Practice Physiological Adaptation questions for the National Council Licensure Examination — RN. Every question includes a full explanation of why the correct answer is right and why the tempting distractors are wrong.
61 questions available · hard difficulty · NCLEX-RN · Free, no registration required
10 example questions with full explanations. Use the interactive practice above to work through the complete set.
Question 1medium
A 58-year-old male with a history of COPD is admitted with increased dyspnea. His ABG results are: pH 7.32, PaCO2 58 mmHg, HCO3 30 mEq/L, PaO2 58 mmHg. Which interpretation is most accurate?
- A.Mixed respiratory and metabolic acidosis
- B.Respiratory acidosis with metabolic compensation✓
- C.Respiratory alkalosis with metabolic compensation
- D.Metabolic acidosis with respiratory compensation
Correct answer: B
The pH of 7.32 indicates acidosis. The elevated PaCO2 of 58 mmHg identifies the primary problem as respiratory (CO2 retention), consistent with COPD exacerbation. The elevated HCO3 of 30 mEq/L (normal 22–26) reflects renal compensation — the kidneys are retaining bicarbonate to buffer the chronic acid load. This combination (pH↓, PaCO2↑, HCO3↑) is classic compensated respiratory acidosis. Option A is incorrect because metabolic acidosis would show a low, not elevated, HCO3.
Question 2medium
A nurse is caring for a patient admitted with an acute ischemic stroke. The patient's blood pressure is 192/104 mmHg and the provider is considering tPA administration. Which assessment finding would be the most critical contraindication to tPA therapy?
- A.The patient has a blood pressure of 192/104 mmHg
- B.The patient is currently taking a statin medication
- C.The patient's last known well time was 5 hours ago✓
- D.The patient's blood glucose is 140 mg/dL
Correct answer: C
tPA (alteplase) is indicated for ischemic stroke only within a 3–4.5 hour window from the last known well time. A symptom onset of 5 hours ago places this patient outside the therapeutic window, making it the most critical absolute contraindication. Elevated blood pressure (≥185/110 mmHg) is also a contraindication, but BP can be treated with antihypertensives prior to tPA administration to bring it within range. Statin use and a mildly elevated blood glucose are not contraindications to tPA.
Question 3medium
A nurse is assessing a patient who was admitted with heart failure. The patient reports waking up at night unable to breathe and needing two pillows to sleep. On auscultation, the nurse notes bilateral crackles in the lung bases. These findings are most consistent with which type of heart failure?
- A.Right-sided heart failure, because increased venous pressure causes peripheral edema and ascites
- B.Left-sided heart failure, because reduced cardiac output causes systemic venous congestion
- C.Right-sided heart failure, because fluid backs up into the pulmonary circulation
- D.Left-sided heart failure, because the left ventricle fails to pump blood forward, causing pulmonary congestion✓
Correct answer: D
Left-sided heart failure causes blood to back up into the pulmonary circulation, resulting in pulmonary edema. Classic signs include paroxysmal nocturnal dyspnea (waking at night short of breath), orthopnea (needing multiple pillows to breathe), and bilateral crackles from fluid in the alveoli. Right-sided heart failure causes systemic venous congestion, manifesting as peripheral edema, jugular venous distension (JVD), and ascites — not pulmonary symptoms. Option B incorrectly attributes systemic venous congestion to left-sided failure.
Question 4medium
A 22-year-old with type 1 diabetes is brought to the emergency department by a friend who states the patient has been vomiting and acting confused for several hours. The nurse notes deep, rapid respirations and a fruity odor on the patient's breath. Which laboratory finding would the nurse most expect to confirm the suspected diagnosis?
- A.Serum glucose of 420 mg/dL with arterial pH of 7.20 and positive serum ketones✓
- B.Serum glucose of 620 mg/dL with serum osmolality of 340 mOsm/kg and absent urine ketones
- C.Serum glucose of 280 mg/dL with arterial pH of 7.38 and elevated HCO3
- D.Serum glucose of 48 mg/dL with a serum sodium of 128 mEq/L
Correct answer: A
The clinical presentation — type 1 diabetes, Kussmaul respirations (deep and rapid), fruity breath, vomiting, and confusion — is classic diabetic ketoacidosis (DKA). DKA is confirmed by hyperglycemia (typically 250–600 mg/dL), metabolic acidosis (pH < 7.30, HCO3 < 18), and the presence of serum or urine ketones. Option C describes hyperosmolar hyperglycemic state (HHS), which occurs in type 2 diabetes and lacks ketosis. Option D describes hypoglycemia. Option A shows a normal pH and elevated HCO3, which would not be consistent with DKA.
Question 5medium
A patient involved in a motor vehicle accident arrives in the emergency department with cool, clammy skin, a blood pressure of 84/52 mmHg, heart rate of 128 bpm, and confusion. The nurse suspects hypovolemic shock. Which intervention takes the highest priority at this time?
- A.Insert a urinary catheter to monitor hourly urine output
- B.Administer oxygen via non-rebreather mask and establish large-bore IV access for fluid resuscitation✓
- C.Obtain a 12-lead ECG to rule out a cardiac cause of the hypotension
- D.Draw blood for a complete metabolic panel and type and crossmatch
Correct answer: B
In hypovolemic shock, the priority is to restore oxygenation and circulating volume simultaneously using the ABCs framework. Applying high-flow oxygen (addressing airway/breathing) and establishing large-bore IV access for rapid fluid resuscitation (addressing circulation) directly target the life-threatening hemodynamic compromise. Urinary catheter insertion (Option A) is important to monitor perfusion but is a secondary intervention.A12-lead ECG (Option C) is appropriate for suspected cardiogenic shock, not trauma-related hypovolemic shock. Laboratory draws (Option D) are necessary but must not delay resuscitation efforts.
Question 6easy
A nurse is assessing a patient with suspected hypoxia. Select all that apply — which of the following are early signs of hypoxia the nurse should recognize?
- A.Restlessness and agitation✓
- B.Confusion and disorientation✓
- C.Cyanosis of the lips and fingertips
- D.Tachycardia✓
- E.Increased respiratory rate✓
Correct answer: A, B, D, E
Early signs of hypoxia include restlessness, agitation, confusion, disorientation, tachycardia, and increased respiratory rate as the body attempts to compensate for inadequate oxygen delivery. Cyanosis is a LATE sign of hypoxia, appearing only after significant oxygen desaturation has occurred (SpO2 typically below 85%). Nurses must recognize the early signs so that intervention occurs before the patient deteriorates to cyanosis, which indicates severe hypoxemia.
Question 7easy
A nurse is caring for a patient admitted with a severe burn injury. Select all that apply — which assessments are consistent with the nurse's priority care for a burn patient in the first 24 hours?
- A.Monitor urine output to assess fluid resuscitation adequacy✓
- B.Apply ice packs directly to burned areas to reduce pain
- C.Assess for circumferential burns that may require escharotomy✓
- D.Initiate IV fluid resuscitation using the Parkland formula✓
Correct answer: A, C, D
In burn care, IV fluid resuscitation using the Parkland formula (4 mL × kg × %TBSA burned) is initiated within the first 24 hours, with half given in the first 8 hours. Urine output (goal 0.5–1 mL/kg/hr in adults) is monitored as the primary indicator of adequate resuscitation. Circumferential burns must be assessed because they can compromise circulation or breathing, necessitating escharotomy. Ice packs are contraindicated because they cause vasoconstriction and tissue damage; cool (not cold) running water is appropriate for minor burns only.
Question 8easy
A nurse is caring for a patient with increased intracranial pressure (ICP). Select all that apply — which nursing interventions are appropriate for this patient?
- A.Elevate the head of the bed to 30 degrees✓
- B.Avoid hip flexion greater than 90 degrees✓
- C.Position the patient in the Trendelenburg position to improve cerebral perfusion
- D.Monitor for Cushing's triad: bradycardia, hypertension, and irregular respirations✓
Correct answer: A, B, D
For increased ICP, the head of bed is maintained at 30 degrees to promote venous drainage from the brain and reduce ICP. Hip flexion greater than 90 degrees increases intra-abdominal pressure, which can impede venous drainage and elevate ICP, so it must be avoided. Cushing's triad (bradycardia, hypertension, and irregular respirations) is a late, ominous sign of severely elevated ICP that the nurse must recognize and report immediately. Trendelenburg positioning is contraindicated in increased ICP because it causes blood to pool in the cerebral vasculature, worsening intracranial pressure.
Question 9easy
A nurse is caring for a client diagnosed with right-sided heart failure. Select all that apply: Which of the following clinical findings are consistent with this condition?
- A.Jugular vein distension (JVD)✓
- B.Crackles in the lung bases
- C.Pitting edema in the lower extremities✓
- D.Ascites✓
- E.Orthopnea
Correct answer: A, C, D
Right-sided heart failure causes backup of blood into the systemic venous circulation, leading to jugular vein distension (JVD), dependent pitting edema, and ascites from portal hypertension. Crackles in the lung bases and orthopnea are signs of left-sided heart failure, where fluid backs up into the pulmonary circulation causing pulmonary congestion.
Question 10easy
A client is admitted with diabetic ketoacidosis (DKA). Select all that apply: Which of the following are expected clinical manifestations?
- A.Kussmaul respirations✓
- B.Fruity breath odor✓
- C.Serum glucose greater than 600 mg/dL with no ketonuria
- D.Nausea and vomiting✓
- E.Dehydration✓
Correct answer: A, B, D, E
DKA is characterized by Kussmaul respirations (deep, rapid breathing to blow off CO2 and compensate for metabolic acidosis), fruity breath from ketone production, nausea and vomiting, and dehydration from osmotic diuresis. Option C describes hyperosmolar hyperglycemic state (HHS), which presents with extreme hyperglycemia (often >600 mg/dL) and the absence of significant ketonuria — not DKA.