NCLEX-PN / LVN free practice test

What you’ll be asked about

The full bank covers these areas. The short random sample may not include every area:

About the real NCLEX-PN / LVN exam

• •Computerized adaptive, like the RN exam — every candidate's form is assembled as they go.
• •Every LPN/VN candidate answers at least 85 items and at most 150, within a five-hour limit including all breaks.
• •Its content distribution is genuinely different from the RN exam: Coordinated Care carries 18–24% where the RN plan's Management of Care carries 15–21%.
• •In a minimum-length exam, 52 items come from the content areas, 18 form three clinical-judgment case studies, and 15 are unscored pretest items.

Source: NCSBN, 2026 NCLEX-PN Test Plan (effective April 2026), III. Administration of the NCLEX-PN — Examination Length — read 2026-09-03.

24 more NCLEX-PN practice questions with rationales

Work each question first, then open the answer. These original CARE-written questions follow the 2026 NCSBN NCLEX-PN Test Plan categories: coordinated care, infection control, pharmacological therapies, health promotion, psychosocial integrity, basic care and comfort, and reduction of risk potential. Each explains the correct answer and why every wrong choice fails. They are separate from the interactive quiz above.

1. Question 1 · Safe and Effective Care Environment: Coordinated Care (participate in client consent process)

   A licensed practical nurse (LPN) in an outpatient endoscopy clinic is preparing a client for a colonoscopy. The consent form is signed, but when the nurse asks the client to describe the procedure, the client says, "I think they are just looking at my stomach. I don't really know what could go wrong." Which action should the nurse take?

   1. A. Explain the risks of colonoscopy to the client and then witness the signature already on the form
   2. B. Notify the provider who obtained consent that the client needs further explanation before the procedure
   3. C. Ask the client to sign a second form that states the client was informed of the procedure
   4. D. Ask the client's adult daughter in the waiting room to sign the consent in place of the client
   Show the answer and rationale

   Correct answer: B. Notify the provider who obtained consent that the client needs further explanation before the procedure

   The provider performing the procedure is responsible for the informed consent discussion, including confirming the client understands the procedure, its purpose, and its risks. The LPN's role in the consent process is to witness the signature and advocate for the client. When the client's statements show the consent is not informed, the nurse withholds proceeding and has the provider clarify.

   • A: Explaining risks is the provider's responsibility, and a nurse witnessing a signature does not make the consent informed.
   • C: A second signature does not correct a lack of understanding; consent must be informed, not just signed.
   • D: A competent adult client signs for themselves; a family member may sign only when the client lacks capacity.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); AORN: Important Considerations When Obtaining Informed Consent

2. Question 2 · Safe and Effective Care Environment: Coordinated Care (assign client care and monitor activities of assistive personnel)

   An LPN is working on a long-term care unit with one unlicensed assistive personnel (UAP) whose competencies were verified at hire. Which task is most appropriate for the LPN to delegate to the UAP?

   1. A. Assessing the skin of a resident who was admitted this morning
   2. B. Feeding a resident who has new difficulty swallowing after a stroke
   3. C. Teaching a resident how to use a new insulin pen
   4. D. Measuring routine vital signs for a resident with stable hypertension
   Show the answer and rationale

   Correct answer: D. Measuring routine vital signs for a resident with stable hypertension

   Delegation requires the right task, circumstances, person, and direction. Taking routine vital signs on a stable resident is within typical UAP training (verify state and facility rules), and the UAP reports values to the nurse, who interprets them. Assessment, teaching, and care of clients with unstable or new problems require nursing judgment and are not delegated.

   • A: Skin assessment on a new admission is an assessment and requires nursing judgment.
   • B: New dysphagia after a stroke carries an aspiration risk and is not a stable, routine task.
   • C: Client teaching about a high-alert medication is a nursing responsibility.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); NCSBN National Guidelines for Nursing Delegation

3. Question 3 · Safe and Effective Care Environment: Safety and Infection Prevention and Control (standard and transmission precautions)

   An LPN is caring for a long-term care resident who has Clostridioides difficile infection with watery diarrhea. The resident is on contact precautions in a private room with a dedicated toilet, and the facility has declared a C. difficile outbreak on the unit. Which action is most important for the nurse to take when leaving the room?

   1. A. Remove the gown and gloves, then rub hands with an alcohol-based hand sanitizer
   2. B. Remove the gown and gloves, then place an N95 respirator on before opening the door
   3. C. Remove the gown and gloves, then wash hands with soap and water
   4. D. Remove the gown and gloves, then ask housekeeping to open the door for the nurse
   Show the answer and rationale

   Correct answer: C. Remove the gown and gloves, then wash hands with soap and water

   C. difficile forms spores that alcohol-based hand rub does not reliably remove in laboratory studies, and CDC encourages washing with soap and water after caring for patients with known or suspected C. difficile during outbreaks because it may remove spores better. Contact precautions (gown and gloves, single room with dedicated toilet, dedicated equipment) are used, not airborne precautions.

   • A: Alcohol-based rub is not reliably effective against spores, and during an outbreak soap and water is encouraged.
   • B: C. difficile spreads by contact, not the airborne route, so a respirator is not indicated.
   • D: Asking another person to open the door does not replace hand hygiene and does not reduce contamination risk.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); CDC: Preventing C. diff; CDC: Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities; CDC: Hand Hygiene in Healthcare Settings (clinical safety)

4. Question 4 · Safe and Effective Care Environment: Coordinated Care (organize and prioritize care based on client needs)

   An LPN on a long-term care unit is beginning the morning shift and has four residents who need attention. Which resident should the LPN see first?

   1. A. A resident found by an aide 10 minutes ago with a new right facial droop and slurred speech
   2. B. A resident with a blood pressure of 148/86 mm Hg who is due for a scheduled antihypertensive
   3. C. A resident with a stage 2 pressure injury on the sacrum whose scheduled dressing change is due
   4. D. A resident who reports no bowel movement for two days and asks for a laxative before breakfast
   Show the answer and rationale

   Correct answer: A. A resident found by an aide 10 minutes ago with a new right facial droop and slurred speech

   New facial droop with slurred speech are warning signs of stroke, a time-critical emergency because treatment depends on how soon symptoms began. The LPN goes to the resident immediately, notes the time last known well, and activates the emergency response or notifies the RN per facility protocol. The other residents have stable, non-urgent needs that can wait a short time.

   • B: A mildly elevated blood pressure without symptoms is not urgent.
   • C: A scheduled dressing change for a stable wound can be done after emergencies are addressed.
   • D: Two days without a bowel movement is a common, non-urgent concern.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); CDC: Stroke Signs and Symptoms

5. Question 5 · Safe and Effective Care Environment: Safety and Infection Prevention and Control (implement least restrictive restraints; safety)

   A resident with dementia on a long-term care unit repeatedly tries to climb out of bed at night and has no prior falls. The resident was toileted 30 minutes ago and is not in pain. Which intervention should the LPN implement first?

   1. A. Apply soft wrist restraints under the facility's standing restraint policy
   2. B. Lower the bed to its lowest position and increase the frequency of night observation rounds
   3. C. Raise all four side rails to full height so the resident cannot climb out of bed
   4. D. Ask the provider for a sedative to give routinely at bedtime to reduce nighttime wandering
   Show the answer and rationale

   Correct answer: B. Lower the bed to its lowest position and increase the frequency of night observation rounds

   Residents must be free from physical restraints imposed for discipline or convenience, and the least restrictive measures are tried first. A low bed and closer observation address fall risk without restricting movement. Restraints require an order and a documented medical need after less restrictive measures fail.

   • A: Wrist restraints are more restrictive and require an order and failed alternatives; a standing policy is not an order.
   • C: Four raised rails can function as a restraint and increase the risk of entrapment and a fall from a greater height.
   • D: A routine sedative used for behavior can be a chemical restraint; it does not address the cause and increases fall risk.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); CMS State Operations Manual, Appendix PP (F604, physical restraints)

6. Question 6 · Safe and Effective Care Environment: Safety and Infection Prevention and Control (standard and transmission precautions)

   An LPN in a primary care clinic is rooming a client who reports a productive cough for four weeks, night sweats, and an 11-pound (5 kg) weight loss. Tuberculosis is suspected. The RN has asked the LPN to prevent exposure to others while the provider is called. Which action is most appropriate?

   1. A. Place the client in a private room using droplet precautions, with a surgical mask for the nurse
   2. B. Seat the client in the waiting room away from others and provide tissues and hand sanitizer
   3. C. Place the client in a private room with contact precautions and a gown and gloves for the nurse
   4. D. Give the client a surgical mask and place the client in an airborne infection isolation room
   Show the answer and rationale

   Correct answer: D. Give the client a surgical mask and place the client in an airborne infection isolation room

   Suspected pulmonary tuberculosis requires airborne precautions: an airborne infection isolation room (a private room with the door closed is the usual fallback when none is available), an N95 or higher respirator for health care personnel who enter, and a surgical mask on the coughing client for source control.

   • A: Droplet precautions with a surgical mask do not protect staff from airborne TB particles.
   • B: Sitting in a waiting room exposes other clients to airborne particles.
   • C: TB is not spread primarily by contact, so gown and gloves alone are not adequate.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); CDC: TB Infection Control in Health Care Settings

7. Question 7 · Physiological Integrity: Pharmacological Therapies (reinforce education; evaluate client response)

   An LPN makes a home health visit to a client who started warfarin for atrial fibrillation two weeks ago. The client's most recent INR was within the prescribed range. Which client statement indicates the teaching about warfarin was understood?

   1. A. "If I forget a dose, I will take two doses the next day to catch up."
   2. B. "I will stay away from green leafy vegetables while I take this drug."
   3. C. "I can take ibuprofen for my knee pain without checking with my provider first."
   4. D. "I will eat about the same amount of leafy greens each week."
   Show the answer and rationale

   Correct answer: D. "I will eat about the same amount of leafy greens each week."

   Vitamin K in foods can change how warfarin works, so intake should stay consistent rather than being eliminated or suddenly increased. Blood tests (INR) guide dosing, and the client should check with the provider or pharmacist before taking other drugs, including over-the-counter anti-inflammatory drugs, which raise bleeding risk.

   • A: MedlinePlus: take a missed dose the same day if remembered; do not double the next day. Doubling raises bleeding risk.
   • B: Eliminating vitamin K foods is unnecessary; consistency is the goal.
   • C: NSAIDs such as ibuprofen can interact with warfarin and increase bleeding risk; the client should check with the provider first.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); MedlinePlus: Warfarin

8. Question 8 · Physiological Integrity: Pharmacological Therapies (collect data prior to medication administration)

   On a medical-surgical unit, an LPN prepares to give a client's scheduled digoxin 0.125 mg by mouth. The order states to hold the dose and notify the provider for an apical pulse below 60 beats/min. The client takes furosemide daily. The apical pulse, counted for one full minute, is 54 beats/min and regular, and this morning's serum potassium is 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take?

   1. A. Give the digoxin as ordered and recheck the apical pulse again in one hour
   2. B. Give half of the dose and report the pulse to the provider at the end of the shift
   3. C. Hold the digoxin and report the pulse and potassium to the RN or provider
   4. D. Give the digoxin because the client's heart rhythm is regular and the dose is due
   Show the answer and rationale

   Correct answer: C. Hold the digoxin and report the pulse and potassium to the RN or provider

   The order sets the hold parameter at an apical pulse below 60, and the pulse is 54, so the dose is held. The low potassium (a possible effect of furosemide) is an added concern: the Lanoxin label states hypokalemia may predispose to digoxin toxicity, and bradycardia can be a sign of toxicity. The nurse reports both findings so the order can be reviewed.

   • A: Giving the dose first violates the hold order and risks toxicity.
   • B: Altering a dose is outside LPN scope, and reporting is delayed.
   • D: A regular rhythm does not override the hold parameter, and the low potassium is an additional concern.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); DailyMed: Lanoxin (digoxin) tablets label; MedlinePlus: Digoxin

9. Question 9 · Physiological Integrity: Pharmacological Therapies (perform calculations needed for medication administration)

   A health care provider orders gabapentin 300 mg by mouth for a long-term care resident with postherpetic neuralgia. The pharmacy label reads gabapentin oral solution 250 mg/5 mL. How many mL should the LPN administer? Record the answer as a whole number or to one decimal place.

   1. A. 1.2 mL
   2. B. 6 mL
   3. C. 7.5 mL
   4. D. 12 mL
   Show the answer and rationale

   Correct answer: B. 6 mL

   Desired dose divided by the concentration on hand, multiplied by the volume: 300 mg / 250 mg x 5 mL = 1.2 x 5 = 6 mL. The oral solution is measured with an oral syringe or calibrated device. Gabapentin can cause dizziness and drowsiness, so fall precautions apply.

   • A: 1.2 mL results from forgetting to multiply by the 5 mL volume.
   • C: 7.5 mL results from using 200 mg instead of 250 mg per 5 mL.
   • D: 12 mL results from using 125 mg instead of 250 mg per 5 mL.

   Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); MedlinePlus: Gabapentin

10. Question 10 · Physiological Integrity: Pharmacological Therapies (calculate and monitor intravenous flow rate)

    A long-term care resident is prescribed 0.9% sodium chloride 1,000 mL to infuse by gravity over 8 hours. The drop factor of the tubing is 15 gtt/mL. At how many drops per minute should the LPN set the flow rate? Round to the nearest whole number.

    1. A. 63 gtt/min
    2. B. 42 gtt/min
    3. C. 31 gtt/min
    4. D. 21 gtt/min
    Show the answer and rationale

    Correct answer: C. 31 gtt/min

    Flow rate (gtt/min) = volume x drop factor / time in minutes. 8 hours = 480 minutes. 1,000 mL x 15 gtt/mL / 480 min = 15,000 / 480 = 31.25, which rounds to 31 gtt/min. The nurse then monitors the rate and the insertion site.

    • A: 63 gtt/min doubles the correct rate, which could cause fluid overload.
    • B: 42 gtt/min comes from using an incorrect infusion time.
    • D: 21 gtt/min comes from using an incorrect drop factor.

    Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026)

11. Question 11 · Physiological Integrity: Pharmacological Therapies (follow the rights of medication administration; high-alert medications)

    At 1130, an LPN is about to give a medical-surgical client insulin lispro 6 units subcutaneously before lunch. The dietary department reports that the lunch tray will be delayed about 60 minutes. What should the nurse do?

    1. A. Hold the injection until the tray arrives, then give it right before or right after eating
    2. B. Give the injection now at 1130 as scheduled so it is already working when the lunch tray arrives
    3. C. Give the injection now and offer juice if the client reports feeling shaky before the tray arrives
    4. D. Wait until one hour after the client has finished eating to give the scheduled insulin
    Show the answer and rationale

    Correct answer: A. Hold the injection until the tray arrives, then give it right before or right after eating

    Insulin lispro is rapid acting; labeling directs administration within 15 minutes before a meal or immediately after a meal. Giving it an hour before food risks hypoglycemia. Insulin is a high-alert medication, so the nurse follows the rights of medication administration, including timing, and verifies the dose per facility policy.

    • B: Giving it now would put the client at risk of hypoglycemia before eating.
    • C: Planning to treat hypoglycemia is not safe when the timing can be corrected first.
    • D: Waiting an hour after the meal falls outside the labeled window and leaves glucose uncontrolled.

    Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); FDA Humalog (insulin lispro) prescribing information

12. Question 12 · Physiological Integrity: Pharmacological Therapies (evaluate client response to medication; adverse reactions)

    An LPN in a long-term care facility is giving morning medications to a resident who started lisinopril five days ago. The resident has new swelling of the lips and tongue and a hoarse voice. What is the nurse's priority action?

    1. A. Give the scheduled lisinopril with a full glass of water and reassess the swelling in one hour
    2. B. Encourage oral fluids and reassess the swelling after the resident has eaten breakfast
    3. C. Give a diphenhydramine tablet from the unit supply and reassess in four hours
    4. D. Hold the lisinopril, stay with the resident, and call for emergency help and the RN
    Show the answer and rationale

    Correct answer: D. Hold the lisinopril, stay with the resident, and call for emergency help and the RN

    Lip and tongue swelling with hoarseness after starting an ACE inhibitor suggests angioedema, which can obstruct the airway. The medication is held, the nurse stays with the resident, and emergency help is called immediately. Waiting or giving an unordered medication delays treatment of a life-threatening problem.

    • A: Giving another dose would continue exposure to the likely cause.
    • B: Fluids do not treat angioedema and swallowing may be unsafe.
    • C: Giving an unordered drug and waiting four hours delays emergency care and is outside the LPN scope.

    Sources: NCSBN 2026 NCLEX-PN Test Plan (effective April 2026); MedlinePlus: Lisinopril

13. Question 13 · Health Promotion and Maintenance - Immunizations (postpartum teaching)

    A client who is breastfeeding is on postpartum day 1. Her prenatal laboratory results show she is not immune to rubella, and she receives the measles, mumps, and rubella (MMR) vaccine before discharge. Which statement by the client indicates that teaching about the vaccine was understood?

    1. A. "I will need to stop breastfeeding for 4 weeks after the injection."
    2. B. "I can try to become pregnant again right away because the virus is killed."
    3. C. "I should avoid becoming pregnant for at least 4 weeks after this vaccine."
    4. D. "I should stay away from my newborn for 4 weeks so I do not spread the virus."
    Show the answer and rationale

    Correct answer: C. "I should avoid becoming pregnant for at least 4 weeks after this vaccine."

    MMR is a live, attenuated vaccine, so CDC advises people of childbearing age to avoid pregnancy for 4 weeks after receiving it. A nonimmune client is vaccinated after delivery to protect future pregnancies, and breastfeeding is not a reason to withhold it. The client should be taught about this pregnancy delay.

    • A: Breastfeeding is not interrupted after postpartum MMR; the vaccine does not require stopping lactation.
    • B: MMR contains live weakened viruses, not killed virus, so pregnancy should be delayed.
    • D: The vaccinated client does not need to be isolated from her newborn; separation is not recommended.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; CDC: Guidelines for Vaccinating Pregnant Women; CDC: Rubella and Pregnancy

14. Question 14 · Health Promotion and Maintenance - Growth and development across the lifespan (infant nutrition)

    The mother of a healthy 4-month-old breastfed infant tells the practical nurse she plans to add rice cereal to the infant's bottle so he will sleep longer at night. Which response by the nurse is best?

    1. A. "Rice cereal is safe to start now as long as the cereal is thinned with plenty of water."
    2. B. "Breast milk alone meets his needs until about 6 months, when we can talk about starting solid foods."
    3. C. "It is better to wait until his first birthday before offering any food besides breast milk."
    4. D. "Start with small amounts of fruit juice first, then add cereal after a few weeks."
    Show the answer and rationale

    Correct answer: B. "Breast milk alone meets his needs until about 6 months, when we can talk about starting solid foods."

    CDC advises that at about 6 months, when the infant shows developmental readiness, foods other than breast milk or formula can be introduced. Before that, breast milk or formula supplies the nutrition the infant needs, so the nurse educates the parent and reinforces waiting for readiness cues. Adding cereal to a bottle is not recommended.

    • A: At 4 months the infant is not yet at the age CDC gives for starting other foods (about 6 months); adding cereal to a bottle is not a safe way to start.
    • C: Waiting until 12 months is too long; complementary foods are introduced at about 6 months.
    • D: Fruit juice is not part of starting complementary foods; CDC advises introducing foods other than breast milk or formula at about 6 months.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; CDC: Infant and Toddler Nutrition - Foods and Drinks

15. Question 15 · Health Promotion and Maintenance - Prenatal care and teaching (danger signs)

    A practical nurse in a prenatal clinic is teaching a client at 34 weeks of gestation about symptoms to report. Which client statement describes a symptom that must be reported to the provider immediately?

    1. A. "My abdomen tightens now and then, but it goes away when I change position."
    2. B. "I get heartburn after large meals, and it eases when I sit upright."
    3. C. "My ankles swell by evening, and the swelling is gone by morning."
    4. D. "I have a headache that acetaminophen does not relieve, and my vision is blurry."
    Show the answer and rationale

    Correct answer: D. "I have a headache that acetaminophen does not relieve, and my vision is blurry."

    A persistent severe headache with vision changes is an urgent maternal warning sign on the CDC list and can signal preeclampsia, which can progress to seizures and stroke. The client needs same-day evaluation. Irregular tightening that stops with position change, heartburn, and mild dependent edema that resolves overnight are common, expected changes late in pregnancy.

    • A: Irregular, non-painful tightening that resolves with position change fits Braxton Hicks contractions.
    • B: Heartburn relieved by upright posture is common in late pregnancy and does not signal a complication.
    • C: Mild ankle swelling that resolves overnight is a normal dependent edema pattern, unlike sudden facial or hand swelling.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; CDC: Urgent Maternal Warning Signs; ACOG: Preeclampsia and High Blood Pressure During Pregnancy

16. Question 16 · Psychosocial Integrity - Therapeutic communication

    A client in an oncology clinic was told yesterday that a lung mass is cancerous. The client says to the practical nurse, "I do not know how I am going to get through this." Which response is most therapeutic?

    1. A. "This news sounds overwhelming. What worries you most right now?"
    2. B. "Try not to worry. The doctors will do everything possible to cure you."
    3. C. "Why do you feel you will not be able to get through this?"
    4. D. "Many people with this diagnosis do well, so let's stay positive."
    Show the answer and rationale

    Correct answer: A. "This news sounds overwhelming. What worries you most right now?"

    Therapeutic communication reflects the client's feeling and uses an open-ended invitation to explore concerns. This conveys acceptance and keeps the client talking. Reassurance, probing questions, and cheerleading shut down expression of the client's real fears.

    • B: This gives false reassurance and a promise of cure that the nurse cannot guarantee.
    • C: A "why" question can sound judgmental and puts the client on the defensive.
    • D: This is premature reassurance that dismisses the client's feelings and may not be accurate.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; National Cancer Institute: Feelings and Cancer

17. Question 17 · Psychosocial Integrity - Crisis intervention (suicide risk)

    During a clinic visit, a client with depression states, "Everyone would be better off without me." Which action should the practical nurse take first?

    1. A. Reassure the client that these feelings usually pass quickly with treatment.
    2. B. Ask the client to sign a no-suicide contract before leaving the clinic.
    3. C. Document the statement and reassess at the next scheduled visit.
    4. D. Ask the client directly about thoughts of suicide and stay with the client.
    Show the answer and rationale

    Correct answer: D. Ask the client directly about thoughts of suicide and stay with the client.

    A statement of being a burden to others is a warning sign of suicide risk, so the nurse first asks directly about thoughts of suicide and stays with the client rather than leaving the client alone. The LPN then promptly informs the RN or provider so a full risk assessment and safety plan are completed. In an emergency, 988 and 911 are available.

    • A: Reassurance minimizes the statement and does not assess for risk.
    • B: No-suicide contracts lack evidence that they prevent suicide and do not replace assessment and safety planning.
    • C: Delaying until the next visit leaves a client at possible immediate risk without assessment.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; NIMH: Suicide Prevention (988 and 911 guidance); PMC: Suicide planning interventions as an evidence-based alternative to no-suicide contracts

18. Question 18 · Psychosocial Integrity - Abuse and neglect (recognition and reporting)

    State law requires health care professionals, including nurses, to report reasonable suspicion of child abuse to child protective services. A practical nurse in a pediatric clinic notes bruising on the cheek and ear of a 3-month-old infant. The caregiver says the infant rolled off a sofa, but an infant this age cannot roll over reliably. The nurse suspects physical abuse. Which action is most appropriate?

    1. A. Ask the caregiver directly whether he or she has hurt the infant.
    2. B. Report the suspicion to child protective services and inform the RN.
    3. C. Wait for radiographs to confirm an injury before deciding whether to report.
    4. D. Document the findings and report only if the caregiver later admits to abuse.
    Show the answer and rationale

    Correct answer: B. Report the suspicion to child protective services and inform the RN.

    Because the stem states that the law requires nurses to report reasonable suspicion, the nurse does not wait for proof or an admission and does not investigate. The nurse documents objective findings and the caregiver's explanation, reports to child protective services, and informs the RN. Bruising in a young infant who cannot yet roll is inconsistent with the explanation given and raises suspicion.

    • A: Confronting the caregiver is not the nurse's role and may endanger the child or compromise investigation.
    • C: The reporting standard is reasonable suspicion; confirmatory testing is not required first.
    • D: Waiting for an admission delays protection of the child; the duty to report is not conditional on disclosure.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; Child Welfare Information Gateway: Reporting Child Abuse and Neglect (reporting requirements vary by state; Childhelp 1-800-4-A-CHILD)

19. Question 19 · Physiological Integrity: Basic Care and Comfort - Nutrition and oral hydration (diet teaching)

    A client newly diagnosed with celiac disease is being taught about a gluten-free diet. Which meal choice by the client indicates that the teaching was effective?

    1. A. Whole-wheat pasta with marinara sauce and a side salad
    2. B. Barley and vegetable soup with a small green salad
    3. C. Grilled chicken, a baked potato, and steamed broccoli
    4. D. Scrambled eggs with rye toast and fresh fruit
    Show the answer and rationale

    Correct answer: C. Grilled chicken, a baked potato, and steamed broccoli

    Celiac disease requires lifelong avoidance of gluten, which is found in wheat, barley, and rye. Meat, potatoes, and vegetables without added gluten-containing ingredients are naturally gluten free. Clients should also read labels for hidden gluten.

    • A: Whole-wheat pasta contains wheat.
    • B: Barley contains gluten, so the soup is not allowed.
    • D: Rye is a gluten-containing grain.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; NIDDK: Eating, Diet, and Nutrition for Celiac Disease

20. Question 20 · Physiological Integrity: Basic Care and Comfort - Mobility and immobility (assistive devices)

    A client with left-sided weakness after a stroke is learning to use a single-tip cane. Which method of walking, demonstrated by the client, is correct?

    1. A. Holds the cane in the right hand and moves the cane and left leg forward together, then the right leg
    2. B. Holds the cane in the left hand and moves the cane and left leg forward together, then the right leg
    3. C. Holds the cane in the right hand and moves the right leg first, then the cane and left leg
    4. D. Holds the cane in the left hand and moves the right leg forward first, then the cane
    Show the answer and rationale

    Correct answer: A. Holds the cane in the right hand and moves the cane and left leg forward together, then the right leg

    A cane is held on the stronger side so it supports the weaker leg and shifts weight away from it. The cane and the weaker leg move forward together, then the stronger leg steps past. With left-sided weakness the cane goes in the right hand and moves with the left leg.

    • B: Holding the cane on the weak side does not offload the weak leg.
    • C: Moving the strong leg first leaves the weak leg without cane support when it bears weight.
    • D: The cane is on the weak side, which reduces stability, and the sequence does not pair cane with the weak leg.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; MedlinePlus: Using a cane (patient instructions); University of Maryland Medical System: Using a Cane

21. Question 21 · Physiological Integrity: Basic Care and Comfort - Elimination (non-pharmacological interventions)

    A 72-year-old client is 2 days after hip arthroplasty and is receiving an opioid analgesic. The client has had no bowel movement for 3 days and has no fluid restriction. Which intervention should the practical nurse include in the plan of care?

    1. A. Limit oral fluids to reduce abdominal bloating and fullness.
    2. B. Provide a low-residue diet until the client passes a stool.
    3. C. Keep the client on bed rest until the bowel function returns.
    4. D. Encourage fluids and fiber-rich foods and assist with ambulation.
    Show the answer and rationale

    Correct answer: D. Encourage fluids and fiber-rich foods and assist with ambulation.

    Opioids slow gut motility. Adequate fluids, gradually increased dietary fiber, and activity help soften stool and stimulate peristalsis without medication. Fiber works best with enough fluid.

    • A: Restricting fluids hardens stool and worsens constipation.
    • B: Low-residue diets reduce stool bulk and can worsen constipation.
    • C: Immobility further slows bowel function; early ambulation is encouraged after surgery.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; NIDDK: Eating, Diet, and Nutrition for Constipation

22. Question 22 · Physiological Integrity: Physiological Adaptation - Fluid and electrolyte imbalances (lab value significance)

    A client who takes furosemide has a serum potassium of 3.0 mEq/L (reference range 3.5 to 5.0 mEq/L). Which finding does the practical nurse expect to observe?

    1. A. Hyperactive bowel sounds with watery diarrhea
    2. B. Positive Chvostek sign with facial twitching
    3. C. Muscle weakness with leg cramps
    4. D. Brisk 3+ deep tendon reflexes
    Show the answer and rationale

    Correct answer: C. Muscle weakness with leg cramps

    Hypokalemia, common with loop diuretics, impairs muscle and nerve function and causes weakness, cramps, constipation or ileus, and cardiac dysrhythmias. Serum potassium of 3.0 mEq/L is below the stated range. Reports of a new irregular pulse should go to the RN or provider.

    • A: Hypokalemia decreases gastrointestinal motility; hyperactive bowel sounds are more consistent with hyperkalemia.
    • B: Facial twitching on tapping the cheek (Chvostek sign) is a sign of hypocalcemia, not hypokalemia.
    • D: Hypokalemia causes diminished, not brisk, reflexes.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; MedlinePlus: Potassium Blood Test

23. Question 23 · Physiological Integrity: Reduction of Risk Potential - Potential for complications of surgical procedures (vital sign trends)

    An adult client is on the day of an open abdominal surgery. Vital signs have been recorded as follows: 1400: BP 122/76 mm Hg, HR 82/min, RR 16/min, SpO2 98%, temperature 98.2 F (36.8 C). 1600: BP 112/68, HR 94, RR 18, SpO2 97%, temperature 98.4 F. 1800: BP 96/58, HR 112, RR 22, SpO2 96%, temperature 98.6 F (37 C); urine output 20 mL over the past 2 hours. Which complication do these findings most suggest?

    1. A. Uncontrolled incisional pain
    2. B. Internal hemorrhage with hypovolemia
    3. C. Postoperative atelectasis
    4. D. Surgical site infection
    Show the answer and rationale

    Correct answer: B. Internal hemorrhage with hypovolemia

    Falling blood pressure with rising heart rate and respiratory rate and low urine output is the classic trend of hypovolemic shock, in the early postoperative period most likely from bleeding. The LPN should recheck the client, inspect the dressing and drains, and notify the RN immediately. Pain typically raises blood pressure.

    • A: Pain tends to raise blood pressure and heart rate rather than lower blood pressure, and would not reduce urine output this way.
    • C: Atelectasis usually causes lowered SpO2, crackles, and low-grade fever, not hypotension with oliguria.
    • D: Infection develops days later with fever and wound changes; temperature here is normal.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; MedlinePlus: Shock; NCSBN 2026 NCLEX-PN Test Plan

24. Question 24 · Physiological Integrity: Reduction of Risk Potential - Oxygen therapy basics (COPD)

    A client with chronic obstructive pulmonary disease (COPD) has a prescription for oxygen by nasal cannula, titrated from 1 to 4 L/min to keep SpO2 at 88% to 92%. The client is receiving 4 L/min, has an SpO2 of 97%, and is calm with a respiratory rate of 14/min. What should the practical nurse do?

    1. A. Reduce the flow rate within the prescribed range and recheck the SpO2.
    2. B. Increase the flow rate to 6 L/min to build up an oxygen reserve for the client.
    3. C. Change to a non-rebreather mask to keep the oxygen saturation high.
    4. D. Continue 4 L/min because an SpO2 of 97% is a normal reading for adults.
    Show the answer and rationale

    Correct answer: A. Reduce the flow rate within the prescribed range and recheck the SpO2.

    In clients at risk for carbon dioxide retention, such as those with COPD, excess oxygen can worsen hypercapnia, so a target SpO2 of 88% to 92% is used (GOLD 2025 report; BTS emergency oxygen guideline). An SpO2 of 97% is above the prescribed target, so the nurse lowers the flow within the order and rechecks, reporting concerns to the RN.

    • B: More oxygen would raise SpO2 further above target and increase hypercapnia risk, and 6 L/min exceeds the order.
    • C: A non-rebreather delivers high concentration oxygen, the opposite of what this client needs.
    • D: 97% is normal in healthy people but is above this client's prescribed target.

    Sources: NCSBN 2026 NCLEX-PN Test Plan; GOLD 2025 Report (oxygen therapy: target saturation 88-92% in COPD exacerbation); British Thoracic Society: Emergency Oxygen guideline (88-92% for patients at risk of hypercapnic respiratory failure)

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