NURS 121L-A Medical-Surgical Nursing Practicum - Week 8
Comprehensive Quiz 2026 |WCU
1. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen via a nasal cannula at 2 L/min. The nurse notes the patient’s respiratory
rate has decreased from 20 to 10 breaths/min and the patient is becoming
lethargic. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Initiate bag-mask ventilation immediately.
C. Notify the physician of potential CO2 narcosis.
D. Perform a physical assessment and check pulse oximetry.
Answer: D
Rationale: In COPD patients, high levels of oxygen can suppress the hypoxic drive, leading
to CO2 retention and lethargy. The nurse must first assess the patient’s clinical status and
oxygenation before intervening or notifying the provider.
2. Which of the following clinical manifestations would the nurse expect to find
in a patient diagnosed with right-sided heart failure?
A. Orthopnea and crackles in the lungs.
B. Paroxysmal nocturnal dyspnea.
C. Frothy, pink-tinged sputum.
D. Peripheral edema and jugular venous distention.
Answer: D
Rationale: Right-sided heart failure results in systemic venous congestion, causing
peripheral edema, JVD, and hepatomegaly. Left-sided failure causes pulmonary symptoms
like crackles and orthopnea.
,3. A nurse is caring for a patient with acute renal failure. The laboratory results
indicate a potassium level of 6.5 mEq/L. Which medication should the nurse
anticipate administering to protect the heart from dysrhythmias?
A. Sodium polystyrene sulfonate (Kayexalate).
B. Regular insulin and D50W.
C. Calcium gluconate.
D. Furosemide (Lasix).
Answer: C
Rationale: While Kayexalate and insulin/D50W help lower potassium levels, Calcium
Gluconate is administered to stabilize the myocardial cell membrane and prevent life-
threatening arrhythmias associated with hyperkalemia.
4. A patient is admitted with a suspected stroke. The nurse knows that the
‘golden window’ for administering Alteplase (tPA) is within how many hours of
the onset of symptoms?
A. 1 hour.
B. 3 to 4.5 hours.
C. 6 to 8 hours.
D. 12 hours.
Answer: B
Rationale: Fibrinolytic therapy with tPA must be initiated within 3 to 4.5 hours of ‘last
known well’ time for ischemic stroke patients to maximize benefit and minimize
hemorrhage risk.
, 5. A patient is 24 hours post-thyroidectomy. The nurse notes positive Chvostek’s
and Trousseau’s signs. Which electrolyte imbalance does the nurse suspect?
A. Hypercalcemia.
B. Hypocalcemia.
C. Hyponatremia.
D. Hypokalemia.
Answer: B
Rationale: Damage to the parathyroid glands during thyroidectomy can cause
hypocalcemia. Chvostek’s (facial twitch) and Trousseau’s (carpal spasm) signs are classic
indicators of neuromuscular irritability from low calcium.
6. When assessing a patient with a chest tube, the nurse notes continuous
bubbling in the water seal chamber. What is the most likely cause?
A. There is an air leak in the system.
B. This is a normal finding in the first 24 hours.
C. The lung has fully re-expanded.
D. The suction regulator is set too high.
Answer: A
Rationale: Intermittent bubbling is expected in a patient with a pneumothorax, but
continuous bubbling in the water seal chamber indicates an air leak either in the patient or
the drainage system.
Comprehensive Quiz 2026 |WCU
1. A patient with Chronic Obstructive Pulmonary Disease (COPD) is receiving
oxygen via a nasal cannula at 2 L/min. The nurse notes the patient’s respiratory
rate has decreased from 20 to 10 breaths/min and the patient is becoming
lethargic. Which action should the nurse take first?
A. Increase the oxygen flow rate to 4 L/min.
B. Initiate bag-mask ventilation immediately.
C. Notify the physician of potential CO2 narcosis.
D. Perform a physical assessment and check pulse oximetry.
Answer: D
Rationale: In COPD patients, high levels of oxygen can suppress the hypoxic drive, leading
to CO2 retention and lethargy. The nurse must first assess the patient’s clinical status and
oxygenation before intervening or notifying the provider.
2. Which of the following clinical manifestations would the nurse expect to find
in a patient diagnosed with right-sided heart failure?
A. Orthopnea and crackles in the lungs.
B. Paroxysmal nocturnal dyspnea.
C. Frothy, pink-tinged sputum.
D. Peripheral edema and jugular venous distention.
Answer: D
Rationale: Right-sided heart failure results in systemic venous congestion, causing
peripheral edema, JVD, and hepatomegaly. Left-sided failure causes pulmonary symptoms
like crackles and orthopnea.
,3. A nurse is caring for a patient with acute renal failure. The laboratory results
indicate a potassium level of 6.5 mEq/L. Which medication should the nurse
anticipate administering to protect the heart from dysrhythmias?
A. Sodium polystyrene sulfonate (Kayexalate).
B. Regular insulin and D50W.
C. Calcium gluconate.
D. Furosemide (Lasix).
Answer: C
Rationale: While Kayexalate and insulin/D50W help lower potassium levels, Calcium
Gluconate is administered to stabilize the myocardial cell membrane and prevent life-
threatening arrhythmias associated with hyperkalemia.
4. A patient is admitted with a suspected stroke. The nurse knows that the
‘golden window’ for administering Alteplase (tPA) is within how many hours of
the onset of symptoms?
A. 1 hour.
B. 3 to 4.5 hours.
C. 6 to 8 hours.
D. 12 hours.
Answer: B
Rationale: Fibrinolytic therapy with tPA must be initiated within 3 to 4.5 hours of ‘last
known well’ time for ischemic stroke patients to maximize benefit and minimize
hemorrhage risk.
, 5. A patient is 24 hours post-thyroidectomy. The nurse notes positive Chvostek’s
and Trousseau’s signs. Which electrolyte imbalance does the nurse suspect?
A. Hypercalcemia.
B. Hypocalcemia.
C. Hyponatremia.
D. Hypokalemia.
Answer: B
Rationale: Damage to the parathyroid glands during thyroidectomy can cause
hypocalcemia. Chvostek’s (facial twitch) and Trousseau’s (carpal spasm) signs are classic
indicators of neuromuscular irritability from low calcium.
6. When assessing a patient with a chest tube, the nurse notes continuous
bubbling in the water seal chamber. What is the most likely cause?
A. There is an air leak in the system.
B. This is a normal finding in the first 24 hours.
C. The lung has fully re-expanded.
D. The suction regulator is set too high.
Answer: A
Rationale: Intermittent bubbling is expected in a patient with a pneumothorax, but
continuous bubbling in the water seal chamber indicates an air leak either in the patient or
the drainage system.
