NCLEX-RN: Health Alterations practice questions questions 126-150

Answer: A. substantia nigra, dopamine

Topic: Parkinson Disease Pathophysiology

Parkinson's disease primarily involves degeneration of the substantia nigra pars compacta in the midbrain, resulting in reduced dopamine production, which causes the characteristic motor symptoms.

Why the others are wrong

• B – Lemniscus structures are sensory pathways; norepinephrine is not the depleted neurotransmitter in Parkinson's.
• C – Red nucleus is not primarily affected; it relates to motor coordination, not dopamine loss.
• D – Tectum nigra is not an anatomic term; dopamine depletion occurs in substantia nigra.

Remember: Substantia nigra loses dopamine in Parkinson'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: C. Smoking history

Topic: Respiratory Risk Assessment

Smoking is the leading modifiable cause of chronic respiratory disease; it directly damages airway epithelium, impairs mucociliary clearance, and accelerates COPD progression, making it the most urgent factor to modify before others.

Why the others are wrong

• A – Allergic rhinitis contributes minimally to chronic lung damage compared with smoking.
• B – Hypertension affects cardiovascular health, not the primary cause of respiratory decline.
• D – Obesity worsens ventilation but smoking poses a greater immediate respiratory threat.

Remember: Quit smoking first; it’s the biggest lung killer.

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. Glomerular Filtration Rate

Topic: Renal Function Assessment

Glomerular filtration rate directly estimates the kidneys' ability to filter blood, providing the most accurate measure of waste removal efficiency.

Why the others are wrong

• A – BUN reflects protein breakdown, not kidney clearance.
• C – Creatinine alone lacks precision without calculating GFR.
• D – Electrolyte panel assesses ion concentrations, not filtration capacity.

Remember: GFR = kidney’s waste‑filtering power.

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. To empower clients to manage pain effectively and safely

Topic: Postoperative Pain Management

Providing detailed instructions about pain medication, including dose and side effects, enables clients to self‑manage pain safely, recognize adverse reactions early, and adhere to the regimen, promoting comfort and preventing complications.

Why the others are wrong

• A – Encouraging alternatives alone may lead to under‑treated pain.
• B – Cost information does not directly affect safe pain management.
• C – Hospital documentation is not the primary purpose of client education.

Remember: Teach meds so patients control pain, not guess side effects.

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. Elderly individuals

Topic: Iron-Deficiency Anemia Risk

Elderly individuals often have reduced dietary intake, decreased gastric acid secretion, and chronic illnesses that impair iron absorption, making inadequate iron intake a common cause of iron‑deficiency anemia in this population.

Why the others are wrong

• A – Athletes may need more iron, but intake is often increased.
• C – Sedentary teens lack menstrual blood loss, so iron deficiency is less likely.
• D – Middle‑aged adults usually meet iron needs with balanced diets.

Remember: Older gut, less iron, higher anemia 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: A. Size of tumor

Topic: Cancer Staging (TNM)

In the TNM system, the 'T' component describes the size and local extent of the primary tumor, guiding prognosis and treatment planning.

Why the others are wrong

• B – Lymph node involvement is denoted by the 'N' component, not 'T'.
• C – Metastasis is represented by the 'M' component, not 'T'.
• D – TNM does not categorize cancer type; it focuses on tumor characteristics.

Remember: T = Tumor size and extent.

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. Get a tattoo saying “Epileptic” on your arm.

Topic: Health Promotion Teaching

Getting a tattoo that labels you as “Epileptic” reinforces stigma, offers no therapeutic benefit, and may increase psychosocial stress; health promotion should empower patients, not label or marginalize them.

Why the others are wrong

• B – Avoiding power tools alone prevents injury; safe practice.
• C – Rest after a seizure supports recovery; it's appropriate health promotion.
• D – Showers reduce fall risk and improve hygiene; beneficial teaching.

Remember: Stigma isn’t promotion; empower, don’t label.

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. Stress incontinence

Topic: Stress Urinary Incontinence

Stress incontinence occurs when increased intra‑abdominal pressure from coughing, sneezing, or exertion overcomes urethral closure, causing involuntary urine leakage. It is the most common type in women and is related to weakened pelvic floor muscles or urethral sphincter dysfunction.

Why the others are wrong

• B – Functional incontinence is leakage due to physical or cognitive barriers to reaching the toilet.
• C – Urge incontinence involves sudden, intense urge to void, not activity‑related leakage.
• D – Overflow incontinence results from bladder overdistention and constant dribbling, not stress triggers.

Remember: Leak when you sneeze? Think stress incontinence.

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. To increase the body's metabolic rate

Topic: Hypothyroidism Management

Levothyroxine replaces deficient thyroid hormone, restoring normal metabolic activity; the primary aim is to raise the body's metabolic rate to alleviate hypothyroid symptoms and normalize physiologic functions.

Why the others are wrong

• B – Inhibiting thyroid hormone production is opposite of replacement therapy; levothyroxine adds hormone.
• C – Reducing TSH is a secondary effect, not the medication’s primary purpose.
• D – Levothyroxine does not cause weight loss; it normalizes metabolism, not directly reduces weight.

Remember: Levothyroxine boosts metabolism, replacing missing thyroid hormone.

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. “I will call right away if my stools appear light in color.”

Topic: Barium Enema Discharge Teaching

Barium is a chalky, white contrast medium. It is expected that stools will appear light-colored or white for several days after the procedure as the barium is excreted, so this does not require immediate medical attention.

Why the others are wrong

• A – High-fiber foods help prevent constipation and aid in clearing the barium.
• B – Clients can typically resume normal activities and return to work the next day.
• C – Increasing fluids is appropriate to prevent barium impaction and promote its elimination.

Remember: Barium makes stools white; this is a normal, expected sight.

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. Increased vulnerability to lung infections and diseases

Topic: Aging Lung Changes

Aging reduces lung elasticity, weakens cough reflex, and diminishes immune defenses, making older adults more prone to respiratory infections and chronic lung disease and related.

Why the others are wrong

• A – Aging impairs, rather than enhances, lung tissue repair after smoke exposure.
• B – Nerve sensitivity does not typically increase to cause chronic cough in aging.
• D – Older lungs do not develop better resistance to environmental particles.

Remember: Elder lungs = higher infection risk, not stronger defenses.

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. A 35-year-old with difficulty speaking and weakness in one side of the body.

Topic: Emergency Triage Prioritization

This patient exhibits classic signs of an acute stroke, including unilateral weakness and difficulty speaking. Because time-sensitive interventions like thrombolytic therapy must be initiated quickly to prevent permanent neurological damage, this patient requires immediate priority attention.

Why the others are wrong

• A – A simple leg laceration is non-urgent and can safely wait for treatment.
• B – Abdominal pain and vomiting require evaluation but are not immediately life-threatening.
• C – Severe pain from a fracture is urgent but not immediately life- or limb-threatening.

Remember: Time is brain: acute stroke symptoms always take priority.

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. Provide a high protein diet

Topic: Chronic Renal Failure Nutrition

In chronic renal failure, protein intake must be limited to decrease nitrogenous waste accumulation; a high‑protein diet increases uremic toxins, accelerates renal decline, and contradicts renal diet recommendations.

Why the others are wrong

• A – Saline lock provides needed IV access; not contraindicated in CRF.
• B – Daily weight monitors fluid balance; essential for CRF management.
• D – Phosphate binders each meal control hyperphosphatemia; appropriate for CRF.

Remember: CRF = low protein, not high protein.

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. Hypoxemia

Topic: Arterial Blood Gas Interpretation

A low PaO2 indicates insufficient oxygen in arterial blood, which defines hypoxemia. It is not an acid–base disorder; it reflects impaired oxygenation from ventilation‑perfusion mismatch, diffusion impairment, or hypoventilation.

Why the others are wrong

• A – Respiratory alkalosis is a high pH condition, not low PaO2.
• C – Metabolic acidosis affects pH and HCO3-, not the PaO2 level.
• D – Respiratory acidosis involves elevated CO2, not decreased oxygen tension.

Remember: Low PaO2 = hypoxemia, the hallmark of poor oxygenation.

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. Adrenal Gland

The adrenal cortex synthesizes mineralocorticoids (aldosterone), glucocorticoids (cortisol), and adrenal androgens; these are the only steroid hormones produced by that gland. Thus, the correct gland is the adrenal gland, located atop the kidneys.

Why the others are wrong

• A – Pineal gland secretes melatonin, not steroid hormones.
• C – Thyroid gland produces T3, T4, and calcitonin, not adrenal steroids.
• D – Parathyroid gland regulates calcium via parathyroid hormone, not steroids.

Remember: Adrenal sits on kidneys, makes cortisol, aldosterone, and androgens.

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. Tendons

Topic: Musculoskeletal Connective Tissue

Tendons are tough bands of fibrous connective tissue that connect muscle to bone, allowing the transmission of force to generate movement. In contrast, other connective tissues serve to stabilize joints or cushion bones.

Why the others are wrong

• A – Joints are the anatomical locations where bones meet, not a type of fibrous tissue.
• B – Cartilage is a supportive, cushioning tissue found at joint surfaces, not a muscle connector.
• D – Ligaments connect bone to bone, providing joint stability rather than transmitting muscle force.

Remember: Tendons tie muscle to bone; ligaments link bone to bone.

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. Notify the provider if the client has a history of metabolic acidosis.

Topic: Metformin Administration

Metformin can precipitate lactic acidosis; a history of metabolic acidosis signals increased risk, so the nurse must alert the provider before giving the drug.

Why the others are wrong

• A – Metformin does not affect potassium levels.
• B – Increasing sodium intake is unnecessary and may worsen hypertension.
• D – Metformin should be taken with meals to lessen GI upset.

Remember: Metformin + metabolic acidosis = provider alert.

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. Crackles in the lungs

Topic: Left‑Sided Heart Failure

Crackles indicate pulmonary congestion from fluid backing up into the lungs, which is the hallmark of left‑sided heart failure; they result from increased hydrostatic pressure in pulmonary capillaries causing alveolar edema and audible rales during auscultation.

Why the others are wrong

• B – Jugular venous distension indicates elevated right atrial pressure, a right‑sided sign.
• C – Ascites results from hepatic congestion due to right‑sided heart failure.
• D – Peripheral edema reflects systemic venous congestion typical of right‑sided failure.

Remember: Left‑sided failure = lungs crackle; right‑sided = legs swell.

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. Recent dental procedures

Topic: Infective Endocarditis Risk Factors

Recent dental procedures can introduce oral bacteria into the bloodstream, causing transient bacteremia that may seed damaged heart valves or prosthetic material, leading to infective endocarditis, especially in individuals with pre‑existing valvular disease.

Why the others are wrong

• B – High cholesterol does not introduce organisms into the bloodstream.
• C – Decreased physical activity is unrelated to bacterial seeding of heart valves.
• D – High blood pressure does not cause bacteremia or valve infection.

Remember: Dental work = mouth bacteria, heart valve 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. Respiratory acidosis

Topic: Acid‑Base Disorders

An increased PaCO2 reflects inadequate ventilation and CO2 retention, which lowers blood pH and produces a primary respiratory acid–base disturbance known as respiratory acidosis in the patient.

Why the others are wrong

• A – Hypoxemia refers to low oxygen, not elevated CO2.
• C – Respiratory alkalosis is characterized by low PaCO2, opposite of this finding.
• D – Metabolic acidosis involves low HCO3‑ and normal/low PaCO2, not high PaCO2.

Remember: High CO2 → breathing problem → respiratory acidosis.

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. Strain urine with every void

Topic: Nephrolithiasis Nursing Care

Straining all urine is essential to capture passed stones or stone fragments for laboratory analysis. Composition analysis identifies the stone type, which directly guides dietary modifications and medical management to prevent future nephrolithiasis recurrence.

Why the others are wrong

• A – Supine positioning does not relieve renal colic; patients should assume positions of comfort.
• B – Fluids should be increased to two to three liters daily, not restricted.
• D – Restricting calcium can actually increase oxalate absorption and promote stone formation.

Remember: Catch the stone: strain every drop to analyze the rock.

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. Cortisol

Topic: Adrenal Cortex Hormones

Cortisol is the main hormone secreted by the adrenal cortex; it influences metabolism, immune response, and stress adaptation, making it the primary regulator of many physiological processes throughout the body.

Why the others are wrong

• A – Epinephrine is produced by the adrenal medulla, not the cortex.
• C – Aldosterone regulates sodium balance, not overall physiological regulation.
• D – Norepinephrine originates from the medulla, not the cortex.

Remember: Cortisol = cortex hormone controlling stress and metabolism.

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. Risk for Bleeding

Topic: Thrombocytopenia Nursing Diagnosis

Thrombocytopenia reduces platelet count, impairing clot formation and increasing hemorrhage risk; therefore the primary nursing diagnosis is Risk for Bleeding, focusing on prevention and early detection of bleeding.

Why the others are wrong

• A – Readiness for Enhanced Knowledge addresses education, not the immediate physiological threat of low platelets.
• B – Impaired Gas Exchange relates to respiratory dysfunction, not platelet deficiency.
• D – Activity Intolerance reflects limited endurance, which is unrelated to thrombocytopenia's bleeding risk.

Remember: Low platelets → watch for bleeding.

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. Control Surgery

Topic: Surgical Classification

Debulking removes part of a tumor to lessen mass effect and symptoms, but does not eradicate disease; its purpose is to control tumor growth and improve quality of life, fitting the definition of control surgery.

Why the others are wrong

• A – Curative surgery intends to eliminate the disease entirely.
• B – Diagnostic surgery is performed to obtain tissue for diagnosis.
• D – Prophylaxis surgery aims to prevent disease before it occurs.

Remember: Debulking = control, not cure.

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 allows Vitamin B12 to be absorbed by the intestines

Topic: Vitamin B12 Absorption

Intrinsic factor, secreted by gastric parietal cells, binds vitamin B12 forming a complex that is recognized by receptors in the terminal ileum, allowing B12 to be absorbed into the bloodstream.

Why the others are wrong

• A – Intrinsic factor is specific to B12, not involved in vitamin C absorption.
• B – Intrinsic factor does not transport B12 to the liver; it enables intestinal absorption.
• D – Intrinsic factor does not directly regulate red blood cell synthesis.

Remember: Intrinsic factor = B12’s intestinal key

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.