COMPREHENSIVE PROFESSIONAL NURSING
LICENSURE & CLINICAL COMPETENCY
EXAMINATION
200 Clinical Questions with In-Depth Rationales & NCLEX-RN
Alignment
Special Focus: Pediatric Nursing, Growth & Development, and Family-
Centered Care
Question 1: A nurse is planning care for a preschooler who is
hospitalized and experiencing separation anxiety. Which of the
following nursing interventions is most appropriate to help reduce
this anxiety?
A. Discourage parents from visiting during painful procedures to
prevent crying.
B. Establish a consistent daily routine and encourage parental
involvement in care.
C. Provide strict isolation precautions to minimize exposure to
unfamiliar stimuli.
D. Explain the hospital discharge date repeatedly in hours and days.
Correct Answer: B
Rationale: Preschoolers experience separation anxiety characterized
by protest, despair, and detachment, particularly in unfamiliar
environments. Establishing a consistent daily routine and
encouraging parental involvement provides security, predictability,
and reassurance. Parents should be encouraged to participate in
care. Preschoolers do not yet understand abstract concepts of time
, (hours/days), making concrete routines and familiar objects far more
effective.
Question 2: Clinical Scenario #2: A toddler is admitted with severe
dehydration secondary to rotavirus gastroenteritis. Which clinical
manifestation should the nurse anticipate?
A. Bounding peripheral pulses
B. Sunken anterior fontanel and oliguria
C. Bradycardia and hypertension
D. Moist mucous membranes and periorbital edema
Correct Answer: B
Rationale: Comprehensive rationale for Question 2: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
Dehydration in infants and toddlers leads to extracellular fluid
volume deficit, manifesting as sunken fontanels, dry mucous
membranes, tachycardia, delayed capillary refill, and oliguria.
Question 3: Clinical Scenario #3: An adolescent is prescribed
isotretinoin for severe nodulocystic acne. Which laboratory test is
mandatory prior to and during therapy?
A. Complete blood count (CBC)
B. Serum lipid panel and liver function tests
C. Thyroid stimulating hormone (TSH)
, D. Serum creatinine and blood urea nitrogen (BUN)
Correct Answer: B
Rationale: Comprehensive rationale for Question 3: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
Isotretinoin is a potent teratogen and can cause significant
hepatotoxicity and hyperlipidemia. Baseline and periodic monitoring
of liver enzymes and lipid levels is required.
Question 4: Clinical Scenario #4: A nurse is caring for a client newly
diagnosed with type 1 diabetes mellitus. Which finding indicates
diabetic ketoacidosis (DKA)?
A. Blood glucose 110 mg/dL, pH 7.42, HCO3 24 mEq/L
B. Blood glucose 450 mg/dL, arterial pH 7.20, serum ketones positive
C. Blood glucose 85 mg/dL, serum osmolarity 270 mOsm/kg
D. Blood glucose 600 mg/dL, pH 7.38, negative urine ketones
Correct Answer: B
Rationale: Comprehensive rationale for Question 4: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
DKA is characterized by hyperglycemia (>250 mg/dL), metabolic
acidosis (pH < 7.3, HCO3 < 18 mEq/L), and presence of serum or
urine ketones.
, Question 5: Clinical Scenario #5: During a blood transfusion, a
client develops lower back pain, chills, and fever within 15 minutes.
What is the nurse's priority action?
A. Slow the infusion rate by half and notify the health care provider.
B. Stop the transfusion immediately and infuse normal saline through
new tubing.
C. Administer diphenhydramine hydrochloride as prescribed and
monitor vital signs.
D. Document the reaction and continue observing the client for
urticaria.
Correct Answer: B
Rationale: Comprehensive rationale for Question 5: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
Lower back pain, chills, and fever are classic signs of an acute
hemolytic transfusion reaction. The immediate priority is to stop the
transfusion, disconnect the blood tubing, and infuse 0.9% sodium
chloride through a separate, new IV line to maintain vascular access
while preserving the remaining blood bag for lab analysis.
Question 6: Clinical Scenario #6: A nurse is assessing a newborn at
1 hour of life. Which finding requires immediate intervention?
A. Acrocyanosis of the hands and feet
B. Respiratory rate of 54 breaths/min with occasional periodic
breathing
C. Grunting on expiration and nasal flaring
LICENSURE & CLINICAL COMPETENCY
EXAMINATION
200 Clinical Questions with In-Depth Rationales & NCLEX-RN
Alignment
Special Focus: Pediatric Nursing, Growth & Development, and Family-
Centered Care
Question 1: A nurse is planning care for a preschooler who is
hospitalized and experiencing separation anxiety. Which of the
following nursing interventions is most appropriate to help reduce
this anxiety?
A. Discourage parents from visiting during painful procedures to
prevent crying.
B. Establish a consistent daily routine and encourage parental
involvement in care.
C. Provide strict isolation precautions to minimize exposure to
unfamiliar stimuli.
D. Explain the hospital discharge date repeatedly in hours and days.
Correct Answer: B
Rationale: Preschoolers experience separation anxiety characterized
by protest, despair, and detachment, particularly in unfamiliar
environments. Establishing a consistent daily routine and
encouraging parental involvement provides security, predictability,
and reassurance. Parents should be encouraged to participate in
care. Preschoolers do not yet understand abstract concepts of time
, (hours/days), making concrete routines and familiar objects far more
effective.
Question 2: Clinical Scenario #2: A toddler is admitted with severe
dehydration secondary to rotavirus gastroenteritis. Which clinical
manifestation should the nurse anticipate?
A. Bounding peripheral pulses
B. Sunken anterior fontanel and oliguria
C. Bradycardia and hypertension
D. Moist mucous membranes and periorbital edema
Correct Answer: B
Rationale: Comprehensive rationale for Question 2: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
Dehydration in infants and toddlers leads to extracellular fluid
volume deficit, manifesting as sunken fontanels, dry mucous
membranes, tachycardia, delayed capillary refill, and oliguria.
Question 3: Clinical Scenario #3: An adolescent is prescribed
isotretinoin for severe nodulocystic acne. Which laboratory test is
mandatory prior to and during therapy?
A. Complete blood count (CBC)
B. Serum lipid panel and liver function tests
C. Thyroid stimulating hormone (TSH)
, D. Serum creatinine and blood urea nitrogen (BUN)
Correct Answer: B
Rationale: Comprehensive rationale for Question 3: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
Isotretinoin is a potent teratogen and can cause significant
hepatotoxicity and hyperlipidemia. Baseline and periodic monitoring
of liver enzymes and lipid levels is required.
Question 4: Clinical Scenario #4: A nurse is caring for a client newly
diagnosed with type 1 diabetes mellitus. Which finding indicates
diabetic ketoacidosis (DKA)?
A. Blood glucose 110 mg/dL, pH 7.42, HCO3 24 mEq/L
B. Blood glucose 450 mg/dL, arterial pH 7.20, serum ketones positive
C. Blood glucose 85 mg/dL, serum osmolarity 270 mOsm/kg
D. Blood glucose 600 mg/dL, pH 7.38, negative urine ketones
Correct Answer: B
Rationale: Comprehensive rationale for Question 4: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
DKA is characterized by hyperglycemia (>250 mg/dL), metabolic
acidosis (pH < 7.3, HCO3 < 18 mEq/L), and presence of serum or
urine ketones.
, Question 5: Clinical Scenario #5: During a blood transfusion, a
client develops lower back pain, chills, and fever within 15 minutes.
What is the nurse's priority action?
A. Slow the infusion rate by half and notify the health care provider.
B. Stop the transfusion immediately and infuse normal saline through
new tubing.
C. Administer diphenhydramine hydrochloride as prescribed and
monitor vital signs.
D. Document the reaction and continue observing the client for
urticaria.
Correct Answer: B
Rationale: Comprehensive rationale for Question 5: In clinical
practice, adherence to evidence-based guidelines ensures patient
safety, accurate assessment, and prioritized nursing interventions.
Lower back pain, chills, and fever are classic signs of an acute
hemolytic transfusion reaction. The immediate priority is to stop the
transfusion, disconnect the blood tubing, and infuse 0.9% sodium
chloride through a separate, new IV line to maintain vascular access
while preserving the remaining blood bag for lab analysis.
Question 6: Clinical Scenario #6: A nurse is assessing a newborn at
1 hour of life. Which finding requires immediate intervention?
A. Acrocyanosis of the hands and feet
B. Respiratory rate of 54 breaths/min with occasional periodic
breathing
C. Grunting on expiration and nasal flaring
