LPN NCLEX® EXAM PREP – NEWEST 2026 EDITION | COMPREHENSIVE
STUDY GUIDE WITH 500+ PRACTICE QUESTIONS, VERIFIED ANSWERS
& DETAILED RATIONALES | COMPLETE NCLEX-PN® SUCCESS
REVIEW | UPDATED TEST-TAKING STRATEGIES | INSTANT PDF
DOWNLOAD
1. The nurse is preparing to administer digoxin to a client with heart failure and notes the client's
serum digoxin level is 2.8 ng/mL. Which action should the nurse take first?
A) Administer the medication as ordered
B) Hold the medication and notify the healthcare provider
C) Administer half the prescribed dose
D) Check the client's apical pulse before administering
➢ Correct Answer: B) Hold the medication and notify the healthcare provider The therapeutic
range for digoxin is 0.5-2 ng/mL; a level of 2.8 ng/mL is above the therapeutic range and
indicates toxicity, requiring the nurse to hold the medication and notify the healthcare
provider for further orders.
2. A client with chronic obstructive pulmonary disease has arterial blood gas results showing pH
7.32, CO2 48 mmHg, and HCO3 26 mEq/L. The nurse interprets these results as indicating which
condition?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
➢ Correct Answer: C) Respiratory acidosis The pH is below 7.35 indicating acidosis, and the
CO2 is elevated above 45 mmHg; since CO2 is inversely related to pH and elevated in this
case, this represents respiratory acidosis with the lungs retaining carbon dioxide.
3. The LPN is caring for a client who states "I just want to die" and observes the client has a living
will in the medical record. What document should the nurse also check for in the client's record?
A) Do not resuscitate order
B) Power of attorney
C) Advance directives
D) Healthcare proxy
➢ Correct Answer: C) Advance directives Advance directives encompass living wills and
healthcare proxies; the nurse should examine the client's medical record for advance
, directives documentation to understand the client's wishes regarding end-of-life care and
treatment preferences.
4. A client with bipolar disorder is taking lithium carbonate and has a serum lithium level of 1.5
mEq/L. Which assessment finding should the nurse prioritize?
A) Fine hand tremors
B) Nausea and vomiting
C) Polyuria and polydipsia
D) Seizure activity
➢ Correct Answer: A) Fine hand tremors The therapeutic range for lithium is 0.6-1.2 mEq/L;
a level of 1.5 mEq/L is elevated; fine hand tremors are an early sign of lithium toxicity, and
the nurse should monitor for progression to more severe symptoms including confusion and
seizures.
5. The nurse is caring for a postoperative client who has a nasogastric tube attached to low
intermittent suction. Which acid-base imbalance is this client at highest risk for developing?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
➢ Correct Answer: D) Metabolic alkalosis Nasogastric suctioning removes gastric acid
(hydrochloric acid) from the stomach, leading to loss of hydrogen ions and bicarbonate
retention; this results in metabolic alkalosis with an elevated pH and elevated HCO3 level.
6. The LPN observes a client walking in the hallway with an open hospital gown and exposing
themselves to other clients. Which statement by the nurse is most appropriate?
A) "You need to close your gown immediately."
B) "This is inappropriate behavior. Please close your robe and return to your room."
C) "Why are you walking around like that?"
D) "Don't you know that's against hospital policy?"
➢ Correct Answer: B) "This is inappropriate behavior. Please close your robe and return to
your room." This statement responds to the client's behavior, sets limits appropriately,
directs the client toward more appropriate social behavior, and rejects the behavior rather
than the person without imposing judgmental attitudes.
7. The nurse is reviewing a client's complete blood count and notes the white blood cell count is
12,500 mm3. Which interpretation of this finding is correct?
A) Normal WBC count
B) Elevated WBC count indicating infection
,C) Decreased WBC count indicating immunosuppression
D) Normal value for an older adult client
➢ Correct Answer: B) Elevated WBC count indicating infection The normal WBC range is
4,500-11,000 mm3; a count of 12,500 mm3 is elevated above the normal range and
typically indicates an infectious process or inflammatory response occurring in the body.
8. A client is receiving intravenous gentamicin for a severe infection. The nurse notes the client's
peak serum gentamicin level is 12 mcg/mL. Which nursing action is most appropriate?
A) Administer the next dose as scheduled
B) Hold the medication and notify the healthcare provider
C) Increase the IV fluid rate to dilute the medication
D) Document the finding as a normal therapeutic level
➢ Correct Answer: B) Hold the medication and notify the healthcare provider The therapeutic
range for gentamicin is 5-10 mcg/mL; a peak level of 12 mcg/mL is above the therapeutic
range and places the client at increased risk for nephrotoxicity and ototoxicity, requiring
the medication to be held and the provider notified.
9. The nurse is prioritizing care for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A) Client with diabetes reporting a blood glucose of 180 mg/dL
B) Client with pneumonia and an oxygen saturation of 88% on room air
C) Client with a urinary tract infection requesting pain medication
D) Client with a new diagnosis of hypertension with blood pressure 152/88 mmHg
➢ Correct Answer: B) Client with pneumonia and an oxygen saturation of 88% on room air
Using the ABC framework, airway and breathing are the highest priority; an oxygen
saturation of 88% is below the normal range of 95-100% and indicates impaired gas
exchange requiring immediate intervention to prevent further respiratory compromise.
10. The LPN is providing care for a client who has been prescribed phenytoin for seizure control.
The nurse reviews the client's laboratory results and notes a serum phenytoin level of 22 mcg/mL.
Which finding should the nurse expect to observe?
A) No adverse effects
B) Nystagmus and ataxia
C) Hypotension and bradycardia
D) Hyperglycemia and polyuria
➢ Correct Answer: B) Nystagmus and ataxia The therapeutic range for phenytoin is 10-20
mcg/mL; a level of 22 mcg/mL is above the therapeutic range and signs of toxicity include
nystagmus, ataxia, diplopia, and sedation that require dose adjustment and monitoring.
, 11. A client with end-stage renal disease has a serum pH of 7.30, CO2 of 32 mmHg, and HCO3 of
18 mEq/L. The nurse recognizes this as which type of acid-base disturbance?
A) Respiratory acidosis with compensation
B) Metabolic acidosis with partial compensation
C) Respiratory alkalosis with compensation
D) Metabolic alkalosis with partial compensation
➢ Correct Answer: B) Metabolic acidosis with partial compensation The pH is below 7.35
indicating acidosis; the HCO3 is below 22 mEq/L indicating metabolic acidosis; the CO2
is decreased below 35 mmHg as the lungs attempt to compensate by blowing off carbon
dioxide, indicating partial compensation.
12. The nurse is teaching a client about the medication paroxetine prescribed for depression.
Which side effect should the nurse instruct the client to report immediately?
A) Drowsiness and fatigue
B) Nausea and decreased appetite
C) Palpitations and bradycardia
D) Weight gain and increased appetite
➢ Correct Answer: C) Palpitations and bradycardia Paroxetine is an SSRI used for
depression, panic disorder, and OCD; side effects include palpitations and bradycardia
which are cardiac effects that should be reported immediately; other side effects include
nausea, vomiting, and decreased appetite.
13. The LPN is reviewing a client's urinalysis results and notes the specific gravity is 1.040. Which
condition does this finding most likely indicate?
A) Diabetes insipidus
B) Overhydration
C) Dehydration
D) Renal failure
➢ Correct Answer: C) Dehydration Normal urine specific gravity is 1.010-1.030; a value of
1.040 is elevated, indicating concentrated urine which occurs with dehydration, decreased
fluid intake, or conditions causing fluid loss such as vomiting, diarrhea, or excessive
sweating.
14. A client who had abdominal surgery 2 days ago has a PTT of 52 seconds. The client is receiving
heparin subcutaneously. Which action should the nurse take?
A) Administer the next scheduled dose of heparin
B) Hold the heparin and notify the healthcare provider
C) Increase the heparin dose as ordered
D) Administer vitamin K as an antidote
STUDY GUIDE WITH 500+ PRACTICE QUESTIONS, VERIFIED ANSWERS
& DETAILED RATIONALES | COMPLETE NCLEX-PN® SUCCESS
REVIEW | UPDATED TEST-TAKING STRATEGIES | INSTANT PDF
DOWNLOAD
1. The nurse is preparing to administer digoxin to a client with heart failure and notes the client's
serum digoxin level is 2.8 ng/mL. Which action should the nurse take first?
A) Administer the medication as ordered
B) Hold the medication and notify the healthcare provider
C) Administer half the prescribed dose
D) Check the client's apical pulse before administering
➢ Correct Answer: B) Hold the medication and notify the healthcare provider The therapeutic
range for digoxin is 0.5-2 ng/mL; a level of 2.8 ng/mL is above the therapeutic range and
indicates toxicity, requiring the nurse to hold the medication and notify the healthcare
provider for further orders.
2. A client with chronic obstructive pulmonary disease has arterial blood gas results showing pH
7.32, CO2 48 mmHg, and HCO3 26 mEq/L. The nurse interprets these results as indicating which
condition?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
➢ Correct Answer: C) Respiratory acidosis The pH is below 7.35 indicating acidosis, and the
CO2 is elevated above 45 mmHg; since CO2 is inversely related to pH and elevated in this
case, this represents respiratory acidosis with the lungs retaining carbon dioxide.
3. The LPN is caring for a client who states "I just want to die" and observes the client has a living
will in the medical record. What document should the nurse also check for in the client's record?
A) Do not resuscitate order
B) Power of attorney
C) Advance directives
D) Healthcare proxy
➢ Correct Answer: C) Advance directives Advance directives encompass living wills and
healthcare proxies; the nurse should examine the client's medical record for advance
, directives documentation to understand the client's wishes regarding end-of-life care and
treatment preferences.
4. A client with bipolar disorder is taking lithium carbonate and has a serum lithium level of 1.5
mEq/L. Which assessment finding should the nurse prioritize?
A) Fine hand tremors
B) Nausea and vomiting
C) Polyuria and polydipsia
D) Seizure activity
➢ Correct Answer: A) Fine hand tremors The therapeutic range for lithium is 0.6-1.2 mEq/L;
a level of 1.5 mEq/L is elevated; fine hand tremors are an early sign of lithium toxicity, and
the nurse should monitor for progression to more severe symptoms including confusion and
seizures.
5. The nurse is caring for a postoperative client who has a nasogastric tube attached to low
intermittent suction. Which acid-base imbalance is this client at highest risk for developing?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
➢ Correct Answer: D) Metabolic alkalosis Nasogastric suctioning removes gastric acid
(hydrochloric acid) from the stomach, leading to loss of hydrogen ions and bicarbonate
retention; this results in metabolic alkalosis with an elevated pH and elevated HCO3 level.
6. The LPN observes a client walking in the hallway with an open hospital gown and exposing
themselves to other clients. Which statement by the nurse is most appropriate?
A) "You need to close your gown immediately."
B) "This is inappropriate behavior. Please close your robe and return to your room."
C) "Why are you walking around like that?"
D) "Don't you know that's against hospital policy?"
➢ Correct Answer: B) "This is inappropriate behavior. Please close your robe and return to
your room." This statement responds to the client's behavior, sets limits appropriately,
directs the client toward more appropriate social behavior, and rejects the behavior rather
than the person without imposing judgmental attitudes.
7. The nurse is reviewing a client's complete blood count and notes the white blood cell count is
12,500 mm3. Which interpretation of this finding is correct?
A) Normal WBC count
B) Elevated WBC count indicating infection
,C) Decreased WBC count indicating immunosuppression
D) Normal value for an older adult client
➢ Correct Answer: B) Elevated WBC count indicating infection The normal WBC range is
4,500-11,000 mm3; a count of 12,500 mm3 is elevated above the normal range and
typically indicates an infectious process or inflammatory response occurring in the body.
8. A client is receiving intravenous gentamicin for a severe infection. The nurse notes the client's
peak serum gentamicin level is 12 mcg/mL. Which nursing action is most appropriate?
A) Administer the next dose as scheduled
B) Hold the medication and notify the healthcare provider
C) Increase the IV fluid rate to dilute the medication
D) Document the finding as a normal therapeutic level
➢ Correct Answer: B) Hold the medication and notify the healthcare provider The therapeutic
range for gentamicin is 5-10 mcg/mL; a peak level of 12 mcg/mL is above the therapeutic
range and places the client at increased risk for nephrotoxicity and ototoxicity, requiring
the medication to be held and the provider notified.
9. The nurse is prioritizing care for four clients on a medical-surgical unit. Which client should
the nurse assess first?
A) Client with diabetes reporting a blood glucose of 180 mg/dL
B) Client with pneumonia and an oxygen saturation of 88% on room air
C) Client with a urinary tract infection requesting pain medication
D) Client with a new diagnosis of hypertension with blood pressure 152/88 mmHg
➢ Correct Answer: B) Client with pneumonia and an oxygen saturation of 88% on room air
Using the ABC framework, airway and breathing are the highest priority; an oxygen
saturation of 88% is below the normal range of 95-100% and indicates impaired gas
exchange requiring immediate intervention to prevent further respiratory compromise.
10. The LPN is providing care for a client who has been prescribed phenytoin for seizure control.
The nurse reviews the client's laboratory results and notes a serum phenytoin level of 22 mcg/mL.
Which finding should the nurse expect to observe?
A) No adverse effects
B) Nystagmus and ataxia
C) Hypotension and bradycardia
D) Hyperglycemia and polyuria
➢ Correct Answer: B) Nystagmus and ataxia The therapeutic range for phenytoin is 10-20
mcg/mL; a level of 22 mcg/mL is above the therapeutic range and signs of toxicity include
nystagmus, ataxia, diplopia, and sedation that require dose adjustment and monitoring.
, 11. A client with end-stage renal disease has a serum pH of 7.30, CO2 of 32 mmHg, and HCO3 of
18 mEq/L. The nurse recognizes this as which type of acid-base disturbance?
A) Respiratory acidosis with compensation
B) Metabolic acidosis with partial compensation
C) Respiratory alkalosis with compensation
D) Metabolic alkalosis with partial compensation
➢ Correct Answer: B) Metabolic acidosis with partial compensation The pH is below 7.35
indicating acidosis; the HCO3 is below 22 mEq/L indicating metabolic acidosis; the CO2
is decreased below 35 mmHg as the lungs attempt to compensate by blowing off carbon
dioxide, indicating partial compensation.
12. The nurse is teaching a client about the medication paroxetine prescribed for depression.
Which side effect should the nurse instruct the client to report immediately?
A) Drowsiness and fatigue
B) Nausea and decreased appetite
C) Palpitations and bradycardia
D) Weight gain and increased appetite
➢ Correct Answer: C) Palpitations and bradycardia Paroxetine is an SSRI used for
depression, panic disorder, and OCD; side effects include palpitations and bradycardia
which are cardiac effects that should be reported immediately; other side effects include
nausea, vomiting, and decreased appetite.
13. The LPN is reviewing a client's urinalysis results and notes the specific gravity is 1.040. Which
condition does this finding most likely indicate?
A) Diabetes insipidus
B) Overhydration
C) Dehydration
D) Renal failure
➢ Correct Answer: C) Dehydration Normal urine specific gravity is 1.010-1.030; a value of
1.040 is elevated, indicating concentrated urine which occurs with dehydration, decreased
fluid intake, or conditions causing fluid loss such as vomiting, diarrhea, or excessive
sweating.
14. A client who had abdominal surgery 2 days ago has a PTT of 52 seconds. The client is receiving
heparin subcutaneously. Which action should the nurse take?
A) Administer the next scheduled dose of heparin
B) Hold the heparin and notify the healthcare provider
C) Increase the heparin dose as ordered
D) Administer vitamin K as an antidote
