NCLEX-RN: Health Alterations practice questions questions 151-175

Answer: C. Hypothermia

Topic: Myxedema Coma

Myxedema coma presents with profound hypothermia because severe hypothyroidism markedly lowers metabolic heat production, leading to a dangerously low core temperature.

Why the others are wrong

• A – Hyperthermia contradicts the low metabolic state.
• B – Patients usually have bradycardia, not tachycardia.
• D – Sweating is minimal; skin is often dry and cool.

Remember: Myxedema coma = cold, not hot.

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. Parathyroid hormone

Topic: Calcium Homeostasis Hormones

Parathyroid hormone is released by the parathyroid glands when serum calcium falls, stimulating bone resorption, renal calcium reabsorption, and activation of vitamin D to raise calcium levels.

Why the others are wrong

• A – Calcitonin is secreted by thyroid C cells in response to high calcium, opposite effect.
• B – Cortisol is an adrenal glucocorticoid, not involved in calcium homeostasis.
• D – Aldosterone regulates sodium and water balance, not calcium.

Remember: Low calcium → PTH; high calcium → calcitonin.

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. Chvostek's sign

Topic: Hypocalcemia Signs

Chvostek's sign is elicited by tapping the facial nerve anterior to the earlobe, triggering involuntary twitching of the facial muscles on the same side, indicating hypocalcemia-induced neuromuscular irritability.

Why the others are wrong

• A – Trousseau's sign is carpopedal spasm induced by inflating a blood pressure cuff.
• B – Seizures are a generalized neurological manifestation of severe hypocalcemia, not localized facial twitching.
• C – Laryngospasm is a severe, life-threatening airway constriction, not localized facial twitching.

Remember: Chvostek's starts with CH, like Cheek twitching.

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. Atherosclerosis in the lower extremities

Peripheral artery disease results from atherosclerotic plaque buildup in the arteries supplying the legs, which narrows vessels and reduces blood flow, leading to ischemic symptoms such as claudication.

Why the others are wrong

• A – Bacterial infection does not cause arterial plaque formation.
• B – Blunt trauma does not produce chronic arterial narrowing characteristic of PAD.
• D – Muscle degeneration affects strength, not arterial lumen narrowing.

Remember: Plaque builds, arteries narrow, legs suffer.

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. Epinephrine (1:1000)

Topic: Anaphylaxis Management

Epinephrine administered intramuscularly reverses airway edema, bronchospasm, and hypotension, making it the immediate, life‑saving first‑line treatment for anaphylaxis. It acts on alpha‑1 receptors to reduce swelling and on beta‑1/2 receptors to support cardiac output and bronchodilation.

Why the others are wrong

• A – Antihistamines treat cutaneous symptoms but do not reverse airway obstruction or hypotension.
• B – Beta‑agonists relieve bronchospasm only; they do not address vascular leakage or hypotension.
• C – Corticosteroids reduce late-phase inflammation; they act hours later, not immediately.

Remember: Epinephrine first, everything else follows.

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 pain relief in a specific body area

Topic: Spinal Block Anesthesia

A spinal block injects local anesthetic into the subarachnoid space, producing loss of sensation and pain relief in the dermatomes supplied by the blocked spinal nerves, typically for surgery below the waist.

Why the others are wrong

• A – Spinal block provides analgesia while patient remains conscious, not unconsciousness.
• C – Spinal block acts on spinal roots, not on peripheral nerves.
• D – It does not aim to relax muscles; it blocks sensation.

Remember: Spinal block = local numbness, not sleep or relaxation.

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. High phosphorus intake

Topic: End-Stage Renal Disease Diet

In ESRD the kidneys cannot excrete phosphate, leading to hyperphosphatemia, secondary hyperparathyroidism, and vascular calcification; therefore dietary phosphorus is limited. Patients are advised to avoid dairy, nuts, and processed foods high in phosphate.

Why the others are wrong

• B – High protein increases nitrogen waste, worsening uremic symptoms in dialysis patients.
• C – Potassium must be restricted to prevent dangerous hyperkalemia and cardiac arrhythmias.
• D – Sodium restriction reduces fluid overload and hypertension in ESRD.

Remember: Kidney disease: cut phosphate, potassium, sodium, 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: D. Assessing staff members' abilities and providing ongoing support.

Topic: Delegation and Supervision

Supervision requires active monitoring, evaluating competency, and offering guidance throughout the task. Assessing a delegatee's abilities ensures tasks align with skill levels, while ongoing support promotes safe, high-quality client care and professional development.

Why the others are wrong

• A – Effective supervision requires constructive, timely, and regular feedback rather than minimal communication.
• B – Supervisors must intervene proactively to guide care, not just during emergencies.
• C – Problems must be addressed promptly to maintain client safety and prevent adverse events.

Remember: Supervision means continuous assessment and support, not just crisis intervention.

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. C-reactive protein (CRP)

Topic: Cardiovascular Inflammation Marker

C-reactive protein is an acute‑phase reactant produced by the liver in response to inflammation and is the most extensively researched biomarker for assessing cardiovascular inflammatory risk.

Why the others are wrong

• A – BNP reflects ventricular stretch and heart failure, not inflammatory status.
• C – Troponin indicates myocardial injury, not systemic inflammation.
• D – Myoglobin rises with muscle damage, lacking specificity for inflammation.

Remember: CRP rises when arteries get inflamed.

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. Diabetic ketoacidosis (DKA)

Topic: Diabetic Ketoacidosis

Fruity breath, deep rapid breathing, confusion, hyperglycemia, and ketonuria are classic signs of diabetic ketoacidosis, an acute metabolic emergency in type 1 diabetes.

Why the others are wrong

• A – HHS occurs in type 2, glucose >600, minimal ketones.
• B – Nephropathy is chronic kidney damage, not an acute metabolic crisis.
• D – Hypoglycemia presents with low glucose, not high levels.

Remember: Fruity breath + Kussmaul breathing = DKA

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. 3-5 days postop

Topic: Postoperative Wound Infection Timing

Surgical site infections usually become clinically evident 3–5 days after the procedure as bacteria multiply and inflammatory response peaks, making this the most common window for postoperative wound infection.

Why the others are wrong

• A – Infection cannot develop within hours; early signs are surgical trauma, not infection.
• C – Too early; bacterial load and inflammation usually not sufficient to produce visible infection.
• D – Slightly later than typical peak; most infections appear earlier, around days 3‑5.

Remember: Surgical infections usually surface on day 3 to 5.

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. Dissection

Topic: Aneurysm Complications

A dissection occurs when blood enters a tear in the intimal layer of an aneurysmal vessel, separating the layers and forming a false lumen; this is the specific complication described.

Why the others are wrong

• A – Hemorrhage describes external bleeding, which differs from the intramural false channel of a dissection.
• C – Rupture is bleeding through the vessel wall, not a tear that creates a false lumen.
• D – Thrombosis refers to clot formation within the aneurysm, not an intimal tear.

Remember: Dissection = intimal tear, false lumen forms inside vessel.

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. Granulocyte Colony-Stimulating Factor (G-CSF)

Topic: Neutropenia Management

Granulocyte Colony-Stimulating Factor directly stimulates bone marrow progenitor cells to increase neutrophil production, making it the standard intervention for chemotherapy‑induced neutropenia.

Why the others are wrong

• A – Antibiotics treat infection but do not increase white blood cell counts.
• B – Corticosteroids do not stimulate marrow production of neutrophils.
• C – Stem cell transplant is reserved for severe marrow failure, not routine chemo neutropenia.

Remember: G‑CSF = growth factor that boosts neutrophils.

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. Troponins

Topic: Cardiac Biomarkers

Troponin I and T are cardiac-specific proteins released after myocardial injury; they rise within 3–6 hours, remain elevated up to 10 days, and provide the most sensitive and specific laboratory marker for diagnosing myocardial infarction.

Why the others are wrong

• A – CK‑MB rises later and is less specific than troponin, leading to more false‑positive results.
• C – Myoglobin rises quickly but is not cardiac specific and normalizes rapidly, limiting diagnostic value.
• D – BNP reflects ventricular stretch and heart failure, not the myocardial necrosis seen in acute infarction.

Remember: Troponins = heart‑specific, stay high, best MI detector.

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. Ensure documentation is reviewed

Topic: Surgical Safety Checklist

Surgical safety checklists include a step to confirm that essential documentation, including signed consent forms, and diagnostic imaging are present and displayed before incision. This ensures the team operates on the correct site with all critical clinical data accessible.

Why the others are wrong

• A – Surgical counts prevent retained foreign bodies and do not evaluate consent forms or radiographs.
• B – This step verifies anesthesia machine function and medication safety, not charts or imaging.
• D – Confirming identity validates the patient's name and birth date, not the clinical documentation itself.

Remember: Images displayed and consent in view keep the surgical plan true.

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. Obstruction of the ureters

Topic: Acute Pyelonephritis Causes

Obstruction of the ureters impedes urine flow, allowing bacteria to ascend and proliferate in the renal pelvis, leading to inflammation of the kidney parenchyma characteristic of acute pyelonephritis.

Why the others are wrong

• A – Inflammation of the bladder describes cystitis, not kidney infection.
• C – Bacterial infection of the urethra causes urethritis, which does not directly involve the kidneys.
• D – Genetic kidney disorders predispose to chronic disease, not the acute bacterial infection seen in pyelonephritis.

Remember: Blocked ureters = backed‑up bacteria, kidney 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. Continuously monitor pulse oximetry levels, respiratory rate, and clinical condition

Topic: COPD Oxygen Management

In COPD patients, excessive oxygen can suppress hypoxic drive, so oxygen therapy must be titrated and patients continuously monitored via pulse oximetry, respiratory rate, and overall clinical status.

Why the others are wrong

• A – Targeting >95% saturation may cause CO2 retention in COPD.
• B – High‑flow oxygen can blunt respiratory drive and worsen hypercapnia.

Remember: Watch O₂; too much harms COPD patients.

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. Ensure cessation of bleeding by applying pressure as needed

Topic: Bone Marrow Biopsy Care

Applying direct pressure to the biopsy site is essential to achieve hemostasis because the procedure creates a vascular puncture; sustained pressure prevents ongoing bleeding and hematoma formation, which are the primary post‑procedure concerns.

Why the others are wrong

• A – Infection monitoring is important later, but it does not prevent immediate bleeding.
• C – Heat increases blood flow, which may exacerbate bleeding rather than reduce it.
• D – Aspirin‑free analgesic is appropriate for pain but does not address bleeding control.

Remember: Press firmly, stop the bleed.

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. 15

Topic: Glasgow Coma Scale

A score of 15 on the Glasgow Coma Scale represents normal, fully alert consciousness, the highest possible total, indicating the best neurological response among the options.

Why the others are wrong

• A – Score of 0 is not a valid GCS total; indicates no response.
• C – Score of 3 indicates deep coma or brain death, the lowest possible.
• D – Score of 8 reflects moderate brain injury, not the best response.

Remember: 15 = fully awake, the highest GCS score.

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. No cancer present in adjacent lymph nodes

Topic: Cancer Staging – N Category

In the TNM classification, the N component describes regional lymph node involvement; N0 specifically denotes that no cancer cells are detected in any nearby lymph nodes.

Why the others are wrong

• A – Indicates multiple nodes involved, which would be N1 or higher.
• B – Describes tumor size, not lymph node status.
• C – Refers to distant metastasis, represented by the M component.

Remember: N0 means nodes are clear of 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: D. A 30-year-old experiencing chest pain and shortness of breath.

Topic: Emergency Patient Prioritization

Using the ABC (Airway, Breathing, Circulation) prioritization framework, a patient presenting with chest pain and shortness of breath indicates potential cardiopulmonary compromise. This represents an immediate threat to life and must be assessed first.

Why the others are wrong

• A – This patient is stable with non-urgent, mild symptoms that do not threaten life.
• B – A potential fracture is painful but musculoskeletal injuries are non-life-threatening and can wait.
• C – While serious, a localized hand burn is stable and does not immediately threaten airway.

Remember: Airway, Breathing, and Circulation always take priority over stable or localized issues.

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. Pituitary gland

Topic: Pituitary Gland Function

The pituitary gland, located at the brain base, releases trophic hormones that regulate growth, metabolism, and other endocrine glands, making it the command center of the endocrine system.

Why the others are wrong

• A – Primarily involved in T‑cell maturation, not systemic hormone regulation.
• B – Secretes cortisol and catecholamines; it is a target organ, not the command center.
• C – Produces melatonin for circadian rhythms; does not control other endocrine glands.

Remember: Pituitary: the brain’s tiny boss directing all endocrine traffic.

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. Pulmonic

Topic: Cardiac Valves

Blood ejected from the right ventricle enters the pulmonary artery through the semilunar pulmonary (pulmonic) valve, which prevents backflow into the right ventricle during diastole.

Why the others are wrong

• B – Mitral valve connects left atrium to left ventricle, unrelated to right‑side flow.
• C – Aortic valve opens from left ventricle into the aorta, not the right heart.
• D – Tricuspid valve lies between right atrium and right ventricle, not after the ventricle.

Remember: Right ventricle → pulmonary valve → lungs.

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. Kept on ice or refrigerated

Topic: Urine Collection for Stones

A 24‑hour urine collection for stone analysis must be kept cold to inhibit bacterial metabolism and prevent degradation of citrate, oxalate, and other solutes, ensuring accurate quantitative results.

Why the others are wrong

• A – Room temperature permits bacterial growth, altering solute concentrations.
• B – Body‑temperature storage accelerates enzymatic changes, invalidating results.
• C – Four‑hour intervals risk degradation before processing.

Remember: Cold urine = reliable stone chemistry.

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 detect the breakdown products of fibrin

Topic: Deep Vein Thrombosis Diagnosis

The D‑dimer assay detects fibrin degradation fragments released when a clot is lysed; elevated levels suggest recent thrombus formation, aiding in ruling out deep vein thrombosis when clinical probability is low.

Why the others are wrong

• A – Kidney function is evaluated by creatinine or BUN, not D‑dimer.
• B – The test does not quantify clot size; it identifies fibrin breakdown.
• D – D‑dimer does not measure glucose; it assesses clot degradation.

Remember: D‑dimer = D for 'Degradation' of fibrin.

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.