LPN/LVN Nurse Refresher
Comprehensive Exam — Code: LPN-NR-
CE | 100-Question Advanced Practice
Exam 2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1.
A client with heart failure suddenly develops severe dyspnea, pink frothy sputum,
and bilateral crackles. Which action should the LPN/LVN take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain the client's daily weight
D. Administer a prescribed oral diuretic
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning improves lung expansion and decreases
venous return, helping reduce pulmonary congestion while additional
interventions are initiated.
,2.
A postoperative client becomes restless and confused. The respiratory rate is
30/min, oxygen saturation is 86% on room air, and the skin is cool. What is the
priority action?
A. Administer an opioid analgesic
B. Reassure the client
C. Apply supplemental oxygen according to protocol
D. Document the findings
Answer: C. Apply supplemental oxygen according to protocol
Rationale: Acute hypoxemia can initially manifest as restlessness and confusion.
Oxygenation is the immediate priority while the cause is assessed and further
treatment is initiated.
3.
A client receiving IV potassium chloride reports burning at the IV site. The site
appears swollen and cool. What should the nurse do first?
A. Slow the infusion
B. Apply a warm compress
C. Stop the infusion
D. Flush the catheter vigorously
Answer: C. Stop the infusion
Rationale: Pain, swelling, and coolness suggest infiltration or extravasation.
Potassium is irritating to tissue, so the infusion should be stopped immediately
and the IV assessed according to facility protocol.
4.
A client with diabetes is awake, diaphoretic, shaky, and has a blood glucose level
of 52 mg/dL. What is the best initial intervention?
,A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Give a high-protein meal
D. Restrict oral intake
Answer: B. Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can swallow safely should receive
approximately 15 g of fast-acting carbohydrate, followed by reassessment of
glucose according to the 15-15 approach.
5.
A client receiving warfarin has an INR of 5.8 and reports new gum bleeding. Which
action is most appropriate?
A. Administer the next scheduled dose
B. Encourage foods high in vitamin K immediately
C. Hold the medication and notify the provider
D. Administer aspirin
Answer: C. Hold the medication and notify the provider
Rationale: An elevated INR accompanied by active bleeding indicates excessive
anticoagulation and requires prompt provider notification and further
management.
6.
A client with COPD is receiving oxygen. Which finding requires the most
immediate attention?
A. Oxygen saturation of 90%
B. Productive cough with clear sputum
C. Increasing somnolence and shallow respirations
D. Respiratory rate of 20/min
Answer: C. Increasing somnolence and shallow respirations
, Rationale: Increasing somnolence with hypoventilation may indicate worsening
carbon dioxide retention and respiratory failure.
7.
A client with suspected stroke suddenly develops facial drooping and right-sided
weakness. Which information is most important to determine immediately?
A. Last bowel movement
B. Time the client was last known well
C. Current dietary preference
D. Previous influenza vaccination
Answer: B. Time the client was last known well
Rationale: The exact last-known-well time is critical because eligibility for time-
sensitive stroke therapies depends on the onset or last-known-normal time.
8.
A client with chronic kidney disease has a potassium level of 6.7 mEq/L. Which
finding is the greatest concern?
A. Muscle weakness
B. Peaked T waves on ECG
C. Mild nausea
D. Increased thirst
Answer: B. Peaked T waves on ECG
Rationale: Severe hyperkalemia can cause life-threatening cardiac
dysrhythmias. ECG changes require immediate intervention and provider
notification.
9.
A client receiving a blood transfusion develops chills, fever, and low back pain 15
minutes after the transfusion begins. What should the nurse do first?
Comprehensive Exam — Code: LPN-NR-
CE | 100-Question Advanced Practice
Exam 2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1.
A client with heart failure suddenly develops severe dyspnea, pink frothy sputum,
and bilateral crackles. Which action should the LPN/LVN take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain the client's daily weight
D. Administer a prescribed oral diuretic
Answer: B. Place the client in high-Fowler's position
Rationale: High-Fowler's positioning improves lung expansion and decreases
venous return, helping reduce pulmonary congestion while additional
interventions are initiated.
,2.
A postoperative client becomes restless and confused. The respiratory rate is
30/min, oxygen saturation is 86% on room air, and the skin is cool. What is the
priority action?
A. Administer an opioid analgesic
B. Reassure the client
C. Apply supplemental oxygen according to protocol
D. Document the findings
Answer: C. Apply supplemental oxygen according to protocol
Rationale: Acute hypoxemia can initially manifest as restlessness and confusion.
Oxygenation is the immediate priority while the cause is assessed and further
treatment is initiated.
3.
A client receiving IV potassium chloride reports burning at the IV site. The site
appears swollen and cool. What should the nurse do first?
A. Slow the infusion
B. Apply a warm compress
C. Stop the infusion
D. Flush the catheter vigorously
Answer: C. Stop the infusion
Rationale: Pain, swelling, and coolness suggest infiltration or extravasation.
Potassium is irritating to tissue, so the infusion should be stopped immediately
and the IV assessed according to facility protocol.
4.
A client with diabetes is awake, diaphoretic, shaky, and has a blood glucose level
of 52 mg/dL. What is the best initial intervention?
,A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Give a high-protein meal
D. Restrict oral intake
Answer: B. Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can swallow safely should receive
approximately 15 g of fast-acting carbohydrate, followed by reassessment of
glucose according to the 15-15 approach.
5.
A client receiving warfarin has an INR of 5.8 and reports new gum bleeding. Which
action is most appropriate?
A. Administer the next scheduled dose
B. Encourage foods high in vitamin K immediately
C. Hold the medication and notify the provider
D. Administer aspirin
Answer: C. Hold the medication and notify the provider
Rationale: An elevated INR accompanied by active bleeding indicates excessive
anticoagulation and requires prompt provider notification and further
management.
6.
A client with COPD is receiving oxygen. Which finding requires the most
immediate attention?
A. Oxygen saturation of 90%
B. Productive cough with clear sputum
C. Increasing somnolence and shallow respirations
D. Respiratory rate of 20/min
Answer: C. Increasing somnolence and shallow respirations
, Rationale: Increasing somnolence with hypoventilation may indicate worsening
carbon dioxide retention and respiratory failure.
7.
A client with suspected stroke suddenly develops facial drooping and right-sided
weakness. Which information is most important to determine immediately?
A. Last bowel movement
B. Time the client was last known well
C. Current dietary preference
D. Previous influenza vaccination
Answer: B. Time the client was last known well
Rationale: The exact last-known-well time is critical because eligibility for time-
sensitive stroke therapies depends on the onset or last-known-normal time.
8.
A client with chronic kidney disease has a potassium level of 6.7 mEq/L. Which
finding is the greatest concern?
A. Muscle weakness
B. Peaked T waves on ECG
C. Mild nausea
D. Increased thirst
Answer: B. Peaked T waves on ECG
Rationale: Severe hyperkalemia can cause life-threatening cardiac
dysrhythmias. ECG changes require immediate intervention and provider
notification.
9.
A client receiving a blood transfusion develops chills, fever, and low back pain 15
minutes after the transfusion begins. What should the nurse do first?
