NURS 121L-A Medical-Surgical Nursing Practicum - Exam 2
Comprehensive Prep 2026 |WCU
1. A nurse is caring for a patient who is 24 hours post-abdominal surgery. The
patient reports a ‘popping’ sensation and the nurse observes a loop of bowel
protruding through the incision. Which action should the nurse take first?
A. Attempt to push the bowel back into the abdominal cavity gently.
B. Place the patient in a High-Fowler’s position to decrease abdominal pressure.
C. Notify the surgeon immediately and prepare the patient for emergency surgery.
D. Cover the protruding organ with sterile dressings soaked in sterile normal saline.
Answer: D
Rationale: This is an evisceration. The immediate nursing priority is to protect the organ
from drying out and infection by covering it with sterile, saline-soaked dressings. Then, the
surgeon should be notified.
2. A patient’s arterial blood gas (ABG) results are: pH 7.31, PaCO2 52 mmHg, and
HCO3 26 mEq/L. How should the nurse interpret these findings?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: A
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), indicating a
respiratory cause. The HCO3 is within normal range, suggesting no compensation yet.
,3. A patient with a history of chronic kidney disease presents with a potassium
level of 6.2 mEq/L. Which EKG change is the nurse most likely to observe?
A. Prominent U waves
B. Tall, peaked T waves
C. ST-segment depression
D. Inverted P waves
Answer: B
Rationale: Hyperkalemia (K+ > 5.0) typically causes tall, peaked T waves, widened QRS
complexes, and eventually cardiac arrest if not treated.
4. Which of the following assessments is the most sensitive indicator of a
change in a patient’s fluid volume status?
A. Checking for pitting edema in the lower extremities
B. Measuring intake and output every 8 hours
C. Daily weights at the same time every morning
D. Assessing skin turgor on the back of the hand
Answer: C
Rationale: Daily weights are the most accurate and sensitive method to monitor fluid
balance. 1 kg of weight gain/loss is roughly equal to 1 liter of fluid.
5. A patient is receiving Total Parenteral Nutrition (TPN) through a central line.
The TPN bag is empty, and the next bag is not yet available from the pharmacy.
What should the nurse hang in the meantime?
A. 0.9% Normal Saline
B. Lactated Ringer’s solution
C. 5% Dextrose in 0.45% Normal Saline
D. 10% Dextrose in water (D10W)
Answer: D
, Rationale: To prevent rebound hypoglycemia when TPN is abruptly stopped or delayed,
D10W should be infused at the same rate as the TPN.
6. The nurse is monitoring a patient post-thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which PRN medication should the
nurse anticipate administering?
A. Potassium chloride
B. Sodium bicarbonate
C. Magnesium sulfate
D. Calcium gluconate
Answer: D
Rationale: Tingling (paresthesia) after a thyroidectomy suggests accidental removal or
injury to the parathyroid glands, leading to hypocalcemia. Calcium gluconate is the
treatment.
7. A patient with Type 1 Diabetes Mellitus is found unconscious and clammy.
The fingerstick glucose is 42 mg/dL. The patient has no IV access. What is the
priority action?
A. Recheck the blood glucose in 15 minutes.
B. Start a peripheral IV and give D50W.
C. Administer 15g of simple carbohydrates orally.
D. Administer 1 mg of Glucagon IM or SQ.
Answer: D
Rationale: In an unconscious patient with hypoglycemia and no IV access, Glucagon IM/SQ
is the fastest way to raise blood glucose.
Comprehensive Prep 2026 |WCU
1. A nurse is caring for a patient who is 24 hours post-abdominal surgery. The
patient reports a ‘popping’ sensation and the nurse observes a loop of bowel
protruding through the incision. Which action should the nurse take first?
A. Attempt to push the bowel back into the abdominal cavity gently.
B. Place the patient in a High-Fowler’s position to decrease abdominal pressure.
C. Notify the surgeon immediately and prepare the patient for emergency surgery.
D. Cover the protruding organ with sterile dressings soaked in sterile normal saline.
Answer: D
Rationale: This is an evisceration. The immediate nursing priority is to protect the organ
from drying out and infection by covering it with sterile, saline-soaked dressings. Then, the
surgeon should be notified.
2. A patient’s arterial blood gas (ABG) results are: pH 7.31, PaCO2 52 mmHg, and
HCO3 26 mEq/L. How should the nurse interpret these findings?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: A
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45), indicating a
respiratory cause. The HCO3 is within normal range, suggesting no compensation yet.
,3. A patient with a history of chronic kidney disease presents with a potassium
level of 6.2 mEq/L. Which EKG change is the nurse most likely to observe?
A. Prominent U waves
B. Tall, peaked T waves
C. ST-segment depression
D. Inverted P waves
Answer: B
Rationale: Hyperkalemia (K+ > 5.0) typically causes tall, peaked T waves, widened QRS
complexes, and eventually cardiac arrest if not treated.
4. Which of the following assessments is the most sensitive indicator of a
change in a patient’s fluid volume status?
A. Checking for pitting edema in the lower extremities
B. Measuring intake and output every 8 hours
C. Daily weights at the same time every morning
D. Assessing skin turgor on the back of the hand
Answer: C
Rationale: Daily weights are the most accurate and sensitive method to monitor fluid
balance. 1 kg of weight gain/loss is roughly equal to 1 liter of fluid.
5. A patient is receiving Total Parenteral Nutrition (TPN) through a central line.
The TPN bag is empty, and the next bag is not yet available from the pharmacy.
What should the nurse hang in the meantime?
A. 0.9% Normal Saline
B. Lactated Ringer’s solution
C. 5% Dextrose in 0.45% Normal Saline
D. 10% Dextrose in water (D10W)
Answer: D
, Rationale: To prevent rebound hypoglycemia when TPN is abruptly stopped or delayed,
D10W should be infused at the same rate as the TPN.
6. The nurse is monitoring a patient post-thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which PRN medication should the
nurse anticipate administering?
A. Potassium chloride
B. Sodium bicarbonate
C. Magnesium sulfate
D. Calcium gluconate
Answer: D
Rationale: Tingling (paresthesia) after a thyroidectomy suggests accidental removal or
injury to the parathyroid glands, leading to hypocalcemia. Calcium gluconate is the
treatment.
7. A patient with Type 1 Diabetes Mellitus is found unconscious and clammy.
The fingerstick glucose is 42 mg/dL. The patient has no IV access. What is the
priority action?
A. Recheck the blood glucose in 15 minutes.
B. Start a peripheral IV and give D50W.
C. Administer 15g of simple carbohydrates orally.
D. Administer 1 mg of Glucagon IM or SQ.
Answer: D
Rationale: In an unconscious patient with hypoglycemia and no IV access, Glucagon IM/SQ
is the fastest way to raise blood glucose.
