NCLEX-PN Nursing — All Questions

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.