1|Page
, 2|Page
NCLEX-RN Physiological Integrity Made Easy
| Covers Fluid/Electrolytes, Pharmacology,
Safety & More Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
1. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which ECG
change does the nurse expect to observe?
A) Flat T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged PR interval
Correct Answer: C
Rationale: Hyperkalemia (K >5.0 mEq/L) causes peaked, tall, tented T waves on
ECG. Flat T waves (A) and prominent U waves (B) are seen in hypokalemia.
Prolonged PR interval (D) can occur but peaked T waves are the classic early
sign.
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value
should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Hypokalemia can precipitate cardiac dysrhythmias, especially in clients with
heart failure who may also be on digoxin. Sodium (A), calcium (C), and
magnesium (D) are less directly affected.
3. A client is receiving a blood transfusion. Fifteen minutes after initiation, the client
reports flank pain and chills. What is the nurse's priority action?
, 3|Page
A) Slow the transfusion rate
B) Stop the transfusion and infuse normal saline
C) Administer diphenhydramine (Benadryl)
D) Notify the blood bank
Correct Answer: B
Rationale: Flank pain and chills indicate an acute hemolytic transfusion
reaction. The priority is to STOP the transfusion immediately, keep the IV line
open with normal saline, and then notify the provider and blood bank. Slowing
the rate (A) is incorrect. Antihistamines (C) are for allergic reactions.
4. A client with COPD has an ABG result of pH 7.30, PaCO2 58 mmHg, HCO3 26 mEq/L.
Which intervention should the nurse implement first?
A) Prepare for intubation
B) Administer oxygen via nasal cannula at 2 L/min
C) Place the client in high-Fowler's position
D) Notify the healthcare provider
Correct Answer: B
Rationale: The ABG shows respiratory acidosis (low pH, high PaCO2). Low-flow
oxygen at 2 L/min is the priority to improve oxygenation without eliminating
the hypoxic drive in COPD clients. Positioning helps but is not first. Intubation is
a later step if oxygen fails.
5. A client with diabetes mellitus reports sweating, tremors, and palpitations. The nurse
checks the blood glucose and it is 52 mg/dL. What is the nurse's priority action?
A) Administer 50% dextrose IV push
B) Give 4 oz of orange juice orally
C) Recheck the blood glucose in 15 minutes
D) Notify the healthcare provider
Correct Answer: B
Rationale: For a conscious client with hypoglycemia (blood glucose <70 mg/dL),
the priority is to give 15 grams of rapid-acting carbohydrate (e.g., 4 oz juice, 3
glucose tablets). IV dextrose (A) is for unconscious clients. Rechecking (C) occurs
15 minutes after treatment. Notifying the provider (D) is not the immediate
priority.
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6. A client is 6 hours post-total hip arthroplasty. Which finding requires immediate
provider notification?
A) Pain level of 6/10 at the surgical site
B) Urine output of 40 mL in the last hour
C) Unilateral calf swelling and redness
D) Temperature of 99.2°F (37.3°C)
Correct Answer: C
Rationale: Unilateral calf swelling, redness, and pain are classic signs of a deep
vein thrombosis (DVT). Post-hip surgery clients are at high risk for DVTs, which
can lead to a pulmonary embolism. Pain (A) is expected, urine output (B) is
adequate, and a low-grade temp (D) is common post-op.
7. The nurse is caring for a client receiving a continuous heparin infusion. Which
laboratory value indicates the therapy is therapeutic?
A) aPTT of 60 seconds
B) INR of 3.0
C) Platelet count of 80,000/mm³
D) PT of 22 seconds
Correct Answer: A
Rationale: For heparin therapy, the therapeutic aPTT is typically 1.5 to 2.5 times
the normal control (usually 60–80 seconds). INR (B) monitors warfarin therapy.
Platelet count (C) is low and indicates possible heparin-induced
thrombocytopenia. PT (D) monitors warfarin or liver function.
8. A client with a tracheostomy has thick, tenacious secretions. Which action should the
nurse take first?
A) Suction the tracheostomy
B) Instill normal saline into the tracheostomy
C) Increase the client's fluid intake
D) Perform chest physiotherapy
, 2|Page
NCLEX-RN Physiological Integrity Made Easy
| Covers Fluid/Electrolytes, Pharmacology,
Safety & More Questions And Well Graded
Solutions With Rationales Updated 2026-
2027
1. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which ECG
change does the nurse expect to observe?
A) Flat T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged PR interval
Correct Answer: C
Rationale: Hyperkalemia (K >5.0 mEq/L) causes peaked, tall, tented T waves on
ECG. Flat T waves (A) and prominent U waves (B) are seen in hypokalemia.
Prolonged PR interval (D) can occur but peaked T waves are the classic early
sign.
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value
should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting.
Hypokalemia can precipitate cardiac dysrhythmias, especially in clients with
heart failure who may also be on digoxin. Sodium (A), calcium (C), and
magnesium (D) are less directly affected.
3. A client is receiving a blood transfusion. Fifteen minutes after initiation, the client
reports flank pain and chills. What is the nurse's priority action?
, 3|Page
A) Slow the transfusion rate
B) Stop the transfusion and infuse normal saline
C) Administer diphenhydramine (Benadryl)
D) Notify the blood bank
Correct Answer: B
Rationale: Flank pain and chills indicate an acute hemolytic transfusion
reaction. The priority is to STOP the transfusion immediately, keep the IV line
open with normal saline, and then notify the provider and blood bank. Slowing
the rate (A) is incorrect. Antihistamines (C) are for allergic reactions.
4. A client with COPD has an ABG result of pH 7.30, PaCO2 58 mmHg, HCO3 26 mEq/L.
Which intervention should the nurse implement first?
A) Prepare for intubation
B) Administer oxygen via nasal cannula at 2 L/min
C) Place the client in high-Fowler's position
D) Notify the healthcare provider
Correct Answer: B
Rationale: The ABG shows respiratory acidosis (low pH, high PaCO2). Low-flow
oxygen at 2 L/min is the priority to improve oxygenation without eliminating
the hypoxic drive in COPD clients. Positioning helps but is not first. Intubation is
a later step if oxygen fails.
5. A client with diabetes mellitus reports sweating, tremors, and palpitations. The nurse
checks the blood glucose and it is 52 mg/dL. What is the nurse's priority action?
A) Administer 50% dextrose IV push
B) Give 4 oz of orange juice orally
C) Recheck the blood glucose in 15 minutes
D) Notify the healthcare provider
Correct Answer: B
Rationale: For a conscious client with hypoglycemia (blood glucose <70 mg/dL),
the priority is to give 15 grams of rapid-acting carbohydrate (e.g., 4 oz juice, 3
glucose tablets). IV dextrose (A) is for unconscious clients. Rechecking (C) occurs
15 minutes after treatment. Notifying the provider (D) is not the immediate
priority.
, 4|Page
6. A client is 6 hours post-total hip arthroplasty. Which finding requires immediate
provider notification?
A) Pain level of 6/10 at the surgical site
B) Urine output of 40 mL in the last hour
C) Unilateral calf swelling and redness
D) Temperature of 99.2°F (37.3°C)
Correct Answer: C
Rationale: Unilateral calf swelling, redness, and pain are classic signs of a deep
vein thrombosis (DVT). Post-hip surgery clients are at high risk for DVTs, which
can lead to a pulmonary embolism. Pain (A) is expected, urine output (B) is
adequate, and a low-grade temp (D) is common post-op.
7. The nurse is caring for a client receiving a continuous heparin infusion. Which
laboratory value indicates the therapy is therapeutic?
A) aPTT of 60 seconds
B) INR of 3.0
C) Platelet count of 80,000/mm³
D) PT of 22 seconds
Correct Answer: A
Rationale: For heparin therapy, the therapeutic aPTT is typically 1.5 to 2.5 times
the normal control (usually 60–80 seconds). INR (B) monitors warfarin therapy.
Platelet count (C) is low and indicates possible heparin-induced
thrombocytopenia. PT (D) monitors warfarin or liver function.
8. A client with a tracheostomy has thick, tenacious secretions. Which action should the
nurse take first?
A) Suction the tracheostomy
B) Instill normal saline into the tracheostomy
C) Increase the client's fluid intake
D) Perform chest physiotherapy
