**THE RAPID CLINICAL MASTERY EXAM: 125 NGN-STYLE DRILLS**
Question 1: A nurse is assessing a client with pericarditis. Which finding is most characteristic?
A) Chest pain that worsens when leaning forward
B) Chest pain that improves when sitting up and leaning forward
C) Substernal chest pressure radiating to the jaw
D) Sharp pain that increases with inspiration and is relieved by lying flat
💫RATIONALE✔️✔️: Pericarditis pain is classically pleuritic and relieved by sitting up and leaning forward
(reduces pericardial friction).
💫ANSWER✔️✔️: B) Chest pain that improves when sitting up and leaning forward
---
Question 2: A client with chronic kidney disease (CKD) has a hemoglobin of 7.8 g/dL. The nurse
anticipates an order for which medication?
A) Ferrous sulfate 325 mg orally three times daily
B) Epoetin alfa subcutaneously three times weekly
C) Folic acid 1 mg orally daily
D) Vitamin B12 1000 mcg intramuscularly monthly
💫RATIONALE✔️✔️: Epoetin alfa stimulates RBC production in CKD-related anemia due to erythropoietin
deficiency.
💫ANSWER✔️✔️: B) Epoetin alfa subcutaneously three times weekly
---
Question 3: A patient with a seizure disorder is prescribed lamotrigine. The nurse should teach the
patient to report which adverse effect immediately?
A) Dizziness and diplopia
B) Rash, especially with fever or flu-like symptoms
C) Metallic taste in the mouth
,D) Weight gain and increased appetite
💫RATIONALE✔️✔️: Lamotrigine can cause Stevens-Johnson syndrome (SJS); any rash requires prompt
evaluation, especially with fever.
💫ANSWER✔️✔️: B) Rash, especially with fever or flu-like symptoms
---
Question 4: A nurse is providing discharge teaching to a client after a percutaneous coronary
intervention (PCI) with a drug-eluting stent. Which statement by the client indicates understanding?
A) "I can stop my clopidogrel after 1 month."
B) "I will take aspirin and clopidogrel for at least 12 months."
C) "I should take ibuprofen for any chest discomfort."
D) "I only need to take my medications if I have chest pain."
💫RATIONALE✔️✔️: Dual antiplatelet therapy for 6-12 months prevents stent thrombosis, a high-
mortality complication.
💫ANSWER✔️✔️: B) "I will take aspirin and clopidogrel for at least 12 months."
---
Question 5: A client with active tuberculosis is started on isoniazid, rifampin, ethambutol, and
pyrazinamide. The nurse teaches the client that rifampin will cause which harmless but expected side
effect?
A) Red-orange discoloration of urine and tears
B) Yellowing of the skin and eyes
C) Decreased visual acuity and color discrimination
D) Peripheral neuropathy of the hands and feet
💫RATIONALE✔️✔️: Rifampin turns body fluids orange-red; this is harmless but should be explained to
prevent alarm.
💫ANSWER✔️✔️: A) Red-orange discoloration of urine and tears
, ---
Question 6: A nurse is assessing a patient with a suspected deep vein thrombosis (DVT) in the left calf.
Which finding is most consistent with DVT?
A) Unilateral calf swelling, warmth, and tenderness
B) Bilateral lower extremity pitting edema
C) Sharp, stabbing chest pain with deep inspiration
D) Cool, pale, pulseless left foot
💫RATIONALE✔️✔️: Unilateral pain, swelling, warmth, and erythema are classic signs of DVT.
💫ANSWER✔️✔️: A) Unilateral calf swelling, warmth, and tenderness
---
Question 7: A client is receiving a dopamine infusion for cardiogenic shock. The nurse notes that the
patient's urine output has increased from 15 mL/hr to 45 mL/hr. This indicates:
A) The dose is too high and should be decreased
B) Renal perfusion has improved as desired
C) The patient is going into heart failure
D) The IV site has infiltrated
💫RATIONALE✔️✔️: At moderate doses, dopamine increases renal and mesenteric blood flow; increased
urine output indicates improved perfusion.
💫ANSWER✔️✔️: B) Renal perfusion has improved as desired
---
Question 8: A nurse is caring for a patient with a new colostomy. The stoma is edematous and beefy red.
What should the nurse do?
A) Apply ice to reduce swelling
B) Notify the surgeon immediately
C) Document the finding as normal
Question 1: A nurse is assessing a client with pericarditis. Which finding is most characteristic?
A) Chest pain that worsens when leaning forward
B) Chest pain that improves when sitting up and leaning forward
C) Substernal chest pressure radiating to the jaw
D) Sharp pain that increases with inspiration and is relieved by lying flat
💫RATIONALE✔️✔️: Pericarditis pain is classically pleuritic and relieved by sitting up and leaning forward
(reduces pericardial friction).
💫ANSWER✔️✔️: B) Chest pain that improves when sitting up and leaning forward
---
Question 2: A client with chronic kidney disease (CKD) has a hemoglobin of 7.8 g/dL. The nurse
anticipates an order for which medication?
A) Ferrous sulfate 325 mg orally three times daily
B) Epoetin alfa subcutaneously three times weekly
C) Folic acid 1 mg orally daily
D) Vitamin B12 1000 mcg intramuscularly monthly
💫RATIONALE✔️✔️: Epoetin alfa stimulates RBC production in CKD-related anemia due to erythropoietin
deficiency.
💫ANSWER✔️✔️: B) Epoetin alfa subcutaneously three times weekly
---
Question 3: A patient with a seizure disorder is prescribed lamotrigine. The nurse should teach the
patient to report which adverse effect immediately?
A) Dizziness and diplopia
B) Rash, especially with fever or flu-like symptoms
C) Metallic taste in the mouth
,D) Weight gain and increased appetite
💫RATIONALE✔️✔️: Lamotrigine can cause Stevens-Johnson syndrome (SJS); any rash requires prompt
evaluation, especially with fever.
💫ANSWER✔️✔️: B) Rash, especially with fever or flu-like symptoms
---
Question 4: A nurse is providing discharge teaching to a client after a percutaneous coronary
intervention (PCI) with a drug-eluting stent. Which statement by the client indicates understanding?
A) "I can stop my clopidogrel after 1 month."
B) "I will take aspirin and clopidogrel for at least 12 months."
C) "I should take ibuprofen for any chest discomfort."
D) "I only need to take my medications if I have chest pain."
💫RATIONALE✔️✔️: Dual antiplatelet therapy for 6-12 months prevents stent thrombosis, a high-
mortality complication.
💫ANSWER✔️✔️: B) "I will take aspirin and clopidogrel for at least 12 months."
---
Question 5: A client with active tuberculosis is started on isoniazid, rifampin, ethambutol, and
pyrazinamide. The nurse teaches the client that rifampin will cause which harmless but expected side
effect?
A) Red-orange discoloration of urine and tears
B) Yellowing of the skin and eyes
C) Decreased visual acuity and color discrimination
D) Peripheral neuropathy of the hands and feet
💫RATIONALE✔️✔️: Rifampin turns body fluids orange-red; this is harmless but should be explained to
prevent alarm.
💫ANSWER✔️✔️: A) Red-orange discoloration of urine and tears
, ---
Question 6: A nurse is assessing a patient with a suspected deep vein thrombosis (DVT) in the left calf.
Which finding is most consistent with DVT?
A) Unilateral calf swelling, warmth, and tenderness
B) Bilateral lower extremity pitting edema
C) Sharp, stabbing chest pain with deep inspiration
D) Cool, pale, pulseless left foot
💫RATIONALE✔️✔️: Unilateral pain, swelling, warmth, and erythema are classic signs of DVT.
💫ANSWER✔️✔️: A) Unilateral calf swelling, warmth, and tenderness
---
Question 7: A client is receiving a dopamine infusion for cardiogenic shock. The nurse notes that the
patient's urine output has increased from 15 mL/hr to 45 mL/hr. This indicates:
A) The dose is too high and should be decreased
B) Renal perfusion has improved as desired
C) The patient is going into heart failure
D) The IV site has infiltrated
💫RATIONALE✔️✔️: At moderate doses, dopamine increases renal and mesenteric blood flow; increased
urine output indicates improved perfusion.
💫ANSWER✔️✔️: B) Renal perfusion has improved as desired
---
Question 8: A nurse is caring for a patient with a new colostomy. The stoma is edematous and beefy red.
What should the nurse do?
A) Apply ice to reduce swelling
B) Notify the surgeon immediately
C) Document the finding as normal
