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

Question 1: A nurse finds a patient who has been in four-point restraints for 4 hours and has not been checked. What is the priority assessment?

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

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

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

Question 2: Why is health assessment important in nursing?

To offer treatment recommendations
To monitor vital signs only
To gather information that guides care planning (Correct answer)
To provide medication

Correct answer: To gather information that guides care planning

Health assessment is the foundational step in the nursing process, serving to systematically gather comprehensive information about a patient's health status. This data, both subjective and objective, is critical for identifying actual and potential health problems. The insights gained directly guide the development of individualized and effective care plans, ensuring patient-centered interventions.

Question 3: When applying a cold pack to a patient's sprained ankle, the LPN should:

Leave the cold pack in place continuously for the first 24 hours
Apply the cold pack directly to bare skin for maximum effect
Limit application to 15–20 minutes and place a cloth barrier between pack and skin (Correct answer)
Apply cold only if the ankle is not visibly swollen

Correct answer: Limit application to 15–20 minutes and place a cloth barrier between pack and skin

Cold packs should be applied for 15–20 minutes with a cloth barrier to prevent tissue damage from prolonged cold exposure or frostbite.

Question 4: A nurse is assigned to care for a patient with Clostridium difficile (C. diff). Which hand hygiene method is most effective against C. diff spores?

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

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

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

Question 5: Which finding in a client receiving a blood transfusion requires the LPN to stop the transfusion immediately?

Blood pressure 130/80 mmHg
Mild itching at the IV site
Temperature increase of 0.5°F from baseline
Chills, back pain, and dark urine (Correct answer)

Correct answer: Chills, back pain, and dark urine

Chills, flank/back pain, and hemoglobinuria (dark urine) are classic signs of an acute hemolytic transfusion reaction, which is life-threatening.

Question 6: A patient is found on the floor. After calling for help, what is the nurse's next priority action?

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

Correct answer: Assess the patient for injury before moving them

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

Question 7: A nurse is assessing a newborn 24 hours after birth. Which finding requires IMMEDIATE follow-up regarding hearing health?

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

Correct answer: Failure to pass the newborn hearing screening

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

Question 8: When performing developmental screening on a 12-month-old, which milestone would the nurse expect the child to have achieved?

Walking independently without support
Speaking in two-word phrases
Drawing a circle
Standing while holding on to furniture (Correct answer)

Correct answer: Standing while holding on to furniture

Pulling to stand and cruising along furniture are typical gross motor milestones for a 12-month-old; independent walking usually occurs around 12–15 months.

Question 9: Which ECG change is most consistent with hyperkalemia in a cardiac patient?

ST segment depression
Peaked T waves (Correct answer)
Shortened PR interval
Prolonged QT interval

Correct answer: Peaked T waves

Hyperkalemia classically produces tall, peaked T waves on the ECG, which can progress to life-threatening arrhythmias.

Question 10: The nurse is preparing to administer an intramuscular injection. To prevent a needlestick injury after the injection, what is the most important action for the nurse to take?

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

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

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

Question 11: Which situation requires the nurse to use an N95 respirator rather than a standard surgical mask?

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

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

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

Question 12: Which action by the LPN demonstrates proper technique when performing a sterile catheter insertion?

Opening the sterile field above waist level after gloving (Correct answer)
Placing sterile items on the bedside table before opening the kit
Using clean gloves to insert the catheter
Touching the sterile drape with bare hands to position it

Correct answer: Opening the sterile field above waist level after gloving

The sterile field must remain above waist level and be handled only with sterile gloves to maintain asepsis during urinary catheterization.

Question 13: A client receiving IV fluid therapy has an intake of 2,800 mL and urine output of 800 mL over the past 8 hours. The LPN should:

Increase IV fluid rate to match the high output
Restrict oral fluids only and continue IV therapy as ordered
Document as normal — 2,800 mL intake is within expected range for an 8-hour shift
Notify the charge nurse of positive fluid balance of 2,000 mL and assess for signs of fluid overload (Correct answer)

Correct answer: Notify the charge nurse of positive fluid balance of 2,000 mL and assess for signs of fluid overload

A 2,000 mL positive fluid balance in 8 hours is significant. With adequate urine output of only 800 mL, fluid retention is likely occurring, requiring assessment for fluid overload and provider notification.

Question 14: A client is receiving IV morphine 2 mg every 4 hours via a PCA pump. The nurse notes the client's respiratory rate is 8 breaths/minute and the client is difficult to arouse. The LPN's priority action is:

Stop all IV medications and call a code
Stimulate the client and recheck the respiratory rate in 30 minutes
Stop the morphine PCA infusion, apply supplemental oxygen, notify the charge nurse, and prepare to administer naloxone (Correct answer)
Decrease the PCA dose setting and monitor for improvement

Correct answer: Stop the morphine PCA infusion, apply supplemental oxygen, notify the charge nurse, and prepare to administer naloxone

A respiratory rate of 8/min with decreased arousal in a client on opioids indicates respiratory depression — a medical emergency requiring opioid cessation, oxygenation, and naloxone administration.

Question 15: A client with deep vein thrombosis (DVT) of the left leg is on heparin therapy. The LPN should immediately report which finding to the charge nurse?

aPTT of 70 seconds (control 30 seconds)
Mild bruising at the IV site
Left calf tenderness and warmth
Sudden onset of chest pain and dyspnea (Correct answer)

Correct answer: Sudden onset of chest pain and dyspnea

Sudden chest pain and dyspnea in a client with DVT suggest pulmonary embolism, a life-threatening emergency requiring immediate escalation.

Question 16: A nurse is assessing a client's body mass index (BMI). Which BMI range is classified as obese according to standard guidelines?

25.0–29.9
30.0 and above (Correct answer)
35.0 and above only
18.5–24.9

Correct answer: 30.0 and above

A BMI of 30.0 or higher is classified as obese; 25.0–29.9 is considered overweight, and 18.5–24.9 is normal weight.

Question 17: A client post-coronary artery bypass graft (CABG) has a mediastinal drainage tube with output of 300 mL in the past hour. The LPN should:

Document as expected and continue monitoring
Clamp the drainage tube
Reposition the client to increase drainage
Immediately notify the charge nurse (Correct answer)

Correct answer: Immediately notify the charge nurse

Post-CABG mediastinal drainage greater than 200 mL/hr indicates excessive bleeding and potential cardiac tamponade, requiring immediate nurse notification and urgent intervention.

Question 18: What is the correct sequence for removing PPE after caring for a patient on contact precautions?

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

Correct answer: Gloves, goggles, gown, mask

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

Question 19: Which action by the LPN best promotes sleep for a hospitalized patient who reports insomnia?

Cluster care activities and reduce environmental noise/lighting in the evening (Correct answer)
Schedule painful procedures and vitals checks at night to consolidate daytime rest
Administer a prescribed sedative immediately at bedtime
Encourage the patient to nap frequently throughout the day

Correct answer: Cluster care activities and reduce environmental noise/lighting in the evening

Clustering care activities and reducing stimulation in the evening support the patient's natural circadian rhythm and promote sleep onset.

Question 20: What is the importance of checking the medication expiration date?

To increase the efficacy of the treatment
To reduce costs
To satisfy regulations
To ensure medications are safe and effective (Correct answer)

Correct answer: To ensure medications are safe and effective

Checking the medication expiration date is a vital safety measure to ensure the drug's potency and safety. Expired medications may lose their therapeutic effectiveness, become chemically altered, or even turn toxic, potentially harming the patient. This simple check guarantees that the medication administered is both safe and capable of providing the intended treatment.

Question 21: A Stage 1 pressure injury is characterized by which clinical finding?

Full-thickness skin and tissue loss with exposed bone
Partial-thickness skin loss with exposed dermis
Non-blanchable erythema on intact skin (Correct answer)
Deep purple or maroon discoloration indicating deep tissue injury

Correct answer: Non-blanchable erythema on intact skin

Stage 1 presents as non-blanchable redness on intact skin, signaling early tissue damage without a break in the skin surface.

Question 22: An LPN is providing wound care to a stage 2 pressure injury. Which dressing type is most appropriate?

Calcium alginate packing
Wet-to-dry gauze dressing
Transparent film or hydrocolloid dressing (Correct answer)
Dry sterile gauze changed twice daily

Correct answer: Transparent film or hydrocolloid dressing

Transparent film or hydrocolloid dressings maintain a moist wound environment, promote healing, and protect stage 2 pressure injuries.

Question 23: Which type of wound healing involves gradual contraction of wound edges, granulation tissue formation, and epithelialization to close a large open wound?

Secondary intention healing (Correct answer)
Delayed primary closure
Primary intention healing
Tertiary intention healing

Correct answer: Secondary intention healing

Secondary intention healing occurs in large or contaminated wounds left open, relying on contraction, granulation tissue, and epithelialization to close gradually.

Question 24: A patient wearing a sequential compression device (SCD) complains of leg numbness. What is the LPN's first action?

Encourage the patient to ambulate
Loosen the device and elevate the legs
Document the finding and reassess in 30 minutes
Remove the SCD and assess circulation (Correct answer)

Correct answer: Remove the SCD and assess circulation

Numbness may indicate impaired circulation or nerve compression, so the SCD must be removed immediately to assess the extremity.

Question 25: A patient with HIV asks the nurse if other staff members need to know about their diagnosis. The nurse's best response is:

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

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

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

Question 26: A patient with amyotrophic lateral sclerosis (ALS) is experiencing progressive dysphagia. Which nursing intervention is most appropriate?

Position the patient upright and offer thickened liquids as ordered (Correct answer)
Encourage thin liquids for easier swallowing
Restrict oral intake and initiate IV fluids only
Recommend a high-fiber solid diet to maintain nutrition

Correct answer: Position the patient upright and offer thickened liquids as ordered

Upright positioning and thickened liquids reduce aspiration risk in ALS patients with dysphagia while maintaining oral nutrition as long as safely possible.

Question 27: A patient receiving opioid analgesics reports constipation. The most appropriate nursing intervention is:

Discontinue the opioid and notify the provider
Restrict fluids to reduce bowel motility
Encourage increased fluid intake, fiber, and mobility as tolerated (Correct answer)
Administer a Fleet enema without an order

Correct answer: Encourage increased fluid intake, fiber, and mobility as tolerated

Increasing fluids, dietary fiber, and mobility are first-line non-pharmacological measures to counteract opioid-induced constipation.

Question 28: A client receiving magnesium sulfate for preeclampsia has absent deep tendon reflexes (DTRs) and a respiratory rate of 12 breaths/minute. The LPN should immediately:

Stop the magnesium infusion and administer calcium gluconate IV (Correct answer)
Reposition the client and continue monitoring DTRs every hour
Increase the magnesium infusion rate to maintain therapeutic levels
Document the findings as expected side effects

Correct answer: Stop the magnesium infusion and administer calcium gluconate IV

Absent DTRs and respiratory rate of 12 are signs of magnesium toxicity. The infusion must be stopped immediately and calcium gluconate (the antidote) administered.

Question 29: A 52-year-old client with a healthy immune system asks the LPN which immunizations they should be considering. Based on current CDC recommendations, which vaccine is appropriate to recommend for this client?

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

Correct answer: Recombinant zoster vaccine (Shingrix) for shingles

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

Question 30: A nurse observes a colleague reusing a single-use vial of insulin for multiple patients. The appropriate action is to:

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

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

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

Question 31: A patient recovering from abdominal surgery reports sudden severe abdominal pain and the LPN assesses a rigid, board-like abdomen. These findings suggest:

Peritonitis (Correct answer)
Paralytic ileus
Incisional hernia
Gastrointestinal hemorrhage

Correct answer: Peritonitis

A rigid board-like abdomen with severe pain indicates peritonitis, an inflammatory or infectious process involving the peritoneum, requiring immediate intervention.

Question 32: Which action by a nurse demonstrates correct use of sterile technique during a urinary catheter insertion?

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

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

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

Question 33: A patient with vancomycin-resistant Enterococcus (VRE) is being discharged to a long-term care facility. The nurse's priority is to:

Withhold VRE information to protect patient confidentiality
Ensure the receiving facility is notified of the patient's VRE status (Correct answer)
Ensure the patient is transported in a negative-pressure vehicle
Instruct the patient to avoid all contact with other residents

Correct answer: Ensure the receiving facility is notified of the patient's VRE status

The receiving facility must be informed of VRE status so they can implement appropriate contact precautions to protect residents and staff.

Question 34: A client with Clostridioides difficile (C. diff) infection has soiled the bed linens. When leaving the client's room after providing care, which method of hand hygiene is most appropriate for the LPN to perform?

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

Correct answer: Washing hands with soap and water.

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

Question 35: Which of the following describes the process of pharmacokinetics in the body?

The movement of a drug through the body, including absorption, distribution, metabolism, and excretion. (Correct answer)
The process of a drug binding to a receptor to produce a therapeutic effect.
The chemical alteration of a drug by the body's enzymes.
The study of how a drug affects the body and its mechanism of action.

Correct answer: The movement of a drug through the body, including absorption, distribution, metabolism, and excretion.

Pharmacokinetics is the study of how the body acts on a drug. It encompasses the four processes of absorption (how the drug gets into the body), distribution (where it goes), metabolism (how it's broken down), and excretion (how it leaves the body).

Question 36: A client with stable angina asks the nurse about sexual activity. The LPN's best response is:

Sexual activity should only occur in the morning when energy is highest
Sexual activity is generally safe if you can climb two flights of stairs without symptoms (Correct answer)
You must complete cardiac rehab before any sexual activity
You should avoid sexual activity indefinitely after a cardiac diagnosis

Correct answer: Sexual activity is generally safe if you can climb two flights of stairs without symptoms

The ability to climb two flights of stairs (or achieve 5 METs on a stress test) without chest pain or dyspnea is a general guideline indicating sufficient cardiac reserve for sexual activity.

Question 37: A postpartum nurse is promoting breastfeeding. Which instruction should be given to a new mother about infant feeding frequency?

Feed on demand, approximately 8–12 times per 24 hours (Correct answer)
Limit each feeding session to 5 minutes per breast
Supplement with formula after each breastfeeding session
Feed every 4–6 hours to allow breast milk to replenish

Correct answer: Feed on demand, approximately 8–12 times per 24 hours

Newborns should breastfeed on demand, approximately 8–12 times in 24 hours, to establish adequate milk supply and meet nutritional needs.

Question 38: An LPN in a pediatric clinic is assessing a toddler with numerous bruises in various stages of healing on their trunk and back. The parent states the child is clumsy and falls a lot. Which of the following actions is the LPN's legal responsibility?

Confront the parent about the suspicious nature of the injuries.
Document the findings and ask the parent to return in one week.
Report the suspected child abuse to the appropriate authorities. (Correct answer)
Tell the parent to implement better safety measures at home.

Correct answer: Report the suspected child abuse to the appropriate authorities.

Nurses are mandated reporters. When there is a suspicion of child abuse, such as bruises in locations not typically associated with accidental falls, the LPN has a legal and ethical obligation to report their findings to Child Protective Services or the designated state agency for investigation.

Question 39: A client is prescribed atorvastatin for hyperlipidemia. The LPN should instruct the client to report which side effect immediately?

Increased appetite
Mild headache and fatigue
Mild constipation
Muscle pain, tenderness, or weakness (Correct answer)

Correct answer: Muscle pain, tenderness, or weakness

Statins like atorvastatin can cause rhabdomyolysis, a breakdown of muscle tissue that can lead to acute kidney injury. Myalgia or weakness must be reported immediately.

Question 40: A patient on clopidogrel (Plavix) is scheduled for elective surgery. What should the nurse communicate to the surgical team?

The patient may need anticoagulation reversal with vitamin K
The medication should typically be stopped 5-7 days before surgery (Correct answer)
The patient needs a platelet transfusion preoperatively
The drug can be safely continued through surgery

Correct answer: The medication should typically be stopped 5-7 days before surgery

Clopidogrel inhibits platelet aggregation; it is typically held 5-7 days before surgery to reduce bleeding risk.

Question 41: An LPN is providing anticipatory guidance to the parents of a 2-year-old toddler during a well-child visit. Which topic is the highest priority for health promotion and injury prevention for this age group?

Discussing the risks and signs of substance abuse.
Reviewing the importance of proper car seat use and water safety. (Correct answer)
Teaching the child about online safety and cyberbullying.
Providing information on advance directives and living wills.

Correct answer: Reviewing the importance of proper car seat use and water safety.

For toddlers (ages 1-3), unintentional injuries are a leading cause of death and disability. Motor vehicle crashes and drowning are major risks. Therefore, reinforcing education on correct car seat use and constant supervision near water are the highest priorities for injury prevention in this age group. The other topics are appropriate for older age groups.

Question 42: When donning a sterile gown, the nurse should consider which areas of the gown to be sterile?

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

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

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

Question 43: An elderly patient with confusion attempts to climb out of bed repeatedly. Which is the LEAST restrictive safety intervention to try first?

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

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

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

Question 44: A nurse is counseling a pregnant client in her first trimester about nutrition. Which supplement is MOST critical to recommend to prevent neural tube defects?

Iron
Folic acid (Correct answer)
Calcium
Vitamin D

Correct answer: Folic acid

Folic acid (400–800 mcg/day) taken before and during early pregnancy significantly reduces the risk of neural tube defects such as spina bifida.

Question 45: A nurse is educating a client about osteoporosis prevention. Which combination of interventions is MOST effective?

Adequate calcium/vitamin D intake and weight-bearing exercise (Correct answer)
High sodium diet and swimming
Bed rest and calcium supplements alone
Low-fat diet and avoidance of all sun exposure

Correct answer: Adequate calcium/vitamin D intake and weight-bearing exercise

Optimal osteoporosis prevention combines adequate calcium and vitamin D intake with weight-bearing physical activity to maximize and maintain bone density.

Question 46: A nurse is caring for a patient with scabies. Which type of precautions is required?

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

Correct answer: Contact precautions

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

Question 47: A postoperative client has a Jackson-Pratt (JP) drain. The LPN notes the drain bulb is full and expanded. What is the correct action?

Leave it; the drain will empty on its own
Clamp the drain and notify the surgeon
Remove the drain per physician protocol
Empty the drain, measure and document the output, then recompress the bulb (Correct answer)

Correct answer: Empty the drain, measure and document the output, then recompress the bulb

JP drains work by negative pressure; when the bulb is full and expanded, it must be emptied, output recorded, and the bulb recompressed to restore suction.

Question 48: The LPN is caring for a patient in Buck's traction for a hip fracture. Which action is correct?

Apply the traction boot over bare skin without padding
Remove the weights when repositioning the patient
Position the affected leg in external rotation
Keep the weights hanging freely at all times (Correct answer)

Correct answer: Keep the weights hanging freely at all times

Traction weights must hang freely and continuously to maintain proper alignment and therapeutic effect.

Question 49: When applying compression stockings to a patient with venous insufficiency, the LPN should:

Apply them in the morning before the patient gets out of bed (Correct answer)
Apply them after the patient ambulates to reduce edema
Apply them only at night during sleep
Apply them while the patient is sitting in the chair

Correct answer: Apply them in the morning before the patient gets out of bed

Compression stockings should be applied in the morning before the patient gets up, when edema is at its minimum, for maximum effectiveness.

Question 50: Which statement about the chain of infection is correct?

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

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

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

Question 51: A nurse accidentally splashes blood into her eyes. What is the FIRST action she should take?

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

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

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

Question 52: A nurse is providing education to a client about testicular self-examination (TSE). Which instruction is CORRECT?

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

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

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

Question 53: An LPN is caring for a client with advanced dementia who has become increasingly agitated and is yelling out. Which of the following interventions should the LPN implement first?

Administer a prescribed PRN sedative medication.
Place the client in a quiet room to reduce stimuli.
Redirect the client by offering a familiar activity.
Assess the client for potential sources of pain or discomfort. (Correct answer)

Correct answer: Assess the client for potential sources of pain or discomfort.

Before implementing other interventions, the LPN should first assess for an underlying physiological cause of agitation, as clients with dementia may be unable to verbalize needs such as pain, hunger, or the need to use the toilet. Addressing a physical cause is the priority.

Question 54: A postpartum client reports her lochia changed from rubra to serosa on day 2. What is the nurse's best response?

This is normal and the lochia will become alba in about a week (Correct answer)
This is abnormal and the physician should be notified
Increase activity to promote normal lochia progression
Apply ice packs to reduce uterine bleeding

Correct answer: This is normal and the lochia will become alba in about a week

Lochia rubra normally transitions to serosa by days 3–4 and then to alba by 10–14 days; early transition on day 2 can be normal variation.

Question 55: When performing wound care, the nurse notes the patient's wound has purulent drainage and a foul odor. Which is the priority nursing action?

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

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

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

Question 56: A school-age child receives a tympanostomy tube (ear tube) and is being discharged. Which instruction should the LPN include?

The child may swim freely but must avoid submerging ears in the bathtub
The tubes will dissolve in 2 weeks — no follow-up is needed
Keep water out of the ear with earplugs during bathing and swimming until the provider clears it (Correct answer)
Apply antibiotic ear drops twice daily for 6 months

Correct answer: Keep water out of the ear with earplugs during bathing and swimming until the provider clears it

Water in the ear canal can travel through the tympanostomy tube into the middle ear, causing otitis media. Earplugs or cotton with petroleum jelly protect the ear during water exposure.

Question 57: A nurse discovers a small fire in a client's wastebasket. After rescuing the client from the immediate area, what is the nurse's next priority action according to the RACE acronym?

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

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

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

Question 58: What is the primary purpose of a clinical pathway (critical pathway) in coordinated care?

To schedule staffing assignments
To replace individualized nursing care plans
To document medication errors
To standardize care and outcomes for specific diagnoses (Correct answer)

Correct answer: To standardize care and outcomes for specific diagnoses

Clinical pathways standardize evidence-based care and expected outcomes for specific diagnoses, promoting consistency and efficiency across the healthcare team.

Question 59: Which of the following is the best example of a primary prevention strategy for promoting health?

Teaching a group of healthy adolescents about the importance of regular exercise and a balanced diet. (Correct answer)
Assisting a client with a new ostomy to learn about stoma care.
Administering prescribed blood pressure medication to a client with hypertension.
Performing a mammogram on a 50-year-old woman to screen for breast cancer.

Correct answer: Teaching a group of healthy adolescents about the importance of regular exercise and a balanced diet.

Primary prevention aims to prevent disease or injury before it ever occurs. Educating healthy adolescents about beneficial lifestyle habits is a classic example of primary prevention. Administering medication for an existing condition and teaching ostomy care are examples of tertiary prevention (managing an existing disease). A screening mammogram is an example of secondary prevention (early detection).

Question 60: Which nursing action is most effective in preventing ventilator-associated pneumonia (VAP) in an intubated patient?

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

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

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

Question 61: A nurse is preparing to administer medication through a central venous catheter. Which action is essential to prevent central line-associated bloodstream infection (CLABSI)?

Scrub the hub with alcohol for at least 15 seconds before access (Correct answer)
Use clean gloves when accessing the port
Flush the line with heparin before each use
Change the central line dressing every 24 hours

Correct answer: Scrub the hub with alcohol for at least 15 seconds before access

Scrubbing the needleless connector hub with alcohol for at least 15 seconds using friction ('scrub the hub') is essential to reduce CLABSI risk.

Question 62: A nurse is counseling a 16-year-old about sun exposure. Which statement by the teenager indicates a need for further teaching?

I should wear UV-protective sunglasses when outside.
A base tan will protect me from sunburn and skin cancer. (Correct answer)
I should seek shade between 10 AM and 4 PM.
I will reapply sunscreen every two hours when outdoors.

Correct answer: A base tan will protect me from sunburn and skin cancer.

There is no safe base tan; any tan represents UV damage and increases the risk of skin cancer and premature aging.

Question 63: A patient's telemetry shows a heart rate of 42 bpm with P waves before each QRS complex and regular rhythm. The LPN should first:

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

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

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

Question 64: A newly admitted client has a history of generalized tonic-clonic seizures. Which of the following items is essential for the LPN to ensure is at the client's bedside to reduce the risk of injury?

Suction equipment and an oxygen source. (Correct answer)
Four-point leather restraints.
An oral airway.
A padded tongue blade.

Correct answer: Suction equipment and an oxygen source.

During and after a seizure, a client is at risk for aspirating secretions and may become hypoxic. Having suction available to clear the airway and oxygen for administration are critical safety measures. Padded tongue blades and oral airways should not be inserted into the mouth of a seizing client as this can cause dental and soft tissue trauma. Restraints should not be used as they can cause injury while the client is convulsing.

Question 65: A patient returns from surgery with a Foley catheter. To prevent catheter-associated urinary tract infection (CAUTI), the nurse should:

Keep the drainage bag at the level of the bladder
Irrigate the catheter with saline every shift
Clamp the catheter tubing when ambulating the patient
Ensure the drainage bag remains below the level of the bladder (Correct answer)

Correct answer: Ensure the drainage bag remains below the level of the bladder

The drainage bag must always be kept below bladder level to prevent backflow of urine, which can introduce bacteria.

Question 66: Which patient behavior indicates the nurse's teaching about home infection prevention was effective?

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

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

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

Question 67: Which environmental condition increases the risk of electrical injury to patients?

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

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

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

Question 68: During a fire in a patient care area, what does the acronym RACE direct staff to do first?

Ring the alarm bell
Run to the nearest exit
Report the fire to administration
Rescue patients in immediate danger (Correct answer)

Correct answer: Rescue patients in immediate danger

RACE stands for Rescue, Alarm, Confine, Extinguish/Evacuate—Rescue of those in immediate danger is always the first priority.

Question 69: A nurse is inserting a peripheral IV in a client's right antecubital fossa. The first attempt fails and blood returns initially but then stops when advancing the catheter. The appropriate next action is to:

Withdraw the catheter slightly and re-thread while injecting saline
Advance the needle further into the vein and re-thread the catheter
Rotate the needle 180 degrees and continue advancing
Remove the entire device, apply pressure, and attempt a new site (Correct answer)

Correct answer: Remove the entire device, apply pressure, and attempt a new site

Once a catheter fails — including when blood returns then stops — the entire device must be removed, pressure applied, and a new attempt made at a different site. Re-advancing a partially inserted needle risks vein injury.

Question 70: A patient with a T4 spinal cord injury is being repositioned. The LPN notes erythema over the sacrum that does not blanch. This indicates:

Stage 1 pressure injury (Correct answer)
Suspected deep tissue injury
Unstageable pressure injury
Stage 2 pressure injury

Correct answer: Stage 1 pressure injury

Non-blanchable erythema over a bony prominence in intact skin is the defining characteristic of a Stage 1 pressure injury.

Question 71: A nurse is caring for a patient post-op who is at risk for deep vein thrombosis (DVT). Which nursing intervention directly reduces this risk?

Applying warm compresses to the lower extremities every 4 hours
Elevating the foot of the bed to promote venous return
Encouraging early ambulation and applying sequential compression devices (Correct answer)
Keeping the patient on strict bedrest for 48 hours

Correct answer: Encouraging early ambulation and applying sequential compression devices

Early ambulation promotes venous circulation, and sequential compression devices prevent venous stasis, both of which directly reduce DVT risk.

Question 72: Which statement is accurate about the enteral (NG tube) administration of medications?

Extended-release and enteric-coated tablets should never be crushed (Correct answer)
The tube position does not need verification if recently placed
Medications should be mixed with the tube feeding formula for convenience
All medications can be crushed and given together through the tube

Correct answer: Extended-release and enteric-coated tablets should never be crushed

Crushing extended-release or enteric-coated tablets destroys their delivery mechanism and can cause toxicity or loss of therapeutic effect.

Question 73: A client with rheumatoid arthritis (RA) asks about managing morning joint stiffness. The LPN's best recommendation is:

Increase dietary protein to rebuild inflamed joint tissue
Avoid all movement until stiffness resolves spontaneously
Apply ice packs to stiff joints for 20 minutes each morning
Take a warm shower or apply warm compresses to stiff joints before activity (Correct answer)

Correct answer: Take a warm shower or apply warm compresses to stiff joints before activity

Warm therapy (shower, warm compress) increases circulation and reduces viscosity of synovial fluid, helping relieve the characteristic morning stiffness of RA.

Question 74: A postpartum client has lochia rubra on day 6 after delivery with a saturated perineal pad in 1 hour. The LPN should:

Advise the client to increase activity to help the uterus contract
Reassure the client that lochia rubra for 6 days is completely normal
Notify the charge nurse — lochia rubra beyond day 3–4 with heavy saturation may indicate postpartum hemorrhage (Correct answer)
Instruct the client to change pads more frequently

Correct answer: Notify the charge nurse — lochia rubra beyond day 3–4 with heavy saturation may indicate postpartum hemorrhage

Lochia typically transitions from rubra (red) to serosa (pink-brown) by day 3–4. Persistent heavy red lochia on day 6 may indicate subinvolution or hemorrhage requiring evaluation.

Question 75: A patient with a latex allergy is scheduled for a procedure. The nurse should:

Ensure the room is stocked with latex-free supplies and alert all team members (Correct answer)
Ask the patient to bring their own latex-free supplies
Document the allergy and proceed with the standard setup
Use only sterile latex gloves during the procedure

Correct answer: Ensure the room is stocked with latex-free supplies and alert all team members

All supplies must be latex-free and all team members must be informed to prevent potentially life-threatening anaphylaxis.

Question 76: A nurse is caring for a patient on halo traction for a cervical spine injury. Which nursing action is essential for this patient?

Check pin sites every shift for signs of infection or loosening (Correct answer)
Tighten the halo vest screws if any looseness is detected
Remove the vest daily for skin inspection and hygiene
Instruct the patient to perform neck rotation exercises

Correct answer: Check pin sites every shift for signs of infection or loosening

Pin site assessment every shift is critical to detect early signs of infection or loosening, which could compromise cervical immobilization and worsen the spinal injury.

Question 77: A client with a lumbar disc herniation is being prepared for a myelogram. Which information is most important for the LPN to communicate to the client before the procedure?

The test requires a 2-day hospital admission
The client must remain flat for 8 hours before the test to allow the contrast to settle
The test involves injection of radioactive isotopes that glow on X-ray
The client should increase fluid intake after the test and report severe headache (Correct answer)

Correct answer: The client should increase fluid intake after the test and report severe headache

After a myelogram (contrast injection into the spinal subarachnoid space), increased fluid intake helps eliminate contrast dye, and severe headache may indicate post-procedure spinal fluid leak requiring reporting.

Question 78: During a well-child visit for a 4-year-old, which vaccine should the nurse anticipate administering according to the CDC immunization schedule?

Hepatitis B booster
HPV series initiation
Varicella (second dose) and DTaP booster (Correct answer)
Meningococcal conjugate vaccine

Correct answer: Varicella (second dose) and DTaP booster

The CDC schedule recommends the second dose of varicella vaccine and a DTaP booster at the 4–6-year well-child visit.

Question 79: A nurse is caring for a client with newly diagnosed hypertension who does not yet require medication. Which lifestyle modification should the nurse emphasize FIRST?

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

Correct answer: Adopt the DASH diet and reduce sodium intake

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

Question 80: Which technique is correct when administering a subcutaneous injection to an average-weight adult?

Insert needle at 90 degrees into muscle, do not aspirate
Insert needle at 90 degrees, aspirate before injecting
Insert needle at 15 degrees, aspirate before injecting
Insert needle at 45 degrees, do not aspirate (Correct answer)

Correct answer: Insert needle at 45 degrees, do not aspirate

Subcutaneous injections are given at a 45-degree angle (or 90 degrees in obese patients) without aspiration per current evidence-based guidelines.

Question 81: An LPN is caring for an elderly client who is confused and has been trying to get out of bed without assistance. After attempting alternative measures without success, the provider orders soft wrist restraints. Which of the following actions is a critical safety measure for the nurse to implement?

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

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

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

Question 82: A patient refuses a prescribed blood transfusion due to religious beliefs. What is the LPN's most appropriate action?

Try to persuade the patient until they agree
Document the refusal and notify the charge nurse or physician (Correct answer)
Administer the transfusion because it is life-saving
Ignore the refusal and proceed with the physician's order

Correct answer: Document the refusal and notify the charge nurse or physician

Competent adults have the legal right to refuse treatment; the LPN must document the refusal and escalate to the RN or physician.

Question 83: A nurse is providing education about cervical cancer prevention to a group of adolescent females. Which statement about the HPV vaccine is ACCURATE?

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

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

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

Question 84: A licensed practical nurse (LPN) is preparing to enter the room of a client diagnosed with pulmonary tuberculosis. Which combination of personal protective equipment (PPE) is essential for the nurse to don before providing care?

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

Correct answer: N95 respirator and gloves

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

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

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

Questions

300 min

Time Limit

50%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
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