Management of Care – LPN Practice Questions

Fifteen NCLEX-PN-style practice items on Management of Care. Items include standard multiple-choice and select-all-that-apply (SATA) formats. Answers reference the numbered options as they appear on the page. Scope of practice is set by each state's nurse practice act; these items reflect the nationally common standards tested on licensure examinations.

Question 1

A charge registered nurse (RN) gives a licensed practical nurse (LPN) a list of tasks for the shift. Which task should the LPN clarify with the RN because it is outside the LPN scope of practice?

1. Administering an intramuscular antibiotic to a stable client.
2. Performing the admission assessment on a client who has just arrived from the emergency department.
3. Changing a sterile dressing on a surgical wound.
4. Inserting a nasogastric tube for enteral feeding.

Answer: 2. Performing the admission assessment on a client who has just arrived from the emergency department.

Rationale: The initial comprehensive assessment requires nursing judgment and forms the basis of the care plan, so it belongs to the registered nurse. The LPN collects focused data and reports findings, but does not perform or sign off on the admission assessment. Options 1, 3, and 4 are established LPN skills for a stable client in most jurisdictions. Clarifying a questionable assignment with the RN, rather than silently performing it or silently refusing it, is the correct professional action.

Question 2

A licensed practical nurse is working with an assistive personnel (AP). Which task is appropriate for the LPN to delegate to the AP?

1. Measuring and recording intake and output for a stable client.
2. Determining whether a client's pain medication was effective.
3. Checking the placement of a nasogastric tube before a feeding.
4. Reinforcing teaching about the use of an incentive spirometer.

Answer: 1. Measuring and recording intake and output for a stable client.

Rationale: Measuring and recording intake and output is a standard, unvarying task on a stable client that requires no nursing judgment. Option 2 is evaluation of a client response, which is a licensed nursing function. Option 3 requires verification of tube placement before instilling anything, a high-risk skill reserved for licensed nurses. Option 4 is teaching, which even in its reinforcing form requires a licensed nurse. Assistive personnel may report what they observe but may not interpret findings or evaluate outcomes.

Question 3

Which activities are within the scope of a licensed practical nurse caring for stable clients? Select all that apply.

1. Administering a subcutaneous insulin dose according to an established sliding scale.
2. Collecting data on a client's lung sounds and reporting the findings to the registered nurse.
3. Creating the nursing care plan for a newly admitted client.
4. Performing tracheostomy care and suctioning.
5. Administering a unit of packed red blood cells.
6. Applying a sterile dressing to a stage 2 pressure injury.

Answer: 1, 2, 4, and 6.

Rationale: Administering insulin according to a prescriber-established sliding scale, collecting and reporting focused data, performing tracheostomy care and suctioning, and providing sterile wound care are all customary LPN functions for a stable client. Option 3 is care planning, which requires the nursing diagnosis and judgment that belong to the registered nurse. Option 5 involves administration of a blood product, which in most jurisdictions must be initiated and administered by a registered nurse. The LPN must always verify scope against the nurse practice act in the state of licensure and against facility policy.

Question 4

A licensed practical nurse is caring for four clients. Which finding should be reported to the supervising registered nurse immediately?

1. A client with heart failure whose weight has increased 1 kg (2.2 lb) since yesterday morning.
2. A client with an indwelling urinary catheter whose output was 60 mL over the past hour.
3. A client 1 day postoperative who reports incisional pain of 5 on a 0 to 10 scale, relieved by the ordered analgesic.
4. A client with type 2 diabetes mellitus whose fasting blood glucose is 118 mg/dL.

Answer: 1. The client with heart failure whose weight has increased 1 kg (2.2 lb) since yesterday morning.

Rationale: A 1 kg gain in 24 hours corresponds to roughly 1 L of retained fluid and signals worsening heart failure before crackles or dyspnea may be evident. This is an unexpected change that requires the registered nurse's assessment. Option 2 is adequate output, since 60 mL/hr exceeds the minimum of about 30 mL/hr. Option 3 is expected postoperative pain that responded to treatment. Option 4 is a mildly elevated but non-urgent fasting glucose. The LPN's central responsibility is to distinguish an expected finding from a change that must be escalated.

Question 5

A licensed practical nurse reports to the charge registered nurse that a client's blood pressure has dropped from 128/76 to 88/50 mm Hg and the client is now confused. The charge nurse says, "I am busy. I will get to it later." Which action should the LPN take next?

1. Document that the charge nurse was notified and continue with the other assigned clients.
2. Notify the nurse manager or house supervisor of the unresolved concern.
3. Telephone the provider directly and request new orders.
4. Wait and report the change during the end-of-shift handoff.

Answer: 2. Notify the nurse manager or house supervisor of the unresolved concern.

Rationale: When a client safety concern is not addressed at one level, the nurse escalates to the next level of the chain of command, promptly and one step at a time, and documents each step. Options 1 and 4 leave a deteriorating client unassessed and expose the LPN to liability for failure to escalate. Option 3 skips a level of the nursing chain of command; the registered nurse is accountable for the assessment that must precede a call for new orders. The LPN's duty to the client is not discharged simply by having told someone once.

Question 6

A caller identifies herself as the employer of a hospitalized client and asks when the client will be able to return to work. Which response by the licensed practical nurse is best?

1. Provide the anticipated discharge date so the employer can plan.
2. Explain that no information can be released without the client's written authorization.
3. Transfer the call to the provider so the provider can answer.
4. Ask the client's spouse whether it is acceptable to release the information.

Answer: 2. Explain that no information can be released without the client's written authorization.

Rationale: Protected health information may be disclosed only to those with a legitimate need to know for treatment, payment, or health care operations, and an employer does not meet that standard. Even confirming that the client is admitted may be a disclosure. Options 1 and 3 release or route information without authorization. Option 4 seeks permission from a person who has no authority to authorize release on behalf of a competent adult. The correct path is the client's own written authorization.

Question 7

While preparing a client for surgery, the licensed practical nurse is asked, "What are the risks of this operation?" The consent form has already been signed. Which action should the LPN take?

1. Describe the common risks that are listed on the consent form.
2. Reassure the client that the procedure is routine and there is no need to worry.
3. Notify the registered nurse and the surgeon that the client has unanswered questions about the procedure.
4. Tell the client to ask the surgeon in the operating room.

Answer: 3. Notify the registered nurse and the surgeon that the client has unanswered questions about the procedure.

Rationale: The provider performing the procedure is responsible for disclosing risks, benefits, and alternatives. A signature obtained from a client who does not understand does not constitute informed consent, and the client may withdraw consent at any time. The nurse advocates by stopping the process and notifying the provider. Option 1 assumes the provider's disclosure duty. Option 2 dismisses a legitimate concern and offers false reassurance. Option 4 defers the question until after the client has been anesthetized or transported.

Question 8

A licensed practical nurse begins the shift with four clients. Which client should the LPN see first?

1. A client whose scheduled dressing change is due.
2. A client who reports new shortness of breath and is using accessory muscles to breathe.
3. A client who requests medication for chronic low back pain rated 6 on a 0 to 10 scale.
4. A client who needs assistance to walk to the bathroom.

Answer: 2. The client who reports new shortness of breath and is using accessory muscles to breathe.

Rationale: New dyspnea with accessory muscle use is a breathing problem and an acute, unexpected change, which outranks every other option under the ABC framework. The LPN should assess the client, raise the head of the bed, apply oxygen if ordered, and report to the registered nurse immediately. Option 1 is a scheduled task. Option 3 is chronic pain, which is real and must be treated but does not precede a respiratory change. Option 4 is an activity of daily living that can be delegated to assistive personnel.

Question 9

A licensed practical nurse enters the room of a client who has a valid do-not-resuscitate order and finds the client apneic and pulseless. Which action should the LPN take?

1. Begin cardiopulmonary resuscitation and call for help.
2. Withhold resuscitation, remain with the client, and notify the registered nurse and the provider.
3. Activate the code blue team while waiting for the registered nurse.
4. Ask the family at the bedside whether resuscitation should be started.

Answer: 2. Withhold resuscitation, remain with the client, and notify the registered nurse and the provider.

Rationale: A do-not-resuscitate order is a valid provider order directing that cardiopulmonary resuscitation not be performed, and initiating resuscitation against it disregards the client's documented wishes. The nurse remains with the client, provides dignity and presence, supports the family, notifies the registered nurse and provider, and documents the findings and the time. Options 1 and 3 violate the order. Option 4 places an already-made decision back onto a grieving family in the moment of death.

Question 10

A licensed practical nurse realizes that an entry was charted on the wrong client's paper record. Which action is correct?

1. Erase the entry and rewrite it on the correct record.
2. Cover the entry with correction fluid and write the correct information.
3. Draw a single line through the entry, label it as an error, and add the date, time, and initials, leaving the original entry readable.
4. Ask the charge nurse to remove the page from the chart.

Answer: 3.

Rationale: The medical record is a legal document, and an error is corrected in a way that preserves the original entry and shows who made the correction and when. Erasing, using correction fluid, or removing pages destroys the record and can be construed as tampering or fraud, which carries far greater consequences than the original error. The LPN should also document the correct information in the correct client's record and notify the registered nurse.

Question 11

Which tasks may a licensed practical nurse appropriately delegate to an assistive personnel? Select all that apply.

1. Assisting a stable client with a bed bath.
2. Ambulating a stable client with a walker who has ambulated successfully with the walker before.
3. Determining whether a reddened area over a client's sacrum is a stage 1 pressure injury.
4. Recording the percentage of the lunch tray eaten by a client with no swallowing difficulty.
5. Emptying a urinary drainage bag and recording the volume.
6. Deciding whether a client is ready to be transferred from the bed to a chair for the first time after surgery.

Answer: 1, 2, 4, and 5.

Rationale: Bathing, ambulating a stable client with a device the client has already used successfully, recording food intake for a client with no swallowing risk, and emptying and measuring a drainage bag are standard, unvarying tasks on stable clients that require no nursing judgment. Option 3 is staging a wound, which is an assessment. Option 6 is a judgment about readiness for a first postoperative transfer, which requires evaluation of the client's status. Assistive personnel may observe and report, such as noting that the sacrum looks red, but may not interpret findings or make care decisions.

Question 12

A licensed practical nurse is floated to a unit and is assigned to perform a skill for which the LPN has never been trained. Which action should the LPN take?

1. Perform the skill, since it was included in the assignment.
2. Inform the charge nurse of the lack of training and request orientation or reassignment of that specific task.
3. Refuse the entire assignment and leave the unit.
4. Ask an assistive personnel who is familiar with the unit to perform the skill.

Answer: 2. Inform the charge nurse of the lack of training and request orientation or reassignment of that specific task.

Rationale: A nurse is accountable for practicing only within demonstrated competence, and performing an untrained skill exposes the client to harm and the nurse to liability. At the same time, refusing an entire assignment without notice can constitute abandonment. The correct action is to accept the assignment, promptly and specifically identify which portion exceeds current competence, and negotiate orientation, supervision, or reassignment of that task. Option 4 delegates a licensed skill to unlicensed personnel, which compounds the problem.

Question 13

A registered nurse has completed initial teaching for a client newly prescribed insulin. Later, the client asks the licensed practical nurse to go over how to draw up the dose again. Which action should the LPN take?

1. Tell the client to wait until the registered nurse is available.
2. Review the steps with the client, observe a return demonstration, and report the client's performance to the registered nurse.
3. Give the client a manufacturer's pamphlet and document that teaching is complete.
4. Refer the client to the pharmacist for instruction.

Answer: 2.

Rationale: The registered nurse performs initial teaching and evaluates learning; the LPN reinforces teaching that has already been initiated and reports the client's response so that the registered nurse can evaluate whether the outcome was met. Reviewing the steps and observing a return demonstration is exactly that reinforcing role. Option 1 withholds appropriate care the LPN may provide. Option 3 substitutes a handout for instruction and documents an outcome that was never evaluated. Option 4 unnecessarily transfers a nursing responsibility.

Question 14

A licensed practical nurse is caring for a client in bilateral soft wrist restraints. Which action by the LPN indicates a need for further education?

1. Securing the restraint straps to the side rail of the bed.
2. Tying the restraint straps using a quick-release knot.
3. Checking circulation, sensation, and skin integrity distal to the restraints.
4. Releasing the restraints every 2 hours to provide range of motion and toileting.

Answer: 1. Securing the restraint straps to the side rail of the bed.

Rationale: Restraints must be secured to the movable part of the bed frame, never to a side rail. A restraint tied to a side rail will pull on the client's limb when the rail is raised or lowered and can cause injury. Options 2, 3, and 4 all describe correct practice: a quick-release knot allows rapid removal in an emergency, neurovascular and skin checks detect impaired circulation and pressure injury, and periodic release with range of motion, toileting, and fluids is required. The LPN should also verify that a current, time-limited provider order exists, because as-needed restraint orders are prohibited.

Question 15

During a bath, a licensed practical nurse notes that an older adult client has bruises in several stages of healing on the upper arms, and the client's adult son answers every question directed to the client. Which action should the LPN take?

1. Confront the son about the possibility that he is harming the client.
2. Document the findings objectively and report the observations to the registered nurse immediately.
3. Wait until the next shift to see whether additional bruises appear.
4. Ask the client in front of the son whether anyone is hurting her.

Answer: 2. Document the findings objectively and report the observations to the registered nurse immediately.

Rationale: Nurses are mandatory reporters of suspected abuse of older and dependent adults, and reporting requires reasonable suspicion, not proof. The LPN's role is to document exactly what was seen, without conclusions or accusations, and to report to the registered nurse so that a full assessment and the required report can be initiated. Option 1 may place the client at greater risk and is not the nurse's investigative role. Option 3 delays protection of a vulnerable client. Option 4 questions the client in the presence of the possible perpetrator, which is unsafe; such questions must be asked privately.

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