NCLEX-RN Physiological Adaptation 2
Exam (2025/2026)
Questions 1–50 – Expert-Level Pathophysiology, Critical Care, and Clinical Management
1. A patient is admitted with acute decompensated heart failure. The nurse
notes crackles in both lungs and an oxygen saturation of 88%. Which
intervention should the nurse implement first?
A. Administer IV furosemide
B. Encourage the patient to ambulate
C. Provide a high-sodium diet
D. Draw blood for BNP levels
Answer: A. Administer IV furosemide
Rationale: Pulmonary congestion and hypoxia indicate fluid overload. Loop diuretics relieve
symptoms rapidly. Ambulation and dietary changes are secondary; labs do not treat acute
symptoms.
2. A patient with chronic kidney disease presents with hyperkalemia (K⁺ 6.5
mEq/L). Which intervention has the fastest onset for lowering potassium?
A. Sodium polystyrene sulfonate
B. Insulin with glucose IV
C. Oral potassium restriction
D. Loop diuretics
Answer: B. Insulin with glucose IV
Rationale: Insulin rapidly shifts potassium into cells. Other interventions act more slowly.
3. A patient develops sudden shortness of breath, chest pain, and
tachycardia after hip surgery. Which is the priority nursing action?
A. Administer morphine
B. Apply oxygen and notify the provider
,C. Encourage deep breathing exercises
D. Monitor vital signs every 4 hours
Answer: B. Apply oxygen and notify the provider
Rationale: Sudden post-op dyspnea and chest pain suggest pulmonary embolism. Rapid
oxygen and provider notification are critical.
4. A patient with cirrhosis shows confusion, asterixis, and fetor hepaticus.
Which lab finding is most likely elevated?
A. Ammonia
B. Bilirubin
C. Creatinine
D. Sodium
Answer: A. Ammonia
Rationale: Hepatic encephalopathy is caused by ammonia accumulation due to impaired liver
metabolism.
5. Which symptom is an early sign of hypovolemic shock?
A. Hypotension
B. Tachycardia
C. Weak, thready pulse
D. Cool, clammy skin
Answer: B. Tachycardia
Rationale: Heart rate increases first to maintain perfusion; hypotension occurs later.
6. A patient is on a ventilator with ARDS. PaO₂ is 55 mmHg on 60% oxygen.
Priority action:
A. Increase FiO₂
B. Notify provider, consider prone positioning
C. Suction airway
D. Administer bronchodilator
Answer: B. Notify provider, consider prone positioning
Rationale: ARDS causes refractory hypoxemia; prone positioning improves oxygenation.
,7. Electrolyte imbalance most common in chronic alcoholism:
A. Hyperkalemia
B. Hypomagnesemia
C. Hypernatremia
D. Hypocalcemia
Answer: B. Hypomagnesemia
Rationale: Alcoholics have malnutrition, renal magnesium loss, and GI depletion.
8. Patient with DKA, K⁺ 3.2 mEq/L before insulin therapy. Priority:
A. IV potassium before insulin
B. Start insulin immediately
C. IV glucose
D. Oral potassium
Answer: A. IV potassium before insulin
Rationale: Insulin lowers K⁺, worsening hypokalemia and arrhythmia risk.
9. Earliest clinical manifestation of left-sided heart failure:
A. Peripheral edema
B. Pulmonary congestion
C. Jugular venous distension
D. Hepatomegaly
Answer: B. Pulmonary congestion
Rationale: Left-sided HF causes pulmonary venous backup.
10. Patient on digoxin reports nausea, visual changes, bradycardia. First
action:
A. Hold digoxin, notify provider
B. Give potassium
C. Check vitals in 1 hour
D. Encourage fluids
, Answer: A. Hold digoxin, notify provider
Rationale: Classic digoxin toxicity signs require immediate action.
11. A patient presents with SIADH. Which lab finding is expected?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: B. Hyponatremia
Rationale: SIADH causes water retention, diluting sodium levels.
12. A patient with COPD has PaCO₂ 60 mmHg and pH 7.32. What acid-base
disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B. Respiratory acidosis
Rationale: High CO₂ with low pH indicates respiratory acidosis due to hypoventilation.
13. A patient is receiving norepinephrine for septic shock. What parameter
should the nurse monitor closely?
A. Urine output
B. Heart rate
C. Blood pressure
D. Oxygen saturation
Answer: C. Blood pressure
Rationale: Norepinephrine is a vasopressor; BP monitoring prevents hypertensive crises.
14. Patient with pancreatitis reports severe epigastric pain radiating to the
back. Priority lab:
Exam (2025/2026)
Questions 1–50 – Expert-Level Pathophysiology, Critical Care, and Clinical Management
1. A patient is admitted with acute decompensated heart failure. The nurse
notes crackles in both lungs and an oxygen saturation of 88%. Which
intervention should the nurse implement first?
A. Administer IV furosemide
B. Encourage the patient to ambulate
C. Provide a high-sodium diet
D. Draw blood for BNP levels
Answer: A. Administer IV furosemide
Rationale: Pulmonary congestion and hypoxia indicate fluid overload. Loop diuretics relieve
symptoms rapidly. Ambulation and dietary changes are secondary; labs do not treat acute
symptoms.
2. A patient with chronic kidney disease presents with hyperkalemia (K⁺ 6.5
mEq/L). Which intervention has the fastest onset for lowering potassium?
A. Sodium polystyrene sulfonate
B. Insulin with glucose IV
C. Oral potassium restriction
D. Loop diuretics
Answer: B. Insulin with glucose IV
Rationale: Insulin rapidly shifts potassium into cells. Other interventions act more slowly.
3. A patient develops sudden shortness of breath, chest pain, and
tachycardia after hip surgery. Which is the priority nursing action?
A. Administer morphine
B. Apply oxygen and notify the provider
,C. Encourage deep breathing exercises
D. Monitor vital signs every 4 hours
Answer: B. Apply oxygen and notify the provider
Rationale: Sudden post-op dyspnea and chest pain suggest pulmonary embolism. Rapid
oxygen and provider notification are critical.
4. A patient with cirrhosis shows confusion, asterixis, and fetor hepaticus.
Which lab finding is most likely elevated?
A. Ammonia
B. Bilirubin
C. Creatinine
D. Sodium
Answer: A. Ammonia
Rationale: Hepatic encephalopathy is caused by ammonia accumulation due to impaired liver
metabolism.
5. Which symptom is an early sign of hypovolemic shock?
A. Hypotension
B. Tachycardia
C. Weak, thready pulse
D. Cool, clammy skin
Answer: B. Tachycardia
Rationale: Heart rate increases first to maintain perfusion; hypotension occurs later.
6. A patient is on a ventilator with ARDS. PaO₂ is 55 mmHg on 60% oxygen.
Priority action:
A. Increase FiO₂
B. Notify provider, consider prone positioning
C. Suction airway
D. Administer bronchodilator
Answer: B. Notify provider, consider prone positioning
Rationale: ARDS causes refractory hypoxemia; prone positioning improves oxygenation.
,7. Electrolyte imbalance most common in chronic alcoholism:
A. Hyperkalemia
B. Hypomagnesemia
C. Hypernatremia
D. Hypocalcemia
Answer: B. Hypomagnesemia
Rationale: Alcoholics have malnutrition, renal magnesium loss, and GI depletion.
8. Patient with DKA, K⁺ 3.2 mEq/L before insulin therapy. Priority:
A. IV potassium before insulin
B. Start insulin immediately
C. IV glucose
D. Oral potassium
Answer: A. IV potassium before insulin
Rationale: Insulin lowers K⁺, worsening hypokalemia and arrhythmia risk.
9. Earliest clinical manifestation of left-sided heart failure:
A. Peripheral edema
B. Pulmonary congestion
C. Jugular venous distension
D. Hepatomegaly
Answer: B. Pulmonary congestion
Rationale: Left-sided HF causes pulmonary venous backup.
10. Patient on digoxin reports nausea, visual changes, bradycardia. First
action:
A. Hold digoxin, notify provider
B. Give potassium
C. Check vitals in 1 hour
D. Encourage fluids
, Answer: A. Hold digoxin, notify provider
Rationale: Classic digoxin toxicity signs require immediate action.
11. A patient presents with SIADH. Which lab finding is expected?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: B. Hyponatremia
Rationale: SIADH causes water retention, diluting sodium levels.
12. A patient with COPD has PaCO₂ 60 mmHg and pH 7.32. What acid-base
disorder is present?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B. Respiratory acidosis
Rationale: High CO₂ with low pH indicates respiratory acidosis due to hypoventilation.
13. A patient is receiving norepinephrine for septic shock. What parameter
should the nurse monitor closely?
A. Urine output
B. Heart rate
C. Blood pressure
D. Oxygen saturation
Answer: C. Blood pressure
Rationale: Norepinephrine is a vasopressor; BP monitoring prevents hypertensive crises.
14. Patient with pancreatitis reports severe epigastric pain radiating to the
back. Priority lab:
