LPN/LVN Clinical Competency
Assessment — Code: LPN-CCA | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and an oxygen saturation of 86%. Which action should the
LPN/LVN take first?
A. Encourage the client to ambulate
B. Apply oxygen and immediately notify the RN/provider
C. Administer the prescribed opioid
D. Place the client in Trendelenburg position
Answer: Apply oxygen and immediately notify the RN/provider
Rationale: A sudden onset of hypoxemia, dyspnea, tachycardia, and pleuritic
chest pain is highly concerning for pulmonary embolism. Oxygen supports gas
exchange while urgent evaluation and escalation occur.
, 2. A client receiving IV antibiotics develops wheezing, facial swelling,
hypotension, and generalized urticaria. Which medication should the nurse
anticipate administering immediately?
A. Diphenhydramine
B. Furosemide
C. Epinephrine
D. Acetaminophen
Answer: Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis because it
rapidly reverses bronchoconstriction, vasodilation, and airway edema.
3. A client with heart failure is receiving furosemide. Which finding requires
the most immediate attention?
A. Weight loss of 1 kg over 2 days
B. Blood pressure of 108/64 mm Hg
C. Potassium level of 2.8 mEq/L
D. Urine output of 1,800 mL/day
Answer: Potassium level of 2.8 mEq/L
Rationale: Severe hypokalemia can cause life-threatening dysrhythmias and
requires prompt intervention, particularly in a client receiving a loop diuretic.
4. A client with diabetes becomes confused, diaphoretic, and tremulous. The
blood glucose is 48 mg/dL, and the client is awake and able to swallow.
What should the LPN/LVN do?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Restrict oral intake
D. Administer long-acting insulin
Answer: Give 15 g of rapid-acting carbohydrate
,Rationale: A conscious client with symptomatic hypoglycemia should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose.
5. A client with COPD has an oxygen saturation of 89% and is experiencing
increased work of breathing. Which intervention is most appropriate?
A. Withhold oxygen because oxygen suppresses respiratory drive
B. Administer oxygen as prescribed and monitor respiratory status
C. Place the client flat in bed
D. Encourage rapid, shallow breathing
Answer: Administer oxygen as prescribed and monitor respiratory status
Rationale: Oxygen should not be withheld from a hypoxemic COPD client.
Oxygen is administered according to the prescribed target range while
respiratory status and clinical response are monitored.
6. A client taking warfarin has an INR of 5.8 and reports bleeding gums. What
is the priority nursing action?
A. Administer the next dose of warfarin
B. Encourage foods high in vitamin K immediately
C. Hold the medication and notify the RN/provider
D. Encourage vigorous tooth brushing
Answer: Hold the medication and notify the RN/provider
Rationale: An elevated INR with active bleeding indicates excessive
anticoagulation. The medication should be held and the prescribing team
notified for further management.
7. A client with a new tracheostomy becomes restless and has noisy
respirations. What should the LPN/LVN assess first?
A. Bowel sounds
B. Airway patency
, C. Peripheral pulses
D. Urine specific gravity
Answer: Airway patency
Rationale: Restlessness and noisy breathing may indicate airway obstruction.
Airway assessment is the immediate priority because obstruction can rapidly
become life-threatening.
8. A client receiving an enteral feeding suddenly develops coughing, cyanosis,
and respiratory distress. What is the priority action?
A. Increase the feeding rate
B. Stop the feeding
C. Flush the tube
D. Place the client supine
Answer: Stop the feeding
Rationale: Coughing, cyanosis, and respiratory distress suggest possible
aspiration. The feeding should be stopped immediately while the airway and
respiratory status are assessed.
9. Which assessment finding in a client with a central venous catheter
requires immediate intervention?
A. Dressing is clean and dry
B. Catheter is secured
C. Sudden dyspnea and unilateral chest pain after catheter manipulation
D. Infusion is running at the prescribed rate
Answer: Sudden dyspnea and unilateral chest pain after catheter manipulation
Rationale: These findings may indicate a pneumothorax or other catheter-
related complication and require immediate assessment and escalation.
10.A client with suspected stroke arrives with facial drooping and unilateral
weakness. Which information is most important to establish?
Assessment — Code: LPN-CCA | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and an oxygen saturation of 86%. Which action should the
LPN/LVN take first?
A. Encourage the client to ambulate
B. Apply oxygen and immediately notify the RN/provider
C. Administer the prescribed opioid
D. Place the client in Trendelenburg position
Answer: Apply oxygen and immediately notify the RN/provider
Rationale: A sudden onset of hypoxemia, dyspnea, tachycardia, and pleuritic
chest pain is highly concerning for pulmonary embolism. Oxygen supports gas
exchange while urgent evaluation and escalation occur.
, 2. A client receiving IV antibiotics develops wheezing, facial swelling,
hypotension, and generalized urticaria. Which medication should the nurse
anticipate administering immediately?
A. Diphenhydramine
B. Furosemide
C. Epinephrine
D. Acetaminophen
Answer: Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis because it
rapidly reverses bronchoconstriction, vasodilation, and airway edema.
3. A client with heart failure is receiving furosemide. Which finding requires
the most immediate attention?
A. Weight loss of 1 kg over 2 days
B. Blood pressure of 108/64 mm Hg
C. Potassium level of 2.8 mEq/L
D. Urine output of 1,800 mL/day
Answer: Potassium level of 2.8 mEq/L
Rationale: Severe hypokalemia can cause life-threatening dysrhythmias and
requires prompt intervention, particularly in a client receiving a loop diuretic.
4. A client with diabetes becomes confused, diaphoretic, and tremulous. The
blood glucose is 48 mg/dL, and the client is awake and able to swallow.
What should the LPN/LVN do?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Restrict oral intake
D. Administer long-acting insulin
Answer: Give 15 g of rapid-acting carbohydrate
,Rationale: A conscious client with symptomatic hypoglycemia should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose.
5. A client with COPD has an oxygen saturation of 89% and is experiencing
increased work of breathing. Which intervention is most appropriate?
A. Withhold oxygen because oxygen suppresses respiratory drive
B. Administer oxygen as prescribed and monitor respiratory status
C. Place the client flat in bed
D. Encourage rapid, shallow breathing
Answer: Administer oxygen as prescribed and monitor respiratory status
Rationale: Oxygen should not be withheld from a hypoxemic COPD client.
Oxygen is administered according to the prescribed target range while
respiratory status and clinical response are monitored.
6. A client taking warfarin has an INR of 5.8 and reports bleeding gums. What
is the priority nursing action?
A. Administer the next dose of warfarin
B. Encourage foods high in vitamin K immediately
C. Hold the medication and notify the RN/provider
D. Encourage vigorous tooth brushing
Answer: Hold the medication and notify the RN/provider
Rationale: An elevated INR with active bleeding indicates excessive
anticoagulation. The medication should be held and the prescribing team
notified for further management.
7. A client with a new tracheostomy becomes restless and has noisy
respirations. What should the LPN/LVN assess first?
A. Bowel sounds
B. Airway patency
, C. Peripheral pulses
D. Urine specific gravity
Answer: Airway patency
Rationale: Restlessness and noisy breathing may indicate airway obstruction.
Airway assessment is the immediate priority because obstruction can rapidly
become life-threatening.
8. A client receiving an enteral feeding suddenly develops coughing, cyanosis,
and respiratory distress. What is the priority action?
A. Increase the feeding rate
B. Stop the feeding
C. Flush the tube
D. Place the client supine
Answer: Stop the feeding
Rationale: Coughing, cyanosis, and respiratory distress suggest possible
aspiration. The feeding should be stopped immediately while the airway and
respiratory status are assessed.
9. Which assessment finding in a client with a central venous catheter
requires immediate intervention?
A. Dressing is clean and dry
B. Catheter is secured
C. Sudden dyspnea and unilateral chest pain after catheter manipulation
D. Infusion is running at the prescribed rate
Answer: Sudden dyspnea and unilateral chest pain after catheter manipulation
Rationale: These findings may indicate a pneumothorax or other catheter-
related complication and require immediate assessment and escalation.
10.A client with suspected stroke arrives with facial drooping and unilateral
weakness. Which information is most important to establish?
