**The Healers’ Crucible: NGN-Ready
Comprehensive RN Licensure Preparation
Exam 2024**
---
**Question 1**
A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. The client states, “I
am not going to be able to give myself shots. I’ll just die.” Which of the following responses by the
nurse is most therapeutic?
A. “You will get used to it after a while. Everyone does.”
B. “It sounds like you are feeling overwhelmed. Let’s talk about what part is most frightening.”
C. “If you don’t take your insulin, you could go into diabetic ketoacidosis and die.”
D. “I can ask the doctor to prescribe an oral medication instead.”
💫RATIONALE✔️✔️: This response uses therapeutic communication techniques of reflection and
exploring. It validates the client’s emotion (overwhelmed) and opens a dialogue without judgment or
false reassurance. Option A offers a platitude. Option C uses a threatening statement. Option D is
clinically inaccurate (oral meds not for type 1).
💫ANSWER✔️✔️: B. “It sounds like you are feeling overwhelmed. Let’s talk about what part is most
frightening.”
---
**Question 2**
A nurse is preparing to administer digoxin 0.25 mg PO daily. The available tablet strength is 0.125 mg.
How many tablets should the nurse administer?
A. 0.5 tablet
,B. 1 tablet
C. 1.5 tablets
D. 2 tablets
💫RATIONALE✔️✔️: Using the formula: Desired dose / Available dose = tablets. 0.25 mg / 0.125 mg = 2
tablets. Always double-check digoxin doses due to narrow therapeutic index (0.5-2 ng/mL). Do not
crush enteric-coated or SR forms.
💫ANSWER✔️✔️: D. 2 tablets
---
**Question 3**
A nurse on a medical-surgical unit is caring for a client who is 2 days postoperative following a bowel
resection. The client reports sudden chest pain and shortness of breath. The nurse notes an oxygen
saturation of 88% on room air. Which of the following actions should the nurse take first?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Notify the provider immediately.
C. Elevate the head of the bed to 90 degrees.
D. Check the client’s blood pressure.
💫RATIONALE✔️✔️: First priority is airway and breathing. The client is hypoxemic (SpO2 88%), so
administering oxygen is the immediate intervention. After oxygen, elevate HOB, then notify provider,
then check BP. This pattern suggests possible pulmonary embolism (PE) post-op.
💫ANSWER✔️✔️: A. Administer oxygen via nasal cannula at 2 L/min.
---
**Question 4**
A nurse is reviewing the laboratory results of a client who has heart failure and is taking furosemide
(Lasix). Which of the following findings should the nurse report to the provider?
A. Potassium 3.2 mEq/L
,B. Sodium 138 mEq/L
C. BUN 18 mg/dL
D. Creatinine 0.8 mg/dL
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (normal
3.5-5.0 mEq/L) increases risk of digoxin toxicity and dysrhythmias. Potassium 3.2 requires notification
and possible supplementation. Other values are normal.
💫ANSWER✔️✔️: A. Potassium 3.2 mEq/L
---
**Question 5**
A charge nurse is observing a newly licensed nurse perform a sterile wound dressing change. Which of
the following actions by the new nurse requires intervention?
A. Opens the sterile kit away from the body.
B. Places the sterile field at waist level.
C. Drops a sterile gauze onto the field 1 inch from the edge.
D. Reaches across the sterile field to retrieve an additional supply.
💫RATIONALE✔️✔️: Reaching across a sterile field contaminates it because non-sterile arms/body shed
microorganisms over the field. The edge is considered contaminated, but 1 inch inside is safe. Opening
away from body and waist-level field are correct.
💫ANSWER✔️✔️: D. Reaches across the sterile field to retrieve an additional supply.
---
**Question 6**
A nurse is providing discharge teaching to a client with chronic obstructive pulmonary disease (COPD)
who uses home oxygen. Which of the following statements by the client indicates a need for further
teaching?
A. “I can smoke only when I am not using my oxygen.”
, B. “I will keep my oxygen tank upright and secured.”
C. “I will check my oxygen level with a pulse oximeter at rest and with activity.”
D. “I will post ‘No Smoking’ signs in my home.”
💫RATIONALE✔️✔️: Smoking near oxygen is a fire and explosion risk. Oxygen supports combustion;
even smoking “when not using” leaves residual oxygen on clothing and environment. This statement
requires immediate correction. Other options are correct safety measures.
💫ANSWER✔️✔️: A. “I can smoke only when I am not using my oxygen.”
---
**Question 7**
A nurse is assessing a client who is receiving a blood transfusion. Fifteen minutes after the start of the
transfusion, the client reports low back pain and chills. Which of the following actions should the
nurse take first?
A. Stop the transfusion.
B. Administer acetaminophen for the chills.
C. Slow the infusion rate to 10 mL/hr.
D. Notify the blood bank.
💫RATIONALE✔️✔️: Low back pain and chills during a transfusion are signs of an acute hemolytic
reaction (ABO incompatibility). The first action is to STOP the transfusion immediately to prevent
further hemolysis. Then disconnect tubing, keep IV line open with saline, notify provider, and send
blood bag and tubing to lab.
💫ANSWER✔️✔️: A. Stop the transfusion.
---
**Question 8**
A nurse is caring for a client who has a prescription for a clear liquid diet. Which of the following items
can the client have? (Select all that apply)
Comprehensive RN Licensure Preparation
Exam 2024**
---
**Question 1**
A nurse is caring for a client who has a new diagnosis of type 1 diabetes mellitus. The client states, “I
am not going to be able to give myself shots. I’ll just die.” Which of the following responses by the
nurse is most therapeutic?
A. “You will get used to it after a while. Everyone does.”
B. “It sounds like you are feeling overwhelmed. Let’s talk about what part is most frightening.”
C. “If you don’t take your insulin, you could go into diabetic ketoacidosis and die.”
D. “I can ask the doctor to prescribe an oral medication instead.”
💫RATIONALE✔️✔️: This response uses therapeutic communication techniques of reflection and
exploring. It validates the client’s emotion (overwhelmed) and opens a dialogue without judgment or
false reassurance. Option A offers a platitude. Option C uses a threatening statement. Option D is
clinically inaccurate (oral meds not for type 1).
💫ANSWER✔️✔️: B. “It sounds like you are feeling overwhelmed. Let’s talk about what part is most
frightening.”
---
**Question 2**
A nurse is preparing to administer digoxin 0.25 mg PO daily. The available tablet strength is 0.125 mg.
How many tablets should the nurse administer?
A. 0.5 tablet
,B. 1 tablet
C. 1.5 tablets
D. 2 tablets
💫RATIONALE✔️✔️: Using the formula: Desired dose / Available dose = tablets. 0.25 mg / 0.125 mg = 2
tablets. Always double-check digoxin doses due to narrow therapeutic index (0.5-2 ng/mL). Do not
crush enteric-coated or SR forms.
💫ANSWER✔️✔️: D. 2 tablets
---
**Question 3**
A nurse on a medical-surgical unit is caring for a client who is 2 days postoperative following a bowel
resection. The client reports sudden chest pain and shortness of breath. The nurse notes an oxygen
saturation of 88% on room air. Which of the following actions should the nurse take first?
A. Administer oxygen via nasal cannula at 2 L/min.
B. Notify the provider immediately.
C. Elevate the head of the bed to 90 degrees.
D. Check the client’s blood pressure.
💫RATIONALE✔️✔️: First priority is airway and breathing. The client is hypoxemic (SpO2 88%), so
administering oxygen is the immediate intervention. After oxygen, elevate HOB, then notify provider,
then check BP. This pattern suggests possible pulmonary embolism (PE) post-op.
💫ANSWER✔️✔️: A. Administer oxygen via nasal cannula at 2 L/min.
---
**Question 4**
A nurse is reviewing the laboratory results of a client who has heart failure and is taking furosemide
(Lasix). Which of the following findings should the nurse report to the provider?
A. Potassium 3.2 mEq/L
,B. Sodium 138 mEq/L
C. BUN 18 mg/dL
D. Creatinine 0.8 mg/dL
💫RATIONALE✔️✔️: Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia (normal
3.5-5.0 mEq/L) increases risk of digoxin toxicity and dysrhythmias. Potassium 3.2 requires notification
and possible supplementation. Other values are normal.
💫ANSWER✔️✔️: A. Potassium 3.2 mEq/L
---
**Question 5**
A charge nurse is observing a newly licensed nurse perform a sterile wound dressing change. Which of
the following actions by the new nurse requires intervention?
A. Opens the sterile kit away from the body.
B. Places the sterile field at waist level.
C. Drops a sterile gauze onto the field 1 inch from the edge.
D. Reaches across the sterile field to retrieve an additional supply.
💫RATIONALE✔️✔️: Reaching across a sterile field contaminates it because non-sterile arms/body shed
microorganisms over the field. The edge is considered contaminated, but 1 inch inside is safe. Opening
away from body and waist-level field are correct.
💫ANSWER✔️✔️: D. Reaches across the sterile field to retrieve an additional supply.
---
**Question 6**
A nurse is providing discharge teaching to a client with chronic obstructive pulmonary disease (COPD)
who uses home oxygen. Which of the following statements by the client indicates a need for further
teaching?
A. “I can smoke only when I am not using my oxygen.”
, B. “I will keep my oxygen tank upright and secured.”
C. “I will check my oxygen level with a pulse oximeter at rest and with activity.”
D. “I will post ‘No Smoking’ signs in my home.”
💫RATIONALE✔️✔️: Smoking near oxygen is a fire and explosion risk. Oxygen supports combustion;
even smoking “when not using” leaves residual oxygen on clothing and environment. This statement
requires immediate correction. Other options are correct safety measures.
💫ANSWER✔️✔️: A. “I can smoke only when I am not using my oxygen.”
---
**Question 7**
A nurse is assessing a client who is receiving a blood transfusion. Fifteen minutes after the start of the
transfusion, the client reports low back pain and chills. Which of the following actions should the
nurse take first?
A. Stop the transfusion.
B. Administer acetaminophen for the chills.
C. Slow the infusion rate to 10 mL/hr.
D. Notify the blood bank.
💫RATIONALE✔️✔️: Low back pain and chills during a transfusion are signs of an acute hemolytic
reaction (ABO incompatibility). The first action is to STOP the transfusion immediately to prevent
further hemolysis. Then disconnect tubing, keep IV line open with saline, notify provider, and send
blood bag and tubing to lab.
💫ANSWER✔️✔️: A. Stop the transfusion.
---
**Question 8**
A nurse is caring for a client who has a prescription for a clear liquid diet. Which of the following items
can the client have? (Select all that apply)
