NCLEX-RN: Health Alterations practice questions questions 101-125

Answer: B. To promote the development of collateral circulation

Topic: Peripheral Arterial Disease

Walking therapy increases shear stress on arterial walls, stimulating angiogenesis and enlargement of existing vessels, which develops collateral circulation to bypass occluded segments, improving perfusion and functional capacity in peripheral arterial disease.

Why the others are wrong

• A – Skin color changes are due to perfusion, not corrected by walking alone.
• C – Infection risk is managed by wound care, not by a walking program.
• D – Walking does not directly relieve chronic pain; it may temporarily worsen claudication.

Remember: Walk to build new vessels around blockages.

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. Dietary deficiency of vitamin B12

Topic: Vitamin B12 Deficiency

The primary cause of vitamin B12 anemia in vegetarians or vegans is insufficient dietary intake of cobalamin because plant foods lack active B12; without animal products, stores become depleted, leading to megaloblastic anemia.

Why the others are wrong

• B – Lack of sunlight exposure relates to vitamin D, not B12 deficiency.
• C – Red meat provides B12; overconsumption does not cause deficiency.
• D – Excessive vitamin C does not affect B12 absorption or cause anemia.

Remember: Vegans lack B12 because plants don’t contain 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. COMT Inhibitor (Entacapone)

Topic: Parkinson Disease Pharmacology

Entacapone inhibits peripheral catechol‑O‑methyltransferase, preventing levodopa breakdown and extending its plasma half‑life, thereby reducing the “off” periods that occur before the next dose of carbidopa/levodopa.

Why the others are wrong

• B – Dopamine agonists can replace levodopa but are not first‑line for off‑period reduction.
• C – Anticholinergics mainly treat tremor, not the wearing‑off phenomenon.
• D – MAO‑B inhibitors modestly prolong levodopa effect but are less effective for early off periods.

Remember: Entacapone blocks COMT, extending levodopa’s ride.

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. Bone Marrow

Topic: Bone Marrow Failure

Aplastic anemia occurs when the bone marrow’s hematopoietic stem cells are damaged or suppressed, preventing production of red cells, white cells, and platelets, resulting in pancytopenia and increased bleeding and infection risk.

Why the others are wrong

• B – The liver metabolizes substances; it is not the site of hematopoiesis in adults.
• C – The heart pumps blood; it does not produce blood components.
• D – The spleen filters blood but does not generate blood cells.

Remember: Aplastic anemia = bone marrow can't make 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: B. Wada Test

Topic: Neurodiagnostic Testing

The Wada test temporarily anesthetizes one cerebral hemisphere with intra‑arterial sodium amobarbital, then assesses language and memory by presenting visual stimuli such as cards to determine hemispheric function.

Why the others are wrong

• A – Invasive EEG records electrical activity but does not involve anesthetizing brain tissue.
• C – Alteration Neuro Test is not a recognized diagnostic procedure.
• D – Neurophysiological Test is a broad term; it does not describe hemispheric anesthesia.

Remember: Wada test = brain “sleep” to test memory cards.

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. Constipation

Topic: Iron Supplement Side Effects

Oral iron preparations often cause gastrointestinal upset, most notably constipation, because iron can irritate the mucosa and reduce intestinal motility, leading to hard, dark stools.

Why the others are wrong

• A – Insomnia is unrelated to iron supplementation.
• C – Weight gain is not a recognized effect of iron therapy.
• D – Diarrhea is less common than constipation with iron.

Remember: Iron slows gut, causing constipation.

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 Hyperthermia

Topic: Malignant Hyperthermia

Malignant hyperthermia is a rare, life‑threatening reaction to certain volatile anesthetics and depolarizing muscle relaxants, causing uncontrolled calcium release in skeletal muscle, leading to hypermetabolism, hyperthermia, acidosis, hyperkalemia, and cardiac arrhythmias.

Why the others are wrong

• A – Anaphylaxis is an allergic reaction with hives, bronchospasm, not hyperthermia from calcium release.
• B – Overdose describes excessive drug amount, not the specific anesthetic-triggered calcium dysregulation.
• D – Hypoventilation causes CO2 retention and hypoxia, not the rapid rise in temperature and muscle metabolism.

Remember: Think ‘malignant hyper‑thermo‑mia’: muscle calcium surge spikes heat.

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. Metabolic rate

Topic: Thyroid Hormone Function

Thyroid hormones T3 and T4 increase basal metabolic rate by stimulating oxygen consumption and heat production in virtually all tissues, influencing protein synthesis, lipolysis, and carbohydrate metabolism.

Why the others are wrong

• A – Blood glucose regulation is primarily mediated by insulin and glucagon, not thyroid hormones.
• C – The fight‑or‑flight response is driven by catecholamines from the adrenal medulla, not thyroid hormones.
• D – Thyroid hormones do not directly control electrolyte balance or blood pressure.

Remember: T3/T4 turn up the body's metabolic furnace.

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. Phagocytosis and defense against infections

Topic: Neutrophil Function

Neutrophils are the most abundant white blood cells; they engulf and destroy bacteria and fungi through phagocytosis, providing the first line of defense against infection.

Why the others are wrong

• A – Neutrophils have no role in thermoregulation; that is controlled by the hypothalamus.
• B – Neutrophils do not produce antibodies; B cells perform that function.
• D – Initiating inflammation is a secondary role; neutrophils mainly ingest pathogens.

Remember: Neutrophils = phagocytic first responders

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. Managing pain

Topic: Balanced Anesthesia Pharmacotherapy

Morphine is an opioid analgesic used in balanced anesthesia to provide perioperative pain management and reduce autonomic responses to surgical stimuli. Other distinct drug classes are used to induce unconsciousness, provide amnesia, and produce neuromuscular blockade.

Why the others are wrong

• B – Neuromuscular blocking agents such as succinylcholine or rocuronium are used to produce skeletal muscle relaxation.
• C – Intravenous anesthetics like propofol or inhaled agents are used to induce unconsciousness, not opioids.
• D – Anesthesia promotes amnesia rather than preventing it; benzodiazepines or inhaled agents produce amnesia.

Remember: Morphine manages pain; it leaves unconsciousness and paralysis to other agents.

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. Encouraging adequate rest and sleep

Topic: Viral Respiratory Infection Care

Rest and sleep allow the body’s immune system to function optimally, reducing fever and muscle aches, and help the patient conserve energy needed for recovery from a viral respiratory infection.

Why the others are wrong

• A – Airborne precautions are for highly transmissible pathogens like TB, not routine viral colds.
• B – Antibiotics target bacteria, not viruses, so they are ineffective for viral infections.
• C – Corticosteroids suppress immunity and are not indicated unless severe inflammation is present.

Remember: Rest fuels the immune system.

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 elastic recoil of the lungs and chest wall, leading to difficulty exhaling

Topic: Aging Respiratory Changes

In older adults the lungs and chest wall lose elastic recoil, so exhalation is less efficient and air trapping occurs, contributing to reduced vital capacity and increased work of breathing.

Why the others are wrong

• B – Brainstem sensitivity decline is minor; primary issue is loss of elastic recoil.
• C – Surfactant production remains adequate; elasticity, not surface tension, changes with age.
• D – Diaphragmatic strength actually decreases, not improves, with aging.

Remember: Aging lungs lose stretch, making exhalation harder.

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. Hypercapnia, elevated levels of carbon dioxide in the blood

Topic: Respiratory Regulation

In healthy individuals, the main stimulus for increasing respiratory rate is elevated arterial CO₂ (hypercapnia). Central chemoreceptors detect the rise, prompting the brainstem to increase depth and frequency of breaths.

Why the others are wrong

• B – Low oxygen triggers breathing only after CO₂ rises; not the primary drive.
• C – Acidosis results from CO₂ accumulation; it is not the initial stimulus.
• D – High blood pressure does not influence the respiratory control centers.

Remember: CO₂ rise = faster breaths.

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. Infants have less flexible larynx compared to adults

Topic: Pediatric Respiratory Anatomy

In infants the larynx is positioned higher and its cartilage is less compliant, resulting in reduced flexibility compared with the adult larynx, which contributes to their susceptibility to airway obstruction.

Why the others are wrong

• A – Infants breathe faster, not slower, due to higher metabolic demand.
• C – Apnea episodes are typical in infants, not commonly seen in older adults.
• D – Children’s airways are smaller in diameter than adult airways.

Remember: Infant larynx: higher, stiffer, less flexible than adult.

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. Encouraging a balanced diet and regular physical activity

Topic: Cancer Primary Prevention

A balanced diet and regular physical activity lower cancer risk by maintaining healthy weight, reducing inflammation, and modulating hormones, making them the cornerstone of primary prevention.

Why the others are wrong

• B – Support‑group referrals address psychosocial needs, not direct cancer risk reduction.
• C – Blood pressure control targets cardiovascular disease, not cancer risk.
• D – Prophylactic surgeries are secondary/tertiary measures, not primary prevention.

Remember: Eat well, move often—your best cancer shield.

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. Liver, scallops, anchovies, sardines, pork

Topic: Uric Acid Nephrolithiasis Diet

Uric acid stones form when urine is persistently acidic and saturated with uric acid. Patients must avoid high-purine foods like organ meats, certain seafood, and pork, as purine breakdown directly produces uric acid.

Why the others are wrong

• A – Spinach and strawberries are rich in oxalate, which is restricted for calcium oxalate stones.
• B – Dairy products are high in calcium, not primarily restricted for uric acid stones.
• D – These vegetables are low in purines and safe to consume with uric acid stones.

Remember: Purines from meats and seafood break down into uric acid stones.

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. Administer glucagon injection or D50 IV push

Topic: Hypoglycemia Management in Older Adults

The client shows signs of severe hypoglycemia; rapid IV glucose (D50) or glucagon is required to restore cerebral glucose immediately, preventing seizures or loss of consciousness.

Why the others are wrong

• A – Oral carbs are unsafe when patient is confused and may aspirate.
• C – Larger oral load is too slow for severe neuroglycopenia.
• D – Leg elevation treats shock, not hypoglycemia.

Remember: Severe low sugar = D50 or glucagon, not food.

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. An autoimmune disorder

Topic: Arthritis Types Comparison

Rheumatoid arthritis is a systemic autoimmune disease in which the immune system attacks the synovial joints. Osteoarthritis is primarily a degenerative wear-and-tear condition caused by mechanical breakdown of articular cartilage rather than an autoimmune etiology.

Why the others are wrong

• A – Joint pain is a primary presenting symptom in both osteoarthritis and rheumatoid arthritis.
• B – Asymmetrical joint involvement characterizes osteoarthritis; rheumatoid arthritis typically presents with symmetrical joint involvement.
• D – Inflammation occurs in both disorders, though it is systemic and autoimmune-driven in rheumatoid arthritis.

Remember: Rheumatoid attacks its own; osteoarthritis wears the bone down.

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. STUFF-stuff soft object in mouth to avoid biting tongue

Topic: Seizure First Aid

Placing an object in the mouth can cause injury; current guidelines advise against it. The correct steps are staying with the patient, ensuring safety, and turning them on their side.

Why the others are wrong

• A – Clearing area prevents injury and allows timing the seizure.
• B – Staying with patient provides safety and seizure monitoring.
• C – Turning patient on side helps maintain airway and drainage.

Remember: Never stuff the mouth; keep airway clear.

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. The brain continues to perceive sensations from a limb that is no longer present.

Phantom limb pain is a real neuropathic pain syndrome where the brain's somatosensory cortex continues to receive and interpret signals, perceiving sensations and pain from a limb that has been surgically removed.

Why the others are wrong

• A – Fear of limb loss is a psychological response, not the physiological cause of phantom pain.
• B – Phantom limb pain is a real, physiological neuropathic condition, not an imagined sensation.
• D – Surgical site infections cause localized stump pain, not neuropathic phantom limb sensations.

Remember: Phantom pain is in the brain, not the imagination.

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. May occur at rest

Topic: Stable Angina Characteristics

Stable angina presents as brief chest pain triggered by exertion or emotional stress, relieved quickly by rest or nitroglycerin, and is controllable with lifestyle changes and medication; it does not occur at rest.

Why the others are wrong

• B – Exercise is a classic trigger for stable angina.
• C – Lifestyle and meds effectively control stable angina.
• D – Short episodes are typical of stable angina.

Remember: Stable angina: exercise‑triggered, brief, stops with rest—not at rest.

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. Reverse Transcription Polymerase Chain Reaction (RT-PCR)

Topic: COVID‑19 Diagnostic Testing

RT‑PCR detects viral RNA and is the gold‑standard diagnostic test for acute COVID‑19 infection, providing highest sensitivity and specificity. It can confirm infection early, even before symptoms appear, and is recommended by CDC and WHO for definitive diagnosis.

Why the others are wrong

• A – Viral culture is time‑consuming, not practical for routine COVID‑19 diagnosis.
• C – Antibody test indicates past exposure, not active infection.
• D – Rapid antigen test is less sensitive; used for screening, not definitive diagnosis.

Remember: RT‑PCR = RNA test, the COVID‑gold standard.

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. Palpation of a thrill over the fistula

Topic: Arteriovenous Fistula Patency

A palpable thrill over the fistula confirms turbulent blood flow, indicating the access is functional and patent; this physical finding is the primary bedside method for assessing AV fistula patency before dialysis.

Why the others are wrong

• A – Capillary refill assesses peripheral perfusion, not fistula patency.
• C – Absence of a bruit suggests inadequate flow, indicating possible thrombosis.
• D – A radial pulse reflects arterial flow, not fistula function.

Remember: Feel the thrill; it means the fistula works.

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. Immune-mediated response

Topic: Acquired Thrombocytopenia Causes

Acquired thrombocytopenia often results from immune-mediated destruction of platelets, such as immune thrombocytopenic purpura or drug‑induced antibodies, which rapidly lower platelet counts despite normal production.

Why the others are wrong

• B – Aplastic anemia leads to pancytopenia, not isolated immune‑mediated platelet loss.
• C – Aspirin impairs platelet function, but does not decrease platelet numbers.
• D – Genetic mutations cause congenital, not acquired, thrombocytopenia.

Remember: Immune attack = acquired low platelets.

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. Negative feedback

Topic: Endocrine Feedback Mechanisms

Negative feedback is the endocrine mechanism where rising hormone levels suppress further secretion, maintaining homeostasis. When sufficient hormone is present, the gland receives inhibitory signals, preventing excess production.

Why the others are wrong

• A – Supply and demand does not describe endocrine regulation.
• B – Positive feedback amplifies hormone release, not inhibits it.
• D – Hormone cascade refers to sequential activation, not inhibition.

Remember: Hormone stops itself when enough is present.

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.