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

In the UK SSKIN care bundle for pressure ulcer prevention, what does "K" stand for?

  1. AKeep clean
  2. BKeep moving
  3. CKeep warm
  4. DKeep dry
2.Nursing fundamentalsHard

A competent adult patient asks the nurse not to tell their family about their cancer diagnosis. What should the nurse do?

  1. ATell the family only if they ask directly
  2. BAsk the doctor to tell the family anyway
  3. CRespect the request and not share the information with the family
  4. DTell the family, because relatives have a right to know about a serious diagnosis
3.Infection control & patient safetyMedium

Before accessing a central venous catheter hub, what should the nurse do?

  1. AWipe it quickly with a dry sterile gauze
  2. BBlow on the hub gently to remove dust
  3. CScrub the hub with an antiseptic and let it dry
  4. DNothing, because the hub is protected under a sterile cap
4.Infection control & patient safetyHard

Which action by a nurse shows that the five moments of hand hygiene are being followed?

  1. AShe wears the same gloves between two patients
  2. BShe cleans her hands only when they look dirty
  3. CShe cleans her hands after touching the bed rail
  4. DShe cleans her hands only at the start and end of the shift
5.Prioritization & delegationMedium

During START triage, a non-walking adult is breathing 36 times a minute. Which category is the victim given?

  1. ABlack (expectant)
  2. BRed (immediate)
  3. CGreen (minor)
  4. DYellow (delayed)
6.Prioritization & delegationHard

A victim heavily contaminated with an industrial chemical arrives at the emergency department with stable vital signs. What should happen first?

  1. AFull assessment inside the main department straight away
  2. BDecontamination before the victim enters the treatment area
  3. CTaking the victim straight to the X-ray department
  4. DPlacing the victim in the waiting room until a doctor is free
7.Clinical nursingMedium

How should a nurse communicate with a patient who has impaired hearing?

  1. ATalk to the patient's relative instead of to the patient directly
  2. BSpeak very quickly to save time
  3. CFace the patient, speak clearly and reduce background noise
  4. DShout loudly from the end of the bed so they can hear
8.Clinical nursingHard

How should pain be assessed in a patient with advanced dementia who cannot describe it?

  1. AWith an observational pain tool that scores facial expression, behaviour and body language
  2. BBy assuming the patient has no pain unless they are crying out or calling for help
  3. CBy asking the patient to rate their pain on a numerical scale from 0 to 10
  4. DBy checking the blood pressure only
9.Lab values & electrolytesMedium

Which instruction is correct for a patient starting oral iron tablets?

  1. ATake each tablet with milk to protect the stomach
  2. BTake the tablet with an antacid to improve absorption
  3. CYour stools may turn dark green or black
  4. DYour urine will turn bright orange while you take it
10.Lab values & electrolytesHard

A patient with diabetes and chronic kidney disease had a CT scan with IV contrast. Two days later, the creatinine has risen from 1.4 to 2.0 mg/dL (124 to 177 µmol/L). Which action is most appropriate?

  1. AGive extra metformin, because the glucose rises after contrast
  2. BReport it, monitor urine output and hold metformin until reviewed
  3. CRestrict all fluids to protect the kidneys from more contrast
  4. DIgnore it, because contrast never affects kidney function
11.PharmacologyMedium

After several years of levodopa treatment, which problem is common?

  1. ADyskinesias and "on–off" fluctuations in response
  2. BPermanent hearing loss
  3. CSevere hypoglycaemia after each dose
  4. DComplete and permanent loss of all Parkinson's symptoms
12.PharmacologyHard

A woman using the combined oral contraceptive pill starts carbamazepine for epilepsy. What is the main concern?

  1. ASevere hypoglycaemia from the combination
  2. BNo concern, because the drugs do not interact
  3. CCarbamazepine toxicity because the pill strongly blocks its metabolism
  4. DContraceptive failure because the hormones are metabolised faster
13.Med-surg: cardiovascular & respiratoryMedium

Which ECG finding is typical of atrial flutter?

  1. AWide, bizarre QRS complexes at 180/min
  2. BA chaotic baseline with no clear P waves and irregular QRS
  3. CRegular sawtooth flutter waves between QRS complexes
  4. DP waves with no relationship to the QRS complexes
14.Med-surg: cardiovascular & respiratoryHard

After a faulty gas heater was found at home, a patient has headache, nausea and confusion. SpO₂ is 99% on air. What is the priority treatment?

  1. AParacetamol (acetaminophen) and observation only
  2. BReassurance, because the oxygen saturation is normal
  3. CHigh-concentration oxygen via a non-rebreather mask
  4. DOxygen at 1 L/min via nasal cannula
15.Med-surg: neuro, endocrine & renalMedium

Before checking a capillary glucose, why should the patient wash their hands with soap and water?

  1. AWashing prevents all infection from the lancet
  2. BSugar on the skin can give a falsely high reading
  3. CSoap makes the blood flow faster from the finger
  4. DWashing lowers the glucose in the blood
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. BAssessing a confused patient whose glucose is 2.6 mmol/L (47 mg/dL)
  3. CDeciding the dose of correction insulin from the glucose result
  4. DChecking pre-meal glucose and reporting results out of range
17.Med-surg: GI, perioperative & oncologyMedium

Which statement about feeding in mild acute pancreatitis fits current guidance?

  1. AOral feeding can restart early, once pain and nausea allow
  2. BFood is withheld until the amylase is back to normal
  3. CPatients must stay nil by mouth for at least three weeks to rest the pancreas
  4. DPatients should be fed only by parenteral nutrition
18.Med-surg: GI, perioperative & oncologyHard

A patient with facial burns from a house fire was talking normally on arrival. Two hours later, the voice is hoarse and there is stridor. What should the nurse do?

  1. AEncourage the patient to rest the voice and reassess tomorrow
  2. BCall for urgent anaesthetic help, as the airway is swelling
  3. CGive a warm drink to soothe the throat
  4. DLay the patient flat to help them sleep
19.Maternity & obstetric nursingMedium

Which baseline variability is considered moderate (normal)?

  1. AAn amplitude of 0 to 2 bpm
  2. BAn amplitude of 6 to 25 bpm
  3. CAn amplitude of more than 25 bpm
  4. DAn amplitude of 3 to 5 bpm
20.Maternity & obstetric nursingHard

Just after her membranes rupture in labour, a woman suddenly becomes very breathless, cyanosed and hypotensive. Which condition should be suspected?

  1. AAmniotic fluid embolism
  2. BA panic attack
  3. CNormal response to a strong contraction
  4. DSupine hypotension
21.Pediatric nursingMedium

A 13-year-old has a concussion during a football match. What is the correct advice?

  1. AContinue training as usual unless there was a loss of consciousness
  2. BAvoid all mental and physical activity, including school, for at least 2 months
  3. CReturn to the match as soon as the headache improves
  4. DNo sport that day; return step by step once symptoms have gone
22.Pediatric nursingHard

A child with nephrotic syndrome is on high-dose corticosteroids. Which instruction is most important for the family?

  1. AGive live vaccines during treatment
  2. BReport fever or signs of infection promptly
  3. CEncourage a high-salt diet
  4. DStop the steroids suddenly when the oedema goes
23.Mental health nursingMedium

How does memantine work in Alzheimer's disease?

  1. AIt blocks NMDA glutamate receptors
  2. BIt blocks dopamine D2 receptors
  3. CIt increases serotonin by blocking its reuptake
  4. DIt inhibits the breakdown of acetylcholine
24.Mental health nursingHard

A patient asks, "Do you think I should divorce my husband?" Which response best supports the patient's autonomy?

  1. A"No, divorce would only make things worse for you."
  2. B"Yes, I think you'd be happier without him."
  3. C"What are your thoughts about the options you have?"
  4. D"You should ask your doctor what to do about it."
25.Nursing math & unit conversionsMedium
209.423 gtt/min? gtt/minround to 1 gtt/min

Practice exercise (made-up values, not clinical guidance). A drip-rate calculation gives 209.423 gtt/min. The rule in this exercise is that drip rates are rounded to the nearest whole drop. What value x do you record?

209.423 gtt/min
x = gtt/min
26.Nursing math & unit conversionsHard
1 cup? mL1½ tbsp? mL½ tsp? mL1 fl oz? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1 cup of tea, 1½ tbsp of liquid supplement, ½ tsp of cough syrup, 1 fl oz of juice. Using the equivalents given, find the total oral intake V in mL.

1 cup = 8 fl oz = 240 mL1 tbsp = 15 mL1 tsp = 5 mL1 fl oz = 30 mL
V = mL
27.Dosage calculationsMedium
45 kg5 mg/kg/day4× per dayD = ? mg

A patient weighs 45 kg. The prescribed dose is 5 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?

45 kg5 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
125 mg/5 mLV = ? mL

A patient weighs 39.6 lb. The prescription is 1 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?

39.6 lb1 mg/kg125 mg/5 mL1 kg = 2.2 lb
V = mL
29.IV infusion ratesMedium
1000 mL20 gtt/mL6 h? gtt/min

Infuse 1000 mL over 6 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL6 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1000 mLleft? mL/h7 h left

1500 mL was ordered over 12 hours. After 5 hours you find that 1000 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

1500 mL / 12 hafter 5 h: 1000 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftmilk100 mLwater200 mLice chips100 mLIV infusion60 mL/h × 12 hIV antibiotic1 × 50 mLurine300 mLurine275 mLwound drain60 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-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.

milk: 100 mLwater: 200 mLice chips: 100 mLIV infusion: 60 mL/h × 12 hIV antibiotic: 1 × 50 mLurine: 300 mLurine: 275 mLwound drain: 60 mL
B = mL
32.IV fluids & fluid balanceHard
1000 mL→ 100 mL/hstart 15:30ttotal​ = ? h75 mL/h × 3 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 15:30 at 75 mL/h. After 3 hours the rate is changed to 100 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 mL75 mL/h · 3 h100 mL/h
t = h
33.Clinical assessment scoresMedium
S? / 4+M? / 4+A? / 4+Mob? / 4+N? / 4+F? / 3Σ?

Practice exercise (made-up values, not clinical guidance). A practice patient is assessed with the Braden scale: sensory perception: no impairment; moisture: occasionally moist; activity: bedfast; mobility: no limitation; nutrition: adequate; friction and shear: problem. Find the Braden total B.

6–23
B =
34.Clinical assessment scoresHard
115?SBPDBPmmHgMAP = 65

Practice exercise (made-up values, not clinical guidance). The team aims for a mean arterial pressure of at least 65 mmHg. A patient’s systolic pressure is 115 mmHg. Using MAP = (SBP + 2·DBP)/3, what is the lowest diastolic pressure DBP that still gives a MAP of 65 mmHg?

MAP 65 mmHgSBP 115 mmHg
DBP = mmHg

3Solutions

1.Nursing fundamentals

Answer: B · Keep moving

Why this is the answer

SSKIN stands for Surface, Skin inspection, Keep moving, Incontinence and moisture, and Nutrition and hydration. Regular repositioning relieves pressure on the skin.

Answer

B · Keep moving
2.Nursing fundamentals

Answer: C · Respect the request and not share the information with the family

Why this is the answer

A patient with capacity decides who may receive their health information. The nurse can explore the patient's reasons and offer support, but must respect the wish.

Answer

C · Respect the request and not share the information with the family
3.Infection control & patient safety

Answer: C · Scrub the hub with an antiseptic and let it dry

Why this is the answer

“Scrub the hub” with an antiseptic such as alcohol or chlorhexidine, with friction and enough time to dry, reduces central line–associated bloodstream infections. Drying time is part of the disinfection.

Answer

C · Scrub the hub with an antiseptic and let it dry
4.Infection control & patient safety

Answer: C · She cleans her hands after touching the bed rail

Why this is the answer

Touching the patient’s surroundings, such as rails and tables, contaminates the hands, so hand hygiene is needed afterwards. Gloves are changed between patients, and hand hygiene is needed whether or not the hands look dirty.

Answer

C · She cleans her hands after touching the bed rail
5.Prioritization & delegation

Answer: B · Red (immediate)

Why this is the answer

In START, a respiratory rate over 30/min means the victim is tagged immediate (red). Rates of 30 or less move on to the perfusion and mental status checks.

Answer

B · Red (immediate)
6.Prioritization & delegation

Answer: B · Decontamination before the victim enters the treatment area

Why this is the answer

A stable, contaminated victim is decontaminated before entering the department, to protect staff, other patients and the victim. Life-saving care may come first only if the victim is unstable.

Answer

B · Decontamination before the victim enters the treatment area
7.Clinical nursing

Answer: C · Face the patient, speak clearly and reduce background noise

Why this is the answer

Facing the patient in good light, speaking clearly at a normal pace, checking hearing aids and reducing noise improves communication. Written information can also help.

Answer

C · Face the patient, speak clearly and reduce background noise
8.Clinical nursing

Answer: A · With an observational pain tool that scores facial expression, behaviour and body language

Why this is the answer

Observational tools such as PAINAD or the Abbey Pain Scale help assess pain in people who cannot self-report. Family and carers can describe changes in usual behaviour.

Answer

A · With an observational pain tool that scores facial expression, behaviour and body language
9.Lab values & electrolytes

Answer: C · Your stools may turn dark green or black

Why this is the answer

Oral iron commonly darkens the stools, which is harmless, but black tarry stools with abdominal pain should be reported. Milk, antacids and tea reduce absorption; vitamin C or orange juice can improve it.Checked against: Ferrograd C patient information leaflet (ferrous sulfate + vitamin C) · electronic medicines compendium (eMC), UK (2018)

Answer

C · Your stools may turn dark green or black
10.Lab values & electrolytes

Answer: B · Report it, monitor urine output and hold metformin until reviewed

Why this is the answer

A creatinine rise of 0.3 mg/dL or more within 48 hours meets the criteria for AKI, and contrast is a recognized risk factor, especially in CKD and diabetes. The nurse reports it, monitors fluid balance and holds metformin until kidney function is reviewed, as metformin can accumulate.Checked against: Acute Kidney Injury · StatPearls (NCBI Bookshelf) (2026); Abdominal CT scan · MedlinePlus (NIH) (2024); Acute kidney failure · MedlinePlus (NIH) (2026)

Answer

B · Report it, monitor urine output and hold metformin until reviewed
11.Pharmacology

Answer: A · Dyskinesias and "on–off" fluctuations in response

Why this is the answer

Long-term levodopa use often leads to motor fluctuations, with periods of good control and periods of stiffness, and to dyskinesias at peak dose. Dose timing and add-on drugs are adjusted to manage this.

Answer

A · Dyskinesias and "on–off" fluctuations in response
12.Pharmacology

Answer: D · Contraceptive failure because the hormones are metabolised faster

Why this is the answer

Carbamazepine induces CYP3A4, speeding up the breakdown of oestrogen and progestogen. Contraceptive levels fall and pregnancy can occur, so another method is advised.

Answer

D · Contraceptive failure because the hormones are metabolised faster
13.Med-surg: cardiovascular & respiratory

Answer: C · Regular sawtooth flutter waves between QRS complexes

Why this is the answer

Atrial flutter is caused by a re-entry circuit in the right atrium, giving regular sawtooth flutter waves, often at about 300/min with 2:1 block (ventricular rate about 150/min). A chaotic baseline with irregular QRS is atrial fibrillation. Like AF, it carries a stroke risk.

Answer

C · Regular sawtooth flutter waves between QRS complexes
14.Med-surg: cardiovascular & respiratory

Answer: C · High-concentration oxygen via a non-rebreather mask

Why this is the answer

Carbon monoxide binds haemoglobin far more strongly than oxygen, causing tissue hypoxia, while pulse oximetry can look normal. High-concentration oxygen speeds CO removal. Carboxyhaemoglobin is measured on a blood gas, and others in the home may also be at risk.

Answer

C · High-concentration oxygen via a non-rebreather mask
15.Med-surg: neuro, endocrine & renal

Answer: B · Sugar on the skin can give a falsely high reading

Why this is the answer

Traces of sugar on the fingers can falsely raise the reading. Hands are washed and dried before testing. The side of the fingertip is used, and lancets are single use.

Answer

B · Sugar on the skin can give a falsely high reading
16.Med-surg: neuro, endocrine & renal

Answer: D · 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

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

Answer: A · Oral feeding can restart early, once pain and nausea allow

Why this is the answer

Early oral or enteral feeding helps maintain the gut barrier and reduces infection compared with prolonged nil by mouth or parenteral nutrition. In mild pancreatitis, a low-fat diet is usually restarted as soon as tolerated; enzyme levels need not be normal first.

Answer

A · Oral feeding can restart early, once pain and nausea allow
18.Med-surg: GI, perioperative & oncology

Answer: B · Call for urgent anaesthetic help, as the airway is swelling

Why this is the answer

Progressive hoarseness and stridor after a facial or inhalation burn mean the airway is narrowing. Early intubation by an experienced anaesthetist is needed before swelling makes it impossible. The patient is sat up and given oxygen.

Answer

B · Call for urgent anaesthetic help, as the airway is swelling
19.Maternity & obstetric nursing

Answer: B · An amplitude of 6 to 25 bpm

Why this is the answer

Moderate variability (6–25 bpm) shows an oxygenated fetus with a functioning autonomic nervous system. Minimal (5 bpm or less) or absent variability can mean hypoxia, sleep or medication effects; more than 25 bpm is marked variability.

Answer

B · An amplitude of 6 to 25 bpm
20.Maternity & obstetric nursing

Answer: A · Amniotic fluid embolism

Why this is the answer

Amniotic fluid embolism causes sudden breathlessness, hypoxia, hypotension and often bleeding from coagulopathy. It is an emergency: call the emergency team and start resuscitation as needed.

Answer

A · Amniotic fluid embolism
21.Pediatric nursing

Answer: D · No sport that day; return step by step once symptoms have gone

Why this is the answer

A child with suspected concussion should never return to play the same day. After a short period of relative rest, a stepwise return to school and then sport is followed, progressing only while symptom-free, with medical review for red flags.

Answer

D · No sport that day; return step by step once symptoms have gone
22.Pediatric nursing

Answer: B · Report fever or signs of infection promptly

Why this is the answer

Children with nephrotic syndrome on steroids are prone to serious infections such as peritonitis and cellulitis. Steroids must be tapered, not stopped suddenly, and live vaccines are deferred during high-dose treatment.

Answer

B · Report fever or signs of infection promptly
23.Mental health nursing

Answer: A · It blocks NMDA glutamate receptors

Why this is the answer

Memantine is an NMDA receptor antagonist used in moderate to severe Alzheimer's disease. It may be combined with a cholinesterase inhibitor.

Answer

A · It blocks NMDA glutamate receptors
24.Mental health nursing

Answer: C · "What are your thoughts about the options you have?"

Why this is the answer

Asking the patient to explore her own options supports problem-solving and autonomy. Giving an opinion, or passing the question on, takes the decision away from her.

Answer

C · "What are your thoughts about the options you have?"
25.Nursing math & unit conversions

Answer: x = 209 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

209.423 → 9

Only the next digit decides

209.423 → 4
4 is 4 or less, so 9 stays.
The digits after it (23) are ignored: round once, never step by step.

Round

x = 209 gtt/min

Answer

x = 209 gtt/min
26.Nursing math & unit conversions

Answer: V = 295 mL

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.

Each item in mL

1 cup = 1·240 = 240 mL
1½ tbsp = 1.5·15 = 22.5 mL
½ tsp = 0.5·5 = 2.5 mL
1 fl oz = 1·30 = 30 mL

Add

V = 240 + 22.5 + 2.5 + 30 = 295 mL

Answer

V = 295 mL
27.Dosage calculations

Answer: D = 56.25 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.

Total per day

5·45 = 225 mg

Per dose

D = 225/4 = 56.25 mg

Answer

D = 56.25 mg
28.Dosage calculations

Answer: V = 0.72 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

39.6/2.2 = 18 kg

Dose

1·18 = 18 mg

Volume

V = (18/125)·5 = 0.72 mL

Answer

V = 0.72 mL
29.IV infusion rates

Answer: R = 56 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

6·60 = 360 min

Drip rate

R = 1000·20/360 = 55.56 ≈ 56 gtt/min

Answer

R = 56 gtt/min

At the bedside you round to the nearest whole drop: 56 gtt/min.

30.IV infusion rates

Answer: Δ = 14.29 %

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.

Original rate

1500/12 = 125 mL/h

New rate

R = 1000/7 = 142.9 mL/h

Percentage change

Δ = (142.9 − 125)/125·100% = 14.29%

Answer

Δ = 14.29%

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

31.IV fluids & fluid balance

Answer: B = 485 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 + 200 = 300 mL
ice chips: 100/2 = 50 mL
IV infusion: 60·12 = 720 mL
IV antibiotic: 1·50 = 50 mL
total intake = 1120 mL

Total output

300 + 275 + 60 = 635 mL

Balance

B = 1120 − 635 = 485 mL

Answer

B = 485 mL

Positive: more fluid went in than came out.

32.IV fluids & fluid balance

Answer: t = 10.8 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

75·3 = 225 mL
1000 − 225 = 775 mL left

Second part

775/100 = 7.75 h

Total time

t = 3 + 7.75 = 10.75 ≈ 10.8 h

Answer

t = 10.8 h

That is about 10 h 45 min, so the bag runs out at about 02:15.

33.Clinical assessment scores

Answer: B = 16

Braden scale: six subscales for pressure-injury risk. Sensory perception, moisture, activity, mobility and nutrition score 1 to 4, from the worst level (1) to no problem (4); friction and shear scores 1 to 3. The total runs from 6 to 23, and a lower total means a higher risk. Common bands: 19–23 not at risk, 15–18 mild risk, 13–14 moderate risk, 10–12 high risk and 9 or below very high risk.

Score each subscale

sensory perception: no impairment → 4
moisture: occasionally moist → 3
activity: bedfast → 1
mobility: no limitation → 4
nutrition: adequate → 3
friction and shear: problem → 1

Add

Braden total = 4 + 3 + 1 + 4 + 3 + 1 = 16

Answer

B = 16
34.Clinical assessment scores

Answer: DBP = 40 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 = (3·65 − 115)/2 = 80/2 = 40 mmHg

Answer

DBP = 40 mmHg

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