NCLEX
- PNAdvanced Practice Examination V2
Comprehensive-Question
150 Review with Clinical
Judgment, Prioritization, Delegation, and Client
Needs Across the Lifespan
a well detailed one
written and graded A+ upgraded
INSTRUCTIONS
This examination contains 150 multiple-choice questions designed to assess advanced practical
nursing knowledge aligned with the 2026 NCLEX-PN® Test Plan. Questions are organized by the
four Client Needs categories as outlined by the NCSBN: Safe and Effective Care Environment
(Coordinated Care 18–24%; Safety and Infection Prevention and Control 10–16%), Health
Promotion and Maintenance (6–12%), Psychosocial Integrity (9–15%), and Physiological
Integrity (Basic Care and Comfort 7–13%; Pharmacological Therapies 10–16%; Reduction of Risk
Potential 9–15%; Physiological Adaptation 7–13%). Select the single best answer for each
question. Each question includes a detailed rationale for the correct answer with explanation of
why distractors are incorrect.
SECTION A: SAFE AND EFFECTIVE CARE ENVIRONMENT — COORDINATED CARE (Questions 1–
36)
1. A practical nurse is providing care to a client who has been diagnosed with end-stage renal
disease and is on a fluid restriction of 1,000 mL per day. The client consumed 400 mL with
,breakfast and 300 mL with lunch, and the healthcare provider prescribed 250 mL of
intravenous antibiotics over 2 hours. Which of the following actions should the nurse take to
appropriately coordinate the client's care?
A. Restrict the client's evening fluid intake to 50 mL to stay within the daily limit
B. Collaborate with the provider to request a change from intravenous to oral antibiotics
C. Administer the intravenous antibiotics and document the total intake as 950 mL for the day
D. Notify the healthcare provider that the client's fluid restriction will be exceeded by 50 mL
Correct Answer: B
Rationale: The nurse should coordinate care by collaborating with the provider to request a
change to oral antibiotics if clinically appropriate (B), as this would help the client remain within
the fluid restriction. Restricting evening fluids to 50 mL (A) is unsafe and may cause the client to
be dehydrated and uncomfortable. Documenting 950 mL (C) is incorrect because the IV
antibiotics add 250 mL, bringing the total to 950 mL, which exceeds the 1,000 mL limit when
considering the IV fluid is part of the total. Notifying the provider without a proposed solution
(D) does not demonstrate proactive coordinated care.
2. A practical nurse is working on a busy medical-surgical unit and is responsible for the care
of four clients. One client with pneumonia has an oxygen saturation of 94% on room air, a
second client with diabetes has a blood glucose of 220 mg/dL and is requesting lunch, a third
client with heart failure has new-onset confusion and crackles in the lung bases, and a fourth
client is scheduled for discharge with new insulin teaching. Which client should the nurse
assess first?
A. The client with pneumonia and oxygen saturation of 94%
B. The client with diabetes and blood glucose of 220 mg/dL
C. The client with heart failure who has new-onset confusion and crackles
D. The client scheduled for discharge with new insulin teaching
Correct Answer: C
Rationale: The client with heart failure who has new-onset confusion and crackles (C) is
exhibiting signs of worsening heart failure, possibly pulmonary edema, and requires immediate
assessment. New-onset confusion in a client with heart failure indicates decreased cerebral
perfusion and should be prioritized as a medical emergency. The client with pneumonia and
94% oxygen saturation (A) is stable with an acceptable saturation level. The client with diabetes
and blood glucose of 220 mg/dL (B) is hyperglycemic but not in immediate danger; the nurse
,can address this after the emergent client. The client scheduled for discharge with new insulin
teaching (D) is stable and can wait.
3. A practical nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which of
the following assignments is appropriate for the nurse to delegate to the UAP?
A. Assist a client who is 2 hours post-operative from a total hip replacement to ambulate to the
bathroom
B. Measure and record the intake and output of a client with a urinary catheter
C. Administer a glycerin suppository to a client with constipation
D. Assess the skin integrity of a client who is on a pressure redistribution mattress
Correct Answer: B
Rationale: Measuring and recording intake and output (B) is a routine task that can be
delegated to UAP. Assisting a client who is 2 hours post-operative to ambulate (A) requires
nursing assessment of the client's stability and should not be delegated. Administering a
suppository (C) is a medication administration task that requires a licensed nurse. Assessing skin
integrity (D) requires nursing judgment and cannot be delegated.
4. A practical nurse is caring for a client with a new diagnosis of insulin-dependent diabetes.
The client is scheduled to be discharged tomorrow and needs instruction on insulin self-
administration, blood glucose monitoring, and dietary management. The nurse notes that the
client is anxious and appears overwhelmed. Which of the following is the most appropriate
action to coordinate the client's discharge teaching?
A. Provide all teaching materials in written format for the client to review at home
B. Begin teaching all the information today and have the client demonstrate return
demonstration
C. Assess the client's readiness to learn and prioritize the most essential information for today
D. Defer all teaching until the family arrives tomorrow
Correct Answer: C
Rationale: Coordinated care requires assessing the client's readiness to learn and prioritizing
essential information (C). An overwhelmed client will not retain large amounts of information.
Written materials alone (A) are insufficient and do not confirm understanding. Teaching
everything at once (B) will overwhelm the client and reduce retention. Deferring all teaching (D)
is unsafe and could delay needed education for safe discharge.
, 5. A practical nurse is participating in a client care conference for a client with complex
medical needs. The client has been non-adherent with the prescribed medication regimen
and has had three hospital readmissions in the past 6 months. Which statement by the nurse
demonstrates appropriate interdisciplinary collaboration?
A. "The client is non-compliant and refuses to take medications as prescribed."
B. "I think the client needs to be placed in a skilled nursing facility."
C. "I have observed that the client often forgets to take medications; perhaps we can explore
the client's barriers to adherence."
D. "The provider needs to prescribe simpler medications."
Correct Answer: C
Rationale: Collaborative care involves exploring the client's barriers to adherence (C) and
problem-solving as a team. Labeling the client as "non-compliant" (A) is judgmental and not
therapeutic. Recommending placement in a skilled nursing facility (B) is outside the scope of the
LPN/VN and not based on a full assessment. Simply changing medications (D) may not address
the underlying reasons for non-adherence.
6. A practical nurse is caring for a client who has an order for a blood transfusion. The nurse
has verified the blood product with another licensed nurse and is preparing to initiate the
transfusion. The client reports a history of allergic reactions to blood products. Which of the
following actions should the nurse take first?
A. Administer the transfusion slowly and monitor for reactions
B. Pre-medicate the client with diphenhydramine as prescribed
C. Notify the provider and request pre-transfusion medications
D. Check the client's current vital signs
Correct Answer: C
Rationale: The nurse should notify the provider and request pre-transfusion medications (C) for
a client with a history of transfusion reactions. Administering the transfusion without pre-
medication (A) is unsafe. Pre-medicating independently (B) is outside the scope unless
specifically ordered. Checking vital signs (D) is important but should occur after notifying the
provider and obtaining orders for pre-medications.
- PNAdvanced Practice Examination V2
Comprehensive-Question
150 Review with Clinical
Judgment, Prioritization, Delegation, and Client
Needs Across the Lifespan
a well detailed one
written and graded A+ upgraded
INSTRUCTIONS
This examination contains 150 multiple-choice questions designed to assess advanced practical
nursing knowledge aligned with the 2026 NCLEX-PN® Test Plan. Questions are organized by the
four Client Needs categories as outlined by the NCSBN: Safe and Effective Care Environment
(Coordinated Care 18–24%; Safety and Infection Prevention and Control 10–16%), Health
Promotion and Maintenance (6–12%), Psychosocial Integrity (9–15%), and Physiological
Integrity (Basic Care and Comfort 7–13%; Pharmacological Therapies 10–16%; Reduction of Risk
Potential 9–15%; Physiological Adaptation 7–13%). Select the single best answer for each
question. Each question includes a detailed rationale for the correct answer with explanation of
why distractors are incorrect.
SECTION A: SAFE AND EFFECTIVE CARE ENVIRONMENT — COORDINATED CARE (Questions 1–
36)
1. A practical nurse is providing care to a client who has been diagnosed with end-stage renal
disease and is on a fluid restriction of 1,000 mL per day. The client consumed 400 mL with
,breakfast and 300 mL with lunch, and the healthcare provider prescribed 250 mL of
intravenous antibiotics over 2 hours. Which of the following actions should the nurse take to
appropriately coordinate the client's care?
A. Restrict the client's evening fluid intake to 50 mL to stay within the daily limit
B. Collaborate with the provider to request a change from intravenous to oral antibiotics
C. Administer the intravenous antibiotics and document the total intake as 950 mL for the day
D. Notify the healthcare provider that the client's fluid restriction will be exceeded by 50 mL
Correct Answer: B
Rationale: The nurse should coordinate care by collaborating with the provider to request a
change to oral antibiotics if clinically appropriate (B), as this would help the client remain within
the fluid restriction. Restricting evening fluids to 50 mL (A) is unsafe and may cause the client to
be dehydrated and uncomfortable. Documenting 950 mL (C) is incorrect because the IV
antibiotics add 250 mL, bringing the total to 950 mL, which exceeds the 1,000 mL limit when
considering the IV fluid is part of the total. Notifying the provider without a proposed solution
(D) does not demonstrate proactive coordinated care.
2. A practical nurse is working on a busy medical-surgical unit and is responsible for the care
of four clients. One client with pneumonia has an oxygen saturation of 94% on room air, a
second client with diabetes has a blood glucose of 220 mg/dL and is requesting lunch, a third
client with heart failure has new-onset confusion and crackles in the lung bases, and a fourth
client is scheduled for discharge with new insulin teaching. Which client should the nurse
assess first?
A. The client with pneumonia and oxygen saturation of 94%
B. The client with diabetes and blood glucose of 220 mg/dL
C. The client with heart failure who has new-onset confusion and crackles
D. The client scheduled for discharge with new insulin teaching
Correct Answer: C
Rationale: The client with heart failure who has new-onset confusion and crackles (C) is
exhibiting signs of worsening heart failure, possibly pulmonary edema, and requires immediate
assessment. New-onset confusion in a client with heart failure indicates decreased cerebral
perfusion and should be prioritized as a medical emergency. The client with pneumonia and
94% oxygen saturation (A) is stable with an acceptable saturation level. The client with diabetes
and blood glucose of 220 mg/dL (B) is hyperglycemic but not in immediate danger; the nurse
,can address this after the emergent client. The client scheduled for discharge with new insulin
teaching (D) is stable and can wait.
3. A practical nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which of
the following assignments is appropriate for the nurse to delegate to the UAP?
A. Assist a client who is 2 hours post-operative from a total hip replacement to ambulate to the
bathroom
B. Measure and record the intake and output of a client with a urinary catheter
C. Administer a glycerin suppository to a client with constipation
D. Assess the skin integrity of a client who is on a pressure redistribution mattress
Correct Answer: B
Rationale: Measuring and recording intake and output (B) is a routine task that can be
delegated to UAP. Assisting a client who is 2 hours post-operative to ambulate (A) requires
nursing assessment of the client's stability and should not be delegated. Administering a
suppository (C) is a medication administration task that requires a licensed nurse. Assessing skin
integrity (D) requires nursing judgment and cannot be delegated.
4. A practical nurse is caring for a client with a new diagnosis of insulin-dependent diabetes.
The client is scheduled to be discharged tomorrow and needs instruction on insulin self-
administration, blood glucose monitoring, and dietary management. The nurse notes that the
client is anxious and appears overwhelmed. Which of the following is the most appropriate
action to coordinate the client's discharge teaching?
A. Provide all teaching materials in written format for the client to review at home
B. Begin teaching all the information today and have the client demonstrate return
demonstration
C. Assess the client's readiness to learn and prioritize the most essential information for today
D. Defer all teaching until the family arrives tomorrow
Correct Answer: C
Rationale: Coordinated care requires assessing the client's readiness to learn and prioritizing
essential information (C). An overwhelmed client will not retain large amounts of information.
Written materials alone (A) are insufficient and do not confirm understanding. Teaching
everything at once (B) will overwhelm the client and reduce retention. Deferring all teaching (D)
is unsafe and could delay needed education for safe discharge.
, 5. A practical nurse is participating in a client care conference for a client with complex
medical needs. The client has been non-adherent with the prescribed medication regimen
and has had three hospital readmissions in the past 6 months. Which statement by the nurse
demonstrates appropriate interdisciplinary collaboration?
A. "The client is non-compliant and refuses to take medications as prescribed."
B. "I think the client needs to be placed in a skilled nursing facility."
C. "I have observed that the client often forgets to take medications; perhaps we can explore
the client's barriers to adherence."
D. "The provider needs to prescribe simpler medications."
Correct Answer: C
Rationale: Collaborative care involves exploring the client's barriers to adherence (C) and
problem-solving as a team. Labeling the client as "non-compliant" (A) is judgmental and not
therapeutic. Recommending placement in a skilled nursing facility (B) is outside the scope of the
LPN/VN and not based on a full assessment. Simply changing medications (D) may not address
the underlying reasons for non-adherence.
6. A practical nurse is caring for a client who has an order for a blood transfusion. The nurse
has verified the blood product with another licensed nurse and is preparing to initiate the
transfusion. The client reports a history of allergic reactions to blood products. Which of the
following actions should the nurse take first?
A. Administer the transfusion slowly and monitor for reactions
B. Pre-medicate the client with diphenhydramine as prescribed
C. Notify the provider and request pre-transfusion medications
D. Check the client's current vital signs
Correct Answer: C
Rationale: The nurse should notify the provider and request pre-transfusion medications (C) for
a client with a history of transfusion reactions. Administering the transfusion without pre-
medication (A) is unsafe. Pre-medicating independently (B) is outside the scope unless
specifically ordered. Checking vital signs (D) is important but should occur after notifying the
provider and obtaining orders for pre-medications.
