National Council Licensure Examination Practice Test

NCLEX-PN exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

The test plan is reviewed and approved by the NCLEX®
Examination Committee (NEC) every three years.
Multiple resources are used- including the latest practice analysis of licensed practical/vocational nurses
(LPN/VNs)- and expert opinions of the NEC- NCSBN staff and nursing regulatory bodies (NRBs) to ensure that
the test plan is consistent with nurse practice acts. Following the endorsement of proposed revisions by
the NEC- the test plan document is presented for approval to the Delegate Assembly- which is the decisionmaking body of NCSBN.
The test plan serves a variety of purposes. It is used to guide candidates preparing for the examination- to
direct item writers in the development of items- and to facilitate the classification of examination items. This
document offers a comprehensive listing of content for each client needs category and subcategory outlined
in the test plan. demo items are provided at the end of each category- which are specific to the client needs
category in that section. There is an item writing guide along with demo case scenarios- which provide
nurse educators with hands-on experience in writing NCLEX-style test items.

Entry into the practice of nursing is regulated by the licensing authorities within each of the NCSBN nursing
regulatory bodies (state- commonwealth and territorial boards of nursing). To ensure public protection- each
jurisdiction requires candidates for licensure to meet set requirements that include passing an examination
that measures the competencies needed to perform safely and effectively as a licensed practical/vocational
nurse (LPN/VN). NCSBN develops a licensure examination- the National Council Licensure Examination for
Practical Nurses (NCLEX-PN®)- which is used by U.S. members to assist in making licensure decisions.
Several steps occur in the development of the NCLEX-PN Test Plan. The first step is conducting a practice
analysis that is used to collect data on the current practice of entry-level LPN/VNs (Report of Findings from
the 2018 LPN/VN Practice Analysis: Linking the NCLEX-PN® Examination to Practice- NCSBN- 2019). Twelve
thousand newly licensed practical/vocational nurses are asked about the frequency and priority of performing nursing care activities. Nursing care activities are then analyzed in relation to the frequency of performance- impact on maintaining client safety and client care settings where the activities are performed. This
analysis guides the development of a framework for entry-level nursing practice that incorporates specific
client needs- as well as processes that are fundamental to the practice of nursing. The next step is the
development of the NCLEX-PN Test Plan- which guides the selection of content and behaviors to be tested.
Variations in jurisdiction laws and regulations are considered in the development of the test plan.
The NCLEX-PN Test Plan provides a concise summary of the content and scope of the licensure examination.
It serves as a guide for examination development as well as candidate preparation. The NCLEX® assesses the knowledge- skills and abilities that are essential for the entry-level LPN/VN to use in order to meet the needs
of clients requiring the promotion- maintenance and restoration of health. The following sections describe
beliefs about people and nursing that are integral to the examination- cognitive abilities that will be tested in
the examination and specific components of the NCLEX-PN Test Plan.

Client Needs
Percentage of Items from Each
Category/Subcategory
Safe and Effective Care Environment
„ Coordinated Care 18–24%
„ Safety and Infection Control 10–16%
Health Promotion and Maintenance 6–12%
Psychosocial Integrity 9–15%
Physiological Integrity
„ Basic Care and Comfort 7–13%
„ Pharmacological Therapies 10–16%
„ Reduction of Risk Potential 9–15%
„ Physiological Adaptation 7–13%

The activity statements used in the 2018 LPN/VN Practice Analysis: Linking the NCLEX-PN®
Examination to
Practice (NCSBN- 2019) preface each of the eight content categories and are identified throughout the test
plan by an asterisk (*). NCSBN performs an analysis of those activities used frequently and identified as
important by entry-level nurses to ensure client safety. This is called a practice analysis; it provides data to
support the NCLEX as a reliable- valid measure of competent- entry-level LPN/VN practice. The practice analysis is conducted every three years.
In addition to the practice analysis- NCSBN conducts a knowledge- skills and abilities (KSA) survey. The primary purpose of this study is to identify the knowledge needed by newly licensed practical/vocational nurses
in order to provide safe and effective care. Findings from both the 2018 LPN/VN Practice Analysis: Linking
the NCLEX-PN®
Examination to Practice (NCSBN- 2019) and the 2018 LPN/VN Nursing Knowledge Survey
(NCSBN- 2019) can be found at www.ncsbn.org/1235.htm. Both documents are used in the development of
the NCLEX-PN Test Plan as well as to inform item development.
All task statements in the 2020 NCLEX-PN®
Test Plan require the nurse to apply the fundamental principles
of clinical decision making and critical thinking to nursing practice. The test plan also makes the assumption
that the nurse integrates concepts from the following bodies of knowledge:
„ Social Sciences (psychology and sociology); and
„ Biological Sciences (anatomy- physiology- biology and microbiology) Collaboration with Interdisciplinary Team
„ Identify roles/responsibilities of health care team members
„ Identify need for nursing or interdisciplinary client care conference
„ Contribute to the development of and/or update the client plan of care
„ Contribute to planning interdisciplinary client care conferences
„ Participate as a member of an interdisciplinary team Concepts of Management and Supervision
„ Recognize and report staff conflict
„ Verify abilities of staff members to perform assigned tasks (e.g.- job description- scope of practice- training- experience)
„ Provide input for performance evaluation of other staff
„ Participate in staff education (e.g.- inservices- continued competency)
„ Use data from various credible sources in making clinical decisions
„ Serve as resource person to other staff
„ Monitor activities of assistive personnel
Confidentiality/Information Security
„ Identify staff actions that impact client confidentiality and intervene as needed (e.g.- access to medical records- discussions at nurses station- change-of-shift reports)
„ Recognize staff member and client understanding of confidentiality requirements
„ Apply knowledge of facility regulations when accessing client records
„ Maintain client confidentiality*
„ Provide for privacy needs Continuity of Care
„ Follow up with client after discharge*
„ Participate in client discharge or transfer*
„ Provide follow-up for unresolved client care issues
„ Provide and receive report*
„ Record client information (e.g.- medical record- referral/transfer form)
„ Use agency guidelines to guide client care (e.g.- clinical pathways- care maps- care plans)
Establishing Priorities
„ Organize and prioritize care based on client needs*
„ Participate in planning client care based upon client needs (e.g.- diagnosis- abilities- prescribed treatment)
„ Use effective time management skills
Ethical Practice
„ Identify ethical issues affecting staff or client
„ Inform client of ethical issues affecting client care
„ Intervene to promote ethical practice
„ Practice in a manner consistent with code of ethics for nurses*
„ Review client and staff member knowledge of ethical issues affecting client care Informed Consent
„ Identify appropriate person to provide informed consent for client (e.g.- client- parent- legal guardian)
„ Participate in client consent process*
„ Describe informed consent requirements (e.g.- purpose for procedure- risks of procedure)
„ Recognize that informed consent was obtained (e.g.- completed consent form- client understanding of procedure)
Information Technology
„ Use information technology in client care*
„ Access data for client or staff through online databases and journals
„ Enter computer documentation accurately- completely and in a timely manner
Legal Responsibilities
„ Identify legal issues affecting staff and client (e.g.- refusing treatment)
„ Verify and process health care provider orders*
„ Recognize self-limitations of task/assignments and seek assistance when needed*
„ Respond to the unsafe practice of a health care provider (e.g.- intervene- report)*
„ Follow regulation/policy for reporting specific issues (e.g.- abuse- neglect- gunshot wound-
communicable disease)*
„ Document client care
„ Provide care within the legal scope of practice*
Performance Improvement (Quality Improvement)
„ Identify impact of performance improvement/quality improvement activities on client care
outcomes
„ Participate in quality improvement (QI) activity (e.g.- collecting data- serving on QI committee)*
„ Document performance improvement/quality improvement activities
„ Report identified performance improvement/quality improvement concerns to appropriate
personnel (e.g.- nurse manager- risk manager)
„ Apply evidence-based practice when providing care*

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Question: 13
Which of the following is not considered one of the five rights of medication administration?
A. client
B. drug
C. dose
D. routine
Answer: D
Explanation:
Dose, client, drug, route and time are considered the five rights of medication.
Question: 14
When giving an intramuscular injection to an infant. Which of the following sites is preferred?
A. Ventrogluteal region
B. Deltoid
C. Vastus lateralis
D. Dorsogluteal region
Answer: C
Explanation:
Vastus lateralis is the ideal choice for infants.
Question: 15
When choosing a needle gauge for an intramuscular injection in a 12 year old boy. Which of the following gauges
would you choose?
A. 27 gauge
B. 25 gauge
C. 22 gauge
D. 20 gauge
Answer: C
Explanation:
22 gauge is recommended for school age children, toddlers, and adolescents while 23-25 gauge is recommended
for infants.
Question: 16
Which of the following is not considered one of the main mechanisms of Type II Diabetes treatment?
A. Medications
B. Nutrition
C. Increased activity
D. Continuous Insulin
Answer: D
Explanation:
Insulin is not required in continuous treatment for every Type II diabetic.
Question: 17
A nurse is caring for a retired MD. The MD asks the question, "What type of cells create exocrine secretions?" The
correct answer is:
A. alpha cells
B. beta cells
C. acinar cells
D. plasma cells
Answer: C
Explanation:
Acinar cells create exocrine secretions.
Question: 18
A nurse is caring for a patient who has experienced burns to the right lower extremity. According to the Rule of
Nines which of the following percents most accurately describes the severity of the injury?
A. 36%
B. 27%
C. 18%
D. 9%
Answer: C
Explanation:
Each lower extremity is scored as 18% according to the Rule of Nines.
Question: 19
A patient has experienced a severe third degree burn to the trunk in the last 36 hours. Which phase of burn
management is the patient in?
A. Shock phase
B. Emergent phase
C. Healing phase
D. Wound proliferation phase
Answer: A
Explanation:
The shock phase is considered the first 24-48 hours in wound management.
Question: 20
A patient has fallen off a bicycle and fractured the head of the proximal fibula. A cast was placed on the patient�s
lower extremity. Which of the following is the most probable result of the fall?
A. Peroneal nerve injury
B. Tibial nerve injury
C. Sciatic nerve injury
D. Femoral nerve injury
Answer: A
Explanation:
The head of the proximal fibula is in close proximity to the peroneal nerve.
Question: 21
A nurse has been ordered to set-up Buck�s traction on a patient�s lower extremity due to a femur fracture. Which
of the following applies to Buck�s traction?
A. A weight greater than 10 lbs. should be used.
B. The line of pull is upward at an angle.
C. The line of pull is straight
D. A weight greater than 20 lbs. should be used.
Answer: C
Explanation:
A straight line of pull is indicated with Buck�s traction.
Question: 22
Which of the following motions is identified with the corresponding action? (Action- Turning palm of hand over to
face in the anterior direction, dorsum of the hand is pointed downward toward the floor.)
A. Pronation
B. Supination
C. Abduction
D. Adduction
Answer: B
Explanation:
Supination- "Holding a bowl of soup in your hand."
Question: 23
A nurse is caring for a retired MD. The MD asks the question, "What type of cells secrete insulin?" The correct
answer is:
A. alpha cells
B. beta cells
C. CD4 cells
D. helper cells
Answer: B
Explanation:
Beta cells secrete insulin.
Question: 24
A nurse is reviewing a patient�s current Lithium levels. Which of the following values is outside the therapeutic
range?
A. 1.0 mEq/L
B. 1.1 mEq/L
C. 1.2 mEq/L
D. 1.3 mEq/L
Answer: D
Explanation:
1.0-1.2 mEq/L is considered standard therapeutic range for patient care.
Question: 25
A client is going to have an endoscopy performed. Which of the following is not a probable reason for an
endoscopy procedure?
Question: 1657
Nurse's Note:
0900: 70-year-old male client with a history of hypertension and diabetes presents to the emergency
department with severe chest pain radiating to the left arm. The client reports associated shortness of
breath and diaphoresis.
Vital Signs:
Temp: 98.6�F (37�C)
P: 115
RR: 22
BP: 180/110
O2: sat 94% on room air
The nurse suspects the client may be experiencing a myocardial infarction. Which finding supports this
suspicion? (Select all that apply.)
A. Diaphoresis.
B. Chest pain radiating to the left arm.
C. Elevated heart rate.
D. Increased blood pressure.
E. Oxygen saturation of 94%.
F. History of diabetes.
Answer: A, B, C, D
Explanation: Diaphoresis, chest pain radiating to the left arm, elevated heart rate, and increased blood
pressure are all classic signs of myocardial infarction, indicating the need for immediate intervention.
Question: 1658
Client History:
70-year-old male client with a history of heart failure presents with increased shortness of breath and a
productive cough. The client reports feeling more fatigued than usual.
Vital Signs:
BP: 130/80
HR: 98
Temp: 99�F (37.2�C)
RR: 30
SpO2: 89% on 2L O2/NC
Identify the priority nursing interventions for this client. (Select All That Apply)
A. Administer diuretics as prescribed
B. Assess lung sounds frequently
C. Educate the client on daily weight monitoring
D. Initiate oxygen therapy
E. Monitor for signs of fluid overload
Answer: A, B, D, E
Explanation: Administering diuretics helps relieve fluid overload. Assessing lung sounds frequently is
critical to evaluate respiratory status. Initiating oxygen therapy addresses hypoxia, and monitoring for
signs of fluid overload ensures timely intervention.
Question: 1659
A client with heart failure is prescribed furosemide. What laboratory value should the nurse monitor
closely? (Select All That Apply)
A. Potassium levels
B. Sodium levels
C. BUN and creatinine
D. Calcium levels
Answer: A, B, C
Explanation: Furosemide can cause electrolyte imbalances, particularly hypokalemia and hyponatremia,
and may affect renal function, necessitating monitoring of BUN and creatinine levels.
Question: 1660
Nurse's Note:
1500: 82-year-old female client with a history of dementia presents with increased agitation and refusal
to eat. The family reports a sudden change in her behavior.
Vital Signs:
Temp: 98.5�F (36.9�C)
P: 80
RR: 16
BP: 120/80
O2: sat 95% on room air
Which 4 findings from the nurse's notes are most important to address immediately?
A. Increased agitation.
B. Refusal to eat.
C. Sudden change in behavior.
D. Normal vital signs.
E. History of dementia.
F. Family concerns.
Answer: A, B, C, F
Explanation: Increased agitation and refusal to eat are concerning as they may indicate underlying
medical issues or acute changes in the client�s condition. A sudden change in behavior necessitates
further evaluation to identify possible causes.
Question: 1661
Nurse's Note:
1600: 49-year-old male client with a history of asthma presents with severe wheezing and shortness of
breath after exposure to allergens. The client reports increased use of his rescue inhaler.
Vital Signs:
Temp: 98.4�F (36.9�C)
P: 100
RR: 28
BP: 125/80
O2: sat 87% on 3L O2 via nasal cannula
Which 4 findings from the nurse's notes are most critical to address immediately?
A. Severe wheezing.
B. Shortness of breath.
C. Increased use of rescue inhaler.
D. Oxygen saturation of 87%.
E. Normal blood pressure.
F. Elevated pulse rate.
Answer: A, B, D, C
Explanation: Severe wheezing and shortness of breath indicate an acute asthma exacerbation requiring
immediate treatment. An oxygen saturation of 87% suggests hypoxia, necessitating urgent intervention.
Question: 1662
Nurse's Note:
2600: 65-year-old male client with a history of chronic heart failure presents with increased edema and
shortness of breath. The client reports a rapid weight gain of 5 pounds over the past week.
Vital Signs:
Temp: 98.7�F (37.1�C)
P: 90
RR: 24
BP: 135/85
O2: sat 90% on 3L O2 via nasal cannula
Which findings from the nurse's notes require immediate attention? (Select all that apply.)
A. Increased edema.
B. Shortness of breath.
C. Rapid weight gain.
D. Oxygen saturation of 90%.
E. Elevated blood pressure.
F. History of heart failure.
Answer: A, B, D, C
Explanation: Increased edema and shortness of breath are indicative of fluid overload that requires urgent
intervention. An oxygen saturation of 90% suggests hypoxia that needs to be addressed immediately.
Question: 1663
A nurse is preparing to administer a blood transfusion. Which of the following assessments should be
performed before starting the transfusion? (Select All That Apply)
A. Check the patient's vital signs
B. Confirm the blood type and Rh factor with another nurse
C. Assess for any history of allergic reactions to blood products
D. Obtain a signed consent form
Answer: A, B, C, D
Explanation: It is essential to check vital signs to establish a baseline, confirm blood type for
compatibility, assess for allergic history to prevent reactions, and ensure that informed consent is
obtained before any transfusion.
Question: 1664
Client History:
65-year-old female client with a history of hypertension presents with severe headache and visual
disturbances. The client reports a sudden onset of symptoms and has a family history of stroke.
Nurse's Note:
Vital signs reveal elevated blood pressure, and the client is diaphoretic. Neurological assessment shows
weakness on the right side.
Determine the priority nursing actions for this client. (Select All That Apply)
A. Administer antihypertensive medication
B. Initiate a stroke protocol
C. Monitor neurological status frequently
D. Prepare for a CT scan
E. Provide education on stroke prevention
Answer: B, C, D
Explanation: Initiating a stroke protocol is crucial for rapid assessment and intervention. Monitoring
neurological status helps detect changes in condition. Preparing for a CT scan is essential to rule out
hemorrhagic stroke.
Question: 1665
A nurse is assessing a client with pneumonia. Which of the following findings would indicate the need
for immediate intervention? (Select All That Apply)
A. Respiratory rate of 28 breaths per minute
B. Oxygen saturation of 90%
C. Productive cough with green sputum
D. Chest pain with inspiration
Answer: A, B, D
Explanation: Increased respiratory rate, low oxygen saturation, and chest pain during inspiration indicate
potential respiratory distress and warrant immediate intervention.
Question: 1666
Nurse's Note:
1500: 65-year-old male client with a history of coronary artery disease presents with chest pain described
as "pressure" and shortness of breath. The client is on aspirin and a beta-blocker.
Vital Signs:
Temp: 98.6�F (37�C)
P: 112
RR: 24
BP: 160/100
O2: sat 94% on room air
What findings from the nurse's notes require immediate intervention? (Select all that apply.)
A. Chest pain described as "pressure."
B. Shortness of breath.
C. Elevated heart rate.
D. Elevated blood pressure.
E. History of coronary artery disease.
F. Oxygen saturation of 94%.
Answer: A, B, D, C
Explanation: Chest pain and shortness of breath in the context of coronary artery disease are critical signs
that require urgent assessment. Elevated heart rate and blood pressure may indicate increased myocardial
oxygen demand, necessitating immediate intervention.
Question: 1667
Client History:
45-year-old client diagnosed with type 1 diabetes presents with severe abdominal pain, nausea, and
vomiting. The client has been experiencing increased thirst and urination. Laboratory results reveal a
blood glucose level of 450 mg/dL and metabolic acidosis.
Nurse's Note:
The client appears lethargic and dehydrated. The respiratory rate is rapid, and breath has a fruity odor.
The renal function tests indicate elevated creatinine levels.
Determine the priority nursing diagnosis for this client. (Select All That Apply)
A. Risk for fluid volume deficit
B. Ineffective airway clearance
C. Impaired glucose metabolism
D. Risk for impaired skin integrity
E. Acute pain related to abdominal distention
Answer: A, C
Explanation: The client presents with hyperglycemia and signs of diabetic ketoacidosis (DKA), indicating
impaired glucose metabolism. Risk for fluid volume deficit is significant due to dehydration from
osmotic diuresis. Addressing these issues is critical for the client�s stabilization.
Question: 1668
Client History:
67-year-old female client with a history of chronic kidney disease presents with fatigue, pruritus, and
confusion. The family reports increased forgetfulness.
Vital Signs:
BP: 120/70
HR: 85
Temp: 98.9�F (37.2�C)
RR: 20
SpO2: 96% on room air
Identify the priority nursing interventions for this client. (Select All That Apply)
A. Administer phosphate binders as prescribed
B. Educate the client on fluid restrictions
C. Monitor laboratory values for renal function
D. Assess skin integrity regularly
E. Implement a low-protein diet
Answer: A, C, E
Explanation: Administering phosphate binders helps manage hyperphosphatemia. Monitoring laboratory
values is essential for tracking renal function, and implementing a low-protein diet is critical to reduce
the workload on the kidneys.
Question: 1669
A nurse is reviewing a client�s lab results. Which result would indicate a need for further investigation in
a patient undergoing treatment for cancer?
A. Elevated white blood cell count
B. Low hemoglobin level
C. Elevated liver enzymes
D. Normal platelet count
Answer: C
Explanation: Elevated liver enzymes could indicate liver metastasis or toxicity from chemotherapy,
requiring further investigation.
Question: 1670
Client History:
79-year-old female client with a history of heart failure presents with sudden onset of shortness of breath
and chest pain. The family reports increased fatigue over the past week.
Nurse's Note:
The client appears anxious, and lung auscultation reveals bilateral crackles. Vital signs indicate
tachycardia and hypotension.
Vital Signs:
BP: 90/60
HR: 110
Temp: 98.6�F (37�C)
RR: 30
SpO2: 92% on 3L O2/NC
Identify the priority nursing interventions for this client. (Select All That Apply)
A. Administer diuretics as prescribed
B. Prepare for possible intubation
C. Assess for signs of fluid overload
D. Monitor vital signs frequently
E. Educate the family on heart failure management
Answer: A, B, C, D
Explanation: Administering diuretics helps relieve fluid overload. Preparing for intubation may be
necessary if the respiratory distress worsens. Assessing for signs of fluid overload is critical, and
monitoring vital signs frequently ensures timely interventions.
Question: 1671
A patient has been diagnosed with chronic obstructive pulmonary disease (COPD) and is experiencing an
exacerbation. What is the most critical nursing intervention?
A. Encourage deep breathing exercises
B. Administer bronchodilators as ordered
C. Provide supplemental oxygen
D. Monitor respiratory rate
Answer: B
Explanation: Administering bronchodilators is critical for relieving bronchospasm and improving airflow
during an exacerbation.
Question: 1672
Nurse's Note:
Report: A 50-year-old client with a history of liver cirrhosis is admitted with gastrointestinal bleeding.
The client reports vomiting bright red blood and has dark, tarry stools.
Vital Signs:
Temp 97�F (36.1�C), HR 130, BP 85/50, RR 24.
Lab Results:
Hgb 8.0 g/dL, Hct 25%, Platelets 90,000/mm3, INR 2.5.
Identify the critical factors for the nurse to consider in this case. (Select all that apply.)
A. Bright red blood in vomit
B. Dark, tarry stools
C. Low hemoglobin and hematocrit levels
D. Elevated INR
E. History of liver cirrhosis
Answer: A, B, C, D, E
Explanation: Each option presents vital information regarding the severity of the client's condition,
indicating significant hemorrhage and potential liver dysfunction requiring immediate nursing action.
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