NCLEX-RN Physiological Adaptation
Exam 3 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Section 1: Cardiovascular and Respiratory Adaptations (Questions 1-25)
1. A nurse is caring for a client with heart failure who presents with dyspnea,
crackles in the lung bases, and peripheral edema. Which medication should the
nurse anticipate administering to reduce preload and alleviate symptoms?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Enalapril
Answer: B. Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by promoting the
excretion of sodium and water, thereby decreasing venous return and fluid
volume in the pulmonary circulation. This alleviates symptoms of pulmonary
congestion such as dyspnea and crackles. Digoxin increases cardiac contractility
but does not directly reduce preload. Metoprolol is a beta blocker that reduces
heart rate and myocardial oxygen demand but does not address fluid overload.
Enalapril is an ACE inhibitor that reduces afterload and preload through
vasodilation, but furosemide is the first-line medication for acute fluid volume
reduction.
2. A client is admitted with acute respiratory distress syndrome (ARDS). Which
arterial blood gas finding is most consistent with this diagnosis?
,A. pH 7.38, PaCO2 45 mmHg, PaO2 80 mmHg, HCO3 24 mEq/L
B. pH 7.32, PaCO2 48 mmHg, PaO2 55 mmHg, HCO3 26 mEq/L
C. pH 7.28, PaCO2 38 mmHg, PaO2 50 mmHg, HCO3 18 mEq/L
D. pH 7.42, PaCO2 30 mmHg, PaO2 75 mmHg, HCO3 20 mEq/L
Answer: C. pH 7.28, PaCO2 38 mmHg, PaO2 50 mmHg, HCO3 18 mEq/L
Rationale: ARDS is characterized by severe hypoxemia (PaO2 < 60 mmHg) that is
refractory to oxygen therapy, along with decreased lung compliance and
bilateral infiltrates. The blood gas in option C shows metabolic acidosis (low pH
and low HCO3) with hypoxemia, which is commonly seen in ARDS due to
impaired gas exchange and tissue hypoperfusion. Option A shows normal
values. Option B shows respiratory acidosis with hypoxemia, which may be seen
in COPD exacerbation. Option D shows partially compensated metabolic acidosis
but with a higher PaO2 than typically seen in ARDS.
3. A client is recovering from a myocardial infarction and is prescribed aspirin
therapy. What is the primary rationale for administering aspirin to this client?
A. To reduce fever and inflammation
B. To prevent platelet aggregation and thrombus formation
C. To decrease myocardial oxygen demand
D. To lower cholesterol levels
Answer: B. To prevent platelet aggregation and thrombus formation
Rationale: Aspirin is administered to clients after myocardial infarction to
irreversibly inhibit cyclooxygenase-1 (COX-1), which prevents the formation of
thromboxane A2 and inhibits platelet aggregation. This reduces the risk of
further thrombus formation and subsequent cardiac events. While aspirin does
have anti-inflammatory and antipyretic effects, these are not the primary
reasons for its use in post-MI management. Aspirin does not significantly affect
myocardial oxygen demand or cholesterol levels; those are addressed by beta
blockers and statins, respectively.
,4. A client with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas showing pH 7.30, PaCO2 58 mmHg, HCO3 28 mEq/L. Which nursing
intervention is a priority?
A. Administer oxygen at 2 L/min via nasal cannula
B. Encourage pursed-lip breathing
C. Administer sodium bicarbonate
D. Prepare for immediate intubation
Answer: B. Encourage pursed-lip breathing
Rationale: This blood gas reveals respiratory acidosis (pH < 7.35, PaCO2 > 45
mmHg) with partial renal compensation (HCO3 elevated above 26 mEq/L), which
is consistent with acute-on-chronic respiratory acidosis in COPD. Pursed-lip
breathing helps maintain positive airway pressure, prevents airway collapse,
and facilitates the exhalation of carbon dioxide, which is the priority
intervention. Oxygen should be administered cautiously in COPD clients to avoid
suppressing the hypoxic drive, and the rate of 2 L/min is appropriate, but it is
not the priority intervention. Sodium bicarbonate is not indicated for respiratory
acidosis because it would worsen carbon dioxide retention. Immediate
intubation is not indicated unless the client shows signs of respiratory failure
unresponsive to conservative measures.
5. A nurse is monitoring a client with a chest tube connected to a water seal
drainage system. Which finding indicates that the chest tube is functioning
properly?
A. Continuous bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber
C. Absence of drainage for 4 hours
D. Subcutaneous emphysema around the insertion site
Answer: B. Tidaling (fluctuation) in the water seal chamber
Rationale: Tidaling in the water seal chamber is a normal finding that indicates
the chest tube is patent and functioning properly. It reflects the pressure
changes in the pleural space during inspiration and expiration. Continuous
, bubbling in the water seal chamber indicates an air leak, which is abnormal and
requires further assessment. Absence of drainage for 4 hours may indicate that
the lung has re-expanded or that the tube is obstructed. Subcutaneous
emphysema indicates air leaking into the subcutaneous tissue, which is a
complication that should be reported.
6. Which assessment finding would indicate that a client with left-sided heart
failure is experiencing worsening pulmonary congestion?
A. Jugular venous distention
B. Hepatomegaly
C. Increased crackles on auscultation
D. Peripheral edema
Answer: C. Increased crackles on auscultation
Rationale: Crackles on auscultation are caused by fluid in the alveoli and are a
hallmark sign of pulmonary congestion in left-sided heart failure. Increased
crackles indicate worsening fluid accumulation in the lungs. Jugular venous
distention, hepatomegaly, and peripheral edema are signs of right-sided heart
failure, which may develop secondary to left-sided failure but do not directly
indicate pulmonary congestion.
7. A client is diagnosed with pulmonary embolism. Which finding is most
indicative of this condition?
A. Bradypnea
B. Hypertension
C. Sudden onset of pleuritic chest pain
D. Decreased heart rate
Answer: C. Sudden onset of pleuritic chest pain
Rationale: Pulmonary embolism typically presents with the sudden onset of
pleuritic chest pain, dyspnea, and tachypnea. The pain is often sharp and
worsens with deep inspiration. Clients with pulmonary embolism usually
experience tachypnea, tachycardia, and hypotension due to impaired gas
Exam 3 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Section 1: Cardiovascular and Respiratory Adaptations (Questions 1-25)
1. A nurse is caring for a client with heart failure who presents with dyspnea,
crackles in the lung bases, and peripheral edema. Which medication should the
nurse anticipate administering to reduce preload and alleviate symptoms?
A. Digoxin
B. Furosemide
C. Metoprolol
D. Enalapril
Answer: B. Furosemide
Rationale: Furosemide is a loop diuretic that reduces preload by promoting the
excretion of sodium and water, thereby decreasing venous return and fluid
volume in the pulmonary circulation. This alleviates symptoms of pulmonary
congestion such as dyspnea and crackles. Digoxin increases cardiac contractility
but does not directly reduce preload. Metoprolol is a beta blocker that reduces
heart rate and myocardial oxygen demand but does not address fluid overload.
Enalapril is an ACE inhibitor that reduces afterload and preload through
vasodilation, but furosemide is the first-line medication for acute fluid volume
reduction.
2. A client is admitted with acute respiratory distress syndrome (ARDS). Which
arterial blood gas finding is most consistent with this diagnosis?
,A. pH 7.38, PaCO2 45 mmHg, PaO2 80 mmHg, HCO3 24 mEq/L
B. pH 7.32, PaCO2 48 mmHg, PaO2 55 mmHg, HCO3 26 mEq/L
C. pH 7.28, PaCO2 38 mmHg, PaO2 50 mmHg, HCO3 18 mEq/L
D. pH 7.42, PaCO2 30 mmHg, PaO2 75 mmHg, HCO3 20 mEq/L
Answer: C. pH 7.28, PaCO2 38 mmHg, PaO2 50 mmHg, HCO3 18 mEq/L
Rationale: ARDS is characterized by severe hypoxemia (PaO2 < 60 mmHg) that is
refractory to oxygen therapy, along with decreased lung compliance and
bilateral infiltrates. The blood gas in option C shows metabolic acidosis (low pH
and low HCO3) with hypoxemia, which is commonly seen in ARDS due to
impaired gas exchange and tissue hypoperfusion. Option A shows normal
values. Option B shows respiratory acidosis with hypoxemia, which may be seen
in COPD exacerbation. Option D shows partially compensated metabolic acidosis
but with a higher PaO2 than typically seen in ARDS.
3. A client is recovering from a myocardial infarction and is prescribed aspirin
therapy. What is the primary rationale for administering aspirin to this client?
A. To reduce fever and inflammation
B. To prevent platelet aggregation and thrombus formation
C. To decrease myocardial oxygen demand
D. To lower cholesterol levels
Answer: B. To prevent platelet aggregation and thrombus formation
Rationale: Aspirin is administered to clients after myocardial infarction to
irreversibly inhibit cyclooxygenase-1 (COX-1), which prevents the formation of
thromboxane A2 and inhibits platelet aggregation. This reduces the risk of
further thrombus formation and subsequent cardiac events. While aspirin does
have anti-inflammatory and antipyretic effects, these are not the primary
reasons for its use in post-MI management. Aspirin does not significantly affect
myocardial oxygen demand or cholesterol levels; those are addressed by beta
blockers and statins, respectively.
,4. A client with chronic obstructive pulmonary disease (COPD) has an arterial
blood gas showing pH 7.30, PaCO2 58 mmHg, HCO3 28 mEq/L. Which nursing
intervention is a priority?
A. Administer oxygen at 2 L/min via nasal cannula
B. Encourage pursed-lip breathing
C. Administer sodium bicarbonate
D. Prepare for immediate intubation
Answer: B. Encourage pursed-lip breathing
Rationale: This blood gas reveals respiratory acidosis (pH < 7.35, PaCO2 > 45
mmHg) with partial renal compensation (HCO3 elevated above 26 mEq/L), which
is consistent with acute-on-chronic respiratory acidosis in COPD. Pursed-lip
breathing helps maintain positive airway pressure, prevents airway collapse,
and facilitates the exhalation of carbon dioxide, which is the priority
intervention. Oxygen should be administered cautiously in COPD clients to avoid
suppressing the hypoxic drive, and the rate of 2 L/min is appropriate, but it is
not the priority intervention. Sodium bicarbonate is not indicated for respiratory
acidosis because it would worsen carbon dioxide retention. Immediate
intubation is not indicated unless the client shows signs of respiratory failure
unresponsive to conservative measures.
5. A nurse is monitoring a client with a chest tube connected to a water seal
drainage system. Which finding indicates that the chest tube is functioning
properly?
A. Continuous bubbling in the water seal chamber
B. Tidaling (fluctuation) in the water seal chamber
C. Absence of drainage for 4 hours
D. Subcutaneous emphysema around the insertion site
Answer: B. Tidaling (fluctuation) in the water seal chamber
Rationale: Tidaling in the water seal chamber is a normal finding that indicates
the chest tube is patent and functioning properly. It reflects the pressure
changes in the pleural space during inspiration and expiration. Continuous
, bubbling in the water seal chamber indicates an air leak, which is abnormal and
requires further assessment. Absence of drainage for 4 hours may indicate that
the lung has re-expanded or that the tube is obstructed. Subcutaneous
emphysema indicates air leaking into the subcutaneous tissue, which is a
complication that should be reported.
6. Which assessment finding would indicate that a client with left-sided heart
failure is experiencing worsening pulmonary congestion?
A. Jugular venous distention
B. Hepatomegaly
C. Increased crackles on auscultation
D. Peripheral edema
Answer: C. Increased crackles on auscultation
Rationale: Crackles on auscultation are caused by fluid in the alveoli and are a
hallmark sign of pulmonary congestion in left-sided heart failure. Increased
crackles indicate worsening fluid accumulation in the lungs. Jugular venous
distention, hepatomegaly, and peripheral edema are signs of right-sided heart
failure, which may develop secondary to left-sided failure but do not directly
indicate pulmonary congestion.
7. A client is diagnosed with pulmonary embolism. Which finding is most
indicative of this condition?
A. Bradypnea
B. Hypertension
C. Sudden onset of pleuritic chest pain
D. Decreased heart rate
Answer: C. Sudden onset of pleuritic chest pain
Rationale: Pulmonary embolism typically presents with the sudden onset of
pleuritic chest pain, dyspnea, and tachypnea. The pain is often sharp and
worsens with deep inspiration. Clients with pulmonary embolism usually
experience tachypnea, tachycardia, and hypotension due to impaired gas
