CSLB General Building (B) — All Questions

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

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

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.Refuse the order because verbal orders are never allowed
• b.Write down the order, read it back, and have the RN or provider co-sign per policy✓
• c.Carry out the order and document it several hours later
• d.Ask a family member to witness the order

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

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.Confront the coworker angrily in front of clients
• c.Alter the record to correct it personally
• 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.Recommendation✓
• b.Response
• c.Rationale
• d.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 reporting new onset of shortness of breath✓
• c.A client requesting a second pillow
• d.A client asking about the lunch menu

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

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

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 reports pain rated 7 of 10 in right lower abdomen at 0900."✓
• b."Client seems to be doing fine today."
• c."Client is being difficult and uncooperative."
• d."Client probably has appendicitis."

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.Refuse the assignment and leave the facility
• b.Accept tasks within the LPN/LVN scope and ask for orientation to the unit✓
• c.Perform any task requested regardless of competence
• d.Care only for clients who require no medications

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

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

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

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.Complete tasks in the order rooms are numbered
• b.Address physiologic and safety needs before comfort or teaching needs✓
• c.Always perform the quickest tasks first
• d.Care for the client the family requests first

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.Begin full CPR immediately
• b.Call the family to ask what to do
• c.Follow the do-not-resuscitate order and notify the RN and provider✓
• d.Wait to see if the client resumes breathing

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 diagnostic laboratory tests
• b.Prescribing physical therapy
• c.Determining the medical diagnosis
• d.Reporting ongoing observations of the client's response to care✓

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.Two✓
• b.One
• c.Four
• d.Five

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

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.Extinguish the fire
• b.Activate the alarm
• c.Rescue the client from immediate danger✓
• d.Contain the fire by closing the door

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 30-year-old ambulating independently
• b.A 25-year-old admitted for observation
• c.A 40-year-old awaiting routine discharge
• d.An 80-year-old on sedatives with a history of dizziness✓

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

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

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

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.Relying on memory instead of the medication record
• c.Leaving medications at the bedside for the client to take later
• d.Checking the medication label against the order three times✓

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

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.The temperature of the food
• b.The client's name against the diet order and tray card✓
• c.The client's favorite foods
• d.Whether the client wants dessert first

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

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.Allow smoking in the room if the window is open
• b.Use petroleum-based lip balm freely
• c.Store the oxygen tank lying flat on the floor
• d.Post 'no smoking' signs and keep oxygen away from open flames✓

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

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.Keeping the drainage bag below the level of the bladder✓
• c.Disconnecting the tubing to collect samples
• d.Placing the drainage bag on the client's abdomen during transport

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 12 months
• c.At 4 years
• d.At 11 years

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 6 months✓
• c.Around 12 months
• d.Around 18 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."I will report any new lump to my provider."
• b."I will note changes in the skin or nipple."
• c."If I feel fine, I never need any screening."✓
• d."I will follow my provider's screening recommendations."

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
• b.Eliminate protein to reduce nausea
• c.Take a vitamin A megadose daily
• d.Take a prenatal vitamin containing folic acid✓

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 only once per month
• c.No strength training at any age
• d.Exercise only when symptoms appear

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
• b.Supine on a firm surface without loose bedding✓
• c.Side-lying with pillows for support
• d.Prone with a blanket for warmth

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."This is a sign of serious kidney failure."
• b."You must be admitted to the hospital immediately."
• c."Mild foot swelling late in the day is common; elevate your legs and report sudden or facial swelling."✓
• d."Stop drinking fluids to reduce the 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.Speaks in full paragraphs
• b.Rides a two-wheeled bicycle
• c.Ties own shoelaces independently
• d.Walks up stairs and uses two-word phrases✓

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.Ensure adequate calcium and vitamin D and perform weight-bearing exercise✓
• b.Avoid all physical activity to protect bones
• c.Increase caffeine and alcohol intake
• d.Avoid sunlight completely at all times

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.Give honey in the first month for energy
• d.Begin with mixed foods to identify allergies faster

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.108/68 mmHg
• b.115/72 mmHg
• c.148/94 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.Decrease fluid intake
• b.Avoid all physical activity
• c.Rely on daily enemas
• d.Increase dietary fiber, fluids, and activity as tolerated✓

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.Apply broad-spectrum sunscreen and avoid peak midday sun✓
• b.Use tanning beds instead of sun exposure
• c.Apply sunscreen only in winter
• d.Rely on a base tan for protection

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.Mild breast tenderness
• b.Vaginal bleeding with abdominal cramping✓
• c.Increased frequency of urination
• d.Occasional mild fatigue

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."My teen should have no interest in peers."
• b."My teen should depend on me for all decisions."
• c."It is normal for my teen to seek independence and value peer relationships."✓
• d."My teen will not question family rules."

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

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

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.Paraphrasing✓
• c.Offering false reassurance
• d.Changing the subject

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

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

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

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

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.Insist the client describe the event in detail immediately
• b.Tell the client to move past the experience
• c.Provide a safe, private environment and allow the client to talk when ready✓
• d.Discuss the incident within earshot of other clients

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.Expressing hope about future plans
• b.Attending group therapy sessions
• c.Discussing coping strategies with the nurse
• d.Giving away personal possessions and stating goodbyes✓

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.Respect the client's wishes and involve the family as the client directs✓
• b.Insist that only the client receive information
• c.Refuse because it violates confidentiality
• d.Share information only with the client's employer

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
• b.A quiet room with reduced stimulation and frequent monitoring✓
• c.A shared room with several visitors
• d.A dark, isolated room with no supervision

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 us."
• b."If you keep yelling, I will leave."
• c."You seem upset. Can you tell me what is troubling you?"✓
• d."Calm down and stop being difficult."

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.Using alcohol to relax each evening
• b.Withdrawing from all social contact
• c.Denying that any problem exists
• d.Talking with a trusted friend and using relaxation techniques✓

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."It is normal to have these feelings after surgery. Would you like to talk about it?"✓
• b."You will have to look at it eventually, so do it now."
• c."Most people adjust quickly, so don't worry."
• d."Let's not discuss it until you feel better."

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; stop asking."
• b."You seem worried. You are safe here, and I will stay with you."✓
• c."Your family abandoned you here."
• d."I already told you the answer three times."

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

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

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 crossed at the ankles
• b.Hip flexed greater than 90 degrees
• c.Legs abducted with a wedge pillow between the knees✓
• d.Turning fully onto the operative side

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.10 L/min by simple mask
• b.15 L/min by nonrebreather
• 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.Fever, chills, and flank pain shortly after the start✓
• b.Blood pressure of 120/70 mmHg
• c.Temperature unchanged from baseline
• d.Report of feeling comfortable

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.Bounding pulses and edema
• b.Dry mucous membranes and poor skin turgor✓
• c.Crackles in the lungs
• d.Distended neck veins

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 tube is connected to low suction
• b.Small amount of greenish drainage
• c.The client reports nausea and the tube has stopped draining✓
• d.The client's mouth is moist

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.Normal healthy stoma
• b.Expected postoperative bruising
• c.Adequate blood supply
• d.Possible impaired circulation that must be reported✓

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.Mild itching under the cast
• c.Pink, warm toes with brisk capillary refill
• d.The cast feels dry and firm

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.Keep the client on strict bed rest
• b.Encourage use of an incentive spirometer and coughing and deep breathing✓
• c.Withhold pain medication so the client stays alert
• d.Limit fluid intake to reduce secretions

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.Weight loss and heat intolerance
• b.Tachycardia and diarrhea
• c.Fatigue, cold intolerance, and constipation✓
• d.Restlessness and tremors

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.Stage 1 pressure injury
• b.Deep tissue injury
• c.Stage 2 pressure injury
• d.Stage 3 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.Clarify with the RN or provider whether the medication should still be given✓
• b.Automatically hold all medications because the client is NPO
• c.Give the medication with a large glass of water
• d.Double the next dose to make up for the missed one

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.Flat supine position
• b.Semi-Fowler's or Fowler's position✓
• c.Trendelenburg position
• d.Prone 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.Document as a normal finding
• b.Increase the client's activity level
• c.Report the decreased output to the RN✓
• d.Clamp the catheter for two hours

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.Have the client lie flat while eating
• b.Offer thin liquids through a straw quickly
• c.Encourage rapid eating to finish meals
• d.Position the client upright and provide thickened liquids as ordered✓

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.Apply a warm compress and continue the infusion
• d.Document and reassess at the end of the shift

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.Encourage the client to lie flat
• b.Apply oxygen as ordered and reposition to high Fowler's✓
• c.Withhold oxygen until the provider rounds
• d.Offer a cold beverage

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
• b.Hoarse voice for a few hours
• c.Tingling around the mouth and muscle twitching✓
• d.Small amount of drainage on the dressing

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.Constipation
• b.Mild anxiety
• c.Urinary retention
• d.Fat or pulmonary embolism✓

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.Eat large meals late in the evening
• c.Lie flat immediately after meals
• d.Increase caffeine and fatty foods

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

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.Pain relieved by eating
• b.Left upper quadrant burning
• c.Right lower quadrant pain with rebound tenderness✓
• d.Painless bright red rectal bleeding

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
• b.Restrict all fluids
• c.Ambulate the client rapidly and independently
• d.Assist with slow position changes and monitor for dizziness✓

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.Check the tubing and connections for an air leak and notify the RN✓
• b.Clamp the chest tube for the rest of the shift
• c.Strip the tubing vigorously and continuously
• d.Raise the drainage system above the chest

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.Kidney stones only
• b.Urinary tract infection✓
• c.Appendicitis
• d.Gallbladder disease

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.Take blood pressure on the affected arm
• b.Draw blood from the affected arm
• c.Avoid blood pressure measurement and venipuncture on the affected arm✓
• d.Keep the affected arm dependent below heart level

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.Walk barefoot at home for comfort
• b.Soak the feet in hot water daily
• c.Trim calluses with a razor at home
• d.Inspect the feet daily and wear well-fitting shoes✓

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.Right-sided weakness and difficulty with speech✓
• b.Left-sided weakness only
• c.Complete loss of vision in both eyes
• d.Inability to hear in both ears

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

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

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.Encourage a high-fat diet
• b.Maintain NPO status to rest the pancreas as ordered✓
• c.Provide frequent large meals
• d.Position the client flat on the back

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.Apical heart rate for a full minute✓
• b.The client's temperature
• 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.Blood glucose
• b.Prothrombin time and INR✓
• c.Serum potassium
• d.White blood cell count

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 with milk
• b.Take iron with an antacid
• c.Take iron with a source of vitamin C such as orange juice✓
• d.Take iron immediately after a large meal every time

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

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 away from major nerves and blood vessels✓
• b.It has the least muscle mass
• c.It is closest to the sciatic nerve
• d.It is used only for infants

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.Take it with dairy products for better absorption
• b.Avoid dairy products and antacids around the time of the dose✓
• c.Take it only at bedtime with milk
• d.Double the dose if a meal is 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.Draw up the NPH (cloudy) insulin first
• b.Shake the vials vigorously before drawing
• c.Draw up the regular (clear) insulin before the NPH (cloudy) insulin✓
• d.Never mix the two insulins in one syringe

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

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.Place the drop directly on the cornea
• c.Allow the dropper to touch the eyelashes
• d.Have the client squeeze the eyes shut tightly afterward

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 double the dose for severe pain
• b.Do not exceed the maximum recommended daily dose and check other products for acetaminophen✓
• c.Take it with alcohol for faster relief
• d.There is no maximum safe dose

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.Swallow the tablet whole with water
• b.Chew the tablet thoroughly
• c.Place the tablet under the tongue and let it dissolve✓
• d.Take three tablets at once immediately

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.Give the next scheduled opioid dose
• b.Encourage the client to sleep
• c.Document as an expected effect
• d.Withhold further opioid, stimulate the client, and notify the RN✓

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.Do not aspirate or massage the injection site✓
• b.Massage the site vigorously after injection
• c.Aspirate for blood return before injecting
• 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.Stop the medication abruptly when feeling better
• b.Do not stop the medication suddenly; taper as directed✓
• 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
• b.Round down and give 1 whole tablet
• c.Give 1 whole tablet and one-half of a scored tablet✓
• d.Crush and estimate the amount

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

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.Flush the tube with water before and after the medication✓
• b.Mix all medications together and crush enteric-coated tablets
• c.Administer the medication without checking tube placement
• 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.Serum potassium of 4.0 mEq/L
• b.Serum potassium of 5.8 mEq/L✓
• c.Normal bowel movement
• d.Blood pressure of 118/74 mmHg

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 hold my breath before pressing the inhaler."
• b."I will exhale while pressing and breathing quickly."
• c."I will breathe in slowly and deeply as I press the inhaler, then hold my breath briefly."✓
• d."I will use the inhaler only after symptoms are severe."

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.2.5 mL
• b.5 mL
• c.15 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.Withhold the medication and verify the order before giving it✓
• b.Reassure the client and give it anyway
• c.Tell the client the pharmacy changed it and proceed
• d.Give a different medication instead

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.Mild transient nausea when starting therapy
• b.Muscle pain, unusual fatigue, and difficulty breathing✓
• c.Slightly bitter taste in the mouth
• d.Occasional soft stools

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

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.Immediate relief of abdominal cramping
• b.Reduction of stomach acid
• c.Prevention of nausea
• 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.Hold the medication and notify the prescriber about the allergy✓
• b.Administer the medication as ordered
• c.Give a smaller test dose without notifying anyone
• d.Give it with an antihistamine to prevent reaction

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.Document the reaction at the end of shift
• d.Increase the infusion rate to finish the dose quickly

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 at bedtime with a heavy snack
• b.Take it only when symptoms occur
• c.Take it in the morning on an empty stomach at the same time each day✓
• d.Stop it once energy improves

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.Bright red urine
• b.Increased salivation
• c.Blurred vision
• d.Dark or black-colored stools✓

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.