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

Where in the eye should eye drops be placed?

  1. ADirectly onto the centre of the cornea
  2. BInto the pocket of the lower eyelid
  3. COnto the upper eyelid while the eye is shut
  4. DInto the inner corner of the eye only
2.Nursing fundamentalsHard

A nurse uses SBAR to call a doctor about a breathless patient. Which item belongs under "Background"?

  1. A"Please come and review him within the next 10 minutes."
  2. BThe patient has COPD and was admitted two days ago with pneumonia
  3. CHis respiratory rate is 30 and his SpO₂ is 86% on 2 L of oxygen
  4. D"I am calling about Mr Smith in bed 4, who is very breathless."
3.Infection control & patient safetyMedium

Which dressing waste should be disposed of in clinical (biohazard) waste?

  1. AAn unused, still-sealed dressing past its date
  2. BA dressing soaked with fluid from an infected wound
  3. CThe outer paper wrapping of a sterile dressing pack
  4. DA clean paper towel used to dry hands
4.Infection control & patient safetyHard

The fire alarm sounds, but the nurse does not know where the fire is. What should the nurse do?

  1. AClose the doors to patient rooms, stay on the unit and wait for instructions
  2. BLeave the unit and the building to find out where the fire is
  3. COpen all doors so patients can be seen easily
  4. DEvacuate all patients down the stairs at once, starting with those in bed
5.Prioritization & delegationMedium

A malnourished patient admitted with alcohol use disorder needs IV glucose. Which vitamin is given before or with it?

  1. AVitamin C (ascorbic acid)
  2. BVitamin K (phytonadione)
  3. CThiamine (vitamin B1)
  4. DVitamin D (calciferol)
6.Prioritization & delegationHard

A patient with anorexia nervosa is admitted. Which finding is the priority?

  1. ARefuses to eat in front of other people
  2. BSays she feels fat although she is very thin
  3. CHeart rate 38/min and potassium 2.8 mEq/L
  4. DHas fine, downy hair on her arms
7.Clinical nursingMedium

A patient with heart failure has pink, frothy sputum and crackles throughout both lungs. What is happening?

  1. AUpper gastrointestinal bleeding
  2. BPneumothorax
  3. CAsthma attack
  4. DAcute pulmonary oedema
8.Clinical nursingHard

A nurse teaches a patient with hypertension about their medicines. Which statement shows a need for further teaching?

  1. A"I'll keep taking my tablets even if I feel well."
  2. B"I'll get up slowly from sitting."
  3. C"I'll stop my tablets once my readings are normal."
  4. D"I'll have my blood pressure checked regularly."
9.Lab values & electrolytesMedium

Why do patients with chronic kidney disease often have anemia?

  1. AThe damaged kidneys filter out and destroy red blood cells
  2. BUremic toxins make the bone marrow produce white cells instead of red cells
  3. CThe kidneys make less erythropoietin, which drives red cell production
  4. DHigh potassium in kidney disease breaks down red cells
10.Lab values & electrolytesHard

A patient's total calcium is 7.6 mg/dL and the albumin is 2.0 g/dL. Using the common correction (add 0.8 mg/dL for each 1 g/dL that albumin is below 4.0), what is the corrected calcium?

  1. A6.0 mg/dL, well below the normal range
  2. B9.2 mg/dL, within the normal range
  3. C7.6 mg/dL, below the normal range
  4. D11.6 mg/dL, above the normal range
11.PharmacologyMedium

Which approach is usually recommended to prevent constipation in a patient on regular opioids?

  1. AAn antidiarrhoeal drug at night to slow the gut
  2. BA stimulant laxative such as senna, often with a stool softener
  3. CBulk-forming fibre alone, with fluid intake restricted
  4. DNo laxative until the patient has not opened the bowels for a week
12.PharmacologyHard

A patient taking a GLP-1 receptor agonist such as semaglutide has severe, constant upper abdominal pain spreading to the back, with vomiting. What should the nurse suspect?

  1. AAcute pancreatitis; the drug is stopped and urgent assessment arranged
  2. BConstipation; a laxative will solve the problem
  3. CExpected nausea; the patient should take the next dose with food
  4. DHypoglycaemia; the patient should eat sweets and continue as usual
13.Med-surg: cardiovascular & respiratoryMedium

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

  1. AStable angina
  2. BPhaeochromocytoma
  3. CAortic stenosis
  4. DAsthma
14.Med-surg: cardiovascular & respiratoryHard

Two days after coronary artery bypass surgery, a patient feels palpitations. The pulse is irregularly irregular at 140/min and BP is 112/70 mmHg. Which rhythm is most likely?

  1. AVentricular fibrillation
  2. BSinus tachycardia
  3. CAtrial fibrillation
  4. DComplete heart block
15.Med-surg: neuro, endocrine & renalMedium

Why may a person with long-standing diabetes have a heart attack without typical chest pain?

  1. AInsulin acts as a strong painkiller
  2. BNerve damage can blunt the pain signals
  3. CHigh glucose protects the heart from pain
  4. DPeople with diabetes do not have heart attacks
16.Med-surg: neuro, endocrine & renalHard

A patient with stable epilepsy on phenytoin started a new medicine last week. They now have nystagmus, an unsteady gait and slurred speech. What should the nurse do?

  1. AGive the next phenytoin dose early to prevent a seizure
  2. BEncourage the patient to walk more to improve their balance
  3. CSuspect phenytoin toxicity, hold the next dose and ask for a drug level
  4. DSuspect a new stroke and give aspirin straight away before any scan
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

A nurse has a needlestick injury after taking blood from a patient with hepatitis B. What should the nurse do first?

  1. AScrub the area hard with a nail brush and alcohol
  2. BWash the site with soap and running water, without scrubbing
  3. CFinish the shift and report it the next day
  4. DSuck the wound to remove as much of the blood as possible
19.Maternity & obstetric nursingMedium

Which reflex causes the newborn's toes to fan out when the sole is stroked from heel to toe?

  1. AStepping reflex
  2. BMoro reflex
  3. CBabinski reflex
  4. DPlantar grasp reflex
20.Maternity & obstetric nursingHard

A fetal tracing shows a smooth, wave-like pattern with no variability, like a sine wave. What should the nurse suspect?

  1. ASevere fetal anaemia
  2. BFetal head compression
  3. CA maternal urinary infection
  4. DA normal fetal sleep cycle
21.Pediatric nursingMedium

Which instruction about giving oral liquid iron to a child is correct?

  1. AGive it with a syringe or straw towards the back of the mouth; dark stools are expected
  2. BGive it mixed in a full bottle of milk to reduce stomach upset
  3. CGive it together with an antacid to protect the stomach
  4. DStop the iron straight away if the stools turn dark green or black, as this means bleeding
22.Pediatric nursingHard

The parents of a child who is being resuscitated ask to stay in the room. What is the best response?

  1. AAllow them to stay if they wish, with a staff member to support and explain
  2. BAsk them to leave, because their presence always harms the team's work
  3. CAllow them to stay only if they help with the compressions
  4. DTell them to wait outside in the corridor until the resuscitation is over
23.Mental health nursingMedium

Which nursing action at mealtimes is most appropriate for a patient with anorexia nervosa?

  1. ALet the patient eat alone in her room for privacy
  2. BTalk with the patient at length about calories during the meal
  3. CAllow the patient to choose to skip meals if she says she feels full or unwell
  4. DSupervise the meal and observe the patient for an agreed period afterwards
24.Mental health nursingHard

On the third day of refeeding, a patient with severe anorexia nervosa develops swollen ankles, a low phosphate and an irregular pulse. What is most likely?

  1. ARefeeding syndrome
  2. BSerotonin syndrome
  3. CAn allergic reaction to the food
  4. DNormal weight gain
25.Nursing math & unit conversionsMedium
1234567891011128:25 PM?19:2520:2508:2521:25

Practice exercise (made-up values, not clinical guidance). A dose is charted at 8:25 PM. Which entry is the same time on the 24-hour clock? Click it.

8:25 PM
  1. 119:25
  2. 220:25
  3. 308:25
  4. 421:25
26.Nursing math & unit conversionsHard
1½ fl oz? mL¾ cup? mL4 tbsp? mL1 tsp? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1½ fl oz of juice, ¾ cup of tea, 4 tbsp of liquid supplement, 1 tsp of cough syrup. Using the equivalents given, find the total oral intake V in mL.

1 fl oz = 30 mL1 cup = 8 fl oz = 240 mL1 tbsp = 15 mL1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
024681010 mL

A child weighing 8 kg is prescribed 5 mg/kg of a drug. The stock solution contains 40 mg/mL. Draw up the dose: what volume V do you give?

8 kg5 mg/kg40 mg/mL
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 200 units of a drug that comes as 1000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

200 units1000 units/mL
V = mL
29.IV infusion ratesMedium
500 mL15 gtt/mL6 h? gtt/min

Infuse 500 mL over 6 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL6 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1 g250 mL? mL/h1.5 mg/min

A bag contains 1 g of a drug in 250 mL. The order is 1.5 mg per minute. At what rate R do you set the pump, in mL/h?

1 g/250 mL1.5 mg/min
R = mL/h
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shifttea200 mLwater240 mLjelly120 mLice chips240 mLIV infusion80 mL/h × 12 hIV antibiotic2 × 50 mLurine475 mLurine275 mLvomit200 mL

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

tea: 200 mLwater: 240 mLjelly: 120 mLice chips: 240 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL→ 200 mL/hstart 14:30ttotal​ = ? h80 mL/h × 4 h

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 14:30 at 80 mL/h. After 4 hours the rate is changed to 200 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.

500 mL80 mL/h · 4 h200 mL/h
t = h
33.Clinical assessment scoresMedium
S? / 4+M? / 4+A? / 4+Mob? / 4+N? / 4+F? / 3Σ?

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

6–23
B =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 43 kg and is 167 cm tall. Calculate the BMI and click the WHO weight category.

43 kg167 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: B · Into the pocket of the lower eyelid

Why this is the answer

Drops go into the lower conjunctival sac, which is less sensitive than the cornea. Pressing gently on the inner corner afterwards reduces drainage into the nose.

Answer

B · Into the pocket of the lower eyelid
2.Nursing fundamentals

Answer: B · The patient has COPD and was admitted two days ago with pneumonia

Why this is the answer

SBAR is Situation (why you are calling), Background (relevant history), Assessment (your findings) and Recommendation (what you need). Clear structure speeds up the response.

Answer

B · The patient has COPD and was admitted two days ago with pneumonia
3.Infection control & patient safety

Answer: B · A dressing soaked with fluid from an infected wound

Why this is the answer

Items contaminated with blood or infectious body fluids go into clinical waste according to local rules. Clean packaging goes into general or recycling waste, so the volume of clinical waste stays as small as possible.

Answer

B · A dressing soaked with fluid from an infected wound
4.Infection control & patient safety

Answer: A · Close the doors to patient rooms, stay on the unit and wait for instructions

Why this is the answer

Closing doors limits the spread of smoke and fire. Staff follow the fire plan, keep corridors clear and prepare for evacuation, but do not evacuate until directed or the fire is in their area.

Answer

A · Close the doors to patient rooms, stay on the unit and wait for instructions
5.Prioritization & delegation

Answer: C · Thiamine (vitamin B1)

Why this is the answer

Thiamine deficiency is common in heavy alcohol use, and giving glucose without thiamine can trigger Wernicke encephalopathy. Thiamine is given before or with glucose.

Answer

C · Thiamine (vitamin B1)
6.Prioritization & delegation

Answer: C · Heart rate 38/min and potassium 2.8 mEq/L

Why this is the answer

Severe bradycardia and low potassium can cause fatal arrhythmias. The body-image beliefs and eating behaviors matter, but physiological safety comes first.

Answer

C · Heart rate 38/min and potassium 2.8 mEq/L
7.Clinical nursing

Answer: D · Acute pulmonary oedema

Why this is the answer

Acute pulmonary oedema causes severe breathlessness, crackles and frothy sputum. Sit the patient up, give oxygen and call urgently for medical help; diuretics are commonly given.

Answer

D · Acute pulmonary oedema
8.Clinical nursing

Answer: C · "I'll stop my tablets once my readings are normal."

Why this is the answer

Hypertension usually needs long-term treatment; stopping because readings are normal often makes blood pressure rise again. Patients should discuss any changes with their prescriber.

Answer

C · "I'll stop my tablets once my readings are normal."
9.Lab values & electrolytes

Answer: C · The kidneys make less erythropoietin, which drives red cell production

Why this is the answer

Diseased kidneys produce less erythropoietin, so the marrow makes fewer red cells. Treatment can include erythropoiesis-stimulating agents and iron.Checked against: Anemia · MedlinePlus (NIH) (2026); Erythropoietin test · MedlinePlus (NIH) (2025)

Answer

C · The kidneys make less erythropoietin, which drives red cell production
10.Lab values & electrolytes

Answer: B · 9.2 mg/dL, within the normal range

Why this is the answer

Corrected calcium = 7.6 + 0.8 × (4.0 − 2.0) = 9.2 mg/dL, which is normal. Low albumin lowers the bound fraction of calcium; the correction is only an estimate, and an ionized calcium is more accurate when it matters.Checked against: Calcium blood test · MedlinePlus (NIH) (2025)

Answer

B · 9.2 mg/dL, within the normal range
11.Pharmacology

Answer: B · A stimulant laxative such as senna, often with a stool softener

Why this is the answer

Opioid-induced constipation does not usually resolve with time, so a laxative is started with the opioid. Stimulant laxatives counter reduced motility; bulk-forming laxatives alone can worsen symptoms if fluid intake is low.

Answer

B · A stimulant laxative such as senna, often with a stool softener
12.Pharmacology

Answer: A · Acute pancreatitis; the drug is stopped and urgent assessment arranged

Why this is the answer

Mild nausea is common with GLP-1 agonists, but severe persistent abdominal pain radiating to the back suggests pancreatitis. The drug is stopped and the patient needs urgent assessment, including serum lipase or amylase.

Answer

A · Acute pancreatitis; the drug is stopped and urgent assessment arranged
13.Med-surg: cardiovascular & respiratory

Answer: B · Phaeochromocytoma

Why this is the answer

Phaeochromocytoma is a catecholamine-secreting tumour, usually of the adrenal medulla. Classic features are paroxysmal headache, sweating, palpitations and hypertension. It is diagnosed with plasma or urine metanephrines.

Answer

B · Phaeochromocytoma
14.Med-surg: cardiovascular & respiratory

Answer: C · Atrial fibrillation

Why this is the answer

New atrial fibrillation affects a large proportion of patients in the first days after cardiac surgery, often due to inflammation, electrolyte shifts and stress. Management includes a 12-lead ECG, checking potassium and magnesium, rate or rhythm control and considering anticoagulation.

Answer

C · Atrial fibrillation
15.Med-surg: neuro, endocrine & renal

Answer: B · Nerve damage can blunt the pain signals

Why this is the answer

Autonomic neuropathy can make a myocardial infarction "silent" or atypical, with breathlessness, fatigue, nausea or sweating rather than chest pain. A low threshold for an ECG is needed.

Answer

B · Nerve damage can blunt the pain signals
16.Med-surg: neuro, endocrine & renal

Answer: C · Suspect phenytoin toxicity, hold the next dose and ask for a drug level

Why this is the answer

Nystagmus, ataxia and slurred speech are classic signs of phenytoin toxicity. Interacting drugs can raise its level. The nurse holds the dose, ensures safety and escalates for a level and a review. A new neurological deficit still needs medical assessment.

Answer

C · Suspect phenytoin toxicity, hold the next dose and ask for a drug level
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 · Wash the site with soap and running water, without scrubbing

Why this is the answer

The site is washed with soap and running water; it may be allowed to bleed gently, but it is not scrubbed or sucked. The injury is reported immediately so that post-exposure assessment, including hepatitis B immunity and treatment if needed, can start quickly.

Answer

B · Wash the site with soap and running water, without scrubbing
19.Maternity & obstetric nursing

Answer: C · Babinski reflex

Why this is the answer

The Babinski reflex, fanning of the toes with dorsiflexion of the big toe, is normal in infants until about 1 year. Pressing the sole near the toes gives the plantar grasp instead.

Answer

C · Babinski reflex
20.Maternity & obstetric nursing

Answer: A · Severe fetal anaemia

Why this is the answer

A sinusoidal pattern is a regular, smooth undulating rhythm without variability. It is associated with severe fetal anaemia, for example from isoimmunisation or fetomaternal haemorrhage, and needs urgent evaluation.

Answer

A · Severe fetal anaemia
21.Pediatric nursing

Answer: A · Give it with a syringe or straw towards the back of the mouth; dark stools are expected

Why this is the answer

Liquid iron can stain teeth, so it is given by syringe or straw and the teeth are brushed afterwards. Milk and antacids reduce absorption, while vitamin C can help. Dark stools are a harmless, expected effect.

Answer

A · Give it with a syringe or straw towards the back of the mouth; dark stools are expected
22.Pediatric nursing

Answer: A · Allow them to stay if they wish, with a staff member to support and explain

Why this is the answer

Many families want to be present, and guidelines support offering this with a dedicated staff member to explain and support them. Family presence can help with grief and does not generally interfere with resuscitation.

Answer

A · Allow them to stay if they wish, with a staff member to support and explain
23.Mental health nursing

Answer: D · Supervise the meal and observe the patient for an agreed period afterwards

Why this is the answer

Supervised meals and observation afterwards reduce hiding or discarding food, vomiting and excessive exercise. Mealtimes should be calm, with conversation that is not focused on food or weight.

Answer

D · Supervise the meal and observe the patient for an agreed period afterwards
24.Mental health nursing

Answer: A · Refeeding syndrome

Why this is the answer

Refeeding after starvation causes insulin release that drives phosphate, potassium and magnesium into cells, causing heart failure, oedema, arrhythmias and confusion. Electrolytes are monitored closely and replaced, and feeding is increased gradually.

Answer

A · Refeeding syndrome
25.Nursing math & unit conversions

Answer: 20:25

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

Convert the hour

8 PM → 8 + 12 = 20

Answer

20:25

Answer

20:25
26.Nursing math & unit conversions

Answer: V = 290 mL

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

Each item in mL

1½ fl oz = 1.5·30 = 45 mL
¾ cup = 0.75·240 = 180 mL
4 tbsp = 4·15 = 60 mL
1 tsp = 1·5 = 5 mL

Add

V = 45 + 180 + 60 + 5 = 290 mL

Answer

V = 290 mL
27.Dosage calculations

Answer: V = 1 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 = 5·8 = 40 mg

Volume

V = 40/40 = 1 mL

On the syringe

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

Answer

V = 1 mL
28.Dosage calculations

Answer: V = 0.2 mL

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

Volume

V = 200/1000 = 0.2 mL

On the syringe

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

Answer

V = 0.2 mL
29.IV infusion rates

Answer: R = 21 gtt/min

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Time in minutes

6·60 = 360 min

Drip rate

R = 500·15/360 = 20.83 ≈ 21 gtt/min

Answer

R = 21 gtt/min

At the bedside you round to the nearest whole drop: 21 gtt/min.

30.IV infusion rates

Answer: R = 22.5 mL/h

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

1000 mg/250 mL = 4 mg/mL

Dose per hour

1.5·60 = 90 mg/h

Pump rate

R = 90/4 = 22.5 mL/h

Answer

R = 22.5 mL/h
31.IV fluids & fluid balance

Answer: I = 1740 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 + 240 + 120 = 560 mL
ice chips: 240/2 = 120 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 2·50 = 100 mL
I = 1740 mL

Answer

I = 1740 mL
32.IV fluids & fluid balance

Answer: t = 4.9 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
500 − 320 = 180 mL left

Second part

180/200 = 0.9 h

Total time

t = 4 + 0.9 = 4.9 h

Answer

t = 4.9 h

That is about 4 h 54 min, so the bag runs out at about 19:24.

33.Clinical assessment scores

Answer: B = 19

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

Score each subscale

sensory perception: slightly limited → 3
moisture: rarely moist → 4
activity: walks frequently → 4
mobility: no limitation → 4
nutrition: adequate → 3
friction and shear: problem → 1

Add

Braden total = 3 + 4 + 4 + 4 + 3 + 1 = 19

Answer

B = 19
34.Clinical assessment scores

Answer: underweight

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 = 43/1.67² = 15.42

Category

underweight

Answer

underweight

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