,Next-Generation NCLEX® (NGN) Examination-Style Questions
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice – Section: The LPN/VN’s Role and the Nursing Process
Using the Clinical Judgment Model
1. An LPN is preparing to administer digoxin 0.25 mg PO to a
78-year-old client. Which action best demonstrates the
LPN’s clinical judgment within the nursing process?
A. Give the medication at 0900 with breakfast as listed on
the MAR.
B. Check the client’s apical pulse for 60 seconds and
withhold if <60 bpm.
C. Ask the client if she prefers to take the pill with water or
juice.
D. Record administration in the e-MAR immediately after
pouring the drug.
Correct Answer: B
Rationale: Assessing the apical pulse before digoxin
administration is a critical safety step that prevents toxicity.
A. Premature administration bypasses assessment; C.
Choice of fluid is patient preference, not a safety priority;
D. Documentation occurs after administration, not during
assessment.
Teaching Point: Always assess heart rate before giving
digoxin.
2. During morning med pass, an LPN notes a new order for
sliding-scale insulin. What is the LPN’s priority action
, before administration?
A. Verify the insulin type with the pharmacy label.
B. Check the client’s most recent blood glucose result.
C. Ask the client’s breakfast food preferences.
D. Ensure the insulin vial is at room temperature.
Correct Answer: B
Rationale: Blood glucose level determines the insulin dose
and prevents hypoglycemia. A. Verification is routine but
not the priority; C/D are helpful but not immediate safety
actions.
Teaching Point: Blood glucose drives sliding-scale insulin
dose.
3. An LPN discovers that an antibiotic is prescribed for a client
with a documented allergy to that class. What is the LPN’s
first step using the clinical judgment model?
A. Administer diphenhydramine prophylactically.
B. Notify the prescribing provider immediately.
C. Hold the dose and document the reason.
D. Reassure the client the reaction was mild last time.
Correct Answer: C
Rationale: Holding the dose protects the client from harm
and aligns with the “recognize cues” step. B follows C; A/D
are unsafe.
Teaching Point: Hold medication when allergy is known.
4. The LPN is asked to transcribe a telephone order for
morphine 2 mg IV q4h PRN pain. Which action best reflects
, legal responsibility?
A. Repeat the order aloud, then document it in the chart.
B. Write the order, then have an RN cosign within 24 hours.
C. Read the order back to the prescriber for confirmation.
D. Accept the order verbally without writing until shift
change.
Correct Answer: C
Rationale: Reading back ensures accuracy and meets legal
standards. A omits prescriber verification; B delays
verification; D is unsafe.
Teaching Point: Read-back is required for telephone orders.
5. An LPN is caring for a client receiving warfarin. Which
assessment finding requires immediate intervention?
A. INR 2.5 within therapeutic range.
B. Petechiae on the upper chest.
C. Client reports mild headache.
D. PT/INR drawn yesterday.
Correct Answer: B
Rationale: Petechiae suggest bleeding, a life-threatening
warfarin complication. A/C/D are expected or non-urgent.
Teaching Point: Petechiae signal warfarin-induced
bleeding.
6. A client questions why the LPN cannot crush an enteric-
coated aspirin. What is the best response?
A. “Crushing destroys the coating and may irritate your
stomach.”
Chapter 1 – Pharmacology and the Nursing Process in LPN
Practice – Section: The LPN/VN’s Role and the Nursing Process
Using the Clinical Judgment Model
1. An LPN is preparing to administer digoxin 0.25 mg PO to a
78-year-old client. Which action best demonstrates the
LPN’s clinical judgment within the nursing process?
A. Give the medication at 0900 with breakfast as listed on
the MAR.
B. Check the client’s apical pulse for 60 seconds and
withhold if <60 bpm.
C. Ask the client if she prefers to take the pill with water or
juice.
D. Record administration in the e-MAR immediately after
pouring the drug.
Correct Answer: B
Rationale: Assessing the apical pulse before digoxin
administration is a critical safety step that prevents toxicity.
A. Premature administration bypasses assessment; C.
Choice of fluid is patient preference, not a safety priority;
D. Documentation occurs after administration, not during
assessment.
Teaching Point: Always assess heart rate before giving
digoxin.
2. During morning med pass, an LPN notes a new order for
sliding-scale insulin. What is the LPN’s priority action
, before administration?
A. Verify the insulin type with the pharmacy label.
B. Check the client’s most recent blood glucose result.
C. Ask the client’s breakfast food preferences.
D. Ensure the insulin vial is at room temperature.
Correct Answer: B
Rationale: Blood glucose level determines the insulin dose
and prevents hypoglycemia. A. Verification is routine but
not the priority; C/D are helpful but not immediate safety
actions.
Teaching Point: Blood glucose drives sliding-scale insulin
dose.
3. An LPN discovers that an antibiotic is prescribed for a client
with a documented allergy to that class. What is the LPN’s
first step using the clinical judgment model?
A. Administer diphenhydramine prophylactically.
B. Notify the prescribing provider immediately.
C. Hold the dose and document the reason.
D. Reassure the client the reaction was mild last time.
Correct Answer: C
Rationale: Holding the dose protects the client from harm
and aligns with the “recognize cues” step. B follows C; A/D
are unsafe.
Teaching Point: Hold medication when allergy is known.
4. The LPN is asked to transcribe a telephone order for
morphine 2 mg IV q4h PRN pain. Which action best reflects
, legal responsibility?
A. Repeat the order aloud, then document it in the chart.
B. Write the order, then have an RN cosign within 24 hours.
C. Read the order back to the prescriber for confirmation.
D. Accept the order verbally without writing until shift
change.
Correct Answer: C
Rationale: Reading back ensures accuracy and meets legal
standards. A omits prescriber verification; B delays
verification; D is unsafe.
Teaching Point: Read-back is required for telephone orders.
5. An LPN is caring for a client receiving warfarin. Which
assessment finding requires immediate intervention?
A. INR 2.5 within therapeutic range.
B. Petechiae on the upper chest.
C. Client reports mild headache.
D. PT/INR drawn yesterday.
Correct Answer: B
Rationale: Petechiae suggest bleeding, a life-threatening
warfarin complication. A/C/D are expected or non-urgent.
Teaching Point: Petechiae signal warfarin-induced
bleeding.
6. A client questions why the LPN cannot crush an enteric-
coated aspirin. What is the best response?
A. “Crushing destroys the coating and may irritate your
stomach.”
