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

What is the correct order of the phases of wound healing?

  1. AMaturation, proliferation, inflammation, haemostasis
  2. BProliferation, inflammation, haemostasis, maturation
  3. CHaemostasis, inflammation, proliferation, maturation
  4. DInflammation, haemostasis, maturation, proliferation
2.Nursing fundamentalsHard

A patient with type 1 diabetes is vomiting and not eating. Which advice is correct?

  1. AStop all insulin until eating normally again
  2. BKeep taking basal insulin and check glucose and ketones more often
  3. CHalve every dose and stop testing the glucose
  4. DDrink only sugar-free fluids and stop testing for ketones until better
3.Infection control & patient safetyMedium

Which kitchen practice helps prevent scald burns in young children?

  1. ALeave hot drinks at the edge of the table
  2. BHold the child while drinking a hot drink
  3. CTurn pot handles toward the back of the stove
  4. DLet the child stand on a chair beside the stove
4.Infection control & patient safetyHard

A patient’s blood splashes onto a nurse’s forearm. The skin is intact. What is the correct response?

  1. AStart HIV post-exposure prophylaxis right away, before any other step is taken
  2. BDo nothing, because intact skin cannot be contaminated
  3. CScrub the area with undiluted bleach
  4. DWash the area with soap and water, then follow the reporting policy
5.Prioritization & delegationMedium

A nurse teaches a patient with COPD pursed-lip breathing. Which statement shows a need for further teaching?

  1. A“I will breathe in through my mouth and out quickly through my nose.”
  2. B“I will make my breath out about twice as long as my breath in.”
  3. C“I will breathe out slowly through pursed lips.”
  4. D“I will breathe in slowly through my nose.”
6.Prioritization & delegationHard

The charge nurse overhears four instructions from an RN to a nursing assistant. Which one needs to be corrected?

  1. A“Walk him to the bathroom and back, and stay with him the whole time.”
  2. B“Check his glucose before lunch and tell me the number straight away.”
  3. C“Check his glucose and give the insulin according to the sliding scale.”
  4. D“Help him wash and change, and tell me at once if you see any red or broken skin.”
7.Clinical nursingMedium

Which technique is correct when suctioning through a tracheostomy?

  1. AApply suction only while withdrawing the catheter, for no more than about 10–15 seconds
  2. BApply suction continuously while inserting the catheter as far as it will go
  3. CKeep suctioning for at least a minute each time to clear all the secretions
  4. DSuction every 15 minutes whether or not secretions are present
8.Clinical nursingHard

A patient with an epidural catheter develops new back pain and increasing leg weakness when the block should be wearing off. What should be suspected?

  1. AAn epidural haematoma or abscess compressing the spinal cord
  2. BMuscle strain from lying in the same position in bed for many hours
  3. CMild hypokalaemia
  4. DThe normal expected effect of the local anaesthetic
9.Lab values & electrolytesMedium

A blood sample drawn just after a patient ate a fatty meal is reported as "lipemic." What does this mean for the results?

  1. AThe sample was contaminated by an IV fluid with dextrose
  2. BHigh fat in the sample may interfere with some test results
  3. CThe sample shows the patient has diabetic ketoacidosis
  4. DThe results are more accurate than in a fasting sample
10.Lab values & electrolytesHard

A patient with alcohol use disorder has a potassium of 3.0 mEq/L despite two days of replacement. The magnesium is 0.9 mEq/L. What is the most appropriate next step?

  1. AGive a diuretic to remove the excess magnesium
  2. BReplace the magnesium; low magnesium keeps the kidneys losing potassium
  3. CStop all electrolyte replacement for 24 hours and recheck
  4. DDouble the potassium dose and leave the magnesium for later
11.PharmacologyMedium

A patient starting sulfasalazine should be told about which harmless effect?

  1. AOrange-yellow colouring of the urine
  2. BWhite spots on the nails
  3. CGreen colouring of the sweat
  4. DBlue colouring of the tongue and gums
12.PharmacologyHard

A patient with heart failure on furosemide is also given metolazone, a thiazide-like diuretic. Which risk increases most?

  1. AHypoglycaemia and weight gain
  2. BSevere hypokalaemia, hyponatraemia and dehydration
  3. CHyperkalaemia and fluid overload
  4. DSevere hypertension, tachycardia and fluid retention
13.Med-surg: cardiovascular & respiratoryMedium

What is the main difference between CPAP and bilevel NIV (often called BiPAP)?

  1. ABilevel NIV adds a higher inspiratory pressure, helping remove CO₂
  2. BBilevel NIV gives oxygen only, without any positive airway pressure
  3. CCPAP is given only through a tracheostomy
  4. DCPAP is mainly used to lower a raised PaCO₂ in COPD exacerbations
14.Med-surg: cardiovascular & respiratoryHard

A patient with asthma has a history of wheeze after taking aspirin. Ibuprofen is prescribed for postoperative pain. What should the nurse do?

  1. AGive it with the reliever inhaler at the same time
  2. BGive it, because ibuprofen is not related to aspirin
  3. CGive it only if the pain score is above 8/10
  4. DWithhold it and ask for an alternative
15.Med-surg: neuro, endocrine & renalMedium

A patient has confirmed meningococcal meningitis. What is usually offered to their close household contacts?

  1. AA full course of IV antibiotics in hospital
  2. BNo action unless they develop symptoms
  3. CA lumbar puncture to check for infection
  4. DPreventive antibiotics
16.Med-surg: neuro, endocrine & renalHard

A patient with an acute stroke has a glucose of 15 mmol/L (270 mg/dL). They do not have known diabetes. What is appropriate?

  1. AStop all IV fluids to lower the glucose
  2. BIgnore it, because stress always raises glucose
  3. CReport it and monitor glucose, as it can worsen outcome
  4. DGive glucose gel to stabilise the level
17.Med-surg: GI, perioperative & oncologyMedium

Why are antiemetics usually given before chemotherapy starts?

  1. AAntiemetics make the chemotherapy work better
  2. BPreventing nausea works better than treating it later
  3. CThey stop the chemotherapy from causing hair loss and mouth sores
  4. DThey cannot be given once nausea has started
18.Med-surg: GI, perioperative & oncologyHard

A colleague suggests giving a saline injection to see whether a patient's pain is "real". What is the best response?

  1. ADeceptive placebos are unethical and do not show pain is "fake"
  2. BIt is acceptable if a senior nurse gives the saline
  3. CIt is a good idea, as long as the patient is not told about it afterwards
  4. DIt should be done only for patients with chronic pain
19.Maternity & obstetric nursingMedium

Which breastfeeding mother should be advised not to breastfeed?

  1. AA mother with a common cold
  2. BA mother who had a caesarean birth
  3. CA mother receiving chemotherapy
  4. DA mother with mastitis
20.Maternity & obstetric nursingHard

A woman with a previous caesarean is having a trial of labour. Which induction agent should the nurse question?

  1. AMisoprostol
  2. BOxytocin used per protocol
  3. CAmniotomy
  4. DA balloon catheter
21.Pediatric nursingMedium

How should oral rehydration solution be given to a child with mild to moderate dehydration who is vomiting?

  1. AAs one large drink every few hours
  2. BIn small amounts, frequently, for example with a spoon or syringe
  3. CMixed with fruit juice to improve the taste
  4. DOnly after the vomiting has stopped for 24 hours, to avoid further losses
22.Pediatric nursingHard

A teenager with severe anorexia nervosa starts nutritional rehabilitation. Which blood result is most important to watch in the first days?

  1. AAmylase
  2. BBilirubin
  3. CCholesterol
  4. DPhosphate
23.Mental health nursingMedium

An 86-year-old nursing home resident becomes acutely confused over two days. Which cause should be considered first?

  1. AThe normal ageing process
  2. BA sudden onset of Alzheimer's disease
  3. CA first episode of schizophrenia caused by moving into the home
  4. DAn infection such as a urinary tract infection, or a medicine side effect
24.Mental health nursingHard

A patient asks the nurse to promise not to tell anyone that she is planning to kill herself. What is the best response?

  1. ATell her you will think about it
  2. BChange the subject
  3. CExplain kindly that you cannot keep this secret because her safety matters, and you need to share it with the team
  4. DPromise to keep the secret so that she keeps talking and trusts you, and do not record it in her notes or tell the team
25.Nursing math & unit conversionsMedium
197 cm1 in = 2.54 cmh = ? in

Practice exercise (made-up values, not clinical guidance). A patient is 197 cm tall. Using 1 in = 2.54 cm, find the height h in inches. Round to one decimal place.

197 cm1 in = 2.54 cm
h = in
26.Nursing math & unit conversionsHard
00:0018:0001:40t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 18:00 and finishes at 01:40 the next morning (24-hour clock). How many minutes t did it run?

18:0001:40
t = min
27.Dosage calculationsMedium
15 kg5 mg/kgD = ? mg

A patient weighs 15 kg and is prescribed 5 mg/kg as a single dose. Find the dose D in mg.

15 kg5 mg/kg
D = mg
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 4400 units of a drug that comes as 10000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

4400 units10000 units/mL
V = mL
29.IV infusion ratesMedium
1500 mL10 gtt/mL5 h? gtt/min

Infuse 1500 mL over 5 hours with a giving set of 10 gtt/mL. Find the drip rate R in drops per minute.

1500 mL5 h10 gtt/mL
R = gtt/min
30.IV infusion ratesHard
840 mLleft? mL/h4 h left

1000 mL was ordered over 6 hours. After 2 hours you find that 840 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?

1000 mL / 6 hafter 2 h: 840 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftsoup150 mLjuice120 mLtea150 mLIV infusion80 mL/h × 12 hIV antibiotic1 × 100 mLurine450 mLurine450 mLurine350 mLurine300 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).

soup: 150 mLjuice: 120 mLtea: 150 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 1 × 100 mLurine: 450 mLurine: 450 mLurine: 350 mLurine: 300 mL
B = mL
32.IV fluids & fluid balanceHard
1000 mL→ 150 mL/hstart 13:00ttotal​ = ? h80 mL/h × 4 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 13:00 at 80 mL/h. After 4 hours the rate is changed to 150 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 mL80 mL/h · 4 h150 mL/h
t = h
33.Clinical assessment scoresMedium
8044SBPDBPmmHgHR 80/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 80/min and a blood pressure of 80/44 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 80/minBP 80/44 mmHg
SI =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 101 kg and is 165 cm tall. Calculate the BMI and click the WHO weight category.

101 kg165 cm
  1. 1underweight
  2. 2healthy weight
  3. 3overweight
  4. 4obesity class I
  5. 5obesity class II
  6. 6obesity class III

3Solutions

1.Nursing fundamentals

Answer: C · Haemostasis, inflammation, proliferation, maturation

Why this is the answer

Healing begins with haemostasis, then inflammation clears debris, proliferation builds new tissue, and maturation (remodelling) strengthens the scar over months.

Answer

C · Haemostasis, inflammation, proliferation, maturation
2.Nursing fundamentals

Answer: B · Keep taking basal insulin and check glucose and ketones more often

Why this is the answer

Sick-day rules say people with type 1 diabetes should never stop their insulin, as illness increases glucose and the risk of ketoacidosis. Frequent testing and early advice are needed.

Answer

B · Keep taking basal insulin and check glucose and ketones more often
3.Infection control & patient safety

Answer: C · Turn pot handles toward the back of the stove

Why this is the answer

Scalds from hot liquids are common childhood burns. Turning pot handles inward, using back burners and keeping hot drinks out of reach reduce the risk.

Answer

C · Turn pot handles toward the back of the stove
4.Infection control & patient safety

Answer: D · Wash the area with soap and water, then follow the reporting policy

Why this is the answer

Blood on intact skin carries very little risk of bloodborne infection, but it is still washed off promptly and handled according to policy. Bleach damages skin, and prophylaxis is for higher-risk exposures.

Answer

D · Wash the area with soap and water, then follow the reporting policy
5.Prioritization & delegation

Answer: A · “I will breathe in through my mouth and out quickly through my nose.”

Why this is the answer

Pursed-lip breathing means breathing in through the nose and out slowly through pursed lips, making exhalation longer. This keeps airways open and reduces air trapping.

Answer

A · “I will breathe in through my mouth and out quickly through my nose.”
6.Prioritization & delegation

Answer: C · “Check his glucose and give the insulin according to the sliding scale.”

Why this is the answer

Giving insulin is medication administration and needs a licensed nurse. Measuring glucose, hygiene and supervised walking are suitable tasks with clear reporting instructions.

Answer

C · “Check his glucose and give the insulin according to the sliding scale.”
7.Clinical nursing

Answer: A · Apply suction only while withdrawing the catheter, for no more than about 10–15 seconds

Why this is the answer

Suctioning only on withdrawal and keeping it brief reduces hypoxia and mucosal damage. Suction is performed when needed, not routinely, and the patient is pre-oxygenated if required.

Answer

A · Apply suction only while withdrawing the catheter, for no more than about 10–15 seconds
8.Clinical nursing

Answer: A · An epidural haematoma or abscess compressing the spinal cord

Why this is the answer

Increasing motor block, back pain or new weakness after an epidural can mean a haematoma or abscess compressing the cord. This is a surgical emergency: stop the infusion and get urgent medical review.

Answer

A · An epidural haematoma or abscess compressing the spinal cord
9.Lab values & electrolytes

Answer: B · High fat in the sample may interfere with some test results

Why this is the answer

Lipemia makes serum cloudy and can interfere with several laboratory methods, giving inaccurate results. The test may need to be repeated, often after a fast, according to laboratory advice.

Answer

B · High fat in the sample may interfere with some test results
10.Lab values & electrolytes

Answer: B · Replace the magnesium; low magnesium keeps the kidneys losing potassium

Why this is the answer

Low magnesium makes the kidneys lose potassium, so hypokalemia does not correct until the magnesium is replaced. Both are common in alcohol use disorder.Checked against: Low blood potassium · MedlinePlus (NIH) (2025); Magnesium Blood Test · MedlinePlus (NIH) (2023)

Answer

B · Replace the magnesium; low magnesium keeps the kidneys losing potassium
11.Pharmacology

Answer: A · Orange-yellow colouring of the urine

Why this is the answer

Sulfasalazine can colour urine and sometimes skin and contact lenses orange-yellow. More serious adverse effects include blood disorders and rash, so blood counts are monitored.

Answer

A · Orange-yellow colouring of the urine
12.Pharmacology

Answer: B · Severe hypokalaemia, hyponatraemia and dehydration

Why this is the answer

Combining a loop and a thiazide diuretic gives a strong synergistic diuresis. This can cause marked electrolyte loss and volume depletion, so weight, electrolytes and kidney function are monitored closely.

Answer

B · Severe hypokalaemia, hyponatraemia and dehydration
13.Med-surg: cardiovascular & respiratory

Answer: A · Bilevel NIV adds a higher inspiratory pressure, helping remove CO₂

Why this is the answer

CPAP gives one continuous pressure that splints the airways and alveoli open, improving oxygenation (for example in pulmonary oedema or OSA). Bilevel NIV adds a higher inspiratory pressure that supports ventilation, so it is used for hypercapnic respiratory failure such as COPD exacerbations.

Answer

A · Bilevel NIV adds a higher inspiratory pressure, helping remove CO₂
14.Med-surg: cardiovascular & respiratory

Answer: D · Withhold it and ask for an alternative

Why this is the answer

In NSAID-exacerbated respiratory disease, aspirin and other COX-1 inhibiting NSAIDs can trigger severe bronchospasm. A patient with a history of reacting to aspirin should not receive other NSAIDs without specialist advice. Paracetamol at usual doses is generally tolerated.

Answer

D · Withhold it and ask for an alternative
15.Med-surg: neuro, endocrine & renal

Answer: D · Preventive antibiotics

Why this is the answer

Close contacts, such as people living in the same household, are offered chemoprophylaxis, for example with ciprofloxacin or rifampicin (rifampin), to clear carriage. Public health teams usually coordinate this.

Answer

D · Preventive antibiotics
16.Med-surg: neuro, endocrine & renal

Answer: C · Report it and monitor glucose, as it can worsen outcome

Why this is the answer

Hyperglycaemia is common after stroke and is linked to worse outcomes. It is reported, monitored and treated in line with local protocols, while avoiding hypoglycaemia. The patient may also be tested for undiagnosed diabetes.

Answer

C · Report it and monitor glucose, as it can worsen outcome
17.Med-surg: GI, perioperative & oncology

Answer: B · Preventing nausea works better than treating it later

Why this is the answer

Chemotherapy-induced nausea and vomiting is better prevented than treated. Antiemetics are given before treatment and regularly afterwards, according to how emetogenic the regimen is.

Answer

B · Preventing nausea works better than treating it later
18.Med-surg: GI, perioperative & oncology

Answer: A · Deceptive placebos are unethical and do not show pain is "fake"

Why this is the answer

A placebo response does not mean pain is not real, and giving placebos without consent is deceptive and damages trust. Pain is assessed with the patient and treated according to the plan.

Answer

A · Deceptive placebos are unethical and do not show pain is "fake"
19.Maternity & obstetric nursing

Answer: C · A mother receiving chemotherapy

Why this is the answer

Breastfeeding is contraindicated with most cytotoxic chemotherapy, untreated active tuberculosis, use of illicit drugs, and in an infant with galactosaemia. Mastitis and colds are not reasons to stop.

Answer

C · A mother receiving chemotherapy
20.Maternity & obstetric nursing

Answer: A · Misoprostol

Why this is the answer

Misoprostol is avoided in women with a uterine scar because of a high risk of uterine rupture. Mechanical methods, amniotomy and carefully monitored oxytocin may be used.

Answer

A · Misoprostol
21.Pediatric nursing

Answer: B · In small amounts, frequently, for example with a spoon or syringe

Why this is the answer

Small, frequent sips are usually tolerated even with vomiting. Juice and fizzy drinks contain too much sugar and too little salt and can worsen diarrhoea.

Answer

B · In small amounts, frequently, for example with a spoon or syringe
22.Pediatric nursing

Answer: D · Phosphate

Why this is the answer

When feeding restarts after starvation, insulin drives phosphate, potassium and magnesium into cells. Low phosphate can cause heart failure, arrhythmias and confusion, so electrolytes are checked often and feeds are increased gradually.

Answer

D · Phosphate
23.Mental health nursing

Answer: D · An infection such as a urinary tract infection, or a medicine side effect

Why this is the answer

Acute confusion in an older adult suggests delirium, which has an underlying cause. Common causes include infections, medicines (especially anticholinergics and sedatives), dehydration, hypoxia, pain and urinary retention.

Answer

D · An infection such as a urinary tract infection, or a medicine side effect
24.Mental health nursing

Answer: C · Explain kindly that you cannot keep this secret because her safety matters, and you need to share it with the team

Why this is the answer

The nurse must not promise secrecy about a risk to life. Being honest about the limits of confidentiality, while staying supportive, keeps the patient safe and maintains trust.

Answer

C · Explain kindly that you cannot keep this secret because her safety matters, and you need to share it with the team
25.Nursing math & unit conversions

Answer: h = 77.6 in

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

Centimetres to inches

h = 197/2.54 = 77.56 ≈ 77.6 in

Answer

h = 77.6 in
26.Nursing math & unit conversions

Answer: t = 460 min

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

18:00 → 24:00 = 360 min

After midnight

00:00 → 01:40 = 100 min

Total

t = 360 + 100 = 460 min

Answer

t = 460 min
27.Dosage calculations

Answer: D = 75 mg

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

Dose

5·15 = 75 mg

Answer

D = 75 mg
28.Dosage calculations

Answer: V = 0.44 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.

Volume

V = 4400/10000 = 0.44 mL

On the syringe

On this 1 mL syringe every small line is 0.01 mL.

Answer

V = 0.44 mL
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

5·60 = 300 min

Drip rate

R = 1500·10/300 = 50 gtt/min

Answer

R = 50 gtt/min
30.IV infusion rates

Answer: Δ = 26 %

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

1000/6 = 166.7 mL/h

New rate

R = 840/4 = 210 mL/h

Percentage change

Δ = (210 − 166.7)/166.7·100% = 26%

Answer

Δ = 26%

This is more than a 25% increase: most hospitals require you to contact the prescriber instead of catching up, and to assess the patient for fluid overload.

31.IV fluids & fluid balance

Answer: B = −70 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: 150 + 120 + 150 = 420 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 1·100 = 100 mL
total intake = 1480 mL

Total output

450 + 450 + 350 + 300 = 1550 mL

Balance

B = 1480 − 1550 = −70 mL

Answer

B = −70 mL

Negative: the patient lost more fluid than went in.

32.IV fluids & fluid balance

Answer: t = 8.5 h

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

First part

80·4 = 320 mL
1000 − 320 = 680 mL left

Second part

680/150 = 4.533 h

Total time

t = 4 + 4.533 = 8.533 ≈ 8.5 h

Answer

t = 8.5 h

That is about 8 h 32 min, so the bag runs out at about 21:32.

33.Clinical assessment scores

Answer: SI = 1

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 = 80/80 = 1

Answer

SI = 1

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

34.Clinical assessment scores

Answer: obesity class II

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

BMI

BMI = 101/1.65² = 37.1

Category

obesity class II

Answer

obesity class II

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