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 care best protects the skin of a patient with frequent urinary incontinence?

  1. AApplying talcum powder thickly after each episode
  2. BLeaving the skin wet so it does not dry out
  3. CScrubbing the area with soap and hot water twice a day
  4. DGentle cleansing after each episode and a barrier product
2.Nursing fundamentalsHard

Aspirate from a newly placed nasogastric tube has a pH of 7. What should the nurse do?

  1. AFlush the tube with water and start the feed
  2. BStart the feed, as a pH of 7 confirms that the tube is in the stomach
  3. CPush air down the tube and listen over the stomach
  4. DNot use the tube and follow policy, which may mean a chest X-ray
3.Infection control & patient safetyMedium

Which PPE does a nurse wear when giving an IV chemotherapy drug?

  1. AA reusable cloth gown and one pair of gloves
  2. BTwo pairs of chemotherapy-tested gloves and a disposable impermeable gown
  3. COne pair of standard latex gloves, changed after the infusion is started
  4. DA surgical mask and no gloves
4.Infection control & patient safetyHard

A patient punches a nurse during care. The nurse is not seriously hurt. What should the nurse do?

  1. APunch the patient back in self-defense
  2. BSay nothing, because violence is part of the job
  3. CRefuse to care for any patient for the rest of the week until the patient is moved
  4. DGet medical assessment and report the assault according to policy
5.Prioritization & delegationMedium

On the first day after abdominal surgery, a patient has a temperature of 37.9 °C and reduced breath sounds at the lung bases. Which nursing action is most helpful?

  1. ARestrict oral fluids so that the lungs do not fill up with extra fluid
  2. BKeep the patient lying flat in bed to rest the incision fully
  3. CGive a cough suppressant so that the incision is not strained
  4. DEncourage deep breathing, coughing and use of the incentive spirometer
6.Prioritization & delegationHard

Which assignment to an LPN/LVN is most appropriate?

  1. AA patient transferred from intensive care one hour ago
  2. BA patient who needs discharge teaching for newly started warfarin
  3. CA patient with new atrial fibrillation who has just started an IV diltiazem infusion
  4. DA patient with stable COPD who needs scheduled nebulized bronchodilators and oral medications
7.Clinical nursingMedium

What is the most common cause of hypernatraemia in frail older inpatients?

  1. ANot drinking enough water
  2. BEating too much salt in one meal
  3. CToo much exercise
  4. DTaking too many vitamins
8.Clinical nursingHard

Soon after starting chemotherapy for a high-grade lymphoma, a patient has rising potassium, phosphate and uric acid with falling urine output. What is the most likely cause?

  1. ARefeeding syndrome
  2. BAdrenal insufficiency
  3. CSyndrome of inappropriate ADH secretion
  4. DTumour lysis syndrome
9.Lab values & electrolytesMedium

Which instruction is correct for a patient starting oral iron tablets?

  1. ATake each tablet with milk to protect the stomach
  2. BTake the tablet with an antacid to improve absorption
  3. CYour stools may turn dark green or black
  4. DYour urine will turn bright orange while you take it
10.Lab values & electrolytesHard

A patient with kidney stones and fatigue has a calcium of 11.6 mg/dL (2.9 mmol/L), a high parathyroid hormone (PTH) and a low phosphate. Which condition is most likely?

  1. AVitamin D deficiency
  2. BHypoparathyroidism
  3. CPrimary hyperparathyroidism
  4. DCancer-related hypercalcemia
11.PharmacologyMedium

A patient starting niacin (nicotinic acid) complains of flushing and warmth after doses. Which advice may reduce this?

  1. ATake aspirin 30 minutes before the niacin, if the prescriber agrees
  2. BTake it on an empty stomach in a hot bath
  3. CDouble the dose to build tolerance faster
  4. DTake the niacin with a hot drink so that it dissolves and acts faster
12.PharmacologyHard

A woman has received a high-dose oxytocin infusion with large volumes of hypotonic fluid for many hours. She now has a headache, confusion and a low serum sodium. What is the most likely cause?

  1. AExcessive salt in the infusion fluid
  2. BNormal tiredness after a long labour
  3. CAn allergic reaction to oxytocin causing brain swelling
  4. DWater intoxication from the antidiuretic effect of oxytocin
13.Med-surg: cardiovascular & respiratoryMedium

A patient with chest pain asks for glyceryl trinitrate. Which information means the nurse should withhold it and contact the prescriber?

  1. AThe patient's blood pressure is 150/90 mmHg
  2. BThe patient took sildenafil earlier today
  3. CThe patient takes a daily statin
  4. DThe patient had a headache last week
14.Med-surg: cardiovascular & respiratoryHard

A patient with COPD on a 28% Venturi mask (SpO₂ 90%) wants to eat a meal. What is the most appropriate plan?

  1. AKeep the Venturi mask on and give only liquids through a straw
  2. BSwitch to nasal cannula at low flow, keeping SpO₂ at 88–92%
  3. CChange to a non-rebreather mask at 15 L/min during the meal
  4. DRemove all oxygen during the meal and replace it afterwards
15.Med-surg: neuro, endocrine & renalMedium

A patient taking dapagliflozin (an SGLT2 inhibitor) is vomiting, with blood ketones of 4.5 mmol/L but a glucose of only 11 mmol/L. What should be suspected?

  1. AEuglycaemic diabetic ketoacidosis
  2. BHyperosmolar hyperglycaemic state
  3. CA normal side effect needing no action
  4. DHypoglycaemia caused by the vomiting
16.Med-surg: neuro, endocrine & renalHard

A man who takes tamsulosin for BPH is listed for cataract surgery. Which statement is correct?

  1. AIt should be swapped for oxybutynin the night before to protect the eye
  2. BTamsulosin has no effects outside the urinary tract, so nothing changes
  3. CThe eye surgeon must be told, as it can cause floppy iris during surgery
  4. DThe dose should be doubled before surgery to prevent urinary retention
17.Med-surg: GI, perioperative & oncologyMedium

Which diet is usually recommended for a patient with cirrhosis and hepatic encephalopathy?

  1. ANo food at all until the confusion settles
  2. BOnly clear fluids for several weeks
  3. CA very low-protein diet for the rest of their life to lower ammonia
  4. DNormal protein and enough calories, with a late-evening snack
18.Med-surg: GI, perioperative & oncologyHard

A patient's ileostomy output is 2.5 L a day. They feel tired and dizzy and are drinking large amounts of water. Which advice is usually appropriate?

  1. ADrink even more plain water and tea to replace the losses
  2. BLimit plain drinks and use an oral rehydration solution
  3. CEat only fruit and fruit juice
  4. DStop all drinking for 24 hours
19.Maternity & obstetric nursingMedium

Which statement describes the "4 Ts" causes of postpartum haemorrhage?

  1. ATone, trauma, tissue and thrombin
  2. BTemperature, tachycardia, tears and time
  3. CTrauma, tension, temperature and thrombosis
  4. DTone, tachycardia, transfusion and tissue
20.Maternity & obstetric nursingHard

A fetal heart rate tracing shows absent baseline variability with recurrent late decelerations. How is this classified and what does it require?

  1. AA normal pattern during fetal sleep
  2. BCategory II: an indeterminate tracing that only needs continued routine observation and documentation
  3. CCategory III: an abnormal tracing that needs prompt intervention and preparation for expedited birth
  4. DCategory I: normal, routine care
21.Pediatric nursingMedium

A child receiving chemotherapy has painful mouth ulcers (mucositis). Which mouth care is best?

  1. ASpicy and acidic foods to stimulate saliva flow
  2. BA soft toothbrush or sponge, bland rinses and soft, cool foods
  3. CMouthwash containing alcohol several times a day
  4. DA hard toothbrush and lemon–glycerine swabs to clean the ulcers
22.Pediatric nursingHard

A healthy 12-month-old has a mild fever and fussiness the evening after receiving vaccines. The parent asks if future vaccines should be stopped. What is the correct answer?

  1. ANo; mild fever and fussiness are common, expected reactions and are not a reason to stop vaccination
  2. BYes; the child should never receive vaccines again
  3. CThe child should take antibiotics before every future vaccine to stop the fever and fussiness from happening again
  4. DYes; any reaction means the child is allergic
23.Mental health nursingMedium

How should a nurse screen a patient for intimate partner violence?

  1. AOnly ask patients who have visible injuries
  2. BAsk in private, without the partner or family present
  3. CAsk in front of the partner to see how he reacts
  4. DAsk the partner instead of the patient
24.Mental health nursingHard

A patient with PTSD is having a nightmare and thrashing in bed. What is the safest way for the nurse to wake him?

  1. AShake him firmly by the shoulders until he is fully awake
  2. BStand at a safe distance, say his name clearly and tell him where he is
  3. CTurn on all the lights and shout loudly so that he wakes up quickly
  4. DHold his arms down firmly so that he cannot hit anyone or hurt himself while he is still asleep
25.Nursing math & unit conversionsMedium
5 lb 1 oz? kg1 lb = 16 oz1 kg = 2.2 lb

Practice exercise (made-up values, not clinical guidance). A newborn weighs 5 lb 1 oz. Using 1 lb = 16 oz and 1 kg = 2.2 lb, find the weight m in kilograms. Round to two decimal places.

5 lb 1 oz1 lb = 16 oz1 kg = 2.2 lb
m = kg
26.Nursing math & unit conversionsHard
107 g/L? g/dL1 L = 10 dL

Practice exercise (made-up values, not clinical guidance). A haemoglobin result is 107 g/L. Express it in g/dL Hb.

107 g/L1 L = 10 dL
Hb = g/dL
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
200 mg/5 mLV = ? mL

A child weighing 10 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 200 mg in 5 mL. What volume V do you give?

10 kg10 mg/kg200 mg/5 mL
V = mL
29.IV infusion ratesMedium
15 gtt/mL40 mL/h? gtt/min

An infusion is ordered at 40 mL/h, but no pump is available. It runs by gravity through a giving set of 15 gtt/mL. Find the drip rate R in drops per minute.

40 mL/h15 gtt/mL
R = gtt/min
30.IV infusion ratesHard
470 mLleft? mL/h10 h left

500 mL was ordered over 12 hours. After 2 hours you find that 470 mL is still in the bag, and the order must still finish on time. By what percentage Δ must the original pump rate be increased?

500 mL / 12 hafter 2 h: 470 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput12-hour shiftjelly120 mLjuice150 mLIV infusion80 mL/h × 12 hIV antibiotic2 × 50 mLurine400 mLurine500 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 12-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.

jelly: 120 mLjuice: 150 mLIV infusion: 80 mL/h × 12 hIV antibiotic: 2 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
1000 mL700 mL infused60 mL/h06:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 1000 mL bag runs by pump at 60 mL/h. At 06:00, 700 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

1000 mL700 mL infused60 mL/h
t = h
33.Clinical assessment scoresMedium
8853SBPDBPmmHgHR 92/min · SI = ?

Practice exercise (made-up values, not clinical guidance). A patient has a pulse of 92/min and a blood pressure of 88/53 mmHg. Find the shock index SI = HR/SBP. Round to two decimal places.

HR 92/minBP 88/53 mmHg
SI =
34.Clinical assessment scoresHard
3210123RR≤89–1112–2021–24≥25SpO₂≤9192–9394–95≥96air / O₂O₂airSBP≤9091–100101–110111–219≥220HR≤4041–5051–9091–110111–130≥131ACVPUAC, V, P, UT °C≤35.035.1–36.036.1–38.038.1–39.0≥39.1lowlow–mediummediumhigh

Practice exercise (made-up values, not clinical guidance). Use the NEWS2 chart (SpO₂ scale 1) for these observations: respiration rate 14/min, SpO₂ 96% on room air, blood pressure 150/90 mmHg, pulse 140/min, alert, temperature 39.2 °C. Which clinical risk group does the patient fall into? Click it.

RR 14SpO₂ 96%airSBP 150HR 140AT 39.2 °C
  1. 1low
  2. 2low–medium
  3. 3medium
  4. 4high

3Solutions

1.Nursing fundamentals

Answer: D · Gentle cleansing after each episode and a barrier product

Why this is the answer

Moisture and urine break down the skin barrier. Prompt, gentle cleansing with a pH-balanced cleanser and a barrier cream or film protects against incontinence-associated dermatitis.

Answer

D · Gentle cleansing after each episode and a barrier product
2.Nursing fundamentals

Answer: D · Not use the tube and follow policy, which may mean a chest X-ray

Why this is the answer

A low pH supports gastric placement (1–5.5 in UK guidance; 5 or below is typical in US guidance). A pH of 7 does not rule out the lungs, so nothing is put down the tube until position is confirmed, usually by X-ray. The "whoosh" air test is unreliable.

Answer

D · Not use the tube and follow policy, which may mean a chest X-ray
3.Infection control & patient safety

Answer: B · Two pairs of chemotherapy-tested gloves and a disposable impermeable gown

Why this is the answer

Hazardous drugs can be absorbed through the skin or inhaled. Staff wear double chemotherapy-tested gloves and a disposable, low-permeability gown, with eye and face protection if splashing is possible.

Answer

B · Two pairs of chemotherapy-tested gloves and a disposable impermeable gown
4.Infection control & patient safety

Answer: D · Get medical assessment and report the assault according to policy

Why this is the answer

Workplace violence should always be reported. Reporting allows care for the injured staff member, review of risks and changes to the patient’s care plan to protect staff and other patients.

Answer

D · Get medical assessment and report the assault according to policy
5.Prioritization & delegation

Answer: D · Encourage deep breathing, coughing and use of the incentive spirometer

Why this is the answer

Reduced basal breath sounds and a mild temperature early after surgery often mean atelectasis. Deep breathing, coughing, incentive spirometry and early mobilization help re-expand the lungs.

Answer

D · Encourage deep breathing, coughing and use of the incentive spirometer
6.Prioritization & delegation

Answer: D · A patient with stable COPD who needs scheduled nebulized bronchodilators and oral medications

Why this is the answer

A stable COPD patient with routine treatments has predictable care. A recent ICU transfer and a newly started IV rate-control infusion need RN assessment, and initial teaching about a new high-alert drug belongs to the RN.

Answer

D · A patient with stable COPD who needs scheduled nebulized bronchodilators and oral medications
7.Clinical nursing

Answer: A · Not drinking enough water

Why this is the answer

Hypernatraemia usually reflects water deficit, often in patients who are confused, unable to drink independently or losing fluid through fever or diarrhoea. Supporting fluid intake prevents it.

Answer

A · Not drinking enough water
8.Clinical nursing

Answer: D · Tumour lysis syndrome

Why this is the answer

Rapid tumour cell death releases potassium, phosphate and nucleic acids (forming uric acid), which can cause AKI and arrhythmias. Prevention includes IV hydration and drugs to lower uric acid.

Answer

D · Tumour lysis syndrome
9.Lab values & electrolytes

Answer: C · Your stools may turn dark green or black

Why this is the answer

Oral iron commonly darkens the stools, which is harmless, but black tarry stools with abdominal pain should be reported. Milk, antacids and tea reduce absorption; vitamin C or orange juice can improve it.Checked against: Ferrograd C patient information leaflet (ferrous sulfate + vitamin C) · electronic medicines compendium (eMC), UK (2018)

Answer

C · Your stools may turn dark green or black
10.Lab values & electrolytes

Answer: C · Primary hyperparathyroidism

Why this is the answer

In primary hyperparathyroidism, usually from an adenoma, PTH is high despite high calcium, and phosphate is low because PTH increases its excretion. Cancer-related hypercalcemia typically has a suppressed PTH.Checked against: Parathyroid Hormone (PTH) Test · MedlinePlus (NIH) (2023); Hyperparathyroidism · MedlinePlus (NIH) (2026)

Answer

C · Primary hyperparathyroidism
11.Pharmacology

Answer: A · Take aspirin 30 minutes before the niacin, if the prescriber agrees

Why this is the answer

Niacin causes prostaglandin-mediated vasodilation and flushing. Aspirin beforehand, taking it with food and avoiding hot drinks and alcohol reduce this effect.

Answer

A · Take aspirin 30 minutes before the niacin, if the prescriber agrees
12.Pharmacology

Answer: D · Water intoxication from the antidiuretic effect of oxytocin

Why this is the answer

Oxytocin has antidiuretic activity at high doses. With large volumes of fluid this can cause water retention and dilutional hyponatraemia, so fluid balance and sodium are monitored.

Answer

D · Water intoxication from the antidiuretic effect of oxytocin
13.Med-surg: cardiovascular & respiratory

Answer: B · The patient took sildenafil earlier today

Why this is the answer

Phosphodiesterase-5 inhibitors such as sildenafil (within about 24 hours) or tadalafil (within about 48 hours) combined with nitrates can cause severe, life-threatening hypotension. Nitrates are also avoided with a systolic pressure below about 90 mmHg.

Answer

B · The patient took sildenafil earlier today
14.Med-surg: cardiovascular & respiratory

Answer: B · Switch to nasal cannula at low flow, keeping SpO₂ at 88–92%

Why this is the answer

Oxygen is prescribed to a target range and should not be stopped for meals in a patient who needs it. Nasal cannulae allow eating and talking; the flow (for example 1–2 L/min) is titrated to keep the saturation in the target range. High-concentration oxygen risks hypercapnia.

Answer

B · Switch to nasal cannula at low flow, keeping SpO₂ at 88–92%
15.Med-surg: neuro, endocrine & renal

Answer: A · Euglycaemic diabetic ketoacidosis

Why this is the answer

SGLT2 inhibitors lower glucose by increasing urinary glucose loss, so DKA can occur with only moderately raised glucose. Ketones should be checked in any unwell patient on these drugs, and the drug is stopped during acute illness (sick-day rules).

Answer

A · Euglycaemic diabetic ketoacidosis
16.Med-surg: neuro, endocrine & renal

Answer: C · The eye surgeon must be told, as it can cause floppy iris during surgery

Why this is the answer

Tamsulosin blocks alpha-1A receptors in the iris dilator muscle as well as in the prostate, which can cause intraoperative floppy iris syndrome during cataract surgery. The effect can persist after the drug is stopped, so the surgeon must know in advance to plan the operation. Whether to pause it is a decision for the team.

Answer

C · The eye surgeon must be told, as it can cause floppy iris during surgery
17.Med-surg: GI, perioperative & oncology

Answer: D · Normal protein and enough calories, with a late-evening snack

Why this is the answer

Protein restriction worsens malnutrition and muscle loss and is no longer routinely advised. Adequate protein and energy, small frequent meals and a late-evening snack are recommended.

Answer

D · Normal protein and enough calories, with a late-evening snack
18.Med-surg: GI, perioperative & oncology

Answer: B · Limit plain drinks and use an oral rehydration solution

Why this is the answer

In high-output stomas, hypotonic drinks increase sodium loss through the stoma. Restricting them and using a glucose–salt oral rehydration solution, with antimotility drugs as prescribed and medical review, helps correct dehydration.

Answer

B · Limit plain drinks and use an oral rehydration solution
19.Maternity & obstetric nursing

Answer: A · Tone, trauma, tissue and thrombin

Why this is the answer

The 4 Ts are tone (atony), trauma (tears, haematomas, rupture), tissue (retained placenta or clots) and thrombin (clotting disorders). Tone is the most common cause.

Answer

A · Tone, trauma, tissue and thrombin
20.Maternity & obstetric nursing

Answer: C · Category III: an abnormal tracing that needs prompt intervention and preparation for expedited birth

Why this is the answer

In the three-tier system, absent variability with recurrent late or variable decelerations, or with bradycardia, is Category III. Intrauterine resuscitation starts at once, the team is called, and birth is expedited if the pattern does not resolve.

Answer

C · Category III: an abnormal tracing that needs prompt intervention and preparation for expedited birth
21.Pediatric nursing

Answer: B · A soft toothbrush or sponge, bland rinses and soft, cool foods

Why this is the answer

Gentle cleaning with a soft brush or sponge, regular saline or bland rinses, analgesia and soft, cool, non-acidic foods protect the mouth. Alcohol mouthwashes and lemon–glycerine swabs dry and irritate the mucosa.

Answer

B · A soft toothbrush or sponge, bland rinses and soft, cool foods
22.Pediatric nursing

Answer: A · No; mild fever and fussiness are common, expected reactions and are not a reason to stop vaccination

Why this is the answer

Mild fever, fussiness and local soreness are common after vaccination and settle within a day or two. Only severe reactions such as anaphylaxis are contraindications. Parents can be told how to manage mild symptoms and when to seek help.

Answer

A · No; mild fever and fussiness are common, expected reactions and are not a reason to stop vaccination
23.Mental health nursing

Answer: B · Ask in private, without the partner or family present

Why this is the answer

Screening should be done privately, using direct, non-judgemental questions. Abuse occurs in all groups, so routine screening is better than asking only those with obvious injuries.

Answer

B · Ask in private, without the partner or family present
24.Mental health nursing

Answer: B · Stand at a safe distance, say his name clearly and tell him where he is

Why this is the answer

A person waking from a trauma nightmare may react defensively. Staying out of reach, using the person's name and orienting him to time and place keeps both the patient and staff safe.

Answer

B · Stand at a safe distance, say his name clearly and tell him where he is
25.Nursing math & unit conversions

Answer: m = 2.3 kg

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.

Ounces to pounds

1 oz/16 = 0.0625 lb
5 + 0.0625 = 5.063 lb

Pounds to kilograms

m = 5.063/2.2 = 2.301 ≈ 2.3 kg

Answer

m = 2.3 kg
26.Nursing math & unit conversions

Answer: Hb = 10.7 g/dL

Dimensional analysis: write the given quantity, then multiply by conversion factors written as fractions (for example 60 min/1 h or 1 mg/1000 mcg) so that each unwanted unit appears once on top and once underneath and cancels. When only the wanted unit is left, calculate. Use the equivalents the question gives and round only the final answer.

Convert

Hb = 107 g/L × (1 L/10 dL) = 10.7 g/dL

Answer

Hb = 10.7 g/dL
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: V = 2.5 mL

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 from weight

10·10 = 100 mg

Volume

V = (100/200)·5 = 2.5 mL

Answer

V = 2.5 mL
29.IV infusion rates

Answer: R = 10 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.

Millilitres per minute

40/60 = 0.6667 mL/min

Drip rate

R = 0.6667·15 = 10 gtt/min

Answer

R = 10 gtt/min
30.IV infusion rates

Answer: Δ = 12.8 %

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

Original rate

500/12 = 41.67 mL/h

New rate

R = 470/10 = 47 mL/h

Percentage change

Δ = (47 − 41.67)/41.67·100% = 12.8%

Answer

Δ = 12.8%

Many hospitals allow such an adjustment up to 25% without a new order; check local policy.

31.IV fluids & fluid balance

Answer: I = 1330 mL

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

Add the intake

oral: 120 + 150 = 270 mL
IV infusion: 80·12 = 960 mL
IV antibiotic: 2·50 = 100 mL
I = 1330 mL

Answer

I = 1330 mL
32.IV fluids & fluid balance

Answer: t = 5 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.

Volume left

1000 − 700 = 300 mL

Time

t = 300/60 = 5 h

Answer

t = 5 h

That is about 5 h 00 min, so the bag runs out at about 11:00.

33.Clinical assessment scores

Answer: SI = 1.05

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 = 92/88 = 1.045 ≈ 1.05

Answer

SI = 1.05

1 or more: a warning sign of shock in this practice case.

34.Clinical assessment scores

Answer: medium

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 14/min → 0
SpO₂ 96% → 0
on air → 0
SBP 150 mmHg → 0
HR 140/min → 3
alert (A) → 0
T 39.2 °C → 2

Total and red scores

NEWS2 = 0 + 0 + 0 + 0 + 3 + 0 + 2 = 5
At least one parameter scores 3.

Risk group

medium

Answer

medium

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

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