NCLEX-RN: Health Alterations practice questions questions 176-200

Answer: C. Fatigue

Topic: Anemia Symptoms

Fatigue occurs because anemia reduces the blood’s capacity to carry oxygen, leading to insufficient tissue oxygenation and resulting in early exhaustion for daily routine activities.

Why the others are wrong

• A – Dry cough does not result from reduced oxygen-carrying capacity.
• B – Ruddy complexion is opposite; anemia typically causes pallor, not redness.
• D – Frequent urination is unrelated to low hemoglobin levels.

Remember: Anemia = tired, pale, weak.

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. It results in inflammation, constriction, and narrowing of the airways.

Topic: Asthma Pathophysiology

Asthma is characterized by airway inflammation, bronchial smooth‑muscle constriction, and mucus hypersecretion, which together narrow the lumen and cause wheezing, dyspnea, and cough.

Why the others are wrong

• A – Lung collapse from surfactant deficiency is unrelated to asthma.
• C – Asthma increases, not reduces, mucus production, causing productive cough.
• D – Airway muscles contract, they do not gain mass or strength.

Remember: Asthma = inflamed, tight, narrowed airways.

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. Venous stasis, hypercoagulability, and injury to a vein

Topic: Deep Vein Thrombosis Pathophysiology

These three factors—venous stasis, hypercoagulability, and endothelial injury—form Virchow's triad, which explains how slowed blood flow, increased clotting tendency, and damage to the vein wall together initiate thrombus formation in deep veins.

Why the others are wrong

• A – Viral infection, dehydration, and inactivity are unrelated to the core Virchow’s triad.
• B – Diabetes, obesity, and pregnancy increase risk but are not the three primary mechanisms.
• D – Atherosclerosis, hypertension, and smoking are arterial risk factors, not DVT mechanisms.

Remember: Virchow’s triad = stasis, clotting, vessel injury.

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. Call 9-1-1 immediately.

Topic: Stroke Emergency Response

Calling 9‑1‑1 immediately is correct because stroke is a time‑critical emergency; rapid EMS activation ensures prompt assessment, possible thrombolytic therapy, and transport to a stroke‑ready facility, which greatly improves outcomes.

Why the others are wrong

• B – Lorazepam can depress respiration and mask stroke signs, delaying definitive care.
• C – Nitroglycerin is for chest pain; it does not treat stroke and may lower blood pressure dangerously.
• D – Relaxation breathing does not address the urgent need for medical evaluation.

Remember: Stroke: call 911, time is brain.

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. Cervical

Topic: Spinal Cord Injury Levels

The cervical spinal cord contains the motor and sensory pathways for the neck, arms, trunk, and legs; injury here disrupts signals to all four limbs, producing tetraplegia (quadriplegia).

Why the others are wrong

• A – Lumbar lesions affect only lower extremities, sparing the arms.
• C – Thoracic injuries cause paraplegia, preserving arm function.
• D – Sacral damage involves pelvic organs and sphincters, not upper limbs.

Remember: Cervical level = all‑limb paralysis.

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. Thrombopoietin receptor agonists

Topic: Thrombocytopenia Management

Thrombopoietin receptor agonists bind to the TPO receptor on megakaryocyte precursors, enhancing their proliferation and maturation, which increases endogenous platelet production and raises platelet counts in thrombocytopenic patients.

Why the others are wrong

• B – Splenectomy removes platelet sequestration but does not stimulate marrow production.
• C – Platelet transfusion replaces platelets temporarily but does not increase marrow output.
• D – Immunosuppressive therapy treats immune-mediated destruction, not platelet production.

Remember: TPO agonists boost the marrow’s platelet factory.

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. 70-110 mg/dl

Topic: Blood Glucose Levels

A normal fasting blood glucose in a healthy adult ranges from 70 to 110 mg/dL; values outside this range suggest hypoglycemia or hyperglycemia and warrant further evaluation.

Why the others are wrong

• B – These values are too narrow and miss the lower end of normal fasting glucose.
• C – This range reflects post‑prandial levels, not the normal fasting range.
• D – Values this low are typical of hypoglycemia, not normal adult glucose.

Remember: Normal fasting glucose: 70‑110 mg/dL.

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. Red Zone

Topic: Asthma Management Zones

Red Zone denotes severe asthma exacerbation; patients use a rescue inhaler and start oral corticosteroids, and if symptoms persist after 15 minutes they must seek emergency care.

Why the others are wrong

• B – Green Zone indicates well‑controlled asthma, no rescue needed.
• C – Blue Zone is for routine maintenance, not acute attacks.
• D – Yellow Zone calls for rescue inhaler only, not steroids or emergency.

Remember: Red means severe—use rescue, steroids, call help.

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. Status Epilepticus

Topic: Seizure Emergencies

Status epilepticus is life‑threatening because seizure activity persists beyond five minutes or recurs without regaining consciousness, leading to hypoxia, neuronal injury, and possible death.

Why the others are wrong

• A – Atonic drop attacks cause falls but are not typically life‑threatening.
• B – Tonic‑clonic seizures are common but usually self‑limited and less immediately fatal.
• D – Petit mal (absence) seizures are brief and rarely cause injury.

Remember: Status epilepticus = seizure emergency, never let it run.

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. Repeating word or sentence

Topic: Seizure Assessment Signs

Repeating a word or sentence (echolalia) reflects a language disturbance, not the motor or autonomic automatisms typical of seizures; seizures present with staring, lip‑smacking, and increased salivation.

Why the others are wrong

• A – Staring spells are classic focal seizure automatisms.
• C – Increased salivation often accompanies focal seizures with oral automatisms.
• D – Lip smacking is a common automatisms during focal seizures.

Remember: Seizure signs: stare, lip‑smack, drool—not echoing words.

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. Reverse Transcription Polymerase Chain Reaction (RT-PCR)

Topic: Influenza Diagnostic Testing

RT‑PCR detects influenza viral RNA with the highest sensitivity and specificity, confirming infection even early in illness; current CDC guidelines recommend it as the preferred diagnostic test for influenza.

Why the others are wrong

• A – Sputum culture identifies bacteria, not viral pathogens.
• B – DFA requires specialized labs and is less sensitive than PCR.
• C – Rapid test is quick but has low sensitivity, missing cases.

Remember: RT‑PCR: gold‑standard, finds flu RNA fast.

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. Dopamine

Topic: Parkinson Disease Neurotransmitters

Parkinson’s disease is characterized by loss of dopaminergic neurons in the substantia nigra, leading to reduced dopamine levels, which cause the classic motor symptoms of tremor, rigidity, and bradykinesia.

Why the others are wrong

• A – Glutamate excess may occur, but it is not the defining neurotransmitter loss.
• C – Serotonin levels are not the primary neurochemical deficit in Parkinson’s disease.
• D – Acetylcholine is typically elevated relative to dopamine, not decreased, in Parkinson’s disease.

Remember: Parkinson’s = dopamine deficiency, think ‘D’ for dopamine and disease.

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. Change in mental status

Topic: Urinary Tract Infection in Elderly

Older adults frequently present with atypical UTI signs; a sudden change in mental status such as confusion or delirium is a hallmark that distinguishes infection in this population from younger patients.

Why the others are wrong

• A – Incontinence occurs often, yet many other conditions cause it.
• C – Difficulty initiating stream suggests obstruction, not a specific UTI sign.
• D – Painful urination is common but not unique to elderly UTIs.

Remember: Confusion, not burning, signals UTI in seniors.

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. Chronic bronchitis and emphysema

Topic: Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease is defined by persistent airflow limitation caused by chronic bronchitis and emphysema, the two primary pathologic processes that together produce the characteristic dyspnea and cough.

Why the others are wrong

• A – Tuberculosis is a bacterial infection; chronic lung cancer is malignant, neither defines COPD.
• B – Asthma is reversible airway disease; pneumonia is an acute infection, not chronic obstructive conditions.
• C – Pneumothorax and pleuritis are pleural disorders, not the airway diseases comprising COPD.

Remember: COPD = Chronic bronchitis + Emphysema, the classic combo.

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. Pernicious anemia

Topic: Vitamin B12 Deficiency

Autoimmune destruction of gastric parietal cells produces antibodies that bind intrinsic factor, preventing vitamin B12 absorption and resulting in megaloblastic anemia; this condition is called pernicious anemia.

Why the others are wrong

• A – Crohn's disease causes malabsorption, not autoimmune intrinsic factor antibodies.
• B – Chronic PPIs lower stomach acid, impairing B12 release, but they don’t produce intrinsic factor antibodies.
• C – Gastric bypass reduces absorptive surface, not antibody‑mediated intrinsic factor loss.

Remember: Autoimmune attack on intrinsic factor = pernicious anemia.

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. Nurse Manager

Topic: Nursing Leadership Roles

The nurse manager is responsible for the day-to-day operations of a specific clinical unit. This includes human resource tasks like interviewing, hiring, scheduling, and ensuring staff meet mandatory training and education requirements.

Why the others are wrong

• A – Focuses on shift-to-shift operations and clinical coordination, not hiring or scheduling.
• B – A broad term for influencing others, not a specific job role with administrative duties.
• C – An executive-level role managing nursing services across the entire organization, not a single unit.

Remember: Managers manage the unit's staff, schedules, and hiring.

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. Decreased blood pressure

Topic: Postoperative Hemorrhage Signs

Postoperative hemorrhage leads to intravascular volume loss, causing compensatory tachycardia and hypotension; thus a drop in blood pressure is an early, common indicator of significant bleeding.

Why the others are wrong

• A – Normal pulse rate may mask bleeding; tachycardia is expected.
• B – Increased blood pressure is not typical; bleeding reduces circulating volume.
• D – Warm, dry skin suggests hyperthermia, not hemorrhagic shock.

Remember: Bleeding drops pressure before skin changes appear.

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. The immune system mistakenly attacks and destroys beta islet cells.

Topic: Type 1 Diabetes Pathophysiology

Type 1 diabetes is an autoimmune disease where the body's immune system mistakenly targets and destroys the insulin-producing beta cells in the pancreatic islets, leading to an absolute insulin deficiency.

Why the others are wrong

• B – This describes insulin resistance, the hallmark pathophysiology of type 2 diabetes.
• C – This is too broad; the autoimmune destruction specifically targets insulin-producing beta cells.
• D – This describes relative insulin deficiency, which is characteristic of type 2 diabetes.

Remember: Type 1: Immune system attacks Beta cells, causing absolute insulin deficiency.

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. High-density lipoproteins (HDL)

Topic: Lipid Profile and CAD

HDL is considered protective because it mediates reverse cholesterol transport, moving cholesterol from peripheral tissues and atherosclerotic plaques back to the liver for metabolism, thereby decreasing plaque buildup and coronary artery disease risk.

Why the others are wrong

• A – LDL deposits cholesterol in arterial walls, promoting plaque formation and CAD.
• B – Elevated triglycerides are a risk factor for atherosclerosis, not protective.
• C – Total cholesterol includes LDL and HDL; high levels indicate increased risk.

Remember: HDL = “good” cholesterol that cleans arteries.

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. Decreased Red Blood Cell (RBC) count

Topic: Anemia Assessment

A low RBC count indicates anemia, which reduces oxygen-carrying capacity, leading to dyspnea and fatigue, especially on exertion. This lab finding directly explains the patient’s symptoms.

Why the others are wrong

• A – High WBC count indicates infection or inflammation, unrelated to oxygen delivery.
• B – Increased platelets reflect thrombocytosis, which does not impair oxygen transport.
• D – Elevated hematocrit suggests polycythemia, not typical cause of dyspnea/fatigue.

Remember: Fewer RBCs = less oxygen = breathlessness and tiredness.

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. SA node

Topic: Cardiac Conduction System

The sinoatrial (SA) node generates the heart’s intrinsic electrical impulse, setting the rhythm for atrial contraction; it fires at 60‑100 beats per minute, making it the heart’s primary pacemaker.

Why the others are wrong

• B – Purkinje fibers rapidly spread the impulse through ventricles; they are not the heart’s pacemaker.
• C – The AV node only delays conduction; it does not initiate the heartbeat.
• D – The Bundle of His conducts impulses to ventricles; it does not generate rhythm.

Remember: SA = 'Start' of the heart's rhythm.

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. Partial thromboplastin time (PTT)

Topic: Hemodialysis Anticoagulation Monitoring

Heparin prolongs the intrinsic and common coagulation pathways, which are reflected by an elevated activated partial thromboplastin time; therefore periodic PTT measurements best indicate heparin‑related bleeding risk during dialysis.

Why the others are wrong

• A – Bleeding time evaluates platelet function, unrelated to heparin anticoagulation.
• B – Thrombin time measures conversion of fibrinogen to fibrin, not heparin effect.
• D – PT assesses extrinsic pathway, not affected by heparin.

Remember: Heparin → check the PTT, not PT or bleeding time.

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. Burning sensation during urination

Topic: Urinary Tract Infection

Cystitis, an inflammation of the bladder, typically presents with dysuria—a burning or painful sensation during urination—often accompanied by urgency and frequency, making this symptom the most characteristic.

Why the others are wrong

• A – Lower back pain suggests kidney involvement, not simple bladder infection.
• B – Left upper quadrant pain is unrelated to bladder inflammation.
• C – Infrequent voiding is opposite of the typical frequency increase seen in cystitis.

Remember: Burning pee = bladder 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.

Answer: A. Cortisone

Topic: Adrenal Hormones

The adrenal cortex synthesizes glucocorticoids, primarily cortisol, and its inactive precursor cortisone; thus cortisone is the hormone linked to the adrenal gland, whereas glycogen, insulin, and calcitonin are produced elsewhere.

Why the others are wrong

• B – Calcitonin is produced by thyroid C‑cells, unrelated to adrenal function.
• C – Insulin is secreted by pancreatic β‑cells, not the adrenal gland.
• D – Glycogen is a stored carbohydrate, not a hormone.

Remember: Adrenal gland = cortisone (glucocorticoid)

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. Cancer has spread to remote parts of the body

Topic: Cancer Staging

Stage IV cancer denotes that malignant cells have spread beyond the primary site to distant organs or tissues, indicating distant metastasis and the most advanced disease stage.

Why the others are wrong

• A – Suggests a small, localized tumor, characteristic of Stage I.
• C – Describes carcinoma in situ, not Stage IV disease.
• D – Implies no spread, which corresponds to early-stage cancer.

Remember: Stage IV means cancer traveled far away.

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.