NCLEX-RN: Health Alterations practice questions questions 251-267

Answer: B. Extras

Topic: CURE Prioritization Hierarchy

The CURE hierarchy is a prioritization framework where "Extras" represent non-essential activities that enhance client comfort and well-being, such as providing a warm blanket or brushing hair, but do not directly impact clinical outcomes.

Why the others are wrong

• A – Routine needs include standard daily care activities like administering scheduled medications or performing assessments.
• C – Critical needs address immediate, life-threatening situations that directly impact client survival and safety.
• D – Urgent needs require prompt attention to prevent complications but are not immediately life-threatening.

Remember: CURE: Critical, Urgent, Routine, and Extras for comfort.

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. Decreased ability of the rib cage to expand and contract

Topic: Aging Lung Changes

Aging stiffens the thoracic cage; calcified costal cartilages and reduced intercostal muscle tone limit rib expansion, decreasing tidal volume and vital capacity.

Why the others are wrong

• A – Diaphragm strength does not increase; it may weaken or remain unchanged with age.
• C – Cough reflex may diminish, but primary structural change is rib cage rigidity, not nerve sensitivity.
• D – Alveolar surface area and diffusion capacity decline, so gas exchange does not increase.

Remember: Stiff ribs = shallow breaths in older adults.

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. Pancreatitis

Topic: Type 2 Diabetes Medication Adverse Effects

Sitagliptin is a DPP‑4 inhibitor; its most serious reported adverse effect is acute pancreatitis, which may present with abdominal pain and elevated enzymes, so nurses must monitor for this.

Why the others are wrong

• A – Hypoglycemia is uncommon unless combined with other glucose‑lowering agents.
• B – Diarrhea is not a common adverse effect of sitagliptin.
• C – Hyperglycemia would indicate treatment failure, not a drug side effect.

Remember: Think pancreas: DPP‑4 inhibitors can inflame it.

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. Headache

Topic: Spinal Anesthesia Complications

A post‑dural puncture headache occurs when anesthetic is injected into the cerebrospinal fluid, causing CSF leakage and reduced intracranial pressure, leading to a characteristic positional headache.

Why the others are wrong

• A – Rare; usually due to needle trauma, not typical complication.
• B – Spinal block affects lower body; respiratory depression is not a direct effect.
• C – Allergic response can occur but is uncommon compared with post‑dural headache.

Remember: Spinal tap → post‑dural puncture headache.

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 cortisol production

Topic: Addison's Disease Etiology

Addison's disease results from insufficient cortisol due to adrenal destruction; autoimmune adrenalitis, infection, or physical loss of gland tissue are common causes. Excessive cortisol production reflects the opposite condition, Cushing syndrome, and does not cause Addison's.

Why the others are wrong

• A – Autoimmune adrenalitis destroys cortex, leading to primary adrenal insufficiency.
• B – TB infection can damage adrenal tissue, resulting in primary adrenal insufficiency.
• C – Physical destruction eliminates cortisol production, directly causing Addison's disease.

Remember: Addison = low cortisol; too much cortisol never causes it.

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. Chronic bronchitis

Topic: Chronic Bronchitis

Chronic exposure to tobacco smoke irritates and inflames the bronchial mucosa, leading to increased mucus production and airway narrowing, which manifests as a persistent cough, dyspnea, and wheezing—classic features of chronic bronchitis.

Why the others are wrong

• B – Lung cancer usually shows weight loss and hemoptysis, not a chronic productive cough with wheeze.
• C – Emphysema is alveolar wall destruction causing airflow limitation, not the productive cough typical of chronic bronchitis.
• D – Asthma involves reversible airway hyperreactivity, not the fixed mucus‑producing changes seen with chronic smoke exposure.

Remember: Secondhand smoke → mucus‑filled airways = chronic bronchitis.

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. Angiotensin-converting enzyme (ACE) inhibitors

Topic: Hypertension in Chronic Kidney Disease

ACE inhibitors are first‑line for hypertension in CKD because they lower systemic pressure, reduce intraglomerular pressure, improve proteinuria, and slow progression of renal damage in affected patients.

Why the others are wrong

• B – Useful for certain cardiac conditions but less effective for CKD‑related hypertension.
• C – May lower blood pressure but lack renal protective benefits seen with ACE inhibitors.
• D – Primarily treat volume overload; they do not address underlying CKD hypertension mechanisms.

Remember: ACE inhibitors protect kidneys while lowering BP.

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. Poikilothermia

Topic: Compartment Syndrome Assessment

The 6 P’s of compartment syndrome include pain, pallor, paresthesia, pulselessness, paralysis, and poikilothermia, which refers to a cold-to-the-touch extremity. This assessment is vital for detecting early neurovascular compromise.

Why the others are wrong

• A – Papilloma is a benign skin growth and unrelated to compartment syndrome.
• C – Palpitation refers to a racing heartbeat, not a localized neurovascular assessment.
• D – Pathology is the study of disease, not a physical sign of ischemia.

Remember: Poikilothermia means a cold limb, keeping neurovascular chances slim.

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. Fever and chills

Topic: Leukopenia Clinical Presentation

Leukopenia reduces white blood cells, impairing immune defense; patients often present with signs of infection such as fever and chills, reflecting the body’s response to bacterial or viral invasion.

Why the others are wrong

• A – Hypertension is a vascular condition, not a leukopenia manifestation.
• B – Joint pain and swelling indicate arthritis, not leukopenia.
• C – Hemoptysis suggests pulmonary bleeding, unrelated to low white cells.

Remember: Low WBCs → fever, chills signal infection.

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. Demonstrating competency for the delegated responsibility.

Topic: Delegation Responsibilities

Once a delegatee accepts a task, they assume responsibility for their own actions, which includes demonstrating the necessary competency to perform the task safely and effectively. They are accountable for the outcome of the delegated activity.

Why the others are wrong

• A – Delegatees must communicate openly with the delegating nurse, especially regarding any concerns.
• B – Confidentiality is a universal professional expectation, not a specific duty of accepting delegation.
• D – Delegatees do not have the authority to sub-delegate tasks to other staff.

Remember: Accept delegation, accept accountability: you must be competent to perform.

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. Cardiac stress test

Topic: Cardiac Diagnostic Testing

A cardiac stress test records ECG changes, blood pressure, and symptoms while the patient exercises, allowing assessment of myocardial perfusion, functional capacity, and detection of ischemia during physical activity.

Why the others are wrong

• A – Echocardiogram images heart at rest, not during exercise.
• B – Holter monitor tracks rhythm continuously, not specifically during graded activity.
• C – Cardiac catheterization visualizes vessels invasively, not exercise performance.

Remember: Stress test = heart’s treadmill exam.

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. Iodine

Topic: Thyroid Hormone Synthesis

Iodine is an essential trace element incorporated into thyroxine (T4) and triiodothyronine (T3); without adequate iodine, the thyroid cannot synthesize these hormones, leading to hypothyroidism.

Why the others are wrong

• A – Islet cells produce insulin; they do not participate in thyroid hormone formation.
• B – Glycogen is a stored carbohydrate, unrelated to hormone production.
• C – Insulin regulates glucose, not thyroid hormone synthesis.

Remember: Iodine = iodine, the iodine in thyroid hormones.

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. Fever

Topic: Kidney Stones

Fever is not typical of kidney stones; stones cause pain, hematuria, urgency, and flank discomfort, but infection‑related fever suggests pyelonephritis or obstructive uropathy, not the stone itself.

Why the others are wrong

• A – Lower back pain is classic colicky pain from stones.
• B – Urinary urgency occurs due to irritation from stones.
• C – Hematuria is a common sign of kidney stones.

Remember: Stones cause pain, blood, urgency—fever signals infection, not the stone.

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. Absent bowel sounds, no flatus or stool

Topic: Postoperative Ileus

Paralytic ileus is a functional bowel obstruction after surgery, characterized by lack of peristalsis, resulting in absent bowel sounds and no passage of flatus or stool.

Why the others are wrong

• A – Rigidity suggests peritonitis or volvulus, not simple ileus.
• C – Hyperactive sounds indicate obstruction, not paralytic ileus.
• D – Fever suggests infection, not ileus.

Remember: No sounds, no gas—paralytic ileus.

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. Spirometry

Topic: Asthma Diagnosis Testing

Spirometry is the standard initial pulmonary function test for suspected asthma because it measures forced expiratory volume in one second and the FEV1/FVC ratio, allowing detection of reversible airway obstruction.

Why the others are wrong

• B – Bronchial responsiveness testing is used after spirometry when diagnosis remains unclear.
• C – Diffusion testing evaluates gas exchange, not airway obstruction typical of asthma.
• D – FVC alone cannot differentiate obstructive from restrictive patterns, so it’s insufficient.

Remember: Spirometry reveals reversible obstruction—first step for asthma.

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. Reduction or absence of all three major blood cell types

Topic: Aplastic Anemia

Pancytopenia means a decrease in all three major blood cell lines—red cells, white cells, and platelets—commonly seen in aplastic anemia resulting from impaired marrow production.

Why the others are wrong

• A – Pancytopenia is a decrease, not an increase, of all cell lines.
• B – Pancytopenia includes low white cells, so an elevated count is opposite.
• C – Pancytopenia refers to low cell counts, not abnormal cell morphology.

Remember: All cells down = pancytopenia.

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. Streptococcus

Topic: Acute Glomerulonephritis Etiology

Group A β‑hemolytic Streptococcus is the classic precipitant of acute post‑streptococcal glomerulonephritis, occurring 1–3 weeks after pharyngitis or impetigo; other bacteria are uncommon causes in adults.

Why the others are wrong

• B – Staph infections rarely trigger acute GN; they are more associated with other renal pathologies.
• C – E. coli causes urinary tract infections, not the immune‑mediated glomerulonephritis seen after streptococcal infection.
• D – H. influenzae is not a common precipitant of acute GN; it mainly causes respiratory infections.

Remember: Strep → post‑infection kidney inflammation.

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.