LPN/LVN Nurse Refresher Course Final
Exam — Code: LPN-NR-FE | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min by nasal cannula. The client becomes increasingly drowsy
and difficult to arouse, with a respiratory rate of 8/min. What is the nurse's
priority action?
A. Increase oxygen to 6 L/min
B. Encourage the client to cough and deep breathe
C. Assess airway and initiate emergency respiratory support
D. Place the client in Trendelenburg position
Answer: C. Assess airway and initiate emergency respiratory support
Rationale: The client has severe respiratory depression and possible carbon
dioxide retention. Airway and ventilation take priority. Increasing oxygen
,without addressing inadequate ventilation can worsen the situation in some
clients with chronic hypercapnia.
2. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 86%. Which complication should the
nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Fluid overload
D. Pneumonia
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are
classic findings of pulmonary embolism and require immediate intervention.
3. A client receiving digoxin reports nausea and seeing yellow-green halos
around lights. The apical pulse is 52/min. What should the nurse do?
A. Administer the medication with food
B. Give the next dose as prescribed
C. Hold the medication and notify the provider
D. Encourage increased potassium intake immediately
Answer: C. Hold the medication and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
manifestations of possible digoxin toxicity. The medication should be withheld
and the provider notified.
4. A client with diabetes is confused, diaphoretic, and shaky. The blood
glucose level is 48 mg/dL, and the client can swallow. What is the priority
intervention?
A. Administer rapid-acting insulin
B. Give approximately 15 g of rapid-acting carbohydrate
,C. Restrict oral intake
D. Administer a high-protein meal immediately
Answer: B. Give approximately 15 g of rapid-acting carbohydrate
Rationale: The client has symptomatic hypoglycemia and can safely swallow.
Rapid-acting carbohydrate should be given, followed by reassessment of blood
glucose.
5. A client receiving warfarin has an INR of 5.8 and reports bleeding gums.
What is the most appropriate nursing action?
A. Administer the scheduled warfarin
B. Hold warfarin and notify the provider
C. Encourage foods high in vitamin K without further assessment
D. Administer aspirin
Answer: B. Hold warfarin and notify the provider
Rationale: A markedly elevated INR combined with active bleeding indicates
increased hemorrhage risk. Warfarin should be held and the provider notified
promptly.
6. A client with heart failure has gained 2.5 kg (5.5 lb) in three days. Which
finding is most concerning?
A. Mild fatigue
B. Increased appetite
C. New bilateral crackles and dyspnea
D. Dry skin
Answer: C. New bilateral crackles and dyspnea
Rationale: Rapid weight gain suggests fluid retention, while crackles and
dyspnea suggest pulmonary congestion and worsening heart failure.
7. A client with a suspected stroke has facial drooping and slurred speech.
Which information is most important to establish?
, A. The client's usual dietary intake
B. The exact time symptoms began or the client was last known well
C. The client's last bowel movement
D. The client's vaccination history
Answer: B. The exact time symptoms began or the client was last known well
Rationale: Stroke treatment decisions are highly time-dependent. Determining
the last-known-well time is essential for evaluating eligibility for acute
interventions.
8. A client with a new tracheostomy becomes restless, cyanotic, and has
markedly decreased air movement. What should the nurse do first?
A. Remove the tracheostomy tube permanently
B. Assess for obstruction and provide emergency airway support
C. Offer oral fluids
D. Place the client flat
Answer: B. Assess for obstruction and provide emergency airway support
Rationale: Sudden respiratory distress after tracheostomy placement may
indicate obstruction or displacement. Maintaining oxygenation and airway
patency is the immediate priority.
9. A client with chronic kidney disease has a potassium level of 6.7 mEq/L and
peaked T waves on the ECG. Which action has the highest priority?
A. Encourage bananas
B. Place the client on cardiac monitoring and notify the provider immediately
C. Administer potassium supplementation
D. Encourage increased oral fluids
Answer: B. Place the client on cardiac monitoring and notify the provider
immediately
Rationale: Severe hyperkalemia with ECG changes can cause fatal dysrhythmias.
Continuous cardiac monitoring and urgent treatment are required.
Exam — Code: LPN-NR-FE | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen at 2 L/min by nasal cannula. The client becomes increasingly drowsy
and difficult to arouse, with a respiratory rate of 8/min. What is the nurse's
priority action?
A. Increase oxygen to 6 L/min
B. Encourage the client to cough and deep breathe
C. Assess airway and initiate emergency respiratory support
D. Place the client in Trendelenburg position
Answer: C. Assess airway and initiate emergency respiratory support
Rationale: The client has severe respiratory depression and possible carbon
dioxide retention. Airway and ventilation take priority. Increasing oxygen
,without addressing inadequate ventilation can worsen the situation in some
clients with chronic hypercapnia.
2. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 86%. Which complication should the
nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Fluid overload
D. Pneumonia
Answer: B. Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia are
classic findings of pulmonary embolism and require immediate intervention.
3. A client receiving digoxin reports nausea and seeing yellow-green halos
around lights. The apical pulse is 52/min. What should the nurse do?
A. Administer the medication with food
B. Give the next dose as prescribed
C. Hold the medication and notify the provider
D. Encourage increased potassium intake immediately
Answer: C. Hold the medication and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
manifestations of possible digoxin toxicity. The medication should be withheld
and the provider notified.
4. A client with diabetes is confused, diaphoretic, and shaky. The blood
glucose level is 48 mg/dL, and the client can swallow. What is the priority
intervention?
A. Administer rapid-acting insulin
B. Give approximately 15 g of rapid-acting carbohydrate
,C. Restrict oral intake
D. Administer a high-protein meal immediately
Answer: B. Give approximately 15 g of rapid-acting carbohydrate
Rationale: The client has symptomatic hypoglycemia and can safely swallow.
Rapid-acting carbohydrate should be given, followed by reassessment of blood
glucose.
5. A client receiving warfarin has an INR of 5.8 and reports bleeding gums.
What is the most appropriate nursing action?
A. Administer the scheduled warfarin
B. Hold warfarin and notify the provider
C. Encourage foods high in vitamin K without further assessment
D. Administer aspirin
Answer: B. Hold warfarin and notify the provider
Rationale: A markedly elevated INR combined with active bleeding indicates
increased hemorrhage risk. Warfarin should be held and the provider notified
promptly.
6. A client with heart failure has gained 2.5 kg (5.5 lb) in three days. Which
finding is most concerning?
A. Mild fatigue
B. Increased appetite
C. New bilateral crackles and dyspnea
D. Dry skin
Answer: C. New bilateral crackles and dyspnea
Rationale: Rapid weight gain suggests fluid retention, while crackles and
dyspnea suggest pulmonary congestion and worsening heart failure.
7. A client with a suspected stroke has facial drooping and slurred speech.
Which information is most important to establish?
, A. The client's usual dietary intake
B. The exact time symptoms began or the client was last known well
C. The client's last bowel movement
D. The client's vaccination history
Answer: B. The exact time symptoms began or the client was last known well
Rationale: Stroke treatment decisions are highly time-dependent. Determining
the last-known-well time is essential for evaluating eligibility for acute
interventions.
8. A client with a new tracheostomy becomes restless, cyanotic, and has
markedly decreased air movement. What should the nurse do first?
A. Remove the tracheostomy tube permanently
B. Assess for obstruction and provide emergency airway support
C. Offer oral fluids
D. Place the client flat
Answer: B. Assess for obstruction and provide emergency airway support
Rationale: Sudden respiratory distress after tracheostomy placement may
indicate obstruction or displacement. Maintaining oxygenation and airway
patency is the immediate priority.
9. A client with chronic kidney disease has a potassium level of 6.7 mEq/L and
peaked T waves on the ECG. Which action has the highest priority?
A. Encourage bananas
B. Place the client on cardiac monitoring and notify the provider immediately
C. Administer potassium supplementation
D. Encourage increased oral fluids
Answer: B. Place the client on cardiac monitoring and notify the provider
immediately
Rationale: Severe hyperkalemia with ECG changes can cause fatal dysrhythmias.
Continuous cardiac monitoring and urgent treatment are required.
