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

What is a portable bladder scanner used for?

  1. ADetecting kidney stones
  2. BMeasuring how much urine is in the bladder without a catheter
  3. CTaking a sterile sample of urine for culture without a catheter
  4. DChecking the urine for blood and protein
2.Nursing fundamentalsHard

Why can a patient with a high fever be in negative fluid balance even when measured intake equals measured output?

  1. AFever increases unmeasured fluid loss through sweating and breathing
  2. BFever makes the kidneys produce extra urine that cannot be measured
  3. CFever causes the body to make extra water from fat
  4. DFever has no effect on the body's water balance
3.Infection control & patient safetyMedium

A patient is booked for an MRI scan. What must the nurse check beforehand?

  1. AWhether the patient has any metal implants or devices, such as a pacemaker
  2. BWhether the patient has eaten a large meal recently
  3. CWhether the patient’s blood glucose has been in the normal range today
  4. DWhether the patient has had a hearing test this year
4.Infection control & patient safetyHard

A patient on long-term high-dose corticosteroids asks for the nasal spray influenza vaccine. What should the nurse explain?

  1. APeople on steroids should never have any influenza vaccine
  2. BEither type is fine, as long as it is given in the morning
  3. CThe nasal spray is the best choice for people on steroids, because it is not injected
  4. DThe nasal spray is a live vaccine, so the injected inactivated vaccine is used instead
5.Prioritization & delegationMedium

A patient on a medical unit tells the nurse he has a plan to end his life and has saved tablets at home. What is the priority action?

  1. AAsk him to promise he will not harm himself
  2. BEnsure constant observation and remove anything he could use to harm himself
  3. CReassure him that things usually look better in the morning after some sleep
  4. DArrange a psychiatry appointment for next week
6.Prioritization & delegationHard

After a head injury, a patient has clear fluid dripping from the nose. Which action should the nurse avoid?

  1. APlacing a loose gauze under the nose
  2. BInserting a tube or suction catheter through the nose
  3. CChecking the fluid for glucose or a halo sign on gauze
  4. DInforming the provider about the drainage
7.Clinical nursingMedium

Which rule is essential for safe use of patient-controlled analgesia (PCA)?

  1. AThe nurse should press it every hour
  2. BOnly the patient should press the button
  3. CRelatives should press it while the patient sleeps
  4. DThe button should be pressed before each meal
8.Clinical nursingHard

A patient with lung cancer develops swelling of the face and arms, distended neck veins and breathlessness that is worse lying down. What should be suspected?

  1. ASuperior vena cava obstruction
  2. BHypothyroidism
  3. CAn allergic reaction to food
  4. DRight-sided heart failure from valve disease
9.Lab values & electrolytesMedium

A patient taking empagliflozin (an SGLT2 inhibitor) has glucose in the urine but a normal blood glucose. What is the best interpretation?

  1. AA sign of kidney failure
  2. BUncontrolled diabetes needing insulin
  3. CA urinary tract infection
  4. DAn expected effect of the drug
10.Lab values & electrolytesHard

Which patient's result should the nurse act on first?

  1. AHemoglobin 6.4 g/dL (64 g/L) with new chest pain and a pulse of 124/min
  2. BHemoglobin 9.6 g/dL (96 g/L) in a patient with stable chronic kidney disease
  3. CPlatelets 140 × 10³/µL in a patient with mild chronic liver disease
  4. DFerritin 15 ng/mL in a well patient with known iron-deficiency anemia on oral iron
11.PharmacologyMedium

A patient takes regular paracetamol (acetaminophen) at home. Which teaching point best prevents accidental overdose?

  1. AUse paracetamol only on an empty stomach
  2. BTake paracetamol with alcohol to improve absorption
  3. CCheck cold and flu remedies, as many also contain paracetamol
  4. DTake an extra dose if the first one does not work within 10 minutes
12.PharmacologyHard

A patient with epilepsy needs pain relief. Why is tramadol used with caution?

  1. AIt causes a sharp rise in blood glucose
  2. BIt always causes respiratory arrest in epilepsy
  3. CIt speeds up the metabolism of all antiepileptic drugs
  4. DIt lowers the seizure threshold
13.Med-surg: cardiovascular & respiratoryMedium

A patient with stable angina is afraid nicotine patches will harm their heart. Which reply is most accurate?

  1. APeople with angina must stop smoking without any help
  2. BNicotine patches are much more harmful to the heart than cigarettes
  3. CNicotine replacement is much safer than smoking and is recommended
  4. DNicotine replacement only works if smoking continues
14.Med-surg: cardiovascular & respiratoryHard

A nurse teaches a patient with heart failure who takes ramipril and spironolactone. Which statement shows a need for further teaching?

  1. A"I will avoid ibuprofen for my joint pain."
  2. B"I will use a salt substitute instead of ordinary salt."
  3. C"I will call if I gain weight quickly or get more breathless."
  4. D"I will weigh myself every morning after I go to the toilet."
15.Med-surg: neuro, endocrine & renalMedium

A seizure has lasted five minutes and is continuing. What is the usual first-line drug treatment?

  1. AIM adrenaline into the outer thigh
  2. BA benzodiazepine such as IV lorazepam or buccal midazolam
  3. CAn IV loading dose of phenytoin before anything else
  4. DIV glucose 50% in every patient, then reassess
16.Med-surg: neuro, endocrine & renalHard

A haemodialysis patient with a tunnelled central venous catheter develops fever and rigors soon after dialysis starts. What should the nurse suspect and do?

  1. AAir embolism; tilt the patient head-up and continue
  2. BNormal reaction to dialysis; continue and give paracetamol only
  3. CDialysis disequilibrium; speed up dialysis to finish sooner
  4. DCatheter-related bloodstream infection; stop, take cultures and escalate
17.Med-surg: GI, perioperative & oncologyMedium

Which initial treatment is usual for symptomatic hypercalcaemia of malignancy?

  1. AA high-calcium diet with extra milk
  2. BIV fluids followed by an IV bisphosphonate
  3. COral calcium tablets and vitamin D
  4. DFluid restriction and a thiazide diuretic
18.Med-surg: GI, perioperative & oncologyHard

A patient with small cell lung cancer is confused and drowsy. Sodium is 118 mmol/L and the urine is highly concentrated. Which complication is likely?

  1. ADiabetes insipidus
  2. BHypercalcaemia of malignancy
  3. CTumour lysis syndrome
  4. DSIADH
19.Maternity & obstetric nursingMedium

A woman in late pregnancy has numbness and tingling in her thumb and first fingers, worse at night. What is the most likely cause?

  1. AA stroke caused by pre-eclampsia
  2. BCarpal tunnel syndrome
  3. CLow blood calcium
  4. DVitamin K deficiency
20.Maternity & obstetric nursingHard

A woman in labour is 8 cm dilated. The fetal heart rate shows decelerations that begin and end with each contraction and mirror its shape, with moderate variability. What is appropriate?

  1. AContinue to monitor; this pattern is benign
  2. BStop all fluids
  3. CTurn off the monitor to reduce anxiety
  4. DPrepare for an emergency caesarean birth
21.Pediatric nursingMedium

A toddler with hand, foot and mouth disease refuses to drink because of painful mouth sores. What is the priority?

  1. ATreating the rash with steroid cream
  2. BStarting antibiotics
  3. CPreventing dehydration
  4. DPreventing hair loss
22.Pediatric nursingHard

A child has had many hospital admissions with unexplained symptoms. They occur only when the mother is present and stop when the child is apart from her. What should the nurse consider?

  1. AA rare genetic disorder that needs more tests at once
  2. BThe child is pretending to be ill to avoid school
  3. CThe ward environment or hospital food is causing the symptoms
  4. DFabricated or induced illness; follow safeguarding procedures
23.Mental health nursingMedium

A woman has new anxiety, weight loss, a tremor, heat intolerance and a fast heart rate. Which test is most important before diagnosing an anxiety disorder?

  1. ASerum lithium level
  2. BThyroid function tests
  3. CUrine drug screen only
  4. DAn MRI of the knee
24.Mental health nursingHard

During a panic attack, a patient breathes very fast and complains of light-headedness and tingling in her fingers and around her mouth. What should the nurse do?

  1. AStay with her and coach her to breathe slowly and steadily
  2. BGive her oxygen at a high flow rate through a mask
  3. CAsk her to breathe into a paper bag for at least 10 minutes
  4. DLeave her alone so that she can calm down without anyone watching
25.Nursing math & unit conversionsMedium
55.0050 kg? kground to 0.1 kg

Practice exercise (made-up values, not clinical guidance). A weight conversion gives 55.0050 kg. The rule in this exercise is that weights are rounded to the nearest tenth of a kilogram. What value x do you record?

55.0050 kg
x = kg
26.Nursing math & unit conversionsHard
120 mL/h? L/day1 day = 24 h1 L = 1000 mL

Practice exercise (made-up values, not clinical guidance). A maintenance infusion runs at 120 mL/h without a break. How many litres V does it deliver in 24 hours?

120 mL/h24 h
V = L
27.Dosage calculationsMedium
60 kg5 mg/kgD = ? mg

A patient weighs 60 kg and is prescribed 5 mg/kg as a single dose. Find the dose D in mg.

60 kg5 mg/kg
D = mg
28.Dosage calculationsHard
00.10.20.30.40.50.60.70.80.911 mL

The prescription is 1320 micrograms. The ampoule contains 2 mg/mL. Draw up the dose in the 1 mL syringe: what volume V do you give?

1320 mcg2 mg/mL
V = mL
29.IV infusion ratesMedium
V = ?60 gtt/mL40 gtt/min8 h

A drip runs at 40 gtt/min through a set of 60 gtt/mL. How many millilitres V does the patient receive in 8 hours?

40 gtt/min60 gtt/mL8 h
V = mL
30.IV infusion ratesHard
400 mg250 mL5 mL/h? mg/h

A bag contains 400 mg of a drug in 250 mL and runs at 5 mL/h. How many milligrams per hour D does the patient receive?

400 mg/250 mL5 mL/h
D = mg/h
31.IV fluids & fluid balanceMedium
IntakeOutput8-hour shiftjuice200 mLwater120 mLIV infusion75 mL/h × 8 hIV antibiotic1 × 50 mLurine250 mLurine225 mLvomit150 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.

juice: 200 mLwater: 120 mLIV infusion: 75 mL/h × 8 hIV antibiotic: 1 × 50 mL
I = mL
32.IV fluids & fluid balanceHard
500 mL60 mL/hstart 09:0015:00: ? mL

Practice exercise (made-up values, not clinical guidance). A 500 mL bag was started at 09:00 and runs by pump at 60 mL/h. How many mL V are left in the bag at 15:00?

500 mL60 mL/h09:00 → 15:00
V = mL
33.Clinical assessment scoresMedium
E3 / 4+V3 / 5+M? / 6GCS 10?

Practice exercise (made-up values, not clinical guidance). A practice chart records GCS 10, with E3 and V3. What motor score M was recorded, and which response does it describe? Give the number.

GCS 10E3V3
M =
34.Clinical assessment scoresHard
underweighthealthy weightoverweightobesity class Iobesity class IIobesity class III

Practice exercise (made-up values, not clinical guidance). An adult weighs 54 kg and is 168 cm tall. Calculate the BMI and click the WHO weight category.

54 kg168 cm
  1. 1underweight
  2. 2healthy weight
  3. 3overweight
  4. 4obesity class I
  5. 5obesity class II
  6. 6obesity class III

3Solutions

1.Nursing fundamentals

Answer: B · Measuring how much urine is in the bladder without a catheter

Why this is the answer

A bladder scanner uses ultrasound to estimate bladder volume, for example after a patient has voided. It helps detect retention and avoids unnecessary catheterisation.

Answer

B · Measuring how much urine is in the bladder without a catheter
2.Nursing fundamentals

Answer: A · Fever increases unmeasured fluid loss through sweating and breathing

Why this is the answer

Insensible losses through the skin and lungs are not measured and rise with fever and fast breathing. A balanced chart can therefore hide a real fluid deficit.

Answer

A · Fever increases unmeasured fluid loss through sweating and breathing
3.Infection control & patient safety

Answer: A · Whether the patient has any metal implants or devices, such as a pacemaker

Why this is the answer

The MRI magnet can move or heat metal objects and can stop some implanted devices from working. Patients are screened for implants, pacemakers, metal fragments and metal items such as jewelry before entering the scanner room.

Answer

A · Whether the patient has any metal implants or devices, such as a pacemaker
4.Infection control & patient safety

Answer: D · The nasal spray is a live vaccine, so the injected inactivated vaccine is used instead

Why this is the answer

The nasal spray influenza vaccine contains live, weakened virus and is avoided in immunosuppressed people. The inactivated injectable vaccine is safe and recommended for them.

Answer

D · The nasal spray is a live vaccine, so the injected inactivated vaccine is used instead
5.Prioritization & delegation

Answer: B · Ensure constant observation and remove anything he could use to harm himself

Why this is the answer

A patient with a plan and means is at high risk. Safety comes first: constant observation, removal of means and urgent referral. A “no-harm promise” does not protect the patient.

Answer

B · Ensure constant observation and remove anything he could use to harm himself
6.Prioritization & delegation

Answer: B · Inserting a tube or suction catheter through the nose

Why this is the answer

Clear nasal drainage after a head injury can be cerebrospinal fluid from a basal skull fracture. Nasal tubes could enter the brain and introduce infection, so they are avoided.

Answer

B · Inserting a tube or suction catheter through the nose
7.Clinical nursing

Answer: B · Only the patient should press the button

Why this is the answer

If the patient becomes too sedated, they stop pressing the button, which protects them. When others press it, this safety mechanism is lost and overdose can occur.

Answer

B · Only the patient should press the button
8.Clinical nursing

Answer: A · Superior vena cava obstruction

Why this is the answer

Superior vena cava obstruction prevents venous drainage from the head and arms. It is an oncological emergency; patients are positioned upright and need urgent specialist treatment.

Answer

A · Superior vena cava obstruction
9.Lab values & electrolytes

Answer: D · An expected effect of the drug

Why this is the answer

SGLT2 inhibitors block glucose reabsorption in the proximal tubule, so glycosuria is expected even with normal blood glucose. Urine glucose cannot be used to monitor control in these patients. The drugs also raise the risk of genital infections and DKA.Checked against: Ketones blood test · MedlinePlus (NIH) (2025)

Answer

D · An expected effect of the drug
10.Lab values & electrolytes

Answer: A · Hemoglobin 6.4 g/dL (64 g/L) with new chest pain and a pulse of 124/min

Why this is the answer

Severe anemia with chest pain and tachycardia suggests the heart is not receiving enough oxygen, which needs urgent action, often including transfusion. The other results are mildly abnormal but expected or stable.Checked against: Anemia · StatPearls (NCBI Bookshelf) (2026)

Answer

A · Hemoglobin 6.4 g/dL (64 g/L) with new chest pain and a pulse of 124/min
11.Pharmacology

Answer: C · Check cold and flu remedies, as many also contain paracetamol

Why this is the answer

Many combination products contain paracetamol, so a patient can take too much without realising. Regular alcohol use and liver disease also increase the risk of liver damage.

Answer

C · Check cold and flu remedies, as many also contain paracetamol
12.Pharmacology

Answer: D · It lowers the seizure threshold

Why this is the answer

Tramadol can cause seizures, especially at high doses or with other drugs that lower the seizure threshold. Its serotonergic action also raises the risk of serotonin syndrome.

Answer

D · It lowers the seizure threshold
13.Med-surg: cardiovascular & respiratory

Answer: C · Nicotine replacement is much safer than smoking and is recommended

Why this is the answer

Nicotine replacement delivers nicotine without carbon monoxide, tar and other toxins and is considered safe in stable heart disease. Combining a patch with a short-acting form and behavioural support gives the best chance of quitting.

Answer

C · Nicotine replacement is much safer than smoking and is recommended
14.Med-surg: cardiovascular & respiratory

Answer: B · "I will use a salt substitute instead of ordinary salt."

Why this is the answer

Many salt substitutes contain potassium chloride. With an ACE inhibitor and spironolactone, both of which raise potassium, they can cause dangerous hyperkalaemia. Daily weights, reporting rapid weight gain and avoiding NSAIDs (which cause fluid retention) are correct.

Answer

B · "I will use a salt substitute instead of ordinary salt."
15.Med-surg: neuro, endocrine & renal

Answer: B · A benzodiazepine such as IV lorazepam or buccal midazolam

Why this is the answer

A seizure lasting five minutes or more (or repeated seizures without recovery) is treated as status epilepticus. A benzodiazepine is given first (IV lorazepam if access is available; buccal or intranasal midazolam or rectal diazepam if not), then a second-line antiseizure drug such as levetiracetam, phenytoin or valproate if the seizure continues. Glucose is checked and given only if low.

Answer

B · A benzodiazepine such as IV lorazepam or buccal midazolam
16.Med-surg: neuro, endocrine & renal

Answer: D · Catheter-related bloodstream infection; stop, take cultures and escalate

Why this is the answer

Fever and rigors when dialysis starts through a central catheter strongly suggest a catheter-related bloodstream infection. Dialysis is stopped or adjusted per protocol, blood cultures are taken (from the catheter and peripherally), the team is informed and IV antibiotics are started as prescribed. The exit site is inspected.

Answer

D · Catheter-related bloodstream infection; stop, take cultures and escalate
17.Med-surg: GI, perioperative & oncology

Answer: B · IV fluids followed by an IV bisphosphonate

Why this is the answer

Hypercalcaemia causes polyuria and dehydration, so IV saline is given first, then a bisphosphonate such as zoledronic acid to reduce bone resorption. Calcium, kidney function and symptoms are monitored.

Answer

B · IV fluids followed by an IV bisphosphonate
18.Med-surg: GI, perioperative & oncology

Answer: D · SIADH

Why this is the answer

Small cell lung cancer can secrete ADH, causing water retention, dilutional hyponatraemia and inappropriately concentrated urine. Management includes fluid restriction and careful correction of sodium to avoid osmotic demyelination.

Answer

D · SIADH
19.Maternity & obstetric nursing

Answer: B · Carpal tunnel syndrome

Why this is the answer

Fluid retention in pregnancy can compress the median nerve in the carpal tunnel. A wrist splint at night often helps, and symptoms usually resolve after birth.

Answer

B · Carpal tunnel syndrome
20.Maternity & obstetric nursing

Answer: A · Continue to monitor; this pattern is benign

Why this is the answer

These are early decelerations, caused by head compression in active labour. With moderate variability they are reassuring, and no intervention is needed beyond continued monitoring.

Answer

A · Continue to monitor; this pattern is benign
21.Pediatric nursing

Answer: C · Preventing dehydration

Why this is the answer

Hand, foot and mouth disease, usually caused by coxsackievirus, is self-limiting. The main risk is dehydration from painful mouth ulcers, so cool fluids, soft foods and analgesia are given and wet nappies are monitored.

Answer

C · Preventing dehydration
22.Pediatric nursing

Answer: D · Fabricated or induced illness; follow safeguarding procedures

Why this is the answer

Fabricated or induced illness (formerly Munchausen syndrome by proxy) is a form of abuse in which a carer invents or causes illness. Careful objective documentation and early involvement of the safeguarding team are essential; the carer should not be confronted alone.

Answer

D · Fabricated or induced illness; follow safeguarding procedures
23.Mental health nursing

Answer: B · Thyroid function tests

Why this is the answer

Hyperthyroidism can mimic anxiety with tremor, palpitations, weight loss and heat intolerance. Medical causes of psychiatric symptoms should always be considered.

Answer

B · Thyroid function tests
24.Mental health nursing

Answer: A · Stay with her and coach her to breathe slowly and steadily

Why this is the answer

Hyperventilation causes respiratory alkalosis, which leads to tingling and dizziness. Calm coaching of slow breathing restores carbon dioxide levels. Breathing into a paper bag is not recommended, because it can cause hypoxia and mask a medical cause.

Answer

A · Stay with her and coach her to breathe slowly and steadily
25.Nursing math & unit conversions

Answer: x = 55 kg

Rounding: look at the digit just after the place you round to: 5 or more rounds up, 4 or less leaves the digit as it is. Round only the final answer, never the steps. Typical exam rules: volumes of 1 mL or more to the nearest tenth, volumes below 1 mL to the nearest hundredth, drip rates to whole drops and weights to one decimal place; always follow the rule the question states.

Digit in the tenths place

55.0050 → 0

Only the next digit decides

55.0050 → 0
0 is 4 or less, so 0 stays.
The digits after it (5) are ignored: round once, never step by step.

Round

x = 55 kg

Answer

x = 55 kg
26.Nursing math & unit conversions

Answer: V = 2.88 L

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.

Volume in a day

120 mL/h × 24 h = 2880 mL

In litres

V = 2880/1000 = 2.88 L

Answer

V = 2.88 L
27.Dosage calculations

Answer: D = 300 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

5·60 = 300 mg

Answer

D = 300 mg
28.Dosage calculations

Answer: V = 0.66 mL

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

Same units

2 mg/mL = 2000 mcg/mL

Volume

V = 1320/2000 = 0.66 mL

Answer

V = 0.66 mL
29.IV infusion rates

Answer: V = 320 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

40·60/60 = 40 mL/h

Volume

V = 40·8 = 320 mL

Answer

V = 320 mL
30.IV infusion rates

Answer: D = 8 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

400/250 = 1.6 mg/mL

Dose rate

D = 1.6·5 = 8 mg/h

Answer

D = 8 mg/h
31.IV fluids & fluid balance

Answer: I = 970 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: 200 + 120 = 320 mL
IV infusion: 75·8 = 600 mL
IV antibiotic: 1·50 = 50 mL
I = 970 mL

Answer

I = 970 mL
32.IV fluids & fluid balance

Answer: V = 140 mL

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.

Elapsed time

09:00 → 15:00 = 6 h

Volume infused

60·6 = 360 mL

Volume left

V = 500 − 360 = 140 mL

Answer

V = 140 mL
33.Clinical assessment scores

Answer: M = 4

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 = 10 − 3 − 3 = 4
M4: withdraws the limb from pressure (normal flexion)

Answer

M = 4
34.Clinical assessment scores

Answer: healthy weight

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

BMI

BMI = 54/1.68² = 19.13

Category

healthy weight

Answer

healthy weight

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