WorksheetsNC1 SET 1
Total questions: 75
Worksheet time: 4hrs 13mins
A patient with severe kyphoscoliosis is breathless lying flat. The nurse elevates the head of bed to 45°. Which physiologic effect best explains the improvement?
Increased functional residual capacity with better alveolar recruitment
Decreased anatomic dead space with reduced tidal volume needs
Reduced pulmonary capillary wedge pressure from venous pooling
Immediate increase in hemoglobin-oxygen affinity at the alveolar level
During septic shock, the nurse notes warm skin and bounding pulses early. Which hemodynamic change best explains this finding?
Systemic vasodilation with decreased afterload and reflex tachycardia
Primary myocardial depression with reduced stroke volume first
Acute rise in venous return due to enhanced skeletal muscle pump
Cerebral vasoconstriction with redistribution of cardiac output
A post-op patient on opioids has RR 8/min and PaCO₂ 60 mmHg. Which medullary mechanism is most depressed?
Ventilatory response to hypercapnia in the central chemoreceptors
Peripheral chemoreceptor response to hypoxemia exclusively
Stretch receptor reflex that terminates inspiration
Voluntary respiratory control originating in the motor cortex
While administering a 1 L NS bolus to a dehydrated adult, which vascular space expands first and most?
Intracellular compartment volume predominantly
Interstitial compartment with minimal change intravascularly
Intravascular (plasma) compartment within the extracellular space
Total body water with equal distribution across all spaces
A client has SIADH from small-cell lung cancer. Which lab pattern is the most consistent?
Serum osmolality high, urine osmolality low, sodium high
Serum osmolality low, urine osmolality high, sodium low
Serum osmolality normal, urine osmolality low, sodium high
Serum osmolality high, urine osmolality high, sodium high
During fast PRBC transfusion, the nurse monitors calcium. Which mechanism makes this physiologic check necessary?
Citrate in stored blood chelates ionized calcium causing hypocalcemia
Hemolysis of donor cells acutely increases serum calcium load
Transfusion raises calcitonin secretion reducing bone resorption
Transfusion lowers parathyroid hormone via volume expansion alone
A runner becomes orthostatic when standing quickly after bed rest. Which immediate physiologic response prevents syncope in most people?
Baroreceptor-mediated sympathetic activation increasing SVR
Increased atrial natriuretic peptide to expand plasma volume
Reduced chemoreceptor firing decreasing ventilation rate
Coronary vasoconstriction to preserve aortic pressure
A patient with COPD uses pursed-lip breathing. Which mechanic best explains reduced dyspnea?
Raised small-airway pressure reduces premature airway collapse
Lowered intrathoracic pressure draws air faster into alveoli
Increased respiratory rate lowers dynamic hyperinflation
Decreased expiratory time reduces gas trapping significantly
The nurse pre-oxygenates for rapid sequence intubation. Which statement best describes the physiologic goal?
Increase alveolar oxygen reservoir by denitrogenation to prolong safe apnea time
Increase dissolved oxygen content to equal bound oxygen on hemoglobin
Induce metabolic alkalosis to improve hemoglobin affinity for oxygen
Reduce cardiac output temporarily to decrease oxygen consumption
An older adult with heart failure develops pulmonary edema. Which mechanisms primarily cause fluid to accumulate in alveoli? Select all that apply.
Increased hydrostatic pressure in pulmonary capillaries
Impaired lymphatic clearance of interstitial fluid
Reduced plasma oncotic pressure from hemoconcentration
Increased capillary permeability from endothelial injury
Decreased alveolar surfactant production lowering surface tension
A client with acute hemorrhage has cool extremities and narrow pulse pressure. Which compensatory change sustains perfusion first?
Peripheral vasoconstriction via sympathetic outflow
Increased urinary sodium excretion to conserve water
Decreased heart rate to lengthen diastolic filling
Immediate rise in erythropoietin to increase oxygen carrying
A patient has metabolic acidosis (pH 7.28, HCO₃⁻ 16). Which expected respiratory response is most accurate?
Reduced tidal volume with normal rate to conserve CO₂
Increased minute ventilation via hyperventilation to lower PaCO₂
Periodic apnea to buffer renal acid excretion
Bronchoconstriction to redirect airflow apically
During isometric handgrip BP rises. Which cardiac variable increases predominantly to raise arterial pressure?
Systemic vascular resistance as afterload rises
End-diastolic volume with fall in afterload
Stroke volume through enhanced venous return only
Coronary flow reduction leading to reflex bradycardia
A patient with hypothyroidism is cold-intolerant and bradycardic. Which primary physiologic deficit explains these signs?
Decreased basal metabolic rate reducing heat production and cardiac output
Increased adrenergic tone raising SVR and pulse pressure
Excess glucocorticoid activity suppressing insulin secretion
Elevated leptin levels enhancing thermogenesis
The nurse evaluates renal autoregulation during hypotension. Which mechanism preserves GFR within limits?
Afferent arteriolar dilation and efferent constriction via RAAS
Systemic venodilation decreasing renal venous return
Prostaglandin-mediated efferent dilation primarily
Baroreflex-mediated tubular water secretion increase
A patient with liver failure bruises easily. Which physiologic change is the best explanation?
Platelet hyperactivity reduces clot formation under shear
Reduced synthesis of clotting factors decreases coagulation
Elevated fibrinogen increases fibrinolysis
Increased vitamin K absorption decreases INR
During prolonged immobility, the nurse plans DVT prophylaxis. Which physiologic risk is most increased?
Venous stasis from reduced calf muscle pump activity
Decreased clotting factors from hepatic suppression
Hyperfibrinolysis from endothelial nitric oxide release
Hypocoagulability from hemodilution in supine position
A client on noninvasive ventilation shows improved oxygenation without higher FiO₂. Which mechanism explains the change?
Recruitment of collapsed alveoli improving V/Q matching
Suppression of hypoxic pulmonary vasoconstriction
Increased physiologic shunt through non-ventilated units
Reduced cardiac output causing lower oxygen extraction
After a large meal, a patient on propranolol has postprandial hypotension. Which physiologic deficit contributes most?
Blunted sympathetic response to splanchnic vasodilation
Excess aldosterone causing inappropriate natriuresis
Vasopressin surge producing mesenteric vasoconstriction
Reactive hyperglycemia raising plasma oncotic pressure
A patient with chronic kidney disease is anemic. Which mechanisms primarily account for this? Select all that apply.
Decreased erythropoietin production by peritubular cells
Increased iron absorption causing sideroblastic changes
Uremic toxins shortening red cell lifespan
Elevated hepcidin reducing iron availability
Enhanced marrow response to hypoxia increasing reticulocytes
A head-injured patient shows rising ICP. Which nursing measures reduce ICP without compromising cerebral perfusion? Select all that apply.
Keep head midline with 30° elevation to promote venous outflow
Avoid fever and treat pain to reduce cerebral metabolic demand
Apply tight cervical collars to stabilize and compress jugulars
Maintain PaCO₂ in normal-low-normal range; avoid sustained hypercapnia
Aggressively hyperventilate to PaCO₂ <25 mmHg for many hours
A patient with right heart failure has elevated JVP and hepatomegaly. Which venous pressure change is primary?
Increased systemic venous pressure with impaired forward flow
Decreased pulmonary capillary pressure with improved LV preload
Reduced right atrial pressure from tricuspid competence
Lowered mean systemic filling pressure improving venous return
A post-op client is hypothermic at 35.0 °C. Which physiologic effect most increases oxygen demand during shivering?
Involuntary skeletal muscle activity increasing metabolic rate
Cutaneous vasodilation raising heat loss and O₂ use
Decreased brown fat thermogenesis in adults
Depression of thyroid axis increasing ATP consumption
A patient receiving loop diuretics develops metabolic alkalosis and hypokalemia. Which renal mechanism is central?
Reduced aldosterone leads to distal H⁺ excretion
Volume contraction activates RAAS increasing distal H⁺ and K⁺ secretion
Inhibited bicarbonate reabsorption in the proximal tubule
Enhanced ammoniagenesis causing systemic acidosis
A trauma patient loses 2 L blood rapidly. Before labs return, which change predicts earliest risk to organ perfusion?
Fall in stroke volume with compensatory tachycardia reducing MAP
Increase in plasma oncotic pressure maintaining capillary refill
Immediate rise in hematocrit from splenic contraction
Sustained urine output due to medullary concentrating power
An older adult with orthostatic hypotension stands and becomes dizzy. Which immediate physiologic change most limits cerebral perfusion in this patient?
Impaired baroreflex-mediated rise in sympathetic tone
Excess atrial natriuretic peptide release on standing
Sudden increase in plasma oncotic pressure with leg pooling
Rapid reduction in arterial oxygen content at the lung
A COPD patient develops acute hypercapnia during a sedated procedure. Which brain region's chemosensitivity is most responsible for the ventilatory drive to CO₂?
Medullary central chemoreceptors sensing CSF pH change
Carotid body glomus cells detecting dissolved oxygen
Pontine pneumotaxic center timing inspiratory off-switch
Cerebral cortex voluntary motor output to diaphragm
A nurse titrates PEEP on a ventilator. Which primary physiologic benefit explains improved oxygenation at constant FiO₂?
Alveolar recruitment that reduces intrapulmonary shunt
Increased anatomic dead space in conducting airways
Reflex bronchoconstriction that redirects flow apically
Decreased venous return that lowers oxygen demand
A trauma patient with hemorrhagic shock has cold, clammy skin. Which neurohormonal mechanism dominates early?
Catecholamine-driven α₁-mediated cutaneous vasoconstriction
Vasopressin-mediated mesenteric vasodilation predominance
Nitric oxide-mediated systemic vasodilation predominance
Insulin surge increasing skeletal muscle blood flow
A patient on high-dose loop diuretics is alkalemic and weak. Which renal and hormonal mechanisms jointly sustain metabolic alkalosis? Select all that apply.
Volume contraction activating RAAS with distal H⁺/K⁺ secretion
Chloride depletion impairing bicarbonate excretion
Increased proximal bicarbonate secretion into tubular lumen
Hypokalemia shifting H⁺ into cells and raising plasma HCO₃⁻
Suppressed aldosterone decreasing distal acid secretion
A patient with acute pancreatitis is NPO and on large-volume IV fluids. Serum calcium drops. Which mechanism best explains the hypocalcemia?
Fat saponification binding ionized calcium in necrotic tissue
Parathyroid hormone overproduction causing renal losses
Calcitonin surge shifting calcium into bone rapidly
Albumin rise reducing total but not ionized calcium
A septic patient is tachypneic with PaO₂ 65 on 60% FiO₂. Which measure most directly reflects impaired oxygen diffusion at the alveolar-capillary membrane?
A-a oxygen gradient widened beyond age-adjusted normal
Mixed venous oxygen saturation elevation from low extraction
PaCO₂ decrease due to hyperventilation from acidosis
Hemoglobin concentration drifting downward with fluids
A nurse evaluates Starling forces in a client with cirrhosis and edema. Which change most strongly favors fluid movement into interstitium?
Low plasma oncotic pressure from hypoalbuminemia
High lymphatic pumping rate in dependent tissues
Increased interstitial hydrostatic pressure with compression
Reduced capillary permeability from endothelial repair
A patient with diabetic ketoacidosis is rapidly hyperventilating. Which arterial blood gas pattern is expected before treatment?
Low pH, low HCO₃⁻, and low PaCO₂
High pH, high HCO₃⁻, and low PaCO₂
Low pH, high HCO₃⁻, and high PaCO₂
Normal pH with low HCO₃⁻, compensated by low PaCO₂
A head-injured patient requires ICP control. Which nursing position best optimizes venous outflow without compromising CPP?
Head midline, HOB ~30°, no neck flexion
Flat supine with pillows under neck to elevate chin
Reverse Trendelenburg 60° with tight cervical collar
High Fowler 90° to maximize gravitational drainage
A sodium level of 118 mEq/L developed gradually over weeks. The patient is awake and asymptomatic. Which safe correction strategies apply? Select all that apply.
Hypertonic saline reserved for severe symptoms or seizures
Limit correction to ≤8-10 mEq/L in 24 hours to avoid ODS
Treat underlying cause and consider careful fluid restriction if appropriate
Rapid normalization to 135 mEq/L within 6 hours to restore tone
Desmopressin is always contraindicated during correction
In myasthenia gravis, which physiological defect at the neuromuscular junction causes fatigable weakness?
Reduced functional acetylcholine receptors on the postsynaptic membrane
Excess acetylcholine release from presynaptic terminals
Increased acetylcholinesterase activity in synaptic cleft
Sodium channel inactivation along the entire motor axon
A patient with carbon monoxide exposure is pink but hypoxic. Which physiologic principle explains low oxygen delivery?
Carboxyhemoglobin reduces O₂-carrying capacity and shifts the dissociation curve left
CO increases dissolved oxygen content sufficiently
CO produces methemoglobin that releases oxygen readily
CO raises PaO₂ above normal by improving diffusion
A nurse notes Kussmaul respirations in uremia. Which purpose does this pattern primarily serve?
Augment CO₂ elimination to compensate metabolic acidosis
Decrease oxygen delivery to slow tissue metabolism
Increase intrathoracic pressure to improve venous return
Prevent atelectasis through reflex bronchoconstriction
A patient on mechanical ventilation develops auto-PEEP (dynamic hyperinflation). Which adjustments most directly reduce auto-PEEP? Select all that apply.
Lower respiratory rate to allow longer expiratory time
Reduce tidal volume and inspiratory time to shorten inspiration
Increase external PEEP far above measured auto-PEEP
Treat airflow obstruction and suction secretions as indicated
Raise inspiratory flow to lengthen inspiratory time
After a large protein meal, a patient with normal physiology demonstrates increased thermogenesis. Which mechanism accounts for this postprandial rise?
Specific dynamic action increasing metabolic rate for substrate processing
Enhanced brown adipose tissue activity in all adults
Immediate thyroid hormone surge from intestinal absorption
Rapid sympathetic withdrawal increasing heat production
A patient with metabolic alkalosis from prolonged vomiting arrives hypotensive. Which physiologic steps correct the alkalosis? Select all that apply.
Isotonic saline to restore volume and chloride for renal HCO₃⁻ excretion
Potassium repletion to reduce renal ammoniagenesis and H⁺ loss
Hyperventilation to raise PaCO₂ and increase pH further
Loop diuretics to accelerate distal hydrogen loss
Acetazolamide despite volume depletion
During exercise, what change most increases oxygen extraction by active skeletal muscle?
Rightward shift of the oxyhemoglobin curve from ↑CO₂/↑H⁺/↑temperature
Leftward shift of the curve improving arterial saturation
Decreased capillary surface area for diffusion
Reduced 2,3-BPG concentration in red blood cells
A patient with Addison disease presents with orthostasis and hyperkalemia. Which hormone deficiency explains both?
Aldosterone deficiency causing salt wasting and ↓K⁺ excretion
Excess cortisol causing renal vasoconstriction
Elevated catecholamines increasing K⁺ uptake
Thyroxine deficiency reducing Na⁺ reabsorption
A patient with acute hypocalcemia after thyroid surgery is numb around the lips and has carpopedal spasm. Which membrane change explains tetany?
Lowered threshold potential increases neuronal excitability
Hyperpolarized resting potential blocks repetitive firing
Inhibited sodium channels reducing depolarization speed
Increased chloride conductance stabilizing membranes
A client with ARDS has refractory hypoxemia. Which ventilatory strategies improve oxygenation safely? Select all that apply.
Higher PEEP to recruit alveoli with cautious hemodynamic monitoring
Low tidal volume ventilation to limit volutrauma
Routine respiratory alkalosis to PaCO₂ <25 mmHg for hours
Prone positioning to enhance V/Q matching
Rapid fluid boluses to raise pulmonary capillary hydrostatic pressure
A patient with right mainstem bronchus intubation suddenly shows left-sided absent breath sounds and hypoxemia. Which physiology explains the desaturation?
Shunt from nonventilated left lung with ongoing perfusion
Dead space from perfused right lung without ventilation
Enhanced diffusion capacity from unilateral ventilation
Alveolar hyperventilation raising PaO₂ in the left lung
A client with liver failure has ascites and low serum sodium. Which primary mechanism explains the hyponatremia?
Non-osmotic vasopressin release due to effective arterial volume depletion
Renal resistance to vasopressin causing free-water loss
Increased distal sodium delivery with osmotic diuresis
Hypothalamic suppression of thirst from cytokines
A patient on propofol infusion develops hypotension. Which physiologic effects of propofol contribute? Select all that apply.
Arterial and venous vasodilation reducing preload and afterload
Myocardial depressant effects lowering stroke volume
Increased sympathetic tone raising systemic resistance
Cerebral vasoconstriction increasing mean arterial pressure
Strong mineralocorticoid effect expanding plasma volume
During fever, which hypothalamic change drives the observed rise in core temperature?
Set-point elevation in the preoptic area mediated by prostaglandin E₂
Direct muscle stimulation without neural mediation
Peripheral vasodilation to conserve metabolic heat
Sudden pituitary ACTH suppression lowering heat loss
You receive handoff for four clients at shift start. Which client should the nurse assess first?
Post-op day 1 with controlled pain who requests a shower after breakfast
New admission with COPD who is drowsy and has SpO₂ 89% on 2 L/min
Stable heart failure client asking about low-sodium meal options
Post-fall client with normal
New admission with COPD who is drowsy and has SpO₂ 89% on 2 L/min. What is the safest action?
Infuse by gravity with the roller clamp fully open
Use an infusion pump and follow max rate policy with cardiac monitoring
Mix with IV push saline to expedite correction
Hang piggyback above a maintenance bag and titrate by symptoms
A client with advanced COPD is short of breath at rest and anxious. Which initial positioning is best?
High Fowler's with arms supported on overbed table for accessory use
Flat supine with a single thin pillow under the head
Side-lying with legs elevated to 30 degrees
Trendelenburg position to increase diaphragmatic excursion
The nurse prepares to insert a nasogastric tube in a lethargic stroke client with impaired gag. Which immediate priority will reduce aspiration risk?
Place client in right lateral position with head neutral
Verify gag and cough; request x-ray confirmation after placement
Ask client to drink water with straw during insertion
Lubricate tube and aim posteriorly while client is supine
A client receiving morphine PCA is difficult to arouse, RR 8/min, SpO₂ 88% on room air. What should the nurse do first?
Stop the PCA, stimulate, provide oxygen, and prepare naloxone per protocol
Document findings and reassess in thirty minutes
Ask the family to hold the handset and observe closely
Increase IV fluids to enhance drug metabolism
You're precepting a new nurse on high-alert medication safety. Which actions are required before administering IV insulin on a med-surg unit? Select all that apply.
Use a programmable infusion device with guardrails enabled
Perform an independent double-check of drug, dose, and concentration
Prepare insulin in a non-labeled syringe to avoid delays
Confirm the most recent capillary glucose with a time stamp
Prime the tubing with heparinized saline to prevent clotting
Your client with a chest tube to water-seal has continuous bubbling in the water-seal chamber. What is the best initial action?
Clamp the tube and leave it clamped for one hour
Inspect system for air leaks from connections to client
Raise the collection chamber to chest level to reduce flow
Add sterile water to suction control chamber to stop bubbling
A client with Clostridioides difficile infection is incontinent. Which PPE and isolation are appropriate during in-room care and linen handling?
Surgical mask and eye shield; airborne isolation
Gown and gloves for all contact; dedicated equipment; soap-and-water hand hygiene
N95 respirator; negative pressure room
Gloves only; alcohol sanitizer preferred after doffing
A client admitted for DVT refuses subcutaneous heparin for VTE prophylaxis, stating, "I only want pills." What is the nurse's best first response?
Explore concerns, teach risk/benefit, and collaborate on acceptable options
Document refusal and stop offering the medication
Request a sitter to convince the client to accept injections
Threaten discharge against medical advice if refusal continues
A new graduate prepares to insert a urinary catheter in a female client. Which steps maintain sterile technique? Select all that apply.
Place the kit on a clean, dry surface and open away then toward self
Use non-dominant hand to separate labia and keep that hand "contaminated"
Advance catheter until urine flows, then a bit further before inflating balloon
Drape sterile field, then reposition client without changing gloves
Inflate balloon if resistance is felt before urine appears
You must prioritize fall prevention for a post-op older adult who insists on walking to the bathroom alone. Which nursing action is most effective?
Raise all side rails and apply soft wrist restraints
Offer a scheduled rounding plan with timely toileting and a gait belt
Turn off bed alarm to reduce noise and confusion
Dim lights at night to promote uninterrupted sleep
A nurse documents "client noncompliant with diet" after a brief teaching session. Which documentation is most appropriate instead?
"Client refused instructions and will likely continue current diet."
"Client stated cost concerns; verbalized understanding but cannot purchase recommended foods."
"Client unwilling; teach-back not necessary due to time."
"Client argumentative and difficult to educate."
Which actions are required before blood transfusion initiation? Select all that apply.
Verify order, consent, and compatibility with a second qualified verifier
Assess baseline vitals and lung sounds before hanging blood
Spike the unit and start before returning from the bedside check
Use appropriate filter tubing and start slowly while observing
Hang with lactated Ringer's to reduce viscosity
A client receiving enteral tube feeding via pump has sudden coughing and drop in SpO₂. What is the priority nursing action?
Stop the feeding, assess airway and tube position, and place on lateral side
Increase the rate to shorten feeding time and reduce aspiration risk
Add thickener to the formula and continue the current rate
Flush the tube with 100 mL water to clear any obstruction
You must delegate one task to an experienced UAP on a busy unit. Which assignment is appropriate?
Ambulate a stable post-op client with a gait belt and report fatigue
Teach use of an incentive spirometer after abdominal surgery
Assess pain level before and after PRN analgesia
Adjust oxygen flow to maintain target saturation
You prepare to give oral digoxin to a heart failure client with apical pulse 50/min and new nausea. What is the best action?
Administer as scheduled and document the slow pulse
Hold the dose, assess ECG and electrolytes, and notify provider
Give double dose later if pulse returns above 60
Provide ginger ale and recheck pulse in 6 hours
A client with dementia becomes agitated during morning care and strikes out. Which initial approach is most effective?
Pause the task, reduce stimuli, use calm validation, and try again with one-step cues
Continue quickly to finish before agitation escalates
Apply restraints to complete morning hygiene safely
Turn on bright lights and reorient loudly to time and place
A nurse is teaching a family home oxygen safety. Which statements are correct? Select all that apply.
Keep oxygen at least 3 meters from open flames and heat sources
Use water-based lubricants; avoid petroleum products near cannula
Secure cylinders upright and check for kinks and leaks routinely
Store tanks in closets under bedding to prevent theft
Smoke only in well-ventilated areas away from the concentrator
A client on contact precautions asks, "Why are you washing with soap and water instead of sanitizer?" The best response is:
Alcohol irritates my skin less than soap in this case
"Soap and water remove C. difficile spores better than sanitizer."
Our unit requires soap after any patient contact
It is more professional to use soap during outbreaks
While hanging enteral meds via a feeding tube, which step prevents drug-formula interactions?
Stop feed, flush, give one medication at a time, and flush between each
Mix all crushed meds with formula to mask taste
Add extended-release capsules to warm formula
Resume feeding concurrently to maintain continuous flow
A client with a large sacral pressure injury needs a dressing change. Which analgesic timing is most appropriate?
Administer ordered analgesic 30 minutes before the procedure
Give analgesic after assessment to evaluate baseline pain
Reserve analgesics for the wound packing step only
Avoid analgesics to maintain accurate pain scores
A nurse is preparing for sterile wound irrigation at the bedside. Which steps maintain asepsis? Select all that apply.
Position a waterproof pad and mask/eye protection for splash
Pour sterile solution without touching the bottle tip to the field
Irrigate from least contaminated to most contaminated area
Use tap water in a clean syringe for deep tunneling wounds
Reuse the sterile basin if only you touched it previously
A post-op client reports 10/10 pain 20 minutes after IV morphine. Vitals: BP 124/78, HR 86, RR 16, SpO₂ 97%. Best next action?
Validate pain, reassess surgical site and PCA history, and consider multimodal adjuncts per orders
Administer additional morphine IV without reassessment
Withhold all analgesics to avoid respiratory depression
Tell the client to use guided imagery instead of medication
During SBAR handoff, which content reflects effective “Assessment”?
“BP 90/58 after standing; likely orthostatic hypotension from diuretics.”
“Admitted yesterday; spouse at bedside and very supportive.”
“Please see orders from cardiology and pharmacy today.”
“I think she might be depressed from her diagnosis.”
The nurse prepares to administer rapid-acting insulin for a client who just received a covered tray. Which safety check is most critical before giving the dose?
Confirm that the client is alert and ready to begin eating now
Verify the client’s last bowel movement within 24 hours
Ask whether the client prefers warm or cold meals
Reweigh the client to confirm the dose per kilogram
