NCLEX-RN Physiological Adaptation Comprehensive Quiz
2026/2027 UPDATE UPDATED ACTUAL Exam Questions
and CORRECT Answers
1. A nurse is caring for a patient with hypokalemia. Which of the following ECG
changes should the nurse expect to observe?
A. Tall peaked T waves
B. Widened QRS complex
C. Prominent U waves
D. Shortened QT interval
Answer: C
Rationale: Hypokalemia typically causes prominent U waves, ST-segment depression, and
flat or inverted T waves. Tall peaked T waves are associated with hyperkalemia.
2. A patient is admitted with a suspected pulmonary embolism. Which is the
priority nursing action?
A. Apply supplemental oxygen
B. Obtain a 12-lead ECG
C. Administer pain medication as ordered
D. Start an intravenous line
Answer: A
Rationale: The priority in managing a pulmonary embolism is maintaining oxygenation
and respiratory stability, making oxygen administration the first action.
,3. Which clinical manifestation is a hallmark sign of the compensatory stage of
shock?
A. Tachycardia
B. Decreased urine output
C. Cold, clammy skin
D. Confusion and lethargy
Answer: A
Rationale: In the compensatory stage of shock, the body uses the sympathetic nervous
system to maintain cardiac output, resulting in tachycardia and narrowed pulse pressure.
4. A patient has a serum sodium level of 120 mEq/L. Which precaution is most
important for the nurse to implement?
A. Cardiac monitoring
B. Strict intake and output
C. Fluid bolus administration
D. Seizure precautions
Answer: D
Rationale: Severe hyponatremia (below 125 mEq/L) puts the patient at high risk for
cerebral edema and seizures.
5. Which arterial blood gas (ABG) result is consistent with a patient in early
stage hypovolemic shock?
A. pH 7.48, PaCO2 30, HCO3 22
B. pH 7.30, PaCO2 50, HCO3 24
C. pH 7.32, PaCO2 40, HCO3 18
D. pH 7.35, PaCO2 45, HCO3 26
Answer: A
Rationale: Early shock often involves hyperventilation as a compensatory mechanism,
leading to respiratory alkalosis (high pH, low PaCO2).
, 6. A nurse assesses a patient with Chvostek’s sign. This finding is indicative of
which electrolyte imbalance?
A. Hypercalcemia
B. Hypermagnesemia
C. Hypokalemia
D. Hypocalcemia
Answer: D
Rationale: Chvostek’s sign (facial twitching when the facial nerve is tapped) is a sign of
neuromuscular irritability caused by hypocalcemia.
7. A patient with Type 1 Diabetes presents with deep, rapid respirations and a
fruity breath odor. The nurse recognizes these as:
A. Kussmaul respirations
B. Cheyne-Stokes respirations
C. Biot’s respirations
D. Hypoventilation
Answer: A
Rationale: Kussmaul respirations are the body’s attempt to compensate for metabolic
acidosis in DKA by blowing off carbon dioxide.
8. In a patient with Acute Respiratory Distress Syndrome (ARDS), which
positioning is most effective for improving oxygenation?
A. High-Fowler’s
B. Prone
C. Supine
D. Left side-lying
Answer: B
Rationale: Prone positioning improves oxygenation in ARDS by recruiting collapsed alveoli
in the posterior lung fields and improving ventilation-perfusion matching.
2026/2027 UPDATE UPDATED ACTUAL Exam Questions
and CORRECT Answers
1. A nurse is caring for a patient with hypokalemia. Which of the following ECG
changes should the nurse expect to observe?
A. Tall peaked T waves
B. Widened QRS complex
C. Prominent U waves
D. Shortened QT interval
Answer: C
Rationale: Hypokalemia typically causes prominent U waves, ST-segment depression, and
flat or inverted T waves. Tall peaked T waves are associated with hyperkalemia.
2. A patient is admitted with a suspected pulmonary embolism. Which is the
priority nursing action?
A. Apply supplemental oxygen
B. Obtain a 12-lead ECG
C. Administer pain medication as ordered
D. Start an intravenous line
Answer: A
Rationale: The priority in managing a pulmonary embolism is maintaining oxygenation
and respiratory stability, making oxygen administration the first action.
,3. Which clinical manifestation is a hallmark sign of the compensatory stage of
shock?
A. Tachycardia
B. Decreased urine output
C. Cold, clammy skin
D. Confusion and lethargy
Answer: A
Rationale: In the compensatory stage of shock, the body uses the sympathetic nervous
system to maintain cardiac output, resulting in tachycardia and narrowed pulse pressure.
4. A patient has a serum sodium level of 120 mEq/L. Which precaution is most
important for the nurse to implement?
A. Cardiac monitoring
B. Strict intake and output
C. Fluid bolus administration
D. Seizure precautions
Answer: D
Rationale: Severe hyponatremia (below 125 mEq/L) puts the patient at high risk for
cerebral edema and seizures.
5. Which arterial blood gas (ABG) result is consistent with a patient in early
stage hypovolemic shock?
A. pH 7.48, PaCO2 30, HCO3 22
B. pH 7.30, PaCO2 50, HCO3 24
C. pH 7.32, PaCO2 40, HCO3 18
D. pH 7.35, PaCO2 45, HCO3 26
Answer: A
Rationale: Early shock often involves hyperventilation as a compensatory mechanism,
leading to respiratory alkalosis (high pH, low PaCO2).
, 6. A nurse assesses a patient with Chvostek’s sign. This finding is indicative of
which electrolyte imbalance?
A. Hypercalcemia
B. Hypermagnesemia
C. Hypokalemia
D. Hypocalcemia
Answer: D
Rationale: Chvostek’s sign (facial twitching when the facial nerve is tapped) is a sign of
neuromuscular irritability caused by hypocalcemia.
7. A patient with Type 1 Diabetes presents with deep, rapid respirations and a
fruity breath odor. The nurse recognizes these as:
A. Kussmaul respirations
B. Cheyne-Stokes respirations
C. Biot’s respirations
D. Hypoventilation
Answer: A
Rationale: Kussmaul respirations are the body’s attempt to compensate for metabolic
acidosis in DKA by blowing off carbon dioxide.
8. In a patient with Acute Respiratory Distress Syndrome (ARDS), which
positioning is most effective for improving oxygenation?
A. High-Fowler’s
B. Prone
C. Supine
D. Left side-lying
Answer: B
Rationale: Prone positioning improves oxygenation in ARDS by recruiting collapsed alveoli
in the posterior lung fields and improving ventilation-perfusion matching.
