Saunders comprehensi ve review for NCLEXRN

Saunders
comprehensi
ve review
for NCLEXRN
Which teaching method is most effective when providing
health care instructions to members of specific populations?
1. Teach-back
2. Video instruction
3. Written materials
4. Verbal explanation - ANSWER-Answer: 1
Rationale: When providing health care instructions to
members of specific populations, return explanation and
demonstration (teach-back) are of particular importance to
ensure safety & and mutual understanding of the
instructions.
Tip: note the strategic words (most effective). Note that the
correct answer is the umbrella option, which encompasses
all other options.
Which is most appropriate when communicating with a
transgender person?
1. Using identified pronouns
2. Using their first name to address them
3. Using pronouns associated with birth sex
4. Anticipating the client's needs and making suggestions -
ANSWER-Answer: 1
Rationale: The nurse needs to address the person with the
name and pronouns they identify with. Anticipating the clients
needs may be seen as judgement and should be avoided
The nurse is volunteering with an outreach program to
provide basic health care for homeless people. Which finding,
if noted, must be addressed first?
1. BP 154/72
2. Visual acuity of 20/200 in both eyes
3. Random BG level of 206
4. Complains of pain associated numbness and tingling in both
feet - ANSWER-Answer: 4
Rationale: The nurse needs to address the complaints of
numbness and tingling in both feet first with this population.
While the BP, BG, and vision results need follow-up, the clients
stated concern must be addressed first
Tip: note the correct answer is the only subjective finding
The nurse is completing an admission assessment of a client
who is intellectually disabled. Which part of the client
encounter may require more time to complete?
1. The history
2. The physical assessment
3. The nursing plan of care
4. The medication reconciliation - ANSWER-Answer: 1
Rationale intellectually disabled clients tend to have difficulty
trying to remember their medical history. Although the other
options rely on the history, they take less time because they
require less client questioning
Tip: note the subject, and recall that individuals in the
population group may have a hard time remembering their
history
The nurse working in a correctional facility is caring for a
new prisoner. The client asks about health risks associated
with living in prison. How would the nurse respond?
1. Health care is very limited in the prison setting
2. Living in a prison isn't different than living at home
3. Living in a prison can predispose a person to different
health conditions
4. Living in a prison is similar to living in a condominium or
dormitory - ANSWER-Answer: 3
Rationale: prison predisposes a person to different health
conditions such as TB, STI's, or other infectious diseases.
The nurse is caring for a client in the emergency department
who presents with a complaint of fatigue and shortness of
breath. Which physical assessment finding, if noted by the
nurse, warrants a need for follow up?
1; Reddened sclera of the eyes
2. Dry flaking noted on the scalp
3. A reddish-purple mark on the neck
4. A scaly rash noted on the elbows and knees - ANSWERAnswer: 3
Rationale: The client must be screened for abuse (bruises,
particularly around the eyes, red/purple marks on the neck,
chronic fatigue, sprained or broken wrists, sexual
dysfunction). Reddened sclera, Dry rash on elbows and
flaking of the scalp do not indicate abuse.
Tip: note strategic words (need for follow-up). focus on the
date in the question and select the option of most concern
and that is related to abuse