NCLEX-RN
Adult Health II Respiratory NCLEX Questions Questions
Extract:
Question 1 of 5
A client undergoes surgery to repair lung injuries. Postoperative orders include the transfusion of one unit of packed red blood cells at a rate of 60 mL/hour. How long would this transfusion take to infuse?
Correct Answer: B
Rationale: A unit of packed red blood cells is approximately 250–300 mL. At 60 mL/hour, 240 mL (close to a unit) takes 240 ÷ 60 = 4 hours.
Question 2 of 5
Which of the following clients is at greatest risk for Buerger's disease?
Correct Answer: A
Rationale: Buerger's disease (thromboangiitis obliterans) is strongly associated with heavy tobacco use, particularly in young males. A 29-year-old male with a 14-year smoking history is at greatest risk. Birth control pills, diabetes, and atherosclerosis are not primary risk factors for Buerger's disease.
Question 3 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.
Question 4 of 5
A nurse assesses a 40-year-old female client with vasospastic disorder (Raynaud’s phenomenon) involving her right hand. The nurse notes the information in the progress notes, as shown below. From these fi ndings, the nurse should formulate which priority nursing diagnosis?
Correct Answer: B
Rationale: The client complains of numbness in her fingertips, thus Disturbed sensory perception (tactile) is the priority nursing diagnosis. The client does not complain of acute pain. The other data suggest that the circulation is adequate at this time, so neither Ineffective tissue perfusion nor Risk for impaired skin integrity is the priority nursing diagnosis.
Question 5 of 5
Which of the following nursing interventions is most important in preventing postoperative complications?
Correct Answer: D
Rationale: Early ambulation prevents multiple complications, including deep vein thrombosis, pneumonia, and atelectasis, by promoting circulation and lung expansion.