NCLEX-PN (National Council Licensure Examination for Practical Nurses) — Questions and Answers

Question 1: Which agent is most commonly used for enzymatic (chemical) debridement of necrotic wound tissue?

Mupirocin (Bactroban)
Povidone-iodine
Silver sulfadiazine
Collagenase (Santyl) (Correct answer)

Correct answer: Collagenase (Santyl)

Collagenase (Santyl) is an enzymatic debriding agent that selectively breaks down necrotic collagen without harming healthy tissue.

Question 2: A nurse is reviewing screening recommendations for an asymptomatic 55-year-old male with a 30 pack-year smoking history who currently smokes. Which screening is indicated?

Low-dose CT scan of the chest annually (Correct answer)
Annual chest X-ray
PET scan every 2 years
Sputum cytology every 6 months

Correct answer: Low-dose CT scan of the chest annually

The USPSTF recommends annual low-dose CT (LDCT) lung cancer screening for adults aged 50–80 with a 20+ pack-year smoking history who currently smoke or quit within the past 15 years.

Question 3: A nurse is teaching a client about the importance of blood pressure monitoring. Which blood pressure reading would the nurse classify as Stage 1 hypertension according to current guidelines?

119/79 mmHg
145/95 mmHg
132/84 mmHg (Correct answer)
110/70 mmHg

Correct answer: 132/84 mmHg

According to ACC/AHA guidelines, Stage 1 hypertension is defined as systolic 130–139 mmHg or diastolic 80–89 mmHg.

Question 4: When is it appropriate for an LPN to refuse to administer a prescribed medication?

When the patient requests a different medication
When the nurse believes the dose is too high based on clinical assessment and safety concerns (Correct answer)
When the medication is not the nurse's preferred drug of choice
When the medication was ordered by a physician the nurse does not know

Correct answer: When the nurse believes the dose is too high based on clinical assessment and safety concerns

The nurse has both the professional and ethical responsibility to question and refuse medication orders that appear unsafe, notifying the provider and documenting the concern.

Question 5: A nurse is assessing a newborn 24 hours after birth. Which finding requires IMMEDIATE follow-up regarding hearing health?

Mild jaundice of the face
Moro reflex present bilaterally
Feeding every 2–3 hours
Failure to pass the newborn hearing screening (Correct answer)

Correct answer: Failure to pass the newborn hearing screening

Failing the newborn hearing screening warrants prompt referral for audiological follow-up to detect and address hearing loss early.

Question 6: A client is prescribed metoprolol succinate for hypertension. The LPN should hold the medication and notify the charge nurse if the client's apical heart rate is below:

70 bpm
55 bpm
50 bpm
60 bpm (Correct answer)

Correct answer: 60 bpm

Beta-blockers such as metoprolol should be held if the heart rate is below 60 bpm, as the drug slows conduction and further bradycardia could be dangerous.

Question 7: The nurse is preparing to change IV tubing. How often should standard primary IV administration sets be routinely changed per CDC guidelines?

Every 24 hours
Every 96 hours (Correct answer)
Every 48 hours
Every 7 days

Correct answer: Every 96 hours

CDC guidelines recommend changing primary and secondary administration sets no more frequently than every 96 hours (4 days) unless clinically indicated.

Question 8: Which nursing action is most effective in preventing ventilator-associated pneumonia (VAP) in an intubated patient?

Providing oral care with chlorhexidine every 2–4 hours (Correct answer)
Keeping the head of the bed flat to reduce aspiration
Suctioning the airway hourly on a fixed schedule
Deflating the endotracheal tube cuff when performing oral care

Correct answer: Providing oral care with chlorhexidine every 2–4 hours

Oral care with chlorhexidine reduces oropharyngeal bacterial colonization, which is a primary source of VAP-causing microorganisms.

Question 9: A client is admitted with influenza and is placed on droplet precautions. Which of the following interventions is a required component of droplet precautions?

Placing the client in a negative-pressure airflow room.
Wearing a gown and gloves for all entry into the room.
Wearing a surgical mask when working within 3 feet of the client. (Correct answer)
Keeping the door to the client's room closed at all times.

Correct answer: Wearing a surgical mask when working within 3 feet of the client.

Droplet precautions are used for pathogens transmitted by respiratory droplets generated by coughing, sneezing, or talking. These precautions require healthcare personnel to wear a surgical mask when in close contact (within 3 to 6 feet) with the patient. A private room is preferred, but a negative-pressure room is for airborne precautions. Gowns and gloves are part of standard precautions or contact precautions, not specifically for droplet precautions unless contact with fluids is anticipated.

Question 10: How should a nurse respond to a medication error?

Ignore the error if the patient is fine
Report the error and follow protocols (Correct answer)
Wait for the supervisor to act
Continue with other tasks

Correct answer: Report the error and follow protocols

In the event of a medication error, a nurse's immediate priority is patient safety. It is crucial to promptly report the error and meticulously follow established institutional protocols. This ensures the patient receives immediate assessment and any necessary interventions, while also facilitating documentation and analysis to prevent similar errors in the future.

Question 11: A patient with dementia is agitated and the LPN applies wrist restraints without an order to prevent the patient from pulling out an IV. This action is:

Justified if family members give verbal consent
A potential false imprisonment violation requiring a physician order first (Correct answer)
Standard nursing practice for confused patients
Acceptable because it protects the patient from self-harm

Correct answer: A potential false imprisonment violation requiring a physician order first

Restraints require a physician's order except in emergencies, and applying them without an order can constitute false imprisonment.

Question 12: The LPN is preparing to ambulate a patient for the first time after surgery. What is the correct sequence of steps?

Assist to standing → dangle at bedside → ambulate → return to bed
Assist to standing → ambulate → dangle if needed → return to bed
Ambulate immediately → dangle if dizzy → return to bed
Dangle at bedside → assist to standing → ambulate → return to bed (Correct answer)

Correct answer: Dangle at bedside → assist to standing → ambulate → return to bed

Dangling at the bedside before standing allows the patient to adjust to position changes and prevents orthostatic hypotension.

Question 13: A nurse accidentally splashes blood into her eyes. What is the FIRST action she should take?

Complete an incident report immediately
Flush the eyes with water or saline for 15 minutes (Correct answer)
Notify the charge nurse and await instructions
Apply antibiotic eye drops

Correct answer: Flush the eyes with water or saline for 15 minutes

Immediate irrigation of the eyes with water or saline for at least 15 minutes is the priority first action after mucous membrane exposure to blood.

Question 14: Which statement about the chain of infection is correct?

Standard precautions target only the infectious agent link
Hand hygiene primarily interrupts the susceptible host link
Breaking any single link in the chain prevents infection transmission (Correct answer)
The portal of entry must be the same as the reservoir

Correct answer: Breaking any single link in the chain prevents infection transmission

The chain of infection has six links, and breaking any one link—such as the mode of transmission—can prevent infection from spreading.

Question 15: An LPN makes a medication error and the patient is unharmed. What is the appropriate next step?

Complete an incident report and notify the charge nurse (Correct answer)
Wait to see if symptoms develop before reporting
Correct the documentation to avoid liability
Say nothing if the patient was not harmed

Correct answer: Complete an incident report and notify the charge nurse

All medication errors must be reported and documented through an incident report regardless of patient outcome, to support quality improvement and safety.

Question 16: A nurse is teaching a 45-year-old male client about colorectal cancer screening. Which recommendation aligns with current US Preventive Services Task Force guidelines?

Begin screening at age 45 with stool-based tests or colonoscopy every 10 years (Correct answer)
Screening is only necessary after age 60
Begin screening at age 40 with annual colonoscopy
Begin screening at age 50 only if family history is positive

Correct answer: Begin screening at age 45 with stool-based tests or colonoscopy every 10 years

The USPSTF recommends colorectal cancer screening beginning at age 45 for average-risk adults using stool-based tests or colonoscopy.

Question 17: A patient is prescribed levothyroxine 100 mcg PO daily. The LPN should instruct the patient to take this medication:

With a calcium supplement for best effect
On an empty stomach 30–60 minutes before breakfast (Correct answer)
With a full meal to reduce GI upset
At bedtime to improve absorption

Correct answer: On an empty stomach 30–60 minutes before breakfast

Levothyroxine should be taken on an empty stomach 30–60 minutes before breakfast to maximize absorption.

Question 18: A nurse is assigned to care for a patient with Clostridium difficile (C. diff). Which hand hygiene method is most effective against C. diff spores?

Chlorhexidine-based hand rub
Plain soap and water
Alcohol-based hand rub
Soap and water with friction for at least 20 seconds (Correct answer)

Correct answer: Soap and water with friction for at least 20 seconds

Alcohol-based hand rubs are ineffective against C. diff spores; soap and water with mechanical friction is required to physically remove spores.

Question 19: A client with Clostridioides difficile (C. diff) infection has soiled the bed linens. When leaving the client's room after providing care, which method of hand hygiene is most appropriate for the LPN to perform?

Using an alcohol-based hand sanitizer.
Wiping hands with an antiseptic towelette.
Washing hands with soap and water. (Correct answer)
Rinsing hands with warm water only.

Correct answer: Washing hands with soap and water.

Clostridioides difficile forms spores that are not effectively killed by alcohol-based hand sanitizers. The most appropriate method of hand hygiene is to wash hands with soap and water, as the mechanical friction helps to physically remove the spores.

Question 20: An elderly patient with confusion attempts to climb out of bed repeatedly. Which is the LEAST restrictive safety intervention to try first?

Raise all four side rails
Apply a vest restraint
Lower the bed and place a fall mat on the floor (Correct answer)
Apply soft wrist restraints

Correct answer: Lower the bed and place a fall mat on the floor

Lowering the bed and placing a fall mat is the least restrictive intervention that reduces injury risk without using physical restraints.

Question 21: A patient is prescribed morphine 4 mg IV PRN for pain. Which assessment finding should cause the LPN to withhold the dose and notify the provider?

Blood pressure of 130/80 mmHg
Pain rating of 6/10
Respiratory rate of 10 breaths/min (Correct answer)
Heart rate of 88 bpm

Correct answer: Respiratory rate of 10 breaths/min

Respiratory depression is a serious opioid side effect; a respiratory rate of 10 or below warrants withholding the dose and notifying the provider.

Question 22: Which patient is at HIGHEST risk for developing a healthcare-associated infection (HAI)?

A 35-year-old with well-controlled type 2 diabetes
A 45-year-old admitted for observation after a fall
A 25-year-old with an uncomplicated appendectomy
A 70-year-old receiving chemotherapy with an indwelling urinary catheter (Correct answer)

Correct answer: A 70-year-old receiving chemotherapy with an indwelling urinary catheter

Immunosuppression from chemotherapy combined with an indwelling urinary catheter dramatically increases HAI risk.

Question 23: A 4-year-old is admitted with suspected lead poisoning. Which initial finding is consistent with this diagnosis?

Petechiae and purpura
Developmental regression and irritability (Correct answer)
Polyuria and polydipsia
Bradycardia and hypotension

Correct answer: Developmental regression and irritability

Lead toxicity commonly causes neurobehavioral changes including developmental regression, irritability, and attention deficits in young children.

Question 24: Which medication class is MOST associated with causing hypokalemia as an adverse effect?

ACE inhibitors
Loop diuretics (Correct answer)
Calcium channel blockers
Beta-blockers

Correct answer: Loop diuretics

Loop diuretics such as furosemide cause significant urinary potassium wasting, leading to hypokalemia.

Question 25: An LPN is assessing lung sounds and hears a high-pitched, continuous musical sound over the right lower lobe. This finding is best described as:

Rhonchi
Pleural friction rub
Wheezing (Correct answer)
Crackles

Correct answer: Wheezing

Wheezing is a high-pitched, continuous, musical sound caused by narrowed or obstructed airways.

Question 26: A client in active labor at 8 cm dilation requests an epidural. Which assessment is most important before the epidural is placed?

Fetal presentation and station
Whether the client has eaten within the last 4 hours
Platelet count, blood pressure, and fluid status (Correct answer)
Client's pain tolerance level and birth plan preferences

Correct answer: Platelet count, blood pressure, and fluid status

Before epidural placement, thrombocytopenia (risk of epidural hematoma), hypotension (worsened by sympathetic blockade), and adequate IV hydration are critical safety assessments.

Question 27: A patient is found on the floor. After calling for help, what is the nurse's next priority action?

Assess the patient for injury before moving them (Correct answer)
Help the patient back into bed immediately
Complete the incident/occurrence report
Notify the patient's family

Correct answer: Assess the patient for injury before moving them

Before moving a fall victim, the nurse must assess for injuries such as fractures or head trauma that could be worsened by repositioning.

Question 28: A nurse is teaching a new mother about sudden infant death syndrome (SIDS) prevention. Which instruction is MOST important?

Place the infant on their back to sleep on a firm, flat surface (Correct answer)
Place the infant in a prone position to prevent aspiration
Share a bed with the infant to monitor breathing
Use a soft mattress with bumper pads for comfort

Correct answer: Place the infant on their back to sleep on a firm, flat surface

The American Academy of Pediatrics recommends placing infants supine (on their back) on a firm, flat sleep surface without soft bedding to reduce SIDS risk.

Question 29: Which organization is responsible for investigating complaints of nursing misconduct and can revoke an LPN's license?

The Joint Commission (TJC)
The State Board of Nursing (Correct answer)
The American Nurses Association (ANA)
The National Council of State Boards of Nursing (NCSBN)

Correct answer: The State Board of Nursing

State Boards of Nursing have the legal authority to investigate complaints and take disciplinary action, including license revocation.

Question 30: A nurse discovers a small fire in a client's wastebasket. After rescuing the client from the immediate area, what is the nurse's next priority action according to the RACE acronym?

Activate the facility's fire alarm system. (Correct answer)
Evacuate all other clients from the unit.
Contain the fire by closing the door to the room.
Extinguish the fire with the nearest fire extinguisher.

Correct answer: Activate the facility's fire alarm system.

The RACE acronym for fire safety stands for Rescue, Alarm, Contain, and Extinguish/Evacuate. After rescuing anyone in immediate danger, the next step is to activate the alarm to alert others and initiate an emergency response.

Question 31: An LPN is reinforcing dietary teaching for a client newly diagnosed with hypertension. Which statement by the client indicates an understanding of the DASH (Dietary Approaches to Stop Hypertension) diet?

"Salted nuts and pretzels are acceptable snacks in any quantity."
"I need to limit my sodium intake and eat more fruits and vegetables." (Correct answer)
"Canned soups and processed foods are good choices for quick meals."
"I should focus on increasing my intake of red meat and whole milk."

Correct answer: "I need to limit my sodium intake and eat more fruits and vegetables."

The DASH diet is a key component of managing hypertension. It emphasizes high intake of fruits, vegetables, and low-fat dairy products, while limiting sodium, saturated fats, and added sugars. The client's statement about limiting sodium and increasing fruits and vegetables correctly reflects the core principles of this eating plan.

Question 32: When caring for a client post-cardiac catheterization via the right femoral artery, which nursing action is the priority?

Encourage ambulation within 1 hour
Apply ice packs to the groin every 2 hours
Keep the right leg straight and assess the puncture site (Correct answer)
Restrict fluids to prevent fluid overload

Correct answer: Keep the right leg straight and assess the puncture site

After femoral artery catheterization, the priority is to maintain leg immobility and frequently assess the puncture site for bleeding, hematoma, or signs of arterial compromise.

Question 33: Which action by a nurse demonstrates correct use of sterile technique during a urinary catheter insertion?

Placing sterile supplies below the waist on the sterile field
Reaching across the sterile field to retrieve the catheter
Using the dominant hand for both sterile and non-sterile contact
Touching only the outside of the sterile drape to position it (Correct answer)

Correct answer: Touching only the outside of the sterile drape to position it

Only the outer 1-inch border of a sterile drape is considered unsterile; the nurse may touch only this border to position it.

Question 34: A neonate born at 38 weeks gestation has a Ballard score assessment. Which physical characteristic indicates greater gestational maturity?

Well-curved ear pinna with firm recoil (Correct answer)
Smooth skin with few creases on the soles
Widely separated labia majora
Abundant lanugo covering the body

Correct answer: Well-curved ear pinna with firm recoil

A well-curved ear pinna with firm, instant recoil indicates greater neuromuscular maturity associated with full-term gestation.

Question 35: A patient with HIV asks the nurse if other staff members need to know about their diagnosis. The nurse's best response is:

'We will post a sign on your door to alert staff.'
'Your diagnosis must be shared with all staff for safety reasons.'
'Only staff directly involved in your care who need to know will be informed.' (Correct answer)
'We keep all diagnoses completely private from all staff members.'

Correct answer: 'Only staff directly involved in your care who need to know will be informed.'

Confidentiality requires that patient health information be shared only on a need-to-know basis with those directly involved in providing care.

Question 36: A client with fibromyalgia asks about pain management strategies. The LPN should teach which non-pharmacological approach as the MOST evidence-based recommendation?

Complete bed rest to avoid muscle overuse and pain flares
Low-intensity aerobic exercise (walking, swimming) to improve pain and functioning (Correct answer)
Avoiding all social and work activities to minimize stress
Applying heat to all tender points for 6–8 hours daily

Correct answer: Low-intensity aerobic exercise (walking, swimming) to improve pain and functioning

Low-intensity aerobic exercise is the single most evidence-based non-pharmacological treatment for fibromyalgia, improving pain, fatigue, sleep, and mood over time.

Question 37: A 2-year-old is brought to the clinic after swallowing a coin. The child is asymptomatic, eating and drinking normally, and has no drooling or respiratory distress. The LPN anticipates:

Immediate surgery to prevent intestinal perforation
Inducing vomiting at home to remove the coin
X-ray confirmation of location; if in stomach, watchful waiting for spontaneous passage (Correct answer)
Emergency endoscopy to remove the coin before it causes damage

Correct answer: X-ray confirmation of location; if in stomach, watchful waiting for spontaneous passage

A coin in the stomach of an asymptomatic child will typically pass spontaneously through the GI tract within 2–4 days. Coins in the esophagus require endoscopic removal.

Question 38: When donning a sterile gown, the nurse should consider which areas of the gown to be sterile?

Only the front from chest to waist and the sleeves to 2 inches above the elbows (Correct answer)
The entire gown including the back and below the waist
The front chest panel and all four sides
The gown is sterile only until the nurse sits down

Correct answer: Only the front from chest to waist and the sleeves to 2 inches above the elbows

The sterile field on a gown is limited to the front from chest to waist and the sleeves from 2 inches above the elbows to the cuffs.

Question 39: A nurse finds a patient who has been in four-point restraints for 4 hours and has not been checked. What is the priority assessment?

Determine why the restraints were applied
Assess circulation, sensation, and skin integrity of restrained limbs (Correct answer)
Check whether a physician's order exists for the restraints
Document the time the restraints were last assessed

Correct answer: Assess circulation, sensation, and skin integrity of restrained limbs

Restraints can compromise circulation within minutes; assessing circulation, sensation, and skin integrity is the immediate safety priority.

Question 40: What is the correct sequence for removing PPE after caring for a patient on contact precautions?

Gown, gloves, mask, goggles
Goggles, mask, gown, gloves
Mask, gown, gloves, goggles
Gloves, goggles, gown, mask (Correct answer)

Correct answer: Gloves, goggles, gown, mask

CDC guidelines specify removing gloves first (most contaminated), then goggles, then gown, then mask to minimize self-contamination.

Question 41: When performing wound care, the nurse notes the patient's wound has purulent drainage and a foul odor. Which is the priority nursing action?

Document findings and continue with routine wound care
Notify the healthcare provider and obtain a wound culture (Correct answer)
Increase wound irrigation frequency
Apply a stronger antiseptic solution to the wound

Correct answer: Notify the healthcare provider and obtain a wound culture

Signs of wound infection require notifying the provider and obtaining a culture to identify the causative organism and guide treatment.

Question 42: A client in active labor has an epidural and her blood pressure drops from 122/78 to 88/52 mmHg. The fetal heart rate shows late decelerations. The LPN's priority intervention is to:

Stop the epidural infusion and wait for the blood pressure to stabilize
Administer IV ephedrine per protocol, turn to left lateral position, increase IV fluids, and apply oxygen (Correct answer)
Increase the epidural anesthetic rate to reduce maternal pain from hypotension
Lay the client flat and elevate her legs 90 degrees

Correct answer: Administer IV ephedrine per protocol, turn to left lateral position, increase IV fluids, and apply oxygen

Epidural-induced hypotension reduces uteroplacental perfusion (causing fetal late decelerations). Immediate treatment: left lateral position, IV fluids, oxygen, and ephedrine if BP remains low.

Question 43: A nurse is working in a community health clinic and wants to use secondary prevention strategies. Which activity BEST exemplifies secondary prevention?

Vaccinating children against measles
Screening adults for hypertension at a health fair (Correct answer)
Teaching teenagers about the dangers of substance abuse
Providing cardiac rehabilitation after a myocardial infarction

Correct answer: Screening adults for hypertension at a health fair

Secondary prevention involves early detection of disease in asymptomatic individuals; screening for hypertension identifies the condition before complications develop.

Question 44: The LPN is caring for a client with a new diagnosis of amyotrophic lateral sclerosis (ALS). Which nursing diagnosis takes the highest priority?

Risk for aspiration related to bulbar involvement (Correct answer)
Chronic pain related to muscle cramps
Impaired physical mobility related to muscle weakness
Ineffective coping related to terminal diagnosis

Correct answer: Risk for aspiration related to bulbar involvement

Bulbar involvement in ALS causes dysphagia and dysarthria, dramatically increasing aspiration risk, which can cause pneumonia — the most common immediate cause of death in ALS.

Question 45: A nurse is providing anticipatory guidance to parents of a 2-year-old. Which safety topic is MOST relevant at this developmental stage?

Driving safety and seatbelt use
Sports-related concussion awareness
Reproductive health education
Poisoning prevention and childproofing cabinets (Correct answer)

Correct answer: Poisoning prevention and childproofing cabinets

Toddlers are at high risk for accidental poisoning due to their exploratory nature; parents should secure all medications and chemicals out of reach.

Question 46: A nurse is using the CAGE questionnaire during a health assessment. Which topic is this tool designed to screen for?

Cognitive impairment
Domestic violence risk
Alcohol use disorder (Correct answer)
Depression and suicidal ideation

Correct answer: Alcohol use disorder

The CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener) is a validated four-question screening tool for alcohol use disorder.

Question 47: A patient prescribed amiodarone should have which organ system monitored regularly for toxicity?

Kidneys and bladder
Pancreas and adrenal glands
Skin and joints only
Lungs and thyroid (Correct answer)

Correct answer: Lungs and thyroid

Amiodarone can cause pulmonary toxicity (pulmonary fibrosis) and thyroid dysfunction (both hypo- and hyperthyroidism) with long-term use.

Question 48: An LPN is caring for a client who is scheduled for a colonoscopy. The client's preparation includes a polyethylene glycol solution. The LPN should monitor the client for which potential complication related to this bowel prep?

Hyperglycemia and increased urine output.
Hypertension and fluid overload.
Electrolyte imbalances and dehydration. (Correct answer)
Constipation and abdominal cramping.

Correct answer: Electrolyte imbalances and dehydration.

Polyethylene glycol solutions are osmotic laxatives that cause a large volume of liquid stool to clean the colon. This can lead to significant fluid and electrolyte losses, putting the client at risk for dehydration, hyponatremia, and hypokalemia. The LPN's role includes monitoring for signs of these imbalances, such as weakness, confusion, or cardiac dysrhythmias.

Question 49: A nurse receives a patient from the emergency department with methicillin-resistant Staphylococcus aureus (MRSA) in a wound. Which room assignment is most appropriate?

A semi-private room with another post-surgical patient
Any available room since MRSA requires only standard precautions
A private room or a room with another MRSA-positive patient (Correct answer)
A negative-pressure isolation room

Correct answer: A private room or a room with another MRSA-positive patient

MRSA requires contact precautions, ideally in a private room or cohorted with another MRSA-positive patient to prevent cross-transmission.

Question 50: A patient's telemetry shows a heart rate of 42 bpm with P waves before each QRS complex and regular rhythm. The LPN should first:

Administer atropine 0.5 mg IV per standing orders
Assess the patient for symptoms such as dizziness or hypotension (Correct answer)
Cardiovert the patient immediately
Document the rhythm and continue routine monitoring

Correct answer: Assess the patient for symptoms such as dizziness or hypotension

Before any intervention, the LPN must assess whether the bradycardia is causing symptoms, as asymptomatic sinus bradycardia may not require treatment.

Question 51: A patient with a peripheral IV complains of pain, and the nurse notices the infusion is not flowing well. The area is cool and pale with swelling. Which condition is present?

Phlebitis
Thrombosis
Air embolism
Infiltration (Correct answer)

Correct answer: Infiltration

Infiltration occurs when IV fluid leaks into surrounding tissue, causing coolness, pallor, swelling, and impaired flow.

Question 52: A family member asks the LPN not to tell the patient about a terminal diagnosis. How should the LPN respond?

Document the family's request and honor it
Agree to withhold the information to protect the patient
Tell the physician to keep the information from the patient
Explain that the patient has the right to know their own diagnosis (Correct answer)

Correct answer: Explain that the patient has the right to know their own diagnosis

Patients have the right to truthful information about their own health (veracity), and the LPN should explain this right while involving the care team.

Question 53: Which situation requires the nurse to use an N95 respirator rather than a standard surgical mask?

Entering the room of a patient with active tuberculosis (Correct answer)
Caring for a patient with MRSA wound infection
Changing the dressing of a patient with C. difficile
Providing care to a patient on droplet precautions for influenza

Correct answer: Entering the room of a patient with active tuberculosis

Active tuberculosis requires airborne precautions including a fit-tested N95 respirator because TB bacilli are transmitted via airborne droplet nuclei.

Question 54: Which environmental condition increases the risk of electrical injury to patients?

Having wet or moist skin when touching electrical equipment (Correct answer)
Operating equipment within its manufacturer-specified voltage
Using equipment inspected by biomedical engineering
Using a three-prong grounded plug

Correct answer: Having wet or moist skin when touching electrical equipment

Wet or moist skin dramatically lowers electrical resistance, increasing the risk of shock when contacting electrical equipment.

Question 55: A 52-year-old client with a healthy immune system asks the LPN which immunizations they should be considering. Based on current CDC recommendations, which vaccine is appropriate to recommend for this client?

Human Papillomavirus (HPV)
Varicella (chickenpox)
Recombinant zoster vaccine (Shingrix) for shingles (Correct answer)
Measles, Mumps, Rubella (MMR)

Correct answer: Recombinant zoster vaccine (Shingrix) for shingles

The Centers for Disease Control and Prevention (CDC) recommends that healthy adults receive the recombinant zoster vaccine (Shingrix) to prevent shingles beginning at age 50. The HPV vaccine is typically recommended for adolescents and young adults. The MMR and Varicella vaccines are usually administered in childhood, although catch-up doses may be needed in certain circumstances.

Question 56: After receiving a telephone order from a physician, what must the LPN do to ensure safety?

Read back the order to the physician for verification before documenting (Correct answer)
Wait until the physician arrives to document the order
Implement the order immediately without documentation
Ask the charge nurse to take the order instead

Correct answer: Read back the order to the physician for verification before documenting

Reading back telephone orders to the physician for verbal confirmation (read-back verification) is required to prevent transcription errors and ensure patient safety.

Question 57: A patient tells the LPN that the physical therapist gave instructions contradicting what the physician ordered. What should the LPN do first?

Tell the patient to follow the physician's orders
Contact the physical therapist to discuss the issue
Document the discrepancy and notify the charge nurse (Correct answer)
Ignore the comment since the PT and physician can resolve it

Correct answer: Document the discrepancy and notify the charge nurse

The LPN should document the discrepancy and notify the charge nurse so the care team can resolve the conflicting instructions through proper communication channels.

Question 58: A nurse is caring for a client with newly diagnosed hypertension who does not yet require medication. Which lifestyle modification should the nurse emphasize FIRST?

Limit fluid intake to 1 liter per day
Adopt the DASH diet and reduce sodium intake (Correct answer)
Begin a high-intensity exercise program immediately
Eliminate all caffeine permanently

Correct answer: Adopt the DASH diet and reduce sodium intake

The DASH (Dietary Approaches to Stop Hypertension) diet combined with sodium reduction is the most evidence-based first-line lifestyle intervention for hypertension.

Question 59: A nurse is providing education to a client about testicular self-examination (TSE). Which instruction is CORRECT?

TSE is only recommended for men over age 50
Perform TSE monthly, ideally after a warm shower (Correct answer)
Avoid TSE if any discomfort is felt
Perform TSE once a year during an annual physical exam

Correct answer: Perform TSE monthly, ideally after a warm shower

Monthly testicular self-examination after a warm shower (when the scrotum is relaxed) is recommended to detect changes early.

Question 60: A nurse is teaching a group of elderly clients about fall prevention at home. Which instruction is MOST appropriate?

Keep hallways dimly lit to avoid disturbing sleep
Wear loose slippers to keep feet comfortable
Remove throw rugs and secure electrical cords (Correct answer)
Avoid using handrails to build leg strength

Correct answer: Remove throw rugs and secure electrical cords

Removing throw rugs and securing cords eliminates common tripping hazards, which is a key evidence-based fall prevention strategy for older adults.

Question 61: An LPN is caring for a client with a new colostomy. The client is refusing to look at the stoma or participate in its care. The LPN's most therapeutic response is:

"I will just change the bag for you so you don't have to deal with it."
"I understand this is a difficult change. I am here to help you when you are ready." (Correct answer)
"It's important to look at it to make sure it's healthy."
"You will have to learn to take care of this eventually."

Correct answer: "I understand this is a difficult change. I am here to help you when you are ready."

This response acknowledges the client's feelings and offers support without being demanding or dismissive. It validates their emotional response to a significant body image change and opens the door for future teaching and participation when the client is emotionally prepared.

Question 62: A patient on contact precautions needs to be transported to radiology. Which action is most appropriate before transport?

Remove all PPE before leaving the room
Cancel the transport until precautions are lifted
Notify the receiving department of precaution status (Correct answer)
Place the patient in a negative-pressure room

Correct answer: Notify the receiving department of precaution status

The receiving department must be notified so they can prepare appropriate isolation measures before the patient arrives.

Question 63: A client with coronary artery disease is experiencing chest pain at rest rated 7/10. The LPN's first action should be:

Administer PRN nitroglycerin sublingually
Assess vital signs and oxygen saturation (Correct answer)
Obtain a 12-lead ECG
Notify the charge nurse immediately

Correct answer: Assess vital signs and oxygen saturation

The first nursing action when a client reports chest pain is a rapid assessment: vital signs, oxygen saturation, and pain characteristics to determine the urgency and inform the team.

Question 64: A patient with anorexia nervosa refuses to eat, saying, 'I look fat even though everyone says I don't.' This distorted body image is best described as:

A cognitive distortion (Correct answer)
A hallucination
An obsession
A delusion of reference

Correct answer: A cognitive distortion

Distorted body image in anorexia is a cognitive distortion where perception of one's body does not match reality.

Question 65: The nurse is preparing to administer an intramuscular injection. To prevent a needlestick injury after the injection, what is the most important action for the nurse to take?

Ask the client to hold pressure on the injection site while the nurse disposes of the needle.
Place the used syringe on the bedside table before disposal.
Recap the needle using the two-handed method.
Activate the needle's safety device immediately after use. (Correct answer)

Correct answer: Activate the needle's safety device immediately after use.

To prevent needlestick injuries, the safety device on the needle should be activated immediately after administering the injection. Used needles should never be recapped and should be disposed of promptly in a designated sharps container.

Question 66: An LPN is floated to a unit and given an assignment involving skills outside their competency. The LPN should:

Ask a colleague to demonstrate the skill once and then proceed
Inform the charge nurse of the competency gap before accepting the assignment (Correct answer)
Refuse the entire assignment and go home
Perform the skills to the best of their ability without mentioning concerns

Correct answer: Inform the charge nurse of the competency gap before accepting the assignment

LPNs are obligated to communicate competency limitations to leadership before accepting assignments that exceed their skill set.

Question 67: A patient is taking lisinopril and develops a persistent dry cough. The LPN should recognize this as which type of reaction?

Toxic drug reaction requiring dialysis
Sign of pulmonary edema
Allergic reaction requiring epinephrine
Common adverse effect of ACE inhibitors (Correct answer)

Correct answer: Common adverse effect of ACE inhibitors

A persistent dry cough is a well-known adverse effect of ACE inhibitors caused by bradykinin accumulation.

Question 68: A nurse is caring for a patient with scabies. Which type of precautions is required?

Droplet precautions
Contact precautions (Correct answer)
Standard precautions only
Airborne precautions

Correct answer: Contact precautions

Scabies is transmitted by direct skin-to-skin contact, requiring contact precautions including gloves and gown.

Question 69: Which needle disposal practice is correct for an LPN?

Bend the needle before placing it in a regular trash bin
Recap the needle using the two-handed technique before disposal
Recap using one hand if the patient is combative
Place uncapped needles directly into a puncture-resistant sharps container (Correct answer)

Correct answer: Place uncapped needles directly into a puncture-resistant sharps container

Uncapped needles should be immediately placed into an approved puncture-resistant sharps container to prevent needlestick injuries.

Question 70: A nurse observes a colleague reusing a single-use vial of insulin for multiple patients. The appropriate action is to:

Document the observation and wait for the next staff meeting
Discuss the concern with the colleague privately and monitor for change
Report the unsafe practice to the charge nurse immediately (Correct answer)
Ignore it since insulin is not a bloodborne pathogen

Correct answer: Report the unsafe practice to the charge nurse immediately

Single-use vials used on multiple patients create a bloodborne pathogen transmission risk and must be reported immediately to prevent patient harm.

Question 71: Why is cultural competence important in nursing?

To respect and understand cultural diversity and provide appropriate care (Correct answer)
To make patients comfortable
To enforce hospital rules
To reduce medical costs

Correct answer: To respect and understand cultural diversity and provide appropriate care

Cultural competence is essential in nursing because it enables nurses to respect and understand the diverse cultural beliefs, values, and practices of their patients. This understanding allows for the provision of culturally appropriate and sensitive care, which improves patient satisfaction, adherence to treatment, and overall health outcomes. By acknowledging and integrating cultural differences, nurses can deliver more effective and personalized care that honors each patient's unique background.

Question 72: A licensed practical nurse (LPN) is preparing to enter the room of a client diagnosed with pulmonary tuberculosis. Which combination of personal protective equipment (PPE) is essential for the nurse to don before providing care?

Gown, gloves, and face shield
Gown and surgical mask
N95 respirator and gloves (Correct answer)
Surgical mask and gloves

Correct answer: N95 respirator and gloves

Pulmonary tuberculosis requires airborne precautions. The essential PPE for airborne precautions includes a fit-tested N95 respirator to prevent inhalation of small airborne particles. Gloves are also necessary as part of standard precautions when contact with bodily fluids is possible.

Question 73: An LPN is caring for an elderly client who is confused and has been trying to get out of bed without assistance. After attempting alternative measures without success, the provider orders soft wrist restraints. Which of the following actions is a critical safety measure for the nurse to implement?

Check the client's circulation and skin integrity every 4 hours.
Secure the restraint ties to the side rails of the bed.
Ensure the restraints are applied tightly to prevent any movement.
Use a quick-release knot to secure the restraints to the bed frame. (Correct answer)

Correct answer: Use a quick-release knot to secure the restraints to the bed frame.

When using restraints, it is crucial to secure them to a part of the bed frame that moves with the client to avoid injury. A quick-release knot must be used to allow for rapid removal in an emergency. Restraints should never be tied to side rails. Circulation and skin checks should be performed much more frequently, typically every 1-2 hours, and the restraint should be snug but not tight.

Question 74: A nurse is preparing to administer a high-alert medication. Which safety practice is most critical?

Performing an independent double-check with another nurse (Correct answer)
Checking the medication color before administration
Preparing the medication at the bedside
Administering the medication before charting

Correct answer: Performing an independent double-check with another nurse

High-alert medications require an independent double-check by a second nurse to reduce the risk of serious patient harm.

Question 75: A patient returns from surgery for an open reduction internal fixation (ORIF) of a femur fracture. Which assessment finding requires the most immediate nursing action?

Slight swelling around the surgical site
Temperature of 37.8°C on postoperative day 1
Mild incisional pain rated 4/10
Capillary refill of 4 seconds in the affected foot (Correct answer)

Correct answer: Capillary refill of 4 seconds in the affected foot

Capillary refill greater than 3 seconds indicates impaired perfusion, which is a sign of neurovascular compromise requiring immediate intervention.

Question 76: A toddler undergoing hospitalization is most likely to experience which type of stress according to developmental theory?

Loss of control over school performance
Fear of body mutilation
Fear of death
Separation anxiety (Correct answer)

Correct answer: Separation anxiety

Separation anxiety is the dominant stressor for toddlers (1–3 years) because they are strongly attached to caregivers.

Question 77: Which patient behavior indicates the nurse's teaching about home infection prevention was effective?

'I will skip handwashing if I use examination gloves during wound care.'
'I will reuse my lancets to save money as long as I clean them with rubbing alcohol.'
'I will wash my hands before and after checking my blood sugar.' (Correct answer)
'I will share my nasal spray with family members if they get a cold.'

Correct answer: 'I will wash my hands before and after checking my blood sugar.'

Washing hands before and after blood glucose monitoring prevents infection at the puncture site and stops the spread of bloodborne pathogens.

Question 78: A nurse discovers that a medication error occurred on the previous shift. What is the priority action?

Identify and confront the nurse who made the error
Report the error to the state nursing board immediately
Document the error in the patient's medical record only
Assess the patient for adverse effects and notify the provider (Correct answer)

Correct answer: Assess the patient for adverse effects and notify the provider

Patient safety is the immediate priority; the nurse must assess for harm and notify the provider so treatment can be initiated if needed.

Question 79: The LPN is providing perineal care to a female client with an indwelling urinary catheter. What is the most important technique to use to prevent infection?

Cleansing the perineal area from front to back (urinary meatus to rectum). (Correct answer)
Cleaning from the rectum towards the urinary meatus.
Washing the catheter tubing towards the body.
Using strong, circular motions around the meatus.

Correct answer: Cleansing the perineal area from front to back (urinary meatus to rectum).

To prevent introducing bacteria from the rectal area into the urinary tract, it is crucial to clean from the area of least contamination (urinary meatus) to the area of most contamination (rectum). This front-to-back technique is a fundamental principle of infection control during perineal care.

Question 80: When caring for a client with a suspected ectopic pregnancy presenting with sharp right lower quadrant pain, vaginal spotting, and a positive pregnancy test, the LPN's priority is:

Prepare the client for a pelvic exam in the LPN's scope of practice
Monitor vital signs closely and report signs of shock to the charge nurse (Correct answer)
Administer oral analgesics and discharge with follow-up instructions
Schedule an outpatient ultrasound for the following week

Correct answer: Monitor vital signs closely and report signs of shock to the charge nurse

Ruptured ectopic pregnancy can cause life-threatening intraabdominal hemorrhage and hypovolemic shock. The LPN must monitor vital signs and report deterioration immediately.

Question 81: A patient is admitted with a suspected herniated lumbar disc at L4-L5. Which finding is most consistent with this diagnosis?

Bilateral arm weakness and neck pain
Hyperreflexia in the lower extremities
Bladder and bowel incontinence as the only symptoms
Positive straight-leg raise test with radiating pain down the leg (Correct answer)

Correct answer: Positive straight-leg raise test with radiating pain down the leg

A positive straight-leg raise test (pain radiating below the knee when the leg is raised) is a classic sign of lumbar disc herniation compressing a nerve root.

Question 82: A nurse is providing education about cervical cancer prevention to a group of adolescent females. Which statement about the HPV vaccine is ACCURATE?

The HPV vaccine treats existing HPV infections
The HPV vaccine is recommended for females only, starting at age 18
The HPV vaccine requires only one dose for full protection
The HPV vaccine is most effective when given before sexual activity begins, ideally at ages 11–12 (Correct answer)

Correct answer: The HPV vaccine is most effective when given before sexual activity begins, ideally at ages 11–12

The HPV vaccine series is most effective when administered before exposure to HPV, with routine vaccination recommended at ages 11–12 for both males and females.

Question 83: A nurse is performing a developmental screening on a 6-month-old infant. Which finding is EXPECTED at this age?

Pincer grasp well-established
Walking with support
Rolling from back to front and sitting with support (Correct answer)
Saying 'mama' and 'dada' with meaning

Correct answer: Rolling from back to front and sitting with support

At 6 months, infants typically roll over in both directions and can sit with support; independent sitting and pincer grasp develop later.

Question 84: A 7-year-old child with asthma is using a metered-dose inhaler (MDI) with a spacer. The LPN evaluates that the child is using the device correctly when the child:

Rapidly exhales after actuation to clear the medication from the lungs
Shakes the inhaler, actuates while inhaling slowly and deeply, and holds the breath for 10 seconds (Correct answer)
Takes rapid shallow breaths after pressing the canister to distribute the medication
Holds the inhaler 2 inches from the mouth without a spacer

Correct answer: Shakes the inhaler, actuates while inhaling slowly and deeply, and holds the breath for 10 seconds

Correct MDI technique requires shaking the inhaler, coordinating slow deep inhalation with actuation, and breath-holding for 10 seconds to maximize medication deposition in the airways.

NCLEX-PN (National Council Licensure Examination for Practical Nurses)

The NCLEX-PN is a standardized exam that determines if a candidate is prepared for entry-level practical/vocational nursing practice.

Questions

300 min

Time Limit

50%

To Pass

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