Editing Nursing Skills and Procedures – LPN Practice Questions

These 15 items test '''Nursing Skills and Procedures''' at practical and vocational nurse complexity: correct technique for foundational skills, safe practice within scope, and recognizing when to notify the registered nurse or provider. Options are numbered as they render; the letter equivalent is given with each answer.

==Question 1==
A licensed practical nurse is inserting an indwelling urinary catheter for a female client. The catheter has been advanced 3 inches and no urine has returned. Which action should the nurse take?
# Inflate the balloon and then advance the catheter further.
# Withdraw the catheter slightly and inflate the balloon.
# Advance the catheter further until urine returns.
# Remove the catheter and notify the registered nurse.

'''Answer:''' 3 (C). Advance the catheter further until urine returns.

''Rationale:'' The balloon is never inflated until urine return confirms the catheter is in the bladder. Inflating in the urethra causes severe trauma and can rupture the urethra, so options 1 and 2 are unsafe. The nurse continues to advance gently until urine appears, then advances another 1 to 2 inches before inflating. Option 4 is premature; the catheter is still sterile and in place, and no resistance has been met. If firm resistance were encountered, the nurse would stop, not force, and notify.

==Question 2==
A licensed practical nurse is setting up a sterile field for a dressing change. Which action indicates the need for correction?
# The nurse holds sterile items above waist level.
# The nurse considers the outer 1 inch border of the field contaminated.
# The nurse reaches across the sterile field to place a gauze pad on the far side.
# The nurse opens the outermost flap of a sterile package away from the body.

'''Answer:''' 3 (C). The nurse reaches across the sterile field to place a gauze pad on the far side.

''Rationale:'' Reaching over a sterile field contaminates it, because skin scales and organisms fall onto the field. The nurse moves around the field instead. Options 1, 2, and 4 are all correct sterile technique: sterile items stay above the waist and in view, the 1 inch border is treated as contaminated, and the first flap of a package is opened away from the body so the nurse never reaches over the contents.

==Question 3==
A licensed practical nurse is performing a dressing change on a clean, healing abdominal incision. Which cleansing technique is correct?
# Clean in a circular motion beginning at the outer edge and moving toward the incision.
# Clean along the incision line first, then outward, using a new gauze for each stroke.
# Scrub back and forth across the incision with a single saturated gauze.
# Clean from the drain site toward the incision using one gauze pad.

'''Answer:''' 2 (B). Clean along the incision line first, then outward, using a new gauze for each stroke.

''Rationale:'' Cleansing always moves from the least contaminated area to the most contaminated area, which means from the incision outward, and a new gauze is used for every stroke so organisms are not carried back. Options 1 and 4 move contaminated material toward the incision. Option 3 both moves back and forth over the wound and reuses a soiled gauze. A drain site is considered more contaminated than an incision, so an incision is cleaned before a drain when both are present.

==Question 4==
A licensed practical nurse is teaching a client how to collect a clean catch midstream urine specimen. Which client statements indicate correct understanding? '''Select all that apply.'''
# "I will clean from front to back before I start."
# "I will start urinating in the toilet, then catch the urine in the cup."
# "I will collect the very first urine that comes out."
# "I will avoid touching the inside of the container or the lid."
# "I will let you know as soon as I am done so the sample can go to the lab."

'''Answer:''' 1, 2, 4, and 5 (A, B, D, E).

''Rationale:'' Cleaning front to back reduces contamination with perineal and rectal flora, and the initial stream is discarded because it flushes urethral organisms, which makes option 3 incorrect. Keeping the inside of the container and lid untouched preserves sterility, and prompt transport prevents bacterial overgrowth that produces falsely elevated colony counts.

==Question 5==
A licensed practical nurse is caring for a client receiving a continuous enteral tube feeding. Which action is most important to prevent aspiration?
# Flush the tube with 30 mL of water every four hours.
# Keep the head of the bed elevated 30 to 45 degrees.
# Warm the formula to room temperature before hanging it.
# Change the feeding bag and tubing every 24 hours.

'''Answer:''' 2 (B). Keep the head of the bed elevated 30 to 45 degrees.

''Rationale:'' Elevating the head of the bed is the single most effective nursing measure for preventing aspiration during enteral feeding, and it is maintained during the feeding and for at least 30 to 60 minutes after an intermittent feeding. Flushing in option 1 maintains patency and hydration but does not prevent aspiration. Options 3 and 4 improve comfort and reduce infection risk but do not address aspiration.

==Question 6==
While a licensed practical nurse is administering an intermittent tube feeding, the client begins coughing forcefully and reports feeling short of breath. Which action should the nurse take '''first'''?
# Stop the feeding.
# Check the residual volume.
# Notify the registered nurse.
# Lower the head of the bed.

'''Answer:''' 1 (A). Stop the feeding.

''Rationale:'' Coughing and dyspnea during a feeding suggest aspiration or tube displacement, and the first action is to stop the flow of formula so no more enters the airway. The nurse then turns the client to the side, suctions as needed, provides oxygen, and notifies the registered nurse, so option 3 follows rather than precedes the immediate protective action. Option 2 wastes time and requires the tube to be used. Option 4 would increase aspiration risk.

==Question 7==
A licensed practical nurse is preparing to administer subcutaneous heparin. Which actions are correct? '''Select all that apply.'''
# Select a site on the abdomen at least 2 inches away from the umbilicus.
# Insert the needle at a 90 degree angle into a pinched skin fold.
# Aspirate for blood return before injecting.
# Massage the site gently after withdrawing the needle.
# Rotate injection sites with each dose.

'''Answer:''' 1, 2, and 5 (A, B, E).

''Rationale:'' Abdominal subcutaneous tissue at least 2 inches from the umbilicus provides consistent absorption, a pinched fold at 90 degrees keeps the drug out of muscle, and site rotation prevents hematoma and tissue damage. Aspiration in option 3 and massage in option 4 both increase bruising and hematoma formation with anticoagulants and are omitted.

==Question 8==
A licensed practical nurse is preparing to give a client both regular insulin and NPH insulin in one syringe. Which sequence is correct?
# Inject air into the regular vial, inject air into the NPH vial, withdraw NPH, then withdraw regular.
# Inject air into the NPH vial, inject air into the regular vial, withdraw regular, then withdraw NPH.
# Withdraw NPH first, then withdraw regular, then inject air into both vials.
# Withdraw regular first, then inject air into the NPH vial, then withdraw NPH.

'''Answer:''' 2 (B). Inject air into the NPH vial, inject air into the regular vial, withdraw regular, then withdraw NPH.

''Rationale:'' Air is injected into the cloudy intermediate-acting insulin first without touching the solution, then into the clear regular insulin, and the clear insulin is drawn up first: clear before cloudy. This sequence prevents contaminating the fast-acting regular insulin vial with the protamine-containing NPH suspension, which would alter its onset. Long-acting analogs such as glargine and detemir are never mixed with any other insulin.

==Question 9==
A licensed practical nurse is administering an intradermal tuberculin skin test. Which technique is correct?
# Insert the needle bevel down at a 45 degree angle and massage the site.
# Insert the needle bevel up at a 5 to 15 degree angle until a small wheal forms.
# Insert the needle at a 90 degree angle into the deltoid muscle.
# Insert the needle at a 45 degree angle into a pinched skin fold on the abdomen.

'''Answer:''' 2 (B). Insert the needle bevel up at a 5 to 15 degree angle until a small wheal forms.

''Rationale:'' Intradermal injection places a very small volume, generally 0.1 mL, just under the epidermis on the inner forearm. The needle is inserted bevel up at a nearly flat angle, and a 6 to 10 mm wheal confirms correct depth. The site is not massaged, because dispersing the medication invalidates the test. Option 3 describes an intramuscular injection and option 4 a subcutaneous injection.

==Question 10==
A licensed practical nurse is caring for a client receiving oxygen at 5 L/min through a nasal cannula. Which nursing actions are appropriate? '''Select all that apply.'''
# Add humidification to the oxygen delivery system.
# Assess the nares and the tops of the ears for skin breakdown.
# Apply a petroleum-based ointment to the client's dry lips.
# Post oxygen precaution signage and confirm that no smoking occurs in the room.
# Increase the flow rate if the client reports feeling short of breath.

'''Answer:''' 1, 2, and 4 (A, B, D).

''Rationale:'' Humidification is added at flow rates above about 4 L/min to prevent mucosal drying and epistaxis, pressure points at the nares and ears must be inspected regularly, and oxygen is a fire accelerant requiring precautions. Option 3 is unsafe, because petroleum-based products are flammable near oxygen; a water-soluble lubricant is used instead. Option 5 is outside scope: oxygen is a medication and the flow rate is changed only with an order, so new dyspnea is assessed and reported to the registered nurse.

==Question 11==
A licensed practical nurse is caring for a client with ''Clostridioides difficile'' infection. Which action is essential?
# Use an alcohol-based hand rub after removing gloves.
# Wash hands with soap and water after removing gloves.
# Wear an N95 respirator when entering the room.
# Place the client in a negative pressure room.

'''Answer:''' 2 (B). Wash hands with soap and water after removing gloves.

''Rationale:'' ''C. difficile'' forms spores that alcohol-based hand rub does not kill, so mechanical removal with soap, water, and friction is required, making option 1 inadequate. The organism spreads by contact, so gown and gloves and a bleach-based sporicidal cleaner are used. Options 3 and 4 describe airborne precautions, which apply to tuberculosis, measles, and varicella, not to ''C. difficile''.

==Question 12==
A licensed practical nurse is performing tracheostomy care. Which action is correct?
# Remove the soiled ties first, then apply clean ties.
# Cut a gauze pad to fit around the tracheostomy tube.
# Secure the new ties before removing the old ties while holding the tube in place.
# Suction the tracheostomy on a routine schedule every two hours.

'''Answer:''' 3 (C). Secure the new ties before removing the old ties while holding the tube in place.

''Rationale:'' Applying new ties before removing the old ones, with the tube held securely, prevents accidental decannulation, which is a potential airway emergency. Option 1 leaves the tube unsecured. Option 2 is unsafe, because cut gauze sheds fibers that can be aspirated into the airway; a manufactured precut tracheostomy dressing is used. Option 4 is incorrect, because suctioning is performed based on assessment findings such as audible secretions, adventitious sounds, or falling saturation, not on a fixed schedule.

==Question 13==
A licensed practical nurse is collecting a 24 hour urine specimen. At hour 14 an assistive personnel accidentally discards one of the client's voids. Which action should the nurse take?
# Estimate the discarded volume and add it to the record.
# Continue the collection and note the missing specimen in the chart.
# Notify the registered nurse, discard the collection, and restart the 24 hour period.
# Extend the collection by an additional four hours to compensate.

'''Answer:''' 3 (C). Notify the registered nurse, discard the collection, and restart the 24 hour period.

''Rationale:'' A 24 hour collection must be complete to be valid, since results are calculated from total volume and total excretion over the timed period. Any lost void invalidates the test, and the collection is restarted after notifying the registered nurse and the laboratory. Options 1, 2, and 4 all yield inaccurate results that could lead to incorrect treatment decisions. Reminding the client and all staff with clear signage prevents recurrence.

==Question 14==
A licensed practical nurse is caring for a client who had an indwelling urinary catheter inserted six hours ago. Which finding should the nurse report to the registered nurse '''immediately'''?
# The drainage bag contains 250 mL of clear yellow urine.
# The client reports mild discomfort at the insertion site.
# No urine has drained in four hours and the client's lower abdomen is firm and distended.
# The catheter tubing is secured to the client's thigh with a securement device.

'''Answer:''' 3 (C). No urine has drained in four hours and the client's lower abdomen is firm and distended.

''Rationale:'' Absent output with suprapubic distension indicates obstruction or malposition, which can lead to bladder injury and must be reported promptly. Before or while reporting, the nurse checks for kinks, dependent loops, and bag position below bladder level. Option 1 is an appropriate output. Option 2 is common initially and is monitored, becoming reportable if it worsens. Option 4 describes correct practice that prevents traction on the urethra.

==Question 15==
A licensed practical nurse is reinforcing teaching for a client who will perform dressing changes at home. Which client statements require further teaching? '''Select all that apply.'''
# "I will call the clinic if the drainage turns thick and yellow green or starts to smell bad."
# "If the old dressing sticks, I will pull it off quickly to get it over with."
# "I will wash my hands before and after I change the dressing."
# "I will pack the wound as tightly as I can so it heals faster."
# "I will write the date and time on the new dressing."

'''Answer:''' 2 and 4 (B, D).

''Rationale:'' A stuck dressing is moistened with sterile normal saline and removed gently, because pulling it off tears away new granulation tissue and causes pain and bleeding. Packing is placed loosely, since tight packing raises pressure in the wound bed, impairs perfusion, and delays healing. Options 1, 3, and 5 are all correct: purulent or malodorous drainage suggests infection and warrants a call, hand hygiene is the primary infection control measure, and labeling the dressing documents when it was changed.

[[Category:Nursing Skills and Procedures]]
[[Category:Licensed Practical Nurse (NCLEX-PN)]]
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