NCLEX-RN Physiological Adaptation 4 Exam – Questions 1-25
1. A client with acute pancreatitis presents with severe epigastric pain radiating to the
back. Which lab result is most indicative of this condition?
A. Elevated AST
B. Elevated amylase and lipase
C. Decreased bilirubin
D. Decreased serum calcium
Answer: B. Elevated amylase and lipase
Rationale: Pancreatic enzymes amylase and lipase are released during pancreatic
inflammation, making them sensitive indicators of acute pancreatitis. AST and bilirubin may be
elevated in hepatobiliary disease, while calcium decreases due to fat saponification in severe
pancreatitis.
2. A client with chronic heart failure develops pulmonary edema. Which intervention is
priority?
A. Administer oxygen
B. Encourage ambulation
C. Offer high-sodium diet
D. Monitor urine output
Answer: A. Administer oxygen
Rationale: Pulmonary edema impairs gas exchange. Oxygenation is a priority to prevent
hypoxia. Sodium restriction and diuretics follow, while ambulation is not appropriate during acute
edema.
3. A client with a history of cirrhosis presents with ascites. Which nursing intervention is
essential?
A. Encourage high-protein diet
B. Monitor daily weights
C. Limit fluid intake to 500 mL/day
D. Administer lactulose every 12 hours
Answer: B. Monitor daily weights
Rationale: Daily weights are a sensitive indicator of fluid accumulation and effectiveness of
,diuretic therapy. Protein intake may be restricted in hepatic encephalopathy; lactulose is for
ammonia reduction, not fluid monitoring.
4. A patient with chronic kidney disease (CKD) develops hyperkalemia (K⁺ 6.2 mEq/L).
Which is the priority action?
A. Administer IV calcium gluconate
B. Provide a high-potassium diet
C. Administer loop diuretics
D. Hold all antihypertensive medications
Answer: A. Administer IV calcium gluconate
Rationale: IV calcium stabilizes cardiac membranes, preventing life-threatening arrhythmias in
severe hyperkalemia. Loop diuretics can remove potassium but are secondary; dietary
adjustments are preventive, not emergency interventions.
5. A client with COPD has a PaO₂ of 55 mmHg and PaCO₂ of 60 mmHg. What acid-base
imbalance is present?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Answer: C. Respiratory acidosis
Rationale: COPD impairs CO₂ elimination, resulting in elevated PaCO₂ and decreased PaO₂.
The corresponding acid-base imbalance is respiratory acidosis.
6. Which electrolyte imbalance is most associated with prolonged vomiting?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypophosphatemia
Answer: B. Hypokalemia
Rationale: Vomiting leads to loss of gastric acid (HCl) and potassium, often resulting in
hypokalemia and metabolic alkalosis.
7. A client presents with a tension pneumothorax. Which clinical manifestation is most
concerning?
, A. Mild dyspnea
B. Tracheal deviation to the unaffected side
C. Productive cough
D. Slight decrease in oxygen saturation
Answer: B. Tracheal deviation to the unaffected side
Rationale: Tension pneumothorax causes mediastinal shift, compressing vital structures.
Tracheal deviation is a critical sign requiring immediate needle decompression.
8. A patient with DKA (diabetic ketoacidosis) has a blood glucose of 550 mg/dL and K⁺ of
3.0 mEq/L. Which intervention is priority?
A. Administer IV insulin
B. Administer IV potassium
C. Give oral glucose
D. Encourage oral hydration
Answer: B. Administer IV potassium
Rationale: Insulin therapy shifts potassium into cells, risking severe hypokalemia. Potassium
must be corrected before insulin administration to prevent cardiac arrest.
9. Which lab finding is most consistent with SIADH?
A. Hypernatremia, low urine osmolality
B. Hyponatremia, concentrated urine
C. Hypokalemia, dilute urine
D. Hypercalcemia, elevated BUN
Answer: B. Hyponatremia, concentrated urine
Rationale: SIADH causes water retention with dilutional hyponatremia; urine becomes
concentrated due to ADH-mediated water reabsorption.
10. A client is receiving heparin therapy. Which lab value is most important to monitor?
A. PT
B. INR
C. aPTT
D. Platelet count
Answer: C. aPTT
Rationale: Heparin prolongs aPTT; monitoring ensures therapeutic anticoagulation while
minimizing bleeding risk. PT/INR monitor warfarin therapy.
1. A client with acute pancreatitis presents with severe epigastric pain radiating to the
back. Which lab result is most indicative of this condition?
A. Elevated AST
B. Elevated amylase and lipase
C. Decreased bilirubin
D. Decreased serum calcium
Answer: B. Elevated amylase and lipase
Rationale: Pancreatic enzymes amylase and lipase are released during pancreatic
inflammation, making them sensitive indicators of acute pancreatitis. AST and bilirubin may be
elevated in hepatobiliary disease, while calcium decreases due to fat saponification in severe
pancreatitis.
2. A client with chronic heart failure develops pulmonary edema. Which intervention is
priority?
A. Administer oxygen
B. Encourage ambulation
C. Offer high-sodium diet
D. Monitor urine output
Answer: A. Administer oxygen
Rationale: Pulmonary edema impairs gas exchange. Oxygenation is a priority to prevent
hypoxia. Sodium restriction and diuretics follow, while ambulation is not appropriate during acute
edema.
3. A client with a history of cirrhosis presents with ascites. Which nursing intervention is
essential?
A. Encourage high-protein diet
B. Monitor daily weights
C. Limit fluid intake to 500 mL/day
D. Administer lactulose every 12 hours
Answer: B. Monitor daily weights
Rationale: Daily weights are a sensitive indicator of fluid accumulation and effectiveness of
,diuretic therapy. Protein intake may be restricted in hepatic encephalopathy; lactulose is for
ammonia reduction, not fluid monitoring.
4. A patient with chronic kidney disease (CKD) develops hyperkalemia (K⁺ 6.2 mEq/L).
Which is the priority action?
A. Administer IV calcium gluconate
B. Provide a high-potassium diet
C. Administer loop diuretics
D. Hold all antihypertensive medications
Answer: A. Administer IV calcium gluconate
Rationale: IV calcium stabilizes cardiac membranes, preventing life-threatening arrhythmias in
severe hyperkalemia. Loop diuretics can remove potassium but are secondary; dietary
adjustments are preventive, not emergency interventions.
5. A client with COPD has a PaO₂ of 55 mmHg and PaCO₂ of 60 mmHg. What acid-base
imbalance is present?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
Answer: C. Respiratory acidosis
Rationale: COPD impairs CO₂ elimination, resulting in elevated PaCO₂ and decreased PaO₂.
The corresponding acid-base imbalance is respiratory acidosis.
6. Which electrolyte imbalance is most associated with prolonged vomiting?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypophosphatemia
Answer: B. Hypokalemia
Rationale: Vomiting leads to loss of gastric acid (HCl) and potassium, often resulting in
hypokalemia and metabolic alkalosis.
7. A client presents with a tension pneumothorax. Which clinical manifestation is most
concerning?
, A. Mild dyspnea
B. Tracheal deviation to the unaffected side
C. Productive cough
D. Slight decrease in oxygen saturation
Answer: B. Tracheal deviation to the unaffected side
Rationale: Tension pneumothorax causes mediastinal shift, compressing vital structures.
Tracheal deviation is a critical sign requiring immediate needle decompression.
8. A patient with DKA (diabetic ketoacidosis) has a blood glucose of 550 mg/dL and K⁺ of
3.0 mEq/L. Which intervention is priority?
A. Administer IV insulin
B. Administer IV potassium
C. Give oral glucose
D. Encourage oral hydration
Answer: B. Administer IV potassium
Rationale: Insulin therapy shifts potassium into cells, risking severe hypokalemia. Potassium
must be corrected before insulin administration to prevent cardiac arrest.
9. Which lab finding is most consistent with SIADH?
A. Hypernatremia, low urine osmolality
B. Hyponatremia, concentrated urine
C. Hypokalemia, dilute urine
D. Hypercalcemia, elevated BUN
Answer: B. Hyponatremia, concentrated urine
Rationale: SIADH causes water retention with dilutional hyponatremia; urine becomes
concentrated due to ADH-mediated water reabsorption.
10. A client is receiving heparin therapy. Which lab value is most important to monitor?
A. PT
B. INR
C. aPTT
D. Platelet count
Answer: C. aPTT
Rationale: Heparin prolongs aPTT; monitoring ensures therapeutic anticoagulation while
minimizing bleeding risk. PT/INR monitor warfarin therapy.
