1
NCLEX PN Exam Bank Prioritization and
Clinical Judgment in Practical Nursing
Table of Contents
Subtopic 1: Recognizing and Responding to Changes in Patient Conditions ...................... 2
Subtopic 2: Delegation, Supervision, and Team Communication in Practical Nursing....... 10
Subtopic 3: Prioritizing Care in Multi-Patient Assignments.............................................. 19
Subtopic 4: Recognizing and Managing Complications in Practical Nursing ..................... 27
Subtopic 5: Delegation and Supervision in Practical Nursing .......................................... 36
Subtopic 6: Delegation Principles and Scope of Practice for LPNs .................................. 45
Subtopic 7: Prioritization During Shift Report and Change of Condition ........................... 54
, 2
Subtopic 1: Recognizing and Responding to Changes in
Patient Conditions
(Questions 1–20)
Question 1:
A practical nurse is caring for a patient post-appendectomy who is now reporting sudden
shortness of breath and chest pain. What should the nurse do first?
A. Perform a focused abdominal assessment
B. Notify the healthcare provider immediately
C. Offer the patient a sedative to reduce anxiety
D. Document the complaint and monitor vital signs
Correct answer: B. Notify the healthcare provider immediately
Rationale: Sudden chest pain and shortness of breath post-surgery could indicate a
pulmonary embolism, a life-threatening emergency. Immediate provider notification is the
priority.
Question 2:
A newly admitted patient has a potassium level of 2.9 mEq/L. Which action should the
nurse take first?
A. Offer a high-potassium diet
B. Notify dietary for supplement recommendations
C. Place the patient on cardiac monitoring
D. Encourage increased fluid intake
Correct answer: C. Place the patient on cardiac monitoring
, 3
Rationale: Hypokalemia increases the risk of cardiac arrhythmias. Continuous cardiac
monitoring is critical for early detection and intervention.
Question 3:
Which client should the nurse see first during morning rounds?
A. Client requesting pain medication
B. Client needing routine dressing change
C. Client with a new onset of confusion
D. Client requesting assistance with ambulation
Correct answer: C. Client with a new onset of confusion
Rationale: Acute confusion may signal a serious issue such as infection, stroke, or hypoxia
and requires immediate evaluation.
Question 4:
A post-operative client begins to exhibit decreased urine output, hypotension, and cool
skin. What is the nurse’s priority action?
A. Increase fluid intake
B. Report findings to the provider immediately
C. Administer an antipyretic
D. Provide warm blankets
Correct answer: B. Report findings to the provider immediately
Rationale: These are signs of hypovolemic shock; immediate medical intervention is
essential to prevent deterioration.
Question 5:
, 4
A diabetic patient becomes confused and shaky during breakfast. What is the nurse's
priority action?
A. Notify the provider
B. Administer insulin
C. Check the blood glucose level
D. Encourage the patient to finish the meal
Correct answer: C. Check the blood glucose level
Rationale: Hypoglycemia is suspected; blood glucose should be assessed first to
determine immediate treatment.
Question 6:
Which patient situation should the nurse address first?
A. A client who needs teaching on a new medication
B. A client who is awaiting discharge paperwork
C. A client with a pain rating of 8/10
D. A client with new-onset slurred speech
Correct answer: D. A client with new-onset slurred speech
Rationale: New slurred speech suggests a possible stroke. Timely evaluation is crucial to
preserve brain function.
Question 7:
A patient receiving IV antibiotics suddenly develops a rash and difficulty breathing. What is
the first action the nurse should take?
A. Stop the infusion
B. Call for help and administer epinephrine per protocol
NCLEX PN Exam Bank Prioritization and
Clinical Judgment in Practical Nursing
Table of Contents
Subtopic 1: Recognizing and Responding to Changes in Patient Conditions ...................... 2
Subtopic 2: Delegation, Supervision, and Team Communication in Practical Nursing....... 10
Subtopic 3: Prioritizing Care in Multi-Patient Assignments.............................................. 19
Subtopic 4: Recognizing and Managing Complications in Practical Nursing ..................... 27
Subtopic 5: Delegation and Supervision in Practical Nursing .......................................... 36
Subtopic 6: Delegation Principles and Scope of Practice for LPNs .................................. 45
Subtopic 7: Prioritization During Shift Report and Change of Condition ........................... 54
, 2
Subtopic 1: Recognizing and Responding to Changes in
Patient Conditions
(Questions 1–20)
Question 1:
A practical nurse is caring for a patient post-appendectomy who is now reporting sudden
shortness of breath and chest pain. What should the nurse do first?
A. Perform a focused abdominal assessment
B. Notify the healthcare provider immediately
C. Offer the patient a sedative to reduce anxiety
D. Document the complaint and monitor vital signs
Correct answer: B. Notify the healthcare provider immediately
Rationale: Sudden chest pain and shortness of breath post-surgery could indicate a
pulmonary embolism, a life-threatening emergency. Immediate provider notification is the
priority.
Question 2:
A newly admitted patient has a potassium level of 2.9 mEq/L. Which action should the
nurse take first?
A. Offer a high-potassium diet
B. Notify dietary for supplement recommendations
C. Place the patient on cardiac monitoring
D. Encourage increased fluid intake
Correct answer: C. Place the patient on cardiac monitoring
, 3
Rationale: Hypokalemia increases the risk of cardiac arrhythmias. Continuous cardiac
monitoring is critical for early detection and intervention.
Question 3:
Which client should the nurse see first during morning rounds?
A. Client requesting pain medication
B. Client needing routine dressing change
C. Client with a new onset of confusion
D. Client requesting assistance with ambulation
Correct answer: C. Client with a new onset of confusion
Rationale: Acute confusion may signal a serious issue such as infection, stroke, or hypoxia
and requires immediate evaluation.
Question 4:
A post-operative client begins to exhibit decreased urine output, hypotension, and cool
skin. What is the nurse’s priority action?
A. Increase fluid intake
B. Report findings to the provider immediately
C. Administer an antipyretic
D. Provide warm blankets
Correct answer: B. Report findings to the provider immediately
Rationale: These are signs of hypovolemic shock; immediate medical intervention is
essential to prevent deterioration.
Question 5:
, 4
A diabetic patient becomes confused and shaky during breakfast. What is the nurse's
priority action?
A. Notify the provider
B. Administer insulin
C. Check the blood glucose level
D. Encourage the patient to finish the meal
Correct answer: C. Check the blood glucose level
Rationale: Hypoglycemia is suspected; blood glucose should be assessed first to
determine immediate treatment.
Question 6:
Which patient situation should the nurse address first?
A. A client who needs teaching on a new medication
B. A client who is awaiting discharge paperwork
C. A client with a pain rating of 8/10
D. A client with new-onset slurred speech
Correct answer: D. A client with new-onset slurred speech
Rationale: New slurred speech suggests a possible stroke. Timely evaluation is crucial to
preserve brain function.
Question 7:
A patient receiving IV antibiotics suddenly develops a rash and difficulty breathing. What is
the first action the nurse should take?
A. Stop the infusion
B. Call for help and administer epinephrine per protocol
