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

Question 1: What is a PRN medication?

A medication given only at bedtime
A mandatory daily medication
A medication given as needed based on patient symptoms rather than on a fixed schedule (Correct answer)
An over-the-counter supplement

Correct answer: A medication given as needed based on patient symptoms rather than on a fixed schedule

PRN medications require assessment of the patient's need and documentation of the indication and response.

Question 2: Which statement by a patient who attempted suicide MOST indicates a continued high risk and should be reported immediately to the charge nurse?

'I've already figured out another way to do it next time.' (Correct answer)
'I feel embarrassed that I ended up here.'
'I'm glad someone found me in time.'
'I don't think my family will ever forgive me.'

Correct answer: 'I've already figured out another way to do it next time.'

Verbalization of a specific alternate plan indicates active suicidal ideation with intent, which represents the highest level of immediate risk. This requires urgent reporting and likely a one-to-one safety watch or transfer to a higher level of psychiatric care.

Question 3: A patient who had abdominal surgery 2 days ago reports discomfort and has not passed flatus. The LVN should first:

Begin a full liquid diet
Encourage ambulation (Correct answer)
Administer a suppository
Insert a nasogastric tube

Correct answer: Encourage ambulation

Ambulation is the most effective first-line nursing intervention to stimulate peristalsis and resolve post-operative ileus.

Question 4: A physician's written order is illegible. What is the most appropriate action for the LVN?

Call the physician to clarify the order before proceeding (Correct answer)
Contact the pharmacy to interpret the order
Interpret the order based on context and carry it out
Skip the order and document it as unreadable

Correct answer: Call the physician to clarify the order before proceeding

The LVN must contact the prescriber directly to clarify any illegible or unclear orders before carrying them out.

Question 5: A nurse is caring for a 3-year-old with epiglottitis. Which action should the nurse avoid?

Examining the throat with a tongue blade (Correct answer)
Allowing the child to sit upright in a position of comfort
Administering prescribed IV antibiotics
Keeping emergency intubation equipment at bedside

Correct answer: Examining the throat with a tongue blade

Examining the throat with a tongue blade in suspected epiglottitis can precipitate complete airway obstruction and is absolutely contraindicated.

Question 6: What factors impair wound healing?

Poor nutrition, diabetes, smoking, infection, medications like steroids, and inadequate blood supply (Correct answer)
Nothing impairs healing
Only age affects healing
Only infection impairs healing

Correct answer: Poor nutrition, diabetes, smoking, infection, medications like steroids, and inadequate blood supply

Multiple patient factors can slow or prevent wound healing, requiring identification and management.

Question 7: A patient who recently lost their job begins exercising daily and channeling energy into volunteer work. The nurse identifies this coping mechanism as:

Repression
Reaction formation
Sublimation (Correct answer)
Denial

Correct answer: Sublimation

Sublimation is a mature defense mechanism in which unacceptable impulses are redirected into socially acceptable activities.

Question 8: When using military time in documentation, which correctly represents 9:45 PM?

1945
2045
2145 (Correct answer)
0945

Correct answer: 2145

Military time adds 12 hours to PM times: 9 PM + 12 = 21, so 9:45 PM = 2145.

Question 9: A nurse is caring for a patient who recently lost a limb. The patient states, 'I don't need to talk to anyone — I'm fine.' Which coping mechanism is the patient most likely demonstrating?

Rationalization
Suppression (Correct answer)
Regression
Intellectualization

Correct answer: Suppression

Suppression is the conscious decision to push distressing thoughts or feelings out of awareness. The patient is actively choosing not to discuss or acknowledge emotional distress, which distinguishes suppression from the unconscious mechanism of repression.

Question 10: The SBAR communication tool stands for which of the following?

Status, Background, Assessment, Report
Situation, Brief, Analysis, Response
Situation, Background, Assessment, Recommendation (Correct answer)
Subject, Brief, Action, Result

Correct answer: Situation, Background, Assessment, Recommendation

SBAR stands for Situation, Background, Assessment, Recommendation — a structured format for clinical handoffs and escalations.

Question 11: What is the difference between subjective and objective data?

Subjective is what the patient reports; objective is what can be measured or observed (Correct answer)
Only objective data matters
They are the same
Only subjective data is documented

Correct answer: Subjective is what the patient reports; objective is what can be measured or observed

Subjective data comes from the patient (symptoms, feelings); objective data is measurable (vital signs, lab results, physical exam findings).

Question 12: When measuring a wound for documentation, how should the LVN correctly record wound dimensions?

Length × Width × Depth (using clock positions: 12 o'clock = head) (Correct answer)
Diameter measured at the widest point only
Circumference and depth only
Width × Depth only

Correct answer: Length × Width × Depth (using clock positions: 12 o'clock = head)

Standard wound documentation uses length (head-to-toe, 12–6 o'clock) × width (side-to-side, 3–9 o'clock) × depth in centimeters.

Question 13: The nurse is preparing to insert a peripheral IV. Which action best reduces the risk of catheter-related bloodstream infection (CRBSI)?

Applying petroleum-based ointment to the insertion site
Scrubbing the insertion site with chlorhexidine and allowing it to dry (Correct answer)
Changing IV tubing every 24 hours regardless of use
Using a larger-gauge catheter for faster flow

Correct answer: Scrubbing the insertion site with chlorhexidine and allowing it to dry

Skin antisepsis with >0.5% chlorhexidine in alcohol, allowed to fully dry, is the evidence-based standard for vascular access site prep.

Question 14: Standard precautions apply to:

Respiratory secretions only
Only patients with known infections
Patients in private rooms only
Blood, body fluids, non-intact skin, and mucous membranes of all patients (Correct answer)

Correct answer: Blood, body fluids, non-intact skin, and mucous membranes of all patients

Standard precautions treat all patients as potentially infectious and apply to blood, all body fluids, non-intact skin, and mucous membranes.

Question 15: Which organism is the primary cause of healthcare-associated MRSA infections?

Staphylococcus aureus (Correct answer)
Enterococcus faecalis
Streptococcus pyogenes
Staphylococcus epidermidis

Correct answer: Staphylococcus aureus

MRSA stands for methicillin-resistant Staphylococcus aureus, a common healthcare-associated pathogen.

Question 16: What is the scope of practice for an LVN?

Performing basic nursing care under the supervision of an RN or physician, as defined by state law (Correct answer)
Performing surgery
Prescribing medications
Independent practice without supervision

Correct answer: Performing basic nursing care under the supervision of an RN or physician, as defined by state law

LVNs provide direct patient care within legally defined boundaries under the supervision of licensed practitioners.

Question 17: Which condition requires contact AND airborne precautions simultaneously?

Varicella (chickenpox) (Correct answer)
Influenza
Clostridioides difficile colitis
MRSA wound infection

Correct answer: Varicella (chickenpox)

Varicella requires both airborne precautions (aerosolized virus) and contact precautions (skin lesions).

Question 18: An LVN notices that a patient diagnosed with schizophrenia is pacing, clenching their fists, and speaking rapidly. Which nursing action should the LVN take FIRST?

Escort the patient to a quiet, low-stimulation environment (Correct answer)
Document the behavior and notify the charge nurse
Ask the patient to explain what they are feeling
Administer the patient's scheduled antipsychotic medication

Correct answer: Escort the patient to a quiet, low-stimulation environment

Safety is the priority when a patient shows signs of escalating agitation. Moving the patient to a calm, low-stimulation environment can de-escalate the situation before it becomes dangerous, and is a non-pharmacological first-line intervention.

Question 19: An LVN is caring for a client with C. difficile (C. diff). Which hand hygiene method is most appropriate?

Antiseptic wipes
Soap and water handwashing (Correct answer)
Either soap or alcohol-based hand rub is equally effective
Alcohol-based hand rub

Correct answer: Soap and water handwashing

Alcohol-based hand rubs are not effective against C. difficile spores; soap and water must be used.

Question 20: The LVN enters a room and finds a patient unresponsive. After calling for help and activating the emergency response system, what is the next step?

Perform a head-tilt chin-lift
Begin rescue breathing
Apply the AED immediately
Check for a carotid pulse for up to 10 seconds (Correct answer)

Correct answer: Check for a carotid pulse for up to 10 seconds

After activating the emergency response, the next step per basic life support protocol is to check for a carotid pulse for no more than 10 seconds.

Question 21: When assessing skin turgor in an older adult patient suspected of dehydration, the nurse should test skin on which body area for the most accurate result?

Abdomen
Back of the hand
Sternum or clavicle area (Correct answer)
Forearm

Correct answer: Sternum or clavicle area

In older adults, skin over the sternum or clavicle is most reliable for turgor assessment because age-related loss of skin elasticity makes hand/forearm results unreliable.

Question 22: A patient is diagnosed with scabies. The nurse should initiate which type of precautions?

Airborne precautions
Droplet precautions
Protective/reverse isolation
Contact precautions (Correct answer)

Correct answer: Contact precautions

Scabies mites are transmitted by direct skin-to-skin contact, so contact precautions are required.

Question 23: Which statement by a patient with generalized anxiety disorder (GAD) indicates a need for further education?

"I drink a glass of wine every night to help me relax before bed." (Correct answer)
"I take my lorazepam (Ativan) as needed when I feel very anxious."
"I try to avoid caffeine and nicotine to reduce my anxiety."
"I find it helpful to exercise regularly to manage my stress."

Correct answer: "I drink a glass of wine every night to help me relax before bed."

Drinking alcohol to relax before bed indicates a need for further education for a patient with generalized anxiety disorder (GAD). While alcohol may provide temporary relief, it is a central nervous system depressant that can worsen anxiety in the long run, disrupt sleep patterns, and lead to dependence. This coping mechanism is maladaptive and counterproductive for managing anxiety effectively.

Question 24: The LVN made a documentation error in a paper chart. What is the correct way to correct it?

Erase the error completely and rewrite
Tear out the page and rewrite the entry
Use correction fluid (white-out) to cover the error
Draw a single line through the error, write 'error,' initial, and date it (Correct answer)

Correct answer: Draw a single line through the error, write 'error,' initial, and date it

The correct method is a single line through the error with 'error,' the nurse's initials, and date — never obliterate original entries.

Question 25: Which behavior indicates a patient is maintaining appropriate therapeutic boundaries with the nurse?

Asking the nurse to be their friend on social media
Offering the nurse a monetary gift as a thank-you
Sharing personal problems with the nurse to get advice
Discussing only care-related concerns during interactions (Correct answer)

Correct answer: Discussing only care-related concerns during interactions

Therapeutic relationships remain focused on the patient's health needs; socializing, gifts, and personal advice fall outside professional boundaries.

Question 26: An LVN is caring for a patient in contact precautions. In what order should PPE be donned before entering the room?

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

Correct answer: Gown, mask, goggles, gloves

The correct donning order for full PPE is gown first, then mask/respirator, then goggles/face shield, then gloves last.

Question 27: A patient with alcohol use disorder is admitted for detoxification. The nurse understands that the priority during detoxification is to:

Administer benzodiazepines as needed for withdrawal symptoms
Encourage the patient to attend Alcoholics Anonymous (AA) meetings daily
Provide group therapy sessions to explore underlying issues
Monitor for signs of delirium tremens (DTs) and manage symptoms (Correct answer)

Correct answer: Monitor for signs of delirium tremens (DTs) and manage symptoms

During alcohol detoxification, the absolute priority is to monitor for and manage signs of delirium tremens (DTs). DTs are the most severe and life-threatening manifestation of alcohol withdrawal, characterized by severe agitation, hallucinations, seizures, and autonomic instability. Prompt recognition and intervention are crucial to prevent serious complications and ensure patient safety.

Question 28: A patient has a fluid restriction of 1,200 mL/day. How should the nurse distribute fluid intake?

Give the majority at night for comfort
Distribute evenly across three shifts (Correct answer)
Give all fluids with meals only
Allow patient to self-manage without guidance

Correct answer: Distribute evenly across three shifts

Distributing fluids evenly across shifts (e.g., 600 mL days, 400 mL evenings, 200 mL nights) prevents both excessive thirst and fluid overload.

Question 29: A patient refuses a prescribed medication. How should the LVN document this?

Administer the medication anyway and document compliance
Document 'refused' with the reason stated by the patient and notify the charge nurse (Correct answer)
Only notify the physician and skip charting the refusal
Leave the medication administration record blank

Correct answer: Document 'refused' with the reason stated by the patient and notify the charge nurse

Medication refusals must be documented with the patient's stated reason, and the charge nurse and physician should be notified.

Question 30: An elderly patient presents with unexplained bruising in various stages of healing and appears fearful when their caregiver enters the room. The nurse's FIRST action is to:

Reassure the patient that everything will be fine and continue the assessment
Confront the caregiver directly and ask if they are harming the patient
Document the findings and report to the charge nurse only at the end of the shift
Report suspected elder abuse to adult protective services (Correct answer)

Correct answer: Report suspected elder abuse to adult protective services

LVNs are mandatory reporters; suspected elder abuse must be reported immediately to the appropriate authority.

Question 31: An older adult patient in a long-term care facility repeatedly refuses to participate in activities and states, 'What's the point? Nobody visits me anyway.' The LVN should identify this patient as being at risk for which psychosocial problem?

Ineffective denial
Acute confusion
Risk for self-directed violence
Social isolation (Correct answer)

Correct answer: Social isolation

The patient's statements about lack of visitors, withdrawal from activities, and a sense of hopelessness are classic indicators of social isolation. This nursing diagnosis reflects a perceived or actual aloneness that the patient experiences as negative, and is especially common in long-term care settings.

Question 32: Which of the following is NOT appropriate to include in an incident report?

Opinion about whose fault the incident was (Correct answer)
Time and location of the incident
Names of witnesses
Description of what was observed

Correct answer: Opinion about whose fault the incident was

Incident reports should contain factual information only — opinions, blame, or assumptions about fault are inappropriate and potentially harmful.

Question 33: Which of the following reusable medical equipment requires high-level disinfection (HLD) before reuse?

Stethoscopes
Blood pressure cuffs
Flexible endoscopes (Correct answer)
Over-bed tables

Correct answer: Flexible endoscopes

Flexible endoscopes contact mucous membranes and are classified as semi-critical devices requiring high-level disinfection per the Spaulding classification.

Question 34: What is therapeutic communication?

Talking about sports
Small talk with patients
Sharing personal stories
Patient-centered communication techniques that promote understanding, trust, and emotional support (Correct answer)

Correct answer: Patient-centered communication techniques that promote understanding, trust, and emotional support

Therapeutic communication uses active listening, open-ended questions, empathy, and reflection to support patients emotionally.

Question 35: Which vitamin deficiency is most directly associated with night blindness?

Vitamin B1
Vitamin C
Vitamin D
Vitamin A (Correct answer)

Correct answer: Vitamin A

Vitamin A is essential for the synthesis of rhodopsin in retinal rods; deficiency impairs vision in low-light conditions.

Question 36: What is a healthcare-associated infection (HAI)?

A pre-existing condition
A community-acquired illness
An infection acquired during the course of receiving healthcare treatment (Correct answer)
An infection from home

Correct answer: An infection acquired during the course of receiving healthcare treatment

HAIs occur during healthcare delivery and were not present at admission, representing a significant patient safety concern.

Question 37: What is the nurse's role in patient confidentiality?

Only doctors handle confidentiality
Confidentiality is optional
Protecting patient information from unauthorized disclosure as required by law and professional ethics (Correct answer)
Sharing information with anyone who asks

Correct answer: Protecting patient information from unauthorized disclosure as required by law and professional ethics

Nurses must safeguard patient information, sharing it only with authorized individuals for legitimate care purposes.

Question 38: Which of the following is the most common reservoir for healthcare-associated infections?

Hospital ventilation systems
Medical equipment
The hands of healthcare workers (Correct answer)
Contaminated food trays

Correct answer: The hands of healthcare workers

Contaminated healthcare worker hands are the most frequent vehicle for HAI transmission.

Question 39: Which of the 'rights' of medication administration refers to ensuring the patient swallows an oral pill rather than stores it?

Right dose
Right route
Right response
Right technique (Correct answer)

Correct answer: Right technique

Right technique includes ensuring the patient actually ingests the medication and does not 'cheek' or hoard it.

Question 40: A patient's MAR shows warfarin 5 mg PO daily. The patient's INR today is 4.8. The LVN should:

Hold the dose and notify the provider (Correct answer)
Double the dose to compensate
Administer the dose as ordered
Administer half the dose

Correct answer: Hold the dose and notify the provider

An INR of 4.8 is supratherapeutic and indicates a high bleeding risk; the dose should be held and the provider notified for further orders.

Question 41: Which description best defines late decelerations on an electronic fetal monitor tracing?

FHR decreases beginning after the peak of a contraction and recovering after the contraction ends (Correct answer)
FHR decreases at the onset of a contraction and returns to baseline at the contraction's end
Abrupt FHR decreases unrelated to contractions
FHR decreases that mirror contractions with no lag time

Correct answer: FHR decreases beginning after the peak of a contraction and recovering after the contraction ends

Late decelerations are gradual FHR decreases that begin after the acme of a contraction and return to baseline after the contraction ends, signaling uteroplacental insufficiency.

Question 42: A nurse is caring for an infant with pyloric stenosis post-pyloromyotomy. Which feeding approach is appropriate?

Gradual introduction of small, frequent feedings starting with clear liquids or formula (Correct answer)
NPO for 72 hours post-operatively
High-concentration formula to compensate for prior malnutrition
Large bolus feedings to assess tolerance

Correct answer: Gradual introduction of small, frequent feedings starting with clear liquids or formula

After pyloromyotomy, feedings are reintroduced gradually, starting with small, frequent amounts of clear liquids then advancing to formula/breast milk.

Question 43: Which documentation entry is correct after administering a medication?

Document immediately after administration, including time, dose, route, and patient response (Correct answer)
Documentation is optional if no adverse effects occurred
Document the medication before administration to save time
Document only if the patient refused the medication

Correct answer: Document immediately after administration, including time, dose, route, and patient response

Medication documentation must occur immediately after administration and include all relevant details to ensure accurate and legal records.

Question 44: What is the purpose of a wound culture?

To grow bacteria for research
To test wound dressing effectiveness
To identify the specific microorganisms causing infection and determine appropriate antibiotic treatment (Correct answer)
To measure wound size

Correct answer: To identify the specific microorganisms causing infection and determine appropriate antibiotic treatment

Wound cultures identify the causative organism and its antibiotic sensitivities, guiding targeted treatment.

Question 45: A patient with borderline personality disorder (BPD) exhibits splitting behavior. The nurse understands this behavior involves:

Severe mood swings and agitation
Confusion and disorientation
Impulsivity and risk-taking behaviors
Switching between extremes of idealization and devaluation (Correct answer)

Correct answer: Switching between extremes of idealization and devaluation

Splitting is a defense mechanism commonly seen in borderline personality disorder (BPD). It involves the inability to integrate positive and negative qualities of oneself or others into a cohesive whole. As a result, individuals with BPD perceive people or situations in extreme, all-good or all-bad terms, rapidly shifting between idealization and devaluation.

Question 46: The minimum necessary standard under HIPAA means that an LVN should:

Avoid documenting sensitive information to minimize exposure
Only access and share the amount of PHI needed to accomplish the specific task (Correct answer)
Access all available patient data to be thorough
Print all records when communicating with other providers

Correct answer: Only access and share the amount of PHI needed to accomplish the specific task

The minimum necessary standard requires that only the PHI required for a specific purpose be accessed, used, or disclosed.

Question 47: A patient admitted for alcohol detoxification is most at risk for life-threatening seizures during which time frame?

4–7 days after last drink
Immediately upon admission
24–72 hours after last drink (Correct answer)
6–24 hours after last drink

Correct answer: 24–72 hours after last drink

Alcohol withdrawal seizures most commonly occur 24–72 hours after the last drink and can be life-threatening without treatment.

Question 48: A client has been placed in contact precautions. Which PPE must the LVN don before entering the room?

Gown, gloves, and N95 respirator
Gloves only
Gown and gloves (Correct answer)
Mask and goggles only

Correct answer: Gown and gloves

Contact precautions require a gown and gloves to prevent transmission of organisms spread by direct or indirect contact.

Question 49: A competent adult client refuses a blood transfusion based on religious beliefs. The LVN should:

Administer the transfusion since it is life-saving
Respect the refusal, document it, and notify the physician (Correct answer)
Ask family members to convince the client to accept treatment
Contact the ethics committee immediately to overrule the refusal

Correct answer: Respect the refusal, document it, and notify the physician

Competent adults have the legal right to refuse any treatment; the LVN must document the refusal and notify the care team.

Question 50: A patient has 3+ pitting edema. When the nurse presses on the ankle, the indentation:

Is 6 mm deep and takes up to 1 minute to rebound (Correct answer)
Disappears immediately
Is greater than 8 mm deep and takes over 2 minutes to rebound
Is 2 mm deep and rebounds in under 15 seconds

Correct answer: Is 6 mm deep and takes up to 1 minute to rebound

3+ pitting edema produces a 6 mm indentation that takes 30–60 seconds to rebound, indicating significant fluid accumulation.

Question 51: An LVN notices a pattern of a patient's blood pressure readings trending upward over several shifts. The most appropriate communication action is to:

Continue monitoring and report at the end of the week
Notify the charge nurse and document the trend and notification (Correct answer)
Document only in the flow sheet and say nothing
Wait for the physician to review the chart independently

Correct answer: Notify the charge nurse and document the trend and notification

Trending vital signs that may indicate deterioration must be reported promptly to the charge nurse, with documentation of the pattern and the communication.

Question 52: The nurse is calculating fluid maintenance for a 20 kg child using the Holliday-Segar method. What is the correct 24-hour fluid requirement?

1500 mL
1000 mL
1600 mL (Correct answer)
2000 mL

Correct answer: 1600 mL

Using Holliday-Segar: 100 mL/kg for the first 10 kg + 50 mL/kg for the next 10 kg = 1000 + 600 = 1600 mL/24 hours.

Question 53: A patient on a psychiatric unit is found hoarding medications in their pillowcase. The LVN's FIRST action is?

Report the finding at the end of the shift during handoff.
Document the finding and continue monitoring.
Ask the patient to explain why they are hoarding them.
Confiscate the medications and notify the RN immediately. (Correct answer)

Correct answer: Confiscate the medications and notify the RN immediately.

Medication hoarding is a patient safety emergency that requires immediate removal of the medications and RN notification.

Question 54: Wound dehiscence is BEST described as:

Formation of a sinus tract connecting to an internal cavity
Protrusion of abdominal organs through an open wound
Partial or complete separation of wound edges after surgical closure (Correct answer)
Tunneling of infection into deeper tissue planes

Correct answer: Partial or complete separation of wound edges after surgical closure

Dehiscence is the partial or complete separation (opening) of previously approximated wound edges.

Question 55: When teaching a patient about wound care at home, the LVN should instruct the patient to report which sign of infection to the provider?

Mild pink coloration of the wound edges in the first 24–48 hours
Slight scabbing along the wound edges after day 3
Itching around the healing wound after 1 week
Increasing redness, swelling, warmth, or pus draining from the wound (Correct answer)

Correct answer: Increasing redness, swelling, warmth, or pus draining from the wound

Increasing redness, warmth, swelling, and purulent drainage are classic signs of infection that require prompt provider notification.

Question 56: A nurse working in a hospital is exposed to a patient later diagnosed with meningococcal meningitis. The exposure was via droplet. The nurse should:

No action is needed if the nurse was not symptomatic
Begin prophylactic antibiotics as directed by employee health (Correct answer)
Isolate oneself from other staff for 21 days
Immediately begin wearing an N95 respirator for 10 days

Correct answer: Begin prophylactic antibiotics as directed by employee health

Post-exposure prophylaxis with rifampin or ciprofloxacin is recommended for close droplet exposures to Neisseria meningitidis.

Question 57: A nurse notices a co-worker skip hand hygiene before entering a patient's room. The best response is to:

Say nothing to avoid conflict
File a formal complaint with the infection control department
Politely remind the co-worker to perform hand hygiene (Correct answer)
Document the incident and report it to the manager later

Correct answer: Politely remind the co-worker to perform hand hygiene

A direct, respectful reminder is the most effective immediate intervention and is consistent with a culture of safety.

Question 58: The nurse assesses a patient using the SAD PERSONS mnemonic. The letter 'P' in this tool stands for:

Presence of psychosis
Prior suicide attempts (Correct answer)
Plan (has a specific plan)
Previous psychiatric hospitalization

Correct answer: Prior suicide attempts

In the SAD PERSONS scale, 'P' stands for Prior suicide attempts, which is one of the strongest predictors of future attempts.

Question 59: What are the rights of medication administration?

Right patient, drug, dose, route, time, documentation, and reason (Correct answer)
Only the right drug
Only three rights exist
Only the right patient and drug

Correct answer: Right patient, drug, dose, route, time, documentation, and reason

The rights serve as safety checks before every medication administration.

Question 60: A patient diagnosed with schizophrenia is experiencing auditory hallucinations. Which nursing intervention is most appropriate?

Encouraging the patient to discuss the hallucinations (Correct answer)
Administering a sedative medication
Restraining the patient to prevent self-harm
Ignoring the hallucinations to avoid reinforcing them

Correct answer: Encouraging the patient to discuss the hallucinations

Encouraging a patient with schizophrenia to discuss their auditory hallucinations in a non-judgmental way is the most appropriate intervention. This approach validates the patient's experience, helps the nurse understand the nature and impact of the hallucinations, and builds trust. It allows for assessment and appropriate intervention without ignoring or reinforcing the delusion.

Question 61: Which of the following best describes 'therapeutic communication' in LVN practice?

Avoiding difficult topics to keep the patient comfortable
Asking multiple questions at once to save time
Employing techniques that promote a patient-centered, trusting relationship (Correct answer)
Using medical jargon to demonstrate competence

Correct answer: Employing techniques that promote a patient-centered, trusting relationship

Therapeutic communication uses active listening, open-ended questions, and empathy to build trust and facilitate patient expression.

Question 62: Which EHR documentation feature helps ensure that medications are administered to the correct patient?

Physician order entry
Barcode medication administration (BCMA) scanning (Correct answer)
Discharge summary templates
Nursing narrative notes

Correct answer: Barcode medication administration (BCMA) scanning

BCMA systems scan the patient's wristband and medication barcode to verify the five rights of medication administration at the point of care.

Question 63: A patient develops a fever, purulent drainage, and erythema at a central line insertion site 72 hours post-placement. This most likely indicates:

Allergic reaction to the dressing material
Phlebitis from the IV solution
Normal inflammatory response to catheter insertion
Central line-associated bloodstream infection (CLABSI) (Correct answer)

Correct answer: Central line-associated bloodstream infection (CLABSI)

Signs of local infection at a central line site appearing 72 hours after insertion are consistent with CLABSI until proven otherwise.

Question 64: A patient's advance directive states 'no artificial nutrition.' The family insists on a feeding tube. The LVN should:

Insert the feeding tube to satisfy the family
Follow the advance directive and report the conflict to the supervising nurse and physician (Correct answer)
Remove the advance directive from the chart to avoid conflict
Ask the patient verbally even though they lack capacity

Correct answer: Follow the advance directive and report the conflict to the supervising nurse and physician

A valid advance directive represents the patient's autonomous wishes and legally supersedes family preferences; conflicts must be escalated through the care team.

Question 65: What is the most common cause of postpartum hemorrhage (PPH)?

Coagulation disorders
Cervical lacerations
Retained placental fragments
Uterine atony (Correct answer)

Correct answer: Uterine atony

Uterine atony—failure of the uterus to contract after delivery—accounts for approximately 80% of all postpartum hemorrhage cases.

Question 66: When applying a wet-to-dry dressing for mechanical debridement, the LVN should:

Saturate the dressing heavily and seal with an occlusive film to retain moisture
Place moist gauze into the wound and allow it to dry before removal to debride non-viable tissue (Correct answer)
Moisten the gauze and remove it while still wet to minimize patient discomfort
Pack dry gauze into the wound and moisten it just before removal

Correct answer: Place moist gauze into the wound and allow it to dry before removal to debride non-viable tissue

Wet-to-dry dressings work by placing moist gauze that dries and adheres to necrotic tissue; when removed dry, it mechanically debrides the wound.

Question 67: Which action best prevents the transmission of bloodborne pathogens during a blood draw?

Recapping the needle with both hands after use
Wearing gloves and washing hands before the procedure only
Using a safety needle and disposing in a sharps container (Correct answer)
Placing the used needle on the overbed table temporarily

Correct answer: Using a safety needle and disposing in a sharps container

Safety-engineered devices and immediate sharps disposal are the primary strategies for preventing needlestick injuries.

Question 68: A patient says 'I feel like nobody cares about me.' Which LVN response best demonstrates therapeutic communication?

Of course people care about you — I care!
Let me connect you with a support group.
Have you discussed this feeling with your doctor?
That must be a very difficult feeling to carry. (Correct answer)

Correct answer: That must be a very difficult feeling to carry.

Reflecting the patient's feelings validates their experience without dismissing or redirecting it.

Question 69: Which document legally authorizes another person to make healthcare decisions for a patient who becomes incapacitated?

Durable power of attorney for healthcare (Correct answer)
POLST form
Do-Not-Resuscitate order
Living will

Correct answer: Durable power of attorney for healthcare

A durable power of attorney for healthcare designates a healthcare proxy to make decisions when the patient lacks decision-making capacity.

Question 70: A patient calls out that their IV site is swollen and painful. The LVN assesses cool, pale skin around the insertion site. This finding indicates:

Thrombosis
Phlebitis
Air embolism
Infiltration (Correct answer)

Correct answer: Infiltration

Infiltration occurs when IV fluid leaks into surrounding tissue, causing swelling, pallor, and coolness at the site.

Question 71: A patient with limited English proficiency needs to be informed about a procedure. The LVN should:

Ask a bilingual family member to interpret the clinical details
Use a qualified medical interpreter per facility policy (Correct answer)
Speak slowly and loudly in English
Proceed with the procedure and explain afterward

Correct answer: Use a qualified medical interpreter per facility policy

Professional medical interpreters are required to ensure accurate informed consent and communication — using family members is not appropriate for clinical decisions.

Question 72: A patient with major depressive disorder who had been withdrawn says 'I finally feel at peace — I've made my decision.' The LVN's PRIORITY action is?

Recognize this as a possible sign of suicidal decision and notify the RN immediately. (Correct answer)
Document the statement and notify the RN at the end of the shift.
Encourage the patient to elaborate on the personal decision they have made.
Praise the patient's positive attitude and encourage them to share it with others.

Correct answer: Recognize this as a possible sign of suicidal decision and notify the RN immediately.

Sudden calmness in a depressed patient often indicates they have decided to act on a suicide plan, which is an emergency.

Question 73: A physician gives the LVN a verbal order over the phone. What is the correct procedure?

Carry out the order immediately and document it later
Refuse verbal orders and request a written order only
Have another nurse listen and co-sign the verbal order before acting
Write the order, read it back to the physician for confirmation, then carry it out (Correct answer)

Correct answer: Write the order, read it back to the physician for confirmation, then carry it out

Verbal orders require a read-back verification to confirm accuracy before implementation, then must be signed by the physician within facility-defined timeframes.

Question 74: What is the purpose of I&O (intake and output) monitoring?

Only counting glasses of water
Tracking medication doses
To track fluid balance by measuring all fluids consumed and excreted (Correct answer)
Measuring food portions

Correct answer: To track fluid balance by measuring all fluids consumed and excreted

I&O monitoring identifies fluid imbalances that could indicate kidney, heart, or other organ dysfunction.

Question 75: How is medication dosing different for pediatric patients?

Children receive adult doses
All children receive the same dose
Doses are calculated based on weight (mg/kg) or body surface area, not adult fixed doses (Correct answer)
Medication dosing is the same at all ages

Correct answer: Doses are calculated based on weight (mg/kg) or body surface area, not adult fixed doses

Weight-based dosing accounts for the wide variation in body size among pediatric patients.

Question 76: A patient with anxiety repeatedly says, 'I'm not really that anxious — I just had too much coffee.' Which defense mechanism is the patient using?

Projection
Displacement
Rationalization (Correct answer)
Repression

Correct answer: Rationalization

Rationalization involves creating logical-sounding excuses to justify anxiety-provoking feelings or behaviors.

Question 77: What are signs of dehydration in infants?

Decreased wet diapers, sunken fontanelle, dry mucous membranes, and lethargy (Correct answer)
Only crying indicates dehydration
Only fever indicates dehydration
Infants cannot become dehydrated

Correct answer: Decreased wet diapers, sunken fontanelle, dry mucous membranes, and lethargy

Infants dehydrate quickly and show specific signs including a sunken soft spot on the head.

Question 78: A patient on chronic corticosteroid therapy is at risk for impaired wound healing because steroids:

Enhance macrophage activity at the wound bed
Suppress the inflammatory response and impair collagen synthesis (Correct answer)
Increase platelet aggregation at the wound site
Accelerate re-epithelialization of wound edges

Correct answer: Suppress the inflammatory response and impair collagen synthesis

Corticosteroids suppress inflammation and impair fibroblast activity and collagen synthesis, slowing all phases of wound healing.

Question 79: A 6-year-old is prescribed 250 mg of amoxicillin oral suspension (125 mg/5 mL). How many mL should the nurse administer per dose?

20 mL
5 mL
10 mL (Correct answer)
15 mL

Correct answer: 10 mL

250 mg ÷ 125 mg/5 mL = 10 mL per dose.

Question 80: What are common age-related changes that affect nursing care?

Decreased sensory acuity, reduced mobility, slower metabolism, thinner skin, and cognitive changes (Correct answer)
No changes occur with aging
Only hearing loss
Only vision changes

Correct answer: Decreased sensory acuity, reduced mobility, slower metabolism, thinner skin, and cognitive changes

Normal aging affects every body system, requiring adapted care approaches.

Question 81: A healthcare worker is accidentally stuck with a needle used on an HIV-positive patient. The initial priority action is to:

Report to the employee health office immediately
Wash the site thoroughly with soap and water (Correct answer)
Start post-exposure prophylaxis within 72 hours
Obtain baseline blood work for the exposed worker

Correct answer: Wash the site thoroughly with soap and water

The immediate first step after a needlestick is to wash the wound with soap and water to reduce pathogen load.

Question 82: A patient returns from surgery with a urinary catheter. The nurse's best action to prevent CAUTI is to:

Keep the drainage bag below bladder level (Correct answer)
Irrigate the catheter daily with saline
Change the catheter every 48 hours
Clamp the tubing periodically

Correct answer: Keep the drainage bag below bladder level

Keeping the drainage bag below the level of the bladder prevents backflow of urine, reducing CAUTI risk.

Question 83: Which ethical principle is MOST directly upheld when an LVN keeps a patient's diagnosis confidential from unauthorized visitors?

Confidentiality/Fidelity (Correct answer)
Beneficence
Justice
Autonomy

Correct answer: Confidentiality/Fidelity

Protecting patient information from unauthorized parties upholds the ethical duty of confidentiality, a component of fidelity to the nurse-patient relationship.

Question 84: A patient with a new colostomy refuses to look at the stoma and says, 'I'm disgusting.' The nurse identifies this as which nursing diagnosis?

Social isolation
Chronic low self-esteem
Disturbed body image (Correct answer)
Ineffective coping

Correct answer: Disturbed body image

Disturbed body image is evidenced by refusal to look at the stoma and negative verbalization about altered appearance.

Question 85: A 78-year-old patient shows confusion, urinary retention, and dry mouth after a new medication is started. These signs are consistent with which drug effect?

Serotonin syndrome
Salicylate toxicity
Opioid overdose
Anticholinergic toxicity (Correct answer)

Correct answer: Anticholinergic toxicity

Anticholinergic toxicity presents with confusion, urinary retention, dry mouth, and constipation, and is especially dangerous in elderly patients.

Question 86: Which finding in wound drainage requires immediate reporting to the RN or provider?

Serous drainage on day 1 post-op
Scant sanguineous drainage post-procedure
Purulent, foul-smelling drainage (Correct answer)
Serosanguineous drainage on day 2

Correct answer: Purulent, foul-smelling drainage

Purulent, foul-smelling drainage indicates infection and must be reported immediately to the supervising RN or provider.

Question 87: A patient on a clear liquid diet asks if they can have orange juice. The LVN should explain that orange juice is:

Allowed because it is a liquid
Not allowed because it is acidic
Not allowed because it contains pulp and is opaque (Correct answer)
Allowed if strained

Correct answer: Not allowed because it contains pulp and is opaque

A clear liquid diet includes only transparent liquids; orange juice is opaque and contains pulp, making it inappropriate for this diet.

Question 88: A patient in crisis states, 'I just can't take it anymore.' The nurse's FIRST action should be to:

Remove all sharp objects from the room
Call the psychiatric team immediately
Ask the patient directly whether they are thinking of suicide (Correct answer)
Administer PRN anxiolytic per standing order

Correct answer: Ask the patient directly whether they are thinking of suicide

Directly asking about suicidal ideation is safe, clinically appropriate, and provides essential assessment data.

Question 89: Which entry demonstrates appropriate late-entry documentation in a patient's chart?

Inserting the note between earlier entries as if written on time
Writing 'Late Entry' with the current date/time and the time the event occurred (Correct answer)
Backdating the entry to match when the event occurred
Asking a colleague to sign the late entry as if they were present

Correct answer: Writing 'Late Entry' with the current date/time and the time the event occurred

Late entries must be labeled 'Late Entry' with the actual time of writing and the original time of the event to maintain accuracy.

Question 90: The nurse is converting a medication order from mg to mcg. How many micrograms are in 0.25 mg?

2500 mcg
2.5 mcg
25 mcg
250 mcg (Correct answer)

Correct answer: 250 mcg

1 mg = 1,000 mcg, so 0.25 mg × 1,000 = 250 mcg.

Question 91: When performing hand hygiene with alcohol-based hand rub, how long should the nurse rub hands together?

15–20 seconds (Correct answer)
60 seconds
5–10 seconds
30–45 seconds

Correct answer: 15–20 seconds

The CDC recommends rubbing hands together for at least 15–20 seconds until dry when using ABHR.

Question 92: A competent adult patient's religious beliefs prohibit blood transfusions. During a life-threatening bleed, the LVN should:

Wait for a family member to override the decision
Call an ethics committee before any nursing action
Respect the refusal and notify the supervising RN and physician immediately (Correct answer)
Administer the transfusion to save the patient's life

Correct answer: Respect the refusal and notify the supervising RN and physician immediately

Competent adult patients have the right to refuse life-saving treatment based on religious or personal beliefs; the LVN must respect this and promptly notify the care team.

Question 93: A patient with active tuberculosis is being transported to radiology. The nurse should instruct the patient to:

No precautions are needed for brief transport
Wear an N95 respirator during transport
Remain in a wheelchair with the door closed
Wear a surgical mask during transport (Correct answer)

Correct answer: Wear a surgical mask during transport

The patient with TB wears a surgical mask during transport to contain respiratory droplets/aerosols.

Question 94: Which oxygen delivery device provides the highest and most precise concentration of oxygen?

Non-rebreather mask
Nasal cannula
Venturi mask (Correct answer)
Simple face mask

Correct answer: Venturi mask

The Venturi mask delivers a precise, controlled oxygen concentration, making it ideal for patients requiring specific FiO2 levels.

Question 95: Protective (reverse) isolation is used for which patient population?

Severely immunocompromised patients such as bone marrow transplant recipients (Correct answer)
Patients with C. difficile diarrhea
Patients with active TB
Patients with open wounds colonized with MRSA

Correct answer: Severely immunocompromised patients such as bone marrow transplant recipients

Protective isolation shields highly immunocompromised patients from environmental organisms that a normal immune system would easily handle.

Question 96: An LVN notes 'Pt. ambulated to BR without assistance' in the chart. Which documentation principle does this reflect?

Inference about patient intent
Use of approved abbreviations and factual language (Correct answer)
Subjective interpretation of behavior
Late entry charting technique

Correct answer: Use of approved abbreviations and factual language

Documentation should use approved abbreviations and factual, observable language rather than interpretation.

Question 97: An LVN is asked by a physician to perform a task outside the LVN scope of practice. The most appropriate response is to:

Perform the task since the physician ordered it
Decline and inform the physician it is outside the LVN scope of practice (Correct answer)
Document that the physician requested the task and then perform it
Perform the task only if a registered nurse is nearby

Correct answer: Decline and inform the physician it is outside the LVN scope of practice

LVNs must practice within their legal scope, and a physician order does not authorize a nurse to exceed that scope.

Question 98: What are mandatory reporting requirements for LVNs?

LVNs must report suspected abuse, neglect, certain communicable diseases, and unsafe practice (Correct answer)
Only report criminal activity
Reporting is optional
Only report to family members

Correct answer: LVNs must report suspected abuse, neglect, certain communicable diseases, and unsafe practice

As mandated reporters, LVNs are legally required to report suspected abuse, neglect, and other specified conditions.

Question 99: Which of the following represents a breach of patient confidentiality by an LVN?

Talking about a patient's condition in a crowded elevator (Correct answer)
Giving shift report to the oncoming nurse in a private area
Documenting care in the patient's medical record
Discussing a patient's diagnosis with their care team

Correct answer: Talking about a patient's condition in a crowded elevator

Discussing patient information in public areas where others can overhear is a confidentiality breach.

Question 100: An LVN accidentally documents information in the wrong patient's electronic chart. What should be done?

Leave the entry and add a note in your own chart
Ask another nurse to fix it without reporting the error
Notify the supervisor, follow facility policy to correct the entry, and document the error (Correct answer)
Delete the entry immediately without any notation

Correct answer: Notify the supervisor, follow facility policy to correct the entry, and document the error

Wrong-patient documentation errors must be reported to the supervisor immediately and corrected per facility policy, as they pose a patient safety risk.

Question 101: Autolytic debridement is best achieved by which wound care intervention?

Using a scalpel to remove necrotic tissue at the bedside
Covering the wound with a moisture-retentive dressing to allow the body's enzymes to dissolve dead tissue (Correct answer)
Irrigating the wound with high-pressure saline
Applying enzymatic ointment such as collagenase

Correct answer: Covering the wound with a moisture-retentive dressing to allow the body's enzymes to dissolve dead tissue

Autolytic debridement uses the body's own enzymes under a moisture-retentive dressing (such as a hydrocolloid or hydrogel) to liquefy necrotic tissue.

Question 102: What are the legal requirements for nursing documentation?

Only abnormal findings need documentation
Accurate, timely, complete, legible, and signed entries that reflect actual care provided (Correct answer)
Documentation is optional for routine care
Brief notes are sufficient

Correct answer: Accurate, timely, complete, legible, and signed entries that reflect actual care provided

Documentation is a legal record and must accurately reflect all assessments, interventions, and patient responses.

Question 103: A 2-year-old is brought to the clinic with a barking cough, inspiratory stridor, and low-grade fever. Which condition does the nurse suspect?

Epiglottitis
Croup (laryngotracheobronchitis) (Correct answer)
Pertussis
Bronchiolitis

Correct answer: Croup (laryngotracheobronchitis)

The classic 'barking' or 'seal-like' cough with inspiratory stridor and low-grade fever in a toddler indicates croup.

Question 104: What signs indicate wound infection?

Only redness
Increased redness, warmth, swelling, purulent drainage, odor, and fever (Correct answer)
Only pain
Wounds never get infected with proper care

Correct answer: Increased redness, warmth, swelling, purulent drainage, odor, and fever

Multiple clinical signs together suggest wound infection requiring treatment.

Question 105: The nurse notices a tear in her glove while caring for a patient with Clostridioides difficile. The priority action is to:

Remove the glove, perform hand hygiene, and reglove (Correct answer)
Finish the task then change gloves
Apply a second glove over the torn one
Notify the charge nurse immediately

Correct answer: Remove the glove, perform hand hygiene, and reglove

A torn glove no longer provides a barrier; the nurse must remove it, perform hand hygiene, and apply a new glove.

Question 106: A frail elderly patient's daughter asks about advance directives. Which statement by the LVN is most appropriate?

'An advance directive documents the patient's wishes for future care and designates a healthcare proxy.' (Correct answer)
'Advance directives cannot be changed once signed.'
'Only physicians can discuss advance directives with patients.'
'Advance directives are only for patients who are actively dying.'

Correct answer: 'An advance directive documents the patient's wishes for future care and designates a healthcare proxy.'

An advance directive is a legal document that specifies a patient's care preferences and can name a healthcare proxy to make decisions if the patient cannot.

Question 107: A client in a wheelchair needs to be transferred to bed. To protect both the client and LVN, which is the correct body mechanic principle?

Keep feet close together while lifting
Bend at the waist to get close to the client
Use a wide base of support and bend at the knees (Correct answer)
Twist the torso to pivot the client into position

Correct answer: Use a wide base of support and bend at the knees

A wide base of support and bending at the knees (not the waist) reduces injury risk by using leg muscles instead of the back.

Question 108: Which solution is considered the safest and most recommended for routine wound irrigation?

Hydrogen peroxide
Acetic acid
Povidone-iodine (Betadine)
Normal saline (0.9% sodium chloride) (Correct answer)

Correct answer: Normal saline (0.9% sodium chloride)

Normal saline is isotonic and non-cytotoxic, making it the preferred solution for wound irrigation without damaging granulation tissue.

Question 109: A patient with depression has been prescribed fluoxetine (Prozac). The nurse should monitor the patient for which potential adverse effect?

Weight gain
Suicidal ideation (Correct answer)
Insomnia
Hypotension

Correct answer: Suicidal ideation

Fluoxetine (Prozac), an SSRI antidepressant, carries a black box warning for an increased risk of suicidal thoughts and behaviors, especially in children, adolescents, and young adults, particularly at the beginning of treatment or with dose changes. While the medication can improve mood, it may initially increase energy before mood fully lifts, potentially giving patients the impetus to act on suicidal ideation. Therefore, close monitoring is crucial.

Question 110: An LVN is caring for a post-operative client at high risk for falls. Which intervention is the priority?

Placing a 'fall risk' sign only on the chart
Applying bilateral wrist restraints
Asking the client's family to watch them at all times
Keeping the bed in the lowest position with side rails up (Correct answer)

Correct answer: Keeping the bed in the lowest position with side rails up

Keeping the bed in the lowest position and raising side rails reduces fall risk by minimizing fall height and providing support.

Question 111: Which situation requires the LVN to file a mandatory report to authorities?

A client who smokes against hospital policy
A family member who disagrees with the treatment plan
Suspected elder abuse observed during home health care (Correct answer)
A client who refuses to take prescribed medications

Correct answer: Suspected elder abuse observed during home health care

LVNs are mandatory reporters and must report suspected abuse or neglect of vulnerable populations such as the elderly.

Question 112: What are vital signs and why are they important?

Temperature, pulse, respiration, and blood pressure — they indicate basic body functions and detect abnormalities (Correct answer)
Only heart rate
Only temperature
Only blood pressure

Correct answer: Temperature, pulse, respiration, and blood pressure — they indicate basic body functions and detect abnormalities

Vital signs are key indicators of physiological function; abnormalities can signal deteriorating health.

Question 113: What are the different types of therapeutic diets?

Only diabetic diets
Regular, clear liquid, full liquid, soft, mechanical soft, pureed, and specialized diets for conditions (Correct answer)
Only regular and liquid
All patients eat the same diet

Correct answer: Regular, clear liquid, full liquid, soft, mechanical soft, pureed, and specialized diets for conditions

Different conditions and abilities require modified diets to ensure adequate nutrition and prevent complications.

Question 114: The process of destroying all forms of microbial life, including spores, is called:

Sanitization
Disinfection
Decontamination
Sterilization (Correct answer)

Correct answer: Sterilization

Sterilization eliminates all microbial life including highly resistant bacterial spores, unlike disinfection which does not kill all spores.

Question 115: A patient's wound shows erythema, warmth, edema, and purulent drainage. The LVN suspects wound infection. Which additional finding would MOST strongly support this assessment?

Wound edges that are approximated without tension
Increased pain at the wound site and fever (Correct answer)
Granulation tissue appearing in the wound bed
Serosanguineous drainage that has decreased in amount

Correct answer: Increased pain at the wound site and fever

Increased local pain combined with systemic signs such as fever strongly supports the diagnosis of wound infection.

Question 116: The LVN is aware that a patient on the unit has a history of violent behavior and is becoming increasingly hostile. For personal safety, the LVN should position themselves?

Directly in front of the patient, within arm's reach to show confidence
Near the room exit, maintaining a clear escape route and safe distance (Correct answer)
Behind the patient to prevent them from leaving the room
Between the patient and the room's exit door

Correct answer: Near the room exit, maintaining a clear escape route and safe distance

Positioning near the exit gives the LVN an escape route and prevents being cornered if the patient becomes physically aggressive.

Question 117: Which nursing action is most important when caring for a patient with bipolar disorder during a manic episode?

Allowing the patient to make financial decisions independently
Limiting physical activity to conserve energy
Providing frequent opportunities for social interaction
Ensuring a quiet, low-stimulation environment (Correct answer)

Correct answer: Ensuring a quiet, low-stimulation environment

During a manic episode, a patient with bipolar disorder experiences elevated energy, racing thoughts, and is easily overstimulated. Ensuring a quiet, low-stimulation environment helps to reduce agitation, promote rest, and prevent the escalation of manic symptoms. This intervention is crucial for the patient's safety and to help them regain control.

Question 118: Which cleaning agent is most effective against Clostridioides difficile spores on environmental surfaces?

Alcohol-based wipes
Hydrogen peroxide spray
Quaternary ammonium compounds
Dilute bleach solution (Correct answer)

Correct answer: Dilute bleach solution

C. difficile spores are resistant to many disinfectants; EPA-registered hypochlorite (bleach) solutions are recommended.

Question 119: A patient signs a consent form but later tells the LVN they did not understand what they signed. The LVN should:

Reassure the patient that the form is standard
Notify the supervising RN or physician so informed consent can be re-established (Correct answer)
Proceed with the procedure since the form is already signed
Ask the patient to sign a second copy of the same form

Correct answer: Notify the supervising RN or physician so informed consent can be re-established

Informed consent requires understanding; if that is lacking, the procedure should be paused and the provider notified to re-explain and re-obtain consent.

Question 120: Which description best characterizes meconium, the newborn's first stool?

Dark green to black with a tarry, sticky consistency (Correct answer)
Clear with a mucous consistency
Yellow, seedy, and loosely formed
Brown and formed, similar to adult stool

Correct answer: Dark green to black with a tarry, sticky consistency

Meconium is composed of swallowed amniotic fluid, intestinal secretions, and bile, giving it a characteristic dark green-to-black, tarry appearance.

Question 121: A patient with decision-making capacity asks the LVN to keep their HIV status secret from their spouse. The LVN should:

Refuse to care for the patient unless they consent to disclosure
Immediately disclose the status to the spouse for their protection
Maintain confidentiality and consult the supervisor about duty-to-warn obligations (Correct answer)
Document the request but share the information with all care team members

Correct answer: Maintain confidentiality and consult the supervisor about duty-to-warn obligations

Confidentiality must be respected, but the LVN should escalate the ethical tension around duty-to-warn to a supervisor or ethics committee for guidance.

Question 122: What is wound irrigation?

Applying dry dressings
Exposing wounds to air
Flushing a wound with solution to remove debris and reduce bacterial load (Correct answer)
Soaking a wound in water

Correct answer: Flushing a wound with solution to remove debris and reduce bacterial load

Wound irrigation cleanses the wound bed, removes contaminants, and promotes healing.

Question 123: A veteran with PTSD becomes startled by a car backfiring and runs out of the waiting room. The nurse's PRIORITY intervention is to:

Follow the patient and begin grounding techniques in a calm voice (Correct answer)
Restrain the patient for safety
Administer PRN benzodiazepine immediately
Document the episode and wait for the patient to return voluntarily

Correct answer: Follow the patient and begin grounding techniques in a calm voice

Grounding techniques (e.g., 5-4-3-2-1 sensory method) help reorient a patient experiencing a PTSD trigger back to the present.

Question 124: The chain of infection includes six links. Which link does hand hygiene primarily break?

Susceptible host
Portal of entry
Mode of transmission (Correct answer)
Infectious agent

Correct answer: Mode of transmission

Hand hygiene interrupts the mode of transmission by removing pathogens from the hands before they can reach a new host.

Question 125: A patient with fluid overload would most likely exhibit which assessment finding?

Tenting of skin
Dependent pitting edema (Correct answer)
Sunken fontanelles
Decreased blood pressure

Correct answer: Dependent pitting edema

Fluid overload causes excess fluid to accumulate in dependent areas due to gravity, resulting in pitting edema of the ankles and legs.

Question 126: When accessing a patient's electronic health record (EHR), which action best protects patient privacy?

Leaving the screen open so oncoming staff can review it
Sharing login credentials with a trusted colleague for efficiency
Logging out of the EHR when stepping away from the workstation (Correct answer)
Accessing records of former patients you know personally

Correct answer: Logging out of the EHR when stepping away from the workstation

Always log out of the EHR when leaving the workstation to prevent unauthorized access to patient information.

Question 127: Normal saline (0.9% NaCl) is classified as which type of intravenous solution?

Hypotonic
Colloid
Isotonic (Correct answer)
Hypertonic

Correct answer: Isotonic

0.9% NaCl is isotonic, meaning it has the same osmolarity as blood and does not cause fluid shifts into or out of cells.

Question 128: When using the PHQ-9 tool, the LVN is screening a patient for:

Suicidal risk stratification
Cognitive impairment
Generalized anxiety disorder
Depression severity (Correct answer)

Correct answer: Depression severity

The PHQ-9 (Patient Health Questionnaire-9) is a validated tool used to screen for and measure the severity of depression.

Question 129: When caring for a patient with anorexia nervosa, the LVN monitors MOST closely for which life-threatening complication?

Rapid weight gain leading to cardiac overload
Hypertensive emergency
Electrolyte imbalances such as hypokalemia (Correct answer)
Hyperglycemia from binge eating episodes

Correct answer: Electrolyte imbalances such as hypokalemia

Severe restriction and purging behaviors deplete potassium and other electrolytes, causing life-threatening cardiac arrhythmias.

Question 130: A patient with OCD spends 3 hours per day washing their hands. The LVN's INITIAL approach should be?

Immediately set strict time limits on all hand-washing behavior.
Allow the ritual while collaborating with the treatment team to gradually reduce it. (Correct answer)
Explain clearly that the behavior is unhealthy and must stop.
Distract the patient with another activity each time the ritual begins.

Correct answer: Allow the ritual while collaborating with the treatment team to gradually reduce it.

Abruptly blocking compulsive rituals increases anxiety; the treatment team uses a gradual, structured approach to reduce them safely.

Question 131: Which behavior by a patient diagnosed with anorexia nervosa should the nurse prioritize as needing immediate intervention?

Refusing to participate in group therapy sessions
Experiencing bradycardia and hypotension (Correct answer)
Complaining of feeling cold despite warm room temperature
Expressing a desire to exercise excessively

Correct answer: Experiencing bradycardia and hypotension

Experiencing bradycardia (slow heart rate) and hypotension (low blood pressure) in a patient with anorexia nervosa indicates severe cardiovascular compromise due to malnutrition and electrolyte imbalances. These are critical physiological signs that put the patient at high risk for cardiac arrest and require immediate medical intervention to stabilize their condition. This is a life-threatening emergency.

Question 132: A patient taking an MAOI (monoamine oxidase inhibitor) asks if they can eat aged cheese. The LVN should advise:

Avoid aged cheese because tyramine in it can cause a hypertensive crisis (Correct answer)
Aged cheese is fine in small amounts
Aged cheese will decrease the drug's effectiveness only
Aged cheese is safe and has no interaction with MAOIs

Correct answer: Avoid aged cheese because tyramine in it can cause a hypertensive crisis

Tyramine-rich foods such as aged cheese interact with MAOIs to cause severe, potentially fatal hypertensive crises.

Question 133: When documenting patient education provided, which information is essential to include?

Only the topic taught
Time spent teaching only
The nurse's personal assessment of the patient's intelligence
Topic covered, method used, patient's response, and evidence of understanding (Correct answer)

Correct answer: Topic covered, method used, patient's response, and evidence of understanding

Complete patient education documentation includes the topic, teaching method, patient response, and demonstration of understanding.

Question 134: The nurse is administering potassium chloride (KCl) intravenously. The correct practice is to:

Administer undiluted only in emergencies
Mix it with normal saline in a syringe and push over 2 minutes
Give it as a rapid IV push to ensure complete delivery
Administer it as a diluted solution via controlled infusion pump, never undiluted IV push (Correct answer)

Correct answer: Administer it as a diluted solution via controlled infusion pump, never undiluted IV push

Undiluted IV potassium can cause fatal cardiac arrhythmias; it must always be diluted and administered via infusion pump at a controlled rate.

Question 135: Which dressing type is BEST for a wound with minimal exudate that requires a moist healing environment and protection from external contamination?

Calcium alginate sheet
Wet-to-dry gauze dressing
Dry sterile gauze
Hydrocolloid dressing (Correct answer)

Correct answer: Hydrocolloid dressing

Hydrocolloid dressings create and maintain a moist wound environment, absorb light exudate, and provide a bacterial barrier for wounds with minimal drainage.

Question 136: When a medication order reads 'morphine 2–4 mg IV PRN pain q4h,' what does PRN mean?

Administer only at night
Administer as needed when the patient reports pain (Correct answer)
Administer every 4 hours regardless of pain level
Administer before meals

Correct answer: Administer as needed when the patient reports pain

PRN (pro re nata) means 'as needed,' so the nurse administers the drug when the patient requires it.

Question 137: What are standard precautions?

Infection prevention practices applied to all patient care regardless of diagnosis (Correct answer)
Fire safety protocols
Precautions only for contagious patients
Emergency procedures only

Correct answer: Infection prevention practices applied to all patient care regardless of diagnosis

Standard precautions assume all patients may be infectious and include hand hygiene, PPE, and safe injection practices.

Question 138: What information should be documented after administering medication?

Only the drug name
Documentation is optional
Only the time
Drug name, dose, route, time, patient response, and the nurse's initials (Correct answer)

Correct answer: Drug name, dose, route, time, patient response, and the nurse's initials

Complete medication documentation provides a legal record and enables care continuity.

Question 139: What is proper PPE donning and doffing sequence?

Gloves first always
Any order is acceptable
Remove everything at once
Don: gown, mask, goggles, gloves. Doff: gloves, goggles, gown, mask — with hand hygiene between steps (Correct answer)

Correct answer: Don: gown, mask, goggles, gloves. Doff: gloves, goggles, gown, mask — with hand hygiene between steps

Proper sequence prevents self-contamination during removal.

Question 140: A patient is ordered to be on a low-Fowler's position. The head of the bed should be elevated to how many degrees?

60 to 90 degrees
15 to 30 degrees (Correct answer)
90 degrees
45 to 60 degrees

Correct answer: 15 to 30 degrees

Low-Fowler's position elevates the head of the bed 15 to 30 degrees, used for patients who cannot tolerate higher elevations.

Question 141: A patient taking clozapine (Clozaril) reports a sore throat and fever. The LVN's PRIORITY action is?

Withhold the medication and notify the RN immediately. (Correct answer)
Reassure the patient that mild infection is a common side effect.
Document the symptoms and continue the medication.
Administer acetaminophen and monitor vital signs.

Correct answer: Withhold the medication and notify the RN immediately.

Sore throat and fever in a clozapine patient may indicate agranulocytosis, a life-threatening drop in white blood cells requiring immediate evaluation.

Question 142: According to current evidence-based guidelines, when should the newborn's first bath be given?

Immediately after birth and cord clamping
At least 24 hours after birth (Correct answer)
After the newborn's first successful feeding
Once the vernix caseosa has fully dried

Correct answer: At least 24 hours after birth

Delaying the bath for at least 24 hours preserves vernix caseosa, supports thermoregulation, reduces infection risk, and promotes breastfeeding initiation.

Question 143: Under HIPAA, an LVN may share a patient's protected health information (PHI) without explicit authorization for which purpose?

A curious coworker asks about a neighbor's diagnosis
A local news reporter covering a health story
Treatment, payment, or healthcare operations (Correct answer)
The patient's employer requesting a status update

Correct answer: Treatment, payment, or healthcare operations

HIPAA permits disclosure of PHI without specific authorization for treatment, payment, and healthcare operations.

Question 144: A terminally ill patient tells the nurse, 'If God lets me live long enough to see my daughter graduate, I promise I'll volunteer at the hospital every week.' The nurse recognizes this as which stage of Kübler-Ross grief?

Bargaining (Correct answer)
Denial
Depression
Acceptance

Correct answer: Bargaining

Bargaining is the stage in which patients make deals or promises — often with a higher power — in hopes of postponing death or loss. The patient is offering a future action in exchange for more time, which is the hallmark of this stage.

Question 145: The LVN is changing a wound dressing and notices the wound edges are approximated with minimal redness. This describes which type of wound healing?

Tertiary intention
Secondary intention
Granulation phase healing
Primary intention (Correct answer)

Correct answer: Primary intention

Primary intention healing occurs when wound edges are closed (approximated), resulting in minimal scarring and faster healing.

Question 146: A patient is placed on droplet precautions. Which PPE is required when entering the room?

N95 respirator
No PPE needed
Surgical mask (Correct answer)
Full face shield only

Correct answer: Surgical mask

Droplet precautions require a surgical mask worn within 3 feet of the patient.

Question 147: When should hand hygiene be performed?

Before and after patient contact, before procedures, after body fluid exposure, and after touching surfaces (Correct answer)
Only when hands are visibly dirty
Once per shift
Only before lunch

Correct answer: Before and after patient contact, before procedures, after body fluid exposure, and after touching surfaces

Hand hygiene at the five key moments is the most effective way to prevent healthcare-associated infections.

Question 148: Which of the following is an example of an intentional tort in nursing?

Failing to document a patient assessment
Forgetting to raise bed rails for a fall-risk patient
Restraining a patient without consent or legal authority (Correct answer)
Administering the wrong dose due to a calculation error

Correct answer: Restraining a patient without consent or legal authority

False imprisonment is an intentional tort; applying restraints without consent or proper legal justification constitutes this violation.

Question 149: An LVN receives a telephone order for a medication that seems unusually high-dose. The best response is to:

Refuse the order without discussion
Administer a lower dose at the nurse's discretion
Administer the dose since the physician ordered it
Question the order by reading it back and expressing concern to the prescriber (Correct answer)

Correct answer: Question the order by reading it back and expressing concern to the prescriber

The LVN should read back the order and voice concern to the prescriber; questioning an unusual order is a professional safety responsibility.

Question 150: The LVN finds a sharps container that is three-quarters full. What is the appropriate action?

Continue using the container until it is completely full
Cap the needles before disposing to free up space
Push the contents down to make more room
Replace the container with a new one (Correct answer)

Correct answer: Replace the container with a new one

Sharps containers should be replaced when three-quarters full to prevent overfilling, which increases the risk of needlestick injury.

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

The NCLEX-PN is the computer-adaptive licensing exam required for Licensed Vocational Nurses (LVNs) and Licensed Practical Nurses (LPNs) across the US, assessing entry-level nursing competency across clinical knowledge and patient care domains.

150

Questions

300 min

Time Limit

70%

To Pass

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Exam Rules

You can skip questions and return to them later
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No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds