**The Pathophysiology & Clinical Judgment Final:
Understanding Disease Processes for the NCLEX**
1. A nurse is caring for a client with right-sided heart failure. Which finding is expected?
A) Pulmonary crackles
B) Peripheral edema and jugular vein distention
C) Paroxysmal nocturnal dyspnea
D) Pink frothy sputum
💫RATIONALE✔️✔️: Right-sided heart failure causes systemic congestion (JVD, peripheral edema,
hepatomegaly). Left-sided causes pulmonary symptoms.
💫ANSWER✔️✔️: B) Peripheral edema and jugular vein distention
---
2. A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which ECG change does the
nurse expect?
A) Flattened T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged QT interval
💫RATIONALE✔️✔️: Hyperkalemia causes tall, peaked T waves, widened QRS, and eventually sine wave
pattern and cardiac arrest.
💫ANSWER✔️✔️: C) Peaked T waves
---
3. A nurse is assessing a client with diabetic ketoacidosis. Which finding indicates metabolic acidosis?
A) Kussmaul respirations
B) Bradypnea
,C) Hypoventilation
D) Apneic periods
💫RATIONALE✔️✔️: Kussmaul respirations (deep, rapid) are the body's attempt to blow off CO₂ to correct
metabolic acidosis.
💫ANSWER✔️✔️: A) Kussmaul respirations
---
4. A client with cirrhosis has ascites and an elevated ammonia level. Which finding indicates worsening
hepatic encephalopathy?
A) Asterixis
B) Increased appetite
C) Hyperreflexia
D) Tachycardia
💫RATIONALE✔️✔️: Asterixis (liver flap) is a flapping tremor of the hands indicating hepatic
encephalopathy.
💫ANSWER✔️✔️: A) Asterixis
---
5. A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which
laboratory finding is expected?
A) Serum sodium 118 mEq/L
B) Serum osmolality 320 mOsm/kg
C) Urine specific gravity 1.002
D) Potassium 5.5 mEq/L
💫RATIONALE✔️✔️: SIADH causes dilutional hyponatremia (<135) due to water retention; urine is
concentrated (high specific gravity).
💫ANSWER✔️✔️: A) Serum sodium 118 mEq/L
---
,6. A client with a traumatic brain injury has an intracranial pressure of 25 mmHg. Which nursing
intervention is priority?
A) Administer mannitol IV
B) Elevate the head of the bed to 30 degrees
C) Hyperventilate the client
D) Administer IV fluids wide open
💫RATIONALE✔️✔️: Elevating HOB to 30 degrees promotes venous drainage and reduces ICP; mannitol is
next.
💫ANSWER✔️✔️: B) Elevate the head of the bed to 30 degrees
---
7. A nurse is assessing a client with acute pancreatitis. Which laboratory finding is most specific for this
condition?
A) Elevated amylase and lipase
B) Elevated bilirubin
C) Hypocalcemia
D) Hyperglycemia
💫RATIONALE✔️✔️: Serum lipase is the most specific marker for acute pancreatitis; amylase also rises but
less specific.
💫ANSWER✔️✔️: A) Elevated amylase and lipase
---
8. A client with chronic obstructive pulmonary disease has a PaO₂ of 55 mmHg and PaCO₂ of 65 mmHg.
Which acid-base imbalance does the nurse expect?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
💫RATIONALE✔️✔️: COPD causes chronic hypercapnia (elevated PaCO₂) leading to respiratory acidosis.
💫ANSWER✔️✔️: C) Respiratory acidosis
, ---
9. A nurse is assessing a client with hyperthyroidism (Graves' disease). Which finding is expected?
A) Weight gain and bradycardia
B) Heat intolerance and tachycardia
C) Cold intolerance and fatigue
D) Constipation and dry skin
💫RATIONALE✔️✔️: Hyperthyroidism increases metabolic rate: heat intolerance, tachycardia, weight loss,
and diarrhea.
💫ANSWER✔️✔️: B) Heat intolerance and tachycardia
---
10. A client with hypothyroidism is admitted with myxedema coma. Which finding requires immediate
action?
A) Hypothermia and bradycardia
B) Weight gain of 5 pounds
C) Dry, brittle hair
D) Constipation
💫RATIONALE✔️✔️: Myxedema coma presents with hypothermia, bradycardia, hypotension, and altered
mental status; a medical emergency.
💫ANSWER✔️✔️: A) Hypothermia and bradycardia
---
11. A nurse is assessing a client with a ruptured abdominal aortic aneurysm. Which finding is most
concerning?
A) Back pain and a pulsatile abdominal mass
B) Hypertension and tachycardia
C) Bounding femoral pulses
D) Nausea and vomiting
Understanding Disease Processes for the NCLEX**
1. A nurse is caring for a client with right-sided heart failure. Which finding is expected?
A) Pulmonary crackles
B) Peripheral edema and jugular vein distention
C) Paroxysmal nocturnal dyspnea
D) Pink frothy sputum
💫RATIONALE✔️✔️: Right-sided heart failure causes systemic congestion (JVD, peripheral edema,
hepatomegaly). Left-sided causes pulmonary symptoms.
💫ANSWER✔️✔️: B) Peripheral edema and jugular vein distention
---
2. A client with chronic kidney disease has a potassium level of 6.8 mEq/L. Which ECG change does the
nurse expect?
A) Flattened T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged QT interval
💫RATIONALE✔️✔️: Hyperkalemia causes tall, peaked T waves, widened QRS, and eventually sine wave
pattern and cardiac arrest.
💫ANSWER✔️✔️: C) Peaked T waves
---
3. A nurse is assessing a client with diabetic ketoacidosis. Which finding indicates metabolic acidosis?
A) Kussmaul respirations
B) Bradypnea
,C) Hypoventilation
D) Apneic periods
💫RATIONALE✔️✔️: Kussmaul respirations (deep, rapid) are the body's attempt to blow off CO₂ to correct
metabolic acidosis.
💫ANSWER✔️✔️: A) Kussmaul respirations
---
4. A client with cirrhosis has ascites and an elevated ammonia level. Which finding indicates worsening
hepatic encephalopathy?
A) Asterixis
B) Increased appetite
C) Hyperreflexia
D) Tachycardia
💫RATIONALE✔️✔️: Asterixis (liver flap) is a flapping tremor of the hands indicating hepatic
encephalopathy.
💫ANSWER✔️✔️: A) Asterixis
---
5. A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which
laboratory finding is expected?
A) Serum sodium 118 mEq/L
B) Serum osmolality 320 mOsm/kg
C) Urine specific gravity 1.002
D) Potassium 5.5 mEq/L
💫RATIONALE✔️✔️: SIADH causes dilutional hyponatremia (<135) due to water retention; urine is
concentrated (high specific gravity).
💫ANSWER✔️✔️: A) Serum sodium 118 mEq/L
---
,6. A client with a traumatic brain injury has an intracranial pressure of 25 mmHg. Which nursing
intervention is priority?
A) Administer mannitol IV
B) Elevate the head of the bed to 30 degrees
C) Hyperventilate the client
D) Administer IV fluids wide open
💫RATIONALE✔️✔️: Elevating HOB to 30 degrees promotes venous drainage and reduces ICP; mannitol is
next.
💫ANSWER✔️✔️: B) Elevate the head of the bed to 30 degrees
---
7. A nurse is assessing a client with acute pancreatitis. Which laboratory finding is most specific for this
condition?
A) Elevated amylase and lipase
B) Elevated bilirubin
C) Hypocalcemia
D) Hyperglycemia
💫RATIONALE✔️✔️: Serum lipase is the most specific marker for acute pancreatitis; amylase also rises but
less specific.
💫ANSWER✔️✔️: A) Elevated amylase and lipase
---
8. A client with chronic obstructive pulmonary disease has a PaO₂ of 55 mmHg and PaCO₂ of 65 mmHg.
Which acid-base imbalance does the nurse expect?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
💫RATIONALE✔️✔️: COPD causes chronic hypercapnia (elevated PaCO₂) leading to respiratory acidosis.
💫ANSWER✔️✔️: C) Respiratory acidosis
, ---
9. A nurse is assessing a client with hyperthyroidism (Graves' disease). Which finding is expected?
A) Weight gain and bradycardia
B) Heat intolerance and tachycardia
C) Cold intolerance and fatigue
D) Constipation and dry skin
💫RATIONALE✔️✔️: Hyperthyroidism increases metabolic rate: heat intolerance, tachycardia, weight loss,
and diarrhea.
💫ANSWER✔️✔️: B) Heat intolerance and tachycardia
---
10. A client with hypothyroidism is admitted with myxedema coma. Which finding requires immediate
action?
A) Hypothermia and bradycardia
B) Weight gain of 5 pounds
C) Dry, brittle hair
D) Constipation
💫RATIONALE✔️✔️: Myxedema coma presents with hypothermia, bradycardia, hypotension, and altered
mental status; a medical emergency.
💫ANSWER✔️✔️: A) Hypothermia and bradycardia
---
11. A nurse is assessing a client with a ruptured abdominal aortic aneurysm. Which finding is most
concerning?
A) Back pain and a pulsatile abdominal mass
B) Hypertension and tachycardia
C) Bounding femoral pulses
D) Nausea and vomiting
