NCLEX-RN: Health Alterations practice questions questions 76-100

Answer: D. Identifying heart failure

Topic: Heart Failure Biomarkers

BNP is released by ventricular myocytes when they are stretched by volume overload; its elevated plasma level is a sensitive marker for heart failure, guiding diagnosis and treatment.

Why the others are wrong

• A – BNP does not reflect coagulation activity.
• B – BNP’s effect on pressure is secondary, not its main purpose.
• C – BNP is not used to evaluate electrolyte status.

Remember: High BNP = heart under stress, think heart failure.

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. Type 2 diabetes

Topic: Diabetes Mellitus Types

In adults over 40, new‑onset polyuria, polydipsia, modest weight loss and a fasting glucose of 148 mg/dL are classic for Type 2 diabetes, which often presents with mild hyperglycemia before complications develop.

Why the others are wrong

• A – Gestational diabetes occurs only during pregnancy.
• B – Type 1 usually appears in youth with rapid, severe hyperglycemia and ketoacidosis.
• D – LADA progresses slowly and is identified by autoantibodies, not first‑line suspicion.

Remember: Middle‑aged, mild fasting glucose → think Type 2.

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. TSH

Topic: Thyroid Function Testing

TSH is produced by the pituitary and rises when thyroid hormone levels are low; in primary hypothyroidism the thyroid cannot synthesize sufficient T3/T4, so negative feedback fails and TSH becomes elevated.

Why the others are wrong

• A – T4 levels are low or normal in hypothyroidism, not elevated.
• C – TSI is associated with Graves disease, causing hyperthyroidism, not hypothyroidism.
• D – T3 is a thyroid hormone that decreases, not increases, in hypothyroidism.

Remember: High TSH signals an under‑active thyroid.

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. Acquired aplastic anemia

Topic: Aplastic Anemia Types

Acquired aplastic anemia, resulting from exposure to drugs, chemicals, radiation, or viral infections, accounts for the majority of cases, in adults, whereas inherited forms are rare.

Why the others are wrong

• B – Fanconi anemia is a rare inherited form, not the predominant type.
• C – Pancytopenic anemia describes the lab findings, not a specific etiology.
• D – Inherited aplastic anemia overall is uncommon compared with acquired cases.

Remember: Most aplastic anemia is acquired, not inherited.

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. Prophylaxis Surgery

Topic: Surgical Classification

Removing a benign mole from a sun‑exposed site is done to prevent possible malignant transformation, which is the purpose of prophylactic surgery. It is not intended to diagnose, cure an existing disease, or relieve symptoms.

Why the others are wrong

• A – Curative surgery treats an existing pathology, whereas the mole is benign and not disease.
• B – Palliative surgery alleviates symptoms of incurable disease, not removal of a harmless lesion.
• D – Diagnosis surgery obtains tissue for diagnosis, not performed solely to prevent disease.

Remember: Remove benign moles to stop future skin cancer.

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. Prerenal

Topic: Acute Renal Failure

Dehydration decreases intravascular volume, lowering renal blood flow and glomerular filtration rate; this reduced perfusion causes a prerenal form of acute renal failure, which is reversible if volume is restored.

Why the others are wrong

• B – Anterenal is not a recognized classification of acute renal failure.
• C – Intrarenal failure stems from intrinsic kidney damage, not from decreased perfusion.
• D – Postrenal injury results from urinary tract obstruction, not from volume depletion.

Remember: Dehydration → low volume → prerenal AKI

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. It is not cardiac-specific

Topic: Myocardial Infarction Biomarkers

Myoglobin is released from all striated muscle, so its serum rise occurs after any muscle injury, making it non‑cardiac‑specific; troponins are released only from damaged myocardium, providing higher specificity for MI diagnosis.

Why the others are wrong

• A – Myoglobin levels are not affected by the clotting cascade.
• B – Myoglobin rises within 1–2 hours, not after 24 hours.
• D – Assays for myoglobin are simple and widely available.

Remember: Myoglobin: muscle protein, not heart‑specific.

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. Encourage early ambulation

Topic: Postoperative DVT Prevention

Early ambulation promotes muscle pump activity, enhancing venous return and preventing stasis, the primary factor in postoperative deep vein thrombosis formation. It also reduces endothelial injury and improves circulation, making it the most effective non‑pharmacologic prophylaxis.

Why the others are wrong

• A – Prolonged leg elevation promotes stasis and does not prevent clots.
• C – Coughing and deep breathing target pulmonary, not lower‑extremity, circulation.
• D – Bedrest increases venous stasis, raising DVT risk.

Remember: Walk early; moving blood stops clots.

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. People over 60 years of age

Topic: Pernicious Anemia Risk

Pernicious anemia results from autoimmune destruction of gastric parietal cells, decreasing intrinsic factor needed for B12 absorption; the prevalence of this autoimmunity rises markedly after age 60, making older adults most at risk.

Why the others are wrong

• B – Vitamin C intake does not cause intrinsic factor deficiency.
• C – High socioeconomic status does not affect intrinsic factor production.
• D – Sunlight exposure relates to vitamin D, not B12 absorption.

Remember: Age‑related autoimmunity makes seniors prone to B12‑intrinsic factor loss.

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. Swelling in the legs and ankles

Topic: Chronic Kidney Disease

Peripheral edema of the legs and ankles occurs as fluid accumulates due to reduced glomerular filtration and sodium retention in advanced CKD, and reflects the common manifestation of volume overload in late-stage disease.

Why the others are wrong

• A – Chest pain usually indicates cardiac ischemia, not a typical CKD symptom.
• B – Polyuria is an early sign of kidney dysfunction, not a late-stage manifestation.
• C – Increased sense of taste is not associated with CKD; taste often diminishes.

Remember: Edema = fluid buildup, hallmark of late CKD.

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. Antigen

Topic: Immunology Basics

An antigen is a molecular structure on the surface of cells that the immune system recognizes as non‑self, signaling the presence of viruses, bacteria, allergens, or tumor cells and initiating an immune response.

Why the others are wrong

• B – Immunoglobulin are circulating antibodies, not markers displayed on cell membranes.
• C – Allergen is the substance that triggers an allergic reaction, not a cell surface marker.
• D – T cell is an immune effector cell, not a surface antigen.

Remember: Antigens are the body's ‘ID tags’ for foreign invaders.

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. To relax bronchial smooth muscles

Topic: Status Asthmaticus Management

IV magnesium sulfate is given in status asthmaticus because it acts as a calcium antagonist, relaxing bronchial smooth muscle and producing bronchodilation when other therapies are insufficient.

Why the others are wrong

• A – Magnesium does not cause bronchoconstriction; it relaxes airway smooth muscle.
• C – It does not directly improve oxygen saturation; bronchodilation is its main effect.
• D – Magnesium’s primary action is bronchodilation, not anti‑inflammatory.

Remember: Magnesium relaxes airway smooth muscle during severe asthma attacks.

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. Calcium

Topic: Bone Mineral Homeostasis

Calcium is the primary mineral stored in the skeletal system. The bones act as a dynamic reservoir, continuously storing and releasing calcium under the influence of hormones to maintain precise serum calcium levels necessary for neuromuscular function.

Why the others are wrong

• A – Potassium is the primary intracellular cation and is not stored or released by bones.
• B – Sodium is primarily an extracellular fluid electrolyte, not stored or continuously regulated by bones.
• D – While stored in bones, it is not the primary mineral regulated for systemic homeostasis.

Remember: Bones are the bank; calcium is the currency constantly deposited and withdrawn.

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. Kidney-ureter-bladder-urethra

Topic: Urinary Tract Flow

Urine is produced in the kidneys, travels down the ureters to the bladder for storage, then exits via the urethra; this sequential pathway matches the kidney‑ureter‑bladder‑urethra order.

Why the others are wrong

• B – Ureter‑kidney‑bladder‑urethra reverses the normal direction of urine flow from kidney to ureter.
• C – Urethra‑bladder‑ureter‑kidney starts with the exit route, not the production site.
• D – Urethra appears before bladder and ureter is after bladder, which is anatomically impossible.

Remember: Kidney → ureter → bladder → urethra, like a one‑way street.

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. Preventing the initial occurrence of cancer

Topic: Primary Prevention Strategies

Primary prevention seeks to stop disease from developing in the first place, using measures such as immunizations, health education, and risk‑factor reduction, thereby preventing the initial occurrence of conditions like cancer.

Why the others are wrong

• A – Chemotherapy treats disease, not prevents it.
• C – Managing symptoms is tertiary prevention, not primary.
• D – Early detection is secondary prevention, not primary.

Remember: Stop disease before it starts.

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. Below 500/µL

Topic: Severe Neutropenia Threshold

An absolute neutrophil count (ANC) below 500/µL indicates severe neutropenia, which places the patient at an extremely high risk for life-threatening infections. Protective isolation precautions are typically initiated at this critical threshold.

Why the others are wrong

• B – This threshold represents mild neutropenia, which is the general cutoff for defining neutropenia.
• C – This threshold represents moderate neutropenia, indicating a moderate risk of infection.
• D – This value is within the normal reference range for absolute neutrophil count.

Remember: Severe neutropenia: ANC under 500 means severe infection 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: B. Hypertension stage 1

Topic: Blood Pressure Classification

A systolic of 134 mmHg and diastolic of 82 mmHg fall within the 130‑139/80‑89 range defined as Stage 1 hypertension for adults in current ACC/AHA guidelines used worldwide.

Why the others are wrong

• A – Elevated is 120‑129 systolic with diastolic under 80.
• C – Crisis demands ≥180 mmHg systolic or ≥120 mmHg diastolic.
• D – Stage 2 requires ≥140 mmHg systolic or ≥90 mmHg diastolic.

Remember: 134/82 sits in the 130‑139/80‑89 Stage 1 box.

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. “I can take with my warfarin in the morning.”

Topic: Phenytoin Patient Teaching

Dilantin (phenytoin) potentiates warfarin’s anticoagulant effect, raising bleeding risk; patients should not be told they can safely take both without monitoring, so this statement shows need for further teaching.

Why the others are wrong

• B – Antacids reduce phenytoin absorption; avoiding them is appropriate.
• C – Gum bleeding/enlargement is a known phenytoin side effect; statement is correct.
• D – Phenytoin can cause urine discoloration; statement is accurate.

Remember: Phenytoin + warfarin = dangerous bleed 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: C. To evaluate blood flow to tissue

Topic: Cardiovascular Assessment

Capillary refill time assesses peripheral perfusion by observing how quickly color returns after pressure, indicating adequacy of blood flow to the tissues. A delayed refill suggests compromised circulation, often seen in shock or peripheral vascular disease.

Why the others are wrong

• A – Venous return is examined with jugular venous pressure, not capillary refill.
• B – Heart murmurs are evaluated by auscultation, not refill time.
• D – Peripheral edema is assessed by pitting, not capillary refill.

Remember: Fast refill = good tissue perfusion; slow = poor circulation.

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. Swelling, especially in the ankles and lower legs

Topic: Venous Insufficiency

Venous insufficiency results from valve failure, causing blood to pool in the lower extremities; the most common manifestation is edema, particularly swelling of the ankles and lower legs, often accompanied by skin changes.

Why the others are wrong

• A – Numbness and tingling reflect nerve involvement, not the primary sign of venous insufficiency.
• B – Sharp, shooting pain is characteristic of neuropathic or arterial disease, not venous insufficiency.
• C – Elevated temperature suggests infection or inflammation, not a typical feature of venous insufficiency.

Remember: Venous insufficiency = swollen ankles

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. Monitoring cardiovascular response to activity

Topic: Iron‑Deficiency Anemia Management

Patients with iron‑deficiency anemia have reduced oxygen‑carrying capacity, so the nurse must first assess how the heart and lungs respond to activity to prevent hypoxia and cardiac strain.

Why the others are wrong

• A – Transfusions are reserved for severe, symptomatic anemia, not routine care.
• B – Sedentary behavior worsens deconditioning and does not address oxygen delivery needs.
• C – Supplements are important but are secondary to evaluating cardiovascular tolerance.

Remember: First check the heart‑lung response before giving iron or blood.

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. It has a duration of action of up to 24 hours.

Topic: Diabetes Insulin Therapy

Insulin detemir is a long‑acting basal insulin; it provides a relatively flat profile with up to 24‑hour duration and no pronounced peak, making it suitable for once‑ or twice‑daily dosing.

Why the others are wrong

• A – Detemir does not peak early; its action is flat.
• B – Onset is about 1‑2 hours, not rapid.
• C – Detemir is basal, not mealtime insulin.

Remember: Detemir lasts a day, no sharp peak.

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. To share any concerns or incidents related to client care.

Topic: Nursing Delegation and Communication

Ongoing communication between the nurse and delegatee is essential to ensure patient safety. It allows the delegatee to promptly report changes in client status, share concerns, and report incidents, enabling the nurse to intervene and modify the plan of care.

Why the others are wrong

• A – Communication encourages ongoing clarification and feedback rather than eliminating the need for it.
• C – Ongoing communication facilitates monitoring, but continuous direct supervision is not always required for delegation.
• D – The licensed nurse always retains ultimate accountability for the delegated task and client outcomes.

Remember: Delegate the task, not the accountability; communicate for safety.

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. Providing information on postoperative breathing exercises and incentive spirometry

Topic: Preoperative Patient Teaching

Preoperative teaching focuses on actions the client must take postoperatively to prevent complications. Teaching deep breathing and incentive spirometry before surgery ensures compliance and proper technique when the client is recovering from anesthesia.

Why the others are wrong

• A – Surgical instrument details are unnecessary, increase anxiety, and do not aid postoperative recovery.
• C – Postoperative pain management typically involves prescribed medications rather than over-the-counter pain relievers.
• D – Explaining anesthesia types and risks is the responsibility of the anesthesia provider, not the nurse.

Remember: Teach deep breathing before surgery to prevent postoperative lung complications.

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. Fifth intercostal space

Topic: Cardiac Physical Assessment

During cardiac auscultation the point of maximal impulse is found where the left ventricle contacts the chest wall, typically at the 5th intercostal space on the mid‑clavicular line in adults.

Why the others are wrong

• A – First intercostal space is too superior; houses aortic area, not PMI.
• C – Second intercostal space corresponds to pulmonary area, not the apical impulse.
• D – Third intercostal space is above the normal PMI location.

Remember: PMI = 5th intercostal, mid‑clavicular line.

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.