NCLEX-RN
Adult Health II Respiratory NCLEX Questions Questions
Extract:
Question 1 of 5
A client is admitted with a bowel obstruction. The client has nausea, vomiting, and crampy abdominal pain. The physician has written orders for the client to be up ad lib, to have narcotics for pain, to have a nasogastric tube inserted if needed, and for I.V. Ringer's Lactate and hyperalimentation fluids. The nurse should do the following in order of priority from first to last:
Correct Answer: B,C,A,D
Rationale: The priority is to administer Ringer's Lactate (
B) to correct dehydration, followed by inserting a nasogastric tube (
C) if needed to decompress the bowel. Ambulation (
A) can promote peristalsis but is less urgent, and hyperalimentation fluids (
D) are started later for long-term nutrition. CN: Physiological adaptation; CL: Synthesize
Question 2 of 5
The nurse has reported to the hospital to work the evening shift on a respiratory unit. The nurse's assignment consists of four clients. Prioritize in order from highest to lowest priority how the nurse would assess the clients after receiving report.
Order the Items
Source Container
Correct Answer: A,B,C,D
Rationale: The client with pneumonia, fever, and shortness of breath is at highest risk for respiratory compromise (
A). The postoperative client with pain (
B) is next due to pain's impact on breathing. The client with suspected tuberculosis and cough (
C) is lower priority but needs isolation precautions. The client with emphysema awaiting a scheduled bronchodilator (
D) is stable.
Question 3 of 5
A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which of the following activities should the nurse instruct the client to avoid?
Correct Answer: A
Rationale: Crossing the legs risks hip dislocation post-surgery.
Question 4 of 5
A client who had a splenectomy is being discharged. Of the following discharge instructions, which is most specific to the client's surgical procedure?
Correct Answer: D
Rationale: Splenectomy increases the lifelong risk of infection due to the spleen's role in immunity. Reporting early signs of infection is the most specific instruction, as it addresses this unique risk. The other instructions are general postoperative advice.
Question 5 of 5
The nurse is teaching a client with a total knee replacement about incision care. Which statement by the client indicates a need for further teaching?
Correct Answer: C
Rationale: Changing the dressing weekly is too infrequent; daily or as-needed changes are required to monitor for infection.