Alterations in body systems and their management

72 NCLEX-RN practice questions on Alterations in body systems and their management, part of Physiological Adaptation. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium · Select all that apply

   The nurse reviews inhaler teaching with an adult who has persistent asthma and uses albuterol and fluticasone. Which client statements indicate the teaching was effective?

   1. AMy cat can keep sleeping on my bed.
   2. BI use fluticasone first when I have an asthma attack.
   3. CI use albuterol when my chest feels tight or I start to wheeze.
   4. DI take fluticasone every day, even on days I feel well.
   5. EI will see my provider if I need albuterol more than 2 days a week.
   6. FI rinse my mouth and spit after using fluticasone.

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   Answer: C, D, E, F

   Evaluate outcomes: the client separates rescue from controller drugs, prevents steroid side effects, knows when control is poor and limits triggers.

   • A: Pet dander in the bedroom is a common trigger that should be limited.
   • B: Inhaled steroids act slowly and do not relieve acute bronchospasm.

2. Question 2 · Medium · Select all that apply

   The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about self-care at home. Which instructions should the nurse include?

   1. ADrink 2 to 3 liters of fluid daily unless restricted
   2. BEat small, frequent high-calorie, high-protein meals
   3. CRaise home oxygen to 6 L/min whenever breathless
   4. DBreathe out slowly through pursed lips
   5. ERest lying flat to save energy
   6. FReceive yearly influenza and recommended pneumococcal vaccines

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   Answer: A, B, D, F

   Generate solutions: COPD teaching covers breathing retraining, nutrition, infection prevention, hydration and safe oxygen use.

   • C: Oxygen is used at the prescribed flow; high flows can worsen carbon dioxide retention.
   • E: Lying flat restricts diaphragm movement; upright or tripod positions ease breathing.

3. Question 3 · Medium · Select all that apply

   The nurse teaches a client with central diabetes insipidus about intranasal desmopressin. Which client statements indicate the teaching was effective?

   1. AI will weigh myself every day at the same time.
   2. BI will report a headache, confusion or sudden weight gain.
   3. CI should drink as much water as I can while I take this.
   4. DI will take an extra dose whenever I urinate more at night.
   5. EI will stop the spray whenever my nose is stuffy.

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   Answer: A, B

   Evaluate outcomes: desmopressin teaching covers daily weights and the signs of water intoxication; extra fluid, extra doses or stopping the drug unadvised are unsafe.

   • C: Drinking beyond thirst on desmopressin can cause hyponatremia.
   • D: Extra doses increase the risk of water intoxication; doses change only as prescribed.
   • E: Congestion can reduce absorption, but the client should contact the provider rather than stop the drug.

4. Question 4 · Hard · Select all that apply

   A client with a chest injury has absent breath sounds on the right. Which findings indicate a tension pneumothorax rather than a simple pneumothorax?

   1. ARespiratory rate of 28/min
   2. BTrachea shifted toward the left
   3. CSharp chest pain on breathing
   4. DHyperresonance on the right side
   5. EBlood pressure falling to 82/50 mm Hg
   6. FDistended neck veins

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   Answer: B, E, F

   Analyze cues: tracheal deviation away from the affected side, hypotension and distended neck veins show mediastinal shift, a tension pneumothorax that needs immediate decompression.

   • A: Tachypnea is present in both and does not separate them.
   • C: Pleuritic pain occurs with both simple and tension pneumothorax.
   • D: Air in the pleural space gives hyperresonance in both types.

5. Question 5 · Hard · Matrix

   Data are gathered on the second hospital day for a client with alcohol-related acute pancreatitis. Classify each finding as expected with the disease or needing urgent action.

   For each row, choose: Expected / Requires immediate follow-up

   1. Serum lipase three times the upper reference limit
   2. Epigastric pain that radiates to the back
   3. Temperature of 100.2°F (37.9°C)
   4. Respiratory rate of 32/min with SpO2 of 87% on room air
   5. Bluish discoloration around the umbilicus
   6. Total calcium of 6.9 mg/dL with muscle twitching

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   Answer:

   • Serum lipase three times the upper reference limit: Expected
   • Epigastric pain that radiates to the back: Expected
   • Temperature of 100.2°F (37.9°C): Expected
   • Respiratory rate of 32/min with SpO2 of 87% on room air: Requires immediate follow-up
   • Bluish discoloration around the umbilicus: Requires immediate follow-up
   • Total calcium of 6.9 mg/dL with muscle twitching: Requires immediate follow-up

   Recognize cues: pain, a raised lipase and low-grade fever fit the disease; Cullen sign, symptomatic hypocalcemia and hypoxemia are complications that need urgent action.

   • Serum lipase three times the upper reference limit: A lipase of 3 times normal or more is part of the diagnosis.
   • Epigastric pain that radiates to the back: This is the classic pain pattern of pancreatitis.
   • Temperature of 100.2°F (37.9°C): A low-grade fever is common with pancreatic inflammation.
   • Respiratory rate of 32/min with SpO2 of 87% on room air: New hypoxemia can signal pleural effusion or acute respiratory distress syndrome.
   • Bluish discoloration around the umbilicus: Cullen sign suggests retroperitoneal bleeding from severe necrotizing pancreatitis.
   • Total calcium of 6.9 mg/dL with muscle twitching: Symptomatic hypocalcemia risks tetany, laryngospasm and dysrhythmias.

6. Question 6 · Medium · Matrix

   Sort these causes of a sudden fall in glomerular filtration into prerenal, intrarenal (intrinsic) or postrenal categories.

   For each row, choose: Prerenal / Intrarenal / Postrenal

   1. Low cardiac output from heart failure
   2. Gentamicin toxicity
   3. Severe vomiting and diarrhea with low blood pressure
   4. Stones blocking both ureters
   5. Enlarged prostate blocking urine outflow
   6. Iodinated contrast for a CT scan

   Answer and explanation in LearnFree account

7. Question 7 · Hard · Select all that apply

   A client with a traumatic brain injury has an intracranial pressure monitor. Which findings require immediate follow-up?

   1. AMean arterial pressure of 74 mm Hg with intracranial pressure of 18 mm Hg
   2. BIntracranial pressure of 11 mm Hg
   3. CIntracranial pressure of 23 mm Hg sustained for 10 minutes
   4. DClear fluid from the nose that forms a halo on gauze
   5. ETemperature of 101.8°F (38.8°C)
   6. FPaCO2 of 37 mm Hg

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8. Question 8 · Hard · Matrix

   A client with a complete thoracic cord transection from a fall arrived in the trauma unit yesterday. Classify each finding as expected during spinal shock or needing urgent action.

   For each row, choose: Expected / Requires immediate follow-up

   1. Loss of sensation two levels higher than on admission
   2. Urinary retention
   3. Flaccid paralysis and absent reflexes below the injury
   4. Body temperature that drifts with room temperature
   5. Heart rate of 44/min with blood pressure of 78/40 mm Hg and warm, dry skin

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9. Question 9 · Medium · Matrix

   A client with asthma uses a peak flow meter at home; the personal best is 500 L/min. For each reading, indicate the asthma action plan zone.

   For each row, choose: Green zone / Yellow zone / Red zone

   1. Peak flow of 450 L/min with no symptoms
   2. Peak flow of 260 L/min after using albuterol
   3. Peak flow of 410 L/min before exercise
   4. Peak flow of 220 L/min with trouble speaking
   5. Peak flow of 340 L/min with a cough at night

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10. Question 10 · Hard · Select all that apply

    Laboratory results for a client with oliguric renal failure after sepsis show potassium 6.8 mEq/L, and the monitor shows tall, peaked T waves. Which prescriptions should the nurse carry out?

    1. ACalcium gluconate IV
    2. BOral potassium chloride with breakfast
    3. CRegular insulin IV with dextrose
    4. DA potassium binder such as sodium zirconium cyclosilicate
    5. EContinuous cardiac monitoring
    6. FNebulized albuterol

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11. Question 11 · Medium · Matrix

    The nurse assesses a client with advanced cirrhosis. For each finding, indicate the complication it most likely reflects.

    For each row, choose: Hepatic encephalopathy / Portal hypertension / Impaired clotting factor synthesis

    1. Flapping tremor of the outstretched hands
    2. Dilated veins radiating from the umbilicus
    3. Enlarged spleen with a low platelet count
    4. Sleeping by day and awake and confused at night
    5. Bleeding gums with an INR of 2.1
    6. Esophageal varices seen on endoscopy

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12. Question 12 · Easy · Select all that apply

    Which findings does the nurse expect in a client in thyroid storm?

    1. AHeart rate of 48/min
    2. BTemperature of 104°F (40°C)
    3. CHeart rate of 150/min
    4. DAgitation and confusion
    5. ECold intolerance
    6. FVomiting and diarrhea

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13. Question 13 · Medium · Select all that apply

    Sitting in a wheelchair at a rehabilitation center, a client with a high thoracic cord lesion develops a pounding headache, facial flushing and sweating, and a blood pressure of 196/108 mm Hg. Which actions should the nurse take?

    1. ARecheck the blood pressure in 1 hour
    2. BLoosen tight clothing and leg straps
    3. CSit the client upright
    4. DLay the client flat with legs raised
    5. ECheck the urinary catheter for kinks or a full bag
    6. FCheck for fecal impaction using an anesthetic lubricant

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14. Question 14 · Hard · Matrix

    A client has a chest tube for a pneumothorax, connected to a wet-suction drainage system. For each finding, indicate whether it is expected or unexpected.

    For each row, choose: Expected / Unexpected

    1. Continuous bubbling in the water-seal chamber on inhalation and exhalation
    2. Crackling under the skin that has spread from the chest wall to the neck
    3. Water in the water-seal chamber rises on inhalation and falls on exhalation
    4. Gentle, continuous bubbling in the suction-control chamber
    5. Drainage unit upright and below the level of the chest

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15. Question 15 · Hard · Select all that apply

    A client with heart failure with reduced ejection fraction is admitted with fluid overload. Which prescriptions should the nurse question?

    1. ALisinopril 5 mg orally daily
    2. BFurosemide 40 mg IV twice daily
    3. C0.9% sodium chloride IV at 150 mL/h
    4. DIbuprofen 600 mg orally every 6 hours for knee pain
    5. EPioglitazone 30 mg orally daily for diabetes

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16. Question 16 · Medium · Select all that apply

    A client is admitted with acute pancreatitis. Which interventions should the nurse anticipate in the first 24 hours?

    1. AMonitoring capillary blood glucose
    2. BChecking for Trousseau and Chvostek signs
    3. CLactated Ringer's solution IV at the prescribed rate
    4. DPositioning on the side with knees flexed or sitting leaning forward
    5. EA high-fat meal to stimulate bowel function
    6. FOpioid analgesia for severe epigastric pain

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17. Question 17 · Medium · Matrix

    Two neurosurgical clients have disorders of water balance after head trauma. Classify each finding as typical of syndrome of inappropriate antidiuretic hormone (SIADH) or diabetes insipidus (DI).

    For each row, choose: SIADH / DI

    1. Intense thirst with a craving for ice water
    2. Serum osmolality of 262 mOsm/kg
    3. Weight gain without peripheral edema
    4. Urine output of 7 liters in 24 hours
    5. Serum sodium of 151 mEq/L
    6. Urine specific gravity of 1.032

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18. Question 18 · Easy · Matrix

    An endocrine unit has one client with primary adrenal insufficiency and another with chronic cortisol excess. Classify each assessment finding as Addison disease or Cushing syndrome.

    For each row, choose: Addison disease / Cushing syndrome

    1. Rounded moon face
    2. Purple stretch marks on the abdomen
    3. Salt craving and weight loss
    4. Bronze darkening of the skin
    5. Serum potassium of 5.8 mEq/L
    6. Blood glucose of 210 mg/dL

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19. Question 19 · Hard · Matrix

    A client with end-stage renal disease on maintenance hemodialysis Monday, Wednesday and Friday arrives for a session. Classify each assessment datum as an anticipated chronic finding or one needing urgent action.

    For each row, choose: Expected with CKD / Requires immediate follow-up

    1. Serum phosphorus of 6.0 mg/dL
    2. Dyspnea with crackles and a 3 kg weight gain since the last dialysis
    3. Serum potassium of 6.9 mEq/L
    4. Pericardial friction rub with chest pain
    5. Serum creatinine of 5.1 mg/dL
    6. Hemoglobin of 9.8 g/dL

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20. Question 20 · Hard · Matrix

    A client is admitted in thyroid storm. For each intervention, indicate whether it is indicated or contraindicated.

    For each row, choose: Indicated / Contraindicated

    1. Levothyroxine to stabilize thyroid levels
    2. Aspirin for fever
    3. Acetaminophen and a cooling blanket for fever
    4. A cool, quiet, dimly lit room
    5. Propranolol for heart rate and tremor

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21. Question 21 · Hard · Select all that apply

    The nurse reassesses a client with decompensated cardiac failure who was given an 80 mg IV push dose of the loop diuretic furosemide at 0900. Which findings should the nurse report?

    1. ABlood pressure of 86/50 mm Hg with dizziness on standing
    2. BCrackles now heard only in the lung bases
    3. CUrine output of 900 mL since the dose
    4. DNew ringing in both ears
    5. ESerum potassium of 3.0 mEq/L

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22. Question 22 · Medium · Matrix

    Before going home, a client hospitalized with cardiac failure explains the self-management plan. Classify each statement as showing understanding or needing more teaching.

    For each row, choose: Shows understanding / Needs more teaching

    1. If I need more pillows to sleep, I will just add them.
    2. Canned soups are a good choice because they are quick to make.
    3. I will call if I gain 2 to 3 pounds in a day or 5 pounds in a week.
    4. I will keep my sodium to about 2,000 mg a day.
    5. I will weigh myself each morning after I urinate and before I eat.

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23. Question 23 · Medium · Matrix

    A client with a subdural hematoma is observed for rising pressure inside the skull. Classify each neurologic or vital-sign change as an early or a late sign.

    For each row, choose: Early sign / Late sign

    1. Irregular breathing pattern
    2. One pupil fixed and dilated
    3. Heart rate falling to 48/min
    4. Headache that gets worse with coughing
    5. New restlessness and difficulty following commands
    6. Blood pressure rising with a widening pulse pressure

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24. Question 24 · Medium · Select all that apply

    The nurse teaches a client with cirrhosis and esophageal varices how to lower the risk of bleeding. Which instructions should the nurse include?

    1. AReport black, tarry stools right away
    2. BAvoid aspirin and ibuprofen
    3. CLift weights to build strength
    4. DTake acetaminophen up to 4 g daily for pain
    5. EAvoid all alcohol
    6. FUse a stool softener to avoid straining

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25. Question 25 · Easy · Select all that apply

    The nurse assesses a client admitted with left-sided heart failure. Which findings are consistent with this condition?

    1. ADistended jugular veins at 45 degrees
    2. BAbdominal ascites
    3. CNeeding three pillows to breathe at night
    4. DCrackles in both lung bases
    5. EEnlarged, tender liver
    6. FShortness of breath when climbing stairs

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