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.

New problemsBack to the course

In the print window, choose “Save as PDF” to keep a copy on your device.

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

During a blood transfusion the patient develops fever, rigors and back pain. What should the nurse do first?

  1. AGive paracetamol and continue the transfusion
  2. BSlow the transfusion down and recheck the observations in an hour
  3. CStop the transfusion and call for urgent medical help
  4. DFinish the bag quickly to reduce exposure
2.Nursing fundamentalsHard

Which sign is usually a late sign of hypoxia?

  1. ARestlessness
  2. BCyanosis
  3. CA rising heart rate
  4. DA rising respiratory rate
3.Infection control & patient safetyMedium

Which measure is part of the bundle for inserting a central venous catheter to prevent bloodstream infection?

  1. AChoosing the femoral vein as the first site in adults
  2. BRoutine replacement of the catheter on a fixed schedule, such as every three days
  3. CGiving antibiotics to every patient before insertion
  4. DChlorhexidine-alcohol skin antisepsis and maximal sterile barrier precautions
4.Infection control & patient safetyHard

A nurse who is not immune to chickenpox was exposed to a patient with varicella before precautions began. What usually happens?

  1. AThe nurse only needs to wear gloves for the next month
  2. BThe nurse continues working with all patients as usual, including newborns
  3. CThe nurse is assessed and kept from patient contact during the incubation period per policy
  4. DThe nurse must take a two-week course of antibiotics to prevent the infection
5.Prioritization & delegationMedium

On day 3 after hip surgery, a patient suddenly becomes short of breath with sharp chest pain and an SpO₂ of 88%. What should the nurse do first?

  1. AMassage the patient’s calves to ease any muscle cramp
  2. BRaise the head of the bed, give oxygen and call for urgent help
  3. CGive the next dose of oral analgesia and reassess the patient in an hour
  4. DEncourage the patient to walk to improve the circulation
6.Prioritization & delegationHard

A patient rescued from a house fire has burns to the face, singed nasal hair and a hoarse voice. What is the priority?

  1. AStarting IV fluid resuscitation calculated from the burn size
  2. BProtecting the airway, preparing for early airway support
  3. CCleaning and dressing the facial burns
  4. DGiving pain relief
7.Clinical nursingMedium

A patient taking digoxin has nausea, a pulse of 48/min and complains that everything looks yellow. What should you suspect?

  1. AHyperthyroidism
  2. BDigoxin toxicity
  3. CHypoglycaemia
  4. DA normal side effect needing no action
8.Clinical nursingHard

A patient with a COPD exacerbation remains acidotic with a high PaCO2 despite optimal medical treatment and controlled oxygen. Which treatment is usually considered next?

  1. ASedation to slow the breathing
  2. BNon-invasive ventilation
  3. CStopping all oxygen therapy
  4. D15 L/min oxygen via a non-rebreathe mask
9.Lab values & electrolytesMedium

Which ECG change is linked to hypocalcemia?

  1. AA shortened QT interval
  2. BTall, peaked T waves
  3. CA prominent delta wave
  4. DA prolonged QT interval
10.Lab values & electrolytesHard

A nursing student has a positive interferon-gamma release assay (IGRA) for tuberculosis, no symptoms and a normal chest X-ray. What does this most likely mean?

  1. ALatent TB infection, which is not contagious
  2. BActive pulmonary TB, which is contagious
  3. CA false result, as the test does not detect TB
  4. DPast BCG vaccination only, with no infection
11.PharmacologyMedium

Which assessment is most important during IV mannitol therapy?

  1. APlatelet count and signs of bleeding
  2. BBlood glucose before meals and signs of hypoglycaemia
  3. CUrine output, electrolytes and signs of fluid overload
  4. DLiver enzymes and signs of jaundice
12.PharmacologyHard

A patient with early aspirin (salicylate) overdose has tinnitus and is breathing fast. Which acid–base pattern is classic?

  1. AMetabolic alkalosis followed by respiratory acidosis
  2. BRespiratory alkalosis followed by metabolic acidosis
  3. CPure metabolic alkalosis
  4. DRespiratory acidosis with normal bicarbonate
13.Med-surg: cardiovascular & respiratoryMedium

Before compression therapy is applied for a venous leg ulcer, which assessment is essential?

  1. AA full blood count and CRP
  2. BA wound swab for culture and sensitivity
  3. CA chest X-ray and ECG
  4. DAn ankle–brachial pressure index (ABPI)
14.Med-surg: cardiovascular & respiratoryHard

A patient with COPD is going home on long-term oxygen. Which teaching point is most important for safety?

  1. AStore spare cylinders next to the cooker
  2. BUse petroleum jelly to soothe dry nostrils
  3. CNever smoke or allow open flames near the oxygen
  4. DTurn the flow up as high as needed when breathless
15.Med-surg: neuro, endocrine & renalMedium

Fifteen minutes after treatment with glucose tablets, a patient's glucose has risen from 3.2 to 5.1 mmol/L. Their next meal is in two hours. What should happen next?

  1. AGive another dose of glucose tablets to push it higher
  2. BNo further action is needed until the next meal is served later
  3. CGive the usual dose of rapid-acting insulin straight away
  4. DGive a longer-acting carbohydrate snack, such as a sandwich
16.Med-surg: neuro, endocrine & renalHard

A patient with lung cancer and SIADH has a sodium of 112 mmol/L and is having seizures. What is the most appropriate treatment?

  1. AHypertonic saline, monitored, with a limited rate of rise
  2. BIV 5% glucose at a high rate until the seizures stop
  3. CRapid correction to 140 mmol/L within the first six hours
  4. DLarge volumes of oral water to help dilute the urine
17.Med-surg: GI, perioperative & oncologyMedium

Which technique is correct when giving a prefilled low molecular weight heparin injection?

  1. ARub the site firmly afterwards to help absorption
  2. BInject into a vein in the back of the hand
  3. CExpel the air bubble first and inject into the deltoid muscle
  4. DLeave the air bubble in and inject into a skin fold
18.Med-surg: GI, perioperative & oncologyHard

A patient with a leg ulcer has an ABPI of 0.5. The doctor's plan mentions starting strong compression bandages. What should the nurse do?

  1. AApply compression but only at night
  2. BApply the strongest compression to speed healing
  3. CWithhold strong compression and discuss urgent vascular referral
  4. DApply compression and elevate the leg above the heart all day
19.Maternity & obstetric nursingMedium

A woman at 32 weeks with known placenta praevia is admitted with bleeding. Which procedure must be avoided?

  1. AA digital vaginal examination
  2. BStarting an IV line
  3. CContinuous fetal heart monitoring
  4. DMeasuring blood pressure
20.Maternity & obstetric nursingHard

A woman at 34 weeks with type 1 diabetes has a blood glucose of 2.8 mmol/L (50 mg/dL), is sweating and shaky but is alert. What should the nurse do first?

  1. AGive fast-acting glucose by mouth and recheck
  2. BWait until her next meal
  3. CCheck the fetal heart rate before any treatment
  4. DGive her usual insulin dose
21.Pediatric nursingMedium

A 5-week-old baby has forceful (projectile) vomiting after every feed and seems hungry afterwards. What is the likely cause?

  1. AHirschsprung disease
  2. BPyloric stenosis
  3. CIntussusception
  4. DGastro-oesophageal reflux that is normal for age
22.Pediatric nursingHard

An infant on digoxin has vomited twice. The apical pulse is below the limit set by the prescriber. What should the nurse do?

  1. AGive the dose with milk to stop the vomiting
  2. BGive the dose and recheck the pulse in an hour
  3. CWithhold the dose and inform the prescriber
  4. DGive half the dose to be on the safe side
23.Mental health nursingMedium

In families of people with schizophrenia, which pattern of "high expressed emotion" is linked to a higher rate of relapse?

  1. ACalm, supportive and warm communication
  2. BEncouraging the patient to take part in activities
  3. CFrequent criticism, hostility and emotional over-involvement
  4. DRegular contact with the care team and other families
24.Mental health nursingHard

A patient with schizophrenia refuses his antipsychotic, saying it makes him feel slow. What is the best initial response?

  1. AExplore his reasons and side effects, and inform the team so the treatment can be reviewed
  2. BRecord "refused" and never discuss it again
  3. CHide the medication in his food
  4. DTell him he will be restrained and given an injection if he does not take the tablets by mouth
25.Nursing math & unit conversionsMedium
94969810010210410635363738394041°F°C? °F37.6 °C

Practice exercise (made-up values, not clinical guidance). A patient’s temperature is 37.6 °C. Convert it to degrees Fahrenheit T with °F = °C × 9/5 + 32. Round to one decimal place.

37.6 °C
T = °F
26.Nursing math & unit conversionsHard
3 fl oz? mL2 tbsp? mL2 tsp? mLΣ = ? mL

Practice exercise (made-up values, not clinical guidance). During a shift a patient takes 3 fl oz of juice, 2 tbsp of liquid supplement, 2 tsp of cough syrup. Using the equivalents given, find the total oral intake V in mL.

1 fl oz = 30 mL1 tbsp = 15 mL1 tsp = 5 mL
V = mL
27.Dosage calculationsMedium
024681010 mL

A child weighing 30 kg is prescribed 7.5 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

30 kg7.5 mg/kg25 mg/mL
V = mL
28.Dosage calculationsHard
20%stockV₁ = ? mL

You must prepare 500 mL of a 1% (w/v) solution from a 20% (w/v) stock solution. What volume of stock V₁ do you need?

C₁ = 20%C₂ = 1%V₂ = 500 mL
V₁ = mL
29.IV infusion ratesMedium
500 mL20 gtt/mL8 h? gtt/min

Infuse 500 mL over 8 hours with a giving set of 20 gtt/mL. Find the drip rate R in drops per minute. Round to the nearest whole number.

500 mL8 h20 gtt/mL
R = gtt/min
30.IV infusion ratesHard
200 mg50 mL5 mL/h? mg/h

A bag contains 200 mg of a drug in 50 mL and runs at 5 mL/h. How many milligrams per hour D does the patient receive?

200 mg/50 mL5 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftwater300 mLtea240 mLIV infusion125 mL/h × 8 hIV antibiotic1 × 100 mLurine450 mLurine300 mLwound drain140 mL

Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the total intake I in mL.

water: 300 mLtea: 240 mLIV infusion: 125 mL/h × 8 hIV antibiotic: 1 × 100 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL100 mL infused150 mL/h19:00t = ? h

Practice exercise (made-up values, not clinical guidance). A 500 mL bag runs by pump at 150 mL/h. At 19:00, 100 mL have already been infused. How many hours t until the bag is empty? Round to one decimal place.

500 mL100 mL infused150 mL/h
t = h
33.Clinical assessment scoresMedium
E2 / 4+V4 / 5+M? / 6GCS 11?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 11, with E2 and V4. What motor score M was recorded, and which response does it describe? Give the number.

GCS 11E2V4
M =
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 97% on room air, blood pressure 136/82 mmHg, pulse 82/min, alert, temperature 36.4 °C. Which clinical risk group does the patient fall into? Click it.

RR 14SpO₂ 97%airSBP 136HR 82AT 36.4 °C
  1. 1low
  2. 2low–medium
  3. 3medium
  4. 4high

3Solutions

1.Nursing fundamentals

Answer: C · Stop the transfusion and call for urgent medical help

Why this is the answer

Suspected transfusion reactions require stopping the transfusion straight away, keeping the IV line open with a new giving set, checking vital signs and calling a doctor. The bag and documents are kept for investigation.

Answer

C · Stop the transfusion and call for urgent medical help
2.Nursing fundamentals

Answer: B · Cyanosis

Why this is the answer

Early hypoxia causes restlessness, anxiety, tachycardia and tachypnoea as the body compensates. Cyanosis appears late, when a lot of haemoglobin is already deoxygenated, so nurses should not wait for it.

Answer

B · Cyanosis
3.Infection control & patient safety

Answer: D · Chlorhexidine-alcohol skin antisepsis and maximal sterile barrier precautions

Why this is the answer

The insertion bundle includes hand hygiene, chlorhexidine-alcohol skin prep, maximal barrier precautions (cap, mask, sterile gown, sterile gloves and a full body drape) and avoiding the femoral site in adults. Routine replacement and routine antibiotics are not recommended.

Answer

D · Chlorhexidine-alcohol skin antisepsis and maximal sterile barrier precautions
4.Infection control & patient safety

Answer: C · The nurse is assessed and kept from patient contact during the incubation period per policy

Why this is the answer

A non-immune worker exposed to varicella may become infectious before the rash appears, so they are usually excluded from patient contact for the incubation period, and post-exposure vaccination or other measures may be offered.

Answer

C · The nurse is assessed and kept from patient contact during the incubation period per policy
5.Prioritization & delegation

Answer: B · Raise the head of the bed, give oxygen and call for urgent help

Why this is the answer

Sudden breathlessness and chest pain after surgery suggest a pulmonary embolism. The nurse supports breathing with positioning and oxygen and escalates at once; walking or leg massage could make things worse.

Answer

B · Raise the head of the bed, give oxygen and call for urgent help
6.Prioritization & delegation

Answer: B · Protecting the airway, preparing for early airway support

Why this is the answer

Singed nasal hair and hoarseness suggest inhalation injury. The upper airway can swell and close within hours, so it is protected early. Fluids, pain relief and wound care follow.

Answer

B · Protecting the airway, preparing for early airway support
7.Clinical nursing

Answer: B · Digoxin toxicity

Why this is the answer

Digoxin toxicity causes nausea, vomiting, bradycardia, arrhythmias and visual disturbances. Low potassium increases the risk. Withhold the dose and report.

Answer

B · Digoxin toxicity
8.Clinical nursing

Answer: B · Non-invasive ventilation

Why this is the answer

In hypercapnic respiratory failure from COPD that persists despite treatment, non-invasive ventilation (bilevel positive pressure) supports ventilation and lowers PaCO2. Stopping oxygen would cause dangerous hypoxia.

Answer

B · Non-invasive ventilation
9.Lab values & electrolytes

Answer: D · A prolonged QT interval

Why this is the answer

Low calcium prolongs the QT interval, which can lead to dangerous arrhythmias. High calcium shortens the QT interval, and peaked T waves are typical of hyperkalemia.

Answer

D · A prolonged QT interval
10.Lab values & electrolytes

Answer: A · Latent TB infection, which is not contagious

Why this is the answer

A positive IGRA with no symptoms and a normal chest X-ray indicates latent TB infection, which cannot spread to others. Treatment of latent TB is often offered to prevent later active disease. The IGRA is much less likely than the skin test to give a false-positive result after BCG vaccination.Checked against: Tuberculosis Screening · MedlinePlus (NIH) (2026); PPD skin test · MedlinePlus (NIH) (2025)

Answer

A · Latent TB infection, which is not contagious
11.Pharmacology

Answer: C · Urine output, electrolytes and signs of fluid overload

Why this is the answer

Mannitol draws fluid into the circulation before it is excreted, which can cause heart failure and pulmonary oedema. The large diuresis can cause dehydration and electrolyte imbalance, so output and electrolytes are monitored.

Answer

C · Urine output, electrolytes and signs of fluid overload
12.Pharmacology

Answer: B · Respiratory alkalosis followed by metabolic acidosis

Why this is the answer

Salicylates stimulate breathing, causing respiratory alkalosis early. They then disturb cell metabolism, causing a metabolic acidosis with a raised anion gap. Adults often show a mixed picture.

Answer

B · Respiratory alkalosis followed by metabolic acidosis
13.Med-surg: cardiovascular & respiratory

Answer: D · An ankle–brachial pressure index (ABPI)

Why this is the answer

Compression helps venous return but can cause tissue necrosis if the arterial supply is inadequate. The ABPI compares ankle and arm systolic pressures; a value below about 0.8 (or above about 1.3, suggesting calcified vessels) needs specialist review before compression.

Answer

D · An ankle–brachial pressure index (ABPI)
14.Med-surg: cardiovascular & respiratory

Answer: C · Never smoke or allow open flames near the oxygen

Why this is the answer

Smoking while using oxygen is a major cause of burns and fatal fires. Patients must keep oxygen away from flames and heat sources, use water-based (not oil-based) lubricants and follow the prescribed flow, because unsupervised increases can worsen CO₂ retention.

Answer

C · Never smoke or allow open flames near the oxygen
15.Med-surg: neuro, endocrine & renal

Answer: D · Give a longer-acting carbohydrate snack, such as a sandwich

Why this is the answer

Once glucose is above 4 mmol/L, a longer-acting carbohydrate (or the next meal if it is due) prevents a recurrence. The cause of the hypoglycaemia should be identified and documented, and the treatment plan reviewed if episodes recur.

Answer

D · Give a longer-acting carbohydrate snack, such as a sandwich
16.Med-surg: neuro, endocrine & renal

Answer: A · Hypertonic saline, monitored, with a limited rate of rise

Why this is the answer

Severe symptomatic hyponatraemia is treated with small boluses of hypertonic saline to raise sodium by a few mmol/L and stop seizures. Overall correction is limited (often to no more than about 8–10 mmol/L in 24 hours) to avoid osmotic demyelination syndrome. Sodium is checked frequently.

Answer

A · Hypertonic saline, monitored, with a limited rate of rise
17.Med-surg: GI, perioperative & oncology

Answer: D · Leave the air bubble in and inject into a skin fold

Why this is the answer

LMWH is injected into a pinched skin fold, often on the abdomen, away from the umbilicus. The air bubble in prefilled syringes is left in, and the site is not rubbed, to reduce bruising.

Answer

D · Leave the air bubble in and inject into a skin fold
18.Med-surg: GI, perioperative & oncology

Answer: C · Withhold strong compression and discuss urgent vascular referral

Why this is the answer

An ABPI of 0.5 suggests severe arterial disease, and strong compression could cause limb ischaemia. The nurse raises the concern and the patient is referred to vascular specialists.

Answer

C · Withhold strong compression and discuss urgent vascular referral
19.Maternity & obstetric nursing

Answer: A · A digital vaginal examination

Why this is the answer

A digital vaginal examination can disrupt a low-lying placenta and cause severe haemorrhage. Monitoring, IV access, blood tests and an ultrasound are appropriate.

Answer

A · A digital vaginal examination
20.Maternity & obstetric nursing

Answer: A · Give fast-acting glucose by mouth and recheck

Why this is the answer

An alert patient with hypoglycaemia is given fast-acting oral carbohydrate, then glucose is rechecked after about 15 minutes and followed by a snack or meal. Treating the mother also protects the fetus.

Answer

A · Give fast-acting glucose by mouth and recheck
21.Pediatric nursing

Answer: B · Pyloric stenosis

Why this is the answer

Pyloric stenosis typically presents at 2–8 weeks with projectile, non-bilious vomiting, hunger after vomiting, weight loss and sometimes a palpable olive-shaped mass.

Answer

B · Pyloric stenosis
22.Pediatric nursing

Answer: C · Withhold the dose and inform the prescriber

Why this is the answer

Vomiting and bradycardia are signs of possible digoxin toxicity. The dose is withheld and the prescriber informed; a digoxin level and potassium level may be checked. The nurse should never alter the dose independently.

Answer

C · Withhold the dose and inform the prescriber
23.Mental health nursing

Answer: C · Frequent criticism, hostility and emotional over-involvement

Why this is the answer

High expressed emotion, including criticism, hostility and over-involvement, is associated with relapse. Family psychoeducation and support can reduce it.

Answer

C · Frequent criticism, hostility and emotional over-involvement
24.Mental health nursing

Answer: A · Explore his reasons and side effects, and inform the team so the treatment can be reviewed

Why this is the answer

Patients have a right to be heard and, in most situations, to refuse treatment. Exploring the reasons and side effects helps the team review the treatment. Covert medication is only allowed under specific legal and policy conditions.

Answer

A · Explore his reasons and side effects, and inform the team so the treatment can be reviewed
25.Nursing math & unit conversions

Answer: T = 99.7 °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

37.6·9/5 = 67.68

Add 32

T = 67.68 + 32 = 99.68 ≈ 99.7 °F

Answer

T = 99.7 °F
26.Nursing math & unit conversions

Answer: V = 130 mL

Household measures and weight: nursing exams use rounded equivalents: 1 teaspoon (tsp) = 5 mL, 1 tablespoon (tbsp) = 15 mL = 3 tsp, 1 fluid ounce (fl oz) = 30 mL = 2 tbsp, and 1 cup = 8 fl oz = 240 mL. For weight, 1 kg = 2.2 lb and 1 lb = 16 oz; for length, 1 inch = 2.54 cm. Set the conversion up so that the unit you do not want cancels out.

Each item in mL

3 fl oz = 3·30 = 90 mL
2 tbsp = 2·15 = 30 mL
2 tsp = 2·5 = 10 mL

Add

V = 90 + 30 + 10 = 130 mL

Answer

V = 130 mL
27.Dosage calculations

Answer: V = 9 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Dose from body weight

D = 7.5·30 = 225 mg

Volume

V = 225/25 = 9 mL

On the syringe

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

Answer

V = 9 mL
28.Dosage calculations

Answer: V₁ = 25 mL

Solution strengths: a percentage strength is grams per 100 mL, so 1% = 1 g/100 mL = 10 mg/mL. A ratio strength 1:1000 means 1 g in 1000 mL = 1 mg/mL; 1:10 000 is 0.1 mg/mL. For a dilution the amount of drug stays the same: C₁·V₁ = C₂·V₂.

Volume of stock

V₁ = 1·500/20 = 25 mL

Answer

V₁ = 25 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

8·60 = 480 min

Drip rate

R = 500·20/480 = 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: D = 20 mg/h

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

Concentration

200/50 = 4 mg/mL

Dose rate

D = 4·5 = 20 mg/h

Answer

D = 20 mg/h
31.IV fluids & fluid balance

Answer: I = 1640 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: 300 + 240 = 540 mL
IV infusion: 125·8 = 1000 mL
IV antibiotic: 1·100 = 100 mL
I = 1640 mL

Answer

I = 1640 mL
32.IV fluids & fluid balance

Answer: t = 2.7 h

Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.

Volume left

500 − 100 = 400 mL

Time

t = 400/150 = 2.667 ≈ 2.7 h

Answer

t = 2.7 h

That is about 2 h 40 min, so the bag runs out at about 21:40.

33.Clinical assessment scores

Answer: M = 5

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 = 11 − 2 − 4 = 5
M5: moves a hand to the site of pressure (localises)

Answer

M = 5
34.Clinical assessment scores

Answer: low

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 97% → 0
on air → 0
SBP 136 mmHg → 0
HR 82/min → 0
alert (A) → 0
T 36.4 °C → 0

Total and red scores

NEWS2 = 0 + 0 + 0 + 0 + 0 + 0 + 0 = 0
No parameter scores 3.

Risk group

low

Answer

low

This is independent practice material. ExamProblems is not affiliated with or endorsed by the organisation that runs this exam, and the exam name is used only to describe the content. NCLEX®, NCLEX-RN® and NCLEX-PN® are trademarks of the National Council of State Boards of Nursing, Inc. (NCSBN), which is not affiliated with ExamProblems and does not endorse it or vouch for its accuracy.

ExamProblems · examproblems.com/courses/nclex-pn-practice-questions