,Next-Generation NCLEX® (NGN) Examination-Style Questions
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice
1. Stem: An 82-year-old resident is ordered digoxin 0.25 mg
PO daily. During the assessment step of the nursing
process, which finding requires the LPN to notify the RN
immediately?
A. Apical pulse 52 beats/min
B. Serum potassium 3.8 mEq/L
C. Client reports mild nausea
D. Last dose given 24 h ago
Correct Answer: A
Rationale (Correct): A heart rate below 60 beats/min may
signal digoxin toxicity; immediate RN notification prevents
further dosing and arrhythmias.
Rationale (Incorrect): B – Potassium is borderline low but
not yet critical. C – Mild nausea may occur but is not an
urgent hold criterion. D – Timing is appropriate; no action
needed.
Teaching Point: Always check apical pulse before giving
digoxin; withhold if <60 bpm.
2. Stem: While preparing insulin, the LPN notices the vial is
labeled “U-500.” What is the priority action in the clinical
judgment model?
, A. Draw up the prescribed units in a U-100 syringe
B. Recalculate and give exactly 1/5 of the ordered volume
C. Hold the medication and clarify with the pharmacist
D. Use a tuberculin syringe for accuracy
Correct Answer: C
Rationale (Correct): U-500 insulin requires special syringes
and orders; holding prevents severe hypoglycemia and
ensures safe clarification.
Rationale (Incorrect): A – U-100 syringe yields 5-fold
overdose. B – Simple math is unsafe without provider
confirmation. D – Tuberculin syringe is not calibrated for U-
500.
Teaching Point: Never substitute syringes for concentrated
insulins without verification.
3. Stem: A postoperative client reports pain 8/10. The LPN
reviews the MAR and sees morphine 2 mg IV q4h PRN last
given 3 h ago. What is the best next step?
A. Administer the next dose now
B. Reassess pain in 1 h
C. Check respiratory rate before giving
D. Offer a heating pad instead
Correct Answer: C
Rationale (Correct): Opioid safety requires checking RR and
sedation level; RR <10 contraindicates dosing.
Rationale (Incorrect): A – Premature; may overdose. B –
Delays relief without safety check. D – Non-pharmacologic
is adjunct, not substitute, for severe pain.
, Teaching Point: Respiratory assessment is mandatory
before every PRN opioid.
4. Stem: The LPN is to give warfarin 5 mg PO. The INR result is
4.8. What action aligns with the nursing process analysis
step?
A. Give the dose as scheduled
B. Hold and notify the provider
C. Split the tablet to give 2.5 mg
D. Recheck INR in 2 h
Correct Answer: B
Rationale (Correct): INR >4 increases bleeding risk;
withholding and notifying allows dose adjustment.
Rationale (Incorrect): A – Increases hemorrhage risk. C –
Unauthorized dose alteration. D – Repeating so soon is not
evidence-based.
Teaching Point: Elevated INR = hold warfarin and notify
provider.
5. Stem: A client on lithium states, “I’ve had diarrhea for 2
days.” Which assessment finding requires the LPN to
contact the RN immediately?
A. Lithium level 1.0 mEq/L
B. Tremor present on outstretched hands
C. Dry mucous membranes
D. Sodium 128 mEq/L
Correct Answer: D
Rationale (Correct): Hyponatremia reduces lithium
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice
1. Stem: An 82-year-old resident is ordered digoxin 0.25 mg
PO daily. During the assessment step of the nursing
process, which finding requires the LPN to notify the RN
immediately?
A. Apical pulse 52 beats/min
B. Serum potassium 3.8 mEq/L
C. Client reports mild nausea
D. Last dose given 24 h ago
Correct Answer: A
Rationale (Correct): A heart rate below 60 beats/min may
signal digoxin toxicity; immediate RN notification prevents
further dosing and arrhythmias.
Rationale (Incorrect): B – Potassium is borderline low but
not yet critical. C – Mild nausea may occur but is not an
urgent hold criterion. D – Timing is appropriate; no action
needed.
Teaching Point: Always check apical pulse before giving
digoxin; withhold if <60 bpm.
2. Stem: While preparing insulin, the LPN notices the vial is
labeled “U-500.” What is the priority action in the clinical
judgment model?
, A. Draw up the prescribed units in a U-100 syringe
B. Recalculate and give exactly 1/5 of the ordered volume
C. Hold the medication and clarify with the pharmacist
D. Use a tuberculin syringe for accuracy
Correct Answer: C
Rationale (Correct): U-500 insulin requires special syringes
and orders; holding prevents severe hypoglycemia and
ensures safe clarification.
Rationale (Incorrect): A – U-100 syringe yields 5-fold
overdose. B – Simple math is unsafe without provider
confirmation. D – Tuberculin syringe is not calibrated for U-
500.
Teaching Point: Never substitute syringes for concentrated
insulins without verification.
3. Stem: A postoperative client reports pain 8/10. The LPN
reviews the MAR and sees morphine 2 mg IV q4h PRN last
given 3 h ago. What is the best next step?
A. Administer the next dose now
B. Reassess pain in 1 h
C. Check respiratory rate before giving
D. Offer a heating pad instead
Correct Answer: C
Rationale (Correct): Opioid safety requires checking RR and
sedation level; RR <10 contraindicates dosing.
Rationale (Incorrect): A – Premature; may overdose. B –
Delays relief without safety check. D – Non-pharmacologic
is adjunct, not substitute, for severe pain.
, Teaching Point: Respiratory assessment is mandatory
before every PRN opioid.
4. Stem: The LPN is to give warfarin 5 mg PO. The INR result is
4.8. What action aligns with the nursing process analysis
step?
A. Give the dose as scheduled
B. Hold and notify the provider
C. Split the tablet to give 2.5 mg
D. Recheck INR in 2 h
Correct Answer: B
Rationale (Correct): INR >4 increases bleeding risk;
withholding and notifying allows dose adjustment.
Rationale (Incorrect): A – Increases hemorrhage risk. C –
Unauthorized dose alteration. D – Repeating so soon is not
evidence-based.
Teaching Point: Elevated INR = hold warfarin and notify
provider.
5. Stem: A client on lithium states, “I’ve had diarrhea for 2
days.” Which assessment finding requires the LPN to
contact the RN immediately?
A. Lithium level 1.0 mEq/L
B. Tremor present on outstretched hands
C. Dry mucous membranes
D. Sodium 128 mEq/L
Correct Answer: D
Rationale (Correct): Hyponatremia reduces lithium
