COMPREHENSIVE NURSING LICENSURE &
CLINICAL COMPETENCY EXAMINATION
Pediatric Nursing, Medical-Surgical, Pharmacology, and Advanced
Clinical Judgement
Featuring 200 Questions with Detailed Rationales
SECTION 1: Pediatric Nursing & Advanced Clinical Scenarios
(Questions 1 - 30)
Question 1: A nurse is admitting an infant who has intussusception.
Which of the following clinical manifestations should the nurse
expect to find in the client's medical history?
A. Projectile vomiting occurring immediately after feeding
B. Watery, green diarrhea containing foul-smelling bacteria
C. Mucus-containing stools mixed with blood and resembling
currant jelly
D. Painless, bright red rectal bleeding during bowel movements
Rationale: Correct Answer: (C). Intussusception occurs when a
segment of the bowel telescopes into an overlying segment,
typically the ileum into the cecum. This leads to lymphatic and
venous obstruction, edema, ischemia, and shedding of mucosa into
the bowel lumen, resulting in classic currant-jelly stools (mucus and
blood). Option A describes pyloric stenosis. Option B is
characteristic of infectious gastroenteritis. Option D is more
common in conditions like Meckel's diverticulum or juvenile
polyps.
,Question 2: [Pediatric Nursing] (Variant 2) A toddler with acute
laryngotracheobronchitis (croup) is admitted. Which finding
requires immediate intervention?
A. Barking cough and low-grade fever
B. Inspiratory stridor when quiet and nasal flaring
C. Hoarseness when crying
D. Mild tachypnea during play
Rationale: Correct Answer: (B). Inspiratory stridor at rest, nasal
flaring, suprasternal retractions, and restlessness indicate impending
airway obstruction.
Question 3: [Pediatric Nursing] (Variant 3) An infant with
ventricular septal defect (VSD) is prescribed digoxin. Which finding
indicates toxicity?
A. Heart rate of 135/min
B. Vomiting and refusal to nurse
C. Increased wet diapers
D. Hypoactive bowel sounds
Rationale: Correct Answer: (B). Gastrointestinal disturbances such
as anorexia, nausea, and vomiting are classic early signs of digitalis
toxicity in infants.
Question 4: [Pediatric Nursing] (Variant 4) A nurse is teaching
parents of a child with cystic fibrosis about pancreatic enzyme
administration. When should enzymes be given?
A. 1 hour before meals
, B. With all meals and snacks
C. Only with high-fat meals
D. At bedtime daily
Rationale: Correct Answer: (B). Pancreatic enzymes must be
administered with all meals and snacks to ensure proper digestion
and absorption of fats, proteins, and carbohydrates.
Question 5: [Pediatric Nursing] (Variant 5) An adolescent with
acute glomerulonephritis is admitted. Which lab finding is
expected?
A. Decreased serum creatinine
B. Elevated anti-streptolysin O (ASO) titer
C. Metabolic alkalosis
D. Thrombocytopenia
Rationale: Correct Answer: (B). Acute post-streptococcal
glomerulonephritis typically follows a recent strep infection,
reflected by an elevated ASO titer.
Question 6: [Pediatric Nursing] (Variant 6) A nurse assesses a
newborn with suspected Hirschsprung disease. Which finding
supports this?
A. Passing meconium within 12 hours
B. Failure to pass meconium within 48 hours and abdominal
distention
C. Projecting watery diarrhea
, D. Palpable olive-shaped mass in RUQ
Rationale: Correct Answer: (B). Hirschsprung disease involves
absence of ganglion cells in the distal colon, leading to failure to
pass meconium, ribbon-like stools, and marked abdominal
distention.
Question 7: [Medical-Surgical & Critical Care] (Variant 7) A client
with diabetic ketoacidosis (DKA) is receiving regular insulin IV.
Serum potassium is 3.2 mEq/L. What is the priority nursing action?
A. Increase the insulin infusion rate
B. Administer sodium bicarbonate immediately
C. Hold insulin and administer potassium replacement as
prescribed
D. Begin 5% dextrose in water without potassium
Rationale: Correct Answer: (C). Insulin drives potassium into cells,
worsening hypokalemia. If potassium is below 3.5 mEq/L, insulin
must be held until potassium is corrected to prevent lethal
arrhythmias.
Question 8: [Medical-Surgical & Critical Care] (Variant 8) A client
is admitted with acute pancreatitis. Which serum lab value is most
diagnostic?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
C. Elevated blood urea nitrogen
D. Decreased white blood cell count
CLINICAL COMPETENCY EXAMINATION
Pediatric Nursing, Medical-Surgical, Pharmacology, and Advanced
Clinical Judgement
Featuring 200 Questions with Detailed Rationales
SECTION 1: Pediatric Nursing & Advanced Clinical Scenarios
(Questions 1 - 30)
Question 1: A nurse is admitting an infant who has intussusception.
Which of the following clinical manifestations should the nurse
expect to find in the client's medical history?
A. Projectile vomiting occurring immediately after feeding
B. Watery, green diarrhea containing foul-smelling bacteria
C. Mucus-containing stools mixed with blood and resembling
currant jelly
D. Painless, bright red rectal bleeding during bowel movements
Rationale: Correct Answer: (C). Intussusception occurs when a
segment of the bowel telescopes into an overlying segment,
typically the ileum into the cecum. This leads to lymphatic and
venous obstruction, edema, ischemia, and shedding of mucosa into
the bowel lumen, resulting in classic currant-jelly stools (mucus and
blood). Option A describes pyloric stenosis. Option B is
characteristic of infectious gastroenteritis. Option D is more
common in conditions like Meckel's diverticulum or juvenile
polyps.
,Question 2: [Pediatric Nursing] (Variant 2) A toddler with acute
laryngotracheobronchitis (croup) is admitted. Which finding
requires immediate intervention?
A. Barking cough and low-grade fever
B. Inspiratory stridor when quiet and nasal flaring
C. Hoarseness when crying
D. Mild tachypnea during play
Rationale: Correct Answer: (B). Inspiratory stridor at rest, nasal
flaring, suprasternal retractions, and restlessness indicate impending
airway obstruction.
Question 3: [Pediatric Nursing] (Variant 3) An infant with
ventricular septal defect (VSD) is prescribed digoxin. Which finding
indicates toxicity?
A. Heart rate of 135/min
B. Vomiting and refusal to nurse
C. Increased wet diapers
D. Hypoactive bowel sounds
Rationale: Correct Answer: (B). Gastrointestinal disturbances such
as anorexia, nausea, and vomiting are classic early signs of digitalis
toxicity in infants.
Question 4: [Pediatric Nursing] (Variant 4) A nurse is teaching
parents of a child with cystic fibrosis about pancreatic enzyme
administration. When should enzymes be given?
A. 1 hour before meals
, B. With all meals and snacks
C. Only with high-fat meals
D. At bedtime daily
Rationale: Correct Answer: (B). Pancreatic enzymes must be
administered with all meals and snacks to ensure proper digestion
and absorption of fats, proteins, and carbohydrates.
Question 5: [Pediatric Nursing] (Variant 5) An adolescent with
acute glomerulonephritis is admitted. Which lab finding is
expected?
A. Decreased serum creatinine
B. Elevated anti-streptolysin O (ASO) titer
C. Metabolic alkalosis
D. Thrombocytopenia
Rationale: Correct Answer: (B). Acute post-streptococcal
glomerulonephritis typically follows a recent strep infection,
reflected by an elevated ASO titer.
Question 6: [Pediatric Nursing] (Variant 6) A nurse assesses a
newborn with suspected Hirschsprung disease. Which finding
supports this?
A. Passing meconium within 12 hours
B. Failure to pass meconium within 48 hours and abdominal
distention
C. Projecting watery diarrhea
, D. Palpable olive-shaped mass in RUQ
Rationale: Correct Answer: (B). Hirschsprung disease involves
absence of ganglion cells in the distal colon, leading to failure to
pass meconium, ribbon-like stools, and marked abdominal
distention.
Question 7: [Medical-Surgical & Critical Care] (Variant 7) A client
with diabetic ketoacidosis (DKA) is receiving regular insulin IV.
Serum potassium is 3.2 mEq/L. What is the priority nursing action?
A. Increase the insulin infusion rate
B. Administer sodium bicarbonate immediately
C. Hold insulin and administer potassium replacement as
prescribed
D. Begin 5% dextrose in water without potassium
Rationale: Correct Answer: (C). Insulin drives potassium into cells,
worsening hypokalemia. If potassium is below 3.5 mEq/L, insulin
must be held until potassium is corrected to prevent lethal
arrhythmias.
Question 8: [Medical-Surgical & Critical Care] (Variant 8) A client
is admitted with acute pancreatitis. Which serum lab value is most
diagnostic?
A. Elevated serum amylase and lipase
B. Decreased serum calcium
C. Elevated blood urea nitrogen
D. Decreased white blood cell count
