Anatomy and Physiology – RN Practice Questions

These questions apply anatomy and physiology at the level expected of the registered nurse candidate: multi-step clinical reasoning, prioritization among several patients, and appropriate delegation. Content aligns with the shared article Anatomy and Physiology.

Question 1

A nurse is caring for four patients at the start of the shift. Which patient should the nurse assess first?

1. A patient with right-sided heart failure who has 2+ pitting edema of both ankles and a 1 kilogram weight gain since yesterday.
2. A patient with left-sided heart failure who is sitting upright, is newly restless, and has coarse crackles in both lung bases.
3. A patient with chronic obstructive pulmonary disease whose oxygen saturation is 90% on 2 liters per minute by nasal cannula.
4. A patient two days after total knee arthroplasty who reports incisional pain rated 6 out of 10.

Answer: 2 (B). The patient with left-sided heart failure who is restless with bilateral crackles.

Rationale: Left-sided heart failure backs blood up into the pulmonary circulation, so crackles plus new restlessness suggest worsening pulmonary congestion and early hypoxia. Restlessness is an early neurologic sign of inadequate oxygenation and precedes cyanosis and a falling saturation, so this patient has an emerging airway and breathing problem. Option 1 describes expected findings of right-sided failure that warrant monitoring but not immediate action. Option 3 is a saturation commonly accepted in chronic obstructive pulmonary disease and is not an acute change. Option 4 is expected postoperative pain and is a comfort priority, not a physiologic emergency.

Question 2

A nurse is caring for a patient with a severe traumatic brain injury. Which interventions should the nurse include to limit further increases in intracranial pressure? Select all that apply.

1. Maintain the head of the bed elevated approximately 30 degrees.
2. Keep the head and neck in a neutral midline position.
3. Cluster nursing care activities to allow uninterrupted rest periods.
4. Suction the endotracheal tube every hour on a routine schedule.
5. Administer a prescribed stool softener to prevent straining.
6. Infuse 0.45% sodium chloride to maintain hydration.

Answer: 1, 2, 3, and 5 (A, B, C, E).

Rationale: The Monro-Kellie doctrine holds that the rigid skull contains a fixed volume of brain tissue, blood, and cerebrospinal fluid, so anything that impairs venous outflow or adds volume raises intracranial pressure. Elevating the head about 30 degrees and keeping the head midline promote jugular venous drainage. Clustering care limits repeated stimulation, each episode of which transiently raises pressure. Stool softeners prevent the Valsalva maneuver, which raises intrathoracic pressure and impedes cerebral venous return. Option 4 is incorrect because suctioning raises intracranial pressure and is performed only when indicated, briefly, and with preoxygenation, never on a routine hourly schedule. Option 6 is incorrect because 0.45% sodium chloride is hypotonic and shifts water into brain cells, worsening cerebral edema.

Question 3

A patient with a spinal cord injury at the T4 level suddenly reports a pounding headache. The nurse finds a blood pressure of 196/104 mmHg, a heart rate of 48 beats per minute, flushing of the face, and cool pale skin below the level of injury. What is the nurse's first action?

1. Administer the prescribed as-needed antihypertensive medication.
2. Place the patient in a sitting position with the head of the bed elevated.
3. Palpate the bladder and check the urinary catheter for kinks.
4. Notify the health care provider of the change in condition.

Answer: 2 (B). Place the patient in a sitting position with the head of the bed elevated.

Rationale: This is autonomic dysreflexia, an exaggerated sympathetic discharge triggered by a noxious stimulus below an injury at or above T6. Sitting the patient upright uses gravity to produce an immediate orthostatic drop in blood pressure and is the fastest intervention to reduce the risk of stroke and seizure. Only after upright positioning does the nurse look for and remove the trigger, most often a distended bladder or fecal impaction, which makes option 3 the correct second action. Option 1 may be needed if the pressure does not fall once the stimulus is removed, but medication is not the first step. Option 4 is appropriate but does not lower the pressure now.

Question 4

A patient is 8 hours post open reduction and internal fixation of a tibial fracture. The patient reports severe deep pain in the calf that is not relieved by opioid analgesia, and the pain intensifies sharply when the nurse passively extends the toes. The pedal pulse is palpable and capillary refill is 2 seconds. Which action should the nurse take?

1. Document the findings as expected postoperative pain and reassess in 1 hour.
2. Elevate the extremity above the level of the heart and apply an ice pack.
3. Loosen any constrictive dressing, keep the limb at heart level, and notify the surgeon immediately.
4. Encourage active range of motion of the ankle to improve circulation.

Answer: 3 (C). Loosen any constrictive dressing, keep the limb at heart level, and notify the surgeon immediately.

Rationale: Pain out of proportion to the injury and pain on passive stretch are the earliest and most sensitive findings in acute compartment syndrome, in which pressure inside a nonexpandable fascial compartment exceeds capillary perfusion pressure. A palpable pulse does not rule it out, because arterial pulses are supplied at a much higher pressure than the capillary bed and are lost only very late, after irreversible muscle and nerve injury. Removing external constriction and keeping the limb at heart level preserves arterial inflow. Option 1 delays care during a limited window before permanent damage. Option 2 is harmful: elevation above the heart lowers arterial perfusion pressure and ice causes vasoconstriction. Option 4 increases tissue pressure and pain.

Question 5

A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which findings would the nurse expect to assess or anticipate? Select all that apply.

1. Peaked T waves on the cardiac monitor.
2. Generalized skeletal muscle weakness.
3. Positive Chvostek sign.
4. Cardiac dysrhythmias, including bradycardia and asystole.
5. Increased urine output with dilute urine.

Answer: 1, 2, and 4 (A, B, D).

Rationale: Potassium is the principal intracellular cation and sets the resting membrane potential. A high extracellular potassium concentration reduces the gradient, making cells initially more excitable and then unable to repolarize normally. On the electrocardiogram this appears as tall peaked T waves, then a widened QRS, and finally bradycardia, ventricular dysrhythmias, and asystole. Skeletal muscle is affected the same way, producing weakness. Option 3 is incorrect because a positive Chvostek sign reflects the neuromuscular irritability of hypocalcemia, not hyperkalemia. Option 5 is incorrect because chronic kidney disease with hyperkalemia is typically associated with reduced, not increased, urine output; the failing kidney is the reason potassium is being retained.

Question 6

A patient in the intensive care unit has a cardiac output of 3.0 liters per minute, a heart rate of 128 beats per minute, a blood pressure of 84/62 mmHg, flat neck veins, and a central venous pressure of 1 mmHg. Which physiologic problem best explains this presentation?

1. Excessive afterload from systemic vasoconstriction.
2. Inadequate preload from decreased circulating volume.
3. Impaired contractility from myocardial ischemia.
4. Excessive preload from fluid overload.

Answer: 2 (B). Inadequate preload from decreased circulating volume.

Rationale: Cardiac output is heart rate multiplied by stroke volume, and stroke volume depends on preload, afterload, and contractility. Flat neck veins and a very low central venous pressure indicate low right-sided filling pressure, meaning there is too little volume returning to the heart. By the Frank-Starling law, less ventricular stretch produces a weaker contraction and a smaller stroke volume, and the tachycardia is a compensatory attempt to preserve cardiac output. Option 1 is unlikely because high afterload typically accompanies a normal or elevated blood pressure. Option 3 would not produce flat neck veins and a central venous pressure of 1 mmHg; failing contractility usually causes backup and elevated filling pressures. Option 4 is contradicted by the low central venous pressure and flat neck veins.

Question 7

A nurse is planning care for a group of patients with the assistance of a licensed practical nurse and an assistive personnel. Which task is most appropriate for the registered nurse to delegate to the assistive personnel?

1. Measuring and recording hourly urine output for a patient receiving a diuretic infusion.
2. Performing the initial neurologic assessment on a newly admitted patient with a head injury.
3. Determining whether a patient's crackles have worsened since the previous shift.
4. Deciding whether a patient with new confusion requires an oxygen saturation recheck and provider notification.

Answer: 1 (A). Measuring and recording hourly urine output.

Rationale: Delegation follows the rule that assessment, evaluation, teaching, and clinical judgment remain with the registered nurse, while stable, standardized data collection tasks with predictable outcomes may be delegated. Measuring and recording urine output is a measurement task within assistive personnel scope, although the registered nurse retains responsibility for interpreting whether output below 30 mL per hour signals inadequate renal perfusion. Options 2 and 3 require assessment skills and clinical interpretation. Option 4 requires clinical judgment about a neurologic change that may represent hypoxia, which is a registered nurse responsibility.

Question 8

A patient recovering from abdominal surgery is receiving intravenous opioid analgesia. The nurse notes a respiratory rate of 7 breaths per minute and difficulty arousing the patient. Arterial blood gas results are pH 7.26, PaCO2 62 mmHg, bicarbonate 25 mEq/L, and PaO2 74 mmHg. How should the nurse interpret these results?

1. Uncompensated metabolic acidosis.
2. Uncompensated respiratory acidosis.
3. Partially compensated respiratory alkalosis.
4. Fully compensated metabolic alkalosis.

Answer: 2 (B). Uncompensated respiratory acidosis.

Rationale: The pH of 7.26 is below the normal range of 7.35 to 7.45, indicating acidosis. The PaCO2 of 62 mmHg is above the normal 35 to 45 mmHg and moves in the direction that explains the acidosis, so the disturbance is respiratory. The bicarbonate of 25 mEq/L is within the normal 22 to 26 mEq/L, meaning the kidneys have not yet compensated, so the disturbance is uncompensated. Physiologically, opioid-induced hypoventilation reduces carbon dioxide elimination; retained carbon dioxide combines with water to form carbonic acid and the pH falls. Option 1 is incorrect because bicarbonate is normal. Option 3 is incorrect because the pH indicates acidosis, not alkalosis. Option 4 is incorrect because a fully compensated state would show a pH within the normal range.

Question 9

A patient receiving chemotherapy has an absolute neutrophil count of 400 per cubic millimeter and a temperature of 100.6 degrees Fahrenheit (38.1 degrees Celsius). The wound from a recent central line insertion looks clean with no redness or drainage. What is the nurse's priority interpretation?

1. The absence of redness and drainage indicates there is no infection.
2. The low-grade temperature is an expected side effect of chemotherapy and can be monitored.
3. The patient may have a serious infection despite minimal local findings, and the provider must be notified urgently.
4. The neutrophil count should be rechecked before any action is taken.

Answer: 3 (C). The patient may have a serious infection despite minimal local findings, and the provider must be notified urgently.

Rationale: The classic local signs of infection, including redness, warmth, swelling, and purulent drainage, are produced by neutrophils migrating into tissue. A severely neutropenic patient cannot generate that response, so a normal-appearing site does not exclude infection and even a modest temperature elevation may be the only sign of overwhelming sepsis. Neutropenic fever is a medical emergency requiring prompt cultures and empiric antibiotics. Options 1 and 2 misinterpret the absence of inflammatory signs as reassurance. Option 4 delays treatment; the count is already known to be critically low.

Question 10

A nurse is caring for a patient with liver cirrhosis who has 3+ pitting edema of the lower extremities and abdominal ascites. The serum albumin is 2.1 g/dL. Which statement best explains the mechanism of this patient's edema?

1. Increased capillary hydrostatic pressure from excess circulating blood volume.
2. Decreased plasma oncotic pressure allowing fluid to remain in the interstitial space.
3. Increased lymphatic drainage pulling fluid into the tissues.
4. Sodium loss causing water to shift out of the vascular compartment.

Answer: 2 (B). Decreased plasma oncotic pressure allowing fluid to remain in the interstitial space.

Rationale: Albumin is synthesized by the liver and is the major contributor to plasma oncotic pressure, the force that draws fluid from the interstitium back into the capillary at its venous end. With cirrhosis, albumin production falls, oncotic pressure drops, and filtered fluid stays in the tissues, producing edema and ascites even though the intravascular volume may be low. Option 1 is incorrect because the intravascular volume in this setting is often depleted rather than excessive, though portal hypertension does contribute a hydrostatic component. Option 3 is incorrect because lymphatic drainage removes interstitial fluid rather than adding to it. Option 4 is incorrect because water follows sodium, so sodium loss would not draw water out of the vessels into the tissues in this pattern.

Question 11

Which functions are normally performed by the kidney? Select all that apply.

1. Production of erythropoietin.
2. Conversion of vitamin D to its active form.
3. Regulation of acid-base balance through hydrogen ion excretion and bicarbonate reabsorption.
4. Production of intrinsic factor for vitamin B12 absorption.
5. Release of renin in response to decreased renal perfusion.
6. Synthesis of albumin and clotting factors.

Answer: 1, 2, 3, and 5 (A, B, C, E).

Rationale: The kidney secretes erythropoietin in response to hypoxia to stimulate red cell production, which is why chronic kidney disease causes anemia. It performs the final hydroxylation that activates vitamin D, which is why kidney failure causes hypocalcemia. It is the long-term regulator of acid-base balance, which is why kidney failure produces metabolic acidosis. It releases renin when perfusion falls, initiating the renin-angiotensin-aldosterone system. Option 4 is incorrect because intrinsic factor is secreted by the parietal cells of the stomach. Option 6 is incorrect because albumin and clotting factors are synthesized by the liver.

Question 12

A patient returns to the unit after a total thyroidectomy. Which assessment finding requires the most immediate nursing action?

1. A hoarse, weak voice.
2. Tingling and numbness around the mouth and in the fingertips.
3. Serosanguineous drainage on the anterior neck dressing.
4. Reported difficulty swallowing solid food.

Answer: 2 (B). Tingling and numbness around the mouth and in the fingertips.

Rationale: The parathyroid glands lie on the posterior surface of the thyroid and may be injured or inadvertently removed during thyroidectomy. Loss of parathyroid hormone causes serum calcium to fall, and because calcium stabilizes nerve membranes, hypocalcemia produces increased neuromuscular excitability. Perioral and digital paresthesias are the earliest manifestation and can progress to carpopedal spasm, tetany, and laryngospasm, which is an airway emergency. The nurse should check serum calcium, assess for Chvostek and Trousseau signs, notify the provider, and confirm that calcium gluconate is available. Option 1 is common after thyroidectomy from transient laryngeal nerve irritation and warrants monitoring. Option 3 is expected in a small amount, though the nurse should check behind the neck for pooling. Option 4 is common from postoperative edema.

Question 13

A patient with a history of heart failure develops new-onset atrial fibrillation with a ventricular rate of 168 beats per minute and reports chest pressure. Which physiologic explanation should guide the nurse's understanding of the chest pain?

1. The rapid rate increases coronary artery filling and causes vessel distention.
2. The rapid rate shortens diastole, reducing coronary artery perfusion and cardiac filling time.
3. The loss of the P wave increases stroke volume and myocardial workload.
4. The rapid rate increases parasympathetic tone and produces coronary vasospasm.

Answer: 2 (B). The rapid rate shortens diastole, reducing coronary artery perfusion and cardiac filling time.

Rationale: The coronary arteries fill during diastole, when the myocardium is relaxed and the aortic valve has closed. As heart rate rises, diastole shortens far more than systole does, so coronary blood flow falls at the very moment myocardial oxygen demand is highest. Shortened diastole also reduces ventricular filling and therefore stroke volume. In atrial fibrillation the loss of organized atrial contraction removes the atrial kick, further reducing filling, which makes option 3 incorrect because stroke volume decreases rather than increases. Option 1 reverses the relationship. Option 4 is incorrect because tachydysrhythmias reflect reduced parasympathetic and increased sympathetic influence.

Question 14

A nurse is assessing a patient 24 hours after an ischemic stroke involving the left middle cerebral artery territory. Which findings would increase the nurse's concern for aspiration risk? Select all that apply.

1. Absent gag reflex on stimulation of the posterior pharynx.
2. A wet, gurgling voice quality after sipping water.
3. Deviation of the tongue when the patient is asked to protrude it.
4. Pooling of secretions in the mouth with drooling.
5. Equal and reactive pupils bilaterally.

Answer: 1, 2, 3, and 4 (A, B, C, D).

Rationale: Safe swallowing depends on cranial nerves IX (glossopharyngeal) and X (vagus) for the gag reflex and pharyngeal phase and on cranial nerve XII (hypoglossal) for tongue movement that propels the bolus. An absent gag, a wet or gurgling voice after fluid intake, tongue deviation, and pooled oral secretions all indicate impairment of these nerves and a high risk of aspiration. The patient should remain nil by mouth until a formal swallow screen is completed. Option 5 is incorrect because pupillary responses reflect cranial nerves II and III and provide no information about swallowing.

Question 15

A patient with diabetic ketoacidosis is receiving a continuous intravenous insulin infusion and normal saline. The serum potassium on admission was 5.4 mEq/L and is now 3.4 mEq/L after 4 hours of therapy. What is the best explanation for this change, and what should the nurse anticipate?

1. The insulin has caused potassium to move from the extracellular fluid into the cells; anticipate a prescription for potassium replacement.
2. The saline has diluted the serum potassium; anticipate slowing the fluid rate with no other change.
3. The correction of acidosis has increased renal potassium reabsorption; anticipate holding all potassium.
4. The insulin has increased potassium excretion by the kidney; anticipate a potassium-sparing diuretic.

Answer: 1 (A). Insulin has shifted potassium intracellularly; anticipate potassium replacement.

Rationale: In diabetic ketoacidosis, acidosis and insulin deficiency drive potassium out of the cells, so the measured serum potassium is often normal or high even though total body potassium is depleted by osmotic diuresis. When insulin therapy begins, potassium moves back into cells along with glucose, and the serum level can fall rapidly and dangerously. Standard practice is to monitor potassium frequently and add replacement to the intravenous fluids, and insulin is generally withheld until potassium is above roughly 3.3 mEq/L. Option 2 underestimates a physiologically important shift. Option 3 misstates the mechanism and would allow a dangerous fall. Option 4 is incorrect because insulin causes a transcellular shift rather than renal potassium wasting, and a potassium-sparing diuretic is not the treatment for hypokalemia in this setting.

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