NCLEX-PN (NCSBN) — practical-nurse clinical judgment, not leftover RN items

An LPN receives a verbal order over the phone from a provider. Which step is essential?

1. Write the order and read it back to the provider for confirmation
2. Carry out the order before documenting
3. Have the UAP take the order
4. Sign the order with the provider's name

Answer: A — Write the order and read it back to the provider for confirmation

A) Correct — read-back of verbal/telephone orders is a Joint Commission safety practice and reduces transcription error. B) Document before implementing. C) UAP cannot take orders. D) Never sign for another clinician.

The LPN identifies a near-miss when a look-alike medication was almost given. Best action?

1. Discard the wrong medication and move on
2. Tell the patient and apologize
3. Complete an incident or safety event report
4. Wait to see if anyone else noticed

Answer: C — Complete an incident or safety event report

A) System learning is lost. B) Disclosure rules apply to actual harm; near-misses are reported through safety systems. C) Correct — incident reports capture near-misses to prevent recurrence. D) Patient safety culture requires reporting.

When caring for a patient with Clostridioides difficile, the LPN should perform hand hygiene by:

1. Using alcohol-based hand rub only
2. Using hand sanitizer for 10 seconds
3. Using gloves only without hand hygiene
4. Washing hands with soap and water

Answer: D — Washing hands with soap and water

A) Alcohol gel does NOT kill C. diff spores. D) Correct — soap and water mechanically remove spores. C) Hygiene is required after glove removal. B) Insufficient for spores.

Restraint use requires which of the following?

1. Family approval
2. Indefinite use
3. No documentation
4. MD order within 24 hours, monitoring, documentation, alternatives first

Answer: D — MD order within 24 hours, monitoring, documentation, alternatives first

A) Not required; clinical decision. D) Correct — restraints require provider order (within 24 hr), q2h monitoring (skin, circulation, mental status), trial of alternatives first, time-limited use. C) Documentation is essential. B) Restraints are time-limited and reassessed.

Which finding in a 70-year-old is an expected age-related change?

1. Decreased lens accommodation (presbyopia)
2. Frequent acute confusion
3. Loss of pupillary response
4. New severe headaches

Answer: A — Decreased lens accommodation (presbyopia)

A) Correct — presbyopia is expected. B) Acute confusion is not normal aging and needs evaluation. C) Pupillary loss is pathologic. D) Severe headache requires evaluation.

Normal adult respiratory rate is:

1. 8-12 breaths per minute
2. 20-30 breaths per minute
3. 12-20 breaths per minute
4. 30-40 breaths per minute

Answer: C — 12-20 breaths per minute

A) That's bradypnea. C) Correct — adult normal range. B) That's adult tachypnea or pediatric range. D) Infant range, not adult.

Which question by the LPN BEST screens for intimate partner violence?

1. 'Do you feel safe at home?'
2. 'Does your partner hit you?'
3. 'Is your partner nice?'
4. 'Are you in love?'

Answer: A — 'Do you feel safe at home?'

B) Too narrow; abuse takes many forms. A) Correct — broad, open question encourages disclosure. C,D) Not specific enough.

A patient with a history of opioid use disorder is admitted for surgery. The LPN should:

1. Withhold pain medication to avoid relapse
2. Treat the patient as drug-seeking
3. Use multimodal pain control and ensure adequate analgesia
4. Give only placebos

Answer: C — Use multimodal pain control and ensure adequate analgesia

A) Undertreatment is unethical and worsens outcomes. C) Correct — adequate analgesia + non-opioid adjuncts is best practice. B) Stigmatizing. D) Unethical.

An LPN observes pressure injury risk on a bed-bound patient. Best intervention:

1. Reposition every 4 hours
2. Apply lotion only
3. Wait until skin breakdown occurs
4. Reposition every 2 hours and assess skin

Answer: D — Reposition every 2 hours and assess skin

A) Too infrequent. D) Correct — q2h repositioning + skin assessment is standard prevention. Combined with moisture management, nutrition, pressure-relieving surfaces. C) Prevention > treatment. B) Lotion alone insufficient.

A provider orders heparin 5,000 units subcutaneously. The vial reads 10,000 units/mL. The LPN should administer:

1. 0.25 mL
2. 0.5 mL
3. 1 mL
4. 2 mL

Answer: B — 0.5 mL

Dose / on-hand × volume = 5,000 / 10,000 × 1 = 0.5 mL. A) Incorrect math. B) Correct. C) Twice the dose. D) Four times.

A patient with COPD has SpO2 of 88% on room air at rest. The LPN should:

1. Apply oxygen at 6 L/min nasal cannula immediately
2. Withhold oxygen entirely
3. Apply low-flow oxygen 1-2 L/min nasal cannula and notify the RN
4. Ambulate the patient

Answer: C — Apply low-flow oxygen 1-2 L/min nasal cannula and notify the RN

A) High-flow may suppress hypoxic drive in some patients. C) Correct — titrate low and escalate per protocol; communicate. B) Hypoxemia harms. D) Worsens hypoxemia.

Select all early signs of increased intracranial pressure. Select all that apply.

1. Decreased level of consciousness
2. Headache
3. Pupil sluggishness
4. Hypotension
5. Vomiting
6. F) Brisk normal pupils

Answer: ABCE

A,B,C,E) Early ICP signs. D) Late Cushing triad component is hypertension, not hypotension. F) Normal finding.

Recommended adult sleep hours?

7-9 hours per night.

Airborne precautions: examples?

Tuberculosis, measles, varicella. Negative pressure room + N95 respirator.

Restraint use: nursing responsibilities?

Document need, try alternatives first, monitor circulation/skin/airway, release periodically, MD order within 24 hrs.

Treat conscious hypoglycemic patient?

15g fast-acting carbs (4 oz juice, glucose tabs). Recheck in 15 min. Repeat if needed.

Insulin onset/peak/duration: Regular insulin (rapid-short)?

Onset 30 min, peak 2-4 hr, duration 6-8 hr.

Average adult total blood volume?

~5 L (4-6 L range).