NCLEX-PN-style practice questions (LPN/LVN): cram pack

Formula sheets, the key method steps for every topic and 34 practice problems, with full solutions at the back.

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1Formulas and methods

Infection control & patient safety

Method

  1. Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
  2. Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
  3. Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
  4. Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
  5. Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.

Prioritization & delegation

Method

  1. Ask what will harm the patient soonest if nothing is done.
  2. Apply ABC (C-A-B in cardiac arrest), then Maslow: physiological needs before safety, safety before psychological needs.
  3. Compare the options: acute before chronic, unstable before stable, unexpected before expected, systemic before local, and check each finding against the patient’s baseline.
  4. Assess before you act unless it is an emergency; then choose the step the others depend on.
  5. For delegation, check the five rights: task, circumstance, person, directions and supervision. Assessment, teaching and evaluation stay with the RN.

Lab values & electrolytes

Method

  1. Compare the value with the laboratory’s own reference range, then with the patient’s baseline and trend.
  2. Check the sample: hemolysis, a delay, or blood drawn near an IV can give false results.
  3. Link the value to its typical signs and to the drugs and conditions that cause it.
  4. Look for interactions: low potassium or magnesium increases digoxin toxicity; dehydration raises lithium.
  5. Act on the patient: assess, hold a drug if the level is unsafe, read back critical values and inform the prescriber.

Med-surg: cardiovascular & respiratory

Method

  1. Name the problem: pump failure, blocked artery, rhythm, clot, airway narrowing, infection or a device problem.
  2. Check the danger signs first: hypoxia, hypotension, chest pain, new confusion, a cold pulseless limb.
  3. Match the oxygen to the patient: 94–98% for most, 88–92% for those at risk of CO₂ retention.
  4. Link each drug to its test and its risk: warfarin and INR, heparin and aPTT and platelets, diuretics and potassium.
  5. Choose the safe first action, then escalate and reassess.

Med-surg: neuro, endocrine & renal

Method

  1. Check the glucose in every patient with new confusion, weakness or a seizure.
  2. Use the level of consciousness as the earliest warning of brain trouble; pupils and Cushing’s triad come late.
  3. For diabetes emergencies, separate DKA (ketones, acidosis) from HHS (very high osmolality, dehydration); give fluids first.
  4. For sodium and water, decide whether ADH is in excess (SIADH) or missing (DI), and correct chronic changes slowly.
  5. For kidney problems, sort the cause into pre-renal, intrinsic or post-renal, and watch potassium and fluid.

Med-surg: GI, perioperative & oncology

Method

  1. Ask what could be hidden: internal bleeding, infection without fever, hypoventilation behind a normal SpO₂.
  2. Use the timing after surgery to narrow the complications: bleeding in hours, chest problems in days, wound and leak problems later.
  3. For pain, assess, treat with multimodal analgesia, reassess, and monitor sedation with every opioid.
  4. For cancer patients, treat any illness during the nadir as neutropenic sepsis and know the oncological emergencies.
  5. For burns, count only partial- and full-thickness areas, start the Parkland clock at the time of the burn and titrate to urine output.

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Pediatric nursing

Method

  1. Note the child’s age first: it sets the normal vital signs, the milestones and the right pain scale.
  2. Assess airway, breathing and circulation, remembering that children compensate and then deteriorate fast.
  3. Match the action to the development stage and involve the family.
  4. Check that the answer is safe for a child: weight-based, no aspirin in viral illness, no codeine under 12.

Mental health nursing

Method

  1. Decide whether there is an immediate risk: suicide, violence, a drug emergency or a physical illness.
  2. Act on safety first: observe, remove means, de-escalate, stop a harmful drug, get help.
  3. Choose the therapeutic response: acknowledge feelings, present reality, avoid false reassurance and “why” questions.
  4. Respect rights: the least restrictive option, consent and confidentiality with its limits.

Nursing math & unit conversions

Metric steps
1 kg = 1000 g, 1 g = 1000 mg, 1 mg = 1000 mcg, 1 L = 1000 mL
Weight and length
1 kg = 2.2 lb, 1 lb = 16 oz, 1 in = 2.54 cm, 1 ft = 12 in
Household measures
1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 8 fl oz = 240 mL
Temperature
°C = (°F − 32)·5/9, °F = °C·9/5 + 32
24-hour clock
PM hours 1–11: add 12; 12 AM = 00:xx; 12 PM = 12:xx
Dose rate
mcg/min × 60/1000 = mg/h
Laboratory factors
glucose 1 mmol/L = 18 mg/dL; creatinine 1 mg/dL = 88.4 µmol/L; Hb 1 g/dL = 10 g/L

Method

  1. Write the given quantity with its unit and the unit you want.
  2. Pick the equivalent: 1000 between kg, g, mg and mcg or L and mL; 1 kg = 2.2 lb; 1 tsp = 5 mL, 1 tbsp = 15 mL, 1 fl oz = 30 mL, 1 cup = 240 mL.
  3. Write it as a fraction so that the unwanted unit cancels; for a rate, use one fraction per unit that changes.
  4. Check the direction: a smaller unit gives a bigger number.
  5. Round only the final answer, to the precision the question names.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

IV fluids & fluid balance

Holliday–Segar per hour
4 mL/kg (first 10 kg) + 2 mL/kg (next 10 kg) + 1 mL/kg (each kg above 20)
Holliday–Segar per day
100 / 50 / 20 mL/kg for the same bands
Fluid balance
intake − output
Ice chips
count as half their volume
Urine output
mL/kg/h = mL / (kg × h)
Infusion time
time (h) = volume left (mL) / rate (mL/h)
Volume infused
mL = rate × time

Clinical assessment scores

Glasgow Coma Scale
GCS = E (1–4) + V (1–5) + M (1–6) = 3–15
APGAR
5 signs × 0–2 = 0–10; 7–10 reassuring, 4–6 moderately abnormal, 0–3 low
Braden scale
5 × (1–4) + 1 × (1–3) = 6–23; ≤ 18 at risk
Morse fall scale
falls 25, diagnosis 15, aid 15/30, IV 20, gait 10/20, mental status 15
NEWS2 risk
0–4 low; single 3 low–medium; 5–6 medium; ≥ 7 high
Mean arterial pressure
MAP = (SBP + 2·DBP)/3 = DBP + PP/3
Pulse pressure and shock index
PP = SBP − DBP, SI = HR/SBP
Body mass index
BMI = kg/m² = 703·lb/in²

Method

  1. Find the score sheet that the question uses and its range (GCS 3–15, APGAR 0–10, Braden 6–23, Morse 0–125).
  2. Score every item separately, matching the description to its level.
  3. Add the item scores and check that the total lies inside the range.
  4. Apply the cut-offs: for NEWS2 also look for any single parameter scoring 3.
  5. For derived values use MAP = (SBP + 2·DBP)/3, PP = SBP − DBP, SI = HR/SBP and BMI = kg/m².

2Practice problems

1.Nursing fundamentalsMedium

Why is high-flow oxygen often humidified?

  1. ATo stop the airways and secretions from drying out
  2. BTo add medicine to the oxygen
  3. CTo make the oxygen more concentrated before it reaches the lungs
  4. DTo cool the patient's temperature
2.Nursing fundamentalsHard

A small fire starts in a patient's room. What is the first action?

  1. AMove the patient away from immediate danger
  2. BOpen the windows to let out the smoke
  3. CGo and find the fire safety officer to ask what should be done
  4. DTry to put out the fire with water
3.Infection control & patient safetyMedium

How are neuromuscular blocking drugs, such as vecuronium, safely stored?

  1. AMixed in the same bin as other high-use drugs
  2. BNext to common IV antibiotics so they are easy to find
  3. CIn the general stock cupboard with the other IV drugs and no special labels
  4. DSeparate from other drugs, with a warning that they cause paralysis
4.Infection control & patient safetyHard

A patient in the emergency waiting room has a cough for six weeks, night sweats, weight loss and blood in the sputum. What should the nurse do first?

  1. AMask the patient and move them to an airborne isolation room
  2. BPlace the patient in a shared cubicle with the curtain closed
  3. CAsk the patient to wait in the waiting room until called
  4. DStart contact precautions with a gown and gloves for staff
5.Prioritization & delegationMedium

Two hours after birth, the nurse finds the uterus firm but above the umbilicus and pushed to the right. What should the nurse do first?

  1. AAsk the patient to lie still for another hour
  2. BHelp the patient empty her bladder
  3. CGive a dose of oxytocin straight away
  4. DMassage the uterus firmly for ten minutes
6.Prioritization & delegationHard

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

  1. ATachycardia
  2. BSweating
  3. CTremor
  4. DPalpitations
7.Clinical nursingMedium

A patient is started on spironolactone while already taking an ACE inhibitor. Which blood result should be watched most closely?

  1. ACalcium, because both drugs lower it
  2. BSodium, because both drugs raise it sharply
  3. CGlucose, because both drugs cause hyperglycaemia
  4. DPotassium, because both drugs can raise it
8.Clinical nursingHard

A patient with severe asthma becomes quiet, with a "silent chest", exhaustion and a falling respiratory rate. What does this indicate?

  1. AAnxiety only
  2. BImprovement of the attack as the bronchospasm settles and the airways relax
  3. CLife-threatening asthma with impending respiratory arrest
  4. DNormal recovery after a nebuliser
9.Lab values & electrolytesMedium

A patient takes high-dose biotin supplements for hair and nails. Why should the nurse report this before blood tests?

  1. ABiotin causes a true rise in blood glucose in all patients
  2. BBiotin can distort some immunoassays, such as troponin or TSH
  3. CBiotin makes the blood clot in the tube before testing
  4. DBiotin lowers the hemoglobin by destroying the red cells
10.Lab values & electrolytesHard

A patient without symptoms has a TSH of 7.5 mIU/L on two occasions with a normal free T4. Which term fits best?

  1. AOvert primary hypothyroidism
  2. BSecondary hypothyroidism
  3. CSubclinical hyperthyroidism
  4. DSubclinical hypothyroidism
11.PharmacologyMedium

Which is a well-known adverse effect of long-term oral corticosteroids?

  1. AHypoglycaemia
  2. BLow blood pressure
  3. CWeight loss
  4. DOsteoporosis
12.PharmacologyHard

An older patient who has taken omeprazole for many years has muscle cramps, tremor and an irregular heartbeat. Which lab finding is most likely linked to the drug?

  1. AHigh serum sodium
  2. BLow serum glucose
  3. CLow serum magnesium
  4. DHigh serum calcium
13.Med-surg: cardiovascular & respiratoryMedium

A patient is starting doxazosin, an alpha-blocker, for hypertension. Which advice is most important?

  1. ATake it with a large glass of grapefruit juice to improve absorption
  2. BStop it suddenly if the heart rate rises after the first few doses
  3. CAvoid all potassium-containing foods
  4. DTake the first dose at bedtime, as dizziness and fainting can occur
14.Med-surg: cardiovascular & respiratoryHard

A patient with severe asthma develops a stable narrow-complex tachycardia, and IV adenosine is prescribed. What should the nurse do?

  1. AQuestion the prescription, as adenosine can cause bronchospasm
  2. BGive it orally instead of intravenously
  3. CGive it as prescribed, as adenosine is safe in every patient
  4. DGive it as a slow infusion over an hour to reduce side effects
15.Med-surg: neuro, endocrine & renalMedium

Which Glasgow Coma Scale score usually suggests that a patient may not be able to protect their own airway?

  1. A13 or below
  2. B15
  3. C8 or below
  4. D11 or above
16.Med-surg: neuro, endocrine & renalHard

A patient has episodes of severe headache, sweating, palpitations and very high blood pressure. Which condition should be considered?

  1. APhaeochromocytoma
  2. BDiabetes insipidus
  3. CAddison's disease
  4. DHypothyroidism
17.Med-surg: GI, perioperative & oncologyMedium

After a spinal anaesthetic, which nursing check is particularly important?

  1. AReturn of leg sensation and movement, and passing urine
  2. BBlood glucose every 15 minutes overnight
  3. CPupil reaction every five minutes for the next full day
  4. DPeak flow before and after each meal
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. ALay the patient flat to help them sleep
  2. BEncourage the patient to rest the voice and reassess tomorrow
  3. CCall for urgent anaesthetic help, as the airway is swelling
  4. DGive a warm drink to soothe the throat
19.Maternity & obstetric nursingMedium

A woman 1 day after birth has a blood pressure of 150/96 mmHg and a headache. She had normal blood pressures in pregnancy. What should the nurse do?

  1. AReassure her that this is normal after birth
  2. BReport it and assess for postpartum pre-eclampsia
  3. CGive paracetamol (acetaminophen) and ignore the blood pressure
  4. DEncourage her to walk to lower her blood pressure
20.Maternity & obstetric nursingHard

A woman at 9 weeks has hCG levels that are much higher than expected, a uterus large for dates, severe vomiting and dark brown spotting. Which condition should be suspected?

  1. AA threatened miscarriage
  2. BAn ectopic pregnancy
  3. CA missed miscarriage
  4. DA hydatidiform (molar) pregnancy
21.Pediatric nursingMedium

Which growth chart finding in a 10-month-old most needs further evaluation?

  1. AWeight that has fallen across two major percentile lines since the last visits
  2. BHead circumference that follows the 75th percentile curve
  3. CLength on the 50th percentile and weight on the 40th percentile
  4. DWeight that has stayed on the 10th percentile since birth
22.Pediatric nursingHard

An 8-year-old tells the nurse that her uncle touches her in a way she does not like and asks the nurse to keep it secret. What is the best response?

  1. APhone the uncle straight away to ask for his side of the story before reporting anything
  2. BListen calmly, praise her for telling, explain it must be shared, and follow safeguarding
  3. CPromise to keep the secret, so that she keeps trusting the nurse and tells more later
  4. DAsk detailed, leading questions to find out exactly what happened
23.Mental health nursingMedium

How does conduct disorder differ from oppositional defiant disorder?

  1. AOppositional defiant disorder includes serious physical aggression towards animals
  2. BConduct disorder involves only arguing with adults and losing one's temper
  3. CThe two disorders are exactly the same and differ only in the age at which they are diagnosed
  4. DConduct disorder involves violating others' rights, such as cruelty, theft or fire setting
24.Mental health nursingHard

A woman arrives in the emergency department after a sexual assault and has a cut on her head that is bleeding. What is the priority?

  1. ACall the police and wait until they arrive before doing anything else, so that no evidence is lost by mistake
  2. BAssess and treat her physical injuries, then offer forensic examination with her consent
  3. CAsk her for a detailed account of the assault before any care
  4. DCollect forensic evidence before treating any injuries
25.Nursing math & unit conversionsMedium
6 ft 6 in1 ft = 12 in1 in = 2.54 cmh = ? cm

Practice exercise (made-up values, not clinical guidance). A patient is 6 ft 6 in tall. Using 1 ft = 12 in and 1 in = 2.54 cm, find the height h in centimetres, to the nearest whole centimetre.

6 ft 6 in1 ft = 12 in1 in = 2.54 cm
h = cm
26.Nursing math & unit conversionsHard
18 g/dL? g/L1 L = 10 dL

Practice exercise (made-up values, not clinical guidance). A haemoglobin result is 18 g/dL. Express it in g/L Hb.

18 g/dL1 L = 10 dL
Hb = g/L
27.Dosage calculationsMedium
024681010 mL

A child weighing 12 kg is prescribed 20 mg/kg of a drug. The stock solution contains 50 mg/mL. Draw up the dose: what volume V do you give?

12 kg20 mg/kg50 mg/mL
V = mL
28.Dosage calculationsHard
25k units1000 mL? mL/h800 units/h

An infusion contains 25000 units of a drug in 1000 mL. The prescription is 800 units per hour. At what rate R do you set the pump, in mL/h?

25000 units/1000 mL800 units/h
R = mL/h
29.IV infusion ratesMedium
500 mL60 gtt/mL10 h? gtt/min

Infuse 500 mL over 10 hours with a giving set of 60 gtt/mL. Find the drip rate R in drops per minute.

500 mL10 h60 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1260 mLleft? mL/h8 h left

1500 mL was ordered over 12 hours. After 4 hours you find that 1260 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 4 h: 1260 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjelly120 mLtea240 mLjuice200 mLice chips120 mLIV infusion60 mL/h × 12 hIV antibiotic1 × 100 mLurine425 mLurine450 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 total intake I in mL. Count ice chips as half their volume.

jelly: 120 mLtea: 240 mLjuice: 200 mLice chips: 120 mLIV infusion: 60 mL/h × 12 hIV antibiotic: 1 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL120 mL/hstart 09:3012:00: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 09:30 and runs by pump at 120 mL/h. How many mL V are left in the bag at 12:00?

500 mL120 mL/h09:30 → 12:00
V = mL
33.Clinical assessment scoresMedium
E3 / 4+V5 / 5+M? / 6GCS 13?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 13, with E3 and V5. What motor score M was recorded, and which response does it describe? Give the number.

GCS 13E3V5
M =
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 20/min, SpO₂ 86% on room air, blood pressure 90/54 mmHg, pulse 64/min, newly confused, temperature 36.9 °C. Which clinical risk group does the patient fall into? Click it.

RR 20SpO₂ 86%airSBP 90HR 64CT 36.9 °C
  1. 1low
  2. 2low–medium
  3. 3medium
  4. 4high

3Solutions

1.Nursing fundamentals

Answer: A · To stop the airways and secretions from drying out

Why this is the answer

Dry gas at high flow dries the mucous membranes and thickens secretions. Humidification keeps the airways moist and secretions easier to clear.

Answer

A · To stop the airways and secretions from drying out
2.Nursing fundamentals

Answer: A · Move the patient away from immediate danger

Why this is the answer

The first priority is to rescue anyone in immediate danger, then raise the alarm, contain the fire by closing doors and only then try to extinguish it if safe. Opening windows feeds a fire with oxygen.

Answer

A · Move the patient away from immediate danger
3.Infection control & patient safety

Answer: D · Separate from other drugs, with a warning that they cause paralysis

Why this is the answer

Neuromuscular blockers stop breathing. They are stored apart from other drugs, often in sealed or colored containers with warnings such as “Paralyzing agent: causes respiratory arrest”.

Answer

D · Separate from other drugs, with a warning that they cause paralysis
4.Infection control & patient safety

Answer: A · Mask the patient and move them to an airborne isolation room

Why this is the answer

Prolonged cough, night sweats, weight loss and hemoptysis suggest pulmonary tuberculosis. The patient wears a surgical mask and is moved quickly to a negative-pressure room, and staff wear respirators. Curtains do not stop airborne particles.

Answer

A · Mask the patient and move them to an airborne isolation room
5.Prioritization & delegation

Answer: B · Help the patient empty her bladder

Why this is the answer

A uterus that is high and displaced to one side usually means a full bladder. A full bladder stops the uterus contracting well, so the nurse helps the patient void and reassesses.

Answer

B · Help the patient empty her bladder
6.Prioritization & delegation

Answer: B · Sweating

Why this is the answer

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

Answer

B · Sweating
7.Clinical nursing

Answer: D · Potassium, because both drugs can raise it

Why this is the answer

Spironolactone and ACE inhibitors both reduce potassium excretion, so the combination can cause dangerous hyperkalaemia. Potassium and renal function should be checked regularly.

Answer

D · Potassium, because both drugs can raise it
8.Clinical nursing

Answer: C · Life-threatening asthma with impending respiratory arrest

Why this is the answer

A silent chest, exhaustion, cyanosis and confusion are life-threatening signs. The patient needs immediate senior and critical care input.

Answer

C · Life-threatening asthma with impending respiratory arrest
9.Lab values & electrolytes

Answer: B · Biotin can distort some immunoassays, such as troponin or TSH

Why this is the answer

Many immunoassays use biotin-streptavidin binding, and high blood biotin levels can give falsely high or low results, for example a falsely low troponin or abnormal thyroid tests. The laboratory and prescriber should know about biotin use.Checked against: Troponin Test · MedlinePlus (NIH) (2023); Biotin Interference with Troponin Lab Tests - Assays Subject to Biotin Interference · U.S. FDA (2022)

Answer

B · Biotin can distort some immunoassays, such as troponin or TSH
10.Lab values & electrolytes

Answer: D · Subclinical hypothyroidism

Why this is the answer

A raised TSH with a normal free T4 is subclinical hypothyroidism; the pituitary is working harder to keep T4 normal. Overt hypothyroidism has a low free T4, and subclinical hyperthyroidism has a low TSH.Checked against: TSH (Thyroid-stimulating hormone) Test · MedlinePlus (NIH) (2024)

Answer

D · Subclinical hypothyroidism
11.Pharmacology

Answer: D · Osteoporosis

Why this is the answer

Long-term corticosteroids reduce bone formation and raise fracture risk. They also cause weight gain, high blood glucose, hypertension and a higher infection risk.

Answer

D · Osteoporosis
12.Pharmacology

Answer: C · Low serum magnesium

Why this is the answer

Long-term PPI use can cause hypomagnesaemia, which leads to cramps, tremor and arrhythmias. Other long-term risks include fractures, vitamin B12 deficiency and C. difficile infection.

Answer

C · Low serum magnesium
13.Med-surg: cardiovascular & respiratory

Answer: D · Take the first dose at bedtime, as dizziness and fainting can occur

Why this is the answer

Alpha-blockers can cause marked first-dose postural hypotension. Taking the first dose at bedtime and rising slowly reduces the risk of falls. They are also used for symptoms of an enlarged prostate.

Answer

D · Take the first dose at bedtime, as dizziness and fainting can occur
14.Med-surg: cardiovascular & respiratory

Answer: A · Question the prescription, as adenosine can cause bronchospasm

Why this is the answer

Adenosine can trigger severe bronchospasm and is generally avoided in asthma. Alternatives such as verapamil may be used, depending on the patient. The nurse raises the concern with the prescriber before giving it.

Answer

A · Question the prescription, as adenosine can cause bronchospasm
15.Med-surg: neuro, endocrine & renal

Answer: C · 8 or below

Why this is the answer

A GCS of 8 or less usually indicates coma and a risk that the patient cannot maintain or protect the airway, so urgent senior and anaesthetic review is needed. The score ranges from 3 to 15, and the components (E, V, M) should be reported separately.

Answer

C · 8 or below
16.Med-surg: neuro, endocrine & renal

Answer: A · Phaeochromocytoma

Why this is the answer

Phaeochromocytoma is a catecholamine-secreting tumour, usually of the adrenal medulla. It causes episodic hypertension, headache, sweating and tachycardia. Before surgery, alpha-blockade is started before any beta-blocker, because beta-blockade alone can cause a hypertensive crisis.

Answer

A · Phaeochromocytoma
17.Med-surg: GI, perioperative & oncology

Answer: A · Return of leg sensation and movement, and passing urine

Why this is the answer

The nurse monitors the level of the block, recovery of leg movement and sensation, BP and bladder function. Urinary retention is common, and early mobilisation is only safe once motor function returns.

Answer

A · Return of leg sensation and movement, and passing urine
18.Med-surg: GI, perioperative & oncology

Answer: C · 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

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

Answer: B · Report it and assess for postpartum pre-eclampsia

Why this is the answer

New hypertension with a headache after birth can be postpartum pre-eclampsia, even with normal readings in pregnancy. The nurse reports it, checks urine protein and symptoms and follows the protocol.

Answer

B · Report it and assess for postpartum pre-eclampsia
20.Maternity & obstetric nursing

Answer: D · A hydatidiform (molar) pregnancy

Why this is the answer

A molar pregnancy causes very high hCG, a uterus larger than dates, hyperemesis and bleeding. Ectopic and failing pregnancies usually have lower than expected hCG.

Answer

D · A hydatidiform (molar) pregnancy
21.Pediatric nursing

Answer: A · Weight that has fallen across two major percentile lines since the last visits

Why this is the answer

A child who grows steadily along a low percentile may simply be small. Crossing two major percentile lines suggests faltering growth and needs assessment of feeding, illness and the social situation.

Answer

A · Weight that has fallen across two major percentile lines since the last visits
22.Pediatric nursing

Answer: B · Listen calmly, praise her for telling, explain it must be shared, and follow safeguarding

Why this is the answer

The nurse listens without showing shock, reassures the child, avoids leading questions, records her words accurately and explains that people who can help need to know. The concern is reported at once through the safeguarding procedure.

Answer

B · Listen calmly, praise her for telling, explain it must be shared, and follow safeguarding
23.Mental health nursing

Answer: D · Conduct disorder involves violating others' rights, such as cruelty, theft or fire setting

Why this is the answer

Oppositional defiant disorder involves angry, argumentative and defiant behaviour. Conduct disorder is more serious, with aggression, destruction of property, deceit, theft or serious violation of rules.

Answer

D · Conduct disorder involves violating others' rights, such as cruelty, theft or fire setting
24.Mental health nursing

Answer: B · Assess and treat her physical injuries, then offer forensic examination with her consent

Why this is the answer

Medical care for injuries comes first. Forensic examination is offered, explained and carried out only with consent, and the nurse supports the survivor's control over each step.

Answer

B · Assess and treat her physical injuries, then offer forensic examination with her consent
25.Nursing math & unit conversions

Answer: h = 198 cm

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.

Height in inches

6·12 + 6 = 78 in

Inches to centimetres

h = 78·2.54 = 198.1 ≈ 198 cm

Answer

h = 198 cm
26.Nursing math & unit conversions

Answer: Hb = 180 g/L

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.

Convert

Hb = 18 g/dL × 10 dL/L = 180 g/L

Answer

Hb = 180 g/L
27.Dosage calculations

Answer: V = 4.8 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 = 20·12 = 240 mg

Volume

V = 240/50 = 4.8 mL

On the syringe

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

Answer

V = 4.8 mL
28.Dosage calculations

Answer: R = 32 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

25000/1000 = 25 units/mL

Pump rate

R = 800/25 = 32 mL/h

Answer

R = 32 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 = 500·60/600 = 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

1500/12 = 125 mL/h

New rate

R = 1260/8 = 157.5 mL/h

Percentage change

Δ = (157.5 − 125)/125·100% = 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: I = 1440 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: 120 + 240 + 200 = 560 mL
ice chips: 120/2 = 60 mL
IV infusion: 60·12 = 720 mL
IV antibiotic: 1·100 = 100 mL
I = 1440 mL

Answer

I = 1440 mL
32.IV fluids & fluid balance

Answer: V = 200 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

09:30 → 12:00 = 2.5 h

Volume infused

120·2.5 = 300 mL

Volume left

V = 500 − 300 = 200 mL

Answer

V = 200 mL
33.Clinical assessment scores

Answer: M = 5

Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.

Motor score

M = 13 − 3 − 5 = 5
M5: moves a hand to the site of pressure (localises)

Answer

M = 5
34.Clinical assessment scores

Answer: high

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 20/min → 0
SpO₂ 86% → 3
on air → 0
SBP 90 mmHg → 3
HR 64/min → 0
newly confused (C) → 3
T 36.9 °C → 0

Total and red scores

NEWS2 = 0 + 3 + 0 + 3 + 0 + 3 + 0 = 9
At least one parameter scores 3.

Risk group

high

Answer

high

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

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