NCLEX-RN Physiological Adaptation Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Medium

   A nurse cares for a client who had a right-sided chest tube placed 24 hours ago for a pneumothorax. While observing the closed drainage unit, the nurse notes continuous vigorous bubbling in the water-seal chamber. Which action should the nurse take first?

   1. AA. Inspect all tubing connections and the insertion site for an air leak
   2. BB. Milk the chest drainage tubing toward the collection chamber
   3. CC. Clamp the chest tube close to the chest wall until the surgeon arrives
   4. DD. Increase the wall suction until the bubbling becomes gentle
   Show answer to question 1

   Answer: A. Inspect all tubing connections and the insertion site for an air leak

   Continuous bubbling in the water-seal chamber signifies an air leak somewhere in the drainage system or pleural space. The nurse must first check the system systematically, beginning with the insertion site dressing and checking all connections down to the drainage unit for dislodgement or loose connections. Routinely clamping the chest tube is dangerous because it can cause a tension pneumothorax and should not be done as a first step.

2. Question 2 of 25Easy

   A client with chronic stable angina is prescribed sublingual nitroglycerin tablets for acute chest pain. Which instruction should the nurse include when teaching the client?

   1. AA. Take one tablet every five minutes up to three doses if pain persists.
   2. BB. Expect to feel alert and energetic shortly after the medication dissolves.
   3. CC. Swallow the tablet immediately with a full glass of cool water.
   4. DD. Store the tablets in a clear plastic organizer to track expiration dates.
   Show answer to question 2

   Answer: A. Take one tablet every five minutes up to three doses if pain persists.

   Clients are instructed to place one tablet under the tongue at the onset of chest discomfort and take one tablet every five minutes for up to three doses; if pain persists after the first dose, emergency medical services should be called immediately. Sublingual nitroglycerin must dissolve under the tongue rather than be swallowed, must be stored in its original dark glass container away from moisture, and commonly causes headache and hypotension rather than increased alertness.

3. Question 3 of 25Easy

   A client with acute respiratory distress syndrome remains hypoxemic with a PaO2 of 56 mm Hg despite mechanical ventilation delivered at a fraction of inspired oxygen (FiO2) of 0.80. Which provider prescription should the nurse anticipate next to manage this refractory hypoxemia?

   1. AA. Increase the set mechanical tidal volume to 10 mL/kg.
   2. BB. Increase the positive end-expiratory pressure setting.
   3. CC. Administer an intravenous loop diuretic bolus.
   4. DD. Switch the ventilation mode to pressure-support only.
   Show answer to question 3

   Answer: B. Increase the positive end-expiratory pressure setting.

   Refractory hypoxemia in acute respiratory distress syndrome is treated by titrating positive end-expiratory pressure upward, which recruits collapsed alveoli, prevents end-expiratory alveolar collapse, and improves gas exchange. Increasing the tidal volume to 10 mL/kg violates lung-protective ventilation protocols, which mandate low tidal volumes of 4 to 8 mL/kg of predicted body weight to avoid barotrauma and volutrauma.

4. Question 4 of 25Medium

   A client with an aneurysmal subarachnoid hemorrhage underwent successful coil embolization six days ago. Today, the client demonstrates a new onset of confusion, progressive lethargy, and a new left-sided pronator drift. Which complication should the nurse suspect?

   1. AA. Cerebral hyperperfusion syndrome
   2. BB. Chemical meningitis from breakdown of subarachnoid blood
   3. CC. Delayed cerebral ischemia from arterial vasospasm
   4. DD. Acute rebleeding of the cerebral aneurysm
   Show answer to question 4

   Answer: C. Delayed cerebral ischemia from arterial vasospasm

   Cerebral vasospasm leading to delayed cerebral ischemia typically occurs between days 3 and 14 following a subarachnoid hemorrhage, peaking around days 7 to 8. Vasospasm causes localized arterial narrowing and reduced perfusion, leading to new or fluctuating focal neurological deficits and altered consciousness. Aneurysmal rebleeding is most common in the first 24 hours prior to repair and presents abruptly with sudden collapse, acute apnea, or catastrophic neurological decline rather than gradual new focal deficits.

5. Question 5 of 25Easy

   A client is being discharged home following hospitalization for an upper gastrointestinal bleed caused by peptic ulcer disease. Which statement by the client indicates a need for further teaching?

   1. AA. I will avoid drinking alcoholic beverages to prevent irritating my stomach lining.
   2. BB. I can take naproxen twice daily whenever my chronic knee pain flares up.
   3. CC. I should report black, tarry stools to my primary healthcare provider right away.
   4. DD. I need to take my prescribed omeprazole every morning before breakfast.
   Show answer to question 5

   Answer: B. I can take naproxen twice daily whenever my chronic knee pain flares up.

   Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen inhibit protective prostaglandin synthesis in the gastric mucosa and impair platelet aggregation, markedly increasing the risk of recurrent ulceration and bleeding. Understanding that melena requires immediate notification, eliminating alcohol consumption, and taking proton pump inhibitors consistently before meals represent appropriate self-care practices that prevent recurrent hemorrhage.

6. Question 6 of 25Easy

   A 28-year-old client with no prior medical history presents with acute jaundice, lethargy, and anorexia. The nurse suspects acute liver failure. Which diagnostic finding, in combination with altered mental status, confirms this condition?

   1. AA. International normalized ratio (INR) of 1.5 or greater
   2. BB. Serum albumin level less than 3.0 g/dL
   3. CC. Serum total bilirubin level greater than 5.0 mg/dL
   4. DD. Serum alkaline phosphatase greater than 250 U/L
   Show answer to question 6

   Answer: A. International normalized ratio (INR) of 1.5 or greater

   Acute liver failure is defined by the rapid onset of severe liver injury characterized by hepatic encephalopathy and impaired protein synthesis (INR of 1.5 or higher) in a client without preexisting cirrhosis. While bilirubin and alkaline phosphatase levels are often elevated, they do not establish the formal diagnosis of acute liver failure. Albumin has a long half-life of roughly 20 days and frequently remains within normal reference ranges during the acute presentation.

7. Question 7 of 25Easy

   A nurse assesses a client who sustained blunt trauma in a motor vehicle collision. Which finding is the earliest clinical indicator of hypovolemic shock?

   1. AA. Sinus tachycardia with a narrowed pulse pressure
   2. BB. Lethargy with unresponsiveness to verbal stimulation
   3. CC. Cold, mottled extremities with absent peripheral pulses
   4. DD. Profound hypotension with a systolic blood pressure below 80 mmHg
   Show answer to question 7

   Answer: A. Sinus tachycardia with a narrowed pulse pressure

   Sinus tachycardia and a narrowed pulse pressure occur early in shock as compensatory mechanisms driven by sympathetic nervous system activation and vasoconstriction to maintain cardiac output. Marked hypotension is a late sign indicating the failure of compensatory mechanisms. Cold, mottled skin and altered responsiveness reflect advanced progressive shock and cellular hypoperfusion.

8. Question 8 of 25Easy

   A 72-year-old client in a skilled nursing facility has a full-thickness wound on the lower leg that is being treated with moist wound dressings. Which finding indicates that the wound is healing?

   1. AA. Beefy red, moist, granular tissue filling the wound base
   2. BB. Yellow slough increasing from 20% to 40% of the wound bed
   3. CC. Thick, rolled wound edges that curl under along the margin
   4. DD. Dry black eschar newly spreading across the wound base
   Show answer to question 8

   Answer: A. Beefy red, moist, granular tissue filling the wound base

   Healthy granulation tissue is beefy red, moist and bumpy because it contains new capillaries and connective tissue. Its growth from the wound base shows that the wound is filling in and healing as expected.

   Why the other options are wrong

   • BAn increase in slough means more devitalized tissue and a wound that is not progressing.
   • CRolled edges, called epibole, stop epithelial cells from migrating across the wound and stall healing.
   • DSpreading eschar indicates tissue death, not healing.

9. Question 9 of 25Medium

   The nurse in the emergency department cares for a client having an acute exacerbation of chronic obstructive pulmonary disease. The client is receiving oxygen via nasal cannula at 2 L/min with an SpO2 of 89%. Which action should the nurse take next?

   1. AA. Discontinue supplemental oxygen until room-air values are re-evaluated
   2. BB. Maintain the flow rate and titrate oxygen to maintain SpO2 between 88% and 92%
   3. CC. Switch the client to a nonrebreather mask delivering 100% oxygen
   4. DD. Increase the nasal cannula oxygen flow rate to 6 L/min immediately
   Show answer to question 9

   Answer: B. Maintain the flow rate and titrate oxygen to maintain SpO2 between 88% and 92%

   The recommended target oxygen saturation for clients with an acute exacerbation of chronic obstructive pulmonary disease who are at risk for hypercapnic respiratory failure is 88% to 92%. Administering excessive oxygen via high-flow devices or high-concentration masks can worsen ventilation-perfusion mismatch and induce severe carbon dioxide retention. Discontinuing oxygen is dangerous because an SpO2 of 89% demonstrates that the client still requires supplemental oxygen therapy.

10. Question 10 of 25Easy

    A nurse in an outpatient clinic administers 1 mg of intramuscular glucagon to an unresponsive client experiencing severe hypoglycemia. Which nursing action is essential immediately following the injection?

    1. AA. Offer 4 ounces of orange juice to drink immediately.
    2. BB. Begin chest compressions at a rate of 100 to 120 per minute.
    3. CC. Elevate the head of the bed to high Fowler position.
    4. DD. Place the client in a side-lying recovery position.
    Show answer to question 10

    Answer: D. Place the client in a side-lying recovery position.

    Glucagon frequently causes nausea and vomiting as the client regains consciousness, creating a high risk for aspiration; placing the client in a side-lying recovery position protects the airway. High Fowler position does not safeguard the airway in an unresponsive individual who cannot maintain protective reflexes. Oral fluids should never be given to an unresponsive client until full consciousness and swallowing ability return, and chest compressions are indicated only in cardiac arrest.

11. Question 11 of 25Medium

    A 72-year-old client in a long-term care facility has a history of heart failure and is receiving furosemide 40 mg daily. The nurse notes that the client has a new onset of confusion, dry mouth, and muscle cramps. Vital signs are: blood pressure 102/68 mm Hg, heart rate 102 beats/min, respiratory rate 18 breaths/min, oxygen saturation 96% on room air. Which laboratory value should the nurse review first?

    1. AA. Serum sodium 138 mEq/L
    2. BB. Serum creatinine 1.1 mg/dL
    3. CC. Serum potassium 3.0 mEq/L
    4. DD. Serum glucose 110 mg/dL
    Show answer to question 11

    Answer: C. Serum potassium 3.0 mEq/L

    Furosemide causes potassium loss, and a potassium of 3.0 mEq/L is clearly low. Hypokalemia explains the muscle cramps and can cause weakness, confusion, and dangerous dysrhythmias, so this value needs attention first.

    Why the other options are wrong

    • AA sodium of 138 mEq/L is normal and does not explain the symptoms.
    • BA creatinine of 1.1 mg/dL is within normal limits.
    • DA glucose of 110 mg/dL is only slightly elevated and does not explain the cramps or confusion.

12. Question 12 of 25Medium

    A client in the oliguric phase of acute kidney injury has a serum potassium level of 6.9 mEq/L. The cardiac monitor displays tall, peaked T waves and widening of the QRS complex. Which medication should the nurse anticipate administering first?

    1. AA. Intravenous regular insulin and 50% dextrose
    2. BB. Oral sodium polystyrene sulfonate
    3. CC. Intravenous calcium gluconate
    4. DD. Intravenous bumetanide
    Show answer to question 12

    Answer: C. Intravenous calcium gluconate

    Intravenous calcium gluconate is the first-line medication administered to stabilize the myocardial cell membrane and prevent life-threatening dysrhythmias when severe hyperkalemia produces electrocardiographic changes. While intravenous insulin and dextrose lower serum potassium by driving it intracellularly, calcium gluconate must be given immediately first to protect the heart. Sodium polystyrene sulfonate facilitates potassium elimination through the gastrointestinal tract but has a delayed onset of hours.

13. Question 13 of 25Medium

    A 31-year-old client with Graves disease who stopped taking methimazole 2 months ago is admitted to the step-down unit with pneumonia. Which finding requires immediate follow-up by the nurse?

    1. AA. Bilateral exophthalmos and a fine tremor of both hands
    2. BB. Weight loss of 10 lb (4.5 kg) over the past 2 months
    3. CC. Warm, moist skin and a report of ongoing intolerance to heat at home
    4. DD. Temperature 104.2°F (40.1°C), heart rate 156/min and agitation
    Show answer to question 13

    Answer: D. Temperature 104.2°F (40.1°C), heart rate 156/min and agitation

    High fever, marked tachycardia and a change in mental status in a client with untreated hyperthyroidism and an acute infection suggest thyroid storm, a life-threatening emergency. The nurse notifies the health care provider immediately and starts cooling measures and cardiac monitoring as prescribed.

    Why the other options are wrong

    • AExophthalmos and a fine tremor are chronic features of Graves disease, not signs of an acute crisis.
    • BWeight loss is an expected result of untreated hyperthyroidism and needs follow-up, but it is not immediately life-threatening.
    • CWarm, moist skin and heat intolerance are expected with a hypermetabolic state and do not by themselves signal a crisis.

14. Question 14 of 25Hard

    A client with an acute aortic dissection is admitted with a blood pressure of 210/118 mm Hg and a heart rate of 105 beats/minute. Which intravenous medication should the nurse anticipate administering first?

    1. AA. Hydralazine
    2. BB. Nitroglycerin
    3. CC. Labetalol
    4. DD. Sodium nitroprusside
    Show answer to question 14

    Answer: C. Labetalol

    In acute aortic dissection, initial therapy focuses on lowering both blood pressure and heart rate to minimize the shearing force against the aortic wall. An intravenous beta blocker such as labetalol or esmolol must be initiated first to control ventricular contractility and heart rate. Pure vasodilators such as sodium nitroprusside or hydralazine cause reflex sympathetic stimulation and tachycardia if administered without prior beta blockade, which can propagate the dissection flap.

15. Question 15 of 25Medium

    An anxious client in the emergency department reports numbness around the mouth, tingling in the fingertips, and dizziness. Arterial blood gas results show: pH 7.52, PaCO2 27 mm Hg, and HCO3 23 mEq/L. Which pathophysiological change explains the client's neuromuscular symptoms?

    1. AA. Intracellular shift of potassium causing peripheral nerve demyelination
    2. BB. Vasodilation of cerebral arteries resulting in decreased perfusion pressure
    3. CC. Increased binding of serum calcium to albumin leading to hypocalcemia
    4. DD. Accumulation of circulating lactic acid inhibiting neurotransmitter release
    Show answer to question 15

    Answer: C. Increased binding of serum calcium to albumin leading to hypocalcemia

    Acute respiratory alkalosis causes hydrogen ions to dissociate from serum albumin to buffer the blood, which frees up negative binding sites on albumin for calcium. This increases calcium-albumin binding and acutely lowers free ionized calcium, producing symptoms of tetany such as circumoral paresthesias and tingling. While potassium does shift intracellularly during alkalosis, it causes muscle weakness or cardiac dysrhythmias rather than rapid paresthesias and tetany from demyelination.

16. Question 16 of 25Hard

    A 49-year-old client with alcohol use disorder is admitted to the step-down unit with malnutrition. Results: magnesium 0.9 mg/dL (reference range 1.7 to 2.2 mg/dL), potassium 3.2 mEq/L and calcium 7.9 mg/dL. The client has tremors and hyperactive deep tendon reflexes. The client is at greatest risk for which complication?

    1. AA. Hypertensive crisis from fluid retention
    2. BB. Ventricular dysrhythmias such as torsades de pointes
    3. CC. Paralytic ileus from slowed gastrointestinal motility
    4. DD. Hypoglycemic coma from impaired gluconeogenesis
    Show answer to question 16

    Answer: B. Ventricular dysrhythmias such as torsades de pointes

    Severe hypomagnesemia, especially with hypokalemia, increases myocardial irritability and prolongs the QT interval, creating a high risk of torsades de pointes and other ventricular dysrhythmias. The tremors and hyperactive reflexes confirm neuromuscular irritability, so the nurse starts cardiac monitoring and anticipates prescribed magnesium replacement.

    Why the other options are wrong

    • AHypomagnesemia does not cause fluid retention or a hypertensive crisis.
    • CIleus is linked mainly to hypokalemia and is far less immediately dangerous than a lethal dysrhythmia.
    • DHypoglycemia can occur with heavy alcohol use, but these results point to cardiac and neuromuscular risk.

17. Question 17 of 25Hard

    A nurse is assessing a client presenting with severe status asthmaticus. While measuring the client's arterial blood pressure during inspiration, the nurse notes a decrease in systolic blood pressure of 18 mm Hg compared to the value obtained during expiration. How should the nurse document and interpret this finding?

    1. AA. Pulse deficit, indicating underlying cardiac dysrhythmias
    2. BB. Widened pulse pressure, indicating increased intracranial pressure
    3. CC. Orthostatic hypotension, indicating intravascular volume depletion
    4. DD. Pulsus paradoxus, indicating severe intrathoracic pressure swings
    Show answer to question 17

    Answer: D. Pulsus paradoxus, indicating severe intrathoracic pressure swings

    Pulsus paradoxus is defined as an abnormally large decrease in systolic blood pressure (greater than 10 mm Hg) during inspiration, caused by hyperinflation of the lungs and severe negative intrathoracic pressure shifts impinging on cardiac filling. Orthostatic hypotension is evaluated by comparing supine and standing blood pressures and heart rates to assess volume status, not respiratory variation during breathing.

18. Question 18 of 25Hard

    A 68-year-old client on a telemetry unit reports sudden palpitations and lightheadedness. The cardiac monitor shows a regular rhythm at 180 beats/min, no visible P waves, and a wide QRS complex (0.14 seconds). The nurse assesses a blood pressure of 88/52 mm Hg, and the client appears pale and diaphoretic. What should the nurse do first?

    1. AA. Place the client in a supine position and apply oxygen at 2 L/min via nasal cannula
    2. BB. Administer a 500 mL bolus of 0.9% sodium chloride over 20 minutes
    3. CC. Administer adenosine 6 mg rapid IV push per protocol
    4. DD. Prepare for synchronized cardioversion at 100 joules
    Show answer to question 18

    Answer: D. Prepare for synchronized cardioversion at 100 joules

    A regular wide-complex tachycardia at 180 beats/min without P waves is most likely ventricular tachycardia. With hypotension, pallor, and diaphoresis, the client is unstable and needs immediate synchronized cardioversion.

    Why the other options are wrong

    • AOxygen and positioning are supportive, but an unstable tachycardia requires immediate electrical therapy.
    • BA fluid bolus does not correct the dysrhythmia that is causing the hypotension.
    • CAdenosine may be considered only for a stable, regular, monomorphic wide-complex rhythm; this unstable client needs cardioversion.

19. Question 19 of 25Hard

    A client with refractory status epilepticus fails to respond to first- and second-line therapies and is intubated for initiation of a continuous propofol infusion. Which monitoring tool should the nurse expect to implement to guide medication titration?

    1. AA. Hourly arterial blood gas measurements to monitor for metabolic alkalosis
    2. BB. Transcranial Doppler ultrasonography every 2 hours to evaluate cerebral blood velocity
    3. CC. Continuous electroencephalography to titrate to burst suppression
    4. DD. Serial lumbar punctures every 6 hours to measure intracranial opening pressure
    Show answer to question 19

    Answer: C. Continuous electroencephalography to titrate to burst suppression

    In refractory status epilepticus treated with general anesthetics such as propofol, continuous electroencephalography (cEEG) is essential because high-dose sedatives suppress clinical motor signs while subclinical electrographic seizures may persist. The anesthetic infusion is typically titrated to a specific electrographic target, such as burst suppression or complete seizure cessation. Serial lumbar punctures are unnecessary and hazardous in unstable clients, and arterial blood gases monitor ventilation rather than antiepileptic efficacy.

20. Question 20 of 25Medium

    A 40-year-old client in the intensive care unit is receiving mechanical ventilation after a drug overdose, and the ventilator rate was increased overnight. Arterial blood gases are pH 7.53, PaCO2 27 mm Hg, HCO3 23 mEq/L and PaO2 96 mm Hg. How should the nurse interpret these results?

    1. AA. Metabolic alkalosis, uncompensated
    2. BB. Respiratory alkalosis, uncompensated
    3. CC. Respiratory acidosis, partially compensated
    4. DD. Metabolic acidosis, fully compensated
    Show answer to question 20

    Answer: B. Respiratory alkalosis, uncompensated

    A pH above 7.45 indicates alkalosis, and the low PaCO2 matches it, so the cause is respiratory, most likely the increased ventilator rate. The bicarbonate is normal, so the kidneys have not yet compensated. The nurse reports the results so the ventilator settings can be adjusted.

    Why the other options are wrong

    • AMetabolic alkalosis requires an elevated bicarbonate, and this client's HCO3 is normal.
    • CRespiratory acidosis requires a pH below 7.35 and a high PaCO2.
    • DMetabolic acidosis requires a low bicarbonate, and full compensation would bring the pH into the normal range.

21. Question 21 of 25Medium

    A 58-year-old client in the intensive care unit is mechanically ventilated on assist-control mode with a set rate of 12 breaths per minute and FiO2 of 0.50. The client's spontaneous respiratory rate is 22 breaths per minute and the ventilator alarms for high pressure. Which action should the nurse take first?

    1. AA. Increase the set rate on the ventilator to 16 breaths per minute.
    2. BB. Assess the client for coughing, bronchospasm, or biting on the tube.
    3. CC. Check the client's oxygen saturation and obtain a stat arterial blood gas.
    4. DD. Suction the endotracheal tube to clear possible secretions.
    Show answer to question 21

    Answer: B. Assess the client for coughing, bronchospasm, or biting on the tube.

    A high-pressure alarm means resistance to airflow has increased. The nurse first assesses the client for coughing, bronchospasm, secretions or biting on the tube, and checks the circuit, to identify the cause before acting.

    Why the other options are wrong

    • AChanging the set rate requires a prescription and does not address the high pressure.
    • CSaturation and blood gases do not identify why the pressure rose.
    • DSuctioning is appropriate only once assessment shows that secretions are the cause.

22. Question 22 of 25Hard

    The nurse on a surgical unit receives report on four clients. Which client should the nurse assess first?

    1. AA. A 70-year-old client 1 day after a colectomy who rates incisional pain 6 of 10 and has a heart rate of 96/min
    2. BB. A 45-year-old client who missed a morning antihypertensive dose and has a blood pressure of 158/94 mm Hg
    3. CC. A 33-year-old client 2 days after an appendectomy who has a temperature of 100.2°F (37.9°C) and a mild cough
    4. DD. A 19-year-old client with a splenic injury whose heart rate rose from 84 to 122/min and who is now restless
    Show answer to question 22

    Answer: D. A 19-year-old client with a splenic injury whose heart rate rose from 84 to 122/min and who is now restless

    A rising heart rate and new restlessness in a client with a splenic injury are early signs of hemorrhage and compensated hypovolemic shock; blood pressure often stays normal until a large volume of blood is lost. This client is the least stable and needs assessment first.

    Why the other options are wrong

    • AModerate pain with a heart rate of 96/min on the first postoperative day needs pain management but is not an emergency.
    • BA mildly elevated blood pressure after a missed dose needs follow-up but is not immediately life-threatening.
    • CA low-grade temperature and mild cough after surgery suggest atelectasis and need attention, but this client is stable.

23. Question 23 of 25Medium

    A client receiving continuous ambulatory peritoneal dialysis instills 2,000 mL of dialysate, but only 900 mL drains out at the end of the drain cycle. The nurse checks the catheter and finds no external kinks or clamps. Which action should the nurse take next?

    1. AA. Assist the client to turn from side to side
    2. BB. Flush the catheter forcefully with normal saline
    3. CC. Prepare the client for emergent catheter replacement
    4. DD. Advance the peritoneal catheter 2 to 3 centimeters
    Show answer to question 23

    Answer: A. Assist the client to turn from side to side

    Incomplete drainage during peritoneal dialysis is frequently caused by catheter tip displacement against the peritoneal wall, pockets of trapped fluid, or constipation; the first-line non-invasive action is repositioning the client onto the side or encouraging ambulation. Advancing or manipulating a peritoneal catheter directly increases the risk of bacterial contamination and organ perforation and must not be performed.

24. Question 24 of 25Medium

    A nurse cares for a 72-year-old client diagnosed with septic shock secondary to pneumonia. Which finding best indicates that systemic tissue perfusion is improving following initial fluid resuscitation?

    1. AA. Core body temperature decreases from 102.2 F (39.0 C) to 99.1 F (37.3 C).
    2. BB. Central venous pressure reaches 16 mm Hg following rapid crystalloid infusion.
    3. CC. White blood cell count drops from 18,500/mm3 to 13,000/mm3.
    4. DD. Serum lactate concentration decreases from 4.8 mmol/L to 2.1 mmol/L.
    Show answer to question 24

    Answer: D. Serum lactate concentration decreases from 4.8 mmol/L to 2.1 mmol/L.

    A downward trend in serum lactate reflects improved cellular oxygenation, decreased anaerobic metabolism, and restored microvascular tissue perfusion. Normalization of temperature and decreasing leukocyte counts indicate resolution of infection and inflammation rather than immediate cellular perfusion. Central venous pressure reflects intravascular volume and cardiac filling pressures rather than adequate organ tissue perfusion.

25. Question 25 of 25Hard

    A client diagnosed with myxedema coma is admitted to the intensive care unit. In addition to intravenous levothyroxine, the health care provider prescribes intravenous hydrocortisone. Which rationale should the nurse provide to the family regarding the administration of the corticosteroid?

    1. AA. It prevents acute adrenal crisis resulting from accelerated cortisol clearance
    2. BB. It accelerates the peripheral conversion of levothyroxine to triiodothyronine
    3. CC. It treats hypothermia by stimulating the hypothalamic temperature set point
    4. DD. It promotes renal free water excretion to correct severe hyponatremia
    Show answer to question 25

    Answer: A. It prevents acute adrenal crisis resulting from accelerated cortisol clearance

    Administration of thyroid hormone in severe hypothyroidism increases the metabolic rate, which accelerates the clearance of endogenous cortisol and can precipitate fatal acute adrenal crisis if underlying secondary or primary adrenal insufficiency is present. Hydrocortisone must be administered before or alongside levothyroxine until adrenal status is evaluated. Glucocorticoids actually inhibit rather than accelerate peripheral conversion of T4 to T3, and they do not directly alter the central thermoregulatory set point.

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