1 Study Guide
2026 |WCU
1. A nurse is reviewing the arterial blood gas (ABG) results for a client with
prolonged vomiting: pH 7.48, PaCO2 44 mmHg, and HCO3 30 mEq/L. Which acid-
base imbalance does the nurse identify?
A. Metabolic Alkalosis
B. Metabolic Acidosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: A
Rationale: Metabolic alkalosis is characterized by an elevated pH (>7.45) and an elevated
bicarbonate level (>26 mEq/L), often caused by the loss of gastric acid through vomiting or
suctioning.
2. During the preoperative assessment, a client reports a family history of a high
fever and muscle rigidity during surgery. Which medication should the nurse
ensure is available on the surgical floor?
A. Atropine sulfate
B. Naloxone hydrochloride
C. Dantrolene sodium
D. Epinephrine
Answer: C
Rationale: Malignant hyperthermia is a life-threatening genetic condition triggered by
volatile anesthetics or succinylcholine; Dantrolene is the primary treatment to reverse
muscle rigidity and hypermetabolism.
,3. A nurse is caring for a postoperative client who has developed an evisceration
of the abdominal wound. What is the priority nursing action?
A. Cover the wound with sterile gauze soaked in sterile normal saline.
B. Place the client in a high-Fowler’s position.
C. Attempt to reinsert the protruding organs gently.
D. Apply a tight abdominal binder to prevent further protrusion.
Answer: A
Rationale: An evisceration is a medical emergency. The nurse must cover the exposed
viscera with sterile, saline-moistened dressings to prevent drying and infection while
notifying the surgeon immediately.
4. A client presents with a serum potassium level of 6.2 mEq/L. Which
electrocardiogram (ECG) change should the nurse expect to observe?
A. Prominent U waves
B. ST-segment depression
C. Inverted T waves
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an ECG as tall,
peaked T waves, prolonged PR intervals, and potentially widened QRS complexes.
5. Which assessment finding is most indicative of hypocalcemia in a client
following a thyroidectomy?
A. Negative Babinski reflex
B. Positive Chvostek’s sign
C. Hyporeflexia of deep tendons
D. Flaccid paralysis
Answer: B
, Rationale: Hypocalcemia can occur after thyroid surgery if the parathyroid glands are
accidentally removed. Chvostek’s sign (facial twitching when the facial nerve is tapped)
indicates neuromuscular irritability.
6. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. The nurse understands that higher
concentrations of oxygen should be avoided because:
A. High oxygen levels can cause pulmonary edema.
B. High oxygen levels increase the risk of spontaneous pneumothorax.
C. The client’s respiratory drive is triggered by low oxygen levels.
D. Oxygen is flammable and increases the risk of fire.
Answer: C
Rationale: In some clients with chronic hypercapnia (COPD), the stimulus to breathe shifts
from high CO2 levels to low O2 levels. Providing too much oxygen can suppress this
‘hypoxic drive’ and lead to respiratory arrest.
7. A nurse is preparing to administer a unit of packed red blood cells (PRBCs).
Which IV solution is the only one compatible for administration with blood
products?
A. Lactated Ringer’s
B. 0.9% Sodium Chloride (Normal Saline)
C. 5% Dextrose in Water (D5W)
D. 0.45% Sodium Chloride (Half Normal Saline)
Answer: B
Rationale: 0.9% Sodium Chloride is the only compatible solution; other solutions like D5W
cause hemolysis, and Lactated Ringer’s can cause clotting due to the calcium content.
2026 |WCU
1. A nurse is reviewing the arterial blood gas (ABG) results for a client with
prolonged vomiting: pH 7.48, PaCO2 44 mmHg, and HCO3 30 mEq/L. Which acid-
base imbalance does the nurse identify?
A. Metabolic Alkalosis
B. Metabolic Acidosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: A
Rationale: Metabolic alkalosis is characterized by an elevated pH (>7.45) and an elevated
bicarbonate level (>26 mEq/L), often caused by the loss of gastric acid through vomiting or
suctioning.
2. During the preoperative assessment, a client reports a family history of a high
fever and muscle rigidity during surgery. Which medication should the nurse
ensure is available on the surgical floor?
A. Atropine sulfate
B. Naloxone hydrochloride
C. Dantrolene sodium
D. Epinephrine
Answer: C
Rationale: Malignant hyperthermia is a life-threatening genetic condition triggered by
volatile anesthetics or succinylcholine; Dantrolene is the primary treatment to reverse
muscle rigidity and hypermetabolism.
,3. A nurse is caring for a postoperative client who has developed an evisceration
of the abdominal wound. What is the priority nursing action?
A. Cover the wound with sterile gauze soaked in sterile normal saline.
B. Place the client in a high-Fowler’s position.
C. Attempt to reinsert the protruding organs gently.
D. Apply a tight abdominal binder to prevent further protrusion.
Answer: A
Rationale: An evisceration is a medical emergency. The nurse must cover the exposed
viscera with sterile, saline-moistened dressings to prevent drying and infection while
notifying the surgeon immediately.
4. A client presents with a serum potassium level of 6.2 mEq/L. Which
electrocardiogram (ECG) change should the nurse expect to observe?
A. Prominent U waves
B. ST-segment depression
C. Inverted T waves
D. Tall, peaked T waves
Answer: D
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests on an ECG as tall,
peaked T waves, prolonged PR intervals, and potentially widened QRS complexes.
5. Which assessment finding is most indicative of hypocalcemia in a client
following a thyroidectomy?
A. Negative Babinski reflex
B. Positive Chvostek’s sign
C. Hyporeflexia of deep tendons
D. Flaccid paralysis
Answer: B
, Rationale: Hypocalcemia can occur after thyroid surgery if the parathyroid glands are
accidentally removed. Chvostek’s sign (facial twitching when the facial nerve is tapped)
indicates neuromuscular irritability.
6. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. The nurse understands that higher
concentrations of oxygen should be avoided because:
A. High oxygen levels can cause pulmonary edema.
B. High oxygen levels increase the risk of spontaneous pneumothorax.
C. The client’s respiratory drive is triggered by low oxygen levels.
D. Oxygen is flammable and increases the risk of fire.
Answer: C
Rationale: In some clients with chronic hypercapnia (COPD), the stimulus to breathe shifts
from high CO2 levels to low O2 levels. Providing too much oxygen can suppress this
‘hypoxic drive’ and lead to respiratory arrest.
7. A nurse is preparing to administer a unit of packed red blood cells (PRBCs).
Which IV solution is the only one compatible for administration with blood
products?
A. Lactated Ringer’s
B. 0.9% Sodium Chloride (Normal Saline)
C. 5% Dextrose in Water (D5W)
D. 0.45% Sodium Chloride (Half Normal Saline)
Answer: B
Rationale: 0.9% Sodium Chloride is the only compatible solution; other solutions like D5W
cause hemolysis, and Lactated Ringer’s can cause clotting due to the calcium content.
