CSLB General Building (B) — All Questions
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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.