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NCLEX-RN Alterations in body systems practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Alterations in body systems sits inside the Physiological Adaptation category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Alterations in body systems sample questions

Question 1

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
Show the answer and explanation

Correct answer: A

Acute pancreatitis releases pancreatic enzymes into the bloodstream. A serum amylase of 800 U/L is several times the upper limit of normal and, with severe epigastric pain radiating to the back, is the finding most consistent with this condition.

Why the other options are wrong:
B: A BUN of 12 mg/dL is normal and does not suggest pancreatitis.
C: A glucose of 90 mg/dL is normal; pancreatitis more often raises glucose.
D: A bilirubin of 0.8 mg/dL is normal and does not support the diagnosis.

Question 2

A 66-year-old client with a history of chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. The client's arterial blood gas results on room air are: pH 7.31, PaCO2 58 mm Hg, PaO2 55 mm Hg, HCO3 26 mEq/L. The nurse administers oxygen at 2 L/min via nasal cannula. One hour later, the client's respiratory rate has decreased from 28 to 18 breaths per minute, and the client is somnolent. What is the nurse's priority action?

  1. A Increase the oxygen flow rate to 4 L/min to improve oxygenation.
  2. B Prepare to assist with noninvasive positive pressure ventilation (BiPAP).
  3. C Reposition the client to a high-Fowler's position and encourage coughing.
  4. D Administer albuterol via nebulizer to relieve bronchospasm.
Show the answer and explanation

Correct answer: B

After oxygen was started, the client's respiratory rate fell and somnolence developed, signaling worsening hypercapnia and CO2 narcosis. Noninvasive positive pressure ventilation supports breathing and lowers the PaCO2.

Why the other options are wrong:
A: More oxygen can further worsen CO2 retention in this client.
C: Positioning and coughing cannot reverse acute hypercapnic respiratory failure.
D: Albuterol treats bronchospasm, not hypoventilation and CO2 narcosis.

Question 3

A 34-year-old client is brought to the emergency department after a high-voltage electrical injury to the left arm. The nurse observes a small entry wound on the left palm and a large exit wound on the left axilla. The client's left arm is cool, mottled, and without palpable pulses. Which assessment finding requires the most immediate action?

  1. A Capillary refill of 5 seconds in the left fingernail beds
  2. B Left upper arm circumference increased by 4 cm in 2 hours
  3. C Serum creatinine kinase level of 45,000 units/L
  4. D Blood pressure of 104/68 mm Hg and heart rate of 112 beats/min
Show the answer and explanation

Correct answer: B

A 4 cm increase in arm circumference over 2 hours, in a cool, mottled, pulseless limb, shows rapidly rising pressure from deep muscle damage. Compartment syndrome threatens the limb within hours and requires immediate surgical decompression, such as fasciotomy.

Why the other options are wrong:
A: Delayed capillary refill confirms poor perfusion already evident from the absent pulses; the rapidly increasing swelling is what demands emergency decompression.
C: A high CK signals rhabdomyolysis that needs aggressive fluids and kidney monitoring, but the limb-threatening compartment syndrome is more time-critical.
D: Mild tachycardia with an acceptable blood pressure needs monitoring and fluid resuscitation but is not the most urgent problem.

Question 4

A 60-year-old client with end-stage renal disease on hemodialysis is admitted with confusion, muscle cramps, and a serum potassium level of 6.8 mEq/L. The cardiac monitor shows peaked T waves. Which nursing intervention should the nurse implement first?

  1. A Give 30 mL of calcium gluconate intravenously over 5 minutes.
  2. B Administer 10 units of regular insulin intravenously with 50 mL of 50% dextrose.
  3. C Administer 30 grams of sodium polystyrene sulfonate orally.
  4. D Call the dialysis unit to schedule an urgent hemodialysis session.
Show the answer and explanation

Correct answer: A

A potassium of 6.8 mEq/L with peaked T waves is an emergency. IV calcium gluconate acts within minutes to stabilize the cardiac cell membrane and protect against dysrhythmias, so it comes first, followed by treatments that shift or remove potassium.

Why the other options are wrong:
B: Insulin with dextrose shifts potassium into cells and is the next step, but it does not protect the heart as quickly as calcium.
C: Sodium polystyrene sulfonate acts slowly over hours and is not used for emergency treatment when ECG changes are present.
D: Dialysis definitively removes potassium but takes time to arrange; the heart must be protected first.

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