**Mastering Clinical Judgment: The NGN
Challenge Exam 2025**
1. A nurse in the emergency department is triaging four clients. Which client should the nurse see first?
A. Client with a ankle laceration, bleeding controlled.
B. Client reporting chest pain that radiates to the jaw.
C. Client with a temperature of 38.3°C (100.9°F) and cough.
D. Client requesting a prescription refill for an inhaler.
💫RATIONALE✔️✔️: Chest pain radiating to the jaw is a classic sign of acute myocardial infarction or
unstable angina, requiring immediate assessment to prevent cardiac arrest.
💫ANSWER✔️✔️: B. Client reporting chest pain that radiates to the jaw.
---
2. A charge nurse is assigning staff for a shift. Which client should be assigned to the registered nurse
(RN) instead of the licensed practical nurse (LPN)?
A. Client with a stable ileostomy requiring stoma care.
B. Client receiving tube feeding via gastrostomy tube.
C. Client with new-onset atrial fibrillation on a cardiac monitor.
D. Client with a urinary tract infection receiving oral antibiotics.
💫RATIONALE✔️✔️: New-onset atrial fibrillation requires complex assessment, interpretation of
telemetry, and potential emergency intervention, which is beyond the LPN scope.
💫ANSWER✔️✔️: C. Client with new-onset atrial fibrillation on a cardiac monitor.
---
3. A nurse is caring for a client with a cuffed endotracheal tube (ETT). Which finding indicates the cuff
pressure is too high?
A. The pilot balloon is firm.
B. A small air leak is heard at the end of inspiration.
,C. The client has a brassy cough and hoarseness.
D. The ETT is positioned at 23 cm at the teeth.
💫RATIONALE✔️✔️: A brassy cough and hoarseness suggest tracheal mucosal injury from excessive cuff
pressure, which can lead to tracheal stenosis or necrosis.
💫ANSWER✔️✔️: C. The client has a brassy cough and hoarseness.
---
4. A nurse is teaching a client with chronic kidney disease (CKD) about a low-phosphorus diet. Which
food choice indicates understanding?
A. A glass of skim milk.
B. A small apple.
C. Cheddar cheese cubes.
D. Peanut butter sandwich.
💫RATIONALE✔️✔️: Apples are low in phosphorus; dairy products, nuts, and peanut butter are high-
phosphorus foods that should be limited in CKD.
💫ANSWER✔️✔️: B. A small apple.
---
5. A client is receiving IV vancomycin. The nurse notes flushing of the face and neck, and a pruritic rash
on the chest. What is the priority action?
A. Stop the infusion immediately.
B. Slow the infusion rate to half.
C. Administer diphenhydramine as ordered.
D. Document the reaction and continue the infusion.
💫RATIONALE✔️✔️: These symptoms describe Red Man Syndrome, a rate-related infusion reaction;
slowing the infusion is the initial intervention to resolve symptoms.
💫ANSWER✔️✔️: B. Slow the infusion rate to half.
---
,6. A postpartum client reports a large, steady trickle of blood from the vagina, but the fundus is firm and
midline. What condition does the nurse suspect?
A. Uterine atony.
B. Retained placental fragments.
C. Vaginal or cervical laceration.
D. Uterine rupture.
💫RATIONALE✔️✔️: A firm uterus with bright red, steady bleeding indicates lower genital tract trauma
(laceration) rather than uterine atony.
💫ANSWER✔️✔️: C. Vaginal or cervical laceration.
---
7. A nurse is caring for a client who is 6 hours post-thyroidectomy. Which assessment finding requires
immediate intervention?
A. Hoarse voice.
B. Pain rated 4/10.
C. Stridor on inspiration.
D. Serous drainage on dressing.
💫RATIONALE✔️✔️: Stridor indicates laryngeal edema or tracheal compression, a life-threatening airway
emergency requiring immediate provider notification.
💫ANSWER✔️✔️: C. Stridor on inspiration.
---
8. A client with a history of peptic ulcer disease reports black, tarry stools. What is the nurse’s priority
action?
A. Ask about consumption of iron supplements.
B. Check the client’s hemoglobin and hematocrit.
C. Assess the client’s blood pressure and heart rate.
D. Prepare the client for an esophagogastroduodenoscopy (EGD).
💫RATIONALE✔️✔️: Black, tarry stools indicate upper GI bleeding; the priority is to assess for
hemodynamic instability (vital signs) before any other intervention.
, 💫ANSWER✔️✔️: C. Assess the client’s blood pressure and heart rate.
---
9. A nurse is administering packed red blood cells. After 30 minutes, the client reports new-onset low
back pain. What is the first action?
A. Slow the infusion rate.
B. Stop the transfusion.
C. Administer acetaminophen.
D. Flush the line with normal saline.
💫RATIONALE✔️✔️: Low back pain during transfusion is a sign of acute hemolytic reaction; stopping the
transfusion immediately is the priority to prevent renal failure and shock.
💫ANSWER✔️✔️: B. Stop the transfusion.
---
10. A client with major depressive disorder has been started on fluoxetine. Which statement by the
client indicates a need for immediate further assessment?
A. “I feel a little more energetic this week.”
B. “I have a dry mouth and some trouble sleeping.”
C. “I think I finally have a plan that will work.”
D. “I’m still sad, but I’m eating a little better.”
💫RATIONALE✔️✔️: A vague statement about “a plan that will work” may indicate suicidal ideation; the
nurse must immediately assess for intent, means, and plan.
💫ANSWER✔️✔️: C. “I think I finally have a plan that will work.”
---
11. A nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates the system is functioning correctly?
A. Continuous bubbling in the water seal chamber.
B. Fluctuation (tidaling) in the water seal chamber with respirations.
C. No drainage in the collection chamber for 6 hours.
Challenge Exam 2025**
1. A nurse in the emergency department is triaging four clients. Which client should the nurse see first?
A. Client with a ankle laceration, bleeding controlled.
B. Client reporting chest pain that radiates to the jaw.
C. Client with a temperature of 38.3°C (100.9°F) and cough.
D. Client requesting a prescription refill for an inhaler.
💫RATIONALE✔️✔️: Chest pain radiating to the jaw is a classic sign of acute myocardial infarction or
unstable angina, requiring immediate assessment to prevent cardiac arrest.
💫ANSWER✔️✔️: B. Client reporting chest pain that radiates to the jaw.
---
2. A charge nurse is assigning staff for a shift. Which client should be assigned to the registered nurse
(RN) instead of the licensed practical nurse (LPN)?
A. Client with a stable ileostomy requiring stoma care.
B. Client receiving tube feeding via gastrostomy tube.
C. Client with new-onset atrial fibrillation on a cardiac monitor.
D. Client with a urinary tract infection receiving oral antibiotics.
💫RATIONALE✔️✔️: New-onset atrial fibrillation requires complex assessment, interpretation of
telemetry, and potential emergency intervention, which is beyond the LPN scope.
💫ANSWER✔️✔️: C. Client with new-onset atrial fibrillation on a cardiac monitor.
---
3. A nurse is caring for a client with a cuffed endotracheal tube (ETT). Which finding indicates the cuff
pressure is too high?
A. The pilot balloon is firm.
B. A small air leak is heard at the end of inspiration.
,C. The client has a brassy cough and hoarseness.
D. The ETT is positioned at 23 cm at the teeth.
💫RATIONALE✔️✔️: A brassy cough and hoarseness suggest tracheal mucosal injury from excessive cuff
pressure, which can lead to tracheal stenosis or necrosis.
💫ANSWER✔️✔️: C. The client has a brassy cough and hoarseness.
---
4. A nurse is teaching a client with chronic kidney disease (CKD) about a low-phosphorus diet. Which
food choice indicates understanding?
A. A glass of skim milk.
B. A small apple.
C. Cheddar cheese cubes.
D. Peanut butter sandwich.
💫RATIONALE✔️✔️: Apples are low in phosphorus; dairy products, nuts, and peanut butter are high-
phosphorus foods that should be limited in CKD.
💫ANSWER✔️✔️: B. A small apple.
---
5. A client is receiving IV vancomycin. The nurse notes flushing of the face and neck, and a pruritic rash
on the chest. What is the priority action?
A. Stop the infusion immediately.
B. Slow the infusion rate to half.
C. Administer diphenhydramine as ordered.
D. Document the reaction and continue the infusion.
💫RATIONALE✔️✔️: These symptoms describe Red Man Syndrome, a rate-related infusion reaction;
slowing the infusion is the initial intervention to resolve symptoms.
💫ANSWER✔️✔️: B. Slow the infusion rate to half.
---
,6. A postpartum client reports a large, steady trickle of blood from the vagina, but the fundus is firm and
midline. What condition does the nurse suspect?
A. Uterine atony.
B. Retained placental fragments.
C. Vaginal or cervical laceration.
D. Uterine rupture.
💫RATIONALE✔️✔️: A firm uterus with bright red, steady bleeding indicates lower genital tract trauma
(laceration) rather than uterine atony.
💫ANSWER✔️✔️: C. Vaginal or cervical laceration.
---
7. A nurse is caring for a client who is 6 hours post-thyroidectomy. Which assessment finding requires
immediate intervention?
A. Hoarse voice.
B. Pain rated 4/10.
C. Stridor on inspiration.
D. Serous drainage on dressing.
💫RATIONALE✔️✔️: Stridor indicates laryngeal edema or tracheal compression, a life-threatening airway
emergency requiring immediate provider notification.
💫ANSWER✔️✔️: C. Stridor on inspiration.
---
8. A client with a history of peptic ulcer disease reports black, tarry stools. What is the nurse’s priority
action?
A. Ask about consumption of iron supplements.
B. Check the client’s hemoglobin and hematocrit.
C. Assess the client’s blood pressure and heart rate.
D. Prepare the client for an esophagogastroduodenoscopy (EGD).
💫RATIONALE✔️✔️: Black, tarry stools indicate upper GI bleeding; the priority is to assess for
hemodynamic instability (vital signs) before any other intervention.
, 💫ANSWER✔️✔️: C. Assess the client’s blood pressure and heart rate.
---
9. A nurse is administering packed red blood cells. After 30 minutes, the client reports new-onset low
back pain. What is the first action?
A. Slow the infusion rate.
B. Stop the transfusion.
C. Administer acetaminophen.
D. Flush the line with normal saline.
💫RATIONALE✔️✔️: Low back pain during transfusion is a sign of acute hemolytic reaction; stopping the
transfusion immediately is the priority to prevent renal failure and shock.
💫ANSWER✔️✔️: B. Stop the transfusion.
---
10. A client with major depressive disorder has been started on fluoxetine. Which statement by the
client indicates a need for immediate further assessment?
A. “I feel a little more energetic this week.”
B. “I have a dry mouth and some trouble sleeping.”
C. “I think I finally have a plan that will work.”
D. “I’m still sad, but I’m eating a little better.”
💫RATIONALE✔️✔️: A vague statement about “a plan that will work” may indicate suicidal ideation; the
nurse must immediately assess for intent, means, and plan.
💫ANSWER✔️✔️: C. “I think I finally have a plan that will work.”
---
11. A nurse is caring for a client with a chest tube connected to a water-seal drainage system. Which
finding indicates the system is functioning correctly?
A. Continuous bubbling in the water seal chamber.
B. Fluctuation (tidaling) in the water seal chamber with respirations.
C. No drainage in the collection chamber for 6 hours.
