NURS 121L-A Medical-Surgical Nursing Practicum Final Exam (Week
15/16) 2026 |WCU
1. A patient with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation with PEEP. The nurse notes a sudden drop in blood pressure and
absent breath sounds on the right side. What is the priority action?
A. Prepare for chest tube insertion
B. Perform endotracheal suctioning
C. Increase the PEEP setting
D. Administer a bolus of IV fluids
Answer: A
Rationale: Sudden hypotension and absent breath sounds in a patient on PEEP suggest a
tension pneumothorax, which is a complication of high airway pressures. Immediate
decompression via chest tube or needle is required.
2. A client with chronic kidney disease (CKD) has a serum potassium level of 6.8
mEq/L. Which electrocardiogram (ECG) change should the nurse expect to
observe first?
A. ST-segment depression
B. Prominent U waves
C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Rationale: Tall, peaked T waves are the earliest ECG sign of hyperkalemia. As levels rise,
the PR interval prolongs and the QRS widens.
,3. The nurse is caring for a patient post-thyroidectomy. The patient reports
numbness and tingling in the fingers and around the mouth. Which medication
should the nurse have readily available?
A. Levothyroxine sodium
B. Potassium chloride
C. Calcium gluconate
D. Sodium nitroprusside
Answer: C
Rationale: Numbness and tingling (paresthesia) after thyroid surgery indicate
hypocalcemia, likely due to accidental parathyroid damage. IV calcium gluconate is the
treatment.
4. A patient is admitted with Diabetic Ketoacidosis (DKA). The initial laboratory
results show blood glucose 550 mg/dL and serum potassium 3.4 mEq/L. Which
order should the nurse implement first?
A. Initiate IV insulin infusion at 0.1 units/kg/hr
B. Administer potassium chloride IV piggyback
C. Apply a cardiac monitor
D. Administer 1 liter of 0.9% Normal Saline bolus
Answer: D
Rationale: The priority in DKA is fluid resuscitation to restore perfusion. While potassium
is low and insulin is needed, initial volume expansion with Normal Saline takes precedence.
, 5. Which clinical manifestation would the nurse expect to find in a patient
diagnosed with right-sided heart failure?
A. Crackles upon auscultation
B. Peripheral edema and jugular venous distention
C. Orthopnea
D. Frothy, pink-tinged sputum
Answer: B
Rationale: Right-sided heart failure causes systemic congestion, leading to peripheral
edema, hepatomegaly, and JVD. Left-sided failure causes pulmonary symptoms like
crackles and orthopnea.
6. A patient with cirrhosis and esophageal varices is prescribed lactulose. What
is the primary therapeutic goal of this medication for this patient?
A. To reduce portal hypertension
B. To promote the excretion of ammonia in the stool
C. To prevent gastrointestinal bleeding
D. To increase serum protein levels
Answer: B
Rationale: Lactulose acidifies the bowel contents, trapping ammonia and causing it to be
excreted in the stool, thereby reducing the risk of hepatic encephalopathy.
7. During a transfusion of packed red blood cells, the patient complains of low
back pain and develops a fever. What is the nurse’s first action?
A. Slow the rate of the transfusion
B. Notify the healthcare provider
C. Stop the transfusion immediately
D. Administer diphenhydramine
Answer: C
15/16) 2026 |WCU
1. A patient with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation with PEEP. The nurse notes a sudden drop in blood pressure and
absent breath sounds on the right side. What is the priority action?
A. Prepare for chest tube insertion
B. Perform endotracheal suctioning
C. Increase the PEEP setting
D. Administer a bolus of IV fluids
Answer: A
Rationale: Sudden hypotension and absent breath sounds in a patient on PEEP suggest a
tension pneumothorax, which is a complication of high airway pressures. Immediate
decompression via chest tube or needle is required.
2. A client with chronic kidney disease (CKD) has a serum potassium level of 6.8
mEq/L. Which electrocardiogram (ECG) change should the nurse expect to
observe first?
A. ST-segment depression
B. Prominent U waves
C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Rationale: Tall, peaked T waves are the earliest ECG sign of hyperkalemia. As levels rise,
the PR interval prolongs and the QRS widens.
,3. The nurse is caring for a patient post-thyroidectomy. The patient reports
numbness and tingling in the fingers and around the mouth. Which medication
should the nurse have readily available?
A. Levothyroxine sodium
B. Potassium chloride
C. Calcium gluconate
D. Sodium nitroprusside
Answer: C
Rationale: Numbness and tingling (paresthesia) after thyroid surgery indicate
hypocalcemia, likely due to accidental parathyroid damage. IV calcium gluconate is the
treatment.
4. A patient is admitted with Diabetic Ketoacidosis (DKA). The initial laboratory
results show blood glucose 550 mg/dL and serum potassium 3.4 mEq/L. Which
order should the nurse implement first?
A. Initiate IV insulin infusion at 0.1 units/kg/hr
B. Administer potassium chloride IV piggyback
C. Apply a cardiac monitor
D. Administer 1 liter of 0.9% Normal Saline bolus
Answer: D
Rationale: The priority in DKA is fluid resuscitation to restore perfusion. While potassium
is low and insulin is needed, initial volume expansion with Normal Saline takes precedence.
, 5. Which clinical manifestation would the nurse expect to find in a patient
diagnosed with right-sided heart failure?
A. Crackles upon auscultation
B. Peripheral edema and jugular venous distention
C. Orthopnea
D. Frothy, pink-tinged sputum
Answer: B
Rationale: Right-sided heart failure causes systemic congestion, leading to peripheral
edema, hepatomegaly, and JVD. Left-sided failure causes pulmonary symptoms like
crackles and orthopnea.
6. A patient with cirrhosis and esophageal varices is prescribed lactulose. What
is the primary therapeutic goal of this medication for this patient?
A. To reduce portal hypertension
B. To promote the excretion of ammonia in the stool
C. To prevent gastrointestinal bleeding
D. To increase serum protein levels
Answer: B
Rationale: Lactulose acidifies the bowel contents, trapping ammonia and causing it to be
excreted in the stool, thereby reducing the risk of hepatic encephalopathy.
7. During a transfusion of packed red blood cells, the patient complains of low
back pain and develops a fever. What is the nurse’s first action?
A. Slow the rate of the transfusion
B. Notify the healthcare provider
C. Stop the transfusion immediately
D. Administer diphenhydramine
Answer: C
