Nursing Excellence:
Comprehensive Clinical
Judgment & Professional
Practice Examination
2026/2027
**Question 1**
The nurse is assessing a client with a diagnosis of diabetic ketoacidosis (DKA). Which laboratory finding is
most consistent with this condition?
A. Serum glucose of 150 mg/dL
B. Serum bicarbonate of 10 mEq/L
C. Serum potassium of 5.5 mEq/L
D. Arterial pH of 7.45
,💫RATIONALE✔️✔️: DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis. A serum
bicarbonate of 10 mEq/L indicates severe metabolic acidosis (normal is 22-26 mEq/L). Serum glucose is
typically >250 mg/dL, and pH is <7.30. Potassium may be elevated initially due to acidosis but is not the
defining feature.
💫ANSWER✔️✔️: B. Serum bicarbonate of 10 mEq/L
---
**Question 2**
The nurse is providing education to a client with a new diagnosis of heart failure. Which statement
indicates the client understands the importance of sodium restriction?
A. "I can eat canned soups as long as I drink extra water."
B. "I should avoid adding salt to my food at the table."
C. "I can use salt substitutes freely."
D. "I should limit my sodium intake to 3,000 mg per day."
💫RATIONALE✔️✔️: Avoiding adding salt to food at the table is an important part of sodium
restriction. Canned soups are high in sodium and should be avoided. Salt substitutes contain potassium
and should be used cautiously. The recommended sodium intake for heart failure is typically 1,500-
2,000 mg per day.
💫ANSWER✔️✔️: B. "I should avoid adding salt to my food at the table."
---
,**Question 3**
The nurse is caring for a client with a new tracheostomy. Which equipment should the nurse ensure is
always at the bedside?
A. An Ambu bag with a mask and the same size tracheostomy tube with obturator
B. A pulse oximeter and a nasal cannula
C. A suction catheter and a bag of normal saline
D. A sterile field and an extra inner cannula
💫RATIONALE✔️✔️: In case of accidental decannulation or obstruction, the nurse must be able to
immediately re-establish the airway. The essential equipment includes an Ambu bag (for ventilation)
and a spare tracheostomy tube of the same size with the obturator. This is a critical patient safety
measure.
💫ANSWER✔️✔️: A. An Ambu bag with a mask and the same size tracheostomy tube with obturator
---
**Question 4**
The nurse is assessing a client who has been diagnosed with borderline personality disorder. Which
behavior is most characteristic of this condition?
A. Grandiose sense of self-importance
B. Intense fear of abandonment
, C. Lack of remorse for harming others
D. Preoccupation with orderliness and perfectionism
💫RATIONALE✔️✔️: Borderline personality disorder is characterized by intense fear of abandonment,
unstable relationships, impulsivity, and emotional dysregulation. Grandiosity is more characteristic of
narcissistic personality disorder, lack of remorse of antisocial personality disorder, and perfectionism of
obsessive-compulsive personality disorder.
💫ANSWER✔️✔️: B. Intense fear of abandonment
---
**Question 5**
The nurse is providing education to a client who is prescribed lithium carbonate for bipolar disorder.
Which instruction is most important?
A. "Take this medication with a high-sodium diet."
B. "Maintain a consistent sodium and fluid intake."
C. "You can stop taking this medication if you feel better."
D. "This medication will work within 24 hours."
💫RATIONALE✔️✔️: Lithium levels can be affected by sodium and fluid intake. Maintaining a
consistent intake helps prevent toxicity or subtherapeutic levels. A low-sodium diet can increase lithium
levels, while excessive fluid intake can decrease them. The client should be taught to report signs of
toxicity.
💫ANSWER✔️✔️: B. "Maintain a consistent sodium and fluid intake."
Comprehensive Clinical
Judgment & Professional
Practice Examination
2026/2027
**Question 1**
The nurse is assessing a client with a diagnosis of diabetic ketoacidosis (DKA). Which laboratory finding is
most consistent with this condition?
A. Serum glucose of 150 mg/dL
B. Serum bicarbonate of 10 mEq/L
C. Serum potassium of 5.5 mEq/L
D. Arterial pH of 7.45
,💫RATIONALE✔️✔️: DKA is characterized by hyperglycemia, metabolic acidosis, and ketosis. A serum
bicarbonate of 10 mEq/L indicates severe metabolic acidosis (normal is 22-26 mEq/L). Serum glucose is
typically >250 mg/dL, and pH is <7.30. Potassium may be elevated initially due to acidosis but is not the
defining feature.
💫ANSWER✔️✔️: B. Serum bicarbonate of 10 mEq/L
---
**Question 2**
The nurse is providing education to a client with a new diagnosis of heart failure. Which statement
indicates the client understands the importance of sodium restriction?
A. "I can eat canned soups as long as I drink extra water."
B. "I should avoid adding salt to my food at the table."
C. "I can use salt substitutes freely."
D. "I should limit my sodium intake to 3,000 mg per day."
💫RATIONALE✔️✔️: Avoiding adding salt to food at the table is an important part of sodium
restriction. Canned soups are high in sodium and should be avoided. Salt substitutes contain potassium
and should be used cautiously. The recommended sodium intake for heart failure is typically 1,500-
2,000 mg per day.
💫ANSWER✔️✔️: B. "I should avoid adding salt to my food at the table."
---
,**Question 3**
The nurse is caring for a client with a new tracheostomy. Which equipment should the nurse ensure is
always at the bedside?
A. An Ambu bag with a mask and the same size tracheostomy tube with obturator
B. A pulse oximeter and a nasal cannula
C. A suction catheter and a bag of normal saline
D. A sterile field and an extra inner cannula
💫RATIONALE✔️✔️: In case of accidental decannulation or obstruction, the nurse must be able to
immediately re-establish the airway. The essential equipment includes an Ambu bag (for ventilation)
and a spare tracheostomy tube of the same size with the obturator. This is a critical patient safety
measure.
💫ANSWER✔️✔️: A. An Ambu bag with a mask and the same size tracheostomy tube with obturator
---
**Question 4**
The nurse is assessing a client who has been diagnosed with borderline personality disorder. Which
behavior is most characteristic of this condition?
A. Grandiose sense of self-importance
B. Intense fear of abandonment
, C. Lack of remorse for harming others
D. Preoccupation with orderliness and perfectionism
💫RATIONALE✔️✔️: Borderline personality disorder is characterized by intense fear of abandonment,
unstable relationships, impulsivity, and emotional dysregulation. Grandiosity is more characteristic of
narcissistic personality disorder, lack of remorse of antisocial personality disorder, and perfectionism of
obsessive-compulsive personality disorder.
💫ANSWER✔️✔️: B. Intense fear of abandonment
---
**Question 5**
The nurse is providing education to a client who is prescribed lithium carbonate for bipolar disorder.
Which instruction is most important?
A. "Take this medication with a high-sodium diet."
B. "Maintain a consistent sodium and fluid intake."
C. "You can stop taking this medication if you feel better."
D. "This medication will work within 24 hours."
💫RATIONALE✔️✔️: Lithium levels can be affected by sodium and fluid intake. Maintaining a
consistent intake helps prevent toxicity or subtherapeutic levels. A low-sodium diet can increase lithium
levels, while excessive fluid intake can decrease them. The client should be taught to report signs of
toxicity.
💫ANSWER✔️✔️: B. "Maintain a consistent sodium and fluid intake."
