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

Question 1: Which nursing action is most effective in preventing ventilator-associated pneumonia (VAP) in an intubated patient?

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

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 2: A nurse is assessing an elderly client using the Timed Up and Go (TUG) test. What is this test evaluating?

Pain level with ambulation
Cognitive function and short-term memory
Mobility, balance, and fall risk (Correct answer)
Cardiovascular endurance

Correct answer: Mobility, balance, and fall risk

The TUG test measures the time taken to rise from a chair, walk 3 meters, return, and sit down, and is used to assess mobility and fall risk in older adults.

Question 3: A nurse is assessing a client's body mass index (BMI). Which BMI range is classified as obese according to standard guidelines?

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

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 4: A patient's IV is infusing behind schedule. The LPN is tempted to increase the rate to 'catch up.' Why is this practice dangerous?

It may cause circulatory overload or electrolyte imbalance (Correct answer)
It wastes IV fluid supplies
It violates hospital policy only
It will cause the IV site to infiltrate

Correct answer: It may cause circulatory overload or electrolyte imbalance

Rapid infusion to 'catch up' can cause circulatory overload and dangerous electrolyte shifts, especially in elderly or cardiac patients.

Question 5: A client with chronic heart failure is being discharged on a sodium-restricted diet. The LPN teaches the client to report which daily weight change to the provider?

Gain of 1 lb over one week
Loss of 0.5 lb in one day
Gain of 2 lb in one day or 5 lb in one week (Correct answer)
Loss of 2 lb in one week

Correct answer: Gain of 2 lb in one day or 5 lb in one week

A weight gain of 2 lb in 24 hours or 5 lb in one week indicates fluid retention and early decompensation, requiring prompt provider notification.

Question 6: 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 7: A patient taking phenytoin (Dilantin) should be taught to report which adverse effect that indicates toxicity?

Increased urination and thirst
Dry mouth and constipation
Skin rash and photosensitivity
Nystagmus, ataxia, and confusion (Correct answer)

Correct answer: Nystagmus, ataxia, and confusion

Nystagmus, ataxia, and confusion are classic signs of phenytoin toxicity, reflecting CNS effects at supratherapeutic serum levels.

Question 8: A client with Guillain-Barré syndrome is being monitored in the hospital. Which assessment finding is the most critical?

Mild weakness in both hands
Areflexia in the lower extremities
Declining forced vital capacity and inability to cough effectively (Correct answer)
Paresthesia in both feet

Correct answer: Declining forced vital capacity and inability to cough effectively

Guillain-Barré syndrome causes ascending paralysis that can involve the respiratory muscles. Declining FVC and inability to cough signals impending respiratory failure requiring immediate intervention.

Question 9: 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)
Domestic violence risk
Depression and suicidal ideation
Cognitive impairment

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 10: 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
Instruct the patient to avoid all contact with other residents
Ensure the receiving facility is notified of the patient's VRE status (Correct answer)
Ensure the patient is transported in a negative-pressure vehicle

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: The LPN is preparing to insert a peripheral IV catheter. Which site should be avoided in a patient who had a left-sided mastectomy?

Right forearm
Right hand dorsum
Right antecubital fossa
Left arm (Correct answer)

Correct answer: Left arm

The left arm should be avoided after left mastectomy due to impaired lymphatic drainage, which increases infection risk and may cause lymphedema.

Question 12: An LPN is reinforcing dietary teaching for a client newly diagnosed with hypertension. Which statement by the client indicates an understanding of the DASH (Dietary Approaches to Stop Hypertension) diet?

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

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

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

Question 13: 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?

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

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 14: A client at 36 weeks gestation presents with a blood pressure of 158/104 mmHg, proteinuria (3+ on dipstick), and a severe frontal headache. The LPN should recognize this as:

Normal blood pressure elevation of late pregnancy
Preterm labor symptoms
Severe preeclampsia requiring immediate escalation (Correct answer)
Gestational hypertension without protein

Correct answer: Severe preeclampsia requiring immediate escalation

BP ≥160/110 mmHg with proteinuria and severe headache meets criteria for severe preeclampsia, a dangerous obstetric emergency requiring immediate intervention and possible delivery.

Question 15: A client receiving intravenous vancomycin develops a trough level of 22 mcg/mL (target 10–20 mcg/mL). The LPN should:

Double the interval between doses without notifying the provider
Administer the next scheduled dose as ordered — this is within normal range
Notify the charge nurse and hold the next dose pending provider review (Correct answer)
Increase the rate of IV hydration to reduce the vancomycin level

Correct answer: Notify the charge nurse and hold the next dose pending provider review

A vancomycin trough of 22 mcg/mL exceeds the target range (10–20 mcg/mL), increasing risk of nephrotoxicity and ototoxicity. The charge nurse and provider must be notified and the next dose held pending review.

Question 16: When providing a bed bath, the LPN should wash the patient in which sequence?

Chest → abdomen → face → legs → perineum
Face → neck → arms → chest → abdomen → legs → perineum (Correct answer)
Perineum → legs → abdomen → chest → face
Feet → legs → abdomen → chest → face

Correct answer: Face → neck → arms → chest → abdomen → legs → perineum

Bathing proceeds from cleanest to least clean areas: face first, perineum last, to prevent transferring microorganisms to cleaner areas.

Question 17: A patient is being discharged after a myocardial infarction. Which statement by the patient indicates correct understanding of activity restrictions?

'I will gradually increase my activity as tolerated per my care plan.' (Correct answer)
'I can resume all my usual activities next week.'
'I should avoid all physical activity permanently.'
'I should stay in bed for at least one month.'

Correct answer: 'I will gradually increase my activity as tolerated per my care plan.'

Cardiac rehabilitation involves gradually increasing activity tolerance, and patients should follow a progressive activity plan as directed by their healthcare team.

Question 18: Which patient behavior indicates the nurse's teaching about home infection prevention was effective?

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

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 19: What is the role of a nurse in end-of-life care?

To make decisions for the family
To monitor symptoms only
To provide compassionate care and support at the end of life (Correct answer)
To offer legal advice

Correct answer: To provide compassionate care and support at the end of life

In end-of-life care, a nurse's primary role is to provide compassionate care and comprehensive support to the patient and their family during this sensitive time. This involves managing pain and symptoms to ensure comfort, offering emotional and spiritual support, and facilitating communication about the patient's wishes and preferences. The nurse acts as an advocate, ensuring dignity and quality of life are maintained according to the patient's values.

Question 20: While assessing a patient who underwent a thyroidectomy 6 hours ago, the LPN observes the patient twitching the face when tapping over the facial nerve. This positive sign is known as:

Kernig's sign
Homans' sign
Trousseau's sign
Chvostek's sign (Correct answer)

Correct answer: Chvostek's sign

A positive Chvostek's sign (facial twitching with tapping over the facial nerve) indicates hypocalcemia, a common post-thyroidectomy complication.

Question 21: A client is admitted with influenza and is placed on droplet precautions. Which of the following interventions is a required component of droplet precautions?

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

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 22: 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)
Increase activity to promote normal lochia progression
This is abnormal and the physician should be notified
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 23: Which statement by the patient indicates an understanding of how to use a metered-dose inhaler (MDI) with a spacer?

'I will take two quick puffs without pausing.'
'I will press the inhaler, then breathe in slowly and hold for 10 seconds.' (Correct answer)
'I will exhale after pressing the inhaler and immediately breathe in.'
'I will shake the spacer to activate the medication.'

Correct answer: 'I will press the inhaler, then breathe in slowly and hold for 10 seconds.'

Proper MDI technique involves actuating the inhaler into the spacer, then inhaling slowly and holding the breath for 10 seconds to maximize deposition.

Question 24: What is the significance of documentation in nursing?

To monitor medications only
To update patient contact information
To track payments
To maintain a legal record and track progress (Correct answer)

Correct answer: To maintain a legal record and track progress

Documentation in nursing is essential for maintaining a legal record of all care provided, interventions performed, and patient responses. This accurate record protects both the patient and the healthcare provider. It also allows the healthcare team to track the patient's progress over time, ensuring continuity of care and facilitating effective communication among providers.

Question 25: Which action should the LPN take FIRST after a needlestick injury during medication administration?

Notify the charge nurse immediately
Call the occupational health department
Complete an incident report
Wash the site thoroughly with soap and water (Correct answer)

Correct answer: Wash the site thoroughly with soap and water

Immediate washing with soap and water is the first priority to reduce risk of infection following a needlestick injury.

Question 26: A client is prescribed D5W (5% dextrose in water) 500 mL IV. The LPN understands this solution is classified as:

Isotonic that distributes evenly throughout the body without shifting fluid
Isotonic in the bag, but becomes hypotonic once infused as the dextrose is metabolized (Correct answer)
Hypertonic in the bag but isotonic once dextrose is metabolized
Hypertonic, pulling fluid from tissues into the vascular space

Correct answer: Isotonic in the bag, but becomes hypotonic once infused as the dextrose is metabolized

D5W is technically isotonic in the bag (308 mOsm/L), but once dextrose is metabolized by cells, it effectively becomes free water (hypotonic), distributing into all body compartments.

Question 27: A patient taking a monoamine oxidase inhibitor (MAOI) should strictly avoid which food?

Fresh fruits and vegetables
Cooked chicken and fish
Aged cheeses and cured meats (Correct answer)
White bread and pasta

Correct answer: Aged cheeses and cured meats

Aged cheeses and cured meats are high in tyramine; MAOIs prevent tyramine breakdown, potentially causing a hypertensive crisis.

Question 28: An LPN is caring for a patient with a chest tube. Which finding requires immediate action?

Drainage of 80 mL over the past hour
Suction control chamber bubbling continuously
Gentle bubbling in the water seal chamber during exhalation
Absence of fluctuation (tidaling) in the water seal chamber (Correct answer)

Correct answer: Absence of fluctuation (tidaling) in the water seal chamber

Absent tidaling may indicate the lung has re-expanded or, more urgently, that the tube is kinked, clamped, or obstructed, requiring immediate assessment.

Question 29: A patient is prescribed metformin 500 mg PO BID. Which condition is an absolute contraindication to this medication?

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

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

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

Question 30: A nurse is caring for a patient on halo traction for a cervical spine injury. Which nursing action is essential for this patient?

Tighten the halo vest screws if any looseness is detected
Check pin sites every shift for signs of infection or loosening (Correct answer)
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 31: A nurse is reviewing screening recommendations for an asymptomatic 55-year-old male with a 30 pack-year smoking history who currently smokes. Which screening is indicated?

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

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 32: Which blood pressure reading in a postpartum patient requires the LPN to immediately notify the provider?

158/108 mmHg (Correct answer)
128/84 mmHg
118/72 mmHg
138/88 mmHg

Correct answer: 158/108 mmHg

A blood pressure of 158/108 mmHg in a postpartum patient meets criteria for severe hypertension and may indicate postpartum preeclampsia, requiring immediate reporting.

Question 33: A nurse is assessing a client's readiness to change smoking behavior using the Transtheoretical Model. The client says, 'I know I should quit but I'm not ready yet.' Which stage does this represent?

Action
Contemplation (Correct answer)
Preparation
Precontemplation

Correct answer: Contemplation

In the contemplation stage, the individual acknowledges the problem and is considering change but has not yet committed to taking action.

Question 34: An LPN is reinforcing teaching about foot care for a client with type 2 diabetes. Which instruction is most important to include to prevent complications?

"It is safe to walk barefoot inside your home."
"Inspect the entire surface of your feet daily for any cuts or blisters." (Correct answer)
"Apply a generous amount of lotion between your toes to prevent cracking."
"Soak your feet in hot water daily to soften the skin."

Correct answer: "Inspect the entire surface of your feet daily for any cuts or blisters."

Due to the risk of peripheral neuropathy (loss of sensation), clients with diabetes may not feel minor injuries to their feet. Daily visual inspection is critical for early detection of cuts, sores, or blisters that could lead to serious infections. Soaking feet in hot water is dangerous due to the risk of burns. Lotion should not be applied between the toes as it can promote fungal growth, and walking barefoot increases the risk of injury.

Question 35: Which environmental condition increases the risk of electrical injury to patients?

Having wet or moist skin when touching electrical equipment (Correct answer)
Operating equipment within its manufacturer-specified voltage
Using a three-prong grounded plug
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 36: A patient receiving vancomycin IV suddenly develops flushing and a red rash on the face, neck, and upper chest. The LPN recognizes this as:

A toxic drug reaction requiring dialysis
A contact allergy to the IV tubing
Anaphylaxis requiring epinephrine
'Red Man Syndrome' caused by too-rapid infusion (Correct answer)

Correct answer: 'Red Man Syndrome' caused by too-rapid infusion

Red Man Syndrome is a non-allergic infusion reaction to vancomycin caused by infusing the drug too rapidly; slowing the infusion resolves it.

Question 37: A nurse is working in a community health clinic and wants to use secondary prevention strategies. Which activity BEST exemplifies secondary prevention?

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

Correct answer: Screening adults for hypertension at a health fair

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

Question 38: 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?

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

Correct answer: N95 respirator and gloves

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

Question 39: When applying a cold pack to a patient's sprained ankle, the LPN should:

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
Leave the cold pack in place continuously for the first 24 hours
Apply the cold pack directly to bare skin for maximum effect

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 40: 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 is recommended for females only, starting at age 18
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)

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

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

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

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

Question 42: Which position is best for a client in acute left-sided heart failure with severe dyspnea?

Semi-Fowler's (30-degree elevation)
Supine with legs elevated
High Fowler's (60–90 degrees) (Correct answer)
Left lateral Sims' position

Correct answer: High Fowler's (60–90 degrees)

High Fowler's position uses gravity to reduce venous return to the heart and shifts fluid away from lung bases, improving respiratory effort in acute pulmonary edema.

Question 43: 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)
10–15 pounds
35–45 pounds
15–20 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 44: What is the importance of communication skills in patient care?

To ensure understanding, trust, and cooperation (Correct answer)
To reduce costs
To improve patient satisfaction
To complete paperwork

Correct answer: To ensure understanding, trust, and cooperation

Effective communication skills are fundamental in patient care for building trust and rapport. They enable nurses to clearly explain conditions and treatments, ensuring patients understand their care plan and feel heard. This fosters cooperation, empowers patients to participate in their recovery, and ultimately leads to better health outcomes.

Question 45: A client with MI has returned from the cardiac catheterization lab with a radial access site. What is the priority assessment?

Restrict arm movement for 24 hours by applying an arm sling
Apply warm compresses to the wrist to promote healing
Keep the arm elevated above heart level for 6 hours
Monitor for access site bleeding and assess radial pulse and capillary refill (Correct answer)

Correct answer: Monitor for access site bleeding and assess radial pulse and capillary refill

After radial artery access, the priority is assessing for bleeding at the compression band site and monitoring neurovascular status (radial pulse, capillary refill, sensation, color) in the affected hand.

Question 46: A client with hypertension is started on an ACE inhibitor. The client calls the clinic reporting a persistent dry cough. The LPN should:

Tell the client to stop the medication immediately
Document and report to the charge nurse or provider (Correct answer)
Reassure the client it will resolve in 2 weeks
Instruct the client to take the medication with food

Correct answer: Document and report to the charge nurse or provider

A persistent dry cough is a well-known side effect of ACE inhibitors caused by bradykinin accumulation. The provider should be notified as an ARB may be substituted.

Question 47: 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)
Plain soap and water
Chlorhexidine-based hand rub
Alcohol-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 48: 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:

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

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 49: A patient taking spironolactone should be instructed to AVOID which dietary item?

Foods high in vitamin K
Foods high in potassium (Correct answer)
Foods high in calcium
Foods high in sodium

Correct answer: Foods high in potassium

Spironolactone is a potassium-sparing diuretic; adding extra dietary potassium increases the risk of life-threatening hyperkalemia.

Question 50: 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?

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

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 51: Which gauge IV catheter provides the FASTEST flow rate for blood transfusion in an emergency?

20-gauge
18-gauge (Correct answer)
22-gauge
24-gauge

Correct answer: 18-gauge

An 18-gauge catheter has the largest lumen of the options listed, allowing the fastest flow rate needed for rapid blood transfusion.

Question 52: 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:

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

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

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

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

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

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

Assess the patient for injury before moving them (Correct answer)
Complete the incident/occurrence report
Notify the patient's family
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 56: A patient is recovering from a lumbar laminectomy. Which patient statement indicates a need for further discharge teaching?

'I need to report any new numbness or tingling in my legs.'
'I should avoid bending, twisting, and prolonged sitting.'
'I should log-roll to get out of bed for the first several weeks.'
'I can lift objects up to 10 pounds starting tomorrow.' (Correct answer)

Correct answer: 'I can lift objects up to 10 pounds starting tomorrow.'

Lifting restrictions after laminectomy typically prohibit lifting more than a few pounds for several weeks; lifting 10 pounds the day after surgery could disrupt the surgical site.

Question 57: A client with heart failure develops sudden-onset dyspnea, pink frothy sputum, and severe anxiety. The priority nursing intervention is:

Obtain a stat 12-lead ECG
Administer oral furosemide as prescribed
Prepare for immediate intubation
Place the client in high Fowler's position and apply oxygen (Correct answer)

Correct answer: Place the client in high Fowler's position and apply oxygen

Pink frothy sputum and sudden dyspnea indicate acute pulmonary edema. The immediate priority is positioning to reduce venous return and applying high-flow oxygen to treat hypoxia.

Question 58: The LPN is caring for a patient who develops a rash, wheezing, and hypotension 10 minutes after starting an IV antibiotic. What is the priority intervention?

Administer oral diphenhydramine as ordered
Slow the infusion rate and notify the charge nurse
Stop the infusion and call for emergency assistance (Correct answer)
Document the reaction and monitor the patient

Correct answer: Stop the infusion and call for emergency assistance

These signs indicate anaphylaxis; the nurse must immediately stop the infusion and activate emergency response to prevent cardiovascular collapse.

Question 59: A nurse observes a colleague reusing a single-use vial of insulin for multiple patients. The appropriate action is to:

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

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

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

Question 60: 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?

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

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

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

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

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

Question 62: A client is receiving potassium chloride (KCl) 40 mEq IV. The LPN knows that this infusion must:

Be mixed in D5W to prevent vein irritation
Be given as an IV bolus for rapid correction of severe hypokalemia
Never exceed a rate of 10–20 mEq/hour for peripheral IV infusion (Correct answer)
Be administered undiluted through a central line

Correct answer: Never exceed a rate of 10–20 mEq/hour for peripheral IV infusion

IV potassium must never be given as a bolus (can cause fatal cardiac arrest) and peripheral infusion must not exceed 10 mEq/hr to prevent venous irritation and cardiac toxicity.

Question 63: 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?

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

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 64: A 10-year-old child with leukemia is receiving chemotherapy and develops a temperature of 38.5°C (101.3°F). The absolute neutrophil count (ANC) is 300 cells/mm³. The LPN should:

Give acetaminophen and monitor for improvement over 24 hours
Apply a cool cloth to the forehead and restrict visitors
Immediately notify the charge nurse — this is a neutropenic fever emergency (Correct answer)
Perform a full physical exam and contact the family

Correct answer: Immediately notify the charge nurse — this is a neutropenic fever emergency

An ANC <500 cells/mm³ with fever constitutes a neutropenic fever — a medical emergency with high mortality from infection. Immediate broad-spectrum IV antibiotics are required.

Question 65: A patient with HIV asks the nurse if other staff members need to know about their diagnosis. The nurse's best response is:

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

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 66: Which of the following best describes a therapeutic bath used to relieve perineal itching and inflammation?

Paraffin bath
Whirlpool bath
Sitz bath (Correct answer)
Medicated sponge bath

Correct answer: Sitz bath

A sitz bath immerses only the perineal and rectal areas in warm water and is used to relieve discomfort and promote healing.

Question 67: A patient is being discharged home after hip replacement surgery. Which member of the interdisciplinary team should the LPN contact to arrange home safety modifications?

Dietitian
Occupational therapist (Correct answer)
Respiratory therapist
Speech-language pathologist

Correct answer: Occupational therapist

An occupational therapist assesses and arranges home safety modifications, including grab bars and raised toilet seats, for patients following hip replacement.

Question 68: 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
Only the front from chest to waist and the sleeves to 2 inches above the elbows (Correct answer)
The front chest panel and all four sides
The entire gown including the back and below the waist

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

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

Correct answer: Common adverse effect of ACE inhibitors

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

Question 70: A client is receiving IV heparin. The nurse notes the aPTT is 120 seconds (control 30 seconds). What action should the LPN take?

Continue the infusion as ordered — this is therapeutic
Increase the heparin rate per protocol
Notify the charge nurse and anticipate reducing or stopping the infusion (Correct answer)
Administer vitamin K as the antidote

Correct answer: Notify the charge nurse and anticipate reducing or stopping the infusion

Therapeutic aPTT is 1.5–2.5x the control (45–75 seconds). An aPTT of 120 seconds (4x control) indicates supratherapeutic anticoagulation with high bleeding risk, requiring dose reduction.

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?

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

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: 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?

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

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

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

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

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

Question 74: 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 75: A client who delivered 2 days ago develops a temperature of 38.5°C (101.3°F), chills, and unilateral breast tenderness with redness and warmth. The LPN suspects:

Mastitis and should report findings to the charge nurse (Correct answer)
Breast abscess requiring surgical drainage
Systemic sepsis requiring blood cultures immediately
Normal engorgement of early lactation

Correct answer: Mastitis and should report findings to the charge nurse

Unilateral breast redness, warmth, tenderness, and fever are classic signs of mastitis — a breast infection most common in breastfeeding women requiring antibiotic treatment.

Question 76: An LPN is caring for an elderly client who is confused and has been trying to get out of bed without assistance. After attempting alternative measures without success, the provider orders soft wrist restraints. Which of the following actions is a critical safety measure for the nurse to implement?

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

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

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

Question 77: An LPN is providing wound care to a stage 2 pressure injury. Which dressing type is most appropriate?

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

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 78: A patient with a history of alcohol withdrawal is admitted. Which symptom requires the LPN to notify the provider immediately?

Insomnia and mild anxiety
Diaphoresis and mild nausea
Mild headache and irritability
Seizure activity and severe tremors (Correct answer)

Correct answer: Seizure activity and severe tremors

Seizures during alcohol withdrawal indicate delirium tremens (DTs), a life-threatening emergency requiring immediate intervention.

Question 79: A nurse is teaching a new mother about sudden infant death syndrome (SIDS) prevention. Which instruction is MOST important?

Use a soft mattress with bumper pads for comfort
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)

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 80: A pressure injury shows full-thickness skin loss with visible subcutaneous fat but no exposed bone, tendon, or muscle. This is classified as:

Stage 4
Stage 1
Stage 3 (Correct answer)
Stage 2

Correct answer: Stage 3

Stage 3 pressure injuries involve full-thickness skin loss with visible subcutaneous tissue; bone, tendon, and muscle remain unexposed.

Question 81: Which document serves as the primary legal record guiding a patient's end-of-life care wishes?

Discharge summary
Medical power of attorney designation
Care coordination plan
Advance directive (Correct answer)

Correct answer: Advance directive

An advance directive is the primary legal document that outlines a patient's wishes regarding end-of-life care, including resuscitation and life support preferences.

Question 82: An LPN is floated to a unit and given an assignment involving skills outside their competency. The LPN should:

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
Ask a colleague to demonstrate the skill once and then proceed

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 83: 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)
aPTT of 70 seconds (control 30 seconds)
Mild bruising at the IV site
Left calf tenderness and warmth

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 84: A patient with left-sided weakness is being transferred from bed to wheelchair. The wheelchair should be placed:

On the patient's right (stronger) side at a 45-degree angle (Correct answer)
On the patient's left side at a 45-degree angle
Directly in front of the bed
On the patient's left side at a 90-degree angle

Correct answer: On the patient's right (stronger) side at a 45-degree angle

Placing the wheelchair on the patient's stronger side allows them to use that side to pivot and bear weight during the transfer.

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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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

op.nysed.gov — Fees, renewal, score validity · verified Oct 2026
nclex.com — Score release, fees, exam format, registration deadline, retake policy, eligibility, test dates, time limit, retake fee, test delivery · verified Oct 2026