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NCLEX-RN Physiological Adaptation
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
A client with heart failure reports worsening shortness of breath and weight gain of 2
kg in 3 days. Which action should the nurse take first?
A) Administer furosemide as prescribed
B) Assess lung sounds and oxygen saturation
C) Restrict the client's fluid intake
D) Notify the healthcare provider
Correct Answer: B
Rationale: The nurse must assess the client first (lung sounds, SpO2, vitals)
before implementing interventions. This is a fundamental NCLEX principle:
Assess before you act. Medications (A) and fluid restriction (C) come after
assessment.
2. 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.
3. 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?
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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. 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.
5. 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.
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6. A client with pneumonia has a pulse oximetry reading of 88% on room air. Which
action should the nurse take first?
A) Apply oxygen at 2 L/min via nasal cannula
B) Encourage the client to cough and deep breathe
C) Notify the respiratory therapist
D) Position the client in semi-Fowler's position
Correct Answer: A
Rationale: A SpO2 of 88% indicates hypoxemia. The priority is to apply
supplemental oxygen to improve oxygenation. Coughing and deep breathing
(B) help clear secretions but do not immediately correct hypoxemia. Positioning
(D) is helpful but not the first action.
7. A client with cirrhosis has ascites and is receiving spironolactone. Which finding
indicates the medication is effective?
A) Decreased serum sodium
B) Increased urine output
C) Decreased abdominal girth
D) Increased serum potassium
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic used to reduce
ascites. A decrease in abdominal girth indicates that fluid is being mobilized
and the medication is effective. Increased urine output (B) is a sign of diuresis
but decreased abdominal girth is the most direct indicator of ascites reduction.
8. A client with anaphylaxis receives epinephrine. Which assessment finding indicates
the medication is effective?
A) Increased blood pressure
B) Decreased respiratory rate
C) Decreased heart rate
D) Increased wheezing
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Correct Answer: A
Rationale: Epinephrine causes vasoconstriction, which increases blood pressure,
and bronchodilation, which improves oxygenation. Increased BP is a desired
effect. Wheezing (D) should decrease, not increase. Heart rate (C) typically
increases due to beta-1 stimulation.
9. A client with diabetes insipidus is receiving desmopressin (DDAVP). Which finding
indicates the medication is effective?
A) Decreased urine output
B) Increased serum sodium
C) Increased thirst
D) Decreased blood pressure
Correct Answer: A
Rationale: Diabetes insipidus causes excessive urine output and polydipsia.
Desmopressin is a synthetic ADH that reduces urine output by increasing water
reabsorption in the kidneys. Increased serum sodium (B) would indicate over-
correction. Thirst (C) should decrease.
10. A client with a history of alcohol use disorder is admitted with pancreatitis. Which
laboratory finding is most concerning?
A) Serum amylase of 200 U/L
B) Serum lipase of 300 U/L
C) Serum calcium of 6.5 mg/dL
D) Serum glucose of 110 mg/dL
Correct Answer: C
Rationale: In acute pancreatitis, hypocalcemia (calcium <8.5 mg/dL) indicates
fat necrosis and is a poor prognostic sign. Amylase (A) and lipase (B) are
expected to be elevated. Glucose (D) may be elevated but hypocalcemia is more
concerning.
11. A client with chronic kidney disease is prescribed a low-potassium diet. Which food
should the client avoid?
NCLEX-RN Physiological Adaptation
Questions And Well Graded Solutions With
Rationales Updated 2026-2027
A client with heart failure reports worsening shortness of breath and weight gain of 2
kg in 3 days. Which action should the nurse take first?
A) Administer furosemide as prescribed
B) Assess lung sounds and oxygen saturation
C) Restrict the client's fluid intake
D) Notify the healthcare provider
Correct Answer: B
Rationale: The nurse must assess the client first (lung sounds, SpO2, vitals)
before implementing interventions. This is a fundamental NCLEX principle:
Assess before you act. Medications (A) and fluid restriction (C) come after
assessment.
2. 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.
3. 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?
, 2|Page
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. 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.
5. 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|Page
6. A client with pneumonia has a pulse oximetry reading of 88% on room air. Which
action should the nurse take first?
A) Apply oxygen at 2 L/min via nasal cannula
B) Encourage the client to cough and deep breathe
C) Notify the respiratory therapist
D) Position the client in semi-Fowler's position
Correct Answer: A
Rationale: A SpO2 of 88% indicates hypoxemia. The priority is to apply
supplemental oxygen to improve oxygenation. Coughing and deep breathing
(B) help clear secretions but do not immediately correct hypoxemia. Positioning
(D) is helpful but not the first action.
7. A client with cirrhosis has ascites and is receiving spironolactone. Which finding
indicates the medication is effective?
A) Decreased serum sodium
B) Increased urine output
C) Decreased abdominal girth
D) Increased serum potassium
Correct Answer: C
Rationale: Spironolactone is a potassium-sparing diuretic used to reduce
ascites. A decrease in abdominal girth indicates that fluid is being mobilized
and the medication is effective. Increased urine output (B) is a sign of diuresis
but decreased abdominal girth is the most direct indicator of ascites reduction.
8. A client with anaphylaxis receives epinephrine. Which assessment finding indicates
the medication is effective?
A) Increased blood pressure
B) Decreased respiratory rate
C) Decreased heart rate
D) Increased wheezing
, 4|Page
Correct Answer: A
Rationale: Epinephrine causes vasoconstriction, which increases blood pressure,
and bronchodilation, which improves oxygenation. Increased BP is a desired
effect. Wheezing (D) should decrease, not increase. Heart rate (C) typically
increases due to beta-1 stimulation.
9. A client with diabetes insipidus is receiving desmopressin (DDAVP). Which finding
indicates the medication is effective?
A) Decreased urine output
B) Increased serum sodium
C) Increased thirst
D) Decreased blood pressure
Correct Answer: A
Rationale: Diabetes insipidus causes excessive urine output and polydipsia.
Desmopressin is a synthetic ADH that reduces urine output by increasing water
reabsorption in the kidneys. Increased serum sodium (B) would indicate over-
correction. Thirst (C) should decrease.
10. A client with a history of alcohol use disorder is admitted with pancreatitis. Which
laboratory finding is most concerning?
A) Serum amylase of 200 U/L
B) Serum lipase of 300 U/L
C) Serum calcium of 6.5 mg/dL
D) Serum glucose of 110 mg/dL
Correct Answer: C
Rationale: In acute pancreatitis, hypocalcemia (calcium <8.5 mg/dL) indicates
fat necrosis and is a poor prognostic sign. Amylase (A) and lipase (B) are
expected to be elevated. Glucose (D) may be elevated but hypocalcemia is more
concerning.
11. A client with chronic kidney disease is prescribed a low-potassium diet. Which food
should the client avoid?
