NURS 121L-A Medical-Surgical Nursing Practicum - Week 3
Assessment (2026 Update) WCU
1. A nurse is caring for a client with a potassium level of 6.2 mEq/L. Which EKG
change is the nurse most likely to observe?
A. Prominent U-waves
B. Shortened PR interval
C. Tall, peaked T-waves
D. ST-segment depression
Answer: C
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests as tall, peaked T-
waves, widened QRS complexes, and prolonged PR intervals on an EKG.
2. Which arterial blood gas (ABG) result indicates partially compensated
respiratory acidosis?
A. pH 7.32, PaCO2 35, HCO3 20
B. pH 7.28, PaCO2 55, HCO3 30
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.35, PaCO2 45, HCO3 24
Answer: B
Rationale: Partial compensation occurs when the pH is still outside normal limits, but the
opposite system (bicarbonate) has moved in the opposite direction to attempt balance.
,3. A client is diagnosed with hypocalcemia. Which clinical manifestation should
the nurse anticipate during the assessment?
A. Positive Chvostek’s sign
B. Hyporeflexia
C. Constipation
D. Polyuria
Answer: A
Rationale: Hypocalcemia causes increased neuromuscular excitability, leading to a
positive Chvostek’s sign (facial twitching) and Trousseau’s sign.
4. During the intraoperative period, a client develops muscle rigidity and a rapid
rise in body temperature. Which medication is the priority for administration?
A. Furosemide
B. Sodium Bicarbonate
C. Dantrolene Sodium
D. Atropine Sulfate
Answer: C
Rationale: Muscle rigidity and hyperthermia are signs of Malignant Hyperthermia, a
surgical emergency treated specifically with Dantrolene.
5. A nurse is assessing a client with fluid volume excess. Which finding is most
consistent with this diagnosis?
A. Decreased central venous pressure
B. Flat neck veins when supine
C. Jugular venous distension
D. Tachycardia with thready pulse
Answer: C
Rationale: Fluid volume excess (hypervolemia) leads to increased venous pressure,
manifesting as jugular venous distension (JVD) and bounding pulses.
, 6. A client with chronic obstructive pulmonary disease (COPD) is at highest risk
for which acid-base imbalance?
A. Metabolic Alkalosis
B. Metabolic Acidosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Rationale: COPD causes chronic CO2 retention due to alveolar hypoventilation, leading to
respiratory acidosis.
7. The nurse is reviewing the labs of a client with Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). Which sodium level is most likely?
A. 155 mEq/L
B. 138 mEq/L
C. 148 mEq/L
D. 128 mEq/L
Answer: D
Rationale: SIADH causes excessive water retention, leading to dilutional hyponatremia
(sodium < 135 mEq/L).
8. Which IV solution is classified as hypotonic?
A. 0.9% Normal Saline
B. Lactated Ringer’s
C. 0.45% Sodium Chloride
D. 5% Dextrose in 0.9% NS
Answer: C
Rationale: 0.45% Sodium Chloride (half-normal saline) has a lower osmolarity than
plasma, making it a hypotonic solution.
Assessment (2026 Update) WCU
1. A nurse is caring for a client with a potassium level of 6.2 mEq/L. Which EKG
change is the nurse most likely to observe?
A. Prominent U-waves
B. Shortened PR interval
C. Tall, peaked T-waves
D. ST-segment depression
Answer: C
Rationale: Hyperkalemia (potassium > 5.0 mEq/L) typically manifests as tall, peaked T-
waves, widened QRS complexes, and prolonged PR intervals on an EKG.
2. Which arterial blood gas (ABG) result indicates partially compensated
respiratory acidosis?
A. pH 7.32, PaCO2 35, HCO3 20
B. pH 7.28, PaCO2 55, HCO3 30
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.35, PaCO2 45, HCO3 24
Answer: B
Rationale: Partial compensation occurs when the pH is still outside normal limits, but the
opposite system (bicarbonate) has moved in the opposite direction to attempt balance.
,3. A client is diagnosed with hypocalcemia. Which clinical manifestation should
the nurse anticipate during the assessment?
A. Positive Chvostek’s sign
B. Hyporeflexia
C. Constipation
D. Polyuria
Answer: A
Rationale: Hypocalcemia causes increased neuromuscular excitability, leading to a
positive Chvostek’s sign (facial twitching) and Trousseau’s sign.
4. During the intraoperative period, a client develops muscle rigidity and a rapid
rise in body temperature. Which medication is the priority for administration?
A. Furosemide
B. Sodium Bicarbonate
C. Dantrolene Sodium
D. Atropine Sulfate
Answer: C
Rationale: Muscle rigidity and hyperthermia are signs of Malignant Hyperthermia, a
surgical emergency treated specifically with Dantrolene.
5. A nurse is assessing a client with fluid volume excess. Which finding is most
consistent with this diagnosis?
A. Decreased central venous pressure
B. Flat neck veins when supine
C. Jugular venous distension
D. Tachycardia with thready pulse
Answer: C
Rationale: Fluid volume excess (hypervolemia) leads to increased venous pressure,
manifesting as jugular venous distension (JVD) and bounding pulses.
, 6. A client with chronic obstructive pulmonary disease (COPD) is at highest risk
for which acid-base imbalance?
A. Metabolic Alkalosis
B. Metabolic Acidosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Rationale: COPD causes chronic CO2 retention due to alveolar hypoventilation, leading to
respiratory acidosis.
7. The nurse is reviewing the labs of a client with Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). Which sodium level is most likely?
A. 155 mEq/L
B. 138 mEq/L
C. 148 mEq/L
D. 128 mEq/L
Answer: D
Rationale: SIADH causes excessive water retention, leading to dilutional hyponatremia
(sodium < 135 mEq/L).
8. Which IV solution is classified as hypotonic?
A. 0.9% Normal Saline
B. Lactated Ringer’s
C. 0.45% Sodium Chloride
D. 5% Dextrose in 0.9% NS
Answer: C
Rationale: 0.45% Sodium Chloride (half-normal saline) has a lower osmolarity than
plasma, making it a hypotonic solution.
