NCLEX-RN
Basic Adult Health Care NCLEX Heart Questions Questions
Extract:
Question 1 of 5
Which outcome is appropriate for a client with a traumatic brain injury?
Correct Answer: B
Rationale: Active participation in therapy is a realistic outcome for recovery in traumatic brain injury.
Question 2 of 5
A client returned from surgery with a debrided open tibial fracture and has a three-way drainage system. The nurse should first:
Correct Answer: D
Rationale: Checking blood pressure for hypotension is the priority, as bleeding from an open fracture can be life-threatening.
Question 3 of 5
Which of the following is contraindicated for a client diagnosed with disseminated intravascular coagulation (DIC)?
Correct Answer: C
Rationale: Warfarin is contraindicated in DIC because it further inhibits clotting factors, worsening bleeding. Treating the underlying cause, administering heparin (to stop clotting), and replacing blood products are standard treatments to manage DIC.
Question 4 of 5
When caring for a client with a chest tube and water-seal drainage system, the nurse should:
Correct Answer: D
Rationale: Keeping the drainage apparatus below chest level prevents fluid backflow into the pleural space. Capping the vent, stripping tubes, or clamping during movement risks complications like pneumothorax.
Question 5 of 5
Which of the following goals is a priority for a client who has undergone surgery for retinal detachment?
Correct Answer: B
Rationale: Preventing an increase in intraocular pressure is the priority to protect the surgical repair and prevent complications like re-detachment or hemorrhage.