This free NCLEX-PN practice test has 25 questions written for practical nurses (LVN and LPN). It covers every client needs category on the NCLEX-PN test plan, from coordinated care and safety to pharmacology and physiological adaptation. Click an answer to see right away if you got it, plus a rationale for every option. Your score shows at the end.
Every question is written from the practical nurse role: collecting data, reinforcing teaching, giving safe care, and knowing when to report to the RN or provider.
Question 1 of 25 Basic Care and Comfort
The practical nurse is preparing to give a prescribed cleansing enema to an adult client. How should the practical nurse position the client?
- Right side-lying with both legs kept straight and together. Incorrect. Lying on the right side works against the path of the colon, so the solution does not flow as well. Straight legs also make the anus harder to see.
- Left side-lying with the right knee bent toward the chest. Correct. In the left side-lying (Sims) position, the solution flows by gravity into the rectum and sigmoid colon, which lie on the left side of the abdomen. Bending the upper knee exposes the anus and helps the client relax.
- Prone with a pillow placed under the hips and abdomen. Incorrect. Lying prone with the hips raised is not a standard enema position and makes it hard to insert the tube and watch the client.
- Sitting upright on the bedside commode. Incorrect. Sitting keeps the solution from flowing up into the colon and makes insertion unsafe. The commode is kept nearby for use after the solution is given.
Question 2 of 25 Safety and Infection Control
A small fire starts in a trash can in the staff break room. After the fire alarm is activated, the practical nurse picks up a fire extinguisher. What is the first step in using the extinguisher?
- Aim the nozzle at the top of the flames. Incorrect. The nozzle is aimed at the base of the fire, where the fuel is burning, not at the top of the flames.
- Squeeze the handle while standing close. Incorrect. The handle cannot be squeezed until the pin is pulled, and the user should keep a safe distance from the fire.
- Sweep the nozzle from side to side. Incorrect. Sweeping side to side is the last step, done while the extinguisher is spraying at the base of the fire.
- Pull the pin to break the tamper seal. Correct. The PASS steps are Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep from side to side. The pin locks the handle, so it must be pulled first.
Question 3 of 25 Health Promotion and Maintenance
The practical nurse is reinforcing teaching about testicular self-examination with a 22-year-old client. Which statement by the client shows correct understanding?
- “I will do the check during or right after a warm shower.”. Correct. Warm water relaxes the scrotum, so the testicles hang lower and are easier to feel. This makes it easier to notice a lump, swelling, or change in size.
- “I should press hard enough to flatten each testicle.”. Incorrect. Each testicle should be rolled gently between the thumb and fingers. Pressing hard causes pain and does not help find a lump.
- “A soft, rope-like cord at the back of a testicle is a lump to report.”. Incorrect. The soft, coiled cord at the back of each testicle is the epididymis, a normal structure. Knowing this helps the client avoid mistaking it for a lump.
- “A painless hard lump can be watched for a few months.”. Incorrect. A painless, hard lump can be an early sign of testicular cancer and should be reported to the provider promptly.
Question 4 of 25 Coordinated Care
A client is admitted to a hospital unit the evening before surgery. The client is wearing a wedding ring and has cash and a credit card. No family members are present. What should the practical nurse do with the valuables?
- Place them in the bedside drawer so the client can reach them. Incorrect. The bedside drawer is not secure, and items can be lost or taken while the client is in surgery.
- Keep them in a nurses’ station drawer until the family arrives. Incorrect. A nurses’ station drawer is not a secure storage area and leaves no record of the items.
- List each item, have the client sign, and secure them per policy. Correct. Valuables are described on the facility’s form, signed for by the client and the nurse, and stored in the hospital safe or another secure area per policy. This protects the client’s property and gives a clear record of what was received.
- Leave them with the client since the client is alert and oriented. Incorrect. The client will be sedated and away from the room during surgery, so the client cannot keep the items safe. Jewelry, including rings, is usually removed or secured before surgery per policy.
Question 5 of 25 Pharmacological Therapies
A client has a prescription for cephalexin 500 mg by mouth every 6 hours. The pharmacy supplies cephalexin oral suspension 250 mg/5 mL. How many milliliters should the practical nurse give for each dose?
- 2.5 mL. Incorrect. This volume contains only 125 mg, which is one fourth of the prescribed dose.
- 10 mL. Correct. Divide the desired dose by the dose on hand and multiply by the volume: 500 mg divided by 250 mg, times 5 mL, equals 10 mL. The dose should be measured with an oral syringe or a marked medication cup.
- 5 mL. Incorrect. This volume contains 250 mg, which is only half of the prescribed dose.
- 20 mL. Incorrect. This volume contains 1,000 mg, which is twice the prescribed dose.
Question 6 of 25 Reduction of Risk Potential
The practical nurse is checking a client’s capillary blood glucose with a glucose meter. Which action is correct?
- Puncture the side of the fingertip rather than the center pad. Correct. The sides of the fingertip have fewer nerve endings than the pad, so the puncture hurts less. Using the sides also protects the pad, which the client relies on for touch.
- Wipe the finger with alcohol and puncture it while it is still wet. Incorrect. Alcohol left on the skin can mix with the blood and change the reading, and it makes the puncture sting. The skin should dry fully first.
- Squeeze the fingertip firmly at the site to get enough blood. Incorrect. Squeezing hard pushes tissue fluid into the sample and can make the result inaccurate. Gently milking the finger from the base is acceptable.
- Hold the client’s hand above heart level before the puncture. Incorrect. Holding the hand below heart level helps blood fill the fingertip. Raising it reduces blood flow to the site.
Question 7 of 25 Psychosocial Integrity
A resident with moderate Alzheimer disease becomes upset in the late afternoon and tells the practical nurse, “I have to go home right now and make supper for my children.” The resident’s children are grown. Which response by the practical nurse is best?
- “Your children are all grown up now and live on their own, so you don’t need to cook.”. Incorrect. Correcting the resident with facts the resident cannot hold onto often increases distress and leads to arguing.
- “You live here now. Let’s look at the calendar so you know where you are.”. Incorrect. Reality orientation can help a client with mild confusion or delirium, but in moderate dementia it often causes frustration and agitation.
- “Don’t worry about supper. Your children will be fine without you tonight.”. Incorrect. This response brushes off the resident’s feelings and does not address the worry behind the statement.
- “You sound worried about your children. Tell me about meals you made for them.”. Correct. Validation responds to the feeling behind the statement instead of arguing about facts. Inviting the resident to talk about a familiar, meaningful role can calm the resident and gently redirect the conversation.
Question 8 of 25 Basic Care and Comfort
The practical nurse checks the meal tray of a client who is on a clear liquid diet after surgery. Which item should be removed from the tray?
- Apple juice. Incorrect. Apple juice is clear, has no pulp, and is allowed on a clear liquid diet.
- Lemon gelatin. Incorrect. Plain gelatin becomes a clear liquid at body temperature and is allowed.
- Vanilla pudding. Correct. Pudding is made with milk and belongs on a full liquid diet, not a clear liquid diet. Clear liquids are see-through and leave little residue in the bowel, so the pudding should be removed and the tray error reported.
- Fat-free chicken broth. Incorrect. Fat-free broth is a clear liquid and is allowed on this diet.
Question 9 of 25 Coordinated Care
A long-term care resident has a new prescription that reads “levothyroxine 100 mg by mouth once daily.” The resident’s previous dose was levothyroxine 100 mcg daily. What should the practical nurse do?
- Contact the prescriber to clarify the dose before giving it. Correct. Levothyroxine is dosed in micrograms, so 100 mg would be 1,000 times the usual dose. The nurse must clarify an unclear or unsafe prescription with the prescriber, following facility policy, before giving the medication.
- Give 100 mcg because that is most likely what was meant. Incorrect. The nurse cannot change a prescription based on a guess, even when the error seems obvious.
- Give the dose as written because it is a new prescription. Incorrect. A dose far outside the safe range could cause serious harm, and the nurse is responsible for questioning it.
- Ask another nurse on the unit which dose the prescriber probably meant. Incorrect. Another nurse cannot decide what the prescriber intended. Only the prescriber can correct the prescription.
Question 10 of 25 Physiological Adaptation
In the dining room, a resident suddenly stands up, grabs at the throat, and cannot speak or cough. Which action should the practical nurse take?
- Have the resident take sips of water to clear the throat. Incorrect. A person with a blocked airway cannot swallow safely, and liquid adds to the risk of aspiration.
- Stand behind the resident and give abdominal thrusts. Correct. A conscious adult who cannot speak or cough has a severe airway obstruction. Abdominal thrusts are given right away and repeated until the object comes out or the person becomes unresponsive, while someone else calls for help.
- Sweep the resident’s mouth with a finger to find the food. Incorrect. A blind finger sweep can push the object deeper. An object is removed from the mouth only if it can be seen.
- Encourage the resident to keep coughing as hard as possible. Incorrect. Encouraging coughing is correct only when the person can still cough forcefully and move air. This resident cannot cough or speak.
Question 11 of 25 Pharmacological Therapies
A client started phenazopyridine for bladder pain from a urinary tract infection. The client calls the clinic and tells the practical nurse that the urine is now reddish-orange. What should the practical nurse tell the client?
- “Stop taking the medication and come in today for a urine test.”. Incorrect. The color change is not a reason to stop the medication or to come in for testing.
- “Drink extra fluids because the color shows dehydration.”. Incorrect. The color comes from the medication, not from concentrated urine.
- “Go to the emergency department because this may be blood.”. Incorrect. This expected color change is not a sign of bleeding, and an emergency visit is not needed.
- “This color change is an expected effect of the medication.”. Correct. Phenazopyridine is a dye that turns urine reddish-orange, and this is harmless. The client should also know it can stain clothing and soft contact lenses.
Question 12 of 25 Safety and Infection Control
The practical nurse has just finished perineal care for a client after an episode of bowel incontinence. The next step is to apply lotion to the client’s arms. What should the practical nurse do?
- Continue with the same gloves, since this is the same client’s care. Incorrect. Gloves soiled with stool carry germs that can be spread to clean areas of the same client’s body.
- Wash the gloved hands with soap and water before going on. Incorrect. Gloves are not washed and reused. Washing does not reliably remove germs and can damage the gloves.
- Remove the gloves, do hand hygiene, and put on clean gloves. Correct. Gloves are changed when moving from a dirty body site to a clean one, and hand hygiene is done after gloves are removed. This keeps germs from the perineal area from spreading to other parts of the body.
- Put a second pair of gloves on over the soiled pair. Incorrect. Layering clean gloves over soiled ones does not remove germs, and hands can be contaminated when the gloves are taken off.
Question 13 of 25 Health Promotion and Maintenance
The practical nurse is collecting data on an 82-year-old resident during a routine visit. Which finding is an expected change of aging?
- New confusion that started 2 days ago. Incorrect. Sudden new confusion is never a normal part of aging. It can signal infection, dehydration, or a medication problem and should be reported.
- Trouble hearing high-pitched sounds. Correct. A gradual loss of the ability to hear high-pitched sounds, called presbycusis, is a common, expected change with aging. The practical nurse can help by facing the resident and speaking clearly in a lower pitch.
- Weight loss of 10 lb (4.5 kg) in the past month. Incorrect. Losing this much weight in a month without trying is not expected and should be reported.
- Needing to sit up in order to breathe at night. Incorrect. Needing to sit up to breathe is not expected with aging and can be a sign of heart failure.
Question 14 of 25 Reduction of Risk Potential
The practical nurse is to collect a swab specimen for culture from a draining wound on a client’s leg. Which action is correct?
- Rinse the wound with sterile saline before swabbing the wound bed. Correct. Rinsing with sterile saline removes surface drainage and debris that hold germs not causing the infection. Swabbing clean tissue in the wound bed gives a more accurate culture.
- Swab the drainage that has pooled on the inside of the old dressing. Incorrect. Old drainage on the dressing is mixed with skin germs and does not show what is growing in the wound.
- Swab the dry skin around the outer edge of the wound. Incorrect. The skin around the wound has normal skin bacteria, which would give misleading results.
- Moisten the swab with tap water before touching the wound. Incorrect. Tap water is not sterile and can add germs to the specimen.
Question 15 of 25 Coordinated Care
While riding in a crowded hospital elevator, the practical nurse hears two coworkers using a client’s name while discussing the client’s new cancer diagnosis. What should the practical nurse do?
- Say nothing because the coworkers are part of the care team. Incorrect. Even care team members discuss client information only in private settings and only as needed for care.
- Report the coworkers to the state board of nursing after the shift. Incorrect. A breach like this is stopped right away and handled through facility policy, not by going straight to the state board.
- Join the conversation to correct the details they have wrong. Incorrect. Joining the conversation adds to the breach of confidentiality.
- Quietly remind them that client information is not discussed here. Correct. Discussing client information where others can hear violates the client’s privacy and HIPAA. The practical nurse should stop the conversation right away in a discreet way and follow facility policy for reporting the breach.
Question 16 of 25 Pharmacological Therapies
The practical nurse is giving several oral medications through a resident’s gastrostomy tube. Which action is correct?
- Mix all of the crushed tablets together in one cup of water. Incorrect. Mixing medications together can cause drug interactions and clog the tube. Each medication is given separately.
- Add the crushed tablets to the bag of tube feeding formula. Incorrect. Medications added to formula may not work as intended, and the resident will not get the full dose if the feeding is stopped.
- Flush the tube with water before and after each medication. Correct. Flushing with water before, between, and after medications keeps the tube open and makes sure each full dose reaches the stomach. Each medication is dissolved and given separately, using the amount of water set by facility policy.
- Crush the extended-release tablet so that it dissolves fully. Incorrect. Crushing an extended-release tablet releases the whole dose at once and can cause an overdose. The practical nurse should ask the provider or pharmacist for another form.
Question 17 of 25 Basic Care and Comfort
A resident has died, and the family wants to see the resident before the funeral home arrives. Which action should the practical nurse take when preparing the body?
- Place the body supine with the head raised on a pillow. Correct. Raising the head slightly keeps blood from pooling in the face, which can cause purple discoloration. Placing the body supine in normal alignment gives the family a natural, peaceful appearance.
- Keep the head lower than the body to improve skin color. Incorrect. Lowering the head lets blood settle in the face and causes discoloration that can distress the family.
- Remove the dentures and store them in a labeled cup. Incorrect. Dentures are usually placed back in the mouth soon after death, per policy, so the face keeps a natural shape before the jaw stiffens.
- Leave the soiled linens in place for the funeral home. Incorrect. The body should be cleaned and soiled linens replaced so the family can view the resident in a clean, dignified setting.
Question 18 of 25 Physiological Adaptation
A client returned to the surgical unit 3 hours ago after abdominal surgery. Which set of findings should the practical nurse report to the RN right away?
- Temperature 99.1 F (37.3 C), pulse 84, incision pain rated 5. Incorrect. A low-grade temperature is common in the first day after surgery, and pain rated 5 is managed with the prescribed analgesic.
- Pulse 122 (was 86), BP 94/60 (was 128/76), cool clammy skin. Correct. A rising pulse, falling blood pressure, and cool, clammy skin are signs of hypovolemic shock, most likely from bleeding. These changes must be reported to the RN at once so the client can be assessed and treated.
- Drowsy but easy to wake, respirations 16, SpO2 95% on room air. Incorrect. Mild drowsiness after anesthesia and opioids is expected when the client wakes easily and breathing and oxygen saturation are normal.
- Small amount of pink-tinged drainage on the incision dressing. Incorrect. A small amount of pink-tinged (serosanguineous) drainage is expected on a new surgical incision.
Question 19 of 25 Coordinated Care
At the start of the shift, the practical nurse notices that a coworker who is about to begin the medication pass smells of alcohol, has slurred speech, and is unsteady. What should the practical nurse do?
- Ask the coworker to drink coffee before starting the medication pass. Incorrect. Coffee does not reverse impairment, and the coworker would still be unsafe to care for clients.
- Offer to give the coworker’s medications for the rest of the shift. Incorrect. Covering for the coworker hides the problem and still leaves clients at risk from other care the coworker gives.
- Talk with the coworker privately about the concern after the shift. Incorrect. Waiting until after the shift lets an impaired nurse care for clients and puts them in danger.
- Report the observations to the charge nurse or supervisor right away. Correct. A nurse who appears impaired is a danger to clients, and the practical nurse has a duty to report it at once. The supervisor follows facility policy to remove the coworker from client care.
Question 20 of 25 Psychosocial Integrity
A client who had a permanent colostomy created 4 days ago turns away each time the practical nurse empties the pouch and says, “I can’t look at that thing.” Which response by the practical nurse is best?
- “You will need to look at it soon so you can care for it at home.”. Incorrect. Pushing the client to look before the client is ready ignores the client’s feelings and can increase distress.
- “Many people have colostomies, and you’ll get used to it quickly.”. Incorrect. This gives false reassurance and minimizes the client’s feelings.
- “It’s hard to see your body change like this. How are you feeling?”. Correct. This response accepts the client’s reaction and invites the client to share specific concerns. Talking about feelings is an early step in adjusting to a change in body image, and the client’s concerns can be shared with the RN.
- “I’ll take care of it for you, so you won’t ever have to look.”. Incorrect. Taking over all care avoids the client’s feelings and delays the self-care the client will need at home.
Question 21 of 25 Safety and Infection Control
The practical nurse is about to give morning medications to a client on a hospital medical-surgical unit and notices the client is not wearing an identification band. The client is alert and states the correct name. What should the practical nurse do?
- Give the medications because the client stated the correct name. Incorrect. A stated name is only one identifier, and hospital policy requires the band to confirm identity. Clients can also answer to the wrong name.
- Have a new identification band placed per policy before giving them. Correct. In the hospital, the identification band is used to compare two identifiers, such as name and date of birth, with the medication record. The practical nurse follows policy to get a new band placed, then verifies identity before giving the medications.
- Compare the name on the door sign with the medication record. Incorrect. Room numbers and door signs are never used to identify a client because clients can be moved or be in the wrong bed.
- Ask the client’s roommate to confirm the client’s name. Incorrect. A roommate is not a reliable source of identity, and asking shares private information.
Question 22 of 25 Pharmacological Therapies
A 72-year-old client who takes prednisone daily started levofloxacin 3 days ago for pneumonia. During a home visit, the client tells the practical nurse that the back of the right ankle is painful and swollen. What should the practical nurse do?
- Report the finding to the RN or provider before the next dose. Correct. Fluoroquinolones such as levofloxacin can cause tendinitis and tendon rupture, most often of the Achilles tendon. The risk is higher in older adults and in people taking corticosteroids, and the drug is usually stopped at the first sign of tendon pain, so the provider needs to know before more doses are taken. The client should rest the ankle until then.
- Encourage the client to stretch and walk to loosen the ankle. Incorrect. Stretching and walking put stress on an inflamed tendon and could cause it to rupture.
- Apply a heating pad and recheck the ankle at the next visit. Incorrect. Waiting until the next visit delays needed action, and heat does not address the drug effect.
- Tell the client this is a common effect that will go away. Incorrect. Tendon pain with this drug is a serious adverse effect that must be reported, not an expected effect.
Question 23 of 25 Reduction of Risk Potential
A client returned to the unit 2 hours ago after a cardiac catheterization through the right femoral artery. Which finding should the practical nurse report to the RN immediately?
- A dime-sized spot of dried blood on the dressing that is not growing. Incorrect. A small, dry spot that is not growing is not a sign of active bleeding. The site is still checked often for new bleeding or swelling.
- Urine output of 200 mL over the past 2 hours. Incorrect. Good urine output is expected because the contrast dye acts as a diuretic and the client is encouraged to drink fluids.
- Right foot cool and pale, with a weaker pedal pulse than before. Correct. A cool, pale foot with a weaker pulse on the side of the puncture can mean a clot or other blockage of blood flow to the leg. This is an emergency that must be reported right away to protect the limb.
- Blood pressure 128/76 mm Hg and a regular pulse of 80. Incorrect. These vital signs are within normal limits and do not suggest bleeding.
Question 24 of 25 Coordinated Care
A practical nurse in a long-term care facility reports to the RN that a resident’s oxygen saturation has dropped from 95% to 88% and the resident is more short of breath. The RN says, “That’s normal for her. I’ll look later,” and does not come. Thirty minutes later, the resident’s breathing is worse. What should the practical nurse do?
- Document the RN’s response and keep monitoring the resident. Incorrect. Documenting and watching alone does not get the resident the care needed for worsening breathing.
- Call the resident’s family and ask them to come in right away. Incorrect. Calling the family does not get the resident assessed or treated and is not the correct way to resolve a care concern.
- Wait for the RN to check on the resident as was promised. Incorrect. The resident’s breathing is getting worse, and more waiting could lead to serious harm.
- Report the change to the nursing supervisor right away. Correct. When a client is getting worse and the RN does not respond, the practical nurse goes to the next level in the chain of command, such as the nursing supervisor or director of nursing. The practical nurse is accountable for advocating for the resident until someone acts.
Question 25 of 25 Physiological Adaptation
On a hot afternoon, a long-term care resident comes inside after sitting in the garden for several hours. The resident is confused, the skin is hot and dry, and the temperature is 104.5 F (40.3 C). Which action should the practical nurse take first?
- Give acetaminophen and recheck the temperature in 1 hour. Incorrect. Heatstroke happens because the body’s cooling system fails, not because of a fever set point, so acetaminophen does not lower the temperature. Waiting an hour delays urgent cooling.
- Move the resident to a cool area and begin cooling measures. Correct. Confusion, hot and dry skin, and a very high temperature after heat exposure point to heatstroke, a medical emergency. Cooling starts right away by moving the resident to a cool area, removing extra clothing, and applying cool water, while the practical nurse calls for the RN and emergency help.
- Offer large glasses of ice water for the resident to drink fast. Incorrect. A confused resident may choke or aspirate when drinking quickly. Fluids by mouth are given only if the resident is alert and can swallow safely.
- Document the findings and recheck the vital signs in 30 minutes. Incorrect. Documenting and waiting delays treatment of a life-threatening condition.
Your score
Want more practice? NCLEX-PN Practice has 1,782 PN-scope questions and a timed exam simulator.
What is on the NCLEX-PN?
Since April 2023, the NCLEX-PN uses the Next Generation NCLEX format. It is a computer adaptive test with 85 to 150 questions and up to 5 hours, including clinical judgment case studies.
Questions are organized by client needs:
- Safe and effective care environment: coordinated care, and safety and infection control.
- Health promotion and maintenance: growth and development, prevention, and screening.
- Psychosocial integrity: coping, mental health, and therapeutic communication.
- Physiological integrity: basic care and comfort, pharmacological therapies, reduction of risk potential, and physiological adaptation.
Tips for NCLEX-PN questions
- Know your scope. The practical nurse collects data, reinforces teaching, and reports changes. Initial assessment, care planning, and initial teaching belong to the RN.
- When a finding is new, unexpected, or getting worse, the answer is often to report it to the RN or provider.
- Safety first: identify the client, prevent falls, and follow infection control every time.
- For medication questions, check the dose, the units, and what to watch for before you give it.
- Read every rationale, including the ones for answers you got right.
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