NCLEX-PN Exam — Questions and Answers

Question 1: An LPN is caring for a postoperative patient who reports chest pain and shortness of breath 48 hours after hip surgery. Which condition should the LPN suspect first?

Atelectasis
Pneumonia
Pleural effusion
Pulmonary embolism (Correct answer)

Correct answer: Pulmonary embolism

Sudden onset of chest pain and dyspnea in a postoperative orthopedic patient strongly suggests pulmonary embolism due to venous thromboembolism risk.

Question 2: Which of the following sensory-perceptual deficits is associated with left-brain stroke (right hemiplegia)?

Difficulty judging position and distance
Impulsivity and impatience at performing tasks
Slow and possibly fearful performance of tasks (Correct answer)
Overestimation of physical abilities

Correct answer: Slow and possibly fearful performance of tasks

A left-brain stroke typically results in right hemiplegia and is associated with deficits in language, analytical thinking, and a cautious, slow, and often fearful approach to tasks. Patients may be hesitant to perform tasks due to a fear of making mistakes or not being able to complete them correctly. This contrasts with the impulsivity often seen in right-brain strokes.

Question 3: Which of the following is an example of semi-critical equipment that requires high-level disinfection?

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

Correct answer: Reusable rectal thermometer

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

Question 4: Which task is within the UAP's scope when caring for a post-operative patient?

Ambulating the patient per the established care plan (Correct answer)
Adjusting the patient-controlled analgesia (PCA) pump
Assessing the surgical wound for signs of infection
Removing staples from the incision site

Correct answer: Ambulating the patient per the established care plan

Ambulating a stable post-op patient per care plan is a routine task UAPs can safely perform.

Question 5: When performing tracheostomy suctioning, what is the maximum recommended suction duration per pass?

20 seconds
30 seconds
45 seconds
10 seconds (Correct answer)

Correct answer: 10 seconds

Each suction pass should not exceed 10 seconds to prevent hypoxia, trauma, and vagal stimulation.

Question 6: The LPN is educating a patient about pursed-lip breathing. Which outcome best indicates the patient understood the technique?

'I use this technique only when I feel a panic attack coming on.'
'I breathe in slowly through pursed lips and out through my nose.'
'I breathe as fast as possible through my pursed lips to move more air.'
'I inhale through my nose for 2 counts and exhale slowly through pursed lips for 4 counts.' (Correct answer)

Correct answer: 'I inhale through my nose for 2 counts and exhale slowly through pursed lips for 4 counts.'

Pursed-lip breathing involves slow nasal inhalation and prolonged exhalation through pursed lips (ratio approximately 1:2) to reduce air trapping and dyspnea.

Question 7: A patient with chronic kidney disease (CKD) stage 4 has a serum potassium of 6.1 mEq/L. Which food should the LPN advise the patient to AVOID?

White rice
White bread
Apples
Bananas (Correct answer)

Correct answer: Bananas

Bananas are high in potassium and should be avoided by patients with hyperkalemia secondary to CKD.

Question 8: An immobilized patient is being cared for by a nurse. How can nurses prevent self-injury when caring for immobile patients?

Avoid bending over, leaning, and stretching when working with the patient (Correct answer)
Put the patient at a comfortable height, which is usually at shoulder level
Keep a safe distance between the patient and nurse when moving the immobile patient
Keep their feet shoulder-width apart, and in a straight line to maintain a proper stance

Correct answer: Avoid bending over, leaning, and stretching when working with the patient

To prevent self-injury when caring for immobile patients, nurses must prioritize proper body mechanics. Avoiding excessive bending over, leaning, and stretching minimizes strain on the nurse's back and joints, significantly reducing the risk of musculoskeletal injuries. Instead, nurses should utilize assistive devices, maintain a wide base of support, and keep the patient close to their body when performing transfers or repositioning.

Question 9: A nurse is caring for a client who has dyspnea and is to receive oxygen continuously. Which of the following oxygen devices should the nurse use to deliver a precise amount of oxygen to the client?

Nonrebreather mask
Venturi mask (Correct answer)
Nasal cannula
Simple face mask

Correct answer: Venturi mask

A Venturi mask is specifically designed to deliver a precise and consistent concentration of oxygen, regardless of the client's breathing pattern. It achieves this by using different adapters that mix oxygen with room air in specific proportions. This makes it the ideal choice when a precise oxygen delivery is required for the client.

Question 10: A 4-year-old with a tibial shaft fracture is the patient the nurse is tasked with caring for. The nurse examines the patient's medical record and discovers a sequence of injuries linked to child abuse. Which of the following can the nurse use to support her claim of child abuse?

Stringent household rules
One or both parents have stressful jobs
One of the patient's parents suffers from a chronic disease
Parents' low education levels (Correct answer)

Correct answer: Parents' low education levels

While child abuse can occur in any demographic, research indicates a correlation between certain socioeconomic factors, including lower parental education levels, and an increased risk of child abuse and neglect. These factors can contribute to environments with higher stress and fewer resources, potentially increasing the likelihood of such incidents. Therefore, this information can serve as a supporting risk factor when investigating suspected child abuse, alongside other clinical evidence.

Question 11: The LPN is preparing to administer insulin glargine. Which action is correct?

Administer it only when the blood glucose exceeds 200 mg/dL
Mix it with regular insulin in the same syringe for convenience
Inject it at the same time each day without mixing with other insulins (Correct answer)
Shake the vial vigorously before drawing up the dose

Correct answer: Inject it at the same time each day without mixing with other insulins

Glargine (Lantus) is a long-acting basal insulin given at a consistent time daily and must never be mixed with other insulins as it alters its pH-dependent action.

Question 12: What are the following hyperthyroidism warning signs and symptoms?

Cold Clammy Skin
Cold Clammy Skin and Dry Skin (Correct answer)
Hair loss
Dry Skin

Correct answer: Cold Clammy Skin and Dry Skin

The provided correct answer, 'Cold Clammy Skin and Dry Skin,' is actually characteristic of *hypothyroidism*, a condition where the thyroid gland is underactive. Hyperthyroidism, which involves an overactive thyroid, typically presents with symptoms like heat intolerance, warm and moist skin, sweating, and fine hair due to an increased metabolic rate. Therefore, the given answer is medically inaccurate for hyperthyroidism.

Question 13: A patient has a pressure injury with full-thickness tissue loss, visible slough covering the wound bed, and undermining present. Which stage is this?

Stage 2
Stage 4
Unstageable (Correct answer)
Stage 3

Correct answer: Unstageable

When slough or eschar obscures the wound base so depth cannot be determined, the injury is classified as unstageable.

Question 14: A patient on insulin therapy reports eating extra food to prevent hypoglycemia. What is the most important education point the nurse should address?

Carbohydrate counting is not necessary for patients on basal insulin alone
Extra food raises blood glucose and weight without preventing hypoglycemia caused by excess insulin (Correct answer)
Snacking before exercise is always appropriate and should be encouraged freely
The patient should simply reduce the insulin dose without provider guidance

Correct answer: Extra food raises blood glucose and weight without preventing hypoglycemia caused by excess insulin

Overeating to prevent hypoglycemia leads to hyperglycemia and weight gain; the underlying insulin dose or timing should be reassessed with the provider.

Question 15: A patient's serum creatinine rises from 0.9 mg/dL to 2.8 mg/dL over 48 hours post-contrast CT scan. What condition does this suggest?

Normal response to IV contrast dye
Pre-renal azotemia from dehydration only
Contrast-induced nephropathy (acute kidney injury) (Correct answer)
Chronic kidney disease exacerbation

Correct answer: Contrast-induced nephropathy (acute kidney injury)

A rapid rise in creatinine within 48-72 hours after contrast administration indicates contrast-induced acute kidney injury.

Question 16: After the thyroid was removed, the patient is being treated by the nurse. Following surgery, the nurse should:

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

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

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

Question 17: During supervision, the LPN observes a UAP performing a task incorrectly. What is the appropriate immediate action?

Allow the UAP to finish and then provide feedback privately
Intervene immediately to prevent patient harm and correct the technique (Correct answer)
Report the UAP to the charge nurse without intervening
File an incident report and address the issue at shift end

Correct answer: Intervene immediately to prevent patient harm and correct the technique

Patient safety requires the LPN to intervene immediately when observing incorrect technique.

Question 18: A patient with type 2 diabetes has a fasting blood glucose of 58 mg/dL and reports feeling shaky and sweating. What is the LPN's priority action?

Call the physician before giving anything by mouth
Give 15 g of fast-acting carbohydrate and recheck glucose in 15 minutes (Correct answer)
Offer a full meal and recheck glucose in one hour
Administer scheduled insulin dose immediately

Correct answer: Give 15 g of fast-acting carbohydrate and recheck glucose in 15 minutes

The 15-15 rule—15 g rapid carbohydrate, recheck in 15 minutes—is the standard first-line treatment for mild-to-moderate hypoglycemia in a conscious patient.

Question 19: Which principle should the LPN follow when performing oropharyngeal suctioning?

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

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

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

Question 20: During urinary catheter insertion, the catheter touches a non-sterile surface and becomes contaminated. What should the nurse do?

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

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

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

Question 21: What is the purpose of collecting a clean-catch midstream urine specimen?

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

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

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

Question 22: A patient has C. difficile diarrhea. Which hand hygiene method is most effective after caring for this patient?

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

Correct answer: Soap and water handwashing

Soap and water is required for C. difficile because alcohol-based hand rubs do not effectively kill C. difficile spores.

Question 23: A patient cannot swallow oral medications due to dysphagia. Which alternative route is most appropriate for analgesic delivery?

Topical lotion
Rectal suppository or IV route per order (Correct answer)
Subcutaneous injection
Oral liquid formulation

Correct answer: Rectal suppository or IV route per order

When a patient cannot take oral medications due to dysphagia, alternative routes such as rectal suppository, IV, or transdermal delivery may be ordered depending on the medication.

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

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

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

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

Question 25: The LPN is caring for a patient with a new PEG tube. What is the earliest the skin around the PEG site should be cleaned?

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

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

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

Question 26: Which action by a UAP requires the LPN to re-evaluate the appropriateness of the delegation?

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

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

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

Question 27: Which technique should the LPN use when administering an intradermal injection for tuberculin skin testing?

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

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

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

Question 28: A patient's platelet count is 45,000/mm³. Which nursing intervention is the highest priority?

Apply firm pressure with a hard object to IV sites
Encourage vigorous ambulation to promote circulation
Implement bleeding precautions and use soft-bristle toothbrush (Correct answer)
Administer aspirin for any pain complaints

Correct answer: Implement bleeding precautions and use soft-bristle toothbrush

Thrombocytopenia (<50,000/mm³) places the patient at severe bleeding risk, requiring strict bleeding precautions.

Question 29: An LPN is caring for a patient with a stage 2 pressure injury on the coccyx. Which dressing type is most appropriate?

Wet-to-dry dressing
Hydrocolloid dressing (Correct answer)
Dry gauze dressing
Alginate dressing

Correct answer: Hydrocolloid dressing

Hydrocolloid dressings maintain a moist wound environment and are recommended for stage 2 pressure injuries with minimal to moderate exudate.

Question 30: Which pain assessment scale is most appropriate for a non-verbal adult patient who cannot self-report?

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

Correct answer: PAINAD (Pain Assessment in Advanced Dementia)

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

Question 31: The LPN is preparing to administer enteral formula through a PEG tube. Which action helps prevent microbial contamination?

Reuse the feeding bag after rinsing with water
Hang the formula bag for up to 24 hours
Refrigerate unopened cans at room temperature
Change the feeding bag and tubing every 24 hours per facility policy (Correct answer)

Correct answer: Change the feeding bag and tubing every 24 hours per facility policy

Changing the feeding bag and tubing every 24 hours (or per facility policy) reduces the risk of bacterial contamination of enteral feedings.

Question 32: When performing urinary catheter insertion, which principle is most critical to prevent urinary tract infection?

Use a larger catheter size for better urine drainage
Use a warmed catheter to ease insertion
Insert the catheter quickly to reduce patient discomfort
Maintain strict sterile technique throughout the procedure (Correct answer)

Correct answer: Maintain strict sterile technique throughout the procedure

Strict sterile technique during catheter insertion is the most important measure to prevent catheter-associated urinary tract infections (CAUTIs).

Question 33: A patient's arterial blood gas shows pH 7.30, PaCO2 28 mmHg, HCO3 13 mEq/L. How should the LPN interpret this?

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

Correct answer: Metabolic acidosis with respiratory compensation

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

Question 34: The LPN is preparing to administer an IM injection in the ventrogluteal site. Which landmark correctly identifies this site?

Center of the upper outer quadrant of the buttock
Greater trochanter, anterior superior iliac spine, and iliac crest (Correct answer)
Two fingerbreadths below the acromion process
Lateral thigh midway between knee and hip

Correct answer: Greater trochanter, anterior superior iliac spine, and iliac crest

The ventrogluteal site is located using the greater trochanter, anterior superior iliac spine, and iliac crest, forming a triangle.

Question 35: A patient's fasting blood glucose is 58 mg/dL and they are diaphoretic and trembling. What should the LPN do first?

Administer insulin per sliding scale
Give 15-20 g of fast-acting carbohydrates and recheck glucose in 15 minutes (Correct answer)
Offer a full meal immediately
Notify the provider before taking any action

Correct answer: Give 15-20 g of fast-acting carbohydrates and recheck glucose in 15 minutes

Symptomatic hypoglycemia requires immediate treatment with 15-20 g of rapid-acting carbohydrates followed by recheck using the 15-15 rule.

Question 36: A patient receiving warfarin has an International Normalized Ratio (INR) of 4.8. The LPN should recognize this value as being:

A normal value for a patient not on anticoagulants
Above the therapeutic range, indicating a risk of bleeding (Correct answer)
Within the therapeutic range
Below the therapeutic range, indicating a risk of clotting

Correct answer: Above the therapeutic range, indicating a risk of bleeding

The therapeutic range for INR for a patient on warfarin is typically 2.0 to 3.0. An INR of 4.8 is significantly elevated above the therapeutic range, indicating an increased risk of bleeding. The nurse should hold the next dose and notify the provider.

Question 37: A infant who was delivered at 41 weeks gestation is being examined by a nurse. Which of the following traits would suggest that the baby is postterm?

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

Correct answer: Leathery skin

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

Question 38: A patient's serum calcium is 11.8 mg/dL. Which symptom is consistent with this lab result?

Tetany and positive Chvostek's sign
Peaked T waves and muscle cramps
Carpopedal spasm and laryngospasm
Muscle weakness, constipation, and confusion (Correct answer)

Correct answer: Muscle weakness, constipation, and confusion

Hypercalcemia (>10.5 mg/dL) causes the classic 'bones, groans, moans, and psychic overtones': muscle weakness, constipation, and altered mentation.

Question 39: An LPN notes a patient's white blood cell (WBC) count is 18,000/mm³. The LPN interprets this finding as most likely indicating:

Anemia
A risk for bleeding
Dehydration
Infection (Correct answer)

Correct answer: Infection

The normal WBC count is typically between 4,500 and 11,000/mm³. An elevated WBC count, known as leukocytosis, is a common physiological response to infection or inflammation as the body increases its production of infection-fighting cells.

Question 40: A patient develops a pressure injury over the ischial tuberosity. Which position places the GREATEST pressure on this site?

Supine
Prone
Side-lying at 30 degrees
Sitting (Correct answer)

Correct answer: Sitting

The sitting position places the highest pressure over the ischial tuberosities, making this site particularly vulnerable in wheelchair-bound patients.

Question 41: When teaching a patient to perform self-monitoring of blood glucose (SMBG), which technique should the nurse emphasize?

Disinfect the site with alcohol and test immediately while still wet
Use the side of the fingertip rather than the pad to reduce pain and get an adequate sample (Correct answer)
Squeeze the fingertip firmly before lancing to ensure a large blood drop
Wipe the first drop of blood away and use the second drop for testing

Correct answer: Use the side of the fingertip rather than the pad to reduce pain and get an adequate sample

The lateral aspect of the fingertip is less sensitive and provides a good blood sample; testing while the site is still wet with alcohol can dilute the sample and give a falsely low reading.

Question 42: When using the clock method to document wound tunneling, 12 o'clock corresponds to which direction?

Toward the patient's head (Correct answer)
The patient's right side
The patient's left side
Toward the patient's feet

Correct answer: Toward the patient's head

In wound clock documentation, 12 o'clock is always oriented toward the patient's head regardless of wound location.

Question 43: A patient with hypothyroidism is started on levothyroxine. Which symptom would indicate the medication is having a therapeutic effect?

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

Correct answer: Improved energy level and normalization of heart rate

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

Question 44: What is the most critical factor for an LPN to consider before delegating any task to a UAP?

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

Correct answer: The stability of the patient's condition

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

Question 45: In order to get their child's ear infection checked, a parent brings their child to the pediatric clinic. The healthcare professional (HCP) affirms the diagnosis and issues a cephalexin prescription. The nurse asks the parent if their child has ever experienced an allergic reaction to medication before submitting the prescription to the pharmacy. Which of the following medications would cause the nurse to contact the HCP if there has been an allergic response in the past?

Amoxicillin (Correct answer)
Gentamycin
Tetracycline
Isotretinoin

Correct answer: Amoxicillin

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

Question 46: An LPN is performing a sterile dressing change. After opening the sterile field, which action contaminates it?

Reaching across the sterile field to place an item (Correct answer)
Keeping the outer 1-inch border of the sterile drape unsterile
Adding sterile saline directly to the sterile field
Holding sterile supplies above waist level

Correct answer: Reaching across the sterile field to place an item

Reaching across a sterile field allows microorganisms from clothing or non-sterile areas to fall onto it, breaking sterile technique.

Question 47: Which statement by a patient newly diagnosed with heart failure indicates a need for further teaching?

'I can eat as much sodium as I want since I'm on a water pill.' (Correct answer)
'I should call my doctor if I gain 2 pounds in one day.'
'I will keep my legs elevated when sitting.'
'I will weigh myself every morning before eating.'

Correct answer: 'I can eat as much sodium as I want since I'm on a water pill.'

Heart failure patients require sodium restriction (typically 2,000 mg/day) regardless of diuretic use to prevent fluid retention.

Question 48: In the PQRST pain assessment acronym, what does the letter 'Q' represent?

Quick — how fast the pain came on
Quantity — how much medication the patient needs
Quality — description of the pain character such as sharp, burning, or dull (Correct answer)
Quadrant — the body area where pain is located

Correct answer: Quality — description of the pain character such as sharp, burning, or dull

In PQRST, Q stands for Quality, which describes the nature or character of the pain (e.g., sharp, throbbing, burning, aching).

Question 49: A patient with chronic kidney disease is placed on a renal diet. Which food should the LPN instruct the patient to AVOID?

Pasta with olive oil
Eggs
Bananas and oranges (Correct answer)
White rice

Correct answer: Bananas and oranges

Bananas and oranges are high in potassium, which must be restricted in chronic kidney disease to prevent hyperkalemia.

Question 50: A patient reports pain rated 8/10 on the numeric scale. What is the LPN's priority action?

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

Correct answer: Administer a PRN analgesic if ordered

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

Question 51: A patient with a new ileostomy asks what the output should look like. What is the correct response?

Dark, tarry output indicating normal digestion
Liquid to semi-liquid output since the colon's water absorption is bypassed (Correct answer)
Formed solid stool similar to normal bowel movements
Completely watery, clear output at all times

Correct answer: Liquid to semi-liquid output since the colon's water absorption is bypassed

An ileostomy drains contents before they reach the colon, so output is liquid to semi-liquid because most water reabsorption occurs in the colon.

Question 52: A nurse is reinforcing teaching on the manifestation of complications to a client who has acute glomerulonephritis. Which of the following complications should the client report to the provider?

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

Correct answer: Pitting edema

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

Question 53: A nurse is providing care for a client who has a placenta previa at 32 weeks of gestation. The nurse notes that the client is actively bleeding. The nurse should anticipate that the provider will prescribe which of the following types of medications?

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

Correct answer: Betamethasone (Celestone)

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

Question 54: A nurse is assisting in the care of a client who has ARDS with absent breath sounds in the lower lobes and dyspnea. Which of the following actions should the nurse take first?

Initiate IV access
Administer oxygen via a high-flow mask (Correct answer)
Prepare for chest tube insertion
Obtain a chest x-ray

Correct answer: Administer oxygen via a high-flow mask

The client has dyspnea and absent breath sounds, indicating significant respiratory distress and impaired gas exchange. The immediate priority is to address the hypoxemia by administering oxygen via a high-flow mask to improve oxygenation. Ensuring adequate oxygenation is a life-saving intervention that takes precedence over other diagnostic or less immediate actions.

Question 55: A patient has a chest tube connected to water-seal drainage. The LPN notices the water level in the water-seal chamber fluctuates with each breath. What does this indicate?

The lung is fully re-expanded
Normal functioning of the water-seal drainage system (Correct answer)
The chest tube is obstructed
There is an air leak in the drainage system

Correct answer: Normal functioning of the water-seal drainage system

Fluctuation (tidaling) in the water-seal chamber with respiration is normal and confirms the system is patent; tidaling stops when the lung fully expands.

Question 56: Which of the following best describes how doctors listen for bowel sounds?

Palpation
Percussion
Rectal examination
Auscultation (Correct answer)

Correct answer: Auscultation

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

Question 57: A patient receiving heparin therapy has an aPTT result of 120 seconds (normal: 25–35 sec, therapeutic range: 60–100 sec). The LPN should:

Notify the provider immediately, as the level is supratherapeutic (Correct answer)
Administer protamine sulfate without waiting for orders
Increase the heparin infusion rate
Continue heparin at the current rate

Correct answer: Notify the provider immediately, as the level is supratherapeutic

An aPTT of 120 seconds is above the therapeutic range, indicating excessive anticoagulation and bleeding risk requiring provider notification.

Question 58: Which statement by a patient indicates understanding of how to use a metered-dose inhaler (MDI) correctly?

'I will place the inhaler directly in my mouth and press it while I breathe normally.'
'I will inhale quickly and forcefully right after I press the inhaler.'
'I will press the inhaler two times rapidly before each use.'
'I will shake the inhaler, exhale fully, press it as I begin to inhale slowly, then hold my breath for 10 seconds.' (Correct answer)

Correct answer: 'I will shake the inhaler, exhale fully, press it as I begin to inhale slowly, then hold my breath for 10 seconds.'

Correct MDI technique includes shaking, exhaling fully, slow inhalation coordinated with actuation, and breath-holding to maximize drug deposition.

Question 59: The Wong-Baker FACES Pain Rating Scale is primarily designed for which patient population?

Children and patients who have difficulty with numeric scales (Correct answer)
Elderly patients with dementia
Critically ill ventilated patients
Postoperative patients in the PACU

Correct answer: Children and patients who have difficulty with numeric scales

The Wong-Baker FACES scale uses facial expression images and is validated for children ages 3 and older and adults who struggle with numeric or verbal scales.

Question 60: A newly diagnosed diabetic patient asks why the provider ordered both insulin glargine at bedtime and insulin aspart with meals. What is the best explanation?

Aspart is a long-acting insulin that keeps glucose stable between meals
Glargine is given at bedtime because it only works during sleep
Glargine covers background insulin needs 24 hours a day, while aspart controls the glucose spike that occurs after eating (Correct answer)
The two insulins are interchangeable; this regimen doubles the safety margin

Correct answer: Glargine covers background insulin needs 24 hours a day, while aspart controls the glucose spike that occurs after eating

A basal-bolus regimen mimics normal pancreatic function: basal insulin (glargine) suppresses hepatic glucose between meals and overnight; bolus insulin (aspart) covers postprandial glucose excursions.

Question 61: A patient is repositioned every 2 hours, but a stage 1 pressure injury develops over the sacrum. What is the MOST appropriate next intervention?

Apply a pressure-redistributing foam dressing (Correct answer)
Apply a wet-to-dry dressing
Increase repositioning to every 30 minutes
Massage the reddened area vigorously

Correct answer: Apply a pressure-redistributing foam dressing

A pressure-redistributing foam dressing reduces focal pressure and shear, helping to prevent progression of a stage 1 injury.

Question 62: A patient's wound culture grows Pseudomonas aeruginosa. Which wound characteristic is MOST associated with this organism?

Thick, brown, malodorous drainage
Thin, serous, yellow-tinged drainage
Blue-green exudate with a fruity odor (Correct answer)
White, cottage-cheese-like exudate

Correct answer: Blue-green exudate with a fruity odor

Pseudomonas aeruginosa infection classically produces blue-green pigmented exudate with a characteristic fruity or grape-like odor.

Question 63: An LPN is assessing a wound with yellow, stringy tissue firmly adherent to the wound bed. This tissue is BEST described as:

Eschar
Epithelial tissue
Granulation tissue
Slough (Correct answer)

Correct answer: Slough

Slough is yellow, tan, or white soft necrotic tissue that may be stringy or adherent to the wound bed.

Question 64: What is women's studies?

Hematology
Gynecology (Correct answer)
Craniotomy
Mastectomy

Correct answer: Gynecology

Gynecology is the specialized branch of medicine that focuses on the health of the female reproductive system and women's health issues throughout their lifespan. It encompasses the diagnosis, treatment, and prevention of diseases related to the female reproductive organs. Therefore, it is the medical field directly associated with 'women's studies' in a healthcare context.

Question 65: A nurse aide reports that a confused elderly patient stated 'the night nurse hit me last night.' Under mandatory reporting requirements, the LPN should:

Dismiss the claim because the patient is confused
Report the allegation to the charge nurse and/or appropriate authority immediately (Correct answer)
Document the statement and monitor the patient for further complaints
Investigate independently before involving administration

Correct answer: Report the allegation to the charge nurse and/or appropriate authority immediately

LPNs are mandatory reporters; allegations of abuse must be reported immediately to the charge nurse and appropriate authority regardless of the patient's cognitive status.

Question 66: A patient on warfarin reports eating large amounts of leafy green vegetables daily. What is the primary concern?

Hyperkalemia from excess potassium
Increased bleeding risk due to vitamin K deficiency
Decreased anticoagulant effect due to high vitamin K intake (Correct answer)
Renal toxicity from oxalate accumulation

Correct answer: Decreased anticoagulant effect due to high vitamin K intake

Vitamin K antagonizes warfarin's anticoagulant effect, so high intake of leafy greens can decrease INR and increase clot risk.

Question 67: An assessment of the patient's diet is to be done by the nurse for a type-2 diabetic patient who is 53 years old. The patient is 5 feet 9 inches tall and 173 pounds in weight. The patient has a 25.5 BMI. What inferences about the patient's health can the nurse draw?

The patient is extremely obese
The patient is overweight (Correct answer)
The patient's weight is normal
The patient is obese

Correct answer: The patient is overweight

A Body Mass Index (BMI) between 25.0 and 29.9 kg/m² is classified as overweight. Since the patient's BMI is 25.5, they fall into this category. For a type-2 diabetic patient, understanding their weight status is crucial, as weight management is a significant component of diabetes care and can directly impact blood sugar control and overall health.

Question 68: A patient receiving IV morphine has a respiratory rate of 8 breaths per minute. What is the nurse's first action?

Place the patient in prone position
Increase the IV infusion rate
Administer naloxone (Narcan) per standing order and notify the RN (Correct answer)
Document the finding and continue monitoring

Correct answer: Administer naloxone (Narcan) per standing order and notify the RN

A respiratory rate below 12/min in a patient on opioids indicates respiratory depression; naloxone (opioid reversal agent) should be administered and the RN notified immediately.

Question 69: Which organism is the MOST common indication for droplet precautions?

Influenza (Correct answer)
MRSA
C. difficile
VRE

Correct answer: Influenza

Influenza is spread via large respiratory droplets and is one of the most common reasons for implementing droplet precautions in healthcare settings.

Question 70: When transporting a patient on airborne precautions, what must the patient wear?

An N95 respirator
A full face shield
A surgical mask (Correct answer)
No mask is needed if transport is brief

Correct answer: A surgical mask

During transport, patients on airborne precautions must wear a surgical mask to contain respiratory secretions; the N95 is worn by healthcare workers, not patients.

Question 71: An LPN is caring for a client with chronic kidney disease (CKD) who is not on dialysis. The client's diet will most likely include a restriction of which nutrient?

Complex carbohydrates
Vitamin C
Protein (Correct answer)
Healthy fats

Correct answer: Protein

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

Question 72: An LPN is caring for an elderly patient with a serum sodium level of 128 mEq/L. The nurse should prioritize monitoring for which of the following?

Peripheral edema
Increased urine output
Elevated blood pressure
Changes in mental status (Correct answer)

Correct answer: Changes in mental status

A sodium level of 128 mEq/L indicates hyponatremia (normal is 135-145 mEq/L). Low sodium levels can cause cerebral edema, leading to neurological changes such as confusion, lethargy, headache, and seizures. Monitoring for changes in mental status is a priority.

Question 73: A patient with a new colostomy refuses to look at the stoma or participate in care. The LPN's best therapeutic response is:

'I understand this is difficult. Would you like to watch while I care for it today?' (Correct answer)
'Many patients feel the same way at first, but you'll get used to it.'
'You'll need to learn this before discharge.'
'Your family can take care of this for you at home.'

Correct answer: 'I understand this is difficult. Would you like to watch while I care for it today?'

Acknowledging the patient's feelings and offering a gradual approach (observing first) respects autonomy and facilitates adaptation to the body change.

Question 74: The LPN delegates perineal care to a UAP. The patient is confused and resistive. What should the UAP do?

Attempt to redirect and try again independently
Stop the task and immediately inform the LPN (Correct answer)
Ask a family member to hold the patient still
Restrain the patient gently and complete the care

Correct answer: Stop the task and immediately inform the LPN

A resistive confused patient may need a different approach or assessment, requiring the LPN's involvement.

Question 75: A patient is prescribed metformin 500 mg twice daily. Which condition is an absolute contraindication for this medication?

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

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

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

Question 76: When drawing up a combined dose of regular and NPH insulin, in which order should the nurse proceed?

Draw NPH first, then add regular to the same syringe
Inject air into regular vial, then NPH; draw NPH first, then regular
Mix them in a separate cup before drawing into the syringe
Inject air into NPH vial, then regular; draw regular first, then NPH (Correct answer)

Correct answer: Inject air into NPH vial, then regular; draw regular first, then NPH

The mnemonic 'clear before cloudy' means draw clear (regular) insulin first to prevent contaminating it with NPH.

Question 77: A patient is diagnosed with Clostridioides difficile (C. diff). What is the most effective method for hand hygiene after providing care?

Wiping hands with a sterile gauze
Using an alcohol-based hand sanitizer
Using an antiseptic foam
Washing hands with soap and water (Correct answer)

Correct answer: Washing hands with soap and water

Alcohol-based hand sanitizers are not effective against C. difficile spores. Therefore, the CDC recommends using soap and water to mechanically remove the spores from the hands after caring for a patient with C. diff.

Question 78: A patient's blood glucose before lunch is 245 mg/dL. The sliding scale orders 4 units of regular insulin for glucose 201–250 mg/dL. The patient also has a scheduled mealtime dose of 8 units of regular insulin. What total dose should the LPN prepare?

16 units (double the scheduled dose when glucose exceeds 200)
8 units (scheduled dose only; never add correction at mealtime)
12 units (8 scheduled + 4 correction) (Correct answer)
4 units (correction dose only; skip scheduled dose when glucose is high)

Correct answer: 12 units (8 scheduled + 4 correction)

Scheduled mealtime insulin and sliding-scale correction insulin are additive; both are given together and drawn into the same syringe if both are regular insulin.

Question 79: The nurse is instructing the spouse of a client with a stroke on how to do passive range of motion to the affected limbs. Which rationale for this intervention will the nurse include in the teaching session?

Maintain cardiopulmonary function
Maintain joint flexibility (Correct answer)
Improve muscle strength
Improve endurance

Correct answer: Maintain joint flexibility

Passive range of motion (PROM) exercises involve a caregiver moving a client's limb without client effort. The primary goal of PROM is to prevent contractures, maintain joint mobility, and improve circulation, thereby preserving joint flexibility. It does not directly improve muscle strength, cardiopulmonary function, or endurance, which typically require active client participation.

Question 80: A UAP reports that a patient's blood pressure is 88/50 mmHg. What is the LPN's priority action?

Reassess the patient immediately and notify the RN (Correct answer)
Ask the UAP to encourage the patient to drink fluids
Document the finding and continue monitoring
Instruct the UAP to recheck in 30 minutes

Correct answer: Reassess the patient immediately and notify the RN

A BP of 88/50 is critically low; the LPN must reassess and escalate to the RN immediately.

Question 81: A patient is using a nasal cannula at 4 L/min. What approximate FiO2 is being delivered?

44%
24%
60%
36% (Correct answer)

Correct answer: 36%

At 4 L/min via nasal cannula, the approximate FiO2 is 36%; each liter per minute adds approximately 4% above the 21% baseline of room air.

Question 82: Which medication is classified as a non-opioid analgesic commonly used for mild to moderate pain?

Morphine sulfate
Acetaminophen (Tylenol) (Correct answer)
Hydromorphone
Oxycodone

Correct answer: Acetaminophen (Tylenol)

Acetaminophen is a non-opioid analgesic and antipyretic that works centrally and is first-line for mild to moderate pain without opioid side effects.

Question 83: Which electrolyte imbalance should the LPN monitor for in a patient receiving amphotericin B?

Hypokalemia (Correct answer)
Hypercalcemia
Hypermagnesemia
Hypernatremia

Correct answer: Hypokalemia

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

Question 84: What is the primary purpose of the LPN providing feedback to a UAP after a delegated task?

To fulfill documentation requirements for the shift
To establish a record for annual performance evaluations
To satisfy Joint Commission standards for staff education
To promote safe, competent practice and improve future performance (Correct answer)

Correct answer: To promote safe, competent practice and improve future performance

Constructive feedback after task completion supports ongoing competency and patient safety.

Question 85: Which intervention is most effective for preventing ventilator-associated pneumonia (VAP) in an intubated patient?

Maintaining head of bed elevation at 30-45 degrees (Correct answer)
Keeping the head of bed flat at all times
Deflating the endotracheal cuff every 4 hours
Performing oral care once daily

Correct answer: Maintaining head of bed elevation at 30-45 degrees

Elevating the head of bed 30-45 degrees reduces aspiration of oropharyngeal secretions, which is the primary mechanism by which VAP develops.

Question 86: An LPN working in a home health setting wants to delegate bathing to a home health aide. Which factor is most critical to assess first?

Whether the family approves of the aide performing the task
Whether the patient's condition is stable enough for UAP-assisted bathing (Correct answer)
Whether the patient prefers morning or evening baths
Whether the aide has worked with similar patients before

Correct answer: Whether the patient's condition is stable enough for UAP-assisted bathing

Patient stability determines whether bathing can be safely delegated to a UAP in the home setting.

Question 87: Which statement reflects the correct relationship between the LPN and the UAP regarding delegation?

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

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

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

Question 88: An LPN is reviewing a patient's chart and notes a positive culture for Vancomycin-resistant Enterococcus (VRE) in a draining wound. Which type of transmission-based precaution is required?

Droplet Precautions
Airborne Precautions
Contact Precautions (Correct answer)
Protective Precautions

Correct answer: Contact Precautions

VRE is a multi-drug resistant organism (MDRO) that is spread by direct or indirect contact with the patient or their environment. Therefore, Contact Precautions, which include wearing a gown and gloves, are necessary to prevent transmission.

Question 89: A nurse is reinforcing teaching a client who has tuberculosis. Which of the following statements should the nurse include when reinforcing the teaching?

You will need to wear a mask at all times
You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication (Correct answer)
You will need to continue to take the multi medication regimen for 4 months
You will need to remain hospitalized for treatment

Correct answer: You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication

Monitoring the effectiveness of tuberculosis treatment involves regular sputum cultures to confirm the absence of Mycobacterium tuberculosis. Sputum samples are typically collected periodically, such as every 2-4 weeks, until two consecutive samples are negative. This is a critical aspect of ensuring successful treatment, confirming the client is no longer infectious, and preventing further transmission.

Question 90: A patient on contact precautions requires a blood pressure measurement. What should the nurse do with the blood pressure cuff?

Use a disposable cuff only if the patient has MRSA
Use the standard shared hall cuff and clean it after
Dedicate a blood pressure cuff for use in that patient's room only (Correct answer)
Avoid taking blood pressure on contact precaution patients

Correct answer: Dedicate a blood pressure cuff for use in that patient's room only

Contact precautions require dedicating non-critical patient care equipment (like BP cuffs) to a single patient to prevent organism spread.

Question 91: Which right of delegation requires the LPN to give the UAP clear instructions about what to do and report?

Right task
Right person
Right direction and communication (Correct answer)
Right supervision

Correct answer: Right direction and communication

The 'right direction and communication' ensures the UAP understands exactly what to do and what changes to report.

Question 92: A nurse is figuring out how much liquid paracetamol to administer to a young patient. The amount of paracetamol in a bottle is 120 mg per 5mL. The youngster is 24 kg in weight. How many mL of paracetamol are required if the relevant dose for children is 15 mg per kg?

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

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

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

Question 93: A patient receiving TPN has a blood glucose of 310 mg/dL. What is the most appropriate nursing action?

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

Correct answer: Notify the provider and anticipate an insulin order

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

Question 94: A patient is ordered a medication that has a narrow therapeutic index. Which nursing action is most important before administration?

Ask the patient if they have taken the medication before
Verify the dose, time, route, and check current serum drug level if applicable (Correct answer)
Check the medication against a drug reference only
Administer quickly to avoid delays in treatment

Correct answer: Verify the dose, time, route, and check current serum drug level if applicable

Medications with narrow therapeutic indices (e.g., digoxin, lithium, phenytoin) require verification of dose, route, timing, and current serum levels to prevent toxicity.

Question 95: An LPN is preparing to administer an oral medication and the patient states, 'I've never seen this pill before.' The correct response is:

Reassure the patient that this is their correct medication and administer it
Hold the medication and verify the order before administration (Correct answer)
Ask a family member if they recognize the medication
Tell the patient the pharmacy sometimes changes pill appearance

Correct answer: Hold the medication and verify the order before administration

Patient concerns about medication should always prompt the nurse to stop and verify the order against the medication administration record before proceeding.

Question 96: When should gloves be changed during patient care?

Only when visibly soiled
When moving from a contaminated body site to a clean site on the same patient (Correct answer)
Only before performing invasive procedures
After each patient contact only

Correct answer: When moving from a contaminated body site to a clean site on the same patient

Gloves must be changed when moving from a contaminated body site (e.g., perineal area) to a clean site on the same patient to prevent cross-contamination.

Question 97: A patient is using a patient-controlled analgesia (PCA) pump. Which action is within the LPN's scope of practice?

Changing the opioid cartridge independently
Monitoring the patient's pain level and respiratory status (Correct answer)
Programming the PCA pump settings
Adjusting the lockout interval

Correct answer: Monitoring the patient's pain level and respiratory status

The LPN monitors the patient's response to PCA therapy including pain levels, sedation, and respiratory status, reporting changes to the RN.

Question 98: Hazardous object handling and disposal are additional duties for nurses. Which of the following actions demonstrates proper treatment of infectious or hazardous wastes?

Used PPEs are disposed in the trash bin along the hallway.
A clear liquid in a vial is disposed by emptying the contents in the washroom.
Photosensitive substances are stored in clean and clear bottles.
Labeling the containers of specimens to be examined. (Correct answer)

Correct answer: Labeling the containers of specimens to be examined.

Proper labeling of specimen containers is a critical step in the safe handling and disposal of infectious or hazardous wastes. It ensures that all personnel are aware of the contents, allowing them to take appropriate precautions during transport, examination, and disposal, thereby preventing misidentification and potential exposure. The other options describe unsafe or improper practices.

Question 99: Which medication class commonly causes urinary retention as a side effect?

Beta-blockers
ACE inhibitors
Anticholinergics (e.g., diphenhydramine, oxybutynin) (Correct answer)
Diuretics

Correct answer: Anticholinergics (e.g., diphenhydramine, oxybutynin)

Anticholinergic medications block muscarinic receptors in the bladder, reducing detrusor muscle contractions and causing urinary retention.

Question 100: The LPN is caring for a patient receiving continuous tube feedings. The patient's residual volume is 280 mL. What is the correct action?

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

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

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

Question 101: A patient with peripheral vascular disease reports leg pain while walking that resolves with rest. The LPN recognizes this as:

Deep vein thrombosis
Cellulitis
Intermittent claudication (Correct answer)
Restless leg syndrome

Correct answer: Intermittent claudication

Intermittent claudication is muscle pain caused by insufficient blood flow during activity that resolves with rest.

Question 102: An LPN is reviewing the morning labs for a patient and notes a serum potassium level of 6.1 mEq/L. What is the LPN's priority action?

Document the finding and recheck in 4 hours
Immediately notify the RN or healthcare provider (Correct answer)
Encourage the patient to eat a banana
Administer a prescribed diuretic

Correct answer: Immediately notify the RN or healthcare provider

A potassium level of 6.1 mEq/L is critically high (hyperkalemia) and places the patient at risk for life-threatening cardiac dysrhythmias. The LPN's priority is to immediately report this finding to the RN or healthcare provider for urgent intervention.

Question 103: What is the normal oxygen saturation (SpO2) range for a healthy adult?

85-90%
90-94%
100% only
95-100% (Correct answer)

Correct answer: 95-100%

Normal SpO2 for healthy adults is 95-100%; values below 90% indicate hypoxemia requiring immediate intervention.

Question 104: A patient with an open, draining wound infected with MRSA is being transferred to a long-term care facility. What must the nurse do?

Notify the receiving facility about the patient's MRSA status (Correct answer)
No special action is needed if the wound is covered
Place the patient in airborne precautions for transport
Require the transport team to wear full hazmat suits

Correct answer: Notify the receiving facility about the patient's MRSA status

Healthcare facilities are required to communicate a patient's infection status (including MRSA) to receiving facilities to ensure continuity of appropriate infection control measures.

Question 105: During uterine contractions, moms create the hormone _________, which causes nursing mothers to expel milk.

Oxytocin (Correct answer)
None of the above
Minotocin
Angiotensin

Correct answer: Oxytocin

Oxytocin is a hormone produced by the hypothalamus and released by the posterior pituitary gland. During breastfeeding, suckling stimulates oxytocin release, which causes the myoepithelial cells in the mammary glands to contract, leading to the 'milk ejection reflex' or 'let-down.' It also plays a crucial role in uterine contractions during labor.

Question 106: A patient taking lithium for bipolar disorder reports tremors, nausea, and blurred vision. The LPN's priority action is to:

Encourage increased fluid intake only
Hold the next dose and notify the RN immediately (Correct answer)
Reassure the patient that these are expected side effects
Administer the next dose with a large glass of water

Correct answer: Hold the next dose and notify the RN immediately

Tremors, nausea, and blurred vision are signs of lithium toxicity, a potentially life-threatening condition requiring immediate reporting and medication withholding.

Question 107: Which of the following tasks may the LPN delegate to a UAP in a long-term care facility?

Measuring and recording urinary output (Correct answer)
Inserting a urinary catheter
Administering a scheduled oral medication
Assessing a new pressure injury

Correct answer: Measuring and recording urinary output

Measuring and recording output is a routine observational task within the UAP's scope.

Question 108: A patient is receiving IV morphine for pain. Which finding requires the LPN to withhold the next dose and notify the RN?

Blood pressure of 118/76 mmHg
Respiratory rate of 10 breaths per minute (Correct answer)
Patient reports mild nausea
Pain score of 6/10

Correct answer: Respiratory rate of 10 breaths per minute

A respiratory rate below 12 breaths per minute indicates opioid-induced respiratory depression and warrants withholding the medication and notifying the RN.

Question 109: What condition slows down metabolic rate?

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

Correct answer: Hypothyroidism

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

Question 110: A patient's urine is dark amber and concentrated. This finding most likely indicates which condition?

Urinary tract infection
Dehydration and insufficient fluid intake (Correct answer)
Renal failure with anuria
Adequate hydration

Correct answer: Dehydration and insufficient fluid intake

Dark amber, concentrated urine is a classic sign of dehydration; the kidneys conserve water by producing less, more concentrated urine.

Question 111: Before administering a bolus enteral feeding via a nasogastric (NG) tube, what is the LPN's priority action?

Flush the tube with 30 mL of water.
Check for gastric residual volume. (Correct answer)
Place the client in a supine position.
Warm the formula in a microwave.

Correct answer: Check for gastric residual volume.

Checking for gastric residual volume is the priority action before administering a bolus feeding. This assesses gastric emptying and helps prevent over-distention and aspiration. If the residual volume is high (per facility policy), the feeding may need to be held and the provider notified.

Question 112: Which positioning is most appropriate for a patient following a below-knee amputation to prevent contractures?

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

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

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

Question 113: The LPN notes that a patient's nasogastric (NG) tube feeding bag has been hanging for 9 hours. What action is required?

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

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

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

Question 114: An infection of a vein clot.

Arteriosclerosis
Phlebotomy
Hemolysis
Thrombophlebitis (Correct answer)

Correct answer: Thrombophlebitis

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

Question 115: A patient with diabetes has a neuropathic foot ulcer. Which assessment finding is MOST characteristic of diabetic neuropathic ulcers?

Located on the gaiter area with surrounding hemosiderin staining
Located on the fingertips with ragged wound edges
Occurs over pressure points on the plantar surface with minimal pain (Correct answer)
Occurs on the lateral malleolus with severe pain

Correct answer: Occurs over pressure points on the plantar surface with minimal pain

Diabetic neuropathic ulcers typically occur on pressure points of the plantar foot and are painless due to sensory neuropathy.

Question 116: A patient has been receiving palliative care for the past several weeks in light of her worsening condition following a series of strokes. The caregiver has rung the call bell, stating that the patient now "stops breathing for a while, then breathes fast and hard, and then stops again." The nurse would recognize that the patient is experiencing

Cheyne-Stokes respirations (Correct answer)
Bradypnea
Death rattle
Apnea

Correct answer: Cheyne-Stokes respirations

Cheyne-Stokes respirations are a pattern of breathing characterized by cycles of progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop (apnea). This pattern is commonly seen in patients nearing the end of life, especially those with severe neurological conditions like stroke, and indicates severe brainstem dysfunction.

Question 117: After being accused of setting a fire, a patient is sent to the psychiatric ward for a forensic assessment. The antisocial personality disorder is his preliminary diagnosis. The nurse would anticipate discovering after looking through the client's file

An expression of remorse for his actions
A history of cruelty to animals (Correct answer)
A below-average intelligence
A history of consistent employment

Correct answer: A history of cruelty to animals

Antisocial personality disorder is characterized by a pervasive disregard for and violation of the rights of others, often with a history of conduct disorder in childhood. A history of cruelty to animals is a common and significant diagnostic criterion for conduct disorder, reflecting a lack of empathy and a precursor to adult antisocial behaviors.

Question 118: When should postural drainage therapy be scheduled to reduce the risk of aspiration?

Only at bedtime regardless of meal timing
Immediately after meals
30 minutes after meals
1-2 hours before or after meals (Correct answer)

Correct answer: 1-2 hours before or after meals

Postural drainage should be performed 1-2 hours before or after meals to reduce the risk of aspiration and prevent nausea or vomiting during the procedure.

Question 119: An LPN is caring for a patient in Buck's traction. Which action is most important to prevent complications?

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

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

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

Question 120: An LPN is caring for a patient with a urinary catheter. Which action BEST prevents catheter-associated urinary tract infection (CAUTI)?

Irrigating the catheter with normal saline daily
Keeping the drainage bag below bladder level at all times (Correct answer)
Clamping the drainage tube when ambulating
Changing the catheter every 72 hours routinely

Correct answer: Keeping the drainage bag below bladder level at all times

Keeping the drainage bag below bladder level prevents urine backflow, which is a major contributor to CAUTI.

Question 121: Several weeks after a stroke, a patient has urinary incontinence resulting from an impaired awareness of bladder fullness. For an effective bladder training program, which nursing intervention will be best to include in the plan of care?

Assist the patient onto the bedside commode every 2 hours (Correct answer)
Limit fluid intake to 1200 mL daily to reduce urine volume
Perform intermittent catheterization after each voiding to check for residual urine
Use an external "condom" catheter to protect the skin and prevent embarrassment

Correct answer: Assist the patient onto the bedside commode every 2 hours

For a patient with impaired awareness of bladder fullness, a scheduled toileting program is crucial for effective bladder training. Assisting the patient to the bedside commode every 2 hours helps establish a routine, prevents incontinence, and ensures regular bladder emptying. This intervention helps retrain the bladder and improve continence by proactively managing voiding times.

Question 122: A patient with COPD requires nutritional support. Which dietary modification is most appropriate to reduce carbon dioxide production?

High-protein, high-carbohydrate diet
High-fat, lower-carbohydrate diet (Correct answer)
High-carbohydrate, low-fat diet
Low-calorie liquid diet only

Correct answer: High-fat, lower-carbohydrate diet

High-fat, lower-carbohydrate diets reduce CO2 production from carbohydrate metabolism, which eases the respiratory burden in COPD patients.

Question 123: Which oxygen delivery device provides the most precise and controlled oxygen concentration?

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

Correct answer: Venturi mask

The Venturi mask uses color-coded jet-mixing adapters to deliver precise, controlled FiO2 concentrations, making it ideal for COPD patients sensitive to high oxygen levels.

Question 124: Which clinical finding indicates that a patient with heart failure is responding positively to diuretic therapy?

Weight loss of 2 pounds since yesterday (Correct answer)
Decrease in urine specific gravity to 1.005
Increase in blood pressure to 150/90 mmHg
Increase in serum sodium to 148 mEq/L

Correct answer: Weight loss of 2 pounds since yesterday

Daily weight loss reflects fluid removal, which is the primary goal of diuretic therapy in heart failure.

Question 125: After a thoracentesis, which assessment finding requires the LPN to report immediately to the physician?

Mild soreness at the puncture site
Sudden onset of dyspnea and tracheal deviation (Correct answer)
SpO2 of 96%
Respiratory rate of 18 breaths/min

Correct answer: Sudden onset of dyspnea and tracheal deviation

Sudden dyspnea and tracheal deviation after thoracentesis may indicate tension pneumothorax, a life-threatening emergency requiring immediate intervention.

Question 126: Which of these nursing actions can the RN working in a long-term care facility delegate to an experienced LPN who is caring for a patient with a permanent tracheostomy?

Assessing the patient's risk for aspiration
Determining the need for replacement of the tracheostomy tube
Educating the patient about self-care of the tracheostomy
Suctioning the tracheostomy when needed (Correct answer)

Correct answer: Suctioning the tracheostomy when needed

LPNs, especially experienced ones, are trained and competent in performing routine procedures like tracheostomy suctioning for stable patients. This task falls within their scope of practice as it is a technical skill rather than requiring complex assessment, diagnosis, or teaching. The other options involve higher-level assessment, critical thinking, and patient education, which are typically within the RN's scope.

Question 127: A patient on a low-sodium diet receives a lunch tray. Which item indicates a dietary error that the LPN should address?

Fresh fruit salad
Unsalted crackers
Plain baked chicken breast
Canned vegetable soup (Correct answer)

Correct answer: Canned vegetable soup

Canned soups are typically very high in sodium and are not appropriate for a low-sodium therapeutic diet.

Question 128: Which intervention is CONTRAINDICATED when caring for a stage 1 pressure injury?

Applying a transparent film dressing
Keeping the skin clean and dry
Increasing turning frequency
Massaging the erythematous area (Correct answer)

Correct answer: Massaging the erythematous area

Massaging over a reddened bony prominence can further damage fragile capillaries and worsen tissue injury.

Question 129: A patient with liver cirrhosis is placed on a protein-restricted diet. The LPN knows this restriction is intended to reduce:

Blood glucose levels
Fluid retention and ascites
Serum triglyceride levels
Serum ammonia levels and risk of hepatic encephalopathy (Correct answer)

Correct answer: Serum ammonia levels and risk of hepatic encephalopathy

Protein restriction in cirrhosis reduces ammonia production from protein metabolism, decreasing the risk of hepatic encephalopathy.

Question 130: Which action by the LPN best demonstrates proper hand hygiene technique according to CDC guidelines?

Wiping hands on a paper towel without washing
Rinsing hands under warm water without soap
Using alcohol-based hand rub for 5 seconds
Washing hands with soap and water for at least 20 seconds (Correct answer)

Correct answer: Washing hands with soap and water for at least 20 seconds

The CDC recommends washing hands with soap and water for at least 20 seconds, especially when hands are visibly soiled or after caring for a patient with C. difficile.

Question 131: A normal blood sugar range is 80 to 180. False or true?

FALSE (Correct answer)
TRUE

Correct answer: FALSE

A normal fasting blood sugar range is typically considered to be 70 to 99 mg/dL. A range of 80 to 180 mg/dL is too broad and includes levels that would be considered prediabetic or diabetic, especially the upper end. Therefore, the statement that 80 to 180 is a normal range is false.

Question 132: A patient is receiving a blood transfusion and develops fever, chills, and lower back pain 15 minutes into the infusion. The LPN should FIRST:

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

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

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

Question 133: A patient's WBC is 1,800/mm³. What is the most important nursing action?

Implement neutropenic precautions and restrict visitors with illness (Correct answer)
Prepare to administer antibiotics immediately
Encourage the patient to increase vitamin C intake
Place the patient in airborne isolation

Correct answer: Implement neutropenic precautions and restrict visitors with illness

Severe leukopenia (<2,000/mm³) indicates high infection risk, requiring protective (neutropenic) precautions to prevent exposure to pathogens.

Question 134: A patient with COPD has an oxygen saturation of 88% on room air. The physician orders oxygen at 1-2 L/min via nasal cannula. The patient asks why they can't have more oxygen. What is the best explanation?

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

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

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

Question 135: A 5-year-old girl with a fever, chills, and trouble walking is taken to the emergency room by her grandmother. The nurse makes an effort to undress the infant but finds it difficult. The nurse also discovered bruising near the vaginal region after conducting a thorough examination. Which of the following should the nurse start with?

Collect the clothing and underwear of the child
Record all the findings
Inform the law enforcement for a possible child abuse (Correct answer)
Provide privacy and disregard the behavior of the child

Correct answer: Inform the law enforcement for a possible child abuse

The nurse's immediate priority is the child's safety. Bruising near the vaginal region, difficulty undressing, and the child's age are strong indicators of potential child abuse, specifically sexual abuse. Nurses are mandated reporters and have a legal and ethical obligation to report suspected abuse to law enforcement or child protective services to ensure the child's protection.

Question 136: A patient receiving a blood transfusion develops chills, back pain, and dark urine 20 minutes into the infusion. The LPN should first:

Administer diphenhydramine as ordered for allergic reaction
Stop the transfusion and notify the RN immediately (Correct answer)
Take vital signs and continue monitoring
Slow the transfusion to keep the vein open

Correct answer: Stop the transfusion and notify the RN immediately

These signs suggest a hemolytic transfusion reaction, a life-threatening emergency requiring immediate cessation of the transfusion.

Question 137: A patient with diabetes and chronic kidney disease (CKD) stage 4 is at increased risk for which insulin-related problem?

Prolonged hypoglycemia because the kidneys normally degrade insulin and this capacity is reduced (Correct answer)
Rapid insulin clearance leading to frequent hyperglycemia
Insulin resistance requiring higher doses due to uremic toxins
No change in insulin pharmacokinetics with CKD

Correct answer: Prolonged hypoglycemia because the kidneys normally degrade insulin and this capacity is reduced

The kidneys contribute significantly to insulin degradation; as renal function declines, insulin half-life extends and hypoglycemia risk increases, often requiring dose reductions.

Question 138: How frequently should a urinary catheter drainage bag be emptied to prevent infection and maintain accurate output measurement?

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

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

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

Question 139: Which glands control hormone levels by negative feedback?

Hypothalumus
Adrenal gland
Both A and C (Correct answer)
Pituitary
Exocrine gland

Correct answer: Both A and C

The hypothalamus and pituitary gland work together as the main control centers for the endocrine system, regulating hormone levels through negative feedback loops. The hypothalamus controls the pituitary, which in turn regulates other endocrine glands, ensuring hormone levels are maintained within a narrow physiological range for proper body function.

Question 140: A patient in restraints must be assessed every:

4 hours
2 hours
30 minutes (Correct answer)
1 hour

Correct answer: 30 minutes

Patients in restraints require assessment every 30 minutes including circulation, skin integrity, and need for continued restraint per The Joint Commission standards.

Question 141: A patient with a pressure injury has a wound bed that is 75% yellow slough and 25% red granulation tissue. How should the LPN document this wound?

Stage III pressure injury with 75% yellow, 25% red tissue (Correct answer)
Unstageable pressure injury
Stage II pressure injury with granulation tissue
Deep tissue pressure injury

Correct answer: Stage III pressure injury with 75% yellow, 25% red tissue

Wound beds are documented by tissue type percentages; slough does not make a wound automatically unstageable unless the wound base is completely obscured.

Question 142: What is the most reliable early indicator of respiratory distress in an adult patient?

Bradycardia
Decreased respiratory rate
Cyanosis
Restlessness and anxiety (Correct answer)

Correct answer: Restlessness and anxiety

Restlessness and anxiety are early signs of hypoxia as the brain detects decreased oxygen; cyanosis is a late sign appearing only after significant desaturation.

NCLEX-PN Exam

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

Questions

300 min

Time Limit

50%

To Pass

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