NCLEX-RN Physiological Adaptation 3 Exam
(2025/2026) – Verified Questions & Answers
for Expert-Level Pathophysiology, Critical
Care Management, and NCLEX®-RN®
Excellence
1. A client with chronic kidney disease presents with fatigue, pallor, and shortness of
breath. Lab results show Hgb 7.5 g/dL. Which intervention should the nurse prioritize?
A. Encourage iron-rich foods
B. Administer erythropoietin as prescribed
C. Schedule for blood transfusion immediately
D. Provide oxygen via nasal cannula
Answer: B
Rationale: CKD leads to anemia due to decreased erythropoietin. Administering erythropoietin
addresses the underlying cause. Blood transfusion is reserved for severe symptomatic anemia.
2. A client with left-sided heart failure has a weight gain of 3 kg in 2 days. Which is the
most appropriate nursing action?
A. Encourage fluid intake
B. Notify the provider
C. Restrict sodium intake
D. Apply compression stockings
,Answer: B
Rationale: Rapid weight gain indicates fluid overload. The provider may need to adjust
medications, especially diuretics.
3. A client with COPD reports increasing dyspnea and productive cough. Which ABG
result indicates respiratory acidosis?
A. pH 7.50, PaCO₂ 28 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L
C. pH 7.42, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
D. pH 7.60, PaCO₂ 30 mmHg, HCO₃⁻ 20 mEq/L
Answer: B
Rationale: Respiratory acidosis is caused by CO₂ retention, lowering pH (<7.35).
4. A post-operative client develops sudden chest pain, dyspnea, and tachycardia. What is
the priority nursing action?
A. Encourage coughing and deep breathing
B. Obtain a complete blood count
C. Administer prescribed analgesics
D. Assess oxygen saturation and notify provider
Answer: D
Rationale: Sudden chest pain may indicate pulmonary embolism. Immediate assessment and
provider notification are critical.
5. A client with cirrhosis develops ascites and peripheral edema. Which lab result
supports the diagnosis?
A. Increased albumin
B. Decreased albumin
C. Elevated hemoglobin
D. Low bilirubin
Answer: B
Rationale: Hypoalbuminemia reduces plasma oncotic pressure, causing fluid accumulation.
6. A client is receiving IV potassium chloride. Which assessment is most important
before administration?
A. Heart rate
,B. Bowel sounds
C. Urine output
D. Blood pressure
Answer: C
Rationale: Adequate renal function is required to excrete potassium safely.
7. A client with diabetes mellitus presents with nausea, vomiting, abdominal pain, and
fruity breath. Blood glucose is 480 mg/dL. Which complication is most likely?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Lactic acidosis
Answer: B
Rationale: DKA is characterized by hyperglycemia, metabolic acidosis, and ketones.
8. Which electrolyte imbalance is most associated with prolonged vomiting?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B
Rationale: Vomiting causes loss of gastric acid and potassium, resulting in hypokalemia.
9. A client with heart failure has an ejection fraction of 30%. Which medication improves
cardiac contractility?
A. Furosemide
B. Lisinopril
C. Digoxin
D. Metoprolol
Answer: C
Rationale: Digoxin increases myocardial contractility (positive inotrope).
10. A client presents with confusion, muscle twitching, and positive Chvostek’s sign after
thyroid surgery. Which electrolyte imbalance is suspected?
, A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypomagnesemia
Answer: B
Rationale: Hypocalcemia post-thyroidectomy occurs due to parathyroid damage; tetany and
Chvostek’s sign are key indicators.
11. A client with Addison’s disease presents with hypotension, hyponatremia, and
hyperkalemia. Which intervention is highest priority?
A. Encourage fluid intake
B. Administer IV hydrocortisone as prescribed
C. Monitor blood glucose
D. Restrict dietary potassium
Answer: B
Rationale: Acute adrenal insufficiency (Addisonian crisis) is life-threatening; IV corticosteroids
are essential.
12. A client with hypovolemic shock exhibits tachycardia, hypotension, and cool clammy
skin. Which is the priority intervention?
A. Start oxygen therapy
B. Establish IV access and begin fluid resuscitation
C. Administer vasopressors
D. Elevate legs
Answer: B
Rationale: Hypovolemic shock requires rapid fluid replacement to restore perfusion.
13. A client with hyperthyroidism reports palpitations, heat intolerance, and weight loss.
Which lab finding confirms the diagnosis?
A. Increased TSH, decreased T3/T4
B. Decreased TSH, increased T3/T4
C. Normal TSH, normal T3/T4
D. Increased TSH, increased T3/T4
Answer: B
Rationale: Hyperthyroidism shows suppressed TSH and elevated T3/T4.
(2025/2026) – Verified Questions & Answers
for Expert-Level Pathophysiology, Critical
Care Management, and NCLEX®-RN®
Excellence
1. A client with chronic kidney disease presents with fatigue, pallor, and shortness of
breath. Lab results show Hgb 7.5 g/dL. Which intervention should the nurse prioritize?
A. Encourage iron-rich foods
B. Administer erythropoietin as prescribed
C. Schedule for blood transfusion immediately
D. Provide oxygen via nasal cannula
Answer: B
Rationale: CKD leads to anemia due to decreased erythropoietin. Administering erythropoietin
addresses the underlying cause. Blood transfusion is reserved for severe symptomatic anemia.
2. A client with left-sided heart failure has a weight gain of 3 kg in 2 days. Which is the
most appropriate nursing action?
A. Encourage fluid intake
B. Notify the provider
C. Restrict sodium intake
D. Apply compression stockings
,Answer: B
Rationale: Rapid weight gain indicates fluid overload. The provider may need to adjust
medications, especially diuretics.
3. A client with COPD reports increasing dyspnea and productive cough. Which ABG
result indicates respiratory acidosis?
A. pH 7.50, PaCO₂ 28 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L
C. pH 7.42, PaCO₂ 40 mmHg, HCO₃⁻ 24 mEq/L
D. pH 7.60, PaCO₂ 30 mmHg, HCO₃⁻ 20 mEq/L
Answer: B
Rationale: Respiratory acidosis is caused by CO₂ retention, lowering pH (<7.35).
4. A post-operative client develops sudden chest pain, dyspnea, and tachycardia. What is
the priority nursing action?
A. Encourage coughing and deep breathing
B. Obtain a complete blood count
C. Administer prescribed analgesics
D. Assess oxygen saturation and notify provider
Answer: D
Rationale: Sudden chest pain may indicate pulmonary embolism. Immediate assessment and
provider notification are critical.
5. A client with cirrhosis develops ascites and peripheral edema. Which lab result
supports the diagnosis?
A. Increased albumin
B. Decreased albumin
C. Elevated hemoglobin
D. Low bilirubin
Answer: B
Rationale: Hypoalbuminemia reduces plasma oncotic pressure, causing fluid accumulation.
6. A client is receiving IV potassium chloride. Which assessment is most important
before administration?
A. Heart rate
,B. Bowel sounds
C. Urine output
D. Blood pressure
Answer: C
Rationale: Adequate renal function is required to excrete potassium safely.
7. A client with diabetes mellitus presents with nausea, vomiting, abdominal pain, and
fruity breath. Blood glucose is 480 mg/dL. Which complication is most likely?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Lactic acidosis
Answer: B
Rationale: DKA is characterized by hyperglycemia, metabolic acidosis, and ketones.
8. Which electrolyte imbalance is most associated with prolonged vomiting?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B
Rationale: Vomiting causes loss of gastric acid and potassium, resulting in hypokalemia.
9. A client with heart failure has an ejection fraction of 30%. Which medication improves
cardiac contractility?
A. Furosemide
B. Lisinopril
C. Digoxin
D. Metoprolol
Answer: C
Rationale: Digoxin increases myocardial contractility (positive inotrope).
10. A client presents with confusion, muscle twitching, and positive Chvostek’s sign after
thyroid surgery. Which electrolyte imbalance is suspected?
, A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypomagnesemia
Answer: B
Rationale: Hypocalcemia post-thyroidectomy occurs due to parathyroid damage; tetany and
Chvostek’s sign are key indicators.
11. A client with Addison’s disease presents with hypotension, hyponatremia, and
hyperkalemia. Which intervention is highest priority?
A. Encourage fluid intake
B. Administer IV hydrocortisone as prescribed
C. Monitor blood glucose
D. Restrict dietary potassium
Answer: B
Rationale: Acute adrenal insufficiency (Addisonian crisis) is life-threatening; IV corticosteroids
are essential.
12. A client with hypovolemic shock exhibits tachycardia, hypotension, and cool clammy
skin. Which is the priority intervention?
A. Start oxygen therapy
B. Establish IV access and begin fluid resuscitation
C. Administer vasopressors
D. Elevate legs
Answer: B
Rationale: Hypovolemic shock requires rapid fluid replacement to restore perfusion.
13. A client with hyperthyroidism reports palpitations, heat intolerance, and weight loss.
Which lab finding confirms the diagnosis?
A. Increased TSH, decreased T3/T4
B. Decreased TSH, increased T3/T4
C. Normal TSH, normal T3/T4
D. Increased TSH, increased T3/T4
Answer: B
Rationale: Hyperthyroidism shows suppressed TSH and elevated T3/T4.
