NCLEX-RN
Adult Health II Respiratory NCLEX Questions Questions
Extract:
Question 1 of 5
When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI), the nurse explains that the purpose of the drug is to:
Correct Answer: B
Rationale: Thrombolytic drugs dissolve clots in coronary arteries, restoring blood flow to the myocardium during an MI, reducing infarct size and improving outcomes.
Question 2 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 3 of 5
The nurse measures the amount of bile drainage from a T-tube and records it by which one of the following method:
Correct Answer: B
Rationale: T-tube drainage is bile output and should be recorded separately on the output record (option
B) to accurately track fluid loss. Adding it to urine output (
A) or wound drainage (
C) is incorrect as it represents a distinct type of output. Subtracting it from intake (
D) is not a standard practice.
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
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.