LPN Midterm Study Guide: Neuro, Renal, GI & Psych Disorders
2026/2027 UPDATE
1. A patient with suspected increased intracranial pressure (ICP) is being
monitored. Which is the earliest sign of neurologic decline?
A. Change in level of consciousness (LOC)
B. Widening pulse pressure
C. Fixed and dilated pupils
D. Bradycardia
Answer: A
Rationale: A change in the level of consciousness is the most sensitive and earliest
indicator of increased ICP. Cushing’s triad (widening pulse pressure, bradycardia, and
irregular respirations) is a late sign.
2. A client is diagnosed with Chronic Kidney Disease (CKD). Which dietary
restriction should the nurse reinforce with the patient?
A. Increased intake of dark leafy greens
B. High protein diet for muscle repair
C. Restriction of potassium and phosphorus
D. Unlimited fluid intake to flush the kidneys
Answer: C
Rationale: In CKD, kidneys cannot effectively excrete potassium and phosphorus, leading
to toxic levels. Protein and fluids are often restricted as well, depending on the stage of the
disease.
,3. The nurse is caring for a patient with Liver Cirrhosis who has developed
hepatic encephalopathy. What is the primary goal of administering Lactulose?
A. To reduce blood pressure in the portal vein
B. To promote the excretion of ammonia through the stool
C. To provide glucose to the brain
D. To decrease the production of bile
Answer: B
Rationale: Hepatic encephalopathy is caused by elevated ammonia levels. Lactulose
creates an acidic environment in the gut that traps ammonia and excretes it via bowel
movements.
4. A patient with Schizophrenia states, ‘The FBI is listening to my thoughts
through the TV.’ Which response by the nurse is therapeutic?
A. It must be frightening to feel like you are being monitored.
B. That is impossible; the TV is only a receiver.
C. I don’t see any FBI agents here; you are safe.
D. Why would the FBI be interested in your thoughts?
Answer: A
Rationale: The nurse should acknowledge the patient’s feelings without validating the
delusion. This builds trust and focuses on the emotional experience.
5. A client with a T6 spinal cord injury reports a sudden, severe headache and is
sweating profusely. What is the priority nursing action?
A. Administer an analgesic for the headache
B. Sit the client upright and check for bladder distension
C. Check the client’s temperature
D. Place the client in a Trendelenburg position
Answer: B
, Rationale: These are signs of Autonomic Dysreflexia, a medical emergency. Sitting the
client up helps lower BP, and the nurse must find the noxious stimulus (usually a full
bladder or impacted bowel).
6. During the oliguric phase of Acute Kidney Injury (AKI), which lab value does
the nurse expect to see?
A. Hypocalcemia and Hyperphosphatemia
B. Hypokalemia
C. Decreased BUN and Creatinine
D. Alkalosis
Answer: A
Rationale: In AKI, phosphorus levels rise because the kidneys cannot excrete it, which
leads to a reciprocal drop in calcium levels.
7. A patient is scheduled for an Esophagogastroduodenoscopy (EGD). What is
the priority nursing assessment post-procedure?
A. Monitoring for signs of rebound tenderness
B. Checking the incision site for drainage
C. Assessing for the return of the gag reflex
D. Ensuring the patient remains on bedrest for 12 hours
Answer: C
Rationale: During an EGD, the throat is numbed with a local anesthetic. To prevent
aspiration, the nurse must ensure the gag reflex has returned before allowing oral intake.
2026/2027 UPDATE
1. A patient with suspected increased intracranial pressure (ICP) is being
monitored. Which is the earliest sign of neurologic decline?
A. Change in level of consciousness (LOC)
B. Widening pulse pressure
C. Fixed and dilated pupils
D. Bradycardia
Answer: A
Rationale: A change in the level of consciousness is the most sensitive and earliest
indicator of increased ICP. Cushing’s triad (widening pulse pressure, bradycardia, and
irregular respirations) is a late sign.
2. A client is diagnosed with Chronic Kidney Disease (CKD). Which dietary
restriction should the nurse reinforce with the patient?
A. Increased intake of dark leafy greens
B. High protein diet for muscle repair
C. Restriction of potassium and phosphorus
D. Unlimited fluid intake to flush the kidneys
Answer: C
Rationale: In CKD, kidneys cannot effectively excrete potassium and phosphorus, leading
to toxic levels. Protein and fluids are often restricted as well, depending on the stage of the
disease.
,3. The nurse is caring for a patient with Liver Cirrhosis who has developed
hepatic encephalopathy. What is the primary goal of administering Lactulose?
A. To reduce blood pressure in the portal vein
B. To promote the excretion of ammonia through the stool
C. To provide glucose to the brain
D. To decrease the production of bile
Answer: B
Rationale: Hepatic encephalopathy is caused by elevated ammonia levels. Lactulose
creates an acidic environment in the gut that traps ammonia and excretes it via bowel
movements.
4. A patient with Schizophrenia states, ‘The FBI is listening to my thoughts
through the TV.’ Which response by the nurse is therapeutic?
A. It must be frightening to feel like you are being monitored.
B. That is impossible; the TV is only a receiver.
C. I don’t see any FBI agents here; you are safe.
D. Why would the FBI be interested in your thoughts?
Answer: A
Rationale: The nurse should acknowledge the patient’s feelings without validating the
delusion. This builds trust and focuses on the emotional experience.
5. A client with a T6 spinal cord injury reports a sudden, severe headache and is
sweating profusely. What is the priority nursing action?
A. Administer an analgesic for the headache
B. Sit the client upright and check for bladder distension
C. Check the client’s temperature
D. Place the client in a Trendelenburg position
Answer: B
, Rationale: These are signs of Autonomic Dysreflexia, a medical emergency. Sitting the
client up helps lower BP, and the nurse must find the noxious stimulus (usually a full
bladder or impacted bowel).
6. During the oliguric phase of Acute Kidney Injury (AKI), which lab value does
the nurse expect to see?
A. Hypocalcemia and Hyperphosphatemia
B. Hypokalemia
C. Decreased BUN and Creatinine
D. Alkalosis
Answer: A
Rationale: In AKI, phosphorus levels rise because the kidneys cannot excrete it, which
leads to a reciprocal drop in calcium levels.
7. A patient is scheduled for an Esophagogastroduodenoscopy (EGD). What is
the priority nursing assessment post-procedure?
A. Monitoring for signs of rebound tenderness
B. Checking the incision site for drainage
C. Assessing for the return of the gag reflex
D. Ensuring the patient remains on bedrest for 12 hours
Answer: C
Rationale: During an EGD, the throat is numbed with a local anesthetic. To prevent
aspiration, the nurse must ensure the gag reflex has returned before allowing oral intake.
