Saunders NCLEX RN Practice Questions - Nurselytic

Correct Answer: C

Rationale: The correct answer is C: A client with COPD with an oxygen saturation of 84%. Oxygen saturation below 90% is considered critical, indicating hypoxemia in a client with COPD. Priority is given to critical physiological needs to avoid potential respiratory distress or failure.

Choices A, B, and D are important but do not pose immediate life-threatening risks. The diabetic client with a blood glucose level of 195 mg/dL can be managed with insulin administration. The family member's questions can be addressed after addressing immediate client needs. The client who requires assistance to use the bathroom can be attended to once the critical client's needs are addressed. Prioritizing based on physiological urgency ensures client safety.

Correct Answer: A

Rationale: The correct answer is A because documenting the client's own words provides direct evidence of their condition and thought process at the time of the incident. This helps in understanding the client's perspective and decision-making, which is crucial for providing appropriate care and preventing future falls.


Choice B is incorrect because while it may be important to document how the fall happened and when the physician was notified, it does not directly capture the client's own words and thoughts.


Choice C is incorrect as it focuses on the conditions of the room rather than the client's own account of the situation.


Choice D is also incorrect as it pertains to the client's medical history and medications, which are important but not directly relevant to documenting the client's immediate situation and actions.

Correct Answer: D

Rationale: The correct answer is D because an oxygen saturation of 96% on room air indicates adequate oxygenation, suggesting the client is stable and can be discharged home. A: Low urine output may indicate dehydration or kidney issues, requiring further monitoring. B: A fever in an infant warrants evaluation for infection, not ready for discharge. C: Recent transition from IV TPN to full liquids may require ongoing monitoring for tolerance and nutritional status.

Correct Answer: C

Rationale: The correct answer is C. Developing a new policy is the most appropriate method for managing moral distress in the workplace because it addresses the root cause of the problematic situation. By creating a policy, organizations can provide clear guidelines and procedures to handle ethical dilemmas, thus empowering healthcare professionals to navigate moral challenges effectively.


Choice A is incorrect as it encourages acceptance of unfairness and could lead to moral disengagement.
Choice B is also incorrect as declining to act in unjustifiable situations can compromise patient care and violate ethical principles.
Choice D is incorrect as it combines two flawed approaches that do not effectively address moral distress. Developing a new policy is the most proactive and systematic approach to managing moral distress in the workplace.

Correct Answer: A

Rationale: The correct answer is A: The approximate length of the surgery. This is the priority topic to instruct the client on admission because knowing the duration of the surgery helps manage the client's expectations and anxiety levels. Understanding the length of the procedure also allows the client to plan for post-operative care and recovery.


Choice B: The type of anticoagulants is important but not as critical on admission as knowing the surgery duration.
Choice C: The time of the next meal is important for preoperative fasting but not as crucial as understanding the surgery length.
Choice D: The length of time until the client can return to work is important, but it is a secondary concern compared to the immediate surgical procedure.