LVN – Licensed Vocational Nurse (California &
Texas) Master Licensing Exam Review | 200+
Practice Questions & Verified Answers |
Comprehensive LVN & NCLEX-PN Study Guide,
California and Texas Nursing Exam Prep,
Fundamentals, Pharmacology, Medical-Surgical
Nursing, Maternal-Newborn, Pediatrics, Mental
Health, Patient Safety, Clinical Skills, Detailed
Rationales
Question 1: A patient who is 3 days post-operative following a total hip
arthroplasty suddenly complains of sharp chest pain and dyspnea. The nurse
notes tachycardia and tachypnea. What is the nurse's priority action?
A. Administer prescribed PRN morphine sulfate for pain.
B. Apply supplemental oxygen and notify the healthcare provider.
C. Encourage the patient to perform incentive spirometry.
D. Assist the patient to ambulate to prevent complications.
CORRECT ANSWER: B. Apply supplemental oxygen and notify the healthcare
provider.
Rationale: The patient is exhibiting classic signs of a pulmonary embolism (PE), a high-
risk complication post-hip surgery due to venous stasis and immobility. The priority
nursing action is to stabilize the patient with oxygen and immediately notify the provider
for further orders (e.g., diagnostic imaging, anticoagulation). Ambulation could dislodge
a clot, and while pain management is important, it is not the priority.
Question 2: A LVN is reinforcing teaching for a patient prescribed a metered-
dose inhaler (MDI) with a spacer for chronic obstructive pulmonary disease
(COPD). Which statement by the patient indicates a need for further teaching?
A. "I should shake the inhaler well before each use."
B. "I will inhale slowly and deeply after pressing the canister."
C. "I should wait 1 minute between puffs if I need a second dose."
D. "I should exhale completely before placing the mouthpiece in my mouth."
CORRECT ANSWER: D. I should exhale completely before placing the
mouthpiece in my mouth.
Rationale: The patient should exhale completely before placing the mouthpiece in their
mouth or actuating the inhaler. Exhaling after placing the mouthpiece in the mouth can
blow medication away from the airway. Shaking, slow inhalation, and waiting between
puffs are all correct techniques.
Question 3: A patient with heart failure is prescribed furosemide (Lasix).
Which laboratory value requires the nurse to notify the healthcare provider
immediately?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 3.0 mEq/L
C. Serum calcium of 9.0 mg/dL
D. Serum magnesium of 2.0 mEq/L
,CORRECT ANSWER: B. Serum potassium of 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes excretion of potassium, leading to
hypokalemia. A potassium level of 3.0 mEq/L is critically low and can predispose the
patient to cardiac dysrhythmias, especially if they are also on digitalis. The other values
are within or near normal limits.
Question 4: When caring for a patient with a nasogastric (NG) tube attached to
low intermittent suction, the LVN notes that the tube has stopped draining.
Which action should the nurse take first?
A. Irrigate the NG tube with sterile water.
B. Reposition the patient onto their left side.
C. Check the placement of the NG tube.
D. Increase the suction pressure to high.
CORRECT ANSWER: C. Check the placement of the NG tube.
Rationale: Before any intervention, the nurse must verify that the NG tube is still in the
correct anatomical position. Repositioning the patient can help, but it is not the first step.
Irrigating a tube of unknown placement can cause aspiration. Increasing suction is
dangerous and should only be done with a provider's order.
Question 5: A patient is receiving a blood transfusion of packed red blood
cells. Fifteen minutes after the transfusion starts, the patient reports low back
pain and chills. What is the LVN's priority action?
A. Slow the transfusion rate and monitor vital signs.
B. Stop the transfusion immediately and keep the IV line open with normal saline.
C. Administer an antihistamine as prescribed.
D. Flush the IV line with heparinized saline.
CORRECT ANSWER: B. Stop the transfusion immediately and keep the IV line
open with normal saline.
Rationale: These are classic signs of an acute hemolytic transfusion reaction. The
priority is to stop the infusion to prevent further reaction, maintain IV access with
normal saline (not medicated fluids), and notify the provider. The blood bag and tubing
should be saved for the blood bank.
Question 6: A patient with type 2 diabetes mellitus is scheduled for a
computed tomography (CT) scan with contrast dye. Which medication should
the nurse question, as it holds a high risk for acute kidney injury when
combined with contrast?
A. Metformin (Glucophage)
B. Glipizide (Glucotrol)
C. Pioglitazone (Actos)
D. Sitagliptin (Januvia)
CORRECT ANSWER: A. Metformin (Glucophage)
Rationale: Metformin is contraindicated in patients receiving IV contrast dye due to
the increased risk of lactic acidosis and acute kidney injury. It is standard practice to
hold metformin for 48 hours before and after the procedure, pending renal function test
results.
,Question 7: The LVN is caring for an elderly patient who is at risk for falls.
Which intervention is most appropriate to include in the patient's plan of care?
A. Keep all four bed rails up while the patient is sleeping.
B. Place a fall-risk bracelet on the patient and keep the bed in the lowest position.
C. Apply wrist restraints to prevent the patient from getting up unassisted.
D. Keep the room dimly lit to promote rest at night.
CORRECT ANSWER: B. Place a fall-risk bracelet on the patient and keep the
bed in the lowest position.
Rationale: Placing the bed in the lowest position minimizes injury if the patient
attempts to get out of bed. A fall-risk bracelet alerts staff. Restraints and raising all four
rails are considered restraints and are not appropriate first-line interventions. Adequate
lighting is required for safety, not dim lighting.
Question 8: A patient with an indwelling urinary catheter is ordered a sterile
urine culture. What is the correct procedure for collecting the specimen?
A. Empty the Foley bag and collect urine from the drainage spout.
B. Aspirate urine from the catheter tubing using a sterile syringe and needle.
C. Collect a clean catch midstream urine sample from the patient.
D. Disconnect the catheter from the tubing and let urine flow into a sterile cup.
CORRECT ANSWER: B. Aspirate urine from the catheter tubing using a sterile
syringe and needle.
Rationale: To obtain a sterile specimen from an indwelling catheter, the nurse should
cleanse the specimen port on the catheter tubing with alcohol, attach a sterile syringe,
and aspirate the urine. This prevents contamination and maintains the closed system.
Never disconnect the catheter or collect from the bag.
Question 9: A patient is prescribed digoxin (Lanoxin) and furosemide (Lasix).
Which assessment finding is most indicative of digoxin toxicity?
A. Tachycardia and hypertension
B. Anorexia, nausea, and visual disturbances
C. Hyperkalemia and hypocalcemia
D. Constipation and dry mouth
CORRECT ANSWER: B. Anorexia, nausea, and visual disturbances
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms (anorexia,
nausea, vomiting) and visual disturbances (blurred vision, yellow-green halos).
Hypokalemia from furosemide increases the risk of toxicity.
Question 10: The LVN is preparing to administer an enteral feeding via a
gastrostomy tube. What is the most accurate method to verify the initial
placement of the tube?
A. Auscultate for air over the epigastric area.
B. Measure the pH of the aspirated gastric contents.
C. Obtain an order for an X-ray confirmation of placement.
D. Observe the color and appearance of the gastric aspirate.
CORRECT ANSWER: C. Obtain an order for an X-ray confirmation of
placement.
, Rationale: An X-ray is the gold standard for confirming initial placement of a
gastrostomy tube. While pH and aspirate appearance are useful for ongoing verification,
they are not as definitive for initial placement. Auscultation is an unreliable method.
Question 11: A patient is 1 day post-operative following a colostomy. The
stoma is edematous and dark red. What is the nurse's best action?
A. Apply an ice pack to the stoma to reduce edema.
B. Notify the healthcare provider immediately.
C. Document the finding as a normal assessment.
D. Massage the stoma gently to promote circulation.
CORRECT ANSWER: C. Document the finding as a normal assessment.
Rationale: For the first 24-48 hours post-surgery, a stoma may be edematous and have
a dark red, purplish appearance due to venous congestion. This is expected. The stoma
should be moist and pink/moist. Notifying the provider is not necessary unless it
becomes pale, dry, or black (signs of necrosis).
Question 12: A patient is receiving lithium carbonate for bipolar disorder. The
LVN notes a serum lithium level of 1.8 mEq/L. Which signs and symptoms
would the nurse anticipate?
A. Polyuria and polydipsia
B. Ataxia, coarse tremors, and confusion
C. Sedation and weight gain
D. Tachycardia and hypertension
CORRECT ANSWER: B. Ataxia, coarse tremors, and confusion
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. A level of 1.8 mEq/L
indicates toxicity. Signs of lithium toxicity include severe tremors, ataxia, confusion,
vomiting, and diarrhea. Polyuria and polydipsia are common side effects of lithium, not
necessarily signs of acute toxicity at this level.
Question 13: When teaching a patient with hypertension about a low-sodium
diet, which food item should the LVN instruct the patient to avoid?
A. Fresh apples
B. Baked chicken breast
C. Canned vegetable soup
D. Brown rice
CORRECT ANSWER: C. Canned vegetable soup
Rationale: Canned foods, especially soups, are notoriously high in sodium as a
preservative and flavor enhancer. Fresh fruits, fresh meats, and unprocessed grains are
naturally low in sodium and are encouraged on a low-sodium diet.
Question 14: A patient is on warfarin (Coumadin) therapy. Which over-the-
counter medication should the nurse instruct the patient to avoid due to an
increased risk of bleeding?
A. Acetaminophen (Tylenol)
B. Ibuprofen (Advil)
C. Diphenhydramine (Benadryl)
Texas) Master Licensing Exam Review | 200+
Practice Questions & Verified Answers |
Comprehensive LVN & NCLEX-PN Study Guide,
California and Texas Nursing Exam Prep,
Fundamentals, Pharmacology, Medical-Surgical
Nursing, Maternal-Newborn, Pediatrics, Mental
Health, Patient Safety, Clinical Skills, Detailed
Rationales
Question 1: A patient who is 3 days post-operative following a total hip
arthroplasty suddenly complains of sharp chest pain and dyspnea. The nurse
notes tachycardia and tachypnea. What is the nurse's priority action?
A. Administer prescribed PRN morphine sulfate for pain.
B. Apply supplemental oxygen and notify the healthcare provider.
C. Encourage the patient to perform incentive spirometry.
D. Assist the patient to ambulate to prevent complications.
CORRECT ANSWER: B. Apply supplemental oxygen and notify the healthcare
provider.
Rationale: The patient is exhibiting classic signs of a pulmonary embolism (PE), a high-
risk complication post-hip surgery due to venous stasis and immobility. The priority
nursing action is to stabilize the patient with oxygen and immediately notify the provider
for further orders (e.g., diagnostic imaging, anticoagulation). Ambulation could dislodge
a clot, and while pain management is important, it is not the priority.
Question 2: A LVN is reinforcing teaching for a patient prescribed a metered-
dose inhaler (MDI) with a spacer for chronic obstructive pulmonary disease
(COPD). Which statement by the patient indicates a need for further teaching?
A. "I should shake the inhaler well before each use."
B. "I will inhale slowly and deeply after pressing the canister."
C. "I should wait 1 minute between puffs if I need a second dose."
D. "I should exhale completely before placing the mouthpiece in my mouth."
CORRECT ANSWER: D. I should exhale completely before placing the
mouthpiece in my mouth.
Rationale: The patient should exhale completely before placing the mouthpiece in their
mouth or actuating the inhaler. Exhaling after placing the mouthpiece in the mouth can
blow medication away from the airway. Shaking, slow inhalation, and waiting between
puffs are all correct techniques.
Question 3: A patient with heart failure is prescribed furosemide (Lasix).
Which laboratory value requires the nurse to notify the healthcare provider
immediately?
A. Serum sodium of 135 mEq/L
B. Serum potassium of 3.0 mEq/L
C. Serum calcium of 9.0 mg/dL
D. Serum magnesium of 2.0 mEq/L
,CORRECT ANSWER: B. Serum potassium of 3.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes excretion of potassium, leading to
hypokalemia. A potassium level of 3.0 mEq/L is critically low and can predispose the
patient to cardiac dysrhythmias, especially if they are also on digitalis. The other values
are within or near normal limits.
Question 4: When caring for a patient with a nasogastric (NG) tube attached to
low intermittent suction, the LVN notes that the tube has stopped draining.
Which action should the nurse take first?
A. Irrigate the NG tube with sterile water.
B. Reposition the patient onto their left side.
C. Check the placement of the NG tube.
D. Increase the suction pressure to high.
CORRECT ANSWER: C. Check the placement of the NG tube.
Rationale: Before any intervention, the nurse must verify that the NG tube is still in the
correct anatomical position. Repositioning the patient can help, but it is not the first step.
Irrigating a tube of unknown placement can cause aspiration. Increasing suction is
dangerous and should only be done with a provider's order.
Question 5: A patient is receiving a blood transfusion of packed red blood
cells. Fifteen minutes after the transfusion starts, the patient reports low back
pain and chills. What is the LVN's priority action?
A. Slow the transfusion rate and monitor vital signs.
B. Stop the transfusion immediately and keep the IV line open with normal saline.
C. Administer an antihistamine as prescribed.
D. Flush the IV line with heparinized saline.
CORRECT ANSWER: B. Stop the transfusion immediately and keep the IV line
open with normal saline.
Rationale: These are classic signs of an acute hemolytic transfusion reaction. The
priority is to stop the infusion to prevent further reaction, maintain IV access with
normal saline (not medicated fluids), and notify the provider. The blood bag and tubing
should be saved for the blood bank.
Question 6: A patient with type 2 diabetes mellitus is scheduled for a
computed tomography (CT) scan with contrast dye. Which medication should
the nurse question, as it holds a high risk for acute kidney injury when
combined with contrast?
A. Metformin (Glucophage)
B. Glipizide (Glucotrol)
C. Pioglitazone (Actos)
D. Sitagliptin (Januvia)
CORRECT ANSWER: A. Metformin (Glucophage)
Rationale: Metformin is contraindicated in patients receiving IV contrast dye due to
the increased risk of lactic acidosis and acute kidney injury. It is standard practice to
hold metformin for 48 hours before and after the procedure, pending renal function test
results.
,Question 7: The LVN is caring for an elderly patient who is at risk for falls.
Which intervention is most appropriate to include in the patient's plan of care?
A. Keep all four bed rails up while the patient is sleeping.
B. Place a fall-risk bracelet on the patient and keep the bed in the lowest position.
C. Apply wrist restraints to prevent the patient from getting up unassisted.
D. Keep the room dimly lit to promote rest at night.
CORRECT ANSWER: B. Place a fall-risk bracelet on the patient and keep the
bed in the lowest position.
Rationale: Placing the bed in the lowest position minimizes injury if the patient
attempts to get out of bed. A fall-risk bracelet alerts staff. Restraints and raising all four
rails are considered restraints and are not appropriate first-line interventions. Adequate
lighting is required for safety, not dim lighting.
Question 8: A patient with an indwelling urinary catheter is ordered a sterile
urine culture. What is the correct procedure for collecting the specimen?
A. Empty the Foley bag and collect urine from the drainage spout.
B. Aspirate urine from the catheter tubing using a sterile syringe and needle.
C. Collect a clean catch midstream urine sample from the patient.
D. Disconnect the catheter from the tubing and let urine flow into a sterile cup.
CORRECT ANSWER: B. Aspirate urine from the catheter tubing using a sterile
syringe and needle.
Rationale: To obtain a sterile specimen from an indwelling catheter, the nurse should
cleanse the specimen port on the catheter tubing with alcohol, attach a sterile syringe,
and aspirate the urine. This prevents contamination and maintains the closed system.
Never disconnect the catheter or collect from the bag.
Question 9: A patient is prescribed digoxin (Lanoxin) and furosemide (Lasix).
Which assessment finding is most indicative of digoxin toxicity?
A. Tachycardia and hypertension
B. Anorexia, nausea, and visual disturbances
C. Hyperkalemia and hypocalcemia
D. Constipation and dry mouth
CORRECT ANSWER: B. Anorexia, nausea, and visual disturbances
Rationale: Early signs of digoxin toxicity include gastrointestinal symptoms (anorexia,
nausea, vomiting) and visual disturbances (blurred vision, yellow-green halos).
Hypokalemia from furosemide increases the risk of toxicity.
Question 10: The LVN is preparing to administer an enteral feeding via a
gastrostomy tube. What is the most accurate method to verify the initial
placement of the tube?
A. Auscultate for air over the epigastric area.
B. Measure the pH of the aspirated gastric contents.
C. Obtain an order for an X-ray confirmation of placement.
D. Observe the color and appearance of the gastric aspirate.
CORRECT ANSWER: C. Obtain an order for an X-ray confirmation of
placement.
, Rationale: An X-ray is the gold standard for confirming initial placement of a
gastrostomy tube. While pH and aspirate appearance are useful for ongoing verification,
they are not as definitive for initial placement. Auscultation is an unreliable method.
Question 11: A patient is 1 day post-operative following a colostomy. The
stoma is edematous and dark red. What is the nurse's best action?
A. Apply an ice pack to the stoma to reduce edema.
B. Notify the healthcare provider immediately.
C. Document the finding as a normal assessment.
D. Massage the stoma gently to promote circulation.
CORRECT ANSWER: C. Document the finding as a normal assessment.
Rationale: For the first 24-48 hours post-surgery, a stoma may be edematous and have
a dark red, purplish appearance due to venous congestion. This is expected. The stoma
should be moist and pink/moist. Notifying the provider is not necessary unless it
becomes pale, dry, or black (signs of necrosis).
Question 12: A patient is receiving lithium carbonate for bipolar disorder. The
LVN notes a serum lithium level of 1.8 mEq/L. Which signs and symptoms
would the nurse anticipate?
A. Polyuria and polydipsia
B. Ataxia, coarse tremors, and confusion
C. Sedation and weight gain
D. Tachycardia and hypertension
CORRECT ANSWER: B. Ataxia, coarse tremors, and confusion
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. A level of 1.8 mEq/L
indicates toxicity. Signs of lithium toxicity include severe tremors, ataxia, confusion,
vomiting, and diarrhea. Polyuria and polydipsia are common side effects of lithium, not
necessarily signs of acute toxicity at this level.
Question 13: When teaching a patient with hypertension about a low-sodium
diet, which food item should the LVN instruct the patient to avoid?
A. Fresh apples
B. Baked chicken breast
C. Canned vegetable soup
D. Brown rice
CORRECT ANSWER: C. Canned vegetable soup
Rationale: Canned foods, especially soups, are notoriously high in sodium as a
preservative and flavor enhancer. Fresh fruits, fresh meats, and unprocessed grains are
naturally low in sodium and are encouraged on a low-sodium diet.
Question 14: A patient is on warfarin (Coumadin) therapy. Which over-the-
counter medication should the nurse instruct the patient to avoid due to an
increased risk of bleeding?
A. Acetaminophen (Tylenol)
B. Ibuprofen (Advil)
C. Diphenhydramine (Benadryl)
