2026/2027 | Updated Actual Exam Aligned with NCSBN
NCLEX-PN Test Plan & Clinical Judgment Model | Pass
Guaranteed - A+ Graded
CLIENT NEEDS CATEGORY: SAFE AND EFFECTIVE CARE ENVIRONMENT
Subcategory: Coordinated Care (Management of Care) - 25 Questions
Q1: Clinical Judgment - Prioritization (Recognize/Analyze Cues)
The LPN receives shift report on four clients. Which client should the LPN assess first?
● A. A 72-year-old with heart failure who reports increased shortness of breath
when walking to the bathroom
● B. A 45-year-old post-appendectomy client requesting pain medication for
incisional pain rated 6/10
● C. A 58-year-old with diabetes whose blood glucose is 248 mg/dL before
breakfast
● D. A 35-year-old with pneumonia whose oxygen saturation is 89% on room air
[CORRECT]
Correct Answer: D
Rationale: The priority framework follows the ABCs (Airway, Breathing, Circulation). An
oxygen saturation of 89% indicates hypoxemia and compromised breathing, which is an
immediate threat to life. According to the NCSBN Clinical Judgment Model, the LPN
must recognize this cue (abnormal SpO2), analyze that it represents a priority
physiological need, and take immediate action .
,Option A represents a stable chronic condition with expected symptoms. Option B is
pain management, which is important but not life-threatening. Option C is elevated
glucose requiring intervention but not immediate; glucose >250 with symptoms like
Kussmaul respirations or confusion would be priority.
Q2: Delegation/Supervision
Which task can the LPN safely delegate to an unlicensed assistive personnel (UAP)?
● A. Administering a scheduled subcutaneous insulin injection
● B. Assisting a stable client with ambulation to the bathroom [CORRECT]
● C. Performing a sterile dressing change on a postoperative wound
● D. Teaching a newly diagnosed diabetic client about foot care
Correct Answer: B
Rationale: The LPN can delegate basic care tasks to UAPs that do not require nursing
judgment, assessment, or sterile technique. Ambulating a stable client is within UAP
scope. Insulin administration (A) requires nursing licensure. Sterile dressing changes
(C) require sterile technique and assessment skills. Client teaching (D) is an LPN/RN
responsibility—UAPs can reinforce teaching but cannot provide initial instruction .
Q3: Legal/Ethical - Informed Consent
A 17-year-old client is admitted for emergency surgery after a motor vehicle accident.
The client is conscious and refuses surgery. The parents demand the surgery proceed.
What is the LPN's best action?
● A. Administer preoperative medications as ordered
● B. Notify the health care provider and nursing supervisor of the refusal
[CORRECT]
● C. Convince the client to consent by explaining the risks of refusal
● D. Proceed with surgery preparation since the parents have consented
,Correct Answer: B
Rationale: Informed consent requires voluntary agreement from a competent adult or
emancipated minor. A 17-year-old may have decision-making capacity depending on
state law. The LPN's role is to report the refusal to appropriate authorities (provider,
supervisor) rather than coerce (C), proceed against wishes (D), or prepare for surgery
(A). This protects client rights and follows legal/ethical protocols .
Q4: HIPAA/Confidentiality
A client's spouse calls the unit asking for information about their partner's condition.
The client has not specified who may receive information. What is the appropriate
response?
● A. Provide general information since they are married
● B. Refuse all information and hang up
● C. State that you cannot confirm or deny anyone is a patient, and the client must
authorize information release [CORRECT]
● D. Provide detailed information if the spouse provides the client's date of birth
Correct Answer: C
Rationale: HIPAA requires written authorization to disclose protected health
information. The LPN cannot confirm the client is even admitted (no-patient directory
status if requested) without authorization. Marriage does not automatically grant
access (A). Hanging up (B) is unprofessional. Verifying identity with DOB (D) does not
substitute for authorization .
Q5: Clinical Judgment - Assignment Making
The LPN is caring for four clients. Which client is most appropriate for the LPN to care
for independently?
, ● A. A client with chest pain awaiting cardiac catheterization who needs
continuous ECG monitoring
● B. A stable client with a urinary tract infection receiving IV antibiotics [CORRECT]
● C. A client with a new tracheostomy who requires frequent suctioning
● D. A client 2 hours post-thoracotomy with chest tubes and epidural analgesia
Correct Answer: B
Rationale: LPN scope includes stable clients with predictable outcomes. The UTI client
(B) has a stable condition, routine IV therapy, and predictable care needs. Options A, C,
and D describe unstable clients requiring complex assessments, invasive monitoring, or
advanced interventions typically requiring RN scope or close supervision in most states
.
Q6: Incident Reporting
The LPN accidentally administers 10 units of regular insulin instead of 10 units of NPH
insulin to a client. What is the first priority action?
● A. Complete the incident report immediately
● B. Assess the client for signs of hypoglycemia and notify the health care provider
[CORRECT]
● C. Wait to see if the client develops symptoms before reporting
● D. Ask the charge nurse to assess the client while you complete documentation
Correct Answer: B
Rationale: Client safety is the priority. The LPN must immediately assess for
hypoglycemia (tachycardia, sweating, confusion, seizures) and notify the provider for
orders (glucose monitoring, carbohydrate administration, glucagon if needed). Incident
reports (A) are completed after client is stable. Waiting (C) is unsafe. Delegating
assessment (D) delays intervention .