,Next-Generation NCLEX® (NGN) Examination-Style Questions
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice
1. An 82-year-old resident is ordered sliding-scale insulin
before breakfast. The LPN/VN notes the blood glucose
reads 48 mg/dL. Applying the clinical judgment model,
what is the nurse’s priority action?
A. Hold the insulin and give 4 oz orange juice.
B. Administer the insulin as prescribed.
C. Recalibrate the glucometer and retest.
D. Notify the dietitian to delay breakfast.
Correct Answer: A
Rationale: Hypoglycemia (≤70 mg/dL) is an immediate
safety risk; rapid-acting carbohydrate reverses it. B risks
worsening hypoglycemia. C delays treatment. D is
secondary; the glucose must be corrected first.
Teaching Point: Treat hypoglycemia before any other
intervention.
2. During morning med pass, an LPN/VN discovers an
electronic medication administration record (eMAR) lists a
new beta-blocker that the patient denies taking before.
What is the nurse’s first step per the nursing process?
A. Administer the drug and document the patient’s
statement.
B. Hold the medication and verify the order with the
, prescriber.
C. Ask the pharmacy to send the previous medication.
D. Educate the patient on the new drug’s benefits.
Correct Answer: B
Rationale: Assessment/validation of unclear orders
prevents error; the nurse must clarify before giving. A risks
harm. C is premature. D occurs after confirmation.
Teaching Point: Always verify questionable orders before
administration.
3. An LPN/VN is preparing to give PO digoxin to a client
whose apical pulse is 52 beats/min. Which action best
demonstrates clinical judgment?
A. Give the medication and reassess in 1 hour.
B. Hold the dose and inform the RN immediately.
C. Recheck the radial pulse for 30 seconds.
D. Split the tablet to give a partial dose.
Correct Answer: B
Rationale: Digoxin is withheld for apical pulse <60;
notifying the RN ensures timely provider contact. A risks
toxicity. C is insufficient; apical is standard. D alters dose
without order.
Teaching Point: Hold digoxin if apical pulse <60; notify RN.
4. A postoperative patient reports pain 8/10 2 hours after IV
morphine. The LPN/VN reviews the MAR and sees the next
dose is due in 1 hour. What is the most appropriate action?
A. Give the morphine early to relieve suffering.
, B. Offer relaxation techniques until the scheduled time.
C. Notify the RN for possible dose adjustment.
D. Document the pain and reassess in 30 minutes.
Correct Answer: C
Rationale: Unrelieved pain may require dose titration or
alternative analgesia; the RN collaborates with prescriber.
A breaches policy. B is insufficient. D delays relief.
Teaching Point: Escalate uncontrolled pain to RN for
provider review.
5. The LPN/VN is teaching a client starting warfarin. Which
statement by the client indicates understanding of the
LPN/VN’s instruction?
A. “I will double my dose if I miss one.”
B. “I’ll keep my intake of leafy greens steady.”
C. “I’ll stop the drug if my gums bleed.”
D. “I need weekly liver enzyme tests.”
Correct Answer: B
Rationale: Consistent vitamin K intake stabilizes INR;
sudden changes alter anticoagulation. A increases bleeding
risk. C requires provider guidance. D monitors PT/INR, not
enzymes.
Teaching Point: Stable vitamin K intake prevents INR
fluctuations.
6. Which action best exemplifies the LPN/VN’s legal scope
regarding medication administration?
A. Adjusting a heparin infusion based on PTT results.
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice
1. An 82-year-old resident is ordered sliding-scale insulin
before breakfast. The LPN/VN notes the blood glucose
reads 48 mg/dL. Applying the clinical judgment model,
what is the nurse’s priority action?
A. Hold the insulin and give 4 oz orange juice.
B. Administer the insulin as prescribed.
C. Recalibrate the glucometer and retest.
D. Notify the dietitian to delay breakfast.
Correct Answer: A
Rationale: Hypoglycemia (≤70 mg/dL) is an immediate
safety risk; rapid-acting carbohydrate reverses it. B risks
worsening hypoglycemia. C delays treatment. D is
secondary; the glucose must be corrected first.
Teaching Point: Treat hypoglycemia before any other
intervention.
2. During morning med pass, an LPN/VN discovers an
electronic medication administration record (eMAR) lists a
new beta-blocker that the patient denies taking before.
What is the nurse’s first step per the nursing process?
A. Administer the drug and document the patient’s
statement.
B. Hold the medication and verify the order with the
, prescriber.
C. Ask the pharmacy to send the previous medication.
D. Educate the patient on the new drug’s benefits.
Correct Answer: B
Rationale: Assessment/validation of unclear orders
prevents error; the nurse must clarify before giving. A risks
harm. C is premature. D occurs after confirmation.
Teaching Point: Always verify questionable orders before
administration.
3. An LPN/VN is preparing to give PO digoxin to a client
whose apical pulse is 52 beats/min. Which action best
demonstrates clinical judgment?
A. Give the medication and reassess in 1 hour.
B. Hold the dose and inform the RN immediately.
C. Recheck the radial pulse for 30 seconds.
D. Split the tablet to give a partial dose.
Correct Answer: B
Rationale: Digoxin is withheld for apical pulse <60;
notifying the RN ensures timely provider contact. A risks
toxicity. C is insufficient; apical is standard. D alters dose
without order.
Teaching Point: Hold digoxin if apical pulse <60; notify RN.
4. A postoperative patient reports pain 8/10 2 hours after IV
morphine. The LPN/VN reviews the MAR and sees the next
dose is due in 1 hour. What is the most appropriate action?
A. Give the morphine early to relieve suffering.
, B. Offer relaxation techniques until the scheduled time.
C. Notify the RN for possible dose adjustment.
D. Document the pain and reassess in 30 minutes.
Correct Answer: C
Rationale: Unrelieved pain may require dose titration or
alternative analgesia; the RN collaborates with prescriber.
A breaches policy. B is insufficient. D delays relief.
Teaching Point: Escalate uncontrolled pain to RN for
provider review.
5. The LPN/VN is teaching a client starting warfarin. Which
statement by the client indicates understanding of the
LPN/VN’s instruction?
A. “I will double my dose if I miss one.”
B. “I’ll keep my intake of leafy greens steady.”
C. “I’ll stop the drug if my gums bleed.”
D. “I need weekly liver enzyme tests.”
Correct Answer: B
Rationale: Consistent vitamin K intake stabilizes INR;
sudden changes alter anticoagulation. A increases bleeding
risk. C requires provider guidance. D monitors PT/INR, not
enzymes.
Teaching Point: Stable vitamin K intake prevents INR
fluctuations.
6. Which action best exemplifies the LPN/VN’s legal scope
regarding medication administration?
A. Adjusting a heparin infusion based on PTT results.
