LPN/LVN Reentry-to-Practice
Competency Exam — Code: LPN-RTP-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A recently reentering LPN/LVN is caring for a client with pneumonia who
suddenly becomes confused, restless, and tachypneic. The oxygen
saturation decreases from 94% to 86%. What is the nurse’s priority action?
A. Encourage oral fluids
B. Reassess the client in 30 minutes
C. Apply supplemental oxygen and assess respiratory status
D. Administer the prescribed antibiotic early
Answer: Apply supplemental oxygen and assess respiratory status.
Rationale: Acute hypoxemia with altered mental status and tachypnea indicates
possible respiratory deterioration. Airway and breathing take priority. The
,antibiotic addresses the underlying infection but does not immediately correct
the life-threatening oxygenation problem.
2. A client taking warfarin reports black, tarry stools. Which action should the
LPN/LVN take first?
A. Encourage foods high in vitamin K
B. Document the finding as an expected medication effect
C. Hold the medication and notify the appropriate provider
D. Administer the next dose with food
Answer: Hold the medication and notify the appropriate provider.
Rationale: Melena may indicate gastrointestinal bleeding, a serious
complication of anticoagulation. The medication should not be administered
until the situation has been evaluated.
3. A client with heart failure has gained 2.5 kg (5.5 lb) in 3 days. Which finding
is most concerning?
A. Mild ankle edema
B. Increased appetite
C. New bilateral crackles and dyspnea at rest
D. Urinary frequency after taking a diuretic
Answer: New bilateral crackles and dyspnea at rest.
Rationale: Rapid weight gain suggests fluid retention, and crackles with
dyspnea at rest may indicate acute pulmonary edema. This requires prompt
intervention.
4. An LPN/LVN is preparing to administer insulin lispro. The client’s meal tray
has not arrived. What should the nurse do?
A. Administer the insulin immediately
B. Administer half the prescribed dose
C. Wait until the meal is available and glucose management is coordinated
D. Substitute regular insulin
,Answer: Wait until the meal is available and glucose management is
coordinated.
Rationale: Rapid-acting insulin such as lispro is generally administered in close
relation to meals. Giving it without available carbohydrate intake increases the
risk of hypoglycemia.
5. A client with chronic kidney disease has a potassium level of 6.4 mEq/L.
Which ECG change would the nurse anticipate?
A. Prominent U waves
B. Peaked T waves
C. Prolonged QT interval from hypokalemia
D. Narrowed QRS with bradycardia only
Answer: Peaked T waves.
Rationale: Hyperkalemia commonly produces tall, peaked T waves and can
progress to PR prolongation, QRS widening, ventricular dysrhythmias, and
cardiac arrest.
6. A client receiving an opioid after surgery is difficult to arouse and has a
respiratory rate of 7/min. What is the priority action?
A. Encourage ambulation
B. Administer the next opioid dose later
C. Support ventilation and initiate appropriate opioid-reversal protocols
D. Offer oral fluids
Answer: Support ventilation and initiate appropriate opioid-reversal protocols.
Rationale: Severe respiratory depression is an emergency. Airway and
ventilation must be supported while the opioid effect is reversed according to
facility protocol and prescription.
7. An older adult with a urinary tract infection becomes acutely confused and
hypotensive. Which condition should the nurse suspect?
, A. Stable chronic dementia
B. Sepsis
C. Mild dehydration only
D. Expected aging
Answer: Sepsis.
Rationale: Acute mental-status change combined with hypotension in a client
with infection is concerning for systemic infection and possible sepsis. Rapid
assessment and escalation are required.
8. A client with COPD has an oxygen saturation of 88% and increased work of
breathing. Which intervention is most appropriate?
A. Withhold oxygen because all oxygen is contraindicated in COPD
B. Apply prescribed oxygen and titrate according to the ordered target
C. Place the client flat
D. Encourage rapid shallow breathing
Answer: Apply prescribed oxygen and titrate according to the ordered target.
Rationale: COPD does not mean oxygen should be withheld. Oxygen is
administered carefully according to the prescribed target while respiratory
status is closely monitored.
9. A client receiving IV potassium chloride reports severe burning at the IV
site. What should the LPN/LVN do first?
A. Increase the infusion rate
B. Stop the infusion and assess the IV site
C. Apply pressure while continuing the infusion
D. Flush forcefully with saline
Answer: Stop the infusion and assess the IV site.
Rationale: Severe pain or burning during IV potassium administration may
indicate infiltration or tissue injury. Potassium must never be administered as an
IV push.
Competency Exam — Code: LPN-RTP-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A recently reentering LPN/LVN is caring for a client with pneumonia who
suddenly becomes confused, restless, and tachypneic. The oxygen
saturation decreases from 94% to 86%. What is the nurse’s priority action?
A. Encourage oral fluids
B. Reassess the client in 30 minutes
C. Apply supplemental oxygen and assess respiratory status
D. Administer the prescribed antibiotic early
Answer: Apply supplemental oxygen and assess respiratory status.
Rationale: Acute hypoxemia with altered mental status and tachypnea indicates
possible respiratory deterioration. Airway and breathing take priority. The
,antibiotic addresses the underlying infection but does not immediately correct
the life-threatening oxygenation problem.
2. A client taking warfarin reports black, tarry stools. Which action should the
LPN/LVN take first?
A. Encourage foods high in vitamin K
B. Document the finding as an expected medication effect
C. Hold the medication and notify the appropriate provider
D. Administer the next dose with food
Answer: Hold the medication and notify the appropriate provider.
Rationale: Melena may indicate gastrointestinal bleeding, a serious
complication of anticoagulation. The medication should not be administered
until the situation has been evaluated.
3. A client with heart failure has gained 2.5 kg (5.5 lb) in 3 days. Which finding
is most concerning?
A. Mild ankle edema
B. Increased appetite
C. New bilateral crackles and dyspnea at rest
D. Urinary frequency after taking a diuretic
Answer: New bilateral crackles and dyspnea at rest.
Rationale: Rapid weight gain suggests fluid retention, and crackles with
dyspnea at rest may indicate acute pulmonary edema. This requires prompt
intervention.
4. An LPN/LVN is preparing to administer insulin lispro. The client’s meal tray
has not arrived. What should the nurse do?
A. Administer the insulin immediately
B. Administer half the prescribed dose
C. Wait until the meal is available and glucose management is coordinated
D. Substitute regular insulin
,Answer: Wait until the meal is available and glucose management is
coordinated.
Rationale: Rapid-acting insulin such as lispro is generally administered in close
relation to meals. Giving it without available carbohydrate intake increases the
risk of hypoglycemia.
5. A client with chronic kidney disease has a potassium level of 6.4 mEq/L.
Which ECG change would the nurse anticipate?
A. Prominent U waves
B. Peaked T waves
C. Prolonged QT interval from hypokalemia
D. Narrowed QRS with bradycardia only
Answer: Peaked T waves.
Rationale: Hyperkalemia commonly produces tall, peaked T waves and can
progress to PR prolongation, QRS widening, ventricular dysrhythmias, and
cardiac arrest.
6. A client receiving an opioid after surgery is difficult to arouse and has a
respiratory rate of 7/min. What is the priority action?
A. Encourage ambulation
B. Administer the next opioid dose later
C. Support ventilation and initiate appropriate opioid-reversal protocols
D. Offer oral fluids
Answer: Support ventilation and initiate appropriate opioid-reversal protocols.
Rationale: Severe respiratory depression is an emergency. Airway and
ventilation must be supported while the opioid effect is reversed according to
facility protocol and prescription.
7. An older adult with a urinary tract infection becomes acutely confused and
hypotensive. Which condition should the nurse suspect?
, A. Stable chronic dementia
B. Sepsis
C. Mild dehydration only
D. Expected aging
Answer: Sepsis.
Rationale: Acute mental-status change combined with hypotension in a client
with infection is concerning for systemic infection and possible sepsis. Rapid
assessment and escalation are required.
8. A client with COPD has an oxygen saturation of 88% and increased work of
breathing. Which intervention is most appropriate?
A. Withhold oxygen because all oxygen is contraindicated in COPD
B. Apply prescribed oxygen and titrate according to the ordered target
C. Place the client flat
D. Encourage rapid shallow breathing
Answer: Apply prescribed oxygen and titrate according to the ordered target.
Rationale: COPD does not mean oxygen should be withheld. Oxygen is
administered carefully according to the prescribed target while respiratory
status is closely monitored.
9. A client receiving IV potassium chloride reports severe burning at the IV
site. What should the LPN/LVN do first?
A. Increase the infusion rate
B. Stop the infusion and assess the IV site
C. Apply pressure while continuing the infusion
D. Flush forcefully with saline
Answer: Stop the infusion and assess the IV site.
Rationale: Severe pain or burning during IV potassium administration may
indicate infiltration or tissue injury. Potassium must never be administered as an
IV push.
