NCLEX-RN
Adult Health II Respiratory NCLEX Questions Questions
Extract:
Question 1 of 5
The client has a nursing diagnosis of Self-care deficit related to the confinement of traction. Which of the following would indicate a successful outcome for this diagnosis?
Correct Answer: A
Rationale: Increased participation in self-care indicates progress toward independence despite traction limitations.
Question 2 of 5
A client with a hip fracture is using a walker. Which observation indicates incorrect use of the walker?
Correct Answer: A
Rationale: Leaning forward over the walker compromises balance and increases fall risk.
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 client is being admitted with a spinal cord transection at C7. Which of the following assessments take priority upon the client's arrival?
Correct Answer: C,E
Rationale: Respirations and blood pressure are the priority assessments for a C7 spinal cord injury, as this level can impair diaphragmatic function and cause neurogenic shock, both life-threatening. Reflexes, bladder function, and temperature are important but secondary to airway and circulation stability.
Question 5 of 5
For breakfast on the morning a client is to have an electroencephalogram (EEG), the client is served a soft-boiled egg, toast with butter and marmalade, orange juice, and coffee. Which of the following should the nurse do?
Correct Answer: B
Rationale: Coffee should be removed because caffeine can alter brain wave activity, affecting EEG results. The other foods do not typically interfere with the test.