NCLEX-PN Nursing — All Questions

A nurse reinforces sun-safety teaching. Which statement by the client indicates correct understanding?

• a."A base tan from a tanning bed will protect my skin from real damage."
• b."Once I have a good tan I won't need to use sunscreen anymore."
• c."I'll use broad-spectrum sunscreen and reapply it every two hours."✓
• d."Sunscreen is really only needed for long days at the beach."

Correct sun safety is broad-spectrum sunscreen reapplied every 2 hours. Relying on a "base tan," using sunscreen only at the beach, and stopping once tanned all reflect misunderstanding.

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 client with dysphagia is eating lunch. Which action prevents aspiration?

• a.Have the client lie flat so the muscles of the throat can relax
• b.Position the client upright and provide thickened liquids as ordered✓
• c.Offer plenty of thin liquids to help wash the food down quickly
• d.Encourage large bites so the client can finish the meal while it is hot

For dysphagia, position the client upright and provide thickened liquids as ordered to prevent aspiration. Thin liquids, lying flat, and large hurried bites all increase aspiration risk.

A client is receiving a tube feeding. To reduce aspiration risk, the nurse keeps the head of the bed at least:

• a.Flat (0 degrees)
• b.90 degrees at all times, even during sleep
• c.About 10 degrees
• d.30 degrees✓

Keep the head of the bed at least 30 degrees during and after tube feeding to reduce aspiration. Flat or barely raised positions increase the risk, and a rigid 90 degrees at all times is neither required nor practical for sleep.

A client 6 hours after a total hip replacement needs positioning. The nurse should:

• a.Elevate both knees sharply on pillows
• b.Turn the client fully onto the operative side
• c.Keep the legs abducted with a pillow between them✓
• d.Cross the client's legs at the ankles for comfort

After a total hip replacement, keep the legs abducted with a pillow between them to prevent dislocation. Crossing the legs, turning onto the operative side, and sharp flexion all risk dislocation.

A client with COPD is short of breath. Which oxygen approach is appropriate?

• a.High-flow oxygen at 10 L/min by simple face mask
• b.Low-flow oxygen, for example 2 L/min, targeting about 88–92%✓
• c.A nonrebreather mask at 15 L/min for routine use
• d.No supplemental oxygen, to preserve the client's hypoxic respiratory drive

In COPD, use low-flow oxygen (for example 2 L/min) targeting about 88–92%. High-flow delivery can blunt the hypoxic respiratory drive, and withholding oxygen from a hypoxic client is unsafe. *(Confirm the target with provider orders.)*

After a thyroidectomy, a client reports tingling around the mouth and muscle twitching. The nurse recognizes this as a sign of:

• a.Hyperkalemia
• b.Normal anesthesia after-effects
• c.Expected postoperative numbness that needs no action
• d.Hypocalcemia that should be reported promptly✓

Perioral tingling and muscle twitching after thyroidectomy indicate hypocalcemia (parathyroid involvement) and should be reported promptly. These findings are not benign postoperative numbness or anesthesia after-effects, and the electrolyte involved is calcium, not potassium.

Which finding in a client with heart failure should the nurse report promptly?

• a.A single episode of mild fatigue after the afternoon walk
• b.A weight gain of 3 pounds since yesterday with new crackles✓
• c.A blood pressure of 118/72 mmHg on the morning check
• d.Clear breath sounds and no edema on the evening data collection

A 3-pound weight gain with new crackles signals fluid overload in heart failure and must be reported promptly. Mild fatigue, a normal blood pressure, and clear lungs without edema are not urgent.

A nurse is teaching a parent about a mild fever and soreness after a childhood vaccine. The nurse explains that these reactions are:

• a.A reason to give a double dose next time
• b.Common, expected, and usually self-limiting✓
• c.A sign the vaccine should be stopped
• d.An allergic reaction requiring epinephrine

Mild fever and soreness after a vaccine are common, expected, and self-limiting. They are not a reason to stop the series, never a reason to change a dose, and not an allergic emergency.

Which statement by the nurse best reflects therapeutic communication?

• a."Everything is going to be just fine, don't worry."
• b."Why didn't you call the office sooner?"
• c."You seem anxious about going home. Tell me more about that."✓
• d."If I were you, I would have the surgery."

Reflecting the client's anxiety and inviting them to say more is therapeutic. False reassurance, giving advice, and a "why" question are nontherapeutic.

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.

An LPN/LVN notices a coworker about to give a medication without checking the client's identification band. The best initial action is to:

• a.Say nothing, because no actual harm has come to the client yet
• b.Report the coworker directly to the state board of nursing immediately
• c.Document the coworker's omission in the client's medical chart
• d.Remind the coworker to verify two identifiers before administering✓

The best initial action protects the client now: remind the coworker to verify two identifiers before administering. Charting the omission or saying nothing leaves the client unprotected, and escalating a single correctable slip straight to the board overshoots.

A caller who identifies himself as a client's close friend asks the nurse for an update on the client's condition. The nurse should:

• a.Provide only the room number and general condition
• b.Transfer the call to the provider to give the update
• c.Give a brief update since the friend sounds concerned
• d.Not release information without the client's authorization✓

Protected health information is not released without the client's authorization, even to a concerned friend. Sharing any update — a brief summary, the room number and general condition, or one relayed through the provider — still breaches confidentiality without consent.

Which client should the LPN/LVN report to the RN first?

• a.A client with a new-onset fever and rising heart rate✓
• b.A client whose pain improved after scheduled medication
• c.A client resting comfortably with stable vital signs
• d.A client who ate 100% of breakfast and ambulated well

A new-onset fever with a rising heart rate is a changing, potentially unstable finding that the LPN/LVN reports to the RN first. The other clients are stable or improving.

Before administering a medication, a client says the pill "looks different from the one I usually take." The nurse should:

• a.Hold the medication and verify the order and drug✓
• b.Ask the client to take it and report any effects
• c.Give a partial dose to be safe
• d.Reassure the client and give it as scheduled

When a client questions a medication, hold it and verify the order and drug before giving. Reassuring the client and giving it anyway, giving it and watching for effects, or improvising a partial dose all risk a medication error.

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 recovering from surgery is at risk for atelectasis and pneumonia. Which intervention does the nurse reinforce?

• a.Shallow breathing to protect the incision
• b.Withholding fluids to reduce secretions
• c.Strict bed rest with minimal movement
• d.Incentive spirometry, coughing, and deep breathing✓

Incentive spirometry, coughing, and deep breathing (with early ambulation) prevent atelectasis and pneumonia. Strict bed rest, withheld fluids, and shallow breathing increase the risk.

A client with a chest tube has continuous bubbling in the water-seal chamber. The nurse recognizes this as:

• a.Expected and requiring no action
• b.A reason to clamp the tube immediately
• c.A possible air leak that should be reported✓
• d.An indication to disconnect and flush the tubing

Continuous bubbling in the water-seal chamber suggests an air leak and should be reported. It is not an expected finding, and clamping or disconnecting the tube can cause a tension pneumothorax.

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.

Which action correctly follows standard precautions?

• a.Reuse gloves between two stable clients to save supplies
• b.Wear gloves only for clients with a known infection
• c.Perform hand hygiene before and after every client contact✓
• d.Recap needles by hand before disposal

Standard precautions include hand hygiene before and after every client contact. Recapping needles by hand, gloving only for known infections, and reusing gloves between clients all violate standard precautions.

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.

A client with a new colostomy turns away and says he "doesn't want to deal with it." The nurse should first:

• a.Insist that the client look at the stoma so he will adjust to it faster
• b.Tell the client that the colostomy may turn out to be temporary
• c.Begin detailed self-care teaching right away to build his confidence
• d.Acknowledge the client's feelings before starting self-care teaching✓

With a new colostomy, acknowledge the client's feelings about the body-image change before beginning self-care teaching. Jumping straight into teaching, minimizing with "it may be temporary," or insisting the client look at the stoma ignores the emotional readiness needed first.

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.

A charge nurse is planning assignments on a medical unit. Which task is appropriate to assign to unlicensed assistive personnel (UAP)?

• a.Measuring and recording intake and output for a stable client✓
• b.Reinforcing wound care instructions with a client at discharge
• c.Adjusting the flow rate on a continuous intravenous infusion
• d.Checking an apical pulse before a scheduled digoxin dose

Recording intake and output for a stable client is a routine, standardized task within the scope of unlicensed assistive personnel. Reinforcing instructions, checking an apical pulse before digoxin, and changing an infusion rate all require licensed nursing judgment and cannot be assigned to UAP.

An LPN/VN is given four tasks by the charge nurse. Which task should the LPN/VN identify as outside the LPN/VN scope of practice?

• a.Changing a dry dressing on a clean incision
• b.Collecting a urine specimen from an indwelling catheter
• c.Performing the admission assessment on a new client✓
• d.Giving a scheduled oral antihypertensive to a stable client

The initial admission assessment belongs to the registered nurse; the LPN/VN contributes data collection to it but does not perform it. Routine oral medication administration, a simple dry dressing change, and specimen collection are all within LPN/VN scope.

A client newly diagnosed with type 2 diabetes asks the LPN/VN about the meal plan that the registered nurse taught yesterday. What is the appropriate action?

• a.Reinforce the teaching the registered nurse gave✓
• b.Evaluate whether the client has met the learning outcomes
• c.Perform the initial teaching session about the new diagnosis
• d.Create an individualized teaching plan for the new diagnosis

Initial teaching, teaching-plan development, and evaluation of learning outcomes are registered nurse responsibilities. The LPN/VN reinforces content the RN has already taught and reports the client's response.

An LPN/VN reads an order in the record that states 'fluid restriction' without a specified volume. What should the LPN/VN do?

• a.Wait until the next shift and pass the question along in report
• b.Ask the registered nurse to clarify the client's fluid restriction✓
• c.Follow the written order as the nurse interprets it independently
• d.Give the amount the client's family reports was ordered at home

An order that is unclear must be clarified before it is carried out. Interpreting it independently, relying on a family report, or deferring it to the next shift all leave the client at risk of receiving the wrong volume.

An LPN/VN is assigned to titrate a continuous intravenous vasoactive infusion, which the state nurse practice act does not permit LPN/VNs to do. What should the LPN/VN do?

• a.Accept the assignment and complete the tasks as carefully as possible
• b.Trade the assignment with another LPN/VN working on the same unit
• c.Notify the nursing supervisor about the scope problem✓
• d.Document that the assignment was unsafe and proceed with the shift

An LPN/VN who is assigned work outside the legal scope of practice must report it through the chain of command before the shift proceeds. Accepting it, trading it, or simply documenting a concern leaves an unlicensed act in place.

An LPN/VN notices that a coworker arriving for the shift has slurred speech, an unsteady gait, and the odor of alcohol. What is the priority action?

• a.Discuss the observation with several colleagues before deciding
• b.Report the impairment to the nursing supervisor✓
• c.Wait to see whether the same behavior occurs on the next shift
• d.Offer to complete the coworker's medication passes for the shift

Suspected impairment of a coworker is an immediate client-safety issue and must be reported through the chain of command. Covering the coworker's work, seeking peer opinions, or waiting for a repeat episode all allow an impaired provider to continue caring for clients.

Before administering a scheduled medication, what must the LPN/VN do to confirm the correct client?

• a.Confirm the room and bed number listed on the medication record
• b.Compare the client's face with the photograph in the paper chart
• c.Ask the client to confirm the name written on the medication label
• d.Verify the client's identity using two client-specific identifiers✓

Two client-specific identifiers, such as full name and date of birth, are required before care is delivered. Room number is not client-specific, a leading question invites a confused client to agree, and a chart photograph may be outdated.

A client is found on the floor beside the bed and reports hip pain. After the client has been assessed by the registered nurse and made safe, what should the LPN/VN do?

• a.Ask the two witnesses to write statements describing what they saw
• b.Report it to the supervisor and file an incident report✓
• c.Review the unit's fall-prevention policy before deciding what to do
• d.Record the details of the fall in the client's permanent medical record

An unusual occurrence is reported through the chain of command and documented on an incident report, which is a risk-management record. The medical record documents the client's condition and care, witness statements are not the nurse's first step, and policy review does not substitute for reporting.

A caller telephones the unit and asks the LPN/VN to confirm whether a named person is a client there. What is the appropriate response?

• a.Share the diagnosis with a caller who says they are family
• b.Confirm the admission and let the caller speak with the client
• c.Provide only the client's room number and general condition report
• d.State that nothing can be released without authorization✓

Protected health information may not be disclosed to a caller without the client's authorization, regardless of the caller's stated relationship. Confirming a room number, an admission, or a diagnosis are all disclosures.

An LPN/VN is asked to witness a client's signature on a surgical consent form. Which action is within the LPN/VN role?

• a.Sign the consent form as the person obtaining the client's consent
• b.Decide whether the client has the capacity to give valid consent
• c.Confirm the client signed and appears to understand✓
• d.Explain the surgical risks and benefits before the client signs

The LPN/VN may witness a signature and verify that the form is complete. Explaining risks and benefits is the provider's duty, and determining decision-making capacity is not an LPN/VN function.

A client brings a completed advance directive to the unit on admission. What should the LPN/VN do with the document?

• a.Advise the client about which treatment choices to select on the form
• b.Complete the advance directive form on the client's behalf tonight
• c.Tell the client the document takes effect only after a hospital stay
• d.Place a copy of the advance directive in the client's medical record✓

The nurse's role is to make the existing directive part of the record and notify the team. Advising specific choices, completing the form for the client, and misstating when a directive applies all interfere with the client's own decision.

An LPN/VN in a long-term care facility observes patterned bruising on an older adult resident's upper arms. What is the required action?

• a.Ask the client's adult daughter to explain how the bruises occurred
• b.Wait for the client to describe what happened before taking action
• c.Report the suspected abuse as state law requires✓
• d.Photograph the injuries and store the images on a personal phone

Nurses are mandatory reporters and must report suspected abuse through the required channel. Questioning the suspected abuser, taking personal photographs, and waiting for a disclosure all delay protection of the client.

A client is being transferred from a medical unit to a rehabilitation unit within the facility. What should the LPN/VN do before the transfer?

• a.Send a printed summary of the chart with the transport personnel
• b.Give report to the receiving nurse before transfer✓
• c.Document the transfer and telephone the receiving unit afterward
• d.Ask the transporter to relay the client's most recent vital signs

A nurse-to-nurse handoff before transfer lets the receiving nurse ask questions and confirm understanding. A printed summary, a message passed through a transporter, and a call placed after the fact all break the two-way exchange a handoff requires.

An LPN/VN is asked to perform a sterile procedure that the LPN/VN has never performed before. What should the LPN/VN do?

• a.Ask the registered nurse to observe and guide✓
• b.Document that the procedure was unfamiliar and complete it anyway
• c.Ask another LPN/VN who has never performed it to assist instead
• d.Review the procedure manual and perform the task independently

Recognizing a personal limitation and requesting supervision is a required professional behavior. Reading a manual, pairing with an equally inexperienced colleague, or documenting the concern and proceeding all leave the client with an unsupervised novice.

An LPN/VN is invited to take part in a unit quality improvement project on alarm fatigue. Which activity is appropriate for the LPN/VN?

• a.Present the committee's conclusions to the hospital board of trustees
• b.Redesign the unit's alarm policy based on the collected findings
• c.Decide which alarm limits the unit should adopt going forward
• d.Collect data on how often the alarm sounds and record the findings✓

Participating in quality improvement by gathering data is squarely within the LPN/VN role. Rewriting policy, setting clinical parameters, and reporting to governance are responsibilities of other members of the team.

An LPN/VN begins morning care for a client who has several ordered treatments due. How should the LPN/VN involve the client in planning the morning?

• a.Complete the tasks that take the least time before the others
• b.Follow the order of tasks listed on the standard care checklist
• c.Begin with the intervention the previous shift did not finish
• d.Ask the client which concerns should be addressed first today✓

Involving the client in decisions about care is an expected professional behavior and improves adherence. A checklist order, a shortest-task-first order, and an unfinished-task order all ignore the client's stated priorities.

A client receiving intravenous antibiotics states, 'I am going home right now, and no one is stopping me.' What should the LPN/VN do first?

• a.Remove the intravenous catheter and gather the client's belongings
• b.Explain that leaving without discharge forfeits any further care
• c.Notify the nursing supervisor of the client's decision✓
• d.Ask the client to sign a form and then escort the client to the exit

A client leaving against medical advice requires the chain of command to be notified so the provider can speak with the client and the correct documentation is completed. A competent adult may leave, but pretending it is routine, threatening loss of care, or dismantling the client's therapy first are all wrong.

A client tells the LPN/VN, 'I do not think I will ever get better.' How should the LPN/VN document this statement?

• a.Record that the client was uncooperative about the plan of care
• b.Note the nurse's opinion of why the client made the statement
• c.Document the client's exact words in quotation marks✓
• d.Summarize the conversation using the nurse's clinical impression

Subjective data is documented verbatim so later readers see what the client actually said. A summarized impression, a judgmental label, and speculation about motive all substitute the nurse's interpretation for the client's words.

A client who speaks limited English needs the discharge instructions reviewed before leaving. What should the LPN/VN do?

• a.Ask for a trained medical interpreter to attend✓
• b.Speak more slowly and loudly using simple everyday English words
• c.Ask the client's teenage grandson to interpret the conversation
• d.Give the client written materials in the preferred language instead

A trained interpreter is required for accurate exchange of health information. Using a family member, especially a minor, raises accuracy and confidentiality problems; speaking louder does not create understanding; and written material does not permit questions.

One licensed nurse on the evening shift calls out and no replacement has been found for the assignment. What should the LPN/VN do?

• a.Divide the missing nurse's clients among the staff already working
• b.Notify the nursing supervisor that the unit is short of licensed staff✓
• c.Ask the assistive personnel to take on the medication administration
• d.Delay the scheduled treatments until additional staff arrive on shift

A staffing shortfall that threatens safe care is reported through the chain of command so coverage can be arranged. Absorbing the assignment, delegating medications to UAP, and postponing ordered treatments each shift risk onto clients.

An LPN/VN notes that a client now ambulates the full length of the hallway, exceeding the goal written in the plan of care. What should the LPN/VN do?

• a.Decide which outcome statement should replace the current one
• b.Ask the registered nurse to update the plan of care✓
• c.Discontinue the intervention that no longer fits the client's needs
• d.Add the new nursing diagnosis to the written plan of care directly

The LPN/VN contributes data and suggestions but the registered nurse revises the plan of care. Adding a nursing diagnosis, stopping a planned intervention, and rewriting outcomes are all RN functions.

An LPN/VN is assigned a client whose personal choices conflict with the nurse's own beliefs. What should the LPN/VN do?

• a.Care for the client using the same standard applied to every client✓
• b.Ask the client to explain personal beliefs before care is provided
• c.Limit contact with the client to the tasks that must be completed
• d.Ask a colleague who shares the client's background to trade clients

Clients are entitled to unbiased treatment and equal access to care regardless of culture, ethnicity, sexual orientation, gender identity, or gender expression. Trading the assignment, minimizing contact, and demanding an explanation all treat the client differently.

An LPN/VN finishes documenting in the electronic health record on a workstation in the medication room. What should the LPN/VN do?

• a.Ask a coworker to watch the screen until the nurse can return
• b.Lock the medication room door while the record stays displayed
• c.Turn the computer monitor away from the hallway before leaving
• d.Log out of the workstation before leaving the medication room✓

Ending the session is the only action that closes access under the nurse's credentials. Turning the screen, locking the room, and asking someone to watch all leave an open session attributable to the nurse.

At the change of shift, the count of a controlled substance is one tablet short of the amount recorded. What should the LPN/VN do?

• a.Document the number found and let the next shift resolve the issue
• b.Ask each nurse on the unit whether a dose was removed in error
• c.Recount the drawer with the same nurse who counted the first time
• d.Report the count discrepancy to the nursing supervisor✓

A controlled substance discrepancy must be reported immediately through the chain of command so it can be investigated. Recounting with the same person, deferring it, and informally polling staff all delay an investigation of a possible diversion.

An LPN/VN has four remaining tasks at the end of the morning. Which should be completed first?

• a.Complete the treatment for the client whose dressing is saturated✓
• b.Chart the care already given to the four clients seen this morning
• c.Return the telephone call from a client's family member first
• d.Restock the supply cart before the next scheduled dressing change

A saturated dressing signals ongoing drainage or bleeding and takes priority over administrative tasks. Restocking, returning a call, and charting completed care can all wait.