Free NCLEX-PN Safe and Effective Care Environment – Coordinated Care Practice Test – Part 2 (Updated 2026)

1. Which federal law establishes national standards to protect patient health information from being disclosed without the patient’s consent or knowledge?

2. The minimum necessary standard under HIPAA requires healthcare workers to:

3. An LPN is caring for a patient scheduled for surgery. The patient’s family member calls and asks for an update on the patient’s condition. Which response by the LPN demonstrates proper understanding of HIPAA permitted disclosures?

4. An LPN posts on her personal social media account: “Had the sweetest elderly patient today who made my shift! He told me the most amazing stories about serving in Vietnam. Healthcare workers are blessed!” Which statement accurately describes this post?

5. Two nurses are riding the hospital elevator discussing a patient’s new diagnosis. A visitor on the elevator asks them to stop discussing patient information. Which action should the LPN take?

6. A licensed practical nurse intentionally accesses a patient’s medical record without a legitimate work-related reason. Which consequence could result from this HIPAA violation?

7. An LPN needs to document in a patient’s electronic health record (EHR) but realizes she forgot her password. The unit secretary offers to let the LPN use her login credentials “just this once” so the LPN can complete her documentation quickly. Which response demonstrates correct understanding of EHR security?

8. An LPN needs to fax patient information to a specialist’s office for a referral. The LPN enters the fax number from memory and sends the document. Moments later, the LPN realizes the number may have been incorrect. Which action should the LPN take FIRST?

9. A patient requests a copy of their complete medical record. The LPN reviews the record and notices it contains mental health treatment notes from a psychiatrist. According to HIPAA, which statement accurately describes the patient’s right to access this information?

10. An LPN discovers that a coworker has been accessing patient records of celebrities admitted to the facility out of curiosity, with no work-related reason. The coworker asks the LPN not to report the violation, promising it won’t happen again. Which action should the LPN take?

11. Which ethical principle requires the nurse to be truthful and honest with patients, even when delivering difficult information?

12. A licensed practical nurse (LPN) witnesses a colleague making repeated medication errors over several weeks. The colleague appears increasingly fatigued and unfocused. Which action is the LPN legally required to take?

13. An elderly patient with advanced dementia is admitted with severe dehydration. The patient’s adult daughter presents a document stating it is a living will requesting no artificial nutrition or hydration. The attending physician orders IV fluids. The LPN understands that which factor is most important in determining whether to follow the advance directive?

14. An LPN is caring for a patient who refuses a prescribed blood transfusion based on religious beliefs. The patient is alert, oriented, and understands the risks of refusing treatment. Which ethical principle is the LPN upholding by respecting the patient’s decision?

15. An LPN responds to a motor vehicle accident scene while driving to work. The LPN stops to provide emergency care to an unconscious victim until paramedics arrive. Which legal protection shields the LPN from civil liability for actions taken at the scene?

16. A 4-year-old child is brought to the clinic by his mother for a routine immunization. During the assessment, the LPN notices multiple bruises in various stages of healing on the child’s back and buttocks. The mother states the child “falls a lot.” When the LPN asks the child how he got the bruises, the mother answers for him. Which action should the LPN take first?

17. An LPN makes a medication error by administering the wrong dose of an antihypertensive medication to a patient. The patient’s blood pressure drops significantly, requiring intervention by the healthcare team. The patient recovers without permanent harm. Which element must be present for this situation to constitute malpractice?

18. An LPN discovers that a patient was given a diagnosis of a sexually transmitted infection (STI). The patient’s spouse calls the unit and asks if the patient has been diagnosed with any infections. Which response by the LPN is most appropriate?

19. An LPN is asked by a supervising RN to perform a wound care procedure that the LPN has not been trained to perform and that appears to be outside the LPN’s scope of practice according to the state’s Nurse Practice Act. The RN states, “I’ll supervise you, so it’s fine.” Which action should the LPN take?

20. An LPN is caring for a terminally ill patient who is experiencing severe pain. The physician has ordered morphine every 4 hours as needed. The patient’s family expresses concern that increasing morphine could “hasten death” and asks the LPN to withhold the next dose despite the patient’s obvious discomfort. The LPN understands that providing adequate pain management at end of life is supported by which ethical principle?

21. Which element must be present for informed consent to be considered valid?

22. A client scheduled for surgery asks the practical nurse (PN) to explain the risks and benefits of the procedure because the surgeon “didn’t have much time to talk.” Which response by the PN is most appropriate?

23. A client is brought to the emergency department unconscious following a motor vehicle crash. The client needs emergency surgery to repair internal bleeding. No family members are present. Which action regarding consent is appropriate?

24. A practical nurse (PN) is caring for a client who signed a consent form for a cardiac catheterization earlier in the day. The client now tells the PN, “I changed my mind—I don’t want this procedure.” Which action should the PN take first?

25. Which statement accurately describes the practical nurse’s (PN) role in informed consent?

26. A practical nurse (PN) is reviewing a consent form with a client before surgery. The client speaks limited English and indicates they do not fully understand the procedure. The surgeon has already left the unit. The client’s adult child is present and urges the PN to “just let them sign—it’s fine, I’ll explain it later.” Which action should the PN take?

27. Which statement best describes the Nurse Licensure Compact (NLC)?

28. A practical nurse (PN) licensed in a compact state moves to a non-compact state to accept a new job. Which action must the PN take before beginning work?

29. A practical nurse (PN) working in a long-term care facility is asked by a provider to discontinue a client’s indwelling urinary catheter and then insert a new one immediately after removal. The PN’s state nurse practice act allows catheter discontinuation but states that insertion requires additional certification that the PN does not have. Which action should the PN take?

30. A newly licensed practical nurse (PN) is unsure whether a specific task is within their scope of practice. Which resource should the PN consult first to determine whether the task is permitted?

31. The practical nurse is preparing to give a telephone report to a provider using SBAR communication. Which component of SBAR should the nurse address first?

32. During shift report, the outgoing nurse states: “Room 204, Mr. Johnson, post-op day 2 hip replacement. He’s been stable, vital signs within normal limits, pain controlled with oral medication. He needs assistance with mobility and his daughter is visiting this afternoon.” Which additional information is most important for the practical nurse to ask about?

33. The practical nurse is caring for a patient who is being transferred to a rehabilitation facility. Which information is most important for the nurse to include in the transfer documentation?

34. An elderly patient is being discharged home after treatment for heart failure. The practical nurse has reinforced discharge teaching about medications, diet, and daily weights. The patient says, “My daughter will help me at home, she’s a nurse.” Which action should the practical nurse take first?

35. The practical nurse notices that a patient scheduled for discharge today has not received the prescribed antibiotic dose due at 0800. The discharge teaching materials have already been reviewed, and the patient is waiting for transportation. Which action should the nurse take first?

36. The practical nurse is using the I-PASS handoff tool during shift change. What does the letter “I” represent in this communication framework?

37. A patient tells the practical nurse, “I’m worried about going home. I live alone and I’m not sure I can manage my insulin injections.” The discharge plan indicates the patient will receive home health services. Which response by the nurse demonstrates the best approach to continuity of care?

38. During a bedside shift report, the patient asks the outgoing nurse why they’re taking a new medication. The outgoing nurse explains the purpose. The receiving practical nurse should take which action?

39. The practical nurse is giving telephone report to a long-term care facility about a patient being transferred. The nurse states: “Mrs. Chen is a 78-year-old admitted for pneumonia, now resolved. She has a Stage 2 pressure injury on her sacrum that requires dressing changes twice daily. She needs assistance with bathing and toileting.” Which component of SBAR is missing from this report?

40. A patient is being discharged with instructions for a follow-up appointment in one week. The patient speaks limited English and appears uncertain about the appointment details. Which action by the practical nurse best promotes continuity of care?

41. The practical nurse is reviewing the components of the Plan-Do-Study-Act (PDSA) cycle for a quality improvement initiative. Which step in the PDSA cycle involves implementing a small-scale change on a trial basis?

42. An 82-year-old patient is being discharged home after hip replacement surgery. The patient lives alone and expresses concern about managing daily activities. Which referral is most appropriate for the practical nurse to recommend to the registered nurse?

43. A practical nurse working in a long-term care facility notices that three patients have developed catheter-associated urinary tract infections (CAUTI) in the past month. The PN has been collecting data for a quality improvement initiative. Which action should the PN take first?

44. Which nursing-sensitive outcome is defined as a hospital-acquired pressure injury that develops as a result of immobility and inadequate repositioning?

45. A patient recovering from a stroke is being discharged to home. The interprofessional team determines the patient needs continued rehabilitation for gait training and activities of daily living. To which interdisciplinary team member should the practical nurse expect a referral?

46. A practical nurse witnesses a patient fall while ambulating to the bathroom. After ensuring the patient’s immediate safety, which action demonstrates proper incident reporting protocol?

47. A quality improvement team is analyzing data showing an increase in medication errors during shift change. The team uses a fishbone diagram to identify root causes. Which category would be most appropriate for documenting errors caused by interruptions during medication administration?

48. The Joint Commission’s National Patient Safety Goals require healthcare facilities to implement specific measures to prevent healthcare-associated infections. Which nursing-sensitive outcome is directly prevented by using aseptic technique during central line access and dressing changes?

49. A practical nurse is caring for a patient who recently experienced the death of a spouse and is having difficulty coping. The patient states, “I don’t know how I’ll go on without my husband.” Which referral should the PN recommend to the registered nurse?

50. A patient with a new colostomy is being prepared for discharge. The patient tells the practical nurse, “I’m worried about how I’ll pay for my ostomy supplies. My insurance barely covers my medications.” The PN reports this concern to the registered nurse. Which interprofessional team member should the RN most likely consult?