NCLEX-RN Physiological Adaptation 1 Exam
(2025/2026) – Verified Questions & Answers
for Advanced Pathophysiology, Complex
Clinical Management, and NCLEX®-RN®
Mastery
Question 1:
A patient with chronic heart failure reports increasing shortness of breath and fatigue. On
assessment, you note crackles in the lungs and mild peripheral edema. Which intervention
should the nurse implement first?
A. Administer a prescribed diuretic
B. Encourage ambulation
C. Elevate the head of the bed
D. Restrict oral fluid intake
Answer: C. Elevate the head of the bed
Rationale: Elevating the head of the bed improves lung expansion and oxygenation, reducing
respiratory distress. Diuretics and fluid restriction are important but addressing immediate
hypoxia takes priority in acute care.
Question 2:
A patient with acute myocardial infarction develops hypotension, tachycardia, and cool clammy
,skin. Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Septic
D. Neurogenic
Answer: A. Cardiogenic
Rationale: Cardiogenic shock occurs when the heart cannot pump effectively, leading to
hypotension, tachycardia, and poor perfusion. Hypovolemic shock is related to fluid loss, septic
shock to infection, and neurogenic shock to spinal cord injury.
Question 3:
A patient with acute kidney injury has a serum potassium level of 6.2 mEq/L. Which action
should the nurse implement first?
A. Administer Kayexalate as prescribed
B. Initiate cardiac monitoring
C. Restrict dietary potassium
D. Notify the provider
Answer: B. Initiate cardiac monitoring
Rationale: Hyperkalemia can cause life-threatening arrhythmias. Immediate cardiac monitoring
is essential while preparing other interventions, such as Kayexalate or dietary restriction.
Question 4:
A patient with diabetic ketoacidosis (DKA) has Kussmaul respirations and fruity-smelling breath.
Which laboratory value is most consistent with this condition?
A. Hypernatremia
B. Hypoglycemia
C. Metabolic acidosis
D. Respiratory alkalosis
Answer: C. Metabolic acidosis
Rationale: DKA leads to accumulation of ketoacids, causing metabolic acidosis. Kussmaul
respirations are a compensatory mechanism to blow off CO₂. Fruity breath is due to acetone.
Question 5:
A patient with COPD has an oxygen saturation of 88% on room air. Which intervention is
,appropriate?
A. Administer high-flow oxygen at 10 L/min
B. Encourage pursed-lip breathing
C. Place the patient in supine position
D. Restrict fluid intake
Answer: B. Encourage pursed-lip breathing
Rationale: Pursed-lip breathing helps prolong exhalation, improving ventilation and gas
exchange. High-flow oxygen may suppress hypoxic drive in COPD. Upright position is preferred,
and fluid restriction is unrelated.
Question 6:
A patient with cirrhosis develops ascites and peripheral edema. Which laboratory result is most
relevant to monitor?
A. Serum sodium
B. Hemoglobin
C. Platelet count
D. Blood glucose
Answer: A. Serum sodium
Rationale: Cirrhosis can cause fluid retention and hyponatremia due to impaired renal handling
of sodium. Monitoring serum sodium is essential to prevent complications like hepatic
encephalopathy.
Question 7:
A patient presents with sudden, severe shortness of breath, hypotension, and distended neck
veins. What is the most likely cause?
A. Tension pneumothorax
B. Pulmonary embolism
C. Asthma exacerbation
D. Pneumonia
Answer: A. Tension pneumothorax
Rationale: Tension pneumothorax causes air trapping, mediastinal shift, hypotension, and JVD.
Pulmonary embolism and asthma can cause dyspnea, but hypotension with distended neck
veins is classic for tension pneumothorax.
, Question 8:
A patient with an acute stroke has right-sided hemiplegia and aphasia. Which nursing
intervention is a priority?
A. Encourage ambulation
B. Assess swallowing before giving food
C. Provide emotional support
D. Perform passive range-of-motion exercises
Answer: B. Assess swallowing before giving food
Rationale: Stroke patients are at high risk for aspiration. Swallowing assessment ensures safe
oral intake before feeding. Mobility and emotional support are important but secondary.
Question 9:
A patient with sepsis is hypotensive and tachycardic. Which IV fluid is most appropriate for
initial resuscitation?
A. 0.9% Normal saline
B. D5W
C. Lactated Ringer’s
D. 3% NaCl
Answer: C. Lactated Ringer’s
Rationale: Lactated Ringer’s is isotonic and preferred for fluid resuscitation in sepsis. Normal
saline is acceptable, but LR helps correct acidosis. D5W is hypotonic, and 3% NaCl is
hypertonic, unsuitable for initial resuscitation.
Question 10:
A patient with hyperthyroidism reports palpitations, weight loss, and heat intolerance. Which lab
value would confirm the diagnosis?
A. Elevated TSH
B. Elevated T3 and T4
C. Low calcium
D. Low cortisol
Answer: B. Elevated T3 and T4
Rationale: Hyperthyroidism is characterized by high circulating thyroid hormones (T3, T4) with
suppressed TSH. Symptoms correlate with increased metabolism.
(2025/2026) – Verified Questions & Answers
for Advanced Pathophysiology, Complex
Clinical Management, and NCLEX®-RN®
Mastery
Question 1:
A patient with chronic heart failure reports increasing shortness of breath and fatigue. On
assessment, you note crackles in the lungs and mild peripheral edema. Which intervention
should the nurse implement first?
A. Administer a prescribed diuretic
B. Encourage ambulation
C. Elevate the head of the bed
D. Restrict oral fluid intake
Answer: C. Elevate the head of the bed
Rationale: Elevating the head of the bed improves lung expansion and oxygenation, reducing
respiratory distress. Diuretics and fluid restriction are important but addressing immediate
hypoxia takes priority in acute care.
Question 2:
A patient with acute myocardial infarction develops hypotension, tachycardia, and cool clammy
,skin. Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Septic
D. Neurogenic
Answer: A. Cardiogenic
Rationale: Cardiogenic shock occurs when the heart cannot pump effectively, leading to
hypotension, tachycardia, and poor perfusion. Hypovolemic shock is related to fluid loss, septic
shock to infection, and neurogenic shock to spinal cord injury.
Question 3:
A patient with acute kidney injury has a serum potassium level of 6.2 mEq/L. Which action
should the nurse implement first?
A. Administer Kayexalate as prescribed
B. Initiate cardiac monitoring
C. Restrict dietary potassium
D. Notify the provider
Answer: B. Initiate cardiac monitoring
Rationale: Hyperkalemia can cause life-threatening arrhythmias. Immediate cardiac monitoring
is essential while preparing other interventions, such as Kayexalate or dietary restriction.
Question 4:
A patient with diabetic ketoacidosis (DKA) has Kussmaul respirations and fruity-smelling breath.
Which laboratory value is most consistent with this condition?
A. Hypernatremia
B. Hypoglycemia
C. Metabolic acidosis
D. Respiratory alkalosis
Answer: C. Metabolic acidosis
Rationale: DKA leads to accumulation of ketoacids, causing metabolic acidosis. Kussmaul
respirations are a compensatory mechanism to blow off CO₂. Fruity breath is due to acetone.
Question 5:
A patient with COPD has an oxygen saturation of 88% on room air. Which intervention is
,appropriate?
A. Administer high-flow oxygen at 10 L/min
B. Encourage pursed-lip breathing
C. Place the patient in supine position
D. Restrict fluid intake
Answer: B. Encourage pursed-lip breathing
Rationale: Pursed-lip breathing helps prolong exhalation, improving ventilation and gas
exchange. High-flow oxygen may suppress hypoxic drive in COPD. Upright position is preferred,
and fluid restriction is unrelated.
Question 6:
A patient with cirrhosis develops ascites and peripheral edema. Which laboratory result is most
relevant to monitor?
A. Serum sodium
B. Hemoglobin
C. Platelet count
D. Blood glucose
Answer: A. Serum sodium
Rationale: Cirrhosis can cause fluid retention and hyponatremia due to impaired renal handling
of sodium. Monitoring serum sodium is essential to prevent complications like hepatic
encephalopathy.
Question 7:
A patient presents with sudden, severe shortness of breath, hypotension, and distended neck
veins. What is the most likely cause?
A. Tension pneumothorax
B. Pulmonary embolism
C. Asthma exacerbation
D. Pneumonia
Answer: A. Tension pneumothorax
Rationale: Tension pneumothorax causes air trapping, mediastinal shift, hypotension, and JVD.
Pulmonary embolism and asthma can cause dyspnea, but hypotension with distended neck
veins is classic for tension pneumothorax.
, Question 8:
A patient with an acute stroke has right-sided hemiplegia and aphasia. Which nursing
intervention is a priority?
A. Encourage ambulation
B. Assess swallowing before giving food
C. Provide emotional support
D. Perform passive range-of-motion exercises
Answer: B. Assess swallowing before giving food
Rationale: Stroke patients are at high risk for aspiration. Swallowing assessment ensures safe
oral intake before feeding. Mobility and emotional support are important but secondary.
Question 9:
A patient with sepsis is hypotensive and tachycardic. Which IV fluid is most appropriate for
initial resuscitation?
A. 0.9% Normal saline
B. D5W
C. Lactated Ringer’s
D. 3% NaCl
Answer: C. Lactated Ringer’s
Rationale: Lactated Ringer’s is isotonic and preferred for fluid resuscitation in sepsis. Normal
saline is acceptable, but LR helps correct acidosis. D5W is hypotonic, and 3% NaCl is
hypertonic, unsuitable for initial resuscitation.
Question 10:
A patient with hyperthyroidism reports palpitations, weight loss, and heat intolerance. Which lab
value would confirm the diagnosis?
A. Elevated TSH
B. Elevated T3 and T4
C. Low calcium
D. Low cortisol
Answer: B. Elevated T3 and T4
Rationale: Hyperthyroidism is characterized by high circulating thyroid hormones (T3, T4) with
suppressed TSH. Symptoms correlate with increased metabolism.
