Free NCLEX-PN Physiological Integrity – Physiological Adaptation Practice Test – Part 2 (Updated 2026)

1. A client has a postoperative wound infection. Which assessment finding should the practical nurse report to the RN immediately?

2. A client is being treated for sepsis. The practical nurse understands that which intervention is the HIGHEST priority during the first hour of sepsis recognition?

3. A client with a urinary tract infection develops the following vital signs: temperature 101.8°F (38.8°C), heart rate 118 bpm, respiratory rate 24/min, WBC 16,000/mm³. The practical nurse recognizes these findings meet the criteria for:

4. A 72-year-old client with a central venous catheter develops fever, chills, and confusion. Blood cultures are positive for Staphylococcus aureus. The practical nurse suspects central line-associated bloodstream infection (CLABSI). Which action is most appropriate for the PN to take?

5. Which assessment finding is the EARLIEST indicator that a client with sepsis is progressing to septic shock?

6. A client with pneumonia is receiving IV antibiotics. The practical nurse knows that which action is most important for preventing the development of sepsis?

7. A client with a stage 3 pressure injury on the sacrum has the following assessment findings: temperature 102.2°F (39°C), heart rate 110 bpm, wound with foul-smelling purulent drainage, and surrounding erythema. Which intervention should the practical nurse implement FIRST?

8. A client who underwent abdominal surgery 3 days ago has the following findings: temperature 99.8°F (37.7°C), incision with slight serous drainage, WBC 11,500/mm³, and states “I feel fine.” On day 4, the temperature is 101.6°F (38.7°C), WBC is 18,000/mm³, incision has purulent drainage with increased redness, and the client reports feeling “weak and dizzy.” The practical nurse interprets these findings as:

9. A client with a Foley catheter has been diagnosed with a catheter-associated urinary tract infection (CAUTI). Which action by the practical nurse is most important for preventing future CAUTIs?

10. The practical nurse is caring for a client on contact precautions for methicillin-resistant Staphylococcus aureus (MRSA). Which personal protective equipment (PPE) is required when entering the client’s room?

11. A client with type 1 diabetes is found confused and diaphoretic. A fingerstick blood glucose reads 42 mg/dL. The client is awake but unable to swallow safely. Which action should the LPN/LVN take FIRST?

12. A client is admitted with diabetic ketoacidosis. The LPN/LVN expects to observe which classic respiratory pattern associated with this metabolic emergency?

13. An elderly client with type 2 diabetes is brought to the emergency department with extreme dehydration, confusion, and a blood glucose of 650 mg/dL. There is no fruity breath odor, and urine ketones are negative. The LPN/LVN recognizes these findings as most consistent with:

14. A client with Graves’ disease develops a fever of 103°F (39.4°C), heart rate of 140 bpm, and severe agitation. The LPN/LVN suspects thyroid storm and should anticipate administering which medication FIRST?

15. A client with a history of hypothyroidism is found unconscious with a body temperature of 93°F (33.9°C), bradycardia (HR 48 bpm), and hypotension. The LPN/LVN recognizes this as myxedema coma and understands that which intervention is the priority?

16. A client with Addison’s disease presents with severe hypotension (BP 78/40), abdominal pain, vomiting, and hypoglycemia after missing several doses of hydrocortisone. The LPN/LVN should anticipate which immediate intervention?

17. According to standard hypoglycemia treatment protocols, after administering 15 grams of fast-acting carbohydrate to a conscious client with blood glucose of 55 mg/dL, when should the LPN/LVN recheck the blood glucose?

18. A client is being treated for diabetic ketoacidosis with IV insulin and fluids. Which laboratory value requires the MOST vigilant monitoring during the first 24 hours of treatment?

19. A client with hyperparathyroidism has a serum calcium level of 14.2 mg/dL (normal: 8.6-10.2 mg/dL). The LPN/LVN should monitor this client MOST closely for which complication?

20. The LPN/LVN is teaching a client with type 1 diabetes about preventing hypoglycemic emergencies. Which statement by the client indicates a need for further teaching?

21. A client arrives at the emergency department with sudden onset of facial drooping, arm weakness, and slurred speech that began 2 hours ago. The spouse reports the symptoms started while watching television. Which action should the PN prioritize FIRST?

22. A client with a diagnosed ischemic stroke is being evaluated for thrombolytic therapy (tPA). The PN reviews the client’s history. Which finding is a CONTRAINDICATION for tPA administration?

23. A client with traumatic brain injury has an intracranial pressure (ICP) monitoring device in place. The PN notes the ICP reading is 22 mmHg. Which action should the PN take FIRST?

24. The PN is caring for a client with increased intracranial pressure. Which assessment finding indicates the EARLIEST sign of neurological deterioration?

25. A client with a spinal cord injury at T4 reports a severe pounding headache and is sweating profusely above the level of injury. The blood pressure is 210/110 mmHg. Which action should the PN take FIRST?

26. A client is having a generalized tonic-clonic seizure in the hospital room. Which action by the PN is MOST appropriate during the seizure?

27. A client who just experienced a seizure is in the postictal state. Which assessment is the PN’s priority during this phase?

28. A client with a suspected stroke is being assessed using the FAST acronym. Which finding corresponds to the “S” in FAST?

29. A client with increased ICP is receiving mannitol (Osmitrol) IV. Which assessment finding indicates the medication is effective?

30. A client with a spinal cord injury at T3 is being educated about preventing autonomic dysreflexia. Which instruction should the PN include in the teaching plan? (Select all that apply.)

31. ### Question
The nurse is caring for a client in hypovolemic shock. Which of the following assessment findings should the nurse expect?

32. ### Question
A client presents with a severe allergic reaction after receiving IV penicillin. The client is experiencing stridor, wheezing, and facial swelling. The nurse should recognize that the client is most likely experiencing which type of shock?

33. ### Question
The nurse is assisting with the care of a client in septic shock who is receiving a norepinephrine infusion. Which finding indicates the vasopressor therapy is effective?

34. ### Question
The nurse is performing a primary survey on a trauma client using the ABCDE approach. Which assessment should the nurse perform first?

35. ### Question
A 68-year-old client presents to the emergency department with chest pain, shortness of breath, and diaphoresis. Assessment reveals blood pressure 84/50 mm Hg, heart rate 120 beats/minute, respiratory rate 28 breaths/minute, and jugular venous distension. Heart sounds reveal an S3 gallop. The nurse should recognize that this client is most likely experiencing which type of shock?

36. ### Question
The nurse is caring for a client who sustained multiple injuries in a motor vehicle collision. The client has an open chest wound, a fractured femur, and facial lacerations. Using the ABCDE framework, which injury should the nurse address first?

37. ### Question
A client with a spinal cord injury at the T4 level is brought to the emergency department. The nurse notes hypotension, bradycardia, and warm, dry skin. The nurse should recognize these findings as characteristic of which type of shock?

38. ### Question
The nurse is caring for a client who received a blood transfusion 15 minutes ago. The client now reports difficulty breathing and appears anxious. Assessment reveals a blood pressure of 88/54 mm Hg, heart rate 118 beats/minute, respiratory rate 32 breaths/minute, and urticaria on the chest. Which action should the nurse take first?

39. ### Question
The nurse is reviewing laboratory results for a client in septic shock. Which finding should the nurse report to the healthcare provider immediately?

40. ### Question
A client arrives at the emergency department with a penetrating chest wound from a stabbing. The nurse notes a small open wound on the left chest with a sucking sound on inspiration. The client’s oxygen saturation is 88% on room air. Which intervention should the nurse implement first?

41. A client with a history of hypertension arrives at the emergency department complaining of severe chest pain radiating to the left arm. The client is diaphoretic and appears anxious. Vital signs: BP 188/102, HR 118, RR 28, SpO2 91% on room air. What is the LPN/LVN’s priority action?

42. The LPN/LVN is caring for a client diagnosed with a pulmonary embolism. Which assessment finding would indicate the greatest concern for deterioration?

43. A client with diabetic ketoacidosis (DKA) has been receiving IV insulin and fluid resuscitation for 6 hours. Current laboratory values show: glucose 180 mg/dL, potassium 3.1 mEq/L, sodium 138 mEq/L, pH 7.32. The client’s IV fluid is D5W with 0.45% normal saline running at 100 mL/hr. What action should the LPN/LVN anticipate?

44. A client receiving a heparin infusion for deep vein thrombosis has an aPTT of 98 seconds (control: 30 seconds). The heparin protocol states: aPTT 81-100 seconds = decrease infusion rate by 2 units/kg/hr. Current infusion rate is 18 units/kg/hr. The client has no signs of bleeding. What is the LPN/LVN’s appropriate action?

45. A client with a urinary tract infection has developed sepsis. Current vital signs: temperature 39.4°C (102.9°F), heart rate 126, blood pressure 88/52, respiratory rate 24, SpO2 94% on 2L oxygen. The provider has ordered IV antibiotics, blood cultures, and a 500 mL normal saline bolus. Which intervention should the LPN/LVN perform FIRST?

46. A client is admitted with a diagnosis of hyperosmolar hyperglycemic state (HHS). Which laboratory finding would the LPN/LVN expect to see?

47. A client sustained a traumatic brain injury 24 hours ago. The LPN/LVN notes the following changes from the previous assessment: Glasgow Coma Scale decreased from 13 to 9, right pupil is 5mm and nonreactive (left is 3mm and reactive), and the client is exhibiting decorticate posturing. What is the priority interpretation of these findings?

48. A client arrives at the emergency department after a motor vehicle accident with multiple injuries. The client is pale, cool, and clammy with a heart rate of 134, blood pressure of 82/50, and barely palpable peripheral pulses. The LPN/LVN recognizes these findings as indicative of which type of shock?

49. A client with acute heart failure is receiving IV furosemide (Lasix) 40 mg. The LPN/LVN should monitor for which expected therapeutic effect?

50. The LPN/LVN is caring for a client with chronic obstructive pulmonary disease (COPD) who is experiencing an acute exacerbation. Which oxygen delivery method is most appropriate for this client?