NCLEX-PN Physiological Adaptation Practice Test 2026/2027 UPDATE
1. A Licensed Practical Nurse (LPN) is caring for a client with heart failure. Which
clinical finding is the most reliable indicator of fluid volume overload?
A. Pitting edema in the lower extremities
B. Increased urinary output
C. Crackles heard upon lung auscultation
D. A weight gain of 2 lbs (0.9 kg) in 24 hours
Answer: D
Rationale: Daily weight is the most accurate and reliable indicator of fluid balance status in
clients with heart failure or renal issues.
2. A client is diagnosed with hypokalemia. Which of the following
electrocardiogram (ECG) changes should the nurse expect to observe?
A. Tall, peaked T waves
B. Widened QRS complex
C. Shortened QT interval
D. Presence of U waves
Answer: D
Rationale: Hypokalemia typically causes ST depression, flat or inverted T waves, and the
appearance of U waves. Tall peaked T waves are seen in hyperkalemia.
,3. The nurse is monitoring a client with respiratory acidosis. Which arterial
blood gas (ABG) result is consistent with this condition?
A. pH 7.48, PaCO2 30 mmHg
B. pH 7.32, PaCO2 50 mmHg
C. pH 7.30, HCO3 18 mEq/L
D. pH 7.50, HCO3 30 mEq/L
Answer: B
Rationale: Respiratory acidosis is characterized by a low pH (below 7.35) and an elevated
PaCO2 (above 45 mmHg).
4. Which clinical manifestation should the nurse prioritize when assessing a
client for early signs of shock?
A. Decreased blood pressure
B. Decreased urine output
C. Increased heart rate
D. Cold, clammy skin
Answer: C
Rationale: Tachycardia is often the earliest sign of shock as the body attempts to maintain
cardiac output. Hypotension is often a late sign.
5. A client with type 1 diabetes is found sweaty, shaky, and confused. What is
the nurse’s priority action?
A. Provide 15 grams of rapid-acting carbohydrates
B. Check the client’s blood glucose level
C. Administer the scheduled dose of insulin
D. Call the healthcare provider immediately
Answer: A
, Rationale: The client is showing signs of hypoglycemia. While checking glucose is ideal,
providing rapid carbs is the priority intervention when symptoms are present to prevent
neurological damage.
6. A nurse is caring for a client with a nasogastric (NG) tube set to low
intermittent suction. The client is at risk for which acid-base imbalance?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: D
Rationale: Gastric secretions are highly acidic. Losing them through NG suctioning leads to
a loss of hydrogen ions, resulting in metabolic alkalosis.
7. A client has a serum sodium level of 128 mEq/L. Which nursing intervention is
most appropriate?
A. Encourage increased oral fluid intake
B. Implement seizure precautions
C. Administer a prescribed diuretic
D. Provide a low-salt diet
Answer: B
Rationale: Hyponatremia (sodium < 135 mEq/L) can cause cerebral edema and increase
the risk for seizures. Safety through seizure precautions is a priority.
1. A Licensed Practical Nurse (LPN) is caring for a client with heart failure. Which
clinical finding is the most reliable indicator of fluid volume overload?
A. Pitting edema in the lower extremities
B. Increased urinary output
C. Crackles heard upon lung auscultation
D. A weight gain of 2 lbs (0.9 kg) in 24 hours
Answer: D
Rationale: Daily weight is the most accurate and reliable indicator of fluid balance status in
clients with heart failure or renal issues.
2. A client is diagnosed with hypokalemia. Which of the following
electrocardiogram (ECG) changes should the nurse expect to observe?
A. Tall, peaked T waves
B. Widened QRS complex
C. Shortened QT interval
D. Presence of U waves
Answer: D
Rationale: Hypokalemia typically causes ST depression, flat or inverted T waves, and the
appearance of U waves. Tall peaked T waves are seen in hyperkalemia.
,3. The nurse is monitoring a client with respiratory acidosis. Which arterial
blood gas (ABG) result is consistent with this condition?
A. pH 7.48, PaCO2 30 mmHg
B. pH 7.32, PaCO2 50 mmHg
C. pH 7.30, HCO3 18 mEq/L
D. pH 7.50, HCO3 30 mEq/L
Answer: B
Rationale: Respiratory acidosis is characterized by a low pH (below 7.35) and an elevated
PaCO2 (above 45 mmHg).
4. Which clinical manifestation should the nurse prioritize when assessing a
client for early signs of shock?
A. Decreased blood pressure
B. Decreased urine output
C. Increased heart rate
D. Cold, clammy skin
Answer: C
Rationale: Tachycardia is often the earliest sign of shock as the body attempts to maintain
cardiac output. Hypotension is often a late sign.
5. A client with type 1 diabetes is found sweaty, shaky, and confused. What is
the nurse’s priority action?
A. Provide 15 grams of rapid-acting carbohydrates
B. Check the client’s blood glucose level
C. Administer the scheduled dose of insulin
D. Call the healthcare provider immediately
Answer: A
, Rationale: The client is showing signs of hypoglycemia. While checking glucose is ideal,
providing rapid carbs is the priority intervention when symptoms are present to prevent
neurological damage.
6. A nurse is caring for a client with a nasogastric (NG) tube set to low
intermittent suction. The client is at risk for which acid-base imbalance?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: D
Rationale: Gastric secretions are highly acidic. Losing them through NG suctioning leads to
a loss of hydrogen ions, resulting in metabolic alkalosis.
7. A client has a serum sodium level of 128 mEq/L. Which nursing intervention is
most appropriate?
A. Encourage increased oral fluid intake
B. Implement seizure precautions
C. Administer a prescribed diuretic
D. Provide a low-salt diet
Answer: B
Rationale: Hyponatremia (sodium < 135 mEq/L) can cause cerebral edema and increase
the risk for seizures. Safety through seizure precautions is a priority.
