NURS 120 | Introduction to Medical-Surgical Nursing | Module Exam 4
(Week 12) Practice Test 2026 |WCU
1. A patient with Type 1 Diabetes Mellitus presents with Kussmaul respirations,
fruity breath, and a blood glucose of 450 mg/dL. Which acid-base imbalance
does the nurse anticipate?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
Answer: D
Rationale: Diabetic Ketoacidosis (DKA) leads to an accumulation of ketones, which are
acidic, resulting in metabolic acidosis. Kussmaul respirations are a compensatory
mechanism to blow off CO2.
2. A client is 12 hours post-thyroidectomy. The nurse notes the client has
developed laryngeal stridor and a positive Chvostek’s sign. What is the priority
nursing action?
A. Check the surgical dressing for hemorrhage
B. Administer intravenous Calcium Gluconate
C. Place the client in a high-Fowler’s position
D. Notify the rapid response team and prepare for intubation
Answer: B
Rationale: A positive Chvostek’s sign and stridor indicate hypocalcemia, a common
complication if the parathyroid glands are accidentally damaged or removed. IV Calcium
Gluconate is the emergency treatment.
,3. The nurse is providing discharge teaching to a client with Addison’s disease.
Which instruction is most important regarding medication management during
periods of high stress?
A. Decrease the dose of prednisone to prevent Cushingoid symptoms
B. Switch to an injectable form of insulin temporarily
C. Skip one dose if nausea occurs to avoid vomiting
D. Increase the dose of glucocorticoids as directed by the provider
Answer: D
Rationale: Clients with adrenal insufficiency (Addison’s) cannot produce extra cortisol
during stress. They must increase their glucocorticoid dose (‘stress dosing’) to prevent
Addisonian crisis.
4. A nurse is caring for a client with a full-thickness burn covering 40% of their
body. Which assessment finding indicates effective fluid resuscitation during the
emergent phase?
A. A heart rate of 120 beats per minute
B. Urine output of 0.5 to 1.0 mL/kg/hr
C. Weight gain of 2 kg in 24 hours
D. A decrease in the hematocrit level
Answer: B
Rationale: Urine output is the most reliable indicator of organ perfusion and adequate
fluid resuscitation in burn patients. The target is typically 0.5-1 mL/kg/hr (or 30-50
mL/hr).
, 5. A client diagnosed with SIADH has a serum sodium level of 118 mEq/L. Which
nursing intervention is a priority for this client?
A. Implement seizure precautions
B. Administer 0.45% normal saline IV
C. Encourage increased oral fluid intake
D. Place the client in the Trendelenburg position
Answer: A
Rationale: Severe hyponatremia (below 120 mEq/L) puts the client at high risk for
cerebral edema, seizures, and coma. Seizure precautions are a safety priority.
6. When teaching a client about the administration of regular insulin and NPH
insulin in the same syringe, which step is correct?
A. Draw up the NPH insulin first, followed by the regular insulin
B. Shake the NPH vial vigorously before drawing it up
C. Use two separate syringes to prevent contamination
D. Inject air into the NPH vial first, then air into the regular vial
Answer: D
Rationale: The correct sequence is: inject air into NPH (cloudy), inject air into Regular
(clear), draw up Regular (clear), then draw up NPH (cloudy). Think ‘Clear before Cloudy’.
7. A client with Hyperosmolar Hyperglycemic State (HHS) is being treated in the
ICU. Which finding distinguishes HHS from Diabetic Ketoacidosis (DKA)?
A. Decreased serum osmolality
B. Presence of ketones in the urine
C. Arterial pH of 7.25
D. Blood glucose level > 600 mg/dL
Answer: D
Rationale: HHS typically presents with much higher blood glucose levels (>600 mg/dL)
and lacks significant ketosis and acidosis, which are hallmark signs of DKA.
(Week 12) Practice Test 2026 |WCU
1. A patient with Type 1 Diabetes Mellitus presents with Kussmaul respirations,
fruity breath, and a blood glucose of 450 mg/dL. Which acid-base imbalance
does the nurse anticipate?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
Answer: D
Rationale: Diabetic Ketoacidosis (DKA) leads to an accumulation of ketones, which are
acidic, resulting in metabolic acidosis. Kussmaul respirations are a compensatory
mechanism to blow off CO2.
2. A client is 12 hours post-thyroidectomy. The nurse notes the client has
developed laryngeal stridor and a positive Chvostek’s sign. What is the priority
nursing action?
A. Check the surgical dressing for hemorrhage
B. Administer intravenous Calcium Gluconate
C. Place the client in a high-Fowler’s position
D. Notify the rapid response team and prepare for intubation
Answer: B
Rationale: A positive Chvostek’s sign and stridor indicate hypocalcemia, a common
complication if the parathyroid glands are accidentally damaged or removed. IV Calcium
Gluconate is the emergency treatment.
,3. The nurse is providing discharge teaching to a client with Addison’s disease.
Which instruction is most important regarding medication management during
periods of high stress?
A. Decrease the dose of prednisone to prevent Cushingoid symptoms
B. Switch to an injectable form of insulin temporarily
C. Skip one dose if nausea occurs to avoid vomiting
D. Increase the dose of glucocorticoids as directed by the provider
Answer: D
Rationale: Clients with adrenal insufficiency (Addison’s) cannot produce extra cortisol
during stress. They must increase their glucocorticoid dose (‘stress dosing’) to prevent
Addisonian crisis.
4. A nurse is caring for a client with a full-thickness burn covering 40% of their
body. Which assessment finding indicates effective fluid resuscitation during the
emergent phase?
A. A heart rate of 120 beats per minute
B. Urine output of 0.5 to 1.0 mL/kg/hr
C. Weight gain of 2 kg in 24 hours
D. A decrease in the hematocrit level
Answer: B
Rationale: Urine output is the most reliable indicator of organ perfusion and adequate
fluid resuscitation in burn patients. The target is typically 0.5-1 mL/kg/hr (or 30-50
mL/hr).
, 5. A client diagnosed with SIADH has a serum sodium level of 118 mEq/L. Which
nursing intervention is a priority for this client?
A. Implement seizure precautions
B. Administer 0.45% normal saline IV
C. Encourage increased oral fluid intake
D. Place the client in the Trendelenburg position
Answer: A
Rationale: Severe hyponatremia (below 120 mEq/L) puts the client at high risk for
cerebral edema, seizures, and coma. Seizure precautions are a safety priority.
6. When teaching a client about the administration of regular insulin and NPH
insulin in the same syringe, which step is correct?
A. Draw up the NPH insulin first, followed by the regular insulin
B. Shake the NPH vial vigorously before drawing it up
C. Use two separate syringes to prevent contamination
D. Inject air into the NPH vial first, then air into the regular vial
Answer: D
Rationale: The correct sequence is: inject air into NPH (cloudy), inject air into Regular
(clear), draw up Regular (clear), then draw up NPH (cloudy). Think ‘Clear before Cloudy’.
7. A client with Hyperosmolar Hyperglycemic State (HHS) is being treated in the
ICU. Which finding distinguishes HHS from Diabetic Ketoacidosis (DKA)?
A. Decreased serum osmolality
B. Presence of ketones in the urine
C. Arterial pH of 7.25
D. Blood glucose level > 600 mg/dL
Answer: D
Rationale: HHS typically presents with much higher blood glucose levels (>600 mg/dL)
and lacks significant ketosis and acidosis, which are hallmark signs of DKA.
