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

Why is a patient with a suspected spinal injury moved by log-rolling?

  1. AIt lets the patient help with the turn
  2. BIt reduces the number of staff needed
  3. CIt is the fastest way to turn any patient, whatever their condition
  4. DIt keeps the head, neck and spine aligned as one unit
2.Nursing fundamentalsHard

A patient says they have no pain, but grimaces and holds their side whenever they move. What should the nurse do?

  1. AExplore the difference gently and assess the pain further
  2. BRecord "no pain" and take no further action
  3. CGive the strongest analgesic available straight away
  4. DTell the patient they are not being honest
3.Infection control & patient safetyMedium

Which patient has the highest risk of a burn from a heating pad?

  1. AA healthy young adult with a strained muscle
  2. BA patient with a sprained wrist who is fully alert
  3. CA patient recovering from a cold
  4. DA patient with diabetic peripheral neuropathy
4.Infection control & patient safetyHard

Who should mark the operative site before surgery?

  1. AThe person who will perform the procedure, with the patient involved where possible
  2. BThe patient, alone, using a marker pen at home on the night before surgery
  3. CThe admitting clerk, using the information written on the consent form
  4. DAny member of the operating room team after anesthesia starts
5.Prioritization & delegationMedium

A nurse cannot read part of a medication order. What should the nurse do?

  1. AAsk another nurse to guess what the order most likely says, then give it
  2. BSkip the drug and not tell anyone until the next ward round
  3. CGive the usual dose of the drug the nurse thinks was meant
  4. DContact the prescriber to clarify the order before giving the drug
6.Prioritization & delegationHard

A team has an RN, an LPN/LVN and a nursing assistant. Which task is the best one to assign to the LPN/LVN?

  1. AAssessing a patient who returned from surgery 30 minutes ago
  2. BMeasuring the vital signs and weights of every patient on the unit before breakfast
  3. CWriting the discharge teaching plan for a patient with new diabetes
  4. DGiving a scheduled subcutaneous anticoagulant injection to a stable patient
7.Clinical nursingMedium

What happens in third-degree (complete) heart block?

  1. AThe ventricles beat very fast and regularly
  2. BThe atria beat chaotically with no P waves, and the ventricular rate is irregular
  3. CNo impulses from the atria reach the ventricles, so they beat independently
  4. DEvery impulse reaches the ventricles, but each one is slightly delayed
8.Clinical nursingHard

An arterial blood gas shows a low PaO2 with a low or normal PaCO2. How is this classified?

  1. AType 1 respiratory failure
  2. BMetabolic acidosis
  3. CType 2 respiratory failure
  4. DNormal blood gas
9.Lab values & electrolytesMedium

A patient with diabetes also takes propranolol. Why is regular glucose monitoring especially important?

  1. AThe drug stops the meter from reading correctly
  2. BThe drug blocks the insulin injection site
  3. CThe drug can mask warning signs of hypoglycemia
  4. DThe drug causes very high glucose in all patients
10.Lab values & electrolytesHard

A patient has a hematocrit of 60% and a raised red cell mass. Which result suggests polycythemia vera rather than secondary polycythemia from chronic hypoxia?

  1. AA high carboxyhemoglobin
  2. BA low oxygen saturation
  3. CA low erythropoietin level
  4. DA high erythropoietin level
11.PharmacologyMedium

During an infusion of a vesicant chemotherapy drug, the patient reports burning, and the site is swollen. What should the nurse do first?

  1. AStop the infusion, leave the cannula in and follow the protocol
  2. BFlush the line with a large volume of saline
  3. CRemove the cannula at once and massage the area firmly
  4. DIncrease the infusion rate to finish quickly
12.PharmacologyHard

Why can beta blockers mask the warning signs of hypoglycaemia in people with diabetes?

  1. AThey block insulin release completely
  2. BThey cause hyperthermia that hides sweating
  3. CThey raise blood glucose so that hypoglycaemia cannot occur at all
  4. DThey blunt adrenergic symptoms such as tremor and palpitations
13.Med-surg: cardiovascular & respiratoryMedium

Which vaccinations are usually recommended for people with COPD?

  1. AA BCG vaccine every five years
  2. BA yearly tetanus booster only
  3. CNo vaccines at all, as they are known to trigger exacerbations
  4. DAnnual influenza and pneumococcal vaccination
14.Med-surg: cardiovascular & respiratoryHard

During CPR on an adult, a nurse notices a colleague compressing at about 140/min and leaning on the chest between compressions. Which correction is most appropriate?

  1. ASlow to 100–120/min and allow full chest recoil
  2. BSpeed up to about 160/min to improve the blood flow
  3. CPress more gently, to a depth of about 2 cm
  4. DStop compressions until a pulse is felt
15.Med-surg: neuro, endocrine & renalMedium

A woman who takes the combined contraceptive pill is starting carbamazepine. What should she be taught?

  1. AThere is no interaction between these two medicines
  2. BCarbamazepine can make the pill less effective, so other contraception is needed
  3. CShe should take both at the same time so they are absorbed together
  4. DThe pill makes carbamazepine toxic, so she must stop the pill
16.Med-surg: neuro, endocrine & renalHard

The nurse has four patients. Which one needs to be seen first?

  1. AA patient with hypothyroidism asking when to take levothyroxine
  2. BA patient with stable CKD waiting for a renal diet review
  3. CA patient with Parkinson's disease whose next dose is due in two hours
  4. DA patient on insulin for DKA whose potassium is now 2.9 mmol/L
17.Med-surg: GI, perioperative & oncologyMedium

What is a Curling's ulcer?

  1. AA pressure ulcer under a splint that has been left on too long
  2. BA leg ulcer caused by venous disease after long bed rest
  3. CA stress ulcer of the stomach or duodenum after a major burn
  4. DA burn on the sole of the foot
18.Med-surg: GI, perioperative & oncologyHard

A patient with a high-voltage electrical injury has small entry and exit wounds. Why is close monitoring needed?

  1. AHidden muscle damage: arrhythmias, rhabdomyolysis, kidney injury
  2. BElectrical injuries never cause damage beneath the skin surface
  3. CSmall skin wounds show that the internal injury must also be minor
  4. DThe only real risk is a minor infection of the skin wounds
19.Maternity & obstetric nursingMedium

A woman with pre-eclampsia is on magnesium sulfate. Why does the nurse monitor her urine output closely?

  1. AUrine output tells the nurse exactly when to stop the infusion after the birth
  2. BMagnesium causes a large diuresis that leads to dehydration
  3. CLow urine output shows that the magnesium is working
  4. DMagnesium is cleared by the kidneys, so oliguria raises the risk of toxicity
20.Maternity & obstetric nursingHard

After birth of the head, the nurse feels the umbilical cord loosely around the baby's neck. What is the appropriate action?

  1. AAsk the woman to stop pushing for 30 minutes
  2. BSlip the loop over the head or let the body deliver through it
  3. CPush the baby's head back into the vagina
  4. DClamp and cut the cord before the shoulders deliver in every case
21.Pediatric nursingMedium

A breastfed infant has gastroenteritis with mild dehydration. What should the nurse advise?

  1. AGive nothing by mouth for 24 hours
  2. BContinue breastfeeding, and give oral rehydration solution as advised
  3. CGive diluted fruit juice instead of breast milk
  4. DStop breastfeeding until the diarrhoea has completely stopped, then restart slowly
22.Pediatric nursingHard

Which IV fluid is usually used for a fluid bolus in a child with shock?

  1. AAn isotonic crystalloid such as 0.9% sodium chloride
  2. B10% glucose solution
  3. C5% glucose in water, given as fast as possible
  4. D0.18% sodium chloride with 4% glucose, given quickly
23.Mental health nursingMedium

Which item is part of a safety plan for a person experiencing domestic violence?

  1. AAvoiding contact with friends and support services so as not to provoke him
  2. BKeeping all important documents in the shared house
  3. CTelling the abuser about plans to leave so that he can prepare
  4. DKeeping an emergency bag with documents, money and keys somewhere safe
24.Mental health nursingHard

A patient with borderline personality disorder says, "If you don't make Anna my nurse again tomorrow, I'll cut myself." What is the most appropriate response?

  1. ATake the statement seriously, assess her risk and explain that nursing assignments are decided by the team
  2. BTell her that if she cuts herself again, she will be discharged from the ward at once without any follow-up
  3. CIgnore the threat, because she is only trying to manipulate staff
  4. DAgree to assign Anna to her every day so that she stays safe
25.Nursing math & unit conversionsMedium
183 cm1 in = 2.54 cmh = ? in

Practice exercise (made-up values, not clinical guidance). A patient is 183 cm tall. Using 1 in = 2.54 cm, find the height h in inches. Round to one decimal place.

183 cm1 in = 2.54 cm
h = in
26.Nursing math & unit conversionsHard
10 mcg/kg/min? mg/h46 kg1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An order reads 10 mcg/kg/min for a patient who weighs 46 kg. Express the dose rate D in mg/h. Round to two decimal places.

10 mcg/kg/min46 kg
D = mg/h
27.Dosage calculationsMedium
22 kg25 mg/kgD = ? mg

A patient weighs 22 kg and is prescribed 25 mg/kg as a single dose. Find the dose D in mg.

22 kg25 mg/kg
D = mg
28.Dosage calculationsHard
125 mg/5 mLV = ? mL

A patient weighs 22 lb. The prescription is 15 mg/kg as a single dose, and the stock contains 125 mg in 5 mL. Using 1 kg = 2.2 lb, what volume V do you give?

22 lb15 mg/kg125 mg/5 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
60 gtt/mL90 mL/h? gtt/min

An infusion is ordered at 90 mL/h, but no pump is available. It runs by gravity through a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

90 mL/h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
500 mg250 mL60 gtt/mL80 mg/h? gtt/min

500 mg of a drug is diluted in 250 mL and given by gravity through a set of 60 gtt/mL. The order is 80 mg per hour. Find the drip rate R in drops per minute.

500 mg/250 mL80 mg/h60 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftjuice100 mLtea240 mLice chips120 mLIV infusion125 mL/h × 8 hIV antibiotic1 × 100 mLurine350 mLurine325 mLwound drain70 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss). Count ice chips as half their volume.

juice: 100 mLtea: 240 mLice chips: 120 mLIV infusion: 125 mL/h × 8 hIV antibiotic: 1 × 100 mLurine: 350 mLurine: 325 mLwound drain: 70 mL
B = mL
32.IV fluids & fluid balanceHard
500 mL100 mL infused80 mL/h13:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 80 mL/h. At 13:00, 100 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL100 mL infused80 mL/h
t = h
33.Clinical assessment scoresMedium
8350SBPDBPmmHgHR 98/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 98/min and a blood pressure of 83/50 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 98/minBP 83/50 mmHg
SI =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 75 kg and is 151 cm tall. Calculate the BMI and click the WHO weight category.

75 kg151 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: D · It keeps the head, neck and spine aligned as one unit

Why this is the answer

Log-rolling turns the body as a single unit while one person controls the head and neck, protecting a possibly unstable spine.

Answer

D · It keeps the head, neck and spine aligned as one unit
2.Nursing fundamentals

Answer: A · Explore the difference gently and assess the pain further

Why this is the answer

When cues conflict, the nurse looks further. Patients may play pain down for many reasons, such as not wanting to bother staff or fearing side effects.

Answer

A · Explore the difference gently and assess the pain further
3.Infection control & patient safety

Answer: D · A patient with diabetic peripheral neuropathy

Why this is the answer

Reduced sensation, as in peripheral neuropathy, prevents a person from feeling heat damage. Patients with poor sensation, poor circulation or confusion need very close monitoring if heat is used at all.

Answer

D · A patient with diabetic peripheral neuropathy
4.Infection control & patient safety

Answer: A · The person who will perform the procedure, with the patient involved where possible

Why this is the answer

Under the Universal Protocol, the site is marked by the person performing the procedure, or an authorized delegate, ideally while the patient is awake and can confirm it. This helps prevent wrong-site surgery.

Answer

A · The person who will perform the procedure, with the patient involved where possible
5.Prioritization & delegation

Answer: D · Contact the prescriber to clarify the order before giving the drug

Why this is the answer

An unclear order must be clarified with the prescriber before the medication is given. Guessing or ignoring the order can harm the patient.

Answer

D · Contact the prescriber to clarify the order before giving the drug
6.Prioritization & delegation

Answer: D · Giving a scheduled subcutaneous anticoagulant injection to a stable patient

Why this is the answer

LPNs/LVNs usually give scheduled injections to stable patients. A fresh postoperative assessment and teaching plans need the RN, and routine vital signs are better given to the assistant so the LPN/LVN can use their skills.

Answer

D · Giving a scheduled subcutaneous anticoagulant injection to a stable patient
7.Clinical nursing

Answer: C · No impulses from the atria reach the ventricles, so they beat independently

Why this is the answer

In complete heart block the atria and ventricles are dissociated, and a slow escape rhythm drives the ventricles. Patients may be dizzy or collapse and often need pacing.

Answer

C · No impulses from the atria reach the ventricles, so they beat independently
8.Clinical nursing

Answer: A · Type 1 respiratory failure

Why this is the answer

Type 1 respiratory failure is hypoxaemia without hypercapnia, as in pneumonia or pulmonary embolism. Type 2 includes a raised PaCO2 from inadequate ventilation, as in COPD exacerbations.

Answer

A · Type 1 respiratory failure
9.Lab values & electrolytes

Answer: C · The drug can mask warning signs of hypoglycemia

Why this is the answer

Beta-blockers, especially nonselective ones, blunt adrenergic warning signs of hypoglycemia such as tremor and tachycardia, and they can delay recovery. Sweating usually remains. Glucose checks help detect lows that the patient may not feel.Checked against: Low blood sugar · MedlinePlus (NIH) (2026)

Answer

C · The drug can mask warning signs of hypoglycemia
10.Lab values & electrolytes

Answer: C · A low erythropoietin level

Why this is the answer

In polycythemia vera, a marrow mutation (usually JAK2) drives red cell production, so erythropoietin is low. In secondary polycythemia from hypoxia (COPD, high altitude, smoking), erythropoietin is high. Often white cells and platelets are also raised in polycythemia vera.Checked against: Erythropoietin test · MedlinePlus (NIH) (2025); Polycythemia vera · MedlinePlus (NIH) (2025)

Answer

C · A low erythropoietin level
11.Pharmacology

Answer: A · Stop the infusion, leave the cannula in and follow the protocol

Why this is the answer

Suspected extravasation of a vesicant is an emergency. The infusion is stopped, the cannula is left in so that drug can be aspirated, and the protocol, which may include an antidote and cold or warm packs, is followed.

Answer

A · Stop the infusion, leave the cannula in and follow the protocol
12.Pharmacology

Answer: D · They blunt adrenergic symptoms such as tremor and palpitations

Why this is the answer

Tremor, palpitations and anxiety in hypoglycaemia are adrenaline-driven; beta blockade dampens them, so patients may notice low glucose later. Sweating is cholinergic and often persists.

Answer

D · They blunt adrenergic symptoms such as tremor and palpitations
13.Med-surg: cardiovascular & respiratory

Answer: D · Annual influenza and pneumococcal vaccination

Why this is the answer

Vaccination against influenza, pneumococcus and other respiratory infections recommended in national schedules (such as COVID-19 and, for older adults, RSV) reduces infections and exacerbations in COPD.

Answer

D · Annual influenza and pneumococcal vaccination
14.Med-surg: cardiovascular & respiratory

Answer: A · Slow to 100–120/min and allow full chest recoil

Why this is the answer

High-quality adult CPR uses a rate of 100–120/min, a depth of 5–6 cm, full recoil after each compression and minimal interruptions. Leaning prevents the chest from re-expanding, so the heart fills less. Compressors should swap about every 2 minutes to avoid fatigue.

Answer

A · Slow to 100–120/min and allow full chest recoil
15.Med-surg: neuro, endocrine & renal

Answer: B · Carbamazepine can make the pill less effective, so other contraception is needed

Why this is the answer

Carbamazepine is a strong liver enzyme inducer, so it lowers hormone levels from the pill and can lead to an unplanned pregnancy. Contraception that is not affected, such as an IUD, is usually advised.

Answer

B · Carbamazepine can make the pill less effective, so other contraception is needed
16.Med-surg: neuro, endocrine & renal

Answer: D · A patient on insulin for DKA whose potassium is now 2.9 mmol/L

Why this is the answer

Insulin drives potassium into cells, and a potassium of 2.9 mmol/L during DKA treatment can cause life-threatening arrhythmias. The insulin rate and potassium replacement need urgent review under the protocol. The other patients are stable.

Answer

D · A patient on insulin for DKA whose potassium is now 2.9 mmol/L
17.Med-surg: GI, perioperative & oncology

Answer: C · A stress ulcer of the stomach or duodenum after a major burn

Why this is the answer

Curling's ulcer is an acute peptic ulcer after severe burns, linked with reduced gut blood flow. Early enteral feeding and acid suppression help prevent it, and GI bleeding is watched for.

Answer

C · A stress ulcer of the stomach or duodenum after a major burn
18.Med-surg: GI, perioperative & oncology

Answer: A · Hidden muscle damage: arrhythmias, rhabdomyolysis, kidney injury

Why this is the answer

Electrical current travels along nerves, vessels and muscles, causing deep injury beneath small skin wounds. Patients need cardiac monitoring, assessment for compartment syndrome and urine checks for myoglobin (dark urine), with a higher urine output target if myoglobinuria is present.

Answer

A · Hidden muscle damage: arrhythmias, rhabdomyolysis, kidney injury
19.Maternity & obstetric nursing

Answer: D · Magnesium is cleared by the kidneys, so oliguria raises the risk of toxicity

Why this is the answer

Magnesium is cleared by the kidneys, so oliguria, which is common in pre-eclampsia, allows levels to rise. The nurse also monitors reflexes, respiratory rate and level of consciousness.

Answer

D · Magnesium is cleared by the kidneys, so oliguria raises the risk of toxicity
20.Maternity & obstetric nursing

Answer: B · Slip the loop over the head or let the body deliver through it

Why this is the answer

A loose nuchal cord can usually be slipped over the head or the baby can be born through it (somersault manoeuvre). Clamping and cutting before birth is reserved for a tight cord that prevents delivery.

Answer

B · Slip the loop over the head or let the body deliver through it
21.Pediatric nursing

Answer: B · Continue breastfeeding, and give oral rehydration solution as advised

Why this is the answer

Breastfeeding should continue during gastroenteritis, with oral rehydration solution added when there are signs of dehydration. Withholding feeds slows recovery and juice can worsen diarrhoea.

Answer

B · Continue breastfeeding, and give oral rehydration solution as advised
22.Pediatric nursing

Answer: A · An isotonic crystalloid such as 0.9% sodium chloride

Why this is the answer

Isotonic crystalloids such as 0.9% sodium chloride or balanced solutions are used for boluses because they expand intravascular volume. Hypotonic fluids such as 5% glucose move into cells and can cause hyponatraemia and brain swelling.

Answer

A · An isotonic crystalloid such as 0.9% sodium chloride
23.Mental health nursing

Answer: D · Keeping an emergency bag with documents, money and keys somewhere safe

Why this is the answer

A safety plan includes an escape bag, important documents, a safe place to go, emergency numbers and a code word with trusted people. The time of leaving can be the most dangerous period.

Answer

D · Keeping an emergency bag with documents, money and keys somewhere safe
24.Mental health nursing

Answer: A · Take the statement seriously, assess her risk and explain that nursing assignments are decided by the team

Why this is the answer

Every threat of self-harm needs assessment, but giving in to it reinforces the behaviour and supports splitting. The nurse addresses safety and feelings while keeping consistent team boundaries.

Answer

A · Take the statement seriously, assess her risk and explain that nursing assignments are decided by the team
25.Nursing math & unit conversions

Answer: h = 72 in

Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.

Centimetres to inches

h = 183/2.54 = 72.05 ≈ 72 in

Answer

h = 72 in
26.Nursing math & unit conversions

Answer: D = 27.6 mg/h

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.

Set up the chain

D = 10 mcg/kg/min × 46 kg × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 10·46·60/1000 = 27.6 mg/h

Answer

D = 27.6 mg/h
27.Dosage calculations

Answer: D = 550 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

25·22 = 550 mg

Answer

D = 550 mg
28.Dosage calculations

Answer: V = 6 mL

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.

Weight in kg

22/2.2 = 10 kg

Dose

15·10 = 150 mg

Volume

V = (150/125)·5 = 6 mL

Answer

V = 6 mL
29.IV infusion rates

Answer: R = 90 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.

Millilitres per minute

90/60 = 1.5 mL/min

Drip rate

R = 1.5·60 = 90 gtt/min

Answer

R = 90 gtt/min

With a microdrip set (60 gtt/mL), gtt/min equals mL/h.

30.IV infusion rates

Answer: R = 40 gtt/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

500/250 = 2 mg/mL

Volume per hour

80/2 = 40 mL/h

Drip rate

R = 40·60/60 = 40 gtt/min

Answer

R = 40 gtt/min
31.IV fluids & fluid balance

Answer: B = 755 mL

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 intake

oral: 100 + 240 = 340 mL
ice chips: 120/2 = 60 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1500 mL

Total output

350 + 325 + 70 = 745 mL

Balance

B = 1500 − 745 = 755 mL

Answer

B = 755 mL

Positive: more fluid went in than came out.

32.IV fluids & fluid balance

Answer: t = 5 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.

Volume left

500 − 100 = 400 mL

Time

t = 400/80 = 5 h

Answer

t = 5 h

That is about 5 h 00 min, so the bag runs out at about 18:00.

33.Clinical assessment scores

Answer: SI = 1.18

Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.

Shock index

SI = 98/83 = 1.181 ≈ 1.18

Answer

SI = 1.18

1 or more: a warning sign of shock in this practice case.

34.Clinical assessment scores

Answer: obesity class I

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 = 75/1.51² = 32.89

Category

obesity class I

Answer

obesity class I

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