NCLEX-PN Nursing — All Questions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which is the correct antidote pairing?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

An LPN/VN receives an order for potassium chloride 20 mEq for a client with a potassium level of 3.0 mEq/L. Which action is correct?

• a.Give it as an intravenous push followed by a saline flush
• b.Give it as an intravenous push over 5 minutes
• c.Give it undiluted through the closest intravenous port
• d.Infuse it diluted at no more than 10 mEq per hour✓

Intravenous potassium is always diluted and infused with a pump at a rate that does not exceed about 10 mEq per hour. Any push or undiluted administration of potassium can cause fatal cardiac arrest.

An LPN/VN is caring for a client who is using patient-controlled analgesia for postoperative pain. Which action is correct?

• a.Press the button for a client too weak to reach it
• b.Ask a family member to press the button during sleep
• c.Raise the basal rate when the client reports more pain
• d.Reinforce that only the client presses the dose button✓

The safety of patient-controlled analgesia depends on the client being the only person who presses the button, because a client who is becoming oversedated stops pressing it. Dosing by proxy and changing the basal rate both remove that safeguard and have caused fatal respiratory depression.

An LPN/VN is mixing regular insulin and NPH insulin in one syringe. Which sequence is correct?

• a.Inject air into both vials, then draw regular before NPH✓
• b.Draw each insulin into a separate syringe and combine
• c.Inject air into both vials, then draw NPH before regular
• d.Draw the NPH first and add the regular to the syringe

Air is injected into both vials, and the clear regular insulin is drawn first so that no long-acting suspension contaminates the rapid-acting vial. Drawing NPH first or combining from two syringes both risk altering the regular insulin.

An LPN/VN is to give 250 mg of an oral medication that is supplied as 125 mg per 5 mL. How many milliliters should the LPN/VN give?

• a.5 mL
• b.20 mL
• c.15 mL
• d.10 mL✓

250 mg divided by 125 mg equals 2 doses, and 2 multiplied by 5 mL equals 10 mL. Five milliliters supplies only 125 mg, 15 mL supplies 375 mg, and 20 mL supplies 500 mg.

An LPN/VN is to infuse 1,000 mL of intravenous fluid over 8 hours using a pump. What rate should be set?

• a.125 mL per hour✓
• b.150 mL per hour
• c.200 mL per hour
• d.100 mL per hour

1,000 mL divided by 8 hours equals 125 mL per hour. At 100 mL per hour the infusion would take 10 hours, at 150 it would take about 6.7 hours, and at 200 it would take 5 hours.

An LPN/VN is reinforcing education with a client starting warfarin. Which statement indicates correct understanding?

• a.I will stop eating all green vegetables from now on
• b.I will double the dose if I forget one on a given day
• c.I will keep my intake of green vegetables about the same✓
• d.I will take an aspirin daily for my aching knee joints

Consistency of vitamin K intake, rather than avoidance, keeps the anticoagulant effect stable. Eliminating greens, doubling a missed dose, and adding daily aspirin all destabilize the therapy or increase bleeding.

An LPN/VN is giving a client eye drops in the right eye. Where should the drop be placed?

• a.In the lower conjunctival sac of the eye✓
• b.At the inner corner near the tear duct
• c.Under the upper lid with the eye closed
• d.Directly onto the center of the cornea

The lower conjunctival sac holds the drop and spreads it across the eye without touching sensitive tissue. Dropping on the cornea causes pain and blinking, the inner corner drains the drop away, and the upper lid is not accessible for instillation.