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LPN/LVN Clinical Judgment Competency
Exam — Code: LPN-CJ-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. An LPN/LVN is caring for a client admitted with pneumonia. The client
becomes increasingly confused, has a respiratory rate of 30/min, BP 88/54
mm Hg, HR 118/min, and oxygen saturation of 86% despite oxygen at 2
L/min via nasal cannula. Which finding requires the LPN/LVN's immediate
action?
A. Confusion
B. Respiratory rate of 30/min
C. Oxygen saturation of 86%
D. Heart rate of 118/min
Answer: Oxygen saturation of 86%
Rationale: An oxygen saturation of 86% despite supplemental oxygen indicates
significant hypoxemia and impaired oxygenation. The LPN/LVN should
,immediately assess airway and breathing, increase oxygen according to
protocol/orders, position the client appropriately, and notify the appropriate
provider or rapid-response team based on the client's condition.
2. A client receiving IV furosemide for acute heart failure has potassium of 2.8
mEq/L and reports generalized weakness and palpitations. What should the
LPN/LVN do first?
A. Administer the scheduled furosemide
B. Encourage potassium-rich foods
C. Hold the medication and notify the provider
D. Reassess the potassium level in 4 hours
Answer: Hold the medication and notify the provider
Rationale: Severe hypokalemia can produce life-threatening dysrhythmias and
muscle weakness. Continuing a potassium-wasting diuretic could worsen the
electrolyte abnormality. The LPN/LVN should promptly report the critical finding
and anticipate potassium replacement and cardiac monitoring.
3. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 88%. Which complication should the
LPN/LVN suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
Answer: Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia
after surgery are classic warning signs of pulmonary embolism. This is an
emergency requiring immediate assessment, oxygen support, and rapid
notification.
, 4. A client with diabetes is pale, diaphoretic, confused, and has a blood
glucose of 48 mg/dL. The client is awake and able to swallow. What
intervention is most appropriate?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Give a high-protein meal
D. Restrict oral intake until glucose is rechecked
Answer: Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can safely swallow should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose in about 15 minutes. Severe hypoglycemia can rapidly progress to
seizures, loss of consciousness, or death.
5. A client with chronic kidney disease has a potassium level of 6.4 mEq/L.
Which assessment finding is the highest priority?
A. Peripheral edema
B. Fatigue
C. Irregular cardiac rhythm
D. Decreased appetite
Answer: Irregular cardiac rhythm
Rationale: Severe hyperkalemia can cause dangerous cardiac conduction
abnormalities and fatal dysrhythmias. Cardiac assessment and ECG monitoring
are priorities when significant hyperkalemia is present.
6. A client with COPD receiving oxygen becomes increasingly drowsy and
difficult to arouse. Which action is most appropriate?
A. Increase oxygen to the maximum flow rate
B. Assess respiratory status and notify the provider immediately
C. Encourage the client to ambulate
D. Administer an oral sedative
, Answer: Assess respiratory status and notify the provider immediately
Rationale: Increasing somnolence in a client with COPD may indicate worsening
hypercapnia or respiratory failure. The LPN/LVN should immediately assess
airway, breathing, oxygenation, and level of consciousness and escalate care as
indicated rather than automatically increasing oxygen to an unrestricted level.
7. A client receiving a blood transfusion develops fever, chills, flank pain, and
hypotension 15 minutes after the transfusion begins. What should the
LPN/LVN do first?
A. Slow the transfusion
B. Stop the transfusion
C. Administer acetaminophen
D. Flush the blood tubing with blood product
Answer: Stop the transfusion
Rationale: These findings suggest an acute transfusion reaction. The transfusion
must be stopped immediately. The IV should be maintained with appropriate
compatible fluid using new tubing according to facility policy, and the provider
and blood bank should be notified.
8. A client with a tracheostomy has sudden respiratory distress and decreased
air movement. What should the LPN/LVN suspect first?
A. Constipation
B. Tracheostomy obstruction
C. Urinary retention
D. Hypoglycemia
Answer: Tracheostomy obstruction
Rationale: Sudden respiratory distress and decreased airflow in a tracheostomy
client may indicate obstruction from secretions, mucus plugging, or
displacement. Airway assessment and immediate intervention are priorities.
LPN/LVN Clinical Judgment Competency
Exam — Code: LPN-CJ-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. An LPN/LVN is caring for a client admitted with pneumonia. The client
becomes increasingly confused, has a respiratory rate of 30/min, BP 88/54
mm Hg, HR 118/min, and oxygen saturation of 86% despite oxygen at 2
L/min via nasal cannula. Which finding requires the LPN/LVN's immediate
action?
A. Confusion
B. Respiratory rate of 30/min
C. Oxygen saturation of 86%
D. Heart rate of 118/min
Answer: Oxygen saturation of 86%
Rationale: An oxygen saturation of 86% despite supplemental oxygen indicates
significant hypoxemia and impaired oxygenation. The LPN/LVN should
,immediately assess airway and breathing, increase oxygen according to
protocol/orders, position the client appropriately, and notify the appropriate
provider or rapid-response team based on the client's condition.
2. A client receiving IV furosemide for acute heart failure has potassium of 2.8
mEq/L and reports generalized weakness and palpitations. What should the
LPN/LVN do first?
A. Administer the scheduled furosemide
B. Encourage potassium-rich foods
C. Hold the medication and notify the provider
D. Reassess the potassium level in 4 hours
Answer: Hold the medication and notify the provider
Rationale: Severe hypokalemia can produce life-threatening dysrhythmias and
muscle weakness. Continuing a potassium-wasting diuretic could worsen the
electrolyte abnormality. The LPN/LVN should promptly report the critical finding
and anticipate potassium replacement and cardiac monitoring.
3. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 88%. Which complication should the
LPN/LVN suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
Answer: Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia
after surgery are classic warning signs of pulmonary embolism. This is an
emergency requiring immediate assessment, oxygen support, and rapid
notification.
, 4. A client with diabetes is pale, diaphoretic, confused, and has a blood
glucose of 48 mg/dL. The client is awake and able to swallow. What
intervention is most appropriate?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Give a high-protein meal
D. Restrict oral intake until glucose is rechecked
Answer: Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can safely swallow should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose in about 15 minutes. Severe hypoglycemia can rapidly progress to
seizures, loss of consciousness, or death.
5. A client with chronic kidney disease has a potassium level of 6.4 mEq/L.
Which assessment finding is the highest priority?
A. Peripheral edema
B. Fatigue
C. Irregular cardiac rhythm
D. Decreased appetite
Answer: Irregular cardiac rhythm
Rationale: Severe hyperkalemia can cause dangerous cardiac conduction
abnormalities and fatal dysrhythmias. Cardiac assessment and ECG monitoring
are priorities when significant hyperkalemia is present.
6. A client with COPD receiving oxygen becomes increasingly drowsy and
difficult to arouse. Which action is most appropriate?
A. Increase oxygen to the maximum flow rate
B. Assess respiratory status and notify the provider immediately
C. Encourage the client to ambulate
D. Administer an oral sedative
, Answer: Assess respiratory status and notify the provider immediately
Rationale: Increasing somnolence in a client with COPD may indicate worsening
hypercapnia or respiratory failure. The LPN/LVN should immediately assess
airway, breathing, oxygenation, and level of consciousness and escalate care as
indicated rather than automatically increasing oxygen to an unrestricted level.
7. A client receiving a blood transfusion develops fever, chills, flank pain, and
hypotension 15 minutes after the transfusion begins. What should the
LPN/LVN do first?
A. Slow the transfusion
B. Stop the transfusion
C. Administer acetaminophen
D. Flush the blood tubing with blood product
Answer: Stop the transfusion
Rationale: These findings suggest an acute transfusion reaction. The transfusion
must be stopped immediately. The IV should be maintained with appropriate
compatible fluid using new tubing according to facility policy, and the provider
and blood bank should be notified.
8. A client with a tracheostomy has sudden respiratory distress and decreased
air movement. What should the LPN/LVN suspect first?
A. Constipation
B. Tracheostomy obstruction
C. Urinary retention
D. Hypoglycemia
Answer: Tracheostomy obstruction
Rationale: Sudden respiratory distress and decreased airflow in a tracheostomy
client may indicate obstruction from secretions, mucus plugging, or
displacement. Airway assessment and immediate intervention are priorities.
