LVN FUNDAMENTALS CMS EXAM 2026 /
2027 with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE - 1. Nursing Process and Clinical Judgment - 2.
Fundamental Patient Care and Safety - 3. Medication Administration
and Pharmacokinetics - 4. Vital Signs and Physical Assessment - 5.
Asepsis, Infection Control, and Wound Care - 6. Perioperative Care and
Mobility - 7. Fluid, Electrolyte, and Acid-Base Balance - 8. Palliative
and End-of-Life Care
1. A licensed vocational nurse is caring for an older adult client admitted with dehydration and
confusion. Which nursing intervention should the nurse prioritize to ensure client safety while
maintaining autonomy?
A. Apply a soft wrist restraint to prevent accidental removal of the intravenous catheter.
B. Implement a scheduled, frequent toileting and fluid offering routine.
C. Obtain a prescription for a chemical restraint to calm the client's nocturnal agitation.
D. Keep all four side rails up and the bed in the highest position for easy staff monitoring.
Answer: B
CORRECT ANSWER : B
Rationale: Implementing a scheduled routine addresses physiological needs and reduces
confusion-related falls by anticipating unmet needs. Restraints (options A and C) and keeping all
four side rails up (option D) violate least-restrictive safety measures and increase the risk of
injury and complications.
2. A nurse is evaluating a client's understanding of dietary restrictions prescribed for chronic kidney
disease. Which statement by the client indicates effective learning regarding potassium
management?
A. "I can eat as many bananas and oranges as I want because they provide necessary energy."
B. "I need to limit foods high in potassium such as potatoes, tomatoes, and citrus fruits."
C. "Potassium is only restricted if I develop severe hypertension and peripheral edema."
, D. "I should substitute regular table salt with potassium chloride salt substitutes."
Answer: B
CORRECT ANSWER : B
Options A and D are incorrect because bananas, oranges, and salt substitutes are high in
potassium and dangerous for renal clients. Option C is incorrect because potassium regulation
is tied to cardiac function and renal excretion, not just blood pressure.
3. A client post-total hip arthroplasty exhibits sudden dyspnea, tachypnea, and pleuritic chest pain.
Which immediate action should the nurse take?
A. Assist the client to an upright position and administer prescribed sublingual nitroglycerin.
B. Elevate the head of the bed, apply supplemental oxygen, and notify the rapid response
team.
C. Massage both lower extremities to promote venous return and dislodge potential thrombi.
D. Prepare the client for immediate ambulation to help expand the lung bases.
Answer: B
CORRECT ANSWER : B
Rationale: The client's symptoms strongly indicate a pulmonary embolism, requiring immediate
oxygenation and medical escalation. Option A addresses cardiac ischemia rather than
pulmonary compromise. Option C is contraindicated as massaging can dislodge a deep vein
thrombosis. Option D would be dangerous for an unstable client.
4. A nurse is preparing to administer digoxin to a client with heart failure. Which assessment
finding requires withholding the medication and notifying the provider?
A. Blood pressure of 128/82 mmHg
B. Serum potassium level of 4.2 mEq/L
C. Apical pulse rate of 52 beats per minute
D. Mild fatigue reported during morning care
Answer: C
CORRECT ANSWER : C
, Rationale: Digoxin should be held if the adult apical pulse is less than 60 beats per minute to
prevent severe bradycardia and toxicity. Options A and B are within normal limits. Option D is a
chronic symptom of heart failure, not an acute contraindication for administration.
5. A client with a stage 3 pressure injury on the sacrum has a wound bed covered in yellow slough.
Which type of debridement is most appropriate for the nurse to anticipate or perform based on
standard protocols?
A. Surgical debridement using a scalpel performed exclusively at the bedside by the nurse.
B. Autolytic debridement using a moisture-retentive dressing to leverage endogenous
enzymes.
C. Radiation debridement to sterilize the wound bed and eliminate bacterial colonization.
D. Mechanical debridement via dry gauze removal every two hours to aggressively strip slough.
Answer: B
CORRECT ANSWER : B
Rationale: Autolytic debridement uses moisture-retentive dressings to allow the body's own
enzymes to soften and liquefy necrotic tissue. Option A is outside the LVN scope for bedside
sharp debridement. Option C is fictional. Option D causes trauma to healthy granulation tissue
and delays healing.
6. While administering morning medications, a nurse realizes a dose of insulin was given to the
wrong client. What is the immediate priority action?
A. Document the medication error in the incident report at the end of the shift.
B. Assess the client for signs of hypoglycemia and check blood glucose immediately.
C. Notify the risk management department before checking on the affected client.
D. Administer a glass of juice and instruct the client to lie down quietly.
Answer: B
CORRECT ANSWER : B
Rationale: Client safety and immediate physiological assessment take absolute precedence
during any error. Option A is a secondary administrative step. Option C delays direct client
care. Option D is premature without first confirming hypoglycemia via blood glucose testing.
, 7. A nurse is caring for a client receiving continuous enteral tube feedings via a nasogastric tube.
Which intervention is essential to prevent aspiration pneumonia?
A. Keep the head of the bed flat during and for 30 minutes after intermittent feedings.
B. Maintain the head of the bed elevated at 30 to 45 degrees continuously.
C. Check residual volume every 12 hours and discard all aspirated contents.
D. Flush the tube with cold tap water only when feedings are completely finished.
Answer: B
CORRECT ANSWER : B
Rationale: Elevating the head of the bed to 30-45 degrees minimizes the risk of regurgitation and
pulmonary aspiration. Option A promotes aspiration. Option C involves discarding residuals
unnecessarily and checking too infrequently for continuous feeds. Option D uses cold water
inappropriately.
8. A client is prescribed a 24-hour urine collection for creatinine clearance. Which action should
the nurse include in the collection protocol?
A. Save the very first urine specimen of the morning to begin the test.
B. Discard the first morning void, note the time, and collect all subsequent urine for 24
hours.
C. Keep the collection container at room temperature throughout the entire duration.
D. Instruct the client to void directly into the toilet for the final specimen collection.
Answer: B
CORRECT ANSWER : B
Rationale: A 24-hour urine collection must start with an empty bladder; the first void is
discarded, and the exact time marks the beginning of the test. Option A invalidates the test by
including residual urine from prior to the test window. Option C is incorrect because specimens
usually require refrigeration or ice. Option D misses the final required collection at the 24-hour
mark.
9. A nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 4 L/min via nasal cannula. The client appears lethargic with slow, shallow
respirations. What is the underlying physiological mechanism?
2027 with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE - 1. Nursing Process and Clinical Judgment - 2.
Fundamental Patient Care and Safety - 3. Medication Administration
and Pharmacokinetics - 4. Vital Signs and Physical Assessment - 5.
Asepsis, Infection Control, and Wound Care - 6. Perioperative Care and
Mobility - 7. Fluid, Electrolyte, and Acid-Base Balance - 8. Palliative
and End-of-Life Care
1. A licensed vocational nurse is caring for an older adult client admitted with dehydration and
confusion. Which nursing intervention should the nurse prioritize to ensure client safety while
maintaining autonomy?
A. Apply a soft wrist restraint to prevent accidental removal of the intravenous catheter.
B. Implement a scheduled, frequent toileting and fluid offering routine.
C. Obtain a prescription for a chemical restraint to calm the client's nocturnal agitation.
D. Keep all four side rails up and the bed in the highest position for easy staff monitoring.
Answer: B
CORRECT ANSWER : B
Rationale: Implementing a scheduled routine addresses physiological needs and reduces
confusion-related falls by anticipating unmet needs. Restraints (options A and C) and keeping all
four side rails up (option D) violate least-restrictive safety measures and increase the risk of
injury and complications.
2. A nurse is evaluating a client's understanding of dietary restrictions prescribed for chronic kidney
disease. Which statement by the client indicates effective learning regarding potassium
management?
A. "I can eat as many bananas and oranges as I want because they provide necessary energy."
B. "I need to limit foods high in potassium such as potatoes, tomatoes, and citrus fruits."
C. "Potassium is only restricted if I develop severe hypertension and peripheral edema."
, D. "I should substitute regular table salt with potassium chloride salt substitutes."
Answer: B
CORRECT ANSWER : B
Options A and D are incorrect because bananas, oranges, and salt substitutes are high in
potassium and dangerous for renal clients. Option C is incorrect because potassium regulation
is tied to cardiac function and renal excretion, not just blood pressure.
3. A client post-total hip arthroplasty exhibits sudden dyspnea, tachypnea, and pleuritic chest pain.
Which immediate action should the nurse take?
A. Assist the client to an upright position and administer prescribed sublingual nitroglycerin.
B. Elevate the head of the bed, apply supplemental oxygen, and notify the rapid response
team.
C. Massage both lower extremities to promote venous return and dislodge potential thrombi.
D. Prepare the client for immediate ambulation to help expand the lung bases.
Answer: B
CORRECT ANSWER : B
Rationale: The client's symptoms strongly indicate a pulmonary embolism, requiring immediate
oxygenation and medical escalation. Option A addresses cardiac ischemia rather than
pulmonary compromise. Option C is contraindicated as massaging can dislodge a deep vein
thrombosis. Option D would be dangerous for an unstable client.
4. A nurse is preparing to administer digoxin to a client with heart failure. Which assessment
finding requires withholding the medication and notifying the provider?
A. Blood pressure of 128/82 mmHg
B. Serum potassium level of 4.2 mEq/L
C. Apical pulse rate of 52 beats per minute
D. Mild fatigue reported during morning care
Answer: C
CORRECT ANSWER : C
, Rationale: Digoxin should be held if the adult apical pulse is less than 60 beats per minute to
prevent severe bradycardia and toxicity. Options A and B are within normal limits. Option D is a
chronic symptom of heart failure, not an acute contraindication for administration.
5. A client with a stage 3 pressure injury on the sacrum has a wound bed covered in yellow slough.
Which type of debridement is most appropriate for the nurse to anticipate or perform based on
standard protocols?
A. Surgical debridement using a scalpel performed exclusively at the bedside by the nurse.
B. Autolytic debridement using a moisture-retentive dressing to leverage endogenous
enzymes.
C. Radiation debridement to sterilize the wound bed and eliminate bacterial colonization.
D. Mechanical debridement via dry gauze removal every two hours to aggressively strip slough.
Answer: B
CORRECT ANSWER : B
Rationale: Autolytic debridement uses moisture-retentive dressings to allow the body's own
enzymes to soften and liquefy necrotic tissue. Option A is outside the LVN scope for bedside
sharp debridement. Option C is fictional. Option D causes trauma to healthy granulation tissue
and delays healing.
6. While administering morning medications, a nurse realizes a dose of insulin was given to the
wrong client. What is the immediate priority action?
A. Document the medication error in the incident report at the end of the shift.
B. Assess the client for signs of hypoglycemia and check blood glucose immediately.
C. Notify the risk management department before checking on the affected client.
D. Administer a glass of juice and instruct the client to lie down quietly.
Answer: B
CORRECT ANSWER : B
Rationale: Client safety and immediate physiological assessment take absolute precedence
during any error. Option A is a secondary administrative step. Option C delays direct client
care. Option D is premature without first confirming hypoglycemia via blood glucose testing.
, 7. A nurse is caring for a client receiving continuous enteral tube feedings via a nasogastric tube.
Which intervention is essential to prevent aspiration pneumonia?
A. Keep the head of the bed flat during and for 30 minutes after intermittent feedings.
B. Maintain the head of the bed elevated at 30 to 45 degrees continuously.
C. Check residual volume every 12 hours and discard all aspirated contents.
D. Flush the tube with cold tap water only when feedings are completely finished.
Answer: B
CORRECT ANSWER : B
Rationale: Elevating the head of the bed to 30-45 degrees minimizes the risk of regurgitation and
pulmonary aspiration. Option A promotes aspiration. Option C involves discarding residuals
unnecessarily and checking too infrequently for continuous feeds. Option D uses cold water
inappropriately.
8. A client is prescribed a 24-hour urine collection for creatinine clearance. Which action should
the nurse include in the collection protocol?
A. Save the very first urine specimen of the morning to begin the test.
B. Discard the first morning void, note the time, and collect all subsequent urine for 24
hours.
C. Keep the collection container at room temperature throughout the entire duration.
D. Instruct the client to void directly into the toilet for the final specimen collection.
Answer: B
CORRECT ANSWER : B
Rationale: A 24-hour urine collection must start with an empty bladder; the first void is
discarded, and the exact time marks the beginning of the test. Option A invalidates the test by
including residual urine from prior to the test window. Option C is incorrect because specimens
usually require refrigeration or ice. Option D misses the final required collection at the 24-hour
mark.
9. A nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is
receiving oxygen at 4 L/min via nasal cannula. The client appears lethargic with slow, shallow
respirations. What is the underlying physiological mechanism?
