The NCLEX-PN (National Council Licensure Examination for Practical Nurses) is a nursing certification awarded by NCSBN.
NCSBN publishes the official exam outline, eligibility rules and fees — see NCSBN's official page before you book.
Twenty NCLEX-PN (National Council Licensure Examination for Practical Nurses) questions, with the answers hidden until you want them — covering Pathology, Management, Procedures, Pharmacology and more. They are real cards from our 1019-card deck, not the 30 on the free preview page, so you can use both. Work through them cold, then use your score below to decide what to study next. NCSBN publishes the official exam outline — check it for the real blueprint.
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Answer each one before opening it. Keep score as you go.
A client at 32 weeks gestation has a BP of 142/92 and 1+ proteinuria. What is the underlying pathophysiological process distinguishing preeclampsia from gestational hypertension?
Show answer →Preeclampsia involves multi-system involvement beyond just elevated BP. The hallmark is generalized vasospasm and endothelial cell damage, leading to reduced organ perfusion. While gestational hypertension is characterized solely by BP >140/90 after 20 weeks, preeclampsia usually includes proteinuria OR new-onset systemic signs (thrombocytopenia, renal insufficiency, impaired liver function). NCLEX Strategy: NCSBN focuses on the new-onset nature after 20 weeks. Distinguish from chronic HTN (pre-existing).
A client with severe preeclampsia shows a sudden drop in platelets to 80,000/mm³ and elevated AST/ALT. What specific syndrome is occurring, and what is the pathological cause of the low platelets?
Show answer →This is HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). Pathophysiology: Microangiopathic hemolytic anemia occurs as RBCs are damaged passing through small, damaged vessels (vasospasm). Low platelets (thrombocytopenia) result from platelet adhesion and consumption at sites of damaged vascular endothelium. Clinical Pearl: HELLP is a life-threatening complication of preeclampsia. Monitor for epigastric pain (liver distention) and bleeding. NCLEX often tests the recognition of these specific lab clusters.
Why does gestational diabetes mellitus (GDM) typically develop after 20 weeks of pregnancy rather than in the first trimester?
Show answer →GDM is driven by placental hormones, primarily Human Placental Lactogen (hPL), cortisol, and growth hormone. These hormones increase in production as the placenta grows, peaking in the 2nd and 3rd trimesters. They create insulin resistance to ensure a steady glucose supply for the fetus. If the maternal pancreas cannot increase insulin production to overcome this resistance, GDM occurs. NCLEX Tip: Remember that insulin needs usually decrease in the 1st trimester but rise significantly in the 2nd and 3rd.
A client is receiving Magnesium Sulfate for preeclampsia. What is the primary therapeutic purpose of this medication, and what pathological sign indicates toxicity?
Show answer →Purpose: Magnesium Sulfate is a CNS depressant used specifically for seizure prophylaxis (preventing eclampsia), NOT as a primary antihypertensive. Toxicity Signs: Loss of deep tendon reflexes (DTRs) is the earliest sign. Pathologically, magnesium blocks neuromuscular transmission. Other signs include respiratory depression (<12/min), decreased urine output (<30mL/hr), and cardiac arrest. Antidote: Calcium Gluconate. NCLEX focus: LPNs must prioritize monitoring DTRs and respiratory rate.
A neonate is born to a mother with poorly controlled GDM. Why is this infant at high risk for profound hypoglycemia immediately after birth?
Show answer →Pathophysiology: In utero, the fetus is exposed to high maternal glucose levels (hyperglycemia). In response, the fetal pancreas produces high levels of insulin (hyperinsulinemia). After delivery, the glucose supply from the mother is abruptly cut off, but the neonate's hyperinsulinemia persists for several hours, causing a rapid drop in blood glucose. NCLEX Strategy: Focus on immediate post-birth monitoring of the neonate's blood sugar and early feeding.
A client with preeclampsia suddenly experiences a tonic-clonic seizure. What is the pathological progression from preeclampsia to eclampsia, and what is the immediate nursing priority?
Show answer →Eclampsia is the onset of seizures in a client with preeclampsia. Pathologically, it results from cerebral edema, vasospasm, and cerebral ischemia. Priority: Patient safety and airway. Turn the client on their side to prevent aspiration and protect from injury. Do not leave the bedside. NCLEX Distractor: The priority is NOT administering magnesium immediately; it is maintaining the airway and preventing injury DURING the seizure. Magnesium is given after/during to prevent recurrence.
What is the primary vascular pathology in preeclampsia that leads to intrauterine growth restriction (IUGR) in the fetus?
Show answer →The pathology is impaired spiral artery remodeling. In a healthy pregnancy, spiral arteries in the uterus widen to allow high blood flow to the placenta. In preeclampsia, these arteries remain narrow and high-resistance. This leads to placental hypoxia and chronic uteroplacental insufficiency, resulting in IUGR and low birth weight. NCLEX Pearl: Recognize that preeclampsia affects the fetus via decreased perfusion, not just the mother's BP.
A client with severe preeclampsia reports sudden, sharp abdominal pain and vaginal bleeding. The uterus feels "board-like." What complication is suspected, and why?
Show answer →Placental Abruption (Abruptio Placentae). Pathophysiology: High pressure from systemic vasospasm and hypertension causes the placenta to prematurely detach from the uterine wall. The board-like abdomen is caused by concealed hemorrhage into the uterine muscle. This is a medical emergency. NCLEX Tip: Differentiate from Placenta Previa (painless bleeding). Abruption is painful and often associated with hypertensive disorders.
An alert, oriented 82-year-old patient refuses their morning antihypertensive medication, stating, I don't like how it makes me feel. Which ethical principle is the LPN upholding by respecting this decision and notifying the RN?
Show answer →Autonomy. This principle refers to the patient's right to self-determination and making their own healthcare decisions. Even if the decision seems detrimental to their health, a competent adult has the right to refuse treatment. The LPN's role is to ensure the patient is informed of the risks of refusal, document the refusal, and report it to the RN/Provider. Exam Tip: NCSBN emphasizes that autonomy is not absolute if it harms others, but in personal care, it is a primary priority. Always assess the patient's understanding before accepting the refusal.
A patient with terminal cancer requests a higher dose of opioids for breakthrough pain. The LPN is concerned about potential respiratory depression but provides the medication as ordered. This action primarily balances which two ethical principles?
Show answer →Beneficence (doing good/relieving pain) and Nonmaleficence (doing no harm). In palliative care, the Rule of Double Effect often applies: an action intended to provide a good effect (pain relief) is ethically permissible even if it has a foreseeable but unintended secondary effect (respiratory depression). Exam Tip: NCLEX-PN often tests the LPN's ability to prioritize comfort in end-of-life care while remaining within the scope of the plan of care. Monitoring the patient's response is the critical implementation step.
Due to a staffing shortage, an LPN must decide which of four stable patients will receive their dressing changes last. Which ethical principle is the nurse applying when ensuring that care is distributed fairly based on clinical need?
Show answer →Justice. This principle involves fairness in the distribution of resources and care. In a clinical setting, justice is applied through triage and prioritization based on acuity and need rather than personal preference or first come, first served. Exam Tip: When you see fairness, allocation of time, or resource management on the NCLEX-PN, the answer is likely Justice. Distractors often include Fidelity (keeping promises) or Veracity (truth-telling).
A patient with left-sided weakness following a stroke is being discharged with a single-point cane. How should the LPN/LVN instruct the patient to hold the cane and what is the correct sequence for ambulation?
Show answer →Hold the cane on the strong side (Right). Sequence: Move the cane forward 6-10 inches, then the weak (Left) leg, then the strong (Right) leg past the cane. Rationale: The cane on the strong side provides a wider base of support and reduces weight on the affected limb. Mnemonic: COAL (Cane Opposite Affected Leg). Cane height should be at the greater trochanter with 15-30 degrees of elbow flexion. Exam Strategy: NCSBN often tests the strong side rule; remember the cane and weak leg move together or the cane moves just before the weak leg to provide support.
A nurse is measuring a client for crutches. To prevent axillary nerve damage, how much space should be between the crutch pad and the axilla, and where should the client's weight be supported during ambulation?
Show answer →2-3 finger widths (approx. 1-1.5 inches) below the axilla. Weight must be supported by the handgrips, NOT the axillae. Rationale: Constant pressure on the axilla can cause crutch palsy (brachial plexus/axillary nerve injury). Elbows should be flexed 15-30 degrees. Handgrips should be level with the ulnar side of the wrist (wrist crease). Exam Strategy: Look for pressure on armpits as a critical safety error in NCLEX-PN questions. Correcting this is a priority intervention to prevent permanent nerve damage.
A patient receiving IV Vancomycin develops flushing, pruritus, and an erythematous rash on the face and neck. What is the LPN/LVN's priority action?
Show answer →Slow the infusion rate. This is Red Man Syndrome (RMS), a rate-related infusion reaction, not a true allergic reaction. NCSBN focus: Safety and administration. RMS is managed by slowing the rate to at least 60-90 minutes. If symptoms of anaphylaxis (wheezing, hives, angioedema) occur, stop the infusion immediately and notify the RN/Provider. Clinical Pearl: Always monitor BP during Vancomycin administration as hypotension can occur.
A patient reports a history of anaphylaxis after taking Penicillin. Which class of antibiotics should the LPN/LVN clarify with the provider before administering?
Show answer →Cephalosporins (e.g., Cephalexin, Ceftriaxone). Due to similar beta-lactam structures, there is a 1-10% cross-sensitivity risk. NCLEX strategy: If the patient's reaction was mild (rash), the provider may still order a cephalosporin. If the reaction was anaphylaxis, the nurse must question the order. Safety is the priority. Always document the specific nature of the previous allergic reaction.
An LPN is caring for a client with profuse watery diarrhea and suspected Clostridioides difficile. Which hand hygiene action is mandatory after providing perineal care?
Show answer →Standard Precautions require soap and water (not alcohol-based rubs) for hand hygiene when caring for clients with C. difficile. The spores are resistant to alcohol; mechanical friction via handwashing for at least 20 seconds is necessary to physically remove spores from the skin. NCLEX Tip: Always choose soap and water for visible soil or suspected C. diff/Norovirus. Alcohol-based rubs are preferred for most other clinical encounters because they are more effective against common pathogens and less drying to the skin.
The LPN is preparing to assist with a bedside procedure where blood splashing is anticipated. In what specific order should the LPN don Personal Protective Equipment (PPE)?
Show answer →The standard sequence for donning PPE is: 1. Gown, 2. Mask or Respirator, 3. Goggles or Face Shield, 4. Gloves. The gloves should be pulled up to cover the cuffs of the gown. NCLEX Strategy: NCSBN emphasizes the bottom-up approach for donning (Gown to Gloves). This ensures maximum coverage and that the most outer layer (gloves) is applied last to maintain the cleanest surface possible before patient contact.
A client reports their last menstrual period (LMP) began on October 14, 2025. Using Naegele's rule, what is the estimated date of delivery (EDD)?
Show answer →ANSWER: July 21, 2026. RATIOANLE: Naegele's rule calculation: Subtract 3 months from the first day of the LMP, add 7 days, and add 1 year (LMP - 3 months + 7 days + 1 year). October 14 minus 3 months = July 14; July 14 plus 7 days = July 21. CLINICAL PEARL: This rule assumes a standard 28-day cycle. On the NCLEX-PN, ensure you do not accidentally add or subtract the wrong number of days. If the LMP is in January, February, or March, you simply add 9 months and 7 days.
During a non-stress test (NST), the LPN notes a fetal heart rate (FHR) baseline of 145 bpm with two 15-bpm increases lasting 15 seconds within 20 minutes. How should the LPN interpret and document these findings?
Show answer →This is a **Reactive Non-Stress Test**, a normal and reassuring finding. In a term fetus, reactive means at least two accelerations of 15 bpm above baseline lasting 15 seconds (15x15) within a 20-minute window. **Rationale:** This indicates a well-oxygenated fetus with an intact central nervous system. **NCLEX Strategy:** NCSBN tests the 15x15 rule for term infants vs. 10x10 for preterm (<32 weeks). If the test is non-reactive after 40 minutes (considering fetal sleep cycles), further testing like a Biophysical Profile (BPP) is usually required.
An LPN is assessing a 75-year-old patient with a history of two falls in the last 6 months who is currently receiving IV fluids. Using the Morse Fall Scale, which findings contribute most significantly to a High Risk classification?
Show answer →A history of falls (25 pts) and an IV/heparin lock (20 pts) are major contributors. Other factors include secondary diagnosis, gait (weak/impaired), and mental status. NCSBN focus: Identifying risk factors early to implement individualized interventions. Clinical Pearl: Any score >45 is typically considered high risk. Assessment must be updated every shift or after any change in status.
17–20 correct
Strong. Move to the hardest material and timed drilling rather than re-reading topics you already know.
12–16 correct
A normal mid-prep score. Work the topics you missed one at a time — the topic pages below are built for exactly that.
Under 12 correct
Early days. Go topic by topic instead of taking more mixed tests: pick your weakest area below and drill it until the questions feel routine.
Pathology questions
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Management questions
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Procedures questions
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Pharmacology questions
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Basics questions
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Assessment questions
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Diagnostics questions
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Try 30 free NCLEX-PN cards firstIt is 20 real question-and-answer cards from our 1019-card NCLEX-PN deck, mixed across topics so it feels like the breadth of the exam. It is not the official NCSBN exam and is not endorsed by NCSBN — for the official outline and any official practice material, go to NCSBN directly.
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