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

The wife of a man with terminal cancer cries often and says she is already grieving for him. What is this called?

  1. ADisenfranchised grief
  2. BComplicated grief
  3. CDelayed grief
  4. DAnticipatory grief
3.Infection control & patient safetyMedium

A nurse has been fit-tested for an N95 respirator. What should the nurse do each time it is put on?

  1. APerform a user seal check
  2. BMoisten the edges so it seals better
  3. CArrange a new fit test
  4. DWear a surgical mask underneath it
4.Infection control & patient safetyHard

A bag of chemotherapy drug leaks onto the floor. What is the first step?

  1. AWipe it up quickly with paper towels and bare hands
  2. BPut on the spill kit’s protective equipment and contain the spill
  3. CLeave it to dry, then clean it up at the end of the shift
  4. DAsk the cleaner to mop it up with the usual mop
5.Prioritization & delegationMedium

Using the Emergency Severity Index, which level fits a 70-year-old with chest pressure that suggests a heart attack, but normal vital signs?

  1. ALevel 2
  2. BLevel 1
  3. CLevel 5
  4. DLevel 4
6.Prioritization & delegationHard

A chemical cleaning fluid splashes into a patient’s eye. What should the nurse do first?

  1. AGive antibiotic eye drops first
  2. BRub the eye gently with a clean tissue to remove the chemical
  3. CFlush the eye with plenty of water or saline straight away
  4. DCover the eye with a dry patch and wait for the provider
7.Clinical nursingMedium

Which of these is a non-drug measure that can help relieve pain?

  1. ARepositioning and distraction
  2. BRestricting visitors completely
  3. CKeeping the patient awake all night
  4. DTelling the patient that the pain is not real
8.Clinical nursingHard

A patient admitted after a fall takes many regular medicines. Which safety step on admission helps prevent medication errors?

  1. AStopping all regular medicines until the day the patient is discharged
  2. BMedicines reconciliation against reliable sources, such as primary care records
  3. CDoubling the doses to make up for any missed while at home
  4. DPrescribing only the medicines that the patient can remember taking
9.Lab values & electrolytesMedium

An older adult takes lisinopril and furosemide and recently started daily ibuprofen for knee pain. The creatinine has risen from 1.0 to 1.8 mg/dL (88 to 159 µmol/L). What is the most likely cause?

  1. ANormal aging of the kidneys over a period of a few weeks
  2. BMore activity has increased the patient's muscle mass quickly
  3. CThe NSAID reduces kidney blood flow on top of the other two drugs
  4. DA laboratory error, since ibuprofen has no effect on the kidney
10.Lab values & electrolytesHard

Four laboratory results arrive. Which one should the nurse act on first?

  1. AHemoglobin 11.8 g/dL (118 g/L) in a patient with chronic kidney disease
  2. BPotassium 6.6 mEq/L in a patient with CKD who has new muscle weakness
  3. CGlucose 140 mg/dL (7.8 mmol/L) after a meal in a patient with diabetes
  4. DSodium 137 mEq/L in a patient admitted with pneumonia yesterday
11.PharmacologyMedium

How should the nurse straighten the ear canal to give ear drops to a 2-year-old child?

  1. ALeave the ear untouched and drop into the canal
  2. BPush the pinna forward and up
  3. CPull the pinna up and back
  4. DPull the pinna down and back
12.PharmacologyHard

A patient with heart failure on furosemide is also given metolazone, a thiazide-like diuretic. Which risk increases most?

  1. AHypoglycaemia and weight gain
  2. BHyperkalaemia and fluid overload
  3. CSevere hypokalaemia, hyponatraemia and dehydration
  4. DSevere hypertension, tachycardia and fluid retention
13.Med-surg: cardiovascular & respiratoryMedium

During an episode of chest pain, a patient's ECG shows new horizontal ST depression. What does this most likely indicate?

  1. AMyocardial ischaemia
  2. BA normal finding during pain
  3. CHyperkalaemia
  4. DPericarditis
14.Med-surg: cardiovascular & respiratoryHard

A one-way speaking valve is fitted to a patient's tracheostomy tube while the cuff is still inflated. What is the danger?

  1. AThere is no danger, as the valve works with any cuff
  2. BThe valve will humidify the air too much
  3. CThe patient cannot breathe out and may suffocate
  4. DThe patient will speak too loudly
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. A6, obeys commands
  2. B4, withdraws from pain
  3. C5, localises to pain
  4. D3, abnormal flexion
16.Med-surg: neuro, endocrine & renalHard

A patient with SIADH needs IV fluid. Which fluid is most likely to worsen the hyponatraemia?

  1. A8.4% sodium bicarbonate
  2. B5% glucose (dextrose, D5W)
  3. C3% saline
  4. D20% human albumin
17.Med-surg: GI, perioperative & oncologyMedium

What is the role of sodium restriction and spironolactone in cirrhosis?

  1. ATo increase potassium loss and prevent hyperkalaemia
  2. BTo lower blood ammonia and treat encephalopathy
  3. CTo reduce sodium and water retention and control ascites
  4. DTo raise the blood pressure and improve kidney blood flow
18.Med-surg: GI, perioperative & oncologyHard

A patient with lung cancer develops facial swelling, distended neck veins and breathlessness that worsens when lying down. Which emergency is likely?

  1. AMassive pulmonary embolism
  2. BSuperior vena cava obstruction
  3. CSpinal cord compression
  4. DHypercalcaemia of malignancy
19.Maternity & obstetric nursingMedium

Which feature suggests a newborn is preterm rather than term?

  1. ACreases covering the whole sole
  2. BLabia majora covering the labia minora
  3. CPlantar creases only on the front of the sole
  4. DFirm ear cartilage that springs back
20.Maternity & obstetric nursingHard

A woman with pre-eclampsia has a tonic–clonic seizure. What should the nurse do first?

  1. ACall for help, stay with her, protect her from injury and turn her onto her side once possible
  2. BRestrain her arms and legs
  3. CInsert a tongue depressor or padded airway between her teeth so that she cannot bite through her tongue
  4. DMeasure the fundal height
21.Pediatric nursingMedium

Which sign shows that a baby is ready to start solid foods?

  1. AStarts waking more often during the night and seems hungry after milk feeds
  2. BHas cut a first tooth
  3. CHas reached 6 weeks of age
  4. DSits with support, holds the head steady and shows interest in food
22.Pediatric nursingHard

Only one negative-pressure room is available. Which child should be placed in it?

  1. AA child with RSV bronchiolitis
  2. BA child with norovirus gastroenteritis and vomiting
  3. CA child with suspected measles
  4. DA child with impetigo
23.Mental health nursingMedium

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

  1. AAmoxicillin
  2. BOmeprazole
  3. CIbuprofen
  4. DParacetamol (acetaminophen)
24.Mental health nursingHard

A colleague suggests putting a loud but non-violent patient in seclusion "because he's annoying everyone". What is the correct response?

  1. AIt is acceptable as long as the patient agrees afterwards
  2. BIt is acceptable as long as the seclusion lasts for less than an hour
  3. CIt is acceptable, because it will make the ward quieter and safer for the other patients
  4. DIt would be inappropriate, because seclusion is only a last resort for serious risk of harm
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C? °F37.7 °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 37.7 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.

37.7 °C
T = °F
26.Nursing math & unit conversionsHard
20 mcg/min? mg/h1 h = 60 min1 mg = 1000 mcg

Practice exercise (made-up values, not clinical guidance). An infusion delivers 20 mcg/min. Express this dose rate D in mg/h.

20 mcg/min1 h = 60 min1 mg = 1000 mcg
D = mg/h
27.Dosage calculationsMedium
90 kg7.5 mg/kg/day4× per dayD = ? mg

A patient weighs 90 kg. The prescribed dose is 7.5 mg/kg per day, given in 4 equal doses. How many milligrams D are given per dose?

90 kg7.5 mg/kg/day4× per day
D = mg
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 2250 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?

2250 units5000 units/mL
V = mL
29.IV infusion ratesMedium
V = ?15 gtt/mL50 gtt/min8 h

A drip runs at 50 gtt/min through a set of 15 gtt/mL. How many millilitres V does the patient receive in 8 hours?

50 gtt/min15 gtt/mL8 h
V = mL
30.IV infusion ratesHard
710 mLleft? mL/h4 h left

1000 mL was ordered over 6 hours. After 2 hours you find that 710 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?

1000 mL / 6 hafter 2 h: 710 mL
Δ = %
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftjuice120 mLsoup200 mLtea200 mLice chips200 mLIV infusion75 mL/h × 8 hIV antibiotic2 × 50 mLurine325 mLurine225 mLurine325 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 67 kg. Find the average urine output U in mL/kg/h. Round to two decimal places.

67 kg8 hurine: 325 mLurine: 225 mLurine: 325 mL
U = mL/kg/h
32.IV fluids & fluid balanceHard
500 mL→ 80 mL/hstart 14:00ttotal​ = ? h75 mL/h × 3 h

Practice exercise (made-up values, not clinical guidance). A 500 mL infusion starts at 14:00 at 75 mL/h. After 3 hours the rate is changed to 80 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 mL75 mL/h · 3 h80 mL/h
t = h
33.Clinical assessment scoresMedium
E3 / 4+V2 / 5+M? / 6GCS 7?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 7, with E3 and V2. What motor score M was recorded, and which response does it describe? Give the number.

GCS 7E3V2
M =
34.Clinical assessment scoresHard
reassuringmoderately abnormallow

Practice exercise (made-up values, not clinical guidance). At 1 minute after birth, a practice newborn has blue or pale skin all over, a heart rate of 95/min, no response to stimulation, limp limbs with no muscle tone and no breathing. Score the APGAR and click how the score is interpreted.

  1. 1reassuring
  2. 2moderately abnormal
  3. 3low

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 · Anticipatory grief

Why this is the answer

Anticipatory grief happens before an expected death. It is a normal reaction, and nurses can support it by listening and involving the family in care.

Answer

D · Anticipatory grief
3.Infection control & patient safety

Answer: A · Perform a user seal check

Why this is the answer

A fit test confirms that a model and size suit the person. A user seal check, breathing in and out to feel for leaks at the edges, is done every time the respirator is put on.

Answer

A · Perform a user seal check
4.Infection control & patient safety

Answer: B · Put on the spill kit’s protective equipment and contain the spill

Why this is the answer

Hazardous drug spills are handled with a spill kit, including chemotherapy-tested gloves, a gown and eye protection. The area is secured and the spill is contained, cleaned and disposed of as hazardous waste, then reported.

Answer

B · Put on the spill kit’s protective equipment and contain the spill
5.Prioritization & delegation

Answer: A · Level 2

Why this is the answer

Possible acute coronary syndrome is a high-risk situation, so the patient is ESI level 2 and should be seen very soon. Level 1 is kept for patients who need an immediate life-saving intervention.

Answer

A · Level 2
6.Prioritization & delegation

Answer: C · Flush the eye with plenty of water or saline straight away

Why this is the answer

Chemical eye injuries are treated by immediate, continuous irrigation with large amounts of water or saline. Delay, rubbing or a patch allows more damage.

Answer

C · Flush the eye with plenty of water or saline straight away
7.Clinical nursing

Answer: A · Repositioning and distraction

Why this is the answer

Positioning, heat or cold where safe, relaxation, distraction and explanation can all reduce pain alongside analgesics.

Answer

A · Repositioning and distraction
8.Clinical nursing

Answer: B · Medicines reconciliation against reliable sources, such as primary care records

Why this is the answer

Medicines reconciliation compares several sources to produce an accurate medication list. It finds omissions, duplications and errors, and is especially important in older people with polypharmacy.

Answer

B · Medicines reconciliation against reliable sources, such as primary care records
9.Lab values & electrolytes

Answer: C · The NSAID reduces kidney blood flow on top of the other two drugs

Why this is the answer

NSAIDs reduce prostaglandin-driven blood flow to the kidney. Combined with an ACE inhibitor and a diuretic, this can cause acute kidney injury, especially in older adults. The nurse reports the result and the NSAID is usually stopped.Checked against: Creatinine blood test · MedlinePlus (NIH) (2025)

Answer

C · The NSAID reduces kidney blood flow on top of the other two drugs
10.Lab values & electrolytes

Answer: B · Potassium 6.6 mEq/L in a patient with CKD who has new muscle weakness

Why this is the answer

A potassium of 6.6 mEq/L with weakness can cause life-threatening arrhythmias. The nurse arranges cardiac monitoring and informs the provider at once. Mild anemia in CKD and a mildly raised glucose after a meal are expected; the sodium is normal.Checked against: High potassium level · MedlinePlus (NIH) (2025)

Answer

B · Potassium 6.6 mEq/L in a patient with CKD who has new muscle weakness
11.Pharmacology

Answer: D · Pull the pinna down and back

Why this is the answer

In children under about 3 years, the pinna is pulled down and back; in adults it is pulled up and back. The child then lies with the treated ear up for a few minutes.

Answer

D · Pull the pinna down and back
12.Pharmacology

Answer: C · Severe hypokalaemia, hyponatraemia and dehydration

Why this is the answer

Combining a loop and a thiazide diuretic gives a strong synergistic diuresis. This can cause marked electrolyte loss and volume depletion, so weight, electrolytes and kidney function are monitored closely.

Answer

C · Severe hypokalaemia, hyponatraemia and dehydration
13.Med-surg: cardiovascular & respiratory

Answer: A · Myocardial ischaemia

Why this is the answer

New horizontal or downsloping ST depression during pain suggests myocardial ischaemia, as in unstable angina or NSTEMI. It should be reported immediately with serial ECGs and troponins. ST depression can also reflect reciprocal change opposite a STEMI.

Answer

A · Myocardial ischaemia
14.Med-surg: cardiovascular & respiratory

Answer: C · The patient cannot breathe out and may suffocate

Why this is the answer

A speaking valve opens on inspiration and closes on expiration, so exhaled air must pass around the tube and up through the larynx. If the cuff is inflated, air cannot escape, causing air trapping and respiratory arrest. The cuff must be fully deflated first.

Answer

C · The patient cannot breathe out and may suffocate
15.Med-surg: neuro, endocrine & renal

Answer: C · 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

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

Answer: B · 5% glucose (dextrose, D5W)

Why this is the answer

5% glucose (5% dextrose, D5W) provides free water once the glucose is metabolised. In SIADH, this water is kept, so sodium falls further. Hypotonic fluids are avoided. Hypertonic saline is used for severe symptomatic hyponatraemia.

Answer

B · 5% glucose (dextrose, D5W)
17.Med-surg: GI, perioperative & oncology

Answer: C · To reduce sodium and water retention and control ascites

Why this is the answer

In cirrhosis, secondary hyperaldosteronism causes sodium and water retention. Sodium restriction and the aldosterone antagonist spironolactone (often with a loop diuretic) reduce ascites. Spironolactone can cause hyperkalaemia and gynaecomastia.

Answer

C · To reduce sodium and water retention and control ascites
18.Med-surg: GI, perioperative & oncology

Answer: B · Superior vena cava obstruction

Why this is the answer

A tumour can compress or invade the superior vena cava, causing facial and arm swelling, dilated chest veins, headache and breathlessness. The patient is sat up and urgently reviewed; treatment includes steroids, stenting and radiotherapy or chemotherapy.

Answer

B · Superior vena cava obstruction
19.Maternity & obstetric nursing

Answer: C · Plantar creases only on the front of the sole

Why this is the answer

Preterm babies have few plantar creases, abundant lanugo, flat areolae, soft ears, prominent labia minora and an extended posture. Creases over the whole sole suggest a term baby.

Answer

C · Plantar creases only on the front of the sole
20.Maternity & obstetric nursing

Answer: A · Call for help, stay with her, protect her from injury and turn her onto her side once possible

Why this is the answer

During an eclamptic seizure, call for help, protect from injury, and after the jerking stops turn her on her side to keep the airway clear and give oxygen. Magnesium sulfate is given as ordered, and the fetus is assessed when the mother is stable.

Answer

A · Call for help, stay with her, protect her from injury and turn her onto her side once possible
21.Pediatric nursing

Answer: D · Sits with support, holds the head steady and shows interest in food

Why this is the answer

Readiness for solids, usually around 6 months, includes good head control, sitting with support, interest in food and loss of the tongue-thrust reflex. Night waking and teething are not signs of readiness.

Answer

D · Sits with support, holds the head steady and shows interest in food
22.Pediatric nursing

Answer: C · A child with suspected measles

Why this is the answer

Negative-pressure rooms are for airborne infections such as measles, chickenpox and tuberculosis. RSV mainly needs contact (and often droplet) precautions, impetigo contact precautions and norovirus contact precautions with strict hand hygiene.

Answer

C · A child with suspected measles
23.Mental health nursing

Answer: C · 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

C · Ibuprofen
24.Mental health nursing

Answer: D · It would be inappropriate, because seclusion is only a last resort for serious risk of harm

Why this is the answer

Seclusion is a restrictive intervention used only to contain severe behaviour likely to cause harm to others, as a last resort, for the shortest time. Using it for convenience or punishment breaches patients' rights.

Answer

D · It would be inappropriate, because seclusion is only a last resort for serious risk of harm
25.Nursing math & unit conversions

Answer: T = 99.9 °F

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.

Multiply by 9/5

37.7·9/5 = 67.86

Add 32

T = 67.86 + 32 = 99.86 ≈ 99.9 °F

Answer

T = 99.9 °F
26.Nursing math & unit conversions

Answer: D = 1.2 mg/h

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.

Set up the chain

D = 20 mcg/min × (60 min/1 h) × (1 mg/1000 mcg)

Calculate

D = 20·60/1000 = 1.2 mg/h

Answer

D = 1.2 mg/h
27.Dosage calculations

Answer: D = 168.8 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.

Total per day

7.5·90 = 675 mg

Per dose

D = 675/4 = 168.8 mg

Answer

D = 168.8 mg
28.Dosage calculations

Answer: V = 0.45 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 = 2250/5000 = 0.45 mL

On the syringe

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

Answer

V = 0.45 mL
29.IV infusion rates

Answer: V = 1600 mL

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

Rate in mL/h

50·60/15 = 200 mL/h

Volume

V = 200·8 = 1600 mL

Answer

V = 1600 mL
30.IV infusion rates

Answer: Δ = 6.5 %

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

1000/6 = 166.7 mL/h

New rate

R = 710/4 = 177.5 mL/h

Percentage change

Δ = (177.5 − 166.7)/166.7·100% = 6.5%

Answer

Δ = 6.5%

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

31.IV fluids & fluid balance

Answer: U = 1.63 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

325 + 225 + 325 = 875 mL

Per kilogram per hour

U = 875/(67·8) = 1.632 ≈ 1.63 mL/kg/h

Answer

U = 1.63 mL/kg/h
32.IV fluids & fluid balance

Answer: t = 6.4 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

75·3 = 225 mL
500 − 225 = 275 mL left

Second part

275/80 = 3.438 h

Total time

t = 3 + 3.438 = 6.438 ≈ 6.4 h

Answer

t = 6.4 h

That is about 6 h 26 min, so the bag runs out at about 20:26.

33.Clinical assessment scores

Answer: M = 2

Glasgow Coma Scale: add the best response in three areas. Eye opening E: 4 spontaneous, 3 to sound or speech, 2 to pressure, 1 none. Verbal V: 5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none. Motor M: 6 obeys commands, 5 localises, 4 normal flexion (withdraws), 3 abnormal flexion, 2 extension, 1 none. The total runs from 3 to 15. After a head injury, 13–15 is usually called mild, 9–12 moderate and 3–8 severe.

Motor score

M = 7 − 3 − 2 = 2
M2: extension of the arms and legs (abnormal extension)

Answer

M = 2
34.Clinical assessment scores

Answer: low

APGAR score: five signs, each scored 0, 1 or 2, checked at 1 and 5 minutes after birth. Appearance (colour): blue or pale 0, pink body with blue extremities 1, pink all over 2. Pulse: absent 0, below 100/min 1, 100/min or more 2. Grimace (reflex irritability): none 0, grimace 1, cry, cough or sneeze 2. Activity (tone): limp 0, some flexion 1, active movement 2. Respiration: absent 0, slow or irregular with a weak cry 1, good with a strong cry 2. A total of 7–10 is reassuring, 4–6 moderately abnormal and 0–3 low.

Score each sign

Appearance: blue or pale skin all over → 0
Pulse: 95/min → 1
Grimace: no response to stimulation → 0
Activity: limp limbs with no muscle tone → 0
Respiration: no breathing → 0

Add

APGAR = 0 + 1 + 0 + 0 + 0 = 1

Interpretation

1 → low

Answer

low

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