NCLEX-RN — Physiological Adaptation 3 (100 knowledge/recall questions)
1. The nurse interprets a patient’s serum potassium of 6.0 mEq/L. Which ECG change is most
likely?
A. Prolonged QT interval
B. U waves
C. Peaked T waves
D. ST elevation
Answer: C. Peaked T waves
Rationale: Hyperkalemia typically produces peaked (tall, narrow) T waves on ECG.
2. A patient with pancreatitis has a serum calcium of 6.8 mg/dL. Which sign is most likely?
A. Positive Chvostek’s sign
B. Flushed, warm skin
C. Bradycardia only
D. Hyperreflexia
Answer: A. Positive Chvostek’s sign
Rationale: Hypocalcemia causes neuromuscular excitability — Chvostek’s sign (facial twitch) is
common.
3. Normal arterial pH range is:
A. 6.8–7.0
B. 7.35–7.45
C. 7.2–7.3
D. 7.50–7.60
Answer: B. 7.35–7.45
Rationale: Normal arterial blood pH is 7.35–7.45.
4. The first-line medication for acute anaphylaxis is:
A. Diphenhydramine IV
B. Epinephrine IM or IV
C. Albuterol inhaler
D. Prednisone PO
Answer: B. Epinephrine IM or IV
Rationale: Epinephrine is the immediate first-line treatment for anaphylaxis to support airway,
breathing, and circulation.
5. Ankle-brachial index (ABI) < 0.90 suggests:
A. Normal arterial flow
B. Peripheral arterial disease
C. Deep vein thrombosis
D. Lymphedema
,Answer: B. Peripheral arterial disease
Rationale: ABI < 0.90 is indicative of peripheral arterial disease.
6. In left heart failure, the nurse expects which primary symptom?
A. Peripheral edema only
B. Pulmonary congestion (dyspnea)
C. Jaundice
D. Ascites
Answer: B. Pulmonary congestion (dyspnea)
Rationale: Left ventricular failure leads to pulmonary venous congestion and dyspnea.
7. The most specific lab to diagnose myocardial necrosis is:
A. CK-MB
B. Troponin I/T
C. Myoglobin
D. BNP
Answer: B. Troponin I/T
Rationale: Troponins are highly specific and sensitive markers of myocardial necrosis.
8. Classic ECG change of an acute transmural myocardial infarction is:
A. ST-segment elevation
B. Diffuse T wave flattening
C. Sinus bradycardia
D. Prolonged PR interval
Answer: A. ST-segment elevation
Rationale: ST elevation suggests transmural (STEMI) myocardial infarction.
9. The earliest sign of hypovolemia is usually:
A. Hypertension
B. Tachycardia
C. Jaundice
D. Bradycardia
Answer: B. Tachycardia
Rationale: Tachycardia is an early compensatory response to decreased circulating volume.
10. For a patient with metabolic acidosis, the respiratory compensation expected is:
A. Hypoventilation to raise pCO₂
B. Hyperventilation to lower pCO₂
C. No change in ventilation
D. Kussmaul respirations only in sleep
Answer: B. Hyperventilation to lower pCO₂
Rationale: Lungs compensate for metabolic acidosis by hyperventilating to reduce pCO₂.
11. The most sensitive indicator of a patient’s immediate oxygenation is:
A. Serum lactate
, B. Peripheral pulse oximetry (SpO₂)
C. Hemoglobin concentration
D. Respiratory rate
Answer: B. Peripheral pulse oximetry (SpO₂)
Rationale: SpO₂ provides immediate, noninvasive estimate of arterial oxygen saturation.
12. A patient with COPD retains CO₂ chronically. The expected arterial pH at baseline is:
A. 7.8 (alkalosis)
B. 7.60
C. Near normal or slightly acidic (7.35–7.38) due to renal compensation
D. 6.9
Answer: C. Near normal or slightly acidic (7.35–7.38) due to renal compensation
Rationale: Chronic CO₂ retention leads to metabolic compensation (increased HCO₃⁻),
normalizing pH close to normal.
13. The most common cause of community-acquired pneumonia is:
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Rhinovirus
Answer: B. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is the most common bacterial cause of
community-acquired pneumonia.
14. A patient on warfarin has an INR goal for atrial fibrillation stroke prevention generally
between:
A. 0.5–1.0
B. 1.0–1.5
C. 2.0–3.0
D. 3.5–4.5
Answer: C. 2.0–3.0
Rationale: Therapeutic INR for most AF indications is 2.0–3.0.
15. The nurse recognizes the classic triad for increased intracranial pressure (Cushing’s triad)
as:
A. Hypertension, bradycardia, irregular respirations
B. Hypotension, tachycardia, tachypnea
C. Fever, bradypnea, hypotension
D. Hypertension, tachycardia, hyperventilation
Answer: A. Hypertension, bradycardia, irregular respirations
Rationale: Cushing’s triad: increasing systolic BP (widened pulse pressure), bradycardia,
irregular respirations — sign of increased ICP.
16. A patient with SIADH is most likely to exhibit:
A. Hypernatremia and polyuria
1. The nurse interprets a patient’s serum potassium of 6.0 mEq/L. Which ECG change is most
likely?
A. Prolonged QT interval
B. U waves
C. Peaked T waves
D. ST elevation
Answer: C. Peaked T waves
Rationale: Hyperkalemia typically produces peaked (tall, narrow) T waves on ECG.
2. A patient with pancreatitis has a serum calcium of 6.8 mg/dL. Which sign is most likely?
A. Positive Chvostek’s sign
B. Flushed, warm skin
C. Bradycardia only
D. Hyperreflexia
Answer: A. Positive Chvostek’s sign
Rationale: Hypocalcemia causes neuromuscular excitability — Chvostek’s sign (facial twitch) is
common.
3. Normal arterial pH range is:
A. 6.8–7.0
B. 7.35–7.45
C. 7.2–7.3
D. 7.50–7.60
Answer: B. 7.35–7.45
Rationale: Normal arterial blood pH is 7.35–7.45.
4. The first-line medication for acute anaphylaxis is:
A. Diphenhydramine IV
B. Epinephrine IM or IV
C. Albuterol inhaler
D. Prednisone PO
Answer: B. Epinephrine IM or IV
Rationale: Epinephrine is the immediate first-line treatment for anaphylaxis to support airway,
breathing, and circulation.
5. Ankle-brachial index (ABI) < 0.90 suggests:
A. Normal arterial flow
B. Peripheral arterial disease
C. Deep vein thrombosis
D. Lymphedema
,Answer: B. Peripheral arterial disease
Rationale: ABI < 0.90 is indicative of peripheral arterial disease.
6. In left heart failure, the nurse expects which primary symptom?
A. Peripheral edema only
B. Pulmonary congestion (dyspnea)
C. Jaundice
D. Ascites
Answer: B. Pulmonary congestion (dyspnea)
Rationale: Left ventricular failure leads to pulmonary venous congestion and dyspnea.
7. The most specific lab to diagnose myocardial necrosis is:
A. CK-MB
B. Troponin I/T
C. Myoglobin
D. BNP
Answer: B. Troponin I/T
Rationale: Troponins are highly specific and sensitive markers of myocardial necrosis.
8. Classic ECG change of an acute transmural myocardial infarction is:
A. ST-segment elevation
B. Diffuse T wave flattening
C. Sinus bradycardia
D. Prolonged PR interval
Answer: A. ST-segment elevation
Rationale: ST elevation suggests transmural (STEMI) myocardial infarction.
9. The earliest sign of hypovolemia is usually:
A. Hypertension
B. Tachycardia
C. Jaundice
D. Bradycardia
Answer: B. Tachycardia
Rationale: Tachycardia is an early compensatory response to decreased circulating volume.
10. For a patient with metabolic acidosis, the respiratory compensation expected is:
A. Hypoventilation to raise pCO₂
B. Hyperventilation to lower pCO₂
C. No change in ventilation
D. Kussmaul respirations only in sleep
Answer: B. Hyperventilation to lower pCO₂
Rationale: Lungs compensate for metabolic acidosis by hyperventilating to reduce pCO₂.
11. The most sensitive indicator of a patient’s immediate oxygenation is:
A. Serum lactate
, B. Peripheral pulse oximetry (SpO₂)
C. Hemoglobin concentration
D. Respiratory rate
Answer: B. Peripheral pulse oximetry (SpO₂)
Rationale: SpO₂ provides immediate, noninvasive estimate of arterial oxygen saturation.
12. A patient with COPD retains CO₂ chronically. The expected arterial pH at baseline is:
A. 7.8 (alkalosis)
B. 7.60
C. Near normal or slightly acidic (7.35–7.38) due to renal compensation
D. 6.9
Answer: C. Near normal or slightly acidic (7.35–7.38) due to renal compensation
Rationale: Chronic CO₂ retention leads to metabolic compensation (increased HCO₃⁻),
normalizing pH close to normal.
13. The most common cause of community-acquired pneumonia is:
A. Pseudomonas aeruginosa
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Rhinovirus
Answer: B. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is the most common bacterial cause of
community-acquired pneumonia.
14. A patient on warfarin has an INR goal for atrial fibrillation stroke prevention generally
between:
A. 0.5–1.0
B. 1.0–1.5
C. 2.0–3.0
D. 3.5–4.5
Answer: C. 2.0–3.0
Rationale: Therapeutic INR for most AF indications is 2.0–3.0.
15. The nurse recognizes the classic triad for increased intracranial pressure (Cushing’s triad)
as:
A. Hypertension, bradycardia, irregular respirations
B. Hypotension, tachycardia, tachypnea
C. Fever, bradypnea, hypotension
D. Hypertension, tachycardia, hyperventilation
Answer: A. Hypertension, bradycardia, irregular respirations
Rationale: Cushing’s triad: increasing systolic BP (widened pulse pressure), bradycardia,
irregular respirations — sign of increased ICP.
16. A patient with SIADH is most likely to exhibit:
A. Hypernatremia and polyuria
