Medical-Surgical Nursing Practicum Exam 4 2026 |WCU
1. A patient with a history of heart failure is admitted with reports of yellow-
green halos around lights and nausea. Which medication should the nurse
suspect as the cause?
A. Digoxin
B. Furosemide
C. Lisinopril
D. Spironolactone
Answer: A
Rationale: Yellow-green visual disturbances and gastrointestinal distress are classic signs
of digoxin toxicity. Therapeutic levels must be monitored (0.5-2.0 ng/mL).
2. A nurse is caring for a patient post-thyroidectomy. The patient reports
tingling in the fingers and toes. Which assessment should the nurse perform
first?
A. Check for Trousseau’s sign
B. Assess the surgical dressing for bleeding
C. Measure blood pressure
D. Monitor oxygen saturation
Answer: A
Rationale: Tingling in extremities post-thyroidectomy suggests hypocalcemia due to
accidental parathyroid damage. Checking for Trousseau’s or Chvostek’s sign identifies
tetany risk.
,3. Which laboratory value is most indicative of a patient’s risk for developing a
fat embolism after a long-bone fracture?
A. Increased white blood cell count
B. Decreased hemoglobin
C. Elevated creatinine
D. Elevated serum lipase
Answer: D
Rationale: While fat embolism is a clinical diagnosis, elevated serum lipase can be a
marker as it breaks down embolized fat. Clinical signs like petechiae and respiratory
distress are paramount.
4. A patient with SIADH is being treated for hyponatremia. Which nursing
intervention is a priority?
A. Initiating seizure precautions
B. Administering hypotonic IV fluids
C. Encouraging oral fluid intake
D. Measuring abdominal girth
Answer: A
Rationale: Severe hyponatremia in SIADH increases the risk of cerebral edema and
seizures. Safety is the priority; fluids should be restricted, not encouraged.
5. In the Parkland Formula for burn resuscitation, what percentage of the total
calculated fluid volume is administered in the first 8 hours?
A. 50%
B. 25%
C. 75%
D. 100%
Answer: A
, Rationale: The Parkland Formula (4mL x kg x %TBSA) dictates that 50% of the fluid is
given in the first 8 hours from the time of the burn injury.
6. A patient presents with a ‘curtain-like’ shadow over their field of vision. This
symptom is most characteristic of:
A. Glaucoma
B. Cataracts
C. Retinal detachment
D. Macular degeneration
Answer: C
Rationale: Retinal detachment often presents as a sudden veil or curtain across the visual
field, which is a medical emergency.
7. Which ABG result is consistent with a patient experiencing a severe asthma
attack and early respiratory failure?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.50, PaCO2 45, HCO3 32
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.32, PaCO2 52, HCO3 26
Answer: D
Rationale: Respiratory acidosis (low pH and high PaCO2) occurs as the patient fatigues
and can no longer compensate for airway obstruction.
8. A patient with Addison’s disease is admitted for an elective surgery. Why is it
critical to administer supplemental glucocorticoids?
A. To manage postoperative pain
B. To improve wound healing rates
C. To prevent acute adrenal crisis from surgical stress
D. To prevent postoperative infection
Answer: C
1. A patient with a history of heart failure is admitted with reports of yellow-
green halos around lights and nausea. Which medication should the nurse
suspect as the cause?
A. Digoxin
B. Furosemide
C. Lisinopril
D. Spironolactone
Answer: A
Rationale: Yellow-green visual disturbances and gastrointestinal distress are classic signs
of digoxin toxicity. Therapeutic levels must be monitored (0.5-2.0 ng/mL).
2. A nurse is caring for a patient post-thyroidectomy. The patient reports
tingling in the fingers and toes. Which assessment should the nurse perform
first?
A. Check for Trousseau’s sign
B. Assess the surgical dressing for bleeding
C. Measure blood pressure
D. Monitor oxygen saturation
Answer: A
Rationale: Tingling in extremities post-thyroidectomy suggests hypocalcemia due to
accidental parathyroid damage. Checking for Trousseau’s or Chvostek’s sign identifies
tetany risk.
,3. Which laboratory value is most indicative of a patient’s risk for developing a
fat embolism after a long-bone fracture?
A. Increased white blood cell count
B. Decreased hemoglobin
C. Elevated creatinine
D. Elevated serum lipase
Answer: D
Rationale: While fat embolism is a clinical diagnosis, elevated serum lipase can be a
marker as it breaks down embolized fat. Clinical signs like petechiae and respiratory
distress are paramount.
4. A patient with SIADH is being treated for hyponatremia. Which nursing
intervention is a priority?
A. Initiating seizure precautions
B. Administering hypotonic IV fluids
C. Encouraging oral fluid intake
D. Measuring abdominal girth
Answer: A
Rationale: Severe hyponatremia in SIADH increases the risk of cerebral edema and
seizures. Safety is the priority; fluids should be restricted, not encouraged.
5. In the Parkland Formula for burn resuscitation, what percentage of the total
calculated fluid volume is administered in the first 8 hours?
A. 50%
B. 25%
C. 75%
D. 100%
Answer: A
, Rationale: The Parkland Formula (4mL x kg x %TBSA) dictates that 50% of the fluid is
given in the first 8 hours from the time of the burn injury.
6. A patient presents with a ‘curtain-like’ shadow over their field of vision. This
symptom is most characteristic of:
A. Glaucoma
B. Cataracts
C. Retinal detachment
D. Macular degeneration
Answer: C
Rationale: Retinal detachment often presents as a sudden veil or curtain across the visual
field, which is a medical emergency.
7. Which ABG result is consistent with a patient experiencing a severe asthma
attack and early respiratory failure?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.50, PaCO2 45, HCO3 32
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.32, PaCO2 52, HCO3 26
Answer: D
Rationale: Respiratory acidosis (low pH and high PaCO2) occurs as the patient fatigues
and can no longer compensate for airway obstruction.
8. A patient with Addison’s disease is admitted for an elective surgery. Why is it
critical to administer supplemental glucocorticoids?
A. To manage postoperative pain
B. To improve wound healing rates
C. To prevent acute adrenal crisis from surgical stress
D. To prevent postoperative infection
Answer: C
