NCLEX-PN Nursing — All Questions

A charge nurse is assigning tasks on a medical unit. Which task is appropriate to delegate to the LPN/LVN?

• a.Providing discharge teaching about a new diagnosis
• b.Administering an oral antibiotic to a stable client✓
• c.Performing the admission assessment on an unstable client
• d.Developing the initial nursing care plan for a new admission

Administering routine oral medications to stable clients is within the LPN/LVN scope. Initial assessments, care-plan development, and client teaching about new content are RN responsibilities. The LPN/LVN reinforces teaching but does not perform the initial teaching.

The LPN/LVN receives a verbal order from a physician during an emergency. What is the most appropriate action?

• a.Write down the order, read it back, and have the RN or provider co-sign per policy✓
• b.Have a family member witness the order so no provider signature is needed later
• c.Carry out the order and document it several hours later at the end of the shift
• d.Refuse the order because an LPN/LVN may never accept a verbal order in an emergency

During an emergency a verbal order may be accepted, but it must be written down and read back to the provider to confirm accuracy. It should be signed by the provider within the facility's required timeframe. Read-back reduces transcription and communication errors.

Which client care assignment is most appropriate to give to unlicensed assistive personnel (UAP)?

• a.Assisting a stable client with a bath and recording oral intake✓
• b.Inserting an indwelling urinary catheter for a stable client
• c.Adjusting the flow rate of an IV infusion that is behind schedule
• d.Evaluating a client's response to pain medication and charting it

UAP may perform basic hygiene and record intake and output for stable clients. Catheter insertion, evaluating medication response, and adjusting IV rates require nursing judgment and licensure. Assessment and evaluation cannot be delegated to UAP.

An LPN/LVN notices a coworker documenting care that was not provided. What is the priority action?

• a.Ignore it because it is not the LPN/LVN's responsibility
• b.Alter the record to correct it personally
• c.Confront the coworker angrily in front of clients
• d.Report the concern to the charge nurse or supervisor✓

Falsifying documentation is a serious ethical and legal violation that must be reported through the chain of command. The LPN/LVN should not alter another person's entry or handle it confrontationally. Reporting protects clients and maintains accurate records.

When using the SBAR communication tool during a hand-off report, the 'R' stands for which component?

• a.Nurse's rationale
• b.Client response
• c.Recommendation✓
• d.Later reassessment

SBAR stands for Situation, Background, Assessment, and Recommendation. The recommendation states what the nurse wants done or is requesting next. Standardized hand-off tools reduce omissions and improve safety.

The LPN/LVN is caring for four clients. Which client should be assessed first?

• a.A client scheduled for discharge this afternoon
• b.A client asking about the lunch menu
• c.A client reporting new onset of shortness of breath✓
• d.A client requesting a second pillow

Airway and breathing problems take priority using the ABC framework. New shortness of breath could signal a life-threatening change and must be assessed immediately. The other requests are non-urgent.

A client refuses a prescribed medication. What is the LPN/LVN's best response?

• a.Tell the client they must take it or be discharged
• b.Respect the refusal, document it, and notify the RN or provider✓
• c.Insist repeatedly until the client agrees
• d.Hide the medication in food without telling the client

Competent adults have the right to refuse treatment. The nurse should honor the refusal, document it, and inform the RN or provider so follow-up can occur. Concealing medication violates client autonomy and trust.

Which situation represents a breach of client confidentiality under HIPAA?

• a.Giving a shift report to the oncoming nurse
• b.Discussing a client's diagnosis with a friend not involved in care✓
• c.Sharing information with the treating physician
• d.Reporting a client's abuse suspicion to authorities

Sharing protected health information with someone not involved in the client's care violates confidentiality. Reporting mandated concerns, communicating with the care team, and giving hand-off report are permitted. Only those with a need to know may access information.

The LPN/LVN is documenting in the electronic health record. Which entry is written correctly?

• a."Client is being difficult and uncooperative with the entire staff."
• b."Client probably has appendicitis based on where the pain is."
• c."Client reports pain rated 7 of 10 in right lower abdomen at 0900."✓
• d."Client seems to be doing just fine today, with no real complaints."

Documentation should be objective, specific, and factual, including measurable data and time. Subjective judgments and unauthorized diagnoses are inappropriate. Clear entries support continuity and legal accuracy.

An LPN/LVN is floated to an unfamiliar unit. Which action is most appropriate?

• a.Care only for clients who need no medications and refuse other assignments
• b.Refuse the assignment and leave the facility before the shift begins
• c.Perform any task the charge nurse requests regardless of competence
• d.Accept tasks within the LPN/LVN scope and ask for orientation to the unit✓

A floated nurse should accept assignments within their scope and competence while requesting orientation to unfamiliar equipment and routines. Refusing to work may be abandonment, but performing unsafe tasks is negligent. Communicating limitations protects clients.

Which task performed by UAP requires the LPN/LVN to intervene immediately?

• a.Ambulating a stable client down the hallway with a gait belt
• b.Emptying a urinary drainage bag and recording the output volume
• c.Repositioning a client's oxygen tubing and adjusting the liter flow✓
• d.Feeding a client who has no swallowing difficulty at lunchtime

Adjusting oxygen flow rate is outside the UAP scope and requires nursing judgment. Feeding a client with no swallowing risk, ambulating with a gait belt, and recording drainage are acceptable UAP tasks. The nurse must correct the unsafe action.

The LPN/LVN is reinforcing discharge instructions. Which statement indicates the client understood teaching about a wound?

• a."I only need to call the clinic if the wound falls off completely."
• b."I will wash my hands before and after changing the dressing."✓
• c."I will remove the dressing and leave the wound open to air right away."
• d."Redness and warmth spreading around the wound are normal for weeks."

Hand hygiene before and after dressing changes prevents infection and reflects correct understanding. Spreading redness and warmth are signs of infection that should be reported. Dressings should be managed as ordered, not removed prematurely.

A client's family asks the LPN/LVN to explain the surgeon's plan for an upcoming operation. What is the best response?

• a."I cannot discuss anything about the surgery with you."
• b."Let me describe the entire surgical procedure for you."
• c."The surgery is simple, so there is nothing to worry about."
• d."I will let the surgeon know you have questions about the plan."✓

Explaining the surgical plan and obtaining informed consent are the provider's responsibility. The nurse should facilitate communication by notifying the surgeon of the family's questions. Reassurance or refusal without follow-up does not meet the family's needs.

Which principle guides prioritization when the LPN/LVN plans care for multiple clients?

• a.Always perform the quickest tasks first so the shift stays on schedule
• b.Address physiologic and safety needs before comfort or teaching needs✓
• c.See the client whose family requests attention first, then the others
• d.Complete tasks in the order the rooms are numbered on the hallway

Maslow's hierarchy directs the nurse to meet physiologic and safety needs before higher-level needs like comfort and education. Room number, task length, and family preference are not valid prioritization frameworks. Life-threatening problems come first.

An advance directive states a client does not want cardiopulmonary resuscitation. The client stops breathing. What should the LPN/LVN do?

• a.Wait several minutes to see whether the client resumes breathing
• b.Begin full CPR immediately, since the directive expired at admission
• c.Follow the do-not-resuscitate order and notify the RN and provider✓
• d.Call the family first and ask them whether to start resuscitation

A valid do-not-resuscitate order must be honored, so resuscitation is not initiated. The nurse provides comfort measures and notifies the RN and provider. Ignoring a legal directive violates the client's expressed wishes.

The LPN/LVN is part of an interdisciplinary care conference. What is the LPN/LVN's primary contribution?

• a.Ordering the diagnostic laboratory tests the team will need
• b.Prescribing the client's physical therapy program and its frequency
• c.Reporting ongoing observations of the client's response to care✓
• d.Determining the client's medical diagnosis for the record

The LPN/LVN contributes bedside observations and data about how the client is responding to interventions. Ordering tests, prescribing therapies, and making medical diagnoses are outside the LPN/LVN scope. Collaboration relies on accurate frontline information.

Before administering a medication, the LPN/LVN should verify at least how many client identifiers?

• a.One
• b.Five
• c.Two✓
• d.Four

The standard of care requires at least two client identifiers, such as name and date of birth, before medication administration. The room number is not an acceptable identifier. Correct identification prevents wrong-client errors.

A client is placed on contact precautions for Clostridioides difficile. Which action is essential?

• a.Wear an N95 respirator when entering the room
• b.Keep the client's door closed with negative pressure
• c.Use alcohol-based hand rub only
• d.Wash hands with soap and water after removing gloves✓

C. difficile spores are not reliably killed by alcohol, so hand washing with soap and water is required. An N95 and negative-pressure room are for airborne precautions, not contact. Gloves and gowns are also used for contact precautions.

The LPN/LVN finds a small fire in a trash can in a client's room. Using the RACE acronym, what is the first action?

• a.Rescue the client from immediate danger✓
• b.Extinguish the fire before doing anything else
• c.Contain the fire by closing the door first
• d.Activate the alarm and wait for the fire team

RACE stands for Rescue, Alarm, Contain, and Extinguish. The first priority is to rescue anyone in immediate danger from the fire. Only after people are safe does the nurse activate the alarm, contain, and extinguish.

Which client is at highest risk for falls and should have safety precautions reinforced?

• a.A 40-year-old awaiting routine discharge this afternoon
• b.An 80-year-old on sedatives with a history of dizziness✓
• c.A 25-year-old admitted overnight for observation
• d.A 30-year-old ambulating independently without aids

Advanced age, sedating medications, and a history of dizziness are major fall-risk factors. Independent younger clients without these factors are at lower risk. Fall precautions such as a low bed and call light within reach are indicated.

The LPN/LVN is about to use a fire extinguisher. Using the PASS technique, what is the first step?

• a.Sweep side to side
• b.Squeeze the handle
• c.Pull the pin✓
• d.Aim at the flames

PASS stands for Pull, Aim, Squeeze, and Sweep. The first step is to pull the safety pin. Then the nurse aims at the base of the fire, squeezes the handle, and sweeps side to side.

A client requires airborne precautions for pulmonary tuberculosis. Which personal protective equipment is required to enter the room?

• a.A face shield only
• b.A standard surgical mask
• c.A gown and gloves only
• d.A fitted N95 respirator✓

Airborne precautions for tuberculosis require a fitted N95 respirator and a negative-pressure room. A standard surgical mask does not filter the small airborne droplet nuclei. Respiratory protection is essential to prevent transmission.

The LPN/LVN prepares to move a heavy client up in bed. Which action best protects the nurse from injury?

• a.Use a friction-reducing device and get help✓
• b.Move the client alone quickly
• c.Keep the feet close together for balance
• d.Bend at the waist and lift with the back

Using a friction-reducing device and additional staff reduces strain and prevents injury. Lifting with the back and working alone increase injury risk. A wide base of support and using leg muscles also protect the nurse.

Which action reduces the risk of a medication error during administration?

• a.Preparing medications for several clients at once and giving them later
• b.Checking the medication label against the order three times✓
• c.Relying on memory instead of the medication record
• d.Leaving medications at the bedside for the client to take later

Checking the label against the order three times and following the rights of administration reduces errors. Pre-pouring for multiple clients and leaving medications at the bedside increase risk. Medications should be given and documented immediately.

A client with a seizure disorder begins to have a generalized seizure. What is the priority nursing action?

• a.Hold the client firmly to stop the movements
• b.Protect the head and turn the client to the side✓
• c.Insert a padded tongue blade into the mouth
• d.Restrain the client's arms and legs

During a seizure the nurse protects the client from injury by cushioning the head and turning them to the side to maintain the airway. Nothing should be forced into the mouth, and the client should not be restrained. Movements should not be held back.

The LPN/LVN receives a client's meal tray. Before assisting with feeding, what should the nurse verify first?

• a.Whether the client would prefer to eat the dessert first
• b.The client's name against the diet order and tray card✓
• c.The temperature of the food and beverages on the tray
• d.The client's favorite foods and least-liked items

The nurse must confirm the tray matches the correct client and the prescribed diet before feeding, preventing errors such as giving a regular diet to a client who is NPO. Food temperature and preferences are secondary. Matching client to order is a core safety check.

Which finding requires the LPN/LVN to question the use of physical restraints?

• a.Regular monitoring of skin and circulation
• b.A current provider order specifying type and duration
• c.Documentation of less restrictive measures tried first
• d.The restraint was applied only for staff convenience✓

Restraints may never be used for staff convenience or discipline. They require a time-limited provider order, trial of less restrictive alternatives, and frequent monitoring. Using restraints for convenience is unsafe and unethical.

The LPN/LVN notes a client's oxygen is in use. Which safety instruction is most important?

• a.Post 'no smoking' signs and keep oxygen away from open flames✓
• b.Allow smoking in the room as long as the window is open
• c.Use petroleum-based lip balm freely to prevent dry lips
• d.Store the oxygen tank lying flat on the floor beside the bed

Oxygen supports combustion, so open flames and smoking must be prohibited and clearly posted. Petroleum-based products near oxygen are a fire hazard, and tanks should be secured upright. Fire prevention is the priority with oxygen therapy.

A client's identification band is missing at the time of a blood glucose check. What should the LPN/LVN do first?

• a.Proceed using the room number as identification
• b.Ask the client next door to confirm the client's name
• c.Skip the check until the next shift
• d.Verify identity and apply a new band before proceeding✓

A missing identification band must be replaced after verifying identity before care that depends on correct identification. Room numbers and other clients are not reliable identifiers. Accurate identification prevents errors.

Which practice best prevents catheter-associated urinary tract infection?

• a.Routinely irrigating the catheter every shift
• b.Disconnecting the tubing to collect samples
• c.Placing the drainage bag on the client's abdomen during transport
• d.Keeping the drainage bag below the level of the bladder✓

Keeping the drainage bag below bladder level prevents backflow of urine and reduces infection risk. Unnecessary irrigation and breaking the closed system increase infection risk. Maintaining a closed, dependent drainage system is key.

According to recommended immunization schedules, an infant should receive the first dose of the hepatitis B vaccine at what age?

• a.Shortly after birth✓
• b.At the 11-year checkup
• c.At the 12-month checkup
• d.At the 4-year checkup

The first hepatitis B dose is recommended shortly after birth, ideally within the first 24 hours. The series continues in infancy. Early vaccination protects against perinatal transmission.

A mother asks when her infant will typically begin to sit without support. What is the best response?

• a.Around 2 months
• b.Around 18 months
• c.Around 12 months
• d.Around 6 months✓

Most infants can sit without support around 6 months of age. Sitting develops after head control and before pulling to stand. Milestones vary somewhat but follow a predictable sequence.

The LPN/LVN reinforces teaching about breast self-awareness. Which client statement indicates a need for further teaching?

• a."If I feel fine, I never need any screening."✓
• b."I will follow my provider's screening recommendations."
• c."I will report any new lump to my provider."
• d."I will note changes in the skin or nipple."

Feeling well does not eliminate the need for recommended screening such as mammography. Reporting new lumps and skin or nipple changes and following screening guidance are correct. Screening detects problems before symptoms appear.

Which nutrition guidance is appropriate for a healthy pregnant client in the first trimester?

• a.Avoid all dairy products for the first trimester
• b.Take a prenatal vitamin containing folic acid✓
• c.Eliminate protein from the diet to reduce nausea
• d.Take a daily megadose of vitamin A for fetal growth

Folic acid supplementation helps prevent neural tube defects and is recommended before and during early pregnancy. Dairy and protein are important nutrients, not to be eliminated. High-dose vitamin A can be harmful in pregnancy.

A client at a wellness clinic asks about recommended physical activity. Which guidance reflects general recommendations for healthy adults?

• a.About 150 minutes of moderate aerobic activity per week✓
• b.Vigorous activity once a month is enough for most healthy adults
• c.Exercise only when symptoms such as fatigue or breathlessness appear
• d.Strength training should be avoided at any age to prevent injury

General guidelines recommend about 150 minutes of moderate aerobic activity weekly plus muscle-strengthening on two or more days. Occasional or symptom-triggered activity is insufficient. Regular activity promotes cardiovascular and metabolic health.

The LPN/LVN is teaching new parents about safe infant sleep. Which position reduces the risk of sudden infant death syndrome?

• a.Prone on a soft mattress with the head turned
• b.Supine on a firm surface without loose bedding✓
• c.Prone with a loose blanket tucked around for warmth
• d.Side-lying propped with pillows to support the back

Placing infants on their back (supine) on a firm surface without soft bedding reduces SIDS risk. Prone and side-lying positions and soft bedding increase risk. A safe sleep environment is a key teaching point.

A pregnant client in the third trimester reports occasional painless swelling of the feet at the end of the day. What is the best response?

• a."Swelling of the feet at any point in pregnancy means your kidneys have already failed."
• b."You must be admitted to the hospital tonight, because swelling this late is an emergency."
• c."Stop drinking fluids until the swelling is gone, since less fluid in means less swelling."
• d."Mild foot swelling late in the day is common; elevate your legs and report sudden or facial swelling."✓

Mild dependent edema is common in late pregnancy and improves with leg elevation. Sudden, severe, or facial swelling should be reported as it may indicate preeclampsia. Restricting fluids is not recommended.

Which finding in a toddler indicates normal growth and development for a 2-year-old?

• a.Walks up stairs and uses two-word phrases✓
• b.Speaks in full paragraphs about the day
• c.Rides a two-wheeled bicycle without training wheels
• d.Ties own shoelaces without any help from an adult

A typical 2-year-old walks up stairs and combines two words into short phrases. Riding a bicycle, tying shoes, and speaking in paragraphs are later skills. Recognizing normal milestones guides anticipatory guidance.

The LPN/LVN reinforces teaching to a postmenopausal client about preventing osteoporosis. Which recommendation is appropriate?

• a.Increase daily caffeine and alcohol intake to stimulate bone turnover
• b.Avoid all physical activity, since weight on the bones causes thinning
• c.Avoid sunlight completely, because sun exposure destroys stored calcium
• d.Ensure adequate calcium and vitamin D and perform weight-bearing exercise✓

Adequate calcium and vitamin D plus weight-bearing exercise help maintain bone density. Inactivity, excess caffeine, and alcohol can worsen bone loss. Moderate sun exposure supports vitamin D synthesis.

A new mother asks about introducing solid foods. Which guidance is generally appropriate?

• a.Start solids at birth
• b.Introduce single-ingredient foods around 6 months✓
• c.Begin with mixed foods to identify allergies faster
• d.Give honey in the first month for energy

Solid foods are typically introduced around 6 months, starting with single-ingredient foods a few days apart to monitor for allergies. Honey is avoided in the first year because of botulism risk. Introducing one food at a time helps identify reactions.

During a health screening, which blood pressure reading in an adult should prompt reinforcement of lifestyle and follow-up?

• a.115/72 mmHg
• b.148/94 mmHg✓
• c.108/68 mmHg
• d.118/76 mmHg

A reading of 148/94 mmHg is elevated and warrants lifestyle counseling and follow-up. The other readings fall within a normal range. Early identification supports blood pressure control.

The LPN/LVN teaches an older adult about preventing constipation. Which recommendation is most appropriate?

• a.Increase dietary fiber, fluids, and activity as tolerated✓
• b.Rely on a daily enema, since an aging bowel cannot empty without one
• c.Avoid all physical activity, since walking tires the bowel muscle further
• d.Decrease fluid intake so that the stool does not become too bulky to pass

Adequate fiber, fluids, and activity promote normal bowel function and prevent constipation. Reducing fluids and activity worsens constipation, and routine enemas are not recommended. Lifestyle measures are the first-line approach.

A client asks how to reduce the risk of skin cancer. Which teaching is appropriate?

• a.Use tanning beds instead of the sun, since their light is safer
• b.Apply sunscreen only in winter, when the sun is closest
• c.Apply broad-spectrum sunscreen and avoid peak midday sun✓
• d.Rely on a base tan to protect the skin all summer

Broad-spectrum sunscreen, protective clothing, and avoiding peak sun reduce skin cancer risk. Tanning beds and 'base tans' increase ultraviolet damage. Sun protection is needed year-round.

The LPN/LVN reinforces teaching about pregnancy danger signs. Which symptom should the client report immediately?

• a.Increased frequency of urination during the day
• b.Vaginal bleeding with abdominal cramping✓
• c.Mild breast tenderness that eases with a support bra
• d.Occasional mild fatigue that is relieved by resting

Vaginal bleeding with cramping may indicate a serious complication and must be reported immediately. Breast tenderness, urinary frequency, and mild fatigue are common, expected changes. Teaching warning signs promotes timely care.

Which statement by an adolescent's parent indicates understanding of adolescent development?

• a."It is normal for my teen to seek independence and value peer relationships."✓
• b."My teen should have no interest in friends of her own age at this stage."
• c."My teen will accept every family rule without ever once questioning it."
• d."My teen should depend on me to make every decision, even the small ones."

Adolescence is characterized by developing identity, seeking independence, and valuing peers. Complete dependence and lack of peer interest are not typical. Understanding this stage helps parents respond supportively.

A client asks about recommended colorectal cancer screening for average-risk adults. Which response reflects general guidance?

• a.Screening should begin at age 70
• b.Regular screening is recommended beginning at around age 45✓
• c.Screening is never necessary without symptoms
• d.Only clients with a family history need screening

Average-risk adults are generally advised to begin colorectal cancer screening around age 45. Screening is recommended even without symptoms or family history. Early screening improves detection and outcomes.

A client newly diagnosed with a terminal illness states, "There must be a mistake in the lab results." Which stage of grief does this reflect?

• a.Acceptance
• b.Denial✓
• c.Depression
• d.Bargaining

Denial is characterized by disbelief and rejecting the reality of the diagnosis. Bargaining involves making deals, and acceptance involves coming to terms with the situation. Recognizing grief stages guides supportive communication.

Which therapeutic communication technique is demonstrated when the nurse restates the client's message in the nurse's own words?

• a.Giving advice
• b.Offering false reassurance
• c.Changing the subject
• d.Paraphrasing✓

Paraphrasing restates the client's message to confirm understanding and encourage further sharing. Giving advice and false reassurance are nontherapeutic. Effective communication supports the client's expression of feelings.

A client experiencing a panic attack is hyperventilating and pacing. What is the nurse's priority action?

• a.Encourage the client to make a list of stressors immediately
• b.Provide detailed education about anxiety disorders
• c.Leave the client alone to calm down
• d.Stay with the client and speak calmly using short, simple statements✓

During a panic attack the nurse should remain with the client and use a calm voice and simple directions to reduce stimulation. Detailed teaching and problem-solving are not effective during acute anxiety. Presence and reassurance promote safety.

The nurse suspects a client is a victim of elder abuse. What is the nurse's legal responsibility?

• a.Report the suspicion according to mandatory reporting laws✓
• b.Keep the suspicion private to avoid conflict with the family
• c.Wait for the client to file a complaint before reporting
• d.Confront the suspected abuser directly before telling anyone

Nurses are mandatory reporters and must report suspected abuse to the appropriate authorities. Confronting the abuser or waiting for the client to act can endanger the client. Reporting protects vulnerable individuals.

A client with depression states, "I feel like a burden to everyone." Which response is most therapeutic?

• a."You shouldn't feel that way; everyone loves you."
• b."Tell me more about how you have been feeling."✓
• c."At least you have a supportive family."
• d."Let's talk about something more pleasant."

Encouraging the client to say more invites expression of feelings and conveys genuine interest. Minimizing feelings, changing the subject, and comparing to others block communication. Open-ended exploration is therapeutic.

A client with dementia becomes agitated in the evening. Which intervention is most appropriate?

• a.Frequently change caregivers to provide stimulation
• b.Increase environmental noise and activity
• c.Provide a calm, well-lit environment and a consistent routine✓
• d.Restrain the client to prevent wandering

A calm, well-lit environment with consistent routines and caregivers reduces evening agitation, sometimes called sundowning. Excess stimulation, restraints, and frequent caregiver changes worsen confusion. Predictability promotes security.

A client who has been assaulted appears withdrawn and avoids eye contact. What is the nurse's best initial approach?

• a.Provide a safe, private environment and allow the client to talk when ready✓
• b.Insist that the client describe the assault in detail before any other care
• c.Discuss the incident in the hallway within earshot of other clients
• d.Tell the client to move past the experience and focus on going home

Providing safety, privacy, and unhurried support helps a trauma survivor feel secure and regain a sense of control. Forcing disclosure or minimizing feelings is harmful. The nurse follows the client's pace.

Which behavior indicates a client may be at immediate risk for suicide and requires priority intervention?

• a.Attending group therapy sessions each morning
• b.Expressing hope about plans after discharge
• c.Giving away personal possessions and stating goodbyes✓
• d.Discussing new coping strategies with the nurse

Giving away belongings and saying goodbye can signal a suicide plan and requires immediate assessment and safety measures. Hopeful statements and engagement in therapy are positive signs. Direct assessment of suicidal intent is essential.

A client from a culture that values family decision-making asks that all information be shared with the family. What is the nurse's best response?

• a.Refuse the request because sharing anything with family violates confidentiality
• b.Respect the client's wishes and involve the family as the client directs✓
• c.Insist that only the client receive information about the diagnosis
• d.Share the information with the client's employer instead of the family

Culturally sensitive care respects the client's preferences about who participates in decisions. When a competent client authorizes family involvement, the nurse honors that choice. Individual and cultural values guide communication.

A client experiencing alcohol withdrawal is anxious and tremulous. Which environment is most appropriate?

• a.A brightly lit, busy room to keep the client engaged and awake
• b.A dark, isolated room checked once at the end of the shift
• c.A quiet room with reduced stimulation and frequent monitoring✓
• d.A shared room with several visitors coming and going

A quiet, low-stimulation environment with close monitoring helps reduce agitation and detects worsening withdrawal. Excess stimulation can heighten anxiety, and isolation without supervision is unsafe. Safety and calm are priorities.

A client verbalizes anger at the nursing staff about the diagnosis. Which response by the nurse is most therapeutic?

• a."You have no reason to be angry with the nursing staff."
• b."You seem upset. Can you tell me what is troubling you?"✓
• c."If you keep yelling at me, I will leave the room."
• d."Calm down and stop being difficult with the staff."

Acknowledging the client's feelings and inviting them to talk helps identify the underlying concern. Defensive or dismissive responses escalate anger and block communication. Reflecting emotion is a therapeutic technique.

Which coping strategy is considered adaptive for a client experiencing situational stress?

• a.Denying that any problem exists until the stress passes
• b.Talking with a trusted friend and using relaxation techniques✓
• c.Withdrawing from all social contact until the situation resolves
• d.Using alcohol each evening to relax and fall asleep faster

Seeking social support and using relaxation are healthy, adaptive coping strategies. Alcohol use, social withdrawal, and denial are maladaptive and can worsen stress. Reinforcing positive coping supports mental health.

A client with a new colostomy states, "I don't want to look at it. It's disgusting." What is the nurse's best response?

• a."Let's not discuss the stoma at all until you are feeling better."
• b."Most people adjust to a colostomy very quickly, so there is really no need to worry."
• c."You will have to look at it eventually, so you may as well get it over with now."
• d."It is normal to have these feelings after surgery. Would you like to talk about it?"✓

Acknowledging feelings about an altered body image and inviting discussion supports adjustment. Pressuring the client or minimizing feelings is nontherapeutic. Emotional support precedes self-care teaching.

A confused older adult repeatedly asks to go home. Which nursing response is most therapeutic?

• a."You cannot go home, so please stop asking me about it."
• b."Your family left you here and they are not coming back for you."
• c."You seem worried. You are safe here, and I will stay with you."✓
• d."I have already answered that same question three times today."

Providing reassurance, orientation, and a calm presence reduces anxiety in a confused client. Harsh or dismissive replies increase distress. Validating feelings and offering comfort are therapeutic.

The LPN/LVN is collecting data on a client with heart failure. Which finding should be reported to the RN promptly?

• a.Clear lung sounds bilaterally
• b.Sudden weight gain of 3 pounds overnight✓
• c.Heart rate of 76 beats per minute
• d.Blood pressure of 122/78 mmHg

A sudden weight gain suggests fluid retention and worsening heart failure and should be reported. Normal blood pressure, clear lungs, and a normal heart rate are reassuring. Daily weights are a key monitoring tool in heart failure.

A client with diabetes reports shakiness, sweating, and dizziness. The blood glucose is 55 mg/dL. What should the LPN/LVN do first?

• a.Encourage the client to rest until symptoms pass
• b.Withhold all food and recheck in one hour
• c.Give 15 grams of a fast-acting carbohydrate✓
• d.Administer the client's evening insulin dose

Symptoms and a glucose of 55 mg/dL indicate hypoglycemia, treated with 15 grams of fast-acting carbohydrate and rechecking in 15 minutes. Giving insulin would worsen hypoglycemia. Prompt treatment prevents progression to severe hypoglycemia.

The LPN/LVN is caring for a client after a total hip replacement. Which position should be maintained to prevent dislocation?

• a.Legs abducted with a wedge pillow between the knees✓
• b.Turned fully onto the operative side to relieve pressure
• c.Legs crossed at the ankles with the knees held together
• d.Hip flexed greater than 90 degrees while sitting upright

Keeping the legs abducted with a wedge pillow prevents adduction and dislocation of the new hip. Crossing the legs, flexing the hip beyond 90 degrees, and lying on the operative side are contraindicated. Positioning protects the prosthesis.

A client with chronic obstructive pulmonary disease has an oxygen order. Which oxygen flow is generally most appropriate?

• a.15 L/min by nonrebreather
• b.10 L/min by simple mask
• c.8 L/min by nasal cannula
• d.2 L/min by nasal cannula✓

Clients with COPD typically receive low-flow oxygen, such as 2 L/min, to maintain adequate oxygenation without suppressing respiratory drive. High flow rates may be used only in emergencies with close monitoring. Titrating to target saturation is important.

The LPN/LVN is monitoring a client receiving a blood transfusion. Which finding suggests a transfusion reaction and requires stopping the infusion?

• a.Temperature unchanged from the pretransfusion baseline value
• b.Report of feeling comfortable and warm under the blankets
• c.Blood pressure of 120/70 mmHg, unchanged from baseline
• d.Fever, chills, and flank pain shortly after the start✓

Fever, chills, and flank pain suggest a hemolytic transfusion reaction; the transfusion must be stopped and the RN notified immediately. Stable vital signs and comfort are reassuring. Early recognition prevents serious harm.

A client is admitted with dehydration. Which finding supports this diagnosis?

• a.Crackles heard throughout both lung fields
• b.Bounding pulses and pitting edema of the ankles
• c.Dry mucous membranes and poor skin turgor✓
• d.Distended neck veins while sitting upright

Dry mucous membranes and poor skin turgor are classic signs of fluid volume deficit. Bounding pulses, edema, crackles, and distended neck veins indicate fluid overload. Assessing hydration status guides fluid therapy.

The LPN/LVN is caring for a client with a nasogastric tube for decompression. Which finding requires prompt attention?

• a.The client reports nausea and the tube has stopped draining✓
• b.A small amount of greenish drainage in the suction canister
• c.The client's mouth and lips are moist following routine oral care
• d.The tube is connected to low intermittent suction as ordered

If drainage stops and the client is nauseated, the tube may be clogged or malpositioned and requires prompt evaluation. Green drainage and connection to suction are expected. Maintaining patency relieves gastric distention.

A client with a new colostomy has a stoma that is dark purple. What does this finding indicate?

• a.Expected bruising from surgery that will fade on its own
• b.Possible impaired circulation that must be reported✓
• c.A sign of an unusually rich blood supply to the stoma
• d.The normal color of a healthy, well-healed stoma

A healthy stoma is pink or red and moist; a dark purple or black stoma suggests compromised blood supply and must be reported immediately. Impaired circulation can lead to necrosis. Prompt reporting allows early intervention.

The LPN/LVN is caring for a client with a cast on the right lower leg. Which finding indicates possible compartment syndrome?

• a.Severe pain unrelieved by medication and numbness of the toes✓
• b.The cast feels dry and firm to the touch several hours later
• c.Pink, warm toes with brisk capillary refill below the cast edge
• d.Mild itching of the skin beneath the upper edge of the cast

Unrelieved severe pain and numbness are warning signs of compartment syndrome, a limb-threatening emergency. Pink, warm toes with brisk capillary refill are normal findings. Neurovascular changes must be reported immediately.

A client is 1 day postoperative after abdominal surgery. Which intervention best prevents postoperative pneumonia?

• a.Limit fluid intake to reduce the amount of secretions in the lungs
• b.Keep the client on strict bed rest until the incision is fully healed
• c.Withhold pain medication so the client stays alert enough to breathe
• d.Encourage use of an incentive spirometer and coughing and deep breathing✓

Incentive spirometry with coughing and deep breathing expands the lungs and clears secretions, preventing atelectasis and pneumonia. Immobility and unrelieved pain reduce lung expansion. Adequate hydration keeps secretions thin.

The LPN/LVN collects data on a client with hypothyroidism. Which finding is consistent with this condition?

• a.Fatigue, cold intolerance, and constipation✓
• b.Weight loss, heat intolerance, and difficulty sleeping
• c.Restlessness, fine hand tremors, and anxiety
• d.Tachycardia, diarrhea, and warm moist skin

Hypothyroidism slows metabolism, causing fatigue, cold intolerance, and constipation. Weight loss, heat intolerance, tachycardia, and tremors indicate hyperthyroidism. Recognizing the pattern guides monitoring.

A client with a pressure injury has a wound with visible subcutaneous fat but no muscle or bone. How is this best described?

• a.Deep tissue injury
• b.Stage 3 pressure injury✓
• c.Stage 2 pressure injury
• d.Stage 1 pressure injury

A stage 3 pressure injury involves full-thickness skin loss with visible subcutaneous fat but no exposed muscle or bone. Stage 1 has intact skin, and stage 2 involves partial-thickness loss. Accurate staging guides treatment.

The LPN/LVN is caring for a client with a seizure history who is NPO for a procedure. Which action is most appropriate regarding antiseizure medication?

• a.Give the medication with a large glass of water despite the NPO order
• b.Double the next dose after the procedure to make up for the missed one
• c.Automatically hold all of the client's medications because the order is NPO
• d.Clarify with the RN or provider whether the medication should still be given✓

Antiseizure medications are often continued even when a client is NPO, so the nurse should clarify orders rather than automatically holding them. Withholding may precipitate seizures. Doubling doses is unsafe.

A client with cirrhosis has ascites. Which position best promotes comfort and breathing?

• a.Prone position with the abdomen down
• b.Flat supine position with one pillow
• c.Semi-Fowler's or Fowler's position✓
• d.Trendelenburg, head-down position

Elevating the head of the bed to a semi-Fowler's or Fowler's position eases breathing by reducing pressure of ascitic fluid on the diaphragm. Flat, head-down, and prone positions increase respiratory effort. Positioning improves ventilation.

The LPN/LVN reviews intake and output for a client with an indwelling catheter. Urine output has been less than 30 mL/hour for several hours. What should the nurse do?

• a.Clamp the catheter for two hours
• b.Increase the client's activity level
• c.Report the decreased output to the RN✓
• d.Document as a normal finding

Urine output persistently below 30 mL/hour may indicate impaired kidney perfusion or obstruction and should be reported. It is not a normal finding to document without action. Timely reporting supports early intervention.

A client recovering from a stroke has difficulty swallowing. Which intervention best reduces the risk of aspiration during meals?

• a.Offer thin liquids through a straw so meals can be finished quickly
• b.Encourage rapid eating so meals are finished before fatigue sets in
• c.Position the client upright and provide thickened liquids as ordered✓
• d.Have the client lie flat during meals to relax the throat muscles

Sitting upright and using thickened liquids as ordered reduces aspiration risk in clients with dysphagia. Lying flat, thin liquids, and rapid eating increase risk. Safe swallowing precautions protect the airway.

The LPN/LVN is caring for a client with a peripheral IV. The site is red, warm, and tender. What is the priority action?

• a.Stop the infusion and remove the IV catheter✓
• b.Increase the infusion rate to flush the vein
• c.Document and reassess at the end of the shift
• d.Apply a warm compress and continue the infusion

Redness, warmth, and tenderness indicate phlebitis; the infusion should be stopped and the catheter removed to prevent complications. Increasing the rate or continuing infusion worsens the problem. The site is then restarted elsewhere as needed.

A client with pneumonia has an oxygen saturation of 88% on room air. Which action should the LPN/LVN take first?

• a.Withhold oxygen until the provider rounds later in the day
• b.Offer a cold beverage and recheck the reading in an hour
• c.Apply oxygen as ordered and reposition to high Fowler's✓
• d.Encourage the client to lie flat to rest the breathing muscles

An oxygen saturation of 88% indicates hypoxemia; applying oxygen as ordered and positioning upright improves oxygenation. Lying flat and withholding oxygen worsen the problem. Prompt oxygenation is the priority.

The LPN/LVN is monitoring a client after a thyroidectomy. Which finding requires immediate attention?

• a.Sore throat when swallowing on the first day
• b.Small amount of drainage on the neck dressing
• c.Hoarse voice for a few hours after surgery
• d.Tingling around the mouth and muscle twitching✓

Tingling around the mouth and muscle twitching suggest hypocalcemia from inadvertent parathyroid injury, a serious complication after thyroidectomy. A sore throat, temporary hoarseness, and minimal drainage are expected. Calcium changes require prompt reporting.

A client with a fractured femur suddenly develops shortness of breath, chest pain, and confusion. What complication should the nurse suspect?

• a.Urinary retention from bed rest
• b.Constipation from immobility
• c.Fat or pulmonary embolism✓
• d.Mild situational anxiety

Sudden dyspnea, chest pain, and confusion after a long-bone fracture may indicate a fat or pulmonary embolism, a medical emergency. These symptoms are not explained by constipation or urinary retention. Rapid recognition and response are critical.

The LPN/LVN is reinforcing teaching to a client with a new diagnosis of gastroesophageal reflux disease. Which instruction is appropriate?

• a.Avoid lying down for 2 to 3 hours after eating✓
• b.Increase caffeine and fatty foods
• c.Eat large meals late in the evening
• d.Lie flat immediately after meals

Remaining upright for several hours after meals reduces reflux. Large late meals, lying flat after eating, and caffeine and fatty foods worsen symptoms. Lifestyle changes are first-line management.

A client is receiving continuous enteral tube feeding. To reduce the risk of aspiration, the head of the bed should be maintained at what minimum elevation?

• a.Prone position
• b.Flat at 0 degrees
• c.At least 30 degrees✓
• d.No more than 10 degrees

Keeping the head of the bed elevated at least 30 degrees during enteral feeding reduces the risk of aspiration. A flat position increases reflux and aspiration risk. Elevation is a key safety measure.

The LPN/LVN collects data on a client with appendicitis. Which finding is most consistent with this condition?

• a.Painless bright red rectal bleeding noted with stools
• b.Left upper quadrant burning an hour after meals
• c.Pain that is fully relieved by eating a meal
• d.Right lower quadrant pain with rebound tenderness✓

Appendicitis classically causes right lower quadrant pain with rebound tenderness. Pain relieved by eating and left upper quadrant burning suggest other conditions. Recognizing the pattern supports timely care.

A client with anemia has a hemoglobin of 7 g/dL and reports fatigue and dizziness on standing. Which intervention is a priority?

• a.Encourage vigorous exercise to raise the hemoglobin faster
• b.Ambulate the client rapidly and without assistance to build stamina
• c.Assist with slow position changes and monitor for dizziness✓
• d.Restrict all fluids so that the blood becomes more concentrated

Low hemoglobin reduces oxygen delivery, causing fatigue and orthostatic symptoms; assisting with slow position changes prevents falls. Vigorous exercise and rapid independent ambulation are unsafe. Safety and energy conservation are priorities.

The LPN/LVN is caring for a client with a chest tube. The nurse notes continuous bubbling in the water-seal chamber. What is the appropriate action?

• a.Strip the tubing vigorously and continuously until the bubbling stops
• b.Check the tubing and connections for an air leak and notify the RN✓
• c.Raise the drainage system above the level of the client's chest
• d.Clamp the chest tube for the rest of the shift and recheck later

Continuous bubbling in the water-seal chamber may indicate an air leak in the system that should be investigated and reported. Clamping a chest tube can cause a tension pneumothorax. The system is kept below the chest.

A client reports burning on urination, urinary frequency, and lower abdominal discomfort. Which condition is most likely?

• a.Urinary tract infection✓
• b.Obstructing kidney stone
• c.Acute gallbladder disease
• d.Early acute appendicitis

Burning on urination, frequency, and suprapubic discomfort are classic signs of a urinary tract infection. These symptoms differ from appendicitis or gallbladder disease. Collecting a urine specimen supports diagnosis.

The LPN/LVN is caring for a client after a mastectomy. Which action helps prevent lymphedema in the affected arm?

• a.Avoid blood pressure measurement and venipuncture on the affected arm✓
• b.Draw blood samples from the affected arm to spare the other side
• c.Keep the affected arm dependent below heart level so that fluid drains
• d.Take blood pressure readings on the affected arm at every check

Avoiding blood pressure measurement and venipuncture on the affected arm helps prevent lymphedema after mastectomy. The arm is also elevated, not kept dependent, to promote lymph drainage. Protecting the arm reduces swelling and infection risk.

A client with diabetes has a foot ulcer. Which teaching point best supports healing and prevents further injury?

• a.Trim calluses at home with a razor blade after bathing
• b.Soak the feet in hot water every day to soften them
• c.Inspect the feet daily and wear well-fitting shoes✓
• d.Walk barefoot at home so the ulcer stays uncovered

Daily foot inspection and well-fitting footwear prevent unnoticed injury and support healing in clients with diabetes. Walking barefoot, hot soaks, and self-trimming calluses increase the risk of injury and infection. Foot care is essential in diabetes.

The LPN/LVN is collecting data on a client who had a stroke affecting the left side of the brain. Which deficit is most likely?

• a.Left-sided weakness with no change in speech
• b.Right-sided weakness and difficulty with speech✓
• c.Inability to hear in both ears with normal strength
• d.Complete loss of vision in both eyes with no weakness

A stroke on the left side of the brain typically causes right-sided weakness and often affects speech because language centers are usually on the left. Left-sided weakness suggests a right-brain stroke. Recognizing deficits guides rehabilitation.

A client with heart failure is prescribed a low-sodium diet. Which food selection indicates understanding of the diet?

• a.Fresh vegetables and grilled chicken✓
• b.Processed lunch meat sandwiches
• c.Canned soup and cured ham
• d.Salted nuts and pickles

Fresh vegetables and unprocessed grilled chicken are low in sodium and appropriate for heart failure. Canned soup, cured meats, salted nuts, and processed meats are high in sodium. Limiting sodium helps control fluid retention.

The LPN/LVN is caring for an immobile client. Which intervention best prevents pressure injuries?

• a.Reposition the client at least every 2 hours✓
• b.Massage reddened bony prominences vigorously
• c.Use a doughnut-shaped cushion under the sacrum
• d.Keep the head of the bed elevated to 90 degrees continuously

Repositioning at least every 2 hours relieves pressure and prevents skin breakdown. Vigorous massage of reddened areas and doughnut cushions can worsen tissue damage. Frequent turning and skin care are key preventive measures.

The LPN/LVN is caring for a client with acute pancreatitis. Which measure is a priority in the acute phase?

• a.Position the client flat on the back to relax the abdomen
• b.Maintain NPO status to rest the pancreas as ordered✓
• c.Encourage a high-fat diet to keep up calorie intake
• d.Provide frequent large meals throughout the day

Keeping the client NPO reduces pancreatic stimulation and rests the inflamed organ during the acute phase. High-fat and large meals stimulate enzyme secretion and worsen pain. Pain control and monitoring are also priorities.

Before administering digoxin, the LPN/LVN should assess which parameter?

• a.The client's temperature
• b.Apical heart rate for a full minute✓
• c.The client's respiratory rate only
• d.The client's blood glucose

Digoxin can slow the heart rate, so the apical pulse should be counted for a full minute before administration. If the rate is below 60 beats per minute in an adult, the dose is typically held and the provider notified. This check prevents bradycardia-related harm.

A client is prescribed warfarin. Which laboratory test is used to monitor its therapeutic effect?

• a.Total white cell count
• b.Fasting blood glucose level
• c.Prothrombin time and INR✓
• d.Serum potassium level

Warfarin's anticoagulant effect is monitored with the prothrombin time and international normalized ratio (INR). Glucose, potassium, and white cell counts are not used to adjust warfarin. Monitoring the INR prevents bleeding and clotting.

The LPN/LVN is administering an oral iron supplement. Which instruction improves absorption?

• a.Take iron right after a large meal, since a full stomach speeds uptake
• b.Take iron with a large glass of milk to improve absorption
• c.Take iron together with an antacid to improve absorption
• d.Take iron with a source of vitamin C such as orange juice✓

Vitamin C enhances the absorption of oral iron, so taking it with orange juice is helpful. Milk and antacids reduce absorption. Iron may be taken with food to reduce stomach upset if needed, but vitamin C aids uptake.

A client is receiving furosemide, a loop diuretic. Which electrolyte imbalance should the LPN/LVN monitor for?

• a.Hyperkalemia
• b.Hypercalcemia
• c.Hypokalemia✓
• d.Hypernatremia

Loop diuretics like furosemide increase potassium excretion and can cause hypokalemia. Signs include muscle weakness and cardiac dysrhythmias. Monitoring potassium and encouraging potassium-rich foods may be indicated.

The LPN/LVN is preparing to give an intramuscular injection to an adult in the ventrogluteal site. Why is this site preferred?

• a.It is approved only for infants and small children
• b.It is closest to the sciatic nerve and needs no landmarks
• c.It is away from major nerves and blood vessels✓
• d.It has the least muscle mass of any injection site

The ventrogluteal site is preferred for many intramuscular injections because it is away from major nerves and blood vessels and has adequate muscle mass. The dorsogluteal site poses more risk to the sciatic nerve. Correct site selection improves safety.

A client is prescribed an oral tetracycline antibiotic. Which instruction is appropriate?

• a.Avoid dairy products and antacids around the time of the dose✓
• b.Take it with dairy products such as milk to improve absorption
• c.Take it only at bedtime with a glass of milk and an antacid
• d.Double the next dose whenever a meal has been missed

Tetracyclines bind with calcium in dairy and with antacids, reducing absorption, so these should be separated from the dose. Doubling doses is unsafe. Proper timing ensures effectiveness.

The LPN/LVN is administering insulin. Which action is correct when giving regular and NPH insulin together in one syringe?

• a.Shake both vials vigorously before drawing up either insulin
• b.Never mix regular and NPH insulin, because the two inactivate each other
• c.Draw up the NPH (cloudy) insulin before the regular (clear) insulin
• d.Draw up the regular (clear) insulin before the NPH (cloudy) insulin✓

When mixing insulins, the regular (clear) insulin is drawn up before the NPH (cloudy) insulin to avoid contaminating the clear vial. Vials are gently rolled, not shaken. Correct technique maintains accurate dosing.

A client taking an angiotensin-converting enzyme (ACE) inhibitor develops a persistent dry cough. What is the appropriate action?

• a.Report the cough to the RN or provider✓
• b.Stop all medications immediately without notification
• c.Increase the dose to relieve the cough
• d.Tell the client the cough is unrelated

A persistent dry cough is a known side effect of ACE inhibitors and should be reported so the provider can consider an alternative. Increasing the dose worsens the effect, and abruptly stopping without guidance is unsafe. Reporting supports appropriate management.

The LPN/LVN is administering eye drops. Which technique is correct?

• a.Instill the drop into the lower conjunctival sac✓
• b.Allow the dropper to touch the eyelashes
• c.Have the client squeeze the eyes shut tightly afterward
• d.Place the drop directly on the cornea

Eye drops should be placed in the lower conjunctival sac, not directly on the cornea, which is sensitive. The dropper should not touch the eye or lashes to avoid contamination. Gentle eyelid closure, not tight squeezing, keeps medication in place.

A client is prescribed acetaminophen for pain. Which teaching point is most important to prevent toxicity?

• a.Take it with an alcoholic drink, since alcohol speeds absorption and eases pain faster
• b.Do not exceed the maximum recommended daily dose and check other products for acetaminophen✓
• c.Double the usual dose whenever the pain is severe, since the daily limit is only a guideline
• d.There is no maximum safe daily dose, so keep taking tablets until the pain finally stops

Acetaminophen can cause liver damage if the maximum daily dose is exceeded, and many combination products contain it. Alcohol increases liver risk. Staying within recommended limits prevents toxicity.

The LPN/LVN is giving a client nitroglycerin sublingually for chest pain. Which instruction is correct?

• a.Take three tablets at once for faster relief of the pain
• b.Place the tablet under the tongue and let it dissolve✓
• c.Chew the tablet thoroughly before swallowing it with food
• d.Swallow the tablet whole with a full glass of water

Sublingual nitroglycerin is placed under the tongue to dissolve for rapid absorption. Swallowing or chewing reduces effectiveness. Doses are typically repeated one at a time at intervals while seeking emergency help if pain persists.

A client receiving an opioid analgesic has a respiratory rate of 8 breaths per minute and is difficult to arouse. What should the LPN/LVN do first?

• a.Document the slow breathing as an expected effect of opioids
• b.Withhold further opioid, stimulate the client, and notify the RN✓
• c.Give the next scheduled opioid dose now to stay ahead of the pain
• d.Let the client sleep undisturbed and recheck at the next shift

A respiratory rate of 8 with sedation suggests opioid-induced respiratory depression; the opioid is withheld, the client stimulated, and the RN notified. Giving more opioid worsens the depression. Naloxone may be indicated per orders.

The LPN/LVN is administering a subcutaneous heparin injection. Which action is correct?

• a.Massage the site vigorously after injection
• b.Aspirate for blood return before injecting
• c.Do not aspirate or massage the injection site✓
• d.Inject into the deltoid muscle

Subcutaneous heparin is given without aspirating or massaging to reduce bruising and tissue trauma. It is injected into subcutaneous tissue, commonly the abdomen, not the deltoid muscle. Proper technique minimizes bleeding at the site.

A client is taking an oral corticosteroid long term. Which instruction is essential?

• a.Do not stop the medication suddenly; taper as directed✓
• b.Stop the medication abruptly when feeling better
• c.Take it on an empty stomach at bedtime
• d.Skip doses during stressful illness

Long-term corticosteroids must be tapered rather than stopped abruptly to avoid adrenal insufficiency. They are usually taken with food to reduce stomach irritation. During illness, doses may need adjustment under provider guidance.

The LPN/LVN calculates that a client needs 2 tablets of a medication. The pharmacy sends tablets that are scored down the middle. The order is for a dose equal to 1.5 tablets. What should the nurse do?

• a.Round up and give 2 whole tablets to avoid splitting
• b.Crush the tablets and estimate half the powder by eye
• c.Give 1 whole tablet and one-half of a scored tablet✓
• d.Round down and give 1 whole tablet and chart the change

Scored tablets may be safely halved, so 1.5 tablets can be given as one whole and one-half tablet to match the exact ordered dose. Rounding up or down changes the dose. Accurate measurement ensures correct dosing.

A client is prescribed an antibiotic. Which instruction helps prevent antibiotic resistance?

• a.Share the antibiotic with family members who feel ill
• b.Complete the entire prescribed course as directed✓
• c.Save leftover antibiotics for the next illness
• d.Stop the antibiotic once symptoms improve

Completing the full prescribed course helps eradicate bacteria and reduces the risk of resistance. Stopping early, saving, or sharing antibiotics promotes resistant organisms. Adherence supports effective treatment.

The LPN/LVN prepares to administer a medication through a feeding tube. Which action is correct?

• a.Mix all medications together and crush enteric-coated tablets
• b.Administer the medication without checking tube placement
• c.Flush the tube with water before and after the medication✓
• d.Use a large-bore needle to push medication quickly

The tube should be flushed with water before and after medication to maintain patency and ensure the full dose is delivered. Enteric-coated tablets should not be crushed, and placement must be verified. Correct technique prevents clogging and errors.

A client is receiving a potassium supplement. Which finding should be reported before giving the next dose?

• a.Blood pressure of 118/74 mmHg
• b.Serum potassium of 5.8 mEq/L✓
• c.Normal bowel movement
• d.Serum potassium of 4.0 mEq/L

A serum potassium of 5.8 mEq/L is elevated, and giving more potassium could cause dangerous hyperkalemia and cardiac effects. A level of 4.0 mEq/L is normal. The nurse should hold the dose and notify the provider.

The LPN/LVN is instructing a client about an albuterol metered-dose inhaler. Which statement indicates correct use?

• a."I will save the inhaler and use it only once my symptoms have become severe."
• b."I will breathe in slowly and deeply as I press the inhaler, then hold my breath briefly."✓
• c."I will breathe out while I press the inhaler, and then take a quick breath in afterward."
• d."I will hold my breath before pressing the inhaler, then breathe in after the spray."

Correct inhaler use involves a slow, deep inhalation coordinated with actuation, followed by breath holding to allow medication to deposit in the lungs. Exhaling during actuation wastes the dose. A spacer can improve delivery.

A client is prescribed a medication ordered as 250 mg. The available concentration is 125 mg per 5 mL. How many milliliters should the LPN/LVN administer?

• a.5 mL
• b.15 mL
• c.2.5 mL
• d.10 mL✓

Using the formula desired over available times the volume: 250 mg divided by 125 mg equals 2, multiplied by 5 mL equals 10 mL. Careful calculation prevents dosing errors. The nurse should double-check high-alert calculations.

The LPN/LVN is administering a medication and the client states, "That pill looks different from my usual one." What should the nurse do?

• a.Reassure the client that the pill is correct and give it
• b.Tell the client the pharmacy changed brands and give the dose
• c.Give a different medication that the client recognizes
• d.Withhold the medication and verify the order before giving it✓

A client's concern that a medication looks unfamiliar is an important safety cue; the nurse should stop and verify the order and drug before administering. Proceeding without checking risks an error. Verification protects the client.

A client taking metformin for type 2 diabetes should be taught to report which symptom that may indicate a rare but serious complication?

• a.Occasional soft stools that settle down on their own
• b.Muscle pain, unusual fatigue, and difficulty breathing✓
• c.Mild transient nausea during the first days of therapy
• d.A slightly bitter or metallic taste in the mouth

Muscle pain, unusual fatigue, and difficulty breathing may indicate lactic acidosis, a rare but serious complication of metformin that must be reported. Mild gastrointestinal effects are common and usually transient. Prompt reporting allows early evaluation.

The LPN/LVN is administering ear drops to an adult. How should the ear be positioned?

• a.Instill drops without repositioning the ear
• b.Pull the pinna up and back✓
• c.Press firmly on the tragus before instilling
• d.Pull the pinna down and back

In adults, the pinna is pulled up and back to straighten the ear canal for drop instillation. In young children it is pulled down and back. Proper positioning ensures the medication reaches the canal.

A client is prescribed a stool softener. What is the expected therapeutic outcome?

• a.Prevention of nausea
• b.Immediate relief of abdominal cramping
• c.Reduction of stomach acid
• d.Softer, more easily passed stools✓

A stool softener works by increasing water content in the stool, producing softer, more easily passed stools. It does not reduce acid, prevent nausea, or relieve cramping directly. It is often used to prevent straining.

The LPN/LVN notes a client is allergic to penicillin. A new order for an antibiotic in the same drug class is written. What should the nurse do?

• a.Give it along with an antihistamine to prevent a reaction
• b.Hold the medication and notify the prescriber about the allergy✓
• c.Administer the medication exactly as the prescriber ordered
• d.Give a smaller test dose first without notifying the prescriber

Administering an antibiotic from a class the client is allergic to could cause a serious reaction, so the nurse holds it and notifies the prescriber. Giving a test dose or masking with an antihistamine is unsafe. Allergy verification prevents harm.

A client is receiving an IV antibiotic and reports itching, and the nurse notes hives and facial swelling. What is the priority action?

• a.Slow the infusion and continue monitoring
• b.Stop the infusion immediately and notify the RN✓
• c.Increase the infusion rate to finish the dose quickly
• d.Document the reaction at the end of shift

Itching, hives, and facial swelling suggest an allergic reaction that could progress to anaphylaxis; the infusion is stopped immediately and the RN notified. Continuing or speeding the infusion endangers the client. Emergency measures may be needed.

A client is prescribed levothyroxine for hypothyroidism. Which instruction is appropriate?

• a.Take it in the morning on an empty stomach at the same time each day✓
• b.Stop taking it as soon as your energy improves, since the thyroid has recovered
• c.Take it only on the days when tiredness or cold intolerance appear
• d.Take it at bedtime with a heavy snack to prevent stomach upset

Levothyroxine is best absorbed when taken in the morning on an empty stomach at a consistent time daily. It is a long-term replacement therapy that should not be stopped when symptoms improve. Consistent timing maintains stable hormone levels.

A client is prescribed ferrous sulfate for iron-deficiency anemia. Which side effect should the LPN/LVN teach the client to expect?

• a.Blurred and double vision
• b.Dark or black-colored stools✓
• c.Increased salivation and drooling
• d.Bright red discoloration of urine

Oral iron commonly causes harmless dark or black stools and may cause constipation. This expected change should not be mistaken for gastrointestinal bleeding. Adequate fluids and fiber help prevent constipation.

A charge nurse is assigning care. Which task is most appropriate to delegate to unlicensed assistive personnel (UAP)?

• a.Deciding whether a client's low urine output should be reported
• b.Reinforcing wound-care teaching for a client going home
• c.Recording the intake and output of a stable client✓
• d.Collecting data on a newly admitted client's pain

UAP may perform routine, standardized tasks on stable clients, such as recording intake and output. Reinforcing teaching and collecting admission data belong to licensed staff, and *deciding* whether a finding should be reported is nursing judgment that cannot be delegated.

An LPN/LVN is caring for a client who says, "I've decided I don't want the surgery." What is the nurse's best action?

• a.Proceed with the pre-op preparation anyway
• b.Explain in detail why the surgery is necessary
• c.Tell the client the provider will be upset
• d.Document the refusal and notify the RN or provider✓

A competent client may refuse treatment. The nurse documents the refusal and notifies the RN or provider — respecting autonomy. Proceeding anyway is battery, guilt-tripping is nontherapeutic, and a detailed explanation of why the surgery is necessary is the provider's role.

Which client should the LPN/LVN assess first?

• a.A stable client awaiting discharge paperwork
• b.A client due for a scheduled dressing change
• c.A client requesting a warm blanket
• d.A client who suddenly becomes short of breath✓

Run the ABCs: a client who suddenly becomes short of breath has a breathing threat that outranks a blanket request, a scheduled dressing, or discharge paperwork. See this client first and report the change.

Before giving any medication, the nurse must verify the client's identity using at least how many identifiers?

• a.Two, such as name and date of birth✓
• b.The room and bed number
• c.Three separate photo IDs
• d.One, if the client answers to their name

Use at least two identifiers, such as name and date of birth. The room or bed number and a single verbal response to a name are unsafe, and three photo IDs is not the standard.

A client with suspected active tuberculosis is admitted. Which precautions are required?

• a.Contact precautions with gloves and gown only
• b.Standard precautions alone
• c.Airborne precautions with an N95 respirator and a negative-pressure room✓
• d.Droplet precautions with a surgical mask worn within close range of the client

Active TB spreads by airborne droplet nuclei, requiring airborne precautions — an N95 respirator and a negative-pressure room. A surgical mask handles droplet organisms; gloves and gown alone handle contact organisms.

A nurse is caring for a client with Clostridioides difficile. Which action is correct?

• a.Place the client in a negative-pressure room
• b.Use alcohol-based hand rub after care
• c.Wear an N95 respirator during care
• d.Wash hands with soap and water after removing gloves✓

*C. difficile* forms spores that alcohol does not kill, so wash with soap and water. Alcohol rub is inadequate, and because *C. difficile* is a contact organism, a negative-pressure room and an N95 respirator are not indicated.

A nurse discovers a fire in a client's trash can. According to RACE, what is the first action?

• a.Activate the alarm at the pull station
• b.Extinguish the fire with the nearest extinguisher
• c.Rescue any client in immediate danger✓
• d.Contain the fire by closing doors

In RACE, the first step is Rescue anyone in immediate danger, then Activate the alarm, Contain, and Extinguish/Evacuate. Rescuing people comes before alarms or extinguishers.

A parent asks when to introduce solid foods to an infant. The correct teaching is to begin around:

• a.6 months, with single-ingredient foods✓
• b.3 months, with mashed fruit
• c.2 months, with cereal in the bottle
• d.12 months, after all teeth appear

Introduce single-ingredient solid foods around 6 months. Cereal in a bottle and solids in the first few months are unsafe, and waiting until 12 months is unnecessarily late.

A pregnant client at 32 weeks reports a severe headache with swelling of the face and hands. The nurse should:

• a.Tell her to rest and recheck in the morning
• b.Recommend an over-the-counter pain reliever
• c.Reassure her that facial swelling is normal
• d.Report the findings promptly as possible preeclampsia✓

Severe headache with facial and hand swelling are danger signs of preeclampsia and must be reported promptly. Facial swelling is not the normal dependent edema of pregnancy; analgesics and waiting until morning delay urgent care.

Which infant sleep practice should the nurse reinforce to reduce the risk of SIDS?

• a.Prone position to prevent aspiration
• b.Supine with soft blankets tucked around the infant
• c.Supine on a firm surface with no loose bedding✓
• d.Side-lying with a rolled towel for support

Safe infant sleep is supine (on the back) on a firm surface with no loose bedding. Side-lying, prone positioning, and soft blankets tucked around the infant all increase SIDS risk.

A client scheduled for a mastectomy says, "I can't imagine looking at myself afterward." The most therapeutic response is:

• a."Why does your appearance matter so much to you?"
• b."Don't worry — reconstruction results are excellent nowadays."
• c."It sounds like you're worried about how your body will change."✓
• d."You should concentrate all your energy on beating the cancer first."

The most therapeutic response reflects the client's feeling and invites more. False reassurance, advice to focus on the cancer, and a "why" question are nontherapeutic and close the conversation.

On a behavioral-health unit, which client is the highest priority?

• a.A client who has refused to attend the morning group session again
• b.A client pacing the day room and repeatedly asking the staff when lunch will be served
• c.A client who gave away his belongings and says he "won't be a burden much longer"✓
• d.A client who is tearful after an upsetting phone call from home

Giving away belongings plus a veiled goodbye are suicide warning signs — this client is the highest priority. Safety first: ask directly and ensure a safe environment. The other clients are distressed but not in immediate danger.

A client is undergoing alcohol withdrawal. Which environment is most appropriate?

• a.A brightly lit room with the television on for stimulation
• b.A quiet, low-stimulation room with close monitoring✓
• c.A shared room to encourage socialization
• d.A room near the busy nurses' station for activity

Alcohol withdrawal requires a quiet, low-stimulation environment with close monitoring, because withdrawal can progress to seizures and delirium tremens. Bright light, television, socialization, and a busy location all add harmful stimulation.

An immobile client is at risk for pressure injury. Which action does the nurse take?

• a.Vigorously massage any reddened areas
• b.Reposition the client at least every 2 hours✓
• c.Keep the head of the bed elevated at all times
• d.Limit repositioning to reduce the client's discomfort

Reposition an immobile client at least every 2 hours to relieve pressure. Vigorous massage of reddened skin worsens tissue injury, constant head-of-bed elevation increases sacral shear, and limiting repositioning raises pressure-injury risk.

A client's urine output has been 25 mL/hr for three hours. The nurse should:

• a.Report the finding as it may indicate poor perfusion✓
• b.Clamp the catheter for one hour and reassess
• c.Document it as an expected postoperative finding
• d.Encourage the client to drink more water and continue monitoring

Urine output persistently below 30 mL/hr may indicate poor perfusion or obstruction and should be reported. Simply encouraging fluids or charting the output as expected delays care, and clamping the catheter is unsafe.

A conscious client with diabetes is diaphoretic and confused; a fingerstick reads 54 mg/dL. The nurse should:

• a.Give 15 g of fast-acting carbohydrate, wait 15 minutes, and recheck✓
• b.Withhold all food and fluids until the provider can be notified
• c.Administer the next scheduled dose of insulin as ordered
• d.Notify the provider, then wait for orders before giving anything by mouth

For symptomatic hypoglycemia in a conscious client, apply the 15-15 rule: 15 g of fast-acting carbohydrate, wait 15 minutes, recheck. Insulin would drive the glucose lower still; waiting for orders or withholding food delays needed treatment.

Fifteen minutes into a blood transfusion, a client develops chills, fever, and low-back pain. The nurse's first action is to:

• a.Stop the transfusion and keep the line open with normal saline✓
• b.Give an antipyretic and continue the transfusion at the prescribed rate
• c.Slow the infusion rate and continue the transfusion as ordered
• d.Increase the rate so the unit finishes before symptoms worsen

Signs of an acute transfusion reaction require you to stop the transfusion immediately and keep the line open with normal saline, then notify the RN. Slowing the rate, medicating and continuing, or speeding up all keep incompatible blood flowing.

An order reads 250 mg by mouth; the available tablets are 125 mg each. How many tablets should the nurse give?

• a.Two tablets✓
• b.Three tablets
• c.Half a tablet
• d.A single tablet

Desired ÷ Available × Quantity = 250 mg ÷ 125 mg × 1 tab = 2 tablets.

Before administering digoxin, the nurse counts an apical pulse of 52 beats per minute for a full minute in an adult client. The nurse should:

• a.Give the dose and recheck the pulse in one hour
• b.Hold the dose and notify the RN✓
• c.Give the dose and document the pulse
• d.Administer half of the ordered dose

Digoxin is held when the adult apical pulse is below 60 bpm. A rate of 52 is below the threshold, so hold the dose and notify the RN. Giving the dose risks worsening bradycardia and toxicity, and "half a dose" is never improvised.

A client is receiving furosemide. The nurse monitors most closely for:

• a.Hypokalemia✓
• b.Hypernatremia
• c.Hyperglycemia as the primary concern
• d.Hypercalcemia

Loop diuretics such as furosemide cause potassium loss, so the priority is monitoring for hypokalemia. The other imbalances listed are not the primary concern with a loop diuretic.

Which is the correct antidote pairing?

• a.Warfarin — vitamin K✓
• b.Opioid — flumazenil
• c.Warfarin — protamine sulfate
• d.Heparin — vitamin K

Warfarin's antidote is vitamin K. Heparin's antidote is protamine sulfate — pairings that join heparin with vitamin K or warfarin with protamine have the two reversed — and the opioid antidote is naloxone, not flumazenil (which reverses benzodiazepines).

A client's serum potassium is 5.8 mEq/L, and a potassium supplement is scheduled. The nurse should:

• a.Give the supplement as ordered
• b.Give a double dose to normalize the level
• c.Give the supplement by rapid IV push
• d.Hold the supplement and notify the RN✓

With a serum potassium of 5.8 mEq/L (elevated), the nurse holds the supplement and notifies the RN. Giving it as ordered, pushing it IV (never done), or doubling the dose would cause dangerous hyperkalemia.

The nurse prepares to give subcutaneous heparin. Which technique is correct?

• a.Inject into the deltoid muscle at a 90-degree angle
• b.Aspirate before injecting to check for blood
• c.Do not aspirate and do not massage the site✓
• d.Massage the site firmly after injecting

For subcutaneous heparin, do not aspirate and do not massage the site, which reduces bruising and hematoma. Aspirating and massaging are both incorrect, and heparin here is a subcutaneous injection, not an intramuscular one.

An order reads amoxicillin 500 mg PO; the suspension is labeled 250 mg per 5 mL. How many mL should the nurse give?

• a.5 mL
• b.15 mL
• c.2.5 mL
• d.10 mL✓

Desired ÷ Available × Quantity = 500 mg ÷ 250 mg × 5 mL = 10 mL.

A client on levothyroxine asks how to take it. The nurse teaches to take it:

• a.With a full meal at dinner
• b.At bedtime with a glass of milk
• c.In the morning on an empty stomach✓
• d.With an antacid to prevent upset

Levothyroxine is taken in the morning on an empty stomach for consistent absorption. Taking it with meals, antacids, or milk reduces absorption.

A client receiving an IV antibiotic develops itching, hives, and facial swelling. The nurse should first:

• a.Stop the infusion and notify the RN✓
• b.Give the next dose early to build tolerance
• c.Document the reaction and reassess in an hour
• d.Slow the infusion and continue to monitor

Itching, hives, and facial swelling suggest an allergic/anaphylactic reaction — stop the infusion and notify the RN. Slowing the infusion, pausing only to document, or giving more of the drug allows the reaction to worsen.

Which task is within the LPN/LVN scope of practice?

• a.Performing the admission assessment on an unstable client
• b.Administering a routine oral antibiotic to a stable client✓
• c.Providing the initial teaching for a new diabetes diagnosis
• d.Developing the initial nursing care plan

Administering a routine oral antibiotic to a stable client is within LPN/LVN scope. Developing the care plan, assessing an unstable admission, and initial teaching for a new diagnosis are RN responsibilities.

An LPN/LVN receives a telephone order from a provider. The correct action is to:

• a.Refuse to take any telephone order under every circumstance
• b.Write the order down, read it back, and have it signed per policy✓
• c.Carry out the order right away and chart it later from memory
• d.Ask another nurse to listen in and remember the order details for you

Telephone orders must be written down, read back, and signed per policy. Charting from memory, relying on another nurse's memory, and refusing every telephone order are all incorrect.

A restrained client requires which of the following?

• a.Indefinite orders that do not need renewal
• b.A time-limited provider order and frequent monitoring✓
• c.Restraints applied for staff convenience during busy shifts
• d.Restraints used before any less-restrictive alternatives

Restraints require a time-limited provider order and frequent monitoring, with less-restrictive alternatives tried first. They are never applied for convenience, never ordered indefinitely, and never used before alternatives.

During a generalized seizure, the nurse should:

• a.Turn the client to the side and cushion the head✓
• b.Hold the client still until movements stop
• c.Restrain the arms and legs to prevent injury
• d.Insert a padded tongue blade to protect the tongue

During a seizure, turn the client to the side and cushion the head to protect the airway and prevent injury. Never insert anything into the mouth, and never restrain or hold the client still.

A nurse reinforces sun-safety teaching. Which statement by the client indicates correct understanding?

• a."A base tan from a tanning bed will protect my skin from real damage."
• b."Once I have a good tan I won't need to use sunscreen anymore."
• c."I'll use broad-spectrum sunscreen and reapply it every two hours."✓
• d."Sunscreen is really only needed for long days at the beach."

Correct sun safety is broad-spectrum sunscreen reapplied every 2 hours. Relying on a "base tan," using sunscreen only at the beach, and stopping once tanned all reflect misunderstanding.

Which client statement about antibiotics shows a need for further teaching?

• a."I'll stop taking them once my symptoms improve."✓
• b."I'll finish the entire prescription even if I feel better."
• c."I won't share these with my family."
• d."I'll take them exactly as scheduled."

"I'll stop taking them once my symptoms improve" shows a need for teaching — antibiotics must be finished to prevent resistance. The other statements are correct.

A client with dysphagia is eating lunch. Which action prevents aspiration?

• a.Have the client lie flat so the muscles of the throat can relax
• b.Position the client upright and provide thickened liquids as ordered✓
• c.Offer plenty of thin liquids to help wash the food down quickly
• d.Encourage large bites so the client can finish the meal while it is hot

For dysphagia, position the client upright and provide thickened liquids as ordered to prevent aspiration. Thin liquids, lying flat, and large hurried bites all increase aspiration risk.

A client is receiving a tube feeding. To reduce aspiration risk, the nurse keeps the head of the bed at least:

• a.Flat (0 degrees)
• b.90 degrees at all times, even during sleep
• c.About 10 degrees
• d.30 degrees✓

Keep the head of the bed at least 30 degrees during and after tube feeding to reduce aspiration. Flat or barely raised positions increase the risk, and a rigid 90 degrees at all times is neither required nor practical for sleep.

A client 6 hours after a total hip replacement needs positioning. The nurse should:

• a.Elevate both knees sharply on pillows
• b.Turn the client fully onto the operative side
• c.Keep the legs abducted with a pillow between them✓
• d.Cross the client's legs at the ankles for comfort

After a total hip replacement, keep the legs abducted with a pillow between them to prevent dislocation. Crossing the legs, turning onto the operative side, and sharp flexion all risk dislocation.

A client with COPD is short of breath. Which oxygen approach is appropriate?

• a.High-flow oxygen at 10 L/min by simple face mask
• b.Low-flow oxygen, for example 2 L/min, targeting about 88–92%✓
• c.A nonrebreather mask at 15 L/min for routine use
• d.No supplemental oxygen, to preserve the client's hypoxic respiratory drive

In COPD, use low-flow oxygen (for example 2 L/min) targeting about 88–92%. High-flow delivery can blunt the hypoxic respiratory drive, and withholding oxygen from a hypoxic client is unsafe. *(Confirm the target with provider orders.)*

After a thyroidectomy, a client reports tingling around the mouth and muscle twitching. The nurse recognizes this as a sign of:

• a.Hyperkalemia
• b.Normal anesthesia after-effects
• c.Expected postoperative numbness that needs no action
• d.Hypocalcemia that should be reported promptly✓

Perioral tingling and muscle twitching after thyroidectomy indicate hypocalcemia (parathyroid involvement) and should be reported promptly. These findings are not benign postoperative numbness or anesthesia after-effects, and the electrolyte involved is calcium, not potassium.

Which finding in a client with heart failure should the nurse report promptly?

• a.A single episode of mild fatigue after the afternoon walk
• b.A weight gain of 3 pounds since yesterday with new crackles✓
• c.A blood pressure of 118/72 mmHg on the morning check
• d.Clear breath sounds and no edema on the evening data collection

A 3-pound weight gain with new crackles signals fluid overload in heart failure and must be reported promptly. Mild fatigue, a normal blood pressure, and clear lungs without edema are not urgent.

A nurse is teaching a parent about a mild fever and soreness after a childhood vaccine. The nurse explains that these reactions are:

• a.A reason to give a double dose next time
• b.Common, expected, and usually self-limiting✓
• c.A sign the vaccine should be stopped
• d.An allergic reaction requiring epinephrine

Mild fever and soreness after a vaccine are common, expected, and self-limiting. They are not a reason to stop the series, never a reason to change a dose, and not an allergic emergency.

Which statement by the nurse best reflects therapeutic communication?

• a."Everything is going to be just fine, don't worry."
• b."Why didn't you call the office sooner?"
• c."You seem anxious about going home. Tell me more about that."✓
• d."If I were you, I would have the surgery."

Reflecting the client's anxiety and inviting them to say more is therapeutic. False reassurance, giving advice, and a "why" question are nontherapeutic.

A nurse is reinforcing teaching about iron supplements. Which effect should the nurse explain is harmless?

• a.A widespread itchy rash
• b.New difficulty breathing
• c.Dark or black stools✓
• d.Severe muscle weakness

Dark or black stools are a harmless expected effect of iron. New difficulty breathing, a widespread itchy rash, and severe muscle weakness are not expected and warrant evaluation.

A client taking metformin reports muscle pain, weakness, and difficulty breathing. The nurse should:

• a.Recommend an antacid for the discomfort
• b.Tell the client to take the next dose early
• c.Reassure the client these are expected effects
• d.Report the findings as possible lactic acidosis✓

Muscle pain, weakness, and difficulty breathing in a client on metformin can signal lactic acidosis and must be reported. These are not expected effects, and delaying with an early dose or an antacid is unsafe.

An LPN/LVN notices a coworker about to give a medication without checking the client's identification band. The best initial action is to:

• a.Say nothing, because no actual harm has come to the client yet
• b.Report the coworker directly to the state board of nursing immediately
• c.Document the coworker's omission in the client's medical chart
• d.Remind the coworker to verify two identifiers before administering✓

The best initial action protects the client now: remind the coworker to verify two identifiers before administering. Charting the omission or saying nothing leaves the client unprotected, and escalating a single correctable slip straight to the board overshoots.

A caller who identifies himself as a client's close friend asks the nurse for an update on the client's condition. The nurse should:

• a.Provide only the room number and general condition
• b.Transfer the call to the provider to give the update
• c.Give a brief update since the friend sounds concerned
• d.Not release information without the client's authorization✓

Protected health information is not released without the client's authorization, even to a concerned friend. Sharing any update — a brief summary, the room number and general condition, or one relayed through the provider — still breaches confidentiality without consent.

Which client should the LPN/LVN report to the RN first?

• a.A client with a new-onset fever and rising heart rate✓
• b.A client whose pain improved after scheduled medication
• c.A client resting comfortably with stable vital signs
• d.A client who ate 100% of breakfast and ambulated well

A new-onset fever with a rising heart rate is a changing, potentially unstable finding that the LPN/LVN reports to the RN first. The other clients are stable or improving.

Before administering a medication, a client says the pill "looks different from the one I usually take." The nurse should:

• a.Hold the medication and verify the order and drug✓
• b.Ask the client to take it and report any effects
• c.Give a partial dose to be safe
• d.Reassure the client and give it as scheduled

When a client questions a medication, hold it and verify the order and drug before giving. Reassuring the client and giving it anyway, giving it and watching for effects, or improvising a partial dose all risk a medication error.

A nurse plans an intramuscular injection for an adult. Which site is generally preferred because it avoids major nerves and vessels?

• a.The anterior thigh midline
• b.The ventrogluteal site✓
• c.The dorsogluteal site
• d.The deltoid for all volumes

The ventrogluteal site is generally preferred for adult IM injections because it avoids major nerves and vessels. The dorsogluteal site risks the sciatic nerve, the deltoid is limited by volume, and "anterior thigh midline" is not the standard landmark.

A client recovering from surgery is at risk for atelectasis and pneumonia. Which intervention does the nurse reinforce?

• a.Shallow breathing to protect the incision
• b.Withholding fluids to reduce secretions
• c.Strict bed rest with minimal movement
• d.Incentive spirometry, coughing, and deep breathing✓

Incentive spirometry, coughing, and deep breathing (with early ambulation) prevent atelectasis and pneumonia. Strict bed rest, withheld fluids, and shallow breathing increase the risk.

A client with a chest tube has continuous bubbling in the water-seal chamber. The nurse recognizes this as:

• a.Expected and requiring no action
• b.A reason to clamp the tube immediately
• c.A possible air leak that should be reported✓
• d.An indication to disconnect and flush the tubing

Continuous bubbling in the water-seal chamber suggests an air leak and should be reported. It is not an expected finding, and clamping or disconnecting the tube can cause a tension pneumothorax.

A client receiving an opioid has a respiratory rate of 8 and is difficult to arouse. The nurse should:

• a.Give the next scheduled opioid dose on time
• b.Hold the opioid, stimulate the client, and notify the RN✓
• c.Encourage the client to rest undisturbed until the next rounds
• d.Document the level of sedation and plan to reassess in two hours

For opioid-induced respiratory depression (rate 8, hard to arouse), hold the opioid, stimulate the client, and notify the RN, anticipating naloxone. Another opioid dose, undisturbed rest, or a two-hour wait to reassess is dangerous.

A nurse is reinforcing teaching for a client starting warfarin. The nurse explains that therapy is monitored with:

• a.Activated partial thromboplastin time (aPTT)
• b.A complete blood count only
• c.Prothrombin time and INR✓
• d.Regular serum potassium levels

Warfarin therapy is monitored with prothrombin time (PT) and INR. aPTT monitors heparin; a CBC alone and potassium levels do not guide warfarin dosing.

Which action correctly follows standard precautions?

• a.Reuse gloves between two stable clients to save supplies
• b.Wear gloves only for clients with a known infection
• c.Perform hand hygiene before and after every client contact✓
• d.Recap needles by hand before disposal

Standard precautions include hand hygiene before and after every client contact. Recapping needles by hand, gloving only for known infections, and reusing gloves between clients all violate standard precautions.

A nurse is instilling ear drops for an adult. The correct technique is to:

• a.Have the client lie with the affected ear down during instillation
• b.Pull the pinna up and back before instilling the drops✓
• c.Pull the pinna down and back as for a young child
• d.Place the drops directly on the eardrum

For an adult, pull the pinna up and back to straighten the ear canal before instilling drops. Down and back is the technique for a young child, drops go into the canal rather than onto the eardrum, and the affected ear should be up, not down.

A client with a new colostomy turns away and says he "doesn't want to deal with it." The nurse should first:

• a.Insist that the client look at the stoma so he will adjust to it faster
• b.Tell the client that the colostomy may turn out to be temporary
• c.Begin detailed self-care teaching right away to build his confidence
• d.Acknowledge the client's feelings before starting self-care teaching✓

With a new colostomy, acknowledge the client's feelings about the body-image change before beginning self-care teaching. Jumping straight into teaching, minimizing with "it may be temporary," or insisting the client look at the stoma ignores the emotional readiness needed first.

An order reads give 1.5 tablets of a medication. This is acceptable only when:

• a.The pharmacy approves splitting any tablet
• b.The tablet is enteric-coated
• c.The tablet is extended-release
• d.The tablet is scored✓

Splitting a tablet to give 1.5 tablets is acceptable only when the tablet is scored. Enteric-coated and extended-release tablets must never be split, and pharmacy approval alone does not make an unscored, coated, or long-acting tablet splittable.

A charge nurse is planning assignments on a medical unit. Which task is appropriate to assign to unlicensed assistive personnel (UAP)?

• a.Measuring and recording intake and output for a stable client✓
• b.Reinforcing wound care instructions with a client at discharge
• c.Adjusting the flow rate on a continuous intravenous infusion
• d.Checking an apical pulse before a scheduled digoxin dose

Recording intake and output for a stable client is a routine, standardized task within the scope of unlicensed assistive personnel. Reinforcing instructions, checking an apical pulse before digoxin, and changing an infusion rate all require licensed nursing judgment and cannot be assigned to UAP.

An LPN/VN is given four tasks by the charge nurse. Which task should the LPN/VN identify as outside the LPN/VN scope of practice?

• a.Changing a dry dressing on a clean incision
• b.Collecting a urine specimen from an indwelling catheter
• c.Performing the admission assessment on a new client✓
• d.Giving a scheduled oral antihypertensive to a stable client

The initial admission assessment belongs to the registered nurse; the LPN/VN contributes data collection to it but does not perform it. Routine oral medication administration, a simple dry dressing change, and specimen collection are all within LPN/VN scope.

A client newly diagnosed with type 2 diabetes asks the LPN/VN about the meal plan that the registered nurse taught yesterday. What is the appropriate action?

• a.Reinforce the teaching the registered nurse gave✓
• b.Evaluate whether the client has met the learning outcomes
• c.Perform the initial teaching session about the new diagnosis
• d.Create an individualized teaching plan for the new diagnosis

Initial teaching, teaching-plan development, and evaluation of learning outcomes are registered nurse responsibilities. The LPN/VN reinforces content the RN has already taught and reports the client's response.

An LPN/VN reads an order in the record that states 'fluid restriction' without a specified volume. What should the LPN/VN do?

• a.Wait until the next shift and pass the question along in report
• b.Ask the registered nurse to clarify the client's fluid restriction✓
• c.Follow the written order as the nurse interprets it independently
• d.Give the amount the client's family reports was ordered at home

An order that is unclear must be clarified before it is carried out. Interpreting it independently, relying on a family report, or deferring it to the next shift all leave the client at risk of receiving the wrong volume.

An LPN/VN is assigned to titrate a continuous intravenous vasoactive infusion, which the state nurse practice act does not permit LPN/VNs to do. What should the LPN/VN do?

• a.Accept the assignment and complete the tasks as carefully as possible
• b.Trade the assignment with another LPN/VN working on the same unit
• c.Notify the nursing supervisor about the scope problem✓
• d.Document that the assignment was unsafe and proceed with the shift

An LPN/VN who is assigned work outside the legal scope of practice must report it through the chain of command before the shift proceeds. Accepting it, trading it, or simply documenting a concern leaves an unlicensed act in place.

An LPN/VN notices that a coworker arriving for the shift has slurred speech, an unsteady gait, and the odor of alcohol. What is the priority action?

• a.Discuss the observation with several colleagues before deciding
• b.Report the impairment to the nursing supervisor✓
• c.Wait to see whether the same behavior occurs on the next shift
• d.Offer to complete the coworker's medication passes for the shift

Suspected impairment of a coworker is an immediate client-safety issue and must be reported through the chain of command. Covering the coworker's work, seeking peer opinions, or waiting for a repeat episode all allow an impaired provider to continue caring for clients.

Before administering a scheduled medication, what must the LPN/VN do to confirm the correct client?

• a.Confirm the room and bed number listed on the medication record
• b.Compare the client's face with the photograph in the paper chart
• c.Ask the client to confirm the name written on the medication label
• d.Verify the client's identity using two client-specific identifiers✓

Two client-specific identifiers, such as full name and date of birth, are required before care is delivered. Room number is not client-specific, a leading question invites a confused client to agree, and a chart photograph may be outdated.

A client is found on the floor beside the bed and reports hip pain. After the client has been assessed by the registered nurse and made safe, what should the LPN/VN do?

• a.Ask the two witnesses to write statements describing what they saw
• b.Report it to the supervisor and file an incident report✓
• c.Review the unit's fall-prevention policy before deciding what to do
• d.Record the details of the fall in the client's permanent medical record

An unusual occurrence is reported through the chain of command and documented on an incident report, which is a risk-management record. The medical record documents the client's condition and care, witness statements are not the nurse's first step, and policy review does not substitute for reporting.

A caller telephones the unit and asks the LPN/VN to confirm whether a named person is a client there. What is the appropriate response?

• a.Share the diagnosis with a caller who says they are family
• b.Confirm the admission and let the caller speak with the client
• c.Provide only the client's room number and general condition report
• d.State that nothing can be released without authorization✓

Protected health information may not be disclosed to a caller without the client's authorization, regardless of the caller's stated relationship. Confirming a room number, an admission, or a diagnosis are all disclosures.

An LPN/VN is asked to witness a client's signature on a surgical consent form. Which action is within the LPN/VN role?

• a.Sign the consent form as the person obtaining the client's consent
• b.Decide whether the client has the capacity to give valid consent
• c.Confirm the client signed and appears to understand✓
• d.Explain the surgical risks and benefits before the client signs

The LPN/VN may witness a signature and verify that the form is complete. Explaining risks and benefits is the provider's duty, and determining decision-making capacity is not an LPN/VN function.

A client brings a completed advance directive to the unit on admission. What should the LPN/VN do with the document?

• a.Advise the client about which treatment choices to select on the form
• b.Complete the advance directive form on the client's behalf tonight
• c.Tell the client the document takes effect only after a hospital stay
• d.Place a copy of the advance directive in the client's medical record✓

The nurse's role is to make the existing directive part of the record and notify the team. Advising specific choices, completing the form for the client, and misstating when a directive applies all interfere with the client's own decision.

An LPN/VN in a long-term care facility observes patterned bruising on an older adult resident's upper arms. What is the required action?

• a.Ask the client's adult daughter to explain how the bruises occurred
• b.Wait for the client to describe what happened before taking action
• c.Report the suspected abuse as state law requires✓
• d.Photograph the injuries and store the images on a personal phone

Nurses are mandatory reporters and must report suspected abuse through the required channel. Questioning the suspected abuser, taking personal photographs, and waiting for a disclosure all delay protection of the client.

A client is being transferred from a medical unit to a rehabilitation unit within the facility. What should the LPN/VN do before the transfer?

• a.Send a printed summary of the chart with the transport personnel
• b.Give report to the receiving nurse before transfer✓
• c.Document the transfer and telephone the receiving unit afterward
• d.Ask the transporter to relay the client's most recent vital signs

A nurse-to-nurse handoff before transfer lets the receiving nurse ask questions and confirm understanding. A printed summary, a message passed through a transporter, and a call placed after the fact all break the two-way exchange a handoff requires.

An LPN/VN is asked to perform a sterile procedure that the LPN/VN has never performed before. What should the LPN/VN do?

• a.Ask the registered nurse to observe and guide✓
• b.Document that the procedure was unfamiliar and complete it anyway
• c.Ask another LPN/VN who has never performed it to assist instead
• d.Review the procedure manual and perform the task independently

Recognizing a personal limitation and requesting supervision is a required professional behavior. Reading a manual, pairing with an equally inexperienced colleague, or documenting the concern and proceeding all leave the client with an unsupervised novice.

An LPN/VN is invited to take part in a unit quality improvement project on alarm fatigue. Which activity is appropriate for the LPN/VN?

• a.Present the committee's conclusions to the hospital board of trustees
• b.Redesign the unit's alarm policy based on the collected findings
• c.Decide which alarm limits the unit should adopt going forward
• d.Collect data on how often the alarm sounds and record the findings✓

Participating in quality improvement by gathering data is squarely within the LPN/VN role. Rewriting policy, setting clinical parameters, and reporting to governance are responsibilities of other members of the team.

An LPN/VN begins morning care for a client who has several ordered treatments due. How should the LPN/VN involve the client in planning the morning?

• a.Complete the tasks that take the least time before the others
• b.Follow the order of tasks listed on the standard care checklist
• c.Begin with the intervention the previous shift did not finish
• d.Ask the client which concerns should be addressed first today✓

Involving the client in decisions about care is an expected professional behavior and improves adherence. A checklist order, a shortest-task-first order, and an unfinished-task order all ignore the client's stated priorities.

A client receiving intravenous antibiotics states, 'I am going home right now, and no one is stopping me.' What should the LPN/VN do first?

• a.Remove the intravenous catheter and gather the client's belongings
• b.Explain that leaving without discharge forfeits any further care
• c.Notify the nursing supervisor of the client's decision✓
• d.Ask the client to sign a form and then escort the client to the exit

A client leaving against medical advice requires the chain of command to be notified so the provider can speak with the client and the correct documentation is completed. A competent adult may leave, but pretending it is routine, threatening loss of care, or dismantling the client's therapy first are all wrong.

A client tells the LPN/VN, 'I do not think I will ever get better.' How should the LPN/VN document this statement?

• a.Record that the client was uncooperative about the plan of care
• b.Note the nurse's opinion of why the client made the statement
• c.Document the client's exact words in quotation marks✓
• d.Summarize the conversation using the nurse's clinical impression

Subjective data is documented verbatim so later readers see what the client actually said. A summarized impression, a judgmental label, and speculation about motive all substitute the nurse's interpretation for the client's words.

A client who speaks limited English needs the discharge instructions reviewed before leaving. What should the LPN/VN do?

• a.Ask for a trained medical interpreter to attend✓
• b.Speak more slowly and loudly using simple everyday English words
• c.Ask the client's teenage grandson to interpret the conversation
• d.Give the client written materials in the preferred language instead

A trained interpreter is required for accurate exchange of health information. Using a family member, especially a minor, raises accuracy and confidentiality problems; speaking louder does not create understanding; and written material does not permit questions.

One licensed nurse on the evening shift calls out and no replacement has been found for the assignment. What should the LPN/VN do?

• a.Divide the missing nurse's clients among the staff already working
• b.Notify the nursing supervisor that the unit is short of licensed staff✓
• c.Ask the assistive personnel to take on the medication administration
• d.Delay the scheduled treatments until additional staff arrive on shift

A staffing shortfall that threatens safe care is reported through the chain of command so coverage can be arranged. Absorbing the assignment, delegating medications to UAP, and postponing ordered treatments each shift risk onto clients.

An LPN/VN notes that a client now ambulates the full length of the hallway, exceeding the goal written in the plan of care. What should the LPN/VN do?

• a.Decide which outcome statement should replace the current one
• b.Ask the registered nurse to update the plan of care✓
• c.Discontinue the intervention that no longer fits the client's needs
• d.Add the new nursing diagnosis to the written plan of care directly

The LPN/VN contributes data and suggestions but the registered nurse revises the plan of care. Adding a nursing diagnosis, stopping a planned intervention, and rewriting outcomes are all RN functions.

An LPN/VN is assigned a client whose personal choices conflict with the nurse's own beliefs. What should the LPN/VN do?

• a.Care for the client using the same standard applied to every client✓
• b.Ask the client to explain personal beliefs before care is provided
• c.Limit contact with the client to the tasks that must be completed
• d.Ask a colleague who shares the client's background to trade clients

Clients are entitled to unbiased treatment and equal access to care regardless of culture, ethnicity, sexual orientation, gender identity, or gender expression. Trading the assignment, minimizing contact, and demanding an explanation all treat the client differently.

An LPN/VN finishes documenting in the electronic health record on a workstation in the medication room. What should the LPN/VN do?

• a.Ask a coworker to watch the screen until the nurse can return
• b.Lock the medication room door while the record stays displayed
• c.Turn the computer monitor away from the hallway before leaving
• d.Log out of the workstation before leaving the medication room✓

Ending the session is the only action that closes access under the nurse's credentials. Turning the screen, locking the room, and asking someone to watch all leave an open session attributable to the nurse.

At the change of shift, the count of a controlled substance is one tablet short of the amount recorded. What should the LPN/VN do?

• a.Document the number found and let the next shift resolve the issue
• b.Ask each nurse on the unit whether a dose was removed in error
• c.Recount the drawer with the same nurse who counted the first time
• d.Report the count discrepancy to the nursing supervisor✓

A controlled substance discrepancy must be reported immediately through the chain of command so it can be investigated. Recounting with the same person, deferring it, and informally polling staff all delay an investigation of a possible diversion.

An LPN/VN has four remaining tasks at the end of the morning. Which should be completed first?

• a.Complete the treatment for the client whose dressing is saturated✓
• b.Chart the care already given to the four clients seen this morning
• c.Return the telephone call from a client's family member first
• d.Restock the supply cart before the next scheduled dressing change

A saturated dressing signals ongoing drainage or bleeding and takes priority over administrative tasks. Restocking, returning a call, and charting completed care can all wait.

A client who had a hip replacement reports pain rated 7 of 10 thirty minutes before a scheduled physical therapy session. What should the LPN/VN do?

• a.Reschedule the therapy session until the client is comfortable
• b.Ask therapy to shorten the session so the client tolerates it
• c.Give the prescribed analgesic before the session✓
• d.Suggest that the client use distraction during the therapy session

Timing an ordered analgesic so its effect covers the session lets the client participate as planned. Shortening, rescheduling, or substituting distraction all reduce the therapy the client is supposed to receive.

A client received the first dose of a newly prescribed antihypertensive four hours ago. What should the LPN/VN do?

• a.Ask the registered nurse to evaluate the response✓
• b.Hold the next dose until the provider reviews it
• c.Decide whether the medication should be continued after this dose
• d.Record that the client tolerated the new medication without difficulty

Evaluation of the client's response against the plan of care and decisions about continuing therapy rest with the registered nurse and provider. The LPN/VN collects and reports the data that evaluation depends on.

A provider gives an LPN/VN a verbal order during an emergency. After writing the order down, what should the LPN/VN do?

• a.Write the order and ask a coworker to check it
• b.Repeat the order silently while writing it to confirm accuracy
• c.Read the order back to the provider and have it verified✓
• d.Enter the order and compare it with the pharmacy profile later

A verbal order is transcribed and then read back to the prescriber for confirmation before it is carried out. A coworker's check, a later pharmacy comparison, and a silent repetition do not confirm the order with the person who gave it.

An alert, oriented client refuses a scheduled dose of a stool softener. What should the LPN/VN do?

• a.Give the medication in a food item the client will accept
• b.Postpone the dose and offer it again in about thirty minutes
• c.Explain that the client has the right to refuse the treatment✓
• d.Tell the client the provider will be upset about the refusal

A competent adult may refuse any treatment, and the refusal is honored, documented, and reported. Applying pressure, concealing a medication, and simply retrying the same approach all bypass the client's decision.

An LPN/VN finds that one side rail on a client's bed will not latch into position. What should the LPN/VN do?

• a.Move the client to a chair until the maintenance staff arrive
• b.Place a folded blanket along the open side of the client's bed
• c.Notify the nursing supervisor about the broken rail✓
• d.Post a sign on the bed warning staff that the rail is damaged

Unsafe equipment is reported so it can be removed from service and repaired. Improvising a barrier, relocating the client without an order, and posting a warning all leave the defective bed in use.

An LPN/VN has delegated a bed-to-chair transfer to assistive personnel. How should the LPN/VN monitor the delegated task?

• a.Complete the transfer using a mechanical lift for both clients
• b.Review the assistive personnel's documentation after the shift
• c.Ask the assistive personnel to describe how the transfer went
• d.Assist the client to a chair and observe the transfer technique✓

Monitoring assistive personnel means directly observing the delegated task. A verbal report, a review of documentation, and doing the task oneself all fail to observe the person actually performing it.

A client being discharged asks about services that could help with meals at home. Which action is within the LPN/VN role?

• a.Telephone the community agency and arrange the first appointment
• b.Give the client the written list of community follow-up resources✓
• c.Explain the eligibility rules for each program the client may use
• d.Decide which of the community programs best suits the client

Providing prepared referral information supports the referral process within the LPN/VN role. Arranging placement, selecting a program, and interpreting eligibility rules belong to the case manager or registered nurse.

A client's sputum culture returns positive for Mycobacterium tuberculosis. What should the LPN/VN do?

• a.Ask the client to notify recent contacts about the exposure
• b.Report the positive result as the policy requires✓
• c.Tell the client's roommate to watch for a cough and fever
• d.Note the result in the chart and mention it in the next report

Communicable disease reporting follows regulation and facility policy so public health can act. Warning a roommate breaches confidentiality, shifting notification to the client is not the required process, and charting alone is not reporting.

A client's family member raises a fist and shouts threats at staff in the hallway. What should the LPN/VN do?

• a.Notify the nursing supervisor about the threats made✓
• b.Explain the visiting policy and document the family's behavior
• c.Continue care and avoid the client's room while the family is present
• d.Ask the family to leave the unit until they are able to calm down

Threats against staff are a security matter reported through the chain of command. Ordering the family out, avoiding the room, and quoting policy all leave a threat unaddressed and can escalate it.

An LPN/VN is documenting the pain level of an alert, oriented client after a dressing change. What should the LPN/VN record?

• a.Ask the family member at the bedside to estimate the pain level
• b.Record the rating the client states for the pain✓
• c.Base the rating on the client's facial expression and posture
• d.Record the rating the previous shift documented for comparison

Self-report is the standard for pain in a client who can communicate. A prior rating, an observed behavior, and a family estimate are all secondary sources.

An LPN/VN finds the wrong medication in a client's drawer and removes it before any dose is given. What should the LPN/VN do?

• a.Treat the matter as closed with no harm to the client
• b.Report the near miss even though the client received no medication✓
• c.Discuss the error privately with the nurse who nearly gave the drug
• d.Note the event in a personal log in case questions arise later

Near misses are reported so the system defect that produced them can be corrected. A private conversation, a personal note, and treating it as closed all keep the hazard in place for the next client.

A client asks to complete a brief prayer before the scheduled morning bath. What should the LPN/VN do?

• a.Explain that hospital routines cannot accommodate the practice
• b.Support the client's spiritual practice when able✓
• c.Ask the chaplain to speak with the client about the routine
• d.Document the request and continue the usual care schedule

Client-reported spiritual and cultural preferences are incorporated into care when they do not compromise safety. Declining, deferring to the chaplain, and documenting without acting all disregard a preference that could be met.

An LPN/VN needs to discuss a client's laboratory results with the registered nurse. What should the LPN/VN do?

• a.Move the conversation to the nurses station near the hallway
• b.Close the door and lower the voice for the talk✓
• c.Use the client's room number rather than the client's name
• d.Wait to discuss the details until the end of the work shift

Privacy is protected by controlling who can overhear the conversation. A nurses station is public, a room number still identifies the client to anyone nearby, and delay does not make the discussion private.

A client arrives for admission carrying a handwritten list of home medications and herbal supplements. What should the LPN/VN do first?

• a.Ask the pharmacy which of the client's supplements are approved
• b.Add the herbal supplements the client mentioned to the record
• c.Tell the client to stop the supplements while in the hospital
• d.Compare the client's list with the current record✓

Medication reconciliation begins by comparing the client's own list with the record and reporting differences. Adding entries independently, instructing the client to stop a substance, and asking pharmacy to judge products all skip the comparison.

A client with a history of wandering is not in the room at medication time and is not in the bathroom or the dayroom. What should the LPN/VN do?

• a.Notify the nursing supervisor that a client is missing✓
• b.Check the sign-out sheet to see whether the client left with family
• c.Ask the assistive personnel to walk the hallways looking for the client
• d.Search the client's room and bathroom a second time before calling

A missing client triggers a facility-wide search and security alert through the chain of command without delay. Repeating a room search, sending one staff member to look, and consulting a sheet all consume time the client may not have.

Just before signing a consent form, a client asks the LPN/VN, 'What are they actually going to do to me?' What should the LPN/VN do?

• a.Reassure the client that the procedure is done here routinely
• b.Explain the procedure again using the consent form as a guide
• c.Tell the client the provider will answer questions afterward
• d.Ask what the provider explained about the procedure✓

When a client voices confusion before signing, the nurse determines what the client understood and reports the gap so the provider can return. Re-explaining, deferring questions, and offering reassurance all leave consent uninformed.

An LPN/VN is documenting an insulin dose in the medication administration record. Which practice should the LPN/VN follow?

• a.Copy the abbreviations the provider used in the written order
• b.Choose abbreviations that other nurses on the unit will recognize
• c.Use the facility's approved abbreviation list here✓
• d.Spell out every term to avoid using abbreviations at all

Documentation uses the abbreviations the facility has approved, which excludes error-prone ones. Avoiding all abbreviations is not the standard, and copying a provider or relying on local custom can reproduce a dangerous abbreviation.

An LPN/VN is preparing to perform perineal care for a client in a semiprivate room. Which action best protects the client's bodily privacy?

• a.Explain the steps of the procedure before uncovering the client
• b.Ask the visitors in the room to step outside during the care
• c.Position the client so the door view is partially obstructed
• d.Draw the curtain and drape the client first✓

Both a visual barrier and draping are needed to protect bodily privacy. Asking visitors out, angling the client, and explaining the steps are all reasonable but none of them shields the client from view.

An LPN/VN finds that a client's ankles are newly swollen and the client has gained 2 kg since yesterday. What should the LPN/VN do?

• a.Report the finding to the registered nurse today✓
• b.Increase the frequency of vital sign checks for the rest of the shift
• c.Chart the finding and continue with the remaining scheduled care
• d.Ask the client whether the symptom has occurred at home before

A change in condition is reported so the registered nurse can assess and the plan can be adjusted. Charting alone, adding checks, and history-taking all delay the assessment the change requires.

An LPN/VN finds several sterile dressing packages in the supply room with expiration dates that have passed. What should the LPN/VN do?

• a.Set the expired items aside and use a package from another unit
• b.Use the packages with sterile seals that are still intact
• c.Report the outdated stock to the nursing supervisor✓
• d.Mark the outdated packages and return them to the supply closet

Expired sterile stock is reported so it is pulled from every location, not just this one. Borrowing from another unit, judging by an intact seal, and returning the items to storage all leave expired supplies available.

A client asks to see what has been written in the medical record. What should the LPN/VN tell the client?

• a.Explain that clients are not permitted to read their own records
• b.Explain that the record may be reviewed with staff✓
• c.Give the client the chart to read at the bedside without notice
• d.Print the portion of the record the client seems most interested in

Clients have a right of access to their records through the facility's established process. Denying access, handing over the chart informally, and selectively printing pages all mishandle that right.

The emergency department calls to send another client to a unit that already has no available licensed staff. What should the LPN/VN do?

• a.Notify the nursing supervisor before accepting the client✓
• b.Ask the sending unit to hold the client until the next work shift
• c.Accept the client and request additional help after the arrival
• d.Assign the incoming client to the assistive personnel for admission

When the unit cannot safely absorb another client, the chain of command decides before the transfer happens. Accepting first, refusing on one's own authority, and assigning an admission to UAP all bypass that decision.

An LPN/VN has just told assistive personnel to record hourly urine output for a specific client. What should the LPN/VN do next?

• a.Check on the delegated tasks near the end of the work shift
• b.Ask the assistive personnel to repeat it back✓
• c.Tell the assistive personnel to ask questions if any come up
• d.Write the delegated tasks on the assignment board for the shift

Confirming understanding is the right direction element of delegation. A written board, an end-of-shift check, and an open invitation to ask questions do not confirm that the message was received correctly.

A client is off the unit for a test when a scheduled medication is due, and the dose is not given. What should the LPN/VN do?

• a.Circle the time and explain the omission in the next handoff
• b.Chart the omitted dose and the reason it was not administered✓
• c.Leave the space blank for the dose that was not given
• d.Ask the oncoming nurse to give the dose and chart it then

An omitted dose is documented with the reason so the record is accurate and the team can act. A blank space, a verbal handoff without documentation, and shifting the dose to another nurse all produce an incomplete record.

A client's symptoms appear to match the criteria of a standing sepsis protocol used on the unit. What should the LPN/VN do?

• a.Ask the registered nurse to apply the criteria✓
• b.Ask the pharmacist to decide whether the protocol should begin
• c.Start the protocol for a client whose symptoms match it
• d.Wait for the provider to visit the unit later in the afternoon

Deciding that a client meets protocol criteria is an assessment and judgment step that belongs to the registered nurse. Starting it independently, waiting for a routine visit, and asking pharmacy to decide all misplace that judgment.

A client is being discharged with four new prescriptions. Which action is within the LPN/VN role?

• a.Give the client the itemized discharge medication list✓
• b.Explain how each new medication will interact with the others
• c.Determine whether the client is ready to manage the medications
• d.Decide which of the client's home medications should be stopped

Providing the prepared list and reinforcing instructions is within LPN/VN scope. Explaining interactions, discontinuing home drugs, and judging readiness require the registered nurse or provider.

During admission care an LPN/VN finds an open area of broken skin over a client's sacrum. What should the LPN/VN do?

• a.Photograph the wound and place the image in the medical record
• b.Report the newly found injury to the registered nurse✓
• c.Apply the dressing the unit uses for wounds of this appearance
• d.Measure the wound and record the stage in the admission note

A newly found pressure injury is reported so the RN can assess and stage it and the provider can order treatment. Photographing, staging, and selecting a dressing all require authority the LPN/VN does not hold for a new wound.

A unit of packed red blood cells has arrived on the unit for a client. What is required before it is administered?

• a.Complete the required two-person check at the bedside✓
• b.Verify the unit against the record with the same nurse twice
• c.Check the unit number and expiration date before hanging it
• d.Confirm the client's blood type with the laboratory by telephone

An independent double check by two qualified people at the bedside is required before blood is administered. Repeating a single person's check, verifying the unit alone, and a telephone confirmation do not meet that standard.

An LPN/VN sees a coworker chart a treatment that the LPN/VN knows was not performed. What should the LPN/VN do?

• a.Tell the client's family that the record contains an inaccuracy
• b.Ask the coworker to write a late entry describing the real care
• c.Correct the coworker's entry so the record reflects actual care
• d.Report the falsified entry to the nursing supervisor✓

Falsified documentation is a legal and ethical violation reported through the chain of command. Editing another person's entry, negotiating a late entry, and disclosing to the family are all outside the nurse's authority.

A provider writes a dose that is higher than the LPN/VN usually sees, but the order is legible, complete, and within the published safe range. What should the LPN/VN do?

• a.Ask the pharmacist to change the order to the more familiar dose
• b.Hold the dose until the provider confirms it during morning rounds
• c.Give half the dose that the provider has ordered
• d.Carry out the order as the provider has written it✓

An order that is legible, complete, and within the accepted range is carried out. Holding a correct dose, splitting it, and asking pharmacy to rewrite it all withhold prescribed therapy without cause.

Two of an LPN/VN's clients simultaneously report new shortness of breath. What should the LPN/VN do?

• a.See the client whose call light was activated the earliest
• b.See the client whose condition the nurse considers most serious
• c.Ask the registered nurse to set the priority order✓
• d.Ask the assistive personnel which client seems most uncomfortable

When two clients appear to be deteriorating at the same time, the RN sets the priority because prioritizing among unstable clients is an assessment judgment. Call-light order, personal judgment about severity, and a UAP impression are not adequate bases.

When should an LPN/VN document the care that has been provided to a client?

• a.Chart the planned care at the start of the scheduled time block
• b.Record the care after confirming the details with the next nurse
• c.Group the charting for all clients at the end of the work shift
• d.Document the care immediately after it is provided to the client✓

Documentation follows the care as closely as possible so it is accurate and timely. Charting in advance is falsification, end-of-shift batching invites error, and confirming with a colleague does not restore accuracy.

A client scheduled for a procedure says the provider left before answering the client's questions about it. What should the LPN/VN do?

• a.Have the family member sign for the client to avoid a delay
• b.Explain the alternatives to the procedure and then obtain consent
• c.Witness the signature of a client who agreed to it
• d.Ask the client to sign only after the provider returns✓

Consent cannot be completed while the client's questions are unanswered by the prescriber. Witnessing anyway, supplying the explanation, and substituting a family signature all produce an invalid consent.

A client who was alert this morning is now drowsy and difficult to arouse. What should the LPN/VN do?

• a.Recheck the vital signs in fifteen minutes and compare the values
• b.Raise the head of the bed and ask the client to breathe slowly
• c.Report the change in condition to the registered nurse✓
• d.Review the record to see whether this pattern has occurred before

A new change in condition is reported so the RN can assess. Rechecking, repositioning, and chart review may all be reasonable in addition, but none of them substitutes for informing the nurse responsible for assessment.

An LPN/VN notices that the unit fire alarm panel shows a fault light and no audible alarm sounds during a test. What should the LPN/VN do?

• a.Report the alarm panel fault to the nursing supervisor✓
• b.Ask the assistive personnel to watch the corridor for smoke
• c.Write a maintenance request for the day shift
• d.Test the alarm pull station at the other end of the hallway

A nonfunctioning life-safety system is reported immediately so interim fire watch measures can be put in place. Testing another station, posting an informal watch, and leaving a written request all delay that response.

An LPN/VN is reinforcing safety education with a client who uses oxygen at home. Which client statement requires follow-up?

• a.I keep petroleum jelly by my chair for dry lips✓
• b.I use a cotton blanket instead of my wool one
• c.I moved my recliner away from the gas stove
• d.I put a no-smoking sign on my front door

Petroleum-based products are flammable in an oxygen-enriched environment and are replaced with water-based products. Moving away from an open flame, posting a no-smoking sign, and choosing cotton over wool are all correct home oxygen precautions.

A client has Clostridioides difficile infection. What should the LPN/VN do after removing gloves and leaving the room?

• a.Use alcohol-based rub and then don clean gloves
• b.Wash the hands with soap and running water✓
• c.Apply alcohol-based hand rub for twenty seconds
• d.Rinse the hands and apply hand cream

C. difficile spores are not killed by alcohol, so hand hygiene after caring for these clients uses soap and water, which physically removes spores. Alcohol-based rub alone, with cream, or followed by gloves leaves spores on the hands.

An LPN/VN discovers a fire in a client's waste basket. What should the LPN/VN do first?

• a.Move the client out of the room to a safe area✓
• b.Close the door of the room to contain the fire
• c.Notify the nursing supervisor of the fire in the room
• d.Use the extinguisher stored in the hallway alcove

The RACE sequence begins with rescue: remove anyone in immediate danger. Reporting, containing the fire by closing the door, and extinguishing all follow, and each of them leaves the client in the room while it is done.

An LPN/VN checks a client who is in bilateral wrist restraints and finds the right hand cool, pale, and swollen. What should the LPN/VN do first?

• a.Document the skin color and temperature of the hand
• b.Release the right wrist restraint to restore circulation✓
• c.Report the circulatory finding to the nursing supervisor
• d.Reposition the client's arm on a pillow for support

Compromised circulation under a restraint is corrected immediately by releasing that restraint; the LPN/VN does not need an order to remove a restraint for safety. Reporting, documenting, and repositioning all leave the constricted limb in place.

An LPN/VN prepares to transfer a client from bed to a wheelchair. Which action protects the LPN/VN from injury?

• a.Hold the client at arm's length while turning
• b.Keep the knees straight and pivot from the waist
• c.Keep the feet apart and bend the knees✓
• d.Twist the trunk toward the chair while lifting

A wide base of support with flexion at the knees and hips uses the strong leg muscles and keeps the load close. Straight knees, an extended reach, and trunk twisting all place the load on the lumbar spine.

A client's chart lists an allergy to shellfish. The provider orders a contrast study for the afternoon. What should the LPN/VN do?

• a.Report the documented allergy before the study is scheduled✓
• b.Record the allergy again on the front of the paper chart
• c.Ask the client whether an antihistamine has ever been taken
• d.Confirm that the allergy band is on the client's wrist

An allergy that may bear on an ordered test is reported so the provider can evaluate the order before the client is sent. Checking the band, taking a medication history, and re-recording the allergy do not inform the prescriber.

An LPN/VN finds an oxygen cylinder standing unsecured next to a client's bed. What should the LPN/VN do first?

• a.Notify the nursing supervisor about the loose cylinder
• b.Ask respiratory therapy to remove it
• c.Post a sign advising staff that the cylinder is loose
• d.Secure the cylinder in an upright holder or rack✓

An unsecured compressed gas cylinder can fall and rupture, so it is stabilized immediately by anyone who finds it. Reporting, posting a warning, and requesting a pickup all leave a projectile hazard beside the client.

An LPN/VN is preparing to perform a sterile dressing change and drops a sterile gauze pad on the edge of the sterile field. What should the LPN/VN do?

• a.Move the pad toward the center of the sterile field
• b.Continue the dressing change and note the contamination
• c.Discard the pad and add a new one to the field✓
• d.Pick the pad up with sterile forceps and reposition it

The outer inch of a sterile field is considered contaminated, so an item that lands there is discarded. Moving it inward, handling it with forceps, and proceeding anyway all carry contamination into the wound.

An infant abduction alert is announced in a hospital. What should the LPN/VN on a medical unit do?

• a.Monitor the assigned exit and observe anyone leaving✓
• b.Notify the nursing supervisor that the alert was heard
• c.Move all clients on the unit into their rooms and wait
• d.Telephone the obstetric unit for a description

Security alerts assign every staff member a post so all exits are covered. Acknowledging the alert, sheltering clients, and telephoning the source unit all leave an exit unwatched during the minutes that matter.

An LPN/VN is preparing to give an intramuscular injection and the client suddenly pulls away, causing the used needle to scratch the LPN/VN's forearm. What should the LPN/VN do first?

• a.Wash the exposed area with soap and running water✓
• b.Ask the client to consent to bloodborne pathogen testing
• c.Complete an occupational exposure incident report form
• d.Report the exposure to the nursing supervisor

First aid after a sharps exposure begins with washing the site. Reporting, completing the exposure form, and arranging source testing all follow immediately afterward but do not come before decontaminating the wound.

An LPN/VN enters a room and finds a client sitting on the edge of the bed, pale and beginning to slump toward the floor. What should the LPN/VN do first?

• a.Ask the client to describe how the dizziness started
• b.Call the nursing supervisor from the bedside telephone
• c.Raise the head of the bed and lower the side rails
• d.Ease the client to the floor while protecting the head✓

When a fall is already in progress, guiding the client down protects the head and prevents an uncontrolled drop. Telephoning, adjusting the bed, and taking a history all leave the client falling unassisted.

An LPN/VN is caring for a client on contact precautions for a multidrug-resistant organism. What should the LPN/VN do when leaving the room?

• a.Remove the gloves in the room and the gown in the hallway
• b.Remove the gown and gloves just outside the doorway
• c.Carry the used gown to the soiled utility room to discard
• d.Remove the gown and gloves inside the client's room✓

Contaminated personal protective equipment is removed and discarded inside the room so organisms are not carried into the corridor. Doffing outside the door, transporting the gown, and splitting the removal all move contamination out of the room.

A client who has a seizure disorder begins a generalized tonic-clonic seizure while lying in bed. What should the LPN/VN do?

• a.Turn the client to the side and protect the head✓
• b.Insert a padded tongue blade between the teeth
• c.Call the nursing supervisor before touching the client
• d.Hold the client's arms still to prevent an injury

Side-lying positioning protects the airway and padding protects the head. Restraining the limbs can cause fractures, placing an object in the mouth can break teeth or obstruct the airway, and leaving the bedside to make a call abandons an unprotected client.

An LPN/VN is assigning care and the unlicensed assistive personnel reports that a bed alarm on a high fall-risk client has been turned off. What should the LPN/VN do first?

• a.Notify the nursing supervisor that the alarm was off
• b.Ask the assistive personnel who turned the alarm off
• c.Turn the bed alarm back on and check the client✓
• d.Add a note to the shift report about the alarm setting

The protection is restored first, and the client is checked because the alarm may have been silent during a fall. Reporting, investigating who did it, and noting it in report all leave the client unprotected in the meantime.

An LPN/VN must apply a soft wrist restraint to a client who is pulling at an endotracheal tube. Which action is correct?

• a.Secure the restraint tie to the movable bed frame✓
• b.Attach the restraint tie to the mattress underneath
• c.Tie the restraint with a square knot at the wrist
• d.Secure the restraint tie to the upper side rail

Restraint ties are fastened to a part of the bed frame that moves with the bed, so raising or lowering the bed does not tighten them. A side rail moves independently, a square knot cannot be released quickly, and a tie under the mattress cannot be reached in an emergency.

During an external disaster response, an LPN/VN is asked to help triage arriving clients. Which client should be treated first?

• a.A client with severe pain and no visible external injury
• b.A client with an open fracture of the lower right leg
• c.A client with noisy, obstructed breathing and a weak pulse✓
• d.A client with a deep laceration that has stopped bleeding

Airway compromise with shock is immediately life-threatening and is treated first. An open fracture, a controlled laceration, and undifferentiated pain are all urgent but survivable during the minutes that airway management requires.

An LPN/VN is reinforcing home safety education with an older adult who lives alone. Which instruction should the LPN/VN include?

• a.Keep the hallway lights off to save energy
• b.Use a rolling stool to reach items on high shelves
• c.Remove loose throw rugs from the walking paths✓
• d.Place an extension cord along the edge of the hallway

Loose rugs are a leading cause of falls in the home. Darkened hallways, an unstable rolling stool, and a cord across a walking route each add a hazard rather than remove one.

An LPN/VN sees an unlicensed assistive personnel preparing to reuse a glucometer lancet device on a second client. What should the LPN/VN do first?

• a.Stop the procedure before the second client is tested✓
• b.Document the observation and review the device policy
• c.Ask the assistive personnel to explain the unit routine
• d.Report the practice to the nursing supervisor right away

A lancing device shared between clients transmits bloodborne pathogens, so the act is interrupted before it happens. Reporting, seeking an explanation, and documenting all allow the exposure to occur first.

An LPN/VN is caring for a client with a draining wound. Which personal protective equipment is required to change the saturated dressing?

• a.A surgical mask and gloves for the dressing change
• b.Gloves alone for a wound that is already covered
• c.A gown and mask without any gloves
• d.Gloves and a gown for the anticipated splash✓

Standard precautions require protection matched to the anticipated exposure, and a saturated dressing means contact with body fluid on the hands and clothing. Gloves alone, a mask substituting for a gown, and omitting gloves all leave a predicted exposure route open.

An LPN/VN notes that a client's identification band is missing during the morning medication pass. What should the LPN/VN do?

• a.Ask the client to state the full name and give the dose
• b.Give the medication and request a band from admitting
• c.Apply a new band after verifying the client's identity✓
• d.Ask a coworker who knows the client to confirm identity

Identity is verified and the band replaced before care continues, so every later encounter has the identifier available. A single verbal check, deferring the band, and relying on a coworker's recognition all leave the client unbanded.

An LPN/VN is preparing to move a client with limited weight-bearing from bed to a stretcher. Which device is appropriate?

• a.A gait belt applied around the client's waist and chest
• b.A draw sheet pulled by one staff member at the head
• c.A mechanical lift operated by a single staff member
• d.A friction-reducing slide board with two staff members✓

A lateral transfer to a stretcher uses a slide board with at least two people. A gait belt is for ambulation and standing, one person pulling a draw sheet risks shearing and injury, and a mechanical lift is not operated alone.

A client on droplet precautions must go to the radiology department. What should the LPN/VN do?

• a.Wrap the client in a clean sheet for the entire transport
• b.Ask radiology to come to the unit with portable equipment
• c.Have the transport staff wear N95 respirators
• d.Place a surgical mask on the client for transport✓

Source control with a surgical mask on the client contains respiratory droplets during transport. Respirators on staff are not the droplet-precaution requirement, a sheet does not contain droplets, and portable equipment is not always an option for the ordered study.

An LPN/VN finds a client's intravenous pump alarming with an occlusion message and the tubing kinked under the client's arm. What should the LPN/VN do first?

• a.Silence the alarm and recheck the pump in ten minutes
• b.Straighten the tubing and check that flow resumes✓
• c.Notify the nursing supervisor that the pump is alarming
• d.Increase the pump rate to overcome the resistance

A visible mechanical cause is corrected on the spot, which is within the LPN/VN's scope. Reporting a kink, silencing an alarm, and raising the rate against an occlusion all delay or worsen the problem.

An LPN/VN notices that a client's oxygen tubing runs across the doorway of the room. What should the LPN/VN do?

• a.Shorten the tubing by coiling it beside the bed
• b.Reroute the tubing away from the doorway✓
• c.Place a warning sign at the entrance to the room
• d.Tape the tubing to the floor across the doorway

Removing the tubing from the walking path eliminates the trip hazard. Taping it down still leaves a raised ridge, a sign relies on people reading it, and coiling excess tubing beside the bed can kink the oxygen flow.

An LPN/VN is assigned to perform safety checks on a client who is in seclusion. How often should the client be observed?

• a.At the beginning and the end of the seclusion period
• b.Once each hour while the client remains in seclusion
• c.Continuously, according to facility policy and the order✓
• d.Every thirty minutes until the seclusion is discontinued

A client in seclusion requires continuous monitoring in the manner the facility policy and order specify, because the client cannot summon help. Half-hourly, hourly, and start-and-end checks all leave long unobserved intervals.

An LPN/VN is caring for a client who has a latex allergy. Which action is appropriate?

• a.Ask the client to describe the reaction before changing supplies
• b.Wear powder-free latex gloves when giving direct care
• c.Remove latex items only from the client's bedside table
• d.Post the allergy and use latex-free supplies at the bedside✓

Latex is removed from the client's environment and the allergy is communicated to everyone entering the room. Powder-free latex is still latex, clearing one surface leaves other sources, and taking a history does not remove exposure.

An LPN/VN finds a spill of blood on the floor of a client's room. What should the LPN/VN do first?

• a.Ask housekeeping to bring a spill kit later
• b.Notify the nursing supervisor about the spill on the floor
• c.Wipe the spill with paper towels from the bedside table
• d.Contain the area so no one walks through the spill✓

Preventing contact and tracking comes first, before the spill is cleaned with the approved kit and disinfectant. Reporting, improvising with paper towels, and requesting a delayed cleanup all leave people walking through a bloodborne hazard.

An LPN/VN is preparing a client's room for a client on protective environment precautions after a stem cell transplant. Which action is appropriate?

• a.Limit the client to a single visitor at any one time
• b.Keep the door open so staff can observe the client
• c.Place a container of alcohol-based rub inside the room
• d.Remove fresh flowers and potted plants from the room✓

Fresh flowers and soil harbor Aspergillus and other fungi that endanger a severely neutropenic client. Hand rub, visitor limits, and an open door do not address that specific hazard, and an open door defeats the positive-pressure airflow.

An LPN/VN observes that a newly hired assistive personnel is not wearing gloves while emptying a urinary drainage bag. What should the LPN/VN do?

• a.Report the practice to the registered nurse later
• b.Ask whether the person received training on standard precautions
• c.Ask the person to stop and put on gloves before continuing✓
• d.Empty the remaining drainage bags on the unit personally

An unsafe practice in progress is stopped immediately, then addressed through education and reporting. A delayed report, a training question, and taking over the rest of the task all allow this exposure to be completed.

An LPN/VN is asked to check that emergency suction equipment at a bedside is ready for use. Which finding indicates the equipment is ready?

• a.The catheter package at the bedside is sealed and dry
• b.The suction tubing is coiled and connected to the wall
• c.The suction generates the set pressure when occluded✓
• d.The collection canister is empty and correctly seated

Only occluding the tubing and watching the gauge reach the set pressure demonstrates that the system actually works. An empty canister, connected tubing, and an intact catheter package are all necessary but none of them tests function.

An LPN/VN is comparing a 15-month-old child to the CDC developmental milestone checklist for that age. Which finding is expected?

• a.The child speaks in phrases of three or four words
• b.The child walks up a flight of stairs alternating feet
• c.The child pedals a small tricycle
• d.The child takes a few steps without being held✓

Taking a few steps alone and stacking two small objects appear on the CDC 15-month checklist. Three- to four-word phrases, alternating feet on stairs, and pedaling a tricycle are milestones of the preschool years, not of a 15-month-old.

An LPN/VN is collecting a health history from a newly admitted client. Which question best elicits the information needed?

• a.Have you had any serious health problems before
• b.Do you have diabetes, hypertension, or asthma
• c.Is there anything in your history I should know
• d.Tell me about the health problems you have had✓

An open-ended invitation lets the client supply history the nurse would not know to ask about. A yes-or-no question, a fixed list, and a vague closing question all narrow the answer before it is given.

An LPN/VN is monitoring a client in early labor. Which finding should be reported to the registered nurse without delay?

• a.Clear fluid with the cord visible at the introitus✓
• b.Contractions lasting 45 seconds every five minutes
• c.Blood-tinged mucus discharge from the vagina
• d.A fetal heart rate of 140 beats per minute at rest

A visible umbilical cord is a prolapse and an obstetric emergency. Contractions every five minutes, bloody show, and a fetal heart rate of 140 are all expected findings in early labor.

An LPN/VN is monitoring a client four hours after a vaginal birth. Which finding requires immediate reporting?

• a.A uterine fundus that is soft and above the umbilicus✓
• b.A fundus that is firm and at the level of the umbilicus
• c.Moderate red lochia saturating one pad in four hours
• d.Afterpains that increase during newborn breastfeeding

A boggy fundus displaced upward suggests uterine atony with possible hemorrhage. A firm midline fundus, moderate lochia at that rate, and afterpains during feeding are all normal postpartum findings.

An LPN/VN is caring for a newborn whose mother tested positive for hepatitis B surface antigen. What should the newborn receive?

• a.Hepatitis B immune globulin at the first well-child visit
• b.Hepatitis B vaccine and immune globulin within 12 hours✓
• c.Hepatitis B vaccine alone within 12 hours of the birth
• d.Hepatitis B vaccine beginning at two months of age

An infant born to a mother who is HBsAg positive receives both hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth, at separate sites. Vaccine alone, delayed immune globulin, and a delayed series all leave the infant unprotected during the highest-risk period.

An LPN/VN is reinforcing education with an adult client about colorectal cancer screening. Which statement should the LPN/VN include?

• a.Screening for average-risk adults begins at age 45✓
• b.Screening is needed only if a relative had the disease
• c.Screening begins after the first symptoms are noticed
• d.Screening is repeated every year regardless of method

Average-risk adults begin colorectal cancer screening at age 45 under current national recommendations. Restricting screening to those with a family history, waiting for symptoms, and applying one interval to every method are all incorrect.

An LPN/VN is collecting baseline physical data on an adult client at admission. Which measurement is part of that baseline?

• a.A diagnosis for the skin lesions that are present
• b.Interpretation of the client's breath sound pattern
• c.A judgment about the client's nutritional status
• d.Height, weight, and condition of the skin✓

Collecting objective baseline data such as height, weight, and skin condition is squarely within LPN/VN scope. Interpreting findings, diagnosing lesions, and drawing a nutritional conclusion are assessment judgments reserved to the registered nurse.

An LPN/VN is reinforcing education about smoking cessation with a client who has just decided to quit. Which action is most helpful?

• a.Describe the long-term risks of continued smoking
• b.Help the client choose a specific quit date✓
• c.Provide a pamphlet on tobacco use
• d.Tell the client to cut down gradually over a year

A client in the preparation stage benefits most from concrete planning, and setting a quit date is the first step. Restating risks, recommending indefinite tapering, and handing over a pamphlet all fit an earlier stage of change.

An LPN/VN is caring for an 82-year-old client who is hard of hearing. Which action improves communication?

• a.Cover the mouth to reduce movement
• b.Speak loudly into the client's better-hearing ear
• c.Face the client and speak in a lower pitch✓
• d.Raise the pitch of the voice to carry the sound

Age-related hearing loss affects high frequencies first, so lowering pitch and allowing the client to see the face helps most. Shouting distorts speech, raising pitch worsens comprehension, and covering the mouth removes visual cues.

An LPN/VN is teaching an adult client who reads at a low literacy level. Which barrier to learning should the LPN/VN address first?

• a.Use the standard printed teaching sheet in larger type
• b.Give the instructions verbally with a demonstration✓
• c.Provide a detailed written handout to read at home
• d.Ask the client to read the instructions back aloud

Matching the method to the client removes the barrier: verbal instruction with demonstration does not depend on reading. A handout, reading aloud, and larger type all still require literacy.

An LPN/VN is assisting with a community blood pressure screening event. Which action is within the LPN/VN role?

• a.Diagnose hypertension in participants with high readings
• b.Decide which participants need urgent care
• c.Tell participants which antihypertensive to request
• d.Measure blood pressures and record the readings✓

Participating in a health screening program by taking and recording measurements is an LPN/VN activity. Recommending drugs, diagnosing, and triaging urgency require a provider or registered nurse.

A client who is 30 weeks pregnant reports a headache that will not go away, blurred vision, and swelling of the face. What should the LPN/VN do?

• a.Darken the room and recheck the client in one hour
• b.Report the findings to the registered nurse immediately✓
• c.Give the client the acetaminophen ordered as needed
• d.Ask the client to lie on the left side and rest quietly

Persistent headache, visual changes, and facial edema in late pregnancy suggest preeclampsia, a potential prenatal complication that must be reported at once. Waiting an hour, treating the headache, and repositioning all delay evaluation of a condition that can progress to seizures.

An LPN/VN is helping an older adult client adjust to retirement. Which response supports this life transition?

• a.Suggest that the client take up a hobby
• b.Ask the client what activities now fill the day✓
• c.Recommend a senior center the client could attend
• d.Reassure the client that the adjustment takes time

Exploring how the client is actually spending time opens the conversation and identifies what support is needed. Suggesting a hobby, offering reassurance, and naming a program all supply an answer before the client's situation is known.

An LPN/VN is caring for a 2-day-old newborn. Which finding should be reported to the registered nurse?

• a.Six wet diapers with a dark green sticky stool
• b.A weight that is 6 percent below the birth weight
• c.A soft, flat anterior fontanel that pulsates slightly
• d.Yellow discoloration of the face and upper chest✓

Visible jaundice extending down the chest at 2 days needs evaluation of the bilirubin level. A soft flat fontanel, transitional stools with adequate voiding, and a 6 percent weight loss are all expected in the first days.

An LPN/VN is asked to help a client identify community resources after discharge. What should the LPN/VN do?

• a.Give the client the facility's list of local agencies✓
• b.Decide which agency best matches the client's income
• c.Notify the nursing supervisor that the client needs help
• d.Tell the client to search for agencies online at home

Identifying community resources for clients is a listed LPN/VN activity, and supplying the prepared list accomplishes it. Escalating a routine task, sending the client away to search alone, and determining eligibility all fail the client or exceed the role.

A client says, 'I have saved up my pills and I am going to take them all tonight.' What should the LPN/VN do?

• a.Search the client's belongings for the medication supply
• b.Stay with the client and tell the supervisor✓
• c.Ask the client to promise not to act on the plan tonight
• d.Encourage the client to discuss this at the group session

A stated plan with available means requires that the client not be left alone and that the chain of command be notified so the client can be evaluated. A safety promise has no protective value, searching alone leaves the client unobserved, and deferring to group delays urgent care.

A client who was told this morning about a new cancer diagnosis is crying quietly. What should the LPN/VN do?

• a.Notify the registered nurse that the client cries
• b.Suggest the client wait until more is known
• c.Sit with the client and allow silence for a time✓
• d.Explain the treatment options that are usually offered

Presence and silence give the client room to express grief and are within the LPN/VN role. Escalating an expected emotional response, supplying treatment information, and asking the client to postpone feelings all close off the expression.

A client with dementia becomes agitated and shouts in the hallway during the evening. What should the LPN/VN do first?

• a.Ask the client to explain why the shouting has started
• b.Tell the client that shouting disturbs the other residents
• c.Notify the nursing supervisor about the client's shouting
• d.Move the client to a quiet area and speak calmly✓

Reducing stimulation and using a calm approach are the first de-escalation steps and are within the LPN/VN role. Escalating, demanding an explanation from a cognitively impaired client, and correcting the behavior all tend to increase agitation.

A client in alcohol withdrawal says, 'There are bugs crawling all over the wall.' What is the appropriate response?

• a.There are no bugs, so you should try to relax now
• b.Tell me how many bugs you can see on that wall
• c.I do not see any bugs, and I will stay here with you✓
• d.I will get something to spray the wall for the bugs

The nurse presents reality without arguing and offers presence, which reduces fear. Playing along reinforces the hallucination, a flat correction with an order to relax dismisses the client, and asking for detail focuses the client on the false perception.

A client tells the LPN/VN, 'I am not taking that blood pressure pill anymore.' What should the LPN/VN say?

• a.Help me understand what has changed for you✓
• b.Your provider prescribed it, so it should be taken
• c.Many clients dislike it at first and then adjust to it
• d.The medication is important for preventing a stroke

Exploring the reason for nonadherence is a listed LPN/VN activity and is what determines the next step. A warning, an appeal to authority, and a generalization all answer before the reason is known.

An angry client is pacing, clenching the fists, and speaking loudly. What should the LPN/VN do?

• a.Keep an arm's length distance and lower the voice✓
• b.Tell the client the behavior must stop
• c.Notify the registered nurse before entering the room
• d.Stand close to the client to show attentive concern

Maintaining personal space and a calm, quiet voice de-escalates an agitated client and keeps an exit available. Escalating first, closing the distance, and issuing a command all raise the risk of assault.

A client who is dying asks the LPN/VN, 'Am I going to die tonight?' What is the appropriate response?

• a.No one can predict how much time is left
• b.Let me get your family so you can talk together
• c.You should try to rest and stay comfortable now
• d.What are you thinking about as you ask me that✓

An open response invites the client to say what the question is really about. A factual deflection, calling in family, and redirecting to comfort all end the conversation the client opened.

An LPN/VN is collecting psychosocial data on a newly admitted client. Which question is appropriate for the LPN/VN to ask?

• a.Which psychiatric diagnosis fits you best
• b.Which of your coping mechanisms are unhealthy for you
• c.How severe would you rate your depression clinically
• d.How have you been sleeping over the past two weeks✓

Collecting concrete data such as sleep patterns is within the LPN/VN role. Assigning a diagnosis, rating clinical severity, and labeling a client's coping as unhealthy are all interpretive judgments.

A client in a long-term care facility repeatedly asks to go home to a house sold years ago. Which approach uses validation therapy?

• a.Your house was sold, and this is your home now
• b.Look at the calendar for today's date
• c.Tell me about the home that you are missing✓
• d.We will talk about going home a little later on

Validation therapy responds to the feeling behind the statement rather than the facts. Correcting the client, orienting to the date, and postponing the topic are all reality-based or dismissive responses that increase distress in advanced dementia.

A client discloses that a staff member slapped the client's hand during the night shift. What should the LPN/VN do?

• a.Ask the client whether the contact could have been accidental
• b.Observe the staff member during this shift
• c.Report the allegation to the nursing supervisor at once✓
• d.Record the client's statement and continue with morning care

An allegation of abuse by staff is reported immediately through the chain of command so an investigation and protection can begin. Questioning the report, watching for a repeat, and documenting alone all leave the client in contact with the accused staff member.

A client with a new colostomy refuses to look at the stoma during the dressing change. What should the LPN/VN do?

• a.Complete the change quickly without any discussion
• b.Tell the client that most people adjust within weeks
• c.Insist that the client observe the procedure today
• d.Acknowledge the difficulty and continue the care✓

Accepting the client's pace while continuing needed care supports adaptation to an altered body image. Insisting, rushing in silence, and offering a generalization all disregard where the client actually is.

An LPN/VN is assisting with a client group session on the psychiatric unit. Which action is appropriate for the LPN/VN?

• a.Decide which members should attend the sessions
• b.Set the therapeutic goals for the group session
• c.Encourage a quiet member to share with the group✓
• d.Interpret the meaning of a member's statement

Participating in a group session by supporting engagement is within LPN/VN scope. Interpretation, goal setting, and membership decisions belong to the group leader or the registered nurse.

A client says, 'Since my stroke I am useless to my family.' What is the most therapeutic response?

• a.You will regain much of your function with therapy
• b.Your family told me they are glad you are here
• c.Everyone feels discouraged after a stroke at first
• d.You feel that you no longer contribute at home✓

Reflecting the client's feeling invites the client to say more and shows the message was heard. Reporting what the family said, promising recovery, and normalizing the feeling all move away from what the client expressed.

An LPN/VN is reinforcing education for the family of a client with Alzheimer disease who becomes agitated at dusk. Which instruction should be included?

• a.Let the client nap for several hours late in the day
• b.Keep the evening routine and the lighting consistent✓
• c.Ask the client each evening what caused the upset
• d.Introduce new activities in the evening for interest

A consistent routine and adequate light reduce sundowning. Novel evening activity increases stimulation, questioning a confused client adds demand, and long late naps disrupt the sleep-wake cycle.

A client who uses a wheelchair says, 'Do not talk to my husband about me as if I am not here.' What should the LPN/VN do?

• a.Apologize and continue the conversation as it was
• b.Ask the husband to step out during future discussions
• c.Explain that the husband asked most of the questions
• d.Address the client directly during all conversations✓

Speaking directly to the client promotes self-advocacy and dignity. Justifying the behavior, removing the spouse, and apologizing without changing the behavior all fail to correct the problem the client identified.

An LPN/VN is caring for a client experiencing an opioid overdose who has a respiratory rate of 6 breaths per minute. What should the LPN/VN do first?

• a.Turn the client to the side
• b.Attempt to arouse the client with a sternal rub
• c.Report the respiratory rate to the nursing supervisor
• d.Open the airway and begin assisted ventilation✓

Severe respiratory depression is treated by supporting ventilation immediately. Reporting, attempting arousal, and side-lying positioning all leave the client hypoventilating while they are carried out.

A client with schizophrenia states that the television is sending personal messages. What is the appropriate response?

• a.I understand that seems real, and I do not hear it✓
• b.The television cannot send messages to any person
• c.Let us turn the television off so it will stop now
• d.What message is the television sending to you now

Acknowledging the client's experience while stating the nurse's own perception maintains trust without reinforcing the delusion. Flat contradiction invites argument, exploring content reinforces the delusion, and removing the television treats it as real.

An LPN/VN observes that a client with depression has not showered in three days. What should the LPN/VN do?

• a.Wait until the client's mood improves this week
• b.Offer a specific time and assist with the shower✓
• c.Explain why daily hygiene matters for the client
• d.Ask the client whether a shower is wanted today

A client with depression is often unable to initiate, so structure and hands-on assistance work best. An open choice invites refusal, an explanation adds no capacity, and waiting for the mood to improve leaves the need unmet.

A client is admitted with a blood alcohol level well above the legal limit and reports drinking daily for years. Which finding should the LPN/VN report as an early sign of withdrawal?

• a.A flushed face with the odor of alcohol present
• b.Pinpoint pupils with slow, shallow respirations
• c.Hand tremors with a pulse of 108 beats per minute✓
• d.Slurred speech with an unsteady, wide-based gait

Tremor and tachycardia in the first hours after the last drink are early withdrawal signs and must be reported. Slurred speech and ataxia reflect intoxication, pinpoint pupils suggest opioids, and flushing with odor reflects recent drinking.

An LPN/VN is caring for a client who reports feeling anxious before surgery. Which action helps most?

• a.Ask what the client understands about the surgery✓
• b.Offer to close the door so the client can be alone
• c.Tell the client the surgeon has done many of these
• d.Describe the recovery room in step-by-step detail

Finding out what the client already knows identifies the specific fear that is driving the anxiety. Reassurance about the surgeon, unrequested detail, and leaving the client alone all address anxiety without knowing its source.

A client with a hearing impairment is scheduled for a procedure and reads lips. What should the LPN/VN do?

• a.Face the client in good light while speaking✓
• b.Stand beside the client and speak into the ear
• c.Exaggerate the mouth movements while speaking
• d.Speak louder so the words are easier to catch

Lip reading requires an unobstructed, well-lit view of the speaker's face at a normal speaking rate. Volume does not help a lip reader, exaggerated movement distorts the shapes, and standing at the side removes the view entirely.

An LPN/VN finds a client in tears after a family visit and the client says, 'Please do not tell anyone.' The client then describes being hit at home. What should the LPN/VN do?

• a.Explain that the report must be made✓
• b.Wait for the client to bring it up again before acting
• c.Agree to keep the disclosure between the two of them
• d.Ask the client to repeat the account to the family

Suspected abuse is a mandatory report, and the client is told honestly that confidentiality cannot be promised here. Agreeing to secrecy, involving the family, and waiting for another disclosure all leave the client unprotected.

An LPN/VN is caring for a client who has been placed on one-to-one observation for self-harm risk. Which action is correct?

• a.Ask another client to alert staff if anything happens
• b.Stay in the doorway while the client uses the bathroom
• c.Check on the client every fifteen minutes as ordered
• d.Remain within arm's reach of the client at all times✓

One-to-one observation means continuous, arm's-length presence including in the bathroom. Interval checks, a doorway position, and relying on another client all create unobserved time.

A client from a culture that values family decision-making asks that the adult children be present for all care discussions. What should the LPN/VN do?

• a.Ask the client to designate one child as the contact
• b.Provide the information and let the client relay it
• c.Explain that health information is given to the client
• d.Arrange the discussions when the children can attend✓

Client-reported cultural preferences are incorporated when the client wants them. Overriding the request, narrowing it to one person, and shifting the work of communication to the client all disregard the client's stated choice.

An LPN/VN notices that a client on the unit has stopped attending meals and sits alone. What should the LPN/VN do?

• a.Sit with the client and ask how the day has been✓
• b.Notify the nursing supervisor of the change
• c.Bring a meal tray to the room to save the client effort
• d.Remind the client that meals are served in the dining room

Approaching the client directly gathers the data that any next step depends on and offers support. Escalating without data, accommodating the isolation, and restating the schedule all miss the change the nurse observed.

An LPN/VN is providing postmortem care and the family asks to stay in the room. What should the LPN/VN do?

• a.Explain that the care must be completed right away
• b.Invite the family to help with the postmortem care
• c.Ask the family to wait in the lounge during the care
• d.Offer the family private time before the care begins✓

Allowing private time supports grieving and is standard practice before postmortem care. Refusing, redirecting the family to a lounge, and recruiting them into the physical care all disregard the family's request.

An LPN/VN is participating in a reminiscence activity with older adults. Which action fits that therapy?

• a.Ask the group to name today's date and season
• b.Ask the group about a favorite childhood meal✓
• c.Ask each member to state a goal for the week
• d.Ask the group to identify the objects on a tray

Reminiscence therapy invites recall of meaningful past experiences. Naming the date is reality orientation, goal setting is a different intervention, and object identification is a cognitive screening task.

A client who is blind is admitted to the unit. Which action should the LPN/VN take?

• a.Rearrange the furniture so the path is the shortest
• b.Ask the family to stay overnight for the first night
• c.Keep the door closed so hallway noise is reduced
• d.Orient the client to the room by walking the layout✓

Systematic orientation to a fixed room layout lets the client move safely and independently. Rearranging furniture, relying on family presence, and closing off sound cues all reduce the client's ability to navigate.

A client repeatedly presses the call light within minutes of each visit. What should the LPN/VN do?

• a.Move the call light farther from the client's reach
• b.Report the frequent calls to the nursing supervisor
• c.Explain that other clients also need the nurse's time
• d.Round on the client at planned set intervals✓

Scheduled rounding meets the underlying need for reassurance and reduces call frequency. Escalating, appealing to fairness, and moving the call light out of reach all leave the need unmet, and the last is unsafe.

An LPN/VN is preparing to give a bolus feeding through a nasogastric tube. How should the client be positioned?

• a.With the head of the bed raised 30 to 45 degrees✓
• b.Flat on the back with the head turned to one side
• c.Sitting upright with the neck flexed toward the chest
• d.On the left side with the head of the bed lowered

Elevating the head of the bed 30 to 45 degrees during and after a feeding reduces reflux and aspiration. Supine positioning and Trendelenburg increase reflux, and neck flexion narrows the airway.

A client with a newly inserted nasogastric tube is about to receive the first feeding. What confirms correct tube placement?

• a.A radiograph read after the tube was inserted✓
• b.Air injected while listening over the epigastrium
• c.Aspirate with a pH of 5.5 from the tube
• d.Absence of coughing when the client swallows water

Radiographic confirmation is the standard before the first use of a blindly inserted feeding tube. A pH of 5.5 is not clearly gastric, the auscultatory air method is unreliable, and absence of coughing does not exclude a tube in the airway.

An LPN/VN is repositioning a client who is on bed rest. How should the client be turned to reduce pressure on the trochanter?

• a.To a 90-degree side-lying position on the hip
• b.To a 30-degree side-lying position✓
• c.To a prone position with the arms above the head
• d.To a fully supine position with the knees flexed

A 30-degree lateral tilt keeps weight off the greater trochanter. Lying directly on the hip concentrates pressure there, supine loading shifts pressure to the sacrum and heels, and prone positioning is not tolerated by most clients.

An LPN/VN observes a reddened area over a client's sacrum that does not turn white when pressed. How should this be described?

• a.Intact skin with nonblanchable redness of the area✓
• b.Partial-thickness skin loss with a shallow open base
• c.Skin loss covered by adherent yellow slough tissue
• d.Full-thickness skin loss with visible subcutaneous fat

Nonblanchable erythema over intact skin is the earliest recognizable pressure injury. Partial-thickness loss, visible fat, and slough-covered loss all describe deeper or obscured injuries.

An LPN/VN is providing care for a client with a stage 2 pressure injury on the heel. Which action is appropriate?

• a.Position the client on that heel for short periods
• b.Massage the reddened skin around the injury
• c.Apply a heat lamp to the area twice each day
• d.Keep the heel elevated off the surface of the bed✓

Offloading the heel removes the pressure that caused the injury. Massage over a compromised area causes further tissue damage, heat lamps dry and burn fragile skin, and any weight bearing continues the injury.

A client who had a stroke has difficulty swallowing. What should the LPN/VN do during meals?

• a.Place food on the weaker side of the client's mouth
• b.Offer thin liquids through a straw between the bites
• c.Seat the client upright and have the chin tucked down✓
• d.Seat the client upright and have the chin lifted up

An upright position with a chin tuck narrows the airway entrance and directs food toward the esophagus. Chin lift opens the airway to food, thin liquids through a straw move fastest and are hardest to control, and the weaker side pockets food.

An LPN/VN is helping a client ambulate with a cane after a right hip replacement. How should the cane be used?

• a.Held in the left hand and moved with the right leg✓
• b.Held in the left hand and moved with the left leg
• c.Held in the right hand and moved before both legs
• d.Held in the right hand and moved with the right leg

The cane is held on the stronger side and advanced together with the weaker leg so the two share the load. Holding it on the affected side, pairing it with the strong leg, or advancing it alone all fail to unload the operative hip.

An LPN/VN is teaching a client with an ostomy about emptying the pouch. When should the pouch be emptied?

• a.When it is completely full at the end of the day
• b.Only when the seal begins to leak
• c.Every four hours whether or not there is output
• d.When it is about one-third to one-half full✓

Emptying at one-third to one-half full keeps the weight from breaking the seal. Waiting until full or until leakage begins guarantees seal failure, and a fixed schedule ignores actual output.

An LPN/VN is caring for a client with an indwelling urinary catheter. Which action prevents infection?

• a.Empty the drainage bag once each work shift
• b.Coil the extra tubing loosely on the bed surface
• c.Disconnect the tubing to obtain a urine specimen
• d.Keep the drainage bag below the bladder✓

Keeping the bag below the bladder prevents backflow of contaminated urine. A fixed emptying schedule may allow overfilling, breaking the closed system introduces organisms, and tubing on the bed can allow dependent loops and reflux.

A client reports constipation and is on a bowel management protocol. Which nonpharmacological measure should the LPN/VN reinforce first?

• a.Increase fluid intake and daily walking as tolerated✓
• b.Increase dietary fiber without changing fluid intake
• c.Restrict food intake until the bowel pattern returns
• d.Use a bedpan rather than walking to the bathroom

Fluid and activity together restore normal transit. Fiber without fluid worsens constipation, bedpan use makes evacuation harder, and restricting food removes the bulk the colon needs.

An LPN/VN is providing morning care for a client with diabetes. Which foot care action is correct?

• a.Dry carefully between the toes after washing✓
• b.Soak the feet in warm water for twenty minutes
• c.Apply lotion generously between the toes
• d.Trim the toenails in a curve at the corners

Moisture between the toes promotes fungal infection and skin breakdown, so the area is dried thoroughly. Soaking macerates skin, curved nail trimming causes ingrown nails, and lotion between the toes traps moisture.

An LPN/VN is caring for a client who is receiving continuous enteral feeding. Which finding suggests intolerance?

• a.Two soft formed stools during the day shift
• b.Abdominal distention with new nausea✓
• c.A residual volume of 60 mL after four hours
• d.Bowel sounds present in all four quadrants

Distention with nausea suggests delayed gastric emptying and possible aspiration risk. A modest residual, normal stools, and present bowel sounds are all expected during tolerated feeding.

An LPN/VN is planning nonpharmacological pain relief for a client with chronic low back pain. Which measure is appropriate?

• a.Ice applied continuously for two hours at a time
• b.Vigorous deep massage directly over the spine
• c.Repositioning with pillow support and slow massage✓
• d.Complete bed rest until the pain fully resolves

Repositioning with support and gentle massage relieve muscle tension without harm. Prolonged bed rest worsens back pain, deep pressure over the spine can injure, and unbroken two-hour ice application damages tissue.

An LPN/VN is measuring intake and output for a client. Which item counts as intake?

• a.The applesauce the client ate at breakfast
• b.The gelatin dessert the client ate at lunch✓
• c.The mashed potatoes served with the dinner
• d.The oatmeal the client finished this morning

Gelatin is liquid at body temperature and is counted as fluid intake. Applesauce, mashed potatoes, and oatmeal are semisolid foods and are not recorded as fluid.

An LPN/VN is performing range-of-motion exercises for an immobilized client. Which action is correct?

• a.Move each joint to the point of resistance only✓
• b.Complete the movements as quickly as tolerated
• c.Perform the exercises only on the unaffected side
• d.Move each joint slightly beyond the point of pain

Movement stops at resistance to protect the joint. Pushing past pain injures tissue, exercising only one side allows contractures on the other, and rapid movement increases spasticity and injury risk.

A client with a hearing aid is admitted to a long-term care unit. How should the LPN/VN store the device overnight?

• a.Turned on and left in the client's bedside drawer
• b.Turned off and sealed in an airtight plastic bag
• c.Turned off with the battery compartment open✓
• d.Turned on and placed in a cup of clean water

Turning the aid off and opening the battery door conserves the battery and lets moisture escape. Water destroys the device, an airtight bag traps moisture, and leaving it on drains the battery.

An LPN/VN is providing postmortem care. Which action should be completed first?

• a.Confirm that the death has been pronounced✓
• b.Wash the body and apply a clean gown
• c.Remove all tubes and lines from the body
• d.Place the body in a supine position with a pillow

Care begins only after the death has been formally pronounced, and in some cases lines must remain in place for the medical examiner. Removing lines, positioning, and bathing all come after that confirmation.

An LPN/VN is preparing a client for sleep. Which measure promotes rest?

• a.Offer a caffeinated beverage in the early evening
• b.Encourage a two-hour nap in the late afternoon
• c.Cluster care so the client has uninterrupted time✓
• d.Keep the overhead lights on for safety checks

Grouping care allows longer uninterrupted sleep cycles. Evening caffeine, bright overhead light, and long late naps all interfere with sleep onset and continuity.

An LPN/VN is assisting a client with a bed bath. Which action is correct?

• a.Wash from the inner to the outer corner of the eye✓
• b.Wash from the outer to the inner corner of the eye
• c.Use soap on the eyelids to remove dried drainage
• d.Use the same section of cloth for both of the eyes

Cleansing from inner to outer canthus moves debris away from the lacrimal duct. Reversing the direction pushes debris into the duct, soap irritates the eye, and reusing the cloth transfers organisms between eyes.

A client with an ileostomy asks about the expected output. What should the LPN/VN reinforce?

• a.The output becomes formed within a few weeks
• b.The output should be measured only once each day
• c.The output requires irrigation each morning
• d.The output stays loose and is emptied often✓

An ileostomy drains loose stool continuously because the colon is no longer absorbing water, so the pouch is emptied frequently and the output never becomes formed. Formed stool, once-daily measurement, and irrigation apply to a descending or sigmoid colostomy, not an ileostomy.

An LPN/VN is caring for a client who uses a walker. Which observation indicates safe use?

• a.The client steps forward before moving the walker
• b.The client's elbows are slightly bent on the grips✓
• c.The client's arms are fully straight when gripping it
• d.The client lifts the walker with each single step

About 15 to 30 degrees of elbow flexion means the walker height is correct. Fully straight arms mean it is too tall, stepping before advancing it removes the support, and lifting it with every step is unstable for a client who needs one.

An LPN/VN is caring for a client on a bladder management protocol after catheter removal. Which finding should be reported?

• a.Voiding 250 mL four hours after the catheter removal
• b.No voiding eight hours after the catheter was removed✓
• c.Mild burning during the first voiding after removal
• d.A sensation of urgency with the first two voidings

No urine output eight hours after removal suggests retention and requires a bladder scan and further action. An adequate first void, transient urgency, and brief burning are all common after catheter removal.

An LPN/VN is irrigating a client's ear as ordered. Which action is correct?

• a.Direct the solution toward the wall of the ear canal✓
• b.Direct the solution straight at the tympanic membrane
• c.Occlude the canal with the syringe tip during flow
• d.Use a solution taken directly from the refrigerator

Aiming at the canal wall lets solution flow around and out, carrying debris with it. Direct pressure on the eardrum can rupture it, cold solution causes vertigo, and occluding the canal traps pressure inside.

An LPN/VN is assisting an immobilized client to prevent complications. Which measure prevents venous stasis?

• a.Keep the legs crossed at the ankles while in bed
• b.Place a pillow under the knees to support the legs
• c.Massage the calf muscles firmly twice each day
• d.Perform hourly ankle pumping while awake✓

Active ankle movement uses the calf muscle pump to move venous blood. A pillow under the knees and crossed ankles both compress popliteal vessels, and calf massage can dislodge an existing clot.

An LPN/VN is evaluating pain in a client with advanced dementia who cannot report it. Which tool is appropriate?

• a.A numeric rating scale explained slowly to the client
• b.A visual analog line the client marks with a pen
• c.The family member's estimate of the client's pain
• d.A behavioral observation scale validated for dementia✓

A validated behavioral scale scores observed indicators such as breathing, vocalization, and body language. Numeric and visual analog scales require abstraction the client cannot do, and a family estimate is not a validated measure.

An LPN/VN is providing site care for a client's gastrostomy tube. Which finding should be reported?

• a.A small amount of clear drainage at the site
• b.Slight rotation of the external bumper on the tube
• c.Green drainage with redness at the site✓
• d.A healed track with intact skin around the tube

Purulent drainage with erythema suggests infection at the exit site. Scant clear drainage, minor bumper rotation, and intact healed skin are all expected findings.

A client on a mechanical soft diet is served a meal tray. Which item should the LPN/VN remove?

• a.The scrambled eggs served with the meal
• b.The raw carrot and celery sticks✓
• c.The ground meat with gravy on the plate
• d.The canned peaches in the small dish

Raw crisp vegetables require chewing that a mechanical soft diet is designed to avoid. Ground meat, scrambled eggs, and canned fruit all meet the texture requirement.

An LPN/VN uses music therapy with a client who has chronic pain. Which action is appropriate?

• a.Play the unit's usual relaxation recording for all
• b.Use the music instead of the ordered analgesic dose
• c.Play the music at a volume that masks unit noise
• d.Let the client select the music that will be played✓

Client-selected music is what makes the intervention effective. A standard recording ignores preference, substituting music for an ordered analgesic withholds treatment, and loud volume adds a stressor.

An LPN/VN finds a client's intravenous site cool, pale, and swollen with no blood return. What should the LPN/VN do first?

• a.Slow the infusion rate and recheck in an hour
• b.Stop the infusion and remove the catheter✓
• c.Reposition the arm and restart the infusion
• d.Apply a warm compress and continue the infusion

Infiltration is managed by stopping the infusion and removing the catheter, which the 2026 PN test plan lists as an LPN/VN activity. Repositioning and restarting, slowing the rate, and applying heat while the infusion continues all allow more fluid into the tissue.

An LPN/VN is monitoring a client receiving a unit of packed red blood cells. Which finding requires the transfusion to be stopped?

• a.Chills and low back pain fifteen minutes into the unit✓
• b.A brief feeling of coolness from the refrigerated blood
• c.Anxiety about receiving blood from an unknown donor
• d.A temperature rise from 36.8 to 37.0 degrees Celsius

Chills with flank or low back pain early in a transfusion suggests an acute hemolytic reaction, and the transfusion is stopped immediately with the line kept open by normal saline. A 0.2-degree rise, the sensation of cool blood, and anxiety are not transfusion reactions.

An LPN/VN is preparing to collect a clean-catch midstream urine specimen. Which instruction is correct?

• a.Begin voiding, then collect the middle portion✓
• b.Collect the entire voiding in the sterile cup
• c.Collect a specimen from the toilet water bowl
• d.Collect the first portion of the urine stream

The midstream portion is collected after the initial stream has flushed the urethra. The first portion carries periurethral organisms, a whole voiding overflows the cup, and toilet water is contaminated.

An LPN/VN performs a blood glucose check and the result is 48 mg/dL in an alert client. What should the LPN/VN do first?

• a.Recheck the glucose on a second meter
• b.Notify the nursing supervisor of the glucose value
• c.Give the client a peanut butter and cheese snack
• d.Give 15 grams of a fast-acting carbohydrate✓

An alert, hypoglycemic client is treated at once with 15 grams of rapidly absorbed carbohydrate and rechecked in 15 minutes. Reporting first, repeating the test, and offering a protein and fat snack all delay the sugar the client needs now.

An LPN/VN is applying sequential compression devices to a postoperative client. Which action is correct?

• a.Apply the sleeves over the client's knee-high socks
• b.Confirm that two fingers fit under the applied sleeve✓
• c.Apply the sleeves to a leg with a newly reddened calf
• d.Remove the sleeves only during the night sleep hours

A two-finger fit means the sleeve is snug without constricting. Applying over bunched socks creates pressure points, removing them at night defeats their purpose during the least mobile hours, and applying them to a leg with suspected thrombosis can dislodge a clot.

An LPN/VN is performing a venipuncture. How long may the tourniquet remain in place?

• a.Until the site has been cleaned and has dried
• b.Until every tube in the order has been filled
• c.No longer than five minutes
• d.No longer than one minute before the draw✓

A tourniquet left longer than about one minute causes hemoconcentration and alters results. Five minutes, the length of the whole draw, and the cleaning interval all exceed that limit.

An LPN/VN is caring for a client who returned from a cardiac catheterization through the right femoral artery. Which finding requires immediate reporting?

• a.A heart rate of 68 with the client lying flat
• b.A cool right foot with a weak pedal pulse✓
• c.A report of mild aching in the right groin area
• d.A small bruise at the insertion site of the catheter

Coolness with a diminished distal pulse suggests arterial occlusion in the catheterized limb. Bruising, mild groin aching, and a normal heart rate on bed rest are expected after the procedure.

An LPN/VN is monitoring a client after a thyroidectomy. Which finding should be reported immediately?

• a.A small amount of drainage on the dressing
• b.A sore throat when the client swallows fluids
• c.Tingling around the mouth and in the fingers✓
• d.Hoarseness of the voice on the first day

Perioral and fingertip tingling suggests hypocalcemia from parathyroid injury and can progress to tetany and laryngospasm. Sore throat, temporary hoarseness, and scant drainage are expected after this surgery.

An LPN/VN is caring for a client with a new plaster cast on the right forearm. Which finding requires immediate reporting?

• a.An itching sensation under the cast
• b.Slight swelling of the fingers on elevation
• c.Pain that increases despite analgesia✓
• d.Warmth of the cast during the drying period

Escalating pain unrelieved by analgesia is the earliest sign of compartment syndrome. Itching, warmth from the curing plaster, and mild swelling that responds to elevation are all expected.

An LPN/VN is preparing a client for surgery in the morning. Which action reduces postoperative pulmonary complications?

• a.Teach the incentive spirometer before surgery✓
• b.Plan to keep the client on bed rest for two days
• c.Teach the client to breathe rapidly and shallowly
• d.Teach the client to avoid coughing after surgery

Learning the spirometer before surgery, when the client is comfortable and alert, makes postoperative use effective. Avoiding cough, prolonged bed rest, and shallow breathing all promote atelectasis.

An LPN/VN checks a client for urinary retention. Which method gives the most reliable measurement?

• a.The client's report of a full or empty bladder
• b.Palpation of the lower abdomen above the pubis
• c.A bladder scan done after the client voids✓
• d.A record of the volume of the client's last void

A postvoid bladder scan measures residual volume directly and noninvasively. Palpation is imprecise, a voided volume says nothing about what remains, and a client's sensation is unreliable in retention.

An LPN/VN is monitoring nasogastric suction for a client after abdominal surgery. Which finding should be reported?

• a.Green drainage collecting slowly in the canister
• b.Complaints of dryness of the mouth and lips
• c.Bright red blood filling the collection canister✓
• d.Intermittent bubbling in the suction control chamber

Bright red blood in gastric drainage suggests active bleeding and must be reported. Green gastric drainage, expected suction function, and oral dryness are all typical during nasogastric suction.

An LPN/VN is performing neurological checks on a client after a head injury. Which change should be reported immediately?

• a.A blood pressure that has risen by 4 millimeters
• b.A pulse that has changed from 74 to 80 per minute
• c.A report of a mild headache relieved by rest
• d.A pupil that is now larger and reacts sluggishly✓

A newly dilated, sluggish pupil suggests rising intracranial pressure with cranial nerve compression. Small blood pressure and pulse changes and a relieved headache are not signs of deterioration.

An LPN/VN is assisting with a lumbar puncture. How should the client be positioned?

• a.Prone with a pillow placed under the abdomen
• b.Sitting upright with the neck extended backward
• c.Side-lying with the knees drawn up to the chest✓
• d.Supine with the head of the bed fully flat

A side-lying curled position separates the vertebral spaces so the needle can pass. Prone positioning blocks access, supine positioning gives no separation, and neck extension does not affect the lumbar spine.

An LPN/VN is caring for a client with a central venous catheter and notices the cap is off and the line is open to air. What should the LPN/VN do first?

• a.Place a new sterile cap on the open catheter hub
• b.Lower the head of the bed and observe the client
• c.Clamp the catheter close to the insertion site✓
• d.Notify the nursing supervisor about the open line

Clamping stops air entry immediately, which is the danger in an open central line. Reporting, capping before clamping, and repositioning all leave the line open while they are done.

An LPN/VN is collecting a sputum specimen for culture. When should the specimen be collected?

• a.At bedtime after the evening oral care
• b.Immediately after the client finishes breakfast
• c.Early in the morning before the client eats✓
• d.During the afternoon when secretions loosen

An early morning specimen contains overnight secretions and the highest organism yield. Post-meal collection risks emesis and contamination, and afternoon and bedtime specimens are more dilute.

An LPN/VN is applying elastic compression stockings. When should they be applied?

• a.In the evening before the client goes to sleep
• b.After the client has been sitting up for an hour
• c.In the morning before the client gets out of bed✓
• d.After the client has walked in the hallway once

Applying them before the legs become dependent prevents venous pooling. Any application after the client has been upright traps the pooled blood the stockings are meant to prevent.

An LPN/VN is monitoring a client on a continuous cardiac monitor and the tracing shows a flat line. What should the LPN/VN do first?

• a.Check the client for a pulse and responsiveness✓
• b.Notify the nursing supervisor about the tracing
• c.Print the strip and place it in the client's record
• d.Replace the electrodes and reposition the leads

A monitor finding is confirmed at the bedside before anything else, because the client is either in asystole or the leads are loose. Reporting, changing electrodes, and printing all delay identifying an arrest.

An LPN/VN is caring for a client scheduled for a colonoscopy. Which finding indicates the preparation was effective?

• a.The client drank half of the prescribed solution
• b.The client reports feeling hungry now
• c.The client passed three formed stools overnight
• d.The last stool passed was clear yellow liquid✓

Clear liquid effluent shows the bowel is adequately cleansed. Formed stool, partial preparation intake, and hunger do not demonstrate cleansing.

An LPN/VN is performing a circulatory check on a client's leg after a vascular procedure. Which technique is correct?

• a.Assess only the leg that had the procedure done
• b.Compare pulses, color, and warmth to the other leg✓
• c.Ask the client whether the leg feels the same as before
• d.Use a blood pressure cuff to check the leg pulses

Side-to-side comparison identifies changes that a single-limb check misses. Checking only the treated leg, using a cuff instead of palpating pulses, and relying on the client's sensation all miss early arterial compromise.

An LPN/VN is preparing to perform a 12-lead electrocardiogram. Where is lead V1 placed?

• a.At the fourth intercostal space to the left of the sternum
• b.At the fifth intercostal space in the anterior axillary line
• c.At the fifth intercostal space in the midclavicular line
• d.At the fourth intercostal space to the right of the sternum✓

V1 sits at the fourth intercostal space at the right sternal border. The left fourth space is V2, the left fifth midclavicular is V4, and the left fifth anterior axillary is V5.

An LPN/VN reviews a client's laboratory results and finds a potassium level of 2.8 mEq/L. Which finding is consistent with this result?

• a.Increased deep tendon reflexes with cramping
• b.Muscle weakness with a soft, distended abdomen✓
• c.Muscle spasm with a positive Chvostek sign
• d.Numbness of the lips with muscle twitching

Hypokalemia produces skeletal muscle weakness and decreased gastrointestinal motility. Chvostek sign, perioral numbness with twitching, and hyperreflexia all reflect hypocalcemia rather than low potassium.

An LPN/VN is monitoring a client with a peripheral intravenous catheter and finds the vein red, warm, and firm along its course. What should the LPN/VN do?

• a.Flush the catheter with saline to test the patency
• b.Apply a cold pack and leave the catheter in place
• c.Discontinue the infusion and remove the catheter✓
• d.Reduce the infusion rate and continue the therapy

A red, warm, cordlike vein is phlebitis, and the catheter is removed. Slowing the rate, cooling the site, and flushing all continue to expose the inflamed vein.

An LPN/VN is preparing to insert an indwelling urinary catheter in a female client. Which action maintains sterile technique?

• a.Hold the labia apart until the catheter is inserted✓
• b.Release the labia to reach for the lubricated catheter
• c.Use the dominant hand to hold the labia apart
• d.Reposition the client after the field has been opened

The hand separating the labia becomes contaminated and must not move until the catheter is in place. Releasing the labia recontaminates the meatus, holding with the dominant hand contaminates the insertion hand, and repositioning disturbs the field.

An LPN/VN measures a client's orthostatic vital signs. Which result indicates orthostatic hypotension?

• a.A pulse increase of 8 beats per minute on standing
• b.A diastolic drop of 6 millimeters of mercury on standing
• c.A systolic drop of 8 millimeters of mercury on standing
• d.A systolic drop of 24 millimeters of mercury on standing✓

Orthostatic hypotension is a fall of at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing. Drops of 8 and 6 mmHg and a rise of 8 beats per minute are all within normal variation.

An LPN/VN is reinforcing education before a client's magnetic resonance imaging study. Which client statement requires follow-up?

• a.I still have my pacemaker from last year✓
• b.I can ask for earplugs during the loud scan
• c.I will need to lie still for the whole study
• d.I removed my watch and my wedding ring

An implanted pacemaker may be a contraindication and must be reported before the study. Lying still, noise protection, and removing metal objects are all correct understandings.

An LPN/VN is monitoring a client after a paracentesis. Which finding should be reported immediately?

• a.A weight that is 3 kilograms lower than before
• b.A report of relief from the abdominal pressure
• c.A small amount of fluid at the site
• d.A pulse of 124 with a falling blood pressure✓

Tachycardia with hypotension after fluid removal suggests hypovolemia or bleeding. Minor site leakage, symptom relief, and weight loss matching the volume removed are all expected.

An LPN/VN is caring for a client whose only working glucometer on the unit has failed its quality control check. What should the LPN/VN do?

• a.Borrow a client's personal meter from the bedside
• b.Delay the glucose checks until the next work shift
• c.Use the failed meter and note the result
• d.Ask the nursing supervisor for a working meter✓

A device that fails quality control is removed from use and replacement equipment is arranged through the chain of command. Using it anyway, borrowing an uncalibrated personal device, and skipping ordered checks all produce unsafe glucose management.

An LPN/VN finds an unresponsive adult client with no normal breathing and no pulse. At what rate should chest compressions be delivered?

• a.80 to 100 compressions each minute
• b.100 to 120 compressions each minute✓
• c.130 to 150 compressions each minute
• d.60 to 80 compressions each minute

Current resuscitation guidelines specify a compression rate of 100 to 120 per minute for adults. Slower rates deliver inadequate perfusion, and rates above 120 shorten filling time between compressions.

An LPN/VN is performing chest compressions on an adult during a cardiac arrest. How deep should each compression be?

• a.At least 2 inches, about 5 centimeters✓
• b.At least half the depth of the chest wall
• c.At least 1 inch, about 2.5 centimeters
• d.At least 3 inches, about 7.5 centimeters

Adult compressions are at least 2 inches deep and not more than about 2.4 inches. One inch is too shallow to generate flow, 3 inches exceeds the safe range, and half the chest depth is the pediatric guideline of about one third.

An LPN/VN is giving CPR alone to an adult before a defibrillator arrives. What compression to ventilation ratio should be used?

• a.10 compressions to 2 breaths
• b.15 compressions to 2 breaths
• c.5 compressions to 1 breath
• d.30 compressions to 2 breaths✓

A single rescuer without an advanced airway uses 30 compressions to 2 breaths in an adult. Fifteen to two is the two-rescuer pediatric ratio, and the other ratios are not used in current practice.

An LPN/VN is suctioning a client's tracheostomy. How long should each suction pass last?

• a.No longer than 40 to 45 seconds
• b.Until the secretions have all cleared
• c.No longer than 25 to 30 seconds
• d.No longer than 10 to 15 seconds✓

Each pass is limited to 10 to 15 seconds because suction removes oxygen along with secretions. Longer passes and suctioning until clear both cause hypoxemia and can trigger bradycardia.

An LPN/VN is suctioning a client's tracheostomy. When should suction be applied?

• a.Continuously from insertion until removal
• b.While advancing the catheter into the airway
• c.Only after the catheter reaches the carina
• d.While withdrawing and rotating the catheter✓

Suction is applied on withdrawal to limit hypoxemia and mucosal injury. Applying it on insertion or continuously damages tissue, and advancing to the carina causes trauma and bradycardia.

An LPN/VN finds a client's chest tube disconnected from the drainage system. What should the LPN/VN do first?

• a.Notify the nursing supervisor that the tube came apart
• b.Tape the two ends together and check for bubbling
• c.Clamp the chest tube close to the chest wall
• d.Place the open end in sterile water at the bedside✓

Submerging the end creates a temporary water seal that stops air from entering the pleural space. Reporting, clamping, and reconnecting a contaminated end all risk a tension pneumothorax or infection.

An LPN/VN is caring for a client with a chest tube and observes continuous bubbling in the water seal chamber. What does this indicate?

• a.Obstruction of the tubing by a clot or debris
• b.An air leak in the system or the client✓
• c.Full reexpansion of the client's collapsed lung
• d.Normal function of the chest drainage system

Continuous bubbling in the water seal chamber signals an air leak that must be located. Intermittent bubbling with exhalation is normal, reexpansion produces no bubbling and no tidaling, and obstruction stops both bubbling and tidaling.

An LPN/VN is caring for a client receiving peritoneal dialysis and notes that the drained effluent is cloudy. What should the LPN/VN do?

• a.Record the finding and complete the next exchange
• b.Increase the dwell time for the next exchange
• c.Warm the next dialysate bag before instilling it
• d.Report the cloudy effluent to the registered nurse✓

Cloudy effluent is the classic early sign of peritonitis and must be reported so a specimen can be obtained and treatment started. Changing the dwell, warming the solution, and simply documenting all allow an infection to progress.

An LPN/VN is caring for a client with an arteriovenous fistula in the left arm. Which action is correct?

• a.Draw the morning blood work from the fistula
• b.Start an intravenous line in the left forearm
• c.Take blood pressures in the client's left arm
• d.Take blood pressures in the client's right arm✓

The fistula arm is protected from compression and punctures so the access stays patent. Cuff pressure, an intravenous start, and a venipuncture in that arm can all thrombose the access.

An LPN/VN checks a client's arteriovenous fistula and finds no thrill on palpation. What should the LPN/VN do?

• a.Document the finding and check again before dialysis
• b.Report the absent thrill to the nurse at once✓
• c.Apply a warm compress and recheck in one hour
• d.Elevate the arm on a pillow and observe the site

A missing thrill suggests the access has clotted, which is a time-sensitive problem. Warm compresses, elevation, and delayed rechecks all consume the time in which the access might be salvaged.

An LPN/VN is caring for a client with a Jackson-Pratt drain. How is suction maintained?

• a.Clamp the drain tubing between the emptying times
• b.Compress the bulb before recapping it each time✓
• c.Attach the bulb to low continuous wall suction
• d.Leave the bulb expanded so drainage flows freely

Squeezing the bulb before recapping creates the negative pressure that pulls drainage. Wall suction is not used, an expanded bulb exerts no suction, and clamping stops drainage altogether.

An LPN/VN is caring for a client whose surgical wound edges have separated with a loop of bowel visible. What should the LPN/VN do first?

• a.Apply a dry pressure dressing over the open area
• b.Cover the area with sterile saline-moistened gauze✓
• c.Notify the nursing supervisor about the open wound
• d.Push the exposed tissue gently back into the wound

Evisceration is covered with sterile moist gauze to keep the tissue viable while help is summoned and the client is kept still. Reporting first, replacing the tissue, and drying the exposed bowel all cause harm.

An LPN/VN is caring for a client with a tracheostomy who suddenly becomes restless with noisy breathing. What should the LPN/VN do first?

• a.Suction the tracheostomy to clear the airway✓
• b.Notify the registered nurse about the restlessness
• c.Raise the head of the bed and observe the client
• d.Increase the oxygen flow rate through the collar

Noisy breathing with restlessness in a client with a tracheostomy usually means secretions are obstructing the airway, and suctioning is within LPN/VN scope. Reporting, adding oxygen past an obstruction, and repositioning all leave the airway blocked.

An LPN/VN is caring for a client whose temperature is 35.1 degrees Celsius after surgery. Which measure should the LPN/VN use?

• a.Apply warmed blankets and cover the client's head✓
• b.Rub the client's arms and legs briskly with a towel
• c.Give a hot beverage while the client is still drowsy
• d.Place a heating pad on high under the client

Passive external warming with warmed blankets and head covering restores temperature safely. Vigorous rubbing can trigger arrhythmias, a heating pad under a client causes burns, and oral fluids are unsafe in a drowsy client.

An LPN/VN is performing a dressing change on a wound ordered to be packed. Which action is correct?

• a.Place a single large piece across the wound top
• b.Fill the cavity level with the surrounding skin
• c.Pack the gauze tightly into the cavity
• d.Pack the gauze loosely into the wound cavity✓

Loose packing keeps the cavity open for drainage without pressure on the wound bed. Tight packing impairs perfusion, filling level with the skin macerates the edges, and a cover piece does not pack the cavity.

An LPN/VN is caring for a client with a colostomy in the descending colon. Which stoma finding should be reported?

• a.A stoma that has become dusky purple in color✓
• b.A stoma that is pink and moist at the surface
• c.Slight swelling of the stoma in the first days
• d.A small amount of bleeding when it is cleaned

A dusky or purple stoma indicates impaired blood supply and possible necrosis. A pink moist stoma, minor bleeding from the vascular mucosa during cleaning, and early edema are all expected.

An LPN/VN is caring for a client on a ventilator and the high pressure alarm sounds. What is the most likely cause?

• a.An increase in the client's tidal volume
• b.Secretions obstructing the client's airway✓
• c.A leak around the endotracheal tube cuff
• d.A disconnection of the ventilator circuit

A high pressure alarm means resistance has increased, most often from secretions, biting, or a kink. A disconnection, a cuff leak, and a larger delivered volume all lower circuit pressure and trigger the low pressure alarm.

An LPN/VN is caring for a client with a permanent pacemaker. Which finding should be reported?

• a.A pulse of 48 with reports of light-headedness✓
• b.A pulse of 72 that is regular at rest
• c.A small bruise under the skin near the device
• d.Mild soreness at the insertion site on day one

A rate below the pacemaker's set rate with symptoms suggests the device is not capturing. A normal paced rate, early incisional soreness, and a small hematoma are expected findings.

An LPN/VN observes a client's cardiac monitor and sees a chaotic waveform with no identifiable complexes. The client is unresponsive. What should the LPN/VN do first?

• a.Obtain a full set of vital signs and a rhythm strip
• b.Check the electrodes and lead connections
• c.Start compressions and call for the defibrillator✓
• d.Notify the nursing supervisor about the rhythm change

An unresponsive client with a chaotic rhythm is in ventricular fibrillation and needs compressions and early defibrillation. Reporting, checking leads, and gathering vital signs all delay the only treatments that work.

An LPN/VN is reinforcing education for a client going home with a new tracheostomy. Which instruction should be included?

• a.Swim in a shallow pool with the neck kept above water
• b.Seal the stoma with an adhesive patch when outdoors
• c.Cover the stoma with a loose cloth when going outside✓
• d.Use a cotton ball taped over the stoma while sleeping

A loose breathable cover filters air without blocking it. Sealing the stoma obstructs breathing, swimming risks drowning through the stoma, and cotton fibers can be inhaled into the airway.

An LPN/VN is caring for a client with heart failure. Which finding suggests worsening fluid overload?

• a.A report of thirst after a salty evening meal
• b.A weight gain of 2 kilograms since yesterday✓
• c.Ankle swelling that resolves with overnight rest
• d.A weight gain of 2 kilograms over two months

Rapid weight gain of about 2 kilograms in a day reflects retained fluid, not tissue. Slow gain, dependent edema that clears overnight, and thirst after salt are not signs of decompensation.

An LPN/VN is caring for a client with chronic obstructive pulmonary disease who is receiving oxygen at 2 liters per minute by nasal cannula. The client reports increased breathlessness. What should the LPN/VN do first?

• a.Notify the nursing supervisor about the breathlessness
• b.Ask the client to breathe through the mouth
• c.Increase the oxygen flow rate to 6 liters per minute
• d.Raise the head of the bed and check the saturation✓

Positioning to ease the work of breathing and measuring the saturation are immediate LPN/VN actions that also produce the data any next step needs. Reporting first, raising the flow without an order, and rapid mouth breathing all fail the client.

An LPN/VN is removing skin staples from a healed surgical incision as ordered. Which finding should stop the procedure?

• a.A small amount of serous fluid appears at one end
• b.The incision line looks pink along its full length
• c.The wound edges separate as staples come out✓
• d.The client reports a pinching feeling with removal

Separation of the wound edges means the incision is not strong enough, and the remaining staples stay in place while the finding is reported. A pink line, a pinching sensation, and scant serous fluid are all expected.

An LPN/VN is caring for a client with a serum sodium of 122 mEq/L. Which finding should the LPN/VN expect?

• a.Extreme thirst with dry, sticky mucous membranes
• b.Increased urine output with a high specific gravity
• c.Flushed dry skin with a low-grade fever
• d.Confusion with muscle weakness and headache✓

Hyponatremia causes cerebral cell swelling, producing confusion, weakness, and headache. Intense thirst with dry membranes, flushed skin with fever, and concentrated high-volume urine all point toward hypernatremia or dehydration instead.

An LPN/VN is providing care for a client receiving hemodialysis three times weekly. Which food choice on the tray should be replaced?

• a.The baked potato served with the dinner✓
• b.The serving of applesauce with the meal
• c.The slice of white bread with the meal
• d.The white rice served with the dinner meal

Potatoes are high in potassium, which a dialysis client cannot excrete between treatments. White rice, white bread, and applesauce are all low in potassium.

An LPN/VN is caring for a client with a wound drainage device and the ordered dressing supplies are not stocked anywhere in the facility. What should the LPN/VN do?

• a.Delay the dressing change until the next work shift
• b.Reuse the outer layer of the current dressing again
• c.Ask the nursing supervisor to obtain the supplies✓
• d.Substitute the closest dressing available on the unit

When ordered supplies are unavailable facility-wide, the chain of command arranges procurement. Substituting a different product, postponing ordered care, and reusing a soiled dressing all change the treatment without authority.

An LPN/VN is caring for a client with a nasogastric tube who begins coughing and has a drop in oxygen saturation during a feeding. What should the LPN/VN do first?

• a.Stop the feeding and raise the head of the bed✓
• b.Notify the nursing supervisor about the coughing
• c.Slow the feeding rate and continue to observe
• d.Flush the tube with water to confirm patency

Stopping the infusion and elevating the head are the immediate actions that limit aspiration. Reporting, flushing, and slowing the rate all continue delivering formula into a possibly compromised airway.

An LPN/VN is reinforcing education with a client who has a new ileal conduit. Which statement indicates correct understanding?

• a.I will limit my fluids to reduce the output
• b.I will empty the pouch when it is one-third full✓
• c.I will change the pouch late in the evening
• d.I will expect the urine to be free of mucus

Emptying at one-third full protects the seal from the weight of urine. Pouch changes are easiest when output is lowest in the morning, fluids are encouraged to flush the conduit, and mucus in the urine is expected because bowel tissue produces it.

An LPN/VN receives an order for potassium chloride 20 mEq for a client with a potassium level of 3.0 mEq/L. Which action is correct?

• a.Give it as an intravenous push followed by a saline flush
• b.Give it as an intravenous push over 5 minutes
• c.Give it undiluted through the closest intravenous port
• d.Infuse it diluted at no more than 10 mEq per hour✓

Intravenous potassium is always diluted and infused with a pump at a rate that does not exceed about 10 mEq per hour. Any push or undiluted administration of potassium can cause fatal cardiac arrest.

An LPN/VN is caring for a client who is using patient-controlled analgesia for postoperative pain. Which action is correct?

• a.Press the button for a client too weak to reach it
• b.Ask a family member to press the button during sleep
• c.Raise the basal rate when the client reports more pain
• d.Reinforce that only the client presses the dose button✓

The safety of patient-controlled analgesia depends on the client being the only person who presses the button, because a client who is becoming oversedated stops pressing it. Dosing by proxy and changing the basal rate both remove that safeguard and have caused fatal respiratory depression.

An LPN/VN is mixing regular insulin and NPH insulin in one syringe. Which sequence is correct?

• a.Inject air into both vials, then draw regular before NPH✓
• b.Draw each insulin into a separate syringe and combine
• c.Inject air into both vials, then draw NPH before regular
• d.Draw the NPH first and add the regular to the syringe

Air is injected into both vials, and the clear regular insulin is drawn first so that no long-acting suspension contaminates the rapid-acting vial. Drawing NPH first or combining from two syringes both risk altering the regular insulin.

An LPN/VN is to give 250 mg of an oral medication that is supplied as 125 mg per 5 mL. How many milliliters should the LPN/VN give?

• a.5 mL
• b.20 mL
• c.15 mL
• d.10 mL✓

250 mg divided by 125 mg equals 2 doses, and 2 multiplied by 5 mL equals 10 mL. Five milliliters supplies only 125 mg, 15 mL supplies 375 mg, and 20 mL supplies 500 mg.

An LPN/VN is to infuse 1,000 mL of intravenous fluid over 8 hours using a pump. What rate should be set?

• a.125 mL per hour✓
• b.150 mL per hour
• c.200 mL per hour
• d.100 mL per hour

1,000 mL divided by 8 hours equals 125 mL per hour. At 100 mL per hour the infusion would take 10 hours, at 150 it would take about 6.7 hours, and at 200 it would take 5 hours.

An LPN/VN is reinforcing education with a client starting warfarin. Which statement indicates correct understanding?

• a.I will stop eating all green vegetables from now on
• b.I will double the dose if I forget one on a given day
• c.I will keep my intake of green vegetables about the same✓
• d.I will take an aspirin daily for my aching knee joints

Consistency of vitamin K intake, rather than avoidance, keeps the anticoagulant effect stable. Eliminating greens, doubling a missed dose, and adding daily aspirin all destabilize the therapy or increase bleeding.

An LPN/VN is giving a client eye drops in the right eye. Where should the drop be placed?

• a.In the lower conjunctival sac of the eye✓
• b.At the inner corner near the tear duct
• c.Under the upper lid with the eye closed
• d.Directly onto the center of the cornea

The lower conjunctival sac holds the drop and spreads it across the eye without touching sensitive tissue. Dropping on the cornea causes pain and blinking, the inner corner drains the drop away, and the upper lid is not accessible for instillation.