NCLEX-PN Exam — Questions and Answers

Question 1: Which scenario represents unsafe delegation by an LPN?

Asking the UAP to assist a patient to the bathroom
Asking the UAP to weigh a patient before breakfast
Asking the UAP to administer a PRN pain medication (Correct answer)
Asking the UAP to take routine vital signs on a stable patient

Correct answer: Asking the UAP to administer a PRN pain medication

Medication administration is outside the UAP's scope of practice and is never a delegable task.

Question 2: A patient prescribed lithium for bipolar disorder should be taught to maintain adequate intake of which substance to prevent toxicity?

Potassium
Magnesium
Sodium (Correct answer)
Calcium

Correct answer: Sodium

Sodium depletion causes the kidneys to reabsorb lithium instead of sodium, leading to lithium toxicity; adequate sodium intake is essential.

Question 3: What is the purpose of collecting a clean-catch midstream urine specimen?

To obtain an uncontaminated sample for culture and sensitivity testing (Correct answer)
To measure the total volume of urine produced in 24 hours
To test urine for glucose and ketones only
To assess kidney function via creatinine clearance

Correct answer: To obtain an uncontaminated sample for culture and sensitivity testing

A clean-catch midstream urine specimen minimizes contamination from perineal flora, providing an accurate sample for urinalysis and urine culture and sensitivity testing.

Question 4: The LPN wants to delegate repositioning a patient with severe osteoporosis to a UAP. What is essential before doing so?

Providing specific repositioning instructions and precautions for that patient (Correct answer)
Confirming the patient has no fall risk according to the chart
Ensuring the patient's family is present during the repositioning
Obtaining a physician's order to allow UAP repositioning

Correct answer: Providing specific repositioning instructions and precautions for that patient

Patients with severe osteoporosis require individualized repositioning instructions to prevent fractures.

Question 5: A patient with Type 2 diabetes is counseled about carbohydrate counting. The LPN explains that one carbohydrate serving equals:

50 grams of carbohydrate
15 grams of carbohydrate (Correct answer)
30 grams of carbohydrate
5 grams of carbohydrate

Correct answer: 15 grams of carbohydrate

One carbohydrate serving is defined as 15 grams of carbohydrate in the exchange system used for diabetic meal planning.

Question 6: What is the minimum acceptable urine output per hour for an adult patient?

50 mL/hr
30 mL/hr (Correct answer)
20 mL/hr
10 mL/hr

Correct answer: 30 mL/hr

A urine output of at least 30 mL/hr (approximately 0.5 mL/kg/hr) is considered the minimum acceptable output, indicating adequate renal perfusion.

Question 7: Which non-pharmacological intervention is most appropriate for a patient experiencing mild musculoskeletal pain?

Administering IV morphine
Applying a warm compress to the affected area (Correct answer)
Increasing IV fluid rate
Placing the patient in Trendelenburg position

Correct answer: Applying a warm compress to the affected area

Warm compresses promote muscle relaxation and increase circulation, making them an appropriate non-pharmacological comfort measure for mild musculoskeletal pain.

Question 8: After the thyroid was removed, the patient is being treated by the nurse. Following surgery, the nurse should:

Maintain the client in a supine position with sandbags placed on either side of the head and neck
Encourage the client to turn her head side to side, to promote drainage of oral secretions
Encourage the client to cough and breathe deeply every 2 hours, with the neck in a flexed position
Maintain the client in a semi-Fowler’s position with the head and neck supported by pillows (Correct answer)

Correct answer: Maintain the client in a semi-Fowler’s position with the head and neck supported by pillows

After a thyroidectomy, maintaining a semi-Fowler's position with head and neck support is crucial. This position helps reduce swelling and tension on the incision site, promotes venous drainage, and facilitates respiratory effort. Supporting the head and neck with pillows prevents hyperextension or flexion, which could strain the surgical site and compromise airway patency.

Question 9: Which action should the LPN take FIRST before initiating a bolus tube feeding?

Check tube placement and residual volume (Correct answer)
Warm the formula to room temperature
Elevate the head of the bed to 30–45 degrees
Flush the tube with 60 mL of water

Correct answer: Check tube placement and residual volume

Verifying tube placement and checking residual volume are the priority safety checks before administering any tube feeding.

Question 10: A patient on NPH insulin asks why their glucose tends to drop around 2–4 AM. What is the best explanation?

Basal metabolic rate drops to zero during deep sleep
NPH peaks 6–12 hours after injection, coinciding with nighttime if given at dinner (Correct answer)
Nighttime exercise increases insulin sensitivity
Liver glycogen is depleted during sleep

Correct answer: NPH peaks 6–12 hours after injection, coinciding with nighttime if given at dinner

NPH peaks at 6–12 hours; an evening dose peaks in the early morning hours, which can cause nocturnal hypoglycemia.

Question 11: Which assessment finding is most indicative of pneumonia?

Hyperresonance on percussion
Decreased respiratory rate with deep breaths
Bronchial breath sounds over peripheral lung fields (Correct answer)
Decreased tactile fremitus

Correct answer: Bronchial breath sounds over peripheral lung fields

Bronchial breath sounds heard over peripheral lung fields (where vesicular sounds are normal) indicate consolidation of lung tissue, a hallmark of pneumonia.

Question 12: A patient with a history of alcoholism is admitted for detoxification. Which early sign of alcohol withdrawal should the LPN monitor for most closely?

Tremors, diaphoresis, and anxiety (Correct answer)
Hypothermia and bradypnea
Hypotension and bradycardia
Miosis and decreased reflexes

Correct answer: Tremors, diaphoresis, and anxiety

Early alcohol withdrawal (6–24 hours after last drink) presents with tremors, diaphoresis, anxiety, and autonomic hyperactivity, which can escalate to seizures and delirium tremens.

Question 13: A nurse is reinforcing teaching on the manifestation of complications to a client who has acute glomerulonephritis. Which of the following complications should the client report to the provider?

Temperature of 36.8C (98.4 F)
Weight gain of 2lb in 1 week
Dry cough
Pitting edema (Correct answer)

Correct answer: Pitting edema

Acute glomerulonephritis often leads to fluid retention due to impaired kidney function, resulting in edema. Pitting edema is a significant manifestation of fluid overload and indicates worsening renal function. This finding should be reported to the provider promptly as it can signal potential complications like hypertension or heart failure.

Question 14: Which principle should the LPN follow when performing oropharyngeal suctioning?

Insert the catheter with suction already applied
Suction every 30 minutes on a fixed schedule regardless of need
Apply suction continuously during catheter insertion
Limit each suctioning pass to no longer than 10-15 seconds (Correct answer)

Correct answer: Limit each suctioning pass to no longer than 10-15 seconds

Limiting each suction pass to 10-15 seconds prevents hypoxia and tracheal mucosal trauma; suction is only applied while withdrawing the catheter.

Question 15: What is the correct positioning for a female patient during urinary catheterization?

Dorsal recumbent position with knees bent and thighs separated (Correct answer)
Left lateral (Sims') position with knees flexed
Sitting upright with legs hanging over the bed
Prone position with a pillow under the hips

Correct answer: Dorsal recumbent position with knees bent and thighs separated

The dorsal recumbent position with knees bent and thighs separated provides optimal visualization and access to the urinary meatus for female catheterization.

Question 16: To create__________________ for the organism, glucose is essential for cellular respirations. <br> <br> Answer: Energy

TRUE (Correct answer)
FALSE

Correct answer: TRUE

Cellular respiration is the metabolic process by which cells convert glucose (and other nutrients) into adenosine triphosphate (ATP), which is the primary energy currency of the cell. Glucose is broken down through a series of reactions to produce ATP, providing the energy needed for various cellular functions and life processes.

Question 17: Which pain assessment scale is most appropriate for a non-verbal adult patient who cannot self-report?

Numeric Rating Scale (NRS)
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Visual Analog Scale (VAS)
Wong-Baker FACES Scale

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale assesses pain in non-verbal adults by observing behavioral indicators such as breathing, vocalization, and body language.

Question 18: Which action is a fundamental component of Standard Precautions that should be applied to all patients?

Wearing an N95 respirator for all patient contact
Performing hand hygiene before and after patient contact (Correct answer)
Wearing a gown and gloves for all patient care
Placing all patients in private rooms

Correct answer: Performing hand hygiene before and after patient contact

Standard Precautions are based on the principle that all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents. Hand hygiene is the single most important practice to reduce the transmission of infections in healthcare settings.

Question 19: A patient's wound shows bright red, moist, granular tissue filling the wound bed. This indicates:

Healthy granulation tissue (Correct answer)
Wound dehiscence
Infected wound tissue
Necrotic tissue requiring debridement

Correct answer: Healthy granulation tissue

Bright red, moist, beefy-appearing granular tissue is healthy granulation tissue, indicating the wound is progressing toward healing.

Question 20: A patient with pulmonary edema receives IV furosemide (Lasix). Which finding best confirms the medication is effective?

Increased blood pressure
Elevated body temperature
Decreased urine output
Improved SpO2 and decreased crackles on auscultation (Correct answer)

Correct answer: Improved SpO2 and decreased crackles on auscultation

Furosemide reduces excess pulmonary fluid through diuresis; effectiveness is confirmed by improved SpO2 and decreased crackles as fluid clears from the alveoli.

Question 21: Which positioning is most appropriate for a patient following a below-knee amputation to prevent contractures?

Keep the residual limb in a dependent position
Place the patient in Trendelenburg position
Elevate the residual limb on pillows at all times
Position the patient prone for 20–30 minutes several times daily (Correct answer)

Correct answer: Position the patient prone for 20–30 minutes several times daily

Prone positioning helps prevent hip flexion contractures that commonly develop after lower-limb amputation.

Question 22: Which electrolyte imbalance is most likely in a patient who has been vomiting for 3 days?

Hypernatremia and respiratory acidosis
Hypokalemia and metabolic alkalosis (Correct answer)
Hyperkalemia and metabolic acidosis
Hyponatremia and respiratory alkalosis

Correct answer: Hypokalemia and metabolic alkalosis

Prolonged vomiting causes loss of hydrochloric acid and potassium, resulting in hypokalemia and metabolic alkalosis.

Question 23: A CKD patient is being informed by a nurse about two therapy alternatives. What benefit of peritoneal dialysis (PD) over hemodialysis is the following?

The procedure for PD does not require a machine. (Correct answer)
The patient needs to allot a schedule for PD since it is done daily.
There is stricter monitoring by healthcare professional when using PD.
A catheter will be surgically attached to your abdominal region.

Correct answer: The procedure for PD does not require a machine.

A key benefit of peritoneal dialysis (PD) over hemodialysis is that it typically does not require a large, external blood filtration machine. While some forms of PD use an automated cycler, the core process utilizes the patient's own peritoneal membrane as a natural filter. This allows for greater flexibility, often enabling patients to perform treatments at home and offering more independence compared to the clinic-based, machine-dependent nature of hemodialysis.

Question 24: A patient with diabetes mellitus has a fingerstick blood glucose reading of 58 mg/dL and is reporting feeling shaky and dizzy. What is the LPN's first nursing action?

Recheck the blood glucose in one hour
Notify the healthcare provider immediately
Administer the patient's scheduled dose of insulin
Provide the patient with 4 ounces of orange juice (Correct answer)

Correct answer: Provide the patient with 4 ounces of orange juice

A blood glucose level below 70 mg/dL with symptoms indicates hypoglycemia, which requires immediate intervention to prevent further decline. The first action is to provide a fast-acting carbohydrate, such as 15 grams of glucose (e.g., 4 oz of juice or regular soda), to quickly raise the blood sugar level.

Question 25: The LPN notes the enteral feeding formula container has been hanging for 10 hours. What should the LPN do?

Refrigerate the remaining formula and resume later
Add more formula to the partially full container
Continue the infusion since it has not expired yet
Discard the formula and replace with a fresh container per policy (Correct answer)

Correct answer: Discard the formula and replace with a fresh container per policy

Open enteral formula containers should not hang for more than 4–8 hours (per manufacturer and facility policy) due to risk of bacterial contamination.

Question 26: A patient's arterial blood gas shows pH 7.30, PaCO2 28 mmHg, HCO3 13 mEq/L. How should the LPN interpret this?

Respiratory alkalosis with metabolic compensation
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis with respiratory compensation (Correct answer)

Correct answer: Metabolic acidosis with respiratory compensation

Low pH with low HCO3 indicates metabolic acidosis; the low PaCO2 reflects respiratory compensation (hyperventilation).

Question 27: The LPN is preparing to administer a liquid medication through a nasogastric tube. Which action should be performed first?

Warm the medication to body temperature
Verify tube placement before administration (Correct answer)
Clamp the tube for 30 minutes after administration
Flush the tube with 30 mL of water

Correct answer: Verify tube placement before administration

Verifying correct NG tube placement is always the priority before introducing any substance to prevent aspiration.

Question 28: What is 'cohorting' in the context of transmission-based precautions?

Assigning one nurse to care for all infectious patients
Grouping patients infected with the same organism together in a shared room (Correct answer)
Isolating one infected patient in a private room
Designating a hallway for infectious patients only

Correct answer: Grouping patients infected with the same organism together in a shared room

Cohorting involves placing patients infected or colonized with the same pathogen together in a shared room when private rooms are not available, to limit transmission to other patients.

Question 29: The LPN is caring for a patient with a new PEG tube. What is the earliest the skin around the PEG site should be cleaned?

24 hours after insertion using soap and water as ordered (Correct answer)
One week after insertion to allow healing
Only when visible soiling is present
Immediately after insertion

Correct answer: 24 hours after insertion using soap and water as ordered

PEG site care typically begins 24 hours post-insertion using soap and water to prevent infection while allowing initial healing.

Question 30: An LPN is caring for a patient with a nasogastric tube for enteral feeding. Before administering the feeding, the nurse should first:

Elevate the head of the bed to 90 degrees
Flush the tube with 30 mL of water
Warm the formula to body temperature
Verify tube placement by checking gastric aspirate pH (Correct answer)

Correct answer: Verify tube placement by checking gastric aspirate pH

Checking gastric aspirate pH (less than 5) confirms NG tube placement in the stomach before feeding.

Question 31: Which of the following is an example of semi-critical equipment that requires high-level disinfection?

Reusable rectal thermometer (Correct answer)
Surgical scalpel
Blood pressure cuff
Examination table

Correct answer: Reusable rectal thermometer

Semi-critical items that contact mucous membranes (like rectal thermometers) require high-level disinfection to eliminate all microorganisms except high numbers of bacterial spores.

Question 32: New colon opening created

Colostomy (Correct answer)
Appendectomy
Colonoscopy
Laparotomy

Correct answer: Colostomy

A colostomy is a surgical procedure that creates a new opening, called a stoma, in the abdominal wall, bringing a section of the colon to the outside. This opening allows for the passage of stool into an external collection pouch, bypassing the rectum. It is performed for various medical reasons, such as bowel obstruction, cancer, or inflammatory bowel disease.

Question 33: What condition slows down metabolic rate?

Cardiac failure
Hypothyroidism (Correct answer)
Cancer
Chronic obstructive pulmonary disease

Correct answer: Hypothyroidism

Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones. These hormones are essential for regulating the body's metabolism. A deficiency in thyroid hormones leads to a slowed metabolic rate, causing symptoms such as fatigue, weight gain, cold intolerance, and decreased energy levels.

Question 34: A patient receiving IV potassium chloride (KCl) complains of burning at the IV site. What is the nurse's priority action?

Increase the IV flow rate to dilute the potassium
Slow the infusion rate and apply a warm compress (Correct answer)
Discontinue the IV and notify the provider
Reassure the patient that this is a normal sensation

Correct answer: Slow the infusion rate and apply a warm compress

IV potassium frequently causes burning due to its irritant nature; slowing the infusion and applying warmth can reduce discomfort without stopping therapy.

Question 35: An LPN is caring for a patient in Buck's traction. Which action is most important to prevent complications?

Keep the foot of the bed elevated
Encourage the patient to perform sit-ups in bed
Assess neurovascular status of the affected limb every 4 hours (Correct answer)
Remove the traction boot every shift for skin assessment

Correct answer: Assess neurovascular status of the affected limb every 4 hours

Regular neurovascular checks detect early signs of compromised circulation or nerve damage in patients in traction.

Question 36: A patient reports pain rated 8/10 on the numeric scale. What is the LPN's priority action?

Notify the charge nurse or supervising RN
Reposition the patient for comfort
Administer a PRN analgesic if ordered (Correct answer)
Document the pain rating in the chart

Correct answer: Administer a PRN analgesic if ordered

When a PRN analgesic is ordered, administering it is the priority intervention for a pain rating of 8/10 before escalating further.

Question 37: A patient is receiving a blood transfusion and develops fever, chills, and lower back pain 15 minutes into the infusion. The LPN should FIRST:

Increase the flow rate to complete the transfusion quickly
Stop the transfusion and maintain IV access with normal saline (Correct answer)
Notify the blood bank to send a replacement unit
Slow the transfusion rate and administer acetaminophen

Correct answer: Stop the transfusion and maintain IV access with normal saline

Signs of a hemolytic transfusion reaction require immediately stopping the transfusion and maintaining IV access with NS while notifying the RN.

Question 38: When caring for a patient with a chest tube connected to water-seal drainage, the LPN notes continuous bubbling in the water-seal chamber. What does this most likely indicate?

The suction is set too high
The tube needs to be clamped immediately
Normal functioning of the drainage system
An air leak in the system or lung (Correct answer)

Correct answer: An air leak in the system or lung

Continuous bubbling in the water-seal chamber indicates an air leak, either from the patient's lung or a break in the system.

Question 39: The unusual circumstance with blue extremities.

Acrocyanosis (Correct answer)
Dermatosis
Tachypnea
Hematemesis

Correct answer: Acrocyanosis

Acrocyanosis is the specific medical term used to describe a persistent, painless, and symmetrical bluish discoloration of the extremities, particularly the hands and feet. This condition results from vasospasm of small blood vessels, leading to reduced blood flow and oxygenation in the affected areas. While often benign, especially in newborns, it signifies the unusual circumstance of blue extremities.

Question 40: A patient's BUN is 35 mg/dL and creatinine is 3.2 mg/dL. These values together suggest which condition?

Normal findings in an elderly patient
Impaired renal function (Correct answer)
Liver failure
Dehydration alone

Correct answer: Impaired renal function

Both elevated BUN and creatinine together indicate impaired glomerular filtration and reduced renal function.

Question 41: What is the most critical factor for an LPN to consider before delegating any task to a UAP?

Whether the task is interesting for the UAP
The UAP's willingness to perform the task
The stability of the patient's condition (Correct answer)
The time of day and staffing levels

Correct answer: The stability of the patient's condition

The patient's stability is the most important consideration. Even routine tasks can become inappropriate to delegate if the patient is unstable, as their condition may change rapidly, requiring the skill and judgment of a licensed nurse.

Question 42: Which electrolyte imbalance most increases a patient's risk for digoxin toxicity?

Hypercalcemia
Hypernatremia
Hypermagnesemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Hypokalemia potentiates digoxin toxicity because low potassium increases myocardial sensitivity to the drug.

Question 43: A patient on opioid analgesics must be monitored closely for which life-threatening complication?

Tachycardia
Hypertension
Respiratory depression (Correct answer)
Hyperglycemia

Correct answer: Respiratory depression

Opioids suppress the central nervous system and can cause respiratory depression, which is the most dangerous and potentially fatal side effect.

Question 44: Which injection site allows the fastest absorption of subcutaneous insulin?

Outer thigh
Buttocks
Upper arm
Abdomen (Correct answer)

Correct answer: Abdomen

The abdomen provides the fastest and most consistent insulin absorption due to its rich subcutaneous blood supply.

Question 45: A patient is prescribed lisinopril for hypertension and develops a persistent dry cough. What is the nurse's best response?

Document the finding and report it to the provider (Correct answer)
Reassure the patient that the cough will resolve after one week
Teach the patient to use cough drops to manage the symptom
Administer a PRN antihistamine to suppress the cough

Correct answer: Document the finding and report it to the provider

A persistent dry cough is a common side effect of ACE inhibitors like lisinopril and should be reported so an alternative medication class can be considered.

Question 46: A patient receiving IV vancomycin develops flushing, erythema, and hypotension during infusion. What is the most likely cause?

Vancomycin-resistant infection
Phlebitis at the IV site
Red Man Syndrome from rapid infusion (Correct answer)
Anaphylactic reaction

Correct answer: Red Man Syndrome from rapid infusion

Red Man Syndrome is a non-immune infusion reaction caused by too-rapid vancomycin administration, causing histamine release.

Question 47: Which of the following best describes how doctors listen for bowel sounds?

Palpation
Rectal examination
Auscultation (Correct answer)
Percussion

Correct answer: Auscultation

Auscultation is the medical term for listening to the internal sounds of the body, typically using a stethoscope. This technique is specifically employed by healthcare professionals to assess bowel sounds, as well as heart sounds, lung sounds, and blood flow. Percussion involves tapping, palpation involves touching, and a rectal examination is a different type of physical assessment.

Question 48: A stage 4 pressure injury exposes bone and tendon. Which dressing characteristic is MOST important for this wound?

Maintaining a moist wound environment (Correct answer)
Applying silver-containing dressings regardless of infection signs
Providing complete occlusion to prevent any gas exchange
Using a dry dressing to absorb maximum exudate

Correct answer: Maintaining a moist wound environment

Maintaining a moist wound environment is essential for promoting granulation and epithelialization in deep wounds like stage 4 injuries.

Question 49: A nurse is reinforcing teaching regarding colon cancer to a group of women ranging from 45 to 65 years of age. Which of the following is an appropriate statement by the nurse?

A sigmoidoscopy is recommended every 5 years beginning at age 60
Colonoscopies for individuals with no family history of cancer should begin at age 40
Fecal occult blood tests should be done annually beginning at age 50 (Correct answer)
An endoscopy provides a definitive diagnosis of colon cancer

Correct answer: Fecal occult blood tests should be done annually beginning at age 50

Current guidelines recommend annual fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT) starting at age 50 for individuals at average risk for colon cancer. These tests help detect hidden blood in the stool, which can be an early sign of colorectal cancer or polyps. Regular screening is vital for early detection and improving treatment outcomes.

Question 50: A diabetic patient's Somogyi effect is suspected. Which assessment finding supports this?

Elevated fasting glucose after documented nocturnal hypoglycemia (Correct answer)
Steadily rising blood glucose throughout the entire day
Normal fasting glucose with postprandial spikes only
Low fasting glucose that remains low all morning

Correct answer: Elevated fasting glucose after documented nocturnal hypoglycemia

The Somogyi effect (rebound hyperglycemia) occurs when nocturnal hypoglycemia triggers counter-regulatory hormone release, causing a high morning glucose.

Question 51: An LPN is administering heparin subcutaneously. Which action is correct technique?

Inject into the abdomen 2 inches from the umbilicus (Correct answer)
Aspirate before injecting to check for blood return
Massage the injection site after administration
Use a 1-inch needle for subcutaneous injection

Correct answer: Inject into the abdomen 2 inches from the umbilicus

Heparin should be injected into the abdomen at least 2 inches from the umbilicus to reduce bruising and ensure proper absorption.

Question 52: Which breath sound indicates the presence of fluid in the alveoli or small airways?

Wheezing
Rhonchi
Stridor
Crackles (rales) (Correct answer)

Correct answer: Crackles (rales)

Crackles (rales) are caused by air moving through fluid-filled or collapsed alveoli and small airways, indicating conditions such as pulmonary edema or pneumonia.

Question 53: A patient's serum lithium level is 2.2 mEq/L. What is the priority nursing action?

Encourage the patient to drink less fluid
Hold lithium, notify the provider, and monitor for toxicity signs (Correct answer)
Administer the next scheduled dose to maintain therapeutic levels
Document and continue to monitor every 8 hours

Correct answer: Hold lithium, notify the provider, and monitor for toxicity signs

Lithium toxicity occurs above 1.5 mEq/L; a level of 2.2 mEq/L is severely toxic and requires immediate intervention to prevent seizures and cardiac dysrhythmias.

Question 54: Which statement reflects the correct relationship between the LPN and the UAP regarding delegation?

The UAP can refuse any task delegated by the LPN without consequence
The LPN directs the UAP's work but cannot discipline them
The LPN is responsible for tasks delegated and must supervise appropriately (Correct answer)
The UAP is independently responsible for all tasks once assigned

Correct answer: The LPN is responsible for tasks delegated and must supervise appropriately

The LPN holds supervisory responsibility for delegated tasks and must monitor their performance.

Question 55: After a tracheostomy tube change, what is the correct cuff pressure range to prevent aspiration while avoiding tracheal tissue ischemia?

20-25 mmHg (Correct answer)
10-15 mmHg
5-10 mmHg
35-40 mmHg

Correct answer: 20-25 mmHg

Tracheostomy cuff pressure should be maintained at 20-25 mmHg to create an adequate seal preventing aspiration while avoiding excessive pressure that causes tracheal mucosal ischemia.

Question 56: A nurse is figuring out how much liquid paracetamol to administer to a young patient. The amount of paracetamol in a bottle is 120 mg per 5mL. The youngster is 24 kg in weight. How many mL of paracetamol are required if the relevant dose for children is 15 mg per kg?

The nurse should give 15 mL of the liquid paracetamol. (Correct answer)
The nurse should give 20 mL of the liquid paracetamol.
The nurse should give 25 mL of the liquid paracetamol.
The nurse should give 10 mL of the liquid paracetamol.

Correct answer: The nurse should give 15 mL of the liquid paracetamol.

First, calculate the total required dose for the patient: 15 mg/kg * 24 kg = 360 mg. Next, determine the volume needed based on the concentration: (360 mg / 120 mg) * 5 mL = 3 * 5 mL = 15 mL. Therefore, the nurse should administer 15 mL of the liquid paracetamol to the patient.

Question 57: An LPN is caring for a client with chronic kidney disease (CKD) who is not on dialysis. The client's diet will most likely include a restriction of which nutrient?

Healthy fats
Vitamin C
Complex carbohydrates
Protein (Correct answer)

Correct answer: Protein

For clients with CKD who are not on dialysis, protein intake is often restricted. The kidneys are responsible for filtering the waste products of protein metabolism (like urea), and in CKD, this function is impaired. Restricting protein reduces the workload on the kidneys.

Question 58: A patient has a stage 3 pressure injury on the heel. What is the recommended approach for heel pressure injuries with stable eschar?

Cover with an alginate dressing and change every 8 hours
Debride the eschar immediately with wet-to-dry dressings
Apply enzymatic debriding agent daily
Leave stable, dry eschar on heel intact as a natural cover (Correct answer)

Correct answer: Leave stable, dry eschar on heel intact as a natural cover

Stable, dry eschar on the heel serves as a biological cover and should not be debrided unless signs of infection develop.

Question 59: A nurse is reinforcing teaching with a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following should be included in the teaching?

Increase protein in the diet (Correct answer)
Eat three moderate-sized meals a day
Eat a bedtime snack that contains a milk product
Drink at least one glass of water with each meal

Correct answer: Increase protein in the diet

For clients with dumping syndrome, increasing protein and fat in the diet helps slow gastric emptying and reduce the rapid shift of fluids into the small intestine. Protein-rich foods are digested more slowly, which can alleviate symptoms like nausea, diarrhea, and dizziness. This dietary modification is a cornerstone of managing dumping syndrome.

Question 60: Which patient statement indicates a correct understanding of the Dawn phenomenon?

'My blood sugar rises in the early morning because of hormones released during sleep, not because I ate anything.' (Correct answer)
'Dawn phenomenon means my insulin stops working after midnight.'
'High morning glucose means I ate too many carbohydrates at dinner.'
'My blood sugar goes low at night and then bounces up—that is why my morning reading is high.'

Correct answer: 'My blood sugar rises in the early morning because of hormones released during sleep, not because I ate anything.'

The Dawn phenomenon results from early-morning surges in counter-regulatory hormones (cortisol, growth hormone) that raise hepatic glucose output without prior hypoglycemia.

Question 61: In order to get their child's ear infection checked, a parent brings their child to the pediatric clinic. The healthcare professional (HCP) affirms the diagnosis and issues a cephalexin prescription. The nurse asks the parent if their child has ever experienced an allergic reaction to medication before submitting the prescription to the pharmacy. Which of the following medications would cause the nurse to contact the HCP if there has been an allergic response in the past?

Isotretinoin
Gentamycin
Amoxicillin (Correct answer)
Tetracycline

Correct answer: Amoxicillin

Cephalexin is a cephalosporin antibiotic, and amoxicillin belongs to the penicillin class of antibiotics. There is a known risk of cross-sensitivity between penicillins and cephalosporins, meaning a patient allergic to penicillin may also experience an allergic reaction to cephalexin. Therefore, a history of amoxicillin allergy would necessitate contacting the HCP to discuss alternative medications or precautions.

Question 62: A patient's serum ammonia level is significantly elevated. Which condition does the LPN associate this with?

Pulmonary hypertension
Renal tubular acidosis
Hepatic encephalopathy (Correct answer)
Diabetic nephropathy

Correct answer: Hepatic encephalopathy

The liver normally converts ammonia to urea; in hepatic failure, ammonia accumulates and crosses the blood-brain barrier causing encephalopathy.

Question 63: Which pain assessment tool is most appropriate for an LPN to use with a non-verbal patient who has dementia?

Numeric Rating Scale (NRS)
Wong-Baker FACES Scale
PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
Visual Analog Scale (VAS)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

The PAINAD scale assesses behavioral indicators of pain (breathing, vocalization, facial expression, body language, consolability) in patients with advanced dementia who cannot self-report.

Question 64: A nurse must perform a high-risk aerosol-generating procedure on a patient with COVID-19. What respiratory protection is required?

Double-layered surgical mask
N95 respirator or higher (Correct answer)
Standard surgical mask
No additional respiratory protection beyond standard precautions

Correct answer: N95 respirator or higher

Aerosol-generating procedures (e.g., intubation, bronchoscopy, suctioning) can produce fine airborne particles, requiring at minimum an N95 respirator to protect the nurse.

Question 65: A patient taking NSAIDs (e.g., ibuprofen) long-term should be monitored for which complication?

Respiratory alkalosis
Hypoglycemia
Hyponatremia and fluid overload
Gastrointestinal bleeding and renal impairment (Correct answer)

Correct answer: Gastrointestinal bleeding and renal impairment

Long-term NSAID use inhibits prostaglandins that protect the gastric mucosa and maintain renal perfusion, leading to GI bleeding and kidney damage.

Question 66: A patient's colostomy bag is one-third to one-half full. The LPN should take which action?

Leave it until the next scheduled change
Empty the bag to prevent leakage and skin breakdown (Correct answer)
Replace the entire appliance immediately
Apply additional tape around the wafer edges

Correct answer: Empty the bag to prevent leakage and skin breakdown

Colostomy bags should be emptied when one-third to one-half full to prevent the weight from breaking the seal and causing leakage.

Question 67: Which assessment finding indicates that a patient with a urinary catheter may have a catheter-associated urinary tract infection (CAUTI)?

Cloudy, foul-smelling urine with fever (Correct answer)
Clear, pale yellow urine
Urine output of 60 mL/hr
Specific gravity of 1.015

Correct answer: Cloudy, foul-smelling urine with fever

Cloudy, foul-smelling urine accompanied by fever and possibly flank pain or confusion are hallmark signs of a CAUTI.

Question 68: Which assessment finding best indicates that a patient's pain medication has been effective?

The patient requests a higher medication dose
The patient is sleeping and cannot be aroused
The patient's blood pressure has increased
The patient reports pain decreased from 8/10 to 2/10 and is able to rest (Correct answer)

Correct answer: The patient reports pain decreased from 8/10 to 2/10 and is able to rest

Effective pain management is indicated by a significant decrease in self-reported pain intensity along with improved function and rest.

Question 69: A post-operative patient's hemoglobin drops from 11 g/dL to 7.2 g/dL within 4 hours. What is the priority assessment?

Assess surgical site for active bleeding and vital signs (Correct answer)
Administer erythropoietin as a first response
Recheck the lab in 2 hours to confirm the result
Encourage oral iron-rich foods

Correct answer: Assess surgical site for active bleeding and vital signs

A rapid significant hemoglobin drop post-operatively suggests active hemorrhage; immediate assessment of the wound and hemodynamic status is critical.

Question 70: A patient with diabetic ketoacidosis (DKA) is admitted. Which laboratory finding is most characteristic of this condition?

Blood glucose > 250 mg/dL, pH < 7.3, positive serum ketones (Correct answer)
Blood glucose 180 mg/dL, pH 7.38, negative serum ketones
Sodium 128 mEq/L, glucose 90 mg/dL, pH 7.30
Glucose > 600 mg/dL, pH 7.36, no ketones

Correct answer: Blood glucose > 250 mg/dL, pH < 7.3, positive serum ketones

DKA is defined by hyperglycemia (usually >250 mg/dL), metabolic acidosis (pH <7.3), and ketonemia/ketonuria; the last option describes hyperosmolar hyperglycemic state (HHS).

Question 71: A patient's CBC shows MCV of 115 fL and hypersegmented neutrophils. What nutritional deficiency is most likely?

Zinc deficiency
Iron deficiency
Vitamin D deficiency
Vitamin B12 or folate deficiency (Correct answer)

Correct answer: Vitamin B12 or folate deficiency

Macrocytosis (MCV >100 fL) with hypersegmented neutrophils is the hallmark of megaloblastic anemia caused by B12 or folate deficiency.

Question 72: A nurse is providing care for a client who has a placenta previa at 32 weeks of gestation. The nurse notes that the client is actively bleeding. The nurse should anticipate that the provider will prescribe which of the following types of medications?

Methylergonovine (Methergine)
Indomethacin (Indocin)
Nifedipine (Adalat)
Betamethasone (Celestone) (Correct answer)

Correct answer: Betamethasone (Celestone)

Betamethasone is a corticosteroid administered to the mother to accelerate fetal lung maturity when preterm birth is anticipated. In a client with placenta previa who is actively bleeding at 32 weeks, there is a high risk of preterm delivery. Therefore, administering betamethasone is crucial to improve the newborn's respiratory outcomes and reduce the risk of respiratory distress syndrome.

Question 73: The LPN is caring for a patient in alcohol withdrawal. Which medication class does the LPN expect to be ordered for symptom management?

Antipsychotics
Benzodiazepines (Correct answer)
Opioid analgesics
Beta-blockers

Correct answer: Benzodiazepines

Benzodiazepines are the first-line treatment for alcohol withdrawal because they cross-react with the GABA receptor system and prevent seizures and delirium tremens.

Question 74: Which electrolyte imbalance should the LPN monitor for in a patient receiving amphotericin B?

Hypermagnesemia
Hypernatremia
Hypokalemia (Correct answer)
Hypercalcemia

Correct answer: Hypokalemia

Amphotericin B is nephrotoxic and commonly causes hypokalemia and hypomagnesemia through renal potassium wasting.

Question 75: A client is prescribed rapid-acting insulin (lispro) on a sliding scale to be administered before meals. The LPN should administer the insulin at what time?

30 to 60 minutes before the meal
No more than 15 minutes before the meal begins (Correct answer)
Immediately after finishing the meal
At the same time each day, regardless of meals

Correct answer: No more than 15 minutes before the meal begins

Rapid-acting insulins, like lispro, aspart, and glulisine, have a very fast onset of action (10-15 minutes). They should be administered shortly before meals (within 15 minutes) to coincide with the rise in blood glucose from food intake.

Question 76: A UAP is assigned to a patient with a new diagnosis. Which action by the LPN is most appropriate?

Allow the UAP to review the medical record independently
Give the UAP a printed copy of the diagnosis for reference
Provide specific instructions about what to observe and report for that patient (Correct answer)
Trust the UAP to know what to monitor based on experience

Correct answer: Provide specific instructions about what to observe and report for that patient

The LPN must individualize instructions for each patient, especially those with new or changing conditions.

Question 77: A patient is in Buck's traction for a femur fracture. The LPN notices the weights are resting on the floor. What is the correct action?

Notify the surgeon and document only
Leave the weights on the floor to reduce pain
Elevate the foot of the bed to restore countertraction (Correct answer)
Remove the weights and reapply later

Correct answer: Elevate the foot of the bed to restore countertraction

The foot of the bed must be elevated so the patient's body weight provides countertraction, allowing the traction weights to hang freely.

Question 78: A infant who was delivered at 41 weeks gestation is being examined by a nurse. Which of the following traits would suggest that the baby is postterm?

Excess body fat
Heels movable fully to the ears
Leathery skin (Correct answer)
Flat areola without breast buds

Correct answer: Leathery skin

Postterm infants, delivered after 42 weeks gestation, often exhibit signs of placental insufficiency due to an aging placenta. This leads to dry, cracked, peeling, and leathery skin, along with a wasted appearance from decreased subcutaneous fat. These physical characteristics are key indicators of a postterm delivery.

Question 79: During urinary catheter insertion, the catheter touches a non-sterile surface and becomes contaminated. What should the nurse do?

Discard the contaminated catheter and obtain a new sterile catheter (Correct answer)
Continue with the insertion since the contamination was minor
Flush the catheter with sterile saline before inserting
Wipe the catheter with an alcohol swab and continue

Correct answer: Discard the contaminated catheter and obtain a new sterile catheter

Any break in sterile technique requires discarding the contaminated catheter and using a new sterile catheter to prevent introducing bacteria into the bladder.

Question 80: Which laboratory value is the LPN most concerned about in a patient receiving long-term heparin therapy?

Serum sodium of 138 mEq/L
Complete blood count showing WBC 9,000/µL
Hemoglobin of 13.5 g/dL
Platelet count dropping from 250,000 to 60,000/µL (Correct answer)

Correct answer: Platelet count dropping from 250,000 to 60,000/µL

A significant drop in platelets during heparin therapy indicates heparin-induced thrombocytopenia (HIT), a life-threatening complication requiring immediate provider notification.

Question 81: A patient with a fractured hip is in Buck's traction preoperatively. The LPN notices the patient has slid down in bed so the weights are resting on the floor. The correct action is to:

Call the orthopedic technician to reset the traction
Reposition the patient up in bed so the weights hang freely (Correct answer)
Remove the traction until the surgeon can reassess
Lift the weights off the floor and reposition the patient

Correct answer: Reposition the patient up in bed so the weights hang freely

The weights must hang freely to maintain traction; repositioning the patient restores the therapeutic pull without disrupting the traction setup.

Question 82: Performing joint plastic surgery.

Pre-operative
Arthrotomy
Thoracotomy
Arthroplasty (Correct answer)

Correct answer: Arthroplasty

Arthroplasty is the surgical procedure specifically designed to restore the function of a joint, often by resurfacing the bones or replacing the entire joint with an artificial prosthesis. The term combines 'arthro-' (joint) and '-plasty' (surgical repair or reconstruction). This procedure is commonly performed to alleviate pain and improve mobility in damaged joints.

Question 83: Which laboratory value indicates that a patient's INR therapeutic goal is being met for atrial fibrillation management with warfarin?

INR 2.5 (Correct answer)
INR 4.5
INR 0.5
INR 1.0

Correct answer: INR 2.5

The therapeutic INR range for atrial fibrillation is 2.0–3.0, and an INR of 2.5 falls within this therapeutic window.

Question 84: A patient receiving chemotherapy is prescribed ondansetron. What is the primary purpose of this medication?

To treat chemotherapy-related mouth sores
To prevent chemotherapy-induced nausea and vomiting (Correct answer)
To prevent infection during immunosuppression
To stimulate white blood cell production

Correct answer: To prevent chemotherapy-induced nausea and vomiting

Ondansetron is a 5-HT3 receptor antagonist used as an antiemetic to prevent nausea and vomiting associated with chemotherapy.

Question 85: When performing a sterile dressing change, the LPN accidentally touches the sterile field with an ungloved hand. What is the correct action?

Apply an antiseptic to the touched area and proceed
Document the breach and monitor for infection
Discard the contaminated supplies and obtain a new sterile setup (Correct answer)
Continue the procedure quickly to minimize contamination time

Correct answer: Discard the contaminated supplies and obtain a new sterile setup

Any break in sterile technique requires discarding contaminated materials and starting fresh to prevent infection.

Question 86: The LPN is preparing to administer medications through a patient's jejunostomy tube (J-tube). Which action is correct?

Mix medications with the enteral formula for ease of administration
Crush all medications and mix them together before instilling
Verify each medication is appropriate for jejunal delivery and flush between each (Correct answer)
Administer medications rapidly to reduce tube clogging

Correct answer: Verify each medication is appropriate for jejunal delivery and flush between each

Each medication must be assessed for compatibility with J-tube delivery (some extended-release formulations cannot be crushed), and the tube must be flushed between each medication to prevent clogging and drug interactions.

Question 87: Which nursing intervention best helps reduce pain and anxiety during a painful dressing change?

Dimming the lights and playing music
Administering PRN analgesic 30 minutes before the procedure (Correct answer)
Applying restraints to prevent patient movement
Performing the procedure as quickly as possible without explanation

Correct answer: Administering PRN analgesic 30 minutes before the procedure

Premedication with an analgesic 30 minutes before a painful procedure ensures peak medication effect and significantly reduces procedural pain.

Question 88: The LPN is performing a head-to-toe assessment and notes that a patient's abdomen is rigid and board-like with guarding. The priority action is to:

Document and reassess in one hour
Report the finding to the RN immediately (Correct answer)
Apply a heating pad to the abdomen for comfort
Encourage ambulation to stimulate bowel motility

Correct answer: Report the finding to the RN immediately

A rigid, board-like abdomen with guarding indicates peritoneal irritation, a medical emergency requiring immediate reporting.

Question 89: A UAP asks the LPN to delegate suctioning a patient with a new tracheostomy. The LPN should:

Teach the UAP and supervise the first time, then delegate independently
Decline to delegate because suctioning a new trach requires clinical assessment (Correct answer)
Ask the charge RN to make the delegation decision
Delegate the task if the UAP has done it before on other patients

Correct answer: Decline to delegate because suctioning a new trach requires clinical assessment

Suctioning a new tracheostomy involves risk and clinical judgment beyond the UAP's scope of practice.

Question 90: Which statement by a patient indicates a need for further teaching about colostomy care?

I can shower with my pouch on or off.
I should change my pouch system every 3-7 days or when leaking.
I will empty my pouch when it is one-third to one-half full.
I should not eat any foods that may cause gas. (Correct answer)

Correct answer: I should not eat any foods that may cause gas.

Patients do not need to eliminate gas-producing foods entirely; they should identify personal triggers and manage their diet to minimize discomfort, not restrict all such foods.

Question 91: A patient using hydrochlorothiazide is told to eat more potassium in her diet. The best treat for a patient who needs more potassium is:

Orange
Avocado (Correct answer)
Apple
Pear

Correct answer: Avocado

Hydrochlorothiazide is a diuretic that can cause potassium loss, leading to hypokalemia. Patients on this medication need to increase their dietary potassium intake. Avocados are an excellent source of potassium, containing significantly more per serving than apples, pears, or oranges, making them the best choice among the options to replenish potassium levels.

Question 92: For the thyroid hormone to work effectively, ____________ is required.

Calcium
Vitamin
None of the above
Iodine (Correct answer)

Correct answer: Iodine

Iodine is an essential trace element crucial for the synthesis of thyroid hormones, specifically thyroxine (T4) and triiodothyronine (T3). The thyroid gland actively takes up iodine from the bloodstream to produce these hormones, which are vital for regulating metabolism, growth, and development. Without sufficient iodine, the thyroid cannot function effectively.

Question 93: The LPN notes that a patient's nasogastric (NG) tube feeding bag has been hanging for 9 hours. What action is required?

Continue the infusion as the bag still has formula
Cap the tube and hold feedings for 2 hours
Change the bag and tubing per facility policy (typically every 4-8 hours) (Correct answer)
Add more formula to the existing bag

Correct answer: Change the bag and tubing per facility policy (typically every 4-8 hours)

Enteral feeding bags and tubing should be changed every 4-8 hours (per facility policy) to prevent bacterial growth and aspiration risk.

Question 94: A nurse is reinforcing teaching with a client who is pregnant about the amniocentesis procedure. Which of the following statements by the client requires clarification?

The test is done to detect genetic abnormalities
I need to have a full bladder at the time of the procedure (Correct answer)
I will report cramping or signs of infection to the physician
I should drink lots of fluids during the 24 hours following the procedure

Correct answer: I need to have a full bladder at the time of the procedure

For an amniocentesis performed in the second or third trimester, a full bladder is generally not required; an empty bladder is often preferred to reduce the risk of bladder puncture. A full bladder is typically needed for an ultrasound in early pregnancy to help visualize the uterus. Therefore, the client's statement about needing a full bladder indicates a misunderstanding and requires clarification.

Question 95: A patient is ordered to receive IV potassium chloride 40 mEq in 100 mL NS over 1 hour. What is the safest administration method?

Mixed into a 50 mL bag and given rapidly
IV bolus push over 5 minutes
Via infusion pump through a peripheral IV (Correct answer)
Administered undiluted via central line

Correct answer: Via infusion pump through a peripheral IV

IV potassium must always be administered slowly via an infusion pump because rapid infusion can cause fatal cardiac arrhythmias.

Question 96: Your body's ______________ levels are controlled by the parathyroid.

Blood sugar
Iodine
Vitamin
Calcium (Correct answer)

Correct answer: Calcium

The parathyroid glands primarily regulate calcium and phosphate levels in the blood. They secrete parathyroid hormone (PTH), which increases blood calcium by stimulating its release from bones, increasing absorption in the intestines, and promoting reabsorption in the kidneys, thereby maintaining calcium homeostasis.

Question 97: A patient states they have been reading about herbal supplements online and wants to start taking St. John's Wort. The LPN knows this herb has a significant interaction with which class of medication?

Anticoagulants such as warfarin
Antihypertensives
Antidepressants and SSRIs (Correct answer)
Nonsteroidal anti-inflammatory drugs

Correct answer: Antidepressants and SSRIs

St. John's Wort induces CYP enzymes that reduce SSRI levels and can trigger serotonin syndrome when combined with antidepressants.

Question 98: A Braden Scale score of 16 indicates which level of pressure injury risk?

Moderate risk
Mild risk (Correct answer)
High risk
No risk

Correct answer: Mild risk

A Braden score of 15–16 indicates mild risk for pressure injury development; scores ≤9 indicate very high risk.

Question 99: A patient tells the LPN they want to leave the hospital against medical advice (AMA). The LPN's first action should be to:

Lock the patient's room door to prevent departure
Call security to detain the patient
Ask the patient to sign the AMA form right away
Notify the RN and charge nurse immediately (Correct answer)

Correct answer: Notify the RN and charge nurse immediately

The LPN must immediately notify the RN and charge nurse so the provider can be notified, risks explained, and proper AMA procedures followed.

Question 100: A patient is prescribed metformin 500 mg twice daily. Which condition is an absolute contraindication for this medication?

Hypertension
Type 2 diabetes mellitus
Renal impairment with eGFR < 30 mL/min (Correct answer)
Hyperlipidemia

Correct answer: Renal impairment with eGFR < 30 mL/min

Metformin is contraindicated in severe renal impairment (eGFR < 30 mL/min) due to the risk of lactic acidosis.

Question 101: Which element must be present for an LPN to legally delegate a task to a UAP?

The patient's verbal agreement to UAP care
State nurse practice act authorization for that task to be delegated (Correct answer)
A physician's written order approving the delegation
A minimum of five years of UAP experience

Correct answer: State nurse practice act authorization for that task to be delegated

Delegation must comply with the state nurse practice act, which defines what LPNs can delegate and to whom.

Question 102: A patient refuses pain medication despite rating pain at 7/10. What is the appropriate nursing action?

Discharge the patient for noncompliance
Document the refusal, explore the patient's concerns, and notify the RN (Correct answer)
Ignore the refusal and document only the pain rating
Administer the medication without the patient's consent

Correct answer: Document the refusal, explore the patient's concerns, and notify the RN

Patients have the right to refuse treatment; the nurse must document the refusal, explore the reasons, provide education, and notify the RN of the patient's pain and refusal.

Question 103: A patient is in skeletal traction for a femur fracture. Which nursing action is the LPN's priority?

Removing the weights when repositioning the patient
Massaging bony prominences vigorously to prevent pressure injuries
Keeping the traction ropes parallel to the bed frame at all times
Assessing neurovascular status of the affected extremity every 2–4 hours (Correct answer)

Correct answer: Assessing neurovascular status of the affected extremity every 2–4 hours

Frequent neurovascular checks (circulation, sensation, movement) detect compartment syndrome or nerve damage, the most serious complications of skeletal traction.

Question 104: A nurse is evaluating a client's understanding about the risk for cancer. Which of the following client statements indicates the need for further teaching?

I see a dermatologist regularly for the mole on my thigh
I tan using an indoor tanning lotion instead of laying out in the sun
I take milk of magnesia for occasional constipation
I used to smoke but switched to chewing tobacco 3 years ago (Correct answer)

Correct answer: I used to smoke but switched to chewing tobacco 3 years ago

Switching from smoking to chewing tobacco does not eliminate the risk of cancer; it merely shifts the type of cancer risk. Chewing tobacco is a known carcinogen and significantly increases the risk of oral, esophageal, and pancreatic cancers. This statement indicates a misunderstanding of cancer risk reduction and highlights the need for further education on tobacco cessation.

Question 105: A patient with celiac disease asks the LPN which grain is safe to consume. Which response is correct?

Barley
Wheat
Rye
Rice (Correct answer)

Correct answer: Rice

Rice is gluten-free and safe for patients with celiac disease; wheat, barley, and rye all contain gluten.

Question 106: A patient is prescribed digoxin 0.125 mg daily. Before administering, the LPN assesses an apical pulse of 52 bpm. What is the priority action?

Administer the dose as prescribed
Administer half the dose
Hold the medication and notify the provider (Correct answer)
Document and reassess in 30 minutes

Correct answer: Hold the medication and notify the provider

Digoxin is held and the provider notified when the apical pulse is below 60 bpm in adults, as bradycardia is a sign of toxicity.

Question 107: An LPN is preparing to enter the room of a patient with suspected pulmonary tuberculosis. Which piece of personal protective equipment (PPE) is essential for the nurse to wear?

Sterile gloves
N95 respirator (Correct answer)
Face shield
Surgical mask

Correct answer: N95 respirator

Pulmonary tuberculosis requires Airborne Precautions. This involves wearing a specially fitted N95 respirator mask to filter out small airborne particles (droplet nuclei) that can remain suspended in the air for long periods.

Question 108: A patient's magnesium level is 1.0 mEq/L. Which clinical manifestation should the LPN monitor for?

Hypertension and flushing
Lethargy, hyporeflexia, and bradycardia
Neuromuscular irritability and positive Trousseau's sign (Correct answer)
Constipation and polyuria

Correct answer: Neuromuscular irritability and positive Trousseau's sign

Hypomagnesemia (<1.5 mEq/L) causes neuromuscular irritability; because it often co-exists with hypocalcemia, Trousseau's sign may be positive.

Question 109: Which clinical finding is most consistent with fecal impaction?

Pale, clay-colored stool with jaundice
Bright red blood coating formed stool
Liquid stool oozing around hard stool mass with no formed stool for several days (Correct answer)
Large, formed brown stool passed once daily

Correct answer: Liquid stool oozing around hard stool mass with no formed stool for several days

Fecal impaction presents with liquid stool leaking around a hard, immovable stool mass; patients often report rectal fullness and no normal bowel movement for days.

Question 110: The LPN is preparing to administer a subcutaneous insulin injection. Which site should be avoided in a patient who is about to exercise their legs?

Thigh (Correct answer)
Abdomen
Upper arm
Upper back

Correct answer: Thigh

Insulin injected into the thigh is absorbed faster during leg exercise, which can cause hypoglycemia, so the abdomen is preferred before leg activity.

Question 111: Providing basic medical care while working under the direction of registered nurses, doctors, and other healthcare professionals.

What do they do? (Correct answer)
education
job growth
length of training

Correct answer: What do they do?

The statement accurately describes the primary responsibilities and scope of practice for a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). LPNs provide direct patient care, perform basic medical tasks, and work collaboratively under the supervision of registered nurses, physicians, and other healthcare professionals. Therefore, the statement directly answers the question of 'What do they do?' within the healthcare field.

Question 112: Which of the following blood glucose values meets the ADA diagnostic criteria for diabetes mellitus?

Fasting plasma glucose of 110 mg/dL
2-hour OGTT glucose of 130 mg/dL
Fasting plasma glucose ≥ 126 mg/dL on two separate occasions (Correct answer)
Random blood glucose of 140 mg/dL without symptoms

Correct answer: Fasting plasma glucose ≥ 126 mg/dL on two separate occasions

The ADA requires a fasting plasma glucose ≥126 mg/dL confirmed on two separate occasions (or once with symptoms) to diagnose diabetes.

Question 113: The nurse is planning care for an adolescent client experiencing the manic phase of bipolar disorder. Which intervention would address hallucinations?

Explain that hallucinations are not real (Correct answer)
Keep isolated in a quiet room
Discuss a homework assignment
Encourage spending time with others

Correct answer: Explain that hallucinations are not real

When a client is experiencing hallucinations, the most appropriate nursing intervention is to gently and calmly explain that the hallucinations are not real. This helps orient the client to reality without directly confronting or arguing with their experience. Providing reality orientation helps to reduce distress and confusion associated with the hallucination.

Question 114: A patient asks an LPN to witness their signature on a consent form for surgery. The LPN should:

Refuse to witness any consent forms as this is outside LPN scope
Witness the signature and document that informed consent was obtained
Witness only that the patient signed voluntarily, not that informed consent was given (Correct answer)
Have the patient sign and counter-sign the form as the witness

Correct answer: Witness only that the patient signed voluntarily, not that informed consent was given

An LPN may witness a patient's signature, attesting only to voluntary signing; obtaining informed consent and explaining risks is the physician's responsibility.

Question 115: An infection of a vein clot.

Phlebotomy
Arteriosclerosis
Thrombophlebitis (Correct answer)
Hemolysis

Correct answer: Thrombophlebitis

Thrombophlebitis is a medical condition characterized by the inflammation of a vein, which is typically accompanied by the formation of a blood clot (thrombus) within that vein. The term combines 'thrombo-' (clot) and 'phlebitis' (inflammation of a vein), accurately describing an infection or inflammation associated with a vein clot.

Question 116: Under standard precautions, how should a nurse handle a patient's soiled linen?

Hold away from the body and place in a labeled linen bag at point of use (Correct answer)
Only bag linen if it is visibly soiled with blood
Shake out before placing in the linen bag to remove debris
Place directly on the floor until transport

Correct answer: Hold away from the body and place in a labeled linen bag at point of use

Soiled linen should be handled minimally, held away from the body to prevent contact with clothing, and bagged at the point of use without shaking to prevent dispersal of microorganisms.

Question 117: A patient receiving TPN has a blood glucose of 310 mg/dL. What is the most appropriate nursing action?

Stop the TPN infusion immediately
Slow the TPN rate by half without notifying the provider
Notify the provider and anticipate an insulin order (Correct answer)
Recheck glucose in 4 hours with no immediate action

Correct answer: Notify the provider and anticipate an insulin order

Hyperglycemia during TPN requires provider notification to adjust insulin coverage; abruptly stopping TPN can cause rebound hypoglycemia.

Question 118: A patient with COPD has an oxygen saturation of 88% on room air. The physician orders oxygen at 1-2 L/min via nasal cannula. The patient asks why they can't have more oxygen. What is the best explanation?

Insurance only covers low-flow oxygen for COPD patients
More oxygen would be wasted since it isn't fully absorbed
Patients with COPD may rely on low oxygen levels to drive their breathing stimulus (Correct answer)
Higher flow rates cause oxygen toxicity within minutes

Correct answer: Patients with COPD may rely on low oxygen levels to drive their breathing stimulus

Some COPD patients develop hypoxic drive, where low oxygen (not CO2) triggers breathing, so high-flow O2 can suppress respirations.

Question 119: Which action by a UAP requires the LPN to re-evaluate the appropriateness of the delegation?

The UAP reports completing the task without the LPN's follow-up check
The UAP asks the LPN a clarifying question before starting the task
The UAP takes slightly longer than expected to complete the task
The UAP consistently makes errors when performing the delegated task (Correct answer)

Correct answer: The UAP consistently makes errors when performing the delegated task

Consistent errors indicate the UAP lacks competency for the task and delegation must be re-evaluated.

Question 120: The doctor has prescribed Sulfamylon cream dressings for a patient who has full-thickness burns on his or her hands and arms. The following should come first for the nurse when changing dressings:

Administering pain medication (Correct answer)
Obtaining a blood glucose by finger stick
Requesting a daily complete blood count
Checking the adequacy of urinary output

Correct answer: Administering pain medication

Changing dressings for full-thickness burns is an extremely painful procedure. The nurse's priority before starting the dressing change should be to administer adequate pain medication. This ensures patient comfort, reduces anxiety, and allows for better cooperation during the procedure, which is essential for effective wound care.

Question 121: A nurse is assisting with the management of a client who is in active labor. Which of the following findings should the nurse report following epidural placement?

Early decelerations
Fetal heart rate 160
Blood pressure 89/54 mmHg (Correct answer)
2+ pedal edema

Correct answer: Blood pressure 89/54 mmHg

Hypotension is a common and serious complication following epidural anesthesia, as it can cause vasodilation and a significant decrease in blood pressure. A blood pressure of 89/54 mmHg is dangerously low and can compromise uteroplacental perfusion, potentially harming the fetus. This finding requires immediate nursing intervention to restore adequate blood pressure.

Question 122: An LPN is preparing to irrigate a client's surgical wound. Which technique demonstrates proper procedure?

Directing the flow of solution from the top to the bottom of the wound. (Correct answer)
Instilling the solution from the outer edge toward the center.
Warming the irrigation solution in the microwave.
Using a high-pressure stream to dislodge debris.

Correct answer: Directing the flow of solution from the top to the bottom of the wound.

Wound irrigation should always proceed from the least contaminated area to the most contaminated area to prevent spreading microorganisms into cleaner parts of the wound. This is often described as cleaning from 'clean to dirty' or from the center of the wound outward.

Question 123: A patient with a new prescription for nitroglycerin sublingual tablets asks how to store them properly. What should the nurse teach?

Refrigerate the tablets to extend shelf life
Store in a clear plastic bag in a cool drawer
Keep the bottle in a shirt pocket for easy access
Keep in the original dark glass bottle away from heat and light (Correct answer)

Correct answer: Keep in the original dark glass bottle away from heat and light

Nitroglycerin degrades rapidly when exposed to heat, light, moisture, or plastic; it must be stored in the original dark glass bottle.

Question 124: A patient's urine specific gravity is 1.030. How should the LPN interpret this finding?

Indicates renal failure with inability to concentrate
Normal, well-hydrated status
Concentrated urine, likely indicating dehydration (Correct answer)
Dilute urine suggesting overhydration

Correct answer: Concentrated urine, likely indicating dehydration

Urine specific gravity >1.025 indicates highly concentrated urine, most commonly due to dehydration or inadequate fluid intake.

Question 125: How frequently should a urinary catheter drainage bag be emptied to prevent infection and maintain accurate output measurement?

Only when completely full
Every 30 minutes regardless of volume
Once per day at the end of the shift
Every 8 hours or when the bag is two-thirds to three-quarters full (Correct answer)

Correct answer: Every 8 hours or when the bag is two-thirds to three-quarters full

The catheter drainage bag should be emptied at least every 8 hours or when two-thirds to three-quarters full to prevent backflow and maintain accurate intake and output records.

Question 126: An LPN is caring for a patient diagnosed with influenza. Which type of room placement is most appropriate for this patient?

A room with the door kept open to observe the patient
A negative-pressure airflow room
A private room or cohort with a patient with the same diagnosis (Correct answer)
Any available semi-private room

Correct answer: A private room or cohort with a patient with the same diagnosis

Influenza is transmitted via droplets. Droplet Precautions require placing the patient in a private room. If a private room is not available, the patient can be cohorted with another patient infected with the same microorganism.

Question 127: Which statement accurately describes the action of long-acting insulin, such as insulin glargine?

It provides a steady level of insulin with no significant peak. (Correct answer)
It must be administered 30 minutes before each meal.
It is cloudy in appearance and must be gently rolled before use.
It has a rapid onset and a peak action in 1-2 hours.

Correct answer: It provides a steady level of insulin with no significant peak.

Long-acting insulins (glargine, detemir) are designed to provide a steady, continuous level of insulin over a 24-hour period. They do not have a pronounced peak, which reduces the risk of hypoglycemia between meals and overnight. This mimics the basal insulin secretion of a healthy pancreas.

Question 128: A patient develops diarrhea 24 hours after starting enteral feedings. Which intervention should the LPN implement first?

Switch to oral intake immediately
Increase the feeding rate to replace lost fluids
Assess for infection, medications, and formula concentration as causes (Correct answer)
Discontinue feedings permanently

Correct answer: Assess for infection, medications, and formula concentration as causes

Diarrhea during enteral feedings has multiple causes including hyperosmolar formula, infection, or medications; assessment guides the appropriate intervention.

Question 129: Which urine output finding requires immediate reporting to the RN or physician?

Urine output of 50 mL over the last hour
No urine output for the past 2 hours in a catheterized patient (Correct answer)
Urine output of 1,800 mL in 24 hours
Urine that appears pale yellow

Correct answer: No urine output for the past 2 hours in a catheterized patient

Anuria (no urine output) in a catheterized patient for 2 hours may indicate catheter obstruction, renal failure, or hemodynamic compromise and requires immediate assessment.

Question 130: Which technique should the LPN use when administering an intradermal injection for tuberculin skin testing?

Insert needle at 5-15 degree angle, bevel up, creating a wheal (Correct answer)
Insert needle at 45-degree angle, aspirate before injecting
Insert needle at 30-degree angle, bevel down
Insert needle at 90-degree angle into subcutaneous tissue

Correct answer: Insert needle at 5-15 degree angle, bevel up, creating a wheal

Intradermal injections are given at a 5-15 degree angle with the bevel up to form a visible wheal just under the skin surface.

Question 131: Which foot-care instruction is most important for a patient with diabetic peripheral neuropathy?

Cut toenails in a rounded shape to prevent ingrown nails
Soak feet in hot water for 20 minutes each evening to improve circulation
Walk barefoot indoors to promote natural foot movement
Inspect feet daily for cuts, blisters, and redness because sensation is reduced (Correct answer)

Correct answer: Inspect feet daily for cuts, blisters, and redness because sensation is reduced

Reduced sensation means injuries go unnoticed; daily visual inspection is the cornerstone of diabetic foot care to catch problems early.

Question 132: A patient with a urinary catheter has output of 20 mL over 2 hours. After ruling out catheter obstruction, what is the LPN's next action?

Increase the patient's oral fluid intake
Irrigate the catheter with normal saline
Report the finding to the RN (Correct answer)
Clamp the catheter for one hour

Correct answer: Report the finding to the RN

Urine output less than 30 mL/hr may indicate renal insufficiency or hypovolemia and must be reported to the RN.

Question 133: The nurse who works in the behavioral health unit is creating a client's plan of care. The client is socially awkward, won't participate in group therapy sessions, and has a history of hurling objects at other clients. Which nursing diagnostic for the client is of the utmost importance?

Risk for other-directed violence (Correct answer)
Impaired social interaction
Ineffective coping
Social isolation

Correct answer: Risk for other-directed violence

The client's history of 'hurling objects at other clients' directly indicates a potential for harm to others. In nursing, client and staff safety is always the highest priority. Therefore, 'Risk for other-directed violence' is the most crucial nursing diagnosis as it addresses the immediate potential for physical harm to individuals in the environment.

Question 134: The LPN is caring for a patient receiving continuous tube feedings. The patient's residual volume is 280 mL. What is the correct action?

Increase the feeding rate to compensate
Stop the feeding and notify the nurse or provider (Correct answer)
Discard the residual and continue feeding
Continue the feeding at the same rate

Correct answer: Stop the feeding and notify the nurse or provider

A gastric residual volume above 200–250 mL indicates delayed gastric emptying and should be reported to the provider before continuing feedings.

Question 135: Which dietary modification is most effective for preventing constipation?

Increasing dietary fiber (25–35 g/day) and fluid intake to at least 8 glasses of water daily (Correct answer)
Increasing protein intake and reducing carbohydrates
Eating three large meals per day instead of smaller frequent meals
Eliminating all dairy products from the diet

Correct answer: Increasing dietary fiber (25–35 g/day) and fluid intake to at least 8 glasses of water daily

A high-fiber diet increases stool bulk and speeds intestinal transit, while adequate fluid intake softens stool and prevents constipation.

Question 136: What symptoms and indicators are present in hypothyroidism?

Depression
Both Answers (Correct answer)
Fatigue

Correct answer: Both Answers

Hypothyroidism, a condition of insufficient thyroid hormone production, significantly slows down the body's metabolism. This metabolic slowdown commonly leads to persistent fatigue and a general lack of energy. Additionally, the hormonal imbalance can affect brain chemistry, often resulting in symptoms of depression and cognitive impairment, making both fatigue and depression key indicators of the condition.

Question 137: Which pulse needs to be felt when a baby is in cardiac arrest in order to assess cardiac function?

Carotid
Pedal
Brachial (Correct answer)
Radial

Correct answer: Brachial

When assessing cardiac function in an infant during cardiac arrest, the brachial pulse is the most reliable and accessible pulse to palpate. The brachial artery is located on the inside of the upper arm, between the elbow and the shoulder, making it easier to locate quickly in an emergency for infants.

Question 138: A brain inflammation.

Encephalitis (Correct answer)
Neuralgia
Neuritis
Thrombosis

Correct answer: Encephalitis

Encephalitis is the precise medical term for inflammation of the brain. This condition can be caused by various factors, including viral infections, bacterial infections, or autoimmune disorders. Symptoms can range from mild flu-like illness to severe neurological complications, making prompt diagnosis and treatment essential.

Question 139: A patient with a plaster leg cast reports that the cast feels hot and has an unpleasant smell. The LPN should:

Report the findings to the RN as signs of possible infection (Correct answer)
Petal the cast edges to improve comfort
Reassure the patient that heat and odor are normal as the cast dries
Apply foot powder near the cast edges to reduce odor

Correct answer: Report the findings to the RN as signs of possible infection

Heat and foul odor from a cast may indicate infection under the cast and require prompt assessment by the RN and physician.

Question 140: The LPN notices the UAP did not report a patient's elevated temperature from two hours ago. What is the priority action?

Immediately assess the patient's current status (Correct answer)
Document the UAP's failure to report in the chart
File a complaint with the nurse manager
Counsel the UAP about reporting requirements

Correct answer: Immediately assess the patient's current status

The LPN's first priority is the patient's current clinical status, not the UAP's behavior.

Question 141: The LPN is caring for a patient in heart failure. Which assessment finding indicates that diuretic therapy is effective?

Weight gain of 2 lb in 24 hours
Urine output of 200 mL over 8 hours
Daily weight decreased by 2 lb and edema reduced (Correct answer)
Increased bilateral crackles on auscultation

Correct answer: Daily weight decreased by 2 lb and edema reduced

Effective diuresis in heart failure is demonstrated by weight loss (approximately 1 lb per liter of fluid lost) and reduced edema.

Question 142: A patient with hypothyroidism is started on levothyroxine. Which symptom would indicate the medication is having a therapeutic effect?

Increased bradycardia
Development of heat intolerance and tremors
Increased weight gain and fatigue
Improved energy level and normalization of heart rate (Correct answer)

Correct answer: Improved energy level and normalization of heart rate

Levothyroxine replaces deficient thyroid hormone; therapeutic effects include improved energy, normalization of heart rate, and resolution of hypothyroid symptoms.

NCLEX-PN Exam

The NCLEX-PN exam certifies that an individual has the entry-level knowledge and skills required to practice as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). It assesses competencies across various client needs categories.

Questions

300 min

Time Limit

50%

To Pass

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