LICENSED PRACTICAL NURSE CERTIFICATION EXAM
PREDICTOR 2026 EDITION Q&A
1. A client with type 2 diabetes is prescribed metformin 500 mg
twice daily. The client reports nausea and metallic taste after
starting the medication. What is the LPN's priority action?
A. Hold the medication and notify the healthcare provider
immediately
B. Reassure the client that these are common side effects that will
subside
C. Administer the medication with food and monitor for
improvement
D. Administer an antiemetic 30 minutes before the next dose
Correct Answer: C
Explanation: Nausea and metallic taste are common initial side
effects of metformin that typically resolve within 1-2 weeks.
Administering with food reduces gastrointestinal upset. Holding
the medication (A) is unnecessary as these aren't signs of lactic
acidosis. Reassurance alone (B) doesn't address the symptom.
Antiemetics (D) aren't first-line for this common side effect.
2. A postoperative client with a nasogastric tube on low intermittent
suction has an output of 800 mL of greenish-brown fluid in 8
hours. The client's vital signs show BP 98/60 mmHg, HR 112 bpm,
and urine output 20 mL/hr. What is the LPN's priority
intervention?
A. Increase the NG tube suction to high intermittent
B. Document the findings as expected postoperative output
, C. Notify the healthcare provider and prepare to administer IV
fluids
D. Irrigate the NG tube with 30 mL normal saline
Correct Answer: C
Explanation: The client shows signs of hypovolemia (tachycardia,
hypotension, low urine output) due to excessive NG output. This
requires immediate provider notification and IV fluid replacement.
Increasing suction (A) would worsen fluid loss. Documentation
alone (B) ignores the clinical deterioration. Irrigation (D) isn't
indicated and could worsen electrolyte imbalance.
3. A client receiving vancomycin 1 g IV every 12 hours has a trough
level drawn 30 minutes before the next dose. The lab result shows
18 mcg/mL. What action should the LPN take?
A. Administer the scheduled dose as ordered
B. Hold the dose and notify the healthcare provider
C. Administer half the dose and monitor closely
D. Request a repeat trough level in 4 hours
Correct Answer: B
Explanation: The therapeutic trough range for vancomycin is 10-15
mcg/mL (or 15-20 mcg/mL for serious infections like MRSA). A
level of 18 mcg/mL is at the high end and increases risk of
nephrotoxicity and ototoxicity. The dose should be held and
provider notified for dose adjustment. Administering (A) risks
toxicity. Half dose (C) isn't appropriate without provider order.
Repeat level (D) delays necessary action.
,4. A 72-year-old client with Parkinson's disease is delayed in
receiving their levodopa-carbidopa dose by 2 hours. The client
develops rigidity, tremors, and difficulty swallowing. What is the
LPN's priority action?
A. Administer the missed dose immediately and document the
delay
B. Place the client in high-Fowler's position and assess airway
patency
C. Offer hard candy to stimulate swallowing and reduce drooling
D. Notify the family about the medication delay
Correct Answer: B
Explanation: Difficulty swallowing indicates potential airway
compromise, which is the priority. High-Fowler's position facilitates
breathing and swallowing. Airway takes precedence over
medication administration (A). Hard candy (C) could cause
aspiration in a client with dysphagia. Family notification (D) isn't
the priority during acute symptoms.
5. A client with chronic kidney disease (CKD) stage 4 has a serum
potassium level of 6.2 mEq/L. The ECG shows peaked T waves.
Which medication should the LPN anticipate the healthcare
provider ordering first?
A. Sodium polystyrene sulfonate (Kayexalate) 30 g orally
B. Regular insulin 10 units IV with 50 mL D50W
C. Furosemide 40 mg IV push
D. Calcium gluconate 10 mL of 10% solution IV
Correct Answer: D
Explanation: Calcium gluconate is the first-line intervention for
, hyperkalemia with ECG changes as it stabilizes cardiac membranes
and prevents arrhythmias within minutes. Insulin/dextrose (B)
lowers potassium but takes 15-30 minutes. Kayexalate (A) takes
hours to work. Furosemide (C) is effective only if the client has
adequate urine output, which may be limited in CKD stage 4.
6. A client with a new tracheostomy is being discharged to home
care. Which instruction should the LPN reinforce for the client's
caregiver?
A. Clean the tracheostomy stoma with hydrogen peroxide twice
daily
B. Keep a spare tracheostomy tube of the same size and one size
smaller available
C. Change the tracheostomy ties while the client is supine to
prevent aspiration
D. Suction the tracheostomy every 2 hours regardless of secretions
Correct Answer: B
Explanation: Having a spare tube (same size and one size smaller)
is critical for emergency reinsertion if dislodgement occurs.
Hydrogen peroxide (A) can irritate the stoma; saline is preferred.
Changing ties supine (C) increases aspiration risk; semi-Fowler's is
safer. Routine suctioning (D) without indication can cause mucosal
trauma; suction only when needed.
7. A pregnant client at 34 weeks gestation presents with sudden,
painless, bright red vaginal bleeding. The fetal heart rate is 140
bpm with moderate variability. What condition should the LPN
PREDICTOR 2026 EDITION Q&A
1. A client with type 2 diabetes is prescribed metformin 500 mg
twice daily. The client reports nausea and metallic taste after
starting the medication. What is the LPN's priority action?
A. Hold the medication and notify the healthcare provider
immediately
B. Reassure the client that these are common side effects that will
subside
C. Administer the medication with food and monitor for
improvement
D. Administer an antiemetic 30 minutes before the next dose
Correct Answer: C
Explanation: Nausea and metallic taste are common initial side
effects of metformin that typically resolve within 1-2 weeks.
Administering with food reduces gastrointestinal upset. Holding
the medication (A) is unnecessary as these aren't signs of lactic
acidosis. Reassurance alone (B) doesn't address the symptom.
Antiemetics (D) aren't first-line for this common side effect.
2. A postoperative client with a nasogastric tube on low intermittent
suction has an output of 800 mL of greenish-brown fluid in 8
hours. The client's vital signs show BP 98/60 mmHg, HR 112 bpm,
and urine output 20 mL/hr. What is the LPN's priority
intervention?
A. Increase the NG tube suction to high intermittent
B. Document the findings as expected postoperative output
, C. Notify the healthcare provider and prepare to administer IV
fluids
D. Irrigate the NG tube with 30 mL normal saline
Correct Answer: C
Explanation: The client shows signs of hypovolemia (tachycardia,
hypotension, low urine output) due to excessive NG output. This
requires immediate provider notification and IV fluid replacement.
Increasing suction (A) would worsen fluid loss. Documentation
alone (B) ignores the clinical deterioration. Irrigation (D) isn't
indicated and could worsen electrolyte imbalance.
3. A client receiving vancomycin 1 g IV every 12 hours has a trough
level drawn 30 minutes before the next dose. The lab result shows
18 mcg/mL. What action should the LPN take?
A. Administer the scheduled dose as ordered
B. Hold the dose and notify the healthcare provider
C. Administer half the dose and monitor closely
D. Request a repeat trough level in 4 hours
Correct Answer: B
Explanation: The therapeutic trough range for vancomycin is 10-15
mcg/mL (or 15-20 mcg/mL for serious infections like MRSA). A
level of 18 mcg/mL is at the high end and increases risk of
nephrotoxicity and ototoxicity. The dose should be held and
provider notified for dose adjustment. Administering (A) risks
toxicity. Half dose (C) isn't appropriate without provider order.
Repeat level (D) delays necessary action.
,4. A 72-year-old client with Parkinson's disease is delayed in
receiving their levodopa-carbidopa dose by 2 hours. The client
develops rigidity, tremors, and difficulty swallowing. What is the
LPN's priority action?
A. Administer the missed dose immediately and document the
delay
B. Place the client in high-Fowler's position and assess airway
patency
C. Offer hard candy to stimulate swallowing and reduce drooling
D. Notify the family about the medication delay
Correct Answer: B
Explanation: Difficulty swallowing indicates potential airway
compromise, which is the priority. High-Fowler's position facilitates
breathing and swallowing. Airway takes precedence over
medication administration (A). Hard candy (C) could cause
aspiration in a client with dysphagia. Family notification (D) isn't
the priority during acute symptoms.
5. A client with chronic kidney disease (CKD) stage 4 has a serum
potassium level of 6.2 mEq/L. The ECG shows peaked T waves.
Which medication should the LPN anticipate the healthcare
provider ordering first?
A. Sodium polystyrene sulfonate (Kayexalate) 30 g orally
B. Regular insulin 10 units IV with 50 mL D50W
C. Furosemide 40 mg IV push
D. Calcium gluconate 10 mL of 10% solution IV
Correct Answer: D
Explanation: Calcium gluconate is the first-line intervention for
, hyperkalemia with ECG changes as it stabilizes cardiac membranes
and prevents arrhythmias within minutes. Insulin/dextrose (B)
lowers potassium but takes 15-30 minutes. Kayexalate (A) takes
hours to work. Furosemide (C) is effective only if the client has
adequate urine output, which may be limited in CKD stage 4.
6. A client with a new tracheostomy is being discharged to home
care. Which instruction should the LPN reinforce for the client's
caregiver?
A. Clean the tracheostomy stoma with hydrogen peroxide twice
daily
B. Keep a spare tracheostomy tube of the same size and one size
smaller available
C. Change the tracheostomy ties while the client is supine to
prevent aspiration
D. Suction the tracheostomy every 2 hours regardless of secretions
Correct Answer: B
Explanation: Having a spare tube (same size and one size smaller)
is critical for emergency reinsertion if dislodgement occurs.
Hydrogen peroxide (A) can irritate the stoma; saline is preferred.
Changing ties supine (C) increases aspiration risk; semi-Fowler's is
safer. Routine suctioning (D) without indication can cause mucosal
trauma; suction only when needed.
7. A pregnant client at 34 weeks gestation presents with sudden,
painless, bright red vaginal bleeding. The fetal heart rate is 140
bpm with moderate variability. What condition should the LPN
