Free NCLEX-RN Physiological Adaptation Questions
Free NCLEX-RN physiological adaptation practice questions with rationales — managing acute, unstable, and chronic conditions.
A client is in early hypovolemic shock after trauma. Which compensatory findings should the nurse anticipate before blood pressure drops significantly? Select all that apply.
- A.Tachycardia
- B.Cool, pale skin with delayed capillary refill
- C.Decreasing urine output
- D.Bounding peripheral pulses with flushed skin
- E.Restlessness and anxiety
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Correct answers: A, B, C, E
In early shock the body protects the core by shunting blood away from the skin, kidneys, and periphery, so the pressure can look normal while the warning signs build. The heart speeds up to keep cardiac output, giving tachycardia. Vasoconstriction makes skin cool and pale with slow refill, and the kidneys cut output to conserve volume. Falling cerebral perfusion shows first as restlessness and anxiety. A late drop in blood pressure means compensation has failed, so catching these early cues saves time.
Why the other options are wrong
- D. Bounding pulses and flushed warm skin reflect vasodilation, which is the opposite of the vasoconstriction seen in hypovolemic shock.
Key takeaway: Early hypovolemic shock shows tachycardia, cool pale skin, falling urine output, and restlessness while blood pressure is still maintained.
A client receiving treatment for severe hyponatremia (serum sodium 116 mEq/L) is started on a 3% hypertonic saline infusion. Which nursing actions are appropriate during this therapy? Select all that apply.
- A.Monitor serum sodium frequently to avoid raising it too quickly
- B.Assess the lungs for crackles and watch for fluid overload
- C.Perform frequent neurologic checks
- D.Encourage the client to drink large amounts of free water
- E.Infuse the hypertonic saline through a controlled infusion pump
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Correct answers: A, B, C, E
With hypertonic saline, slow and controlled is the rule, because correcting sodium too fast injures the brain. Raising serum sodium too quickly can cause osmotic demyelination, so the nurse monitors levels closely and runs the fluid on a pump for a precise rate. Neuro checks catch both worsening hyponatremia and overcorrection. The concentrated salt also pulls fluid into the vessels, so lung assessment guards against overload. Pushing free water would dilute sodium further and undo the therapy.
Why the other options are wrong
- D. Drinking large amounts of free water lowers sodium further, working against the correction and worsening hyponatremia.
Key takeaway: Hypertonic saline must be raised slowly on a pump with close sodium, neuro, and fluid-overload monitoring to prevent osmotic demyelination.
A client with Graves disease is admitted with thyroid storm: temperature 40.2 C, heart rate 160 and irregular, agitation, and vomiting. Which findings and interventions are consistent with safe management of thyroid storm? Select all that apply.
- A.Administering a beta blocker such as propranolol to control heart rate and tremor
- B.Applying active cooling measures and acetaminophen for hyperthermia
- C.Giving aspirin as the preferred antipyretic
- D.Administering an antithyroid drug such as propylthiouracil
- E.Expecting the heart rate to trend down toward 100 as treatment takes effect
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Correct answers: A, B, D, E
Thyroid storm management hits the problem from several angles: beta blockers blunt the adrenergic surge (rate, tremor, agitation), antithyroid drugs like propylthiouracil stop new hormone synthesis, and hyperthermia is treated with cooling plus acetaminophen. A falling heart rate toward 100 shows the plan is working, which is how you evaluate the outcome. Aspirin is avoided because it displaces thyroid hormone from binding proteins and raises free hormone levels, worsening the crisis. Acetaminophen is the antipyretic of choice here.
Why the other options are wrong
- C. Aspirin displaces thyroid hormone from protein binding, raising free hormone and worsening the storm; use acetaminophen.
Key takeaway: In thyroid storm, use beta blockers, antithyroid drugs, and cooling with acetaminophen; avoid aspirin.
A client in diabetic ketoacidosis is on an insulin infusion. Initial glucose was 620 mg/dL; it is now 250 mg/dL. The serum bicarbonate is still low and the anion gap remains elevated. What does the nurse anticipate the provider will order next?
- A.Stop the insulin infusion immediately
- B.Add dextrose to the IV fluids and continue the insulin infusion
- C.Give a 50 mL ampule of dextrose 50% IV push
- D.Begin a continuous IV bicarbonate drip
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Correct answer: B
In DKA the goal is to clear ketones and close the anion gap, not just lower glucose. Insulin must keep running until the gap normalizes and bicarbonate recovers. Once glucose reaches roughly 200-250 mg/dL, you add dextrose to the fluids so the insulin can continue safely without causing hypoglycemia. Here the gap is still open and bicarbonate is still low, so the acidosis is unresolved. Stopping insulin would let ketogenesis restart. Adding dextrose and continuing insulin treats the acidosis while preventing a glucose crash.
Why the other options are wrong
- A. Tempting because glucose is nearly normal, but stopping insulin reopens ketogenesis and stalls gap closure.
- C. A D50 push treats symptomatic hypoglycemia; this client is at 250 mg/dL, not hypoglycemic.
- D. Bicarbonate is reserved for severe acidosis (pH < 6.9) and does not address the underlying ketosis here.
Key takeaway: In DKA, keep insulin running until the anion gap closes; add dextrose when glucose nears 200-250 mg/dL.
A client with a COPD exacerbation is receiving oxygen at 2 L/min by nasal cannula and reports feeling better. A new nurse wants to increase the oxygen to 6 L/min to push the saturation above 95%. What is the best response?
- A."Let's keep the flow low and target a saturation around 88 to 92 percent for this client."
- B."Go ahead, higher oxygen is always safer in respiratory distress."
- C."We should switch to a non-rebreather to reach 100 percent."
- D."Increase it to 6 liters but only for one hour."
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Correct answer: A
In COPD, the target oxygen saturation is usually 88 to 92 percent, not normal-high. Many of these clients chronically retain CO2, and pushing saturation too high can blunt their respiratory drive and worsen hypercapnia. The client is comfortable at 2 L/min, so the safe action is to keep the flow controlled and aim for that lower target. Flooding with oxygen to chase a high number can do harm. Titrate to the goal range and reassess rather than maximizing the number.
Why the other options are wrong
- B. Higher oxygen is not always safer in COPD; it can suppress respiratory drive and raise CO2.
- C. A non-rebreather pushes saturation far above the safe COPD target and risks hypercapnia.
- D. Time-limiting an unsafe high flow does not make it appropriate for this client.
Key takeaway: In COPD, titrate oxygen to a target saturation of 88 to 92 percent to avoid suppressing respiratory drive.