NCLEX-RN Physiological Adaptation 2 Exam
(2025/2026) – Verified Questions & Answers
for Advanced Pathophysiology, Complex
Clinical Management, and NCLEX®-RN®
Mastery
A patient presents with crushing chest pain and ST elevation on ECG. The priority immediate
intervention is:
A. Give oral aspirin only
B. IV antibiotics
C. Initiate reperfusion therapy (PCI or thrombolytics) and give aspirin
D. Start insulin infusion
Answer: C. Initiate reperfusion therapy (PCI or thrombolytics) and give aspirin
Rationale: STEMI requires urgent reperfusion plus antiplatelet therapy to limit myocardial
damage.
,1. The most specific cardiac biomarker for 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 remain elevated after myocardial injury.
2. Classic symptoms of left-sided heart failure include:
A. Peripheral edema and hepatomegaly
B. Pulmonary congestion and dyspnea
C. Jaundice and pruritus
D. Hematuria only
Answer: B. Pulmonary congestion and dyspnea
Rationale: Left ventricular failure usually produces pulmonary symptoms due to
congestion.
3. Atrial fibrillation increases stroke risk primarily because:
A. It causes myocardial infarction
B. It promotes stasis in the atria leading to thrombus formation
C. It lowers blood pressure only
D. It causes hyperglycemia
Answer: B. It promotes stasis in the atria leading to thrombus formation
Rationale: Ineffective atrial contraction leads to clot formation, increasing embolic
stroke risk.
4. An ABI (ankle-brachial index) of 0.6 indicates:
A. Normal perfusion
B. Mild PAD
C. Moderate to severe peripheral arterial disease
D. Venous insufficiency
Answer: C. Moderate to severe peripheral arterial disease
Rationale: ABI <0.9 indicates PAD; 0.4–0.7 suggests moderate disease.
5. The murmur of aortic stenosis is typically loudest at:
A. Left lower sternal border
B. Right upper sternal border and radiates to the carotids
C. Apex only
D. Back only
Answer: B. Right upper sternal border and radiates to the carotids
Rationale: Aortic stenosis is a systolic ejection murmur best heard at the right upper
sternal border with carotid radiation.
,6. BNP is elevated in heart failure because:
A. It is released by the liver during hypoxia
B. It is secreted by ventricles in response to stretch
C. It indicates renal failure only
D. It measures pulmonary artery pressure only
Answer: B. It is secreted by ventricles in response to stretch
Rationale: Ventricular stretch triggers BNP release, correlating with volume/pressure
overload.
7. The immediate treatment for symptomatic bradycardia (hemodynamic instability) is:
A. Oral beta-blocker
B. Atropine IV, and if ineffective, pacing or IV chronotropes
C. Give insulin
D. Observe only
Answer: B. Atropine IV, and if ineffective, pacing or IV chronotropes
Rationale: Atropine is first-line for symptomatic bradycardia; pacing or infusions if
refractory.
8. A patient on warfarin with mechanical valve typically has an INR goal of:
A. 0.5–1.0
B. 1.0–1.5
C. 2.5–3.5 (often higher than standard)
D. 4.5–5.5
Answer: C. 2.5–3.5 (often higher than standard)
Rationale: Mechanical valves usually require a higher therapeutic INR range than atrial
fibrillation alone.
9. The best initial test for suspected acute aortic dissection is:
A. Chest x-ray only
B. CT angiography of chest (if stable) or transesophageal echo if unstable
C. MRI only
D. Echocardiogram only
Answer: B. CT angiography of chest (if stable) or transesophageal echo if
unstable
Rationale: CTPA/CTA visualizes the dissection; TEE is useful if unstable and in
OR/ICU.
10.A patient with acute pulmonary edema should be positioned:
A. Trendelenburg
B. Supine
C. Upright (high-Fowler’s) with legs down
D. Prone
Answer: C. Upright (high-Fowler’s) with legs down
, Rationale: Upright position reduces venous return and improves ventilation.
11.Acute pericarditis pain typically improves with:
A. Lying flat
B. Sitting forward and leaning forward
C. Deep inspiration
D. Eating
Answer: B. Sitting forward and leaning forward
Rationale: Pericardial pain is relieved by sitting forward reducing pericardial pressure.
12.A patient with acute MI receives tPA. A contraindication to tPA is:
A. Recent intracranial hemorrhage or hemorrhagic stroke
B. Mild hypertension controlled with meds
C. Age 60 only
D. Non-smoker status
Answer: A. Recent intracranial hemorrhage or hemorrhagic stroke
Rationale: History of hemorrhagic stroke is an absolute contraindication to
thrombolysis.
13.The most common cause of right-sided heart failure is:
A. Left-sided heart failure leading to increased pulmonary pressures
B. Liver disease only
C. Kidney stones only
D. Pancreatitis only
Answer: A. Left-sided heart failure leading to increased pulmonary pressures
Rationale: Chronic left HF raises pulmonary pressures, causing right ventricular failure.
14.In hypovolemic shock, expected vital sign pattern includes:
A. Bradycardia and hypertension
B. Tachycardia, hypotension, and cold clammy skin
C. Warm flushed skin and bounding pulses
D. Normal vitals
Answer: B. Tachycardia, hypotension, and cold clammy skin
Rationale: Compensatory tachycardia and vasoconstriction lead to hypotension and
cool extremities.
15.Treatment for symptomatic ventricular tachycardia without pulse:
A. IV amiodarone only
B. Immediate unsynchronized (defibrillation) CPR and defibrillation per ACLS
C. Give oral antiemetic
D. Observe
Answer: B. Immediate unsynchronized (defibrillation) CPR and defibrillation per
ACLS
(2025/2026) – Verified Questions & Answers
for Advanced Pathophysiology, Complex
Clinical Management, and NCLEX®-RN®
Mastery
A patient presents with crushing chest pain and ST elevation on ECG. The priority immediate
intervention is:
A. Give oral aspirin only
B. IV antibiotics
C. Initiate reperfusion therapy (PCI or thrombolytics) and give aspirin
D. Start insulin infusion
Answer: C. Initiate reperfusion therapy (PCI or thrombolytics) and give aspirin
Rationale: STEMI requires urgent reperfusion plus antiplatelet therapy to limit myocardial
damage.
,1. The most specific cardiac biomarker for 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 remain elevated after myocardial injury.
2. Classic symptoms of left-sided heart failure include:
A. Peripheral edema and hepatomegaly
B. Pulmonary congestion and dyspnea
C. Jaundice and pruritus
D. Hematuria only
Answer: B. Pulmonary congestion and dyspnea
Rationale: Left ventricular failure usually produces pulmonary symptoms due to
congestion.
3. Atrial fibrillation increases stroke risk primarily because:
A. It causes myocardial infarction
B. It promotes stasis in the atria leading to thrombus formation
C. It lowers blood pressure only
D. It causes hyperglycemia
Answer: B. It promotes stasis in the atria leading to thrombus formation
Rationale: Ineffective atrial contraction leads to clot formation, increasing embolic
stroke risk.
4. An ABI (ankle-brachial index) of 0.6 indicates:
A. Normal perfusion
B. Mild PAD
C. Moderate to severe peripheral arterial disease
D. Venous insufficiency
Answer: C. Moderate to severe peripheral arterial disease
Rationale: ABI <0.9 indicates PAD; 0.4–0.7 suggests moderate disease.
5. The murmur of aortic stenosis is typically loudest at:
A. Left lower sternal border
B. Right upper sternal border and radiates to the carotids
C. Apex only
D. Back only
Answer: B. Right upper sternal border and radiates to the carotids
Rationale: Aortic stenosis is a systolic ejection murmur best heard at the right upper
sternal border with carotid radiation.
,6. BNP is elevated in heart failure because:
A. It is released by the liver during hypoxia
B. It is secreted by ventricles in response to stretch
C. It indicates renal failure only
D. It measures pulmonary artery pressure only
Answer: B. It is secreted by ventricles in response to stretch
Rationale: Ventricular stretch triggers BNP release, correlating with volume/pressure
overload.
7. The immediate treatment for symptomatic bradycardia (hemodynamic instability) is:
A. Oral beta-blocker
B. Atropine IV, and if ineffective, pacing or IV chronotropes
C. Give insulin
D. Observe only
Answer: B. Atropine IV, and if ineffective, pacing or IV chronotropes
Rationale: Atropine is first-line for symptomatic bradycardia; pacing or infusions if
refractory.
8. A patient on warfarin with mechanical valve typically has an INR goal of:
A. 0.5–1.0
B. 1.0–1.5
C. 2.5–3.5 (often higher than standard)
D. 4.5–5.5
Answer: C. 2.5–3.5 (often higher than standard)
Rationale: Mechanical valves usually require a higher therapeutic INR range than atrial
fibrillation alone.
9. The best initial test for suspected acute aortic dissection is:
A. Chest x-ray only
B. CT angiography of chest (if stable) or transesophageal echo if unstable
C. MRI only
D. Echocardiogram only
Answer: B. CT angiography of chest (if stable) or transesophageal echo if
unstable
Rationale: CTPA/CTA visualizes the dissection; TEE is useful if unstable and in
OR/ICU.
10.A patient with acute pulmonary edema should be positioned:
A. Trendelenburg
B. Supine
C. Upright (high-Fowler’s) with legs down
D. Prone
Answer: C. Upright (high-Fowler’s) with legs down
, Rationale: Upright position reduces venous return and improves ventilation.
11.Acute pericarditis pain typically improves with:
A. Lying flat
B. Sitting forward and leaning forward
C. Deep inspiration
D. Eating
Answer: B. Sitting forward and leaning forward
Rationale: Pericardial pain is relieved by sitting forward reducing pericardial pressure.
12.A patient with acute MI receives tPA. A contraindication to tPA is:
A. Recent intracranial hemorrhage or hemorrhagic stroke
B. Mild hypertension controlled with meds
C. Age 60 only
D. Non-smoker status
Answer: A. Recent intracranial hemorrhage or hemorrhagic stroke
Rationale: History of hemorrhagic stroke is an absolute contraindication to
thrombolysis.
13.The most common cause of right-sided heart failure is:
A. Left-sided heart failure leading to increased pulmonary pressures
B. Liver disease only
C. Kidney stones only
D. Pancreatitis only
Answer: A. Left-sided heart failure leading to increased pulmonary pressures
Rationale: Chronic left HF raises pulmonary pressures, causing right ventricular failure.
14.In hypovolemic shock, expected vital sign pattern includes:
A. Bradycardia and hypertension
B. Tachycardia, hypotension, and cold clammy skin
C. Warm flushed skin and bounding pulses
D. Normal vitals
Answer: B. Tachycardia, hypotension, and cold clammy skin
Rationale: Compensatory tachycardia and vasoconstriction lead to hypotension and
cool extremities.
15.Treatment for symptomatic ventricular tachycardia without pulse:
A. IV amiodarone only
B. Immediate unsynchronized (defibrillation) CPR and defibrillation per ACLS
C. Give oral antiemetic
D. Observe
Answer: B. Immediate unsynchronized (defibrillation) CPR and defibrillation per
ACLS
