,Next-Generation NCLEX® (NGN) Examination-Style Questions
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice
1. A 72-year-old resident in a long-term care facility is
prescribed a new transdermal fentanyl patch. What is the
LPN’s priority action before applying the first patch?
A. Check the MAR for the last dose of any opioid.
B. Inspect the skin site for irritation or lesions.
C. Recalculate the equianalgesic dose with the RN.
D. Ask the patient to rate current pain on a 0–10 scale.
Correct Answer: B. Inspect the skin site for irritation or
lesions.
Rationale: A compromised skin barrier impairs absorption
and increases systemic exposure. Checking the MAR (A) is
routine, not priority. Recalculating equianalgesic dosing (C)
is an RN responsibility. Assessing pain (D) is needed but
occurs after ensuring site integrity.
Teaching Point: Always assess skin integrity before
transdermal drug application.
2. While preparing 0900 medications, the LPN discovers that
the pharmacy has dispensed digoxin 0.25 mg PO instead of
the prescribed 0.125 mg. What is the LPN’s most
appropriate action?
A. Give half of the scored 0.25 mg tablet and document
the dose.
, B. Return the tablet to the bottle and request the correct
strength.
C. Hold the dose and notify the pharmacist immediately.
D. Ask the charge nurse to verify the tablet can be split
safely.
Correct Answer: C. Hold the dose and notify the
pharmacist immediately.
Rationale: The LPN must not alter dose form; holding the
medication prevents error while awaiting correct supply.
Splitting (A, D) risks inaccurate dosing. Returning to bottle
(B) violates unit-dose policy.
Teaching Point: Never modify dose form; follow chain-of-
command for dispensing errors.
3. During morning med pass, a patient refuses his warfarin
tablet, stating, “It makes me feel dizzy.” What is the LPN’s
first step?
A. Chart the refusal and inform the charge nurse.
B. Explain the risk of stroke if he skips the dose.
C. Check the INR result from yesterday’s lab work.
D. Suggest taking the tablet with food to reduce dizziness.
Correct Answer: A. Chart the refusal and inform the charge
nurse.
Rationale: Documentation and prompt RN notification
preserve legal record and allow timely provider contact.
Explaining risks (B) or offering strategies (D) without RN
guidance exceeds LPN scope; checking INR (C) is not the
immediate priority.
, Teaching Point: Document patient refusals immediately
and escalate per facility policy.
4. An LPN is reviewing pre-op orders for a patient scheduled
for knee arthroscopy. The order reads: “Hold metformin on
day of surgery.” Which clinical judgment supports this
directive?
A. Metformin potentiates anesthetic agents, increasing
sedation risk.
B. Metformin is nephrotoxic when combined with IV
contrast.
C. Risk of lactic acidosis rises if renal perfusion decreases
intra-op.
D. Metformin delays gastric emptying, raising aspiration
risk.
Correct Answer: C. Risk of lactic acidosis rises if renal
perfusion decreases intra-op.
Rationale: Metformin-associated lactic acidosis is a rare
but life-threatening complication precipitated by
hypoperfusion or hypoxia. Other choices describe
inaccurate or less critical concerns.
Teaching Point: Hold metformin peri-operatively to prevent
lactic acidosis.
5. A newly admitted client has sliding-scale insulin ordered
AC and HS. Before administering the 0730 dose, the LPN
should obtain which assessment?
A. Last bowel movement time and consistency
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice
1. A 72-year-old resident in a long-term care facility is
prescribed a new transdermal fentanyl patch. What is the
LPN’s priority action before applying the first patch?
A. Check the MAR for the last dose of any opioid.
B. Inspect the skin site for irritation or lesions.
C. Recalculate the equianalgesic dose with the RN.
D. Ask the patient to rate current pain on a 0–10 scale.
Correct Answer: B. Inspect the skin site for irritation or
lesions.
Rationale: A compromised skin barrier impairs absorption
and increases systemic exposure. Checking the MAR (A) is
routine, not priority. Recalculating equianalgesic dosing (C)
is an RN responsibility. Assessing pain (D) is needed but
occurs after ensuring site integrity.
Teaching Point: Always assess skin integrity before
transdermal drug application.
2. While preparing 0900 medications, the LPN discovers that
the pharmacy has dispensed digoxin 0.25 mg PO instead of
the prescribed 0.125 mg. What is the LPN’s most
appropriate action?
A. Give half of the scored 0.25 mg tablet and document
the dose.
, B. Return the tablet to the bottle and request the correct
strength.
C. Hold the dose and notify the pharmacist immediately.
D. Ask the charge nurse to verify the tablet can be split
safely.
Correct Answer: C. Hold the dose and notify the
pharmacist immediately.
Rationale: The LPN must not alter dose form; holding the
medication prevents error while awaiting correct supply.
Splitting (A, D) risks inaccurate dosing. Returning to bottle
(B) violates unit-dose policy.
Teaching Point: Never modify dose form; follow chain-of-
command for dispensing errors.
3. During morning med pass, a patient refuses his warfarin
tablet, stating, “It makes me feel dizzy.” What is the LPN’s
first step?
A. Chart the refusal and inform the charge nurse.
B. Explain the risk of stroke if he skips the dose.
C. Check the INR result from yesterday’s lab work.
D. Suggest taking the tablet with food to reduce dizziness.
Correct Answer: A. Chart the refusal and inform the charge
nurse.
Rationale: Documentation and prompt RN notification
preserve legal record and allow timely provider contact.
Explaining risks (B) or offering strategies (D) without RN
guidance exceeds LPN scope; checking INR (C) is not the
immediate priority.
, Teaching Point: Document patient refusals immediately
and escalate per facility policy.
4. An LPN is reviewing pre-op orders for a patient scheduled
for knee arthroscopy. The order reads: “Hold metformin on
day of surgery.” Which clinical judgment supports this
directive?
A. Metformin potentiates anesthetic agents, increasing
sedation risk.
B. Metformin is nephrotoxic when combined with IV
contrast.
C. Risk of lactic acidosis rises if renal perfusion decreases
intra-op.
D. Metformin delays gastric emptying, raising aspiration
risk.
Correct Answer: C. Risk of lactic acidosis rises if renal
perfusion decreases intra-op.
Rationale: Metformin-associated lactic acidosis is a rare
but life-threatening complication precipitated by
hypoperfusion or hypoxia. Other choices describe
inaccurate or less critical concerns.
Teaching Point: Hold metformin peri-operatively to prevent
lactic acidosis.
5. A newly admitted client has sliding-scale insulin ordered
AC and HS. Before administering the 0730 dose, the LPN
should obtain which assessment?
A. Last bowel movement time and consistency
