NURS 120 | Introduction to Medical-Surgical Nursing | Week 10 High-
Difficulty Comprehensive Quiz 2026 |WCU
1. A patient’s arterial blood gas (ABG) results are: pH 7.26, PaCO2 54 mmHg, and
HCO3 24 mEq/L. Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45 mmHg),
which is consistent with the respiratory system causing the acidosis. The HCO3 is within
the normal range, indicating no compensation yet.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. Which finding should the nurse report
immediately?
A. Oxygen saturation of 91%
B. Productive cough with clear sputum
C. Respiratory rate of 10 breaths per minute
D. Bilateral wheezing on expiration
Answer: C
Rationale: In patients with COPD, high oxygen levels can suppress the hypoxic drive to
breathe. A respiratory rate of 10 is low and may indicate respiratory depression, requiring
immediate intervention.
,3. Which electrolyte imbalance is most likely to cause the presence of a U wave
on an electrocardiogram (ECG)?
A. Hyperkalemia
B. Hypocalcemia
C. Hypokalemia
D. Hypermagnesemia
Answer: C
Rationale: Hypokalemia is associated with the development of U waves, ST-segment
depression, and flat or inverted T waves on an ECG.
4. The nurse is caring for a post-operative patient who reports sudden chest
pain and dyspnea. The nurse notes a heart rate of 110 bpm and an oxygen
saturation of 88%. What is the priority nursing action?
A. Obtain an ECG
B. Administer morphine for pain
C. Encourage the use of an incentive spirometer
D. Apply oxygen and elevate the head of the bed
Answer: D
Rationale: These signs suggest a pulmonary embolism. Applying oxygen and elevating the
head of the bed are immediate life-saving interventions to improve oxygenation and reduce
respiratory distress.
5. A patient is admitted with a serum sodium level of 120 mEq/L. Which
assessment finding is the nurse’s priority?
A. Altered level of consciousness and seizures
B. Hypotension
C. Muscle weakness
D. Dry mucous membranes
Answer: A
, Rationale: Severe hyponatremia (<125 mEq/L) causes cerebral edema, which leads to
neurological changes, including confusion, seizures, and coma. This is a medical emergency.
6. A nurse is teaching a patient about the use of a peak flow meter for asthma
management. Which statement by the patient indicates a need for further
teaching?
A. I should use the meter while standing up.
B. I will breathe out slowly and steadily into the mouthpiece.
C. I will record the highest of three readings.
D. I should use the meter at the same time every day.
Answer: B
Rationale: The peak flow meter requires a forceful, rapid exhalation to accurately measure
the maximum speed of expiration.
7. Which clinical manifestation would the nurse expect to find in a patient with
respiratory alkalosis?
A. Kussmaul respirations
B. Tingling of the fingers and toes (paresthesia)
C. Hypoventilation
D. Warm, flushed skin
Answer: B
Rationale: Alkalosis increases binding of calcium to albumin, lowering ionized calcium
levels, which causes neuromuscular irritability and paresthesia.
Difficulty Comprehensive Quiz 2026 |WCU
1. A patient’s arterial blood gas (ABG) results are: pH 7.26, PaCO2 54 mmHg, and
HCO3 24 mEq/L. Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45 mmHg),
which is consistent with the respiratory system causing the acidosis. The HCO3 is within
the normal range, indicating no compensation yet.
2. A patient with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min via nasal cannula. Which finding should the nurse report
immediately?
A. Oxygen saturation of 91%
B. Productive cough with clear sputum
C. Respiratory rate of 10 breaths per minute
D. Bilateral wheezing on expiration
Answer: C
Rationale: In patients with COPD, high oxygen levels can suppress the hypoxic drive to
breathe. A respiratory rate of 10 is low and may indicate respiratory depression, requiring
immediate intervention.
,3. Which electrolyte imbalance is most likely to cause the presence of a U wave
on an electrocardiogram (ECG)?
A. Hyperkalemia
B. Hypocalcemia
C. Hypokalemia
D. Hypermagnesemia
Answer: C
Rationale: Hypokalemia is associated with the development of U waves, ST-segment
depression, and flat or inverted T waves on an ECG.
4. The nurse is caring for a post-operative patient who reports sudden chest
pain and dyspnea. The nurse notes a heart rate of 110 bpm and an oxygen
saturation of 88%. What is the priority nursing action?
A. Obtain an ECG
B. Administer morphine for pain
C. Encourage the use of an incentive spirometer
D. Apply oxygen and elevate the head of the bed
Answer: D
Rationale: These signs suggest a pulmonary embolism. Applying oxygen and elevating the
head of the bed are immediate life-saving interventions to improve oxygenation and reduce
respiratory distress.
5. A patient is admitted with a serum sodium level of 120 mEq/L. Which
assessment finding is the nurse’s priority?
A. Altered level of consciousness and seizures
B. Hypotension
C. Muscle weakness
D. Dry mucous membranes
Answer: A
, Rationale: Severe hyponatremia (<125 mEq/L) causes cerebral edema, which leads to
neurological changes, including confusion, seizures, and coma. This is a medical emergency.
6. A nurse is teaching a patient about the use of a peak flow meter for asthma
management. Which statement by the patient indicates a need for further
teaching?
A. I should use the meter while standing up.
B. I will breathe out slowly and steadily into the mouthpiece.
C. I will record the highest of three readings.
D. I should use the meter at the same time every day.
Answer: B
Rationale: The peak flow meter requires a forceful, rapid exhalation to accurately measure
the maximum speed of expiration.
7. Which clinical manifestation would the nurse expect to find in a patient with
respiratory alkalosis?
A. Kussmaul respirations
B. Tingling of the fingers and toes (paresthesia)
C. Hypoventilation
D. Warm, flushed skin
Answer: B
Rationale: Alkalosis increases binding of calcium to albumin, lowering ionized calcium
levels, which causes neuromuscular irritability and paresthesia.
