LPN/LVN Medical-Surgical Competency
Exam — Code: LPN-MEDSURG-COMP |
100-Question Advanced Practice Exam
2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A client with heart failure is receiving IV furosemide. Which finding requires
the LPN/LVN to notify the provider immediately?
A. Urine output of 1,500 mL over 24 hours
B. Potassium level of 2.8 mEq/L
C. Blood pressure of 108/64 mmHg
D. Decreased ankle edema
Answer: B. Potassium level of 2.8 mEq/L
Rationale: Furosemide can cause significant potassium loss. A potassium level of
2.8 mEq/L places the client at risk for dangerous ventricular dysrhythmias and
requires prompt intervention.
, 2. A client with COPD receiving oxygen at 2 L/min by nasal cannula becomes
increasingly somnolent. The respiratory rate is 8/min. Which action is the
priority?
A. Increase oxygen to 6 L/min
B. Place the client supine
C. Assess respiratory status and notify the RN/provider immediately
D. Encourage oral fluids
Answer: C. Assess respiratory status and notify the RN/provider immediately
Rationale: Severe somnolence and respiratory depression in a client with COPD
may indicate worsening hypercapnia or respiratory failure. Increasing oxygen
independently may worsen ventilation in some clients. Immediate assessment
and escalation are required.
3. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L.
Which prescription should the nurse question?
A. IV regular insulin infusion
B. Cardiac monitoring
C. IV potassium replacement
D. Isotonic IV fluids
Answer: A. IV regular insulin infusion
Rationale: Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. When potassium is severely low, potassium replacement is
generally initiated before insulin according to the prescribed DKA protocol.
, 4. A client with pneumonia has a respiratory rate of 32/min, oxygen
saturation of 86%, and new confusion. Which intervention has the highest
priority?
A. Encourage coughing exercises
B. Apply prescribed supplemental oxygen
C. Offer oral fluids
D. Obtain a sputum specimen
Answer: B. Apply prescribed supplemental oxygen
Rationale: Hypoxemia with acute mental-status changes represents an
immediate airway and breathing concern. Oxygenation should be addressed
promptly while additional interventions are initiated.
5. A client taking warfarin has an INR of 5.8 and reports bleeding gums. What
is the priority action?
A. Administer the next dose
B. Encourage foods high in vitamin K
C. Hold the medication and notify the provider
D. Encourage increased fluid intake
Answer: C. Hold the medication and notify the provider
Rationale: An INR of 5.8 with active bleeding indicates excessive
anticoagulation. The medication should be withheld and the provider notified
for further management.
6. A client with chronic kidney disease has a potassium level of 6.4 mEq/L.
Which finding is most concerning?
A. Muscle weakness
B. Peaked T waves
, C. Mild nausea
D. Increased thirst
Answer: B. Peaked T waves
Rationale: Severe hyperkalemia can cause fatal cardiac dysrhythmias. Peaked T
waves are a classic ECG manifestation requiring immediate intervention.
7. A client with suspected pulmonary embolism suddenly develops severe
dyspnea and chest pain. Which action should the LPN/LVN take first?
A. Encourage ambulation
B. Place the client in a high-Fowler position and apply prescribed oxygen
C. Give oral fluids
D. Obtain a routine temperature
Answer: B. Place the client in a high-Fowler position and apply prescribed
oxygen
Rationale: Pulmonary embolism can rapidly impair oxygenation. Positioning to
maximize ventilation and administering prescribed oxygen address the
immediate respiratory threat.
8. A client with a new ileostomy has a stoma that appears dusky purple. What
should the nurse do?
A. Document the finding as expected
B. Apply petroleum jelly
C. Notify the RN/provider immediately
D. Irrigate the stoma
Answer: C. Notify the RN/provider immediately
Exam — Code: LPN-MEDSURG-COMP |
100-Question Advanced Practice Exam
2026 | Questions & Answers with
Detailed Rationales | Complete Exam
Prep & Study Guide
1. A client with heart failure is receiving IV furosemide. Which finding requires
the LPN/LVN to notify the provider immediately?
A. Urine output of 1,500 mL over 24 hours
B. Potassium level of 2.8 mEq/L
C. Blood pressure of 108/64 mmHg
D. Decreased ankle edema
Answer: B. Potassium level of 2.8 mEq/L
Rationale: Furosemide can cause significant potassium loss. A potassium level of
2.8 mEq/L places the client at risk for dangerous ventricular dysrhythmias and
requires prompt intervention.
, 2. A client with COPD receiving oxygen at 2 L/min by nasal cannula becomes
increasingly somnolent. The respiratory rate is 8/min. Which action is the
priority?
A. Increase oxygen to 6 L/min
B. Place the client supine
C. Assess respiratory status and notify the RN/provider immediately
D. Encourage oral fluids
Answer: C. Assess respiratory status and notify the RN/provider immediately
Rationale: Severe somnolence and respiratory depression in a client with COPD
may indicate worsening hypercapnia or respiratory failure. Increasing oxygen
independently may worsen ventilation in some clients. Immediate assessment
and escalation are required.
3. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L.
Which prescription should the nurse question?
A. IV regular insulin infusion
B. Cardiac monitoring
C. IV potassium replacement
D. Isotonic IV fluids
Answer: A. IV regular insulin infusion
Rationale: Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. When potassium is severely low, potassium replacement is
generally initiated before insulin according to the prescribed DKA protocol.
, 4. A client with pneumonia has a respiratory rate of 32/min, oxygen
saturation of 86%, and new confusion. Which intervention has the highest
priority?
A. Encourage coughing exercises
B. Apply prescribed supplemental oxygen
C. Offer oral fluids
D. Obtain a sputum specimen
Answer: B. Apply prescribed supplemental oxygen
Rationale: Hypoxemia with acute mental-status changes represents an
immediate airway and breathing concern. Oxygenation should be addressed
promptly while additional interventions are initiated.
5. A client taking warfarin has an INR of 5.8 and reports bleeding gums. What
is the priority action?
A. Administer the next dose
B. Encourage foods high in vitamin K
C. Hold the medication and notify the provider
D. Encourage increased fluid intake
Answer: C. Hold the medication and notify the provider
Rationale: An INR of 5.8 with active bleeding indicates excessive
anticoagulation. The medication should be withheld and the provider notified
for further management.
6. A client with chronic kidney disease has a potassium level of 6.4 mEq/L.
Which finding is most concerning?
A. Muscle weakness
B. Peaked T waves
, C. Mild nausea
D. Increased thirst
Answer: B. Peaked T waves
Rationale: Severe hyperkalemia can cause fatal cardiac dysrhythmias. Peaked T
waves are a classic ECG manifestation requiring immediate intervention.
7. A client with suspected pulmonary embolism suddenly develops severe
dyspnea and chest pain. Which action should the LPN/LVN take first?
A. Encourage ambulation
B. Place the client in a high-Fowler position and apply prescribed oxygen
C. Give oral fluids
D. Obtain a routine temperature
Answer: B. Place the client in a high-Fowler position and apply prescribed
oxygen
Rationale: Pulmonary embolism can rapidly impair oxygenation. Positioning to
maximize ventilation and administering prescribed oxygen address the
immediate respiratory threat.
8. A client with a new ileostomy has a stoma that appears dusky purple. What
should the nurse do?
A. Document the finding as expected
B. Apply petroleum jelly
C. Notify the RN/provider immediately
D. Irrigate the stoma
Answer: C. Notify the RN/provider immediately
