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

Question 1: A patient with borderline personality disorder (BPD) exhibits splitting behavior. The nurse understands this behavior involves:

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

Correct answer: Switching between extremes of idealization and devaluation

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

Question 2: An elderly patient is on multiple medications. Which term describes the use of five or more medications simultaneously, common in older adults?

Synergism
Polypharmacy (Correct answer)
Contraindication
Pharmacokinetics

Correct answer: Polypharmacy

Polypharmacy refers to the concurrent use of five or more medications and increases the risk of adverse drug reactions in elderly patients.

Question 3: A patient is diagnosed with scabies. The nurse should initiate which type of precautions?

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

Correct answer: Contact precautions

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

Question 4: Which element is NOT required to prove nursing malpractice?

Patient injury resulting from the breach
Intent to harm the patient (Correct answer)
Breach of the standard of care
A duty owed to the patient

Correct answer: Intent to harm the patient

Malpractice (professional negligence) requires duty, breach, causation, and damages — intent to harm is not required and is associated with intentional torts, not negligence.

Question 5: A patient is placed on droplet precautions. Which PPE is required when entering the room?

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

Correct answer: Surgical mask

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

Question 6: A patient with OCD spends 3 hours per day washing their hands. The LVN's INITIAL approach should be?

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

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

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

Question 7: What is an advance directive?

A hospital admission form
A legal document expressing a patient's wishes about future medical treatment if they cannot communicate (Correct answer)
A medication list
An insurance authorization

Correct answer: A legal document expressing a patient's wishes about future medical treatment if they cannot communicate

Advance directives include living wills and healthcare powers of attorney, guiding care when patients cannot speak for themselves.

Question 8: Which entry demonstrates appropriate late-entry documentation in a patient's chart?

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

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

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

Question 9: A patient with dementia is pacing and appears distressed. Which nursing intervention should be tried first?

Identify and address potential unmet needs (pain, hunger, toileting) (Correct answer)
Administer a PRN sedative medication
Apply soft restraints to keep the patient safe
Place the patient in isolation to reduce stimulation

Correct answer: Identify and address potential unmet needs (pain, hunger, toileting)

Assessing for unmet needs such as pain, hunger, or the need to toilet often resolves agitation in dementia patients without medication.

Question 10: What should be included in an incident report?

An opinion about why it happened
Only the patient's name
A blame assignment
Factual description of what happened, who was involved, actions taken, and patient outcome (Correct answer)

Correct answer: Factual description of what happened, who was involved, actions taken, and patient outcome

Incident reports document facts objectively without assigning blame, supporting quality improvement and risk management.

Question 11: A patient develops a fever, purulent drainage, and erythema at a central line insertion site 72 hours post-placement. This most likely indicates:

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

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

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

Question 12: Which behavior by a patient diagnosed with anorexia nervosa should the nurse prioritize as needing immediate intervention?

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

Correct answer: Experiencing bradycardia and hypotension

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

Question 13: What is a change-of-shift report?

A structured handoff communication summarizing each patient's status, changes, and care plan (Correct answer)
An equipment inventory
A general meeting about hospital policies
A break schedule

Correct answer: A structured handoff communication summarizing each patient's status, changes, and care plan

Shift reports ensure continuity of care by transferring essential patient information between nurses.

Question 14: A patient reports pain as 7 out of 10. The LVN administers prescribed analgesics and should reassess pain within how long for oral medications?

15 minutes
2 hours
4 hours
30 to 60 minutes (Correct answer)

Correct answer: 30 to 60 minutes

Oral analgesics typically reach peak effect in 30 to 60 minutes, making this the appropriate reassessment window.

Question 15: An LVN is caring for a client with C. difficile (C. diff). Which hand hygiene method is most appropriate?

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

Correct answer: Soap and water handwashing

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

Question 16: Which nutritional finding is most common and concerning in elderly long-term care residents?

Protein-calorie malnutrition (Correct answer)
Hyperkalemia from excess dietary potassium
Iron overload
Vitamin D toxicity

Correct answer: Protein-calorie malnutrition

Protein-calorie malnutrition is prevalent in elderly residents due to decreased appetite, dysphagia, depression, and functional limitations.

Question 17: A patient returns from surgery with a urinary catheter. The nurse's best action to prevent CAUTI is to:

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

Correct answer: Keep the drainage bag below bladder level

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

Question 18: When should hand hygiene be performed?

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

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

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

Question 19: An LVN is caring for a patient with moderate Alzheimer's disease who repeatedly asks where she is. What is the best response?

Ignore the question to avoid reinforcing the behavior
Firmly remind her she has been told many times
Redirect and reassure her calmly each time (Correct answer)
Place a sign on the door that she must read

Correct answer: Redirect and reassure her calmly each time

Calm redirection and reassurance are therapeutic for dementia patients; arguing or ignoring increases agitation and distress.

Question 20: Which combination places a fetus at greatest risk for hemolytic disease of the newborn due to Rh incompatibility?

Mother Rh-positive, Father Rh-positive
Mother Rh-negative, Father Rh-negative
Mother Rh-negative, Father Rh-positive (Correct answer)
Mother Rh-positive, Father Rh-negative

Correct answer: Mother Rh-negative, Father Rh-positive

An Rh-negative mother carrying an Rh-positive fetus (inherited from the Rh-positive father) can develop anti-Rh antibodies that attack fetal red blood cells.

Question 21: A patient scores 14 on the Braden Scale. What does this indicate?

No risk present
Low pressure ulcer risk
Moderate pressure ulcer risk (Correct answer)
High pressure ulcer risk

Correct answer: Moderate pressure ulcer risk

A Braden Scale score of 13–14 indicates moderate risk; lower scores indicate greater vulnerability to pressure injuries.

Question 22: A patient in wrist restraints should be assessed and the restraints released for how long at minimum every 2 hours?

10 minutes (Correct answer)
15 minutes
5 minutes
30 minutes

Correct answer: 10 minutes

Restraints should be released for at least 10 minutes every 2 hours to provide skin care, ROM exercises, and assess circulation.

Question 23: A terminally ill patient tells the nurse, 'If God lets me live long enough to see my daughter graduate, I promise I'll volunteer at the hospital every week.' The nurse recognizes this as which stage of Kübler-Ross grief?

Denial
Acceptance
Depression
Bargaining (Correct answer)

Correct answer: Bargaining

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

Question 24: An LVN is asked to perform a task that falls outside their scope of practice. The appropriate response is to:

Attempt the task to avoid delaying patient care
Perform the task if a more experienced nurse is nearby
Ask a nursing assistant to perform the task instead
Decline and explain that the task exceeds their scope of practice (Correct answer)

Correct answer: Decline and explain that the task exceeds their scope of practice

LVNs must practice within their legally defined scope and must refuse tasks that exceed those boundaries to protect patient safety.

Question 25: A 10-month-old infant is diagnosed with iron-deficiency anemia. Which dietary teaching should the nurse provide to the parents?

Avoid all fruit juices as they inhibit iron absorption
Introduce iron-fortified cereals and pureed meats (Correct answer)
Limit green vegetables due to iron interference
Increase cow's milk intake to 32 oz per day

Correct answer: Introduce iron-fortified cereals and pureed meats

Iron-fortified cereals and pureed meats are excellent dietary sources of iron for infants; excessive cow's milk can inhibit iron absorption and cause GI blood loss.

Question 26: The LVN smells smoke in the hallway. Using the RACE mnemonic, which action comes first?

Contain — close all doors
Alarm — activate the fire alarm
Extinguish — attempt to put out the fire
Rescue — move clients in immediate danger (Correct answer)

Correct answer: Rescue — move clients in immediate danger

RACE stands for Rescue, Alarm, Contain, Extinguish — rescuing clients in immediate danger is always the first priority.

Question 27: Which action should the LVN take when disposing of an unused controlled substance after partial administration?

Return it to the pharmacy without documentation
Waste the remainder in the presence of a witness and document per facility policy (Correct answer)
Pour it down the sink alone without documentation
Store the remaining controlled substance in a personal locker until the next dose is due

Correct answer: Waste the remainder in the presence of a witness and document per facility policy

Controlled substances must be wasted with a witness and documented to prevent diversion and comply with regulatory requirements.

Question 28: A nurse is caring for a patient who recently lost a limb. The patient states, 'I don't need to talk to anyone — I'm fine.' Which coping mechanism is the patient most likely demonstrating?

Regression
Suppression (Correct answer)
Rationalization
Intellectualization

Correct answer: Suppression

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

Question 29: What is the most common cause of postpartum hemorrhage (PPH)?

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

Correct answer: Uterine atony

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

Question 30: Which behavior indicates a patient is maintaining appropriate therapeutic boundaries with the nurse?

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

Correct answer: Discussing only care-related concerns during interactions

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

Question 31: Which bony prominence is at highest risk for pressure injury development in a patient lying in the supine position?

Ischial tuberosity
Greater trochanter
Sacrum and coccyx (Correct answer)
Lateral malleolus

Correct answer: Sacrum and coccyx

The sacrum and coccyx bear the greatest pressure load in the supine position, making them the highest-risk sites for pressure injuries.

Question 32: The nurse is preparing to insert a peripheral IV. Which action best reduces the risk of catheter-related bloodstream infection (CRBSI)?

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

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

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

Question 33: What are the signs of fluid overload?

Only weight gain
Edema, weight gain, crackles in lungs, elevated blood pressure, and jugular vein distension (Correct answer)
No visible signs
Only swollen feet

Correct answer: Edema, weight gain, crackles in lungs, elevated blood pressure, and jugular vein distension

Fluid overload manifests across multiple systems: cardiovascular, respiratory, and peripheral.

Question 34: When a medication order reads 'morphine 2–4 mg IV PRN pain q4h,' what does PRN mean?

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

Correct answer: Administer as needed when the patient reports pain

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

Question 35: A patient who recently received a cancer diagnosis sits silently with tears rolling down their face. Which response by the LVN is MOST therapeutic?

'Try not to cry — you need to stay positive for your treatment.'
'Would you like me to call your doctor to explain the diagnosis again?'
'I know exactly how you feel; my aunt had cancer too.'
'I'm here with you. Take all the time you need.' (Correct answer)

Correct answer: 'I'm here with you. Take all the time you need.'

Sitting with the patient and offering a presence-based response acknowledges their emotions without minimizing, redirecting, or projecting. This demonstrates empathy and uses the therapeutic technique of offering self, which is most appropriate in a moment of acute grief.

Question 36: A postpartum patient at 3 weeks after delivery reports feeling detached from her baby and having thoughts of harming her infant. The nurse recognizes this as:

Postpartum depression requiring outpatient referral
Postpartum blues
Normal adjustment to parenthood
Postpartum psychosis requiring urgent intervention (Correct answer)

Correct answer: Postpartum psychosis requiring urgent intervention

Thoughts of harming the infant indicate postpartum psychosis, a psychiatric emergency requiring immediate intervention.

Question 37: A nurse changes a dressing on a wound colonized with VRE. After removing gloves, the next action is to:

Apply new gloves immediately
Perform hand hygiene (Correct answer)
Dispose of soiled dressing
Document the procedure

Correct answer: Perform hand hygiene

Hand hygiene must be performed immediately after removing gloves to prevent organism transfer.

Question 38: When documenting a patient's pain using the SOAP format, where would you record the patient's verbal report of pain severity?

Objective
Assessment
Subjective (Correct answer)
Plan

Correct answer: Subjective

Subjective data includes information reported by the patient, such as their verbal description of pain.

Question 39: During Leopold's maneuvers, what information does the first maneuver (fundal grip) provide?

The attitude of the fetal head
The degree of fetal descent into the pelvis
The location of the fetal back
What part of the fetus occupies the fundus (Correct answer)

Correct answer: What part of the fetus occupies the fundus

The first Leopold's maneuver involves palpating the fundus to determine whether the fetal head or breech is located at the top of the uterus.

Question 40: A competent adult client refuses a blood transfusion based on religious beliefs. The LVN should:

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

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

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

Question 41: How is medication dosing different for pediatric patients?

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

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

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

Question 42: A patient with schizophrenia states, 'The government has implanted a chip in my brain.' The nurse correctly identifies this as a:

Persecutory delusion (Correct answer)
Auditory hallucination
Negative symptom of schizophrenia
Somatic delusion

Correct answer: Persecutory delusion

A persecutory delusion involves the belief that one is being controlled, monitored, or harmed by an external force.

Question 43: Which finding in wound drainage requires immediate reporting to the RN or provider?

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

Correct answer: Purulent, foul-smelling drainage

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

Question 44: What is proper PPE donning and doffing sequence?

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

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

Proper sequence prevents self-contamination during removal.

Question 45: A patient diagnosed with celiac disease must strictly avoid which dietary component?

Lactose
Fructose
Gluten (Correct answer)
Purine

Correct answer: Gluten

Celiac disease is an autoimmune condition triggered by gluten, found in wheat, barley, and rye, which damages the small intestinal villi.

Question 46: A client's family member asks the LVN to share the client's diagnosis with them. The client has not provided consent. The LVN should:

Share the information if the family member is listed as next of kin
Refuse to disclose and explain that client consent is required under HIPAA (Correct answer)
Share only the diagnosis since it is not treatment information
Ask the charge nurse to share the information instead

Correct answer: Refuse to disclose and explain that client consent is required under HIPAA

HIPAA protects all patient health information; disclosure to family members requires patient authorization except in specific circumstances.

Question 47: Which observation in a psychiatric unit should an LVN report IMMEDIATELY to the supervising RN?

A patient is sleeping more than usual.
A patient is giving away personal belongings and saying goodbye to staff. (Correct answer)
A patient requests a phone call with a family member.
A patient refuses to attend group therapy.

Correct answer: A patient is giving away personal belongings and saying goodbye to staff.

Giving away possessions and saying goodbyes are classic warning signs of suicidal intent requiring immediate escalation.

Question 48: When performing passive range-of-motion exercises, the LVN should move each joint to the point of:

Slight resistance
Maximum extension only
Pain and beyond
Resistance, then stop (Correct answer)

Correct answer: Resistance, then stop

Passive ROM exercises should be performed to the point of resistance and then stopped to avoid injury to the patient's joints.

Question 49: The nurse notices a tear in her glove while caring for a patient with Clostridioides difficile. The priority action is to:

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

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

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

Question 50: A patient with major depressive disorder who had been withdrawn says 'I finally feel at peace — I've made my decision.' The LVN's PRIORITY action is?

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

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

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

Question 51: What is the normal range for fetal heart rate (FHR)?

110–160 beats per minute (Correct answer)
100–140 beats per minute
80–120 beats per minute
120–180 beats per minute

Correct answer: 110–160 beats per minute

A normal fetal heart rate is 110–160 beats per minute; sustained rates outside this range warrant further assessment for fetal distress.

Question 52: An LVN notes 'Pt. ambulated to BR without assistance' in the chart. Which documentation principle does this reflect?

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

Correct answer: Use of approved abbreviations and factual language

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

Question 53: When transferring a patient from bed to wheelchair, the LVN should lock the wheelchair wheels and place it at what angle to the bed?

90 degrees
Parallel to the bed
45 degrees (Correct answer)
180 degrees

Correct answer: 45 degrees

The wheelchair is placed at a 45-degree angle to the bed to minimize the distance and pivot needed during the transfer.

Question 54: Which organism is the primary cause of healthcare-associated MRSA infections?

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

Correct answer: Staphylococcus aureus

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

Question 55: Which type of IV solution causes fluid to shift out of cells, causing them to shrink?

Hypotonic
Hypertonic (Correct answer)
Colloid
Isotonic

Correct answer: Hypertonic

Hypertonic solutions draw water out of cells by osmosis, causing cells to shrink and are used to treat severe hyponatremia.

Question 56: When removing PPE after caring for a contact-precaution patient, which item is removed first?

Goggles
Mask
Gown
Gloves (Correct answer)

Correct answer: Gloves

Gloves are removed first because they are the most contaminated item; gloves are removed before the gown.

Question 57: Which solution is considered the safest and most recommended for routine wound irrigation?

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

Correct answer: Normal saline (0.9% sodium chloride)

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

Question 58: The nurse applies an external electronic fetal monitor (EFM) to assess a client's uterine contractions and evaluate the fetal heart rate (FHR). However, the client is uncomfortable and changes positions frequently, making FHR hard to assess. Consequently, the physician decides to switch to an internal EFM. Before internal monitoring can begin, which of the following must occur?

The membranes must rupture (Correct answer)
The fetus must be at 0 station
The client must receive anesthesia
The cervix must be fully dilated

Correct answer: The membranes must rupture

Internal electronic fetal monitoring (EFM) involves placing electrodes directly on the fetal scalp and a pressure catheter inside the uterus. For these devices to be inserted, the amniotic membranes must have ruptured. This allows direct access to the fetus and the intrauterine cavity, which is a critical prerequisite for internal monitoring.

Question 59: Which action best prevents the transmission of bloodborne pathogens during a blood draw?

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

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

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

Question 60: Total parenteral nutrition (TPN) must be administered through which type of access?

Nasogastric tube
Peripheral IV line
Central venous catheter (Correct answer)
Subcutaneous port

Correct answer: Central venous catheter

TPN is a hypertonic solution that causes phlebitis if given peripherally and must be administered via central venous access.

Question 61: Before applying a physical restraint, which action is the LVN's highest priority?

Ensure a valid physician or provider order exists (Correct answer)
Obtain a signed patient consent form
Document the reason in the chart
Notify the patient's family

Correct answer: Ensure a valid physician or provider order exists

Physical restraints require a valid provider order before application; this is a legal and regulatory requirement.

Question 62: What is contact isolation?

Isolating the patient from all visitors
Only wearing masks
Normal care without special equipment
Precautions for patients with infections spread by direct or indirect contact, requiring gown and gloves (Correct answer)

Correct answer: Precautions for patients with infections spread by direct or indirect contact, requiring gown and gloves

Contact precautions include gown and gloves for all patient contact, plus dedicated equipment.

Question 63: Which vitamin supplement is most important during the first trimester of pregnancy to prevent neural tube defects?

Vitamin A
Vitamin D
Folic acid (Correct answer)
Vitamin C

Correct answer: Folic acid

Folic acid (vitamin B9) is essential in early pregnancy to support neural tube closure and prevent defects such as spina bifida.

Question 64: What is the SBAR communication framework?

Situation, Background, Assessment, Recommendation — a structured method for clinical communication (Correct answer)
A type of medical chart
A patient assessment tool
A billing code

Correct answer: Situation, Background, Assessment, Recommendation — a structured method for clinical communication

SBAR provides a standardized format for communicating critical patient information efficiently.

Question 65: The minimum necessary standard under HIPAA means that an LVN should:

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

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

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

Question 66: A patient with post-traumatic stress disorder (PTSD) is experiencing a flashback. The nurse's priority intervention is to:

Ensure a safe environment and reassure the patient (Correct answer)
Encourage the patient to confront and re-experience the traumatic event
Administer a prescribed sedative to calm the patient
Provide distraction by engaging the patient in a conversation

Correct answer: Ensure a safe environment and reassure the patient

During a flashback, a patient with PTSD is intensely re-experiencing the traumatic event as if it's happening in the present, leading to extreme fear and disorientation. The nurse's immediate priority is to ensure the patient's physical safety and provide a calm, reassuring presence. This helps to reorient them to reality and create a sense of security, reducing distress.

Question 67: A 2-year-old is brought to the clinic with a barking cough, inspiratory stridor, and low-grade fever. Which condition does the nurse suspect?

Bronchiolitis
Croup (laryngotracheobronchitis) (Correct answer)
Pertussis
Epiglottitis

Correct answer: Croup (laryngotracheobronchitis)

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

Question 68: A patient with paranoid schizophrenia refuses to eat, stating the food is poisoned. The BEST nursing approach is to:

Insist the patient eat and document refusal if they don't
Offer factory-sealed, single-serve food items the patient can open themselves (Correct answer)
Have another patient demonstrate the food is safe by eating it first
Explain in detail how the food is prepared in the hospital kitchen

Correct answer: Offer factory-sealed, single-serve food items the patient can open themselves

Offering sealed, commercially packaged foods reduces the patient's fear of tampering and supports nutritional intake.

Question 69: A patient signs a consent form but later tells the LVN they did not understand what they signed. The LVN should:

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

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

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

Question 70: Which of the following is an example of objective data to document in a patient's chart?

Blood pressure 148/92 mmHg (Correct answer)
Patient seems to be in pain
Patient appears anxious
Patient states 'I feel dizzy'

Correct answer: Blood pressure 148/92 mmHg

Objective data is measurable and observable; a specific blood pressure reading is a clear example.

Question 71: A patient's family member demands to see the patient's chart without the patient's consent. The LVN should:

Call security immediately
Provide a summary of the patient's condition verbally
Allow access since family members are legally entitled to records
Deny access and explain that only the patient or authorized representative may authorize release (Correct answer)

Correct answer: Deny access and explain that only the patient or authorized representative may authorize release

HIPAA protects patient privacy; family members have no automatic right to records without the patient's explicit authorization.

Question 72: A patient refuses a prescribed medication. How should the LVN document this?

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

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

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

Question 73: The SBAR communication tool stands for which of the following?

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

Correct answer: Situation, Background, Assessment, Recommendation

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

Question 74: Which of the following is NOT true of delegation?

A nurse should delegate tasks that have expected outcomes.
A nurse should always delegate patient assessments. (Correct answer)
A nurse can delegate tasks such as taking vital signs.
A nurse should never delegate the task of patient evaluations.

Correct answer: A nurse should always delegate patient assessments.

Patient assessment is a core responsibility of a registered nurse (RN) that requires critical thinking, clinical judgment, and the application of the nursing process. These complex activities cannot be delegated to unlicensed assistive personnel (UAP) or other healthcare providers with a different scope of practice. While some data collection may be delegated, the comprehensive assessment and interpretation of findings remain the nurse's professional responsibility to ensure patient safety and appropriate care planning.

Question 75: An LVN is asked by a physician to perform a task outside the LVN scope of practice. The most appropriate response is to:

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

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

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

Question 76: Which action is most appropriate when the LVN observes bright red drainage soaking through a post-operative dressing 1 hour after surgery?

Remove the dressing and apply a new one
Reinforce the dressing and notify the charge nurse or physician immediately (Correct answer)
Apply firm manual pressure and wait 30 minutes before reporting
Document the finding and reassess in 2 hours

Correct answer: Reinforce the dressing and notify the charge nurse or physician immediately

Bright red saturation of a dressing within the first hour post-op suggests hemorrhage; the dressing should be reinforced and the provider notified immediately.

Question 77: When teaching a patient about wound care at home, the LVN should instruct the patient to report which sign of infection to the provider?

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

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

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

Question 78: A patient in the transition phase of labor (8–10 cm dilated) reports a strong urge to push. What is the nurse's priority action?

Prepare the patient for an emergency cesarean section
Encourage the patient to begin pushing immediately
Administer oxytocin to accelerate delivery
Assess cervical dilation before allowing the patient to push (Correct answer)

Correct answer: Assess cervical dilation before allowing the patient to push

Complete dilation (10 cm) must be confirmed before pushing; pushing on an incompletely dilated cervix can cause lacerations and complications.

Question 79: What is professional negligence in nursing?

Only errors causing death
Any mistake a nurse makes
Failure to provide care that meets the standard expected of a reasonably competent nurse in similar circumstances (Correct answer)
Only medication errors

Correct answer: Failure to provide care that meets the standard expected of a reasonably competent nurse in similar circumstances

Negligence requires four elements: duty, breach, causation, and damages.

Question 80: A patient with bipolar disorder in the manic phase is talking rapidly and pacing. Which intervention is the priority?

Encourage participation in a stimulating group activity.
Redirect the patient to a calm, quiet environment. (Correct answer)
Provide arts and crafts to channel excess energy.
Allow the behavior to self-resolve without intervention.

Correct answer: Redirect the patient to a calm, quiet environment.

Reducing stimulation in the environment helps decrease escalating manic behavior and promotes safety.

Question 81: The LVN is reviewing orders and notes a medication prescribed at 10 times the normal adult dose. The appropriate action is to:

Administer half the ordered dose as a compromise
Call the provider to clarify the order before administration (Correct answer)
Ask another nurse to administer the dose instead
Administer the dose because the provider ordered it

Correct answer: Call the provider to clarify the order before administration

Nurses have a legal and ethical duty to question orders that appear unsafe; clarifying with the provider protects the patient.

Question 82: What is the recommended head-of-bed elevation for a patient receiving continuous enteral tube feedings?

0–10 degrees (flat)
60–90 degrees (upright)
15–20 degrees
30–45 degrees (Correct answer)

Correct answer: 30–45 degrees

Elevating the head of the bed 30–45 degrees during and for at least 30 minutes after tube feeding reduces aspiration risk.

Question 83: An LVN suspects a colleague documented care that was never actually provided. The most appropriate action is to:

Ignore it and assume there was a misunderstanding
Report the concern to the charge nurse or supervisor per facility policy (Correct answer)
Alter the colleague's entry to reflect what likely occurred
Confront the colleague publicly at the nursing station

Correct answer: Report the concern to the charge nurse or supervisor per facility policy

Falsification of medical records is a serious legal and ethical violation; the LVN must report the concern through proper channels.

Question 84: The LVN made a documentation error in a paper chart. What is the correct way to correct it?

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

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

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

Question 85: Which patient statement indicates a need for FURTHER TEACHING about their newly prescribed SSRI?

'It may take 2 to 4 weeks before I notice improvement in my mood.'
'I should call my doctor if I have any thoughts of harming myself.'
'I should take this medication with food to help with nausea.'
'I can stop taking this medication as soon as I feel better.' (Correct answer)

Correct answer: 'I can stop taking this medication as soon as I feel better.'

SSRIs must be tapered gradually under medical supervision; abrupt discontinuation causes withdrawal syndrome and risks relapse.

Question 86: A patient is prescribed metoprolol 50 mg PO BID. How many doses will the nurse administer in 24 hours?

3
2 (Correct answer)
4
1

Correct answer: 2

BID means twice daily, so the nurse administers 2 doses in 24 hours.

Question 87: When documenting patient care, the LVN makes an error in a paper chart. The correct action is to:

Erase the error completely
Draw a single line through the error, initial, and date it (Correct answer)
Remove the page and rewrite the entry
Use correction fluid to cover the error

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

A single line through the error with initials and date preserves the original entry and meets legal documentation standards.

Question 88: An LVN notices that a patient diagnosed with schizophrenia is pacing, clenching their fists, and speaking rapidly. Which nursing action should the LVN take FIRST?

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

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

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

Question 89: The LVN must administer an enteric-coated aspirin. Which instruction to the patient is correct?

Swallow the tablet whole with a full glass of water (Correct answer)
Dissolve the tablet under the tongue
Chew the tablet thoroughly before swallowing
Crush the tablet and mix with applesauce

Correct answer: Swallow the tablet whole with a full glass of water

Enteric-coated tablets must be swallowed whole to protect the stomach lining and ensure proper drug release.

Question 90: What is a healthcare-associated infection (HAI)?

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

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

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

Question 91: A 5-year-old is scheduled for a tonsillectomy. In the immediate post-operative period, which assessment is the nurse's highest priority?

Temperature elevation above 38°C
Frequent swallowing indicating bleeding (Correct answer)
Pain level using FACES scale
Oral intake of clear liquids

Correct answer: Frequent swallowing indicating bleeding

Frequent swallowing in a post-tonsillectomy patient is a sign of hemorrhage as the child swallows blood draining from the surgical site.

Question 92: Which of the following is an example of a vector-borne mode of disease transmission?

Contact with a wound infected with MRSA
Inhaling droplet nuclei containing measles
Sharing contaminated needles
Mosquito transmitting malaria (Correct answer)

Correct answer: Mosquito transmitting malaria

Vector-borne transmission occurs when a living organism (e.g., mosquito) carries and transmits a pathogen to a host.

Question 93: An LVN witnesses a patient fall in the hallway. After ensuring patient safety, what is the NEXT priority documentation action?

Wait until end of shift to document
File an incident/occurrence report and document in the chart separately (Correct answer)
Complete a nursing note in the chart only
Ask another nurse to document the event

Correct answer: File an incident/occurrence report and document in the chart separately

An incident report (occurrence report) must be filed separately from the chart, and the event is also documented in the nursing notes.

Question 94: What is the nursing process?

Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE) (Correct answer)
Patient discharge planning
Filing paperwork
Medication administration only

Correct answer: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE)

The nursing process provides a systematic framework for delivering patient care.

Question 95: Which finding in a diabetic foot wound warrants URGENT referral for further evaluation for osteomyelitis?

Mild peripheral edema with intact overlying skin
A deep wound that probes to bone with surrounding erythema (Correct answer)
A wound covered in dry eschar without surrounding inflammation
A superficial wound with granulating base and scant drainage

Correct answer: A deep wound that probes to bone with surrounding erythema

The 'probe-to-bone' test — when a sterile instrument contacts bone within a diabetic foot ulcer — has high predictive value for osteomyelitis.

Question 96: Which of the following best describes 'therapeutic communication' in LVN practice?

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

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

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

Question 97: Autolytic debridement is best achieved by which wound care intervention?

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

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

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

Question 98: When providing perineal care for a female patient, the LVN should cleanse in which direction?

Side to side
Front to back (Correct answer)
Back to front
In a circular motion

Correct answer: Front to back

Perineal care for females must be performed front to back to prevent introducing rectal bacteria into the urethral and vaginal areas.

Question 99: A patient who had abdominal surgery 2 days ago reports discomfort and has not passed flatus. The LVN should first:

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

Correct answer: Encourage ambulation

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

Question 100: A patient tells the nurse, 'I can't do anything right.' Which response by the nurse is MOST therapeutic?

'What makes you feel that way?' (Correct answer)
'Lots of patients feel the same way at first.'
'You'll feel better once your medication kicks in.'
'Of course you can — don't say that.'

Correct answer: 'What makes you feel that way?'

Asking what makes the patient feel that way explores the underlying concern and validates their experience.

Question 101: Which EHR documentation feature helps ensure that medications are administered to the correct patient?

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

Correct answer: Barcode medication administration (BCMA) scanning

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

Question 102: What are vital signs and why are they important?

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

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

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

Question 103: What is the purpose of a wound culture?

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

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

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

Question 104: A patient's blood pressure is 148/92 mmHg. Which position should the LVN place the patient in before retaking the reading?

Left lateral Sims' position
Sitting with feet flat on the floor for 5 minutes (Correct answer)
Supine with legs elevated
Standing upright

Correct answer: Sitting with feet flat on the floor for 5 minutes

The patient should rest in a sitting position with feet flat for at least 5 minutes before an accurate blood pressure measurement is taken.

Question 105: An elderly patient presents with unexplained bruising in various stages of healing and appears fearful when their caregiver enters the room. The nurse's FIRST action is to:

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

Correct answer: Report suspected elder abuse to adult protective services

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

Question 106: What is de-escalation in psychiatric nursing?

Sedating the patient
Using physical restraints immediately
Communication techniques used to calm an agitated patient and prevent escalation to violence (Correct answer)
Ignoring agitated behavior

Correct answer: Communication techniques used to calm an agitated patient and prevent escalation to violence

De-escalation uses verbal and nonverbal techniques to reduce tension: calm voice, empathetic listening, and giving choices.

Question 107: A patient with chronic kidney disease (CKD) on dialysis needs dietary restriction of which two nutrients?

Sodium and calcium
Iron and zinc
Potassium and phosphorus (Correct answer)
Magnesium and folate

Correct answer: Potassium and phosphorus

CKD patients cannot excrete potassium and phosphorus efficiently, leading to dangerous hyperkalemia and hyperphosphatemia.

Question 108: Which of the following is the most common reservoir for healthcare-associated infections?

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

Correct answer: The hands of healthcare workers

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

Question 109: When planning care for a patient with severe depression, the LVN prioritizes which level of Maslow's hierarchy?

Esteem
Self-actualization
Love and belonging
Safety (Correct answer)

Correct answer: Safety

Safety is the priority for patients with severe depression due to the high risk of self-harm and suicidal ideation.

Question 110: An LVN is caring for a patient with an arterial (ischemic) leg ulcer. Which intervention is CONTRAINDICATED?

Elevating the limb above heart level to reduce edema (Correct answer)
Protecting the foot from trauma with padded footwear
Referring the patient for vascular evaluation
Keeping the skin moisturized to prevent cracking

Correct answer: Elevating the limb above heart level to reduce edema

Elevating an ischemic limb further reduces already compromised arterial perfusion, worsening tissue ischemia.

Question 111: Which enteral formula modification is most appropriate for a patient with diabetes receiving tube feedings?

Standard isotonic formula at increased rate
Low-carbohydrate, high-fiber, high-fat formula (Correct answer)
High-carbohydrate, low-fat formula
High-protein, high-simple-sugar formula

Correct answer: Low-carbohydrate, high-fiber, high-fat formula

Diabetes-specific formulas are lower in carbohydrates and higher in fat and fiber to reduce postprandial glucose spikes.

Question 112: What are the rights of medication administration?

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

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

The rights serve as safety checks before every medication administration.

Question 113: A physician's written order is illegible. What is the most appropriate action for the LVN?

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

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

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

Question 114: Which scenario best illustrates the ethical principle of justice in nursing?

Encouraging patients to make their own healthcare decisions
Following all physician orders without question
Keeping a patient's diagnosis secret from their family
Providing equal pain management to all patients regardless of their ability to pay (Correct answer)

Correct answer: Providing equal pain management to all patients regardless of their ability to pay

Justice requires fair and equitable distribution of care and resources without discrimination based on social or economic status.

Question 115: During change-of-shift report, which information is most critical for the oncoming nurse to receive?

Dietary preferences from the previous week
The patient's insurance information
Current vital signs, significant changes, and pending orders (Correct answer)
Housekeeping requests for the room

Correct answer: Current vital signs, significant changes, and pending orders

Change-of-shift report must include current clinical status, significant changes, and any pending or new orders to ensure continuity of care.

Question 116: The chain of infection includes six links. Which link does hand hygiene primarily break?

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

Correct answer: Mode of transmission

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

Question 117: What are the signs of elder abuse?

Only physical bruises
Only occurs in nursing homes
Elder abuse does not exist
Unexplained injuries, poor hygiene, withdrawal, fear of caregivers, and sudden financial changes (Correct answer)

Correct answer: Unexplained injuries, poor hygiene, withdrawal, fear of caregivers, and sudden financial changes

Elder abuse may be physical, emotional, financial, or neglectful, and nurses are mandated reporters.

Question 118: An LVN witnesses a co-worker falsifying a patient's medication administration record. What should the LVN do?

Report the falsification to the supervisor and document the observation (Correct answer)
Confront the co-worker privately and take no further action
Correct the record without telling anyone
Ignore it to avoid workplace conflict

Correct answer: Report the falsification to the supervisor and document the observation

Falsifying medical records is fraudulent and illegal; the LVN has a professional and legal duty to report it to a supervisor.

Question 119: When administering a transdermal patch, the LVN should:

Cut the patch in half if the dose seems too high
Apply the new patch to the same site as the old one to maintain consistency
Remove the old patch, clean the skin, and rotate sites with each new patch (Correct answer)
Apply the patch over clothing to prevent skin irritation

Correct answer: Remove the old patch, clean the skin, and rotate sites with each new patch

Removing the old patch, cleaning residual medication, and rotating sites prevents skin irritation and ensures consistent drug delivery.

Question 120: An LVN observes signs of physical abuse on an elderly patient admitted from a nursing home. The LVN is legally required to:

Report the suspected abuse to the supervisor and appropriate authorities (Correct answer)
Document findings but take no further action unless ordered
Wait for the family to visit before making any report
Confront the nursing home staff directly

Correct answer: Report the suspected abuse to the supervisor and appropriate authorities

LVNs are mandated reporters; suspected elder abuse must be reported to the supervisor and the relevant protective services agency.

Question 121: What are therapeutic boundaries in nurse-patient relationships?

Professional limits that define the appropriate scope of the relationship and protect both parties (Correct answer)
Personal friendships with patients
Avoiding all patient interaction
Only following doctor's orders

Correct answer: Professional limits that define the appropriate scope of the relationship and protect both parties

Professional boundaries maintain therapeutic relationships while preventing exploitation or dependency.

Question 122: When using the PHQ-9 tool, the LVN is screening a patient for:

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

Correct answer: Depression severity

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

Question 123: The LVN is changing a wound dressing and notices the wound edges are approximated with minimal redness. This describes which type of wound healing?

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

Correct answer: Primary intention

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

Question 124: What electrolyte imbalances should LVNs monitor for?

Electrolytes do not need monitoring
Sodium, potassium, calcium, and magnesium — each causing specific symptoms when too high or low (Correct answer)
Only sodium
Only during IV therapy

Correct answer: Sodium, potassium, calcium, and magnesium — each causing specific symptoms when too high or low

Electrolyte imbalances can cause cardiac arrhythmias, muscle weakness, seizures, and other serious complications.

Question 125: Which side effect of benzodiazepines causes the MOST concern when prescribed to older adult patients?

Elevated blood pressure
Increased appetite and weight gain
Fall risk secondary to excessive sedation (Correct answer)
Increased alertness and restlessness

Correct answer: Fall risk secondary to excessive sedation

Benzodiazepines cause sedation and impaired coordination in older adults, significantly increasing their risk of falls and fractures.

Question 126: An LVN notices a pattern of a patient's blood pressure readings trending upward over several shifts. The most appropriate communication action is to:

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

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

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

Question 127: Which of the following is considered a high-alert medication requiring extra verification steps before administration?

Docusate sodium (Colace)
Insulin (Correct answer)
Acetaminophen (Tylenol)
Famotidine (Pepcid)

Correct answer: Insulin

Insulin is a high-alert medication with a narrow therapeutic window; errors can cause life-threatening hypoglycemia or DKA.

Question 128: What are the different types of therapeutic diets?

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

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

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

Question 129: A patient receiving negative pressure wound therapy (NPWT/wound VAC) should be monitored for which priority complication?

Hyperthermia from the vacuum seal
Skin breakdown from excessive moisture
Bleeding or hemorrhage at the wound site (Correct answer)
Hypertension from the negative pressure

Correct answer: Bleeding or hemorrhage at the wound site

NPWT can dislodge clots or damage fragile tissue, making bleeding and hemorrhage a priority safety concern requiring ongoing monitoring.

Question 130: A physician gives the LVN a verbal order over the phone. What is the correct procedure?

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

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

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

Question 131: Which of the following represents a breach of patient confidentiality by an LVN?

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

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

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

Question 132: A healthcare worker is accidentally stuck with a needle used on an HIV-positive patient. The initial priority action is to:

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

Correct answer: Wash the site thoroughly with soap and water

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

Question 133: Which documentation practice best protects the LVN from legal liability?

Charting care before it is provided to save time
Using correction fluid to remove charting errors
Leaving blank spaces in the chart if no changes occurred
Documenting objectively, accurately, and contemporaneously with care provided (Correct answer)

Correct answer: Documenting objectively, accurately, and contemporaneously with care provided

Accurate, objective, and timely documentation provides a legal record of care given and is the nurse's best defense in litigation.

Question 134: Which oxygen delivery device provides the highest and most precise concentration of oxygen?

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

Correct answer: Venturi mask

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

Question 135: When using military time in documentation, which correctly represents 9:45 PM?

2045
0945
2145 (Correct answer)
1945

Correct answer: 2145

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

Question 136: A patient with borderline personality disorder frequently tells one nurse, 'You're the only one who understands me,' while telling another, 'That other nurse is terrible.' The nurse recognizes this as:

Undoing
Intellectualization
Splitting (Correct answer)
Projection

Correct answer: Splitting

Splitting is a hallmark defense mechanism in borderline personality disorder in which people or situations are seen as all good or all bad.

Question 137: Which of the following best represents the steps of the chain of infection?

Bacteria, viruses, local infection, systemic infection
Host, transmission, inflammation, sterilization
Acute transmission, chronic transmission, asepsis, and sepsis
Etiologic agent, reservoir, portal of exit, method of transmission, portal of entry to the susceptible host, susceptible host (Correct answer)

Correct answer: Etiologic agent, reservoir, portal of exit, method of transmission, portal of entry to the susceptible host, susceptible host

The chain of infection outlines the six essential links required for an infectious disease to spread. These links are the etiologic agent (the pathogen), the reservoir (where it lives), the portal of exit (how it leaves the reservoir), the method of transmission (how it travels), the portal of entry (how it enters a new host), and the susceptible host (the individual who can get infected). Breaking any one of these links is crucial for preventing the spread of infection.

Question 138: A patient receiving IV heparin develops sudden hematuria and petechiae. The LVN should first:

Stop the infusion and notify the charge nurse or provider immediately (Correct answer)
Increase the infusion rate
Administer vitamin K
Document findings and continue the infusion

Correct answer: Stop the infusion and notify the charge nurse or provider immediately

Signs of bleeding are serious adverse effects of heparin; the infusion must be stopped and the provider notified immediately.

Question 139: Which of the following is NOT appropriate to include in an incident report?

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

Correct answer: Opinion about whose fault the incident was

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

Question 140: Which strategy is MOST effective when de-escalating an agitated patient?

Using firm, authoritative commands to establish control
Speaking softly, maintaining non-threatening body language, and allowing personal space (Correct answer)
Immediately initiating a show of force to prevent violence
Surrounding the patient with multiple staff members

Correct answer: Speaking softly, maintaining non-threatening body language, and allowing personal space

Calm verbal communication, non-threatening posture, and maintaining personal space are evidence-based de-escalation techniques.

Question 141: A nurse notices a co-worker skip hand hygiene before entering a patient's room. The best response is to:

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

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

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

Question 142: A therapeutic milieu in an inpatient psychiatric unit refers to:

The structured environment designed to promote healing and safe behavior (Correct answer)
A medication management protocol for behavioral control
A locked unit with restricted patient movement
One-on-one nursing observation around the clock

Correct answer: The structured environment designed to promote healing and safe behavior

A therapeutic milieu is a carefully structured, safe, and supportive inpatient environment that itself serves as a treatment modality.

Question 143: A nurse is caring for a patient on contact precautions. A family member asks to visit. The nurse should:

Refuse all visitors to protect them
Allow the visit without restrictions since family are not healthcare workers
Instruct the visitor to wear gloves and gown and perform hand hygiene (Correct answer)
Ask the visitor to stand in the doorway only

Correct answer: Instruct the visitor to wear gloves and gown and perform hand hygiene

Visitors entering a contact precaution room should follow the same PPE requirements as healthcare workers.

Question 144: What are the legal requirements for nursing documentation?

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

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

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

Question 145: Under HIPAA, an LVN may share a patient's protected health information (PHI) without explicit authorization for which purpose?

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

Correct answer: Treatment, payment, or healthcare operations

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

Question 146: Which condition requires contact AND airborne precautions simultaneously?

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

Correct answer: Varicella (chickenpox)

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

Question 147: The LVN is preparing to change a sterile dressing. Which action would break sterile technique?

Reaching across the sterile field to place supplies (Correct answer)
Keeping sterile items above waist level
Allowing only sterile items to touch the sterile field
Opening the sterile field away from the body

Correct answer: Reaching across the sterile field to place supplies

Reaching across a sterile field contaminates it because the arm passes over the sterile area.

Question 148: Which statement by a patient who attempted suicide MOST indicates a continued high risk and should be reported immediately to the charge nurse?

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

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

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

Question 149: Under HIPAA, which of the following is permissible without specific patient authorization?

Sharing records with the patient's employer
Disclosing information to law enforcement without a subpoena
Giving records to the patient's spouse without the patient's consent
Releasing information to other treating providers for continuity of care (Correct answer)

Correct answer: Releasing information to other treating providers for continuity of care

HIPAA permits disclosure of PHI to other treating providers without authorization because it is needed for treatment purposes.

Question 150: A Stage II pressure injury is best characterized by which finding?

Intact skin with non-blanchable erythema
Full-thickness skin loss exposing subcutaneous tissue
Full-thickness tissue loss with exposed bone or tendon
Partial-thickness skin loss with a shallow open bed or intact blister (Correct answer)

Correct answer: Partial-thickness skin loss with a shallow open bed or intact blister

Stage II pressure injuries involve partial-thickness skin loss presenting as a shallow open wound or intact/ruptured serum-filled blister.

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

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

150

Questions

300 min

Time Limit

70%

To Pass

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Exam Rules

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