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

How should a patient collect a midstream urine sample?

  1. ACollect the last few drops after the bladder is empty
  2. BCollect the very first part of the stream in the pot, then pass the rest into the toilet
  3. CPass the first part into the toilet, then catch the middle part in the pot
  4. DCollect urine from the toilet bowl after passing it
2.Nursing fundamentalsHard

A pressure ulcer shows full-thickness tissue loss with exposed bone. How is it classified?

  1. ACategory 3
  2. BSuspected deep tissue injury
  3. CCategory 2
  4. DCategory 4
3.Infection control & patient safetyMedium

A parent says, “I tell my son his medicine is candy so he takes it.” What should the nurse teach?

  1. AThis is a good idea and makes giving medicine easier
  2. BIt is fine as long as the medicine is kept in the fridge
  3. CDo not call medicine candy, because the child may take it when no one is watching
  4. DIt only matters for medicines that taste bitter or are hard to swallow
4.Infection control & patient safetyHard

A patient is on contact precautions. Which task is appropriate for the nurse to delegate to assistive personnel?

  1. AHelping the patient bathe while wearing a gown and gloves
  2. BDeciding when the precautions can be stopped
  3. CAssessing the wound for new signs of infection during the bath
  4. DTeaching the family how to follow the precautions
5.Prioritization & delegationMedium

A patient with angina is taught to use sublingual nitroglycerin (GTN). Which statement shows a need for further teaching?

  1. A“I will take five tablets one after the other before I call for help.”
  2. B“If the pain has not eased as my action plan says, I will call emergency services.”
  3. C“I will carry the tablets with me when I go out.”
  4. D“I will sit or lie down when I take a tablet.”
6.Prioritization & delegationHard

At the end of a shift, the nurse’s relief has not arrived and the patients are acutely ill. What should the nurse do?

  1. ALeave a written note at the station and go home
  2. BLeave on time, because the shift has officially ended
  3. CStay and tell the charge nurse, and hand over before leaving
  4. DAsk a nursing assistant to watch the patients until someone comes
7.Clinical nursingMedium

Which finding with a groin hernia needs urgent surgical review?

  1. AThe lump has been present for several years without pain
  2. BThe lump has become painful and tender and cannot be pushed back
  3. CThe lump disappears completely when the patient lies down flat
  4. DThe lump gets bigger when the patient coughs
8.Clinical nursingHard

A patient on an unfractionated heparin infusion is also started on warfarin. Which tests are used to monitor each drug?

  1. AINR for heparin and APTT for warfarin
  2. BAPTT for heparin and INR for warfarin
  3. CD-dimer for both drugs
  4. DPlatelet count for both drugs
9.Lab values & electrolytesMedium

A stool test for Clostridioides difficile is ordered. Which sample is appropriate?

  1. AAn unformed (liquid or soft) stool
  2. BA rectal swab from a patient with constipation
  3. CAny stool after a laxative dose
  4. DA formed, hard stool sample
10.Lab values & electrolytesHard

During surgery under general anesthesia, a patient develops a rising end-tidal CO2, muscle rigidity and tachycardia, then a high potassium and a rising temperature. Which condition is most likely?

  1. AAcute hemolytic transfusion reaction
  2. BHypovolemic shock
  3. CMalignant hyperthermia
  4. DHypoglycemia from fasting
11.PharmacologyMedium

How should a topical corticosteroid cream usually be applied?

  1. AOn broken, infected skin to speed healing
  2. BUnder a tight plastic dressing every night without advice
  3. CAs a thick layer over the whole body
  4. DAs a thin layer to the affected area only, as directed
12.PharmacologyHard

Which regimen is standard for eradicating Helicobacter pylori?

  1. AAcid suppression plus at least two antibiotics, often with bismuth, for 14 days
  2. BAn antacid alone, taken after meals and at bedtime for six months
  3. CAn H2 blocker taken only when pain occurs
  4. DA single dose of an antibiotic given intravenously
13.Med-surg: cardiovascular & respiratoryMedium

A patient with asthma uses their reliever inhaler more than three times a week. What does this suggest?

  1. AThe preventer inhaler is no longer needed
  2. BThe reliever no longer works and should be stopped
  3. CAsthma is well controlled with the current plan
  4. DAsthma control is poor and treatment needs review
14.Med-surg: cardiovascular & respiratoryHard

After cardiac catheterisation via the radial artery, which assessment is most important?

  1. ABowel sounds and abdominal girth every hour after the test
  2. BPupil size and reaction to light every 15 minutes
  3. CCirculation, sensation and movement of the hand, and the site
  4. DUrine specific gravity every four hours
15.Med-surg: neuro, endocrine & renalMedium

Which long-term risk should a kidney transplant recipient be taught to reduce with sun protection?

  1. AGout
  2. BSkin cancer
  3. CKidney stones
  4. DHair loss
16.Med-surg: neuro, endocrine & renalHard

A patient in a halo vest for a cervical spine fracture has a cardiac arrest. What must be immediately available?

  1. AThe tool to open the front of the vest for CPR
  2. BA hard board to slide under the vest
  3. CScissors to cut through the skull pins
  4. DA pillow to raise the head and shoulders
17.Med-surg: GI, perioperative & oncologyMedium

Which nerve is at risk if the arm is poorly padded at the elbow during surgery?

  1. AUlnar nerve
  2. BSciatic nerve
  3. CFemoral nerve
  4. DFacial nerve
18.Med-surg: GI, perioperative & oncologyHard

A patient with three fractured ribs is taking shallow breaths because of pain. Why is effective analgesia a priority?

  1. AGood analgesia makes rib fractures heal fully within a few days
  2. BRib pain always means the heart is damaged
  3. CPain relief is only needed for the patient's comfort
  4. DShallow breathing can lead to atelectasis and pneumonia
19.Maternity & obstetric nursingMedium

A woman is pregnant. She previously had twins at 35 weeks (both alive) and a miscarriage at 10 weeks. What is her GTPAL?

  1. AG4 T0 P2 A1 L2
  2. BG3 T1 P0 A1 L2
  3. CG3 T0 P1 A1 L2
  4. DG2 T0 P1 A1 L2
20.Maternity & obstetric nursingHard

A woman at 41 weeks has a Bishop score of 3 and is booked for induction. What is the most likely first step?

  1. AA high-dose oxytocin infusion straight away
  2. BAn emergency caesarean
  3. CCervical ripening with a prostaglandin
  4. DAn immediate amniotomy at the bedside
21.Pediatric nursingMedium

How does hydroxyurea (hydroxycarbamide) help children with sickle cell disease?

  1. AIt increases fetal haemoglobin, which reduces sickling
  2. BIt replaces the missing clotting factors
  3. CIt kills bacteria in the blood and prevents infections
  4. DIt removes extra iron after blood transfusions
22.Pediatric nursingHard

During an insulin infusion for diabetic ketoacidosis, why is potassium monitored closely?

  1. AInsulin causes the kidneys to hold on to potassium, so blood levels rise dangerously
  2. BInsulin moves potassium into the cells, so blood potassium can fall sharply
  3. CPotassium is needed to dissolve the insulin in the drip
  4. DPotassium has no role in DKA; it is a routine test only
23.Mental health nursingMedium

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

  1. ASupervise the meal and observe the patient for an agreed period afterwards
  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. DLet the patient eat alone in her room for privacy
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. BPromise to keep the secret so that she keeps talking and trusts you, and do not record it in her notes or tell the team
  3. CExplain kindly that you cannot keep this secret because her safety matters, and you need to share it with the team
  4. DChange the subject
25.Nursing math & unit conversionsMedium
12.9115 kg? kground to 0.1 kg

Practice exercise (made-up values, not clinical guidance). A weight conversion gives 12.9115 kg. The rule in this exercise is that weights are rounded to the nearest tenth of a kilogram. What value x do you record?

12.9115 kg
x = kg
26.Nursing math & unit conversionsHard
½ tsp · 3/day · 5 d? × 100 mL1 tsp = 5 mL

Practice exercise (made-up values, not clinical guidance). A prescription reads ½ tsp of an oral suspension three times a day for 5 days. The suspension comes in 100 mL bottles. Using 1 tsp = 5 mL, how many whole bottles N must be supplied so the course is complete?

½ tspthree times a day5 days100 mL1 tsp = 5 mL
N =
27.Dosage calculationsMedium
45 kg2 mg/kgD = ? mg

A patient weighs 45 kg and is prescribed 2 mg/kg as a single dose. Find the dose D in mg.

45 kg2 mg/kg
D = mg
28.Dosage calculationsHard
20k units1000 mL? mL/h500 units/h

An infusion contains 20000 units of a drug in 1000 mL. The prescription is 500 units per hour. At what rate R do you set the pump, in mL/h?

20000 units/1000 mL500 units/h
R = mL/h
29.IV infusion ratesMedium
1000 mL20 gtt/mL10 h? gtt/min

Infuse 1000 mL over 10 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

1000 mL10 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
200 mL15 gtt/mL28 gtt/mint = ? h

A drip runs at 28 gtt/min through a set of 15 gtt/mL. There are 200 mL left in the bag. How many hours t until it is empty? Round to one decimal place.

28 gtt/min15 gtt/mL200 mL
t = h
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjuice150 mLtea200 mLwater200 mLice chips120 mLIV infusion50 mL/h × 12 hIV antibiotic2 × 50 mLurine150 mLurine375 mLurine475 mLwound drain80 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The patient weighs 105 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

105 kg12 hurine: 150 mLurine: 375 mLurine: 475 mLwound drain: 80 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
500 mL50 mL/hstart 07:0015:00: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 07:00 and runs by pump at 50 mL/h. How many mL V are left in the bag at 15:00?

500 mL50 mL/h07:00 → 15:00
V = mL
33.Clinical assessment scoresMedium
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≥39.1

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 18/min, SpO₂ 86% on supplemental oxygen, blood pressure 96/58 mmHg, pulse 110/min, newly confused, temperature 37.8 °C. What is the NEWS2 total score?

RR 18SpO₂ 86%O₂SBP 96HR 110CT 37.8 °C
NEWS2 =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 75 kg and is 152 cm tall. Calculate the BMI and click the WHO weight category.

75 kg152 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 · Pass the first part into the toilet, then catch the middle part in the pot

Why this is the answer

After cleaning, the first stream flushes bacteria from the urethra, so the midstream part is collected in a sterile container. This reduces contamination.

Answer

C · Pass the first part into the toilet, then catch the middle part in the pot
2.Nursing fundamentals

Answer: D · Category 4

Why this is the answer

Category 4 (Stage 4 in the US NPIAP system) involves full-thickness tissue loss with exposed bone, tendon or muscle. It carries a high risk of osteomyelitis and needs specialist input.

Answer

D · Category 4
3.Infection control & patient safety

Answer: C · Do not call medicine candy, because the child may take it when no one is watching

Why this is the answer

Calling medicine candy encourages children to look for it and swallow it, which can lead to poisoning. Parents are taught to call medicine medicine and keep it locked away.

Answer

C · Do not call medicine candy, because the child may take it when no one is watching
4.Infection control & patient safety

Answer: A · Helping the patient bathe while wearing a gown and gloves

Why this is the answer

Assistive personnel can carry out routine care for a stable patient, using the correct PPE. Assessment, teaching and clinical judgement, such as deciding when to stop precautions, cannot be delegated to them.

Answer

A · Helping the patient bathe while wearing a gown and gloves
5.Prioritization & delegation

Answer: A · “I will take five tablets one after the other before I call for help.”

Why this is the answer

Action plans differ slightly: US guidance says to call emergency services if pain is not better 5 minutes after the first dose, while UK guidance allows a second dose after 5 minutes and a 999 call if pain persists 5 minutes later. Taking many doses in a row delays care and can cause severe hypotension.

Answer

A · “I will take five tablets one after the other before I call for help.”
6.Prioritization & delegation

Answer: C · Stay and tell the charge nurse, and hand over before leaving

Why this is the answer

The nurse must not leave patients without handing over to another qualified nurse. Telling the charge nurse allows staffing to be arranged safely.

Answer

C · Stay and tell the charge nurse, and hand over before leaving
7.Clinical nursing

Answer: B · The lump has become painful and tender and cannot be pushed back

Why this is the answer

An irreducible, painful, tender hernia, especially with vomiting, suggests incarceration or strangulation. This is a surgical emergency because the trapped bowel can become ischaemic.

Answer

B · The lump has become painful and tender and cannot be pushed back
8.Clinical nursing

Answer: B · APTT for heparin and INR for warfarin

Why this is the answer

The APTT reflects the intrinsic pathway and is used to adjust heparin infusions. Warfarin is monitored by the INR, a standardised prothrombin time. Platelets are also checked on heparin to detect HIT.

Answer

B · APTT for heparin and INR for warfarin
9.Lab values & electrolytes

Answer: A · An unformed (liquid or soft) stool

Why this is the answer

C. difficile testing is done on unformed stool from patients with diarrhea, because many people carry the organism without disease. Testing formed stool, or stool after laxatives, can lead to misdiagnosis.Checked against: C. diff Testing · MedlinePlus (NIH) (2026)

Answer

A · An unformed (liquid or soft) stool
10.Lab values & electrolytes

Answer: C · Malignant hyperthermia

Why this is the answer

Malignant hyperthermia is a genetic hypermetabolic reaction to volatile anesthetics or succinylcholine. Muscle cells release calcium, producing CO2, heat, rigidity, hyperkalemia and very high CK. It is treated with dantrolene and stopping the trigger.

Answer

C · Malignant hyperthermia
11.Pharmacology

Answer: D · As a thin layer to the affected area only, as directed

Why this is the answer

Thin application to affected skin limits systemic absorption and skin atrophy. Occlusive dressings increase absorption and are used only when prescribed.

Answer

D · As a thin layer to the affected area only, as directed
12.Pharmacology

Answer: A · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days

Why this is the answer

Eradication combines acid suppression (usually a PPI) with at least two antibiotics; bismuth quadruple therapy for 14 days is now often first-line because clarithromycin resistance makes older triple therapy fail. Taking every dose matters, and cure is confirmed with a breath or stool test.

Answer

A · Acid suppression plus at least two antibiotics, often with bismuth, for 14 days
13.Med-surg: cardiovascular & respiratory

Answer: D · Asthma control is poor and treatment needs review

Why this is the answer

Needing a reliever often, waking at night with symptoms or limiting activity indicates poorly controlled asthma. Inhaler technique, adherence and triggers should be checked and the regular preventer treatment stepped up.

Answer

D · Asthma control is poor and treatment needs review
14.Med-surg: cardiovascular & respiratory

Answer: C · Circulation, sensation and movement of the hand, and the site

Why this is the answer

After radial access, the compression device and puncture site are checked for bleeding or haematoma, and the hand for colour, warmth, capillary refill, sensation and movement. Radial artery occlusion and forearm compartment syndrome are possible complications.

Answer

C · Circulation, sensation and movement of the hand, and the site
15.Med-surg: neuro, endocrine & renal

Answer: B · Skin cancer

Why this is the answer

Transplant recipients have a much higher risk of skin cancers, especially squamous cell carcinoma, because of immunosuppression. Sun protection and regular skin checks are important.

Answer

B · Skin cancer
16.Med-surg: neuro, endocrine & renal

Answer: A · The tool to open the front of the vest for CPR

Why this is the answer

The tool to release the anterior vest is kept attached to the vest so it can be opened quickly for CPR or airway management. Pin sites need regular care to prevent infection, and the patient needs teaching about skin care under the vest.

Answer

A · The tool to open the front of the vest for CPR
17.Med-surg: GI, perioperative & oncology

Answer: A · Ulnar nerve

Why this is the answer

The ulnar nerve runs superficially at the elbow and is a common site of positioning injury. Careful padding and avoiding pressure on the elbow help prevent numbness and weakness of the hand.

Answer

A · Ulnar nerve
18.Med-surg: GI, perioperative & oncology

Answer: D · Shallow breathing can lead to atelectasis and pneumonia

Why this is the answer

Uncontrolled chest wall pain prevents deep breaths and coughing, leading to atelectasis, sputum retention and pneumonia, particularly in older adults. Multimodal analgesia, sometimes with regional blocks, and physiotherapy are used.

Answer

D · Shallow breathing can lead to atelectasis and pneumonia
19.Maternity & obstetric nursing

Answer: C · G3 T0 P1 A1 L2

Why this is the answer

Gravida includes the current pregnancy: 3. The twins were preterm (20–36 weeks) and count as one birth: T0 P1. The miscarriage gives A1, and 2 children are living: L2. Counting the twins twice gives the G4 P2 mistake.

Answer

C · G3 T0 P1 A1 L2
20.Maternity & obstetric nursing

Answer: C · Cervical ripening with a prostaglandin

Why this is the answer

A low Bishop score means the cervix is not ready. Cervical ripening with prostaglandins or a balloon catheter is done before oxytocin or amniotomy, which may not be possible with a closed cervix.

Answer

C · Cervical ripening with a prostaglandin
21.Pediatric nursing

Answer: A · It increases fetal haemoglobin, which reduces sickling

Why this is the answer

Hydroxyurea raises the level of fetal haemoglobin (HbF), which does not sickle, reducing pain crises and acute chest syndrome. Regular blood counts are needed because it can lower white cells and platelets.

Answer

A · It increases fetal haemoglobin, which reduces sickling
22.Pediatric nursing

Answer: B · Insulin moves potassium into the cells, so blood potassium can fall sharply

Why this is the answer

Total body potassium is low in DKA, though blood levels may look normal at first. Insulin and correction of acidosis drive potassium into cells, risking hypokalaemia and arrhythmias, so potassium is added to fluids and checked often.

Answer

B · Insulin moves potassium into the cells, so blood potassium can fall sharply
23.Mental health nursing

Answer: A · 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

A · Supervise the meal and observe the patient for an agreed period afterwards
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: x = 12.9 kg

Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.

Digit in the tenths place

12.9115 → 9

Only the next digit decides

12.9115 → 1
1 is 4 or less, so 9 stays.
The digits after it (15) are ignored: round once, never step by step.

Round

x = 12.9 kg

Answer

x = 12.9 kg
26.Nursing math & unit conversions

Answer: N = 1

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.

Total volume

2.5 mL × 3 × 5 = 37.5 mL

Bottles

37.5/100 = 0.375 → N = 1

Answer

N = 1
27.Dosage calculations

Answer: D = 90 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

2·45 = 90 mg

Answer

D = 90 mg
28.Dosage calculations

Answer: R = 25 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

20000/1000 = 20 units/mL

Pump rate

R = 500/20 = 25 mL/h

Answer

R = 25 mL/h
29.IV infusion rates

Answer: R = 33 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 = 1000·20/600 = 33.33 ≈ 33 gtt/min

Answer

R = 33 gtt/min

At the bedside you round to the nearest whole drop: 33 gtt/min.

30.IV infusion rates

Answer: t = 1.8 h

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.

Rate in mL/h

28·60/15 = 112 mL/h

Time left

t = 200/112 = 1.786 ≈ 1.8 h

Answer

t = 1.8 h
31.IV fluids & fluid balance

Answer: U = 0.79 mL/kg/h

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 urine

150 + 375 + 475 = 1000 mL

Per kilogram per hour

U = 1000/(105·12) = 0.7937 ≈ 0.79 mL/kg/h

Answer

U = 0.79 mL/kg/h
32.IV fluids & fluid balance

Answer: V = 100 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

07:00 → 15:00 = 8 h

Volume infused

50·8 = 400 mL

Volume left

V = 500 − 400 = 100 mL

Answer

V = 100 mL
33.Clinical assessment scores

Answer: NEWS2 = 11

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 18/min → 0
SpO₂ 86% → 3
on oxygen → 2
SBP 96 mmHg → 2
HR 110/min → 1
newly confused (C) → 3
T 37.8 °C → 0

Add

NEWS2 = 0 + 3 + 2 + 2 + 1 + 3 + 0 = 11

Answer

NEWS2 = 11
34.Clinical assessment scores

Answer: obesity class I

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 = 75/1.52² = 32.46

Category

obesity class I

Answer

obesity class I

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