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

A patient with a leg injury is climbing stairs with crutches. Which leg should go up first?

  1. AThe unaffected leg
  2. BThe crutches always go first
  3. CBoth legs together
  4. DThe injured leg
2.Nursing fundamentalsHard

A urine culture reports a mixed growth of several organisms. What is the most likely explanation?

  1. AThe laboratory used the wrong test
  2. BThe patient has several serious infections at once
  3. CThe sample was contaminated during collection
  4. DThe patient is resistant to all antibiotics
3.Infection control & patient safetyMedium

A family member tells the nurse, “My father is not himself. Something is wrong.” The hospital has a family-activated rapid response system. What is correct?

  1. AThe family must wait for the next scheduled ward round to raise the concern with a doctor
  2. BThe family should call emergency services from outside the hospital
  3. CThe family can call the rapid response team if they are worried and staff have not responded
  4. DOnly doctors may call the rapid response team
4.Infection control & patient safetyHard

A patient’s WBC is 4,000/mm3, with 30% neutrophils and 5% bands. What is the absolute neutrophil count (ANC)?

  1. A3,500/mm3
  2. B1,400/mm3
  3. C1,200/mm3
  4. D140/mm3
5.Prioritization & delegationMedium

A nurse asks a nursing assistant to use a mechanical lift. The assistant says they have never been trained to use it. Which right of delegation would be violated if the nurse insisted?

  1. ARight person
  2. BRight task
  3. CRight supervision and evaluation
  4. DRight directions and communication
6.Prioritization & delegationHard

A patient with diabetes takes propranolol. Which sign of hypoglycemia is most likely to still appear?

  1. ATachycardia
  2. BTremor
  3. CPalpitations
  4. DSweating
7.Clinical nursingMedium

The WHO analgesic ladder recommends:

  1. AGiving analgesia only when pain becomes severe
  2. BStarting all patients on strong opioids
  3. CMoving from non-opioids to weak and then strong opioids as pain increases
  4. DUsing only non-drug methods for cancer pain
8.Clinical nursingHard

A patient took a large paracetamol (acetaminophen) overdose six hours ago and says they feel well. Why is treatment still urgent?

  1. AParacetamol damage only shows up in the kidneys, many weeks later
  2. BPatients who feel well after six hours never need any treatment at all
  3. CLiver damage develops later, and the antidote works best when given early
  4. DParacetamol overdose causes immediate breathing problems
9.Lab values & electrolytesMedium

A patient with an upper gastrointestinal bleed has a BUN of 48 mg/dL (urea 17 mmol/L) and a normal creatinine. What is the most likely explanation?

  1. AThe liver has stopped making urea because of the bleeding
  2. BDigested blood adds protein, which the liver turns into urea
  3. CSkeletal muscle is breaking down because of the blood loss
  4. DThe kidneys have suddenly lost most of their function
10.Lab values & electrolytesHard

Which patient's result should the nurse act on first?

  1. AHemoglobin 9.6 g/dL (96 g/L) in a patient with stable chronic kidney disease
  2. BFerritin 15 ng/mL in a well patient with known iron-deficiency anemia on oral iron
  3. CPlatelets 140 × 10³/µL in a patient with mild chronic liver disease
  4. DHemoglobin 6.4 g/dL (64 g/L) with new chest pain and a pulse of 124/min
11.PharmacologyMedium

Combining an SSRI with which drug most increases the risk of serotonin syndrome?

  1. AA monoamine oxidase inhibitor
  2. BOmeprazole
  3. CParacetamol
  4. DAmoxicillin
12.PharmacologyHard

A patient who has had several courses of bleomycin develops a dry cough and worsening breathlessness. What should the nurse suspect?

  1. AAsthma caused by anxiety
  2. BA normal effect that will pass in a day
  3. CHeart failure from bleomycin
  4. DPulmonary fibrosis from bleomycin
13.Med-surg: cardiovascular & respiratoryMedium

Which investigation is most often used to confirm a pulmonary embolism?

  1. ASputum culture
  2. BAbdominal ultrasound
  3. CPeak flow measurement
  4. DCT pulmonary angiography
14.Med-surg: cardiovascular & respiratoryHard

After four days of antibiotics for pneumonia, a patient still has fever and pleuritic pain. There is dullness and reduced breath sounds at the right base. What complication should be suspected?

  1. AA parapneumonic effusion or empyema
  2. BAsthma triggered by the infection
  3. CNormal recovery from pneumonia
  4. DAn allergic reaction to the antibiotic
15.Med-surg: neuro, endocrine & renalMedium

A patient has acute glomerulonephritis with oedema and high blood pressure. Which nursing care is most appropriate?

  1. AGive large amounts of IV fluid
  2. BCheck the weight once a week
  3. CMonitor BP, fluid balance and daily weight
  4. DEncourage a high-salt diet to balance the fluids
16.Med-surg: neuro, endocrine & renalHard

An 89-year-old with stage 5 CKD and severe heart failure, who has capacity, decides not to start dialysis. What is the nurse's best response?

  1. ARespect the decision and support symptom-focused care
  2. BAsk the family to change the patient's mind
  3. CStop all care, because nothing more can be done
  4. DTell the patient they must start dialysis by law
17.Med-surg: GI, perioperative & oncologyMedium

Which area is used as a quick estimate of 1% of body surface area for small or scattered burns?

  1. AThe examiner's palm including the fingers
  2. BThe patient's hand and forearm
  3. CThe patient's thumbnail
  4. DThe patient's palm including the fingers
18.Med-surg: GI, perioperative & oncologyHard

After forearm fracture surgery, a patient has severe pain not eased by opioids, made worse by passively moving the fingers. What should the nurse do?

  1. AReassure the patient that this pain is expected
  2. BRaise the arm as high as possible and give a further dose of opioid
  3. CApply ice and a tighter bandage to reduce the swelling
  4. DLoosen any tight dressing, keep the arm at heart level and escalate
19.Maternity & obstetric nursingMedium

A woman at 37 weeks had a placental abruption. Which laboratory finding suggests she is developing disseminated intravascular coagulation (DIC)?

  1. AA high fibrinogen level and high platelets
  2. BA raised haemoglobin level
  3. CA low white cell count only
  4. DA low fibrinogen level and low platelets
20.Maternity & obstetric nursingHard

After the membranes rupture, the nurse sees the umbilical cord protruding from the vagina. What is the first action?

  1. ACover the cord with a dry towel, keep her lying flat and wait for the doctor
  2. BAsk the woman to push with the next contraction
  3. CCall for help and lift the presenting part off the cord with a gloved hand
  4. DGently push the cord back into the vagina
21.Pediatric nursingMedium

Using the 100–50–20 rule, what is the daily maintenance fluid requirement for a 15 kg child?

  1. A1000 mL per day
  2. B1500 mL per day
  3. C1250 mL per day
  4. D750 mL per day
22.Pediatric nursingHard

After hypospadias repair, a toddler has a urinary catheter. Which nursing action has priority?

  1. ALimit fluids for the first days so that less urine passes over the repair
  2. BKeep the catheter draining freely and check for kinks or blockage
  3. CRemove the dressing on the first day to check the wound
  4. DClamp the catheter for a few hours to train the bladder
23.Mental health nursingMedium

An 84-year-old asks for an over-the-counter sleep aid containing diphenhydramine. What is the main concern?

  1. AIts anticholinergic effects can cause confusion, urine retention and falls
  2. BIt has no effects at all in people over 80, so it will not help her sleep
  3. CIt raises blood pressure to dangerous levels in older adults
  4. DIt is a strong opioid that causes severe dependence
24.Mental health nursingHard

A patient says, "My boss didn't say hello this morning, so she must think I'm useless." Which cognitive distortion is shown, and what is a helpful nursing response?

  1. AMind reading; ask what other reasons there might be for the boss's behaviour
  2. BPersonalisation; advise the patient to ask for a new manager
  3. CAll-or-nothing thinking; agree that the boss is being unfair
  4. DCatastrophising; tell the patient that she will definitely not be fired
25.Nursing math & unit conversionsMedium
12345678910111210:30 AM?22:3011:3009:3010:30

Practice exercise (made-up values, not clinical guidance). A dose is charted at 10:30 AM. Which entry is the same time on the 24-hour clock? Click it.

10:30 AM
  1. 122:30
  2. 211:30
  3. 309:30
  4. 410:30
26.Nursing math & unit conversionsHard
00:0020:2501:05t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 20:25 and finishes at 01:05 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.

20:2501:05
t = h
27.Dosage calculationsMedium
024681010 mL

A child weighing 8 kg is prescribed 10 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

8 kg10 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
57 kg188 cmBSA = √(h·w/3600)100 mg/m²D = ? mg

A patient is 188 cm tall and weighs 57 kg. The prescription is 100 mg/m². Using the Mosteller formula BSA = √(height (cm) × weight (kg)/3600), find the dose D in mg.

188 cm57 kg100 mg/m²
D = mg
29.IV infusion ratesMedium
60 gtt/mL100 mL/h? gtt/min

An infusion is ordered at 100 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.

100 mL/h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
100 mg250 mL12 mL/h? mcg/min

An infusion of 100 mg in 250 mL runs at 12 mL/h. How many micrograms per minute D does the patient receive?

100 mg/250 mL12 mL/h
D = mcg/min
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftmilk200 mLsoup250 mLtea150 mLIV infusion50 mL/h × 12 hIV antibiotic1 × 50 mLurine225 mLurine475 mLurine375 mLwound drain150 mLvomit200 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 68 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

68 kg12 hurine: 225 mLurine: 475 mLurine: 375 mLwound drain: 150 mLvomit: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
1000 mL150 mL/hstart 12:4517:15: ? mL

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag was started at 12:45 and runs by pump at 150 mL/h. How many mL V are left in the bag at 17:15?

1000 mL150 mL/h12:45 → 17:15
V = mL
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 23/min, SpO₂ 91% on supplemental oxygen, blood pressure 78/46 mmHg, pulse 88/min, alert, temperature 37.9 °C. What is the NEWS2 total score?

RR 23SpO₂ 91%O₂SBP 78HR 88AT 37.9 °C
NEWS2 =
34.Clinical assessment scoresHard
92?SBPDBPmmHgMAP = 60

Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 60 mmHg. A patient’s systolic pressure is 92 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 60 mmHg?

MAP 60 mmHgSBP 92 mmHg
DBP = mmHg

3Solutions

1.Nursing fundamentals

Answer: A · The unaffected leg

Why this is the answer

Going up, the strong leg steps first and lifts the body, followed by the crutches and the injured leg. Going down, the crutches and injured leg go first.

Answer

A · The unaffected leg
2.Nursing fundamentals

Answer: C · The sample was contaminated during collection

Why this is the answer

A mixed growth usually means skin or perineal bacteria contaminated the sample. A clean-catch midstream sample, or a sample from the catheter sampling port, gives a more reliable result.

Answer

C · The sample was contaminated during collection
3.Infection control & patient safety

Answer: C · The family can call the rapid response team if they are worried and staff have not responded

Why this is the answer

Family-activated rapid response systems allow patients and families to call for help directly when they notice a worrying change. The nurse should also take the concern seriously and assess the patient.

Answer

C · The family can call the rapid response team if they are worried and staff have not responded
4.Infection control & patient safety

Answer: B · 1,400/mm3

Why this is the answer

ANC = 4,000 × (0.30 + 0.05) = 1,400/mm3. This is below normal (neutropenia), so the patient has a raised risk of infection.

Answer

B · 1,400/mm3
5.Prioritization & delegation

Answer: A · Right person

Why this is the answer

Right person means the delegate has the training and competence for the task. Using a lift is normally a delegable task, but not to someone who has not been trained. The nurse should arrange training or do the task with help.

Answer

A · Right person
6.Prioritization & delegation

Answer: D · Sweating

Why this is the answer

Beta-blockers can hide tachycardia, palpitations and tremor during hypoglycemia. Sweating is mainly cholinergic, so it usually remains, and patients are taught to check glucose when they sweat.

Answer

D · Sweating
7.Clinical nursing

Answer: C · Moving from non-opioids to weak and then strong opioids as pain increases

Why this is the answer

The ladder moves from non-opioids (such as paracetamol) to weak opioids and then strong opioids, with adjuvants at any step. Regular dosing is preferred for persistent pain.

Answer

C · Moving from non-opioids to weak and then strong opioids as pain increases
8.Clinical nursing

Answer: C · Liver damage develops later, and the antidote works best when given early

Why this is the answer

Paracetamol overdose may cause few early symptoms, but liver failure can develop over days. Acetylcysteine is most effective when started early, guided by timed paracetamol levels.

Answer

C · Liver damage develops later, and the antidote works best when given early
9.Lab values & electrolytes

Answer: B · Digested blood adds protein, which the liver turns into urea

Why this is the answer

Blood in the upper gut is digested, and the absorbed protein is converted to urea, so the BUN rises out of proportion to the creatinine. Reduced kidney blood flow from volume loss can add to the rise.Checked against: BUN - blood test · MedlinePlus (NIH) (2025)

Answer

B · Digested blood adds protein, which the liver turns into urea
10.Lab values & electrolytes

Answer: D · Hemoglobin 6.4 g/dL (64 g/L) with new chest pain and a pulse of 124/min

Why this is the answer

Severe anemia with chest pain and tachycardia suggests the heart is not receiving enough oxygen, which needs urgent action, often including transfusion. The other results are mildly abnormal but expected or stable.Checked against: Anemia · StatPearls (NCBI Bookshelf) (2026)

Answer

D · Hemoglobin 6.4 g/dL (64 g/L) with new chest pain and a pulse of 124/min
11.Pharmacology

Answer: A · A monoamine oxidase inhibitor

Why this is the answer

SSRIs block serotonin reuptake and MAO inhibitors block its breakdown. Together they can cause serotonin syndrome with agitation, hyperthermia, tremor and clonus.

Answer

A · A monoamine oxidase inhibitor
12.Pharmacology

Answer: D · Pulmonary fibrosis from bleomycin

Why this is the answer

Bleomycin can cause pneumonitis and pulmonary fibrosis, especially at higher cumulative doses. New respiratory symptoms are reported, and lung function may be monitored.

Answer

D · Pulmonary fibrosis from bleomycin
13.Med-surg: cardiovascular & respiratory

Answer: D · CT pulmonary angiography

Why this is the answer

CT pulmonary angiography (CTPA) shows filling defects in the pulmonary arteries. It uses iodinated contrast, so renal function and contrast allergy are checked. A ventilation–perfusion (V/Q) scan is an alternative, for example in pregnancy or renal impairment.

Answer

D · CT pulmonary angiography
14.Med-surg: cardiovascular & respiratory

Answer: A · A parapneumonic effusion or empyema

Why this is the answer

Persistent fever and signs of pleural fluid suggest a parapneumonic effusion, which may become infected (empyema). Ultrasound and diagnostic pleural aspiration are needed, and an infected collection usually needs a chest drain in addition to antibiotics.

Answer

A · A parapneumonic effusion or empyema
15.Med-surg: neuro, endocrine & renal

Answer: C · Monitor BP, fluid balance and daily weight

Why this is the answer

In acute glomerulonephritis, salt and water retention cause oedema and hypertension. Close monitoring of BP, input and output and daily weights is needed, often with salt and fluid restriction and antihypertensives.

Answer

C · Monitor BP, fluid balance and daily weight
16.Med-surg: neuro, endocrine & renal

Answer: A · Respect the decision and support symptom-focused care

Why this is the answer

A competent patient can refuse dialysis. The nurse makes sure the choice is informed, respects it and supports conservative kidney management, with symptom control, advance care planning and palliative care input.

Answer

A · Respect the decision and support symptom-focused care
17.Med-surg: GI, perioperative & oncology

Answer: D · The patient's palm including the fingers

Why this is the answer

The patient's palm with the fingers together is about 1% of their total body surface area. It is useful for small or patchy burns. Simple erythema (superficial burns) is not included in the total.

Answer

D · The patient's palm including the fingers
18.Med-surg: GI, perioperative & oncology

Answer: D · Loosen any tight dressing, keep the arm at heart level and escalate

Why this is the answer

These are early signs of compartment syndrome, where raised pressure in a muscle compartment reduces blood flow. Constrictive dressings are released, the limb is kept at heart level and urgent surgical review is needed, as fasciotomy may be required.

Answer

D · Loosen any tight dressing, keep the arm at heart level and escalate
19.Maternity & obstetric nursing

Answer: D · A low fibrinogen level and low platelets

Why this is the answer

In DIC, widespread clotting consumes fibrinogen and platelets, leading to bleeding. Fibrinogen is normally raised in pregnancy, so a low level is especially concerning.

Answer

D · A low fibrinogen level and low platelets
20.Maternity & obstetric nursing

Answer: C · Call for help and lift the presenting part off the cord with a gloved hand

Why this is the answer

Relieve the pressure on the cord by keeping the presenting part off it, call for urgent help and use a knee–chest or head-down position. Do not try to replace the cord; if it is outside, it can be covered with warm, moist saline gauze. Birth is usually expedited.

Answer

C · Call for help and lift the presenting part off the cord with a gloved hand
21.Pediatric nursing

Answer: C · 1250 mL per day

Why this is the answer

First 10 kg: 10 × 100 = 1000 mL. Next 5 kg: 5 × 50 = 250 mL. Total = 1250 mL per day, or about 52 mL per hour.

Answer

C · 1250 mL per day
22.Pediatric nursing

Answer: B · Keep the catheter draining freely and check for kinks or blockage

Why this is the answer

After repair, the catheter or stent protects the new urethra while it heals. It must drain freely; blockage causes bladder spasm and pressure on the repair. Fluids are encouraged, and the dressing is managed as the surgeon directs.

Answer

B · Keep the catheter draining freely and check for kinks or blockage
23.Mental health nursing

Answer: A · Its anticholinergic effects can cause confusion, urine retention and falls

Why this is the answer

Diphenhydramine is strongly anticholinergic and sedating. In older adults, it can cause delirium, constipation, urinary retention and falls, and is generally avoided.

Answer

A · Its anticholinergic effects can cause confusion, urine retention and falls
24.Mental health nursing

Answer: A · Mind reading; ask what other reasons there might be for the boss's behaviour

Why this is the answer

Mind reading is assuming others' thoughts without evidence. Exploring alternative explanations, such as the boss being busy, helps the patient test the thought and reduce distress.

Answer

A · Mind reading; ask what other reasons there might be for the boss's behaviour
25.Nursing math & unit conversions

Answer: 10:30

24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.

Convert the hour

10 AM → 10

Answer

10:30

Answer

10:30
26.Nursing math & unit conversions

Answer: t = 4.67 h

24-hour clock: from 1 PM onwards add 12 to the hour (3:45 PM = 15:45). Midnight to 12:59 AM is 00:00–00:59, and 12:00–12:59 PM stays 12:00–12:59. Going back, subtract 12 from hours 13–23 and add PM; hours 00 become 12 AM. Count time across midnight in two parts: up to 24:00 (00:00), then from 00:00 on.

Before midnight

20:25 → 24:00 = 215 min

After midnight

00:00 → 01:05 = 65 min

Total

215 + 65 = 280 min
t = 280/60 = 4.667 ≈ 4.67 h

Answer

t = 4.67 h
27.Dosage calculations

Answer: V = 3.2 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Dose from body weight

D = 10·8 = 80 mg

Volume

V = 80/25 = 3.2 mL

On the syringe

On this 10 mL syringe every small line is 0.2 mL.

Answer

V = 3.2 mL
28.Dosage calculations

Answer: D = 172.5 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 = √(188·57/3600) = √2.977 = 1.725 m²

Dose

D = 100·1.725 = 172.5 mg

Answer

D = 172.5 mg
29.IV infusion rates

Answer: R = 100 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

100/60 = 1.667 mL/min

Drip rate

R = 1.667·60 = 100 gtt/min

Answer

R = 100 gtt/min

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

30.IV infusion rates

Answer: D = 80 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

100000 mcg/250 mL = 400 mcg/mL

Dose per hour

12·400 = 4800 mcg/h

Dose per minute

D = 4800/60 = 80 mcg/min

Answer

D = 80 mcg/min
31.IV fluids & fluid balance

Answer: U = 1.32 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

225 + 475 + 375 = 1075 mL

Per kilogram per hour

U = 1075/(68·12) = 1.317 ≈ 1.32 mL/kg/h

Answer

U = 1.32 mL/kg/h
32.IV fluids & fluid balance

Answer: V = 325 mL

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.

Elapsed time

12:45 → 17:15 = 4.5 h

Volume infused

150·4.5 = 675 mL

Volume left

V = 1000 − 675 = 325 mL

Answer

V = 325 mL
33.Clinical assessment scores

Answer: NEWS2 = 10

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 23/min → 2
SpO₂ 91% → 3
on oxygen → 2
SBP 78 mmHg → 3
HR 88/min → 0
alert (A) → 0
T 37.9 °C → 0

Add

NEWS2 = 2 + 3 + 2 + 3 + 0 + 0 + 0 = 10

Answer

NEWS2 = 10
34.Clinical assessment scores

Answer: DBP = 44 mmHg

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.

Rearrange

DBP = (3·MAP − SBP)/2

Substitute

DBP = (3·60 − 92)/2 = 88/2 = 44 mmHg

Answer

DBP = 44 mmHg

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