Physiological Adaptation - Part 2

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Question 1 of 30

1. Question

1. Which of the following situations warrants a measurement for orthostatic hypotension?

A. A 36-year old male with a spinal injury.
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B. An 86-year old female with significantly altered mental status.
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C. A 58-year old female with near-syncope.
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D. A 41-year old male with acute deep vein thrombosis.
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Hint

Hint: Orthostatic vital signs are indicated when a patient has symptoms of transient cerebral hypoperfusion on position change—think lightheadedness or near‑fainting with posture shifts rather than unrelated diagnoses like DVT or altered mental status.
Question 2 of 30

2. Question

2. A nurse is caring for a client who has a sodium level of 126 mEq/L. Which of the following symptoms should the nurse expect to see with this client?

A. Nystagmus.
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B. Orthostatic hypotension.
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C. Hallucinations.
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D. Dry skin.
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Hint

Hint: Significant hyponatremia primarily affects the brain by causing cerebral edema—look for altered mental status and neuropsychiatric signs (e.g., confusion, agitation, hallucinations) rather than primarily skin or vestibular findings.
Question 3 of 30

3. Question

3. A 58-year old client is being tested for rheumatoid arthritis. Her physician orders an erythrocyte sedimentation rate (ESR). Which of the following results is most likely to be associated with arthritis?

A. 5 mm/hr.
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B. 12 mm/hr.
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C. 28 mm/hr.
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D. 40 mm/hr.
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Hint

Hint: ESR increases with systemic inflammation; values well above the typical upper limit for adults (often >20–30 mm/hr) are most consistent with active inflammatory arthritis.
Question 4 of 30

4. Question

4. Which of the following statements best describes compartment syndrome?

A. An injury causes pain and tingling that starts in the buttock and travels down the leg.
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B. An injury causes swelling within muscle tissue that leads to anoxia of nerves and muscles.
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C. An injury causes permanent flexion of the interphalangeal joint, resulting in deformity.
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D. An injury causes pain and swelling of the median plantar nerve.
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Hint

Hint: Think about rising pressure inside a closed fascial compartment that compromises circulation, causing severe pain, tense swelling, and progressive ischemia of muscles and nerves.
Question 5 of 30

5. Question

5. Mrs. G is seen for follow-up after testing for chronically high blood glucose levels. Her physician diagnoses her with type 1 diabetes. Which of the following information is part of this client’s education about this condition?

A. Type 1 diabetes occurs from increased carbohydrate intake and decreased exercise.
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B. Type 1 diabetes is treated through diet and exercise.
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C. Type 1 diabetes occurs from destruction of beta cells in the pancreas.
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D. Type 1 diabetes results in the cells rejecting the body's insulin.
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Hint

Hint: Focus on pathophysiology: type 1 diabetes arises from loss of insulin production due to immune-mediated damage to the pancreas’ insulin-producing beta cells, not primarily from lifestyle or insulin resistance.
Question 6 of 30

6. Question

6. Mrs. F has been diagnosed with hyperparathyroidism. Which of the following complications is Mrs. F at highest risk of developing?

A. Hyponatremia.
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B. Hypocalcemia.
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C. Hypermagnesemia.
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D. Hypercalcemia.
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Hint

Hint: Think about excess parathyroid hormone effects: it increases bone resorption and renal calcium reabsorption, which leads to elevated serum calcium.
Question 7 of 30

7. Question

7. When preparing to give a client a narcotic analgesic, which of the following information should the nurse provide as part of education?

A. Take the medication on an empty stomach.
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B. Lie down for one hour after taking the medication.
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C. The medication may cause constipation.
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D. The medication may cause heartburn.
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Hint

Hint: Remember that narcotic analgesics commonly slow gastrointestinal motility, so patient teaching should include awareness of bowel habit changes and strategies to prevent constipation.
Question 8 of 30

8. Question

8. A client is admitted to a nursing unit with a remittent fever. Which statement best describes this pattern of fever?

A. A persistent fever that has lasted over 24 hours.
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B. A fever that lasts 2 days followed by normal temperature for 2 days, followed by fever again.
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C. A fever that lasts 2 days followed by normal temperature for 12 hours, followed by fever again.
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D. A fever that spikes and then lowers without returning to normal.
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Hint

Hint: Remittent fever involves wide temperature fluctuations over 24 hours that remain above normal, unlike relapsing or intermittent patterns where temperatures return to baseline between febrile periods.
Question 9 of 30

9. Question

9. Which of the following components is associated with hypertonic dehydration?

A. Plasma sodium levels between 130 and 150 mEq/L.
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B. Fluid moves from extracellular space to intracellular space.
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C. Water loss is greater than electrolyte loss.
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D. Physical signs and symptoms are grossly apparent.
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Hint

Hint: Hypertonic dehydration involves a net water deficit relative to solutes, leading to increased serum osmolality and water shifting out of cells—think hypernatremia and cellular dehydration.
Question 10 of 30

10. Question

10. Your patient has been diagnosed with herpes simplex virus 2. Which of the following would NOT be included in your teaching of this patient?

A. If you have symptoms, you should avoid sexual contact with other individuals.
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B. With treatment, this condition can be cured.
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C. This disease is highly contagious.
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D. You may experience tingling in the skin before an active outbreak occurs.
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Hint

Hint: Recall that HSV establishes latency in nerve ganglia and treatment suppresses outbreaks and viral shedding but does not eliminate the virus from the body.
Question 11 of 30

11. Question

11. Sinusitis is caused by a:

A. Bacteria.
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B. Fungus.
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C. Virus.
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D. Any of the above.
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Hint

Hint: Remember that sinus infections may arise from different types of pathogens depending on the clinical context—acute viral causes, secondary bacterial infection, and fungal causes in certain patients should all be considered.
Question 12 of 30

12. Question

12. A local sign of infection is which of the following?

A. Swelling.
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B. Rapid pulse.
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C. Fever.
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D. High white blood count.
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Hint

Hint: Differentiate local versus systemic manifestations—local signs are confined to the affected area (e.g., redness, heat, pain, and fluid accumulation), whereas fever, rapid pulse, and high WBC are systemic responses.
Question 13 of 30

13. Question

13. A systemic sign of infection is ______________.

A. swelling.
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B. redness.
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C. heat.
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D. a lack of appetite.
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Hint

Hint: Focus on systemic versus local signs—systemic findings affect the whole body (for example, fever, malaise, or changes in appetite) rather than localized redness, swelling, or warmth.
Question 14 of 30

14. Question

14. A complication of osteoporosis is _______________.

A. rheumatoid arthritis.
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B. gouty arthritis.
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C. dorsal flexion.
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D. joint deformity.
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Hint

Hint: Think about how decreased bone density leads to fractures and structural collapse of bones (especially vertebrae), resulting in altered joint/bone alignment rather than inflammatory arthritides.
Question 15 of 30

15. Question

15. A nurse finds one of her clients unresponsive in his room. He is not breathing and does not have a pulse. After calling for help, what is the next action of the nurse?

A. Administer 2 ventilations.
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B. Perform a head-tilt, chin lift to open the airway.
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C. Begin chest compressions.
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D. Perform a jaw thrust to open the airway.
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Hint

Hint: Follow the adult basic life support sequence: after confirming unresponsiveness and calling for help, prioritize high-quality chest compressions immediately before giving breaths.
Question 16 of 30

16. Question

16. A nurse is caring for a client with severe mitral regurgitation and decreased cardiac output. The nurse assesses the client for mental status changes. What is the rationale for this intervention?.

A. Decreased cardiac output can cause hypoxia to the brain.
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B. Mental status changes may be a side effect of the client's medication.
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C. Mitral regurgitation is a complication associated with some neurological disorders.
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D. The client may be confused about his diagnosis.
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Hint

Hint: Think about how reduced cardiac output affects cerebral perfusion—insufficient blood flow and oxygen delivery to the brain commonly manifests as changes in mental status.
Question 17 of 30

17. Question

17. Which of the following is a potential side effect of ibuprofen?

A. Headache.
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B. Urinary retention.
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C. Hematuria.
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D. Low blood pressure.
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Hint

Hint: Consider common adverse effects of NSAIDs like ibuprofen—think about their impact on renal function and platelet aggregation which can increase bleeding risk, including blood in urine.
Question 18 of 30

18. Question

18. An 85-year old client is diagnosed with hypernatremia due to lack of fluid intake and dehydration. The nurse knows that symptoms of hypernatremia include:

A. Lack of thirst.
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B. Pale skin.
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C. Hypertension.
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D. Swollen tongue.
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Hint

Hint: Hypernatremia causes water to shift out of cells leading to dehydration of tissues—think dry mucous membranes and oral changes rather than decreased thirst or skin pallor.
Question 19 of 30

19. Question

19. A client is brought into the emergency department after finishing a course of antibiotics for a urinary tract infection. The client is experiencing dyspnea, chest tightness and is agitated. Her blood pressure is 88/58, she has generalized hives over the course of her body and her lips and tongue are swollen. After the nurse calls for help, what is the next appropriate action?

A. Start an IV and administer a 1-liter bolus of Lactated Ringer's solution.
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B. Administer 0.3 mg of 1:1000 epinephrine IM.
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C. Administer 15 mg diphenhydramine IM.
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D. Monitor the client until help arrives.
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Hint

Hint: This presentation is classic for severe anaphylaxis—airway compromise, hypotension, angioedema—and the priority is to give immediate intramuscular epinephrine; supportive measures follow.
Question 20 of 30

20. Question

20. A nurse is performing CPR on a client when a co-worker brings an automated external defibrillator (AED). The nurse prepares to apply the patches to the client’s chest when she notes that he has a large amount of thick chest hair. What is the next action of the nurse?

A. Apply the pads to the chest and provide a shock.
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B. Wipe the client's chest down with a towel before applying the pads.
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C. Shave the client's chest to remove the hair.
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D. Do not use the AED.
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Hint

Hint: Effective pad-to-skin contact is essential for AED energy delivery, so quickly remove dense chest hair (using the razor from the AED kit if available) to ensure good conduction before shocking.
Question 21 of 30

21. Question

21. A nurse is educating a client who was recently diagnosed with diverticulosis. What types of foods should the nurse recommend for this client?

A. Whole grain cereal.
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B. Eggs.
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C. Cottage cheese.
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D. Fish.
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Hint

Hint: Focus on increasing dietary fiber to bulk stools and ease passage—encourage high-fiber choices like bran, fruits, and vegetables rather than low-fiber proteins or dairy.
Question 22 of 30

22. Question

22. A client is brought into the emergency room where the physician suspects that he has cardiac tamponade. Based on this diagnosis, the nurse would expect to see which of the following signs or symptoms in this client?

A. Fever, fatigue, malaise.
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B. Hypotension and distended neck veins.
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C. Cough and hemoptysis.
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D. Numbness and tingling in the extremities.
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Hint

Hint: Think of Beck’s triad for acute cardiac tamponade—signs result from impaired ventricular filling due to pericardial fluid, producing elevated venous pressure and reduced arterial pressure.
Question 23 of 30

23. Question

23. Which of the following descriptions best describes the function of the thyroid gland?

A. The thyroid gland converts glucose into glycogen.
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B. The thyroid hormone secretes cortisol during times of stress.
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C. The thyroid gland regulates body metabolism.
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D. The thyroid gland affects skin pigmentation.
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Hint

Hint: Think about which endocrine gland primarily controls basal metabolic rate, energy use, and thermoregulation rather than stress hormones, pigment changes, or direct glycogen storage.
Question 24 of 30

24. Question

24. A client in the ICU has been intubated and placed on a ventilator. The physician orders synchronous intermittent mandatory ventilation (SIMV). Which statement best describes the work of this mode of ventilation?

A. The ventilator delivers a set rate and tidal volume regardless of whether the client is attempting to breathe.
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B. The ventilator coordinates delivered breaths with the client's respiratory efforts.
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C. The ventilator provides a supplemental breath for every third breath of the client.
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D. The ventilator provides breaths during the expiratory phase of the client's respirations.
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Hint

Hint: Focus on the term that implies the ventilator times its support to the patient’s own inspiratory efforts, allowing spontaneous breaths to be recognized and assisted rather than overriding them.
Question 25 of 30

25. Question

25. A client is seen for testing to rule out Rocky Mountain Spotted Fever. Which of the following signs or symptoms is associated with this condition?

A. Fever and rash.
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B. Circumoral cyanosis.
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C. Elevated glucose levels.
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D. All of the above.
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Hint

Hint: Remember Rocky Mountain spotted fever is a tick-borne rickettsial illness classically presenting with systemic fever and a characteristic rash that often begins on the wrists/ankles and spreads inward—think infectious, not metabolic or cyanotic signs.
Question 26 of 30

26. Question

26. Which of the following actions is part of preparation of a medication from an ampule?

A. Snap the neck of the ampule toward the body.
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B. Hold the ampule upside down when drawing up the medication.
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C. Expel excess air bubbles back into the ampule.
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D. Always use the same needle for drawing as the one used for the injection.
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Hint

Hint: Use gravity to keep the medication pooled at the ampule’s opening before withdrawing with a filter needle, and always break the neck away from yourself for safety.
Question 27 of 30

27. Question

27. Mr. C is brought to the hospital with severe burns over 45% of his body. His heart rate is 124 bpm and thready, BP 84/46, respirations 24/minute and shallow. He is apprehensive and restless. Which of the following types of shock is Mr. C at highest risk for?

A. Septic shock.
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B. Hypovolemic shock.
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C. Neurogenic shock.
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D. Cardiogenic shock.
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Hint

Hint: Consider the massive fluid loss and plasma leakage that occurs with extensive burns leading to decreased intravascular volume, tachycardia, hypotension and weak peripheral pulses from reduced preload.
Question 28 of 30

28. Question

28. Based on Mr. C’s assessment, which of the following nursing interventions is most appropriate?

A. Elevate the lower extremities to 45 degrees to promote venous return.
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B. Place Mr. C in the Trendelenburg position.
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C. Administer total parenteral nutrition.
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D. Monitor urine output.
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Hint

Hint: Prioritize assessing end-organ perfusion—tracking renal output is a sensitive, immediate indicator of the patient’s hemodynamic status and response to treatment.
Question 29 of 30

29. Question

29. Mr. L was working in his garage at home and had an accident with a power saw. He is brought into the emergency department by a neighbor with a traumatic hand amputation. What is the first action of the nurse?

A. Place a tourniquet at the level of the elbow.
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B. Apply direct pressure to the injury.
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C. Administer a bolus of 0.9% Normal Saline.
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D. Elevate the injured extremity on a pillow.
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Hint

Hint: Prioritize immediate hemorrhage control at the bedside—use the simplest, most rapid method first to stop bleeding (reserve more invasive measures if bleeding cannot be controlled).
Question 30 of 30

30. Question

30. A client is admitted for a head injury. His body is lying in an abnormal position and the physician states he is exhibiting decorticate posturing. Based on this assessment, the nurse can expect to find the client with:

A. The legs extended and rotated internally; the elbow, wrists, and fingers flexed.
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B. The legs pulled toward the chest; the head bent back at a 30-degree angle.
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C. The back arched; the arms and legs extended and rigid.
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D. The legs extended and rotated externally; the head turned to the right or the left.
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Hint

Hint: Decorticate posturing indicates a lesion above the brainstem—think flexor posturing of the arms (wrists/fingers) with extension of the lower extremities rather than generalized arching or rigid extension of all limbs.

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Physiological Adaptation – Part 2

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