NURS 121L-A | Medical-Surgical Nursing Practicum | Module Exam 4
(Week 12) 2026 |WCU
1. A patient is admitted with suspected Acute Respiratory Distress Syndrome
(ARDS). Which clinical finding is most indicative of the ‘exudative phase’ of
ARDS?
A. Increased lung compliance and decreased work of breathing
B. Refractory hypoxemia despite high levels of supplemental oxygen
C. Respiratory alkalosis caused by hypoventilation
D. Presence of clear, thin secretions upon suctioning
Answer: B
Rationale: Refractory hypoxemia, where the PaO2 does not increase significantly with
increased FiO2, is a hallmark sign of the exudative phase of ARDS due to intrapulmonary
shunting.
2. When monitoring a patient with a Swan-Ganz catheter, the nurse notes a
Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. What is the most likely
interpretation?
A. The patient is experiencing hypovolemic shock
B. The patient has normal left ventricular end-diastolic pressure
C. The patient is showing signs of left-sided heart failure or fluid overload
D. The patient has pulmonary hypertension without left heart involvement
Answer: C
Rationale: A normal PAWP is 4-12 mmHg. An elevated PAWP (22 mmHg) indicates
increased pressure in the left atrium, which is characteristic of left-sided heart failure or
hypervolemia.
,3. A patient in the ICU is on mechanical ventilation with Positive End-Expiratory
Pressure (PEEP) set at 15 cm H2O. Which complication should the nurse
prioritize monitoring?
A. Metabolic alkalosis
B. Pneumothorax due to barotrauma
C. Increased cardiac output
D. Reduced dead space ventilation
Answer: B
Rationale: High levels of PEEP increase the risk of barotrauma, which can lead to
pneumothorax or subcutaneous emphysema due to the high pressure in the alveoli.
4. A patient with Chronic Kidney Disease (CKD) presents with a serum potassium
level of 7.2 mEq/L and tall peaked T waves on the ECG. Which medication
should the nurse expect to administer first to stabilize the cardiac membrane?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Sodium bicarbonate
C. Regular insulin and 50% dextrose
D. Calcium gluconate
Answer: D
Rationale: While insulin and Kayexalate help lower potassium, Calcium gluconate is
administered first in severe hyperkalemia to stabilize the myocardial cell membrane and
prevent lethal dysrhythmias.
, 5. During the first 24 hours of a burn injury, what is the primary goal of fluid
resuscitation using the Parkland formula?
A. To restore electrolyte balance by giving large amounts of hypotonic saline
B. To prevent acute tubular necrosis by maintaining urine output at 0.5-1 mL/kg/hr
C. To decrease capillary permeability and prevent protein loss
D. To maintain a central venous pressure (CVP) of at least 15 mmHg
Answer: B
Rationale: The primary goal of fluid resuscitation in burns is to maintain organ perfusion.
Adequate renal perfusion is reflected by a urine output of 0.5 to 1 mL/kg/hr in adults.
6. A nurse is caring for a patient with a traumatic brain injury. The patient’s
blood pressure is 180/60 mmHg, heart rate is 45 bpm, and respirations are
irregular. What does this ‘Cushing's Triad’ indicate?
A. Increased intracranial pressure with potential brain herniation
B. Resolved intracranial pressure
C. Impending hypovolemic shock
D. Typical response to pain medication
Answer: A
Rationale: Cushing’s Triad (systolic hypertension with widening pulse pressure,
bradycardia, and irregular respirations) is a late sign of increased ICP indicating brainstem
compression.
7. A patient with a history of heart failure is prescribed Digoxin. Which
electrolyte imbalance increases the risk of Digoxin toxicity?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypercalcemia
Answer: A
(Week 12) 2026 |WCU
1. A patient is admitted with suspected Acute Respiratory Distress Syndrome
(ARDS). Which clinical finding is most indicative of the ‘exudative phase’ of
ARDS?
A. Increased lung compliance and decreased work of breathing
B. Refractory hypoxemia despite high levels of supplemental oxygen
C. Respiratory alkalosis caused by hypoventilation
D. Presence of clear, thin secretions upon suctioning
Answer: B
Rationale: Refractory hypoxemia, where the PaO2 does not increase significantly with
increased FiO2, is a hallmark sign of the exudative phase of ARDS due to intrapulmonary
shunting.
2. When monitoring a patient with a Swan-Ganz catheter, the nurse notes a
Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. What is the most likely
interpretation?
A. The patient is experiencing hypovolemic shock
B. The patient has normal left ventricular end-diastolic pressure
C. The patient is showing signs of left-sided heart failure or fluid overload
D. The patient has pulmonary hypertension without left heart involvement
Answer: C
Rationale: A normal PAWP is 4-12 mmHg. An elevated PAWP (22 mmHg) indicates
increased pressure in the left atrium, which is characteristic of left-sided heart failure or
hypervolemia.
,3. A patient in the ICU is on mechanical ventilation with Positive End-Expiratory
Pressure (PEEP) set at 15 cm H2O. Which complication should the nurse
prioritize monitoring?
A. Metabolic alkalosis
B. Pneumothorax due to barotrauma
C. Increased cardiac output
D. Reduced dead space ventilation
Answer: B
Rationale: High levels of PEEP increase the risk of barotrauma, which can lead to
pneumothorax or subcutaneous emphysema due to the high pressure in the alveoli.
4. A patient with Chronic Kidney Disease (CKD) presents with a serum potassium
level of 7.2 mEq/L and tall peaked T waves on the ECG. Which medication
should the nurse expect to administer first to stabilize the cardiac membrane?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Sodium bicarbonate
C. Regular insulin and 50% dextrose
D. Calcium gluconate
Answer: D
Rationale: While insulin and Kayexalate help lower potassium, Calcium gluconate is
administered first in severe hyperkalemia to stabilize the myocardial cell membrane and
prevent lethal dysrhythmias.
, 5. During the first 24 hours of a burn injury, what is the primary goal of fluid
resuscitation using the Parkland formula?
A. To restore electrolyte balance by giving large amounts of hypotonic saline
B. To prevent acute tubular necrosis by maintaining urine output at 0.5-1 mL/kg/hr
C. To decrease capillary permeability and prevent protein loss
D. To maintain a central venous pressure (CVP) of at least 15 mmHg
Answer: B
Rationale: The primary goal of fluid resuscitation in burns is to maintain organ perfusion.
Adequate renal perfusion is reflected by a urine output of 0.5 to 1 mL/kg/hr in adults.
6. A nurse is caring for a patient with a traumatic brain injury. The patient’s
blood pressure is 180/60 mmHg, heart rate is 45 bpm, and respirations are
irregular. What does this ‘Cushing's Triad’ indicate?
A. Increased intracranial pressure with potential brain herniation
B. Resolved intracranial pressure
C. Impending hypovolemic shock
D. Typical response to pain medication
Answer: A
Rationale: Cushing’s Triad (systolic hypertension with widening pulse pressure,
bradycardia, and irregular respirations) is a late sign of increased ICP indicating brainstem
compression.
7. A patient with a history of heart failure is prescribed Digoxin. Which
electrolyte imbalance increases the risk of Digoxin toxicity?
A. Hypokalemia
B. Hyponatremia
C. Hyperkalemia
D. Hypercalcemia
Answer: A
