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NCLEX-PN: The LPN/VN Role
Coordinated Care, PN vs RN scope, what to report, working with UAP, and consent and client rights under the 2026 NCLEX-PN test plan
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The 2026 test plan
In effect April 1, 2026 to March 31, 2029. Adaptive: 85 to 150 items in up to 5 hours, breaks included. Clinical judgment: 3 six-item case studies plus about 10% stand-alone items. Every exam also has 15 unscored pretest items. If no age is given, the client is an adult; a client can also be a family or group.
| Client Needs category | Range | Midpoint |
|---|---|---|
| Coordinated Care | 18–24% | 21% |
| Safety and Infection Prevention and Control | 10–16% | 13% |
| Health Promotion and Maintenance | 6–12% | 9% |
| Psychosocial Integrity | 9–15% | 12% |
| Basic Care and Comfort | 7–13% | 10% |
| Pharmacological Therapies | 10–16% | 13% |
| Reduction of Risk Potential | 9–15% | 12% |
| Physiological Adaptation | 7–13% | 10% |
PN and RN: who does what
The LPN/VN works under the direction of an RN, APRN, physician or other authorized provider. The plan defines the PN nursing process as data collection, planning, implementation and evaluation.
| RN | LPN/VN |
|---|---|
| Comprehensive and admission assessment | Collects data; focused checks (neuro, circulation) |
| Develops the care plan | Contributes to and updates it |
| Initial teaching | Reinforces teaching |
| Evaluates the plan | Assists; evaluates client responses |
| Complex or unstable clients | Stable clients with predictable outcomes |
What to report
Report to the RN or primary health care provider, as the item and policy direct:
- Change from baseline: vital signs, LOC, orientation, strength, output
- Abnormal lab or point-of-care results; basic monitor-strip abnormalities
- Complications: fever, hypotension, limb pain, possible clot
- Adverse drug effects; unexpected responses such as bleeding
- Refusal, or questions about a procedure or consent
- Unsafe practice, staff conflict, controlled-substance count errors
- Abuse, neglect, gunshot wounds, communicable disease, per law
Scope: the plan vs your state
| Task | In the 2026 PN plan |
|---|---|
| Oral, tube, SubQ, ID, IM, topical, inhaled meds | Administer |
| IV piggyback (secondary) meds | Administer |
| IV flow rates | Calculate, monitor |
| Peripheral IV | Maintain, remove |
| Central venous catheter | Maintain |
| Pain devices (PCA, epidural) | Maintain |
| Urinary catheter, NG tube | Insert, maintain, remove |
| Blood products | Monitor the transfusion |
| IV push | Not listed |
State examples: Ohio LPNs may hang IV antibiotics but may not start or maintain blood, program a PCA pump, or push IV drugs other than flushes (dialysis aside). IV-certified California LVNs may start IV fluids, including blood, but not IV medications.
Working with UAP
- Assignment: routine care within a person's role. Delegation: a nursing task beyond it
- Five rights: task, circumstance, person, direction and communication, supervision and evaluation
- Suits UAP: ADLs, ambulation, positioning, vital signs, I&O on stable clients
- Not for UAP: assessment, teaching, clinical judgment, unstable clients
- Check competence, give specific directions, then monitor and evaluate
- Accountability: the UAP for doing an accepted task correctly; the nurse for the client overall
- LPN/VNs delegate only where state law allows; tell the RN or supervisor when a client change requires a new assignment
Rights, consent and legal duties
- Refusal: explore why, report to the RN or provider, document
- Informed consent: the provider explains and obtains it; the PN checks the signed form and understanding, and calls the provider back if questions remain
- Who consents: the client; for a minor, a parent or guardian; for an adult without capacity, the health care proxy (DPOA-HC) or a court-appointed guardian
- Advance directives: give information, verify status, review living will and proxy
- Use a qualified interpreter, not family or children (narrow exceptions)
- Protect privacy; intervene when rights are violated
- Verify orders and question unsafe ones; seek help when needed; document errors and near misses (incident report)
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Related one-pagers
- Next Gen NCLEX: Clinical JudgmentThe six NCJMM steps, NGN item types and partial-credit scoring on the 2026 NCLEX-RN and NCLEX-PN
- Prioritization and DelegationWho to see first, five rights, scope, SBAR and escalation for NCLEX-RN and PN
Sources
- NCSBN. 2026 NCLEX-PN Test Plan (effective April 2026). Link
- NCSBN. NCLEX Test Plans page. Link
- NCSBN and ANA. National Guidelines for Nursing Delegation, effective 4/29/2019. Link
- NCSBN Model Act, revised August 2021. Link
- NCSBN Model Rules, revised August 2021. Link
- Kentucky Board of Nursing. AOS #27 Components of LPN Practice (revised 10/2025). Link
- Ohio Revised Code 4723.18, Administration of adult intravenous therapy (effective April 6, 2023). Link
- Ohio Revised Code 4723.181, IV therapy procedures LPNs may perform (effective April 6, 2023). Link
- Cal. Code Regs. tit. 16, § 2542, Definition (via Cornell LII). Link
- Cal. Code Regs. tit. 16, § 2542.1, Intravenous Therapy (via Cornell LII). Link
- California Board of Vocational Nursing and Psychiatric Technicians. About Us. Link
- California BVNPT. Frequently Asked Questions. Link
- California Business and Professions Code § 2860.5 (amended by SB 994, effective January 1, 2023). Link
- Open RN. Nursing Management and Professional Concepts, 2e (WisTech Open, 2024), 3.3 Assignment. Link
- Open RN. Nursing Management and Professional Concepts, 2e, 3.4 Delegation. Link
- Open RN. Nursing Management and Professional Concepts, 2e, 5.6 Other Legal Issues. Link
- Open RN. Nursing Advanced Skills (WisTech Open), 3.3 Applying the Nursing Process (blood products). Link
- Open RN. Nursing Advanced Skills (WisTech Open), 3.2 Basic Concepts (transfusion reactions), via LibreTexts. Link
- 42 CFR § 489.102, Requirements for providers (advance directives), via Cornell LII. Link
- 45 CFR § 92.201, Meaningful access for individuals with limited English proficiency, via Cornell LII. Link
- Washington State Board of Nursing. Can the licensed practical nurse administer epinephrine for anaphylaxis without an order? (FAQ). Link