2026 NCLEX Pathophysiology Practice Questions
Answer Rationales Disease Processes Signs Symptoms
Clinical Manifestations Patient Priorities Nursing
Judgment Review
1. A patient with a history of heart failure is admitted with shortness of breath
and crackles in the lungs. Which pathophysiological process is the priority for
the nurse to address?
A. Decreased cardiac output leading to fluid overload
B. Increased systemic vascular resistance
C. Impaired gas exchange due to alveolar edema
D. Myocardial ischemia due to increased oxygen demand
Answer: C. Impaired gas exchange due to alveolar edema
Rationale: The patient is exhibiting classic signs of pulmonary edema (shortness
of breath, crackles) resulting from left-sided heart failure. The immediate priority
is to address the impaired gas exchange caused by fluid in the alveoli, as this is the
most life-threatening issue. While decreased cardiac output is the root cause, the
immediate clinical manifestation requiring intervention is the respiratory
compromise.
2. A nurse is assessing a patient with suspected meningitis. Which of the
following clinical manifestations is most indicative of meningeal irritation?
A. A positive Babinski sign
B. Nuchal rigidity
C. Ataxia
D. Intention tremor
Answer: B. Nuchal rigidity
Rationale: Nuchal rigidity (stiff neck) is a classic sign of meningeal irritation,
which occurs when the meninges become inflamed. A positive Babinski sign
indicates an upper motor neuron lesion, while ataxia and intention tremors are
associated with cerebellar dysfunction.
3. A patient with type 1 diabetes presents with fruity breath, Kussmaul
respirations, and a blood glucose of 450 mg/dL. The nurse should prioritize
assessing for which of the following?
,A. Hyperkalemia
B. Hypernatremia
C. Metabolic alkalosis
D. Fluid overload
Answer: A. Hyperkalemia
Rationale: The patient is exhibiting signs of diabetic ketoacidosis (DKA). In
DKA, the lack of insulin causes potassium to shift out of the cells and into the
bloodstream, leading to hyperkalemia, even though total body potassium may be
depleted. Cardiac monitoring is a priority due to the risk of fatal arrhythmias.
4. A patient is admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). Which of the following signs indicates the patient
is developing respiratory failure?
A. Increased sputum production
B. A respiratory rate of 24 breaths per minute
C. A decreased level of consciousness
D. Use of accessory muscles
Answer: C. A decreased level of consciousness
Rationale: A decreased level of consciousness is a late and ominous sign of
respiratory failure in a patient with COPD. It indicates cerebral hypoxia and
hypercapnia (increased carbon dioxide levels). While increased sputum, tachypnea,
and accessory muscle use are signs of respiratory distress, a change in mental
status is the most critical indicator of impending failure.
5. A nurse is caring for a patient with an acute kidney injury (AKI). Which of
the following clinical manifestations is the priority for the nurse to monitor?
A. Decreased urine output
B. Hyperkalemia
C. Peripheral edema
D. Nausea and vomiting
Answer: B. Hyperkalemia
Rationale: Hyperkalemia is the most life-threatening complication of acute kidney
injury because it can lead to fatal cardiac arrhythmias. While decreased urine
output is a hallmark sign of AKI and edema is common, the priority is to monitor
and manage potassium levels to prevent cardiac arrest.
6. A patient with a history of cirrhosis is admitted with confusion and
asterixis. The nurse should anticipate which of the following
,pathophysiological processes?
A. Hepatic encephalopathy due to increased ammonia levels
B. Esophageal varices due to portal hypertension
C. Ascites due to decreased albumin production
D. Jaundice due to increased bilirubin levels
Answer: A. Hepatic encephalopathy due to increased ammonia levels
Rationale: The patient is exhibiting signs of hepatic encephalopathy (confusion,
asterixis), which occurs when the liver is unable to detoxify ammonia. The priority
is to address the underlying cause by reducing ammonia levels, often with
lactulose.
7. A nurse is assessing a patient with a suspected myocardial infarction (MI).
Which of the following clinical manifestations is most common in women?
A. Crushing chest pain
B. Pain radiating to the left arm
C. Shortness of breath and fatigue
D. Nausea and vomiting
Answer: C. Shortness of breath and fatigue
Rationale: Women often present with atypical symptoms of MI, such as shortness
of breath, fatigue, indigestion, and jaw or back pain, rather than the classic
crushing chest pain radiating to the left arm. This difference in presentation can
lead to delayed diagnosis and treatment.
8. A patient with a deep vein thrombosis (DVT) is at risk for which of the
following life-threatening complications?
A. Pulmonary embolism
B. Stroke
C. Myocardial infarction
D. Aneurysm
Answer: A. Pulmonary embolism
Rationale: A deep vein thrombosis (DVT) in the lower extremities can dislodge
and travel through the venous system to the lungs, causing a pulmonary embolism
(PE). A PE is a life-threatening emergency that obstructs blood flow to the lungs.
9. A nurse is caring for a patient with a spinal cord injury at the T6 level. The
patient suddenly develops a severe headache, hypertension, and bradycardia.
The nurse should suspect:
A. Septic shock
, B. Autonomic dysreflexia
C. Spinal shock
D. Neurogenic shock
Answer: B. Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a life-threatening condition that can occur in
patients with spinal cord injuries at or above the T6 level. It is triggered by a
noxious stimulus below the level of the injury (e.g., a full bladder). The classic
signs are severe hypertension, bradycardia, a pounding headache, and
flushing/sweating above the level of the injury.
10. A patient is admitted with a diagnosis of a hemorrhagic stroke. Which of
the following is the priority nursing intervention?
A. Administer a thrombolytic agent.
B. Lower blood pressure aggressively.
C. Maintain a patent airway and monitor neurological status.
D. Place the patient in a supine position.
Answer: C. Maintain a patent airway and monitor neurological status.
Rationale: For a hemorrhagic stroke, the priority is supportive care.
Thrombolytics are contraindicated. Blood pressure is often managed cautiously, as
aggressive lowering can compromise perfusion. The immediate priorities are
maintaining the ABCs (Airway, Breathing, Circulation) and closely monitoring for
neurological deterioration.
11. A patient is diagnosed with a pulmonary embolism. Which of the following
clinical manifestations is most common?
A. Sudden onset of pleuritic chest pain
B. Bradycardia
C. Hypertension
D. A dry, non-productive cough
Answer: A. Sudden onset of pleuritic chest pain
Rationale: The most common presenting symptom of a pulmonary embolism is
the sudden onset of dyspnea and pleuritic chest pain (pain that worsens with
breathing). Other signs include tachycardia, tachypnea, and anxiety. Bradycardia
and hypertension are not typical findings.
12. A nurse is assessing a patient with hypothyroidism. Which of the following
clinical manifestations would the nurse expect to find?
A. Weight loss and heat intolerance
Answer Rationales Disease Processes Signs Symptoms
Clinical Manifestations Patient Priorities Nursing
Judgment Review
1. A patient with a history of heart failure is admitted with shortness of breath
and crackles in the lungs. Which pathophysiological process is the priority for
the nurse to address?
A. Decreased cardiac output leading to fluid overload
B. Increased systemic vascular resistance
C. Impaired gas exchange due to alveolar edema
D. Myocardial ischemia due to increased oxygen demand
Answer: C. Impaired gas exchange due to alveolar edema
Rationale: The patient is exhibiting classic signs of pulmonary edema (shortness
of breath, crackles) resulting from left-sided heart failure. The immediate priority
is to address the impaired gas exchange caused by fluid in the alveoli, as this is the
most life-threatening issue. While decreased cardiac output is the root cause, the
immediate clinical manifestation requiring intervention is the respiratory
compromise.
2. A nurse is assessing a patient with suspected meningitis. Which of the
following clinical manifestations is most indicative of meningeal irritation?
A. A positive Babinski sign
B. Nuchal rigidity
C. Ataxia
D. Intention tremor
Answer: B. Nuchal rigidity
Rationale: Nuchal rigidity (stiff neck) is a classic sign of meningeal irritation,
which occurs when the meninges become inflamed. A positive Babinski sign
indicates an upper motor neuron lesion, while ataxia and intention tremors are
associated with cerebellar dysfunction.
3. A patient with type 1 diabetes presents with fruity breath, Kussmaul
respirations, and a blood glucose of 450 mg/dL. The nurse should prioritize
assessing for which of the following?
,A. Hyperkalemia
B. Hypernatremia
C. Metabolic alkalosis
D. Fluid overload
Answer: A. Hyperkalemia
Rationale: The patient is exhibiting signs of diabetic ketoacidosis (DKA). In
DKA, the lack of insulin causes potassium to shift out of the cells and into the
bloodstream, leading to hyperkalemia, even though total body potassium may be
depleted. Cardiac monitoring is a priority due to the risk of fatal arrhythmias.
4. A patient is admitted with an acute exacerbation of chronic obstructive
pulmonary disease (COPD). Which of the following signs indicates the patient
is developing respiratory failure?
A. Increased sputum production
B. A respiratory rate of 24 breaths per minute
C. A decreased level of consciousness
D. Use of accessory muscles
Answer: C. A decreased level of consciousness
Rationale: A decreased level of consciousness is a late and ominous sign of
respiratory failure in a patient with COPD. It indicates cerebral hypoxia and
hypercapnia (increased carbon dioxide levels). While increased sputum, tachypnea,
and accessory muscle use are signs of respiratory distress, a change in mental
status is the most critical indicator of impending failure.
5. A nurse is caring for a patient with an acute kidney injury (AKI). Which of
the following clinical manifestations is the priority for the nurse to monitor?
A. Decreased urine output
B. Hyperkalemia
C. Peripheral edema
D. Nausea and vomiting
Answer: B. Hyperkalemia
Rationale: Hyperkalemia is the most life-threatening complication of acute kidney
injury because it can lead to fatal cardiac arrhythmias. While decreased urine
output is a hallmark sign of AKI and edema is common, the priority is to monitor
and manage potassium levels to prevent cardiac arrest.
6. A patient with a history of cirrhosis is admitted with confusion and
asterixis. The nurse should anticipate which of the following
,pathophysiological processes?
A. Hepatic encephalopathy due to increased ammonia levels
B. Esophageal varices due to portal hypertension
C. Ascites due to decreased albumin production
D. Jaundice due to increased bilirubin levels
Answer: A. Hepatic encephalopathy due to increased ammonia levels
Rationale: The patient is exhibiting signs of hepatic encephalopathy (confusion,
asterixis), which occurs when the liver is unable to detoxify ammonia. The priority
is to address the underlying cause by reducing ammonia levels, often with
lactulose.
7. A nurse is assessing a patient with a suspected myocardial infarction (MI).
Which of the following clinical manifestations is most common in women?
A. Crushing chest pain
B. Pain radiating to the left arm
C. Shortness of breath and fatigue
D. Nausea and vomiting
Answer: C. Shortness of breath and fatigue
Rationale: Women often present with atypical symptoms of MI, such as shortness
of breath, fatigue, indigestion, and jaw or back pain, rather than the classic
crushing chest pain radiating to the left arm. This difference in presentation can
lead to delayed diagnosis and treatment.
8. A patient with a deep vein thrombosis (DVT) is at risk for which of the
following life-threatening complications?
A. Pulmonary embolism
B. Stroke
C. Myocardial infarction
D. Aneurysm
Answer: A. Pulmonary embolism
Rationale: A deep vein thrombosis (DVT) in the lower extremities can dislodge
and travel through the venous system to the lungs, causing a pulmonary embolism
(PE). A PE is a life-threatening emergency that obstructs blood flow to the lungs.
9. A nurse is caring for a patient with a spinal cord injury at the T6 level. The
patient suddenly develops a severe headache, hypertension, and bradycardia.
The nurse should suspect:
A. Septic shock
, B. Autonomic dysreflexia
C. Spinal shock
D. Neurogenic shock
Answer: B. Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a life-threatening condition that can occur in
patients with spinal cord injuries at or above the T6 level. It is triggered by a
noxious stimulus below the level of the injury (e.g., a full bladder). The classic
signs are severe hypertension, bradycardia, a pounding headache, and
flushing/sweating above the level of the injury.
10. A patient is admitted with a diagnosis of a hemorrhagic stroke. Which of
the following is the priority nursing intervention?
A. Administer a thrombolytic agent.
B. Lower blood pressure aggressively.
C. Maintain a patent airway and monitor neurological status.
D. Place the patient in a supine position.
Answer: C. Maintain a patent airway and monitor neurological status.
Rationale: For a hemorrhagic stroke, the priority is supportive care.
Thrombolytics are contraindicated. Blood pressure is often managed cautiously, as
aggressive lowering can compromise perfusion. The immediate priorities are
maintaining the ABCs (Airway, Breathing, Circulation) and closely monitoring for
neurological deterioration.
11. A patient is diagnosed with a pulmonary embolism. Which of the following
clinical manifestations is most common?
A. Sudden onset of pleuritic chest pain
B. Bradycardia
C. Hypertension
D. A dry, non-productive cough
Answer: A. Sudden onset of pleuritic chest pain
Rationale: The most common presenting symptom of a pulmonary embolism is
the sudden onset of dyspnea and pleuritic chest pain (pain that worsens with
breathing). Other signs include tachycardia, tachypnea, and anxiety. Bradycardia
and hypertension are not typical findings.
12. A nurse is assessing a patient with hypothyroidism. Which of the following
clinical manifestations would the nurse expect to find?
A. Weight loss and heat intolerance
