NCLEX RN Physiological Adaptation
Exam 2 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Question 1
A 72-year-old male patient with a history of chronic obstructive pulmonary
disease (COPD) is admitted with acute exacerbation. His arterial blood gas results
show: pH 7.28, PaCO2 68 mmHg, HCO3 32 mEq/L, and PaO2 58 mmHg. Which
interpretation of these results is most accurate?
A) Uncompensated metabolic acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Uncompensated respiratory alkalosis
Answer: B) Partially compensated respiratory acidosis
Rationale: The ABG results show a low pH (7.28) indicating acidosis. The
elevated PaCO2 (68 mmHg) indicates respiratory acidosis. The elevated HCO3
(32 mEq/L) demonstrates renal compensation, but because the pH remains
below normal, this is only partial compensation. The body is attempting to
compensate by retaining bicarbonate, but the respiratory component remains
the primary problem. This is a classic presentation of acute-on-chronic
respiratory failure in a COPD patient.
Question 2
A patient with severe heart failure is receiving furosemide (Lasix) 80 mg IV push.
,Which assessment finding indicates the medication is having the desired
therapeutic effect?
A) Increased blood pressure
B) Decreased peripheral edema
C) Increased heart rate
D) Decreased urine output
Answer: B) Decreased peripheral edema
Rationale: Furosemide is a loop diuretic that works by blocking the sodium-
potassium-chloride cotransporter in the thick ascending limb of the loop of
Henle. The desired therapeutic effect is to reduce fluid volume overload, which
manifests as decreased peripheral edema, decreased pulmonary congestion, and
improved breathing. While blood pressure may decrease, the primary goal in
heart failure management is fluid reduction. Decreased urine output would
indicate medication failure or renal impairment.
Question 3
A 45-year-old female patient is admitted with diabetic ketoacidosis (DKA). Her
blood glucose is 586 mg/dL, potassium is 3.2 mEq/L, and pH is 7.15. Which
intervention should the nurse anticipate initiating first?
A) IV insulin bolus followed by continuous infusion
B) IV normal saline at 500 mL/hour
C) IV potassium replacement
D) IV sodium bicarbonate
Answer: B) IV normal saline at 500 mL/hour
Rationale: Fluid resuscitation is the priority intervention in DKA. The patient is
severely dehydrated due to osmotic diuresis from hyperglycemia. Restoring
intravascular volume improves tissue perfusion and helps lower blood glucose
by diluting it and enhancing renal excretion. Insulin therapy should be initiated
after fluid resuscitation has begun and potassium levels are confirmed, as insulin
,drives potassium into cells and can precipitate dangerous hypokalemia. Sodium
bicarbonate is rarely indicated and only for severe acidosis with hemodynamic
compromise.
Question 4
A patient with end-stage renal disease (ESRD) is scheduled for hemodialysis.
Which laboratory value should the nurse report to the healthcare provider before
the procedure?
A) Serum potassium of 5.2 mEq/L
B) Serum phosphorus of 4.5 mg/dL
C) Hemoglobin of 7.8 g/dL
D) Serum calcium of 9.2 mg/dL
Answer: C) Hemoglobin of 7.8 g/dL
Rationale: A hemoglobin of 7.8 g/dL indicates severe anemia and should be
reported before dialysis. Dialysis can cause further blood loss through the
dialysis circuit and anticoagulation. The patient may require a blood transfusion
prior to dialysis to prevent hemodynamic instability. Additionally, erythropoietin
therapy may need to be adjusted. Potassium of 5.2 mEq/L is elevated but
expected in ESRD and dialysis will correct this. Phosphorus of 4.5 mg/dL is also
elevated but manageable with dialysis and phosphate binders. Serum calcium of
9.2 mg/dL is within normal limits.
Question 5
A 68-year-old male patient who had a total knee replacement 24 hours ago
reports sudden onset of chest pain and shortness of breath. His oxygen saturation
is 88% on room air. What is the most likely cause of these symptoms?
A) Myocardial infarction
B) Pulmonary embolism
, C) Pneumothorax
D) Atelectasis
Answer: B) Pulmonary embolism
Rationale: This patient is at high risk for venous thromboembolism due to recent
major orthopedic surgery and immobility. The sudden onset of chest pain,
dyspnea, and hypoxemia are classic signs of pulmonary embolism (PE). While
myocardial infarction could present similarly, the surgical and immobility risk
factors make PE more likely. The obstruction of pulmonary blood flow leads to
ventilation-perfusion mismatch and hypoxemia. Immediate interventions include
high-flow oxygen, assessment for hemodynamic stability, and diagnostic studies
such as CT angiography or V/Q scan.
Question 6
A patient with cirrhosis of the liver is exhibiting confusion, asterixis, and a flapping
tremor of the hands. Which laboratory value is most likely elevated in this
condition?
A) Serum bilirubin
B) Serum albumin
C) Serum ammonia
D) Serum alkaline phosphatase
Answer: C) Serum ammonia
Rationale: The patient is exhibiting signs of hepatic encephalopathy, a
complication of liver failure. In cirrhosis, the liver cannot effectively convert
ammonia to urea for excretion, leading to accumulation of ammonia in the
blood. Elevated ammonia levels are neurotoxic and cause the classic symptoms
of confusion, altered mental status, asterixis (liver flap), and in severe cases,
coma. Treatment focuses on reducing ammonia levels through lactulose
administration, dietary protein restriction, and addressing precipitating factors
such as gastrointestinal bleeding or infection.
Exam 2 Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
Question 1
A 72-year-old male patient with a history of chronic obstructive pulmonary
disease (COPD) is admitted with acute exacerbation. His arterial blood gas results
show: pH 7.28, PaCO2 68 mmHg, HCO3 32 mEq/L, and PaO2 58 mmHg. Which
interpretation of these results is most accurate?
A) Uncompensated metabolic acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Uncompensated respiratory alkalosis
Answer: B) Partially compensated respiratory acidosis
Rationale: The ABG results show a low pH (7.28) indicating acidosis. The
elevated PaCO2 (68 mmHg) indicates respiratory acidosis. The elevated HCO3
(32 mEq/L) demonstrates renal compensation, but because the pH remains
below normal, this is only partial compensation. The body is attempting to
compensate by retaining bicarbonate, but the respiratory component remains
the primary problem. This is a classic presentation of acute-on-chronic
respiratory failure in a COPD patient.
Question 2
A patient with severe heart failure is receiving furosemide (Lasix) 80 mg IV push.
,Which assessment finding indicates the medication is having the desired
therapeutic effect?
A) Increased blood pressure
B) Decreased peripheral edema
C) Increased heart rate
D) Decreased urine output
Answer: B) Decreased peripheral edema
Rationale: Furosemide is a loop diuretic that works by blocking the sodium-
potassium-chloride cotransporter in the thick ascending limb of the loop of
Henle. The desired therapeutic effect is to reduce fluid volume overload, which
manifests as decreased peripheral edema, decreased pulmonary congestion, and
improved breathing. While blood pressure may decrease, the primary goal in
heart failure management is fluid reduction. Decreased urine output would
indicate medication failure or renal impairment.
Question 3
A 45-year-old female patient is admitted with diabetic ketoacidosis (DKA). Her
blood glucose is 586 mg/dL, potassium is 3.2 mEq/L, and pH is 7.15. Which
intervention should the nurse anticipate initiating first?
A) IV insulin bolus followed by continuous infusion
B) IV normal saline at 500 mL/hour
C) IV potassium replacement
D) IV sodium bicarbonate
Answer: B) IV normal saline at 500 mL/hour
Rationale: Fluid resuscitation is the priority intervention in DKA. The patient is
severely dehydrated due to osmotic diuresis from hyperglycemia. Restoring
intravascular volume improves tissue perfusion and helps lower blood glucose
by diluting it and enhancing renal excretion. Insulin therapy should be initiated
after fluid resuscitation has begun and potassium levels are confirmed, as insulin
,drives potassium into cells and can precipitate dangerous hypokalemia. Sodium
bicarbonate is rarely indicated and only for severe acidosis with hemodynamic
compromise.
Question 4
A patient with end-stage renal disease (ESRD) is scheduled for hemodialysis.
Which laboratory value should the nurse report to the healthcare provider before
the procedure?
A) Serum potassium of 5.2 mEq/L
B) Serum phosphorus of 4.5 mg/dL
C) Hemoglobin of 7.8 g/dL
D) Serum calcium of 9.2 mg/dL
Answer: C) Hemoglobin of 7.8 g/dL
Rationale: A hemoglobin of 7.8 g/dL indicates severe anemia and should be
reported before dialysis. Dialysis can cause further blood loss through the
dialysis circuit and anticoagulation. The patient may require a blood transfusion
prior to dialysis to prevent hemodynamic instability. Additionally, erythropoietin
therapy may need to be adjusted. Potassium of 5.2 mEq/L is elevated but
expected in ESRD and dialysis will correct this. Phosphorus of 4.5 mg/dL is also
elevated but manageable with dialysis and phosphate binders. Serum calcium of
9.2 mg/dL is within normal limits.
Question 5
A 68-year-old male patient who had a total knee replacement 24 hours ago
reports sudden onset of chest pain and shortness of breath. His oxygen saturation
is 88% on room air. What is the most likely cause of these symptoms?
A) Myocardial infarction
B) Pulmonary embolism
, C) Pneumothorax
D) Atelectasis
Answer: B) Pulmonary embolism
Rationale: This patient is at high risk for venous thromboembolism due to recent
major orthopedic surgery and immobility. The sudden onset of chest pain,
dyspnea, and hypoxemia are classic signs of pulmonary embolism (PE). While
myocardial infarction could present similarly, the surgical and immobility risk
factors make PE more likely. The obstruction of pulmonary blood flow leads to
ventilation-perfusion mismatch and hypoxemia. Immediate interventions include
high-flow oxygen, assessment for hemodynamic stability, and diagnostic studies
such as CT angiography or V/Q scan.
Question 6
A patient with cirrhosis of the liver is exhibiting confusion, asterixis, and a flapping
tremor of the hands. Which laboratory value is most likely elevated in this
condition?
A) Serum bilirubin
B) Serum albumin
C) Serum ammonia
D) Serum alkaline phosphatase
Answer: C) Serum ammonia
Rationale: The patient is exhibiting signs of hepatic encephalopathy, a
complication of liver failure. In cirrhosis, the liver cannot effectively convert
ammonia to urea for excretion, leading to accumulation of ammonia in the
blood. Elevated ammonia levels are neurotoxic and cause the classic symptoms
of confusion, altered mental status, asterixis (liver flap), and in severe cases,
coma. Treatment focuses on reducing ammonia levels through lactulose
administration, dietary protein restriction, and addressing precipitating factors
such as gastrointestinal bleeding or infection.
