Saunders Comprehensive Review for the Nclex-
RN Examination |2025| complete exam test
questions and verified answers (MULTIPLE
CHOICES) AND RATIONALES|GET IT 100%
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Terms in this set (25)
1. The nurse is assigned to Answer: 4
care for four clients. In
planning client rounds, Rationale: Airway is always the highest priority, and
which client would the the nurse would attend to the client with asthma
nurse assess first? who requested a breathing treatment during the
previous shift. This could indicate that the client was
1. A postoperative client experiencing difficulty breathing. The clients
preparing for discharge described in options 1, 2, and 3 have needs that
with a new medication would be identified as intermediate priorities.
2. A client requiring daily
dressing changes of a
recent surgical incision
3. A client scheduled for
a chest x-ray after
insertion of a nasogastric
tube
4. A client with asthma
who requested a
breathing treatment
during the previous shift
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2. The nurse employed in Answer: 4
an emergency
department is assigned Rationale: In an emergency department, triage
to triage clients coming involves brief client assessment to classify clients
to the emergency according to their need for care and includes
department for treatment establishing priorities of care. The type of illness or
on the evening shift. The injury, the severity of the problem, and the resources
nurse would assign available govern the process. Clients with trauma,
priority to which client? chest pain, severe respiratory distress or cardiac
arrest, limb amputation, or acute neurological
1. A client complaining of deficits and those who have sustained chemical
muscle aches, a splashes to the eyes are classified as emergent and
headache, and history of are the highest priority. Clients with conditions such
seizures as a simple fracture, asthma without respiratory
2. A client who twisted distress, fever, hypertension, abdominal pain, or a
their ankle when renal stone have urgent needs and are classified as
rollerblading and is a second priority. Clients with conditions such as a
requesting medication minor laceration, sprain, or cold symptoms are
for pain classified as nonurgent and are a third priority.
3. A client with a minor
laceration on the index
finger sustained while
cutting an eggplant
4. A client with chest pain
who states that they just
ate pizza that was made
with a very spicy sauce
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3. A nursing graduate is Answer: 4
attending an agency
orientation regarding the Rationale: In team nursing, nursing personnel are
nursing model of practice led by a registered nurse leader in providing care to
implemented in the a group of clients. Option 1 identifies functional
health care facility. The nursing. Option 2 identifies a component of case
nurse is told that the management. Option 3 identifies primary nursing
nursing model is a team (relationship-based practice).
nursing approach. The
nurse determines that
which scenario is
characteristic of the
team-based model of
nursing practice?
1. Each staff member is
assigned a specic task for
a group of clients.
2. A staff member is
assigned to determine
the client's needs at
home and begin
discharge planning.
3. A single registered
nurse (RN) is responsible
for providing care to a
group of six clients with
the aid of an assistive
personnel (AP).
4. An RN leads two
licensed practical nurses
(LPNs) and three APs in
providing care to a group
of 12 clients.
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