NURS 121L-A Medical-Surgical Nursing Practicum - Week 4
Comprehensive Quiz 2026 |WCU
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. The nurse notes the patient’s arterial blood
gas (ABG) results: pH 7.30, PaCO2 58 mmHg, and PaO2 62 mmHg. Which action
should the nurse prioritize?
A. Increase the oxygen flow rate to 6 L/min.
B. Prepare for immediate endotracheal intubation.
C. Administer a PRN dose of a sedative to reduce anxiety.
D. Monitor the patient for signs of respiratory depression.
Answer: D
Rationale: Patients with chronic hypercapnia (high PaCO2) may rely on a hypoxic drive for
respiration. Providing too much oxygen can suppress this drive, leading to respiratory
depression. The nurse must monitor closely.
2. Following a total hip arthroplasty, which clinical manifestation should the
nurse recognize as a potential indication of a fat embolism syndrome?
A. Petechiae on the chest and axilla.
B. Pain in the operative hip during movement.
C. Reduced bowel sounds in all quadrants.
D. Localized swelling of the calf.
Answer: A
Rationale: Fat embolism syndrome is a serious complication of long bone or joint
fractures/surgeries. Petechiae on the upper body and chest is a hallmark sign that
differentiates it from a pulmonary embolism.
,3. A nurse is caring for a patient in the oliguric phase of acute kidney injury
(AKI). Which laboratory finding is the most critical to report to the provider?
A. Serum sodium of 132 mEq/L.
B. Serum creatinine of 2.1 mg/dL.
C. Serum potassium of 6.2 mEq/L.
D. Blood urea nitrogen (BUN) of 30 mg/dL.
Answer: C
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) is the most life-threatening electrolyte
imbalance in AKI because it can lead to fatal cardiac arrhythmias.
4. During the administration of a blood transfusion, the patient complains of
chills, lower back pain, and nausea. What is the nurse’s immediate priority?
A. Slow the infusion rate and notify the physician.
B. Check the patient’s vital signs and continue monitoring.
C. Administer diphenhydramine as ordered.
D. Stop the transfusion and disconnect the tubing.
Answer: D
Rationale: Chills and back pain are signs of an acute hemolytic reaction. The nurse must
stop the transfusion immediately to prevent further exposure to the incompatible blood.
5. A patient is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). Which
of the following initial provider orders should the nurse perform first?
A. Infuse 0.9% Normal Saline at 1,000 mL/hr.
B. Obtain an arterial blood gas (ABG) sample.
C. Administer 10 units of regular insulin IV bolus.
D. Administer potassium chloride 20 mEq IV.
Answer: A
Rationale: In DKA, the priority is to restore circulatory volume and tissue perfusion
through rapid fluid resuscitation before addressing hyperglycemia with insulin.
, 6. The nurse is assessing a patient with right-sided heart failure. Which clinical
finding is most consistent with this diagnosis?
A. Crackles in the lung bases.
B. Dependent edema and jugular venous distention.
C. Orthopnea and paroxysmal nocturnal dyspnea.
D. Pink, frothy sputum.
Answer: B
Rationale: Right-sided heart failure leads to systemic venous congestion, causing
peripheral edema and distended neck veins. Lung findings are typically associated with
left-sided failure.
7. Which of the following is a late sign of increased intracranial pressure (ICP) in
a patient with a traumatic brain injury?
A. Restlessness and irritability.
B. Dilated pupils that are sluggishly reactive.
C. Constant, dull headache.
D. Bradypnea and widening pulse pressure.
Answer: D
Rationale: Cushing’s Triad (systolic hypertension with widening pulse pressure,
bradycardia, and irregular respirations) is a late sign of brainstem compression and high
ICP.
8. The nurse is preparing to administer Digoxin to a patient. Which assessment
finding would require the nurse to hold the medication?
A. Blood pressure of 100/60 mmHg.
B. Apical heart rate of 54 beats per minute.
C. Respiratory rate of 14 breaths per minute.
D. Potassium level of 4.8 mEq/L.
Answer: B
Comprehensive Quiz 2026 |WCU
1. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. The nurse notes the patient’s arterial blood
gas (ABG) results: pH 7.30, PaCO2 58 mmHg, and PaO2 62 mmHg. Which action
should the nurse prioritize?
A. Increase the oxygen flow rate to 6 L/min.
B. Prepare for immediate endotracheal intubation.
C. Administer a PRN dose of a sedative to reduce anxiety.
D. Monitor the patient for signs of respiratory depression.
Answer: D
Rationale: Patients with chronic hypercapnia (high PaCO2) may rely on a hypoxic drive for
respiration. Providing too much oxygen can suppress this drive, leading to respiratory
depression. The nurse must monitor closely.
2. Following a total hip arthroplasty, which clinical manifestation should the
nurse recognize as a potential indication of a fat embolism syndrome?
A. Petechiae on the chest and axilla.
B. Pain in the operative hip during movement.
C. Reduced bowel sounds in all quadrants.
D. Localized swelling of the calf.
Answer: A
Rationale: Fat embolism syndrome is a serious complication of long bone or joint
fractures/surgeries. Petechiae on the upper body and chest is a hallmark sign that
differentiates it from a pulmonary embolism.
,3. A nurse is caring for a patient in the oliguric phase of acute kidney injury
(AKI). Which laboratory finding is the most critical to report to the provider?
A. Serum sodium of 132 mEq/L.
B. Serum creatinine of 2.1 mg/dL.
C. Serum potassium of 6.2 mEq/L.
D. Blood urea nitrogen (BUN) of 30 mg/dL.
Answer: C
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) is the most life-threatening electrolyte
imbalance in AKI because it can lead to fatal cardiac arrhythmias.
4. During the administration of a blood transfusion, the patient complains of
chills, lower back pain, and nausea. What is the nurse’s immediate priority?
A. Slow the infusion rate and notify the physician.
B. Check the patient’s vital signs and continue monitoring.
C. Administer diphenhydramine as ordered.
D. Stop the transfusion and disconnect the tubing.
Answer: D
Rationale: Chills and back pain are signs of an acute hemolytic reaction. The nurse must
stop the transfusion immediately to prevent further exposure to the incompatible blood.
5. A patient is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). Which
of the following initial provider orders should the nurse perform first?
A. Infuse 0.9% Normal Saline at 1,000 mL/hr.
B. Obtain an arterial blood gas (ABG) sample.
C. Administer 10 units of regular insulin IV bolus.
D. Administer potassium chloride 20 mEq IV.
Answer: A
Rationale: In DKA, the priority is to restore circulatory volume and tissue perfusion
through rapid fluid resuscitation before addressing hyperglycemia with insulin.
, 6. The nurse is assessing a patient with right-sided heart failure. Which clinical
finding is most consistent with this diagnosis?
A. Crackles in the lung bases.
B. Dependent edema and jugular venous distention.
C. Orthopnea and paroxysmal nocturnal dyspnea.
D. Pink, frothy sputum.
Answer: B
Rationale: Right-sided heart failure leads to systemic venous congestion, causing
peripheral edema and distended neck veins. Lung findings are typically associated with
left-sided failure.
7. Which of the following is a late sign of increased intracranial pressure (ICP) in
a patient with a traumatic brain injury?
A. Restlessness and irritability.
B. Dilated pupils that are sluggishly reactive.
C. Constant, dull headache.
D. Bradypnea and widening pulse pressure.
Answer: D
Rationale: Cushing’s Triad (systolic hypertension with widening pulse pressure,
bradycardia, and irregular respirations) is a late sign of brainstem compression and high
ICP.
8. The nurse is preparing to administer Digoxin to a patient. Which assessment
finding would require the nurse to hold the medication?
A. Blood pressure of 100/60 mmHg.
B. Apical heart rate of 54 beats per minute.
C. Respiratory rate of 14 breaths per minute.
D. Potassium level of 4.8 mEq/L.
Answer: B
