LVN NCLEX COMPLETE EXAM QUESTIONS WITH CORRECT SOLUTIONS UPDATED 2025/2026 ALREADY GRADED||100% GUARANTEED PASS!!!<<NEWEST VERSION>>

LVN NCLEX COMPLETE EXAM QUESTIONS WITH CORRECT SOLUTIONS UPDATED 2025/2026 ALREADY GRADED||100% GUARANTEED PASS!!!&lt;&lt;NEWEST VERSION&gt;&gt; What causes respiratory acidosis/alkalosis? - ANSWER A failure of the lungs to regulate the carbonic acid concentration in the blood. Any process that interferes with normal ventilation and causes a decrease or increase in excretions of acids in the body poses the risk of causing (SELECT ALL THAT APPLY): a) respiratory acidosis b) metabolic alkalosis c) respiratory alkalosis d) metabolic acidosis - ANSWER a) respiratory acidosis c) respiratory alkalosis What causes metabolic acidosis/alkalosis? - ANSWER A failure of the kidneys to regulate the bicarbonate concentration in the blood. If the kidneys are unable to correct metabolic acidosis, the __________ will respond in an attempt to correct the imbalance. - ANSWER Lungs Which regulatory system is the body's SECOND line of defense in keeping the pH within normal limits? 1. Blood buffers 2. Respiratory system 3. Renal system 4. Blood pressure - ANSWER 2. Respiratory system If the lungs are unable to correct respiratory acidosis, the __________ will respond in an attempt to correct the imbalance. - ANSWER Kidneys What is the largest fluid compartment in the body? 1. Intracellular 2. Extracellular 3. Interstitial 4. Intravascular - ANSWER 1. Intracellular The movement of water from an area of lower concentration to an area of higher concentration occurs through which of the following? 1. Diffusion 2. Filtration 3. Active transport 4. Osmosis - ANSWER 4. Osmosis Which abbreviation is used to indicate hydrogen ion concentration in the body? 1. mEq 2. ATP 3. pH 4. mL - ANSWER 3. pH Passive transport includes what physiologic processes? (Select all that apply.) 1. Osmosis 2. Diffusion 3. Filtration 4. Sodium-potassium pump 5. Compensatory metabolic acidosis - ANSWER 1. Osmosis 2. Diffusion 3. Filtration The nurse finds a client with schizophrenia lying under a bench in the hall. The client says, "God told me to lie here." What is the best response by the nurse? a) "I didn't hear anyone talking; come with me to your room." b) "What you heard was in your head; it was your imagination." c) "Come to the dayroom and watch television; you'll feel better." d) "God wouldn't tell you to lie there in the hall. God wants you to behave reasonably." - ANSWER a) "I didn't hear anyone talking; come with me to your room." The nurse is focusing on reality and trying to distract and refocus the client's attention. "What you heard was in your head; it was your imagination" is too blunt and belittling; this approach rarely is effective. "Come to the dayroom and watch television; you'll feel better" is false reassurance; the nurse does not know that the client will feel better. "God wouldn't tell you to lie in the hall; God wants you to behave reasonably" may be interpreted as belittling or an attempt to convince the client that the behavior is irrational, which is usually ineffective. A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information? a) Low purine b) Low calcium c) High phosphorus d) High alkaline ash - ANSWER b) Low calcium Calcium and phosphorus are components of these stones; foods high in calcium and phosphorus should be avoided. Low purine and high alkaline ash diets are indicated for clients with gout. Foods high in phosphorus must be avoided. A client hospitalized with a severe myocardial infarction tells the nurse, "My life is over. I may as well just give up." What is the best response by the nurse? a) "You feel your life is over?" b) "Have you nothing to live for?" c) "We are not going to let you die." d) "Everything will be fine. Do not worry." - ANSWER a) "You feel your life is over?" The response "You feel your life is over?" invites the client to expand on the statement, and feelings and fears may be discussed. The response "Have you nothing to live for?" addresses the future rather than the present; the statement may make the client defensive and may close off communication. The response "We are not going to let you die" is not a client-centered response and is false reassurance; the nurse does not know whether the client will recover. The nurse's statement "Everything will be fine. Do not worry." is also giving the client false reassurance. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions. What behavior by a client with a long history of alcohol abuse is an indication that the client may be ready for treatment? a) Drinking only socially b) Not drinking for a week c) Hospitalization for detoxification d) Verbalizing an honest desire for help - ANSWER d) Verbalizing an honest desire for help When clients with alcohol problems voice a desire for help, it usually signifies that they are ready for treatment, because they are admitting they have a problem. Adherence to an alcohol treatment program requires abstinence. A week is too short a time to signal readiness for treatment. Hospitalization alone is not an indication that the client is really ready for treatment, because many factors can influence admission. Which statement or question is best when asking a toddler about breakfast? a) "Do you want to have breakfast?" b) "Why don't you have a cheese sandwich?" c) "You can have an egg and toast or cereal with milk." d) "Would you like to have toast with jam and cheese?" - ANSWER c) "You can have an egg and toast or cereal with milk." Toddlers exhibit negativism and tend to say "no" to everything. So it is better to give them options rather than asking them questions that can be answered with a "no." Therefore, the toddler should be given a choice between an egg and toast or cereal with milk. The question "Do you want to have breakfast?" can be easily answered with a "no." The statement "Why don't you have a cheese sandwich?" doesn't offer any option, and the child may refuse. The question "Would you like to have toast with jam and cheese?" could also be answered with a "no." Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. In what situation should a nurse anticipate that a client will experience a phobic reaction? a) When seeking attention from others b) When thinking about the feared object c) When coming into contact with the feared object d) When being exposed to an unfamiliar environment - ANSWER c) When coming into contact with the feared object With phobias, the individual transfers anxiety to a safer inanimate object or situation. Therefore the anxiety and resulting feelings will be precipitated only when the client is in direct contact with the object or situation. Phobias are severe anxiety reactions, not attention-seeking actions. It is not thinking about the feared object that causes anxiety; it is the possibility of having to come into contact with it. It is the presence of the phobic object or situation that triggers the anxiety, not the unfamiliarity of the environment. A nurse is interacting with a depressed, suicidal client. What themes in the client's conversation are of most concern to the nurse? a) Power b) Betrayal c) Loneliness d) Hopelessness e) Indecisiveness - ANSWER c) Loneliness d) Hopelessness Loneliness and a sense of isolation may play a role in the intent to commit suicide. A real or perceived lack of support increases the risk for suicide because there is no "lifeline of caring." The main factor leading to acting-out on suicidal impulses is the feeling of hopelessness; there are no longer reasons to live. The struggle for power and dominance is more commonly encountered in the verbalizations of clients with paranoid schizophrenia. Betrayal is a feeling more often verbalized by clients with a diagnosis of a borderline personality disorder. An indecisive individual usually will not make the decision to commit suicide. A depressed client has feelings of failure and a low self-esteem. In what activity should the client initially be encouraged to become involved? a) Joining other clients in playing a board game b) Singing in a karaoke contest to be held at the end of the week c) Assisting a staff member in working on the monthly bulletin board d) Selecting the movie to be played during the evening recreation period - ANSWER c) Assisting a staff member in working on the monthly bulletin board Working on the bulletin board with staff members involves minimal energy and decision-making and is the least threatening activity. Playing a board game is too stressful at this time; it will be a better intervention when self-esteem improves and depression lessens. Singing karaoke is too stressful an activity because it requires energy and good self-esteem, which the client does not have at this time. Selecting a movie is too stressful at this time; it will be a better intervention when selfesteem improves and depression lessens. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses. An infant is being admitted with bacterial meningitis. The nurse knows the priority nursing action is: a) Assessing the infant's neurological status b) Beginning intravenous fluids and antibiotics c) Implementing respiratory isolation precautions d) Teaching the parents the importance of maintaining a quiet environment - ANSWER c) Implementing respiratory isolation precautions The infant's illness is contagious, and the nurse, as well as other clients, must first be protected with the implementation of respiratory isolation precautions. Assessment of neurological status, implementation of prescribed fluids and antibiotics, and parental teaching may be done after assessment. Also, antibiotics are usually not administered until after all cultures have been obtained. An older client is transferred to a nursing home from a hospital with a diagnosis of dementia. One morning, after being in the nursing home for several days, the client is going to join a group of residents in recreational therapy. The nurse sees that the client has laid out several outfits on the bed but is still wearing nightclothes. What should the nurse do? a) Help the client dress and explain when residents are expected at the activity b) Prompt the client to dress more quickly to avoid delaying the other residents c) Help the client select appropriate attire and offer to help the client get dressed d) Allow the client time to dress but explain that client has missed the opportunity to attend the activity - ANSWER c) Help the client select appropriate attire and offer to help the client get dressed Helping the client select appropriate attire and offering help in getting dressed aid the client in decision-making; new situations may be stressful and may lead to ambivalent feelings. Helping the client dress and explaining when residents are expected at the activity are not sharing decision-making; the client may not remember this explanation in the future. Reminding the client to dress more quickly to avoid delaying the other residents may make the client feel guilty and may increase anxiety. The client may perceive being told that the opportunity to attend the activity has been missed as punishment. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. When teaching a client about using a diaphragm as a form of contraception, the nurse should tell her that the diaphragm: a) May or may not be used with a spermicidal lubricant b) Should remain in place for at least 6 hours after intercourse c) Must be inserted with the dome facing down to be maximally effective d) Often appears puckered but that this will not interfere with its effectiveness - ANSWER b) Should remain in place for at least 6 hours after intercourse The should remain in place for at least 6 hours after intercourse because the spermicidal jelly or cream requires this amount of time to be effective. The diaphragm must always be used with a spermicide to be effective. The diaphragm may be inserted with the dome facing either up or down and still be effective. Puckering, especially near the rim, may indicate thin spots that could rupture during intercourse; the diaphragm should be replaced if puckering is found. A client is hospitalized with a diagnosis of emphysema. The nurse provides teaching and should begin with which aspect of care? a) The disease process and breathing exercises b) How to control or prevent respiratory infections c) Using aerosol therapy, especially nebulizers d) Priorities in carrying out everyday activities - ANSWER a) The disease process and breathing exercises Clients need to understand the disease process and how interventions, such as breathing exercises, can improve ventilation. Learning to control or prevent respiratory infections is important, but it should be taught later. Although it is helpful to know about aerosol therapy and nebulizers, knowing how to use aerosol therapy, especially nebulizers, should be taught later. Although it is important to teach the client how to set priorities in carrying out everyday activities, this should be taught later. Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude. A client who is having a difficult labor is found to have cephalopelvic disproportion. Which medical order should the nurse question? a) Maintain NPO status. b) Start peripheral IV of ¼ NS. c) Record fetal heart tones every 15 minutes. d) Piggyback another 10-unit bag of oxytocin (Pitocin). - ANSWER d) Piggyback another 10-unit bag of oxytocin (Pitocin). When there is cephalopelvic disproportion, a is indicated; infusing oxytocin (Pitocin) at this time could result in fetal compromise and uterine rupture. The nothing-by-mouth (NPO) status is appropriate in anticipation of a cesarean birth. A peripheral IV is needed not only for hydration but also for venous access if IV medications become necessary. The client probably has an electronic monitor recording the fetal heart rate and uterine contractions; the findings of these assessments should be documented regularly in accordance with hospital protocol. Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question. A client is found to have paranoid schizophrenia, and the practitioner prescribes a typical antipsychotic medication. After a 1-month hospitalization the client is discharged home with instructions to continue the antipsychotic and a referral for weekly mental health counseling. The picture illustrates the client's physical status as observed by the nurse on the client's first visit to the community mental health clinic. What extrapyramidal side effect has developed? a) Dystonia b) Akathisia c) Tardive dyskinesia d) Pseudoparkinsonism - ANSWER b) Akathisia Akathisia, an extrapyramidal side effect of typical antipsychotics, is motor restlessness. The client is unable to sit or stand still and feels the need to move, pace, rock, swing the legs, or tap the feet. The condition occurs within 5 to 90 days of the initiation of therapy. Dystonia is muscle spasms of the face, tongue, head, neck, jaw, or back, usually resulting in exaggerated posturing. This extrapyramidal side effect of typical antipsychotics occurs within 1 hour to 1 week of the initiation of therapy. Tardive dyskinesia is facial, ocular, oral/buccal, lingual/masticatory, and systemic movements. This extrapyramidal side effect of typical antipsychotics may occur 6 months or more after the initiation of therapy. Pseudoparkinsonism has characteristics similar to those of Parkinson's disease (e.g., shuffling gait, tremors, rigidity, bradykinesia). This extrapyramidal side effect of typical antipsychotics may occur anytime after the initiation of therapy. What should the nurse discuss with new parents to help them prepare for infant care? a) Allowing crying time to help the lungs develop b) Establishing a set feeding schedule to promote steady weight gain c) Counting the number of stool diapers daily to confirm adequate hydration d) Learning specific behaviors involving states of wakefulness to promote positive interactions - ANSWER d) Learning specific behaviors involving states of wakefulness to promote positive interactions Discussing behaviors during the baby's waking times that will promote positive interaction helps parents understand the unique features of their newborn and promotes interaction and care during periods of wakefulness. A healthy infant's lungs are developed at birth. It is best that infants be on a demand feeding schedule, not a routine schedule. Demand feeding provides for individuality; healthy infants gain weight steadily. Counting the number of stool diapers daily is not a reliable method of determining adequate hydration. A client is admitted with the diagnosis of possible myocardial infarction, and a series of diagnostic tests are prescribed. Which blood level should the nurse expect will increase first if this client has had a myocardial infarction? a) Alanine aminotransferase (ALT) b) Serum aspartate aminotransferase (AST) c) Total lactate dehydrogenase (LDH) d) Troponin T (cTnT) - ANSWER d) Troponin T (cTnT) Troponin T has an extraordinarily high specificity for myocardial cell injury. Cardiac troponins elevate sooner and remain elevated longer than many of the other enzymes that reflect myocardial injury. ALT is found predominantly in the liver; it is found in lesser quantities in the kidneys, heart, and skeletal muscles, and is primarily used to diagnose and monitor liver, not heart, disease. AST, also known as (serum glutamic-oxaloacetic transaminase (SGOT), is elevated 8 hours after a myocardial infarction. Total LDH () levels elevate 24 to 48 hours after a myocardial infarction. Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass. A 6-week-old infant and his mother arrive in the emergency department in an ambulance. The father arrives several minutes later with two children, 7 and 9 years old. The infant is not breathing, and the eventual diagnosis is sudden infant death syndrome (SIDS). The parents take turns holding the infant in another room. The nurse remains present and provides emotional support to the parents. What is an important short-term goal for this family? a) Identifying the problems that they will be facing as a result of the loss of the infant b) Accepting that there was nothing that they could have done to prevent the infant's death. c) Including the infant's siblings in the events and grieving in the wake of the infant's death d) Seeking out other families who have lost infants to SIDS and obtaining support from them. - ANSWER c) Including the infant's siblings in the events and grieving in the wake of the infant's death The other children need to be involved with the grieving process and to work through their own feelings. Identifying the problems that the family will be facing in regard to the loss of the infant is a long-term goal. It is too early to seek out other families who have lost infants to SIDS and receive support from them. It is premature to accept that there was nothing that the family could have done to prevent the infant's death; in fact, they may never achieve this goal. A toddler with a puncture wound to the sole is brought to the emergency department. Because of a language barrier the caregiver cannot provide a clear history of previous tetanus immunizations. Tetanus immunoglobulin (TIG) is prescribed by the practitioner. The nurse explains to the caregiver that this medication is given because it: a) Produces lifelong passive immunity to tetanus b) Confers short-term passive defense against tetanus c) Induces long-lasting active protection from tetanus d) Stimulates the production of antibodies to fight tetanus - ANSWER b) Confers short-term passive defense against tetanus TIG contains antibodies, not the live or attenuated virus; it confers short-term passive immunity that is temporary. Tetanus toxoid, not TIG, stimulates the production of antibodies. An anxious client reports experiencing pain in the abdomen and feeling empty and hollow. A diagnostic workup reveals no physical causes of these clinical findings. What term best reflects what the client is experiencing? a) Dissociation b) Somatization c) Stress response d) Anxiety reaction - ANSWER b) Somatization Somatization is erroneously attributing an anxious feeling to a body system or part. Dissociation is separating an overwhelming event from one's consciousness. The stress response results from being exposed to a threatening stimulus. An anxiety reaction is the body's reaction to a stressful event. A nurse is planning to teach facts about hyperglycemia to a client with the diagnosis of diabetes. What information should the nurse include in the discussion about what causes diabetic acidosis? a) Breakdown of fat stores for energy b) Ingestion of too many highly acidic foods c) Excessive secretion of endogenous insulin d) Increased amounts of cholesterol in the extracellular compartment - ANSWER a) Breakdown of fat stores for energy In the absence of insulin , which facilitates the transport of glucose into cells, the body breaks down proteins and fats to supply energy; ketones, a by-product of fat metabolism, accumulate, causing metabolic acidosis (pH below 7.35). The pH of food ingested has no effect on the development of acidosis. The opposite of excessive secretion of endogenous insulin is true. Cholesterol level has no effect on the development of acidosis. A client with varicose veins asks a nurse what is involved when ligation and stripping are performed rather than sclerotherapy. What should the nurse consider when planning a response in language the client will understand? a) Plaque from within the veins is abraded. b) The dilated saphenous veins are removed. c) Superficial veins are anastomosed to deep veins. d) An umbrella filter is placed in the large affected veins. - ANSWER b) The dilated saphenous veins are removed. During a ligation, the saphenous vein is removed. Plaque is an arterial, rather than a venous, problem. Anastomosing superficial veins to deep veins is not done during this surgery; superficial and deep veins usually are attached by communicating veins. An umbrella filter placed in the large affected veins prevents emboli from traveling to the lung; it is not a vein ligation and stripping. A client who has acromegaly and insulin-dependent diabetes undergoes a hypophysectomy. The nurse identifies that further teaching about the hypophysectomy is necessary when the client states, "I know I will: a) Be sterile for the rest of my life." b) Require larger doses of insulin than I did preoperatively." c) Have to take cortisone or a similar drug for the rest of my life." d) Have to take thyroxine or a similar medication for the rest of my life." - ANSWER b) Require larger doses of insulin than I did preoperatively." The hypophysis (pituitary gland) does not directly regulate insulin release. This is controlled by serum glucose levels. Because somatotropin release will stop after the hypophysectomy , any elevation of blood glucose level caused by somatotropin also will stop. Infertility may be expected after a hypophysectomy because the follicle-stimulating hormone and its releasing factor will no longer be present to stimulate spermatogenesis. When adrenocorticotropic hormone (ACTH) is absent, cortisone will have to be administered. Thyroid-stimulating hormone will not be present; extrinsic thyroxine will have to be taken. A client with burns develops a wound infection. The nurse plans to teach the client that local wound infections primarily are treated with what type of antibiotics? a) Oral b) Topical c) Intravenous d) Intramuscular - ANSWER b) Topical Topical antibiotics are applied directly to the wound and are effective against many gram-positive and gram-negative organisms found on the skin. Although oral, intravenous, and intramuscular antibiotics may be administered, they are most effective for systemic rather than local infections; the vasculature in and around a burn is impaired and the medication may not reach the organisms in the wound. A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the client? a) The dietary intake of carbohydrates must be restricted. b) Chemotherapy may be used in conjunction with the surgery. c) Thyroxine replacement therapy will be required indefinitely. d) A tracheostomy requires an alternate means of communication. - ANSWER c) Thyroxine replacement therapy will be required indefinitely. Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent hypothyroidism. Increased intake of carbohydrates and proteins is needed because of the increased metabolic activity associated with hyperthyroidism. Chemotherapy is uncommon; radiation may be used to eradicate remaining tissue. A tracheostomy is not planned; it is needed only in an emergency related to respiratory distress. A client's diet is modified to eliminate foods that act as cardiac stimulants. The nurse should teach the client to avoid what foods? a) Iced tea b) Red meat c) Club soda d) Hot cocoa e) Chocolate pudding - ANSWER a) Iced tea d) Hot cocoa e) Chocolate pudding Tea contains caffeine, which stimulates catecholamine release and acts as a cardiac stimulant; tea should be avoided. Hot cocoa contains chocolate, which contains caffeine; it stimulates catecholamine release and acts as a cardiac stimulant. Cocoa should be avoided. The chocolate in chocolate pudding has a high caffeine content, which may stimulate catecholamine release and act as a cardiac stimulant; chocolate should be avoided. Red meat does not stimulate the myocardium; however, it should be decreased or eliminated if serum cholesterol levels are elevated. Club soda does not contain caffeine and does not stimulate the myocardium; however, most club sodas contain sodium, which promotes fluid retention and should be avoided by a client with a cardiac condition. When obtaining the history of a client recently diagnosed with type 1 diabetes, the nurse expects to identify the presence of: a) Edema b) Anorexia c) Weight loss d) Hypoglycemic episodes - ANSWER c) Weight loss Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting. Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia. Polyphagia, not anorexia, occurs with diabetes as the client attempts to meet metabolic needs. Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal. A client with a history of hypertension and left ventricular failure arrives for a scheduled clinic appointment and tells the nurse, "My feet are killing me. These shoes got so tight." The nurse's best initial action is to: a) Weigh the client b) Notify the primary health care provider c) Take the client's pulse rate d) Listen to the client's breath sounds - ANSWER d) Listen to the client's breath sounds