**The NGN Clinical Judgment & Prioritization
Intensive: Comprehensive Nursing Mastery
Exam**
1. A nurse is caring for a client with a chest tube. Which finding requires immediate intervention?
A) Continuous bubbling in the water seal chamber
B) Occasional bubbling in the suction control chamber
C) Tidaling in the water seal chamber
D) Serosanguineous drainage 100 mL in 8 hours
💫RATIONALE✔️✔️: Continuous bubbling in water seal indicates an air leak; intermittent bubbling in
suction chamber is normal.
💫ANSWER✔️✔️: A) Continuous bubbling in the water seal chamber
---
2. A client with diabetic ketoacidosis has a blood glucose of 480 mg/dL. The nurse anticipates which IV
fluid initially?
A) 0.9% normal saline
B) 0.45% normal saline
C) D5W
D) D5 0.45% NS
💫RATIONALE✔️✔️: Isotonic saline restores intravascular volume and corrects hypotension before insulin
and dextrose are added.
💫ANSWER✔️✔️: A) 0.9% normal saline
---
3. A nurse is preparing to administer a blood transfusion. Which IV solution is compatible?
A) Lactated Ringer’s
,B) 5% Dextrose in water
C) 0.9% Normal saline
D) 0.45% Normal saline
💫RATIONALE✔️✔️: Only 0.9% normal saline is compatible with blood products; other solutions cause
hemolysis.
💫ANSWER✔️✔️: C) 0.9% Normal saline
---
4. A client with bipolar disorder is taking lithium. Which lab finding indicates toxicity?
A) Lithium level 0.8 mEq/L
B) Sodium 138 mEq/L
C) Lithium level 1.8 mEq/L
D) BUN 12 mg/dL
💫RATIONALE✔️✔️: Therapeutic lithium level is 0.6-1.2 mEq/L; level >1.5 indicates toxicity with risk of
seizures and coma.
💫ANSWER✔️✔️: C) Lithium level 1.8 mEq/L
---
5. A nurse is assessing a client with ectopic pregnancy. Which finding is most concerning?
A) Vaginal spotting
B) Unilateral lower quadrant pain
C) Referred shoulder pain
D) Nausea
💫RATIONALE✔️✔️: Referred shoulder pain indicates diaphragmatic irritation from intra-abdominal
bleeding, a surgical emergency.
💫ANSWER✔️✔️: C) Referred shoulder pain
---
6. A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L nasal
cannula. Which action is correct?
, A) Increase oxygen to 4 L
B) Apply a non-rebreather mask at 15 L
C) Maintain current oxygen and assess ABGs
D) Decrease oxygen to 1 L
💫RATIONALE✔️✔️: COPD clients should maintain oxygen to achieve 88-92% saturation; increasing may
suppress respiratory drive.
💫ANSWER✔️✔️: C) Maintain current oxygen and assess ABGs
---
7. A nurse is caring for a client receiving fentanyl PCA. The respiratory rate is 8 breaths/min. Which
medication should be prepared?
A) Flumazenil
B) Naloxone
C) Naltrexone
D) Epinephrine
💫RATIONALE✔️✔️: Naloxone reverses opioid-induced respiratory depression; administer immediately
and prepare for repeat dosing.
💫ANSWER✔️✔️: B) Naloxone
---
8. A nurse is teaching a client with a new prescription for warfarin. Which statement requires immediate
correction?
A) “I will use an electric razor to shave”
B) “I can eat spinach salads daily”
C) “I will take ibuprofen if I get a headache”
D) “I will wear a medical alert bracelet”
💫RATIONALE✔️✔️: Ibuprofen (NSAID) increases bleeding risk and should be avoided with warfarin;
acetaminophen is safer.
💫ANSWER✔️✔️: C) “I will take ibuprofen if I get a headache”
Intensive: Comprehensive Nursing Mastery
Exam**
1. A nurse is caring for a client with a chest tube. Which finding requires immediate intervention?
A) Continuous bubbling in the water seal chamber
B) Occasional bubbling in the suction control chamber
C) Tidaling in the water seal chamber
D) Serosanguineous drainage 100 mL in 8 hours
💫RATIONALE✔️✔️: Continuous bubbling in water seal indicates an air leak; intermittent bubbling in
suction chamber is normal.
💫ANSWER✔️✔️: A) Continuous bubbling in the water seal chamber
---
2. A client with diabetic ketoacidosis has a blood glucose of 480 mg/dL. The nurse anticipates which IV
fluid initially?
A) 0.9% normal saline
B) 0.45% normal saline
C) D5W
D) D5 0.45% NS
💫RATIONALE✔️✔️: Isotonic saline restores intravascular volume and corrects hypotension before insulin
and dextrose are added.
💫ANSWER✔️✔️: A) 0.9% normal saline
---
3. A nurse is preparing to administer a blood transfusion. Which IV solution is compatible?
A) Lactated Ringer’s
,B) 5% Dextrose in water
C) 0.9% Normal saline
D) 0.45% Normal saline
💫RATIONALE✔️✔️: Only 0.9% normal saline is compatible with blood products; other solutions cause
hemolysis.
💫ANSWER✔️✔️: C) 0.9% Normal saline
---
4. A client with bipolar disorder is taking lithium. Which lab finding indicates toxicity?
A) Lithium level 0.8 mEq/L
B) Sodium 138 mEq/L
C) Lithium level 1.8 mEq/L
D) BUN 12 mg/dL
💫RATIONALE✔️✔️: Therapeutic lithium level is 0.6-1.2 mEq/L; level >1.5 indicates toxicity with risk of
seizures and coma.
💫ANSWER✔️✔️: C) Lithium level 1.8 mEq/L
---
5. A nurse is assessing a client with ectopic pregnancy. Which finding is most concerning?
A) Vaginal spotting
B) Unilateral lower quadrant pain
C) Referred shoulder pain
D) Nausea
💫RATIONALE✔️✔️: Referred shoulder pain indicates diaphragmatic irritation from intra-abdominal
bleeding, a surgical emergency.
💫ANSWER✔️✔️: C) Referred shoulder pain
---
6. A client with chronic obstructive pulmonary disease has an oxygen saturation of 88% on 2 L nasal
cannula. Which action is correct?
, A) Increase oxygen to 4 L
B) Apply a non-rebreather mask at 15 L
C) Maintain current oxygen and assess ABGs
D) Decrease oxygen to 1 L
💫RATIONALE✔️✔️: COPD clients should maintain oxygen to achieve 88-92% saturation; increasing may
suppress respiratory drive.
💫ANSWER✔️✔️: C) Maintain current oxygen and assess ABGs
---
7. A nurse is caring for a client receiving fentanyl PCA. The respiratory rate is 8 breaths/min. Which
medication should be prepared?
A) Flumazenil
B) Naloxone
C) Naltrexone
D) Epinephrine
💫RATIONALE✔️✔️: Naloxone reverses opioid-induced respiratory depression; administer immediately
and prepare for repeat dosing.
💫ANSWER✔️✔️: B) Naloxone
---
8. A nurse is teaching a client with a new prescription for warfarin. Which statement requires immediate
correction?
A) “I will use an electric razor to shave”
B) “I can eat spinach salads daily”
C) “I will take ibuprofen if I get a headache”
D) “I will wear a medical alert bracelet”
💫RATIONALE✔️✔️: Ibuprofen (NSAID) increases bleeding risk and should be avoided with warfarin;
acetaminophen is safer.
💫ANSWER✔️✔️: C) “I will take ibuprofen if I get a headache”
