Infection Control
Which situation requires the LPN to wash hands with soap and water instead of using alcohol gel?
A. Before performing medication administration
B. After removing gloves
C. After assisting with a patient who has C. difficile
D. Before entering a patient room
Correct Answer: C. After assisting with a patient who has C. difficile
Rationale:
Alcohol gel does not kill C. diff spores. Soap and water are required to physically remove spores.
Alcohol-based sanitizer is appropriate for routine care unless hands are visibly soiled or caring for spore-forming organisms.
A patient receiving IV vancomycin begins experiencing flushing, itching, and redness of the face and upper chest. What is the most appropriate LPN action?
A. Stop the infusion and notify the RN/provider
B. Administer diphenhydramine STAT
C. Increase the infusion rate
D. Document this expected reaction
Correct Answer: A. Stop the infusion and notify the RN/provider
Rationale:
Flushing, rash, and redness indicate Red Man Syndrome, caused by rapid infusion of vancomycin. The infusion should be stopped and restarted at a slower rate once evaluated. It is NOT an allergic reaction, but it is unsafe to continue.
Which patient should be assessed first by the LPN?
A. A diabetic patient who is diaphoretic and shaky
B. A patient requesting a warm blanket
C. A patient whose IV pump is alarming “air in line”
D. A patient asking when they can eat lunch
Correct Answer: A. A diabetic patient who is diaphoretic and shaky
Rationale:
Diaphoresis + shakiness = hypoglycemia, which can progress rapidly to unconsciousness.
Air in IV line can wait briefly (pump prevents air entry).
Comfort and food requests are nonurgent.
Which finding indicates fluid volume deficit?
A. Bounding peripheral pulses
B. Increased blood pressure
C. Dry mucous membranes and tachycardia
D. Crackles auscultated in the lungs
Correct Answer: C. Dry mucous membranes and tachycardia
Rationale:
Dehydration → low circulating volume → tachycardia, dry mucous membranes, low urine output.
Bounding pulses and crackles indicate fluid overload, not deficit.
Before administering a medication, the LPN scans the patient’s armband and the scanner alerts “Wrong patient.” The patient states, “That’s my medicine. I get that every day.” What should the LPN do?
A. Give the medication because the patient recognizes it
B. Confirm with the nurse manager before giving it
C. Reassess the scanner and verify two patient identifiers
D. Print a new armband and continue medication administration
Correct Answer: C. Reassess the scanner and verify two patient identifiers
Rationale:
The patient’s statement does NOT replace the need for two identifiers.
Do not administer medication until the correct patient is verified.
Replacing the armband without verification is unsafe.
Which finding places an older adult patient at the highest risk for infection?
A. Temperature of 97.9°F
B. Use of an indwelling urinary catheter
C. High-protein diet
D. Report of mild fatigue
Correct Answer: B. Use of an indwelling urinary catheter
Rationale:
Indwelling urinary catheters greatly increase the risk of CAUTIs, a major source of healthcare-associated infections. A slightly low temperature and fatigue are common in older adults and do not directly cause infection.
The LPN is teaching a patient taking warfarin about food interactions. Which meal indicates the highest risk for reduced drug effectiveness?
A. Grilled chicken with a baked potato
B. Spinach salad with broccoli
C. Rice with roasted turkey
D. Yogurt with fruit
Correct Answer: B. Spinach salad with broccoli
Rationale:
Foods high in vitamin K (spinach, kale, broccoli) decrease warfarin effectiveness → increased clotting risk. Patients must keep vitamin K intake consistent.
Which patient should the LPN see first?
A. A patient with a Foley catheter reporting cloudy urine
B. A patient with a temperature of 101.4°F
C. A patient with a new heart rate of 122 bpm and chills
D. A patient receiving IV antibiotics who reports nausea
Correct Answer: C. A patient with a new heart rate of 122 bpm and chills
Rationale:
High heart rate + chills = possible early sepsis → immediate evaluation. Fever alone is not as urgent as systemic signs. Cloudy urine suggests UTI but is not emergent. Nausea from antibiotics is expected.
A patient has a sodium level of 125 mEq/L. Which symptom would the LPN expect?
A. Increased thirst
B. Confusion and headache
C. Slow capillary refill
D. Elevated blood pressure
Correct Answer: B. Confusion and headache
Rationale:
Hyponatremia causes cerebral edema, leading to confusion, headache, seizures, and decreased LOC.
Thirst is more common with hypernatremia.
A medication is ordered to be given “stat.” What does this mean?
A. Give within 30 minutes of the scheduled time
B. Give immediately, one time only
C. Give when the medication is available
D. Give after the patient finishes eating
Correct Answer: B. Give immediately, one time only
Rationale:
A stat order means immediate single dose.
This takes priority over routine and PRN medications.
During a sterile procedure, the LPN reaches across the sterile field to grab sterile supplies. No items were touched. What should the nurse do?
A. Continue the procedure because nothing was touched
B. Replace only items in the center of the field
C. Treat the sterile field as contaminated and replace it
D. Ask another nurse to inspect the field before proceeding
Correct Answer: C. Treat the sterile field as contaminated and replace it
Rationale:
Reaching over the sterile field causes airborne contamination due to shedding of microorganisms from clothing and skin. The field is no longer sterile, even if nothing was touched.
A patient receiving IV morphine becomes drowsy, with a respiratory rate of 8 breaths/min. What is the priority nursing action?
A. Notify the provider
B. Slow the IV infusion rate
C. Administer naloxone per protocol
D. Attempt to arouse the client
Correct Answer: C. Administer naloxone per protocol
Rationale:
RR < 10 = opioid-induced respiratory depression.
Naloxone is the immediate reversal agent. Arousing the client is not adequate for airway compromise.
Which client should the LPN see first?
A. A client with asthma who is wheezing mildly
B. A client with pneumonia who is diaphoretic and restless
C. A client with COPD who is requesting PRN albuterol
D. A client with a chest tube with 2 cm of gentle bubbling in the water seal
Rationale:
Restlessness + diaphoresis = early signs of hypoxia, requiring immediate attention. Mild wheezing or normal chest tube bubbling is not first priority.
COPD breathing treatments are important but not emergent compared to signs of decompensation.
A patient receiving 0.9% NS at 150 mL/hr begins experiencing shortness of breath and crackles in both lower lobes. What is the priority action?
A. Increase the IV rate
B. Stop the infusion and elevate the head of the bed
C. Encourage oral fluids instead
D. Apply compression stockings
Correct Answer: B. Stop the infusion and elevate the head of the bed
Rationale:
These findings indicate fluid overload → risk for pulmonary edema.
Priority: stop fluids, improve breathing by elevating HOB, then notify RN/provider.
Increasing fluids would worsen symptoms.
Before giving an IV antibiotic, the LPN notes that the patient has a continuous infusion of normal saline running. What should the LPN do first?
A. Hang the antibiotic with no concerns
B. Stop the IV and flush with 20 mL saline
C. Check the antibiotic’s compatibility with normal saline
D. Increase the IV flow rate to finish the current bag faster
Correct Answer: C. Check the antibiotic’s compatibility with normal saline
Rationale:
Certain medications cannot mix with specific IV fluids because they may crystallize or deactivate.
Compatibility must be confirmed before administration.
The LPN observes a UAP delivering a tray to a patient on contact precautions without wearing PPE. What is the priority action?
A. Report the UAP to the charge nurse
B. Educate the UAP immediately about required PPE
C. Notify infection control
D. Document the incident in the patient’s chart
Correct Answer: B. Educate the UAP immediately about required PPE
Rationale:
Immediate correction is needed to prevent cross-contamination. Reporting and documentation may follow, but interrupting the unsafe action is the priority.
The provider orders 10 units of regular insulin and 20 units of NPH to be given in one syringe. How should the LPN prepare the insulin?
A. Draw up NPH first, then regular
B. Draw up regular first, then NPH
C. Mix both insulins in the vial before drawing
D. Give them in separate syringes only
Correct Answer: B. Draw up regular first, then NPH
Rationale:
Clear → Cloudy
Regular (clear) goes first, then NPH (cloudy).
Prevents contamination of the regular insulin vial.
Which postoperative patient requires priority assessment?
A. A patient with 20 mL/hr serosanguinous drainage in a JP drain
B. A patient with a saturated abdominal dressing and BP 88/50
C. A patient requesting pain medication for pain rated 6/10
D. A patient with a low-grade fever (100.1°F) on postoperative day 1
Correct Answer: B. A patient with a saturated abdominal dressing and BP 88/50
Rationale:
Hypotension + heavy bleeding = possible hemorrhage, which is life-threatening. JP drainage of 20 mL/hr is normal. Pain and low-grade fever are expected post-op findings.
Which assessment finding suggests hypocalcemia?
A. Positive Chvostek’s sign
B. Polyuria
C. Flushed, warm skin
D. Decreased muscle excitability
Correct Answer: A. Positive Chvostek’s sign
Rationale:
Hypocalcemia increases neuromuscular excitability → Chvostek’s and Trousseau’s signs.
Polyuria is associated with hypercalcemia or diabetes insipidus.
Warm skin is not related.
Which medication requires two-nurse verification before administration?
A. Oral furosemide
B. Subcutaneous heparin
C. IV morphine 2 mg
D. Regular insulin given subcutaneously
Correct Answer: D. Regular insulin given subcutaneously
Rationale:
Insulin is a high-alert medication and typically requires independent double-checks. Heparin also may require verification depending on facility policy, but insulin is universally checked.
The LPN is caring for a patient with vancomycin-resistant Enterococcus (VRE) who is being discharged to a long-term care facility. Which action is the priority?
A. Educate the family about avoiding all physical contact
B. Notify the receiving facility of the patient’s VRE status
C. Disinfect the client’s room with bleach-based products
D. Place the client on airborne precautions during transport
Correct Answer: B. Notify the receiving facility of the patient’s VRE status
Rationale:
The priority is continuity of infection control between facilities. VRE requires contact precautions, not airborne. Family contact is not prohibited with proper hygiene.
A patient taking digoxin reports nausea, decreased appetite, and seeing yellow halos around lights. The LPN checks the digoxin level and finds it is 2.4 ng/mL. What should the LPN do first?
A. Hold the next dose of digoxin
B. Administer the scheduled dose
C. Give an antiemetic
D. Increase the client’s potassium intake
Correct Answer: A. Hold the next dose of digoxin
Rationale:
A digoxin level above 2.0 ng/mL suggests toxicity.
Classic symptoms: nausea, anorexia, visual disturbances. The LPN must hold the medication and notify the RN/provider. Increasing potassium is not done without orders.
Which patient is the highest priority?
A. A patient with cellulitis of the leg who reports increased redness
B. A patient with a wound VAC reporting mild discomfort
C. A patient with a new temp of 100.8°F after surgery
D. A patient with an infected foot ulcer whose pedal pulses are now difficult to palpate
Correct Answer: D. A patient with an infected foot ulcer whose pedal pulses are now difficult to palpate
Rationale:
Loss of pulses = circulatory compromise, which threatens limb viability. Requires immediate evaluation. Increasing redness and low-grade fever are expected in infection but not emergent. Wound VAC discomfort is normal.
A patient with kidney failure has a potassium level of 6.2 mEq/L. Which assessment finding indicates this electrolyte imbalance is becoming dangerous?
A. Muscle cramps
B. Constipation
C. Tall, peaked T waves on ECG
D. Decreased deep tendon reflexes
Correct Answer: C. Tall, peaked T waves on ECG
Rationale:
Hyperkalemia affects cardiac conduction, causing tall peaked T waves—an early sign of life-threatening arrhythmias.
Muscle cramps can occur with both low and high potassium.
Constipation and decreased reflexes are more typical of hypercalcemia or hypokalemia.
A patient has a PRN order for oxycodone 5 mg PO every 6 hours for pain rated 7–10. The patient reports pain rated 8/10, but the LPN notes the last dose was given 4 hours ago. What should the LPN do?
A. Administer the oxycodone now
B. Offer non-pharmacologic pain relief and reassess
C. Request an early dose from the provider
D. Document that the patient must wait 2 more hours
Correct Answer: C. Request an early dose from the provider
Rationale:
The medication cannot be given early without an order.
The patient’s pain is severe (8/10), so simply waiting or offering non-pharmacologic interventions is not enough.
The appropriate action is to seek an additional or adjusted order.