Licensure Examination Questions with
Answers Updated
1. A client on clozapine presents with fever, tachycardia, and muscle rigidity. Which
laboratory finding is most critical to confirm the suspected diagnosis?
A. Serum creatine kinase (CK) level
B. White blood cell count with differential
C. Serum lithium level
D. Thyroid stimulating hormone (TSH)
Answer: A. Serum creatine kinase (CK) level
Rationale: Neuroleptic Malignant Syndrome (NMS) is characterized by fever, autonomic
instability, and rigidity; elevated CK confirms muscle breakdown. While clozapine requires
WBC monitoring for agranulocytosis, the acute presentation suggests NMS, making CK the
priority.
2. Which statement by a client prescribed lithium carbonate indicates a need for
immediate intervention?
A. "I take my lithium with a full glass of water."
B. "I follow a low-sodium diet to control my blood pressure."
C. "I have been sweating a lot during my daily runs."
D. "I take my lithium at the same time every night."
Answer: B. "I follow a low-sodium diet to control my blood pressure."
Rationale: Low sodium intake can lead to lithium toxicity as the kidneys reabsorb lithium
in place of sodium. Increased sweating and dehydration also increase risk, but the
low-sodium diet is a direct contraindication to safe lithium therapy.
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,3. A client with borderline personality disorder uses splitting behavior. Which nursing
intervention is most appropriate?
A. Allow the client to choose which staff member provides care.
B. Confront the client about manipulative behavior in front of peers.
C. Maintain consistent communication among all staff members.
D. Assign the client to a single primary nurse for all shifts.
Answer: C. Maintain consistent communication among all staff members.
Rationale: Splitting is managed by consistent staff communication and a unified treatment
approach. Confrontation or allowing manipulation exacerbates the behavior; a single
nurse may become the target of idealization or devaluation.
4. During a mental status exam, a client exhibits pressured speech, flight of ideas, and
psychomotor agitation. Which priority nursing diagnosis should be addressed first?
A. Risk for other-directed violence
B. Impaired social interaction
C. Disturbed thought processes
D. Ineffective coping
Answer: A. Risk for other-directed violence
Rationale: Manic symptoms with agitation increase the risk for aggression; safety is the
priority. While thought processes and social interaction are impaired, the immediate risk of
violence requires first-line intervention.
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,5. A client is prescribed haloperidol decanoate. Which statement by the client indicates
correct understanding of the medication?
A. "I will take this pill every day with breakfast."
B. "I need to come in for an injection every 2 to 4 weeks."
C. "I can stop the medication once my symptoms improve."
D. "I should avoid sunlight while taking this drug."
Answer: B. "I need to come in for an injection every 2 to 4 weeks."
Rationale: Haloperidol decanoate is a long-acting injectable antipsychotic administered
every 2-4 weeks. It is not an oral medication, and abrupt discontinuation can lead to
relapse; photosensitivity is not a primary concern.
6. Which intervention is most appropriate for a client experiencing a panic attack?
A. Encourage the client to describe the trigger in detail.
B. Stay with the client and use short, simple sentences.
C. Administer a PRN benzodiazepine immediately.
D. Move the client to a quiet room alone to de-escalate.
Answer: B. Stay with the client and use short, simple sentences.
Rationale: During a panic attack, the client's ability to process information is limited; a
calm, present nurse using simple language helps reduce anxiety. Leaving the client alone
or demanding detailed discussion can worsen the panic.
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, 7. A client with anorexia nervosa is admitted with a BMI of 15. Which refeeding
syndrome complication should the nurse monitor for?
A. Hypernatremia
B. Hypophosphatemia
C. Hypercalcemia
D. Metabolic alkalosis
Answer: B. Hypophosphatemia
Rationale: Refeeding syndrome is characterized by hypophosphatemia, hypokalemia, and
hypomagnesemia due to insulin surge. Hypernatremia, hypercalcemia, and alkalosis are
not typical; monitoring electrolytes is critical.
8. Which legal principle requires that a client be informed of the risks and benefits
before a procedure?
A. Beneficence
B. Autonomy
C. Informed consent
D. Nonmaleficence
Answer: C. Informed consent
Rationale: Informed consent is the legal doctrine that ensures clients understand and
voluntarily agree to treatment. Autonomy is the ethical principle underlying consent, but
the legal requirement is informed consent.
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