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

Question 1: A patient with hypothyroidism develops myxedema coma. Which clinical manifestations are expected?

Hyperthermia, tachycardia, and agitation
Hyperglycemia, polyuria, and polydipsia
Hypertension, hyperreflexia, and diaphoresis
Hypothermia, bradycardia, and decreased level of consciousness (Correct answer)

Correct answer: Hypothermia, bradycardia, and decreased level of consciousness

Myxedema coma is a life-threatening exacerbation of hypothyroidism characterized by extreme metabolic slowing: profound hypothermia, bradycardia, and coma.

Question 2: 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?

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

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

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

Question 3: 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:

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

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 4: A patient is receiving a blood transfusion and develops chills, back pain, and tea-colored urine 30 minutes after starting. The LPN's priority action is:

Slow the infusion rate and apply warm blankets
Administer diphenhydramine per standing order and continue transfusion
Increase the flow rate to complete the transfusion faster
Stop the transfusion and infuse normal saline through new tubing (Correct answer)

Correct answer: Stop the transfusion and infuse normal saline through new tubing

These signs indicate a hemolytic transfusion reaction; the transfusion must be stopped immediately and normal saline started through new IV tubing.

Question 5: Which action by the LPN best supports a patient's self-esteem during a depressive episode?

Encourage the patient to socialize with others immediately
Avoid discussing the depression to prevent reinforcing negative thoughts
Assign simple, achievable tasks and offer genuine praise for completion (Correct answer)
Tell the patient to focus on positive things in their life

Correct answer: Assign simple, achievable tasks and offer genuine praise for completion

Small successes build confidence and self-efficacy, which are impaired during depression.

Question 6: A patient with heart failure is prescribed furosemide. Which electrolyte imbalance is the most common adverse effect the LPN should monitor?

Hypokalemia (Correct answer)
Hypercalcemia
Hypernatremia
Hypermagnesemia

Correct answer: Hypokalemia

Furosemide is a loop diuretic that causes significant urinary potassium loss, leading to hypokalemia as its most common electrolyte adverse effect.

Question 7: 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
Low-fat diet and avoidance of all sun exposure
Bed rest and calcium supplements alone

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 8: 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)
Alcohol-based hand rub
Plain soap and water
Chlorhexidine-based hand rub

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 9: What does patient confidentiality mean in nursing?

To tell the patient’s family
To share with anyone in the hospital
To keep patient information private and share it with authorized personnel (Correct answer)
To share information with colleagues freely

Correct answer: To keep patient information private and share it with authorized personnel

Patient confidentiality in nursing means strictly keeping all patient information private and only sharing it with authorized personnel who have a legitimate need to know for the patient's care. This ethical and legal obligation protects sensitive health data, builds trust between patients and healthcare providers, and respects patient autonomy. Adhering to confidentiality guidelines, such as HIPAA, is fundamental to professional nursing practice.

Question 10: A patient with vancomycin-resistant Enterococcus (VRE) is being discharged to a long-term care facility. The nurse's priority is to:

Ensure the receiving facility is notified of the patient's VRE status (Correct answer)
Withhold VRE information to protect patient confidentiality
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 11: A nurse is counseling a 16-year-old about sun exposure. Which statement by the teenager indicates a need for further teaching?

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

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

Administering prescribed blood pressure medication to a client with hypertension.
Assisting a client with a new ostomy to learn about stoma care.
Teaching a group of healthy adolescents about the importance of regular exercise and a balanced diet. (Correct answer)
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 13: A nurse accidentally splashes blood into her eyes. What is the FIRST action she should take?

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

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

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

Question 14: Which statement about medication reconciliation is MOST accurate for the LPN role?

It is performed only by pharmacists
It is performed only at hospital admission
It is performed at every transition of care (Correct answer)
It is optional if the patient's chart is up to date

Correct answer: It is performed at every transition of care

Medication reconciliation must occur at every transition of care (admission, transfer, and discharge) to prevent medication errors.

Question 15: An LPN is floated to a unit and given an assignment involving skills outside their competency. The LPN should:

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

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

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

Question 16: Which nursing action is most effective in preventing ventilator-associated pneumonia (VAP) in an intubated patient?

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

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

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

Question 17: A postpartum nurse is promoting breastfeeding. Which instruction should be given to a new mother about infant feeding frequency?

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

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

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

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 19: A patient with chronic kidney disease (CKD) is receiving IV fluids. Which IV solution poses the GREATEST risk for this patient and should be used with caution?

Lactated Ringer's (Correct answer)
0.9% NaCl
0.45% NaCl
D5W

Correct answer: Lactated Ringer's

Lactated Ringer's contains potassium (4 mEq/L), which is dangerous in CKD patients who already have impaired potassium excretion and risk hyperkalemia.

Question 20: A patient reports crushing chest pain radiating to the left arm. What is the LPN's FIRST action?

Draw cardiac enzyme labs
Notify the charge nurse or physician immediately (Correct answer)
Obtain a 12-lead ECG
Administer nitroglycerin

Correct answer: Notify the charge nurse or physician immediately

The LPN must immediately notify the charge nurse or physician of suspected myocardial infarction symptoms before initiating other interventions.

Question 21: Which action by the LPN best reduces the risk of a surgical site infection in a postoperative client?

Irrigate the wound with tap water
Apply antibiotic ointment from the supply cart
Change the dressing using sterile technique (Correct answer)
Remove the dressing to allow air exposure

Correct answer: Change the dressing using sterile technique

Using sterile technique during dressing changes is the standard evidence-based practice to prevent surgical site infections.

Question 22: 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 23: 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.
Teaching the child about online safety and cyberbullying.
Reviewing the importance of proper car seat use and water safety. (Correct answer)
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 24: A client with coronary artery disease is experiencing chest pain at rest rated 7/10. The LPN's first action should be:

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

Correct answer: Assess vital signs and oxygen saturation

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

Question 25: A client with multiple sclerosis (MS) is experiencing a relapse with worsening fatigue. The most important nursing intervention is:

Administering high-dose aspirin for pain relief
Keeping room temperature warm to improve muscle function
Encouraging the client to push through fatigue with regular exercise
Scheduling rest periods throughout the day and avoiding heat exposure (Correct answer)

Correct answer: Scheduling rest periods throughout the day and avoiding heat exposure

Fatigue management in MS includes scheduled rest, energy conservation techniques, and avoiding heat (Uhthoff's phenomenon), which worsens symptoms by slowing nerve conduction.

Question 26: When performing wound care, the nurse notes the patient's wound has purulent drainage and a foul odor. Which is the priority nursing action?

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

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 27: 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?

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

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

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

Question 28: 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?

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

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 29: 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?

Keeping the patient on strict bedrest for 48 hours
Encouraging early ambulation and applying sequential compression devices (Correct answer)
Elevating the foot of the bed to promote venous return
Applying warm compresses to the lower extremities every 4 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 30: A client with myasthenia gravis is admitted to the hospital. The LPN recognizes that a myasthenic crisis differs from a cholinergic crisis in that myasthenic crisis presents with:

Hypertension and fever
Muscle weakness that improves with edrophonium (Tensilon) test (Correct answer)
Excessive secretions, bradycardia, and miosis
Diarrhea and urinary incontinence

Correct answer: Muscle weakness that improves with edrophonium (Tensilon) test

In myasthenic crisis, the Tensilon test shows temporary improvement in muscle strength because insufficient acetylcholine is reaching the neuromuscular junction.

Question 31: What is the correct sequence for removing PPE after caring for a patient on contact precautions?

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

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

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

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

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

Question 33: 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 34: A patient with Addison's disease presents in adrenal crisis. Which finding is most expected?

Hypertension and hypernatremia
Hyperglycemia and hypokalemia
Severe hypotension and hyponatremia (Correct answer)
Bradycardia and weight gain

Correct answer: Severe hypotension and hyponatremia

Adrenal crisis (acute cortisol and aldosterone deficiency) causes profound hypotension and hyponatremia due to sodium wasting and inability to maintain vascular tone.

Question 35: A client receiving a continuous IV heparin infusion develops petechiae, nosebleed, and oozing from the venipuncture site. The LPN should:

Administer vitamin K as the reversal agent for heparin
Apply direct pressure to bleeding sites and continue monitoring
Document the findings and notify the provider at morning rounds
Immediately stop the heparin infusion and notify the charge nurse (Correct answer)

Correct answer: Immediately stop the heparin infusion and notify the charge nurse

Signs of bleeding complications from heparin therapy require immediate discontinuation of the infusion and urgent notification, not continuation while applying pressure.

Question 36: Which statement by a patient indicates a need for further mental health teaching about medication adherence in bipolar disorder?

'I should report hand tremors to my provider.'
'I can stop my lithium once I feel stable for a few weeks.' (Correct answer)
'I need to drink plenty of water while on lithium.'
'I should have my lithium levels checked regularly.'

Correct answer: 'I can stop my lithium once I feel stable for a few weeks.'

Discontinuing lithium when feeling stable is dangerous and a common cause of relapse; patients must understand that stability is due to the medication.

Question 37: A nurse is educating a client about the benefits of physical activity. According to US physical activity guidelines for adults, what is the minimum recommended amount of moderate-intensity aerobic activity per week?

100 minutes per week
75 minutes per week
300 minutes per week
150 minutes per week (Correct answer)

Correct answer: 150 minutes per week

The US Physical Activity Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity (or 75 minutes of vigorous activity) per week for adults.

Question 38: Which patient is at HIGHEST risk for developing a healthcare-associated infection (HAI)?

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

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

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

Question 39: A client is admitted with influenza and is placed on droplet precautions. Which of the following interventions is a required component of droplet precautions?

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

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

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

Question 40: The nurse is preparing to change IV tubing. How often should standard primary IV administration sets be routinely changed per CDC guidelines?

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

Correct answer: Every 96 hours

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

Question 41: When preparing to administer a subcutaneous heparin injection, the LPN should inject at which angle?

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

Correct answer: 45 to 90 degrees

Subcutaneous injections are administered at a 45- to 90-degree angle depending on the amount of subcutaneous tissue present.

Question 42: Which situation requires the nurse to use an N95 respirator rather than a standard surgical mask?

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

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

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

Correct answer: Alcohol use disorder

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

Question 44: A nurse is caring for a pregnant client and teaching about appropriate weight gain during pregnancy. For a client with a normal pre-pregnancy BMI, what is the recommended total weight gain?

25–35 pounds (Correct answer)
35–45 pounds
15–20 pounds
10–15 pounds

Correct answer: 25–35 pounds

Institute of Medicine guidelines recommend a total gestational weight gain of 25–35 pounds for women with a normal pre-pregnancy BMI (18.5–24.9).

Question 45: A patient is ordered 1 L of Lactated Ringer's over 8 hours via an infusion pump. At what rate should the nurse program the pump?

125 mL/hr (Correct answer)
150 mL/hr
83 mL/hr
100 mL/hr

Correct answer: 125 mL/hr

1000 mL ÷ 8 hours = 125 mL/hr is the correct infusion pump rate.

Question 46: Which needle disposal practice is correct for an LPN?

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

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

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

Question 47: A client has bilateral knee osteoarthritis and asks about low-impact exercise options. The LPN's BEST recommendation is:

Heavy resistance training with a focus on leg press machines
Swimming or water aerobics — buoyancy reduces joint load while maintaining fitness (Correct answer)
Complete rest until a knee replacement can be scheduled
Running 5 miles per day to strengthen surrounding muscles

Correct answer: Swimming or water aerobics — buoyancy reduces joint load while maintaining fitness

Aquatic exercise (swimming, water aerobics) provides cardiovascular conditioning, muscle strengthening, and improved joint mobility with minimal weight-bearing stress on arthritic knees.

Question 48: The LPN is educating a 48-year-old client of average risk about routine colorectal cancer screening. The nurse should inform the client that which of the following is a recommended screening option?

Blood work to check for tumor markers annually.
A barium enema every 2 years.
A colonoscopy every 10 years. (Correct answer)
A yearly abdominal CT scan.

Correct answer: A colonoscopy every 10 years.

The American Cancer Society recommends that people at average risk for colorectal cancer start regular screening at age 45. A colonoscopy performed every 10 years is a primary and highly effective visual screening method. Abdominal CT scans, barium enemas, and blood tumor markers are not standard routine screening tests for average-risk individuals.

Question 49: A client with a fractured femur is placed in skeletal traction. The LPN's priority assessment is:

Neurovascular status of the affected extremity (Correct answer)
Pin sites for signs of infection
Pain level and analgesic effectiveness
Weight hanging freely and ropes unobstructed

Correct answer: Neurovascular status of the affected extremity

Neurovascular assessment — checking the 6 Ps (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) — is the priority because traction can impair circulation or nerve function.

Question 50: 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 is most effective when given before sexual activity begins, ideally at ages 11–12 (Correct answer)
The HPV vaccine treats existing HPV infections
The HPV vaccine requires only one dose for full protection
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 51: An elderly patient with confusion attempts to climb out of bed repeatedly. Which is the LEAST restrictive safety intervention to try first?

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

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

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

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 53: A client requires a central venous catheter (CVC) insertion. Which position and preparation reduces air embolism risk during insertion?

Place in Trendelenburg position (head lower than feet) and have the client hold breath during insertion (Correct answer)
Elevate the head of bed 45 degrees and have the client perform the Valsalva maneuver
Sit the client at 90 degrees and turn the head toward the insertion site
Place the client flat and have them breathe deeply during needle insertion

Correct answer: Place in Trendelenburg position (head lower than feet) and have the client hold breath during insertion

Trendelenburg position increases central venous pressure, distending the vein for easier access and reducing the risk of air entering the catheter during insertion by raising venous pressure above atmospheric.

Question 54: A client is scheduled for a stress test. Which instruction should the LPN include in the teaching?

Continue taking beta-blockers as usual the morning of the test
Wear dress shoes to the test for proper support
Avoid caffeine and smoking for at least 24 hours before the test (Correct answer)
Eat a large meal before the test for sustained energy

Correct answer: Avoid caffeine and smoking for at least 24 hours before the test

Caffeine and smoking can artificially alter heart rate response, skewing test results. Both should be avoided for 24 hours before a cardiac stress test.

Question 55: A patient with a traumatic brain injury has a GCS score of 8. How should the nurse interpret this finding?

Severe traumatic brain injury (Correct answer)
Normal neurological function
Mild traumatic brain injury
Moderate traumatic brain injury

Correct answer: Severe traumatic brain injury

A GCS score of 8 or below indicates severe traumatic brain injury and is associated with significant risk of complications including herniation.

Question 56: A patient is prescribed a regular diet but has difficulty chewing due to poor dentition. The LPN should:

Crush all solid foods and mix with water
Withhold meals until the dentist evaluates the patient
Provide only liquids until further orders are obtained
Notify the dietitian to change the diet to a mechanical soft consistency (Correct answer)

Correct answer: Notify the dietitian to change the diet to a mechanical soft consistency

The dietitian should be notified so the diet can be appropriately modified to mechanical soft to meet the patient's nutritional needs safely.

Question 57: A nurse observes a colleague reusing a single-use vial of insulin for multiple patients. The appropriate action is to:

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

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 58: 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)
Change the central line dressing every 24 hours
Flush the line with heparin before each use
Use clean gloves when accessing the port

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

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

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

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

Question 60: The nurse is teaching a new mother about newborn care. Which statement about umbilical cord care is most accurate?

Apply antibiotic ointment daily to prevent infection
Keep the cord dry and expose it to air to promote drying (Correct answer)
Cover the cord with a bandage to protect it from bacteria
Submerge the infant in a tub bath until the cord falls off

Correct answer: Keep the cord dry and expose it to air to promote drying

Keeping the cord dry and exposed to air promotes drying and separation, and current guidelines recommend dry care rather than antiseptic application.

Question 61: 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?

Four-point leather restraints.
Suction equipment and an oxygen source. (Correct answer)
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 62: 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 63: A client with stable angina asks the nurse about sexual activity. The LPN's best response is:

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

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 64: A patient is brought to the ED after a suicide attempt and says, 'I'm fine now — it was a mistake.' The LPN's priority assessment is:

Assess current suicidal ideation, lethality, plan, and means (Correct answer)
Ask the family if the patient has a history of attention-seeking
Educate the patient about the consequences of suicide on loved ones
Accept the statement and focus on medical stabilization only

Correct answer: Assess current suicidal ideation, lethality, plan, and means

A post-attempt statement of being 'fine' does not indicate safety; thorough risk assessment is always the priority.

Question 65: A wound that has not progressed through the normal healing stages after 4 weeks is classified as a(n):

Contaminated wound
Acute wound
Dehisced wound
Chronic wound (Correct answer)

Correct answer: Chronic wound

A chronic wound is defined by failure to heal within an expected timeframe, generally more than 4 weeks without meaningful progress.

Question 66: A nurse is providing education to a client about testicular self-examination (TSE). Which instruction is CORRECT?

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

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 67: Which approach is most therapeutic when a patient is experiencing an auditory hallucination?

Agree with the patient that the voices are present
Acknowledge that you do not share the experience but that you can see it is real to the patient (Correct answer)
Leave the patient alone until the hallucination passes
Tell the patient the voices are not real and to ignore them

Correct answer: Acknowledge that you do not share the experience but that you can see it is real to the patient

Acknowledging the patient's distress without reinforcing the hallucination maintains trust and reality orientation.

Question 68: A client with gout is having an acute attack in the right great toe. Which nursing intervention provides the most immediate relief?

Massaging the joint firmly to break up uric acid crystals
Apply warm, moist compresses to increase blood flow
Encourage the client to walk to mobilize the joint
Elevate the extremity and apply ice packs wrapped in a cloth (Correct answer)

Correct answer: Elevate the extremity and apply ice packs wrapped in a cloth

During acute gout, elevation reduces swelling and cold therapy numbs pain and decreases inflammation. The joint should not be massaged or walked on, as this intensifies pain.

Question 69: 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 and surgical mask
N95 respirator and gloves (Correct answer)
Surgical mask and gloves
Gown, gloves, and face shield

Correct answer: N95 respirator and gloves

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

Question 70: During a well-child visit for a 4-year-old, which vaccine should the nurse anticipate administering according to the CDC immunization schedule?

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

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 71: A client with Parkinson's disease is prescribed levodopa-carbidopa. The LPN should teach the client to:

Expect rapid improvement in symptoms within 24 hours
Avoid vitamin B6 supplements which reduce levodopa effectiveness (Correct answer)
Take the medication only when tremors become severe
Take the medication with a high-protein meal for best absorption

Correct answer: Avoid vitamin B6 supplements which reduce levodopa effectiveness

Vitamin B6 (pyridoxine) enhances the peripheral decarboxylation of levodopa, reducing the amount reaching the brain. Carbidopa reduces this effect but high-dose B6 can overcome it.

Question 72: A client is admitted with dehydration. Assessment findings include dry mucous membranes, poor skin turgor, urine output of 20 mL/hr, and serum sodium of 148 mEq/L. The LPN anticipates which IV fluid will be ordered?

Normal saline (0.9% NaCl) — isotonic saline to expand vascular volume
Lactated Ringer's solution to correct acidosis
0.45% NaCl (half-normal saline) — hypotonic fluid to replace free water deficit (Correct answer)
3% NaCl to correct hypernatremia

Correct answer: 0.45% NaCl (half-normal saline) — hypotonic fluid to replace free water deficit

A serum sodium of 148 mEq/L indicates hypernatremia from free water deficit. Hypotonic solution (0.45% NaCl) is used to replace free water and gradually correct hypernatremia.

Question 73: The LPN is caring for a client receiving IV heparin. Which lab value is most important to monitor?

aPTT (Correct answer)
Platelet count only
Serum fibrinogen
PT/INR

Correct answer: aPTT

Activated partial thromboplastin time (aPTT) is the primary lab used to monitor and titrate IV heparin therapy.

Question 74: Which environmental condition increases the risk of electrical injury to patients?

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

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

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

Question 75: 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
Clamp the catheter tubing when ambulating the patient
Ensure the drainage bag remains below the level of the bladder (Correct answer)
Irrigate the catheter with saline every shift

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

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

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 77: A nurse is caring for a patient who had an ischemic stroke 2 hours ago. The physician is considering tPA administration. Which assessment finding would be a contraindication?

Blood pressure of 148/88 mmHg
Onset of symptoms within 3 hours
Patient on warfarin with an INR of 2.8 (Correct answer)
Blood glucose of 110 mg/dL

Correct answer: Patient on warfarin with an INR of 2.8

An INR greater than 1.7 due to anticoagulation therapy is a contraindication to tPA because of the significantly increased risk of hemorrhagic conversion.

Question 78: A patient receiving opioid analgesics reports constipation. The most appropriate nursing intervention is:

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

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 79: Which IV fluid is classified as an isotonic crystalloid solution?

D5W
3% NaCl
0.9% NaCl (Correct answer)
0.45% NaCl

Correct answer: 0.9% NaCl

0.9% NaCl (normal saline) is isotonic, with an osmolarity close to plasma (~308 mOsm/L).

Question 80: A patient on contact precautions needs to be transported to radiology. Which action is most appropriate before transport?

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

Correct answer: Notify the receiving department of precaution status

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

Question 81: A nurse is caring for a patient with scabies. Which type of precautions is required?

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

Correct answer: Contact precautions

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

Question 82: 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
Instruct the client to change pads more frequently
Notify the charge nurse — lochia rubra beyond day 3–4 with heavy saturation may indicate postpartum hemorrhage (Correct answer)
Reassure the client that lochia rubra for 6 days is completely normal

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

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

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

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

Question 84: When donning a sterile gown, the nurse should consider which areas of the gown to be sterile?

The gown is sterile only until the nurse sits down
The entire gown including the back and below the waist
The front chest panel and all four sides
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.

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

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

Questions

300 min

Time Limit

50%

To Pass

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