NCLEX-PN-style practice questions (LPN/LVN): cram pack

Formula sheets, the key method steps for every topic and 34 practice problems, with full solutions at the back.

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1Formulas and methods

Infection control & patient safety

Method

  1. Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
  2. Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
  3. Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
  4. Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
  5. Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.

Prioritization & delegation

Method

  1. Ask what will harm the patient soonest if nothing is done.
  2. Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
  3. Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
  4. Assess before you act unless it is an emergency; then choose the step the others depend on.
  5. For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.

Lab values & electrolytes

Method

  1. Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
  2. Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
  3. Link the value to its typical signs and to the drugs and conditions that cause it.
  4. Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
  5. Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.

Med-surg: cardiovascular & respiratory

Method

  1. Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
  2. Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
  3. Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
  4. Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
  5. Choose the safe first action, then escalate and reassess.

Med-surg: neuro, endocrine & renal

Method

  1. Check the glucose in every patient with new confusion, weakness or a seizure.
  2. Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
  3. For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
  4. For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
  5. For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.

Med-surg: GI, perioperative & oncology

Method

  1. Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
  2. Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
  3. For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
  4. For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
  5. For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Pediatric nursing

Method

  1. Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
  2. Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
  3. Match the action to the development stage and involve the family.
  4. Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.

Mental health nursing

Method

  1. Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
  2. Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
  3. Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
  4. Respect rights: the least restrictive option, consent and confidentiality with its limits.

Nursing math & unit conversions

Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
Temperature
°C = (°F − 32)·5/9, °F = °C·9/5 + 32
24-hour clock
PM hours 1–11: add 12; 12 AM = 00:xx; 12 PM = 12:xx
Dose rate
mcg/min × 60/1000 = mg/h
Laboratory factors
glucose 1 mmol/L = 18 mg/dL; creatinine 1 mg/dL = 88.4 µmol/L; Hb 1 g/dL = 10 g/L

Method

  1. Write the given quantity with its unit and the unit you want.
  2. Pick the equivalent: 1000 between kg, g, mg and mcg or L and mL; 1 kg = 2.2 lb; 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 240 mL.
  3. Write it as a fraction so that the unwanted unit cancels; for a rate, use one fraction per unit that changes.
  4. Check the direction: a smaller unit gives a bigger number.
  5. Round only the final answer, to the precision the question names.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

IV fluids & fluid balance

Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time

Clinical assessment scores

Glasgow Coma Scale
GCS = E (1–4) + V (1–5) + M (1–6) = 3–15
APGAR
5 signs × 0–2 = 0–10; 7–10 reassuring, 4–6 moderately abnormal, 0–3 low
Braden scale
5 × (1–4) + 1 × (1–3) = 6–23; ≤ 18 at risk
Morse fall scale
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²

Method

  1. Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
  2. Score every item separately, matching the description to its level.
  3. Add the item scores and check that the total lies inside the range.
  4. Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
  5. For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².

2Practice problems

1.Nursing fundamentalsMedium

Which of these is recorded as fluid intake on a fluid balance chart?

  1. AWound drainage
  2. BVomit
  3. CIntravenous fluids
  4. DUrine output from a catheter
2.Nursing fundamentalsHard

A patient with new swallowing difficulty is prescribed a modified-release tablet. What should the nurse do?

  1. AOmit the medicine without telling anyone
  2. BCut the tablet into quarters and give the pieces one at a time with water
  3. CContact the prescriber or pharmacist for a suitable alternative
  4. DCrush the tablet and mix it with yoghurt
3.Infection control & patient safetyMedium

Why are independent double checks used for some medicines, such as insulin and heparin infusions?

  1. AA second person checking separately catches missed errors
  2. BTo share responsibility between two nurses if an error happens
  3. CTo make the preparation process faster
  4. DBecause these drugs are very expensive to waste
4.Infection control & patient safetyHard

During a power cut in a US hospital, a ventilator must stay powered. Where should it be plugged in?

  1. AInto any white outlet in the room
  2. BInto a red outlet connected to the emergency generator
  3. CInto an extension cord from the corridor
  4. DInto the outlet that is closest to the bed, whatever its color
5.Prioritization & delegationMedium

A woman calls to say her husband suddenly has a drooping face and slurred speech. What should the nurse advise?

  1. ADrive him to the hospital yourself after he has eaten dinner
  2. BCall emergency services now and note the time it started
  3. CLet him lie down and see if it improves
  4. DBook an appointment with his doctor next week
6.Prioritization & delegationHard

An infant is choking and cannot cry or breathe. Which technique is correct?

  1. AA blind finger sweep of the mouth
  2. BBack blows and chest thrusts
  3. CAbdominal thrusts, as in adults
  4. DHolding the infant upside down by the feet
7.Clinical nursingMedium

Why are people with diabetes advised to have regular eye screening?

  1. ATo measure their blood glucose through the eye
  2. BTo check whether they need reading glasses for close work
  3. CTo prevent conjunctivitis
  4. DTo detect diabetic retinopathy early, before sight is lost
8.Clinical nursingHard

A nurse teaches a patient with asthma about a new inhaled steroid "preventer". Which statement shows a need for further teaching?

  1. A"I will use it every day even when I feel well."
  2. B"I will only use it when I'm wheezy."
  3. C"I'll keep my reliever inhaler with me."
  4. D"I will rinse my mouth after using it."
9.Lab values & electrolytesMedium

A patient is starting atorvastatin. Which laboratory test is usually checked at baseline?

  1. AThyroid antibodies
  2. BBlood cultures
  3. CSerum lipase
  4. DLiver enzymes
10.Lab values & electrolytesHard

A patient on lithium has had vomiting and diarrhea for 3 days and has been taking ibuprofen. They now have a coarse tremor and confusion. The lithium level is 2.2 mEq/L. What is the best interpretation and action?

  1. ALithium toxicity; hold lithium and report urgently
  2. BA normal level; continue lithium as prescribed
  3. CIbuprofen side effects only; give it with food
  4. DA low level; ask for the lithium dose to be raised
11.PharmacologyMedium

A partial agonist is given together with a high dose of a full agonist. What happens to the response?

  1. AIt doubles, because both drugs activate the receptor
  2. BIt rises above the maximum of the full agonist
  3. CIt falls, because the partial agonist competes for the receptors
  4. DIt stays exactly the same as with the high dose of full agonist alone
12.PharmacologyHard

A patient on lisinopril for hypertension starts taking ibuprofen every day for knee pain. What is the main concern?

  1. AA higher risk of a dry cough than with lisinopril alone
  2. BWeaker blood pressure control, kidney injury and high potassium
  3. CFaster liver metabolism of lisinopril, so it stops working
  4. DA large fall in blood pressure, with fainting and falls on standing up
13.Med-surg: cardiovascular & respiratoryMedium

Which history is a contraindication to thrombolysis for a STEMI?

  1. AA previous haemorrhagic stroke
  2. BA previous appendicectomy many years ago
  3. CMild asthma controlled with inhalers
  4. DTreated high blood pressure
14.Med-surg: cardiovascular & respiratoryHard

A patient with both COPD and heart disease is more breathless, with bilateral basal crackles, raised JVP, ankle swelling and a markedly raised NT-proBNP. Which problem is most likely driving this episode?

  1. AA primary spontaneous pneumothorax
  2. BAn asthma attack
  3. CDecompensated heart failure
  4. DHyperventilation from anxiety
15.Med-surg: neuro, endocrine & renalMedium

Several hours after a carotid endarterectomy, which finding needs the most urgent action?

  1. AMild pain at the incision site
  2. BA small amount of dried blood on the dressing
  3. CA blood pressure slightly above the baseline
  4. DAn expanding neck swelling with noisy breathing
16.Med-surg: neuro, endocrine & renalHard

Which task can the registered nurse delegate to a trained healthcare assistant (nursing assistant)?

  1. ATeaching a new patient how to inject insulin
  2. BChecking pre-meal glucose and reporting results out of range
  3. CAssessing a confused patient whose glucose is 2.6 mmol/L (47 mg/dL)
  4. DDeciding the dose of correction insulin from the glucose result
17.Med-surg: GI, perioperative & oncologyMedium

Which PPE is usually recommended when giving cytotoxic chemotherapy?

  1. AChemo-tested gloves and impermeable gown
  2. BNo PPE, because the infusion bag is sealed
  3. CA paper surgical mask but no gloves
  4. DOrdinary cotton gloves and a plastic apron
18.Med-surg: GI, perioperative & oncologyHard

A nurse teaches a patient going home between chemotherapy cycles. Which statement shows a need for further teaching?

  1. A"I'll keep the emergency number and call if I feel shivery."
  2. B"I'll check my temperature whenever I feel hot, shivery or unwell."
  3. C"If I get a fever, I'll take paracetamol and see if it settles."
  4. D"I'll wash my hands often and avoid people with infections."
19.Maternity & obstetric nursingMedium

Which finding on day 4 after a caesarean suggests a wound infection?

  1. ARedness, warmth and discharge
  2. BA closed incision with intact edges
  3. CMild numbness of the skin near the scar
  4. DMild tenderness without redness
20.Maternity & obstetric nursingHard

A woman has cytomegalovirus (CMV) infection in pregnancy. Which outcome in the baby is a major concern?

  1. APhenylketonuria
  2. BOpen neural tube defects such as spina bifida
  3. CHearing loss and developmental delay
  4. DClubfoot only
21.Pediatric nursingMedium

Which diet is usually advised for a child with nephrotic syndrome while there is oedema?

  1. AA carbohydrate-free diet to reduce fluid retention
  2. BA high-salt diet to replace losses in the urine
  3. CNo added salt
  4. DA protein-free diet to rest the kidneys completely
22.Pediatric nursingHard

A 15-year-old in traction for a femur fracture is withdrawn and irritable. Which intervention best fits his developmental stage?

  1. AMove him to a room with toddlers so the ward is less lonely
  2. BSet a strict timetable for him that staff decide without his input
  3. CArrange contact with friends and let him control parts of his daily routine
  4. DAsk his parents to stay with him at all times and make decisions for him
23.Mental health nursingMedium

Which principle applies to the use of physical restraint?

  1. AIt can be used for staff convenience on a busy shift, provided that it is documented and reviewed by the team afterwards
  2. BIt is a last resort when less restrictive measures have failed, with close monitoring and release as soon as safe
  3. CIt does not need to be documented
  4. DIt can be used as a punishment for rule-breaking
24.Mental health nursingHard

A patient says, "I'm such a failure. My wife left me and I lost my job." The nurse answers, "Don't worry, things will get better soon." What is wrong with this response?

  1. AIt uses the technique of presenting reality wrongly
  2. BIt explores the problem too deeply too early
  3. CIt is too direct and confronting
  4. DIt is false reassurance that dismisses the patient's feelings
25.Nursing math & unit conversionsMedium
24.099 gtt/min? gtt/minround to 1 gtt/min

Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 24.099 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?

24.099 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
1 tbsp · 2/day · 10 d? mL1 tbsp = 15 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads 1 tbsp of an oral suspension every 12 hours for 10 days. Using 1 tbsp = 15 mL, how many mL V are needed for the whole course?

1 tbspevery 12 hours10 days1 tbsp = 15 mL
V = mL
27.Dosage calculationsMedium
18 kg25 mg/kgD = ? mg

A patient weighs 18 kg and is prescribed 25 mg/kg as a single dose. Find the dose D in mg.

18 kg25 mg/kg
D = mg
28.Dosage calculationsHard
38 kg127 cmBSA = √(h·w/3600)75 mg/m²D = ? mg

A patient is 127 cm tall and weighs 38 kg. The prescription is 75 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

127 cm38 kg75 mg/m²
D = mg
29.IV infusion ratesMedium
500 mL10 gtt/mL2 h? gtt/min

Infuse 500 mL over 2 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL2 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
400 mg500 mL18 mL/h? mcg/min

An infusion of 400 mg in 500 mL runs at 18 mL/h. How many micrograms per minute D does the patient receive?

400 mg/500 mL18 mL/h
D = mcg/min
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shifttea240 mLjelly120 mLice chips200 mLIV infusion80 mL/h × 12 hIV antibiotic2 × 50 mLurine450 mLurine200 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 69 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

69 kg12 hurine: 450 mLurine: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
1000 mL→ 50 mL/hstart 13:00ttotal​ = ? h100 mL/h × 2 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 13:00 at 100 mL/h. After 2 hours the rate is changed to 50 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

1000 mL100 mL/h · 2 h50 mL/h
t = h
33.Clinical assessment scoresMedium
3210123RR≤89–1112–2021–24≥25SpO₂≤9192–9394–95≥96air / O₂O₂airSBP≤9091–100101–110111–219≥220HR≤4041–5051–9091–110111–130≥131ACVPUAC, V, P, UT °C≤35.035.1–36.036.1–38.038.1–39.0≥39.1

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 14/min, SpO₂ 98% on room air, blood pressure 118/70 mmHg, pulse 82/min, unresponsive, temperature 38.1 °C. What is the NEWS2 total score?

RR 14SpO₂ 98%airSBP 118HR 82UT 38.1 °C
NEWS2 =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 105 kg and is 196 cm tall. Calculate the BMI and click the WHO weight category.

105 kg196 cm
  1. 1underweight
  2. 2healthy weight
  3. 3overweight
  4. 4obesity class I
  5. 5obesity class II
  6. 6obesity class III

3Solutions

1.Nursing fundamentals

Answer: C · Intravenous fluids

Why this is the answer

Intake includes oral fluids, enteral feeds and IV fluids, including drug infusions. Urine, vomit, drainage and stool are output.

Answer

C · Intravenous fluids
2.Nursing fundamentals

Answer: C · Contact the prescriber or pharmacist for a suitable alternative

Why this is the answer

Crushing a modified-release tablet can release the full dose at once and cause toxicity. The prescriber or pharmacist can suggest a liquid, a patch or another drug, and any omitted dose is documented.

Answer

C · Contact the prescriber or pharmacist for a suitable alternative
3.Infection control & patient safety

Answer: A · A second person checking separately catches missed errors

Why this is the answer

In an independent double check, a second qualified person checks the order, the drug, the dose, the calculation and the pump settings on their own. This catches errors that could cause serious harm with high-alert medications.

Answer

A · A second person checking separately catches missed errors
4.Infection control & patient safety

Answer: B · Into a red outlet connected to the emergency generator

Why this is the answer

In US hospitals, red outlets are usually connected to the emergency generator. Life-support equipment is plugged into them, and battery backups are checked as part of emergency planning.

Answer

B · Into a red outlet connected to the emergency generator
5.Prioritization & delegation

Answer: B · Call emergency services now and note the time it started

Why this is the answer

Stroke is time-critical. Emergency services can begin assessment on the way and take the patient to a stroke center; the time of onset guides treatment.

Answer

B · Call emergency services now and note the time it started
6.Prioritization & delegation

Answer: B · Back blows and chest thrusts

Why this is the answer

For a choking infant, the nurse gives cycles of five back blows and five chest thrusts. Abdominal thrusts are not used in infants, and blind finger sweeps can push the object deeper.

Answer

B · Back blows and chest thrusts
7.Clinical nursing

Answer: D · To detect diabetic retinopathy early, before sight is lost

Why this is the answer

Diabetic retinopathy often has no symptoms until it is advanced. Screening allows early treatment that can prevent blindness.

Answer

D · To detect diabetic retinopathy early, before sight is lost
8.Clinical nursing

Answer: B · "I will only use it when I'm wheezy."

Why this is the answer

Inhaled corticosteroids must be used regularly to reduce airway inflammation and prevent attacks. The short-acting reliever is used for symptoms.

Answer

B · "I will only use it when I'm wheezy."
9.Lab values & electrolytes

Answer: D · Liver enzymes

Why this is the answer

Statins can raise liver enzymes, so a baseline ALT is usually checked, with a lipid panel to judge response. Routine repeat liver tests are not always needed, but symptoms of liver injury or muscle pain should be reported.Checked against: Statins · MedlinePlus (NIH) (2025)

Answer

D · Liver enzymes
10.Lab values & electrolytes

Answer: A · Lithium toxicity; hold lithium and report urgently

Why this is the answer

A level of 2.2 mEq/L with coarse tremor and confusion is lithium toxicity. Fluid loss and NSAIDs both reduce lithium excretion by the kidneys. The dose is held, the provider is informed at once, and fluids and close monitoring are expected; severe cases may need dialysis.

Answer

A · Lithium toxicity; hold lithium and report urgently
11.Pharmacology

Answer: C · It falls, because the partial agonist competes for the receptors

Why this is the answer

A partial agonist has lower efficacy. When it displaces a full agonist from receptors, the total response drops. Buprenorphine can precipitate withdrawal in people using full opioid agonists for this reason.

Answer

C · It falls, because the partial agonist competes for the receptors
12.Pharmacology

Answer: B · Weaker blood pressure control, kidney injury and high potassium

Why this is the answer

NSAIDs block prostaglandins that dilate the afferent arteriole and promote sodium loss. With an ACE inhibitor this can reduce blood pressure control and cause kidney injury and hyperkalaemia, especially if a diuretic is also used.

Answer

B · Weaker blood pressure control, kidney injury and high potassium
13.Med-surg: cardiovascular & respiratory

Answer: A · A previous haemorrhagic stroke

Why this is the answer

Absolute contraindications include any previous intracranial haemorrhage, recent ischaemic stroke, active internal bleeding, suspected aortic dissection and recent major trauma or surgery. Thrombolysis is used when primary PCI cannot be delivered in time.

Answer

A · A previous haemorrhagic stroke
14.Med-surg: cardiovascular & respiratory

Answer: C · Decompensated heart failure

Why this is the answer

Basal crackles, raised JVP, oedema and a high natriuretic peptide point to heart failure rather than a COPD exacerbation alone. Distinguishing them matters, because treatment (diuretics and HF drugs versus bronchodilators and steroids) is different. Both may occur together.

Answer

C · Decompensated heart failure
15.Med-surg: neuro, endocrine & renal

Answer: D · An expanding neck swelling with noisy breathing

Why this is the answer

A neck haematoma after carotid surgery can compress the airway quickly. It needs immediate senior help and may need the wound opened. Neurological checks for new stroke and cranial nerve damage are also part of routine care.

Answer

D · An expanding neck swelling with noisy breathing
16.Med-surg: neuro, endocrine & renal

Answer: B · Checking pre-meal glucose and reporting results out of range

Why this is the answer

Trained assistants can measure and record glucose and report abnormal results. Dose decisions, teaching and the assessment of an unstable patient need the registered nurse.

Answer

B · Checking pre-meal glucose and reporting results out of range
17.Med-surg: GI, perioperative & oncology

Answer: A · Chemo-tested gloves and impermeable gown

Why this is the answer

Cytotoxic drugs can be absorbed through skin or inhaled. Staff use chemotherapy-tested gloves (often double), impermeable long-sleeved gowns and eye protection where splashing could occur, along with closed-system devices and safe disposal.

Answer

A · Chemo-tested gloves and impermeable gown
18.Med-surg: GI, perioperative & oncology

Answer: C · "If I get a fever, I'll take paracetamol and see if it settles."

Why this is the answer

Fever or feeling unwell during the nadir may mean neutropenic sepsis, which needs urgent assessment and antibiotics within an hour. Patients must call the emergency line straight away, not wait at home.

Answer

C · "If I get a fever, I'll take paracetamol and see if it settles."
19.Maternity & obstetric nursing

Answer: A · Redness, warmth and discharge

Why this is the answer

Redness spreading from the incision, warmth, swelling, purulent discharge, gaping edges and fever suggest infection. Numbness near the scar is common and not a sign of infection.

Answer

A · Redness, warmth and discharge
20.Maternity & obstetric nursing

Answer: C · Hearing loss and developmental delay

Why this is the answer

Congenital CMV is a leading cause of non-genetic sensorineural hearing loss and can cause microcephaly and developmental delay. Hand hygiene after contact with young children's saliva and urine reduces the risk.

Answer

C · Hearing loss and developmental delay
21.Pediatric nursing

Answer: C · No added salt

Why this is the answer

During the oedematous phase, salt is limited to reduce fluid retention, and fluids may be restricted if advised. Protein is not stopped; a normal, balanced intake for age is usually recommended.

Answer

C · No added salt
22.Pediatric nursing

Answer: C · Arrange contact with friends and let him control parts of his daily routine

Why this is the answer

Adolescents are working on identity and independence, and peers are very important. Hospital stay threatens both, so contact with friends, privacy and choices about routines help him cope.

Answer

C · Arrange contact with friends and let him control parts of his daily routine
23.Mental health nursing

Answer: B · It is a last resort when less restrictive measures have failed, with close monitoring and release as soon as safe

Why this is the answer

Restraint is used only to prevent imminent harm, after de-escalation fails, following law and policy. The patient's breathing, circulation and wellbeing are monitored continuously, and everything is documented.

Answer

B · It is a last resort when less restrictive measures have failed, with close monitoring and release as soon as safe
24.Mental health nursing

Answer: D · It is false reassurance that dismisses the patient's feelings

Why this is the answer

False reassurance minimises the patient's concerns and discourages further talk. A therapeutic response would acknowledge the losses and invite the patient to share more.

Answer

D · It is false reassurance that dismisses the patient's feelings
25.Nursing math & unit conversions

Answer: x = 24 gtt/min

Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.

Digit in the ones place

24.099 → 4

Only the next digit decides

24.099 → 0
0 is 4 or less, so 4 stays.
The digits after it (99) are ignored: round once, never step by step.

Round

x = 24 gtt/min

Answer

x = 24 gtt/min
26.Nursing math & unit conversions

Answer: V = 300 mL

Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.

Volume per dose

1 tbsp = 1·15 = 15 mL

Whole course

V = 15 mL × 2/day × 10 = 300 mL

Answer

V = 300 mL
27.Dosage calculations

Answer: D = 450 mg

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Dose

25·18 = 450 mg

Answer

D = 450 mg
28.Dosage calculations

Answer: D = 86.84 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Body surface area

BSA = √(127·38/3600) = √1.341 = 1.158 m²

Dose

D = 75·1.158 = 86.84 mg

Answer

D = 86.84 mg
29.IV infusion rates

Answer: R = 42 gtt/min

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Time in minutes

2·60 = 120 min

Drip rate

R = 500·10/120 = 41.67 ≈ 42 gtt/min

Answer

R = 42 gtt/min

At the bedside you round to the nearest whole drop: 42 gtt/min.

30.IV infusion rates

Answer: D = 240 mcg/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

400000 mcg/500 mL = 800 mcg/mL

Dose per hour

18·800 = 14400 mcg/h

Dose per minute

D = 14400/60 = 240 mcg/min

Answer

D = 240 mcg/min
31.IV fluids & fluid balance

Answer: U = 0.79 mL/kg/h

Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Total urine

450 + 200 = 650 mL

Per kilogram per hour

U = 650/(69·12) = 0.785 ≈ 0.79 mL/kg/h

Answer

U = 0.79 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 18 h

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

First part

100·2 = 200 mL
1000 − 200 = 800 mL left

Second part

800/50 = 16 h

Total time

t = 2 + 16 = 18 h

Answer

t = 18 h

That is about 18 h 00 min, so the bag runs out at about 07:00.

33.Clinical assessment scores

Answer: NEWS2 = 4

NEWS2 (National Early Warning Score 2, Royal College of Physicians 2017): score each of the seven parameters with the chart (respiration rate, SpO₂ on scale 1, air or supplemental oxygen, systolic blood pressure, pulse, consciousness on the ACVPU scale and temperature) and add the scores. Clinical risk: 0–4 low; a score of 3 in any single parameter low–medium; 5–6 medium; 7 or more high. A total of 5 or more needs an urgent response.

Score each parameter

RR 14/min → 0
SpO₂ 98% → 0
on air → 0
SBP 118 mmHg → 0
HR 82/min → 0
unresponsive (U) → 3
T 38.1 °C → 1

Add

NEWS2 = 0 + 0 + 0 + 0 + 0 + 3 + 1 = 4

Answer

NEWS2 = 4
34.Clinical assessment scores

Answer: overweight

Body mass index: BMI = weight (kg)/height (m)², with the height converted to metres first. With pounds and inches, BMI = 703 × weight (lb)/height (in)². WHO adult categories: below 18.5 underweight, 18.5–24.9 healthy weight, 25.0–29.9 overweight, 30.0–34.9 obesity class I, 35.0–39.9 obesity class II and 40 or more obesity class III.

BMI

BMI = 105/1.96² = 27.33

Category

overweight

Answer

overweight

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