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. sample 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 sample 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?
1. client
2. drug
3. dose
4. routine
Answer: D
Explanation:
tion: 14
giving an intramuscular injection to an infant. Which of the following sites is preferred?
entrogluteal region ltoid
astus lateralis orsogluteal region
er: C
anation:
lateralis is the ideal choice for infants.
tion: 15
choosing a needle gauge for an intramuscular injection in a 12 year old boy. Which of the following ga you choose?
gauge gauge gauge gauge
er: C
anation:
uge is recommended for school age children, toddlers, and adolescents while 23-25 gauge is recommen fants.
tion: 16
Dose, client, drug, route and time are considered the five rights of medication.
Ques
When
1. V
2. De
3. V
4. D
Answ
Expl Vastus Ques
When uges
would
1. 27
2. 25
3. 22
4. 20
Answ
Expl
22 ga ded
for in
Ques
Which of the following is not considered one of the main mechanisms of Type II Diabetes treatment?
1. Medications
2. Nutrition
3. Increased activity
4. 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:
1. alpha cells
2. beta cells
3. acinar cells
4. plasma cells
Answer: C
Explanation:
Acinar cells create exocrine secretions.
Question: 18
se is caring for a patient who has experienced burns to the right lower extremity. According to the Rule
which of the following percents most accurately describes the severity of the injury?
%
%
%
er: C
anation:
ower extremity is scored as 18% according to the Rule of Nines.
tion: 19
ient has experienced a severe third degree burn to the trunk in the last 36 hours. Which phase of burn gement is the patient in?
ock phase mergent phase ealing phase
ound proliferation phase
er: A
anation:
hock phase is considered the first 24-48 hours in wound management.
tion: 20
ient has fallen off a bicycle and fractured the head of the proximal fibula. A cast was placed on the patie
A nur of
Nines
1. 36
2. 27
3. 18
4. 9%
Answ
Expl Each l Ques
A pat mana
1. Sh
2. E
3. H
4. W
Answ
Expl The s Ques
A pat nt�s
lower extremity. Which of the following is the most probable result of the fall?
1. Peroneal nerve injury
2. Tibial nerve injury
3. Sciatic nerve injury
4. 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?
1. A weight greater than 10 lbs. should be used.
2. The line of pull is upward at an angle.
3. The line of pull is straight
4. 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
onation pination bduction dduction
er: B
anation:
ation- "Holding a bowl of soup in your hand."
tion: 23
se is caring for a retired MD. The MD asks the question, "What type of cells secrete insulin?" The corre answer is:
pha cells ta cells D4 cells lper cells
er: B
anation:
ells secrete insulin.
tion: 24
se is reviewing a patient�s current Lithium levels. Which of the following values is outside the therapeut
mEq/L
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.)
1. Pr
2. Su
3. A
4. A
Answ
Expl Supin Ques
A nur ct
1. al
2. be
3. C
4. he
Answ
Expl Beta c Ques
A nur ic
range?
1. 1.0
2. 1.1 mEq/L
3. 1.2 mEq/L
4. 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.
98.6�F (37�C)
80/110
94% on room air
urse suspects the client may be experiencing a myocardial infarction. Which finding supports ion? (Select all that apply.)
phoresis.
est pain radiating to the left arm. vated heart rate.
reased blood pressure. ygen saturation of 94%. tory of diabetes.
er: A, B, C, D
nation: Diaphoresis, chest pain radiating to the left arm, elevated heart rate, and increased blo re are all classic signs of myocardial infarction, indicating the need for immediate interventi
ion: 1658
Vital Signs: Temp:
P: 115
RR: 22
BP: 1
O2: sat
The n this
suspic
1. Dia
2. Ch
3. Ele
4. Inc
5. Ox
6. His Answ
Expla od
pressu on.
Quest
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)
1. Administer diuretics as prescribed
2. Assess lung sounds frequently
3. Educate the client on daily weight monitoring
4. Initiate oxygen therapy
5. Monitor for signs of fluid overload Answer: A, B, D, E
nation: Administering diuretics helps relieve fluid overload. Assessing lung sounds frequentl to evaluate respiratory status. Initiating oxygen therapy addresses hypoxia, and monitoring f fluid overload ensures timely intervention.
ion: 1659
nt with heart failure is prescribed furosemide. What laboratory value should the nurse monit y? (Select All That Apply)
assium levels dium levels
N and creatinine cium levels
er: A, B, C
nation: Furosemide can cause electrolyte imbalances, particularly hypokalemia and hyponatre ay affect renal function, necessitating monitoring of BUN and creatinine levels.
ion: 1660
Expla y is
critical for
signs o
Quest
A clie or
closel
1. Pot
2. So
3. BU
4. Cal Answ
Expla mia,
and m
Quest
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?
1. Increased agitation.
2. Refusal to eat.
3. Sudden change in behavior.
4. Normal vital signs.
5. History of dementia.
nation: 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
evaluation to identify possible causes.
ion: 1661
Note:
9-year-old male client with a history of asthma presents with severe wheezing and shortnes after exposure to allergens. The client reports increased use of his rescue inhaler.
igns:
98.4�F (36.9�C)
25/80
87% on 3L O2 via nasal cannula
4 findings from the nurse's notes are most critical to address immediately? vere wheezing.
ortness of breath.
reased use of rescue inhaler.
Family concerns. Answer: A, B, C, F Expla
further
Quest
Nurse's
1600: 4 s of
breath
Vital S Temp: P: 100
RR: 28
BP: 1
O2: sat Which
1. Se
2. Sh
3. Inc
4. Oxygen saturation of 87%.
5. Normal blood pressure.
6. 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
35/85
90% on 3L O2 via nasal cannula
findings from the nurse's notes require immediate attention? (Select all that apply.) reased edema.
ortness of breath. pid weight gain.
ygen saturation of 90%. vated blood pressure. tory of heart failure.
er: A, B, D, C
nation: Increased edema and shortness of breath are indicative of fluid overload that requires ention. An oxygen saturation of 90% suggests hypoxia that needs to be addressed immediatel
ion: 1663
nurse is preparing to administer a blood transfusion. Which of the following assessments should med before starting the transfusion? (Select All That Apply)
eck the patient's vital signs
RR: 24
BP: 1
O2: sat Which
1. Inc
2. Sh
3. Ra
4. Ox
5. Ele
6. His Answ
Expla urgent
interv y.
Quest
A be
perfor
1. Ch
2. Confirm the blood type and Rh factor with another nurse
3. Assess for any history of allergic reactions to blood products
4. 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:
mine the priority nursing actions for this client. (Select All That Apply) minister antihypertensive medication
iate a stroke protocol
nitor neurological status frequently pare for a CT scan
vide education on stroke prevention er: B, C, D
nation: Initiating a stroke protocol is crucial for rapid assessment and intervention. Monitorin ogical status helps detect changes in condition. Preparing for a CT scan is essential to rule o rhagic stroke.
ion: 1665
nurse is assessing a client with pneumonia. Which of the following findings would indicate the need mediate intervention? (Select All That Apply)
spiratory rate of 28 breaths per minute ygen saturation of 90%
ductive cough with green sputum
Vital signs reveal elevated blood pressure, and the client is diaphoretic. Neurological assessment shows weakness on the right side.
Deter
1. Ad
2. Init
3. Mo
4. Pre
5. Pro Answ
Expla g
neurol ut
hemor
Quest
A
for im
1. Re
2. Ox
3. Pro
4. 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
indings from the nurse's notes require immediate intervention? (Select all that apply.) est pain described as "pressure."
ortness of breath.
vated heart rate. vated blood pressure.
tory of coronary artery disease. ygen saturation of 94%.
er: A, B, D, C
nation: Chest pain and shortness of breath in the context of coronary artery disease are critica quire urgent assessment. Elevated heart rate and blood pressure may indicate increased myoc
demand, necessitating immediate intervention.
ion: 1667
istory:
-old client diagnosed with type 1 diabetes presents with severe abdominal pain, nausea, an ng. The client has been experiencing increased thirst and urination. Laboratory results reveal lucose level of 450 mg/dL and metabolic acidosis.
O2: sat 94% on room air What f
1. Ch
2. Sh
3. Ele
4. Ele
5. His
6. Ox
Answ
Expla l signs
that re ardial
oxygen
Quest
Client H
45-year d
vomiti a
blood g
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)
1. Risk for fluid volume deficit
2. Ineffective airway clearance
3. Impaired glucose metabolism
4. Risk for impaired skin integrity
5. 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.
istory:
-old female client with a history of chronic kidney disease presents with fatigue, pruritus, a ion. The family reports increased forgetfulness.
igns: 20/70
98.9�F (37.2�C)
96% on room air
Identify the priority nursing interventions for this client. (Select All That Apply) minister phosphate binders as prescribed
ucate the client on fluid restrictions
nitor laboratory values for renal function sess skin integrity regularly
plement a low-protein diet er: A, C, E
nation: Administering phosphate binders helps manage hyperphosphatemia. Monitoring labor is essential for tracking renal function, and implementing a low-protein diet is critical to red rkload on the kidneys.
Question: 1668
Client H
67-year nd
confus
Vital S BP: 1
HR: 85
Temp: RR: 20 SpO2:
1. Ad
2. Ed
3. Mo
4. As
5. Im
Answ
Expla atory
values uce
the wo
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?
1. Elevated white blood cell count
2. Low hemoglobin level
3. Elevated liver enzymes
4. Normal platelet count Answer: C
Explanation: Elevated liver enzymes could indicate liver metastasis or toxicity from chemotherapy, requiring further investigation.
Quest
Client H
ion: 1670
istory:
-old female client with a history of heart failure presents with sudden onset of shortness of est pain. The family reports increased fatigue over the past week.
Note:
ient appears anxious, and lung auscultation reveals bilateral crackles. Vital signs indicate ardia and hypotension.
igns: 0/60
10
98.6�F (37�C)
92% on 3L O2/NC
Identify the priority nursing interventions for this client. (Select All That Apply) minister diuretics as prescribed
pare for possible intubation ess for signs of fluid overload nitor vital signs frequently
ucate the family on heart failure management
79-year breath
and ch
Nurse's The cl tachyc
Vital S BP: 9
HR: 1
Temp: RR: 30 SpO2:
1. Ad
2. Pre
3. Ass
4. Mo
5. Ed
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?
1. Encourage deep breathing exercises
2. Administer bronchodilators as ordered
3. Provide supplemental oxygen
4. Monitor respiratory rate Answer: B
an exacerbation.
ion: 1672
Note:
A 50-year-old client with a history of liver cirrhosis is admitted with gastrointestinal bleed ient reports vomiting bright red blood and has dark, tarry stools.
igns:
7�F (36.1�C), HR 130, BP 85/50, RR 24.
esults:
.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.) ght red blood in vomit
k, tarry stools
hemoglobin and hematocrit levels vated INR
tory of liver cirrhosis
er: A, B, C, D, E
Explanation: Administering bronchodilators is critical for relieving bronchospasm and improving airflow during
Quest
Nurse's
Report: ing.
The cl
Vital S Temp 9
Lab R Hgb 8
1. Bri
2. Dar
3. Low
4. Ele
5. His Answ
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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