NCLEX-RN: Health Alterations practice questions questions 226-250

Answer: D. Hypotension

Topic: Cushing Syndrome

Cushing's disease/syndrome is characterized by excess cortisol, causing hypertension, central obesity, fatigue, and proximal muscle weakness; hypotension is atypical, therefore making it the correct answer.

Why the others are wrong

• A – Fatigue commonly occurs from cortisol excess and sleep disturbances.
• B – Muscle weakness, especially proximal, is a hallmark of cortisol‑induced catabolism.
• C – Rapid weight gain is typical due to central obesity and fat redistribution.

Remember: Cortisol raises pressure; low pressure isn’t Cushing’s.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Cogwheel Rigidity

Topic: Parkinson Disease Rigidity

Cogwheel rigidity describes a ratchety resistance to passive movement, where the limb moves in brief catches interspersed with smooth motion, reflecting combined rigidity and tremor typical of Parkinson disease.

Why the others are wrong

• A – Lead pipe rigidity is uniform, constant resistance without the jerky catches.
• B – Pronate rigidity is not a recognized term in Parkinsonian movement disorders.
• C – Flexor rigidity refers to increased flexor tone, not the ratchety pattern described.

Remember: Cogwheel = ratchet‑like catches during passive movement.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Too few platelets

Thrombocytopenia is defined as a reduced number of circulating platelets (thrombocytes). With fewer platelets, clot formation is impaired, placing the patient at risk for easy bruising, petechiae, and potentially serious bleeding.

Why the others are wrong

• A – Platelet excess describes thrombocytosis, not thrombocytopenia.
• C – High white cells indicate leukocytosis, unrelated to thrombocytopenia.
• D – White blood cell count relates to leukopenia, not platelet disorders.

Remember: Thrombocytopenia = low platelets, think ‘thin’ clotting.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Neurofibrillary tangles and neuritic plaques

Topic: Alzheimer’s Disease Pathology

Neurofibrillary tangles and neuritic plaques are the characteristic neuropathologic findings in Alzheimer’s disease, reflecting tau protein accumulation and amyloid‑β deposition that cause synaptic loss and cognitive decline.

Why the others are wrong

• A – Dopamine reduction is linked to Parkinson’s, not Alzheimer’s disease.
• B – Meningeal inflammation occurs in meningitis, not in Alzheimer’s neurodegeneration.
• D – Transient neuronal discharge describes seizures, not the chronic pathology of Alzheimer’s.

Remember: Alzheimer’s = plaques and tangles, not dopamine or meningitis.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Impaired venous valves

Topic: Venous Insufficiency Pathophysiology

Venous insufficiency results from valve incompetence that allows retrograde flow, leading to pooling and increased venous pressure in the legs, which chronically damages the venous walls and causes edema, skin changes, and ulceration.

Why the others are wrong

• A – Lack of exercise may worsen symptoms but does not cause valve failure.
• B – Arterial blockage causes ischemia, not venous reflux.
• C – Varicose veins are a manifestation, not the primary cause.

Remember: Faulty valves let blood flow backward.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Cerebral angiography

Topic: Cerebral Angiography Allergies

Cerebral angiography requires iodinated contrast media; patients with iodine or shellfish allergy are at risk for severe reactions, so the nurse screens for these allergies before the procedure.

Why the others are wrong

• A – EMG assesses muscle activity via electrodes and involves no contrast media.
• B – EEG uses electrical recording only; no contrast agents are administered.
• D – Electroneurography records nerve conduction; it does not require iodinated contrast.

Remember: Contrast‑based brain scan = iodine allergy check.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Near the trachea

Topic: Thyroid Gland Anatomy

The thyroid gland lies in the anterior neck, wrapped around the trachea just below the larynx; its proximity to the airway influences symptoms like dysphagia and breathing changes and guides neck assessments and medication administration.

Why the others are wrong

• B – Kidneys are retroperitoneal; thyroid is in neck.
• C – Stomach is in abdomen; thyroid resides in cervical region.
• D – Hypothalamus is in brain; thyroid is peripheral neck organ.

Remember: Thyroid hugs the trachea in the front of the neck.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Ureter

Topic: Urolithiasis Location

Pain described as intense, sharp, wavelike, radiating to the scrotum with urinary urgency and scant output is classic for a stone lodged in the ureter, causing renal colic as it passes down the urinary tract.

Why the others are wrong

• B – Renal calyx stones cause flank pain, not scrotal radiation.
• C – Papillary stones typically present with hematuria, not colicky radiation.
• D – Urethral obstruction yields weak stream, not flank colic.

Remember: Ureter stones = colicky flank pain radiating to groin.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Adjacent to the hypothalamus in the brain

Topic: Endocrine Gland Anatomy

The pituitary gland resides in the sella turcica of the brain, directly beneath the hypothalamus and connected by the pituitary stalk, making its location essential for its neuroendocrine functions and related nursing care.

Why the others are wrong

• A – Stomach is far from pituitary; no endocrine link.
• C – Kidneys are not related to pituitary; adrenal glands sit atop kidneys.
• D – Trachea is in neck; pituitary is intracranial.

Remember: Pituitary sits under brain, linked to hypothalamus.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Family history of kidney stones

Topic: Chronic Kidney Disease Risk Factors

Family history of kidney stones does not independently increase CKD risk, unlike hypertension, diabetes, and chronic glomerulonephritis, which cause progressive renal damage and are well‑established contributors to renal function decline.

Why the others are wrong

• A – Diabetes causes hyperfiltration and nephropathy, a major CKD cause.
• C – Hypertension damages glomeruli, leading to CKD.
• D – Chronic glomerulonephritis directly impairs renal tissue, progressing to CKD.

Remember: Stones rock, but they don’t crack kidneys.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Duodenum, jejunum, ileum, large intestine, rectum

Topic: Gastrointestinal Tract Anatomy

After leaving the stomach, chyme enters the small intestine, passing sequentially through the duodenum, jejunum, and ileum. It then enters the large intestine for water absorption before being stored in the rectum for excretion.

Why the others are wrong

• A – This represents the reverse order of food passage through the lower gastrointestinal tract.
• C – This reverses the correct order of the small intestine segments (duodenum, jejunum, ileum).
• D – The duodenum precedes the jejunum; this option incorrectly places the jejunum first.

Remember: Dow Jones Industrial (DJI) index: Duodenum, Jejunum, Ileum.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Hypothyroidism

Topic: Thyroid Disorders

Hypothyroidism is defined by insufficient synthesis and release of thyroid hormones, leading to a slowed metabolic rate and related clinical signs.

Why the others are wrong

• A – Myxedema coma is a life‑threatening complication of untreated hypothyroidism, not the disorder itself.
• C – Hashimoto's is an autoimmune cause of hypothyroidism, not the primary disorder description.
• D – Hyperthyroidism involves excess thyroid hormone production, not reduction.

Remember: Low thyroid output = hypothyroidism.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Peripheral neuropathy

Topic: Vitamin B12 Deficiency

Untreated vitamin B12 anemia damages myelin sheaths, leading to demyelination of peripheral nerves; this manifests as tingling, numbness, and loss of proprioception, known as peripheral neuropathy.

Why the others are wrong

• A – Vitamin B12 deficiency does not increase muscle strength; it may cause weakness.
• B – Vision is not enhanced; deficiency can cause optic neuropathy.
• D – Cognitive function typically declines, not improves, with chronic B12 deficiency.

Remember: B12 loss = nerve damage, not stronger muscles.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Dual-Energy X-ray Absorptiometry (DEXA) scans

Topic: Bone Density Testing

Dual-Energy X-ray Absorptiometry (DEXA) is the gold standard diagnostic test used to measure bone mineral density, assess osteoporosis risk, and monitor treatment efficacy.

Why the others are wrong

• B – An EMG measures electrical activity of muscles and nerves, not bone density.
• C – MRI visualizes soft tissues, ligaments, and cartilage, not bone mineral density.
• D – A bone scan detects abnormal bone metabolism, infections, or fractures using radioactive tracers.

Remember: DEXA detects density; MRI maps soft tissue.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. 500 ml

Topic: Renal Physiology

The kidneys must generate at least 500 mL of urine each day; this minimum output ensures adequate clearance of metabolic waste and prevents accumulation of toxins. Values lower than this indicate oliguria and possible renal impairment.

Why the others are wrong

• A – One liter exceeds the minimum required; it's not the lowest amount needed.
• C – Same as option A; 1000 ml is above the minimum required output.
• D – Five hundred liters is physiologically impossible and far beyond normal urine production.

Remember: Kidneys need ≥500 mL urine daily to clear waste.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Topical application

Topic: Local Anesthesia Administration

Local anesthesia targets a specific, limited area of tissue. Topical application directly numbs the skin or mucous membranes before minor interventions like biopsies or dental work, avoiding the widespread systemic effects of general or neuraxial anesthesia.

Why the others are wrong

• B – Inhaled agents induce general anesthesia rather than localized, site-specific tissue numbness.
• C – Epidural injections provide central neuraxial regional anesthesia, which is too extensive for minor procedures.
• D – Intravenous administration delivers systemic sedation or general anesthesia, not superficial local numbing.

Remember: Topical numbs the surface spot directly without systemic or spinal spread.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Analysis of cerebral spinal fluid (CSF)

Topic: Bacterial Meningitis Diagnosis

CSF analysis is the classic diagnostic test for bacterial meningitis; it provides cell count, glucose, protein levels, and Gram stain/culture, directly confirming the presence of bacterial infection in the central nervous system.

Why the others are wrong

• A – EEG evaluates brain electrical activity, primarily for seizures, not infection diagnosis.
• C – CBC provides general blood data; it cannot directly identify meningitis pathogens.
• D – EMG measures peripheral nerve and muscle activity, which is unrelated to central nervous system infection.

Remember: CSF tap reveals the bug in meningitis.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Bradykinesia

Topic: Parkinson Disease Motor Symptoms

Bradykinesia describes the characteristic slow, deliberate movements in Parkinson’s disease that impair swallowing, facial expression, and coordinated actions. It reflects reduced amplitude and speed of voluntary motions, distinguishing it from tremor or rigidity.

Why the others are wrong

• A – Pill‑rolling describes a resting tremor of the hands, unrelated to swallowing or facial bradykinesia.
• B – Akinesia means absence of movement, not the slowed movements described.
• C – Freeze‑up tremors refer to episodic freezing, not the continuous slowness of movement.

Remember: Slow moves = bradykinesia, not tremor.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Align and immobilize the fracture

Topic: Skeletal Traction Purpose

Skeletal traction applies a pulling force directly to the bone using pins or wires. Its primary therapeutic purpose is to realign bone fragments and immobilize the fractured extremity to maintain proper alignment and promote healing.

Why the others are wrong

• B – Spasm reduction provides secondary pain relief, but immobilization is the primary therapeutic goal.
• C – Immobilization does not improve circulation and actually increases the risk of deep vein thrombosis.
• D – Traction restricts movement and temporarily decreases joint flexibility to allow proper bone healing.

Remember: Traction: Pull to align, hold to heal.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Right Circumstance

Topic: Five Rights of Delegation

The NCSBN defines the Five Rights of Delegation as the right task, right circumstance, right person, right directions/communication, and right supervision/evaluation. 'Right circumstance' ensures the patient's condition is stable and the setting is appropriate for delegation.

Why the others are wrong

• A – Autonomy is an ethical principle, not one of the five rights of delegation.
• B – This is not one of the five established NCSBN rights of delegation.
• D – Independent decision-making is not a component of the NCSBN delegation framework.

Remember: TCPDS: Task, Circumstance, Person, Direction, Supervision.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Excessive number of red blood cells which thicken the blood supply

Topic: Polycythemia Vera

Polycythemia vera is a myeloproliferative neoplasm characterized by uncontrolled red blood cell production, leading to increased blood viscosity and a thickened blood supply, which can cause hypertension and thrombosis.

Why the others are wrong

• A – White blood cells are not primarily increased in polycythemia vera.
• B – Vaso‑occlusive events describe sickle cell disease, not polycythemia vera.
• C – Hemorrhage risk is secondary, not the defining feature of polycythemia vera.

Remember: Too many reds make blood run like syrup.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: B. Sleep apnea

Topic: Respiratory Risk Factors

Obesity and GERD are strong risk factors for obstructive sleep apnea, and the combination increases upper airway collapse during sleep, making sleep apnea the most likely respiratory alteration.

Why the others are wrong

• A – COPD is associated with smoking and chronic bronchitis, not the presented risk factors.
• C – Asthma risk is hereditary, but obesity and GERD more directly cause sleep apnea.
• D – Lung cancer is primarily linked to smoking, not obesity or GERD.

Remember: Obesity + GERD = high sleep apnea risk.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: D. Managing symptoms, enhancing quality of life, and reducing complications

Topic: Cancer Care Continuum

Tertiary prevention aims to reduce the impact of an established disease by managing symptoms, preventing complications, and improving the patient’s functional status and quality of life, as in cancer survivorship care.

Why the others are wrong

• A – Early detection is secondary prevention, aimed at identifying disease before symptoms develop.
• B – Lifestyle modification targets risk reduction, fitting primary or secondary prevention, not established disease management.
• C – That describes primary prevention, which seeks to stop disease before it starts.

Remember: Tertiary prevention = treat, comfort, and keep living well with disease.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: C. Malignant cells have the potential to invade and harm tissues.

Topic: Neoplastic Cell Behavior

Malignant cells are characterized by uncontrolled growth and the ability to invade surrounding tissues and spread to distant sites, distinguishing them from benign cells which remain localized and non‑invasive.

Why the others are wrong

• A – Malignant cells proliferate without regulation, not in a controlled manner.
• B – Benign cells do not metastasize; they stay at the original site.
• D – Malignant cells are not confined; they can infiltrate beyond their origin.

Remember: Malignant means Metastasize and destroy nearby tissue.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

Answer: A. Decreased blood pressure, increased pulse

Topic: Postoperative Cardiovascular Signs

Postoperative cardiovascular compromise often presents with hypotension and tachycardia as the body attempts to maintain perfusion despite reduced cardiac output, making decreased blood pressure with an increased pulse the classic sign.

Why the others are wrong

• B – Cyanosis appears later with severe hypoxia, not initial compromise.
• C – Warm, clammy skin suggests hyperthermia, not cardiac failure.
• D – Hypertension and tachycardia are uncommon early signs of compromise.

Remember: Low pressure, fast pulse signals heart trouble after surgery.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.