NURS 121L-A Medical-Surgical Nursing Practicum Module Exam 3
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 oxygen
saturation is 88% and they are increasingly lethargic. Which action should the
nurse take first?
A. Assess the patient’s respiratory rate and depth
B. Increase the oxygen flow rate to 4 L/min
C. Notify the rapid response team
D. Perform an arterial blood gas (ABG) analysis
Answer: A
Rationale: Assessment is the first step. Lethargy in a COPD patient receiving oxygen can
indicate CO2 retention (narcosis), and the nurse must assess the respiratory status before
intervening or calling for help.
2. The nurse is caring for a patient who is 24 hours post-abdominal surgery. The
patient suddenly reports sharp chest pain and shortness of breath. Which
complication should the nurse suspect first?
A. Myocardial infarction
B. Pulmonary embolism
C. Pneumothorax
D. Atelectasis
Answer: B
Rationale: Sudden onset chest pain and dyspnea in a post-operative patient are classic
signs of a pulmonary embolism, a life-threatening complication.
,3. A patient’s arterial blood gas (ABG) results are: pH 7.31, PaCO2 50 mmHg, and
HCO3 24 mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg with a normal
HCO3 indicates that the source is respiratory.
4. A patient is diagnosed with Heart Failure and is prescribed Digoxin. Which
laboratory result would most concern the nurse regarding potential Digoxin
toxicity?
A. Serum sodium of 138 mEq/L
B. Serum calcium of 9.2 mg/dL
C. Serum magnesium of 2.0 mg/dL
D. Serum potassium of 3.2 mEq/L
Answer: D
Rationale: Hypokalemia (low potassium) significantly increases the risk of Digoxin toxicity
because potassium and digoxin compete for binding sites on the sodium-potassium ATPase
pump.
, 5. The nurse is providing discharge instructions to a patient with a new
prescription for Warfarin. Which statement by the patient indicates a need for
further teaching?
A. I will use a soft-bristled toothbrush.
B. I will report any dark, tarry stools to my doctor.
C. I will increase my intake of spinach and kale to stay healthy.
D. I will use an electric razor for shaving.
Answer: C
Rationale: Warfarin is a vitamin K antagonist. Spinach and kale are high in vitamin K, and a
sudden increase in intake can decrease the effectiveness of Warfarin. Patients should
maintain a consistent intake.
6. A patient with Type 1 Diabetes Mellitus presents with a blood glucose of 600
mg/dL, fruity breath, and Kussmaul respirations. What is the priority nursing
intervention?
A. Administer IV regular insulin
B. Initiate large-bore IV access and fluid resuscitation
C. Administer subcutaneous glucagon
D. Assess the patient’s neurological status
Answer: B
Rationale: In Diabetic Ketoacidosis (DKA), the priority is fluid resuscitation to restore
circulatory volume and perfusion before or concurrent with insulin therapy.
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 oxygen
saturation is 88% and they are increasingly lethargic. Which action should the
nurse take first?
A. Assess the patient’s respiratory rate and depth
B. Increase the oxygen flow rate to 4 L/min
C. Notify the rapid response team
D. Perform an arterial blood gas (ABG) analysis
Answer: A
Rationale: Assessment is the first step. Lethargy in a COPD patient receiving oxygen can
indicate CO2 retention (narcosis), and the nurse must assess the respiratory status before
intervening or calling for help.
2. The nurse is caring for a patient who is 24 hours post-abdominal surgery. The
patient suddenly reports sharp chest pain and shortness of breath. Which
complication should the nurse suspect first?
A. Myocardial infarction
B. Pulmonary embolism
C. Pneumothorax
D. Atelectasis
Answer: B
Rationale: Sudden onset chest pain and dyspnea in a post-operative patient are classic
signs of a pulmonary embolism, a life-threatening complication.
,3. A patient’s arterial blood gas (ABG) results are: pH 7.31, PaCO2 50 mmHg, and
HCO3 24 mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg with a normal
HCO3 indicates that the source is respiratory.
4. A patient is diagnosed with Heart Failure and is prescribed Digoxin. Which
laboratory result would most concern the nurse regarding potential Digoxin
toxicity?
A. Serum sodium of 138 mEq/L
B. Serum calcium of 9.2 mg/dL
C. Serum magnesium of 2.0 mg/dL
D. Serum potassium of 3.2 mEq/L
Answer: D
Rationale: Hypokalemia (low potassium) significantly increases the risk of Digoxin toxicity
because potassium and digoxin compete for binding sites on the sodium-potassium ATPase
pump.
, 5. The nurse is providing discharge instructions to a patient with a new
prescription for Warfarin. Which statement by the patient indicates a need for
further teaching?
A. I will use a soft-bristled toothbrush.
B. I will report any dark, tarry stools to my doctor.
C. I will increase my intake of spinach and kale to stay healthy.
D. I will use an electric razor for shaving.
Answer: C
Rationale: Warfarin is a vitamin K antagonist. Spinach and kale are high in vitamin K, and a
sudden increase in intake can decrease the effectiveness of Warfarin. Patients should
maintain a consistent intake.
6. A patient with Type 1 Diabetes Mellitus presents with a blood glucose of 600
mg/dL, fruity breath, and Kussmaul respirations. What is the priority nursing
intervention?
A. Administer IV regular insulin
B. Initiate large-bore IV access and fluid resuscitation
C. Administer subcutaneous glucagon
D. Assess the patient’s neurological status
Answer: B
Rationale: In Diabetic Ketoacidosis (DKA), the priority is fluid resuscitation to restore
circulatory volume and perfusion before or concurrent with insulin therapy.
