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

Lying and standing blood pressure are measured. Which result meets the usual definition of orthostatic hypotension?

  1. AA rise in systolic pressure of 20 mmHg on standing
  2. BA fall in systolic pressure of 5 mmHg or more after 10 minutes of standing still
  3. CA rise in heart rate of 5 beats per minute on standing
  4. DA fall in systolic pressure of 20 mmHg or more within 3 minutes of standing
3.Infection control & patient safetyMedium

Before helping a patient from bed into a wheelchair, what should the nurse do with the wheelchair?

  1. ALock the brakes and place it close to the bed on the patient’s stronger side
  2. BPlace it at the foot of the bed, facing away
  3. CPlace it on the patient’s weaker side so that side is supported
  4. DLeave the brakes off so the chair can move along with the patient during the pivot
4.Infection control & patient safetyHard

A patient has signed a surgical consent form but tells the nurse, “I don’t really understand what they are going to do.” What should the nurse do?

  1. AReassure the patient that the surgeon knows best and continue with the preparation
  2. BGive the preoperative sedative so the patient relaxes
  3. CExplain the risks and benefits in place of the surgeon
  4. DInform the surgeon so the procedure can be explained again before any sedation
5.Prioritization & delegationMedium

A nurse teaches a patient about levothyroxine. Which statement shows a need for further teaching?

  1. A“I will take it on an empty stomach with a glass of water.”
  2. B“I will take it at the same time each morning.”
  3. C“I will keep taking it even when I feel well.”
  4. D“I will take it at breakfast with my calcium tablet.”
6.Prioritization & delegationHard

Which patient needs airborne precautions rather than droplet precautions?

  1. AA child with pertussis (whooping cough)
  2. BA teenager with mumps
  3. CAn adult with influenza
  4. DA child with chickenpox (varicella)
7.Clinical nursingMedium

A patient with anaphylaxis is hypotensive but has no breathing difficulty. How should they be positioned?

  1. AStanding up and walking around
  2. BSitting upright with the legs dangling
  3. CLying face down
  4. DLying flat, with the legs raised
8.Clinical nursingHard

A patient taking dapagliflozin is vomiting and unwell, with high blood ketones and a blood glucose of only 11 mmol/L (198 mg/dL). What should be suspected?

  1. AHyperosmolar hyperglycaemic state
  2. BEuglycaemic diabetic ketoacidosis
  3. CHypoglycaemia
  4. DSimple gastroenteritis with no further concern
9.Lab values & electrolytesMedium

A patient starts lisinopril (an ACE inhibitor). Which laboratory values should the nurse expect to be monitored?

  1. APotassium and creatinine
  2. BCalcium and phosphate
  3. CALT and bilirubin
  4. DTSH and free T4
10.Lab values & electrolytesHard

A healthy woman at 10 weeks of pregnancy has a slightly low TSH with a normal free T4 and no symptoms. What is the most likely explanation?

  1. AhCG stimulates the thyroid in early pregnancy
  2. BShe has developed Graves disease in pregnancy
  3. CThe result shows severe primary hypothyroidism
  4. DShe has pituitary failure from the pregnancy
11.PharmacologyMedium

How can the absorption of oral iron be improved?

  1. ATake it at the same time as an antacid to protect the stomach
  2. BTake it with vitamin C, such as orange juice, on an empty stomach
  3. CTake it with a cup of strong tea
  4. DTake it with a glass of milk
12.PharmacologyHard

A patient develops a dry cough on an ACE inhibitor and is switched to losartan. Why is losartan less likely to cause cough?

  1. AIt also acts as a bronchodilator
  2. BIt does not block the breakdown of bradykinin
  3. CIt blocks histamine receptors in the airways
  4. DIt is excreted faster by the kidney
13.Med-surg: cardiovascular & respiratoryMedium

A patient with supraventricular tachycardia is to receive IV adenosine. What should the nurse warn them about?

  1. AA headache that lasts for several days afterwards
  2. BSeveral hours of drowsiness, slurred speech and confusion afterwards
  3. CA burning pain along the arm vein for about a week
  4. DBrief flushing or chest tightness and a pause of a few seconds
14.Med-surg: cardiovascular & respiratoryHard

A ventilated patient with severe ARDS is to be turned prone. What is the main reason, and the key nursing risk?

  1. AIt improves digestion and gut motility; the main risk is constipation
  2. BIt lowers the blood pressure; the main risk is rebound hypertension
  3. CIt improves oxygenation; risks are pressure injury and tube displacement
  4. DIt treats infection; the risk is fever
15.Med-surg: neuro, endocrine & renalMedium

When the nurse squeezes the trapezius muscle, the patient brings a hand up above the collarbone towards the stimulus. Which GCS motor score is this?

  1. A3, abnormal flexion
  2. B6, obeys commands
  3. C4, withdraws from pain
  4. D5, localises to pain
16.Med-surg: neuro, endocrine & renalHard

A patient taking lithium has polyuria and thirst, and the urine does not concentrate after desmopressin. What is the most likely cause?

  1. ACranial DI after a head injury
  2. BSIADH caused by lithium
  3. CNephrogenic DI caused by lithium
  4. DNewly developed type 1 diabetes
17.Med-surg: GI, perioperative & oncologyMedium

Why are laxatives and enemas avoided when appendicitis is suspected?

  1. AThey always cause the appendix to bleed heavily
  2. BThey stop antibiotics from being absorbed
  3. CThey make the blood tests impossible to read
  4. DThey may increase the risk of perforation
18.Med-surg: GI, perioperative & oncologyHard

An incontinent patient has diffuse, shiny, red and broken skin in the natal cleft and buttocks with irregular edges, not over a bony prominence. What is most likely?

  1. AIncontinence-associated dermatitis
  2. BAn arterial ulcer caused by poor circulation
  3. CA category 4 pressure ulcer over the sacrum
  4. DA full-thickness burn
19.Maternity & obstetric nursingMedium

Which is a common sign of iron deficiency anaemia in pregnancy?

  1. ATiredness, pallor and breathlessness
  2. BWeight gain and ankle swelling
  3. CIncreased appetite and frequent urination
  4. DHigh blood pressure and headache
20.Maternity & obstetric nursingHard

Just after delivery of the placenta, a woman suddenly has severe pain, heavy bleeding and shock. No fundus can be felt abdominally and a mass is seen at the vulva. What is most likely?

  1. AUterine atony
  2. BCervical laceration
  3. CUterine inversion
  4. DAmniotic fluid embolism
21.Pediatric nursingMedium

The nurse uses a blood pressure cuff that is too small for a child's arm. What effect will this have?

  1. AThe reading will be falsely low
  2. BThe cuff will not inflate at all
  3. CThe reading will be falsely high
  4. DThe reading will be accurate but slower to obtain
22.Pediatric nursingHard

A 10-year-old with suspected appendicitis has had severe abdominal pain, but it suddenly gets much better. What may this mean?

  1. AThe appendix may have perforated; report it immediately
  2. BThe pain medication has cured the problem
  3. CIt is a normal change that needs no follow-up
  4. DThe appendicitis has resolved and the child can go home
23.Mental health nursingMedium

When is the risk of suicide particularly high for patients after psychiatric inpatient care?

  1. AOnly after one year at home
  2. BThere is no change in risk after discharge
  3. CIn the first weeks after discharge
  4. DOnly while the patient is asleep in hospital
24.Mental health nursingHard

Which finding best helps to distinguish serotonin syndrome from neuroleptic malignant syndrome?

  1. AConfusion occurs only in neuroleptic malignant syndrome, never in serotonin syndrome
  2. BSweating occurs only in neuroleptic malignant syndrome
  3. CFever is present only in serotonin syndrome
  4. DHyperreflexia and clonus with a rapid onset suggest serotonin syndrome
25.Nursing math & unit conversionsMedium
0.56594 mL? mLround to 0.01 mL

Practice exercise (made-up values, not clinical guidance). A dose calculation for a small injection gives 0.56594 mL. The rule in this exercise is that volumes below 1 mL are rounded to the nearest hundredth of a mL. What value x do you record?

0.56594 mL
x = mL
26.Nursing math & unit conversionsHard
1½ fl oz? mL1½ tsp? mL¼ cup? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 1½ fl oz of juice, 1½ tsp of cough syrup, ¼ cup of tea. Using the equivalents given, find the total oral intake V in mL.

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

A child weighing 23 kg is prescribed 4 mg/kg of a drug. The stock solution contains 20 mg/mL. Draw up the dose: what volume V do you give?

23 kg4 mg/kg20 mg/mL
V = mL
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 3650 units of a drug that comes as 5000 units/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

3650 units5000 units/mL
V = mL
29.IV infusion ratesMedium
1000 mL20 gtt/mL4 h? gtt/min

Infuse 1000 mL over 4 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 mL4 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
200 mg100 mL15 gtt/mL200 mg/h? gtt/min

200 mg of a drug is diluted in 100 mL and given by gravity through a set of 15 gtt/mL. The order is 200 mg per hour. Find the drip rate R in drops per minute.

200 mg/100 mL200 mg/h15 gtt/mL
R = gtt/min
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftwater240 mLtea240 mLjuice200 mLIV infusion100 mL/h × 8 hIV antibiotic1 × 50 mLurine225 mLurine425 mLurine400 mLwound drain70 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).

water: 240 mLtea: 240 mLjuice: 200 mLIV infusion: 100 mL/h × 8 hIV antibiotic: 1 × 50 mLurine: 225 mLurine: 425 mLurine: 400 mLwound drain: 70 mL
B = mL
32.IV fluids & fluid balanceHard
500 mL→ 50 mL/hstart 16:30ttotal​ = ? h100 mL/h × 3 h

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 16:30 at 100 mL/h. After 3 hours the rate is changed to 50 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 mL100 mL/h · 3 h50 mL/h
t = h
33.Clinical assessment scoresMedium
14178SBPDBPmmHgHR 98/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 98/min and a blood pressure of 141/78 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 98/minBP 141/78 mmHg
SI =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 103 kg and is 169 cm tall. Calculate the BMI and click the WHO weight category.

103 kg169 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: A · 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

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

Answer: D · A fall in systolic pressure of 20 mmHg or more within 3 minutes of standing

Why this is the answer

Orthostatic hypotension is usually defined as a fall of at least 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of standing. It is an important finding in falls assessment.

Answer

D · A fall in systolic pressure of 20 mmHg or more within 3 minutes of standing
3.Infection control & patient safety

Answer: A · Lock the brakes and place it close to the bed on the patient’s stronger side

Why this is the answer

Locked brakes stop the chair rolling away during the transfer. Placing it close to the bed on the stronger side lets the patient lead with their strong leg.

Answer

A · Lock the brakes and place it close to the bed on the patient’s stronger side
4.Infection control & patient safety

Answer: D · Inform the surgeon so the procedure can be explained again before any sedation

Why this is the answer

Informed consent is the responsibility of the person doing the procedure. If the patient does not understand, the nurse pauses the process and tells the surgeon, before any sedative drug is given.

Answer

D · Inform the surgeon so the procedure can be explained again before any sedation
5.Prioritization & delegation

Answer: D · “I will take it at breakfast with my calcium tablet.”

Why this is the answer

Levothyroxine is best absorbed on an empty stomach and is separated from calcium and iron by several hours. It is usually lifelong, so it is not stopped when the patient feels better.

Answer

D · “I will take it at breakfast with my calcium tablet.”
6.Prioritization & delegation

Answer: D · A child with chickenpox (varicella)

Why this is the answer

Varicella spreads by the airborne route (and contact), so it needs an airborne infection isolation room. Influenza, pertussis and mumps are spread mainly by droplets.

Answer

D · A child with chickenpox (varicella)
7.Clinical nursing

Answer: D · Lying flat, with the legs raised

Why this is the answer

Lying flat with the legs raised supports circulation in anaphylactic shock. Patients with breathing difficulty may prefer to sit up, but should not stand or walk, as this can cause collapse.

Answer

D · Lying flat, with the legs raised
8.Clinical nursing

Answer: B · Euglycaemic diabetic ketoacidosis

Why this is the answer

SGLT2 inhibitors can cause DKA with near-normal or modestly raised glucose because glucose is lost in the urine. Ketones should be checked in unwell patients on these drugs.

Answer

B · Euglycaemic diabetic ketoacidosis
9.Lab values & electrolytes

Answer: A · Potassium and creatinine

Why this is the answer

ACE inhibitors reduce aldosterone, so potassium can rise, and they lower the filtration pressure in the kidney, so creatinine can rise. Both are checked before and soon after starting or increasing the dose.Checked against: Hyperkalemia · StatPearls (NCBI Bookshelf) (2025)

Answer

A · Potassium and creatinine
10.Lab values & electrolytes

Answer: A · hCG stimulates the thyroid in early pregnancy

Why this is the answer

hCG is structurally similar to TSH and stimulates the thyroid, peaking at the end of the first trimester, so TSH often falls slightly. With a normal free T4 and no symptoms, this is usually physiologic and is interpreted with pregnancy-specific ranges.Checked against: TSH (Thyroid-stimulating hormone) Test · MedlinePlus (NIH) (2024)

Answer

A · hCG stimulates the thyroid in early pregnancy
11.Pharmacology

Answer: B · Take it with vitamin C, such as orange juice, on an empty stomach

Why this is the answer

Vitamin C keeps iron in its more absorbable ferrous form. Milk, antacids, tea and some antibiotics reduce iron absorption. If the stomach becomes upset, it may be taken with food, accepting lower absorption.

Answer

B · Take it with vitamin C, such as orange juice, on an empty stomach
12.Pharmacology

Answer: B · It does not block the breakdown of bradykinin

Why this is the answer

ACE (kininase II) breaks down bradykinin, so ACE inhibitors raise bradykinin, which can cause cough and angioedema. ARBs block the angiotensin II receptor without affecting bradykinin breakdown.

Answer

B · It does not block the breakdown of bradykinin
13.Med-surg: cardiovascular & respiratory

Answer: D · Brief flushing or chest tightness and a pause of a few seconds

Why this is the answer

Adenosine is given as a rapid IV bolus followed by a saline flush, with continuous ECG monitoring. It briefly blocks AV node conduction, often causing a few seconds of asystole, flushing, chest discomfort, breathlessness or a sense of doom. The effects last only seconds.

Answer

D · Brief flushing or chest tightness and a pause of a few seconds
14.Med-surg: cardiovascular & respiratory

Answer: C · It improves oxygenation; risks are pressure injury and tube displacement

Why this is the answer

Prone positioning improves ventilation–perfusion matching and oxygenation and improves survival in severe ARDS. Turning needs a trained team. Risks include accidental extubation or line removal and pressure damage to the face, chest and knees, so careful positioning and skin checks are essential.

Answer

C · It improves oxygenation; risks are pressure injury and tube displacement
15.Med-surg: neuro, endocrine & renal

Answer: D · 5, localises to pain

Why this is the answer

Localising to pain (5) means a purposeful movement towards the source of pain. Withdrawal (4) is pulling away, abnormal flexion (3) is decorticate posturing, and obeying commands (6) needs no pain at all. A central stimulus, such as a trapezius squeeze, is used to test for localising.

Answer

D · 5, localises to pain
16.Med-surg: neuro, endocrine & renal

Answer: C · Nephrogenic DI caused by lithium

Why this is the answer

Lithium is a common cause of nephrogenic DI, in which the collecting ducts do not respond to ADH, so desmopressin has little effect. Management includes specialist review of the lithium, access to water and monitoring of sodium and lithium levels.

Answer

C · Nephrogenic DI caused by lithium
17.Med-surg: GI, perioperative & oncology

Answer: D · They may increase the risk of perforation

Why this is the answer

Stimulating peristalsis can raise pressure on an inflamed appendix and may lead to rupture and peritonitis. The patient is kept nil by mouth while awaiting surgical assessment.

Answer

D · They may increase the risk of perforation
18.Med-surg: GI, perioperative & oncology

Answer: A · Incontinence-associated dermatitis

Why this is the answer

Incontinence-associated dermatitis is inflammation from urine or faeces, with diffuse redness and superficial erosion. It is managed with gentle cleansing, barrier products and managing incontinence, and is different from a pressure ulcer.

Answer

A · Incontinence-associated dermatitis
19.Maternity & obstetric nursing

Answer: A · Tiredness, pallor and breathlessness

Why this is the answer

Iron deficiency causes fatigue, pallor, breathlessness, palpitations and sometimes pica. A full blood count and ferritin confirm the diagnosis.

Answer

A · Tiredness, pallor and breathlessness
20.Maternity & obstetric nursing

Answer: C · Uterine inversion

Why this is the answer

An absent fundus on palpation with a mass in the vagina and shock suggest uterine inversion. Help is called immediately, oxytocin is stopped and the uterus is replaced as soon as possible by the medical team.

Answer

C · Uterine inversion
21.Pediatric nursing

Answer: C · The reading will be falsely high

Why this is the answer

A cuff that is too small gives falsely high readings, and one that is too large gives falsely low readings. The bladder width should be about 40% of the arm circumference.

Answer

C · The reading will be falsely high
22.Pediatric nursing

Answer: A · The appendix may have perforated; report it immediately

Why this is the answer

Sudden relief of pain in appendicitis can indicate perforation, which is followed by peritonitis with worsening pain, fever and rigidity. It needs urgent reporting.

Answer

A · The appendix may have perforated; report it immediately
23.Mental health nursing

Answer: C · In the first weeks after discharge

Why this is the answer

The period shortly after discharge carries a high risk of suicide. Early follow-up, a safety plan and clear crisis contacts help bridge the transition.

Answer

C · In the first weeks after discharge
24.Mental health nursing

Answer: D · Hyperreflexia and clonus with a rapid onset suggest serotonin syndrome

Why this is the answer

Both can cause fever, confusion and autonomic instability. Serotonin syndrome starts within hours and causes neuromuscular excitation (hyperreflexia, clonus). NMS develops over days with "lead-pipe" rigidity and slowed reflexes.

Answer

D · Hyperreflexia and clonus with a rapid onset suggest serotonin syndrome
25.Nursing math & unit conversions

Answer: x = 0.57 mL

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 hundredths place

0.56594 → 6

Only the next digit decides

0.56594 → 5
5 is 5 or more, so round 6 up.
The digits after it (94) are ignored: round once, never step by step.

Round

x = 0.57 mL

Answer

x = 0.57 mL
26.Nursing math & unit conversions

Answer: V = 112.5 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
1½ tsp = 1.5·5 = 7.5 mL
¼ cup = 0.25·240 = 60 mL

Add

V = 45 + 7.5 + 60 = 112.5 mL

Answer

V = 112.5 mL
27.Dosage calculations

Answer: V = 4.6 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 = 4·23 = 92 mg

Volume

V = 92/20 = 4.6 mL

On the syringe

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

Answer

V = 4.6 mL
28.Dosage calculations

Answer: V = 0.73 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 = 3650/5000 = 0.73 mL

On the syringe

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

Answer

V = 0.73 mL
29.IV infusion rates

Answer: R = 83 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

4·60 = 240 min

Drip rate

R = 1000·20/240 = 83.33 ≈ 83 gtt/min

Answer

R = 83 gtt/min

At the bedside you round to the nearest whole drop: 83 gtt/min.

30.IV infusion rates

Answer: R = 25 gtt/min

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

200/100 = 2 mg/mL

Volume per hour

200/2 = 100 mL/h

Drip rate

R = 100·15/60 = 25 gtt/min

Answer

R = 25 gtt/min
31.IV fluids & fluid balance

Answer: B = 410 mL

Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Total intake

oral: 240 + 240 + 200 = 680 mL
IV infusion: 100·8 = 800 mL
IV antibiotic: 1·50 = 50 mL
total intake = 1530 mL

Total output

225 + 425 + 400 + 70 = 1120 mL

Balance

B = 1530 − 1120 = 410 mL

Answer

B = 410 mL

Positive: more fluid went in than came out.

32.IV fluids & fluid balance

Answer: t = 7 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

100·3 = 300 mL
500 − 300 = 200 mL left

Second part

200/50 = 4 h

Total time

t = 3 + 4 = 7 h

Answer

t = 7 h

That is about 7 h 00 min, so the bag runs out at about 23:30.

33.Clinical assessment scores

Answer: SI = 0.7

Blood pressure values: pulse pressure PP = SBP − DBP. Mean arterial pressure MAP ≈ (SBP + 2·DBP)/3 = DBP + PP/3, an estimate based on the heart spending about two thirds of each beat in diastole at a normal heart rate (less accurate when the heart rate is fast); a MAP of at least about 65 mmHg is a common target for organ perfusion. The shock index SI = heart rate/SBP is normally about 0.5–0.7; a value above about 1 is a warning sign of shock.

Shock index

SI = 98/141 = 0.695 ≈ 0.7

Answer

SI = 0.7

Within or below the usual 0.5–0.7.

34.Clinical assessment scores

Answer: obesity class II

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

BMI

BMI = 103/1.69² = 36.06

Category

obesity class II

Answer

obesity class II

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