NCLEX-RN Physiological Adaptation practice questions

Question 1

A 28-year-old client with acute asthma exacerbation is receiving a continuous albuterol nebulizer treatment. The client's respiratory rate is 38 breaths/min, SpO2 89% on 4 L oxygen via nasal cannula, and peak expiratory flow rate is 30% of predicted. Which intervention should the nurse anticipate next?

1. A Discontinue the nebulizer and administer intravenous aminophylline.
2. B Prepare for noninvasive positive pressure ventilation.
3. C Switch to a metered-dose inhaler with a spacer.
4. D Apply a non-rebreather mask at 15 L/min.

Question 2

A 45-year-old client is admitted to the medical-surgical unit with acute pancreatitis. The nurse notes severe epigastric pain radiating to the back, nausea, and vomiting. Vital signs: temperature 38.5°C, heart rate 110 bpm, blood pressure 90/60 mm Hg, respiratory rate 22 breaths/min. Which laboratory value is most consistent with this condition?

1. A Serum amylase 800 U/L
2. B Blood urea nitrogen 12 mg/dL
3. C Serum glucose 90 mg/dL
4. D Serum bilirubin 0.8 mg/dL

Question 3

A 58-year-old client post-abdominal surgery has a surgical wound with a closed drainage system. On day 3, the nurse observes that the wound drainage has changed from serosanguineous to purulent, and the client’s temperature is 38.6°C (101.5°F). The wound edges are red and edematous. Which action should the nurse take first?

1. A Notify the healthcare provider of the change in wound status
2. B Remove the drainage system and apply a dry sterile dressing
3. C Irrigate the wound with sterile normal saline and pack it
4. D Obtain a wound culture and then apply a sterile dressing

Question 4

A 52-year-old client with diabetic ketoacidosis has the following arterial blood gas results: pH 7.22, PaCO2 28 mm Hg, HCO3 12 mEq/L, PaO2 95 mm Hg. The nurse reviews the client's serum potassium level of 5.8 mEq/L. Which condition does the nurse identify?

1. A Mixed metabolic acidosis and respiratory acidosis
2. B Metabolic alkalosis with respiratory compensation
3. C Metabolic acidosis with partial respiratory compensation
4. D Respiratory alkalosis with metabolic compensation

Question 5

A 52-year-old client with acute myeloid leukemia is receiving their first dose of intravenous cytarabine. Fifteen minutes into the infusion, the client reports sudden chest tightness, dyspnea, and a feeling of throat swelling. Vital signs: heart rate 124 bpm, blood pressure 86/50 mm Hg, respiratory rate 28/min, oxygen saturation 89% on room air. The nurse notes urticaria on the client's trunk. What is the nurse's priority action?

1. A Apply a non-rebreather mask at 15 L/min and prepare for intubation.
2. B Stop the cytarabine infusion immediately and maintain the IV access.
3. C Administer epinephrine 0.3 mg intramuscularly in the anterolateral thigh.
4. D Slow the cytarabine infusion rate and administer diphenhydramine 50 mg IV.

Question 6

A 66-year-old client with pneumonia is receiving oxygen at 4 L/min via nasal cannula. The nurse assesses the client and finds the respiratory rate is 24 breaths per minute, oxygen saturation is 91%, and the client is using accessory muscles. Arterial blood gas results show pH 7.32, PaCO2 48 mm Hg, PaO2 58 mm Hg, HCO3 24 mEq/L. The nurse notifies the provider. Which prescription should the nurse anticipate?

1. A Prepare for endotracheal intubation and mechanical ventilation due to acute respiratory failure.
2. B Administer albuterol 2.5 mg via nebulizer and reassess oxygen saturation in 15 minutes.
3. C Increase oxygen to 6 L/min via nasal cannula and repeat arterial blood gas in 1 hour.
4. D Initiate non-invasive positive pressure ventilation (NIPPV) with bi-level positive airway pressure.

Question 7

A 78-year-old client in the intensive care unit with acute kidney injury has a serum creatinine of 4.2 mg/dL, BUN of 88 mg/dL, and urine output of 100 mL over the past 12 hours. The nurse reviews the most recent laboratory results and finds a serum potassium of 6.8 mEq/L. Which finding on the cardiac monitor requires immediate action?

1. A PR interval of 0.18 seconds
2. B First-degree atrioventricular block with a heart rate of 62/min
3. C U waves in the precordial leads
4. D Widened QRS complexes with absent P waves

Question 8

A 72-year-old client with chronic obstructive pulmonary disease (COPD) is admitted with acute dyspnea and a productive cough with thick yellow sputum. Vital signs: BP 140/88 mm Hg, HR 96/min, RR 28/min, temperature 38.4°C, oxygen saturation 89% on room air. Which nursing intervention is most important to implement first?

1. A Administer bronchodilator therapy via nebulizer as prescribed
2. B Start intravenous access with a 20-gauge catheter as prescribed
3. C Place the client in a high-Fowler's position and apply oxygen
4. D Obtain a sputum specimen for culture and sensitivity

Question 9

A 72-year-old client in a long-term care facility has a history of heart failure and is receiving furosemide 40 mg daily. The nurse notes that the client has a new onset of confusion, dry mouth, and muscle cramps. Vital signs are: blood pressure 102/68 mm Hg, heart rate 102 beats/min, respiratory rate 18 breaths/min, oxygen saturation 96% on room air. Which laboratory value should the nurse review first?

1. A Serum sodium 138 mEq/L
2. B Serum creatinine 1.1 mg/dL
3. C Serum potassium 3.0 mEq/L
4. D Serum glucose 110 mg/dL

Question 10

A 76-year-old client with chronic kidney disease stage 4 is admitted to the medical unit with confusion and muscle weakness. The serum potassium level is 6.8 mEq/L. The nurse reviews the electrocardiogram and sees tall, peaked T waves. Which intervention should the nurse implement first?

1. A Administer intravenous regular insulin 10 units with 50 mL of 50% dextrose.
2. B Administer oral sodium polystyrene sulfonate 15 grams.
3. C Administer intravenous calcium gluconate 10% 10 mL over 5 minutes.
4. D Administer intravenous 0.9% sodium chloride at 100 mL per hour.