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

Which patient goal is written in a SMART way?

  1. AThe patient will try to eat more
  2. BThe patient will walk 20 metres with a frame by Friday
  3. CThe patient will feel better soon
  4. DThe patient will improve mobility
2.Nursing fundamentalsHard

A patient taking furosemide has a serum potassium of 3.0 mmol/L (3.0 mEq/L). Why is this important?

  1. AThe level is normal and needs no action
  2. BLoop diuretics cause potassium loss, and low levels can cause arrhythmias
  3. CFurosemide raises potassium, so this level is falsely low and can be ignored
  4. DLow potassium only causes mild thirst
3.Infection control & patient safetyMedium

An order reads “Give potassium chloride by IV push.” What should the nurse do?

  1. ANot give it, and contact the prescriber, because it is never given by IV push
  2. BGive half by IV push and the rest later
  3. CDilute it in a small syringe and push it
  4. DGive it slowly by IV push over two minutes while watching the cardiac monitor
4.Infection control & patient safetyHard

A nurse is unsure whether a sterile glove touched the edge of the sterile field. What is the correct action?

  1. AAsk the patient whether they saw it
  2. BTreat the glove as contaminated and change it
  3. CWipe the glove with alcohol
  4. DContinue, because the nurse is not sure
5.Prioritization & delegationMedium

A parent of a child with influenza talks with the nurse. Which statement shows a need for further teaching?

  1. A“I will keep my child home from school and away from others while unwell.”
  2. B“I will give my child plenty of fluids.”
  3. C“I will call if my child has trouble breathing.”
  4. D“I will give my child aspirin to bring the fever down.”
6.Prioritization & delegationHard

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

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

A patient is having a 12-lead ECG. Where are the chest electrodes placed?

  1. AIn standard numbered positions across the front and left of the chest
  2. BIn a straight line down the centre of the sternum from top to bottom
  3. CAnywhere on the chest where the skin is clear
  4. DOn both shoulders and both hips only
8.Clinical nursingHard

Why are early surgery and early mobilisation recommended for older patients with a hip fracture?

  1. AThey reduce complications such as pneumonia, pressure ulcers and delirium
  2. BThey allow the bone to heal fully without any need for pain relief
  3. CThey make physiotherapy and rehabilitation unnecessary after discharge
  4. DThey mainly reduce the cost of the operation
9.Lab values & electrolytesMedium

On the first day after major surgery, a patient's white cell count is 12.5 × 10³/µL, with no fever or wound signs. What is the best interpretation?

  1. AA laboratory error, since surgery lowers white cells
  2. BDefinite wound infection that needs antibiotics now
  3. CA common stress response to surgery that is monitored
  4. DA sign of leukemia that needs bone marrow testing
10.Lab values & electrolytesHard

A young adult has fatigue, bruising and fever. The white cell count is 85 × 10³/µL with many blasts, the hemoglobin is 7.9 g/dL (79 g/L) and the platelets are 22 × 10³/µL. What is the most likely diagnosis?

  1. AIron-deficiency anemia
  2. BAcute leukemia
  3. CPolycythemia vera
  4. DAcute viral infection
11.PharmacologyMedium

Which assessments are most important during a magnesium sulfate infusion?

  1. ABlood glucose, pupil size and pupil reaction to light
  2. BTemperature and skin colour only
  3. CBowel sounds and appetite
  4. DDeep tendon reflexes, respiratory rate and urine output
12.PharmacologyHard

During an IV glyceryl trinitrate (nitroglycerin) infusion for chest pain, the patient's blood pressure drops to 82/50 mmHg and he feels faint. What is the nurse's first action?

  1. ASit the patient fully upright and give paracetamol for the headache
  2. BStop or reduce the infusion as per protocol, lay the patient flat and notify the prescriber
  3. CGive a sublingual nitroglycerin tablet and increase the rate to relieve the remaining chest pain
  4. DIncrease the infusion rate to improve blood flow to the heart
13.Med-surg: cardiovascular & respiratoryMedium

Which investigation is most often used to confirm a pulmonary embolism?

  1. APeak flow measurement
  2. BSputum culture
  3. CAbdominal ultrasound
  4. DCT pulmonary angiography
14.Med-surg: cardiovascular & respiratoryHard

Which instruction from the registered nurse to a healthcare assistant (unlicensed assistive personnel) caring for a patient with COPD is most appropriate?

  1. A"Turn his oxygen up to whatever he needs if he looks short of breath."
  2. B"Teach him how to use his new inhaler this afternoon after his rest."
  3. C"Listen to his chest after lunch and let me know what you can hear."
  4. D"Tell me straight away if his SpO₂ is under 88% or he is more breathless."
15.Med-surg: neuro, endocrine & renalMedium

Why is once-daily prednisolone usually taken in the morning with food?

  1. ABecause it cannot be absorbed at night
  2. BBecause it causes drowsiness and is safer to take during the day
  3. CTo match the natural cortisol rhythm and protect the stomach
  4. DBecause food doubles the strength of the dose
16.Med-surg: neuro, endocrine & renalHard

A patient's chronic hyponatraemia was corrected from 115 to 132 mmol/L in 24 hours. Two days later they develop slurred speech, difficulty swallowing and limb weakness. What is the most likely cause?

  1. AOsmotic demyelination syndrome
  2. BHypoglycaemia from poor intake
  3. CNormal recovery from hyponatraemia
  4. DA new stroke unrelated to the sodium
17.Med-surg: GI, perioperative & oncologyMedium

Why are antibody levels checked after a healthcare worker receives the hepatitis B vaccine?

  1. ATo decide whether they need a liver biopsy
  2. BTo confirm that the vaccine produced immunity
  3. CTo check whether they caught hepatitis B from the vaccine
  4. DTo measure liver damage caused by the vaccine
18.Med-surg: GI, perioperative & oncologyHard

On day 3 after surgery, a patient has a temperature of 38.6 °C, respiratory rate 24/min, pulse 118/min, BP 92/58 mmHg and new confusion. What should the nurse do?

  1. AEscalate urgently and start the sepsis pathway
  2. BEncourage oral fluids and wait for the doctor's round
  3. CRecord the observations and continue routine care
  4. DGive paracetamol and recheck in four hours
19.Maternity & obstetric nursingMedium

Progesterone relaxes smooth muscle in pregnancy. Which common complaint does this help explain?

  1. AConstipation
  2. BNasal stuffiness
  3. CGum bleeding
  4. DIncreased appetite
20.Maternity & obstetric nursingHard

Six hours after birth, a woman has not passed urine. The fundus is boggy and displaced to the right, and bleeding has increased. Why is this a priority?

  1. AA full bladder is a sign of normal recovery
  2. BUrine retention only matters after a caesarean birth, not after a vaginal one
  3. CA full bladder prevents the uterus from contracting and increases bleeding
  4. DIt shows that the epidural is still working well
21.Pediatric nursingMedium

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

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

A healthy breastfed baby has lost 7% of her birth weight on day 3. What is the best interpretation?

  1. AThis is severe dehydration and needs immediate IV fluids
  2. BThis shows breastfeeding has failed, so formula should replace breast milk from now on
  3. CThis is within the usual range; observe a feed and follow the weight
  4. DThis weight loss is only normal in formula-fed babies
23.Mental health nursingMedium

Which medicine is most likely to raise a patient's lithium level?

  1. AParacetamol (acetaminophen)
  2. BIbuprofen
  3. COmeprazole
  4. DAmoxicillin
24.Mental health nursingHard

An older patient receiving haloperidol for agitation has an episode of fainting and palpitations. Which test does the nurse expect to be ordered first?

  1. AAn ECG to look for a prolonged QT interval
  2. BA serum lithium level
  3. CA liver function test
  4. DA white blood cell count with differential
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C97 °F? °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 97 °F. Convert it to degrees Celsius T with °C = (°F − 32) × 5/9. Round to one decimal place.

97 °F
T = °C
26.Nursing math & unit conversionsHard
00:0020:0505:55t = ?

Practice exercise (made-up values, not clinical guidance). An infusion starts at 20:05 and finishes at 05:55 the next morning (24-hour clock). How many hours t did it run? Give the answer in hours as a decimal, rounded to two decimal places.

20:0505:55
t = h
27.Dosage calculationsMedium
35 kgBSA = 1.07 m²100 mg/m²D = ? mg

A patient weighing 35 kg has a body surface area of 1.07 m². The prescription is 100 mg/m². Find the dose D in mg.

35 kgBSA = 1.07 m²100 mg/m²
D = mg
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 465 micrograms. The ampoule contains 0.5 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

465 mcg0.5 mg/mL
V = mL
29.IV infusion ratesMedium
250 mL15 gtt/mL3 h? gtt/min

Infuse 250 mL over 3 hours with a giving set of 15 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

250 mL3 h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
1 g250 mL? mL/h2 mg/min

A bag contains 1 g of a drug in 250 mL. The order is 2 mg per minute. At what rate R do you set the pump, in mL/h?

1 g/250 mL2 mg/min
R = mL/h
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftwater300 mLsoup250 mLjelly120 mLIV infusion100 mL/h × 8 hIV antibiotic1 × 100 mLurine225 mLurine275 mLurine275 mLurine300 mLvomit200 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The patient weighs 70 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

70 kg8 hurine: 225 mLurine: 275 mLurine: 275 mLurine: 300 mLvomit: 200 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
1000 mL→ 50 mL/hstart 11:00ttotal​ = ? h75 mL/h × 4 h

Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 11:00 at 75 mL/h. After 4 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.

1000 mL75 mL/h · 4 h50 mL/h
t = h
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 22/min, SpO₂ 89% on room air, blood pressure 136/82 mmHg, pulse 126/min, newly confused, temperature 39.2 °C. What is the NEWS2 total score?

RR 22SpO₂ 89%airSBP 136HR 126CT 39.2 °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 74 kg and is 175 cm tall. Calculate the BMI and click the WHO weight category.

74 kg175 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 · The patient will walk 20 metres with a frame by Friday

Why this is the answer

A SMART goal states exactly what is expected, how it will be measured and by when. "Walk 20 metres with a frame by Friday" can be checked; "feel better" cannot.

Answer

B · The patient will walk 20 metres with a frame by Friday
2.Nursing fundamentals

Answer: B · Loop diuretics cause potassium loss, and low levels can cause arrhythmias

Why this is the answer

Furosemide increases potassium loss in the urine. Hypokalaemia causes muscle weakness and cardiac arrhythmias, so the result is reported and replacement considered.

Answer

B · Loop diuretics cause potassium loss, and low levels can cause arrhythmias
3.Infection control & patient safety

Answer: A · Not give it, and contact the prescriber, because it is never given by IV push

Why this is the answer

Potassium chloride given by IV push can cause fatal cardiac arrhythmias and arrest. It is only given diluted by controlled infusion, so the nurse does not give it and contacts the prescriber.

Answer

A · Not give it, and contact the prescriber, because it is never given by IV push
4.Infection control & patient safety

Answer: B · Treat the glove as contaminated and change it

Why this is the answer

The principle is “if in doubt, it is not sterile”. The edge of the field is non-sterile, so the glove is changed. Continuing on an uncertain basis puts the patient at risk of infection.

Answer

B · Treat the glove as contaminated and change it
5.Prioritization & delegation

Answer: D · “I will give my child aspirin to bring the fever down.”

Why this is the answer

Aspirin in children with viral illnesses such as influenza or chickenpox is linked to Reye syndrome. Fluids, rest at home and reporting breathing trouble are correct.

Answer

D · “I will give my child aspirin to bring the fever down.”
6.Prioritization & delegation

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

Why this is the answer

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

Answer

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

Answer: A · In standard numbered positions across the front and left of the chest

Why this is the answer

The six chest leads (V1–V6) have standard anatomical positions, from the 4th intercostal space beside the sternum to the mid-axillary line. Wrong placement can change the ECG and lead to misinterpretation.

Answer

A · In standard numbered positions across the front and left of the chest
8.Clinical nursing

Answer: A · They reduce complications such as pneumonia, pressure ulcers and delirium

Why this is the answer

Delayed surgery and immobility increase the risk of chest infection, VTE, pressure ulcers, delirium and loss of independence. Guidelines recommend surgery within about 24–48 hours of admission (UK guidance: the day of or day after) and mobilisation soon after.

Answer

A · They reduce complications such as pneumonia, pressure ulcers and delirium
9.Lab values & electrolytes

Answer: C · A common stress response to surgery that is monitored

Why this is the answer

A mild leukocytosis is common after surgery because of tissue injury and the stress response. It is monitored along with temperature and wound assessment. A rising count after several days, or fever, suggests infection.Checked against: WBC count · MedlinePlus (NIH) (2025)

Answer

C · A common stress response to surgery that is monitored
10.Lab values & electrolytes

Answer: B · Acute leukemia

Why this is the answer

Many circulating blasts with anemia and thrombocytopenia suggest acute leukemia: malignant cells crowd out normal production in the marrow. Despite the high white count, the patient has few working white cells and is at high risk of infection and bleeding.Checked against: Laboratory Evaluation of Acute Leukemia · StatPearls (NCBI Bookshelf) (2025)

Answer

B · Acute leukemia
11.Pharmacology

Answer: D · Deep tendon reflexes, respiratory rate and urine output

Why this is the answer

Loss of reflexes is an early sign of magnesium toxicity, followed by respiratory depression and cardiac arrest. Low urine output allows magnesium to accumulate.

Answer

D · Deep tendon reflexes, respiratory rate and urine output
12.Pharmacology

Answer: B · Stop or reduce the infusion as per protocol, lay the patient flat and notify the prescriber

Why this is the answer

Hypotension is a major adverse effect of nitrates due to venous and arterial dilation. The infusion is stopped or reduced, the patient is positioned flat to improve venous return, and the prescriber is informed.

Answer

B · Stop or reduce the infusion as per protocol, lay the patient flat and notify the prescriber
13.Med-surg: cardiovascular & respiratory

Answer: D · CT pulmonary angiography

Why this is the answer

CT pulmonary angiography (CTPA) shows filling defects in the pulmonary arteries. It uses iodinated contrast, so renal function and contrast allergy are checked. A ventilation–perfusion (V/Q) scan is an alternative, for example in pregnancy or renal impairment.

Answer

D · CT pulmonary angiography
14.Med-surg: cardiovascular & respiratory

Answer: D · "Tell me straight away if his SpO₂ is under 88% or he is more breathless."

Why this is the answer

Delegated tasks should come with specific parameters for reporting. Changing oxygen therapy, chest assessment and patient teaching need a registered nurse's knowledge and judgement. Clear reporting instructions keep the patient safe.

Answer

D · "Tell me straight away if his SpO₂ is under 88% or he is more breathless."
15.Med-surg: neuro, endocrine & renal

Answer: C · To match the natural cortisol rhythm and protect the stomach

Why this is the answer

Morning dosing mimics the normal early-morning cortisol peak, causes less adrenal suppression and less sleep disturbance. Taking it with food reduces gastric irritation.

Answer

C · To match the natural cortisol rhythm and protect the stomach
16.Med-surg: neuro, endocrine & renal

Answer: A · Osmotic demyelination syndrome

Why this is the answer

Rapid correction of chronic hyponatraemia shrinks brain cells and can damage the myelin of the pons and other areas. Symptoms (dysarthria, dysphagia, quadriparesis, "locked-in" state) appear days later. This is why correction rates are limited and sodium is monitored closely.

Answer

A · Osmotic demyelination syndrome
17.Med-surg: GI, perioperative & oncology

Answer: B · To confirm that the vaccine produced immunity

Why this is the answer

Some people do not develop protective anti-HBs antibodies after vaccination. Testing identifies non-responders, who may need further doses and advice after exposures.

Answer

B · To confirm that the vaccine produced immunity
18.Med-surg: GI, perioperative & oncology

Answer: A · Escalate urgently and start the sepsis pathway

Why this is the answer

These findings suggest sepsis with poor perfusion. Urgent medical review and a sepsis bundle, including blood cultures, antibiotics within an hour, lactate, fluids and urine output monitoring, improve survival.

Answer

A · Escalate urgently and start the sepsis pathway
19.Maternity & obstetric nursing

Answer: A · Constipation

Why this is the answer

Progesterone slows gut motility, which causes constipation and contributes to heartburn because the lower oesophageal sphincter relaxes. Gum bleeding and nasal stuffiness are mainly due to oestrogen and increased blood flow.

Answer

A · Constipation
20.Maternity & obstetric nursing

Answer: C · A full bladder prevents the uterus from contracting and increases bleeding

Why this is the answer

A distended bladder pushes the uterus up and aside, causing atony and more bleeding. Help her to void, or catheterise per order, then reassess the fundus and the bleeding.

Answer

C · A full bladder prevents the uterus from contracting and increases bleeding
21.Pediatric nursing

Answer: C · 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

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

Answer: C · This is within the usual range; observe a feed and follow the weight

Why this is the answer

Newborns commonly lose up to about 7–10% of birth weight in the first days and usually regain it by about 2 weeks. At this level, observing a feed, checking latch and nappy output and rechecking weight are appropriate.

Answer

C · This is within the usual range; observe a feed and follow the weight
23.Mental health nursing

Answer: B · Ibuprofen

Why this is the answer

NSAIDs, thiazide diuretics and ACE inhibitors reduce lithium clearance and can cause toxicity. Paracetamol is usually preferred for mild pain in patients on lithium.

Answer

B · Ibuprofen
24.Mental health nursing

Answer: A · An ECG to look for a prolonged QT interval

Why this is the answer

Haloperidol and several other antipsychotics can prolong the QT interval, which increases the risk of dangerous ventricular arrhythmias. Fainting and palpitations need an ECG and a check of potassium and magnesium.

Answer

A · An ECG to look for a prolonged QT interval
25.Nursing math & unit conversions

Answer: T = 36.1 °C

Temperature: °C = (°F − 32) × 5/9 and °F = °C × 9/5 + 32. Subtract 32 before you multiply when going from °F, and add 32 after you multiply when going from °C. A quick check: 37 °C is 98.6 °F, and every 1 °C is 1.8 °F.

Subtract 32

97 − 32 = 65

Multiply by 5/9

T = 65·5/9 = 36.11 ≈ 36.1 °C

Answer

T = 36.1 °C
26.Nursing math & unit conversions

Answer: t = 9.83 h

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

Before midnight

20:05 → 24:00 = 235 min

After midnight

00:00 → 05:55 = 355 min

Total

235 + 355 = 590 min
t = 590/60 = 9.833 ≈ 9.83 h

Answer

t = 9.83 h
27.Dosage calculations

Answer: D = 107 mg

Body-surface-area dosing: many cytotoxic and some paediatric doses are prescribed per square metre of body surface area: dose (mg) = dose per m² × BSA (m²). The Mosteller formula estimates BSA = √(height (cm) × weight (kg)/3600).

Dose

D = 100·1.07 = 107 mg

Answer

D = 107 mg
28.Dosage calculations

Answer: V = 0.93 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.

Same units

0.5 mg/mL = 500 mcg/mL

Volume

V = 465/500 = 0.93 mL

Answer

V = 0.93 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

3·60 = 180 min

Drip rate

R = 250·15/180 = 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 = 30 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

2·60 = 120 mg/h

Pump rate

R = 120/4 = 30 mL/h

Answer

R = 30 mL/h
31.IV fluids & fluid balance

Answer: U = 1.92 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

225 + 275 + 275 + 300 = 1075 mL

Per kilogram per hour

U = 1075/(70·8) = 1.92 mL/kg/h

Answer

U = 1.92 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 18 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

75·4 = 300 mL
1000 − 300 = 700 mL left

Second part

700/50 = 14 h

Total time

t = 4 + 14 = 18 h

Answer

t = 18 h

That is about 18 h 00 min, so the bag runs out at about 05:00.

33.Clinical assessment scores

Answer: NEWS2 = 12

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 22/min → 2
SpO₂ 89% → 3
on air → 0
SBP 136 mmHg → 0
HR 126/min → 2
newly confused (C) → 3
T 39.2 °C → 2

Add

NEWS2 = 2 + 3 + 0 + 0 + 2 + 3 + 2 = 12

Answer

NEWS2 = 12
34.Clinical assessment scores

Answer: healthy weight

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 = 74/1.75² = 24.16

Category

healthy weight

Answer

healthy weight

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