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 says, "I've never seen this tablet before," as the nurse offers it. What should the nurse do?

  1. AReassure the patient that the tablet is correct and give it
  2. BLeave the tablet on the table for the patient to take later
  3. CGive half the tablet until the doctor visits
  4. DStop and recheck the prescription before giving it
2.Nursing fundamentalsHard

In English law, giving a treatment to a competent adult who has clearly refused it may amount to:

  1. ATheft
  2. BBreach of an employment contract
  3. CBattery (trespass to the person)
  4. DDefamation of character
3.Infection control & patient safetyMedium

Why can side rails be dangerous for a confused, restless patient?

  1. ASide rails stop staff from reaching the patient in an emergency
  2. BSide rails make the bed move by itself
  3. CSide rails always cause pressure injuries
  4. DThe patient may climb over them or get trapped in gaps
4.Infection control & patient safetyHard

A nurse cannot find a confused patient who was in their room 15 minutes ago. What should the nurse do first?

  1. AAlert staff and security at once, following the missing-patient procedure
  2. BDocument the absence at the end of the shift
  3. CCall the family to ask whether the patient has gone home on their own
  4. DWait an hour in case the patient comes back
5.Prioritization & delegationMedium

A patient receiving IV magnesium sulfate for pre-eclampsia has absent knee reflexes and a respiratory rate of 10/min. What does the nurse do first?

  1. AGive oral fluids to help clear the drug faster
  2. BIncrease the infusion to prevent a seizure
  3. CStop the magnesium infusion and call for help
  4. DTurn the patient onto her back and recheck later
6.Prioritization & delegationHard

Six hours after surgery, a patient has not passed urine, feels the urge to go and has a firm swelling above the pubic bone. What is the most likely problem?

  1. AA normal effect of the anesthetic
  2. BDehydration from fasting before surgery
  3. CAcute kidney injury with no urine made
  4. DUrinary retention
7.Clinical nursingMedium

A patient on haemodialysis has an arteriovenous fistula in the left arm. Which nursing care is correct?

  1. AApply a tight bandage over the fistula at night to protect it
  2. BKeep the arm raised and still at all times
  3. CUse the fistula arm for routine IV cannulas
  4. DAvoid blood pressure readings and blood samples on that arm
8.Clinical nursingHard

A day after surgery, a patient's haemoglobin has fallen from 125 g/L to 85 g/L (12.5 to 8.5 g/dL) and their heart rate has risen to 118/min. What is the priority?

  1. AEncourage the patient to eat iron-rich foods
  2. BRecheck the haemoglobin next week
  3. CDocument the result and take no further action
  4. DEscalate urgently, as the patient may be bleeding
9.Lab values & electrolytesMedium

How should a patient collect a clean-catch midstream urine sample?

  1. ACollect the very first urine of the stream directly in the sterile cup
  2. BFill the cup completely, then add tap water if there is not enough
  3. CCollect urine from the toilet bowl after voiding into the toilet
  4. DClean the area, start voiding into the toilet, then catch the middle part
10.Lab values & electrolytesHard

After a crush injury, a patient's urine dipstick is strongly positive for blood, but microscopy shows almost no red cells. CK is very high. What best explains this?

  1. AMyoglobin from damaged muscle is in the urine
  2. BBleeding is coming from the bladder lining
  3. CThe sample was contaminated with menstrual blood
  4. DA kidney stone is scraping the ureter lining
11.PharmacologyMedium

Which group of signs suggests opioid withdrawal?

  1. AYawning, runny nose, sweating, dilated pupils and diarrhoea
  2. BConstipation, itching and a slow heart rate
  3. CPinpoint pupils, slow breathing and drowsiness
  4. DDry mouth, urinary retention, blurred vision and confusion
12.PharmacologyHard

Two days after starting chemotherapy for a leukaemia with a high white cell count, a patient has reduced urine output. Which lab pattern suggests tumour lysis syndrome?

  1. AHigh potassium, high phosphate, high uric acid and low calcium
  2. BNormal electrolytes with a high haemoglobin
  3. CHigh sodium, high glucose and low potassium
  4. DLow potassium, low phosphate, low uric acid and high calcium
13.Med-surg: cardiovascular & respiratoryMedium

A patient who had a leg amputation says they feel burning pain in the missing foot. What is the best response?

  1. AAdvise that it will be ignored until it stops
  2. BExplain that burning pain in the missing foot shows wound infection
  3. CExplain that phantom limb pain is real and arrange treatment
  4. DTell the patient the pain must be imaginary as the foot has gone
14.Med-surg: cardiovascular & respiratoryHard

Before the morning dose of digoxin, a patient's apical pulse is 54/min and they feel nauseated. What should the nurse do?

  1. AGive the dose and an antiemetic, then recheck the pulse tomorrow
  2. BGive the dose, because only a radial pulse counts
  3. CWithhold the dose and report it, as toxicity is possible
  4. DGive half the dose and recheck the pulse in an hour
15.Med-surg: neuro, endocrine & renalMedium

A patient on peritoneal dialysis has gained weight and has higher glucose levels. Which part of the treatment is the likely cause?

  1. AAir entering the abdomen during exchanges
  2. BGlucose absorbed from the dialysis fluid
  3. CSodium lost into the dialysis fluid
  4. DProtein lost into the dialysis fluid
16.Med-surg: neuro, endocrine & renalHard

Which nursing care is important for a patient receiving mannitol for raised intracranial pressure?

  1. AStopping the fluid balance chart during treatment
  2. BClamping the catheter to keep fluid in the body
  3. CClose monitoring of urine output, sodium and osmolality
  4. DGiving the drug orally with meals to reduce nausea
17.Med-surg: GI, perioperative & oncologyMedium

Why are patients with diabetes often placed early on the operating list?

  1. ABecause they need to go home before midday
  2. BTo shorten fasting and reduce swings in blood glucose
  3. CBecause their surgery always takes longer than others
  4. DBecause their wounds heal faster in the morning
18.Med-surg: GI, perioperative & oncologyHard

During burn resuscitation, a 70 kg adult's urine output has been 120 mL/h for 3 hours, and the face and limbs are very oedematous. What should the nurse do?

  1. AGive a diuretic without discussing it
  2. BDiscuss reducing the fluid rate with the team
  3. CIncrease the fluid rate to keep the output high
  4. DStop all IV fluids completely and remove the catheter
19.Maternity & obstetric nursingMedium

At station +2, where is the presenting part?

  1. A2 cm below the ischial spines
  2. BAt the level of the ischial spines
  3. C2 cm above the ischial spines
  4. DFloating above the pelvic inlet
20.Maternity & obstetric nursingHard

A newborn born after a shoulder dystocia holds one arm limp at the side, internally rotated, with the wrist flexed. What is most likely?

  1. ADevelopmental hip dysplasia
  2. BClubfoot
  3. CErb's palsy
  4. DFacial nerve palsy
21.Pediatric nursingMedium

Which finding at a 2-year check most needs a speech and language referral?

  1. AThe child prefers to play beside other toddlers
  2. BThe child is not yet combining any two words
  3. CThe child says "no" to most suggestions
  4. DThe child uses about 50 words or more
22.Pediatric nursingHard

A 4-year-old has had pallor, tiredness, bruising, bone pain and fevers for 3 weeks. What is the most important next step?

  1. AIron supplements for 3 months, then review
  2. BA course of antibiotics for a viral infection
  3. CReassurance that these are growing pains that will pass with time
  4. DAn urgent full blood count to look for leukaemia
23.Mental health nursingMedium

Which serious adverse effects are associated with carbamazepine?

  1. AHair growth and gum overgrowth only, which are mainly cosmetic problems
  2. BRapid weight loss
  3. CBlood disorders such as agranulocytosis, and severe skin reactions
  4. DHearing loss
24.Mental health nursingHard

An 80-year-old patient taking a benzodiazepine for sleep fell at night on the way to the toilet. After checking her for injury, what is the most appropriate next step?

  1. ADo nothing more, because falls are normal in older people
  2. BUse bed rails and a restraint every night to keep her safely in bed until the morning
  3. CReport the fall, put falls precautions in place and ask for a review of her sleep medicine
  4. DGive an extra dose so that she sleeps through the night without getting up
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C100.5 °F? °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 100.5 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.

100.5 °F
T = °C
26.Nursing math & unit conversionsHard
2 tsp · 4/day · 10 d? mL1 tsp = 5 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads 2 tsp of an oral suspension four times a day for 10 days. Using 1 tsp = 5 mL, how many mL V are needed for the whole course?

2 tspfour times a day10 days1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
024681010 mL

A child weighing 28 kg is prescribed 10 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?

28 kg10 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
40k units500 mL? mL/h1200 units/h

An infusion contains 40000 units of a drug in 500 mL. The prescription is 1200 units per hour. At what rate R do you set the pump, in mL/h?

40000 units/500 mL1200 units/h
R = mL/h
29.IV infusion ratesMedium
1500 mL20 gtt/mL10 h? gtt/min

Infuse 1500 mL over 10 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute.

1500 mL10 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
200 mg100 mL60 gtt/mL120 mg/h? gtt/min

200 mg of a drug is diluted in 100 mL and given by gravity through a set of 60 gtt/mL. The order is 120 mg per hour. Find the drip rate R in drops per minute.

200 mg/100 mL120 mg/h60 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shifttea200 mLjelly100 mLjuice150 mLIV infusion100 mL/h × 8 hIV antibiotic2 × 100 mLurine375 mLurine300 mLvomit150 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 total intake I in mL.

tea: 200 mLjelly: 100 mLjuice: 150 mLIV infusion: 100 mL/h × 8 hIV antibiotic: 2 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL80 mL/hstart 13:4515:45: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 13:45 and runs by pump at 80 mL/h. How many mL V are left in the bag at 15:45?

500 mL80 mL/h13:45 → 15:45
V = mL
33.Clinical assessment scoresMedium
12273SBPDBPmmHgHR 126/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 126/min and a blood pressure of 122/73 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 126/minBP 122/73 mmHg
SI =
34.Clinical assessment scoresHard
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≥39.1lowlow–mediummediumhigh

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 21/min, SpO₂ 98% on room air, blood pressure 112/68 mmHg, pulse 114/min, alert, temperature 39.2 °C. Which clinical risk group does the patient fall into? Click it.

RR 21SpO₂ 98%airSBP 112HR 114AT 39.2 °C
  1. 1low
  2. 2low–medium
  3. 3medium
  4. 4high

3Solutions

1.Nursing fundamentals

Answer: D · Stop and recheck the prescription before giving it

Why this is the answer

A patient questioning a medicine may be a sign of an error. The nurse holds the dose, checks the prescription and the drug and explains before giving it.

Answer

D · Stop and recheck the prescription before giving it
2.Nursing fundamentals

Answer: C · Battery (trespass to the person)

Why this is the answer

Touching or treating a person without valid consent can be battery, even if the treatment was meant to help. This is why consent is needed before care.

Answer

C · Battery (trespass to the person)
3.Infection control & patient safety

Answer: D · The patient may climb over them or get trapped in gaps

Why this is the answer

Confused patients may climb over rails and fall from a greater height or become trapped between the rail and mattress. Alternatives such as low beds and close observation are often safer.

Answer

D · The patient may climb over them or get trapped in gaps
4.Infection control & patient safety

Answer: A · Alert staff and security at once, following the missing-patient procedure

Why this is the answer

A missing vulnerable patient is an emergency. The nurse immediately activates the facility’s missing-patient procedure so a search starts, and the provider and family are informed per policy.

Answer

A · Alert staff and security at once, following the missing-patient procedure
5.Prioritization & delegation

Answer: C · Stop the magnesium infusion and call for help

Why this is the answer

Loss of deep tendon reflexes and slow breathing suggest magnesium toxicity. The nurse stops the infusion, supports breathing and escalates; calcium gluconate is the antidote kept ready.

Answer

C · Stop the magnesium infusion and call for help
6.Prioritization & delegation

Answer: D · Urinary retention

Why this is the answer

An urge to void with a palpable bladder points to retention, not reduced urine production. The nurse confirms with a bladder scan if available and follows the prescribed plan, such as catheterization.

Answer

D · Urinary retention
7.Clinical nursing

Answer: D · Avoid blood pressure readings and blood samples on that arm

Why this is the answer

The fistula arm is protected from pressure, cannulas and blood tests to prevent damage and clotting. Nurses check for a palpable thrill and audible bruit, which show it is working.

Answer

D · Avoid blood pressure readings and blood samples on that arm
8.Clinical nursing

Answer: D · Escalate urgently, as the patient may be bleeding

Why this is the answer

A large fall in haemoglobin with tachycardia suggests ongoing blood loss. The nurse assesses the patient with ABCDE, checks wounds and drains and escalates for urgent review.

Answer

D · Escalate urgently, as the patient may be bleeding
9.Lab values & electrolytes

Answer: D · Clean the area, start voiding into the toilet, then catch the middle part

Why this is the answer

Cleaning the urethral area and discarding the first part of the stream reduce contamination from skin and urethral bacteria. The inside of the sterile container must not be touched, and the sample should reach the laboratory promptly.Checked against: Clean catch urine sample · MedlinePlus (NIH) (2024)

Answer

D · Clean the area, start voiding into the toilet, then catch the middle part
10.Lab values & electrolytes

Answer: A · Myoglobin from damaged muscle is in the urine

Why this is the answer

The dipstick blood test detects heme, which is present in both hemoglobin and myoglobin. Positive "blood" without red cells, together with a very high CK, indicates myoglobinuria from rhabdomyolysis, which can damage the kidneys. IV fluids and close monitoring of urine output and potassium are needed.Checked against: Myoglobin urine test · MedlinePlus (NIH) (2025); Rhabdomyolysis · MedlinePlus (NIH) (2025); Creatine Kinase · MedlinePlus (NIH) (2023)

Answer

A · Myoglobin from damaged muscle is in the urine
11.Pharmacology

Answer: A · Yawning, runny nose, sweating, dilated pupils and diarrhoea

Why this is the answer

Opioid withdrawal causes rhinorrhoea, lacrimation, yawning, sweating, mydriasis, cramps, diarrhoea and anxiety. It is very unpleasant but rarely life-threatening in healthy adults.

Answer

A · Yawning, runny nose, sweating, dilated pupils and diarrhoea
12.Pharmacology

Answer: A · High potassium, high phosphate, high uric acid and low calcium

Why this is the answer

Rapid tumour cell death releases potassium, phosphate and nucleic acids (which become uric acid). Phosphate binds calcium, lowering it; prevention includes IV fluids and drugs that lower uric acid.

Answer

A · High potassium, high phosphate, high uric acid and low calcium
13.Med-surg: cardiovascular & respiratory

Answer: C · Explain that phantom limb pain is real and arrange treatment

Why this is the answer

Phantom limb pain is common after amputation and arises from changes in nerves and the brain. It is real and treated with analgesia, including drugs for neuropathic pain, plus measures such as mirror therapy. It does not mean infection.

Answer

C · Explain that phantom limb pain is real and arrange treatment
14.Med-surg: cardiovascular & respiratory

Answer: C · Withhold the dose and report it, as toxicity is possible

Why this is the answer

A common rule is to withhold digoxin and inform the prescriber if the apical pulse is below 60/min (or below the set parameter) or if there are toxic features such as nausea, vomiting, visual disturbance or a new arrhythmia. A digoxin level, ECG, potassium and renal function are usually checked. The nurse does not change a dose on their own initiative.

Answer

C · Withhold the dose and report it, as toxicity is possible
15.Med-surg: neuro, endocrine & renal

Answer: B · Glucose absorbed from the dialysis fluid

Why this is the answer

Standard PD fluids contain glucose to pull water out by osmosis. Some glucose is absorbed, adding calories and raising blood glucose. Glucose monitoring and diet advice are needed, and other solutions may be used.

Answer

B · Glucose absorbed from the dialysis fluid
16.Med-surg: neuro, endocrine & renal

Answer: C · Close monitoring of urine output, sodium and osmolality

Why this is the answer

Mannitol draws water out of the brain into the blood and is excreted by the kidneys, causing a large diuresis. Monitoring for dehydration, hypotension, electrolyte disturbance and high osmolality is required, and a urinary catheter is usually needed.

Answer

C · Close monitoring of urine output, sodium and osmolality
17.Med-surg: GI, perioperative & oncology

Answer: B · To shorten fasting and reduce swings in blood glucose

Why this is the answer

Shorter fasting reduces the risk of hypoglycaemia and makes it easier to restart normal eating and medicines. Glucose is monitored, and a variable-rate insulin infusion may be used for longer fasts.

Answer

B · To shorten fasting and reduce swings in blood glucose
18.Med-surg: GI, perioperative & oncology

Answer: B · Discuss reducing the fluid rate with the team

Why this is the answer

An output of about 1.7 mL/kg/h suggests over-resuscitation. Excess fluid ("fluid creep") worsens oedema and can cause pulmonary oedema and compartment syndromes, so the rate is reviewed and reduced under the burn protocol.

Answer

B · Discuss reducing the fluid rate with the team
19.Maternity & obstetric nursing

Answer: A · 2 cm below the ischial spines

Why this is the answer

Station is measured in centimetres relative to the ischial spines. Negative numbers are above them, 0 is at their level and positive numbers are below them, towards the outlet.

Answer

A · 2 cm below the ischial spines
20.Maternity & obstetric nursing

Answer: C · Erb's palsy

Why this is the answer

Erb's palsy (C5–C6 injury) gives the "waiter's tip" posture and an absent Moro on that side. Most recover with gentle positioning and physiotherapy.

Answer

C · Erb's palsy
21.Pediatric nursing

Answer: B · The child is not yet combining any two words

Why this is the answer

By 2 years most children use at least about 50 words and combine two words. Not combining words at 2 years needs assessment, including a hearing test. Saying "no" and parallel play are normal toddler behaviour.

Answer

B · The child is not yet combining any two words
22.Pediatric nursing

Answer: D · An urgent full blood count to look for leukaemia

Why this is the answer

Pallor (low red cells), bruising (low platelets), infections or fever (abnormal white cells) and bone pain from marrow expansion together suggest leukaemia. An urgent full blood count and blood film are needed.

Answer

D · An urgent full blood count to look for leukaemia
23.Mental health nursing

Answer: C · Blood disorders such as agranulocytosis, and severe skin reactions

Why this is the answer

Carbamazepine can cause agranulocytosis and aplastic anaemia, hyponatraemia and Stevens–Johnson syndrome. It is a strong enzyme inducer and interacts with many drugs.

Answer

C · Blood disorders such as agranulocytosis, and severe skin reactions
24.Mental health nursing

Answer: C · Report the fall, put falls precautions in place and ask for a review of her sleep medicine

Why this is the answer

Benzodiazepines increase the risk of falls in older adults. After a fall, the nurse reports it, reduces risks such as poor lighting and the distance to the toilet, and asks for a medication review.

Answer

C · Report the fall, put falls precautions in place and ask for a review of her sleep medicine
25.Nursing math & unit conversions

Answer: T = 38.1 °C

Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.

Subtract 32

100.5 − 32 = 68.5

Multiply by 5/9

T = 68.5·5/9 = 38.06 ≈ 38.1 °C

Answer

T = 38.1 °C
26.Nursing math & unit conversions

Answer: V = 400 mL

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

Volume per dose

2 tsp = 2·5 = 10 mL

Whole course

V = 10 mL × 4/day × 10 = 400 mL

Answer

V = 400 mL
27.Dosage calculations

Answer: V = 7 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 = 10·28 = 280 mg

Volume

V = 280/40 = 7 mL

On the syringe

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

Answer

V = 7 mL
28.Dosage calculations

Answer: R = 15 mL/h

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.

Concentration

40000/500 = 80 units/mL

Pump rate

R = 1200/80 = 15 mL/h

Answer

R = 15 mL/h
29.IV infusion rates

Answer: R = 50 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

10·60 = 600 min

Drip rate

R = 1500·20/600 = 50 gtt/min

Answer

R = 50 gtt/min
30.IV infusion rates

Answer: R = 60 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

200/100 = 2 mg/mL

Volume per hour

120/2 = 60 mL/h

Drip rate

R = 60·60/60 = 60 gtt/min

Answer

R = 60 gtt/min
31.IV fluids & fluid balance

Answer: I = 1450 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.

Add the intake

oral: 200 + 100 + 150 = 450 mL
IV infusion: 100·8 = 800 mL
IV antibiotic: 2·100 = 200 mL
I = 1450 mL

Answer

I = 1450 mL
32.IV fluids & fluid balance

Answer: V = 340 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

13:45 → 15:45 = 2 h

Volume infused

80·2 = 160 mL

Volume left

V = 500 − 160 = 340 mL

Answer

V = 340 mL
33.Clinical assessment scores

Answer: SI = 1.03

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 = 126/122 = 1.033 ≈ 1.03

Answer

SI = 1.03

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

34.Clinical assessment scores

Answer: medium

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 21/min → 2
SpO₂ 98% → 0
on air → 0
SBP 112 mmHg → 0
HR 114/min → 2
alert (A) → 0
T 39.2 °C → 2

Total and red scores

NEWS2 = 2 + 0 + 0 + 0 + 2 + 0 + 2 = 6
No parameter scores 3.

Risk group

medium

Answer

medium

A total of 5 or more calls for an urgent clinical response.

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