Free NCLEX-PN practice questions

Answer: D

• A. The client is ill but not in a life-threatening emergency, and a transfer without an order bypasses both the provider and the chain of command.
• B. Closer monitoring is reasonable, but on its own it accepts a plan the LPN believes is unsafe without ever telling the provider why.
• C. Tempting, and it is the right step if the concern is voiced again and still not addressed, but escalating now skips the assertive challenge that may settle the problem on this call.
• D. Correct. The provider has heard a report but not a stated safety concern; the LPN now voices it plainly and asks for the action she wants, which is the first challenge of the two-challenge rule.

New confusion with fever and a rising heart rate in an older adult is a significant change that may signal a serious infection. TeamSTEPPS teaches that when an assertion is ignored, the challenger is responsible for voicing the concern assertively at least two times so that it is heard, and only if the outcome is still unacceptable takes a stronger course of action through the supervisor and the chain of command. Here the LPN has only reported data; she has not yet said she is worried. Stating the concern and the request ("I am concerned about her and I am asking you to see her tonight") often changes the plan, and if it does not, the RN supervisor is next.

Sources: AHRQ TeamSTEPPS Pocket Guide

Answer: A

• A. Correct. She has the right to voice a grievance without retaliation, and the agency must investigate and document complaints; the LPN explains this and passes the concern to the supervisor, who can also protect her during the review.
• B. Tempting because it honors her request, but leaving her exposed to rushed, unsafe bathing while the LPN watches protects no one; her fear of retaliation is a reason to use the protected process, not to stay silent.
• C. A direct talk seems quick, but it reveals the complaint to the person she fears without any agency protection, and it bypasses the supervisor who assigns and evaluates aides.
• D. Clients must be told about the state hotline, and she may use it, but the LPN has received the complaint and the agency must investigate it; handing it off leaves the agency unaware and puts the burden on a frightened client.

Home health rules give clients the right to voice grievances about care to the agency or an outside body and to be free from reprisal for doing so. The agency must investigate complaints from clients and families, document the complaint and its resolution, and act to prevent further problems, including retaliation, during the investigation. Clients are also told about the state hotline. The LPN reassures the client that the process protects her, and reports the concern to the supervisor responsible for aide assignment and supervision. Left standing wet and cold, an older adult is at risk of falls and chilling, so silence is not safe.

Sources: NCSBN NCLEX-PN Test Plan (2026); Home Health Patient Rights, 42 CFR 484.50

Answer: A

• A. Correct. Her chosen bedtime is a resident right; the LPN arranges help at that time and makes sure the preference is written into her plan of care so every shift follows it.
• B. Tempting as a kind gesture, but it treats staff convenience as the rule; residents have the right to choose their own schedules, including sleeping and waking times.
• C. Speaking with the assistant helps, but 'when she can' leaves the bedtime to workload; unless the assignment changes and the plan of care records the preference, the problem returns on the next busy shift.
• D. Medicating a resident to fit the staff's timetable is the opposite of advocacy and exposes an older adult to fall and confusion risks.

Under federal long-term care rules, residents have the right to self-determination, including choosing activities and schedules, sleeping and waking times among them, consistent with their interests, assessments and plan of care. An alert resident's lifelong 2200 bedtime is her choice, not a scheduling problem to be solved at her expense. The LPN, who assigns and supervises nursing assistants within PN scope, changes the evening assignment so help is available at 2200 and reports the preference so the care plan reflects it, which protects her right on every shift.

Sources: Requirements for Long-Term Care Facilities, 42 CFR Part 483; NCSBN NCLEX-PN Test Plan (2026); LTC Resident Rights, 42 CFR 483.10

Answer: D

• A. The client asked a question; he did not refuse, so charting a refusal is inaccurate and leaves the dose unresolved.
• B. A change of manufacturer is a common reason, but assuming it skips the check that would catch a wrong drug, dose or order; the explanation can come after the pharmacy confirms it.
• C. The MAR may match while the tablet does not, or the order itself may be wrong; a client's concern is a cue to recheck rather than proof that the MAR is right.
• D. Correct. The client's question is a safety check: the LPN stops, compares the product with the order and MAR, and confirms with the pharmacist before giving it.

Clients who know their medications are the last safeguard in the administration process, and a client who says a pill looks different may be pointing to a wrong drug, a wrong strength or another client's medication. Open RN guidance tells the nurse to listen when a client voices a concern about a medication, explore it, verify the order and discuss it with the prescriber when needed before giving the drug, to prevent an error. A different manufacturer is a common, harmless reason for a new color or shape, and the pharmacist can confirm that quickly; until then the LPN holds the dose and tells the client it is being checked.

Sources: Open RN Nursing Skills, 2e (2023)

Answer: D

• A. Localized zoster is not spread by droplets; the risk is contact with lesion fluid.
• B. The lesions contain varicella virus and can infect non-immune contacts.
• C. These apply to disseminated zoster or localized zoster in immunocompromised clients.
• D. Correct. Localized zoster in an immunocompetent client requires standard precautions and covered lesions.

Herpes zoster precautions: standard with covered lesions for localized disease in immunocompetent clients; airborne and contact for disseminated disease or any zoster in immunocompromised clients until lesions crust. Non-immune and pregnant staff are not assigned to these clients.

Bottom line: Localized zoster in an immunocompetent client needs standard precautions with lesions covered; disseminated zoster or any zoster in immunocompromised clients needs airborne and contact precautions.

Sources: CDC Isolation Precautions Guideline (2007); Ignatavicius, Med-Surg Nursing, 11th ed.

Answer: B

• A. Parental presence reduces distress at this age.
• B. Correct. Preschoolers learn through play, fear body harm, and often believe illness is punishment for something they did.
• C. Simple, concrete words the child understands are more effective.
• D. Preschoolers have little sense of time; explanations come just before the procedure.

Preschoolers (3 to 5) think magically, fear mutilation and see illness as punishment. Therapeutic play, simple honest words, letting the child touch the equipment, offering small choices, keeping parents present and praising cooperation are the strategies that work.

Bottom line: Preschoolers think magically and fear body harm, so use therapeutic play, let them handle equipment, and give simple honest explanations before procedures.

Sources: Wong's Care of Infants & Children, 12th ed.

Answer: C

• A. Contact with the baby aids grieving.
• B. This minimizes the loss.
• C. Correct. Acknowledging the baby, using the baby’s name and offering memory-making such as mementos support healthy grief.
• D. Silence increases isolation.

Perinatal loss care: privacy with a room away from other newborns, time with the baby, memory boxes, naming, photographs, spiritual rituals, information about autopsy and burial options, lactation suppression guidance, follow-up calls and support groups. Grief is acknowledged for both parents.

Bottom line: After perinatal loss, support healthy grief by offering parents time to see and hold the baby, create mementos and use the baby's name.

Sources: Maternity & Women's Health Care, 13th ed.

Answer: B

• A. Severe hypokalemia with bradycardia requires monitored IV replacement.
• B. Correct. These findings are life-threatening. Severe medical instability and impaired insight justify urgent intervention and possible involuntary treatment.
• C. Arguing is ineffective.
• D. The client is at risk of death.

Medical admission criteria for eating disorders: heart rate below 50 (45 at night), blood pressure below 90/45, orthostatic changes, temperature below 35.6 °C, electrolyte disturbances, dysrhythmias, 75% or less of median BMI, acute food refusal or suicidality. Capacity may be impaired by starvation.

Bottom line: Severe bradycardia, hypotension and hypokalemia in anorexia nervosa are life-threatening and require urgent admission, since starvation can impair the client's capacity to refuse.

Sources: Varcarolis' Psychiatric Nursing, 10th ed.

Answer: D

• A. Direct pressure can rupture the drum.
• B. Cold or hot solutions stimulate the vestibular system and cause dizziness and nausea.
• C. Irrigation is contraindicated with a perforated drum or drainage.
• D. Correct. Warm solution, the pinna pulled up and back, and a gentle stream directed at the canal wall prevent vertigo and injury.

Ear irrigation: confirm the drum is intact, soften wax first with drops if ordered, position the client with the ear over a basin, use gentle pressure, and document return and the client’s response. Contraindications: perforation, tympanostomy tubes, recent ear surgery, otitis externa. Eye irrigation flows from the inner to the outer canthus; bladder irrigation uses sterile solution and monitors true urine output.

Bottom line: For adult ear irrigation, confirm the eardrum is intact, use body-temperature solution, pull the pinna up and back, and aim the stream at the canal wall.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; Potter & Perry Fundamentals, 12th ed.

Answer: C

• A. Catheters cause infection and are not used solely for incontinence.
• B. Powder cakes and irritates moist skin.
• C. Correct. Prompt changes, a pH-balanced cleanser and barrier protection prevent incontinence-associated dermatitis.
• D. Harsh cleansing damages the skin.

Incontinence-associated dermatitis differs from pressure injury: it is diffuse, in skin folds and moist areas, with irritation rather than over bony prominences. Prevention: toileting programs, breathable absorbent products, gentle cleansing, moisture barriers, and treating fungal infection when present.

Bottom line: Prevent incontinence-associated dermatitis by changing absorbent products promptly, cleansing gently with a pH-balanced cleanser and applying a moisture barrier.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; Bryant & Nix, Acute & Chronic Wounds, 6th ed.; Potter & Perry Fundamentals, 12th ed.

Answer: C

• A. The label says to contact the provider before restarting after an interruption, and restarting includes a titration phase; the client does not resume the old dose alone, because full-dose niacin brings back strong flushing.
• B. Hot drinks, alcohol and spicy foods around the dose increase flushing and itching, so the label says to avoid them.
• C. Correct. The label allows aspirin up to 325 mg taken 30 minutes before niacin to reduce flushing, and niacin ER is taken at bedtime after a low-fat snack.
• D. Extended-release niacin must be swallowed whole; breaking, crushing or chewing it defeats the release design.

Flushing, with warmth, redness, itching or tingling of the skin, is the most common reason clients stop niacin. The extended-release label lists ways to reduce it: take niacin at bedtime after a low-fat snack, take aspirin (up to 325 mg) about 30 minutes before the dose if prescribed, and avoid alcohol, hot drinks and spicy foods around dosing time. Tolerance to flushing develops over several weeks, and after a long interruption the dose is re-titrated rather than restarted at the old level. The LPN also reinforces getting up slowly if flushing wakes the client and reporting dizziness to the provider.

Sources: Niacin extended-release tablets label (Amneal, 2026)

Answer: B

• A. Inhaled corticosteroids do not relieve acute bronchospasm.
• B. Correct. The rescue inhaler is for sudden symptoms, the controller is daily maintenance even when well, and rinsing prevents oral thrush.
• C. Controller therapy continues even when symptom-free.
• D. The bronchodilator goes first to open the airways for the steroid.

Asthma inhalers: short-acting beta agonists (albuterol) rescue acute symptoms; inhaled corticosteroids prevent attacks and are used daily with mouth rinsing to avoid candidiasis and hoarseness. When both are due, the bronchodilator goes first. Needing the rescue inhaler more than twice a week means control is inadequate.

Bottom line: Short-acting beta agonists rescue acute asthma symptoms, while inhaled corticosteroids are daily controllers used even when well, followed by mouth rinsing.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; GINA Asthma Strategy Report (2026); NAEPP Asthma Focused Updates (2020)

Answer: B

• A. Unreliable and potentially harmful.
• B. Correct. Unilateral calf swelling and tenderness after pelvic surgery suggest deep vein thrombosis; the client stays in bed with the leg elevated, the calf is not massaged, and the provider is notified.
• C. Massage risks embolization.
• D. Evaluation must come first.

Deep vein thrombosis: Virchow triad (stasis, endothelial injury, hypercoagulability); signs include unilateral swelling, pain, warmth and erythema, though many are silent. Diagnosis: D-dimer and duplex ultrasound. Treatment: anticoagulation, early ambulation once treated, compression for symptoms. Watch for pulmonary embolism (sudden dyspnea, chest pain, tachycardia).

Bottom line: Unilateral calf swelling, warmth and tenderness after surgery suggest deep vein thrombosis; avoid massaging the leg and notify the provider.

Sources: Ignatavicius, Med-Surg Nursing, 11th ed.; Lewis's Medical-Surgical Nursing, 13th ed.

Answer: A

• A. Correct. Coughing, a wet voice, a faster respiratory rate and a falling saturation during a feeding suggest aspiration; Open RN directs the nurse to immediately notify the provider and withhold feedings until tube placement is verified.
• B. Breath sounds are useful data to collect and report, but documenting them while the pump runs lets more formula reach the airway and delays the call the provider needs.
• C. Residual volume is one sign of feeding intolerance, but it does not answer whether formula is entering the airway, and checking it while the pump runs delays withholding the feeding and calling the provider.
• D. Any formula still running can go on entering the lungs, and changing the rate is a change to the ordered regimen.

Feedings given into a misplaced tube, or refluxed and aspirated, can cause life-threatening aspiration pneumonia. Open RN teaches that if a client develops respiratory symptoms that suggest aspiration, the nurse immediately notifies the provider and withholds enteral feedings and medications until tube placement is verified. Withholding the feeding removes the source, and the provider decides on placement checks and further care. The LPN keeps the head of the bed at 30 to 45 degrees, stays with her, rechecks oxygen saturation and breath sounds, reports to the RN as well, and does not restart the feeding until placement and the plan are confirmed.

Sources: Open RN Nursing Skills, 2e (2023); NCSBN NCLEX-PN Test Plan (2026)

Answer: B

• A. Reporting an unverified value can trigger unneeded orders. If a reading from a good site is still low, it is reported promptly.
• B. Correct. Cold hands and poor circulation can give a falsely low finger reading, and artificial nails can distort it too; an earlobe (or forehead) sensor gives a reading worth acting on.
• C. Oxygen treats true hypoxemia, but nothing about this resident suggests it, and starting it before the reading is confirmed treats a number rather than the client.
• D. Deep breathing does not fix a probe problem, and if the low value were real, an hour is too long to wait.

A pulse oximeter estimates saturation from light passing through a pulsing capillary bed, so anything that blocks the light or reduces blood flow under the sensor distorts it. Nail polish and artificial nails can affect the accuracy of the reading, and cold hands or poor peripheral circulation can cause falsely low values. When the reading does not fit the client, the LPN confirms it before acting: compares the oximeter pulse with the radial pulse, looks for respiratory distress, and moves the sensor to an alternate site such as the earlobe or forehead. This resident has no distress, so the probe is the likeliest problem. A low value from a good site with a matching pulse is reported to the RN without delay.

Sources: Lapum et al., Vital Sign Measurement Across the Lifespan: 4.11 Oxygen Saturation Technique (LibreTexts); Open RN Nursing Skills, 11.2 Basic Concepts of Oxygenation (LibreTexts)