LPN/LVN Final Nurse Refresher
Competency Exam — Code: LPN-NR-
FINAL | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A client with heart failure suddenly develops severe dyspnea, bilateral
crackles, pink frothy sputum, and an oxygen saturation of 82%. Which
action should the LPN/LVN take first?
A. Encourage oral fluids
B. Place the client in high-Fowler position and apply oxygen as prescribed
C. Obtain the client's daily weight
D. Administer the scheduled oral diuretic
Answer: Place the client in high-Fowler position and apply oxygen as prescribed
,Rationale: Acute pulmonary edema is life-threatening. Positioning upright
improves ventilation, while oxygen supports gas exchange. Further
interventions, including IV diuretics, may follow after immediate stabilization.
2. A client receiving digoxin has an apical pulse of 52/min and reports nausea
and seeing yellow halos around lights. What is the priority action?
A. Administer the medication with food
B. Recheck the pulse after ambulation
C. Hold digoxin and notify the healthcare provider
D. Encourage potassium-rich foods
Answer: Hold digoxin and notify the healthcare provider
Rationale: Bradycardia, nausea, and visual disturbances are classic findings
associated with digoxin toxicity. The medication should be withheld and the
provider notified.
3. A postoperative client suddenly becomes restless, tachycardic, and short of
breath and reports sharp chest pain that worsens with inspiration. Which
complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
Answer: Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety are
concerning for pulmonary embolism and require immediate intervention.
4. A client with diabetes is awake, diaphoretic, confused, and has a blood
glucose of 48 mg/dL. What should the LPN/LVN do first?
A. Administer scheduled insulin
B. Give 15 g of rapid-acting carbohydrate
,C. Encourage the client to ambulate
D. Administer glucagon immediately
Answer: Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can safely swallow should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose.
5. A client with COPD has an oxygen saturation of 86% and increasing
respiratory distress. Which intervention is most appropriate?
A. Withhold oxygen because of COPD
B. Apply prescribed oxygen and reassess respiratory status
C. Have the client lie flat
D. Encourage rapid, deep breathing
Answer: Apply prescribed oxygen and reassess respiratory status
Rationale: Oxygen should not be withheld from a hypoxemic client with COPD.
Controlled oxygen therapy is used while monitoring respiratory status and
oxygenation.
6. A client taking warfarin has an INR of 5.8 and reports bleeding gums. Which
action is most appropriate?
A. Administer the next dose early
B. Hold the medication and notify the provider
C. Encourage increased vitamin K intake immediately
D. Administer aspirin
Answer: Hold the medication and notify the provider
Rationale: A markedly elevated INR with active bleeding indicates excessive
anticoagulation. Warfarin should be held and the provider notified for further
management.
, 7. A client with suspected stroke suddenly develops facial drooping and
slurred speech. What information is most important to establish
immediately?
A. Last bowel movement
B. Last known well time
C. Usual sleeping pattern
D. Dietary preferences
Answer: Last known well time
Rationale: Determining when the client was last known to be neurologically
normal is critical for evaluating eligibility for time-sensitive stroke therapies.
8. A client receiving IV potassium chloride complains of burning at the IV site.
What should the nurse do first?
A. Increase the infusion rate
B. Assess the IV site and stop the infusion if infiltration or phlebitis is suspected
C. Apply pressure over the site while continuing the infusion
D. Flush the line rapidly
Answer: Assess the IV site and stop the infusion if infiltration or phlebitis is
suspected
Rationale: Potassium is irritating to veins and extravasation can cause tissue
injury. The site must be assessed promptly.
9. A client with chronic kidney disease has potassium of 6.4 mEq/L and
peaked T waves on the ECG. What is the priority concern?
A. Constipation
B. Cardiac dysrhythmia
C. Fluid deficit
D. Hypoglycemia
Answer: Cardiac dysrhythmia
Competency Exam — Code: LPN-NR-
FINAL | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A client with heart failure suddenly develops severe dyspnea, bilateral
crackles, pink frothy sputum, and an oxygen saturation of 82%. Which
action should the LPN/LVN take first?
A. Encourage oral fluids
B. Place the client in high-Fowler position and apply oxygen as prescribed
C. Obtain the client's daily weight
D. Administer the scheduled oral diuretic
Answer: Place the client in high-Fowler position and apply oxygen as prescribed
,Rationale: Acute pulmonary edema is life-threatening. Positioning upright
improves ventilation, while oxygen supports gas exchange. Further
interventions, including IV diuretics, may follow after immediate stabilization.
2. A client receiving digoxin has an apical pulse of 52/min and reports nausea
and seeing yellow halos around lights. What is the priority action?
A. Administer the medication with food
B. Recheck the pulse after ambulation
C. Hold digoxin and notify the healthcare provider
D. Encourage potassium-rich foods
Answer: Hold digoxin and notify the healthcare provider
Rationale: Bradycardia, nausea, and visual disturbances are classic findings
associated with digoxin toxicity. The medication should be withheld and the
provider notified.
3. A postoperative client suddenly becomes restless, tachycardic, and short of
breath and reports sharp chest pain that worsens with inspiration. Which
complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism
C. Pneumonia
D. Fluid overload
Answer: Pulmonary embolism
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and anxiety are
concerning for pulmonary embolism and require immediate intervention.
4. A client with diabetes is awake, diaphoretic, confused, and has a blood
glucose of 48 mg/dL. What should the LPN/LVN do first?
A. Administer scheduled insulin
B. Give 15 g of rapid-acting carbohydrate
,C. Encourage the client to ambulate
D. Administer glucagon immediately
Answer: Give 15 g of rapid-acting carbohydrate
Rationale: A conscious client who can safely swallow should receive
approximately 15 g of rapid-acting carbohydrate, followed by reassessment of
glucose.
5. A client with COPD has an oxygen saturation of 86% and increasing
respiratory distress. Which intervention is most appropriate?
A. Withhold oxygen because of COPD
B. Apply prescribed oxygen and reassess respiratory status
C. Have the client lie flat
D. Encourage rapid, deep breathing
Answer: Apply prescribed oxygen and reassess respiratory status
Rationale: Oxygen should not be withheld from a hypoxemic client with COPD.
Controlled oxygen therapy is used while monitoring respiratory status and
oxygenation.
6. A client taking warfarin has an INR of 5.8 and reports bleeding gums. Which
action is most appropriate?
A. Administer the next dose early
B. Hold the medication and notify the provider
C. Encourage increased vitamin K intake immediately
D. Administer aspirin
Answer: Hold the medication and notify the provider
Rationale: A markedly elevated INR with active bleeding indicates excessive
anticoagulation. Warfarin should be held and the provider notified for further
management.
, 7. A client with suspected stroke suddenly develops facial drooping and
slurred speech. What information is most important to establish
immediately?
A. Last bowel movement
B. Last known well time
C. Usual sleeping pattern
D. Dietary preferences
Answer: Last known well time
Rationale: Determining when the client was last known to be neurologically
normal is critical for evaluating eligibility for time-sensitive stroke therapies.
8. A client receiving IV potassium chloride complains of burning at the IV site.
What should the nurse do first?
A. Increase the infusion rate
B. Assess the IV site and stop the infusion if infiltration or phlebitis is suspected
C. Apply pressure over the site while continuing the infusion
D. Flush the line rapidly
Answer: Assess the IV site and stop the infusion if infiltration or phlebitis is
suspected
Rationale: Potassium is irritating to veins and extravasation can cause tissue
injury. The site must be assessed promptly.
9. A client with chronic kidney disease has potassium of 6.4 mEq/L and
peaked T waves on the ECG. What is the priority concern?
A. Constipation
B. Cardiac dysrhythmia
C. Fluid deficit
D. Hypoglycemia
Answer: Cardiac dysrhythmia
