**THE NURSING MASTERY EXAMINATION: 2026
ULTIMATE PRACTICE DRILL**
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**Question 1**
A patient with a history of heart failure is admitted with crackles in all lung fields and an oxygen
saturation of 88% on room air. After placing the patient in high-Fowler's position, what is the nurse's
priority action?
A) Administer furosemide 40 mg IV push
B) Apply a non-rebreather mask at 15 L/min
C) Notify the healthcare provider
D) Obtain a stat chest x-ray
---
💫RATIONALE✔️✔️: High-Fowler's position is the immediate independent action; administering
furosemide is the next priority to reduce preload and pulmonary congestion.
💫ANSWER✔️✔️: A) Administer furosemide 40 mg IV push
---
**Question 2**
A nurse is caring for a patient with a new colostomy. Which statement by the patient indicates correct
understanding of stoma care?
A) "I will change the pouch every day to prevent infection."
B) "My stoma should be moist and pinkish-red in color."
C) "I can use aspirin to clean around the stoma site."
D) "A dark purple stoma is a normal sign of healing."
---
💫RATIONALE✔️✔️: A healthy stoma is pink to red and moist; dark purple or black indicates ischemia and
requires immediate provider notification.
,💫ANSWER✔️✔️: B) "My stoma should be moist and pinkish-red in color."
---
**Question 3**
A patient receiving a heparin infusion has an APTT result of 110 seconds (control 30 seconds). The
patient has no signs of bleeding. What should the nurse do first?
A) Increase the infusion rate by 2 mL/hr
B) Decrease the infusion rate by 2 mL/hr
C) Stop the infusion and notify the provider
D) Continue the infusion and recheck in 6 hours
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💫RATIONALE✔️✔️: Therapeutic APTT is 1.5-2.5 times control (45-75 seconds); 110 seconds is
supratherapeutic with bleeding risk; decrease the rate per protocol.
💫ANSWER✔️✔️: B) Decrease the infusion rate by 2 mL/hr
---
**Question 4**
A 3-year-old child presents to the emergency department with inspiratory stridor, barky cough, and
drooling. The child is sitting upright and refuses to lie down. What is the nurse's priority action?
A) Inspect the throat with a tongue depressor
B) Obtain a lateral neck x-ray
C) Prepare for immediate intubation
D) Administer racemic epinephrine via nebulizer
---
💫RATIONALE✔️✔️: Drooling + stridor + upright posture suggests epiglottitis; throat manipulation can
cause complete airway obstruction. Prepare for artificial airway.
💫ANSWER✔️✔️: C) Prepare for immediate intubation
, ---
**Question 5**
A nurse is administering digoxin 0.25 mg PO to a patient with heart failure. The apical pulse is 52 bpm
and irregular. What should the nurse do?
A) Administer the digoxin as ordered
B) Hold the dose and reassess in 30 minutes
C) Hold the dose and notify the healthcare provider
D) Check the digoxin level before administering
---
💫RATIONALE✔️✔️: Digoxin is withheld for an apical pulse <60 bpm in adults; the irregular rhythm also
suggests possible toxicity. Notify the provider immediately.
💫ANSWER✔️✔️: C) Hold the dose and notify the healthcare provider
---
**Question 6**
A patient with major depressive disorder started sertraline 6 days ago. The patient suddenly has more
energy and tells the nurse, "I finally figured out how to end the pain." What is the priority nursing
action?
A) Place the patient on one-to-one observation
B) Ask the patient to sign a no-harm contract
C) Remove all sharp objects from the room
D) Notify the healthcare provider for a medication change
---
💫RATIONALE✔️✔️: Increased energy with persistent low mood is a high-risk window for suicide; one-to-
one constant observation is the most protective intervention.
💫ANSWER✔️✔️: A) Place the patient on one-to-one observation
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ULTIMATE PRACTICE DRILL**
---
**Question 1**
A patient with a history of heart failure is admitted with crackles in all lung fields and an oxygen
saturation of 88% on room air. After placing the patient in high-Fowler's position, what is the nurse's
priority action?
A) Administer furosemide 40 mg IV push
B) Apply a non-rebreather mask at 15 L/min
C) Notify the healthcare provider
D) Obtain a stat chest x-ray
---
💫RATIONALE✔️✔️: High-Fowler's position is the immediate independent action; administering
furosemide is the next priority to reduce preload and pulmonary congestion.
💫ANSWER✔️✔️: A) Administer furosemide 40 mg IV push
---
**Question 2**
A nurse is caring for a patient with a new colostomy. Which statement by the patient indicates correct
understanding of stoma care?
A) "I will change the pouch every day to prevent infection."
B) "My stoma should be moist and pinkish-red in color."
C) "I can use aspirin to clean around the stoma site."
D) "A dark purple stoma is a normal sign of healing."
---
💫RATIONALE✔️✔️: A healthy stoma is pink to red and moist; dark purple or black indicates ischemia and
requires immediate provider notification.
,💫ANSWER✔️✔️: B) "My stoma should be moist and pinkish-red in color."
---
**Question 3**
A patient receiving a heparin infusion has an APTT result of 110 seconds (control 30 seconds). The
patient has no signs of bleeding. What should the nurse do first?
A) Increase the infusion rate by 2 mL/hr
B) Decrease the infusion rate by 2 mL/hr
C) Stop the infusion and notify the provider
D) Continue the infusion and recheck in 6 hours
---
💫RATIONALE✔️✔️: Therapeutic APTT is 1.5-2.5 times control (45-75 seconds); 110 seconds is
supratherapeutic with bleeding risk; decrease the rate per protocol.
💫ANSWER✔️✔️: B) Decrease the infusion rate by 2 mL/hr
---
**Question 4**
A 3-year-old child presents to the emergency department with inspiratory stridor, barky cough, and
drooling. The child is sitting upright and refuses to lie down. What is the nurse's priority action?
A) Inspect the throat with a tongue depressor
B) Obtain a lateral neck x-ray
C) Prepare for immediate intubation
D) Administer racemic epinephrine via nebulizer
---
💫RATIONALE✔️✔️: Drooling + stridor + upright posture suggests epiglottitis; throat manipulation can
cause complete airway obstruction. Prepare for artificial airway.
💫ANSWER✔️✔️: C) Prepare for immediate intubation
, ---
**Question 5**
A nurse is administering digoxin 0.25 mg PO to a patient with heart failure. The apical pulse is 52 bpm
and irregular. What should the nurse do?
A) Administer the digoxin as ordered
B) Hold the dose and reassess in 30 minutes
C) Hold the dose and notify the healthcare provider
D) Check the digoxin level before administering
---
💫RATIONALE✔️✔️: Digoxin is withheld for an apical pulse <60 bpm in adults; the irregular rhythm also
suggests possible toxicity. Notify the provider immediately.
💫ANSWER✔️✔️: C) Hold the dose and notify the healthcare provider
---
**Question 6**
A patient with major depressive disorder started sertraline 6 days ago. The patient suddenly has more
energy and tells the nurse, "I finally figured out how to end the pain." What is the priority nursing
action?
A) Place the patient on one-to-one observation
B) Ask the patient to sign a no-harm contract
C) Remove all sharp objects from the room
D) Notify the healthcare provider for a medication change
---
💫RATIONALE✔️✔️: Increased energy with persistent low mood is a high-risk window for suicide; one-to-
one constant observation is the most protective intervention.
💫ANSWER✔️✔️: A) Place the patient on one-to-one observation
---
