NCLEX-PN NCLEX Practical Nursing Exam Prep – Real Practice Questions,
Answers & Detailed Rationales (Updated 2026) | Medical-Surgical
Nursing, Pharmacology & Medication Administration, Pediatrics &
Maternal-Newborn Care, Mental Health Nursing, Patient Safety & Infection
Control, Prioritization & Delegation, Clinical Judgment, NCLEX-Style Case
Studies & Practical Nursing Review
Question 1: A licensed practical nurse is preparing to administer insulin to a client
with diabetes mellitus. Which action should the nurse take FIRST before
administering the medication?
A. Verify the client's identity using two identifiers
B. Check the client's blood glucose level
C. Review the physician's order for insulin type and dose
D. Assess the client for signs of hypoglycemia
CORRECT ANSWER: C. Review the physician's order for insulin type and dose
Rationale: Before administering any medication, the LPN must first verify the
physician's order to ensure the "five rights" of medication administration: right patient,
right drug, right dose, right route, and right time. While verifying identity, checking blood
glucose, and assessing for hypoglycemia are important, confirming the order is the
foundational first step to prevent medication errors.
Question 2: Which intervention is MOST appropriate for a licensed practical nurse
to implement when caring for a client with a newly applied cast on the right arm?
A. Elevate the extremity on pillows to reduce swelling
B. Apply heat to the cast to promote drying
C. Cover the cast with plastic to keep it dry during bathing
D. Insert objects into the cast to relieve itching
CORRECT ANSWER: A. Elevate the extremity on pillows to reduce swelling
Rationale: Elevation of a casted extremity promotes venous return and reduces edema,
which is critical in the first 24-48 hours after cast application. Applying heat can cause
burns under the cast, covering with plastic traps moisture and promotes skin
breakdown, and inserting objects into the cast can cause skin injury or infection.
Question 3: A client is receiving oxygen via nasal cannula at 2 L/min. Which
assessment finding indicates the oxygen therapy is effective?
A. Respiratory rate of 24 breaths per minute
B. Oxygen saturation of 96% on pulse oximetry
C. Presence of bilateral crackles on auscultation
D. Client reports feeling short of breath
CORRECT ANSWER: B. Oxygen saturation of 96% on pulse oximetry
,Rationale: An oxygen saturation of 96% falls within the normal range (95-100%) and
indicates adequate oxygenation. A respiratory rate of 24 is tachypneic, crackles suggest
fluid in the lungs, and shortness of breath are all signs of inadequate oxygenation or
respiratory compromise.
Question 4: When performing hand hygiene, which action by the licensed practical
nurse demonstrates proper technique?
A. Washing hands for at least 10 seconds with soap and water
B. Using alcohol-based hand rub when hands are visibly soiled
C. Turning off the faucet with a clean paper towel after washing
D. Applying hand lotion before performing hand hygiene
CORRECT ANSWER: C. Turning off the faucet with a clean paper towel after
washing
Rationale: Turning off the faucet with a clean paper towel prevents recontamination of
clean hands. Handwashing should last at least 20 seconds, alcohol-based rubs should
not be used on visibly soiled hands, and lotion should be applied after, not before, hand
hygiene to avoid interfering with antimicrobial efficacy.
Question 5: A client with hypertension is prescribed lisinopril. Which adverse
effect should the licensed practical nurse instruct the client to report
immediately?
A. Dry cough
B. Swelling of the lips or face
C. Dizziness upon standing
D. Mild headache
CORRECT ANSWER: B. Swelling of the lips or face
Rationale: Swelling of the lips, face, or tongue indicates angioedema, a potentially life-
threatening adverse reaction to ACE inhibitors like lisinopril that requires immediate
medical attention. While dry cough, dizziness, and headache are common side effects,
they are not emergencies.
Question 6: Which finding should the licensed practical nurse report to the
registered nurse IMMEDIATELY for a client who had abdominal surgery 12 hours
ago?
A. Temperature of 99.2°F (37.3°C)
B. Serous drainage on the dressing
C. Absence of bowel sounds
D. Rigid, board-like abdomen
CORRECT ANSWER: D. Rigid, board-like abdomen
Rationale: A rigid, board-like abdomen suggests peritonitis or internal bleeding, which
are surgical emergencies requiring immediate intervention. Low-grade fever, serous
,drainage, and absent bowel sounds are expected findings in the immediate
postoperative period.
Question 7: A licensed practical nurse is caring for a client with a stage II pressure
injury on the sacrum. Which intervention is MOST appropriate?
A. Massage the area to promote circulation
B. Apply a hydrocolloid dressing
C. Cleanse the wound with hydrogen peroxide
D. Keep the area exposed to air to promote drying
CORRECT ANSWER: B. Apply a hydrocolloid dressing
Rationale: Hydrocolloid dressings maintain a moist wound environment, promote
autolytic debridement, and protect stage II pressure injuries from further trauma.
Massaging pressure-injured skin can cause further tissue damage, hydrogen peroxide is
cytotoxic to healing tissue, and exposure to air dries the wound bed and delays healing.
Question 8: When administering oral medications to a client with dysphagia, which
action should the licensed practical nurse take?
A. Crush all medications and mix with applesauce
B. Offer medications with a thickened liquid
C. Administer medications with the client lying flat
D. Give multiple pills at once to reduce swallowing attempts
CORRECT ANSWER: B. Offer medications with a thickened liquid
Rationale: Thickened liquids reduce the risk of aspiration in clients with dysphagia. Not
all medications can be crushed (e.g., extended-release formulations), the client should
be upright during administration to facilitate safe swallowing, and giving one pill at a
time with adequate time between doses is safer than multiple pills simultaneously.
Question 9: A client is scheduled for a fasting blood glucose test. Which instruction
should the licensed practical nurse provide?
A. "You may drink black coffee before the test."
B. "Avoid all food and beverages except water for 8-12 hours before the test."
C. "Take your usual morning medications with a small sip of water."
D. "Eat a light breakfast 2 hours before the test."
CORRECT ANSWER: B. "Avoid all food and beverages except water for 8-12 hours
before the test."
Rationale: Fasting blood glucose testing requires 8-12 hours of nothing by mouth
except water to ensure accurate results. Coffee, even black, can affect glucose levels,
and eating or drinking other substances invalidates the fasting state. Medication
instructions should be verified with the provider.
, Question 10: Which assessment finding in a newborn requires IMMEDIATE
intervention by the licensed practical nurse?
A. Acrocyanosis of the hands and feet
B. Respiratory rate of 50 breaths per minute
C. Grunting with each expiration
D. Temperature of 97.8°F (36.6°C)
CORRECT ANSWER: C. Grunting with each expiration
Rationale: Grunting is a sign of respiratory distress in newborns, indicating the infant is
trying to maintain alveolar expansion and oxygenation. Acrocyanosis is normal in the
first 24-48 hours, a respiratory rate of 50 is within normal limits (30-60 breaths/min), and
a temperature of 97.8°F is acceptable for a newborn.
Question 11: A licensed practical nurse is preparing to administer a subcutaneous
injection of heparin. Which site is MOST appropriate?
A. Deltoid muscle
B. Abdomen, at least 2 inches from the umbilicus
C. Ventrogluteal area
D. Vastus lateralis muscle
CORRECT ANSWER: B. Abdomen, at least 2 inches from the umbilicus
Rationale: The abdomen is the preferred site for subcutaneous heparin injections
because it has consistent absorption and avoids major blood vessels. The deltoid,
ventrogluteal, and vastus lateralis are intramuscular injection sites, not subcutaneous.
Question 12: Which action by the licensed practical nurse demonstrates proper
body mechanics when assisting a client to transfer from bed to chair?
A. Keeping feet close together for stability
B. Bending at the waist to lift the client
C. Using a gait belt and keeping the back straight
D. Twisting the torso while moving the client
CORRECT ANSWER: C. Using a gait belt and keeping the back straight
Rationale: Using a gait belt provides a secure hold, and maintaining a straight back with
bent knees uses leg muscles to prevent nurse injury. Keeping feet close together
reduces base of support, bending at the waist strains the back, and twisting increases
risk of musculoskeletal injury.
Question 13: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Why should the nurse avoid
increasing the oxygen flow rate without a provider order?
A. High oxygen levels can cause oxygen toxicity
B. COPD clients may lose their hypoxic drive to breathe
Answers & Detailed Rationales (Updated 2026) | Medical-Surgical
Nursing, Pharmacology & Medication Administration, Pediatrics &
Maternal-Newborn Care, Mental Health Nursing, Patient Safety & Infection
Control, Prioritization & Delegation, Clinical Judgment, NCLEX-Style Case
Studies & Practical Nursing Review
Question 1: A licensed practical nurse is preparing to administer insulin to a client
with diabetes mellitus. Which action should the nurse take FIRST before
administering the medication?
A. Verify the client's identity using two identifiers
B. Check the client's blood glucose level
C. Review the physician's order for insulin type and dose
D. Assess the client for signs of hypoglycemia
CORRECT ANSWER: C. Review the physician's order for insulin type and dose
Rationale: Before administering any medication, the LPN must first verify the
physician's order to ensure the "five rights" of medication administration: right patient,
right drug, right dose, right route, and right time. While verifying identity, checking blood
glucose, and assessing for hypoglycemia are important, confirming the order is the
foundational first step to prevent medication errors.
Question 2: Which intervention is MOST appropriate for a licensed practical nurse
to implement when caring for a client with a newly applied cast on the right arm?
A. Elevate the extremity on pillows to reduce swelling
B. Apply heat to the cast to promote drying
C. Cover the cast with plastic to keep it dry during bathing
D. Insert objects into the cast to relieve itching
CORRECT ANSWER: A. Elevate the extremity on pillows to reduce swelling
Rationale: Elevation of a casted extremity promotes venous return and reduces edema,
which is critical in the first 24-48 hours after cast application. Applying heat can cause
burns under the cast, covering with plastic traps moisture and promotes skin
breakdown, and inserting objects into the cast can cause skin injury or infection.
Question 3: A client is receiving oxygen via nasal cannula at 2 L/min. Which
assessment finding indicates the oxygen therapy is effective?
A. Respiratory rate of 24 breaths per minute
B. Oxygen saturation of 96% on pulse oximetry
C. Presence of bilateral crackles on auscultation
D. Client reports feeling short of breath
CORRECT ANSWER: B. Oxygen saturation of 96% on pulse oximetry
,Rationale: An oxygen saturation of 96% falls within the normal range (95-100%) and
indicates adequate oxygenation. A respiratory rate of 24 is tachypneic, crackles suggest
fluid in the lungs, and shortness of breath are all signs of inadequate oxygenation or
respiratory compromise.
Question 4: When performing hand hygiene, which action by the licensed practical
nurse demonstrates proper technique?
A. Washing hands for at least 10 seconds with soap and water
B. Using alcohol-based hand rub when hands are visibly soiled
C. Turning off the faucet with a clean paper towel after washing
D. Applying hand lotion before performing hand hygiene
CORRECT ANSWER: C. Turning off the faucet with a clean paper towel after
washing
Rationale: Turning off the faucet with a clean paper towel prevents recontamination of
clean hands. Handwashing should last at least 20 seconds, alcohol-based rubs should
not be used on visibly soiled hands, and lotion should be applied after, not before, hand
hygiene to avoid interfering with antimicrobial efficacy.
Question 5: A client with hypertension is prescribed lisinopril. Which adverse
effect should the licensed practical nurse instruct the client to report
immediately?
A. Dry cough
B. Swelling of the lips or face
C. Dizziness upon standing
D. Mild headache
CORRECT ANSWER: B. Swelling of the lips or face
Rationale: Swelling of the lips, face, or tongue indicates angioedema, a potentially life-
threatening adverse reaction to ACE inhibitors like lisinopril that requires immediate
medical attention. While dry cough, dizziness, and headache are common side effects,
they are not emergencies.
Question 6: Which finding should the licensed practical nurse report to the
registered nurse IMMEDIATELY for a client who had abdominal surgery 12 hours
ago?
A. Temperature of 99.2°F (37.3°C)
B. Serous drainage on the dressing
C. Absence of bowel sounds
D. Rigid, board-like abdomen
CORRECT ANSWER: D. Rigid, board-like abdomen
Rationale: A rigid, board-like abdomen suggests peritonitis or internal bleeding, which
are surgical emergencies requiring immediate intervention. Low-grade fever, serous
,drainage, and absent bowel sounds are expected findings in the immediate
postoperative period.
Question 7: A licensed practical nurse is caring for a client with a stage II pressure
injury on the sacrum. Which intervention is MOST appropriate?
A. Massage the area to promote circulation
B. Apply a hydrocolloid dressing
C. Cleanse the wound with hydrogen peroxide
D. Keep the area exposed to air to promote drying
CORRECT ANSWER: B. Apply a hydrocolloid dressing
Rationale: Hydrocolloid dressings maintain a moist wound environment, promote
autolytic debridement, and protect stage II pressure injuries from further trauma.
Massaging pressure-injured skin can cause further tissue damage, hydrogen peroxide is
cytotoxic to healing tissue, and exposure to air dries the wound bed and delays healing.
Question 8: When administering oral medications to a client with dysphagia, which
action should the licensed practical nurse take?
A. Crush all medications and mix with applesauce
B. Offer medications with a thickened liquid
C. Administer medications with the client lying flat
D. Give multiple pills at once to reduce swallowing attempts
CORRECT ANSWER: B. Offer medications with a thickened liquid
Rationale: Thickened liquids reduce the risk of aspiration in clients with dysphagia. Not
all medications can be crushed (e.g., extended-release formulations), the client should
be upright during administration to facilitate safe swallowing, and giving one pill at a
time with adequate time between doses is safer than multiple pills simultaneously.
Question 9: A client is scheduled for a fasting blood glucose test. Which instruction
should the licensed practical nurse provide?
A. "You may drink black coffee before the test."
B. "Avoid all food and beverages except water for 8-12 hours before the test."
C. "Take your usual morning medications with a small sip of water."
D. "Eat a light breakfast 2 hours before the test."
CORRECT ANSWER: B. "Avoid all food and beverages except water for 8-12 hours
before the test."
Rationale: Fasting blood glucose testing requires 8-12 hours of nothing by mouth
except water to ensure accurate results. Coffee, even black, can affect glucose levels,
and eating or drinking other substances invalidates the fasting state. Medication
instructions should be verified with the provider.
, Question 10: Which assessment finding in a newborn requires IMMEDIATE
intervention by the licensed practical nurse?
A. Acrocyanosis of the hands and feet
B. Respiratory rate of 50 breaths per minute
C. Grunting with each expiration
D. Temperature of 97.8°F (36.6°C)
CORRECT ANSWER: C. Grunting with each expiration
Rationale: Grunting is a sign of respiratory distress in newborns, indicating the infant is
trying to maintain alveolar expansion and oxygenation. Acrocyanosis is normal in the
first 24-48 hours, a respiratory rate of 50 is within normal limits (30-60 breaths/min), and
a temperature of 97.8°F is acceptable for a newborn.
Question 11: A licensed practical nurse is preparing to administer a subcutaneous
injection of heparin. Which site is MOST appropriate?
A. Deltoid muscle
B. Abdomen, at least 2 inches from the umbilicus
C. Ventrogluteal area
D. Vastus lateralis muscle
CORRECT ANSWER: B. Abdomen, at least 2 inches from the umbilicus
Rationale: The abdomen is the preferred site for subcutaneous heparin injections
because it has consistent absorption and avoids major blood vessels. The deltoid,
ventrogluteal, and vastus lateralis are intramuscular injection sites, not subcutaneous.
Question 12: Which action by the licensed practical nurse demonstrates proper
body mechanics when assisting a client to transfer from bed to chair?
A. Keeping feet close together for stability
B. Bending at the waist to lift the client
C. Using a gait belt and keeping the back straight
D. Twisting the torso while moving the client
CORRECT ANSWER: C. Using a gait belt and keeping the back straight
Rationale: Using a gait belt provides a secure hold, and maintaining a straight back with
bent knees uses leg muscles to prevent nurse injury. Keeping feet close together
reduces base of support, bending at the waist strains the back, and twisting increases
risk of musculoskeletal injury.
Question 13: A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Why should the nurse avoid
increasing the oxygen flow rate without a provider order?
A. High oxygen levels can cause oxygen toxicity
B. COPD clients may lose their hypoxic drive to breathe
