NCLEX-PN Nursing — All Questions

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which client should the LPN/LVN assess first?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Which is the correct antidote pairing?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A restrained client requires which of the following?

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

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

During a generalized seizure, the nurse should:

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

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