PRN 1409 Final Exam Review Guide Actual
Exam 2026/2027 | Client-Centered Care III
with Detailed Rationales | Pass Guaranteed
– A+ Graded
EXAM BLUEPRINT OVERVIEW
Table
Section Questio Cognitive Level
ns
Complex Medical-Surgical Conditions 18 25% Recall / 55% Application / 20%
Analysis
Perioperative Nursing Care 8 Application/Analysis
Emergency & Disaster Nursing 8 Application/Analysis
Advanced Pharmacology & High-Alert 14 Application/Analysis
Medications
Leadership & Delegation in LPN Scope 10 Application/Analysis
, Mental Health Crises & Therapeutic 10 Application/Analysis
Communication
End-of-Life & Palliative Care 8 Application/Analysis
Maternal-Newborn Complications 8 Application/Analysis
Pediatric Complex Care 8 Application/Analysis
Integrative Client-Centered Scenarios 8 Analysis
TOTAL 100
SECTION 1: COMPLEX MEDICAL-SURGICAL CONDITIONS (Questions
1–18)
Q1: A client with heart failure exacerbation receives IV furosemide 40 mg. One hour
later, the client reports lightheadedness and urine output of 400 mL. Vital signs: BP
88/52 mmHg, HR 110 bpm, RR 18. Which action should the LPN take FIRST?
A. Administer another dose of furosemide as ordered
B. Notify the RN of hypotension and assess for hypovolemia [CORRECT]
C. Encourage oral fluids to increase BP
D. Place the client in Trendelenburg position
,Correct Answer: B
Rationale: Furosemide-induced diuresis can cause hypovolemia and hypotension; the
LPN must notify the RN immediately for further assessment and possible fluid
resuscitation or IV fluid orders. Trendelenburg position is no longer recommended due
to respiratory compromise.
Q2: A client with COPD presents with acute exacerbation, altered mental status, and
arterial blood gas: pH 7.25, PaCO2 72 mmHg, PaO2 58 mmHg, HCO3 32 mEq/L. Which
oxygen delivery method is MOST appropriate?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min [CORRECT]
C. Venturi mask at 40% FiO2
D. High-flow nasal cannula at 40 L/min
Correct Answer: B
Rationale: This client has acute-on-chronic respiratory acidosis with CO2 retention
(hypercapnia). High-flow oxygen can suppress the hypoxic drive in COPD clients.
Low-flow oxygen (1-2 L/min nasal cannula) titrated to SpO2 88-92% prevents CO2
narcosis while maintaining adequate oxygenation.
Q3: A client with acute kidney injury (AKI) has the following labs: BUN 68 mg/dL,
creatinine 4.2 mg/dL, potassium 6.2 mEq/L. Which finding requires IMMEDIATE
intervention?
A. BUN of 68 mg/dL
B. Potassium of 6.2 mEq/L [CORRECT]
, C. Creatinine of 4.2 mg/dL
D. All of the above are equally urgent
Correct Answer: B
Rationale: Hyperkalemia >6.0 mEq/L is life-threatening and can cause fatal cardiac
arrhythmias. Immediate interventions include calcium gluconate (cardiac membrane
stabilization), insulin with glucose (intracellular shift), and sodium polystyrene sulfonate
(elimination). ECG monitoring is essential.
Q4: A client with type 1 diabetes presents with Kussmaul respirations, fruity breath, and
blood glucose of 520 mg/dL. Arterial blood gas shows pH 7.28. Which laboratory
finding is MOST consistent with diabetic ketoacidosis (DKA)?
A. Bicarbonate 28 mEq/L
B. Positive serum ketones and anion gap 22 [CORRECT]
C. Serum osmolality 280 mOsm/kg
D. Potassium 3.2 mEq/L
Correct Answer: B
Rationale: DKA is characterized by hyperglycemia, positive serum ketones, metabolic
acidosis (low bicarbonate), and elevated anion gap (>12). Kussmaul respirations are
compensatory for metabolic acidosis. HHS (hyperosmolar hyperglycemic state) has
higher osmolality (>320) without significant ketosis.
Q5: A client with DKA is receiving IV insulin infusion. Which action should the LPN take
when the blood glucose reaches 250 mg/dL?
A. Stop the insulin infusion immediately
Exam 2026/2027 | Client-Centered Care III
with Detailed Rationales | Pass Guaranteed
– A+ Graded
EXAM BLUEPRINT OVERVIEW
Table
Section Questio Cognitive Level
ns
Complex Medical-Surgical Conditions 18 25% Recall / 55% Application / 20%
Analysis
Perioperative Nursing Care 8 Application/Analysis
Emergency & Disaster Nursing 8 Application/Analysis
Advanced Pharmacology & High-Alert 14 Application/Analysis
Medications
Leadership & Delegation in LPN Scope 10 Application/Analysis
, Mental Health Crises & Therapeutic 10 Application/Analysis
Communication
End-of-Life & Palliative Care 8 Application/Analysis
Maternal-Newborn Complications 8 Application/Analysis
Pediatric Complex Care 8 Application/Analysis
Integrative Client-Centered Scenarios 8 Analysis
TOTAL 100
SECTION 1: COMPLEX MEDICAL-SURGICAL CONDITIONS (Questions
1–18)
Q1: A client with heart failure exacerbation receives IV furosemide 40 mg. One hour
later, the client reports lightheadedness and urine output of 400 mL. Vital signs: BP
88/52 mmHg, HR 110 bpm, RR 18. Which action should the LPN take FIRST?
A. Administer another dose of furosemide as ordered
B. Notify the RN of hypotension and assess for hypovolemia [CORRECT]
C. Encourage oral fluids to increase BP
D. Place the client in Trendelenburg position
,Correct Answer: B
Rationale: Furosemide-induced diuresis can cause hypovolemia and hypotension; the
LPN must notify the RN immediately for further assessment and possible fluid
resuscitation or IV fluid orders. Trendelenburg position is no longer recommended due
to respiratory compromise.
Q2: A client with COPD presents with acute exacerbation, altered mental status, and
arterial blood gas: pH 7.25, PaCO2 72 mmHg, PaO2 58 mmHg, HCO3 32 mEq/L. Which
oxygen delivery method is MOST appropriate?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min [CORRECT]
C. Venturi mask at 40% FiO2
D. High-flow nasal cannula at 40 L/min
Correct Answer: B
Rationale: This client has acute-on-chronic respiratory acidosis with CO2 retention
(hypercapnia). High-flow oxygen can suppress the hypoxic drive in COPD clients.
Low-flow oxygen (1-2 L/min nasal cannula) titrated to SpO2 88-92% prevents CO2
narcosis while maintaining adequate oxygenation.
Q3: A client with acute kidney injury (AKI) has the following labs: BUN 68 mg/dL,
creatinine 4.2 mg/dL, potassium 6.2 mEq/L. Which finding requires IMMEDIATE
intervention?
A. BUN of 68 mg/dL
B. Potassium of 6.2 mEq/L [CORRECT]
, C. Creatinine of 4.2 mg/dL
D. All of the above are equally urgent
Correct Answer: B
Rationale: Hyperkalemia >6.0 mEq/L is life-threatening and can cause fatal cardiac
arrhythmias. Immediate interventions include calcium gluconate (cardiac membrane
stabilization), insulin with glucose (intracellular shift), and sodium polystyrene sulfonate
(elimination). ECG monitoring is essential.
Q4: A client with type 1 diabetes presents with Kussmaul respirations, fruity breath, and
blood glucose of 520 mg/dL. Arterial blood gas shows pH 7.28. Which laboratory
finding is MOST consistent with diabetic ketoacidosis (DKA)?
A. Bicarbonate 28 mEq/L
B. Positive serum ketones and anion gap 22 [CORRECT]
C. Serum osmolality 280 mOsm/kg
D. Potassium 3.2 mEq/L
Correct Answer: B
Rationale: DKA is characterized by hyperglycemia, positive serum ketones, metabolic
acidosis (low bicarbonate), and elevated anion gap (>12). Kussmaul respirations are
compensatory for metabolic acidosis. HHS (hyperosmolar hyperglycemic state) has
higher osmolality (>320) without significant ketosis.
Q5: A client with DKA is receiving IV insulin infusion. Which action should the LPN take
when the blood glucose reaches 250 mg/dL?
A. Stop the insulin infusion immediately
