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NCLEX-RN category

NCLEX Physiological Adaptation Practice Questions

Quick answer

Physiological Adaptation is weighted at 11 to 17 percent of the NCLEX-RN and covers care of clients with acute, chronic or life-threatening physical conditions. On a 150-question exam that can be up to 25 questions, and most of them ask what you would do first.

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This category is where the exam tests whether you can recognize a client who is getting worse before the numbers go off the chart. The questions mix medical conditions you studied separately in school, so a single item can involve a kidney, a heart and a lab value at once. The common trap is answering with what you would do eventually instead of what you would do first. Read every stem for the one finding that changes the picture, and ask yourself whether the client's airway, breathing or circulation is at risk right now. The questions below are drawn from across the category. The sub-topic pages linked at the bottom go deeper into cardiac, respiratory, fluids, endocrine and neurological care.

Practice questions

1

A client admitted with a gastrointestinal bleed has a blood pressure of 86/50 mm Hg, heart rate 128, and cool, clammy skin. Which action should the nurse take first?

  1. AInsert a nasogastric tube for gastric lavage
  2. BPlace the client flat and start a second large-bore IV with 0.9% sodium chloride
  3. CDraw a type and crossmatch and send it to the blood bank
  4. DDocument the findings and reassess in 30 minutes
Show answer

Answer: B

The client is in hypovolemic shock. Restoring circulating volume comes first, and a second large-bore line allows fluids and blood to run fast.

Why the others are wrong

A nasogastric tube and a crossmatch are both appropriate soon after, but neither restores perfusion. Waiting 30 minutes with these vital signs is unsafe.

2

A client with a urinary tract infection develops a temperature of 102.6 F, heart rate 118, respiratory rate 26, and a new onset of confusion. The nurse suspects sepsis. Which intervention is the priority?

  1. AApply a cooling blanket
  2. BObtain blood cultures and then start the prescribed IV antibiotic
  3. CPlace the client on bed rest with the side rails up
  4. DEncourage oral fluids to 2 liters a day
Show answer

Answer: B

Early antibiotics save lives in sepsis, and cultures are drawn first so the organism can be identified without being masked by the drug.

Why the others are wrong

Cooling and safety measures are supportive but do not treat the infection. Oral fluids are too slow for a client who likely needs IV fluid resuscitation.

3

A client with a 40% total body surface area burn is in the first 24 hours after injury. Which finding tells the nurse that fluid resuscitation is adequate?

  1. AUrine output of 35 mL/hr
  2. BBlood pressure of 92/58 mm Hg
  3. CSerum potassium of 5.6 mEq/L
  4. DHeart rate of 122 beats per minute
Show answer

Answer: A

In the emergent phase of a burn, urine output of 30 to 50 mL/hr in an adult is the best bedside sign that the kidneys are perfused and fluids are keeping up.

Why the others are wrong

A low blood pressure and a fast heart rate both suggest the client is still volume depleted. A high potassium reflects cell damage, not fluid status.

4

A client receiving hemodialysis through a left forearm arteriovenous fistula is being admitted. Which action by a newly hired nurse requires the charge nurse to intervene?

  1. APalpating the fistula for a thrill
  2. BTeaching the client to avoid sleeping on the left arm
  3. CObtaining a blood pressure on the left arm
  4. DAuscultating the fistula for a bruit
Show answer

Answer: C

Blood pressures, blood draws and IV lines are never done on the fistula arm because compression or puncture can clot the access.

Why the others are wrong

Feeling for a thrill, listening for a bruit, and protecting the arm from pressure are all correct care of a fistula.

5

A client with cirrhosis has a serum ammonia of 110 mcg/dL and is becoming drowsy and confused. Which prescription should the nurse question?

  1. ALactulose 30 mL by mouth three times a day
  2. BA diet providing 1.2 g/kg of protein daily
  3. CLorazepam 1 mg IV as needed for agitation
  4. DRifaximin 550 mg by mouth twice daily
Show answer

Answer: C

Sedatives are cleared by the liver and will deepen hepatic encephalopathy. The confusion is the ammonia, not anxiety, and it is treated by lowering the ammonia.

Why the others are wrong

Lactulose and rifaximin both lower ammonia. Protein is no longer restricted in hepatic encephalopathy and moderate protein intake is now standard.

6

A client with chronic kidney disease has a potassium of 6.4 mEq/L and peaked T waves on the monitor. Which prescription should the nurse carry out first?

  1. ASodium polystyrene sulfonate by mouth
  2. BCalcium gluconate IV
  3. CA low potassium diet
  4. DRegular insulin IV with dextrose
Show answer

Answer: B

Peaked T waves mean the heart is already affected. Calcium gluconate stabilizes the cardiac membrane within minutes and prevents a lethal arrhythmia while the other treatments start to work.

Why the others are wrong

Insulin with dextrose moves potassium into cells over 15 to 30 minutes, and sodium polystyrene removes it over hours. A diet change does nothing in the next few minutes.

7

A client is 2 hours post laparoscopic cholecystectomy. Which finding should the nurse report to the surgeon immediately?

  1. AShoulder pain rated 4 out of 10
  2. BA small amount of serosanguineous drainage on the port dressing
  3. CAbdominal rigidity with a heart rate of 120 beats per minute
  4. DNausea after the first sips of water
Show answer

Answer: C

A rigid abdomen with tachycardia suggests bleeding or bile leak into the peritoneum and needs the surgeon now.

Why the others are wrong

Shoulder pain from the carbon dioxide used during surgery is expected. Minimal drainage and mild nausea after anesthesia are common and are managed by the nurse.

8

A client with sickle cell disease arrives with severe pain in the arms and legs, a temperature of 100.9 F and oxygen saturation of 91%. Which action should the nurse take first?

  1. AApply cold packs to the painful joints
  2. BStart oxygen and IV fluids, and give the prescribed opioid analgesic
  3. CEncourage the client to walk in the hall to improve circulation
  4. DRestrict fluids to prevent heart failure
Show answer

Answer: B

A vaso-occlusive crisis is treated with oxygen, hydration and prompt opioid pain relief, all of which reduce sickling and tissue damage.

Why the others are wrong

Cold causes vasoconstriction and worsens sickling. Walking during a crisis increases oxygen demand. Fluids are increased, not restricted, to thin the blood and improve flow.

9

A client with a history of peptic ulcer disease reports sudden, severe epigastric pain and a board-like abdomen. Vital signs are blood pressure 100/62 mm Hg and heart rate 112. What should the nurse anticipate?

  1. AGiving an antacid and rechecking in one hour
  2. BPreparing the client for emergency surgery and keeping them NPO
  3. CInserting a rectal tube to relieve gas
  4. DEncouraging a bland diet and small meals
Show answer

Answer: B

Sudden severe pain with a rigid abdomen is a perforated ulcer, a surgical emergency. The client is kept NPO, a nasogastric tube is usually placed, and IV fluids and antibiotics are started.

Why the others are wrong

Antacids, a rectal tube and diet changes do nothing for a hole in the stomach wall and delay definitive care.

10

The nurse is caring for a client with a new ileostomy. Which statement by the client shows a correct understanding of discharge teaching?

  1. A"My output should be formed stool within a week."
  2. B"I should empty the pouch when it is one third to one half full."
  3. C"I can stop drinking extra fluids once the stoma shrinks."
  4. D"A dark purple stoma means it is healing well."
Show answer

Answer: B

Emptying at one third to one half full prevents the weight of the contents from pulling the seal loose.

Why the others are wrong

Ileostomy output stays liquid to pasty because the colon is bypassed. Fluid losses are high from an ileostomy, so extra fluid is a permanent habit. A healthy stoma is pink to red and moist; purple or black means poor blood supply and must be reported.

Quick tips

  • Every stem has a hidden "first". Find the finding that threatens airway, breathing or circulation and answer to that before anything else.
  • Shock, sepsis and perforation all show up as tachycardia plus a falling blood pressure. When you see that pair, think volume and emergency, not comfort.
  • Learn the one bedside number that proves treatment is working for each condition: urine output for burns and shock, potassium for kidney disease, ammonia for liver failure, oxygen saturation for respiratory conditions.
  • A client who was stable and is now confused has a physical cause until proven otherwise. The exam wants you to look for the cause, not to sedate.
  • Stomas, fistulas and new surgical sites each have one or two findings that must be reported right away. Learn those for each, and treat everything else as expected recovery.

Related topics

FAQ

What is Physiological Adaptation on the NCLEX?

It is one of the eight client-need categories in the NCSBN test plan. It covers nursing care for clients with acute, chronic or life-threatening physical health conditions, including shock, sepsis, organ failure, surgical complications and unexpected changes in condition.

How many Physiological Adaptation questions are on the NCLEX-RN?

The 2026 test plan sets the range at 11 to 17 percent. On the minimum 85-question exam that is roughly 9 to 14 questions; on a full 150-question exam it can be up to 25.

What is the best way to study Physiological Adaptation?

Practice priority and "what first" questions rather than rereading disease chapters. Most items in this category give you a deteriorating client and ask for the next action, so training that decision daily is what raises your score.

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