Medical-Surgical Nursing Practicum Exam 3 2026 |WCU
1. A nurse is caring for a patient who is 24 hours post-abdominal surgery. The
patient reports sudden shortness of breath and chest pain. What is the nurse’s
priority action?
A. Apply oxygen and elevate the head of the bed
B. Administer the prescribed PRN analgesic for pain
C. Assess the surgical site for dehiscence
D. Notify the surgeon immediately
Answer: A
Rationale: The patient’s symptoms are indicative of a pulmonary embolism, a common
post-operative complication. Elevating the head of the bed and providing oxygen are the
immediate priorities to improve oxygenation before notifying the physician.
2. A client is admitted with an exacerbation of Chronic Obstructive Pulmonary
Disease (COPD). Which arterial blood gas (ABG) result would the nurse expect to
see?
A. pH 7.48, PaCO2 32, HCO3 22
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.32, PaCO2 52, HCO3 28
D. pH 7.25, PaCO2 35, HCO3 18
Answer: C
Rationale: Patients with COPD typically exhibit respiratory acidosis (low pH, high PaCO2)
with partial or full metabolic compensation (elevated HCO3) due to chronic CO2 retention.
,3. A patient with heart failure is receiving Digoxin. Which laboratory result
would most concern the nurse regarding potential Digoxin toxicity?
A. Sodium 138 mEq/L
B. Magnesium 2.0 mEq/L
C. Potassium 3.1 mEq/L
D. Calcium 9.5 mg/dL
Answer: C
Rationale: Hypokalemia (low potassium) significantly increases the risk of Digoxin toxicity
because potassium and digoxin compete for binding sites on the sodium-potassium ATPase
pump.
4. The nurse is assessing a patient following a thyroidectomy. Which finding
requires immediate intervention?
A. Tingling in the fingers and toes
B. Serum calcium level of 9.0 mg/dL
C. Hoarseness while speaking
D. Moderate serosanguinous drainage on the dressing
Answer: A
Rationale: Tingling in the extremities (paresthesia) is an early sign of hypocalcemia, which
can occur if the parathyroid glands are accidentally damaged or removed during thyroid
surgery, leading to tetany.
5. A patient is receiving a blood transfusion and begins to experience chills,
fever, and low back pain. What is the nurse’s first action?
A. Slow the infusion rate
B. Stop the transfusion and disconnect the tubing
C. Administer diphenhydramine
D. Check the patient’s temperature
Answer: B
, Rationale: These symptoms suggest a hemolytic transfusion reaction. The nurse must
immediately stop the transfusion and disconnect the tubing at the hub to prevent further
exposure to the blood product.
6. A patient with Type 1 Diabetes is found unresponsive and diaphoretic. What
should be the nurse’s first action?
A. Check the capillary blood glucose level
B. Administer 15g of oral glucose gel
C. Administer 1mg of Glucagon IM
D. Call a Code Blue
Answer: A
Rationale: While hypoglycemia is suspected, the nurse should quickly verify the blood
glucose level to guide treatment, though if a glucometer is not immediately available,
treating for hypoglycemia in an unresponsive diabetic is prioritized. Based on nursing
protocols, checking glucose is the standard first step.
7. Which assessment finding in a patient with a chest tube connected to a
water-seal drainage system requires immediate follow-up?
A. Intermittent bubbling in the water seal chamber during coughing
B. Continuous bubbling in the water seal chamber
C. Fluctuation of the water level with respirations (tidaling)
D. 100 mL of serosanguinous drainage in the last 4 hours
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
system or the patient’s pleural space, which prevents the re-expansion of the lung.
1. A nurse is caring for a patient who is 24 hours post-abdominal surgery. The
patient reports sudden shortness of breath and chest pain. What is the nurse’s
priority action?
A. Apply oxygen and elevate the head of the bed
B. Administer the prescribed PRN analgesic for pain
C. Assess the surgical site for dehiscence
D. Notify the surgeon immediately
Answer: A
Rationale: The patient’s symptoms are indicative of a pulmonary embolism, a common
post-operative complication. Elevating the head of the bed and providing oxygen are the
immediate priorities to improve oxygenation before notifying the physician.
2. A client is admitted with an exacerbation of Chronic Obstructive Pulmonary
Disease (COPD). Which arterial blood gas (ABG) result would the nurse expect to
see?
A. pH 7.48, PaCO2 32, HCO3 22
B. pH 7.35, PaCO2 40, HCO3 24
C. pH 7.32, PaCO2 52, HCO3 28
D. pH 7.25, PaCO2 35, HCO3 18
Answer: C
Rationale: Patients with COPD typically exhibit respiratory acidosis (low pH, high PaCO2)
with partial or full metabolic compensation (elevated HCO3) due to chronic CO2 retention.
,3. A patient with heart failure is receiving Digoxin. Which laboratory result
would most concern the nurse regarding potential Digoxin toxicity?
A. Sodium 138 mEq/L
B. Magnesium 2.0 mEq/L
C. Potassium 3.1 mEq/L
D. Calcium 9.5 mg/dL
Answer: C
Rationale: Hypokalemia (low potassium) significantly increases the risk of Digoxin toxicity
because potassium and digoxin compete for binding sites on the sodium-potassium ATPase
pump.
4. The nurse is assessing a patient following a thyroidectomy. Which finding
requires immediate intervention?
A. Tingling in the fingers and toes
B. Serum calcium level of 9.0 mg/dL
C. Hoarseness while speaking
D. Moderate serosanguinous drainage on the dressing
Answer: A
Rationale: Tingling in the extremities (paresthesia) is an early sign of hypocalcemia, which
can occur if the parathyroid glands are accidentally damaged or removed during thyroid
surgery, leading to tetany.
5. A patient is receiving a blood transfusion and begins to experience chills,
fever, and low back pain. What is the nurse’s first action?
A. Slow the infusion rate
B. Stop the transfusion and disconnect the tubing
C. Administer diphenhydramine
D. Check the patient’s temperature
Answer: B
, Rationale: These symptoms suggest a hemolytic transfusion reaction. The nurse must
immediately stop the transfusion and disconnect the tubing at the hub to prevent further
exposure to the blood product.
6. A patient with Type 1 Diabetes is found unresponsive and diaphoretic. What
should be the nurse’s first action?
A. Check the capillary blood glucose level
B. Administer 15g of oral glucose gel
C. Administer 1mg of Glucagon IM
D. Call a Code Blue
Answer: A
Rationale: While hypoglycemia is suspected, the nurse should quickly verify the blood
glucose level to guide treatment, though if a glucometer is not immediately available,
treating for hypoglycemia in an unresponsive diabetic is prioritized. Based on nursing
protocols, checking glucose is the standard first step.
7. Which assessment finding in a patient with a chest tube connected to a
water-seal drainage system requires immediate follow-up?
A. Intermittent bubbling in the water seal chamber during coughing
B. Continuous bubbling in the water seal chamber
C. Fluctuation of the water level with respirations (tidaling)
D. 100 mL of serosanguinous drainage in the last 4 hours
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the
system or the patient’s pleural space, which prevents the re-expansion of the lung.
