Managing acute, chronic, and life-threatening physical conditions. Try 8 free questions below, each with the answer, a rationale, and the source it was checked against.
11–17% of the NCLEX-RN162 questions in NCLEXSimReviewed October 2026
Physiological Adaptation is one of the eight client needs categories in the NCSBN NCLEX-RN test plan. Expect questions on Shock, Fluid and electrolytes, Emergencies, Cardiac rhythms, Respiratory failure, and OB and pediatric emergencies.
How to study Physiological Adaptation
Study emergencies as a sequence: what you see, what it means, what you do first (DKA, sepsis, stroke, PE, anaphylaxis, tension pneumothorax).
Review fluid and electrolyte imbalances by their ECG and neuromuscular signs (peaked T waves, Chvostek and Trousseau signs).
Practice burn math: rule of nines and the Parkland formula (half in the first 8 hours).
Use case studies to practice all six clinical judgment steps in one scenario.
A client's chest tube water-seal chamber has stopped tidaling. The client is breathing comfortably with equal breath sounds bilaterally, and the tubing is free of kinks and clots. How should the nurse interpret this?
Show answer and rationale
Correct answer: A
Tidaling stops when the lung re-expands or when the tubing is kinked or occluded. With a re-expanded lung on x-ray, this is expected. Otherwise, the nurse checks for kinks or clots.
Physiological Adaptation · Multiple choice · Take action
A client has stable supraventricular tachycardia at 190/min and normal blood pressure. What should the nurse expect to try first?
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Correct answer: D
For stable, regular narrow-complex tachycardia, vagal maneuvers (such as a modified Valsalva) are tried first, then adenosine. Cardioversion is for unstable clients.
Source: AHA. Guidelines for CPR and ECC (adult tachycardia algorithm)
Physiological Adaptation · Select all that apply · Generate solutions
A client with suspected sepsis has a BP of 82/48 mm Hg and lactate of 4.2 mmol/L. Which actions should the nurse anticipate in the first hour? Select all that apply.
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Correct answers: A, B, E
Sepsis hour-1 bundle: measure lactate, draw blood cultures before antibiotics, start broad-spectrum antibiotics, give 30 mL/kg crystalloid for hypotension or lactate at least 4 mmol/L, and start vasopressors if hypotension persists.
Which finding is consistent with acute pericarditis?
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Correct answer: C
Pericarditis typically causes sharp, pleuritic chest pain that improves when sitting forward and worsens lying down, often with a pericardial friction rub.
Source: ESC. 2025 Guidelines for the Management of Myocarditis and Pericarditis
A client opens the eyes only to pain, makes inappropriate words, and withdraws from a painful stimulus. What is the Glasgow Coma Scale score?
points
Show answer and rationale
Answer: 9 points
Eye opening to pain = 2; inappropriate words = 3; withdraws from pain = 4. Total = 9. A GCS of 8 or below usually indicates the need for airway protection.
Source: Teasdale & Jennett. Glasgow Coma Scale; Lewis's Med-Surg
1,059 fact-checked questions, a full adaptive exam that stops by the real rules, a proctored test-day mode with an integrity report, 8 NGN case studies, bedside simulations, and ACLS megacodes. Free.