NCLEX-PN Nursing — All Questions

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

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

Administering routine oral medications to stable clients is within the LPN/LVN scope. Initial assessments, care-plan development, and client teaching about new content are RN responsibilities. The LPN/LVN reinforces teaching but does not perform the initial teaching.

The LPN/LVN receives a verbal order from a physician during an emergency. What is the most appropriate action?

• a.Write down the order, read it back, and have the RN or provider co-sign per policy✓
• b.Have a family member witness the order so no provider signature is needed later
• c.Carry out the order and document it several hours later at the end of the shift
• d.Refuse the order because an LPN/LVN may never accept a verbal order in an emergency

During an emergency a verbal order may be accepted, but it must be written down and read back to the provider to confirm accuracy. It should be signed by the provider within the facility's required timeframe. Read-back reduces transcription and communication errors.

Which client care assignment is most appropriate to give to unlicensed assistive personnel (UAP)?

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

UAP may perform basic hygiene and record intake and output for stable clients. Catheter insertion, evaluating medication response, and adjusting IV rates require nursing judgment and licensure. Assessment and evaluation cannot be delegated to UAP.

An LPN/LVN notices a coworker documenting care that was not provided. What is the priority action?

• a.Ignore it because it is not the LPN/LVN's responsibility
• b.Alter the record to correct it personally
• c.Confront the coworker angrily in front of clients
• d.Report the concern to the charge nurse or supervisor✓

Falsifying documentation is a serious ethical and legal violation that must be reported through the chain of command. The LPN/LVN should not alter another person's entry or handle it confrontationally. Reporting protects clients and maintains accurate records.

When using the SBAR communication tool during a hand-off report, the 'R' stands for which component?

• a.Nurse's rationale
• b.Client response
• c.Recommendation✓
• d.Later reassessment

SBAR stands for Situation, Background, Assessment, and Recommendation. The recommendation states what the nurse wants done or is requesting next. Standardized hand-off tools reduce omissions and improve safety.

The LPN/LVN is caring for four clients. Which client should be assessed first?

• a.A client scheduled for discharge this afternoon
• b.A client asking about the lunch menu
• c.A client reporting new onset of shortness of breath✓
• d.A client requesting a second pillow

Airway and breathing problems take priority using the ABC framework. New shortness of breath could signal a life-threatening change and must be assessed immediately. The other requests are non-urgent.

A client refuses a prescribed medication. What is the LPN/LVN's best response?

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

Competent adults have the right to refuse treatment. The nurse should honor the refusal, document it, and inform the RN or provider so follow-up can occur. Concealing medication violates client autonomy and trust.

Which situation represents a breach of client confidentiality under HIPAA?

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

Sharing protected health information with someone not involved in the client's care violates confidentiality. Reporting mandated concerns, communicating with the care team, and giving hand-off report are permitted. Only those with a need to know may access information.

The LPN/LVN is documenting in the electronic health record. Which entry is written correctly?

• a."Client is being difficult and uncooperative with the entire staff."
• b."Client probably has appendicitis based on where the pain is."
• c."Client reports pain rated 7 of 10 in right lower abdomen at 0900."✓
• d."Client seems to be doing just fine today, with no real complaints."

Documentation should be objective, specific, and factual, including measurable data and time. Subjective judgments and unauthorized diagnoses are inappropriate. Clear entries support continuity and legal accuracy.

An LPN/LVN is floated to an unfamiliar unit. Which action is most appropriate?

• a.Care only for clients who need no medications and refuse other assignments
• b.Refuse the assignment and leave the facility before the shift begins
• c.Perform any task the charge nurse requests regardless of competence
• d.Accept tasks within the LPN/LVN scope and ask for orientation to the unit✓

A floated nurse should accept assignments within their scope and competence while requesting orientation to unfamiliar equipment and routines. Refusing to work may be abandonment, but performing unsafe tasks is negligent. Communicating limitations protects clients.

Which task performed by UAP requires the LPN/LVN to intervene immediately?

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

Adjusting oxygen flow rate is outside the UAP scope and requires nursing judgment. Feeding a client with no swallowing risk, ambulating with a gait belt, and recording drainage are acceptable UAP tasks. The nurse must correct the unsafe action.

The LPN/LVN is reinforcing discharge instructions. Which statement indicates the client understood teaching about a wound?

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

Hand hygiene before and after dressing changes prevents infection and reflects correct understanding. Spreading redness and warmth are signs of infection that should be reported. Dressings should be managed as ordered, not removed prematurely.

A client's family asks the LPN/LVN to explain the surgeon's plan for an upcoming operation. What is the best response?

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

Explaining the surgical plan and obtaining informed consent are the provider's responsibility. The nurse should facilitate communication by notifying the surgeon of the family's questions. Reassurance or refusal without follow-up does not meet the family's needs.

Which principle guides prioritization when the LPN/LVN plans care for multiple clients?

• a.Always perform the quickest tasks first so the shift stays on schedule
• b.Address physiologic and safety needs before comfort or teaching needs✓
• c.See the client whose family requests attention first, then the others
• d.Complete tasks in the order the rooms are numbered on the hallway

Maslow's hierarchy directs the nurse to meet physiologic and safety needs before higher-level needs like comfort and education. Room number, task length, and family preference are not valid prioritization frameworks. Life-threatening problems come first.

An advance directive states a client does not want cardiopulmonary resuscitation. The client stops breathing. What should the LPN/LVN do?

• a.Wait several minutes to see whether the client resumes breathing
• b.Begin full CPR immediately, since the directive expired at admission
• c.Follow the do-not-resuscitate order and notify the RN and provider✓
• d.Call the family first and ask them whether to start resuscitation

A valid do-not-resuscitate order must be honored, so resuscitation is not initiated. The nurse provides comfort measures and notifies the RN and provider. Ignoring a legal directive violates the client's expressed wishes.

The LPN/LVN is part of an interdisciplinary care conference. What is the LPN/LVN's primary contribution?

• a.Ordering the diagnostic laboratory tests the team will need
• b.Prescribing the client's physical therapy program and its frequency
• c.Reporting ongoing observations of the client's response to care✓
• d.Determining the client's medical diagnosis for the record

The LPN/LVN contributes bedside observations and data about how the client is responding to interventions. Ordering tests, prescribing therapies, and making medical diagnoses are outside the LPN/LVN scope. Collaboration relies on accurate frontline information.

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.

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.

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.

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.

A client who had a hip replacement reports pain rated 7 of 10 thirty minutes before a scheduled physical therapy session. What should the LPN/VN do?

• a.Reschedule the therapy session until the client is comfortable
• b.Ask therapy to shorten the session so the client tolerates it
• c.Give the prescribed analgesic before the session✓
• d.Suggest that the client use distraction during the therapy session

Timing an ordered analgesic so its effect covers the session lets the client participate as planned. Shortening, rescheduling, or substituting distraction all reduce the therapy the client is supposed to receive.

A client received the first dose of a newly prescribed antihypertensive four hours ago. What should the LPN/VN do?

• a.Ask the registered nurse to evaluate the response✓
• b.Hold the next dose until the provider reviews it
• c.Decide whether the medication should be continued after this dose
• d.Record that the client tolerated the new medication without difficulty

Evaluation of the client's response against the plan of care and decisions about continuing therapy rest with the registered nurse and provider. The LPN/VN collects and reports the data that evaluation depends on.

A provider gives an LPN/VN a verbal order during an emergency. After writing the order down, what should the LPN/VN do?

• a.Write the order and ask a coworker to check it
• b.Repeat the order silently while writing it to confirm accuracy
• c.Read the order back to the provider and have it verified✓
• d.Enter the order and compare it with the pharmacy profile later

A verbal order is transcribed and then read back to the prescriber for confirmation before it is carried out. A coworker's check, a later pharmacy comparison, and a silent repetition do not confirm the order with the person who gave it.

An alert, oriented client refuses a scheduled dose of a stool softener. What should the LPN/VN do?

• a.Give the medication in a food item the client will accept
• b.Postpone the dose and offer it again in about thirty minutes
• c.Explain that the client has the right to refuse the treatment✓
• d.Tell the client the provider will be upset about the refusal

A competent adult may refuse any treatment, and the refusal is honored, documented, and reported. Applying pressure, concealing a medication, and simply retrying the same approach all bypass the client's decision.

An LPN/VN finds that one side rail on a client's bed will not latch into position. What should the LPN/VN do?

• a.Move the client to a chair until the maintenance staff arrive
• b.Place a folded blanket along the open side of the client's bed
• c.Notify the nursing supervisor about the broken rail✓
• d.Post a sign on the bed warning staff that the rail is damaged

Unsafe equipment is reported so it can be removed from service and repaired. Improvising a barrier, relocating the client without an order, and posting a warning all leave the defective bed in use.

An LPN/VN has delegated a bed-to-chair transfer to assistive personnel. How should the LPN/VN monitor the delegated task?

• a.Complete the transfer using a mechanical lift for both clients
• b.Review the assistive personnel's documentation after the shift
• c.Ask the assistive personnel to describe how the transfer went
• d.Assist the client to a chair and observe the transfer technique✓

Monitoring assistive personnel means directly observing the delegated task. A verbal report, a review of documentation, and doing the task oneself all fail to observe the person actually performing it.

A client being discharged asks about services that could help with meals at home. Which action is within the LPN/VN role?

• a.Telephone the community agency and arrange the first appointment
• b.Give the client the written list of community follow-up resources✓
• c.Explain the eligibility rules for each program the client may use
• d.Decide which of the community programs best suits the client

Providing prepared referral information supports the referral process within the LPN/VN role. Arranging placement, selecting a program, and interpreting eligibility rules belong to the case manager or registered nurse.

A client's sputum culture returns positive for Mycobacterium tuberculosis. What should the LPN/VN do?

• a.Ask the client to notify recent contacts about the exposure
• b.Report the positive result as the policy requires✓
• c.Tell the client's roommate to watch for a cough and fever
• d.Note the result in the chart and mention it in the next report

Communicable disease reporting follows regulation and facility policy so public health can act. Warning a roommate breaches confidentiality, shifting notification to the client is not the required process, and charting alone is not reporting.

A client's family member raises a fist and shouts threats at staff in the hallway. What should the LPN/VN do?

• a.Notify the nursing supervisor about the threats made✓
• b.Explain the visiting policy and document the family's behavior
• c.Continue care and avoid the client's room while the family is present
• d.Ask the family to leave the unit until they are able to calm down

Threats against staff are a security matter reported through the chain of command. Ordering the family out, avoiding the room, and quoting policy all leave a threat unaddressed and can escalate it.

An LPN/VN is documenting the pain level of an alert, oriented client after a dressing change. What should the LPN/VN record?

• a.Ask the family member at the bedside to estimate the pain level
• b.Record the rating the client states for the pain✓
• c.Base the rating on the client's facial expression and posture
• d.Record the rating the previous shift documented for comparison

Self-report is the standard for pain in a client who can communicate. A prior rating, an observed behavior, and a family estimate are all secondary sources.

An LPN/VN finds the wrong medication in a client's drawer and removes it before any dose is given. What should the LPN/VN do?

• a.Treat the matter as closed with no harm to the client
• b.Report the near miss even though the client received no medication✓
• c.Discuss the error privately with the nurse who nearly gave the drug
• d.Note the event in a personal log in case questions arise later

Near misses are reported so the system defect that produced them can be corrected. A private conversation, a personal note, and treating it as closed all keep the hazard in place for the next client.

A client asks to complete a brief prayer before the scheduled morning bath. What should the LPN/VN do?

• a.Explain that hospital routines cannot accommodate the practice
• b.Support the client's spiritual practice when able✓
• c.Ask the chaplain to speak with the client about the routine
• d.Document the request and continue the usual care schedule

Client-reported spiritual and cultural preferences are incorporated into care when they do not compromise safety. Declining, deferring to the chaplain, and documenting without acting all disregard a preference that could be met.

An LPN/VN needs to discuss a client's laboratory results with the registered nurse. What should the LPN/VN do?

• a.Move the conversation to the nurses station near the hallway
• b.Close the door and lower the voice for the talk✓
• c.Use the client's room number rather than the client's name
• d.Wait to discuss the details until the end of the work shift

Privacy is protected by controlling who can overhear the conversation. A nurses station is public, a room number still identifies the client to anyone nearby, and delay does not make the discussion private.

A client arrives for admission carrying a handwritten list of home medications and herbal supplements. What should the LPN/VN do first?

• a.Ask the pharmacy which of the client's supplements are approved
• b.Add the herbal supplements the client mentioned to the record
• c.Tell the client to stop the supplements while in the hospital
• d.Compare the client's list with the current record✓

Medication reconciliation begins by comparing the client's own list with the record and reporting differences. Adding entries independently, instructing the client to stop a substance, and asking pharmacy to judge products all skip the comparison.

A client with a history of wandering is not in the room at medication time and is not in the bathroom or the dayroom. What should the LPN/VN do?

• a.Notify the nursing supervisor that a client is missing✓
• b.Check the sign-out sheet to see whether the client left with family
• c.Ask the assistive personnel to walk the hallways looking for the client
• d.Search the client's room and bathroom a second time before calling

A missing client triggers a facility-wide search and security alert through the chain of command without delay. Repeating a room search, sending one staff member to look, and consulting a sheet all consume time the client may not have.

Just before signing a consent form, a client asks the LPN/VN, 'What are they actually going to do to me?' What should the LPN/VN do?

• a.Reassure the client that the procedure is done here routinely
• b.Explain the procedure again using the consent form as a guide
• c.Tell the client the provider will answer questions afterward
• d.Ask what the provider explained about the procedure✓

When a client voices confusion before signing, the nurse determines what the client understood and reports the gap so the provider can return. Re-explaining, deferring questions, and offering reassurance all leave consent uninformed.

An LPN/VN is documenting an insulin dose in the medication administration record. Which practice should the LPN/VN follow?

• a.Copy the abbreviations the provider used in the written order
• b.Choose abbreviations that other nurses on the unit will recognize
• c.Use the facility's approved abbreviation list here✓
• d.Spell out every term to avoid using abbreviations at all

Documentation uses the abbreviations the facility has approved, which excludes error-prone ones. Avoiding all abbreviations is not the standard, and copying a provider or relying on local custom can reproduce a dangerous abbreviation.

An LPN/VN is preparing to perform perineal care for a client in a semiprivate room. Which action best protects the client's bodily privacy?

• a.Explain the steps of the procedure before uncovering the client
• b.Ask the visitors in the room to step outside during the care
• c.Position the client so the door view is partially obstructed
• d.Draw the curtain and drape the client first✓

Both a visual barrier and draping are needed to protect bodily privacy. Asking visitors out, angling the client, and explaining the steps are all reasonable but none of them shields the client from view.

An LPN/VN finds that a client's ankles are newly swollen and the client has gained 2 kg since yesterday. What should the LPN/VN do?

• a.Report the finding to the registered nurse today✓
• b.Increase the frequency of vital sign checks for the rest of the shift
• c.Chart the finding and continue with the remaining scheduled care
• d.Ask the client whether the symptom has occurred at home before

A change in condition is reported so the registered nurse can assess and the plan can be adjusted. Charting alone, adding checks, and history-taking all delay the assessment the change requires.

An LPN/VN finds several sterile dressing packages in the supply room with expiration dates that have passed. What should the LPN/VN do?

• a.Set the expired items aside and use a package from another unit
• b.Use the packages with sterile seals that are still intact
• c.Report the outdated stock to the nursing supervisor✓
• d.Mark the outdated packages and return them to the supply closet

Expired sterile stock is reported so it is pulled from every location, not just this one. Borrowing from another unit, judging by an intact seal, and returning the items to storage all leave expired supplies available.

A client asks to see what has been written in the medical record. What should the LPN/VN tell the client?

• a.Explain that clients are not permitted to read their own records
• b.Explain that the record may be reviewed with staff✓
• c.Give the client the chart to read at the bedside without notice
• d.Print the portion of the record the client seems most interested in

Clients have a right of access to their records through the facility's established process. Denying access, handing over the chart informally, and selectively printing pages all mishandle that right.

The emergency department calls to send another client to a unit that already has no available licensed staff. What should the LPN/VN do?

• a.Notify the nursing supervisor before accepting the client✓
• b.Ask the sending unit to hold the client until the next work shift
• c.Accept the client and request additional help after the arrival
• d.Assign the incoming client to the assistive personnel for admission

When the unit cannot safely absorb another client, the chain of command decides before the transfer happens. Accepting first, refusing on one's own authority, and assigning an admission to UAP all bypass that decision.

An LPN/VN has just told assistive personnel to record hourly urine output for a specific client. What should the LPN/VN do next?

• a.Check on the delegated tasks near the end of the work shift
• b.Ask the assistive personnel to repeat it back✓
• c.Tell the assistive personnel to ask questions if any come up
• d.Write the delegated tasks on the assignment board for the shift

Confirming understanding is the right direction element of delegation. A written board, an end-of-shift check, and an open invitation to ask questions do not confirm that the message was received correctly.

A client is off the unit for a test when a scheduled medication is due, and the dose is not given. What should the LPN/VN do?

• a.Circle the time and explain the omission in the next handoff
• b.Chart the omitted dose and the reason it was not administered✓
• c.Leave the space blank for the dose that was not given
• d.Ask the oncoming nurse to give the dose and chart it then

An omitted dose is documented with the reason so the record is accurate and the team can act. A blank space, a verbal handoff without documentation, and shifting the dose to another nurse all produce an incomplete record.

A client's symptoms appear to match the criteria of a standing sepsis protocol used on the unit. What should the LPN/VN do?

• a.Ask the registered nurse to apply the criteria✓
• b.Ask the pharmacist to decide whether the protocol should begin
• c.Start the protocol for a client whose symptoms match it
• d.Wait for the provider to visit the unit later in the afternoon

Deciding that a client meets protocol criteria is an assessment and judgment step that belongs to the registered nurse. Starting it independently, waiting for a routine visit, and asking pharmacy to decide all misplace that judgment.

A client is being discharged with four new prescriptions. Which action is within the LPN/VN role?

• a.Give the client the itemized discharge medication list✓
• b.Explain how each new medication will interact with the others
• c.Determine whether the client is ready to manage the medications
• d.Decide which of the client's home medications should be stopped

Providing the prepared list and reinforcing instructions is within LPN/VN scope. Explaining interactions, discontinuing home drugs, and judging readiness require the registered nurse or provider.

During admission care an LPN/VN finds an open area of broken skin over a client's sacrum. What should the LPN/VN do?

• a.Photograph the wound and place the image in the medical record
• b.Report the newly found injury to the registered nurse✓
• c.Apply the dressing the unit uses for wounds of this appearance
• d.Measure the wound and record the stage in the admission note

A newly found pressure injury is reported so the RN can assess and stage it and the provider can order treatment. Photographing, staging, and selecting a dressing all require authority the LPN/VN does not hold for a new wound.

A unit of packed red blood cells has arrived on the unit for a client. What is required before it is administered?

• a.Complete the required two-person check at the bedside✓
• b.Verify the unit against the record with the same nurse twice
• c.Check the unit number and expiration date before hanging it
• d.Confirm the client's blood type with the laboratory by telephone

An independent double check by two qualified people at the bedside is required before blood is administered. Repeating a single person's check, verifying the unit alone, and a telephone confirmation do not meet that standard.

An LPN/VN sees a coworker chart a treatment that the LPN/VN knows was not performed. What should the LPN/VN do?

• a.Tell the client's family that the record contains an inaccuracy
• b.Ask the coworker to write a late entry describing the real care
• c.Correct the coworker's entry so the record reflects actual care
• d.Report the falsified entry to the nursing supervisor✓

Falsified documentation is a legal and ethical violation reported through the chain of command. Editing another person's entry, negotiating a late entry, and disclosing to the family are all outside the nurse's authority.

A provider writes a dose that is higher than the LPN/VN usually sees, but the order is legible, complete, and within the published safe range. What should the LPN/VN do?

• a.Ask the pharmacist to change the order to the more familiar dose
• b.Hold the dose until the provider confirms it during morning rounds
• c.Give half the dose that the provider has ordered
• d.Carry out the order as the provider has written it✓

An order that is legible, complete, and within the accepted range is carried out. Holding a correct dose, splitting it, and asking pharmacy to rewrite it all withhold prescribed therapy without cause.

Two of an LPN/VN's clients simultaneously report new shortness of breath. What should the LPN/VN do?

• a.See the client whose call light was activated the earliest
• b.See the client whose condition the nurse considers most serious
• c.Ask the registered nurse to set the priority order✓
• d.Ask the assistive personnel which client seems most uncomfortable

When two clients appear to be deteriorating at the same time, the RN sets the priority because prioritizing among unstable clients is an assessment judgment. Call-light order, personal judgment about severity, and a UAP impression are not adequate bases.

When should an LPN/VN document the care that has been provided to a client?

• a.Chart the planned care at the start of the scheduled time block
• b.Record the care after confirming the details with the next nurse
• c.Group the charting for all clients at the end of the work shift
• d.Document the care immediately after it is provided to the client✓

Documentation follows the care as closely as possible so it is accurate and timely. Charting in advance is falsification, end-of-shift batching invites error, and confirming with a colleague does not restore accuracy.

A client scheduled for a procedure says the provider left before answering the client's questions about it. What should the LPN/VN do?

• a.Have the family member sign for the client to avoid a delay
• b.Explain the alternatives to the procedure and then obtain consent
• c.Witness the signature of a client who agreed to it
• d.Ask the client to sign only after the provider returns✓

Consent cannot be completed while the client's questions are unanswered by the prescriber. Witnessing anyway, supplying the explanation, and substituting a family signature all produce an invalid consent.

A client who was alert this morning is now drowsy and difficult to arouse. What should the LPN/VN do?

• a.Recheck the vital signs in fifteen minutes and compare the values
• b.Raise the head of the bed and ask the client to breathe slowly
• c.Report the change in condition to the registered nurse✓
• d.Review the record to see whether this pattern has occurred before

A new change in condition is reported so the RN can assess. Rechecking, repositioning, and chart review may all be reasonable in addition, but none of them substitutes for informing the nurse responsible for assessment.

An LPN/VN notices that the unit fire alarm panel shows a fault light and no audible alarm sounds during a test. What should the LPN/VN do?

• a.Report the alarm panel fault to the nursing supervisor✓
• b.Ask the assistive personnel to watch the corridor for smoke
• c.Write a maintenance request for the day shift
• d.Test the alarm pull station at the other end of the hallway

A nonfunctioning life-safety system is reported immediately so interim fire watch measures can be put in place. Testing another station, posting an informal watch, and leaving a written request all delay that response.